Health Conditions

Deaf to the World: Newborn Infant Hearing Screening

When I was a baby, I slept soundly. The noise of pots and pans in the kitchen and even a vacuum cleaner failed to wake me. When my grandparents took me for a walk, I didn’t startle when a dog came up behind my stroller and barked.

I was quiet too. I didn’t really verbalize or make age-appropriate sounds. All this led my parents to suspect that I had a hearing loss, but the pediatrician disagreed.

He brought in an alarm clock and when it went off, I didn’t stir. This resulted in an EEG, which confirmed that I was deaf.

Finally, at my one-year checkup — when my parents again voiced their concerns — the doctor told Mom to face the wall with me on her lap. He brought in an alarm clock and when it went off, I didn’t stir. This resulted in an EEG, which confirmed that I was deaf.

My diagnosis didn’t come until I was 14 months old, even though I was born with a profound hearing loss. The critical development window for language was already narrowing. Thankfully, I was outfitted with hearing aids and immediately placed in speech and language therapy. Due to my parents’ commitment and perseverance, I was raised to lipread and speak, and lead an independent life.

Because I was born in the early 70s, stories like mine are commonplace, with many diagnoses occurring even later.

Rates of hearing loss

According to the American Academy of Pediatrics, hearing loss is one of the most common birth conditions with about three infants out of 1,000 born with some form of hearing loss. Infants admitted to intensive care units at birth can also end up with hearing loss as a byproduct of their care.

According to the American Academy of Pediatrics, hearing loss is one of the most common birth conditions with about three infants out of 1,000 born with some form of hearing loss.

The National Institutes of Health (NIH) says that in the past, on average, children were first identified with hearing impairments at age two-and-a-half to three-years-old. Many were identified even later, after the critical period for speech and language development was long past. This kind of delay can lead to significant educational costs and learning difficulties, says the National Conference of State Legislatures (NCSL).

At the time, only babies born with conditions that put them at high risk for hearing loss (like low birth weight) were screened. This meant that roughly 50 percent of newborns with hearing loss were sent home undetected.

Legislation

In 1993, the NIH Consensus Development Conference recommended that all babies be screened for hearing loss before being discharged from the hospital. Only Hawaii and Rhode Island had this requirement in place at this point in time. Eventually, other states joined their ranks.

Now, more than 95 percent of all newborns in the U.S. are screened for hearing loss shortly after birth, the NIH reports, and all states have established Early Hearing Detection and Intervention (EHDI). Of these, 43 states plus the District of Columbia and Puerto Rico have mandated newborn hearing screening programs. The approach varies by state, and 14 states allow newborns to be exempt if a parent objects to the testing. You can find out your state’s EHDI summary here.

Because the cause of my hearing loss is unknown but most likely due to a recessive gene, and I married a hearing man, I didn’t know if my children would inherit my disability. I knew that if my children were deaf, they would be in good hands. As a mother, however, I wanted the best for them and hoped they would be hearing. I didn’t want them to have the same challenges I did.

When I gave birth to my first child in 2002, my state didn’t have mandatory newborn hearing screening in place. Because my daughter chose to arrive on a holiday weekend, we couldn’t even get her tested at my hospital. I wasn’t willing to wait, so upon my discharge we drove immediately to the Children’s Hospital to get her tested. She tested negative. I don’t even want to think about how many kids may have slipped through the cracks.

Three years later, when I had my son, hearing screening was mandatory. The difference was stark; he was taken from my room early on and returned shortly thereafter with a clean bill of health.

Afterward, whenever I visited friends in the hospital to meet their newborns, I was struck by how natural the process was. It became an expected part of the hospital stay, with happy stickers on newborns proclaiming “I had my hearing tested!”

Deaf to the World: Newborn Infant Hearing Screening2

Screening

The screening isn’t invasive, nor is it something to fear. Two screening tests may be used, and they’re both quick, painless, and may be done while baby is sleeping or lying still. HealthyChildren.org describes the tests:

  • Automated Auditory Brainstem Response (AABR) – measures how the hearing nerve responds to sound by playing clicks or tones through soft earphones into baby’s ears. Three electrodes are placed on baby’s head to measure the hearing nerve’s response.
  • Otoacoustic Emissions (OAE) – measures sound waves produced in the inner ear by placing a tiny probe just inside baby’s ear canal that measures the response (echo) when clicks or tones are played.

Sometimes babies fail the initial screening even if they don’t have hearing loss. Fluid in the ear can be a culprit, for example, which is why further testing is important in these cases. If shown to have a hearing loss, a thorough hearing and medical evaluation should take place as soon as possible.

Follow up

Naturally, because some hearing loss can occur later or on a smaller level, it’s important to have children’s hearing tested as they age. What’s disturbing is that almost half of babies who don’t pass their newborn hearing screens are lost to follow-up.

Left undetected, hearing impairments in infants can negatively impact speech and language acquisition, academic achievement, and social and emotional development. If detected, however, these negative impacts can be diminished and even eliminated through early intervention.

The National Center for Hearing Assessment and Management at Utah State University says, “Left undetected, hearing impairments in infants can negatively impact speech and language acquisition, academic achievement, and social and emotional development. If detected, however, these negative impacts can be diminished and even eliminated through early intervention.”

If a cochlear implant – an implanted device that bypasses the damaged part of the ear and provides sound – is chosen, education costs to society are $30,000-$200,000 lower, NIH says.

Another reason early intervention is so important is the benefits of cochlear implantation are greater with respect to language development when done young. Early implantation utilizes the early language development window present in young children.

Research published in Ear & Hearing, February 2003 has found that “children with average learning ability who receive a cochlear implant at or before five years of age have the potential to produce and understand English language at a level comparable with that of their hearing peers.”

We’ve come a long way since I was diagnosed, but there’s no excuse for less than 100 percent participation when it comes to screening, testing, and treatment. Each baby — with or without hearing loss – deserves a chance to succeed.

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Lisa A. Goldstein

Lisa A. Goldstein

Lisa A. Goldstein is a freelance journalist with a Master’s in Journalism from UC Berkeley. She has two kids, a love of books and sweets, and wishes her metabolism is what it used to be.

1 Comment

  1. July 11, 2016 at 7:17 pm — Reply

    Ms. Goldstein;

    Please take a look at the HEARLab developed by the National Acoustic Laboratory of Australia. This instrument provides objective analysis and superior fitting of hearing aids on infants and children. You can find a HEARLab at the Children’s hospital in Oakland not too far from you in Berkeley.

    Darroch Cahen

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