Hearing Screening

Early Newborn Hearing Screening Leads to Early Detection and Intervention for Hearing Loss

Posted 03/25/2009

Marilyn W. Edmunds, PhD, CRNP; Laurie E. Scudder, MS, NP

Biernath K, Holstrum WJ, Eichwald J
J Midwifery Womens Health. 2009;54:18-26

Article Summary

A variety of conditions can cause loss of hearing in a newborn infant. More than half of profound congenital hearing loss is believed to be genetic in origin. For every child with a profound hearing loss, there are an estimated 1 or 2 children with lesser but clinically significant bilateral or unilateral loss. Genetic deafness is usually caused either by the possession of a single gene (dominant deafness) or 2 genes (recessive deafness). Genetic causes of hearing loss can be categorized as syndromic (having symptoms in addition to hearing loss, such as blindness or heart defects) or nonsyndromic (having no additional symptoms). The majority of genetic cases of hearing loss are nonsyndromic, autosomal recessive. The major environmental (nongenetic) cause of hearing loss is congenital cytomegalovirus (CMV) infection, a condition that occurs in 1 in 150 live births. The risk for permanent disability is highest when a woman becomes infected with CMV during the first trimester of pregnancy. Infection control practices to prevent exposure to CMV must be followed by all women who are pregnant or trying to become pregnant.

Universal newborn hearing screening is becoming the standard of care in the United States. The US Preventive Services Task Force (USPSTF) reported in July 2008 that there is scientific evidence to recommend newborn hearing screening for all infants, updating their statement of 2001.^[1] Universal newborn hearing screening is the first step in the national Early Hearing Detection and Intervention (EHDI) program.

The Joint Committee on Infant Hearing Loss 2007: Principles of EHDI state^[2]:

All infants should have access to hearing screening using a physiologic measure before 1 month of age. All infants who do not pass the initial hearing screen and the subsequent rescreening should have appropriate audiologic and medical evaluations, to confirm the presence of hearing loss, before 3 months of age. All infants with confirmed permanent hearing loss should receive intervention services before 6 months of age. A simplified, single point of entry into an intervention system appropriate to children with hearing loss is optimal. The EHDI system should be family-centered with infant and family rights and privacy guaranteed through informed choice, shared decision making, and parental consent. Families should have access to information about all intervention and treatment options and counseling with regard to hearing loss. The child and family should have immediate access to high-quality technology, including hearing aids, cochlear implants, and other assistive devices when appropriate. All infants and children should be monitored for hearing loss in the medical home. Continued assessment of communication development should be provided by appropriate providers to all children with or without risk indicators for hearing loss. Appropriate interdisciplinary intervention programs for deaf and hard-of-hearing infants and their families should be provided by professionals who are knowledgeable about childhood hearing loss. Intervention programs should recognize and build on strengths, informed choices, traditions, and cultural beliefs of the families. Information systems should be designed to interface with electronic health records and should be used to measure outcomes and report the effectiveness of EHDI services at the community, state, and federal levels.

Viewpoint

The goal of newborn hearing screening is to identify hearing problems early so that infants will develop the best communication and language skills possible. Midwives and other obstetric providers should educate women in regard to CMV infection, its possible effects on the newborn, and infection control practices to reduce the risk of acquiring CMV during pregnancy. This information is particularly important for women who are planning to become pregnant.

FULL ARTICLE HERE

Hearing Loss in Babies

Hearing Loss in Babies

According to the National Institutes of Health (NIH), nearly 12,000 babies are born each year in the United States with a hearing impairment. It is estimated that serious hearing loss occurs in about one to three of every 1,000 healthy newborns, and in two to four of every 100 babies in newborn intensive care units. Without screening or testing, hearing loss may not be noticed until the baby is more than 1 year old. If hearing loss is not detected until later years, there will not be stimulation of the brain's hearing centers. This can affect the maturation and development of hearing, and can delay speech and language. Social and emotional development and success in school may also be affected.

Most hearing loss is congenital (present at birth), but some babies develop hearing loss after they are born. Hearing loss is more likely in premature babies and babies with respiratory problems who have required long-term use of breathing machines, those with previous infections, and those taking certain medications.

Because of these risks, many health organizations including the National Institutes of Health (NIH) and the American Academy of Pediatrics (AAP) now recommend universal infant hearing screening. This means all newborn babies should be screened for hearing loss.

Most often, the parents are the first to detect hearing loss in their child. Unfortunately, many children with severe hearing loss from birth are not diagnosed until 2 1/2 or 3 years of age.

What are the different types of hearing loss?

Hearing loss can be categorized by many different types. Two types of hearing loss are sensorineural and conductive. Both types of hearing loss can be congenital (present at birth) or acquired.

• sensorineural - a loss of function within the inner ear or with the connection to the brain. Causes of this type of hearing loss include:
  
  
  • congenital factors - conditions present at birth, such as:
    
    
    • infection by the mother with toxoplasmosis, rubella, cytomegalovirus, herpes, or syphilis
      
      
    • genetic factors and syndromes the child has at birth
      
      
    • low birthweight
      
      
    • hereditary (in the family)
      
      
  • acquired
    
    
    • loud noise exposure
    • trauma
    • infections
    • damage from certain medications that can be harmful to the ears
      
      
• conductive hearing loss - a problem in the outer or middle ear where sound waves are not sent to the inner ear correctly. Conductive hearing loss is the most common type of hearing loss in children and is usually acquired. Factors that may cause this type of hearing loss are:
  
  
  • congenital factors - conditions present at birth, such as:
    
    
    • anomalies of the pinna (the outside of the ear)
      
      
    • anomalies of the tympanic membrane (eardrum)
      
      
    • anomalies of the external ear canal
      
      
    • anomalies of the ossicles (the three tiny bones that deliver the sound waves to the middle ear)
      
      
  • acquired
    
    
    • excessive wax
    • foreign bodies in the ear canal, such as beads or popcorn kernels
    • tumors of the middle ear
    • problems with the eustachian tube
    • ear infections such as otitis media
    • chronic ear infections with fluid in the middle ear
    • perforation of the eardrum

Full article found here.