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Health Care Settings: Overview Profile of an Newborn
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Last Modified: 06/16/2008

Permanent hearing loss is the most common birth defect in the United States. Approximately 1 out of every 300 children in the U.S. is born with a significant hearing loss.1 Most newborns in the U.S. now receive an initial hearing screening prior to hospital discharge.2 As a result, some babies may be referred to a pediatric audiologist and fitted with hearing aids by four weeks of age. Unfortunately, follow-up from newborn hearing screening has been less comprehensive in most states with only about 50% of infants who are referred for medical or audiological follow-up receiving timely assessment or intervention.3 It is estimated that by school age new cases of permanent hearing loss occur in approximately 6 per 1000 children in addition to the 3 per 1000 likely to be detected at birth.4 Further, an estimated 35% of pre-school children experience repeated episodes of ear infections and intermittent hearing loss, some untreated for extended periods.5 Although newborn screening has done much to improve detection of permanent hearing loss,6,7 children not screened at birth, lost to follow-up, or presenting with post-neonatal hearing loss may still be picked up too late to prevent serious developmental problems associated with untreated hearing loss. 8

Many professional organizations recognize the value of periodic hearing screening for young children. The American Academy of Pediatrics recommends periodic hearing screening between birth and school-age because hearing is central to language development, communication, and learning.9 Head Start Performance Standards require that a hearing screening be conducted within the first 45 days of enrollment. Part C of the Individuals with Disabilities Education Act (IDEA) requires a timely, comprehensive, multidisciplinary evaluation that includes hearing and communication development.10

Introduction to Otoacoustic Emission (OAE) Screening

Traditionally, professionals working in health care settings such as Community Health Clinics and Primary Care Physician offices have had to rely on subjective methods (hand clapping, bell ringing and parent questionnaires) when screening children 0 – 3 years of age for hearing loss. While many providers have recognized that these methods are not reliable for screening young children, they have been uncertain how to update their hearing screening practices. Although tympanometry and pneumatic otoscopy are used routinely to check for middle ear fluid that can compromise hearing, these tools cannot assess inner ear functioning to screen for permanent sensorineural hearing loss.

Otoacoustic emissions (OAE) hearing screening, used widely in hospital-based newborn hearing screening programs, represents a significant advance for health care providers screening young children. An objective method that screens hearing in a range of sound frequencies critical for normal speech and language development, portable OAE screening is the most practical method for screening infants and toddlers because it:

  • Does not require a behavioral response from the child11
  • Can help to detect sensorineural hearing loss and call attention to hearing disorders affecting the pathway to the inner ear
  • Is quick and painless
  • Can be conducted by anyone who is trained to use the equipment and is skilled in working with children.

The OAE Screening Procedure

The procedure is performed with a portable handheld screening unit. A small probe is placed in the child's ear canal. This probe delivers a low-volume sound stimulus into the ear.

The cochlea responds by producing an otoacoustic emission, sometimes described as an echo, that travels back through the middle ear to the ear canal and is analyzed by the screening unit.

(click to enlarge)
In approximately 30 seconds, the result is displayed on the screening unit as a "pass" or a "refer." Otoacoustic emissions (OAE) screening can help to detect sensorineural hearing loss occurring in the cochlea. It can also call attention to hearing disorders affecting the pathway to the inner ear. If a child does not pass the OAE screening, a health care provider should evaluate the middle ear using tympanometry (or pneumatic otoscopy) to determine whether there is fluid in the middle ear or an active ear infection (otitis media). After treatment has been completed and the health care provider determines that the pathway to the cochlea is clear, an OAE rescreen should be performed. If the pathway to the cochlea is clear, and the ear still does not pass the OAE, the child should be referred to a pediatric audiologist for a complete evaluation.

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REFERENCES

  1. White KR. Universal newborn hearing screening using transient-evoked otoacoustic emissions: Past, present and future. Seminars in Hearing, 1996, 17 (2) 171-173

  2. State Summary Statistics: Universal Newborn Hearing Screening. Retrieved March 17, 2006 from http://www.infanthearing.org/status/unhsstate.html.

  3. Centers for Disease Control. Infants Tested for Hearing Loss – United States, 1999-2001. Available at: http://www.cdc.gov/ncbddd/ehdi/documents/mm5241.pdf. Accessed March 6, 2007.

  4. American Speech-Language-Hearing Association. Guidelines for audiology services in the schools. ASHA. 1993: 35(Suppl.10); 24-32.

  5. American Speech-Language-Hearing Association. Causes of Hearing Loss in Children. Available at: http://www.asha.org/public/hearing/disorders/causes.html. Accessed March 6, 2007.

  6. Harrison M, Roush J, Wallace J. Trends in age of identification and intervention in young children with hearing loss. Ear and Hearing. 2003;24:89-95.

  7. Commission on Education of the Deaf: Toward Equality; Education of the Deaf. Washington, DC: U.S. Government Printing Office, 1988.

  8. Niskar AS. Prevalence of hearing loss among children 6 to 19 years of age: The third national health and nutritional health examination survey. Journal of the American Medical Association. 1998; 279:1071-1075.

  9. American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care. Available at: http://pediatrics.aappublications.org/cgi/content/full/105/3/645/F1. Accessed March 6, 2007.

  10. National Early Childhood Technical Assistance Center. Screening, Assessment and Evaluation. Available at http://www.nectas.unc.edu/topics/earlyid/screeneval.asp. Accessed April 4, 2007.

  11. Cunningham M, Cox EO; American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine, Section on Otolaryngology and Bronchoesophagology. Hearing assessment in infants and children: recommendations beyond neonatal screening. Pediatrics. 2003;111:436–440.