March 13-15, 2016 • San Diego, CA


3/15/2016  |   9:40 AM - 10:10 AM   |  Topical Session 4   |  Royal Palm 1/2   |  9 - Program Evaluation and Quality Improvement

Be careful what you wish for!

The intent of newborn hearing screening is to identify, as soon after birth as possible, infants who have a congenital permanent hearing loss. To accomplish this intent, a two-stage protocol has been recommended to reduce false referrals, thus decreasing the number of children needing a diagnostic assessment, and also reducing the potential loss to follow-up. The CDC estimates that two to three infants per 1,000 live births are born deaf or with a hearing loss. National data in various studies, as reported by the CDC, show that hearing loss in children ranges from 5% to 14.9%. Yet nationally in 2013, only 1.5% of screened newborn infants referred for diagnostic assessment. Whether all this difference can be attributed to late onset or progressive hearing loss is unknown. However, research has found that the two-stage protocol may be missing as many as 23% of infants with a permanent hearing loss. Other studies report that one-third of patients using cochlear implants had passed newborn hearing screening. Further, some infants diagnosed with GJB2 associated hearing loss had been undetected by newborn hearing screening. This presentation explores whether we may be sacrificing specificity for sensitivity. Sensitivity has been achieved by the significant reduction over the past decade in the percentage of children referring for a diagnostic evaluation. But in achieving high sensitivity, has specificity been compromised so that some infants born with a permanent hearing loss are unidentified at birth? The presentation concludes with a discussion of how to best achieve a balance between sensitivity and specificity so that we do get what we wish for––identifying every young child who has a permanent hearing loss as early in life as possible.

  • Know that the common two-stage protocol may be missing some babies who have a permanent hearing loss
  • Understand the importance of evaluating screening programs by examining sensitivity and specificity
  • Describe ways to improve ensuring that all infants who have a permanent hearing loss are identified as early in live as possible

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Jean Johnson (Primary Presenter,POC), Center on Disability Studies, jeanj@hawaii.edu;
Dr. Johnson serves as an Assistant Professor and Principal Investigator with the Center on Disability Studies at the University of Hawai'i. She holds an undergraduate degree in Special Education (teaching the deaf), masters degree in Audiology and in Public Health, and a doctoral degree in Public Health from the University of Hawai'i. Before joining CDS, she was the Coordinator of the Zero-to-Three Hawai'i project to provide services to infants and toddlers with special needs. She spent many years in Guam and Micronesia establishing programs for children and adults with disabilities. She currently works on several newborn hearing screening projects in the Marshall Islands and American Samoa. In 2011, she received the Antonia Brancia Maxon Award for EHDI Excellence. Dr. Johnson is passionate about issues of social justice, especially as they relate to persons with disabilities and people from the islands.


Financial - No relevant financial relationship exist.

Nonfinancial - No relevant nonfinancial relationship exist.