Conductive
Hearing Loss Indicators: affects the outer and middle ear.
Delayed Onset
Sensorineural Hearing Loss Indicators: affects in the inner
ear and possibly beyond.
Hearing Loss due to Prenatal Factors: (Congenital Hearing Loss - the child is born with the hearing loss)
Prenatal damage to the cochlear may be due to the partial or lack of
cochlear development (inner ear), viral or parasitical invasion,
spontaneous malformations or inherited syndromes.
The most common syndromes are Usher's syndrome and Pendred's syndrome. Usher's syndrome results in a hearing loss that ranges from moderate to profound and a degenerative visual loss. Any child with a profound hearing loss should be evaluated for eye disorders. Pendred's syndrome is a recessive endocrine-metabolic disorder characterized by goiter formation and results in a moderate to profound sensorineural hearing loss that is usually progressive in nature.
Other
syndromes that cause hearing loss include:
Disorders Causing Hearing Loss at Birth:
PROTOCOLS FOR SCREENING AND REFERRALS: (IN NORTH DAKOTA)
Screening Protocol
The following material is designed to supplement the First Sounds Universal Newborn Hearing Screening Protocol flow chart.
Birth: Includes hospital births and home births
Initial Hearing Screening with OAE or ABR: Each infant will receive an initial hearing screening with frequency specific ABR (Auditory Brainstem Response) screening equipment or with OAE (Otoacoustic Emissions) screening equipment.
Four possible outcomes from the initial screening:
1. Pass: The infant passed the initial screening. Parents should be given information concerning hearing loss and normal auditory development. The infant is released from the screening process.
Risk Factor: If the infant falls under the risk factor category, a reevaluation should be scheduled for three years every six months. Refer the infant to appropriate personnel.
Enter in data and report to the State Reporting System: Each infant’s results are entered into a state wide data system (Oz) by hospital staff and reported to North Dakota Center for Persons with Disabilities (NDCPD) at Minot State University.
2. Fail/Refer: The infant did not pass the initial screening.
Rescreen before discharge: The infant will be rescreened before hospital discharge. If the infant passed the screening and does not fall under the risk factor categories, he/she is released from the process.
Risk Factor: If the infant falls under the risk factor category, a reevaluation should be scheduled for three years every six months. Refer the infant to appropriate personnel.
2-6 weeks post birth: Rescreen with OAE or ABR: If the infant failed the first screening, an additional screening should be scheduled two to six weeks post birth using OAE or ABR screening equipment.
Refer/Fail: If the infant fails the rescreening, an audiological evaluation with OAEs, ABR and immitance should be scheduled within six to twelve weeks post birth.
If hearing loss is confirmed, the infant (with prior medical approval), should begin the intervention process. Additionally, the infant must be referred to early intervention services within 30 days of identification.
Enter in data and report to the State Reporting System: Each infant’s results are entered into a state wide data system (Oz) by hospital staff and reported to North Dakota Center for Persons with Disabilities (NDCPD) at Minot State University.
3. Missed: The infant was not screened before hospital discharge or was missed due to home birth.
2-4 Weeks Outpatient Screening: If the infant was missed by the screening program, the parents must be notified by phone and in writing by the hospital. Screening (OAE or ABR) must be scheduled within two to four weeks post birth.
Pass or Refer (Follow Pass or Refer to flow chart from top): If the infant passed and does not fall under the risk factor categories, he or she may be released from the screening process. If the infant failed the rescreening, he/she should receive an audiology evaluation with OAEs , ABR and immitance within six to twelve weeks.
If hearing loss is confirmed, the infant (with prior medical approval), should begin the intervention process. Additionally, the infant must be referred to early intervention services within 30 days of identification.
Enter in data and report to the State Reporting System: Each infant’s results are entered into a state wide data system (Oz) by hospital staff and reported to North Dakota Center for Persons with Disabilities (NDCPD) at Minot State University.
4. Refused by Parents: The parents have the right to refuse the screening since law does not mandate it.
2-4 weeks, Notify MD: Within two to four weeks, the infant’s family physician must be notified.
2-4 Weeks Outpatient Screening: If the infant was missed by the screening program, the parents must be notified by phone and in writing by the hospital. An additional screening must be scheduled within two to four weeks.
Pass or Refer (Follow Pass or Refer to flow chart from top): If the infant passed and does not fall under the risk factor categories, he or she may be released from the screening process. If the infant failed the rescreening, he/she must receive an audiology evaluation with OAEs , ABR and immitance within six to twelve weeks.
If hearing loss is confirmed, the infant (with prior medical approval), should begin the intervention process. Additionally, the infant must be referred to early intervention services within 30 days of identification.
Enter in data and report to the State Reporting System: Each infant’s results are entered into a state wide data system (Oz) by hospital staff and reported to North Dakota Center for Persons with Disabilities (NDCPD) at Minot State University.
Newborn (0 to 4 months)
A newborn (0 to 4 months) usually reacts suddenly to loud sounds
through movements such as widening the eyes, jumping or extending the
arms and legs. Parents should look for signs of localization from their
child. Localization is eye movement or turning the head towards the
direction of the sound source.
3 to 6 months
A baby of 3 to 6 months of age should turn and search out a
different sound. They should also be able to respond to the sound of
their name. During this particular developmental time, the baby will
play with sounds by cooing and babbling. The baby should be smile or
stop crying when either of the parents speaks to him/her. In addition,
the baby should act differently to the ways the parents talk to him/her
(angry, friendly, loving).
6 to 10 months
A baby of 6 to 10 months of age should be able to seek out
the sound source. When his or her name is called, the baby should look
towards the speaker. In addition, the baby should respond to both soft
and loud sounds. Familiar sounds such as a doorbell ringing or a dog
barking should get a response from the baby. The baby should also pay
attention when the parents talk to him/her.
10 to 15 months
A baby or 10 to 15 months will begin to increase his or her
babbling and begin to more closely resemble speech. The baby plays with
sounds and is able to put sounds together in different patterns.
15 to 18 months
A child of 15 to 18 months is able to directly localize to
most sounds. In addition, the child can understand simple phrases,
identify familiar objects such as body parts and follow simple
directions. A child at 18 months should have an expressive vocabulary
of 20 or more words and short phrases.
Advisory Board Members Participating Hospitals Project StaffAbout First Sounds Infant Hearing Loss Facts Where do I go for HelpHome Top of Page Email First Sounds |
Advisory Board Members Participating Hospitals Project StaffAbout First Sounds Infant Hearing Loss Facts Where do I go for HelpHome Top of Page Email First Sounds |
FACTS ON INFANT HEARING LOSS
Approximately 33 babies are born every day with a significant hearing loss in the United States. Nearly 50% of newborns with hearing loss are not diagnosed until at least the second year of life.
Hearing loss among newborns is 20 times more prevalent than phenlyketonuria (PKU), a condition for which all newborns are screened for.
The average age that children with hearing loss are initially diagnosed, ranges from 12 to 25 months. Studies have shown that when hearing loss is detected later, an important time frame for developing speech and language skills has passed. As a result, speech and language development is delayed and academic and social skills may be adversely affected.
Research has confirmed that treatment has the best results when infant hearing loss is identified and intervention is begins before the child reaches six months of age.
Less than 20% of the children born in the U.S. are born in hospitals that offer universal newborn hearing screening programs.
The National Institute of Health, American Academy of Pediatrics, American Academy of Audiology, the Joint committee on Infant Hearing, and the Healthy People 2000 Report recommend that children with congenital hearing loss be identified before six months of age.
A unilateral hearing loss that remains undetected will have negative consequences. Even children with a hearing loss in one ear are ten times as likely to be held back by a grade as compared to children with normal hearing in both ears.
Infants identified with hearing loss may be fit with hearing amplification as young as four weeks of age. Appropriate and comprehensive early intervention helps these children develop with better language, cognitive, and social skills.
High Risk Criteria For Hearing Loss in Infants (0 to 28 days old)
*Indicators associated with sensorineural and/or conductive hearing loss in infants