Facts on Hearing Loss

• Everyday in the United States, approximately 1 in 1,000 newborns (or 33 babies every day) is born profoundly deaf with another 2-3 out of 1,000 babies born with partial hearing loss, making hearing loss the number one birth defect in America.¹

• Newborn hearing loss is 20 times more prevalent than phenylketonuria (PKU), a condition for which all newborns are currently screened.²

• Of the 12,000 babies in the United States born annually with some form of hearing loss, only half exhibit a risk factor - meaning that if only high-risk infants are screened, half of the infants with some form of hearing loss will not be tested and identified.³ In actual implementation, risk-based newborn hearing screening programs identify only 10-20% of infants with hearing loss.⁴ When hearing loss is detected beyond the first few months of life, the most critical time for stimulating the auditory pathways to hearing centers of the brain may be lost, significantly delaying speech and language development.

• Only 69% of babies are now screened for hearing loss before 1 month of age (up from only 22% in 1998). Of the babies screened, only 56% who needed diagnostic evaluations actually received them by 3 months of age. Moreover, only 53% of those diagnosed with hearing loss were enrolled in early intervention programs by 6 months of age.⁵ As a result, these children tend to later re-emerge in our schools’ special education (IDEA, Part B) programs.

• When children are not identified and do not receive early intervention, special education for a child with hearing loss costs schools an additional $420,000, and has a lifetime cost of approximately $1 million per individual.⁶

Early Hearing Detection & Intervention (EHDI) Recommendations

• The Joint Committee on Infant Hearing ⁷ and U.S. Public Health Service’s Healthy People 2010 health objectives⁸ recommend that all newborns be screened for hearing loss by 1 month of age, have diagnostic follow-up by 3 months, and receive appropriate intervention services by 6 months of age.

• A National Institutes of Health (NIH) Consensus Panel in 1993 recommended hearing screening of all newborns. The consensus report concluded that the best opportunity for achieving this goal is provided by the development of hearing screening programs for newborns in hospital nurseries or in birthing centers, prior to discharge.⁹

• The U.S. Preventive Services Task Force in 2001 concluded that universal newborn hearing screening does lead to earlier identification and treatment. However, there were not enough clinical studies of sufficient size and strength to evaluate long-term outcomes. While the preponderance of anecdotal evidence and clinical research indicates that EHDI provides substantial benefit, additional clinical outcome studies and clinical trials are needed.¹⁰

  Methods and Costs for Newborn Hearing Screening

• Advances in technology for newborn hearing screening at most birthing hospitals have allowed for cost containment, with current charges ranging from $25 to $60. The cost of identifying a newborn with hearing loss is less than one-tenth the cost of identifying newborns with PKU, hypothyroidism, or sickle cell anemia, which are screened for in nearly every state.¹¹

• Currently, two types of electrophysiologic procedures are used to screen newborns singly or in combination:

• Auditory brainstem responses (ABR) are measured by placing sensors on the baby’s head. Sound is then introduced to the baby’s ears through tiny earphones while the child sleeps. A computer allows brainwave activity to be recorded to indicate whether the ear and auditory brainstem pathway are responding to sound. This test is painless and takes only about 5 minutes.

• Otoacoustic emissions (OAE) are faint sounds produced by most normal inner ears. The sounds cannot be heard by people, but can be detected by very sensitive microphones that are placed in the ear canal. During testing, a tiny flexible plug is inserted into the baby’s ear and sound is then projected into the ear through the plug. A microphone inside the plug records the otoacoustic emissions that the normal ear produces in response to the incoming sound. Testing is also painless, takes about 5 minutes to complete, and can be done while the baby sleeps.

• These measures are changing and advancing with new technologies.

  Benefits of Early Hearing Detection and Intervention

• Infants identified with hearing loss can be fit with amplification by as young as 4 weeks of age. With appropriate early intervention, children with hearing loss can be mainstreamed in regular elementary and secondary education classrooms.¹² Recent research has concluded that children born with a hearing loss who are identified and given appropriate intervention before 6 months of age demonstrated significantly better speech and reading comprehension than children identified after 6 months of age.^{13, 14}

• Even mild hearing loss can significantly interfere with the reception of spoken language and education performance. Research indicates that children with unilateral hearing loss (in one ear) are ten times as likely to be held back at least one grade compared to children with normal hearing.^{15, 16, 17} Similar academic achievement lags have been reported for children with even slight hearing loss.¹⁸ Children with mild hearing loss miss 25-5% of speech in the classroom and may be inappropriately labeled as having a behavior problem.¹⁹

• Recent clinical studies indicate that early detection of hearing loss followed with appropriate intervention minimizes the need for extensive habilitation during the school years and therefore reduces the burden on the IDEA Part B program.^{20, 21} In contrast, a 30-year Gallaudet study revealed that half of the children with hearing loss graduate from high school with a 4th grade reading level or less.²²