Technologies for screening in primary care
The Joint Committee on Infant Hearing (JCIH) updated its screening guidelines last year. The JCIH recommends 2 separate hearing screening protocols: 1) for those admitted to a NICU for more than 5 days; and 2) for babies born in well nurseries.1
All NICU babies (representing 10% of the entire newborn population) may be at risk for neurosensory hearing loss and auditory neuropathy and should undergo hearing screening using an automated auditory brainstem response (AABR) test prior to discharge. Infants cared for in the NICU who do not pass the AABR should be referred directly to an audiologist for rescreening and, when indicated, given a comprehensive audiologic evaluation including diagnostic ABR.
In the well nursery, babies can undergo a screening using either AABR testing or otoacoustic emissions (OAE) testing with a rescreening by the hospital as outpatient with either technology. Alternatively, newborns in the well nursery can undergo an initial screen with either technology with a rescreen before discharge with either technology should the baby not pass the initial screen. All babies who refer from the well nursery should be rescreened by the hospital before aged 1 month or rescreened in the pediatrician’s office (using OAE devices, see below). If this is not possible, they should be referred to a pediatric audiologist for follow-up. It is the goal of Universal Newborn Hearing Screening (UNHS) that screening is completed by age 1 month, audiologic diagnosis is completed by age 3 months, and that the hearing-impaired child is enrolled in early intervention by age 6 months.1
Primary care providers have several tools at their disposal for screening young children for hearing loss. According the American Academy of Pediatrics (AAP) Bright Futures Guidelines, children should be screened for hearing loss at ages 4 ,5, 6, 8, and 10 years; once between the ages of 11 and 14 years; once between ages 15 and 17 years; and once between the ages of 18 and 21 years.9 Screening performed at age 10 years or younger usually is done at 2000 to 5000 Hz. Older children also should be screened at 6000 to 8000 Hz to detect high-frequency hearing loss. Screening also should be performed any time a provider is concerned about hearing loss, as would be the case with children presenting with delayed speech or those with prolonged or recurrent otitis media. In an office environment, OAE screeners are affordable and screening can be completed in minutes.
1. Joint Committee on Infant Hearing. Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs. JEHDI. 2019;4(2):1-44.
2. Todd NW. The etiologies of childhood hearing impairment. In: NCHAM E-Book: A Resource Guide for Early Hearing Detection and Intervention. National Center for Hearing Assessment and Management; 2015; ch 6. Accessed April 8, 2020. http://www.infanthearing.org/ehdi-ebook/2015_ebook/6-Chapter6Etiologies2015.pdf
3. Centers for Disease Control and Prevention. 2017 Annual Data Early Hearing Detection and Intervention (EHDI) Program. Last reviewed December 5, 2019. Accessed April 8, 2020. https://www.cdc.gov/ncbddd/hearingloss/ehdi-data2017.html
4. Xoinis K, Weirather Y, Mavoori H, Shaha SH, Iwamoto LM. Extremely low birth weight infants are at high risk for auditory neuropathy. J Perinatol. 2007;27(11):718-723.
5. Korver AM, van Zanten GA, Meuwese-Jongejeugd A, van Straaten HL, Oudesluys-Murphy AM. Auditory neuropathy in a low-risk population: a review of the literature. Int J Pediatr Otorhinolaryngol. 2012;76(12):1708-1711.
6. Barret TS, White KR. Trends in hearing loss among adolescents. Pediatrics. 2017;140(6):e20170619.
7. Robinshaw HM. Early intervention for hearing impairment: differences in the timing of communicative and linguistic development. Br J Audiol. 1995;29(6):315-334.
8. Apuzzo ML, Yoshinaga-Itano C. Early identification of infants with significant hearing loss and the Minnesota Child Development Inventory. Semin Hear. 1995;16:124-139.
9. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
10. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131:e964-e999.
11. Sabo DL. Assessment of the young pediatric patient. In: The NCHAM E-Book: A Resource Guide for Early Hearing Detection and Intervention. National Center for Hearing Assessment and Management; 2015:ch 5. Accessed April 8, 2020. https://www.infanthearing.org/ehdi-ebook/2015_ebook/5-Chapter5Assessment2015.pdf