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As newborn hearing-screening programs have expanded, more and more infants and young children need hearing services. Medicaid is one of the primary sources of funding for such services and, by law, must establish payment rates that are sufficient to enlist enough providers to provide services. In this study we compared 2005 Medicaid reimbursement rates for hearing services for infants and young children in 15 states with the payment rates for the same services by Medicare and commercially available health insurance. On average, Medicaid rates for the same services were only 67% as high as Medicare and only 38% as high as commercial fees. Furthermore, most Medicaid rates declined from 2000 to 2005, and many states did not have billing codes for a significant number of the hearing services needed by infants and young children. These factors likely contribute to infants and young children with hearing loss not being able to get the hearing services they need to benefit from early identification of hearing loss. These data also raise questions about the extent to which states are meeting the federal requirement that Medicaid payments be sufficient to enlist enough providers so that care and services are adequately available to the general population in the geographic area.

This study assessed the feasibility of doing hearing screening in Migrant, American Indian and Early Head Start programs using otoacoustic emissions (OAE) technology. Staff members were trained to screen 0-3-year-old children for hearing loss using handheld OAE equipment and a multi-step screening and referral protocol. Of the 3486 children screened as a part of the study, 77% passed an OAE screening at the first step, 18% more passed an OAE screening at the second step, and 5% were ultimately referred for medical or audiological follow-up. Eighty children were identified as having a hearing loss or disorder of the outer, middle or inner ear requiring treatment. Of these 80, six had permanent bilateral or unilateral hearing loss. Although the protocol suggested that the multi-step screening procedure should be completed within a 4-week time period or less, analysis of the data showed that for children requiring more than an initial OAE screening, the length of time over which the screening was completed ranged from 7 to 12 weeks. The median time required to complete a single OAE screening session was 4 minutes per child. The results demonstrate that OAE screening of young children using this protocol is practical and effective. The implications for conducting periodic hearing screening throughout early childhood are discussed.

WHAT'S KNOWN ON THIS SUBJECT: The incidence of permanent hearing loss doubles between birth and school age. Otoacoustic emissions screening has been used successfully in early childhood educational settings to identify children with losses not found through newborn screening. WHAT THIS STUDY ADDS:Using otoacoustic emissions to screen the hearing of young children during routine health care visits is feasible and can lead to the identification of permanent hearing loss overlooked by providers relying solely on subjective methods. abstract OBJECTIVES: Otoacoustic emissions (OAE) technology, used widely in newborn hearing screening programs and validated by professional organizations as a reliable and objective tool, is beginning to be recognized as superior to subjective methods when screening young children in a variety of settings. This study examines the efficacy of integrating OAE hearing screening into services routinely provided in health care settings. METHODS:Three federally funded clinics serving low-income and uninsured people in a metropolitan area participated in the 10-month study. Subjects included 846 children (842 in the target population ,5 years of age and 4 older siblings) who were screened during routine visits to their primary care providers using a distortion product OAE instrument. A multistep screening and diagnostic protocol, incorporating middle ear evaluation and treatment, was followed when children did not pass the initial screening. Audiological evaluation was sought for children not passing a subsequent OAE screening. RESULTS:Of the 846 children screened, 814 (96%) ultimately passed the screening or audiological assessment and 29 (3%) exited the study. Three children (1 was ,5 years of age and 2 were .5) were identified with permanent hearing loss. CONCLUSIONS:The rate of identification of permanent hearing loss in this study is similar to findings from a study of OAE screening in early childhood educational settings. OAE screening holds the potential for being an effective method for helping to identify young children with permanent hearing loss in primary care settings.

Sich day In tin-life of ;i young child with an undetected hearing Ids-, is ;i day without lull access to language. When hearing loss goes undetected, the remitting language deficits can become overwhelming obstacles to literacy, educational achievement, socialization, and school readiness Several programs, such a.-Head Stan, Early and Periodic Screening, Diagnosis and Treatment, and Pan C of the Individuals with Disabilities Education Act, are responsible for providing hearing screening to many young children nationwide. These programs have typically bad to rely on subjec tive hearing screening methods. Otoacousilc emissions technology, used widely in hospital-based newborn screening programs, is beginning to be recognized as a more practical and effective al ternative when screening children from birth to^years of agi-. Successful otoacoustic emissions screening in early childhood settings Is dependent on consultation from an experienced pedlatrk audlologlst, selcctfon ofappropriate equipment, adherence to an appropriate screening and followup protocol, ami access to training and follow-up technical assistance. When these elements are prcsi-nt. children with a wide ranj:c of hearing health conditions tan be identified in a timely manner.

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