The current status of EHDI programs in the United States

Abstract

The importance of identifying congenital hearing loss during the first few months of life has been recognized for almost 60 years. Unfortunately, until more effective newborn hearing screening equipment and procedures were developed in the late 1980s, it was not practical to implement programs for identifying hearing loss during the first few months of life. This paper reviews the activities implemented by the federal government in the last 15 years to promote more effective Early Hearing Detection and Intervention (EHDI) programs, and summarizes legislation passed by states related to universal newborn hearing screening. In surveys conducted in 1998 and 2001, State EHDI Coordinators were asked to rate the degree to which various issues were obstacles to implementing effective EHDI programs. The most serious obstacles are the shortage of qualified pediatric audiologists, inadequate reimbursement for screening and diagnosis, and lack of knowledge among primary health care providers about EHDI issues. Opposition to EHDI programs by hospital administrators was rated substantially lower in 2001 than in 1998. State EHDI Coordinators were also surveyed about how well their EHDI program is addressing issues related to screening, diagnosis, early intervention, linkages to medical home providers, tracking and data management, and family support programs. Although substantial progress has been made, many gaps remain with current EHDI programs.

Screening for hearing loss in early childhood programs

“…The overall referral rate of 5% also compares favorably with the referral rates reported by effective hospital-based newborn hearing screening programs (White, 2003). Additionally, the specificity of 98.8% and the positive predictive value of 67.2% demonstrates that "over-referral" was not a problem.…”

Clinical aspects of hereditary hearing loss

“…However, milder but still clinically significant degrees of unilateral or bilateral hearing loss occur in an additional one to two infants. 5,6 More than 50% of all prelingual deafness cases are hereditary in nature, with the remaining 40% to 50% of cases secondary to environmental factors such as infectious or iatrogenic causes (Fig. 2).…”

A focus group study of consumer attitudes toward genetic testing and newborn screening for deafness

“…The goals of the state-based EHDI programs are to screen all newborns for hearing before one month of age using audiologic techniques, diagnose the hearing loss no later than three months of age and coordinate appropriate intervention services no later than six months of age. 6,7 Discussions about how to best incorporate genetic services into the current EHDI program framework have been initiated. 8 -11 While auditory hearing screening is an effective and relatively inexpensive way to detect hearing loss in the newborn period, a major limitation is that all forms of prelingual hearing loss are not expressed at birth and could be missed by EHDI programs based solely on audiologic testing.…”