|Early Hearing Detection and Intervention Program|
As mentioned on the home page, legislation requiring all Connecticut birth facilities to implement a universal newborn hearing screening program, took effect on July 1, 2000. As a result, all infants born are screened for hearing loss at birth, unless the parent refuses due to religious reasons. The following FAQ’s are listed chronologically and will help answer questions, and at the same time, explaining the process.
What is the Universal Newborn Hearing Screening Program?
It is a program that began in Connecticut on July 1, 2000, under which all babies are screened for hearing loss at birth. The Department of Public Health (DPH) is the state agency that oversees the program and developed program guidelines for birth hospitals and audiologists to follow.
Why are infants screened for hearing loss at such an early age?
Hearing loss is the most commonly occurring disability in infants. In the United States, one out of 33 babies is born with congenital hearing loss, every day. Early hearing detection and intervention is essential in promoting healthy development in children.
The first few months of life offer the critical “window of opportunity” for stimulating the auditory pathways to the hearing center of the brain, which is necessary to help children learn fundamental language, social, and cognitive skills. Studies have shown that infants who are identified, with a hearing loss, and receive care by 6 months of age will develop age-appropriate language by three years of age. In the past, the average age of hearing loss identification was 33 months of age. Late identification of a hearing loss leads to speech, language, and developmental delays.
The earlier a child with hearing loss is identified, the less impact it will have on their development as that child learns to communicate. Studies show that babies with hearing loss can learn typical language if:
The hearing loss is discovered as early as possible after birth
Hearing aids are fitted by 3 months of age, if appropriate
They are enrolled in an early intervention program as soon as a hearing loss is found.
Screening infants for hearing loss is so important that Connecticut passed legislation that all birth facilities conduct newborn hearing screenings as a standard of care, as of July 1, 2000. The Department of Public Health’s goal is to assure that all infants are screened for hearing loss at birth; diagnostic testing is conducted by an audiologist within three months, if appropriate; and children are enrolled in the Connecticut "Birth to Three System" for early intervention, by six months of age, if services are needed.
How are infants screened for hearing loss?
There are two screening methods that are used in Connecticut. They are otoacoustic emissions (OAE) and auditory brainstem response (ABR).
With the otoacoustic emissions (OAE) method, tiny earplugs, which emit sound, are placed in the infant’s ears; sound bounces off the infant’s cochlea and the response to the sound is recorded. The otoacoustic emissions method is very sensitive to fluid or other debris, which may be in the ear canal. In order to obtain accurate results it is extremely important not to screen the baby too soon after birth, to ensure a relatively clear ear canal and proper probe fit, as well as making sure the infant is in a quiet state.
The second screening method is Auditory Brainstem Response (ABR). Earphones that emit sound are placed on the infant’s ears. Soft electrodes are placed on the infant’s forehead, neck, and/or shoulder and record the auditory nerve response to the sound.
Both methods use a computer to interpret the infant’s response to the sound and generate a screening result. The screenings are relatively quick and painless and are usually conducted when the infant is sleeping or in a quiet state. The infant’s parent can request to be present during the screening. Results are recorded as "pass" or "refer." Refer means the child did not pass the test.
What screening methods are used by hospitals?
Connecticut hospitals use OAE, ABR, or a combination of both methods to screen for hearing loss in infants.
The first screening method used can be either an otoacoustic emission (OAE) or an auditory brainstem response (ABR), depending on the hospital the infant is born in. Any infant that does not pass the first screening is rescreened before discharge using the ABR method and referred for diagnostic testing, if appropriate. All neonatal intensive care unit (NICU) babies should have the hearing screening done using the ABR method.
DPH recommends that infants who do not pass an OAE screening have an ABR screening before discharge. The hearing screening should be done in the hospital before the baby goes home.
May a parent refuse to have their infant's hearing screened?
Yes. A parent may refuse the screening if such screening is in conflict with their religious tenets. The birthing facility will ask the parent to sign a refusal waiver.
What if the infant does not pass the hearing screening conducted at birth?
The Connecticut EHDI guidelines state that if an infant does not pass the first hearing screen at birth, the screening will be repeated prior to discharge using the ABR method.
If an infant does not pass the second hearing screen performed at the hospital, then the family will be referred to an audiologist that specializes in working with infants for diagnostic evaluation.
Also, according to a new law that takes effect January 1, 2016, any newborn who does not pass the second hearing test, often referred to as a "rescreen", will also be given a simple and painless test to determine if cytomegalovirus (CMV) is present. For more information please see: CT EHDI CMV.
It is very important that the parent bring the child to an audiologist for follow-up testing, if indicated. The hospital only conducts a screening; an audiologist must conduct the diagnostic testing. Diagnostic testing involves a battery of tests with specialized equipment.
It is recommended that the parent brings a copy of the child's hearing screenings to the audiology appointment.
What is a diagnostic evaluation and how does it differ from the hearing screening done at the hospital?
Diagnostic testing is conducted by an audiologist and is more comprehensive than the initial screening. A diagnosis will not be made based on one test alone, but rather will consist of a group of tests.
Who can conduct diagnostic testing of an infant’s hearing?
It is important for families to find the appropriate professional to evaluate their infant’s hearing. Although a number of professionals can "test hearing,” not all of them have the experience or equipment needed to test and diagnose infants or to make recommendations for additional follow-up. The family should take the infant to an audiologist that specializes in working with infants and young children. For a list of Connecticut-based audiologists that meet the recommendations set forth by the Connecticut EHDI Advisory Board for the diagnostic testing of infants, please click here.
Once an infant has had a diagnostic test, which was conducted by an audiologist that specializes in infant hearing loss, does the family have to remain with that audiologist for follow-up and management of the infant's hearing loss?
No. There are many audiologists in Connecticut who are able to provide follow-up and management of a hearing loss once the diagnosis has been made.
What happens if a child is diagnosed with a hearing loss?
The Connecticut Department of Public Health and the infant’s primary care provider will be notified of the diagnostic testing results.
The audiologist will refer the family to Child Development Infoline (CDI, 1-800-505-7000). Depending on the type and degree of the hearing loss the child will be referred to the Connecticut Birth to Three System.
Birth to Three offers early intervention and other services, most of which are provided in the child’s home. Early hearing detection and intervention is essential in preventing speech, language, and other delays in children’s development. For additional information and a complete copy of the Birth to Three Service Guidelines (available in English, Spanish, and seven other languages) visit: http://www.birth23.org/
What causes hearing loss in infants?
Genetic: Hearing loss is a common condition occurring in infancy. For many children the cause is genetic. The recessive gene responsible for genetic hearing loss in children has been identified (Connexin-26). Genetic evaluation is available for parents of a child with a hearing loss. You should speak to your child’s doctor for more information on genetic counseling or contact one of the state’s Genetic Treatment Centers:
|University of Connecticut
Division of Human Genetics
65 Kane Street
West Hartford, CT 06119
Telephone: (860) 523-6499
Fax: (860) 523-6465
|Yale University School of Medicine
Department of Human Genetics
333 Cedar Street
New Haven, CT 06520
Telephone: (203) 785-2660
Fax: (203) 785-3404
Non-genetic: There are many other non-genetic causes of hearing loss. A child may pass the hearing screening at birth but may still be at risk for a progressive hearing loss. Progressive hearing loss happens over a period of time and is usually associated with certain risk factors, or other events, that increase the likelihood that the child may develop a hearing loss at some point in the future. The risk factors can be used as a "red flag" to remind parents to have the child’s hearing re-checked periodically. Your child’s primary care provider can advise you on the appropriate follow-up.
If at any time there is concern from the parent about a child’s ability to hear and/ or response to sound, the parent should notify the child’s physician or primary care provider and ask to have their child’s hearing evaluated.
What are the Risk Factors for Hearing Loss?
When a newborn passes the hearing screen it means that the baby has normal hearing at that point in time. However, a hearing loss can develop over time for many reasons. If at any time a caregiver has concerns about a child’s speech or hearing, talk to the baby’s doctor about arranging to have his or her hearing tested.
A Parent’s Guide to Risk Factors Associated with Hearing Loss
Babies with any of the following risk indicators, regardless of the status of their hearing screening result prior to discharge, should have more frequent monitoring of their audiological status. An audiologist experienced in working with infants and young children should conduct the follow-up testing.
Caregiver concern* regarding hearing, speech, language or developmental delay.
Family history* of Permanent Congenital Hearing Loss (PCHL).
Hyperbilirubinemia requiring exchange transfusion.
In-utero infections such as cytomegalovirus*, herpes, rubella, syphilis, and toxoplasmosis.
Craniofacial anomalies, including those involving the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies.
Physical findings such as white forelock, associated with a syndrome known to include a sensorineural or permanent conductive hearing loss
Syndromes associated with hearing loss or progressive or late onset hearing loss* such as: Neurofibromatosis; osteopetrosis; Usher; Waardenburg; Alport; Pendred; and Jervell and Lange-Nielson syndromes.
Neonatal Intensive Care for more than 5 days, including any of the following: Extracorporeal membrane oxygenation (ECMO)*, Assisted ventilation, or Exposure to ototoxic medications (gentamycin and tobramycin) or loop diuretics (furosemide/lasix).
Culture positive postnatal infections associated with sensorineural hearing loss* such as: Confirmed bacterial and viral (especially herpes viruses and varicella) meningitis
Head trauma, especially basal skull/temporal bone fracture* requiring hospitalization
Neurodegenerative disorders*, such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich’s ataxia and Charcot-Marie-Tooth syndrome
*Are of greater concern for delayed onset hearing loss.
My newborn passed their hearing screening test, does this mean their hearing will remain at an acceptable level?
Not necessarily. A child may pass the hearing screening test at birth, but may still be at risk for a progressive hearing loss. Progressive hearing loss happens over a period of time and is usually associated with certain risk factors, or other events that increase the likelihood that the child may develop a hearing loss at some point in the future. The risk factors can be used as a "red flag" to remind parents to have the child’s hearing re-checked periodically. Your child’s primary care provider can advise you on the appropriate follow-up.
If at any time there is concern from the parent about a child’s ability to hear and/or response to sound, the parent should notify the child’s physician or primary care provider and ask to have their child’s hearing evaluated.
What Warning Signs of potential hearing loss should a parent look for?
There are many “achievements” in speech, language, and awareness a child should be making. Eye contact when spoken to, sounding out words, and even being startled by sounds are clues to the child’s development. For a complete list Please see: The “Listen Up” Speech, Hearing, and Behavior Checklist for Parents Pamphlet: PDF English or Español
Yes, there are both state and national resources available.
Please see: The Links, Resources, and Forms page.