Congenital hearing loss occurs in 1-3 out of 1000 infants in the United States and often found in babies whose parents have normal hearing. There is well-established evidence that early identification of hearing loss and appropriate early intervention can mitigate the potential for poor language acquisition. The Joint Committee on Infant Hearing’s Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs, and their statement entitled, “Newborn and Infant Hearing Loss: Detection and Intervention” supports universal newborn hearing screening and outlines best practices in the timing and methods for follow up hearing screening and participation in early intervention. Early detection of hearing loss facilitates language acquisition and future opportunities for educational success.
Pediatricians and others in pediatric primary care providers play a vital role in mitigating developmental delays in infants and young children who are deaf and hard of hearing. Those providing a medical home for children can ensure appropriate and timely referrals to providers that can perform evaluations and are knowledgeable about congenital hearing loss. DPH provides an Early Hearing, Detection, and Intervention (EHDI) coordinator for each county to assist in follow-up services for families of infants who do not pass the initial hearing screening. You can find your local EHDI Coordinator online at https://sendss.state.ga.us/sendss/!mch.coord_search.
Since its release, the EHDI program adopted the AAP Guidelines for Pediatric Medical Home Providers, available online at https://pediatrics.aappublications.org/content/120/4/898/tab-figures-data. This algorithm maps the 1 – 3 – 6 follow-up guidelines for newborn hearing screening as shown in Figure 1. Outlined below are the key components of the physicians’ role in this process:
- For all newborns, obtain written results of newborn hearing screening from the birthing facility. Results are available via a web portal through the Georgia Department of Public Health’s State Electronic Notifiable Disease Surveillance System (SendSS) or eReports. Physicians can register for SendSS and eReports by following these links https://sendss.state.ga.us/sendss/login.screen; https://ereports.ga.gov/dph/eReports/weblogin.aspx?MsgNum=0&Locale=1033
- By one month of age, ensure that all newborns receive a hearing screening. Infants who “refer” on their initial screening, in one or both ears, must receive a follow-up hearing screen. Infants that pass their initial screening do not need additional testing unless concerns arise. If the initial hearing screen uses an automated auditory brainstem response (a-ABR) screener, then the same test must be performed during the outpatient, follow-up hearing screen.
- By three months of age, infants that refer on their outpatient follow-up screen, send for a diagnostic evaluation. Complete only one outpatient screening, as repeated screenings do not provide enough information to determine appropriate follow-up recommendations. Repeated screenings delay the identification of hearing loss. After three months of age, sedation may be required for testing, which can be a deterrent for parents. EHDI coordinators can assist in locating appropriate providers, as needed.
- By six months of age, support referrals to early intervention, otolaryngology, ophthalmology, and genetics, after diagnosis of permanent hearing loss. A suspected or confirmed case of hearing loss in children from birth to age 5 is a notifiable disease and requires a report to the Georgia Department of Public Health. Therefore, it is important to notify the EHDI program upon confirmation of permanent childhood hearing loss. Send a copy of the diagnostic report to the EHDI Program or a surveillance form for reporting hearing loss for children five and under, located on the GA Chapter of the American Academy of Pediatrics website. EHDI Coordinators will work with the child’s physician and family to assist in linking infants with early intervention services.
- Otitis media with effusion can lead to permanent hearing loss. Infants and children must be referred to an otolaryngologist and audiologist.
- Hearing loss may develop at any age; therefore, it is important to monitor all infants for progressive or late-onset hearing loss. Referral for audiological evaluation is recommended at least once before age 30 months for infants who have risk indicators for late-onset hearing loss, such as family history of permanent childhood hearing loss, neonatal intensive care unit stay of more than five days duration, and parental concern. Included is a list of risk indicators in the attached algorithm.
For more information on the Georgia EHDI Program, please visit https://dph.georgia.gov/EHDI
or call 404-651-5482