Hearing loss is the most prevalent permanent disability encountered by physicians treating children. The commonly accepted statistic from the Joint Committee on Infant Hearing is 3 per 1,000 of the newborn population will have a hearing loss. Additionally, another 2 to 3 per 1,000 children will acquire a hearing loss after birth.
North Carolina passed legislation (PDF, 106 KB) to require birthing hospitals to screen hearing in 1999 and most hospitals began such screening in 2000. Therefore, the vast majority of infants entering a medical practice in North Carolina will have received a hearing screening at their birthing facility. Results of the Newborn Hearing Screening are sent to the primary care medical practice serving an infant by the birthing facility. Results can also be obtained directly from the NC Early Hearing Detection and Intervention Program office.
Most initial hearing screenings are conducted with an Automated Auditory Brainstem Response (AABR) screener, although some hospitals use an Oto-Acoustic Emission (OAE) screener. Both methods screen mid to high frequency sounds. An AABR screening tests the responsiveness of the complete auditory system from the ear to the brain whereas an OAE screening results stem from Outer Hair Cell response in the cochlea. It is possible, although rare, for a baby to pass an OAE screening but still have a condition of hearing loss called Auditory Neuropathy/Dsynchrony. In this condition the auditory signal does not arrive in the brain in a synchronus manner and the child will hear a very distorted signal. Thus, the child may not meet speech and language developmental expectations. Read questions (PDF, 49 KB) concerning the physician's role in the follow-up of an infant who did not pass newborn hearing screening.
The NC Division of Public Health recommends that medical practices serving young children provide regular physiologic hearing screening at least for children at risk for acquired hearing loss. Consultation for such screening can be obtained from your area EHDI Regional Consultant (PDF, 149 KB). These screenings should be done in conjunction with normal developmental assessment.
Early identification of hearing loss resulting from Newborn Hearing Screening and other subsequent physiologic hearing screenings in conjunction with improved amplification technology has resulted in vastly improved expected outcomes for infants and toddlers with hearing loss. The NC Early Hearing Detection and Intervention (EHDI) Program's goals are to ensure that all hearing impaired babies are identified by one month of age, are diagnosed by three months, and have received amplification and/or intervention in place by six months. If these goals are met, the majority of hearing impaired children can develop normal speech and language skills and function optimally in the hearing world.
North Carolina has a support system for families of young children with hearing loss. The first step is to identify and diagnose the hearing loss and to complete any necessary medical treatment.If hearing loss is diagnosed, the following referrals should be made using the Permission for Referral Form (PDF, 138 KB; Spanish version):
In the event that a child in your practice needs to be referred to an audiologist for an evaluation, there are certain results you should expect. It is important that a child be evaluated by a Pediatric Audiologist (PDF, 66 KB). Your EHDI Regional Consultant (PDF, 149 KB) can provide you with the names of such practices in your area. For information concerning what you should expect from a child's audiological evaluation, please see the North Carolina Pediatric Diagnostic Audiology Protocol.