Universal hearing screening: Why restrict it to the very young?

By David H. Kirkwood

“There is nothing so powerful as an idea whose time has come.” The truth of that statement, originally written by Victor Hugo (in French), has been proven over and over. One example from the field of hearing care is universal newborn hearing screening (UNHS).

Twenty-five years ago, I doubt there was a country or state or city in the world where screening infants at birth for hearing loss was routine practice. Today, every U.S. state and territory has an Early Hearing Detection and Intervention (EHDI) program, and UNHS is the practice in more and more countries around the world.

Identifying hearing loss as early as possible was always a good idea. However, for a variety of reasons it was not until the 1990s that it was an idea whose time had come. Technology played a big role. The invention of ways to measure otoacoustic emissions (OAE) and auditory brainstem response (ABR) made it possible to detect hearing loss in people of any age and stage of mental development.

Another factor that made the idea of infant screening so powerful was research showing that the younger a child was provided with hearing aids or a cochlear implant the better he or she would be able to communicate and learn.

The success that visionary pediatric audiologists had in fitting babies at a very early age—younger than had previously been considered feasible—provided more ammunition for the UNHS movement.



What I find troubling is how little is still being done to identify and address hearing loss beyond the first few years of life. Typically, children in the U.S. are screened only at birth and when they enter kindergarten. That leaves a crucial time gap during which babies and toddlers who develop hearing loss post-natally are likely have it go unnoticed and untreated, resulting in language and learning delays.

The failure to screen kids regularly after kindergarten means that temporary hearing loss resulting from ear infections, so common among grade schoolers, is likely to go unrecognized and not be compensated for in the classroom. The same is true of noise-induced hearing loss in adolescents, which is a growing concern.

Identifying hearing loss in students of any age is doubly valuable. First, it enables parents to address the damage that has already been done. Secondly, it can alert them and their child to the causes of the loss–often a dangerous level of noise exposure—and motivate them to take action to prevent further damage.



Increasingly, I am seeing evidence of growing support for more frequent screening for hearing loss.

In January, The Journal of Developmental and Behavioral Pediatric published an article reporting on a study that found that objective hearing screenings conducted during routine doctor visits are feasible and effective in detecting post-natal hearing loss.

The study, a collaboration between the John Tracy Clinic, the Saban Research Institute of Children’s Hospital Los Angeles, and the UCLA David Geffen School of Medicine, drew upon data from 1965 young children screened for post-natal hearing loss. The researchers found that screening could usually be conducted in less than 10 minutes, using technologies that are affordable, portable, and simplified for easy operation by trained medical staff.

The authors point out that if the newborn screening misses a hearing loss or if a loss develops in the child’s first few years, unless the child is screened again before kindergarten he or she is likely to be handicapped during a significant period for language and cognitive development.



Further bolstering the case for more frequent hearing screening has been the extensive coverage in the media of an alarming increase in hearing loss among adolescents. Using data from the National Health and Nutrition Examination Survey, authors of an article in the Journal of the American Medical Association reported that in the years 2005 and 2006, 19.5% of children ages 12-19 had some degree of hearing loss. That was a sharp increase over the 14.9% rate of hearing loss in the same age group in the years 1988-1994. The portion of 12-19-year-olds who had a hearing loss of 25 dB or greater rose from 3.5% in the earlier group to 5.3% in 2005 and 2006.



It appears that the mounting evidence and publicity in support of hearing screening for children have not gone unnoticed. A May 2012 survey by the University of Michigan Mott Children’s Hospital National Poll on Children’s Health found that a sizable majority of parents with children 17 years and younger favored mandatory screening for children.

At least two-thirds of the approximately 850 parents who responded to the poll were supported screening children in every age group they were asked about.

Screening of young children was especially popular, with 77% of parents approving it for 2- and 3-year-olds and 82% for kids 6 or 7. Seventy-one percent favored screening kids age 10 and 11 and 67% those 16 and 17.



The conditions are ripe for hearing screening to become routine for children of all ages. The technology is there to make screening quick and affordable. The value of of early identification and treatment is proven. There is a growing realization that hearing loss in children is not rare. And it appears that there is public support.

However, even ideas whose time has come do not turn into reality without individuals emerging to lead the cause. For example, strong as the case was for universal newborn hearing screening, it would never have become a reality without the contributions of Marion Downs, David Kemp, Christine Yoshinaga-Itano, Judy Gravel, and many others.

It’s time for new leaders—audiologists, parent groups, consumer advocates, educators, physicians, public health officials, and others who understand the importance of the issue—to step up and speak out in favor of regular hearing screening for all children throughout their school years.