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ANN ARBOR,
MI - As of this year, 101 Michigan hospitals have programs
to test the hearing of newborn babies before they go home. These
efforts have gotten countless children needed help, before hearing
loss hinders their ability to learn and develop speech and language
skills.
 But
what about the many infants whose hearing loss doesn't set in until
later, who don't get a newborn test, or who don't receive follow-up
attention after a failed test? Many parents and doctors don't know
the signs of childhood hearing loss, or the factors that increase
a child's risk.
Hearing loss
is an "invisible" condition, often not suspected and diagnosed
until a child fails to develop speech around the age of two. But
by then, a child with hearing loss has missed out on a lot of sound
input, which can in turn affect his or her communication, learning,
behavior and emotional development - and future performance in school
and at work.
That's why
the University of Michigan Health
System is launching a new two-part program aimed at improving
the odds that Michigan children with hearing loss will be diagnosed
early, and assisting families of hearing-impaired children in obtaining
appropriate treatment.
The first part
of the program, called EHDI ("Eddy") for Early Hearing
Detection and Intervention, was created to identify children born
with hearing loss and those at risk to develop it later. It's one
of the nation's most complete early childhood hearing programs,
providing educational materials to parents and doctors, and following
at-risk infants until they reach school age to ensure that any hearing
loss is caught as soon as possible. This week, UMHS is sending a
fax to thousands of Michigan pediatricians and family physicians,
introducing the program.
"We salute
the spirit of grass-roots campaigns for universal newborn screening,
which have done much to improve awareness and diagnosis," says
Paul Kileny, Ph.D., UMHS director of audiology
and electrophysiology. "Now, we want to expand the safety
net through education and clinical innovation, so that every child
with a hearing loss is identified and treated as early as possible.
We hope our program can serve as a model for the state and the nation."
Hearing loss is the most common disorder in babies at birth, explains
Breena Scharrer, M.A., the audiologist who coordinates the EHDI
program in the UMHS Department
of Otolaryngology. Two of every 1,000 babies born in Michigan
in the year 2000 had a significant hearing loss - ten times the
combined rate of all the disorders for which the state screens babies'
blood.
"Every
child with a hearing loss, no matter when it begins or what the
cause, deserves a chance to reach his or her full potential,"
Scharrer says. "Only through comprehensive screening and follow-up,
and vigilance by parents and health care providers alike, can we
reach this goal."
Scharrer, together
with audiologist Lori Van Riper, M.S., oversees newborn testing
in the U-M Women's Hospital birthing center, Holden Neonatal Intensive
Care Unit and C.S. Mott Children's Hospital. UMHS has offered hearing
screening to all infants with at least one hearing-loss risk factor
for more than 15 years, identifying nearly 300 babies with hearing
loss.
In the past
year, the program was expanded to screen virtually all babies cared
for at UMHS. The staff uses the Automated Brainstem Auditory Evoked
Response test, the "gold standard" of tests for accuracy
but one that requires trained staff to administer.
Among other
features, the UMHS program includes seven-days-a-week staffing to
ensure that all newborns receive a hearing screening before discharge,
most within 12 to 24 hours of birth. Many newborns brought to UMHS
because of a high-risk birth or serious medical condition are also
tested. Kileny credits Mott Hospital administrator Pat Warner for
funding the program, which costs about $30 per baby and is not mandated
or funded by Michigan law, nor covered by insurers and other payers
despite being recommended by the American
Academy of Pediatrics.
Already, the
EHDI program has ensured that virtually all infants born or treated
at UMHS have their hearing screened. But the screening is only the
first step in the comprehensive program.
Even with universal
testing, she says, nationwide research has shown that 30 percent
of babies who fail the test never get follow-up testing, often because
parents don't know where to turn. Countless other infants and toddlers
show signs of hearing loss in the months and years after birth,
but a lack of information or resources for parents and doctors keep
them from getting help.
The UMHS program
is designed to overcome these problems. "We hope to improve
care through surveillance, diagnosis and treatment," says Kileny.
"We want others to copy our approach and help close the gaps
in the current system. And, we hope we can increase awareness of
risk factors and symptoms among health care providers."
Under EHDI,
the UMHS audiology staff has a detailed protocol to follow depending
on an infant's initial test results and risk factors. For children
whose newborn screening results or known risk factors warrant a
referral for additional testing, parents receive reminder letters
for upcoming appointments. Their physicians receive information
on the test results and risk factors, including recommendations
for follow-up care when appropriate.
Even children
who pass their initial hearing screening and have no known risk
factors for a future hearing loss are monitored under the program.
When they have their initial test, their parents receive a brochure
outlining important milestones in a child's hearing, speech and
language development. Seven months later, the parents receive a
questionnaire to complete and return to UMHS, which asks them to
examine their child's responses to sounds, and his or her speech
development. If the results raise questions about a child's hearing,
the family is contacted and a follow-up test is scheduled.
For those parents whose infants are diagnosed with a hearing problem,
UMHS has prepared a support program that can help in the first bewildering
days and months after diagnosis. The new Children with Hearing Loss:
Assistance and Resources for Michigan Families (CHARM) program works
with families to obtain hearing aids and locate educational resources
in their local area.
The program,
funded by the Carls Foundation and developed by Pediatric Otolaryngology
with the help of Audiology, is provided at no cost to families.
Marci Lesperance,
M.D., a pediatric otolaryngologist key to the development of the
CHARM program, says, "Even though we are identifying hearing
loss in children at a very young age, there's often a delay in the
use of hearing aids and other rehabilitation services. But we know
that early intervention has a significant impact on a child's speech
and language development."
Adds Angelique
Boerst, M.A.., an audiologist working with the CHARM program, "This
program was created to decrease the time between when a family learns
about a child's hearing loss, and when they begin rehabilitation.
The sooner families receive help, the better for their child."
Families in
the CHARM program will receive a series of newsletters and a new
25-minute video titled "First Steps: An Introduction to Hearing
Loss." Produced with funding from FRIENDS of UMHS and the Carls
Foundation, it features three children with hearing loss and their
parents, and gives basic information on hearing loss, hearing aids,
and the importance of follow-up care.
The CHARM program
also emphasizes education of parents and health care providers about
the risk factors for, and signs of, hearing loss in infants and
children. In the fax being sent this week, UMHS will remind Michigan
pediatricians and family physicians of the risk factors, introduce
the EHDI program, and invite them to request a copy of the "First
Steps" video.
Special notes
on this release
For more
on EHDI and CHARM, visit www.med.umich.edu/childhearinginfo,
or call 734-764-3486.
Listening
& speech milestones in children:
(If a child does not reach these, a hearing test is recommended.)
- At birth,
babies should awaken or startle to loud sounds, make pleasurable
sounds and respond or hush to a caregiver's voice.
- By three
months, babies will watch a speaking parent's face, smile when
spoken to, and repeat cooing sounds.
- From 4 to
6 months, infants will respond to changes in a parent's tone of
voice, look for the source of sounds like dogs barking or doorbells
ringing, and babble or use simple sounds.
- From 7 to
12 months, toddlers will begin to recognize words for common items,
enjoy games like peek-a-boo, and begin to make speech sounds and
use one or two words.
- From 1 to
2 years, a child will point to objects by name, follow simple
commands like "roll the ball", begin to ask simple questions
and use more words each month.
- From 2 to
3 years, children understand differences like "in and out",
follow two-part requests like "get the ball and put it on
the table," can name most objects and use short sentences.
Risk factors
for hearing loss:
- Parent or
guardian concern about hearing, speech or language development
- Family history
of childhood hearing loss
- Infections
the mother had during pregnancy, such as syphilis, herpes and
rubella
- Bacterial
meningitis
- Misshapen
ears, and ear "tags" or "pits", or cleft palate
- Serious
infection or illness needing treatment in a neonatal intensive
care unit
- Head injury
with a skull fracture or loss of consciousness
- Repeated
or long-term presence of fluid in the eardrum for at least three
months
Notes for
reporters: For more information on this program, a copy of the
"First Steps" video, or interviews with U-M hearing experts
and families with a hearing-impaired child, please call UMHS Public
Relations at 734-764-2220 or e-mail umhsmedia@umich.edu.
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