Lenore Shisler

Primary Care Physicians' Knowledge, Attitudes, and Practices Related to Newborn Hearing Screening

OBJECTIVE. Universal newborn hearing screening focuses on providing the earliest possible diagnosis for infants with permanent hearing loss. The goal is to prevent or minimize the consequences of sensorineural hearing loss on speech and language development through timely and effective diagnosis and interventions. Pediatricians are in a key position to educate families about the importance of follow-up, if they are well informed. The objective of this study was to survey the attitudes, practices, and knowledge of primary care physicians in relation to newborn hearing screening and follow-up. METHODS. A survey was created on the basis of input from focus groups with primary care physicians. Surveys (n = 12211) were sent to primary care physicians in 21 states and 1 territory (Puerto Rico) regarding practices, knowledge, and attitudes related to universal newborn hearing screening. The response rate was 16.1% (n = 1968). RESULTS. Physicians reported a high level of support for universal newborn hearing screening; 81.6% judged it to be very important to screen all newborns for hearing loss at birth. Although physicians reported confidence in talking with parents about screening results, they indicated a lack of confidence in discussing follow-up procedures and intervention needs. Several important gaps in knowledge were identified, and these represent priorities for education, as based on their relevance to medical management and parent support. Physicians expressed a strong preference for action-oriented resources. CONCLUSION. Pediatricians and other primary care providers recognize the benefits of early detection and intervention for permanent hearing loss in infants. The current system of newborn hearing screening can be enhanced by strengthening the medical communitys involvement in the process from screening to follow-up. Physician roles will be supported through the provision of action-oriented resources that educate parents about the importance of follow-up and that prepare professionals to incorporate appropriate surveillance procedures in daily practice.

Using otoacoustic emissions to screen for hearing loss in early childhood care settings

OBJECTIVE Until recently, no objective tool has been available to help health and early childhood education providers screen young children for hearing loss. The aim of this study was to screen underserved children <or=3 years of age for hearing loss using otoacoustic emissions (OAE) technology and to systematically document multi-step screening and diagnostic outcomes. METHODS A total of 4,519 children, <or=3 years of age in four states were screened by trained lay screeners using portable OAE equipment set to deliver stimuli and measurement levels sensitive to mild hearing loss as low as 25 decibels (dB) hearing level. The screening and follow-up protocol specified that children not passing the multi-step OAE screening be evaluated by local physicians and hearing specialists. RESULTS Of the 4,519 children screened as a part of the study, 257 (6%) ultimately required medical or audiological follow-up. One hundred and seven children were identified as having a hearing loss or disorder of the outer, middle or inner ear requiring treatment or monitoring. Of these 107 children, 5 had permanent bilateral and 2 had permanent unilateral hearing loss. The seven children with permanent hearing loss included four who had passed newborn screening, two who were not screened at birth and one who did not receive follow-up services after referring from newborn screening. CONCLUSIONS OAE screening, using a multi-step protocol, was found to be a feasible and accurate practice for identifying a wide range of hearing-health conditions warranting monitoring and treatment among children <or=3 years of age in early childhood care programs. Future studies are needed to: (1) further examine barriers to effective OAE screening in early childhood care settings and (2) explore the value of extending early childhood OAE hearing screening into health care clinics and settings where young children receive routine care.

Using Otoacoustic Emissions to Screen Young Children for Hearing Loss in Primary Care Settings

OBJECTIVES: Otoacoustic emissions (OAE) technology, used widely in newborn hearing screening programs and validated by professional organizations as a reliable and objective tool, is beginning to be recognized as superior to subjective methods when screening young children in a variety of settings. This study examines the efficacy of integrating OAE hearing screening into services routinely provided in health care settings. METHODS: Three federally funded clinics serving low-income and uninsured people in a metropolitan area participated in the 10-month study. Subjects included 846 children (842 in the target population <5 years of age and 4 older siblings) who were screened during routine visits to their primary care providers using a distortion product OAE instrument. A multistep screening and diagnostic protocol, incorporating middle ear evaluation and treatment, was followed when children did not pass the initial screening. Audiological evaluation was sought for children not passing a subsequent OAE screening. RESULTS: Of the 846 children screened, 814 (96%) ultimately passed the screening or audiological assessment and 29 (3%) exited the study. Three children (1 was <5 years of age and 2 were >5) were identified with permanent hearing loss. CONCLUSIONS: The rate of identification of permanent hearing loss in this study is similar to findings from a study of OAE screening in early childhood educational settings. OAE screening holds the potential for being an effective method for helping to identify young children with permanent hearing loss in primary care settings.

The costs and benefits of providing early intervention to very young, severely hearing-impaired children in the United States: The conceptual outline of a longitudinal research study and some preliminary findings

This paper presents the conceptual framework for a newly instituted longitudinal research study into the costs and benefits of providing early intervention to very young, severely hearing-impaired children in the USA and the results of one of the studies after 2 years of intervention. The research design employs randomised procedures, blind assessment and treatment verification. The overall project is part of a 20 experiment national study that addresses specific questions about the effects of early intervention on the psychological development of hearing-impaired children. Those questions regard age-at-start, treatment intensity and programme variation. Two of the three experiments with hearing-impaired children are still in developmental stages, whilst the third, a communication methods comparison, has been started. The preliminary findings of the third experiment (which include 2 years of intervention effects) are presented. Two groups of young, severely hearing-impaired children between the ages of 18 months and 5 years (one an oral-aural group and one called an English sign language group) have received 20 months of intervention in one or other of the groups. Their developmental progress has been measured using the Battelle Developmental Inventory, several specific English language measures and two family measures. Whilst both groups showed significant progress over intervention time on all measures, the performance differences between the two groups were not statistically significant in any of the psychological domains tested.