Are EHDI Systems Missing Children With Minimal Hearing Loss? National EHDI Meeting 03/04/05 W. June Holstrum, Ph.D Danielle Ross, Ph.D. -Danielle Ross from the EHDI team in the Division of Human Development and Disability. -Welcome to the first CDC-EHDI journal club brown bag. -Jamie & Michele -Title of paper I’m going to present today: “Outcomes of Children with Mild-Profound Congenital Hearing loss at 7-8 Years: A Population Study.”

Prevalence Ref Number Prevalence Definitions 1 2,325 Ages 7, 10, 13 12.4% – 14% >20dB 2 1,228 Grades 3, 6, 9 All = 11.3% Minimal = 5.4% Unilateral >20dB Bi-Low-freq 20-40dB Bi-High-freq: >25dB 3 11,748 Age 15 14.5% 4 Review All ages 7.6-17.4% Adjusted for various definitions 5 6,166 Age 6-19 14.9% 16dB or greater Low and high frequencies 6 6,222 Age 6-16 Unilateral: 6.86% Bilateral: 1.42% 15-30dB Low frequency Additionally: US Dept.of HHS ’91 – 5% of children 18 and under US Public Health Service ’90 – 8.3% of U.S. children have “educationally significant” 1.     Axelsson, A., Aniansson, G. and Costa, O. (1987) Hearing loss in school children. A longitudinal study of sensorineural hearing impairment. Scand Audiol, 16:137-43. 2.     Bess, FH.,Dodd-Murphy, J. & Parker, R.A. (1998) Children with minimal sensorineural hearing loss: Prevalence, Educational Performance, and Functional Status. Ear & Hearing, 19(5)339-53. 3.    Sorri, M & Rantakallia, P. (1985). Prevelance of hearing loss at the age of 15 in a birth cohort of 12,000 children from northern Findland. Scand. Audiol. 14(4):203-7. 4.     Goldstein, D.P.(1984) Hearing Impairment. ASHA, Sept. p24-36. 5.     Niskar, A., Kiezak, S., Holmes, A., Esteban, E., Rubin, C. and Brody, D.(1998) Prevalence of hearing loss among chidren 6 to 19 years of age. JAMA, 279:1071-1075. (NHANES). 6.Ross, D., Visser, S., Kenneson, A, and Holstrum, J. (2004) A work in progress – looking at NHANES data.

Difference in Prevalence Estimates Study population Age of subjects Sample size Method of sampling Population based/Clinical sample Based on records/interviews/audiological tests Definitions of hearing loss Laterality (best/worse ear) Frequency dB Threshold Age: Infants: 1-6/1000 School age: 1%-14% Seniors: 32% Threshold: > 15 or 25 or 40

Estimates of HL in Newborns Year Source Identified/1000 2003 DSHPSHWA 1.08/1000 1994 Rhode Island 5.95/1000 RI (DIPS) 1.4/1000 2000 New York 2/1000 1999 United Kingdom 1.18/1000 (40dB +bilat) 2005 Milti-site Study (OAE/AABR) 1.82/1000 2.37/1000 (Rhode Island) White, KR, Vohr, BR, Maxon, AB, Behrens, TR, McPherson, MG, Mauk, GW. (1994) Screening all newborns for hearing loss using transient evoked otoacoustic emissions. Pediatric Oto Rhino Laryngology, 29: 203-217. (NY) Dalzell, L, et. Al. (2000) The New York State Universal Newborn Hearing Screening Demonstration Project: Ages of Hearing Loss Identification, Hearing Aid Fitting, and Enrollment in EI. Early & Hearing. 21(2):118-130 (UK) Watkin, P.M. & Baldwin, M. (1999) Confirmation of deafness in infancy. Archive of Dis Child, 81:380-89. Multi-site: In press

Possible Explanations for Change is Prevalence (From birth to School Age) Progressive or late onset Infections/illnesses, e.g. OME Trauma Noise EHDI system misses

DSHPSHWA Data Y2003 DSHPSHWA Survey Data from 27 states Number born = 1,503,627 Number Screened = 1,457,639 (96%) Number Identified = 1,646 (1.1/1000) Number categorized = 1,252 826 Bilateral (66%) 426 Unilateral (34%) % Lost to System = 42% (0 – 90%) Directors of Speech and Hearing Programs in State Health and Welfare Agencies Only about 1/1000

Hearing Loss by Category Unilateral = 34% Bilateral = 66% Mild 33 28 Moderate 35 Severe 18 Profound 14 20 Data from Y2003 DSHPSHWA Survey (27 States Reporting)

Mild Unilateral Hearing Loss by State (33% of all Unilateral were Mild) 1 10 14 19 40 2 11 15 20 3 12 22 21 45 4 13 25 47 5 23 50 6 24 7 16 29 53 8 17 31 26 56 9 18 32 27 61

Mild Bilateral Hearing Loss by State (28% of all Bilateral were Mild) 1 10 15 19 33 2 11 16 20 3 12 17 21 4 7 13 22 35 5 8 14 23 36 6 26 24 43 25 28 45 9 18 27 58

Possible Explanations for Missing Infants with Minimal HL Technology Screeners Lack of interest in minimal hearing loss Lost to the system Lack of follow-up of high-risk infants Emphasis on lowering referral rates

Conclusions (Too many misses - Need more home runs) Babies with mild and unilateral losses are being missed. Improve EHDI Systems to Identity desired level of loss Reduce lost to the system Screening needs to be on-going Need prevalence studies on HL in preschool years.