1. 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.”

2. 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 %
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:
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)
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: (NHANES).
6.Ross, D., Visser, S., Kenneson, A, and Holstrum, J. (2004) A work in progress – looking at NHANES data.

3. 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

4. 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:
(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):
(UK) Watkin, P.M. & Baldwin, M. (1999) Confirmation of deafness in infancy. Archive of Dis Child, 81:
Multi-site: In press

5. 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

6. 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

7. 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)

8. 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

9. 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

10. 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

11. 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.