1. Early Hearing Detection and Intervention in the Year 2000

2. Number of Hospitals Doing Universal Newborn Hearing Screening Number of Programs

5. Why is Early Identification of Hearing Loss so Important? Congenital hearing loss interferes with the most basic human need to communicate with others

6. "Blindness separates people from things. Deafness separates people from people." --- Helen Keller

7. Why is Early Identification of Hearing Loss so Important? Congenital hearing loss interferes with the most basic human need to communicate with others Hearing loss is the most frequent birth defect

8. Reported Prevalence Rates of Bilateral Permanent Childhood Hearing Loss (PCHL) in Population-based Studies 4.0 3.5 3.0 2.5 2.0 1.5 1.0.5 0 20253035404550556065 4 2 9 8 7 5 16 10 dB Threshold Level (loss criterion) Prevalence per 1,000 1. Barr (1980), n = 65,000 7. Parving (1985), n = 82,265 2. Downs (1978), n = 10,726 8. Sehlin et al. (1990), n = 63,463 3. Feinmesser et al. (1986), n = 62,000 9. Sorri & Rantakallio (1985), n = 11,780 4. Fitzland (1985), n = 30,89010. Davis & Wood (1992), n = 29,317 5. Kankkunen (1982), n = 31,28011. Fortnum et al. (1996), n = 552,558 6. Martin (1982), n = 4,126,26812. Watkin et al. (1990), n = 51,250 12 11 3

9. Percentage of Sensorineural Hearing Losses Which Are Unilateral # of Hearing Impaired Author (year) Children in Sample % Unilateral Kinney (1953) 1307 48% Brookhauser, Worthington 1829 37% & Kelly (1991) Watkin, Baldwin, & Laoide (1990) 171 35%

10. Incidence per 10,000 of Congenital Defects/Diseases

11. Why is Early Identification of Hearing Loss so Important? Congenital hearing loss interferes with the most basic human need to communicate with others Hearing loss is the most frequent birth defect Undetected hearing loss has serious negative consequences

12. Consequences of Hearing Loss Severe/Profound PCHL Losses Mild Bilateral and Unilateral PCHL Losses Fluctuating Conductive Loss 2 2 2

13. Reading Comprehension Scores of Hearing and Deaf Students ' ' ' ' ' ' ' ',,,,,,,,,,, 89101112131415161718 Age in Years 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 Grade Equivalents Deaf Hearing, ' Schildroth, A.N., & Karchmer, M.A. (1986).Deaf children in America. San Diego: College Hill Press.

14. Effects of Unilateral Hearing Loss Math Language Math Language Social Math Language Math Language Social 0th10th20th30th40th50th60th Percentile Rank Normal HearingUnilateral Hearing Loss Keller & Bundy (1980) (n = 26; age = 12 yrs) Peterson (1981) (n = 48; age = 7.5 yrs) Bess & Thorpe (1984) (n = 50; age = 10 yrs) Blair, Peterson & Viehweg (1985) (n = 16; age = 7.5 yrs) Culbertson & Gilbert (1986) (n = 50; age = 10 yrs) Average Results Math = 30th percentile Language = 25th percentile Social = 32nd percentile

15. Effects of Mild Fluctuating Conductive Hearing Loss Teele, et al., 1990 194 children followed prospectively from 0-7 years. Days child had otitis media between 0-3 years assessed during normal visits to physician. Data on intellectual ability, school achievement, and language competency individually measured at 7 years by "blind" diagnosticians. Results for children with less than 30 days OME were compared to children with more than 130 days adjusted for confounding variables. ) ) ) ) Effect Size for Outcome Measure Less vs. More OME WISC-R Full Scale.62 Metropolitan Achievement Test Math.48 Reading.37 Goldman Fristoe Articulation.43 Teele, D.W., Klein, J.O., Chase, C., Menyuk, P., Rosner, B.A., and the Greater Boston Otitis media Study Group (1990). Otitis media in infancy and intellectual ability, school achievement, speech, and language at age 7 years.The Journal of Infectious Diseases,162, 685-694.

16. Why is Early Identification of Hearing Loss so Important? Hearing loss is the most frequent birth defect Undetected hearing loss has serious negative consequences There are dramatic benefits associated with early identification of hearing loss

17. Yoshinaga-Itano, et al., 1996 Compared language abilities of hearing-impaired children identified before 6 months of age (n = 46) with similar children identified after 6 months of age (n = 63). All children had bilateral hearing loss ranging from mild to profound, and normally-hearing parents. Language abilities measured by parent report using the Minnesota Child Development Inventory (expressive and comprehension scales) and the MacArthur Communicative Developmental Inventories (vocabulary). Cross-sectional assessment with children categorized in 4 different age groups. 6 6 6 6 Yoshinaga-Itano, C., Sedey, A., Apuzzo, M., Carey, A., Day, D., & Coulter, D. (July 1996).The effect of early identification on the development of deaf and hard-of-hearing infants and toddlers. Paper presented at the Joint Committee on Infant Hearing Meeting, Austin, TX.

18. 13-18 mos (n = 15/8) 19-24 mos (n = 12/16) 25-30 mos (n = 11/20) 31-36 mos (n = 8/19) 0 5 10 15 20 25 30 35 Identified BEFORE 6 Months Identified AFTER 6 Months Expressive Language Scores for Hearing Impaired Children Identified Before and After 6 Months of Age Chronological Age in Months Language Age in Months

19. 13-18 mos (n = 15/8) 19-24 mos (n = 12/16) 25-30 mos (n = 11/20) 31-36 mos (n = 8/19) 0 50 100 150 200 250 300 Identified BEFORE 6 Months Identified AFTER 6 Months Vocabulary Size for Hearing Impaired Children Identified Before and After 6 Months of Age Chronological Age in Months Vocabulary Size

20. 0.81.21.82.22.83.23.84.24.8 0 1 2 3 4 5 6 Identified <6 mos (n = 25) Identified >6 mos (n = 104) Age (yrs) Language Age (yrs) Boys Town National Research Hospital Study of Earlier vs. Later Moeller, M.P. (1997).Personal communication, moeller@boystown.org 129 deaf and hard-of-hearing children assessed 2x each year. Assessments done by trained diagnostician as normal part of early intervention program. ) )

23. Good work, but I think we might need just a little more detail right here. Implementing Effective EHDI Programs Then a miracle occurs out Start

25. . Status of Universal Newborn Hearing Screening in the United States. Percentage of Births Screened 90%+ 21 - 50% 1 - 20% 3 51 - 90%

26. Tremendous Progress During the Last Decade Less than 30 with UNHS in 1993; compared with almost 1400 today Almost 2 million babies are screened every year prior to discharge 32 states have passed legislation related to newborn hearing screening

27. The Other Side of the Coin.... 2,700 hospitals are not yet screening for hearing loss More than 2 million babies are NOT screened every year prior to discharge Most states who have passed legislation have not yet implemented it Only 9 states (accounting for 7% of the births) have implemented reasonable state wide programs

28. www.infanthearing.org Some babies are born listeners... Others need your help!

29. 1. There are resources available to help you

30. Screening is only the first part of an Early Hearing Detection and Intervention System OAE Screening Prior to Hospital Discharge ABR Screening Fail Comprehensive Hearing Evaluation Before 6 Months of Age

31. 3. Just Do It!