American Speech-Language-Hearing Association

Illinois Hearing Screening Requirements for Newborns and School-Aged Children

The following information summarizes hearing screening programs for newborns and school-aged children.

The information has been collected by researching individual state statutes, regulations, policy documents, and by contacting each state. The information is reviewed on an annual basis. Please be advised that regulations and policy may change at any time, so always check with your state for the most up-to-date information.

Newborn Screening

Screening

  1. All hospitals performing deliveries will provide bilateral hearing screening to infants born in their institution. In the event that a newborn does not pass, the hospital shall provide another screening (rescreening). These screenings shall be provided prior to discharge.
  2. If a newborn is placed in the neonatal intensive care unit (NICU) or transferred to another hospital without written documentation of a completed hearing screening, the hearing screening will be completed by the receiving hospital, prior to discharge.
  3. All hospitals performing deliveries will make provisions for outpatient screenings for infants born in the home or other location outside the hospital when requested by the parents or the child's physician.

Intervention

  1. The hospital shall provide written information to all parents giving birth or transferred to its facility and to the infant's primary care provider, when identified, that includes procedures used for hearing screening, limitations of screening procedures, and results of the hearing screening.
  2. In the event that an infant does not pass the screenings, the hospital shall provide written information to the parents recommending further diagnostic testing and explaining how diagnostic tests may be obtained.
  3. The hospital shall maintain written documentation in the infant's clinical record. The documentation shall include: procedures used for hearing screening, time and location of the screening, individual administering the screening test, outcome of the screening, and recommendation for further testing.

Standards/Protocols

  1. Technology for screening must:
    • measure a physiologic response;
    • be implemented with objective response criteria;
    • use a procedure that measures the status of the peripheral auditory system and that is highly correlated with hearing status;
    • be designed for newborn hearing screening.
  2. The methodology used shall detect, at a minimum, all infants with unilateral or bilateral hearing loss equal to or greater than 35 dBHL.
  3. The methodology used should have a false-positive rate (the proportion of infants without hearing loss who are labeled incorrectly by the screening process as having significant hearing loss) of 3% or less.
  4. The methodology used should have a false-negative rate (the proportion of infants with significant hearing loss missed by the screening program) approaching zero.

Tracking/Reporting

  1. Hospitals shall report screening results to the Illinois Department of Public Health (IDPH).
    • Hospitals shall report all required data per IDPH reporting requirements and methods.
    • In order to capture all children who may have a hearing loss, infant specific information shall be reported to IDPH within 7 calendar days after the hearing screening/rescreening for all infants. The infant specific information shall include the infant's name, date of birth, place of birth (hospital), mother's name and address, mother's maiden name, hearing screening test results and date of screening.
    • Infants with results other than bilateral pass or who are deceased, the parent's/guardian's name, address, and name of the primary care physician shall be reported to IDPH.
    • For infants who transfer to another hospital prior to screening, the "test result" reported to IDPH by the birthing hospital shall be listed as "transferred" and shall indicate the date of transfer and the hospital to which the child was transferred.
  2. IDPH will maintain a registry of infants in need of follow-up as a result of the newborn hearing screening program. The registry will include all infants who did not pass the newborn hearing screening in the hospital and who did not file a written religious exemption.
  3. IDPH will notify the infant's primary care physician, as indicated to IDPH by the hospital. IDPH will provide written notification to both the infant's physician named on the hospital record and the parents/guardians, within 5 business days after the receipt of the hospital report, regarding the need for follow-up for infants not passing the screening.
  4. Persons who conduct any procedure necessary to complete an infant's hearing screening or diagnostic follow-up shall report this information to IDPH. Diagnostic follow-up results shall be reported to IDPH within 30 days after testing.
  5. When hearing loss is confirmed, IDPH will make referrals to the Early Intervention Program, to Hearing and Vision Connections, to Division of Specialized Care for Children (DSCC), and to the Maternal and Child Health (MCH) Family Case Management Agency.
  6. IDPH will notify the appropriate MCH Family Case Management Agency or local health department, in writing, of infants with no reported diagnostic testing 60 days after the initial hospital report regarding any non-bilateral pass test result.
  7. The local MCH Family Case Management Agency or local health department will provide appropriate follow-up services and report results to IDPH.

School-Age Screening

Ages/Populations Screened

  1. Hearing screening services shall be provided annually for all preschool children three years of age or older in any public or private educational program or licensed child care facility.
  2. Hearing screening services shall be provided annually for all school age children who are in kindergarten, grades 1, 2, and 3; are in any special education class; have been referred by a teacher; or are transfer students. These screening services shall be provided in all public, private, and parochial schools. Hearing screening is recommended in grades 4, 6, 8, 10, and 12.

Who Can Screen

Hearing screening services shall be provided by a hearing screening technician trained and certified by IDPH.

Training for Screeners

Any person with a high school education or its equivalent who is working in or supervising or has an agreement to work in or supervise a school hearing screening program may apply for training.

The training course for hearing screening technicians shall include, but shall not be limited to, the following topics: establishing and managing a hearing conservation program, hearing conservation for children, anatomy of the ear, disorders of hearing in children, the audiometer, physics of sound, the measurement of hearing, selecting a testing room, threshold tests, testing preschool children, testing exceptional children, and follow-up. The training course shall also include laboratory practice, practicum experience, and a written examination.

Type of Testing

Screening Procedures

  1. For the screening stage of identification audiometry, the following pure-tone frequencies and intensity levels shall be used:
  2. Test Frequencies in Cycles Per Second Screening Levels in Decibels

    500 Hz
    1000 Hz
    2000 Hz
    4000 Hz

    25 db
    25 db
    25 db
    25 db

  3. If a child fails to hear any tone at 25 dB, you should immediately raise the level to 35 dB and present it again. If the child responds at the 35 dB level, move on to the next test frequency and present the tone at 25 dB. In the event the child's condition is such that recommended screening procedures are not applicable, the child should receive alternative services if the child is considered at risk for hearing difficulties.

Pass-Fail Criteria

  1. A child is considered to have "failed" the screening test, if he:
    1. fails to hear any tone at 35 dB in either ear; or
    2. fails to hear any two tones at 25 dB in the same ear
  2. Children "failing" the screening test should be given a second screening identical to the first and judged by the same criteria. The second screening should occur within two weeks of the first test. Those children who fail the second screening should then have a threshold test.

Threshold Test Procedures

It is recommended that the right ear be tested first. Always begin testing at 1000 Hz. After determining threshold at 1000 Hz, continue with the following frequencies: 2000, 4000, 8000, 500 and 250 Hz. Then switch to the opposite ear and repeat the entire procedure at 1000, 2000, 4000, 8000, 500 and 250 Hz.

Equipment Standards

  1. Pure-tone audiometers utilized for identification audiometry must comply with minimum specifications established by the American National Standards Institute as published in the American National Standard Specifications for Audiometers. (ANSI 3.6 1996)
  2. Pure-tone audiometers utilized for identification audiometry must undergo an electro-acoustic coupler calibration check a minimum of once per calendar year. The electro-acoustic calibration check shall include the following measurements:
    1. frequency count;
    2. attenuator linearity; and
    3. earphone sound pressure level output.
  3. Annual calibration check services can be acquired from either IDPH (for a $10 fee) or other qualified entity (a dealer or manufacturer who has technical knowledge and experience in repair and maintenance of audiometric equipment). Any audiometer that does not meet ANSI 3.6 (1996) and/or does not pass the listening or visual check is required to be calibrated and/or repaired by a dealer or manufacturer who has technical knowledge and experience in repair and maintenance of audiometric equipment.

Follow-up Protocols & Documentation

  1. Medical examination must be immediately recommended in written form to parents or guardians of all children who meet the referral criteria as a result of threshold testing. The names of these children shall be reported to the local education agency (LEA), or its designee, for educational screening, including audiological review.
  2. The screening agent or its designee shall initiate recommendations for medical examination, educational screening, and further audiological evaluation and shall coordinate those activities necessary to complete medical management of the child suspected of a hearing impairment.

Resources

For further information on hearing screening requirements, visit these websites:

Questions regarding state advocacy issues? Call ASHA at 800-498-2071 and ask for the State Advocacy Team.

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