Carefully designed and implemented screening programs improve early identification of babies with hearing impairment (White et al., 1994). As recognized by the U.S. Department of Health and Human Services, Public Health Service (1990), the National Institutes of Health Consensus Panel (1993), and the Joint Committee on Infant Hearing (1994), early identification of and intervention for childhood hearing impairment is a national health objective.
In 1994, the Joint Committee on Infant Hearing endorsed the goal of universal detection of infants with hearing impairment as early as possible (Joint Committee on Infant Hearing, 1994). The Joint Committee specified that all infants with hearing impairment should be identified before 3 months of age and receive intervention by 6 months of age. To achieve this goal, screening all newborn infants with physiologic auditory measures is recommended to identify those infants most likely to have peripheral hearing impairment that may interfere with health, development, communication, or education. For infants not screened at birth, these guidelines may be applied for infants through developmental age approximately 6 months.
Hearing impairment is defined as unilateral or bilateral sensorineural and/or conductive hearing levels of greater than 20 dB HL. Current screening methodologies for this population allow reliable detection of hearing impairments of greater than 30 dB HL. Screening for unilateral hearing impairment is recommended to identify infants and young children at risk for communicative and academic difficulties (Bess, Klee, & Culbertson, 1986; Bess & Tharpe, 1986; Culbertson & Gilbert, 1986; Klee & Davis-Dansky, 1986; Oyler, Oyler, & Matkin, 1987, 1988). Because behavioral screening procedures do not yield accurate predictions of hearing impairment for neonates and very young infants (Durieux-Smith, Picton, Bernard, MacMurray, & Goodman, 1991; Joint Committee on Infant Hearing, 1994), the presence of hearing impairment may be inferred from physiologic measures (auditory brainstem response and/or otoacoustic emissions). In these cases, estimates may correlate well with hearing sensitivity in a limited range of frequencies.
The following outline contains recommended guidelines for the development, supervision, and delivery of screening programs for hearing impairment in neonates and infants (birth through 6 months of age). The Panel provides a discussion of issues related to the rationale and assumptions underlying its recommendations. The Panel intends that this discussion section be fully considered prior to implementation of the recommendations.
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