The Journal of the Arkansas Medical Society Issue 2 Vol 115 | Page 13

A
C L O S E R
Using technology, hearing ability
must be provided as close as possible
to typical hearing level, if the child
is to learn to listen and use spoken
language. The child’s family may
choose one of five language educa-
tion programs:
• Auditory-oral: teaches child to use
residual hearing by using hear-
ing aids or cochlear implants plus
speechreading (lip reading); no
sign language
• Auditory-verbal: includes above
plus teaching parents to help child
become auditory communicator;
no speechreading or sign language
• Bilingual-bicultural: teaches child
to use American Sign Language
(ASL) as first language and English
as second; deaf culture is taught
with ASL as common language
• Cued speech: teaches child how to
see and hear spoken language
• Total communication: teaches
combination of all methods
plus ASL
Parent involvement is critical to
finding the best choice for each child.
Language education programs must
start by six months to maximize
a child’s ability to learn language.
(https://www.cdc.gov/ncbddd/hear-
ingloss/freematerials/Communica-
tion_Brochure.pdf)
To accomplish the goal of early
intervention by six months, we must:
• Screen all babies for hearing loss
before one month of age
• Ensure that babies who do
not pass the screen receive an
audiologic evaluation no later
than three months (https://www.
cdc.gov/ncbddd/hearingloss/
screening.html)
• Enroll babies with confirmed
hearing loss in early intervention
services no later than six months
L O O K
AT
Q U A L I T Y
A CLOSER LOOK AT QUALITY
A major obstacle to these goals
is the delay caused by repeating the
failed screening exam after one month
of age, before receiving complete
audiologic evaluation. Any baby
older than one month who h as failed
the hearing screen should have an
expeditious audiologic evaluation to
confirm or rule out hearing loss. This
will allow early diagnosis and interven-
tion services to begin no later than six
months. Delays in early intervention
result in permanent spoken language
delays. Evidence indicates that many
children with sensorineural hearing
loss experience improved language
abilities with early intervention.
Children with hearing loss
are at risk not only for lifelong
deficits in speech and language
acquisition, but poor academic
performance, personal-
social maladjustments and
emotional difficulties.
Children with hearing loss are at
risk not only for lifelong deficits in
speech and language acquisition,
but poor academic performance,
personal-social maladjustments and
emotional difficulties. In addition to
developmental delays, these children
may have behavioral problems such
as attention deficit/hyperactivity
disorder, autism or learning disabilities.
They should have regular surveillance
of developmental milestones. The
CDC’s Learn the Sign Act Early
(LTSAE) materials and smart phone
Milestone app are useful tools to
teach parents how to monitor their
child’s development. (Free download:
www.cdc.gov/MilestoneTracker)
Patients may find this simpler tool
(https://afmc.org/product-category/
practices/epsdt-well-child-practices/)
more helpful. When delays are
detected in any domain, the child’s
primary care provider (PCP) should do
a complete developmental screening
with a tool like the Ages and Stages
Questionnaire.
While virtually all babies born in
Arkansas are screened for hearing
loss, those who fail the screen are not
being diagnosed in a timely man-
ner. We are failing to provide early
intervention services by six months
for all babies diagnosed with hearing
loss. Delays are never acceptable. All
PCPs, otolaryngologists, audiologists
and early intervention providers must
work together to be sure that all of
Arkansas’ babies with hearing loss get
timely, early-intervention services.
Hearing loss in babies is a
neurodevelopmental emergency.
Any delay in auditory stimulation,
or a reduced auditory signal during
the optimal developmental stage,
may cause permanent, irretrievable
reassignment of auditory brain cells.
There is a limited window of time
during which babies can catch up
to their normal-hearing peers. s
Dr. Mease is Medical Director,
Child and Adolescent Health,
Arkansas Department of Health.
REFERENCES
1. Appler JM and Goodrich LV, Connecting
the ear to the brain: Molecular Mecha-
nism of Auditory Circuit Assembly, Prog
Neurobiol 2011 Apr; 93(4): 488
2. Yoshinaga-Itano, Sedley, Wiggin, Chung,
Early Hearing and Vocabulary of Children
with Hearing Loss, Pediatrics. 2017; 140(2)
3. American Academy of Pediatrics, Guid-
ance for the Clinician in Rendering
Pediatric Care, Clinical Report- Hearing
Assessment in Infants and Children:
Recommendations Beyond Neonatal
Screening. Pediatrics. 2009; 124; 1252
NUMBER 2
AUGUST 2018 • 37