- The Washington Times - Sunday, July 16, 2000

As of this month, no newborn will be able to leave a Virginia hospital without having received a hearing screening. Maryland enacted similar legislation last year and the D.C. City Council currently has a bill pending on the matter.
When proud parents take an infant home from the hospital, they may not realize that their baby can't hear and by the time they do, it could be too late, says Dr. Eugene Sussman, a pediatrician at Holy Cross Hospital in Silver Spring.
"If the brain doesn't hear normal sounds from birth, at 10 to 15 months, it loses the capacity to hear sound," Dr. Sussman says. "My friend is an Ob-Gyn, and his wife is an audiologist. They're bright people, and they did not pick up on their child's hearing loss until one year. You would think, 'She's an audiologist, and she didn't pick up on the fact that her own child had a hearing loss?' But babies respond to vibrations and motion, and they gurgle and babble no matter what, so it's hard to tell when they can't hear."
Early intervention is the key in treating hearing loss, he says. In the past, doctors screened newborns for hearing only if they had a family history of deafness or a history of medical problems that could induce auditory problems.
Children with no history were overlooked, Dr. Sussman says, and would arrive at a doctor's office at age 3 with severe hearing problems.
"The average age of identifying a child with hearing loss is still 2 to 3 years of age. That is too late with respect to speech and language development, which is well-established by 1 to 2 years of age," says Gilbert Herer, an audiologist and director of infant hearing screening at Children's National Medical Center in the District who created and developed the Universal Newborn Hearing Screening system. "We must have the opportunity to identify hearing loss as quickly as possible."
Using the UNHS system, practitioners administer screenings using two techniques: Otoacoustic Emissions and Auditory Brainstem Response. One of the two screenings is typically conducted within 24 hours of birth. Costs range from $30 to $75, depending on which hospital and which test is used.
The OAE takes just 45 seconds for each ear and the ABR takes about 2 minutes per ear. Both types of screenings are automated, and neither requires the participation of the infant, explains Dr. Ken Henry, director of infant hearing screening at Inova Fairfax and Fair Oaks hospitals in Virginia.
"In fact," Dr. Henry says, "we deliberately try to do it early in the morning while the babies are still asleep."
The OAE uses a soft probe, placed within the ear canal. A series of sounds are then sent into the ear. If cells respond correctly, a message is then sent to the baby's brain and the ear actually sends a barely audible sound back out, where it is picked up by a microphone, Mr. Herer says.
The ABR screening works by measuring the brain's electrical activity using a series of clicks. Sensors placed on the baby's head and neck detect levels of activity in the newborn's brainstem generated after auditory stimulation, he says.
Following the introduction of the UNHS program, Mr. Herer reports that of approximately 19,000 newborns screened at Holy Cross Hospital since 1997, 99.8 percent of all babies with hearing loss were detected before they left the hospital. The overall incidence of hearing loss among infants screened was 2.3 out of every 1,000.
If a child's hearing loss is detected early enough, Mr. Herer says, then treatments such as hearing aids or cochlear implants can be administered. Cochlear implants, tiny devices, are implanted in the ear and produce an electrical signal transmitted directly to the auditory system by bypassing damaged cells. The child will progress normally and can expect to develop language skills at the same rate as children without hearing problems.
If hearing loss goes undetected, the child will be at a disadvantage compared with his or her peers, Dr. Henry says.
"The child is playing catch-up for the rest of their lives," he says.

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