General Findings

Permanent Childhood Hearing Loss
Screening

General Findings


 

External Scientific Evidence

Evidence-Based Practice Guidelines
U.S. Preventive Services Task Force; Agency for Healthcare Research and Quality

Universal Screening for Hearing Loss in Newborns
U.S. Preventive Services Task Force (2008).
Rockville (MD): Agency for Healthcare Research and Quality.
Added: July 2012

Description
This guideline provides recommendations for the universal screening for hearing loss in newborns. This guideline is based on a systematic review conducted by Nelson, et al. (2008). Levels of evidence are provided and defined as: Grade A recommendations indicate that the service is recommended and that there is high certainty that the net benefit is substantial. Grade B recommendations indicate that the service is recommended and there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Grade C recommendations indicate that the service should not be routinely provided and that there may be considerations that support providing the service in an individual patient. There is moderate or high certainty that the net benefit is small. Grade D recommendations indicate that the service should not be provided and there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits. Grade I indicates that there is insufficient evidence to assess the balance of benefits and harms of the service.

Recommendations
The U.S. Preventive Services Task Force recommends that all newborn infants be screened for hearing loss (Grade B evidence).

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New York State Department of Health, Early Intervention Program; U.S. Department of Education

Clinical Practice Guideline: Report of the Recommendations. Hearing Loss, Assessment and Intervention for Young Children (Age 0-3 Years)
New York State Department of Health, Early Intervention Program. (2007).
Albany (NY): NYS Department of Health, Publication No. 4967, 354 pages.
Added: July 2012

Description
This evidence-based and consensus-based guideline provides recommendations for the assessment and intervention of hearing loss for young children ages birth to three. The guideline targets parents and professionals. Recommendations of interest to audiologists and speech-language pathologists include screening, assessment, and management of hearing and assessment of communication. Each recommendation is provided with a strength of evidence rating defined as Level A (strong evidence), Level B (moderate evidence), Level C (limited evidence), Level D1 (consensus panel opinion based on topics where a systematic review has been conducted), and Level D2 (consensus panel opinion not based on findings from a systematic review).

Recommendations

  • “It is recommended that a newborn hearing screening program include the following components:

    • Infant hearing screening with an objective physiologic test before discharge from the birthing facility

    • Communication of screening results to parents

    • Provision of written educational materials

    • Follow-up for repeat infant hearing screening or provision of referrals to obtain follow-up screening on an outpatient basis for infants who do not pass inpatient hearing screening

    • Referral of infants who do not pass screening for appropriate evaluation and early intervention services

    • Documenting screening results and developing data systems to follow up on infants who do not pass newborn screening

    • Establishing quality assurance programs to evaluate the effectiveness of newborn screening and to ensure that all infants are screened for hearing loss” (Level D2 Evidence) (p. 42).

  • If access to a hospital screening is not possible then the infant’s hearing should be screened by one month of age (Level D1 Evidence).

  • Noise in the testing environment can lead to less accurate screening results (Level C Evidence).

  • Hearing screenings should be conducted in a quiet environment when the infant is asleep and not attached to any monitoring devices (Level D1 Evidence).

  • Regardless of hearing loss type or severity (including mild), early identification and intervention can result in improved outcomes including age-appropriate linguistic milestones (Level C Evidence).

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Institute for Clinical Systems Improvement

Preventive Services for Children and Adolescents
(2011).
Bloomington (MN): Institute for Clinical Systems Improvement, 88 pages.
Added: July 2012

Description
This guideline provides recommendations for preventive services for children and adolescents. The primary audiences are health professionals and experts. Preventive services are graded and defined as:

  • Level I: Providers must assess the need for and recommend these services to every patient. These have the highest value and are worthy of attention at every opportunity.

  • Level II: Providers should assess the need for and recommend these services to every patient. These have demonstrated value, although less than Level I services, and should be provided whenever possible.

  • Level III: Providers could recommend these services to patients, but only after careful consideration of costs and benefits. These are services for which the evidence of effectiveness is currently incomplete or equivocal, or which may have the potential for significant harm. Providing these services is left to the judgment of individual medical groups, clinicians and their patients. Decisions about preventive services in particular should be made based on the principles of shared decision-making.

  • Level IV: These services are not supported by evidence and should not be recommended. They may have insufficient evidence of effectiveness, clear evidence of lack of effectiveness, or the potential for significant harm without any benefit.

Recommendations
"Universal screening of infants for congenital hearing loss should be recommended before one month of age" (Level II service) (p. 21).

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Evidence-Based Systematic Reviews
Screening in Child Health: Studies of the Efficacy and Relevance of Preventive Care Practices
Weber, P., & Jenni, O. (2012).
Deutsches Ärzteblatt International, 109(24), 431-435.
Added: April 2014

Description
This is a systematic review of the published literature investigating screening procedures and programs for young children.

Conclusions
"The effectiveness of newborn hearing screening…has been confirmed with regard to making an exact diagnosis and effectiveness of early treatment by means of cochlear implants for the child’s speech/language development and school development" (p 433).

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The Cost-Effectiveness of Universal Newborn Screening for Bilateral Permanent Congenital Hearing Impairment: Systematic Review
Colgan, S., Gold, L., et al. (2012).
Academic Pediatrics, 12(3), 171-180.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: May 2013

Description
This is a systematic review of the published and unpublished literature investigating the long-term costs and outcomes of universal newborn hearing screening (UNHS) for permanent congenital hearing impairment.

Conclusions

  • "Despite its worldwide adoption, UNHS is yet to be established as a cost-effective investment" (p. 178).

  • "There is a lack of evidence for the long-term costs and outcomes of these programs, and it is therefore premature to draw any conclusions about their cost-effectiveness. There is a clear need for further research before any policy recommendations can be made" (p. 179).

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The Impact of Early Identification of Permanent Childhood Hearing Impairment on Speech and Language Outcomes
Pimperton, H., & Kennedy, C. R. (2012).
Archives of Disease In Childhood, 97(7), 648-653.
Added: May 2013

Description
This is a review of the published literature investigating the effects of early hearing detection and intervention on language outcomes in children with hearing impairment.

Conclusions

  • The authors concluded that universal newborn hearing screening and early identification of permanent childhood hearing loss were "associated with benefits to language development in deaf children, with more consistent evidence provided for links between early identification and positive language outcomes" (p. 651).

  • It was noted that "early identification must be coupled with comprehensive early intervention programmes to improve the quality of language input for children" particularly within the sensitive period of language development of the first few months of life (p. 651).

  • Included studies "used cut-off points for early identification of 6 months and 9 months, suggesting a time window for the ability to maximally benefit from intervention following early identification that ends before the age of 1 year" (p. 651).

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Universal Neonatal Hearing Screening
Merlin, T., Hedayati, H., et al. (2007).
Adelaide: Adelaide Health Technology Assessment (AHTA), MSAC reference 17 Assessment Report, 266 pages.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: May 2013

Description
This is a review of the literature examining the prevalence of permanent childhood hearing loss (PCHL), the diagnostic accuracy of hearing screening tests used for universal newborn hearing screening (UNHS), and the safety, effectiveness and cost-effectiveness of UNHS.

Conclusions

  • No physical harm resulting from UNHS was reported in any of the studies. Some studies suggested that there was a "slight increase in anxiety and depression in mothers if their infant received a negative screening test, but these states remained within the normal ranges, and as such no clinically important differences were identified" (p. 150).

  • Based on the literature, referral, diagnosis, and management of PCHL happens earlier and more frequently with UNHS than without it.

  • The evidence indicates that children identified through UNHS have increased receptive language abilities however the evidence for improved expressive language abilities or overall communicative abilities is unclear. Data on the impact of UNHS on longer-term outcomes such as education and employment have not yet been reported.

  • "From the available literature it can be concluded that, in the short term, the costs for the additional cases identified and diagnosed by UNHS are greater per unit than those of targeted screening. However, taking a societal perspective over the long term suggests that identifying a larger proportion of hearing impaired children at an early stage (i.e., < 6 months of age) would result in a cost saving over all" (p. 151).

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Early Detection of Hearing Impairment in Newborns and Infants
Ptok, M. (2011).
Deutsches Aerzteblatt International, 108(25), 426-431.
Added: July 2012

Description
This is a systematic review of the literature examining the early detection and treatment of hearing loss in newborns and infants.

Conclusions

  • “The current scientific evidence supports the demand of universal newborn hearing screening (UNHS) conducted by carefully trained personnel” (p. 431).

  • “On the available evidence, the risks and disadvantages of UNHS are slight” (p. 431).

  • “A functioning system for tracking both no-screened children and those with conspicuous screening result is of crucial importance” (p. 431).

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Universal Newborn Hearing Screening, a Revolutionary Diagnosis of Deafness: Real Benefits and Limitations
Papacharalampous, G. X., Nikolopoulos, T. P., et al. (2011).
Eur Arch Otorhinolaryngol, 268(10), 1399-1406.
Added: July 2012

Description
This is a systematic review of the literature investigating the efficacy, results, and outcomes of universal newborn hearing screening.

Conclusions
“A well-organized education system and a dedicated secretariat team are of paramount importance in order to reduce the rate of infants lost to follow-up” (p. 1405).

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Auditory Screening and Hearing Loss Prevention: A Review of the Clinical Evidence and Guidelines
Canadian Agency for Drugs and Technologies in Health. (2011).
Ottawa (CAN): Canadian Agency for Drugs and Technologies in Health, 17 pages.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a review of health technology assessments, systematic reviews, meta-analyses, and evidence-based guidelines investigating the appropriate age to conduct universal newborn hearing screening and initiate treatments following a positive diagnosis of permanent childhood hearing loss.

Conclusions
“Evidence regarding the appropriate age to initiate treatments following a positive diagnosis of permanent hearing impairment and the appropriate age to conduct universal screening (and by whom) following universal newborn hearing screening is limited” (p. 2).

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Neonatal Screening for Early Detection of Hearing Impairment. Final Report S05-01
Institute for Quality and Efficiency in Health Care (IQWiG). (2007).
Cologne (GER): Institute for Quality and Efficiency in Health Care (IQWiG), 187 pages.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a review of studies investigating the benefits and harms of universal newborn hearing screening (UNHS) in the detection of hearing impairment and patient-relevant therapy goals.

Conclusions

  • "UNHS can improve the chances that a child with congenital hearing impairment is diagnosed and treated at an earlier stage. It cannot be certainly inferred from the studies available what consequences this has for the development of these children" (p. 5).

  • "There are indications (not evidence) that children with hearing impairment identified by UNHS have advantages in language development. The comparison between children treated earlier vs. those treated later also provides indications that children with earlier treatment may have advantages in language development" (p. 5).

  • "It is insufficiently investigated how newborn hearing screening affects other outcomes relevant to the children, such as quality of life, development at school, and occupational or social situation" (p. 5).

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Universal Neonatal Hearing Screening Versus Selective Screening as Part of the Management of Childhood Deafness
Puig, T., Municio, A., et al. (2005).
Cochrane Database of Systematic Reviews (2).

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a systematic review of randomized controlled trials investigating the long-term effectiveness of a universal neonatal screening and early treatment programs for hearing impairment.

Conclusions
No studies meeting the inclusion criteria were available; therefore no conclusions could be drawn. “Universal newborn hearing screening programmes have proven valuable in increasing detection of children with hearing loss. However, there is no evidence on the long-term effectiveness of universal newborn hearing screening programmes on psychological, language and education-related outcomes, compared with selective screening programmes” (p. 4).

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Evaluation of Universal Newborn Hearing Screening in Japan: An Analysis of the Literature
Okubo, S., Takahashi, M., et al. (2005).
Nippon Koshu Eisei Zasshi, 52(11), 928-933.
Added: July 2012

Description
This is a systematic review of controlled trials and observational studies investigating screening with otoacoustic emissions (OAE) or auditory brainstem response (ABR) in the neonatal population in Japan and the effects of intervention after early identification.

Conclusions
“The utility of UNHS [Universal Newborn Hearing Screening] in Japan is still inconclusive because of the lack of best practice standards to assess the clinical markers for distinction between impaired and normal hearing. Our results highlight the need for assessment of the accuracy of screening and the effectiveness of early detection before nation-wide implementation of UNHS" (p. 931).

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Universal Newborn Hearing Screening: Systematic Review to Update the 2001 US Preventive Services Task Force Recommendation
Nelson, H. D., Bougatsos, C., et al. (2008).
Pediatrics, 122(1), e266-276.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is an updated systematic review of controlled trials and observational studies addressing outcomes of infants screened for hearing loss by 6 months of age.

Conclusions

  • "Results of this review indicate that infants identified with PCHL [permanent childhood hearing loss] through UNHS [universal newborn hearing screening] have significantly earlier referral, diagnosis, and treatment than those identified in other ways.” (p. 274).

  • Children who underwent UNHS had better scores than those who did not on receptive language but not on expressive language or speech.

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A Systematic Review of the Literature on Early Intervention for Children with a Permanent Hearing Loss
Kumar, S., et al. (2008).
Technical report produced for Queensland Health, Brisbane, Australia.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a systematic review of qualitative and quantitative empirical research pertaining to permanent childhood hearing loss. It is intended to assist stakeholders in providing appropriate support for these children.

Conclusions
“There is little doubt of the importance of early detection and early intervention for children who have a hearing loss. Whilst high level evidence is lacking (Level I and II), there is a sufficient number of methodologically strong research publications (Level III) that support the use of early detection and early intervention for children who have a hearing loss. This body of evidence indicates that the earlier the detection and subsequent intervention, the better the outcomes are for children who have a hearing loss” (p. 492).

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Hearing Screening in Newborns. Systematic Review of Accuracy, Effectiveness, and Effects of Interventions after Screening
Wolff, R., Hommerich, J., et al. (2009).
Archives of Disease in Childhood, [Epub ahead of print].

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is a systematic review of randomized and non-randomized controlled trials investigating the accuracy and effectiveness of hearing screening in newborns and investigating the effects of early intervention.

Conclusions
“There is a lack of high-quality evidence regarding all elements of newborn hearing screening” (p. 12). Because of the lack of reliable studies, possible harms from neonatal hearing screening could not be evaluated” (p. 11).

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Clinical Expertise/Expert Opinion

Consensus Guidelines
Joint Committee on Infant Hearing

Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs
Joint Committee on Infant Hearing (2007).
Pediatrics, 120(4), 898-921.
Added: July 2012

Description
This consensus-based guideline provides recommendations for screening infants for hearing loss, assessing infants identified as at-risk for hearing impairment, and providing appropriate early intervention for infants with hearing impairment. The intended audience of these guidelines is not specified, however they are relevant to all professionals involved in the screening, assessment or treatment of hearing in infants.

Recommendations

  • “All infants should have access to hearing screening using a physiologic measure no later than 1 month of age” (p. 5).

  • If a child was born outside of the hospital or was discharged prior to receiving a hearing screening then outpatient screening should be made available to the infant before 1 month of age.

  • Even if only one ear failed the initial screening, both ears should be re-screened.

  • Infants who are re-admitted to the hospital within the first month of life with conditions that are associated with hearing loss should receive a repeat hearing screening before hospital discharge.

  • If needed, outpatient re-screening should occur within one month and testing should include both ears even if only one ear failed the initial screening.

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American Academy of Pediatrics

Hearing Assessment in Infants and Children: Recommendations Beyond Neonatal Screening
Harlor, A., Bower, C., et al. (2009).
Pediatrics, 124(4), 1252-1263.
Added: July 2012

Description
This guideline provides recommendations for the early identification of hearing loss in young children. The target audience of this guideline is pediatricians but many key recommendations are applicable for audiologists serving this population.

Recommendations

  • Ongoing preventive health care should include a periodic objective hearing screening of all children.

  • An objective hearing screening should be performed if there is any parental concern about hearing loss.

  • Developmental issues “may preclude accurate results on routine audiometric screening and testing. In this situation, referral to an otorhinolaryngologist and a pediatric audiologist who has the necessary equipment and expertise to test infants and young children should be made” (p. 1252).

  • Any failed objective screening result requires a referral to an audiologist for definitive testing.

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Commission for the Early Detection of Hypoacusis (CODEPEH), Spain

Early Hearing Detection and Intervention: 2010 CODEPEH Recommendation
Trinidad-Ramos, G., de Aguilar, V. A., et al. (2010).
Acta Otorrinolaringologica Espanola, 61(1), 69-77.
Added: July 2012

Description
This guideline provides recommendations for early hearing detection and intervention (EHDI) programs. The target audience of this guideline is audiologists and speech-language pathologists. Recommendations are provided in the areas of screening, audiological evaluation, intervention and surveillance.

Recommendations

  • If a re-screen is indicated, infants “should be evaluated bilaterally even if only one side did not pass the initial test” (p. 71).

  • The following are quality indicators of newborn hearing screening programs:

    • The objective of the program is to reveal all unilateral/bilateral hearing loss present at birth regardless of severity or etiology. “Screening procedures must ensure false negatives tend towards 0%” (p. 74).

    • The first hearing screening should take place within the first month of life on more than 95% of children. All children who did not pass the first screening should be re-screened.

    • The referral rate from screening should not exceed 4%. Confirmatory testing should be carried out during the third month of life on all children failing the re-screen.

    • Adequate early intervention should be established before 6 months of age with at least 90% of eligible children.

    • If amplification is required, “no more than one month should pass between the indication and adaptation [of the amplification] in 95% of the candidates” (p. 75).

    • For children with late-onset congenital or acquired hearing loss, “95% should have started treatment within 45 days after diagnosis” (p. 75).

  • To monitor the quality of newborn hearing screening programs key data should be collected such as: the number of newborns screened on hospital admission, number of newborns confirmed with hearing loss before 3 months of age, the number of infants enrolled in early intervention by 6 months, number of children with non-syndromic hearing loss who have adequate language and communication skills by school age, and the number of children referred for cochlear implants.

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Client/Patient/Caregiver Perspectives

Parents’ Compliance with and Impressions of a Maturing Community-Based Early Hearing Detection and Intervention Program: An Update
Danhauer, J. L., Pecile, A. F., et al. (2008).
Journal of the American Academy of Audiology, 19(8), 612-629.
Added: May 2013

Description
This is a study of 150 babies who were screened and monitored through a community-based early hearing detection and intervention program. The study assessed parental compliance with program recommendations and parents’ impressions of the program.

Conclusions
Only seven (of 34) families completed the questionnaire. The results of the questionnaire indicated:

  • Most parents understood the purpose of the hearing screening however, many felt the explanation of the hearing-screening program was difficult to understand and suggested that the explanations could be improved by presenting it in the family’s primary language.

  • Parents were divided in their satisfaction with the presentation of screening results. Suggestions for improvement included sharing the results in the parents’ preferred language and not giving "the impression that their child has a hearing problem if they fail [the screening] the first time. Cultural difference may dictate the best ways to provide such information for families (e.g., with entire families and translators present if necessary)" (p. 623).

  • Most parents thought the staff was sensitive to the needs of the family and baby however there was not always a clear understanding of the need for a hearing re-screening.

  • Nearly all of the parents indicated they would recommend newborn hearing screening to others.

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Universal Newborn Hearing Screening: Parental Reflections on Very Early Audiological Management
McCracken, W., Young, A., et al. (2008).
Ear & Hearing, 29(1), 54-64.
Added: July 2012

Description:
This qualitative study was conducted to understand parent perspectives of Universal Newborn Hearing Screening (UNHS) in England. Data was collected from 45 parents of children with hearing loss (identified through UNHS) by way of a narrative interview process. 

Conclusions

  • Parents were frustrated by the disruption of services along the process from early identification to intervention.  Parents felt that the speed of screening was not matched by the speed of the identification and amplification processes.

  • Parents were all in favor of very early screening and felt that this offered enhanced opportunities for developmental progress.

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Results of Newborn Screening for Hearing Loss: Effects on the Family in the First 2 Years of Life
Vohr, B. R., Jodoin-Krauzyk, J., et al. (2008).
Archives of Pediatrics & Adolescent Medicine, 162(3), 205-211.
Added: July 2012

Description:
This cohort study was implemented to determine if there were differences in stress level and family impact for mothers of children screened and diagnosed with hearing loss (HL), mothers of children who failed the initial screen and passed the rescreen (false-positives), and mothers of children who passed the initial screen. Mothers of 145 infants were included in this study and responded to several standardized measures administered during home visits at three time points.

Conclusions

  • Mothers of infants who received false-positive results did not report increased stress or impact.

  • Mothers of infants with hearing loss indicated a larger financial and overall impact, and greater caregiver burden compared to mothers of infants who passed the hearing screening.

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Parents’ Perspective on the Impact of the Early Diagnosis of Childhood Hearing Loss
Fitzpatrick, E., Graham, I. D., et al. (2007).
International Journal of Audiology, 46(2), 97-106.
Added: July 2012

Description:
This study measures parents’ perceptions of the effects of early or late identification of hearing loss in their children. Seventeen parents participated in semi-structured interviews.  Seven children had been identified via a systematic screening and 10 were identified via traditional referral approaches.

Conclusions

  • The dominant theme across this sample of parents was that “early diagnosis of hearing loss is valuable and that universal hearing screening should be included as part of the Canadian health care system” (p. 100).

  • Advantages of universal screening were stressed most strongly by parents who were unaware of their child’s hearing loss until well after 1 year. Their primary issues were related to delayed diagnosis, missed opportunity for hearing, delayed language development, and frustrations with accessing services.

  • A few parents commented that delayed diagnosis (through typical referral process) allowed them some time to bond with their child without knowing about the hearing loss.

  • The majority of parents believed that early diagnosis provided a better long-term prognosis for their child’s speech and language development and better access to hearing and environmental awareness, though some parents noted that their child would not have received a cochlear implant prior to one year of age regardless of age at identification.

  • “Some families felt that it was better for the child’s self-concept to have been identified in infancy both for the child herself and for the family with respect to accepting the child as an individual with a hearing loss” (p. 102).

  • “Both parents of screened and unscreened children referred to the notion of guilt associated with not being aware of the presence of a hearing loss” (p. 102).

  • “Other families described a strong need to know… whether the hearing loss was present at birth. As described by one family, there was a nagging need to just know if the hearing problem was present at birth or if something had happened during early childhood” (p. 102).

  • Regarding the gap in their child’s development, parents discussed a sense of urgency and a feeling of lost time. “In some cases, they felt they had little time to investigate the options for their child’s communication development” (p. 102). The sense of this gap differed between families of screened and referred children, especially for parents of children identified at 12 to 18 months.

  • The shock of learning of the presence of a hearing problem was sometimes described as greater by families of children screened for hearing loss as compared to families who were referred and had suspected a hearing loss for some time.

  • Parents of children who had been identified with hearing loss through a referral system often described the process as frustrating and confusing. Though for other parents, there appeared to be a more seamless process between social support services and diagnostic services.

  • “From the parents’ experiences, screening appeared to facilitate access to qualified audiological services, in that for parents of screened children, there was a clear structure in place from screening to audiologic assessment” (p. 103).

  • There was a great deal of variation regarding access to services after receiving the diagnosis by place, region, and family, and patterns were difficult to establish.

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Maternal Anxiety Following Newborn Hearing Screening: The Moderating Role of Knowledge
Crockett, R., Wright, A. J., et al. (2006).
Journal of Medical Screening, 13(1), 20-25.
Added: July 2012

Description:
This study investigates the impact of newborn hearing screening on maternal anxiety and the moderating role of knowledge. Questionnaires were sent to 344 mothers falling into one of four groups after newborn hearing screening. Mothers in group 1 had received news of a clear response on a first or second screening test; mothers in group 2 had children who had clear responses on the third screening test, mothers in group 3 received news of a failed response on the third screening test in one year; and mothers in group 4 received news of a failed response in both ears on the third screening test.

Conclusions

  • "Although state anxiety across the sample was in the normal range, there was a significant linear trend for anxiety to increase across the four groups as the potential seriousness of the results increased” (p. 24).

  • "Although overall knowledge about hearing screening did not have a significant moderating effect on maternal anxiety, understanding that the most likely reason for ‘no clear responses’ was not hearing loss moderated the emotional impact of a bilateral referral, with mothers understanding this having lower anxiety and worry and greater certainty about their babies’ hearing being normal” (p. 24).

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Parental Experiences of the Newborn Hearing Screening Programme in Wales: A Postal Questionnaire Survey
Fox, R., & Minchom, S. (2008).
Health Expectations, 11(4), 376-383.
Added: July 2012

Description:
This study was designed to obtain information regarding parents’ experiences and satisfaction with the newborn hearing screening program in Wales. Questionnaires were mailed and returned by 177 parents (59%).

Conclusions

  • “This study found overall high levels of satisfaction with [Newborn Hearing Screening Wales] (NBHSW)” (p. 380).

  • “In this study, women whose babies had no clear responses were least satisfied” (p. 381).

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Maternal Anxiety and Satisfaction Following Infant Hearing Screening: A Comparison of the Health Visitor Distraction Test and Newborn Hearing Screening
Crockett, R., Baker, H., et al. (2005).
Journal of Medical Screening, 12(2), 78-82.
Added: July 2012

Description:
This study compares outcomes of maternal anxiety and satisfaction following two child hearing screening programs; the newborn hearing screening program and the health visitor distraction test (at eight months).

Conclusions

  • “The pattern of results was broadly similar across both tests, with those who received the newborn hearing test being more satisfied and, if a satisfactory result was received on this test, having more positive attitudes to the test”  (p. 81).

  • “The results of this study do not suggest that testing in the newborn period causes greater emotional distress than later testing” (p. 81).

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Parents’ of Deaf Children Evaluative Accounts of the Process and Practice of Universal Newborn Hearing Screening
Young, A., & Tattersall, H. (2005).
Journal of Deaf Studies & Deaf Education, 10(2), 134-145.
Added: July 2012

Description:
This article presents the results of an interview of 45 parents of children correctly identified with deafness in the Newborn Hearing Screening Programme of England.

Conclusions

  • The experiences of parents fell into one of three broad themes:

    • The parents felt little or no cause for concern regarding the inconclusive message.

    • The parents felt that the inconclusive message was concerning, but the concern was not associated with the screening process.

    • The parents felt that the inconclusive message was concerning and linked to the screening process.

  • Seven of 45 families in the sample found the screening process to be unsatisfactory.

  • Two factors that the parents felt impacted their anxiety as a result of the screening processes included the manner in which the screener went about his or her job and the explanations provided.

  • Most parents in this sample thought that downplaying the possibility that the screening result might have indicated that deafness was appropriate, however three couples in particular noted that they would have preferred if someone had acknowledged that deafness was one of the possible reasons for not passing the screen.

  • Parents expressed a desired for an explanation as to why the screening result might be inconclusive and reported far less satisfaction with the screening process and more anxiety when they were given a ‘vague’ message or questionable explanations.

  • Two couples in this sample misunderstood the screening process and believed that referral indicated that their child was definitely deaf.

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Parents’ Needs Following Identification of Childhood Hearing Loss
Fitzpatrick, E., Angus, D., et al. (2008).
American Journal of Audiology, 17(1), 38-49.
Added: July 2012

Description:
This is a qualitative study exploring the needs of parents following identification of their child’s hearing loss.  Seventeen families in Ontario, Canada participated in semi-structured interviews.

Conclusions

  • All parents viewed newborn hearing screening services, audiology, and therapy services as important parts of the service delivery model for children with hearing loss.

  • Some parents expressed dissatisfaction with the timely access to audiology services following initial identification of hearing loss, however this appeared to only include children diagnosed prior to the initiation of universal screening. 

  • Some parents expressed dissatisfaction with the manner of the communication of the diagnosis.

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Parent and Professional Perspectives on the Western Australian Infant Hearing Screening Program
Sutherland, J., Remine, M. D., et al. (2008).
Deafness & Education International, 10(3), 168-188.
Added: July 2012

Description:
This study collects information from parents, newborn hearing screeners, and Telethon Speech and Hearing (TSH) professionals from the Western Australian Infant Screening for Hearing (WISH) Program. Questionnaire responses were obtained from 17 participants (51.6% response rate; six parents, five screeners, and six TSH professionals).

Conclusions

  • Five of six parents were satisfied with the screening services offered.  One family was satisfied but noted the cost and lack of rebate.

  • Though screening occurred in the first week of the child’s life, most parents (5/6) felt that screening had a positive effect on their relationship with their child.

  • The remaining parent felt that the screening had affected their initial relationship; however the importance of early diagnosis was understood.

  • Parents reported that some of their concerns were addressed in early intervention sessions, but a counseling appointment early in the process may be beneficial.

  • Parents were happy with the communication provided by WISH, though one parent noted that the reassurance gave a false sense of hope.

  • Parents’ wait time for additional audiological testing was 7.6 days on average. All parents indicated that any further delay would have caused distress.

  • Parents were generally satisfied with support services. Specifically parents indicated that they were well informed of early intervention options, and opportunities to meet with other parents. One parent suggested increased privacy when receiving results.

  • Parents as well as screeners noted a need for more information about WISH services prior to meeting with screeners.

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Infant Hearing Loss in South Africa: Age of Intervention and Parental Needs for Support
van der Spuy, T., & Pottas, L. (2008).
International Journal of Audiology, 47(Suppl 1), S30-S35.
Added: July 2012

Description
This study explores the needs of parents of infants with hearing loss in South Africa. Data were collected by means of questionnaire and group discussion with 54 parents.

Conclusions
Parents noted that the waiting period between screening and diagnosis was traumatic and indicted that the time spent to determine the extent and type of hearing loss should be a short as possible.

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Universal Newborn Hearing Screening: Systematic Review to Update the 2001 US Preventive Services Task Force Recommendation
Nelson, H. D., Bougatsos, C., et al. (2008).
Pediatrics, 122(1), e266-276.

This review meets the criteria for a high-quality evidence-based systematic review.
Added: July 2012

Description
This is an updated systematic review of controlled trials and observational studies addressing outcomes of infants screened for hearing loss by 6 months of age.

Conclusions
"Studies of adverse effects of screening indicate that usual parental reactions to an initial nonpass include worry, questioning, and distress. Negative emotions resolve for most parents when a diagnostic test is provided with a normal result" (p. 274).

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