Abstract
This study assessed the feasibility of doing hearing screening in Migrant, American Indian and Early Head Start programs using otoacoustic emissions (OAE) technology. Staff members were trained to screen 0–3-year-old children for hearing loss using handheld OAE equipment and a multi-step screening and referral protocol. Of the 3486 children screened as a part of the study, 77% passed an OAE screening at the first step, 18% more passed an OAE screening at the second step, and 5% were ultimately referred for medical or audiological follow-up. Eighty children were identified as having a hearing loss or disorder of the outer, middle or inner ear requiring treatment. Of these 80, six had permanent bilateral or unilateral hearing loss. The median time required to complete a single OAE screening session was 4 minutes per child. The results demonstrate that OAE screening of young children using this protocol is practical and effective. The implications for conducting periodic hearing screening throughout early childhood are discussed.
Friday, August 24, 2007
Eiserman et al. (2007) Screening for heairng loss in early childhood programs
Are the conclusions of this article supported by its data?
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8 comments:
This study emphasized the need for intermittent universal hearing screening during the toddler and preschool years; backing it up with evidence. It is interesting to me that it is mandatory to screen for disorders which are less common because of their deep impact on the child when hearing loss can have a profound negative affect when left untreated. I would like to see information on the effectiveness of other types of hearing screening in order to have something to compare to for efficacy.
This article addresses an underserved population as it relates to hearing screening. We now expect hearing screening at birth, but the crucial years during early childhood are often overlooked. This article does an excellent job of explaining why we need to pay attention to hearing during early childhood. Their data supports the feasibility of screening young children using OAEs. The most troubling aspect of this article was the number of children lost to follow-up. Further research is needed to understand how to improve getting families to the next step when a child fails the screening. Additionally, it would be important to understand the extent and type of support that screeners need to be successful and for programs to be sustainable.
This article discusses the importance of periodic screening with OAEs. Early Identification of hearing loss is important and without periodic screeing children who present with hearing loss subsequent to birth may be missed or go without necessary services for a period of time. This article indicates that this screening can be done in about 4 minutes per child and without the need of additional staff or hours, although some training for OAE screenings is required. One concern for doing periodic OAE screenings is timely follow-up, in this study several kids were not followed up with due to headstart programs closing for the season. The article suggests following up in about 2 weeks allowing the whole process to be completed in about 30 days.
This study makes it very clear that hearing screenings and early diagnoses of hearing loss for children at birth and during the preschool years is crucial to their development. The results of the study strongly support its purpose of discovering the feasibility of performing OAE screenings at HeadStart programs. It is clear that there is a need for such screenings and that staff need assistance in implementing a proper plan. The results of this study show that the amount of time, results (# of true positives), and the sensitivity of OAE equipment are such that the implementation of such a program would be very worthwhile. Questions remain how such a large program could be applied. I think the next step might be to investigate where the financial resources for the equipment and training could come from, and how the program could be supervised to ensure its continuation.
Eiserman, et. al. have made the clear argument in favor of OAEs as a screening tool in early childhood. OAEs can be completed quickly and their results are reliable. The only concern is that OAEs be used more than once for each child during their development. That is, a one-time administration of OAEs may 'pass' a child but the same child may have a progressive or late-onset hearing loss. Periodic OAEs is the key but few educational programs have this equipment. The other issue raised in the study is the loss to follow up of those children identified. More research and better systems are needed to ensure that all children who fail a newborn hearing screening receive appropriate follow up services. Isn't this why we do screening in the first place?
The Eiserman, et al. study provides data supporting the identification of hearing loss when using OAE screening during the pre-school years. Data did not convince me that multiple screens after birth would (necessarily) be cost-effective when only 1 or 2 children per 1,000 would be identified in this manner. The evaluation of cost-effectiveness would also need to include the number of children referred and found to have normal hearing or fluctuating loss not requiring intervention.
The 3-step protocol resulted in fewer false positives though children were lost to follow-up. It would be interesting to know how many children lost to f/u were from the Migrant Farm program -- this program lasts for a specific time period and may have inflated the "children lost" figure.
The conclusions I drew from this article were that we need to have periodic hearing screenings for kids. This article targeted an underserved population, but I think it could also show that all kids could benefit from periodic screenings. Most school screenings are not performed yearly. I felt that the multi-step screening protocol was very useful for lower false-positive results, but it would have been nice if they could have done the steps within the 14 days recommended so a better idea of why the kids failed the first time could be determined.
I think this is a valuable study. Often research is developed for and understood by other researchers only. Too often the information is too complex and/or too convoluted for the average consumer to understand. This study is fairly straightforward and rational in the methods used to gather the data. I mention this because, as a consumer of current research on deaf issues, I want the information to be accessible - not only being able to obtain it, but to understand it and then use the data to do my job better. In my opinion, research should have practical application.
I think the subject of the study is a timely one to discuss due to the impact of childhood hearing loss (occurring after birth). I appreciated the authors' emphasis on the critical aspect of temporary hearing loss, uni-lateral losses, and progressive losses. The practical application of this study is in the field of education where these three types of hearing loss often prove to be more lethal in nature than a clear-cut profound, sensori-neural loss. A profound loss can be identified quickly and services put in place to deal with the deafness at an early age. But temporary, uni-lateral, and progressive losses frequently go undetected until the negative impact of hearing loss can no longer be ignored - especially as it relates to academic achievement.
Periodic OAE's would reveal the need for intervention for a child and timely service delivery could be established.
From an educator's viewpoint, this is a critical study that professionals working with children need to read and understand the implications for the population they serve.
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