Universal neonatal hearing screening (UNHS), which is part of early hearing detection and intervention (EHDI) programmes, refer to those services aimed at screening hearing of all newborns, regardless of the presence of a risk factor for hearing loss. UNHS is the first step in the EHDI program which indicates whether a newborn requires further audiological assessment to determine the presence or absence of permanent hearing loss. Newborn hearing screening uses objective testing methods (usually otoacoustic emission (OAE) testing or automated auditory brainstem response (ABR) testing) to screen the hearing of all newborns in a particular target region, regardless of the presence or absence of risk factors. Even among developed countries, until the 1990s, it could take years for hearing-impaired child to be diagnosed and to benefit from a health intervention and amplification. This delay still can happen in developing countries. If children are not exposed to sounds and language during their first years of life because of a hearing loss, they will have difficulty in developing spoken or signed language; cognitive development and social skills could also be affected. This screening separates children into two groups—those with a high index of suspicion (more likely to have permanent congenital hearing loss) and those with a low index of suspicion (less likely to have permanent congenital hearing loss). Those in the first group are referred for diagnostic testing. Newborn hearing screening has been implemented in many regions worldwide since the early 2000s as it aims to reduce the age of detection for hearing loss—meaning that diagnosed children can receive early intervention, which is more effective because the brain's ability to learn language (spoken, cued, or signed) reduces as the child ages. Children born with permanent congenital hearing loss have historically performed worse educationally, had poorer language acquisition, social functioning and vocational choices than their hearing peers.
Overview In order to be most effective in minimizing developmental delays and promoting communication, education and social development, timely and appropriate interventions need to follow the early identification of hearing loss. Interventions for children with permanent congenital hearing loss ranges from devices that amplify sound to devices that replace the function of a damaged inner ear to communication modalities including spoken language, sign language, and cued speech. The choice of interventions depends on the degree and the cause of hearing loss, accessibility, affordability and family choice. For interventions to be effective, they should be appropriate, timely, family-centered and undertaken through a coordinated interdisciplinary approach, which includes access to specialists who have the professional qualifications and specialized knowledge and skills to support and promote optimal development outcomes. Key elements for ensuring the best outcomes for children with hearing loss may include:
hearing devices, such as hearing aids, and middle ear or cochlear implants; hearing assistive technology, such as FM/radio systems and loop systems; therapy to develop spoken language, such as auditory-verbal therapy, cued speech and auditory-oral therapy; development of nonverbal communication, such as sign language (see also American Sign Language). EHDI programmes exist in many countries, including the United States, United Kingdom, Australia, New Zealand, and the majority of countries making up the European Union. In order to maximize language and communication competence, literacy development, and psychosocial well-being, the U.S. Joint Committee on Infant Hearing endorses the goals that 1) all newborns should undergo hearing screening using physiologic measures prior to hospital discharge, but no later than one month of age 2) all infants whose do not pass screening should have appropriate audiologic diagnosis no later than three months of age and 3) all infants identified as deaf or hard of hearing in one or both ears should be referred to early targeted and appropriate intervention services as soon as possible after diagnosis, but no later than six months of age. Newborn hearing screening employs objective assessment methods, either with automated (ABR) or (OAE), or both for initial and/or rescreening procedures.
Rates of congenital hearing loss Hearing loss in neonates is the most common congenital birth defect and sensory disorder, and can be caused by a variety of reasons. Research has placed the prevalence of significant permanent hearing loss in neonates at 1–2 per 1000 live births in the United States. With this screening, many forms of congenital hearing loss can be detected. Congenital hearing loss can be due to genetic causes, environmental exposures during pregnancy, or health complications shortly after birth. Population-based studies in Europe and North America have identified a consistent prevalence of approximately 0.1% of children having a hearing loss of more than 40 decibels through review of health or education records, or both. Other international studies using different methods or criteria have reported higher estimates. In the United States, studies have shown a wide range of estimates for the number of children with hearing loss depending upon the reported age range, type, degree, frequency, laterality and method of ascertainment (e.g. audiometric testing, parental report, record review). Audiometric data of adolescents aged 12 to 19 years obtained through the National Health and Nutrition Examination Survey (NHANES) identified 3% to 5% of adolescents with hearing loss of 25 decibels or more and 15% to 20% with hearing losses of greater than 15 decibels.
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