A "Hearing Evaluation" for Newborns

The other day a friend of mine mentioned that her daughter (newborn) had a hearing test in the hospital before she was discharged and she asked me how that is possible. It occurred to me that some people think newborns are still tested with the startle reflex test (this test was performed by moving up behind a sleeping baby, making a very loud noise and seeing if they startle).


The startle reflex test was never a very reliable means to assess an infant's hearing and it certainly did not rule out hearing loss of all types and degrees. Thankfully technology and research has brought about a new way to evaluated newborn hearing status.


One of the most common ways to test an infant in the hospital nursery is with otoacoustic emissions (OAEs) testing. Otoacoustic emissions are like little "echos" that are reflected back from sound stimulating the cochlea (the cochlea is the hearing organ). These "echos" are a by product of a healthy cochlear amplifier. In other words... a healthy ear will send back an echo that can be measured without the patient having to do anything except remain still and quiet for a minute or two.


There are limitations to this test as it will not rule out mild hearing loss and in some cases infants will pass this evaluation in the nursery. Mild hearing loss can be a significant barrier to a child's development of language, speech and reading skills. If your child passed the nursery newborn hearing screening but later shows signs of struggling with learning to talk or later still when in school have their hearing re-evaluated.


Additionally it is possible to fail this test and still have normal hearing. OAEs are very small echos and are impacted by other problems such as fluid in the ear or noisy breathing. When an infant fails a screening in the newborn nursery it is important to follow up as instructed and remember that routine screenings are helpful at identifying children with hearing loss at a young age but will sometimes be incorrect.


When an infant fails an OAE screening in the nursery there is another test that is often performed called auditory brainstem response (ABR) testing. This is an excellent way to evaluated hearing sensitivity and can be used routinely or when OAEs fail. However, the test is more complex and requires a soundly sleeping baby. Electrodes are attached to the head and sounds are played while brainwaves are analyzed. Assuming that this test can be completed without the baby waking up it will give a better picture of the hearing status. Since many babies are discharged within 48 hours it is not always possible to perform a complete ABR and a referral for more testing will be given if your child is identified for follow up. Again, it is important to follow up as instructed. Hearing loss effects 1 in 10 people and in young children is can impact development on many levels.

Hearing screenings for newborns are now provided in hospitals around the country routinely. When I was born that was not the case. My hearing loss was not discovered until I was 4 years old. I struggled as a young child in learning to read, I needed speech therapy and I sometime feel that I never caught up with my peers on a social level so I am very thankful for the newborn screenings that will help identify children with hearing loss sooner and give them more complete exposure to the hearing world when it matters most.


Here are some great resources on the web:


Boys Town National Research Hospital
http://www.babyhearing.org/

Centers for Disease Control and Prevention
http://www.cdc.gov/ncbddd/ehdi/

[these sites will lead you to even more resources - happy web surfing]

This blog posted by Suzanne Yoder, Au.D. Doctor of Audiology and owner of HearWell Center. Please visit our website for more information http://www.hearwellcenter.com/

Of Hearing Loss & Legislation

There are two especially important pieces of pending legislation in congress now that are particularly relevant to both Audiology as a profession and all Americans with hearing loss. The proposed bills recognize the effect of hearing loss on our aging population and summarized their findings in the Medicare Hearing Health Care Enhancement Act of 2007. The following is pulled directly from the bill section 2.

“Congress finds the following:

(1) Approximately 30,000,000 Americans experience some degree of hearing loss and by 2030 that number is expected to increase to 78,000,000 Americans.

(2) Hearing impairment is one of the most common conditions affecting older adults, with approximately 33 percent of Americans aged 60 years and over, and 40 to 50 percent of those aged 75 years and older, experiencing hearing loss.

(3) Hearing loss is a major barrier to participating in society, both economically and socially.

(4) Hearing loss among senior citizens, if left untreated, can result in isolation and depression.

(5) The Department of Veterans Affairs allows veterans to directly access audiologists and has reported that this policy, adopted in 1992, provides high-quality, efficient, and cost-effective hearing care.

(6) The Office of Personnel Management allows Federal employees and Members of Congress to directly access audiologists through the Federal Employees Health benefits Program.

(7) Audiologists are licensed in each State and the District of Columbia and the scope of services furnished by audiologists is determined by each such jurisdiction involved.

(8) Consistency in Federal policy with respect to hearing health care services should be encouraged to the greatest extent possible.”

H.R.
1665 IH
Sec. 2 Findings

These findings have led to the proposal of two bills. The first is the “Hearing Aid Assistance Tax Credit Act” which would provide a tax credit for the out of pocket expense of hearing aids of up to $500 per qualifying hearing aid or $1000 tax credit for two hearing aids. This benefit would be available to individuals of age 55 and over and could be claimed every five years. As an Audiologist I am thrilled to see the government begin to recognize the importance of hearing aids as a vital part of senior healthcare. The second bill is the aforementioned Medicare Hearing Health Care Enhancement Act of 2007. This bill recognizes the cost efficiency gained when patients are able to go directly to an Audiologist without the need to first get a referral from another doctor.

If these bills pass it will be a significant step forward in making it easier and more affordable than ever before to get quality hearing care to millions of Americans. Please consider taking action today. Just follow these links:

1. You can review these bills through their links from this page or go to http://thomas.loc.gov/home/c110query.html and search by the bill numbers S. 1410 and H.R. 1665.
2. To generate an automatic letter to print and send your congressman about these and other issues please see the American Academy of Audiology website and their “Take Action” page at http://capwiz.com/audiology/home/.
3. Also, you can visit the Better Hearing Institute’s “Hearing Aid Tax Credit” webpage at http://www.hearingaidtaxcredit.org/

As exciting as these bills are they still need to be passed to make a difference. If you or someone close to you is affected by hearing loss please take a moment to make a difference.

This blog posted by Suzanne Yoder, Au.D. Doctor of Audiology and owner of HearWell Center. Please visit our website for more information http://www.hearwellcenter.com/

Guidelines for when to visit an Audiologist

Here are some general guidelines to follow when choosing who to visit first for your hearing or vestibular disorder:

For Emergencies such as sudden, dramatic hearing loss, extreme pain, excessive bleeding, and head injuries please visit your local emergency room.

See an audiologist for hearing or vestibular conditions that have occurred gradually without incident or injury to your ears. Audiologists specialize in the diagnosis and treatment of hearing loss and vestibular disorders. You can see an audiologist at anytime in the course of your treatment for a hearing or vestibular disorder. Audiologists will refer you to a medical specialist if symptoms and/or diagnosis are questionable or an obvious medical condition exists. Often hearing loss is caused by factors that are not medically treatable such as age, long-term noise exposure or hereditary hearing loss. Seeing an audiologist first can help you determine the best course of treatment for your hearing loss.

Audiologists have specialized training in the treatment of hearing loss including hearing aids, assistive devices, alerting devices, treatment of tinnitus (ringing in the ear), treatment of hyperacusis (sensitivity to loud sound), treatment of auditory processing disorders, and other disorders that affect hearing. Physicians rarely have this knowledge and unless they have attended an audiology degree program they would not be able to provide these services in a comprehensive manner without referral to an audiologist.

See a physician for any obvious medical conditions: sudden and dramatic changes in hearing, pain, drainage, unusual odor, injury, bleeding, skin lesions, debilitating dizziness and vertigo, etc. Physicians can prescribe medications or imaging (CT Scan or MRI) if necessary. Some physicians can also perform surgery where hearing loss is reversible.

In some offices you will find audiologists and physicians working side-by-side within the same practice. Today it is more common for physicians and audiologists to have independent practices and refer to each other when needed. Many insurance plans do not require a referral to be seen by and audiologist, however it is recommended that you confirm coverage before making an appointment to be seen.

Medicare patients are currently required to provide a referral from a physician for coverage of audiological services. In time Medicare patients will have the option to see an audiologist directly just as you have the option to see a Dentist, Optometrist or Chiropractor without a referral. Currently those under federal health plans are allowed direct access to audiologists. Would you like to have the same privilege and the ability to control your healthcare decisions when it comes to your hearing care? This will depend on the passing of Medicare Hearing Health Care Enhancement Act of 2007 (HR 1665- the Direct Access bill) and you can help by contacting your government officials through this website sponsored by the American Academy of Audiology.

HearWell Center strives to meet the needs of each individual patient by working as a team with the other medical specialists in the community. We will communicate with your family doctor and any specialist you see where necessary to ensure proper follow up and treatment.

What is an Au.D.?

Au.D. is a degree designation that stands for Doctor of Audiology.

Doctorate in Audiology (Au.D.) is the most common degree earned in order to practice audiology today. You may also see audiologist who have Master's degrees (M.A. or M.S. or M.Ed.) or Doctor of Philosophy (Ph.D.). An Au.D. is a clinical degree that can be used in many ways. Audiologists holding an Au.D. can practice clinical audiology, they can perform research and they can teach.

It is necessary in most of the United States to have an Au.D. in order to obtain a license to practice audiology today. Master's Degree programs are being phased out however, audiologists practicing with their Master's Degree or equivalent will continue under the licensure laws that were in place at the time that they were originally licensed. Some audiologists have chosen to complete this level of education by going back to school and earning the Au.D. and others have decided to continue practicing with their Master's or equivalent degree.

You can learn more about the Au.D. and the profession of audiology by visiting these links:
Academy of Doctors of Audiology (ADA) http://www.audiologist.org/
American Academy of Audiology (AAA) http://www.audiology.org/