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Using Otoacoustic Emissions to Screen Young Children for Hearing Loss in Primary Care Settings
Pediatrics (June, 2013)

Contextual Conditions for Expanding Periodic Early Childhood Hearing Screening [PDF]
EHDI E-mail Express (May, 2013)
Abstract: The viability of expanding periodic hearing screening to more children does not necessarily hinge on universal adoption nor is it linked to any single, specific service setting. Rather than asking whether periodic hearing screening can be justified as a universal practice, it may be more fruitful to focus on identifying the contextual conditions within which periodic hearing screening is a “natural fit” and can complement, rather than compete with, other important services provided. Demonstrations to date suggest that OAE screening can be integrated successfully into a variety of early childhood educational and healthcare contexts when specific conditions are met: 1) easy and repeated access to children and families; 2) access to follow-up medical and audiological services; 3) capacity to track children requiring follow up; 4) stable staffing; 5) a budget to permit purchase of equipment and supplies; 6) programmatic emphasis on monitoring language development and hearing; and 6) interdisciplinary collaboration and coordination with other entities promoting hearing health and development (e.g., State EHDI programs). When these contextual conditions are present in an early childhood educational or healthcare system, periodic OAE screening can often be integrated seamlessly and with great success. If these conditions are not present, it may not make sense for providers to purchase screening equipment or attempt to implement a hearing screening program. Perhaps one day, all children can have their hearing screened during the critical, early, language-learning years, but in the present moment, it is likely we can extend the benefits to many more than ever before within settings where it is a natural fit.

The Audiologist's Role in Advancing Periodic Hearing Screening in Early Childhood Education Settings
Access Audiology (November, 2011)
Abstract: Audiologists have played an important role over the past 2 decades in ensuring that newborns in the United States receive a hearing screening. This is significant because approximately one to three children per thousand are identified with congenital hearing loss shortly after birth. Of the 1.6% of children who do not pass the newborn screen, however, nearly half may not be receiving the recommended follow-up diagnostic or intervention services (Centers for Disease Control and Prevention, 2011). Furthermore, illness, injury, or genetic factors can cause hearing loss at any time, and by school age, approximately six to seven children per thousand are likely to have a permanent hearing loss (Bamford et al., 2007; National Institute on Deafness and Other Communication Disorders, 2005). Periodic hearing screening during the early childhood years increases the likelihood that children lost to follow-up from newborn screening, along with children presenting with postneonatal hearing loss, will receive the timely diagnostic and intervention services needed during the critical language learning years. Audiologists and other knowledgeable professionals can help implement hearing screening practices and protocols that can be carried out effectively by lay screeners in a variety of early childhood settings.

Identifying Hearing Loss in Young Children [PDF]
Zero to Three (2010) 24-28
Abstract: Hearing loss can too easily be misdiagnosed or overlooked by providers serving young children. Parents and professionals may observe a language delay—an "invisible" condition -- while failing to identify the underlying cause. Otoacoustic emissions (OAE) hearing screening technology, used extensively with newborns, is becoming an essential tool, relied on by early childhood service providers in identifying young children who need comprehensive audiologic evaluation and intervention. With accurate screening/evaluation practices, hearing loss can be identified and early and appropriate intervention can be initiated without delay.

Screening for hearing loss in early childhood programs [PDF]
Early Childhood Research Quarterly (2007) 22, 105-117
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. Although the protocol suggested that the multi-step screening procedure should be completed within a 4-week time period or less, analysis of the data showed that for children requiring more than an initial OAE screening, the length of time over which the screening was completed ranged from 7 to 12 weeks. 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.

Updating Hearing Screening Practices in Early Childhood Settings [PDF]
Infants and Young Children (2008) 21 [3], 186-191
Abstract: Each day in the life of a young child with an undetected hearing loss is a day without full access to language. When hearing loss goes undetected, the resulting language deficits can become overwhelming obstacles to literacy, educational achievement, socialization, and school readiness. Several programs such as Head Start, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), and Part C of the Individuals with Disabilities Education Act are responsible for providing hearing screening to many young children nationwide. These programs have typically had to rely on subjective hearing screening methods. Otoacoustic emissions (OAE) technology, used widely in hospital-based newborn screening programs, is beginning to be recognized as a more practical and effective alternative when screening children from birth to 3 years of age. Successful OAE screening in early childhood settings is dependent on consultation from an experienced pedlatric audlologlst, selection of appropriate equipment, adherence to an appropriate screening and follow-up protocol, and access to training and follow-up technical assistance. When these elements are present, children with a wide range of hearing health conditions can be identified in a timely manner.

Using Otoacoustic Emissions to Screen for Hearing Loss in Early Childhood Care Settings
International Journal of Pediatric Otorhinolaryngology (2008) 72, 475-482
Abstract: Until recently, no objective tool has been available to help health and early childhood education providers screen young children for hearing loss. The aim of this study was to screen underserved children <= 3 years of age for hearing loss using Otoacoustic Emissions (OAE) technology and to systematically document multi-step screening and diagnostic outcomes. A total of 4519 children, <= 3 years of age in 4 states were screened by trained lay screeners using portable OAE equipment set to deliver stimuli and measurement levels sensitive to mild hearing loss as low as 25 decibels (dB) hearing level. The screening and follow-up protocol specified that children not passing the multi-step OAE screening be evaluated by local physicians and hearing specialists. Of the 4519 children screened as a part of the study, 257 (6%) ultimately required medical or audiological follow-up. One hundred and seven children were identified as having a hearing loss or disorder of the outer, middle or inner ear requiring treatment or monitoring. Of these 107 children, 5 had permanent bilateral and 2 had permanent unilateral hearing loss. The 7 children with permanent hearing loss included 4 who had passed newborn screening, 2 who were not screened at birth and 1 who did not receive follow-up services after referring from newborn screening. OAE screening, using a multi-step protocol, was found to be a feasible and accurate practice for identifying a wide range of hearing-health conditions warranting monitoring and treatment among children <= 3 years of age in early childhood care programs. Future studies are needed to: 1) further examine barriers to effective OAE screening in early childhood care settings, and 2) explore the value of extending early childhood OAE hearing screening into health care clinics and settings where young children receive routine care.

Hearing Screening in Early Childhood Settings [PDF]
The ASHA Leader (November 4, 2008)
Abstract: The potential for enhancing newborn screening follow-up by improving Head Start screening is capturing the attention of early hearing detection and intervention communities nationwide.