ECHOs of EHDI:

1. ECHOs of EHDI: How Periodic Early Childhood Screening is Growing William Eiserman, PhD, Lenore Shisler, MS, Terry Foust, AuD - CCC-A, Randi Winston, AuD - FAAA, Karl White, PhD, Jan Buhrmann, PhD

2. Despite progress related to newborn hearing screening, approximately 10% of newborns in the US are not screened at birth, and 30-50% of infants who do not pass their newborn hearing screening are lost to follow-up. Estimated incidence of sensorineural hearing loss in the US triples between birth and the school-age years, from 1 in 300 to 3 in 300 Hearing loss can occur at any time in a child’s life. Progressive and late-onset may occur at any time throughout early childhood Approximately 35% of preschool children will have repeated ear infections before 3 years of age, nearly always resulting in fluctuating conductive hearing loss. Without regular, physiologic screening, hearing loss is often impossible to detect. Children with unidentified hearing loss are often identified with speech and language delays, described as having behavioral disorders or learning disabilities Why is Periodic Hearing Screening so Important?

3. Where is periodic screening happening? • Head Start Programs • Health care settings/Well-child visits • Part C / Child find • Community Outreach programs

4. In 2005, Head Start served • Approximately 968,000 children • 152,000 were under 3 years • In more than 20,000 centers

5. Head Start has a standing commitment to periodic early hearing screening All children must receive a hearing screening within the first 45 days of enrollment and annually thereafter.

6. Status of Head Start Hearing Screening Practices Most Head Start programs are relying on outdated subjective, screening methods such as hand clapping, bell ringing, and parent questionnaires to screen children 0 – 3 years of age.

7. Most Head Start programs are unaware that Otoacoustic Emissions (OAE) technology, used with newborns, can also be used successfully in early childhood settings.

8. The Hearing Head Start ECHO Project Purpose: • update hearing screening practices for children birth to three years served by Head Start programs nationwide through use of Otoacoustic Emissions (OAE) technology • ensure that all children with hearing health needs receive timely and appropriate intervention.

9. 15 States • Oregon • Washington • Utah • North Carolina • District of Columbia • Nebraska • Kansas • Colorado • Alaska • Michigan • Arkansas • Connecticut • Illinois • Hawai’i • Missouri

10. Outcomes n=4518 children screened 257 (6%) were referred for medical/audiological follow-up • 107 (42%) identified with a hearing loss or disorder requiring treatment or monitoring • * 7 Permanent hearing loss • * 83 Otitis media • * 2 Occluded PE Tubes • * Excessive earwave or congestion • 52 (20%) normal/no treatment required • 98 (38%) exited program before diagnosis/referral appointment completed

11. Early Identification of Hearing Loss Introducing… a multimedia instructional package for health care providers Conducting periodical Otoacoustic Emissions (OAE) hearing screening with infants and toddlers during well child visits Helping Children Hear and Now

12. Instructional Package • Three-part instructional DVD (22 min) • Instructional Guide • Protocol and Documentation Forms

13. Content • Part 1 – Overview • Part 2 - Equipment use and step-by-step demonstration of OAE screening with infants and toddlers • Part 3 - Integrating OAE screening within a larger hearing health protocol

14. Next Steps