Newborn Hearing Screening Frequently Asked Questions

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Texas Early Hearing Detection and Intervention (TEHDI)

baby 10

  

Why screen hearing?

Does Texas have a hearing screening law?

Is the hearing screen paid for in Texas?

How are babies screened?

How many babies do not pass the hearing screen?

What role does TEHDI have in the hearing screen?

What is new in the program?

What are some of the challenges?

What resources are available?

What do I do if I don’t know whether my baby had a hearing screen at the birth facility?

What if my baby was born at home or in a birthing center and no hearing screening was done?

What are my next steps if my baby does not pass the hearing screen at the birth facility, or is not tested before we leave?

Where can I find resources about hearing loss in infants and young children?

What is an audiological evaluation?

What are the areas of the hearing system?

What is the difference between a hearing screening and a diagnostic hearing evaluation?

 

 

Why screen hearing?  

  • Two to three babies with hearing loss or deafness are born in Texas daily, making this the most prevalent birth condition of all conditions identified at birth. Hearing loss and deafness are two to three times more prevalent than the combination of all other conditions for which screening occurs at birth.
  • Research shows that the primary window for stimulation of the auditory neural pathways in the brain is from birth to six months. Failure to identify hearing loss and deafness prior to six months of age impacts the development of language and learning potential, creating a developmental emergency.
  • The Texas process is designed to identify newborns with potential hearing loss, do further testing to define the degree and type of hearing loss, fit children with hearing aids if appropriate, and enroll them in intervention services prior to six months of age.

Does Texas have a hearing screening law?

  • House Bill 714 during the 76th Legislative Session passed and became effective 9-1-1999. Rules went into place in May 2000. 
  • Military facilities are federally exempt from participating in state mandates such as hearing screening, and in calendar year 2005 there were around 5,200 births at three military facilities in Texas.
  • The DSHS system is called the Texas Early Hearing Detection and Intervention (TEHDI) application of the eSP™ system designed and maintained by the newborn hearing screening contractor, OZ Systems. Licenses are made available by DSHS to Texas birth facilities for this web-based system. 
  • House Bill 411 passed in 2011 and became effective January 1, 2012.  For more information, please visit our Legislative Page.

Is the hearing screen paid for in Texas?

  • Medicaid and insurance companies that provide newborn services cover the costs of the birth screen and any resulting testing until the infant is 24 months of age.

How are babies screened?

  • Birth facility programs choose one of two objective test methods, or a combination of both Screening/Automated Auditory Brainstem Response (AABR) testing or Transient or Distortion Product Otoacoustic Emissions (OAE) testing. Screening typically occurs 10 - 12 hours after birth when the fluid in the middle ear space and the debris in the ear canal have cleared. Both methods are highly effective and quick to perform, do not cause discomfort, and can be done while the baby is sleeping.
  • Screening AABR testing is done by attaching small electrodes to the baby’s head, sending an auditory signal into the ear canal and through the neural part of the hearing system, and receiving the response to the signal in the auditory centers of the brain. This test shows whether the neural part of the auditory system is working. It takes around 10-15 minutes to perform and the results are automatically generated from the system.
  • Screening OAE testing is done by sealing off the outside of the ear canal with a small ear tip, sending an auditory signal into the ear canal and into the cochlea, the portion of the auditory system that converts the mechanical sound wave into electrical energy and sends it on to the brain. If the cochlea is normal, it will respond to the auditory signal by sending a signal back. A tiny microphone in the ear tip picks up the signal. The testing takes 5 - 10 minutes and the results are automatically generated from the system.

How many babies do not pass the hearing screen?

  • Two percent (2%) of those babies receiving a newborn hearing screening do not pass at birth.

What role does the TEHDI program have in the hearing screen?

  • Provide a system and technical assistance to birth facilities under the statute.
  • Certify and monitor certification standards for birth facility programs.
  • Ensure that newborns identified with hearing loss and deafness receive follow-up services and intervention.

Are other state agencies involved in the hearing detection and intervention process?

  • The TEHDI program works closely with the Department of Assistive and Rehabilitative Services (DARS) through two programs, Early Childhood Intervention (ECI) and Deaf and Hard of Hearing Services (DHHS), to ensure the follow-up and intervention piece. A two-page chart showing the 1-3-6 month guide to the hearing screening and intervention process is available.  1-3-6 Guide
  • DARS - ECI has a Memorandum of Understanding with the Texas Education Agency for Auditory Impairment services through the Local Education Agency (LEA).
  • Once a child is referred to ECI evaluation and an Individual Family Service Plan will be developed within 45 days, and needed services determined.
  • Identified services are available to age 35 months through ECI, at which time ECI and the LEA coordinate transition services when the child reaches the third birthday.

What is new in the program?

  • The Center for Disease Control (CDC) grant activities are the focus of a Cooperative Agreement to enhance the ability of the TEHDI program to ensure that those babies identified with hearing loss are clearly identified throughout the continuum of care. To this end, the TEHDI program is contracting with parent support groups for outreach activities with hearing services providers to support the use of the TEHDI management information system (MIS) throughout the follow-up care process.  In an effort to promote the use of the TEHDI MIS, the program is involved in a campaign to increase interoperability and the use of the Newborn Admission Notification Information (NANI) tool for licensed birthing facilities that will allow for the automated creation of records populated with demographic data.

  • Additional grant activities through the Health Resources and Services Administration (HRSA) involve a statewide audiology outreach project with a primary goal to engage audiologists in more active and consistent reporting through regular use of the TEHDI management information system (MIS). Regular use is encouraged to improve loss to follow-up and loss to documentation for infants and toddlers needing time sensitive care. The project is designed to determine which pediatric audiologists currently serve children from birth to five years of age in each of the health service regions in Texas. The project will then reach out to Texas pediatric audiologists to determine how to improve the reporting system, as well as make the MIS a more useful and effective tool for timely follow-up care.

What are some of the challenges?

  • Texas has the second highest birth rate in the nation, with around 394,675 in 2010.
  • Approximately 54% of the follow-up screens performed are reported to DSHS. The HRSA grant efforts are making it possible to follow more of the babies, but the results of this effort will not be fully known for another year.
  • There are around 1,150 licensed audiologists in Texas, and it is estimated that only about 10% of them are pediatric audiology specialists. This leaves some areas of Texas, primarily rural, without local pediatric audiologists, and families must drive to nearby urban cities for services. It is encouraging to note that more audiologists are including pediatric testing in their practices, and the TEHDI Program is hopeful that the numbers will continue to grow.

What resources are available?

  • Texas has Pediatric Protocols for Audiology that describe diagnostic protocols for evaluating babies who do not pass the birth hearing screen and follow-up screen.

What do I do if I don’t know whether my baby had a hearing screen at the birth facility?

  • Contact the birth facility to find out whether your baby was tested. Each family is supposed to be offered a hearing screen for the baby. Each facility has a person who is the program manager for newborn hearing screening. Ask to speak to that person.
  • Check discharge paperwork for hearing screening result documentation.  You should know the results of the testing before you and your baby leave the birth facility, and should have a copy of the results.

What if my baby was born at home and no hearing screening was done?

  • You can have your baby screened by a local audiologist. Select the region on the map where you live.  The facilities are alphabetical by city and there is a note that lets you know the ages of the children the audiologist is able to test.
  • Be sure to ask about charges for a hearing screen for a newborn. ·
  • Another option is a hospital in your area that does hearing screening for babies in the community who were not born at that hospital. Check with local hospitals to find out whether they offer this service.

What are my next steps if my baby does not pass the hearing screen at the birth facility, or is not tested before we leave?

Step 1

  • Contact the birth facility and determine if outpatient services are provided. 
  • If the birth facility does not offer outpatient screenings, talk with your baby’s health care advocate and get a referral to a pediatric audiologist.  For a pedatric audiologist in your local area, call OZ Systems at 1-866-427-5768. 

Step 2 - If your baby does not pass the follow-up screen

  • Your physician will refer you to the ECI program to help you with intervention services. A pediatric audiologist will do a number of tests on your baby to identify the kind of hearing loss and degree of hearing loss your baby has. The testing can take several hours, and will probably happen across several visits to the office.  The pediatric audiologist will do additional testing and may recommend hearing aids for your baby. Hearing aids may be fit on babies immediately.  

Step 3 - This step can happen while you are working on Step 2

  • ECI will work with you to develop a plan for your baby to receive the services that are needed.
  • There is no charge for their services if your child has hearing or vision loss.
  • Within 45 days of referral to ECI, a team will help you get evaluations for your child and create an Individual Family Service Plan.

Where can I find resources about hearing loss in infants and young children?

  • There is an excellent resource developed by the University of Texas at Dallas Callier Center for Communication Disorders. The resource is called Texas Connect, Family Resource Guide. The guide covers a wide range of information from definitions and terms to state and national resources, information on navigating the Texas system, and answers about communication options for your child. The Texas Connect Guide is a good first step in getting information. Your audiologist and the staff at the ECI program will also be able to direct you to resources.

What is an audiological evaluation?

  • An audiological evaluation, sometimes also called a hearing assessment, is a group of tests that check different parts of the auditory system in order to identify the area of the auditory system that is not working appropriately. The results of the evaluation are often put on a graph called an audiogram which shows the areas of hearing loss (low, middle or high pitched sounds) and degree of hearing loss (mild, moderate, profound). The unit of measure for hearing is the decibel. The decibel level for each frequency (pitch) is charted on the audiogram or another graph, depending on the testing done.

What are the areas of the hearing system?

  • The hearing system can be divided into four areas, the outer ear, the middle ear, the inner ear, and the auditory centers of the brain. The hearing system can have something go wrong in any single area, or a combination of areas. The audiologist will perform a group of tests to find the area(s) that are involved in your baby’s hearing loss.
Inner ear

Outer ear:

  • The outer ear includes the ear and the ear canal that goes down to the eardrum. Evaluation of this area includes visual inspection with an instrument called an otoscope, and clearing of wax and other debris from the ear canal if needed.

Middle ear:

  • The middle ear includes the eardrum (tympanic membrane), the bones in the middle ear space, and the Eustachian tube, which keeps the atmospheric pressure inside the middle ear cavity equal to the pressure in the air around us. Fluid in this space can cause hearing problems when a baby has fluid behind the eardrum as a result of allergies or infection.
  • Tympanometry is a test done to check the middle ear. If the middle ear space is filled with fluid, hearing loss can be a result. Hearing loss resulting from a problem in the outer and/or middle ear is called a conductive hearing loss, and can often be managed medically. If the problem in this area cannot be medically managed, hearing aids may be appropriate.

Inner ear:

  • The inner ear structures include the cochlea and the balance mechanism. The cochlea changes sound from vibration to an electrical signal and sends the signal along the acoustic nerve to the brain. If a problem happens in the cochlea, the hearing loss is called a sensorineural loss. This kind of hearing loss can be helped by hearing aids. If there is a problem in both the middle ear and inner ear, the hearing loss is called a mixed loss.

 

cochlea

Central auditory system (brain):

  • If the auditory centers of the brain, located in the temporal lobe, are not functioning, the hearing loss is called a “neural” hearing loss. This means that the signal is getting to the brain but the brain cannot understand it.

 

brainauditory

Scale of Hearing Impairment Based on the Pure-Tone Average at 500, 1000 and 2000 Hz (information exerpted from Introduction to Audiology, Frederick N. Martin & John Greer Clark, Eighth Edition, used with permission)

 

Scale of Hearing Impairment Based on the Pure-Tone Average
Pure tone Average in decibels Degree of Communication Impact Consider Hearing Aids Consider Communication Training
-10 to 15 None No No
16 to 20 Slight Possibly Possibly
21 to 40 Mild Probably Probably
41 to 70 Moderate Definitely Definitely
71 to 90      Severe Definitely Definitely
91 + Profound* Definitely Definitely
       

* A cochlear implant may be considered with this degree of communication impact

What is the difference between a hearing screening and a diagnostic hearing evaluation?

  • The purpose of the hearing screening is to quickly test one part of the auditory system to find out whether it is working properly. The section “How are babies screened?” describes the testing that is done. OAE tests the cochlea to see if it is working and the ABR tests the neural system to see if it is working. Diagnostic hearing testing uses the same methods of testing but checks at more frequencies and levels. Screening takes less than 10 minutes, and diagnostic testing takes two to three hours, and all parts of the hearing system are assessed. Testing is done while the baby is asleep. It may take more than one appointment to get all of the testing done. Your audiologist can explain all the tests, why they are being done, and what was found.
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Last updated July 18, 2014