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Push Is On for Infant Hearing Tests - 
Results Make a Lifetime of Difference

Wall Street Journal 4/8/98


Sara Soltani and Daniel Baucino are playmates whose families live a
short drive apart in Greensboro, N.C. Both children were born nearly
deaf.

Yet Sara is just 2 1/2 and speaks almost as clearly as other
toddlers. Her vocabulary is just about normal for her age, and she is
in preschool with hearing children. Dan, who is five, is much harder
to understand. His vocabulary is two years delayed, his mother says,
and he needs speech therapy five days a week.

Simple as it might sound, the key difference between Sara and Dan is
this: early detection.

Sara's deafness was identified within days of her birth. She was
fitted with hearing aids at just three months. Dan's condition wasn't
discovered until his second year. And as it turns out, such delays are
crucial.

New scientific evidence overwhelmingly shows that infants whose
deafness is detected early, and certainly within the first six months
after birth, can learn to communicate far better than those whose
impairment is found later. But hearing loss can be surprisingly hard
to detect in an infant, and screening for it has long been the
exception, not the rule.

Hospitals usually test a baby's hearing only when there are risk
factors such as a family history of hearing loss, low birth weight,
or perinatal infection. This approach misses about half the children
who are deaf or hard of hearing, recent screening programs show.

Of the four million children born in the U.S. every year, anywhere
between 12,000 and 24,000 suffer from some degree of hearing loss.
Many of those who are otherwise healthy won't be detected until they
are two or older, when the window of opportunity for language
acquisition has begun to close.

Yet many pediatricians question the need to test seemingly healthy
babies, worrying that false positives would unnecessarily alarm new
parents. Without their wholehearted advocacy, voluntary testing in
hospitals has been slow to take off. It doesn't help that, with the
growth of managed care, hospitals are under pressure to cut out tests
deemed nonessential.

These obstacles are falling fast. On the heels of the scientific
studies showing what a difference early detection can make, calls for
universal screening are gaining strength. At the same time, the tests
themselves are becoming faster, more reliable and cheaper. The
equipment resembles a laptop computer with a tiny microphone that
fits into a baby's ear. The tests now cost an estimated $25 each,
including labor and supplies, compared with $300 or more for the
older ones.

Over the past year, four states have passed laws to mandate the
tests, bringing to six the number of states that require them. A bill
introduced in Congress last November would fund the creation of a
data-collection program at the Centers for Disease Control and
Prevention in Atlanta. In California, Governor Pete Wilson has
earmarked funds to test 70% of all newborns in the state.

Perhaps most significantly, the prestigious American Academy of
Pediatrics plans to reconsider the matter. In 1994, there "was not
enough evidence to say that everyone should do it," says Allen
Erenberg, medical director of Kern Medical Center in Bakersfield,
Calif., a member of the academy's task force examining the issue of
universal screening. But now, he says, some "very good studies" are
emerging that may support a change.

"Suddenly, this has become the right thing to do," says Yvonne S.
Sininger, an executive at the House Ear Institute in Los Angeles.
Karl White, director of the National Center for Hearing Assessment
and Management in Logan, Utah, predicts that "within 10 years at the
outside," universal hearing screening will be a standard of care and
commonplace in all hospitals. He says that already, more than 400
hospitals are routinely screening all newborns, up from 11 in 1993.

Detecting infant hearing problems is trickier than it seems. Children
may react to a loud whistle or siren, but not hear well enough to
hear conversation around them. Or they may respond to small movements,
or subtle lighting shifts, that parents erroneously interpret as
evidence of hearing. Almost all children who are born deaf have some
ability to hear; and fewer than 10% of them are born without any
hearing at all.

Dan Baucino's mother is a nurse who didn't suspect any problem in her
son until he was 14 months old. Intervention was delayed further
because there weren't any deaf services in the rural community where
his family lived at the time. "We didn't have a clue," Mrs. Baucino
says.

Neither did Kelly Pugeda. The stay-at-home mother in Placentia,
Calif., felt uneasy when her son turned two and wasn't talking.
Tyler's doctor told her boys don't always talk as fast, especially
when they have an older brother who is close in age, she recalls.

Nobody suspected a problem until one day a balloon that Tyler was
sitting on suddenly burst beneath him. It made a loud "pop" that
frightened everyone nearby, but Tyler didn't react. "It was then we
knew there was a problem, but we went into denial," Mrs. Pugeda says.
She didn't know the importance of early action, so she didn't feel
any urgency about having him tested.

Mrs. Pugeda feels guilty now. Tyler's hearing loss is probably
congenital, though it's possible that it developed later. He just
turned four, and Mrs. Pugeda says "he does little gestures, and
sounds come out, but I'm the only one besides my husband who
understands what he's saying."

The reasons why early detection and intervention can dramatically
improve a child's communications skills aren't well-understood. An
answer may lie in the way the human brain develops. Neuroscientists
are discovering that the wiring of the brain continues after birth
and into the first years of life. Early experiences, such as auditory
stimulation, appear to strengthen the brain's neural circuits.
Without stimulation, some of those connections may wither away.

Numerous studies of childhood language development have been
undertaken in recent years. Researchers have shown, for instance,
that by six months, babies' perception of spoken sounds is altered by
exposure to a specific language. If a child hasn't learned language
or speech within the first year of life, he or she rapidly loses the
capacity to do so.

Christine Yoshinago-Itano is chairwoman of the University of Colorado
at Boulder's department of speech, language and hearing sciences. In
her studies, 72 children whose hearing loss was identifed before the
age of six months showed markedly better language development than 78
children whose loss was identified later. At age five, children in
the early-identified group were still performing within the normal
range; the others were functioning at about 60% of their chronological
age.

These findings confirm what families with two deaf children have long
believed. Alicia Walsh was 2 1/2 and Megan was only six months old
when their hearing was tested by chance at their brother's preschool
in Montana. The boy's hearing was fine. The girls both failed and
were found to have a congenital hearing problem that left them with
moderate-to-severe loss.

 From the start, the girls received the same type of educational
intervention and speech therapy, says their mother, Catherine Walsh.
Megan, nine months old when she was fitted with a hearing aid, has
had almost normal language development. The tone, inflection and pitch
of her speech are more like those of a hearing person, Mrs. Walsh
says. Alicia's language had to be painstakingly learned
sound-by-sound. The two girls are now 18 and 20. "It has been much
more difficult and a struggle for Alicia than for her sister," Mrs.
Walsh says.

Calls for infant hearing tests go back at least 30 years to Marion
Downs, a pioneer in the field. An expert panel at the National
Institutes of Health issued a statement in 1993 recommending that
high-risk infants be screened for hearing loss before discharge from
the hospital, and that all infants be screened before three months of
age. But translating those recommendations into practice hasn't been
easy.

In Colorado, for example, the Department of Public Health and
Environment launched a voluntary screening program in 1992. When the
health-care market consolidated and shifted to managed care, some
hospitals decided that "anything that isn't absolutely required,
we're not going to do," says Vickie Thomson, coordinator for the
Colorado Newborn Hearing Screening Project.

Rose Medical Center, a large Denver hospital, abandoned its year-old
screening program early last year. Hospital officials contend that
the decision was based on philosophical differences and not economics.
Some doctors and parents found the tests "inconvenient" because they
sometimes delayed the discharge of healthy babies, says Roger Barkin,
a vice president for Rose Medical's parent, a joint venture of
HealthOne, a nonprofit system, and Columbia/HCA Healthcare Corp., the
for-profit chain. The hospital moved to give pediatricians a choice,
and some opted to stop testing, he says.

Still, the hospital's reversal helped spur passage last year of a new
Colorado law that requires 85% of all newborns to be tested by July
1999. Rose Medical and four other HealthOne/Columbia hospitals plan to
comply by the end of this year. Dr. Barkin says he doesn't know what
the costs will be.

But they won't be as high as they once were. The new generation of
technology now on the market works out cheaper per patient. The most
common technologies are otoacoustic emissions and automated auditory
brainstem response, with prices ranging between $4,500 and $18,000.
Tests of otoacoustic emissions measure a tiny echo that travels back
out the ear canal after a sound is introduced into it. The automated
ABR system evaluates brain-wave responses detected through sensors on
the baby's head.

Sara Soltani is one of the lucky ones. She was tested in the hospital
because she was seven weeks premature and weighed only 3 1/2 pounds,
and a series of subsequent tests confirmed the diagnosis.

Then began the really arduous task. Mrs. Soltani quit her job at
American Express Co. to teach her newborn how to listen. She soon
discovered how frustrating and tedious it can be.

When Sara was a tiny baby, Mrs. Soltani would make 100 noises; Sara
would respond to two of them. When she grew older, her mother would
repeat a sound 150 times before Sara could imitate it. There were
times when Mrs. Soltani wanted "to lock myself in a room and not
talk," she says. "I am not Supermom."

To help develop Sara's sensitivity to sound, Mrs. Soltani started
buying the loudest, most irritating noisemakers she could find. Her
first big success came not with a toy, but with a metal spoon and an
iron pot that she banged together. Sara, then four months old,
whirled her head around to see what was going on.

Mrs. Soltani continued using games to help Sara understand that
things have a name, and there is an association between objects and
sounds. Now, when Sara wants to listen to a music tape, she must
recite the song titles. When she wants a toy, she has to ask for it
by name. When she wanders into the kitchen, looking for something to
drink, her mother waits for her to verbalize her request: "Big
bottle," Sara says. Her mother opens the refrigerator and hands a
bottle to her.

Mrs. Soltani is always on the lookout for any sign that Sara is
falling behind, at times using a hearing child the same age as Sara
who lives down the street as a benchmark. When she saw last October
that he was counting aloud and Sara wasn't, she used blocks, shoes,
steps, or any other available prop to invent verbal numbers games.
Sara was soon counting to 13.

Daniel Baucino hasn't been so lucky. He had a minor heart problem
when he was born in Washington D.C., but his condition didn't trigger
a hearing test. After his deafness was discovered, it took two more
years to decide what to do. The family had relocated after Dan's
birth to a small town in Virginia. "If universal screening had been
in place, we would never have moved to a rural community," says Dan's
mother, Susan. The Baucino family eventually moved to Greensboro to
find services for Dan. He was three years old when he underwent
surgery for a cochlear implant.

Mrs. Baucino says she was told by many professionals that Dan would
never talk. But after the implant, he began intense language training
with a therapist and a special teacher. A year later, he began to
speak. "We have lost time," says his mother.

"Early intervention is so key to success," stresses Karen Parrish,
Dan's speech therapist at his preschool. Dan is making good progress
now, but he wasn't getting much auditory stimulation during a critical
period of language development, she says. By contrast, Sara is
flourishing because her problem was identified early, and her mother
has worked diligently "to intensify and make more abundant" the role
of sound in Sara's life, the therapist says.

"You don't know how lucky I am," Mrs. Soltani says. "I am a person
the system worked for." 

Copyright 1998, Dow Jones & Company