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PEDIATRICS

CHILDHOOD

HEARING

LOSS

IN SAN ANTONIO

By Mark Boston, MD, FAAP, FACS

earing loss affects an estimated 2-3 of every 1,000 infants shortly after birth. Legislation passed in 1999 (HB 714) established
H born in the United States and approximately 1 of every standards and criteria for newborn hearing screening (NBHS) in
birthing centers throughout Texas. The current “opt-out” NBHS
1,000 newborns has severe to profound hearing impair-
ment (deaf). More than 90 percent of deaf infants are program screens approximately 97 percent of births in Texas. Data
born to hearing parents and the vast majority of these parents choose from the 2015 Texas Early Hearing Detection and Intervention
to raise their children in a hearing world. Prior to the advent of early (TEHDI) Program shows that of 397,465 infants who were
hearing screening and advanced technology, these children experi- screened 5,697 (1.4 percent) were referred based on the screening.1
enced significant delays and limitations in language development, ed- Of those 5,697 who did not pass the NBHS, 491 were ultimately
ucational success and vocational opportunities. Today, however, a diagnosed with hearing loss.
linked system of early identification, technology, and specialized ed- In addition to NBHS, Texas law also requires that children receive
ucation provides deaf and hearing-impaired children an opportunity hearing screening within 120 days of school enrollment as well as
to live, learn, work and succeed in a hearing world. during the 1st, 3rd, 5th and 7th grades in all public, private,
No technologic advancement has improved the opportunity for parochial, or denominational schools. The continued surveillance
deaf children to develop spoken language and educational success of children’s hearing is important because many hearing impaired
than has the cochlear implant. Cochlear implants do not “cure” children are born with normal hearing but develop hearing loss over
deafness but they can provide access to spoken language at a level the first few years of life. Similar to NBHS, most children who fail
unobtainable with hearing aids. And when cochlear implants are a a school hearing screen will ultimately be found to have normal
component of a comprehensive program including strategies to hearing. But the screening process is designed to ensure that no
maximize the benefits of the cochlear implant in supportive home hearing-impaired child is denied access to appropriate services be-
and educational environments, prelingually deaf children can attain cause of a failure to detect their hearing loss.
educational and professional milestones on par with their normal- At The Children’s Hospital of San Antonio, our audiologists (and
hearing peers. But the fullest benefits of cochlear implants can only otolaryngologists) see a large number of infants and children re-
be realized with early identification of deaf and hearing impaired ferred for a failed NBHS or school screening. With the 90 percent
infants and children. of infants and children who have normal hearing the office visit be-
Prior to mandated hearing screening programs, most deaf chil- comes an opportunity to discuss healthy hearing habits and how to
dren were not identified until they were two or three years of age spot the signs of potential hearing loss, as well as a chance to share
or older. Recognizing the lifelong impact this delay had on children, good news with a family. For those who are diagnosed with hearing
childhood hearing specialists worked with elected officials to estab- loss, the discussion is typically much longer and focused on answer-
lish laws to ensure that hearing impaired infants were identified ing caregiver questions and discussing the next steps of language

18 San Antonio Medicine • June 2018