Newborns

The Happiest Baby—With Noise-Induced Hearing Loss

By Nadine Dehgan

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Nothing in my life compared to giving birth and being able to hold my heart in my arms. As most sleep-deprived new parents will attest, there also is nothing quite like the helplessness you feel when this tiny person whom you love more than anything won’t settle and continuously cries (after being fed, changed, swaddled, and is fever-free).

Before my oldest daughter was born I thought I was well-equipped to be a parent. I had always been around children, was the second oldest of six children, became an aunt at 19, had a strict  pediatrician, took my parenting class seriously—and read “The Happiest Baby on the Block,” a best-selling book by Harvey Karp, M.D., recommended to me by other new parents.

Nine years later, it has been brought to my attention Karp’s ardently recommended action of “shh-ing” my daughters is extremely damaging to an infant, or any human. He advises the “shh-ing” sound needed to activate a crying baby’s calming reflex is a rough, rumbly whoosh noise that is as loud as your infant’s crying. This is at least 115 decibels (dB), according to Oregon pediatric audiologists Heather Durham, Au.D., and Shelby Atwill, Au.D. Alarmingly, sounds over 80 dB for an extended period of time are damaging and anything greater than 100 dB for even a few minutes can cause permanent noise-induced hearing loss (NIHL).

NIHL is an epidemic for American children—one in five are estimated to have significant hearing loss before the age of 20. I wonder how many children suffer from NIHL as a result of well-intentioned parents who relied on this harmful advice.

I remember reading I could put my daughters at ease by putting my mouth close to their ears and making a strong “shhhhhhhh” noise. The sound of someone’s forceful “shhhh” directly in your ear can actually be painful. (Please do not try it!) Babies have super hearing—the best hearing humans will have in their lives is when they are first born. I shudder to think how loudly I was “shh-ing” my daughters to sleep. The louder they cried, the louder I “shh-ed,” thinking I needed to do more to soothe them as I had learned.

A new grandparent and supporter of Hearing Health Foundation (HHF) recently alerted me to this danger, and after testing the decibels of my so-called soothing “shhh” sounds, I immediately had a pit in my stomach because indeed the noise is loud—dangerously loud. I had “shhh-ed” my daughters for countless nights and naps. White noise machines (usually in a stuffed animal) placed right near a baby’s head can be equally dangerous.

Like sun exposure, loud noise exposure has a cumulative effect; it could be that “inevitable” age-related hearing loss is merely the result of a lifetime of living in our noisy environments with unprotected hearing. Parents with newborns who are difficult to calm down need another, less risky option for inducing sleep, one without lifelong consequences.  



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The Path to Funding for Universal Newborn Hearing Screening

By Pranav Parikh

Due to the complexities of a multi-trillion-dollar federal budget, it can often be difficult to understand where all the money ends up. For recipients of Medicaid and their children, part of the government’s longstanding policy is to provide access to quality healthcare low-income communities could not otherwise afford. Medicaid recipients represent approximately 23 percent of the total U.S. population, with an enrollment of 74,550,529 individuals.

According to President Donald Trump’s Fiscal Year (FY) 2018 proposed budget, deemed the “America First” budget, and a nonpartisan CBO report, Medicaid will receive cuts totaling $610 billion USD over the next 10 years. In 2015, the U.S. Government spent $545.1 billion USD on Medicaid services. President Trump alludes to waste and redundancies as his justification of the proposed cuts.

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One of the planned cuts will negatively impact newborn children and be detrimental to the well-being of infants across the country: Universal Newborn Hearing Screening. The terrifying impact is summarized below.
 

What exactly is being removed?
In his FY18 proposed budget, President Trump upheld his campaign promise by cutting what he deems “unnecessary and wasteful spending.” Unfortunately, one program that got the axe was the $18 million USD allocated towards newborn hearing screenings. This earmarked funding has doubled the percentage of newborns receiving hearing screenings before leaving the hospital from 46.5% to 97% just in the last decade. Without early detection, children will be at a distinct disadvantage in tackling hearing loss present at birth.

Why does this matter?
Every day, 33 children are born with some form of hearing loss, designating hearing loss as the most common congenital birth defect in the U.S. Reasons babies may have hearing loss present at birth include an inherited trait, ototoxic chemical, or a viral infection during a mother’s pregnancy. Challenges associated with having hearing loss can be overcome through early intervention, however it is imperative treatment and therapy are started as early as possible. As stated on the U.S. Government Department of Health and Human Services website, “If not identified early, [hearing loss] is likely to delay or impair a child’s development. Hearing problems are difficult to detect through observation alone, so almost all newborns have their hearing checked with special equipment.” 

What types of tests are done?
Aside from behavioral characteristics displayed by infants with hearing loss, there are two main tests conducted by physicians to determine any level of auditory impairment. The first of which is called Otoacoustic Emissions, a test designed to the test functionality of outer hair cells. A negative reading on this test is typically associated with cochlear dysfunction. The second test is called Auditory Brainstem Response (ABR) and determines activity of the auditory nerve through stimulation in the baby’s ear. A negative reading on this test indicates some issue with the vestibulocochlear nerve such as auditory neuropathy, but could also indicate problems with other parts of the ear. Both of these tests can be done while the baby is asleep and offer more concrete evidence to either rule out or diagnose infant hearing loss.

Have studies shown early intervention to be more effectual than later in childhood?
Yes, there are many studies that have shown that early intervention, especially for those receiving treatment within the first six months after birth, increases levels of cognitive function and advanced development. The control group of one study, led by Dr. Christine Yoshinaga-Itano at the University of Colorado-Boulder, showed that those who did not receive treatment or therapy within the first six months after birth had greater difficulty with oral communication and language comprehension.

What happens if children have undiagnosed hearing loss?
Hearing loss as a condition can present a number of symptoms associated with other disabilities, leading to improper diagnoses. For example, when children exhibit a lack of response to loud noise, or don't answer when spoken to, they sometimes are misdiagnosed by professionals as being autistic. If hearing loss is present and detected at birth, doctors will have access to necessary information earlier and children will be better off in the long run in developing their communication and learning abilities.

If funding for newborn hearing screening is decreased or removed entirely, what does that mean for those suffering from hearing loss?
At the moment, only 67.1% of those diagnosed with hearing loss receive early intervention before six months of age. With lower early detection and screening rates, this percentage will drop further. Without early intervention programs in place, children are at a noticeable disadvantage in developing hearing and speech functionality. After the age of three, it is considerably more difficult for children to develop the speaking and listening skills that are in line with their typical-hearing peers.

Would early intervention actually save money down the road in potential education costs?Some students with hearing loss utilize special education services, such as CART or note-taking, to ensure they don’t miss any of the materials and learnings while in the classroom. Access to the necessary technology and equipment, as well as highly trained teachers, is an expense incurred by school districts across the country.

A recent report released by the National Center for Hearing Assessment and Management states that treatment of hearing loss in children within the first three months of life can save up to $400,000 USD in eventual special educational costs by the time the hard of hearing student graduates high school. By bridging the gap early, and ensuring better interpersonal and cognitive skills in the first years of age, these children will require much less specialized instruction in future years. Essentially, early detection and intervention pays for itself.

Is there any legislation, not including the President’s proposed budget, that addresses this issue?
In March 2017, the Early Hearing Detection and Intervention (EDHI) Act was introduced on the House floor by Representatives Doris Matsui (D-CA-06) and Brett Guthrie (R-KY-02). A companion measure was also introduced in the Senate by Senators Rob Portman (R-OH) and Tim Kaine (D-VA). EHDI reauthorizes funding for Universal Newborn Hearing Screening for the next five (5) years, as well as establishes a database hub to collect information on the results of these tests. If the measure passes, parents will be assured of their child’s hearing health, and one of the nation’s largest public health concerns receives the necessary attention it deserves.


Undoubtedly, funding for newborn hearing screening is imperative. Hearing Health Foundation (HHF)'s Pranav Parikh spoke with Congresswoman Matsui’s staff on the reasons for proposing the legislation, and why she took the lead on tackling such an important issue. “So much of a child’s development happens in the first few years of their life, which is why early detection and intervention is so important,” said Matsui. “This bill will ensure that more infants have access to critical hearing screenings, so parents can be informed about the options for their children’s care.” It is comforting to know children suffering with hearing loss have an ally in our nation’s capital.

As Vickie Glenn, a Medicaid Coordinator for Tri-County Special Education recently stated in a New York Times article, “This isn’t Republicans or Democrats. It’s just kids.” Fortunately, President Trump’s proposed budget appears to be a “purely political document,” according to Peter Coy from Bloomberg BusinessWeek, possibly serving as a trial balloon and nothing more. Congress, even with a conservative majority consisting of many fiscal hawks, will likely reject many of the proposed cuts, as Texas Senator and chairman of the Freedom Caucus John Cornyn remarked, “we know the President’s budget isn’t going to be passed as is.” For now, at least, Universal Newborn Hearing Screening will receive its necessary and deserved funding.

And, finally, an urgent call to action from Nadine Deghan, CEO of HHF:
HHF has strongly supported Newborn Hearing Screening. In the 1990s, we championed legislation to encourage these simple but critical tests for our nation’s babies. For those who feel passionately about newborn screening funding, please contact your Congressional Representative and your Senator to let them know your views.

 

 

 

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Marion Downs Appreciation

By Amy Gross

I had no idea how influential Marion Downs had been—and at the time, still was—regarding newborn infant screening, but it didn't take much research to discover that this woman was a big, big deal. I don't know why, but her passing on November 13, 2014, caught me by surprise. It didn't matter that she had reached her 100th birthday; I, like many of her fans, found it difficult to accept that the force known as Marion Downs had moved on, peacefully, in her sleep.

Marion (she wouldn't let me call her "Ms. Downs") was 92 when we spoke. She was still skiing and swimming and playing tennis competitively, and one of the photos in “Shut Up and Live!” showed her gleefully skydiving with a handsome young instructor (she made sure to point out the "handsome" part several times). I had read every word of her book, in which she provided candid advice for anyone dealing with the aging process: the importance of weight training, why hearing aids are critical in the health of a marriage, and how to maintain a healthy sex life into one's senior years. I loved that she was able to make me blush more than a few more times; the woman minced no words.

What had put Marion Downs on the map, audiologically speaking, were her pioneering efforts, beginning in the early 1960s, in the essentially unheard-of area of infant hearing testing. An audiologist herself, Marion and a research partner started hearing testing for newborns before those infants had even left the hospital, fitting even the tiniest babies with hearing aids. Today, thanks to Early Hearing and Detection Intervention programs, 97 percent of newborns have their hearing screened. Knowing what we know today about the importance of hearing with respect to language and even cognitive development in extremely young children, there's no telling how many infants with hearing loss were identified as such in a timely manner, and their developmental skills saved, because of Marion Downs's work.  

The Marion Downs Center in Denver, Colorado, a nonprofit organization that espouses, as Marion did herself, a cradle to grave approach in dealing with hearing loss, will continue her efforts in advocating for those with hearing loss. Marion was a visionary in the world of hearing health. Her legacy lives on, quite visibly, in the children whose lives she touched.

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