By Michael Severson, MD, FAAP, pediatrician and EHDI Advisory Board Member; Faith Kidder, CPNP, Child and Teen Checkups at the Minnesota Department of Health, and Cara Weston, Newborn & Child Follow Up Unit at the Minnesota Department of Health
Hearing screeners in Minnesota have a valuable new resource in the Guidelines for Hearing Screening after the Newborn Period to Kindergarten Age, recently approved by the Minnesota Newborn Hearing Screening Advisory Committee.
The new guidelines provide Minnesota-specific information and resources, including details on screening equipment, protocols, and pass/refer criteria, as well as Individuals with Disabilities Education Act (IDEA) Part C and Part B referral and evaluation. They also clarify documentation and reporting requirements.
The biggest impact of these guidelines on the primary care provider’s practice is the definitive direction given to screeners thereby streamlining their decision making and referral process, which in turn assists providers in the timely identification of children most at risk for permanent hearing loss. The guidelines provide different referral recommendations and timelines for at-risk children, which separates them from those who have transient or fluctuating hearing loss due to otitis media with effusion.
Consistent with American Academy of Pediatrics (AAP) and Joint Commission on Infant Hearing 2007 recommendations, children who pass their newborn hearing screening but have a risk factor for hearing loss should be referred to an audiologist by 24-30 months of age. The guidelines clarify that this should occur as soon as a concern is identified.
The guidelines give specific direction regarding the appropriate use of otoacoustic emissions (OAE) screening for children after the newborn stage through three years of age, or when developmentally necessary in older children, and the use of tympanometry in identifying the absence of middle ear effusion. The screening algorithm for OAE and tympanometry calls for a waiting period of 14-21 days if a child has a REFER on both OAE screening and tympanometry, but primary care providers can proceed directly to the step of middle ear evaluation—saving valuable time for the family and potentially reaching a diagnosis more quickly.
Pure tone audiometry is recommended for screening children age three and older, with tympanometry used as indicated by the guidelines as a second stage screen for children with a pure tone screening REFER. For children who REFER on pure tone audiometry screening at a primary care visit, the provider may proceed directly to the step of middle ear evaluation.
Hearing screening in early childhood plays a critical role in the EHDI process by identifying children with permanent and longstanding fluctuating childhood hearing loss that may affect health, communication, learning and development. With prompt referral and follow-up, Minnesota children have an opportunity to receive appropriate and timely care and services which lead to better health and educational outcomes. For more information, please contact the Minnesota EHDI program at ehdi@state.mn.us or call (651) 201 – 3650 or visit www.improveehdi.org/mn/index.cfm
Find the guidelines online at: www.improveehdi.org/mn/library/files/afternewbornperiodguidelines.pdf
Screening algorithm for OAE and tympanometry: www.improveehdi.org/mn/library/files/oaetympflowchart.pdf
