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Re: When is early hearing intervention late?

Dear Editor,

The landmark research by Yoshinaga-Itano et al of the USA in 1998[1] provided by far the greatest impetus for the current global drive for the detection of newborns with permanent congenital and early-onset hearing loss (PCEHL) before 3 months and intervention by 6 months of age. However, there have since been reservations about the generalisability of the 6 months threshold for optimal outcomes in cognitive, speech and language development across populations.[2,3] The recent review by Kennedy and McCann[4] has highlighted significant differences between this earlier US study and current findings from Australia and UK on optimal threshold for efficacious intervention..

It is difficult to predict ways in which the emerging evidence will affect public health policy on universal newborn hearing screening (UNHS). It may well be that there will never be a uniform age when intervention can be considered late within and across populations But there is little doubt that this information is quite important for the beneficiaries of UNHS as well as the service providers. For instance, it could abate the sense of hopelessness that is often inadvertently conveyed to parents who may prefer more time beyond the hospital stay to confront and overcome the anxiety about possible screening outcomes. Similarly, it offers service providers wider time-span for detecting some children with progressive and late-onset hearing loss that would have been otherwise missed by current UNHS programmes.

It could be rightly argued that there is no effective alternative to screening of all newborns before hospital discharge if we must detect the highest number of children with PCEHL as early as possible. Getting parents to return to hospital solely for newborn hearing screening is less likely to be as effective, but in busy neonatal units where babies are discharged in less than 48 hours we may well avoid an Olympic sprint race to screen by all means because of the hope that the new evidence on early intervention offers. Perhaps we should place more emphasis on the need to see parents as much enthusiastic as the service providers about newborn hearing screening. The chances are that screening will still hardly be delayed beyond the most propitious period for intervention even in communities where significant number of births occurs outside hospitals.

References

(1). Yoshinaga-Itano C, Sedey AL, Coulter DK, et al. Language of early- and later-identified children with hearing loss. Pediatrics 1998;102:1116-71

(2). Kennedy CR. Neonatal screening for hearing impairment. Arch Dis Child 2000;83:377-82

(3). Olusanya BO, Luxon LM, Wirz SL. Benefits and challenges of newborn hearing screening for developing countries. Int J Pediatr Otorhinolaryngol 2004;68:287-305