
DATE: Wednesday, May 7, 1997                TAG: 9705070471

SECTION: LOCAL                   PAGE: B1   EDITION: FINAL 

SOURCE: BY LIZ SZABO, STAFF WRITER 

                                            LENGTH:  116 lines

EVMS RESEARCHERS SEEK MANDATORY HEARING TESTS FOR ALL VA. NEWBORNS NEW TECHNOLOGY MAKES ACCURATE SCREENING AFFORDABLE.

Researchers at Eastern Virginia Medical School have tested new technology that could be the key to providing affordable, accurate hearing tests for all newborns in the days immediately after birth.

The researchers plan to ask legislators to introduce a bill in the General Assembly next year that would mandate screening every newborn using this new technique. The Virginia Medical Society supports the proposed legislation.

Hearing loss is the most common birth defect, affecting six out of 1,000 newborns. Many more children lose their hearing later in life; roughly 8 percent of the adult population has some hearing loss.

But many children with hearing problems are not diagnosed until they are 2 or 3 years old, a delay that can significantly delay their language development.

``Our goal for the state of Virginia is to have every child tested before they leave the hospital,'' said Dr. Barry Strasnick, director of pediatric otology at EVMS and a proponent of universal screening.

Today, Virginia hospitals screen only newborns at high risk for hearing loss - those with risk factors such as low birth-weight, bacterial infections or a family history of deafness. But 90 percent of deaf children are born to hearing parents, Strasnick said. By testing only high-risk babies, doctors miss 50 percent of those with hearing loss, he said.

Unlike old-fashioned hearing tests, the new procedure, called ``automated auditory brain-stem response,'' can be performed on infants - even while they are sleeping - because it does not require any conscious feedback from the child, Strasnick said.

With the new procedure, sensors measure a baby's brain-wave responses to a series of clicks, delivered through cushioned earphones. Then a computer analyzes the baby's brain responses and compares those to the responses of a hearing child.

Infants whose brain-wave responses vary from the norm are referred to audiologists, who can then determine whether a child has an ear infection or more permanent hearing loss.

One of the procedure's main appeals is its automation, which reduces the need for specialists. The test can be administered by technicians or even health volunteers, who can take the portable equipment on the road into rural areas, Strasnick said.

The screening equipment's price tag - $10,000 a unit - makes it too expensive for individual pediatricians, but affordable for hospitals, Strasnick said. Screenings cost between $18 and $35 each.

If hospitals or health insurance companies agree to fund the procedure, doctors could test every newborn, Strasnick said.

Most managed care health insurance plans typically pay hospitals a pre-set amount of money for each birth, leaving hospitals to decide how to divide the payments on tests and procedures.

Hospitals already test for many diseases at birth, although hearing loss is not part of routine testing. Strasnick hopes hospitals will agree to offer the hearing screening once they learn of the study's success.

The EVMS study found the new procedure to be completely accurate, said John T. Jacobson, director of audiology at EVMS. The study had no false positive or negative screenings, he said.

The National Institutes of Health has endorsed universal hearing screening, but some pediatricians oppose requiring it by law.

Universal screening can only be effective if patients have access to audiologists for follow-up tests, said Dr. Frank Aiello, a pediatrician at EVMS and Children's Hospital of The King's Daughters. A law requiring a hearing screening would be expensive and difficult to put in place at rural hospitals, which often lack access to technology or audiologists, he said.

Many pediatricians also have been concerned about false positive results.

An earlier version of the technology found hearing loss in 25 percent of children screened, Strasnick said. Referring one-quarter of all babies for follow-up hearing exams would make universal screening impractical - as well as emotionally stressful for parents.

But Strasnick and Jacobson found the new technology to be much more accurate. The test found abnormal hearing in only two of 100 babies tested. Ear infections caused by fluid in the ears - one of the most common early childhood illnesses - also show up. Doctors can treat such temporary hearing losses easily with antibiotics.

Early diagnosis of hearing loss allows doctors to provide children with hearing aids, language therapy or surgery in order to prevent communication and developmental delays, Strasnick said.

Most deaf and hard of hearing children are not diagnosed until they are 2 or 3 years old, after they have missed the most critical years of language acquisition, Strasnick said.

The average deaf high school graduate reads at only a fourth-grade level - largely because of inadequate early language stimulation, he said.

But deaf children of deaf parents who learn sign language as babies show equal language development with their hearing peers. Doctors can fit infants as young as 3 months old with hearing aids, said Claire Jacobson, director of audiology at Children's Hospital of The King's Daughters.

And research has suggested that babies diagnosed before they are 6 months old - and who receive hearing aids and speech and language therapy - perform at the same level as hearing children by the time they are 5 or 6 years old, Claire Jacobson said.

Karen Robinson wishes her daughter had been tested at birth.

Alexis was not diagnosed as deaf until she was nearly a year old. The child, who now wears hearing aids and receives intensive speech and language therapy, has about the same speech development as any other 18-month-old baby, with a vocabulary of more than half a dozen words.

Many deaf educators also endorse universal screening.

``Early testing is a great idea,'' said Lynn Frankel, sign communication coordinator at the Virginia School for the Deaf and Blind in Hampton. ``The sooner parents learn about the hearing loss, the sooner they can begin to accept it and do something about it.'' ILLUSTRATION: [Color Photo]

The new test measures a baby's brain-wave responses to sounds

delivered through earphones, above.

Parents interested in having their children tested should ask their

pediatrician about AABR, or call the audiology department at

Children's Hospital of The King's Daughters at (804) 668-9327.

IAN MARTIN/The Virginian-Pilot

Claire A. Jacobson, director of audiology at Children's Hospital of

The King's Daughters, supports automated hearing screenings of

infants like 5-month-old Kenneth Smith. The new procedure showed

that Kenneth's hearing is fine.