TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.
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October 2020Background
Infant hearing loss occurs at an incidence of 1.4 per 1,000 births, and children born with hearing loss are at a significant risk of language development delays (CDC, April 30, 2020. www.cdc.gov/ncbddd/hearingloss/research.html). The identification, management, and reporting of infant hearing loss are public health issues overseen by the CDC and coordinated by state Early Infant Hearing Detection and Intervention (EHDI) programs. To prevent delays in diagnosis/intervention, universal infant hearing screening standards and programs were developed and piloted during the 1990s. These standards were subsequently implemented throughout the United States as a result of position statements and policy recommendations of the United States Preventive Services Task Force, Joint Committee on Infant Hearing (JCIH), and the National Institutes of Health in 1999 to 2000 (Pediatrics. 2013;131:e1324–e1349). Through their joint efforts, these agencies created the EHDI guidelines, also known as the 1-3-6 guidelines, which recommend the following: All infants should have hearing screening after birth no later than 1 month of age, infants with abnormal screening results should have definitive diagnostic hearing testing no later than 3 months of age, and infants who are found to have hearing loss should receive early intervention services no later than 6 months of age (Pediatrics. 2013;131:e1324–e1349). According to the CDC, EHDI programs exist in all 50 states, and 97% of infants in the United States undergo hearing screening; however, nearly 30% of infants with hearing loss are delayed in diagnosis, and approximately 30% of infants with hearing loss do not receive early intervention care. Lack of adherence to the 1-3-6 guidelines and poor utilization of EHDI services are high priority areas for the JCIH (Pediatrics. 2013;131:e1324–e1349). EHDI programs require significant coordination and cost; thus, it is important to determine whether or not adherence to the 1-3-6 guidelines has any effect on speech development. The purpose of this article was to assess the literature regarding the impact of adherence to 1-3-6 EHDI guidelines on pediatric spoken language outcomes.
Best Practice
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Adherence to meeting EHDI 1-3-6 diagnostic and intervention guidelines has a compelling effect on pediatric language development based on recent literature. Healthcare professionals need to play an active role within their states to support EHDI initiatives and adherence to these 1-3-6 guidelines. Otolaryngologists and audiologists who are involved in diagnosis and intervention for pediatric hearing loss should be proactive to ensure that children in their care, as well as those in their community, meet these guidelines, and to lead in early intervention, including cochlear implantation for appropriate candidates. Furthermore, based on the literature in this field, clinicians should strive to provide support and education for families regarding adherence to EHDI guidelines that may lead to timely diagnosis and intervention for congenital hearing loss, which, in turn, may positively influence pediatric language development.