Addressing Barriers to Early Hearing Detection and Intervention Through Innovation

By Shawna Jackson, Andrew Calvert, Andrea Gohmert, and Angela Shoup

This article is a part of the July/August, Volume 35, Number 4, Audiology Today issue. 

Identification of Opportunity

According to the Centers for Disease Con­trol and Prevention, in 2019, 98.4 percent of infants in the United States received a hearing screening in their first month of life (Centers for Disease Control and Prevention, 2022). However, after failure of newborn screening, many infants are not completing the early hearing detection and intervention (EHDI) process in the time frame recommended by the Joint Committee on Infant Hearing (2019). These goals recommend a hearing screening by one month of age, diagnosis of hearing loss by three months, and initiation of appropriate early intervention services, including amplification if indicated, by six months.

In 2018, the Callier Center for Communi­cation Disorders at The University of Texas at Dallas embarked on an ongoing investigation of barriers to reaching the Joint Committee on Infant Hearing diagnosis of hearing loss and early intervention goals in the state of Texas with the objective of developing scalable strategies to improve EHDI outcomes. A committee gathered existing documents for review, including research reports, legislation, data from Texas EHDI and the Centers for Disease Control and Prevention, and recommended protocols. Stakeholders were identified and interviewed about their experiences in the Texas EHDI process. 

Participants included pediatricians, educators involved with early intervention, rural physicians, Early Childhood Intervention providers, the Texas Department of State Health Services, leaders with the Texas Perinatal Care Surveillance System and the Texas Perinatal Quality Care Collaborative, parents, leaders with midwife and birth centers, audiologists, and speech-language pathologists. Several barriers have been identified, including socioeconomic factors, such as time away from work, cost of transportation, and distance to pediatric audiology services.   

Careful evaluation of the typical care pathway revealed that multiple appointments are required following failure of newborn hearing screening, often with prolonged intervals between appointments. These appointments include outpatient diagnosis and confirmation of hearing loss followed by fitting of amplification. Frequently, there is a time delay of four to six weeks between confirmation of hearing loss and fitting of amplification. Further analysis indicated that much of this delay is due to processing time for custom earmolds and lack of predictability of receipt of custom earmolds. 

A prolonged interval between diagnosis and initiation of early intervention services decreases the likelihood of meeting the developmentally important goal of intervention by six months of age, further compounding the socioeconomic burden on the family. If a hearing aid could be fit immediately following the diagnosis of hearing loss, it would help meet the EHDI 1-3-6 goals (Joint Committee on Infant Hearing, 2019), increase hearing-health-care efficiency, reduce the number of appointments, and decrease time from diagnosis to intervention.

At the Callier Center for Communication Disorders, the traditional process of custom earmold procurement typically takes from two to four weeks but increased to four to six weeks during the COVID-19 pandemic due to supply chain and shipping interruptions. This process resulted in delays of fitting amplification devices, outgrown custom earmolds by the time they were received, and decreased effective use time of a custom earmold.