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Early Identification of Young Children with Hearing Loss in Federally Qualified Health Centers

Bhatia, Parul MD, FAAP*; Mintz, Sandra MS, CCC-A; Hecht, Barbara F. PhD; Deavenport, Alexis DrPH, MCHES§; Kuo, Alice A. MD, PhD

Journal of Developmental & Behavioral Pediatrics: January 2013 - Volume 34 - Issue 1 - p 15–21
doi: 10.1097/DBP.0b013e318279899c
Original Article

Objective: While newborn hearing screening has improved outcomes for children diagnosed with hearing loss, the screening protocol is incomplete in the critical early developmental years, particularly among underserved populations. To address this gap, 7 federally qualified health centers (FQHCs) implemented a periodic, objective infant-toddler hearing screening program during well-child visits. The study aimed to determine the ability of these primary care providers to implement the hearing screening protocol and to identify children in need of audiologic follow-up.

Method: This study represents a prospective chart review. Children aged 0 to 3 years presenting to participating clinics for well-child care visits were offered the hearing screen, which included a brief risk factor questionnaire, otoacoustic emissions (OAEs), and tympanometry. Main outcome measures were time to screen, accuracy of physician interpretation of the tympanogram results, and screening results requiring immediate audiology follow-up.

Results: Among 1965 OAE screens, 75% took <10 minutes, and 205 patients (10%) failed OAEs in at least 1 ear; based on tympanometry, middle ear effusions were present in 102 of these cases (50%), while 45 cases (22%) raised concerns for sensorineural hearing loss. Physicians accurately interpreted tympanogram results in 89% of cases. There were 5 patients identified with confirmed permanent sensorineural hearing loss.

Conclusion: Findings demonstrate that infant-toddler hearing screening in FQHCs is feasible to conduct, and it may effectively identify cases of postnatal hearing loss. This is one of the first studies in a primary care setting using OAE technology coupled with tympanometry, allowing physicians to better triage patients for immediate audiology referral.

*Division of General Pediatrics, Department of Pediatrics, Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA

Hearing Conservation and Audiology Services, Ventura County Office of Education, Camarillo, CA

Clarke Schools for Hearing and Speech, Boston Campus, Canton, MA

§Division of General Pediatrics, Department of Pediatrics, USC University Center for Excellence in Developmental Disabilities, Children’s Hospital Los Angeles, Los Angeles, CA

Division of General Internal Medicine and Health Services Research, Department of Medicine, Department of Pediatrics, UCLA Center for Healthier Children, Families and Communities, UCLA David Geffen School of Medicine, Los Angeles, CA.

Address for reprints: Parul Bhatia, MD, FAAP, Division of General Pediatrics, Department of Pediatrics, Children’s Hospital Los Angeles, USC Keck School of Medicine, 4650 Sunset Boulevard, #76, Los Angeles, CA 90027; e-mail:

Disclosure: Data for the infant-toddler hearing screening program was collected from Baby Sound Check®, a program supported by grants to the John Tracy Clinic from the Rosenthal Family Foundation and Kaiser Community Benefit Foundation. P. Bhatia, S. Mintz, and B. F. Hecht received salary support from a grant from the Rosenthal Family to the John Tracy Clinic. Remaining authors declare no conflicts of interest.

The project was developed and implemented by the John Tracy Clinic in collaboration with AltaMed Health Services Corporation and Venice Family Clinic.

Received April , 2012

Accepted October , 2012

© 2013 Lippincott Williams & Wilkins, Inc.