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The audiologist's role in early intervention

Sieminski, Louis R.

doi: 10.1097/01.HJ.0000366914.47796.23
HEARING & Children

Louis R. Sieminski, PhD, who owns a private practice in Kingston, PA, was a consultant to the Pennsylvania Department of Health. There he helped develop and secure funding for the state's infant hearing screening program. Readers may contact Dr. Sieminski at

As statewide EHDI (early hearing detection and intervention) programs evolve and screenings for hearing loss increase in Head Start, early intervention (EI) programs, and healthcare settings, the role of the audiologist will expand in scope and importance. It is imperative that audiologists be prepared to take the lead role in improving screening techniques, diagnosis of hearing loss, and properly fitted hearing devices, and thereby improve outcomes. Audiologists are the true experts and the success or failure of these programs falls squarely on their shoulders.

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Since 1990, statewide EHDI programs have grown significantly. But while an impressive 94% of babies born in the U.S. are screened for hearing loss, 6% are not screened, and far more are not screened effectively. Alarmingly, 45% of babies who fail a screen are lost to follow-up, so their hearing loss goes undetected and untreated.

Effective EHDI programs require an integrated statewide system that brings multiple disciplines together to detect and treat hearing loss as early in life as possible. There must be a seamless integration of universal newborn screening, prompt diagnosis, effective intervention, and statewide tracking of all babies. All participating disciplines are important, but none more than the audiologist. Sadly, most hospital EHDI programs have little or no involvement by an audiologist. Many hospitals do not have an audiologist to ensure effective screening, early diagnosis, and appropriate referrals. There are too few pediatric audiologists in many rural areas to provide easy access and early detection and intervention.

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Head Start and EI programs for children have grown in number and have provided documented successful outcomes. Children in these programs with undetected hearing loss are negatively affected academically, socially, and behaviorally. By school age, new cases of permanent hearing loss occur in an estimated 6 per 1000 children in addition to the 3 per 1000 born with hearing loss. And more than 35% of pre-school children will experience ear infections and intermittent hearing loss.

Many organizations, including ASHA, AAA, and the American Academy of Pediatrics, recognize the importance of screening all pre-school children. Head Start requires hearing screening within 45 days of enrollment.

The National Center in Early Hearing Detection and Intervention has begun Head Start hearing screening pilot projects in 20 states. It has helped organize local Early Childhood Hearing Outreach (ECHO) teams to begin screenings in Head Start programs. Each team has a local audiologist to assist in the screening and follow-up. As with EHDI, the key to success is the involvement of the audiologist. Contact a Head Start program in your area and ask about their hearing screening program and how you might get involved.

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Local healthcare clinics and primary-care physicians' offices often use crude methods and antiquated equipment to screen pre-schoolers for hearing loss—if they screen at all. Audiologists are needed to help these facilities establish proper screening techniques and obtain the tools, such as tympanometers and OAE screening equipment, to identify children with hearing loss, both conductive and sensorineural. Many primary-care and pediatric offices do not routinely screen for hearing loss due to lack of time, money, and expertise. However, since they see many children routinely, they are best positioned to identify those with hearing loss. Future trends will demand effective screening of children seen in these facilities. Again, the audiologist must be poised to help and lead.

For information about EHDI programs in your state, visit

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