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BEGIN TRANSCRIPT:
OPERATOR: Welcome to the American Speech-Language-Hearing Association’s podcast
series, highlighting issues in the field of human communication.
JOE: Hearing screening at school is critical care of the young. Often, such screening is the first
step in detecting hearing loss that could otherwise have profound negative impact on children if
it goes undetected. We will look at the national picture of hearing screening in public schools,
what it is, why it is important, and how it is done, and when and where it is taking place or not
taking place, such as the case currently in New York City.
We will also discuss what parents can do to help ensure that their children are screened. Our
guests are: Pam Mason. Pam is an audiologist as well as the Director of Audiology Professional
Practices at the American Speech Language Hearing Association, or ASHA; Jim Potter, ASHA’s
Director of Government Relations and Public Policy; and Laurie Hanin, PhD, Executive Director
of the Center for Hearing and Communication in New York City. An ASHA member, Dr. Hanin
is also an audiologist who has specialized in pediatric care. [0:01:11.2]
Welcome, everyone, and thank you for being here. Pam, I would like to begin with you, if I may,
and I have a simple question to start the discussion. Exactly what is hearing screening, and who
says it is important for the young and why?
PAM MASON: Well, thank you. First, let me define what a hearing screening is and what it is
not. Hearing screening is not the same thing as a complete hearing evaluation. Instead, it is a
quick and easy way to identify children who may have a hearing problem.
Hearing screening programs remove children with normal hearing quickly, leaving children who
refer and need further testing to find out more about the hearing loss, such as how bad is the
hearing problems and what can be done to improve the hearing. [0:01:59.6]
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In the United States today, over 90 percent of newborns have hearing screening before they go
home from the birth hospital. As successful as these programs are, they still do not identify all
children with hearing loss. The newborn hearing screening often does not identify children with
mild hearing loss. These types of hearing loss can go unnoticed in the preschool years. Hearing
screening at school entry may be the first time the hearing loss is identified.
You know, it is not just ASHA that understands the importance of school hearing screening
programs. The importance is recognized by several other leading children’s health and hearing
organizations, including the CDC, Health Resources Services Administration, the American
Academy of Pediatrics, the Educational Audiology Association, and the National Institute for
Deafness and Other Communication Disorders. [0:02:59.2]
JOE: That is a pretty impressive group that is concerned about hearing screening. What is
known, Pam, about the extent of hearing loss among the young?
PAM MASON: Well, I am going to throw out some numbers here, so I hope I am not confusing
anyone. Approximately 15 percent of all school-age children have some degree of hearing loss in
one or both ears. Most of this population of children have already been identified with hearing
loss through the newborn hearing screening program that I mentioned.
JOE: Right.
PAM MASON: And they are receiving intervention services and are wearing hearing aids,
cochlear implants, or using other technology. But for those with mild or unilateral hearing loss that is a hearing loss in one ear - those children may not have been identified during the newborn
hearing screening and that number is about 2.5 million in the United States. That is one in every
20 school-aged child may have a mild or unilateral hearing loss, and without the proper
identification and treatment, more than a third of this group of children are projected to fail at
least one grade at school. And as you can see, this creates a huge, costly burden to the
educational system. [0:04:16.3]
JOE: Right. Dr. Hanin, Pam Mason has painted a pretty compelling picture of the need for
hearing screening. I guess a question for you is why does the screening need to happen in schools
as opposed to, for example, in an audiologist’s or a pediatrician’s office?
DR. LAURIE HANIN: First of all, I just want to say that I could not agree with Pam more; she is
right on the money. For many years schools have seemed to be the most effective place to ensure
that screenings can happen and that they are done appropriately. I do not really see that a
screening program could possibly be completed out by audiologists in their private offices for a
couple of reasons. I do not think it is reasonable to expect that parents would necessarily bring
their children in one at a time, and because of that it would be far more costly to have it done, if
it even could be done effectively, and it would be very expensive to have audiologists actually do
all the screenings. [0:05:18.3]
In most school programs, as I understand it, the programs are supervised by an audiologist, but
other individuals are trained to do the screenings. I think that staff in a pediatrician’s office
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probably could be trained to do screenings, but I cannot imagine realistically how that effort
would be supervised so that best practices audiologically would be in place.
And I think another reason why it has really been done so much in school, in a way, similar to
the universal newborn hearing screening programs, is that the children are captive in the school,
they are there, and that I think for a long time we have believed that that is the best place to get
to them all at various critical points in time. [0:05:58.2]
JOE: For you, Dr. Hanin, what comes to mind in thinking about what is the most appropriate and
effective way to actually conduct a hearing screening, be it in a school or anywhere else?
DR. LAURIE HANIN: Well, I think it is important to distinguish between, you know, preschool
and school age versus the newborn screening program. So since we are most concerned I think
about that at this moment, you know, traditionally pure tone screenings have been done on
school-age children either through plate (ph) conditioning techniques or children raising their
hand, depending on their age and ability. And I believe that most often it is recommended that
screening be conducted at 1,000, 2,000, and 4,000 hertz at 20 dB. And I do believe that it is most
effective to pair this with tympanometry, or measuring the middle ear function, to be able to
identify which of the referrals may be due to middle ear problems.
I know that some programs incorporate a pure tone threshold surge, which is taking it one step
further to also try to - for those children who do fail the initial screening - to really see if they can
get some information on the level of the potential hearing loss.
I believe that there is now some interest and pilot programs actually underway investigating the
use of autoacoustic emissions for screening in this particular age population, and I do believe that
the efficacy of this should be looked into. And if the results are good, it would definitely be
easier to train staff to do it effectively. It would not require - hardly any cooperation on the part
of the children and probably could be done quicker. [0:07:35.1]
JOE: Pam Mason, what is the national picture with respect to hearing screening of the young in
schools?
PAM MASON: Well, the situation varies from state to state and there is no federal mandate.
However, most states have mandates for hearing screening, and for the states with programs,
each of them may have a different protocol. Who is qualified to screen? How are the screeners
trained? At what year in school did the hearing screenings take place? Are there follow-up
procedures in place to inform parents, physicians, teachers, et cetera? As you can see, there is a
great deal of variability across the nation.
JOE: Are there any examples of stellar programs that are taking place that could serve as models
for other areas of the country?
PAM MASON: Well, I can speak generally. I would say that a state with a mandate to provide
school-based screening, as children enter school, and again, periodically during the school years,
is a good first step. When a state has a program that is administered by an audiologist and has a
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set of standard procedures for training, recording, reporting, I would consider them to be a model
school screening program. [0:08:46.8]
JOE: All right. I would like to ask both Pam Mason and Laurie Hanin about the question of who
is - what type of professional or clinician is in the best position to administer a hearing screening.
Because I know that we are going to be discussing the situation in New York City and that is an
issue in that discussion there. So would you talk about that a bit? I mean what sort of
qualifications or training should a person who is administering hearing screening have? Either
one of you. [0:09:26.6]
PAM MASON: It is Pam. I think you are talking about who is actually doing the screening.
JOE: The screening, yes.
PAM MASON: When I was speaking about administering the program, I meant that there should
be an audiologist as the overseer of all of the components to the program.
JOE: Okay.
PAM MASON: It may include the specific training of the individuals that are doing the
screening. What do you think, Dr. Hanin?
DR. LAURIE HANIN: I agree with you. I think the supervisor of the program and overall
coordinator really needs to be an audiologist, but I do not think that an audiologist needs to be
the one who is actually giving the pure tone screening to the children, especially when we are
talking about school-age children. I think there is a variety of individuals that could do it. I know
that in New York it has been school nurses, paraprofessionals. I think there is a wide range of
people who could be effectively trained if they are trained by an audiologist. [0:10:28.3]
JOE: I see.
PAM MASON: Absolutely.
JOE: Okay, Jim Potter. Jim, in late June 2009, New York City decided to suspend hearing
screening of its public school students, and that move has prompted ASHA to urge Mayor
Bloomberg to restore the screening. Would you please summarize what is known about that
decision, why it is of concern to ASHA, and what action ASHA has taken as a result.
JIM POTTER: Thanks, Joe. The stated reason for the New York City’s Department of
Education’s cancellation of this critical program is based on the statement in their regulations
that the U.S. Preventative Services Task Force does not recommend hearing screening in schoolaged children. [0:11:11.0]
Now, this reference is from an outdated 1996 report that focused on adult hearing screening, but
also recommended against newly born hearing screening as well as hearing screening among
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school-aged children. However, in 2008, the task force took a favorable recommendation for
newborn hearing screening.
It is also our understanding that the task force is currently revising this 1996 report that will
focus only on adult hearing screening and they will not be carrying forward this recommendation
against school-aged screening in its revised report which is due to be released in 2010.
Beyond this, city officials have declined to elaborate on their decision. But clearly, there has
been a paradigm shift in the last 15 years for early hearing detection and intervention among
children, including screening recommendations. And there are serious questions and a general
lack of credibility in the use of antiquated recommendations for the purpose of canceling this
critical program for hearing screening amongst school-aged children in New York City. To
challenge this decision, ASHA has embarked on an advocacy and media campaign to request
that Mayor Bloomberg overturn this decision and reinstate hearing screening program for New
York City school children. [0:12:28.6]
JOE: How has ASHA communicated its position on the decision to the Bloomberg
administration?
JIM POTTER: ASHA’s President, Sue Hale, sent a letter to Mayor Bloomberg and copied other
departments effecting this decision. We have continued to try to contact the mayor’s office and
the other departments, but to date they have not wanted to engage in any explanation or respond
to the letter itself.
JOE: Okay. Dr. Hanin, you are there in New York City. I was wondering if you could comment
on what you know to be the need for hearing screening there and what is your general take on the
fact that it is no longer taking place in public schools.
DR. LAURIE HANIN: Oh, I feel like I have so much to say on this, but I will keep it relatively
brief. The one thing I can say is when I first heard what I thought was a rumor, that New York
City cancelled the screenings, I really thought it was a rumor and then actually went online and
found a memo to the principals from September that said that effective September ‘09 there
would be no more screenings, so I knew it was true. [0:13:47.3]
In New York City, here at the Center for Hearing and Communication where I work, we have
actually received some private funding from foundations and individuals to screen preschoolers
in a variety of different programs, and in the past four years we have screened about 13,000
children to date with a 26 percent failure rate. And now we clearly do not come close to reaching
all of the children, so I know that there are children who are entering kindergarten with hearing
loss. [0:14:15.9]
JOE: Right.
DR. LAURIE HANIN: The majority of these children have conductive hearing loss, and it is
probably temporary. But at the time that they are failing the screening, they are not hearing, and
what we are doing is a pure tone screening and tympanometry. Hearing screening in New York
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City had already been cut quite a bit. My understanding is that what was happening was it had
already been reduced down to screening children upon entry into school at kindergarten and first
grade and it was not being done beyond that. I have some information from people that are
involved in the program that that was not being done consistently either. There are stories that I
have heard from some providers who see the children afterwards, of children who immigrated
from non-English-speaking countries, who were placed in school at age nine or ten without
screenings; one of them went through several months of school and he was deaf. His mother
assumed that the professionals would just figure it out, so she did not let them know. [0:15:22.1]
I think that screening in New York City is very difficult just due to sheer size. In 2008, there
were 128,000 children who were registered in kindergarten and first grade in only the public
schools. So there is no question that there has to be an efficient and accurate method and that is
why I am a little intrigued about the use of autoacoustic emissions, if that would make it easier.
So I know it is definitely a different challenge than in a smaller city. But I would argue that
because of the size, it can almost be more important. And I think it was really not a good
decision and there is no question the children will be hurt by this, and ultimately it will cost more
with more medial education. [0:16:09.1]
JOE: Interesting. Jim, putting aside the New York City situation, AHSA has been a leader in
advocating for hearing screening of the young in other respects. Would you briefly talk about
that and what future advocacy is being contemplated?
JIM POTTER: Joe, ASHA has been a key proponent in fostering federal funding and state laws
for early hearing detection intervention for newborns. Currently, ASHA’s efforts to restore
school screening in New York City is part of a broader strategy to promote hearing screening
among all ages. As part of its hearing screening across a life’s span campaign, ASHA is
developing recommendations for school-age hearing screening and intervention. As Pam noted,
while a majority of states mandate routine hearing screenings, requirements vary significantly.
[0:16:58.3]
ASHA’s efforts will then focus on three areas: one, implementing national uniform standards,
techniques, and protocols for school-aged hearing screening and intervention; two, student and
parent education on hearing loss and hearing protection, much like the anti-smoking efforts in
schools today; and three, promoting classroom acoustics or reducing classroom noise through
federal funding and helping state and local policymakers understand the negative impact that
noisy classrooms can have on a child’s ability to learn.
JOE: Pam, if you are a parent, what steps can you take to ensure that your children are being
screened properly? I am speaking generally. If you are a parent anywhere in the country and you
are listening to this and you want to find out about whether hearing screening is taking place,
what sorts of steps can you take and what sorts of questions should one ask? [0:18:00.8]
PAM MASON: Okay, well, first, if you do know that your particular school district does not
offer school hearing screenings, I would recommend that you advocate with the school to have a
routine school hearing screening program established under the direction of an audiologist, and
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you can contact ASHA to locate more information and resources to support your advocacy
efforts. However, in the meantime, discuss with your family doctor any concerns that you may
have about your child’s speech, language, or hearing. And it is important to follow up on your
concerns and have your child’s hearing fully evaluated by a certified audiologist.
And I would like to add one more thing, please; that it is important to understand that the terms
“mild,” “slight,” or “minimal” can be confusing to a family. These terms underemphasize the
negative effects of - any degree of hearing loss can have on a child’s success at school.
JOE: That is a great point. Dr. Hanin and Jim Potter, if you are a parent with children in New
York City public schools at this point in time, which happens to be October 2009, what options
do you have to get or to advocate for a hearing screening for them? Dr. Hanin, if you would go
first, please.
DR. LAURIE HANIN: Sure. And I just want to - again, a lot of it is similar to what Pam said.
And I really also appreciate her comment about mild not really representing what happens to a
child. There is a statistic that a child with a mild hearing loss can miss as much as 50 percent of
what goes on in a classroom, and I think that that is important for everybody to know.
[0:19:48.4]
In New York City it is very similar to other parts of the country. If a parent has no concern about
their child’s hearing, everything seems to be going along okay and the child has no significant
history of middle ear problems, I would probably recommend asking the pediatrician if they do
screenings in their office, because some do, and that is one area. [0:20:09.9]
If there is any concern whatsoever, then I would talk to the pediatrician and really request a
referral to an audiologist, if possible, one who does work a lot with children, for a full
evaluation. Unfortunately, with the way insurance is most of the time, insurance won’t pay for a
hearing screening. If it did, I think it would be interesting to just have every child screened by an
audiologist, but insurance won’t cover that. And it is probably not necessarily the best route to
say every child without any concern should have a full audiological evaluation. It is probably just
not a doable thing.
JIM POTTER: And Joe, New York City parents, grandparents, and other residents can write or
e-mail Mayor Bloomberg, urging them to reverse this decision, by visiting online at ASHA’s
website, and they can write to takeaction.asha.org. Again, that is takeaction.asha, A-S-H-A, dot
org. [0:21:16.4]
JOE: Very good. This has been a great discussion, everyone. Thank you for your participation.
Listeners are invited to check out other ASHA podcasts at www.asha.org. They can also find an
audiologist and speech language pathologist in their local area at www.asha.org/proserv/.
OPERATOR: Be sure to check www.asha.org periodically for the latest pod cast in this
continuing series.
END TRANSCRIPT
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