for 

Pediatric Primary Care Providers

for 

Pediatric Primary Care Providers

Just In Time Just In Time

Early Hearing Detection and Intervention (EHDI) Early Hearing Detection and Intervention (EHDI)

DE PAR TMENT

OF

H

E

A

L

T

H

&

HUMAN SE R V ICE S U. SA
Just In Time Just In Time

Hearing Screening Hearing ScreeningBefore ONE month of age: Before ONE month of age:

Evaluation Evaluation Hearing Diagnostic Audiological Hearing Diagnostic AudiologicalBefore THREE months of age: Before THREE months of age:

Early Intervention Early InterventionBefore SIX months of age: Before SIX months of age:

1

3

6

So That Your Patient’s Care Is Right On Time So That Your Patient’s Care Is Right On Time So That Your Patient’s Care Is Right On Time
Just In Time

A Message for the Primary Care Provider

Just In Time

A Message for the Primary Care Provider

Detection and Intervention (EHDI) Detection and Intervention (EHDI)the 1-3-6 goals of Early Hearing the 1-3-6 goals of Early Hearing you and the families you serve meet you and the families you serve meet Just in Time materials can assist Just in Time materials can assist 

children in your practice children in your practicecare for the infants and care for the infants and you provide hearing health you provide hearing health Materials in this kit will help Materials in this kit will help 
Facts About Infant Hearing Loss Facts About Infant Hearing Loss

 3 infants out of every 1,000 have a hearing loss

disordersHearing loss is one of the most common congenital 

 Only 50% have an identified risk factor

two hearing parents90% of infants born with hearing loss have 



improved communication outcomesfor families) before 6 months of age provides Early intervention (programs and services 

 3 infants out of every 1,000 have a hearing loss

disordersHearing loss is one of the most common congenital 

 Only 50% have an identified risk factor

two hearing parents90% of infants born with hearing loss have 



improved communication outcomesfor families) before 6 months of age provides Early intervention (programs and services 

American Academy of Pediatrics Infant Hearing Position, 1999
Just In Time Just In Time

Early Hearing Detection and Intervention (EHDI) Early Hearing Detection and Intervention (EHDI)

Before 1

Month

Before 1

Month


newbornsEnsure hearing screening for all 



page)parent/guardian (refer to risk factors onset or progressive hearing loss with Review results & risk factors for late



evaluation for all “Refers”Schedule diagnostic audiological 



newbornsEnsure hearing screening for all 



page)parent/guardian (refer to risk factors onset or progressive hearing loss with Review results & risk factors for late



evaluation for all “Refers”Schedule diagnostic audiological 

Hearing Screening Hearing Screening

Just In Time Just In Time

Before 1 Month of Age Before 1 Month of Age
Hearing Screening Technologies Hearing Screening Technologies

3⁄4

Otoacoustic Emissions (OAE)

cochleagenerated by the outer hair cells in the OAE measures sound waves (emissions) 

3⁄4

Otoacoustic Emissions (OAE)

cochleagenerated by the outer hair cells in the OAE measures sound waves (emissions) 

3⁄4

Response (AABR)Automated Auditory Brainstem 

to clicks presented via electrodesAABR measures neural responses 

3⁄4

Response (AABR)Automated Auditory Brainstem 

to clicks presented via electrodesAABR measures neural responses 
Just In Time Just In Time

Early Hearing Detection and Intervention (EHDI) Early Hearing Detection and Intervention (EHDI)

Before 3

Months

Before 3

Months


initial screen or re-screenevaluation for babies who do not pass the Schedule a pediatric diagnostic audiological

 If a diagnosis is confirmed:

– Schedule ENT exam and – Refer to Early Intervention (Part C) 

ophthalmology exam

– Provide medical clearance for 

if chosen by the familyhearing aids\cochlear implants\therapies 

– Provide medical referrals: genetics, 

neurology, developmental pediatrics



initial screen or re-screenevaluation for babies who do not pass the Schedule a pediatric diagnostic audiological

 If a diagnosis is confirmed:

– Schedule ENT exam and – Refer to Early Intervention (Part C) 

ophthalmology exam

– Provide medical clearance for 

if chosen by the familyhearing aids\cochlear implants\therapies 

– Provide medical referrals: genetics, 

neurology, developmental pediatrics Diagnostic 

Audiological Evaluation

Diagnostic 

Audiological Evaluation

Just In Time

Before 3 Months of Age

Just In Time

Before 3 Months of Age
Just In Time Just In Time

Early Hearing Detection and Intervention (EHDI) Early Hearing Detection and Intervention (EHDI)

Before 6

Months

Before 6

Months
 Complete the ENT evaluation



follow-up, etcinformation about cochlear implants, including ear molds, hearing aids, Provide pediatric audiology services 



Services (Part C)Enroll child in Early Intervention 



regarding communication optionsProvide family with information 



service providers for continuity of careCommunicate with family and other 

 Complete the ENT evaluation

follow-up, etcinformation about cochlear implants, including ear molds, hearing aids, Provide pediatric audiology services 



Services (Part C)Enroll child in Early Intervention 



regarding communication optionsProvide family with information 



service providers for continuity of careCommunicate with family and other 

Early Intervention Early Intervention

Before 6 Months of Age Before 6 Months of Age

Just In Time Just In Time
Communication Choices

Early Intervention and 

Communication

Choices

Communication

Choices
Communication Choices

It is the family’s choice

Communication Choices

It is the family

’

s choice



Communication programs include: Communication programs include:

American Sign Language (ASL) American Sign Language (ASL)

 Auditory Auditory

-Oral

 Auditory Auditory

-Verbal

 Cued Speech Cued Speech Total Communication Total Communication

with the needs of the child and the family. with the needs of the child and the family.other parents to determine which methodology is compatible other parents to determine which methodology is compatible intervention programs and talking with professionals and intervention programs and talking with professionals and Families could benefit from visiting their state/local early Families could benefit from visiting their state/local early
Primary Care Provider’s Role 

(Medical Home)

Primary Care Provider’s Role 

(Medical Home)

American Academy of Pediatrics American Academy of Pediatricsmaximum potential.” maximum potential.”and their families achieve their and their families achieve their services needed to help children services needed to help children medical and non-medical medical and non-medical to identify and access all the to identify and access all the as partners in a medical home as partners in a medical home professionals and parents act professionals and parents act “The pediatric health care “The pediatric health care 

What is a medical home? What is a medical home?


of agescreened prior to hospital discharge or before one month screened prior to hospital discharge or before one monthEnsure that all newborns in your practice have been Ensure that all newborns in your practice have been 



diagnostic audiology evaluation diagnostic audiology evaluation Refer all babies who do not pass screening for pediatric Refer all babies who do not pass screening for pediatric 



with parents with parentsReview any risk factors and discuss hearing monitoring Review any risk factors and discuss hearing monitoring 

American Academy of Pediatrics, UNHS Brochure for Physicians, 2002

Primary Care Provider’s Role Primary Care Provider’s Role
Onset or Progressive 

Risk Factors for Late 

Hearing Loss

Onset or Progressive 

Risk Factors for Late 

Hearing Loss
Progressive Hearing Loss Progressive Hearing Loss

Facts about Late Onset or Facts about Late Onset or 



any time after birthA late onset or progressive hearing loss can occur at 



develop a hearing lossEven babies who “pass” their initial screening test can 



assessments (every 6 months until 3 years of age)Infants with risk factors need to have periodic hearing 



any time after birthA late onset or progressive hearing loss can occur at 



develop a hearing lossEven babies who “pass” their initial screening test can 



assessments (every 6 months until 3 years of age)Infants with risk factors need to have periodic hearing 
or Progressive Hearing Loss or Progressive Hearing Loss

Risk Factors for Late Onset Risk Factors for Late Onset 

 Family history of childhood hearing loss

with hearing lossCraniofacial anomalies or syndromes associated 



(C)ytomegalovirus, and (H)erpesTORCH (T)oxoplasmosis, (O)ther Agents, (R)ubella, 

 Ototoxic medications (aminoglycosides, diuretics, others) Bacterial meningitis

 Family history of childhood hearing loss

with hearing lossCraniofacial anomalies or syndromes associated 



(C)ytomegalovirus, and (H)erpesTORCH (T)oxoplasmosis, (O)ther Agents, (R)ubella, 

 Ototoxic medications (aminoglycosides, diuretics, others) Bacterial meningitis

Joint Committee on Infant Hearing, 2000
or Progressive Hearing Loss or Progressive Hearing Loss

Risk Factors for Late Onset Risk Factors for Late Onset 



ventilator use, or ECMOPersistent Pulmonary Hypertension (PPHN), prolonged 

 Hyperbilirubinemia (requiring exchange transfusion) Neurodegenerative disorders Head trauma

(lasting 3 months or longer)Recurrent or persistent otitis media with effusion 



ventilator use, or ECMOPersistent Pulmonary Hypertension (PPHN), prolonged 

 Hyperbilirubinemia (requiring exchange transfusion) Neurodegenerative disorders Head trauma

(lasting 3 months or longer)Recurrent or persistent otitis media with effusion 
Thank you for your time. 

Please refer to the websites 

further information.

on the next pages for 

Thank you for your time. 

Please refer to the websites 

further information.

on the next pages for 

Just In Time Just In Time

Brought to you in part by the Provider Education Subcommittee, Family Issues Committee

Brought to you in part by the Provider 

Education Subcommittee, Family Issues Committee
Web Sites Web Sites 

http://www.agbell.orgfor the DeafAlexander Graham Bell Association 



http://www.audiology.orgAmerican Academy of Audiology



http://www.aap.orgAmerican Academy of Pediatrics



http://www.deafchildren.orgAmerican Society for Deaf Children



http://www.asha.orgAssociationAmerican Speech-Language-Hearing 



http://www.agbell.orgfor the DeafAlexander Graham Bell Association 



http://www.audiology.orgAmerican Academy of Audiology



http://www.aap.orgAmerican Academy of Pediatrics



http://www.deafchildren.orgAmerican Society for Deaf Children



http://www.asha.orgAssociationAmerican Speech-Language-Hearing 

For more information: For more information:


http://www.auditory-verbal.orgAuditory-Verbal International, Inc.



http://www.beginningssvcs.comWho Are Deaf or Hard-of-HearingBeginnings For Parents of Children



http://www.babyhearing.orghttp://www.boystownhospital.orgBoys Town National Research Hospital

(My Baby’s Hearing)



Email: ehdi@cdc.govhttp://www.cdc.gov/ncbddd/ehdiEarly Hearing Detection and InterventionCenters for Disease Control and Prevention, 



http://www.auditory-verbal.orgAuditory-Verbal International, Inc.



http://www.beginningssvcs.comWho Are Deaf or Hard-of-HearingBeginnings For Parents of Children



http://www.babyhearing.orghttp://www.boystownhospital.orgBoys Town National Research Hospital

(My Baby’s Hearing)



Email: http://www.cdc.gov/ncbddd/ehdiEarly Hearing Detection and InterventionCenters for Disease Control and Prevention, 

ehdi@cdc.gov

Web Sites Web Sites


http://www.familyvoices.orgFamily Voices



http://www.handsandvoices.orgHands & Voices



http://www.hrsa.govAdministrationHealth Resources and Services 



http://johntracyclinic.orgJohn Tracy Clinic



http://www.jcih.org Joint Committee on Infant Hearing



http://www.familyvoices.orgFamily Voices



http://www.handsandvoices.orgHands & Voices



http://www.hrsa.govAdministrationHealth Resources and Services 



http://johntracyclinic.orgJohn Tracy Clinic



http://www.jcih.org Joint Committee on Infant Hearing

Web Sites Web Sites


http://www.colorado.edu/slhs/mdncfor Infant HearingMarion Downs National Center



http://www.nad.orgNational Association of the Deaf



http://www.infanthearing.organd ManagementNational Center for Hearing Assessment



http://www.cuedspeech.orgNational Cued Speech Association



http://clerccenter.gallaudet.edu/InfoToGoLaurent Clerc National Deaf Education Center



http://www.colorado.edu/slhs/mdncfor Infant HearingMarion Downs National Center



http://www.nad.orgNational Association of the Deaf



http://www.infanthearing.organd ManagementNational Center for Hearing Assessment



http://www.cuedspeech.orgNational Cued Speech Association



http://clerccenter.gallaudet.edu/InfoToGoLaurent Clerc National Deaf Education Center

Web Sites Web Sites
2-25-05

Web Sites Web Sites 

http://www.nidcd.nih.govCommunication DisordersInstitute on Deafness and Other National Institutes of Health, National 



http://www.ed.govRehabilitative ServicesOffice of Special Education and 



http://www.raisingdeafkids.orgRaising Deaf Kids



http://www.tdi-online.orgTelecommunications for the Deaf, Inc.



http:// http://Communication Disorders Communication DisordersInstitute on Deafness and Other Institute on Deafness and Other National Institutes of Health, National National Institutes of Health, National 

www.nidcd.nih.gov www.nidcd.nih.gov



http:// http://Rehabilitative Services Rehabilitative ServicesOffice of Special Education and Office of Special Education and 

www.ed.gov www.ed.gov



http:// http://Raising Deaf Kids Raising Deaf Kids

www.raisingdeafkids.org www.raisingdeafkids.org



http://www.tdi http://www.tdiTelecommunications for the Deaf, Inc. Telecommunications for the Deaf, Inc.

-online.org online.org