Early Hearing Detection and Intervention (EHDI)

Guidelines for Pediatric Medical Home Providers

Newborn Screening Screening Completed Diagnostic Evaluation Intervention Services
Birth Before 1 Month Before 3 Months Before 6 Months
Identify a Medical Home
for every infant Pediatric Audiologic Audiologist Reports to State Continued enrollment
Evaluationb with in IDEA* Part C
EHDI* Program (transition to Part B at
Capacity to Perform: Every child with a permanent 3 years of age)
Hospital-based OAE* hearing loss, as well as all normal
Inpatient Screening ABR* follow-up results Referrals by Medical
OAE/AABR* (only AABR or Frequency-specific Home for specialty
ABR if NICU* 5+ days) tone bursts Refer to IDEA* Part C evaluations, to
All results sent to Air & bone conduction Coordinating agency for early determine etiology
Medical Home Sedation capability intervention and identify related
(only needed for some infants) conditions:
Team Advises Family About: Otolaryngologist
All communication options; (required)
No more
Home different communication modes; Ophthalmologist
than 2
screening
Birthsa Outpatient assistive listening devices (recommended)
attempts
recommended
Re-Screeninga (hearing aids, cochlear implants, Geneticist (recommended)
prior to (OAE/AABR*) etc); parent support programs Developmental
discharge Hearing
All results sent to Loss pediatrics, neurology,
Medical Home Unilateral/Bilateral; Medical & Otologic Evaluations cardiology, nephrology
and State EHDI* Sensorineural/ To recommend treatment and (as needed)
Failed Program Conductive/Mixed;
Screen, or Mild/Moderate/
provide clearance for hearing
Missed, or Normal aid fitting Pediatric audiology
Severe/
Incompleteac Hearing Profound
Behavioral response
Pediatric Audiology audiometry
Pass Failc Ongoing monitoring
Pass Hearing aid fitting and monitoring

*OAE = Otoacoustic Emissions, AABR

= Automated Auditory Brainstem
Ongoing Care of All Infants ; Coordinated by the Medical Home Provider
d
Response, ABR = Auditory Brainstem
Response, EHDI = Early Hearing
• Provide parents with information about hearing, speech, and language milestones Detection and Intervention, IDEA =
• Identify and aggressively treat middle ear disease Individuals with Disabilities Education
Act, NICU = Newborn Intensive Care
• Provide vision screening (and referral when indicated) as recommended in the AAP “Bright Futures Guidelines, 3rd Ed.” Unit, AAP = American Academy of
• Provide ongoing developmental screening (and referral when indicated) per the AAP “Bright Futures Guidelines, 3rd Ed.” Pediatrics
• Refer promptly for audiology evaluation when there is any parental concern‡ regarding hearing, speech, or language development
• Refer for audiology evaluation (at least once before age 30 months) infants who have any risk indicators for later-onset hearing loss: Notes:
- Family history of permanent childhood hearing loss‡ (a) In screening programs that do not
provide Outpatient Screening, infants
- Neonatal intensive care unit stay of more than 5 days duration, or any of the following (regardless of length of stay): will be referred directly from Inpatient
ECMO‡, mechanically-assisted ventilation, ototoxic medications or loop diuretics, exchange transfusion for hyperbiliruinemia Screening to Pediatric Audiologic
Evaluation. Likewise, infants at
- In utero infections such as cytomegalovirus‡, herpes, rubella, syphilis, and toxoplasmosis higher risk for hearing loss (or loss
- Postnatal infections associated with hearing loss‡, including bacterial and viral meningitis to follow-up) also may be referred
- Craniofacial anomalies, particularly those that involve the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies directly to Pediatric Audiology.
- Findings suggestive of a syndrome associated with hearing loss (Waardenburg, Alport, Jervell and Lange-Nielsen, Pendred) (b) Part C of IDEA* may provide
- Syndromes associated with progressive or delayed-onset hearing loss‡ (neurofibromatosis, osteopetrosis, Usher Syndrome) diagnostic audiologic evaluation
services as part of Child Find activities.
- Neurodegenerative disorders‡ (such as Hunter Syndrome) or sensory motor neuropathies (such as Friedreich’s ataxia and
Charcot Marie Tooth disease) (c) Even infants who fail screening in
- Head trauma, especially basal skull/temporal bone fracture that requires hospitalization only one ear should be referred for
further testing of both ears
- Chemotherapy‡
‡Denotes risk indicators of greater concern. Earlier and/or more frequent referral should be considered. (d) Includes infants whose parents
refused initial or follow-up hearing
screening.
February 2010 - American Academy of Pediatrics Task Force for Improving Newborn Hearing Screening, Diagnosis and Intervention (www.medicalhomeinfo.org)
Appropriate Referrals 1. Audiologist knowledgeable in pediatric
screening and amplification
5. Speech/language therapist and/or aural rehabilitation
therapist knowledgeable in pediatric hearing loss 9. Equipment vendor(s)
Name: Name: Name:

Telephone number: Telephone number: Telephone number:

Fax: Fax: Fax:

Date of referral: Date of referral: Date of referral:

2. Otolaryngologist knowledgeable in 6. Sign language classes if parents 10. State EHDI Coordinator
pediatric hearing loss choose manual approach http://www.infanthearing.org/status/cnhs.html

Name: Name: Name:

Telephone number: Telephone number: Telephone number:

Fax: Fax: Fax:

Date of referral: Date of referral: Date of referral:

7. Ophthalmologist knowledgeable in co-morbid 11. AAP Chapter Champion

3. Local early intervention service coordinator conditions in children with hearing loss www.medicalhomeinfo.org/screening/hearing.html

Name: Name: Name:

Telephone number: Telephone number: Telephone number:

Fax: Fax: Fax:

Date of referral: Date of referral: Date of referral:

8. Clinical geneticist knowledgeable

4. Family support resources, financial resources in hearing loss 12. Family physician(s)
Name: Name: Name:

Telephone number: Telephone number: Telephone number:

Fax: Fax: Fax:

Date of referral: Date of referral: Date of referral:

The recommendations in this document do not indicate an exclusive course

National Resources of treatment or serve as a standard of medical care. Variations, taking into
account individual circumstances, may be appropriate.
Alexander Graham Bell American Speech-Language- Hearing Laurent Clerc National Deaf National Institute on Copyright © 2002 American Academy of Pediatrics, revised 2010. No part
Association for the Deaf and Association (ASHA) Education Center and Clearing- Deafness and Other of this document may be reproduced in any form or by any means without
Hard of Hearing (AG Bell) 800/498-2071 house at Gallaudet University Communication prior written permission from the American Academy of Pediatrics except
202/337-5220 www.asha.org clerccenter.gallaudet. Disorders (NIDCD) for 1 copy for personal use.
www.agbell.org edu/InfoToGo 800/241-1044
Boys Town Center for www.nidcd.nih.gov This project is funded by an educational grant from the Maternal and
American Academy of Audiology (AAA) Childhood Deafness Child Health Bureau, Health Resources and Services Administration,
National Association of
US Department of Health and Human Services.
800/AAA-2336 www.babyhearing.org the Deaf (NAD) Oberkotter Foundation
www.audiology.org 301/587-1788 www.oraldeafed.org
Centers for Disease Control www.nad.org
American Academy of Pediatrics and Prevention
847/434-4000 www.cdc.gov/ncbddd/ehdi National Center on Hearing
www.aap.org Assessment and Management
Families for Hands and Voices (NCHAM)
American Society for Deaf Children 217/357-3647 435/797-3584
717/703-0073 www.handsandvoices.org www.infanthearing.org
www.deafchildren.org