Adventures in Hearing

Also known as Adventures in Despair…

Actually, that may be too strong…Adventures in Supreme Dislike and Urgent Hopefulness is more like it.

As an SLP I know how important hearing is…I also know how important early intervention is…So newborn hearing screenings just makes sense. Particularly when we consider how much better the prognosis is for those children identified (and supported*) early. When we consider the prevalence of newborn hearing loss it seems vital…The American Academy of Pediatrics reported that hearing loss effects as many as 3 infants per 1,000. 

Now, I realize that there is such a thing as too much regulation…but seriously? Why would any state NOT want to endorse mandatory newborn hearing screenings?

“According to the American Academy of Pediatrics, hearing loss is one of the most frequently occurring birth defects; approximately 3 infants per 1,000 are born with moderate, profound or severe hearing loss.  Hearing loss is even more common in infants admitted to intensive care units at birth.” That insert was from the National Conference Of State Legislation. The information there may be a bit old, it was last updated in 2011, but I have an unhappy suspicion it’s probably about right.

Let’s do a little math (I know right? I don’t do math, just ask me…but even I can figure this out). A newborn hearing screening typically costs about $10-$50 per baby. The cost for a child to receive special education services from school-age to graduation, is approximately $400,000. Now granted, there will be early intervention costs – and some costs in school…but if hearing loss is identified (and supported*) early it may not be necessary to have a student in special-education the entire time. It’s no longer a game of playing catch-up (and never really succeeding), but rather the task of teaching differently early on. Now, granted, I am not a mathematician (trust me! I’m not…) but it doesn’t take a budget genius to figure out what is more cost-effective. Okay…let’s get some perspective here…

North Dakota live births per year: 8,974 (2009)

(Now this math gets a bit trickier)… If 3 out of 1000 births are affected (9×3) – then in North Dakota alone there were nearly 27 children born with a moderate to profound hearing loss. Cost for screening those 27 children= $1,350. If those children were not identified the cost for special education for them could be as high as $10,800,000…hmmm…

California live births per year: 526,774 (2009)

In California there were 1,578 (526×3) children born with a moderate to profound hearing loss. Cost for screening those 1,578 children = $78,900. That gives a special education cost of $631,200,000.

US live births per year: 4,130,665 (2009)

In the US (4,130×3) the number of newborns affected was 12,390. Cost for screening those 12,390 = $619,500. That means, that without newborn hearing screenings, the projected cost for special education for those babies born in the US in 2009 with moderate-profound hearing loss was $4,956,000,000. . Wow…that’s just 2009. I don’t even want to contemplate 2010, 2011, and 2012.

To me, it just makes sense that $50 spent early on is FAR better than $400,000 or bigger picture… $619K is better than nearly $5billion (and lots of heartache) later. Why is it then that there are still some states that don’t require newborn hearing screenings? It’s not invasive or dangerous to the infant. ABRs are quick, painless, and can be done asleep or awake.

According to Newborn Hearing Screening State Laws  there are only 36 states that require newborn hearing screenings to be performed. Thirty-six? I’m ashamed to admit that the state I currently work in (North Dakota) is one of the 14 that doesn’t. Only 17 states have laws that say insurance should pay for the hearing screenings. Some states require birthing centers to screen, but hospitals don’t have to, etc…it seems as though there are a lot of loopholes.

One day…(hopefully soon)…we will quit playing Russian Roulette with our infants. We will be in a place where ALL infants regardless of where they are born (birthing center, hospital, home, side of the road) will have a newborn hearing screening soon after birth…and where those infants identified with hearing loss will receive treatment immediately to help minimize difficulties. It’s time to be pro-active and not re-active.

So…tell me. Does your state/province/country require newborn hearing screenings? Did you have to look it up? (I did..I thought ND required it – I was very disappointed to see we did not). Are you for or against screening infants? Drop me a line and let me know.

Until then…Adventure on!


* Updated to change wording. A kind reader reminded me of a poor word choice I made. We don’t “treat” hearing loss. It’s not a disease like a cold…it’s a way of life. She suggested the word “aided” to show the use of amplification which I disagreed with because. I chose the word “support” to show all levels of support that is accepted/offered/availed/used by the individuals with hearing loss and their loved ones. Whether that “support” includes amplification, immersion in the Deaf community, resources in the school, etc. Regardless of the choice of words – the sooner support is offered to these children and their families – the better the outcome…and that, after all is what’s important. Thank you Stephanie for reminding me – words are powerful. I appreciate your insight.

6 thoughts on “Adventures in Hearing

  1. Sadly, our newborn hearing screening procedures are good but not great. An incredible number of children are lost in the follow-up process. As an SLP who focuses on working with children with hearing loss, I can tell you that more than half of my patients, who are now being identified at two years-old, have parents who do not know if their kid passed NBHS.

    I also caution you with your word choice. Be careful when using words like “treated” with hearing loss. The great divide between the worlds of ASL and Listening and Spoken Language is a heated one. Using terms such as “treated” makes hearing loss appear to be a disease, which I guarantee will upset people in the Deaf community and possibly others as well. I recommend “aided” to indicate the child has been fitted with amplification. You can research more on numbers, language and current issues at (AG Bell’s website)

    • Good point about the word use Stephanie. However, I believe “treated” goes beyond “aided” which is why I used it. To me, I choose the word treatment because it goes beyond amplification. Sometimes the “treatment” is counseling, or signing…and sometimes it includes amplification. I work with students even if they are not “aided.”

      I am most definitely aware that hearing loss is not a disease…Neither is a speech difference, a learning difference, or any of the other difficulties for which I see children.

      I’m also aware that many people in the Deaf community opt to not receive any services for their children with hearing loss and I respect that decision. Perhaps there’s a better word for the help these children receive than treatment or aided. Something that encompasses the whole child and not just the hearing mechanism.

      None of the parents of my students knew if their child had a NBHS or not let alone whether or not they passed. Looking at the criteria for when NBHS’s are supposed to occur, it doesn’t surprise me. Even in the states where it is mandated – it doesn’t cover every hospital or home births.

      Thanks for your comment…and your reminder of word choices. I’ll definitely update the post when I find a more appropriate word. 🙂


  2. I believe it’s a law in CT. Both my kids were screened before leaving the hospital. It was nice to have peace of mind.

  3. Ok, I love you Mary! And I agree with you on the screening.

    However, let’s get the math right (I had bad statistics–it’s just ingrained into my being at this point)

    To catch those few infants with hearing loss, you have to test ALL the infants. If you knew which were the ones with hearing loss, you won’t need to screen them! So, the math looks more like this:

    Area Births Hearing Loss Cost of Screening Cost of Care Difference
    ND 9000 27 $450,000 $10,800,000 $10,350,000
    CA 526000 1,578 $26,300,000 $631,200,000 $604,900,000
    US 4,130,665 12,392 $206,533,250 $4,956,798,000 $4,750,264,750

    Now, like I said, I agree with you 100% on the screening.

    My only caveat is that it should be mandated right AFTER Pulse Oximiter screening ( which detects >90% of Congenital Heart Defects and would save lives, not money.


Comments are closed.