In Karnataka, efforts on to combat the challenge of a hidden disability in newborns: hearing impairment

As late identification of hearing problems among the newborns can result in permanent hearing loss, early screening is being done on a priority in Karnataka, with the Mysuru-based All India Institute of Speech and Hearing (AIISH), a premier institute in the field of speech and hearing, under the Union Ministry of Health and Family, successfully running a Newborn Screening (NBS) programme.

Under the NBS, newborns are screened for communication disorders before they are discharged from the hospital they are born in. To do this, AIISH has collaborated with several hospitals to conduct screening programmes to detect hearing impairment and other developmental disabilities that can affect speech and language development. The screening has been helping in early intervention for those identified with the disorders, as any delay in the identification poses a risk, and affects successful management of children with hearing loss, according to AIISH.

AIISH has been running campaigns for early interventions and has joined hands with various hospitals in Mysuru and elsewhere in the State, besides select locations in other parts of the country. “Children born with hearing loss will not develop speech since they don’t hear it and therefore early interventions are a must,” said experts at AIISH here.

First three crucial years

According to AIISH, the first three years of life is the most crucial period for acquiring speech and language skills. Babies acquire speech and language from the time they are born, and one of the ways they learn is through hearing. If they have any problem with hearing and/or other disorders they may have delayed speech and language development, it explains.

As part of NBS, over 60,000 infants are screened every year using state-of-art technology within seven days of their birth at the identified hospitals. The newborns who did not pass the screening test were evaluated in detail within two months of their birth to confirm the presence of hearing loss.

Earlier data said about 3 in 1,000 newborns are known to have permanent hearing loss. But recent data from NBS says it is 5 in 1,000 newborns and for about two of these infants, the hearing loss is permanent These infants typically won’t have any overt signs due to which the hearing loss goes undetected unless a hearing screening test is conducted. It is important to know that hearing loss can be accurately identified right at birth through audiological tests, the institute said in a note during the expansion of NBS.

 “Over 95% of hearing loss cases stem from damage to the inner ear, which is often not visible to the naked eye. It is called a hidden disability,” explain AIISH’s audiologists Indira C.P. and Sandeep M., from the Department of Prevention of Communication Disorders.

The only reliable methods for detecting hearing loss in newborns are objective tests like otoacoustic emissions (OAE) and auditory brainstem responses (ABR). Without these tests, hearing loss may go undetected, preventing children from developing speech. It is scientifically well-established that early intervention is crucial, they explain.

The 1-3-6 rule

The 1-3-6 rule recommends that all newborns undergo hearing loss screening at one month of age. At-risk infants should have a diagnostic assessment at three months, and intervention should start at six months. “Following these timelines will help children with hearing loss develop speech and communication skills on par with their hearing peers,” the audiologists advice, highlighting the significance of early identification of hearing loss in infants.

However, AIISH,  says that the age of identification in India is late — beyond 3 years. It is said based on the reports that less than 1% of newborns in India are screened for hearing loss.

By the time parents notice signs of hearing difficulties such as a lack of response to sounds, it is often too late. This leads to significant developmental challenges for the child and puts an immense burden of hearing disability on the family and society, according to experts at AIISH.

Consequently, AIISH has joined hands with the Department of Health and Family Welfare, Government of Karnataka, to educate medical teams working under Rashtriya Bal Swasthya Karyakram (RBSK) and District Early Intervention Centre (DEIC) on early screening of communication disorders in children.

AIISH collaborates with District Early Intervention Center (DEIC), Mysuru, with the purpose of carrying out newborn screening in the taluk hospitals on a quarterly basis. The AIISH’s team of experts would visit the taluk hospitals on that day to conduct newborn screening and identify at-risk infants. The DEIC team brings the infants born over the last three months to the taluk hospitals on a specified day and the AIISH team would visit the taluk hospitals on that day to conduct newborn screening and identify at-risk infants.

The Department of Prevention of Communication Disorders at AIISH, which is coordinating the ongoing efforts, is dedicated to outreach activities, conducting newborn hearing screening, hearing screening for industrial workers, screening for ear and hearing disorders in schoolchildren, hearing screening for elderly, as its routine activities.

With these efforts, more infants and geographical regions are being benefited by the NBS programme. Those identified through the screening programme are treated either in DEIC or AIISH as per the convenience of the patients.

The importance of rehabilitation

The newborn screening tests are done by experts at AIISH, Mysuru, in three stages – screening, assessment and rehabilitation and sensitisation.

They identify those at risk for communication disorders by screening every newborn for hearing impairment and other developmental disabilities, using state-of-the-art technologies.

A team of experts, including audiologists, speech-language pathologists and ENT specialists carry out the tests to detect newborns at-risk. If the newborn has no risk factors, passing all the tests, then the screening is considered complete, according to the Department of Prevention of Communication Disorders, AIISH.

However, if the infants are identified as at-risk, then they undergo assessment and rehabilitation, and further management by the experts and doctors. Re-screening is done only when the newborn does not pass the screen for certain reasons. The AIISH’s team has been sensitising and educating parents and caregivers to support them in detecting late onset disorders, details accessed from the department said.

Cases are referred to speech and language therapy in at-risk newborns since early intervention is key for the children to overcome the impairment, according to AIISH.