The Need for Universal Hearing Screens for

The Need for Universal Hearing Screens for
Policy
Brief
The Need for Universal Hearing
Screens for Quebec Babies
Julie Cumin
McGill University
Fall 2014
In the fall of 2014 the IHSP welcomed eleven McGill students from across the University
for a 14-week Internship. Training sessions focused on communicating research
findings to the media or general public, and gaining insight into different disciplinary
approaches. In addition to in-depth research projects carried out in collaboration with
faculty and staff, interns devoted ten to fifteen hours to short policy projects on a topic
of their choice. Students were asked to frame an issue, find at least two points of
supporting evidence and develop rudimentary policy recommendations. The following
document reflects the short timeframe given to students to complete this task, and may
not be a polished product.
Please note the opinions reflected in this document do not necessarily reflect the
opinions of the IHSP.
Two out of 1000
THE NEED FOR
UNIVERSAL HEARING
SCREENS FOR QUEBEC
BABIES
newborns are
born with
hearing loss,
hindering their
speech
THE ISSUE
Two out of 1000 newborns are born with hearing loss, hindering
their speech development. Without appropriate early assistance
such as cochlear implants, these children may not be able to
perform normal activities for their age group, and will
require specialized education at a high cost for Quebec's
government.
When newborns benefit from immediate hearing screens,
interventions can begin instantly to ensure better success rates of
hearing aids and cochlear implants, in order to promote normal
speech development.
Quebec Health Ministry should implement newborn hearing
screens, which lead to early intervention, encouraging normal
speech development.
DESPITE QUEBEC’S GOVERNMENT
ANNOUNCING A PLAN FOR PROVINCEWIDE NEWBORN HEARING SCREENS IN
2009, ONLY 20-25% OF BABIES WERE
TESTED IN 2013.
Cover photo source: https://www.flickr.com/photos/rharrison/5798161758/
development.
Context: Why It matters
Children who suffer from hearing loss at birth are at a severe disadvantage for developing normal
speech. This often causes poor performance at school and limits career options. In Montreal, two
schools for the deaf offer specialised education, at a cost of around $30,000 per year per child for
their pre-school program (compared to around $10,000 a year for Quebec’s most expensive
private pre-schools). Technology such as cochlear implants can permit normal speech
development, especially if implanted before the age of 2. In cases such as these, many children
enter the first grade with language skills very close to those of children their age with normal
hearing. These implants are completely covered by RAMQ if they are necessary to a child’s
language development.
The Montreal Oral School for the Deaf and Mackay Centre Schools in Montreal offer several
programs for infants, pre-schoolers and school-aged children up until the end of high school,
which integrate children with hearing loss into the public school system.
Studies have demonstrated that earlier hearing screens lead to earlier diagnosis, which
has a significant impact on age of cochlear implementation and spoken language
acquisition.
WHAT ARE THE BENEFITS?
Educational Benefits: Including children with hearing impairments in regular classrooms has
additional benefits. Studies suggest that inclusive classrooms significantly improve sensibility and
academic performance of both disabled and typical students. This effect is especially strong in
elementary school, supporting mainstreaming of children with hearing loss as soon as possible.
WHAT TECHNOLOGY IS AVAILABLE?
The two technologies that currently exist to test newborn hearing are:


Otoacoustic Emission Test (OAE)
o Most cost-effective
o High rate of false positive error (around 15%)
Auditory Brainstem Response Test (ABR)
o Child must be asleep or otherwise immobilised (requires anaesthesia after 6
months old)
o Thorough testing can take up to 2 hours
o Very accurate
Considering the lower cost of OAE, it should be implemented province-wide to test
newborns’ hearing, with ABR being recommended as soon as possible if the infant fails the
first test (in order to also avoid possible complications with anaesthetics).
Economic Benefits: Lifetime cost of a cochlear implant is around $90,000—significantly less
than the cost to the government for children who do not receive intervention early, and require
specialized education, resulting in decreased employability and higher education costs. A
newborn hearing screen is completely non-invasive, lasts approximately 10 minutes and yet the
Quebec National Institute for Public Health estimates a net benefit of $1.7 million a year, mostly
due to increased mainstreaming into public school (saving approximately $20,000 per year per
child) and increased career opportunities.
Quebec Should Lead the Way
Speech-Language and Audiology Canada released their annual “Universal Newborn Hearing
Screen” report card for 2014, with Quebec ranking 9th out of 13 Canadian provinces and territories
on percentage of newborns in the province receiving this screen (currently about 20%). With
Quebec often ranking first in Canadian healthcare quality, a leadership stance on this issue should
be expected, not only to maintain this status but also to encourage other provinces to follow in its
lead. There is no real prevention for hearing loss at birth and therefore newborn hearing screens
are currently the method leading to the best outcomes.
RECOMMENDATIONS
The Quebec Coalition for Newborn Hearing Screens should continue to lobby
the government and propose realistic implementation programs (cost of technology, training of
nurses, referrals etc.…).
Hospitals should carry pamphlets and nurses should inform new parents of the potential risks
of hearing loss, in order to increase pressure on RAMQ to provide this service indiscriminately
and free of charge.
Private audiology clinics
would still benefit from parents choosing to privately conduct
further hearing tests following a failed newborn test, and would not lose receivers of cochlear
implants from private healthcare.
Quebec Health Ministry should implement newborn hearing screens, which lead to early
intervention, encouraging normal speech development.
Screen all newborns
WIN-WIN OUTCOME:
Universal Newborn Hearing Screens is a politically blind issue, with few negative outcomes, the
worst of which is false positive rates, which would mean unnecessary further testing. However,
positive outcomes can be life changing for children with hearing loss and their families, at the
cost of 15minutes and a $25 non-invasive, painless test. The Quebec government needs to
follow through on a promise that has been pending for five years and that will ultimately result in
a new benefit.
SOURCES
http://www.ncbi.nlm.nih.gov/pubmed/24383227
http://www.newuniversity.org/2009/11/news/uci-research-with-cochlear-implants-no-longerfalling-on-deaf-ears/
http://www.nejm.org/doi/full/10.1056/NEJMra0911225
http://sac-oac.ca/sites/default/files/resources/Report%20Card-2014_EN.pdf
http://onlinelibrary.wiley.com/store/10.1111/j.1467-9604.1996.tb00046.x/asset/j.14679604.1996.tb00046.x.pdf?v=1&t=i2evv8mp&s=56cbc566e8abc3e70a5ffc0549c94daaa03cb339
Institute for Health and Social Policy, McGill University
1130 avenue des Pins Ouest
Montréal, QC, H3A 1A3
www.mcgill.ca/ihsp
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