Hearing Test Called a Blessing

Ryan Yager was born on Sept. 17, a full-term, 9-pound second son of Oxford residents MaryEllen and Dan Yager. The pregnancy was uneventful and progressed normally. He was a cute, chubby and happy baby.

However, what his parents could not have known was that Ryan was born with a severe hearing impairment. If he had been born in California where his 5-year-old brother Garrett was born, it may have taken the Yagers as long as two years to realize that their son had a severe hearing impairment.

Instead, Ryan was born at Duke University Hospital, where for more than a year, audiologists have been performing hearing tests on all newborn babies.

"At first, when they mentioned the test, I didn't give it much thought," MaryEllen Yager recalls. "Our first son was born in California, and they didn't do a hearing test. It is really a blessing to now live in a state where they do these tests. We've been told there is a very good chance that Ryan will be able to develop communications skills because it was detected early."

A baby's brain undergoes key neurological developments during the first year or so of life, allowing the child to acquire language skills, according to the Duke experts.

At the end of 1999, Duke University Hospital began routinely screening all newborn babies for hearing impairments. Before then, Duke had been screening only those babies who were considered to be at high risk for hearing disabilities -- those with deaf parents, in the neonatal intensive care unit, and born prematurely.

Beginning in October 2000, all hospitals within North Carolina are required by state law to perform hearing screening tests on all newborns.

"Ryan is a classic example of the type of baby this program was designed for," said Ann Mabie, a Duke audiologist. "He and his mother had none of the traditional risk factors. Research has shown that more than half of children with hearing impairments are born without any of the risk factors. Hearing impairments usually aren't found until the age of 2, but by that time, much of the crucial period for language development has passed."

The test itself is called an Auditory Brainstem Response (ABR) test. It is simple and non-invasive, and is usually performed while the newborn sleeps. Audiologists place a tiny set of earphones in the baby's ears and attach three electrodes on the baby's head. Clicks are played through the headphones, and the electrodes record the brain's activity in response to the clicks.

The test can take between three and 20 minutes, depending on the baby. It can be performed on newborns as young as 12 hours after birth.

When his impairment was first discovered by ABR a day after birth, and confirmed in the following days by additional tests, Ryan was the first case of hearing impairment revealed by the new program.

Since Ryan's birth in September, three more babies born at Duke who would not have fit within the high-risk category were also detected with varying levels of hearing impairment. Their deficits were confirmed by further testing and audiologists at Duke have already started treatment strategies for them.

"The good news is that if we catch the deficits early we can begin doing things to improve these babies' chances of normal language acquisition," Mabie said.

In Ryan's case, that means first fitting him with a hearing aid. After the initial fitting, he will return to Duke audiologists periodically to refine the aid's capabilities as they learn more about his specific deficits. Depending on the results of further tests, he will also likely have speech therapy as well.

It is estimated that as many as 24,000 babies are born in the United States with a hearing disability, making it the most common disability in newborns, Mabie said. Its incidence is higher than such conditions as cerebral palsy, cystic fibrosis and Down's syndrome.

"It's crucial that we identify these babies early, because depending on the reason for the impairment, there are many strategies or therapies we can use to make sure that the baby does not fall behind in acquiring language," Mabie said.