Primary care providers are the medical home for NC children and families. Hearing loss is one of the most prevalent permanent disabilities encountered by physicians treating children.
Each year in North Carolina, around 200 babies are diagnosed with permanent hearing loss or approximately 2 of every 1,0000 newborns. Additionally, another 2 to 3 per 1,000 children will acquire hearing loss after birth. Early identification of hearing loss and early intervention are critical to speech, language, social and educational development in children.
As the primary care provider, it is your role to connect families to the appropriate audiological, intervention and consultative medical services to develop a plan specifically designed for the infant identified with hearing loss or identified with factors associated with early hearing loss. The Joint Committee on Infant Hearing Position Statement charges you to “assume responsibility to ensure that the audiological assessment is conducted on infants who do not pass screening and must initiate referrals for medical specialty evaluations necessary to determine the etiology of the hearing loss.” Your cooperation is imperative for ensuring that the child achieves the best possible outcomes.
Hearing Screening in North Carolina
North Carolina passed legislation to require birthing hospitals to screen hearing in 1999 and most hospitals began such screening in 2000. Therefore, the vast majority of infants entering a medical practice in North Carolina will have received a hearing screening at their birthing facility. Results of the Newborn Hearing Screening are sent to the primary care medical practice serving an infant by the birthing facility. Results can also be obtained directly from the NC Early Hearing Detection and Intervention Program office.
Read more in the flyer: Twenty Years of Newborn Hearing Screening in North Carolina.
North Carolina Early Hearing Detection and Intervention (NC EHDI) Program
The NC Early Hearing Detection and Intervention (EHDI) Program's goals are to ensure that all deaf or hard of hearing babies are screened/rescreened by one month of age, are diagnosed by three months, and have received amplification (if warranted) and/or have early intervention in place by six months. If these goals are met, the majority of deaf or hard-of-hearing children can develop normal speech and language skills and function optimally in the hearing world.
The EHDI Program offers consultation, training and education to birthing facilities, medical providers, audiologists, early interventionists and other providers working with infants and children to help meet the EHDI goals.
The EHDI Regional Consultants provide help to families and service providers at no charge.
NC EHDI Advisory Committee
Mission: The EHDI Advisory Committee is committed to the adoption of Universal Newborn Hearing Screening and Early Hearing Detection and Intervention Programs. Our goal is to facilitate the early identification, diagnosis, amplification and intervention of infants and children with hearing loss in order to maximize developmental outcomes.
Purpose: The purpose of the EHDI Advisory Committee is to guide the development, coordination, and quality evaluation of community-based EHDI programs. Specifically,
- To foster an understanding of the Early Hearing Detection and Intervention (EHDI) process within community settings with families and professionals;
- To encourage the development of efficient programs involved in the EHDI process including screening, re-screening, diagnosis, amplification, habilitation, and intervention within community settings;
- To encourage research of EHDI services within community settings; and
- To review NC State EHDI program performance as compared to the National EHDI quality indicators and outcome measurements for a Universal Newborn Hearing Screening Program and EHDI Tracking and Surveillance System.
Most initial hearing screenings are conducted with an Automated Auditory Brainstem Response (AABR) screener, although some hospitals use an Oto-Acoustic Emission (OAE) screener. Both methods screen mid to high-frequency sounds. An AABR screening tests the responsiveness of the complete auditory system from the ear to the brain whereas an OAE screening results from Outer Hair Cell response in the cochlea. It is possible, although rare, for a baby to pass an OAE screening but still have a condition of hearing loss called Auditory Neuropathy/ Dyssynchrony. In this condition, the auditory signal does not arrive in the brain in a synchronous manner and the child will hear a very distorted signal. Thus, the child may not meet speech and language developmental expectations.
Infants who have received care in the NICU represent 10% to 15% of the newborn population and have been shown to have a higher prevalence of elevated hearing thresholds compared to infants from well-baby nurseries (Robertson et al., 2009; Vohr et al., 2000). For complete information review the 2019 JCIH Position Statement, Page 9.
Per JCIH 2019, The equipment used for screening must be calibrated, and annually re-calibrated, by the manufacturer or other entity (e.g., special-instruments distributor or hospital clinical engineering department).
Read frequently asked questions by parents about the newborn hearing screening process and follow-up.
Comparison of Newborn Hearing Screening Equipment:
To learn more about the different newborn hearing screening equipment review this table created by the National Center for Hearing Assessment and Management (NCHAM). The table was last updated in 2021. Additional research may be necessary to identify all available hearing screening equipment.
The NC Early Hearing Detection and Intervention (EHDI) Program’s goal is to facilitate the early identification, diagnosis, amplification and intervention of infants and children with hearing loss to maximize developmental outcomes. National EHDI Goals include the following 1-3-6 timeline:
- Infants complete screening by one month of age;
- Infants needing a diagnostic test have it done by three months of age; and,
- Infants with hearing loss receive intervention by six months of age.
Best Practices for Medical Home Providers
The AAP recommends the first newborn hearing screening test be completed at the birthing hospital (AAP, 2014a); however, there may be an occasional situation when this is not possible. Examples include infants born at home and not screened by the midwife or birth attendant, infants whose parents decline hospital-based screening but later realize the merits of screening and consent to office-based screening, and infants who were inadvertently missed at the hospital for any reason. If, on these rare occasions, the first newborn hearing screen is performed in the medical office, all of the guidelines concerning equipment needs, screening techniques, follow-up, and reporting of results to state entities would apply (AAP, 2014a, 2014b):
- Rescreening of infants must be performed using an automated physiologic measurement (OAE or AABR), not by assessing behavioral responses to environmental sounds or noises (e.g., using whispered speech or noisemakers).
- Physicians who rescreen in the medical office are obligated to report rescreen outcomes (both pass and fail results) to the state EHDI system.
- The equipment used for rescreening must be calibrated, and annually re-calibrated, by the manufacturer or other entity (e.g., special-instruments distributor or hospital clinical engineering department).
- There must be a quiet environment for office-based testing to avoid having children fail the rescreening even if they have normal hearing.
- Office-based personnel who perform the rescreening must be appropriately trained in the use of the equipment.
- Infants who were hospitalized in the NICU and who did not pass a hospital-based screening should be referred directly to a pediatric audiologist and not rescreened in the medical home, due to the increased likelihood of hearing loss including auditory neuropathy (American Academy of Pediatrics, 2014a).
- At the time of rescreening, both ears should be tested, even if only one ear did not pass the screening performed at the hospital.
Surveillance in the Medical Home
The child who has a passing result on newborn hearing screening may develop, or show evidence of, childhood hearing loss. If one to two infants out of every thousand are diagnosed as deaf or hard of hearing at birth, it is estimated that another one to two per thousand will later be diagnosed with permanent hearing loss (Mehra, Eavey, & Keamy,2009). This may reflect delayed-onset hearing loss as well as missed conductive, sensory, or neural hearing loss at the time of newborn hearing screen.
Regardless of previous hearing-screening outcomes, all infants with or without risk factors should receive ongoing surveillance of communicative development beginning at 2 months of age during well-child visits in the medical home (AAP Committee, 2017). Infants who do not pass the speech-language portion of a medical home global screening or for whom there is a concern regarding hearing or language should be referred for speech-language evaluation and audiology assessment.
Risk Factors for Early Childhood Hearing Loss
A significant number of children will pass the newborn screen or rescreen who are still at risk for later-onset hearing loss due to perinatal and/or postnatal risk factors, including (but not limited to) NICU stay, infection, ototoxic medications, or identified syndromes. The list of established risk factors for early childhood hearing loss was revised by the JCIH in 2019*, with the age of recommended audiologic diagnostic follow-up and monitoring lowered significantly for most risk factors to no later than 9 months of age.
In the event that a child in your practice needs to be referred to an audiologist for an evaluation,. it is important that a child be evaluated by a Pediatric Audiologist. Your EHDI Regional Consultant can provide you with the names of such practices in your area.
You can also use the Early Hearing Detection and Intervention-Pediatric Audiology Links to Services (EHDI Pals) website to locate pediatric audiologists in your area. For information concerning what you should expect from a child's audiological evaluation, please see the North Carolina Pediatric Diagnostic Audiology Protocol.
Read questions frequently asked by parents about the newborn hearing screening process and follow-up.
North Carolina has a support system for families of young children with hearing loss. The first step is to identify and diagnose the hearing loss and to complete any necessary medical treatment.
Any amount of hearing loss can affect a child’s speech, language, social, emotional, and educational development. It’s important to take advantage of early intervention services to help deaf or hard of hearing children be as successful and on target as they can be. Many early intervention services are free of charge.
If hearing loss is diagnosed, the following early intervention referrals should be made using the Permission for Referral Form:
The North Carolina Infant-Toddler Program (ITP) provides services for the development of infants and toddlers with special needs and their families. These services are provided through your local Children’s Developmental Services Agencies - CDSA. Evaluation and service coordination are free. A child and family may receive support and services if the child is up to 3 years old and has a developmental delay or established condition, including hearing loss.
Once CDSA services are accepted, a family can be connected with a teacher of the deaf and hard of hearing through the Early Learning Sensory Support Program for Children with Hearing Impairments (ELSSP-HI). They will work on listening skills and language development. These services are different than speech therapy services. If CDSA services are declined, ELSSP-HI cannot work with the family.
BEGINNINGS for Parents of Children who are Deaf or Hard of Hearing: (birth-21 years old) is a non-profit organization that help parents understand the needs of children who are deaf or hard of hearing. They support families as they make decisions about their child, and they assist parents during the early decision-making stages and throughout their educational career.
The American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention (EHDI) program is part of a cooperative agreement between the AAP and the Maternal and Child Health Bureau. The goal of the AAP EHDI program is to improve the effectiveness of newborn hearing screening, diagnosis, and intervention by increasing the involvement of pediatricians, other physicians, and nonphysician clinicians in state EHDI programs.
Centers for Disease Control (CDC) Early Hearing Detection and Intervention Annual Data.
Family Support Resources in North Carolina: EHDI Program resources and NC family support resources.
Funding Information: Medical care for hearing loss can be expensive. You can explore the resources below to find ways to pay for services and devices.
More Resources: Additional North Carolina resources that may help families navigate their child’s hearing loss.
As a family who is learning about your child's hearing loss, we know you may be feeling many emotions. A valuable resource is Family Support.
Family support is a way to connect with other families who have children with hearing loss. Families often feel empowered when they talk to other families who have been on a similar journey and are able to share their stories and provide unbiased support. We encourage you to learn about family support resources available in North Carolina to support your family's needs.
Family Support Resources in North Carolina
EHDI Regional Consultants and Parent Consultants
EHDI has ten regional consultants and two-parent consultants, one of whom is bilingual in English and Spanish. Our staff can help connect your family to available resources.
NOTE: Parent consultants provide service to the entire state.
The EHDI Parent Support Team
The Early Hearing Detection and Intervention (EHDI) Parent Support Team is a diverse network of parents formed to provide parent-to-parent support for families that have a child who is deaf or hard of hearing. Each parent mentor has been trained to provide support for your family in an unbiased way as you and your child navigate the journey of hearing loss. The role of the parent mentor is to listen, help when asked, and connect you to various parent resources available in our state.
See the Parent Support Team flyers for more information.
The EHDI Family Focus Email
This is a monthly email specifically designed for families who have children that are deaf or hard of hearing. At the beginning of each month, you can receive an email that:
- Spotlights a resource in NC for D/HH kids and their families
- A list of community events for families with D/HH kids
- Facts and information to help you advocate for your child
- Personal Stories of families with D/HH children in NC
If you are interested in receiving this monthly email from NC EHDI - You can Subscribe here.
The email is currently available in English but a Spanish Family Focus Email is under development.
The Care Project
The Care Project is a nonprofit organization dedicated to bringing hope to families who have children and/or adults with hearing challenges through counseling experiences aimed at the processing of the emotional stages of grief. Family retreats are organized, funded, and hosted by The CARE Project.
BEGINNINGS for Parents of Children Who are Deaf or Hard of Hearing
BEGINNINGS assists parents of children who are deaf or hard of hearing, deaf parents with hearing children and professionals serving them from birth through age 21 by providing information and support to empower them as informed decision-makers. Support is provided by helping parents access services, promoting early identification of hearing loss and awareness of early intervention programs and educational services.
Hearing Impaired Toddlers and Children Have Unlimited Potential (HITCHUP)
These groups are organized and led by parents of children with hearing loss and share information and support with other families at several locations across the state.
HITCHUP operates mainly via Facebook.
- NOTE: For Facebook pages, you may be prompted to log in to your personal Facebook account before you are taken to the HITCH-UP page. These are private groups so you will need to submit a request to join the group.
Triunfa Caracol Latino: Este es un grupo de apoyo para los padres que tienen niños con pérdidas auditiva de cualquier tipo. Por éste medio nos podemos aconsejar unos con otros, compartir experiencias o simplemente publicar algún comentario relacionado con el tema.
CODA Connections, Inc. is a 501(c )3 non-profit established to serve Deaf families and Children Of Deaf Adults. They strive to connect Deaf families and children to critical resources to ensure each family member reaches their full potential.
- Camp Cheerio (May)in Glade Valley, NC for deaf and hard-of-hearing children and their families of all ages.
- Camp Dogwood (September)in Sherrills Ford, NC for Deaf-Blind adults and teens.
- Camp Woodbine (October)in Raleigh, NC is for hearing-impaired children age 3 and above and their families. Free.
- Sertoma Deaf Camp (June)in Ellerbe, NC is for children ages 8-16 who are deaf, hard of hearing, or signing.
Support resources for general special needs:
Exceptional Children's Assistance Center (ECAC) is dedicated to empowering families and improving lives, particularly for North Carolina families raising children ages 0 to 26 with disabilities. As a non-profit organization operated by and staffed primarily with parents of children with disabilities, we understand the needs of families as they navigate the special education process.
Family Support Network (FSN) of North Carolina enhances the lives of children who have special needs by providing support, education, and caring connections to their families. Find an FSN affiliate program that services your county.
First Resource Center connects individuals with disabilities and their families with the resources they need to thrive in the community including coordinating with government agencies, schools, or community partners. Serving Buncombe, Henderson, and Madison counties.
Children with Special Health Care Needs Help Line (1-800-737-3028)is a toll-free contact for those living with, caring for, or concerned about a child with special health care needs. Callers can learn about health care programs as well as funding resources available to North Carolina residents.
NCCARE360 is the first statewide network that unites health care and human services organizations with a shared technology that enables a coordinated, community-oriented, person-centered approach for delivering care in North Carolina. NCCARE360 helps providers electronically connect those with identified needs to community resources and allow for feedback and follow-up.