2024.6.20
Starting in 2023, with support from the Aurora Trust, Children’s Hearing Foundation (CHF) initiated a three-year promotional project for pre-school hearing screening. This project aims to raise awareness and ensure the early detection of late-onset hearing loss in children.
” During the screening process, it has been observed that occasionally one or two children do not respond consistently. Public health nurses often ask, ‘Did you hear the sound?’”
“However, how can the tester know if the child raised their hand because they heard the test sound, the question, or simply because they felt the teacher was watching them? How can we better guide children during the screening?”
In a meeting room, audiologists, social workers, and researchers shared their observations from visiting various county governments to understand the current implementation of preschool hearing screening. An essential part of this promotional project is establishing hearing screening procedures and standards, as well as promoting education and training for public health personnel. What is the current clinical reality? What have we learned from visiting different counties and cities? What progress has been made in the promotional project so far? Let me share these insights with you, highlighting the importance of pre-school hearing screening for our children.
Q1: Taiwan has fully implemented newborn hearing screening since 2012, allowing children to be screened within 72 hours and detect hearing loss early. Why then is there a need to promote preschool hearing screening?
A: Despite our collective efforts resulting in a newborn hearing screening rate that ranks among the highest globally, we still occasionally observe older children being diagnosed with hearing loss when they seek assistance from institutions or medical facilities. This is related to mild, late-onset, or progressive hearing loss.
Q2: What are mild, late-onset, and progressive hearing loss? How do they differ from the hearing loss detectable at birth?
A: Due to structural or genetic factors, some children develop hearing loss as they grow older. Others may have very mild hearing loss at a young age that barely passes initial screenings, thus escaping early detection. As these children grow older, their ability to understand and respond to the screening process improves, making it easier to identify hearing loss through behavioral responses. Additionally, hearing can gradually worsen with age. These conditions are difficult to detect during the newborn period. Therefore, an appropriate preschool screening mechanism serves as an effective second layer of protection, establishing an additional defense line to significantly improve the early detection rate of hearing problems in children.
Q3: From a data perspective, what is the current status of pre-school hearing screenings in Taiwan?
A: According to WHO statistics, the average failure rate for pre-school hearing screenings is about 13 per thousand. However, the failure rates in various counties and cities in Taiwan differ not only from this number but also from each other. Some counties and cities even lack annual data due to various factors. In other words, using the population data from the Department of Household Registration of the Ministry of the Interior and the average failure rate as a reference, we can estimate that there are potentially thousands of children with hearing loss in Taiwan who have not been detected in a timely manner.
Q4: Beyond the data, what other insights were gained from visiting various counties and cities to observe the implementation of preschool hearing screenings?
A: Upon visiting frontline operations, we discovered that factors such as funding, the pandemic, and staff turnover or transitions have led some counties and cities to rely solely on “individual experience” for training, with no unified training conducted for many years. This has resulted in discrepancies in screening procedures and standards across administrative regions. Additionally, individual habits have led to the development of different screening methods. These issues are not only present within the same county but also vary between different counties. These underlying factors significantly affect the implementation and consistency of preschool hearing screenings.
Q5: How can we address these issues?
A: After visiting the frontlines and analyzing the existing problems, we hope to improve the entire preschool hearing screening system through a multi-pronged approach involving the public sector, early intervention professionals, and the general public.
For the public sector, it is essential to incorporate preschool hearing screening into national children’s health policies. This includes promoting standardized and accurate screening procedures and restarting screening programs in counties and cities where they are currently not implemented. Regular training sessions should be established in areas lacking standard training.
Early intervention professionals should have access to a series of courses to expand their relevant knowledge and skills. This will help build a qualified network of hearing and speech professionals who can also access continuous professional development opportunities.
For the general public, educational materials on hearing screening and early intervention awareness should be effectively disseminated. By doing so, we can raise awareness about the importance of early detection and intervention.
Additionally, we have already invited experts from various fields, including the public sector, to form a committee dedicated to achieving these goals. This collaborative effort aims to enhance the overall effectiveness and consistency of preschool hearing screening.
Q6: What progress has CHF made in the preschool hearing screening promotion project?
A: Currently, the governments of Keelung, Kaohsiung, Yilan, Nantou, and Tainan have opened their doors to collaborate with us to varying degrees. We are working to structure preschool hearing screening through training for frontline professionals, such as early intervention specialists, childcare providers, and public health nurses who conduct the actual screenings.
In 2024, we have completed four training sessions for public health personnel and plan to hold over eight workshops on hearing and speech knowledge. We hope more county and city governments will recognize the importance of this issue and join the project. Our goal is to eventually incorporate preschool hearing screening into national policy, similar to the newborn hearing screening program. This would create a comprehensive second layer of hearing protection for Taiwanese children, making it easier to detect and address hearing health issues early on.
Full Article Published in NO.45 of the Children’s Hearing Foundation Biannual Journal
