5. Hearing screening programs around the world

The major aim of hearing screening program is to detect a disease at a stage when treatment can be effective in reducing long-term complications [24]. According to the estimates provided by the World Health Organization (WHO), nearly 7.5 million children suffer from hearing loss [25]. Around 80% of them live in low- to middle-income countries [26].

In the absence of a systematic effort to screen infants with hearing loss, the average age of detection is well over 2 years, and detection may be as late as 6 years in sub-Saharan Africa [27]. In Kenya, many children with hearing impairment are not identified until 5–7 years old due to stigma, while some are hidden and are never diagnosed [28].

India launched the National Programme for Prevention and Control of Deafness. Under this program, the following two-part protocol for infant hearing screening is being complemented: institution- and community-based screening. First, screen every baby born in a hospital or admitted there soon after birth using OAE and second, screen babies who are not born in a hospital; screening is carried out using a brief questionnaire and behavioral testing.

In 2011, 97.9% of babies born in the United States had their hearing screened in the first few weeks of life according to Centers for Disease Control and Prevention (CDC) [29].

In Europe and England, two models are used: first, in hospital before discharge, if discharge takes place before the test is completed, a letter is sent asking the mother to attend an appointment for the screening test and second, in some areas, the test is done at home by a health visitor nurse.

Although newborn hearing screening programs have greatly improved outcomes for those diagnosed with hearing loss in the immediate newborn period, there is no objective universal screening protocol in place during the critical early development years [28]. Unfortunately, school-age children are rarely screened for hearing loss during routine clinical examination, and health authorities pay little attention to audiometric evaluation particularly in primary schools.

#### 5.1. Comprehensive approach to hearing screening in Poland

One of the priority activities of the Institute of Physiology and Pathology of Hearing in Kajetany is a screening program for children of all ages. The Institute team, in collaboration with numerous national centers, has laid the groundwork for screening programs and developed methods, procedures, and devices for carrying out them. He was the coordinator and producer of many programs. Based on this, two screening models have been created—newborn and school-age children.

#### 5.1.1. Newborn hearing screening

4.4. Play audiometry

118 An Excursus into Hearing Loss

3. Average time: 15–30 min test

3. Average time: 15- to 30-min test

4.5. Pure-tone audiometry

Behavioral test of auditory thresholds in response to speech and frequency-specific stimuli is presented through earphones and/or bone vibrator. This test is dedicated to children of 2–4 years old. A test that uses a special audiometer which is able to transmit sounds at different volumes and pitches into child's ears. This test is modified slightly in the toddler age group and made into a game. The toddler is asked to do something with a toy (such as touch or move a toy) every time when a sound is heard through earphones. Air-conduction hearing threshold levels of greater than 20 dB at any of these frequencies indicate possible hearing impairment. This test relies on the cooperation of the child, which may not always be given.

1. Advantages: ear-specific results; assesses auditory perception of child

earphone. In that test, the most important is the cooperation of the child. 1. Advantages: ear-specific results; assesses auditory perception of child

5. Hearing screening programs around the world

[25]. Around 80% of them live in low- to middle-income countries [26].

due to stigma, while some are hidden and are never diagnosed [28].

2. Limitations: depends on the level of understanding and cooperation of the child

The major aim of hearing screening program is to detect a disease at a stage when treatment can be effective in reducing long-term complications [24]. According to the estimates provided by the World Health Organization (WHO), nearly 7.5 million children suffer from hearing loss

In the absence of a systematic effort to screen infants with hearing loss, the average age of detection is well over 2 years, and detection may be as late as 6 years in sub-Saharan Africa [27]. In Kenya, many children with hearing impairment are not identified until 5–7 years old

India launched the National Programme for Prevention and Control of Deafness. Under this program, the following two-part protocol for infant hearing screening is being complemented: institution- and community-based screening. First, screen every baby born in a hospital or

2. Limitations: attention span of child may limit the amount of information obtained

Behavioral test measuring auditory thresholds in response to frequency-specific stimuli is presented through earphones for children of 4 years and older. A test that uses a audiometer which is able to produces sounds at different frequently and intensity into child's ears. The child usually wears some type of earphones. Each ear should be tested at 500, 1000, 2000, and 4000 Hz. Results greater than 20 dB at any frequencies indicate possible hearing loss. In this age group, the child is simply asked to respond in some way when the tone is heard in the

> The foundation on which the modern screening system was based was a research program for 150,000 newborns with funds in 15 neonatal and infants' centers in Warsaw. It was realized in 1992–1994 under the direction of Professor Maria Góralowna, and we cooperate with the team Diagnostic-Therapeutic and Rehabilitation Center "Cochlear Center" headed by Professor H. Skarżyński.

> In the years 1995–1998, under the direction of Professor H. Skarżyński, a grant awarded to the Minister of Health, "Development of a unified screening program for neonates with hearing defects" was implemented. As part of the program, methods and procedures for screening hearing in newborns were developed, as well as their models - universal and intended for newborns at risk. At the end of the project, a draft of the Minister of Health was prepared for hearing screening in neonates.

> In 1998, the grants were awarded the team award of the Minister of Health first degree. Another important initiative was implemented in 1996-1998, when the Institute of Physiology and Pathology of Hearing participated in the European program "European Concerted Action AHEAD (Advancement of Hearing Assessment Methods and Devices). This program aimed to develop a common European position on hearing screening for newborns.

> In 1998, in Milan, a consensus on universal screening of hearing in newborns in Europe was signed. The signature on the Polish side was by Professor H. Skarżyński.

In the years 1998–2001, in the framework of the Government Action Plan for Disability Achievement, in which several dozen centers participated, hearing screening were disseminated and enriched. Alternative diagnostic, therapeutic, and rehabilitation facilities have been created for future screening programs. In 70 centers, more than 60,000 newborns and infants were examined.

"EU Council Conclusions on Early Detection and Treatment of Communication Disorders in

Hearing Screening around the World http://dx.doi.org/10.5772/intechopen.73535 121

Thanks to all these activities, Poland is currently at the forefront of countries that perform

Every large-scale project involving children or adults is a great opportunity for early detection of congenital or acquired defects. In response to social needs related to the early detection of birth defects and acquired by detection and prevention, the Institute of Physiology and Hearing Pathology was involved in the implementation of the project, which was named System of

The project's innovation is the use of a system to assist patients with remote diagnosis and to transfer the results of their research to the health services sector. Integrating patient data into the "SZOK"® system will allow for quick service and thus shorten patient waiting times for visits to IFPS or other specialized facilities and as a comprehensive patient medical base. The system can also be successfully used in other healthcare and other medical fields. It is a unique solution in the field of telemedicine and e-health and is an excellent starting point for the

Moreover, a standard for the transmission of audiological screening results has been implemented in the "SZOK"® system, which is developed within the Institute's project, so that it is adapted to obtain research results from other institutions and collect them in one place

Children, including the use of eHealth tools and innovative solutions".

5.1.3. System of integrated communication operations "SZOK"®

Integrated Communication Operations "SZOK"®.

Figure 1. System of integrated communication operations "SZOK"®.

Center for Screening.

(Figure 1).

hearing screening in children of all ages.

#### 5.1.2. School-aged children hearing screening

In 1999, the team of the Institute of Physiology and Pathology of Hearing collaborated with Brigham Young University of the United States and University of Michigan. M. Curie-Skłodowska from Lublin conducted pioneering screening of hearing in various regions of the country in a group of about 6000 children and adolescents in school age. Studies have shown that every 5 children aged 6–18 have hearing problems.

As part of the implementation of various programs (e.g., the Ministry of Health—the "Program for the Care of Persons with Hearing Loss in Poland"—the Mazovian Regional Health Service, the Ministry of National Education and Sport) conducted by the Institute of Physiology and Hearing Pathology in the years 2000–2006 in cooperation with the dozens of centers around the country, modern multimedia tools are developed for hearing screening. To use the program "I hear …" has trained over 3500 people and screened many centers. In cooperation with the Gdansk University of Technology, highly specialized systems such as "I can hear…," "I can see…," and "I can speak…" have been developed. About 16 million people from 62 countries have used the Internet.

Since 2007, a hearing screening program has been launched in Warsaw for children in class VI. Since 2011, the program also includes children in first grades. In total, these programs have covered up to now more than 56,000 children in Warsaw.

In the years 2008–2011, the programs were conducted by the Institute of Physiology and Pathology of Hearing in cooperation with the Contribution Fund of Social Insurance of Farmers and the Agricultural Insurance Fund Social screening in rural centers and small towns. Within these programs, nearly 300,000 children were studied.

In 2008, new multimedia tool—Platform for Sense Examination—used in screening was developed by the Institute of Physiology and Hearing Pathology in cooperation with the Institute of Sensory Organs. In addition, local screening programs were implemented, within the Ministry of National Education, which involved around 500 psychological and pedagogical clinics throughout the country.

In June 2007, the Institute team organized an exhibition at the European Parliament in Brussels. "HEAR-VISION-SPEAK" is the basis of communication and integration of the young generation of Europe. The exhibit was accompanied by a series of lectures, and numerous audiophiles and audiologists were examined by MEPs. The abovementioned actions aimed to draw Europeans' attention to the major social problem of communication disorders.

The exhibition was an introduction to further European activity. More than 3 years of negotiations and preparations resulted in the signing of the European Consensus on Audiology, Vision and Speech Screening in preschool and school children on June 22, 2011. There was great support during the Polish Presidency and an important argument for the adoption of the "EU Council Conclusions on Early Detection and Treatment of Communication Disorders in Children, including the use of eHealth tools and innovative solutions".

Thanks to all these activities, Poland is currently at the forefront of countries that perform hearing screening in children of all ages.
