Universal screening for infant hearing impairment : not simple, not risk-free, not necessarily beneficial, and not presently justified

In our judgment, before any societal decision is made as to whether to institute a universal screening program for hearing impairment in young infants, many questions for which answers are not now available must be answered. To answer those questions will require extensive research. Clearly, the authors of the Consensus Statement were not unmindful of the scope of the problem, for they included in the Statement a listing of proposed future studies they considened important. Among these were: "controlled trials of screening by audiologists versus trained non-professionals on volunteers; controlled trials of the influence of different settings...on the effectiveness of screening procedures; comparison of early intervention with later intervention...; evaluate the validity and reliability of screening instruments...; test the feasibility of screening methods...in infant populations...in remote satellite clinics...; determine whether a two-tier screening system...wonks better than [a single scneen]...study the cost-effectiveness of universal screening for infant hearing impairment." We heartily agree that these studies, and other studies, are important—indeed, crucial. So crucial, in fact, that, until they have been conducted and their results tabulated, no rational decision on undertaking universal screening for infant hearing loss is possible. We, too, believe that early identification is important; however, the precipitate launching of mass screening could work to deter the eventual development of an effective early identification program. In the meantime, to identify infants at risk for hearing impairment, continued reliance on the high-risk register as recommended by the Joint Committee on Infant Hearing,4 but in combination with an automated rather than conventional ABR screen, seems to be a more practical, cost-effective approach.