The Republic, Andrew Laker, Associated Press
ADVANCE FOR MONDAY FEB. 20 - In this Feb. 3, 2012 photo, Alma Salas, right, holds her one-year-old daughter Jihovana Sandoval-Salas as Early Head Start family support worker Carla Reed inserts a hearing test device into her ear, in Columbus, Ind. Early Head Start, a state pilot program is trying to identify hearing problems in young children through periodic hearing screenings.

COLUMBUS, Ind. — Jihovana Sandoval-Salas is a 1-year-old girl who is all smiles and bright, brown eyes, but six months ago her mother grew concerned because she was much quieter than most infants.

A hearing screening through Early Head Start in Columbus started unraveling the mystery. The girl's doctors believe she could have hearing loss that is affecting her speech development.

Columbus' Early Head Start, operated by Human Services Inc., provides educational and developmental programs for children ages 0 to 3 from lower-income families. Since July, it has been part of a state pilot program funded by a grant through the Early Childhood Hearing Outreach initiative, which is trying to identify hearing problems in young children through periodic hearing screenings. The grant required no local match.

Indiana law requires babies to have their hearing screened at birth, but many children do not receive hearing screenings again until they're about to start kindergarten, said Melissa McComb, a registered nurse at Early Head Start. Screenings of infants and toddlers by Early Head Start have identified one child with hearing loss and 25 who had problems in their ears that required the surgical insertion of tubes, McComb said.

Early Head Start personnel have been trained to use otoacoustic emissions hearing screening technology on the children. The equipment is portable and easy to use, which also allows for in-home testing, said Jay Cherry, an audiologist and consultant to the Columbus pilot program.

An ear piece is inserted into the child's ear. The tester pushes a button on a handheld device that sends a sound into the ear to the cochlea. The device measures the echo, Cherry said.

Failing results could indicate fluid in the ear, an infection or even hearing loss, he said. In those cases, children are first referred to their pediatrician to see if some physical problem exists in the ear that needs to be addressed. The pediatrician then could refer the child to an audiologist if hearing loss is suspected.

One in 300 children screened at birth have permanent hearing loss, and one in 300 develop permanent hearing loss after birth, according to the National Center for Hearing Assessment and Management. Hearing problems can lead to stunted language development, said Tonya Scott, manager of Early Head Start.

By catching problems early, children can receive help with speech development if it is needed, McComb said.

Scott said she's noticed hearing and speech improvements in children who have had tubes inserted in their ears.

"It's just a tremendous difference in them," she said.

Alma Salas, Jihovana's mother, said she was worried something was wrong because her daughter wouldn't make a lot of noise.

Salas said the situation was confusing because Jihovana looked normal, but her quietness wasn't.

"She should have been making more sounds than what she was," said Carla Reed, a family support worker from Early Head Start who has tested Jihovana's hearing with the otoacoustic emissions device.

All new children in Early Head Start are screened within the first 45 days. Jihovana was first screened last summer. It indicated a problem with the left ear. A follow-up screening a month later also indicated a problem, Reed said.

A referral to the girl's pediatrician led to the discovery of an ear infection. It was treated, but when Jihovana's ears were tested three weeks later, the screening indicated she needed another referral, Reed said.

Her pediatrician set up a test at Columbus Regional Hospital's audiology department. The test detected some hearing loss, so she was referred to First Steps, a program which provides speech therapy and teaches sign language.

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Early Head Start families incur no costs for appointments or tests because they all are on Medicaid, Scott said.

Salas said doctors don't know yet how bad the hearing loss is, and added that tubes are being considered because fluid in the ears could be part of the problem.

Knowing why Jihovana has been so quiet has been helpful, Salas said.

"She was concerned then, but it's better now that she knows," Reed added.

The Early Head Start programs in Columbus, Marion and Terre Haute were chosen for the pilot program.

Information from: The Republic,