Risk Factors For Hearing Impairment Research Articles

Risk factors for hearing impairment among U.S. adults with diabetes: National Health and Nutrition Examination Survey 1999-2004.

OBJECTIVEThe objective of this study was to examine the risk factors of low/mid-frequency and high-frequency hearing impairment among a nationally representative sample of diabetic adults.RESEARCH DESIGN AND METHODSData came from 536 participants, aged 20–69 years, with diagnosed or undiagnosed diabetes who completed audiometric testing during 1999–2004 in the National Health and Nutrition Examination Survey (NHANES). We defined hearing impairment as the pure-tone average >25 dB hearing level of pure-tone thresholds at low/mid-frequencies (500; 1,000; and 2,000 Hz) and high frequencies (3,000; 4,000; 6,000; and 8,000 Hz) and identified independent risk factors using logistic regression.RESULTSControlling for age, race/ethnicity, and marital status, odds ratios for associations with low/mid-frequency hearing impairment were 2.20 (95% CI 1.28–3.79) for HDL <40 mg/dL and 3.55 (1.57–8.03) for poor health. Controlling for age, race/ethnicity, sex, and income-to-poverty ratio, odds ratios for associations with high-frequency hearing impairment were 4.39 (1.26–15.26) for history of coronary heart disease and 4.42 (1.26–15.45) for peripheral neuropathy.CONCLUSIONSLow HDL, coronary heart disease, peripheral neuropathy, and having poor health are potentially preventable correlates of hearing impairment for people with diabetes. Glycemic control, years since diagnosis, and type of glycemic medication were not associated with hearing impairment.

Risk factors associated with hearing loss in infants: An analysis of 5282 referred neonates

Objective The aim of our study was to evaluate the frequency of risk factors and their influence on – the distribution and manifestation of – hearing loss in infants. The study was conducted at the Department of Laryngology in the Upper Silesian Center for Child Health in Katowice (Poland), as part of the Polish National Universal Neonatal Hearing Screening, conducted from 2003 to 2009. Materials and methods The selected population included every newborn that twice tested positive on the transient evoked otoacoustic emission (TEOAE) screening test, as well as all neonates with one or more risk factors as defined by the Joint Committee of Infant Hearing in 2000 (JCIH). The following procedures were used with each neonate: otolaryngological examination (with otoscopy), tympanometry, automated otoacoustic emission (AOAE), and auditory brainstem response (ABR). A total of 5282 infants were examined. Subjects were categorized into two groups: the first group consisted of 2986 (56.53%) neonates with risk factors of hearing loss, while the second group included 2296 (43.47%) neonates without any known risk factors, but who twice tested positive on the TEOAE screening. Results Among all infants examined (5282), sensorineural hearing loss (SNHL) was identified in 240 cases (4.54%), and conductive hearing loss (CHL) in 40 cases (0.76%), while normal hearing (NH) appeared in 5002 cases (94.70%). In the first group, SNHL was identified in 128 neonates (4.29%), and CHL in 28 (0.94%), while NH appeared in 2830 (94.78%). The largest percentage of SNHL (15.52%) appeared in children with identified or suspected syndromes associated with hearing loss. The next highest frequency of SNHL was comprised of children subjected to mechanical ventilation for a period in excess of 5 days (11.45%). Only a small percentage (2.86%) of SNHL appeared to be due to the use of ototoxic medications, despite the fact that this factor is the most prevalent (33.13%) of all analyzed risk factors of hearing impairment. After ototoxic medications, the frequencies of risk factors are as follows: premature birth (16.21%); low birth weight (12.04%); intensive care in excess of 7 days (10.64%). Furthermore, as the number of coexisting risk factors increases, the probability of SNHL in infants is seen to also increase. For children with one to four coexisting risk factors, the probability of SNHL ranges from 3.15% to 5.56%; for five or more risk factors the probability nearly doubles. Conclusion Our results indicate that syndromes associated with hearing loss and mechanical ventilation for more than 5 days were statistically significant risk factors in the occurrence of hearing loss. The most common risk factors are ototoxic medications, premature birth, low birth weight, and intensive care in excess of 7 days. As the number of risk factors an infant is exposed to grows, the probability of hearing impairment increases. The large percentage of children with sensorineural hearing loss in the absence of any known risk factors demonstrates the necessity of hearing examinations in all neonates.

Prevalence and Risk Factors of Hearing Impairment Among Primary-School Children in Shebin El-Kom District, Egypt

This study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students. A total of 555 children (6-12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools. The screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice. The prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools.

Risk Factors for Hearing Loss after Pediatric Meningitis in Japan

We sought to identify predictors for hearing loss in Japanese children with meningitis. We analyzed 155 cases of pediatric meningitis without other entities causing hearing loss in children admitted to Saitama Children's Medical Center between 1990 and 2005 for potential risk factors for hearing loss, using multiple logistic regression. Auditory brain stem response tests were performed to evaluate hearing loss. Of 155 children, 35 (23%) developed hearing loss (21 unilaterally and 14 bilaterally). Profound hearing loss (greater than 90 dB normal hearing level) occurred in 15 patients (9.7%; 4 unilaterally and 11 bilaterally). Of 112 patients with positive cerebrospinal fluid cultures, 27 (24%) developed hearing loss and 13 (12%) showed profound loss. Of 22 patients with Streptococcus pneumoniae meningitis, 11 (50%) developed hearing loss and 7 (32%) showed profound loss. Of 54 patients with Haemophilus influenzae meningitis, 11 (20%) developed hearing loss and 4 (7.4%) showed profound loss. High serum C-reactive protein levels and cerebrospinal fluid cultures positive for Streptococcus pneumoniae were identified as significant risk factors for hearing loss. A high serum C-reactive protein level was first identified as a risk factor for hearing impairment after pediatric meningitis.

Risk factors for elevation of ABR threshold in NICU-treated infants

Objective Several risk factors for hearing impairment among infants treated in the neonatal intensive care unit (NICU) have been reported, but there have been few studies that show the correlation strength between the risk factors in NICU-treated infants and hearing impairment in childhood. The aim of this study was to clarify the relationship between risk factors in NICU-treated infants and a deteriolation of auditory brainstem response (ABR) threshold in their childhood. Methods One hundred one NICU-treated infants with ABR threshold of 50 dBnHL or more underwent 2nd ABR test at 20 months after delivery. Multiple regression analysis was performed with ABR threshold change as an objective variable and risk factors as explanatory variables. Results Two ABR tests of the 101 infants resulted in that 7 showed an elevation of ABR threshold by 20 dB, 70 showed a drop of ABR threshold by 20 dB, and 24 showed no significant change. Multiple regression analysis revealed that the factors contributing to the elevation of ABR threshold were congenital diaphragmatic hernia, severe respiratory disease, and a high C-reactive protein (CRP) level. Conclusions In the infants treated in NICU, an incidence of ABR threshold of 50 dBnHL or more was 9.0%, and 6.9% of the infants with the ABR threshold abnormality showed a significant elevation of ABR threshold in their childhood. Factors significantly related to an elevation of ABR threshold were a history of congenital diaphragmatic hernia, severe respiratory disease, and elevation of CRP. In infants with such factors, periodical examination of hearing is required.

Hearing impairment and poverty: The epidemiology of ear disease in Peruvian schoolchildren

Objectives 1) To measure prevalence of hearing impairment (HI) in schoolchildren living in poverty in Peru. 2) To identify risk factors for HI and assess its impact on academic performance. Study Design Cross-sectional. Setting Elementary schools in an asentimiento humano (shantytown) near Lima, Peru, October 2008 to March 2009. Subjects Schoolchildren (n = 335), ages six to 19 years. Methods Audiological health was assessed with pure-tone audiometry, tympanometry, and otoscopy. The primary outcome was HI, defined as average threshold >25 dB HL for 0.5, 1, 2, and 4 kHz, in one or both ears (per World Health Organization/International Organization for Standardization). A questionnaire on health history was administered to parents. Statistical analysis included univariate analysis for χ 2 values and odds ratios (ORs), and multivariate logistic regression. Results HI prevalence: 6.9 percent (95% confidence interval [CI] 4.2%-9.6%). Risk factors for HI (OR, 95% CI, P value): neonatal jaundice (5.59, 1.63-19.2, 0.015), seizure (7.31, 2.50-21.4, 0.0013), hospitalization (4.01, 1.66-9.68, 0.003), recurrent otitis media (5.06, 1.98-12.9, 0.002), past otorrhea (4.70, 1.84-12.0, 0.003), family history of HI at <35 years (2.91, 1.19-7.14, 0.026), tympanic membrane abnormality (13.8, 4.48-42.7, <0.001), cerumen impaction (15.8, 4.71-53.1, <0.001), and eustachian tube dysfunction (4.87, 1.74-13.7, <0.001). HI was an independent predictor of academic failure (3.36, 1.15-9.82, 0.03). Conclusions Impoverished Peruvian schoolchildren were four to seven times more likely to experience HI than children living in higher-income countries. Untreated middle ear disease in the context of limited access to pediatric care was a major risk factor for HI. Furthermore, HI was associated with worse scholastic achievement. These results support prioritization of pediatric ear health as an essential component of the global health agenda, especially in resource-poor countries.

Newborn hearing screening on infants at risk

Objectives This article presents the results of newborn hearing screenings on infants at risk of hearing impairment at the French University Hospital of Besançon from 2001 to 2007. Materials and methods All newborns at risk of hearing impairment were tested according to the method recommended by the Joint Committee on Infant Hearing (JCIH): a two-step automated oto-acoustic emissions (AOAE) program, completed by an auditory brainstem response (ABR) for the positive diagnosis of hearing impairment. The screening started with AOAE on the third day of life, at the earliest. If one or both ears did not have AOAE, the infant was re-tested at which time, should the AOAE again be positive, ABR was performed. When the ABR threshold was 40 dB or more, the infant was referred to an audiologist specialized in infant deafness for diagnosis confirmation and management. Results Over the period, 1461 infants were screened, among whom 4.55% were diagnosed as deaf or hard of hearing. Nearly 10% of the infants were lost to follow up. Forty-six children had a sensorineural hearing impairment, of which 34 were bilateral and were managed before the age of 6 months. The risk factors for sensorineural hearing loss were (in order of statistical significance): severe birth asphyxia; neurological disorder; syndromes known to be associated with hearing loss; TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections; family history of deafness; age at the time of screening; and the association of 2 or more risk factors. However, birth weight inferior to 1500 g and premature birth before the 34th week of pregnancy did not show a statistically significant influence on sensorineural hearing loss. Craniofacial anomalies (mostly cleft palate and ear aplasia) were a significant factor for conductive hearing loss. Conclusion Our selected hearing screening on infants at risk allowed 60 deaf children access to early management. However, too many children were lost to follow up; which revealed that better information regarding risk of hearing loss must be provided to parents and paramedics and universal newborn screening needs to be performed. The most important result of this study is that in a population of hearing impaired children, with an impairment incidence close to what is commonly reported, the association of several risk factors proves to be a significant additional risk factor for hearing impairment.

Risk factors of hearing impairment in Indian children: a retrospective case-file study

A significant proportion of school children are hearing impaired and they suffer from various academic and adjustment problems. Identification of risk factors will help in containing the problems. In this context this study aims to find the causative factors of hearing impairment. Data obtained from 1000 case files indicated that mean age of detection by parents was 3.03 years. A considerable gap between the mean age of detection and availing audiological rehabilitation was observed. Prenatal diseases, exposure to X-rays during gestation, premature delivery, low birth weight, postnatal jaundice, neonatal seizures and rubella were the significant predictors of hearing impairment. Therefore, children with a history of these predictive factors should be periodically screened for hearing impairment. At a higher level, mass education programmes may include imparting information on preventive measures and early identification of these risk factors.

Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Examination Survey, 1999 to 2004.

Diabetes might affect the vasculature and neural system of the inner ear, leading to hearing impairment. To determine whether hearing impairment is more prevalent among U.S. adults with diabetes. Cross-sectional analysis of nationally representative data. National Health and Nutrition Examination Survey, 1999 to 2004. 5140 noninstitutionalized adults age 20 to 69 years who had audiometric testing. Hearing impairment was assessed from the pure tone average of thresholds over low or mid-frequencies (500, 1000, and 2000 Hz) and high frequencies (3000, 4000, 6000, and 8000 Hz) and was defined as mild or greater severity (pure tone average >25 decibels hearing level [dB HL]) and moderate or greater severity (pure tone average >40 dB HL). Hearing impairment was more prevalent among adults with diabetes. Age-adjusted prevalence of low- or mid-frequency hearing impairment of mild or greater severity in the worse ear was 21.3% (95% CI, 15.0% to 27.5%) among 399 adults with diabetes compared with 9.4% (CI, 8.2% to 10.5%) among 4741 adults without diabetes. Similarly, age-adjusted prevalence of high-frequency hearing impairment of mild or greater severity in the worse ear was 54.1% (CI, 45.9% to 62.3%) among those with diabetes compared with 32.0% (CI, 30.5% to 33.5%) among those without diabetes. The association between diabetes and hearing impairment was independent of known risk factors for hearing impairment, such as noise exposure, ototoxic medication use, and smoking (adjusted odds ratios for low- or mid-frequency and high-frequency hearing impairment were 1.82 [CI, 1.27 to 2.60] and 2.16 [CI, 1.47 to 3.18], respectively). The diagnosis of diabetes was based on self-report. The investigators could not distinguish between type 1 and type 2 diabetes. Noise exposure was based on participant recall. Hearing impairment is common in adults with diabetes, and diabetes seems to be an independent risk factor for the condition.

Deficiência auditiva na toxoplasmose congênita detectada pela triagem neonatal

A toxoplasmose congênita pode causar déficit neurossensorial em até 20% dos casos e o tratamento no primeiro ano de vida melhora o prognóstico. No Brasil, desconhece-se o impacto da infecção na hipoacusia. OBJETIVO: Avaliar a audição de crianças com toxoplasmose congênita identificadas pela triagem neonatal. MATERIAL E MÉTODO: Estudo prospectivo de crianças com toxoplasmose congênita identificadas pela triagem neonatal (IgM anti-T. gondii) em Belo Horizonte, durante 2003/2004. Realizada sorologia confirmatória (mãe/filho) e consideradas positivas as crianças apresentando IgM e/ou IgA nos primeiros seis meses ou IgG aos 12 meses de vida. Avaliações auditivas ao diagnóstico e após 12 meses incluíram Audiometria Comportamental, Emissões Otoacústicas, Imitanciometria, Audiometria de Tronco Encefálico. RESULTADOS: Dentre 30.808 crianças triadas (97% dos nascidos vivos), 20 apresentavam toxoplasmose congênita, 15 (75%) com infecção subclínica. Dezenove crianças realizaram avaliação auditiva. Quatro apresentaram déficit neurossensorial (21,1%). Uma criança apresentou outros fatores de risco para hipoacusia; nas outras três, a toxoplasmose foi o único fator observado. Duas crianças, tratadas adequadamente com antiparasitários, apresentaram déficit auditivo, em desacordo com a literatura. CONCLUSÃO: Os achados sugerem que a toxoplasmose congênita, prevalente no Brasil, é um fator de risco para hipoacusia e o impacto dessa infecção nas perdas auditivas deve ser estudado.

Hearing loss in congenital toxoplasmosis detected by newborn screening

SummaryCongenital toxoplasmosis may cause sensorineural deficit in up to 20% of the patients and proper treatment in the first year improves prognosis. In Brazil, this infection's impact on hearing impairment is unknown.AimTo evaluate hearing of newborns with congenital toxoplasmosis identified by the newborn screening service.MethodThis prospective study analyzed children with congenital toxoplasmosis identified by newborn screening (IgM anti-T.gondii) in Belo Horizonte during 2003/2004. The presence of IgM and/or IgA in the first 6 months or IgG at 12 months-of age in serology was used as case definition. Hearing tests were carried out at the time of diagnosis and 12 months later, including behavioral audiometry, evoked otoacoustic emission and brainstem evoked responses audiometry.ResultsAmong 30.808 screened children (97% of live births), 20 had congenital toxoplasmosis, 15 (75%) were asymptomatic at birth. Nineteen children were evaluated by hearing tests. Four had sensorineural impairment (21.1%). One child had other risk factors for hearing impairment; the other three had no other risk factors but toxoplasmosis. Two properly children treated still had hearing loss, in disagreement with current literature.ConclusionResults suggest that congenital toxoplasmosis, common in Brazil, is a risk factor for hearing impairment and its impact on hearing loss deserves further studies.

Triagem auditiva em hospital público de Belo Horizonte, Minas Gerais, Brasil: deficiência auditiva e seus fatores de risco em neonatos e lactentes

The objective of this study was to estimate the prevalence of hearing impairment in children in a public hospital in Belo Horizonte, Minas Gerais, Brazil, and to investigate the association with risk factors described in the literature. This study was cross-sectional and retrospective and analyzed 798 newborns and infants evaluated in the Universal Neonatal Hearing Screening Program from June 2002 to December 2003. The risk factors established by the Joint Committee on Infant Hearing in 1994 and Azevedo in 1996 were studied, besides prematurity. Prevalence of hearing impairment was 1.8% (15 cases). A multivariate logistic regression analysis was used to verify associations between risk factors and hearing impairment, showing a significant statistical association (p < 0.05) between hearing loss and suspicion of hearing loss by relatives, hyperbilirubinemia (serum level requiring exchange transfusion), ototoxic drugs, and low birth weight. A significant prevalence of hearing impairment in neonates and infants was confirmed. Attention should thus be focused on risk factors for hearing impairment, using hearing programs that ensure prevention, early detection, and intervention.

The role of current audiological tests in the early diagnosis of hearing impairment in children

Permanent hearing impairment is a significant and relatively common condition in newborns, affecting at least 1 child per 1000 live births. The early identification of hearing loss is very important in order to begin early rehabilitation and for optimizing normal development of language. We examined 70 children with parental suspicion of a hearing loss. Brainstem Evoked Response Audiometry was performed and the group was divided into three subgroups. The following parameters were analyzed: the average age of hearing loss-identification, the time of parental first suspicion of a hearing loss, as well as risk factors for hearing impairment. Of 70 children with parental suspicion of a hearing loss, in 17 cases normal hearing or mild hearing loss (up to 40 dB HL) was found (group 1), 16 children were suffering from moderate and severe hearing loss (40 to 90 dB HL) (group II), and 37% of children were suffering from profound hearing loss (greater than 90 dB HL) (group III). Up to the age of 2, the diagnosis was made in 17.64% of children in group I, in 25% in group II, and in 58.8% in group III. The average age of hearing loss identification was 2.83, 3.32, 2.32 years in groups I, II, III, respectively, although parents suspected hearing problems at least one year earlier. Presence of hearing impaired family members as well as of risk factors were not sufficient reasons to get a medical check-up. The use of otoacoustic emission testing in routine clinical practice, as well as education of parents and pediatricians, was followed by earlier detection of hearing loss in regard to our previous study (10 years ago). The mean age of diagnosis in our region is still over 2 years, but establishment of a universal screening program may help reduce the age of hearing loss detection.

Prevalence of hearing impairment in an adult population in southern Taiwan

The objective of this study was to estimate the prevalence of hearing impairment in a representative adult population in southern Taiwan and compare the results to those of similar studies in other countries. A stratified systematic cluster sample of 1140 residents, aged ≥20 years, of Tainan City was studied from 2001 to 2003. The test battery included otoscopy, pure-tone audiometry, and a questionnaire covering relevant personal, occupational, and family history. The hearing threshold level (HTL) was defined as the better ear pure-tone average (BPTA) (i.e. the average of hearing thresholds at frequencies 500, 1000, 2000, and 4000 Hz). The prevalence of hearing impairment was 21.4% (95% confidence interval: 19.3–23.7%) at BPTA ≥25 dB HTL. Middle ear disease was a significant risk factor for hearing impairment in addition to age and gender. The overall prevalence of hearing impairment may be higher in Taiwan (17.1%) than in western populations (11.5%), but differences in the definition of hearing impairment severity and variation in sex distribution among studies may account for this higher prevalence.

Universal newborn hearing screening in Mexico: Results of the first 2 years

The purpose of this study is to present the results of the first 2 years of universal newborn hearing screening and the prevalence of congenital hearing loss in Monterrey, Mexico. We performed a descriptive study of the first 2 years after starting of the newborn screening program in a private hospital in Mexico. The program is organized into levels. We using for initial evaluation an automated auditory brainstem response (AABR). If the test was positive, the audiologist conducted and auditory brainstem response (ABR) test and other specialized testing was performed. Babies with hearing impairment were referred for early intervention. A total of 3066 newborns were screened (99.9%). The prevalence of sensorineural and bilateral hearing loss was of 0.65/1000 newborns. Seventy-three neonates (2.37%) had a risk factor for hearing impairment. A total of 0.22% (n=7) of those studied were referred for ABR testing. Of the patients referred to the audiologist, 100% were seen. The positive predictive value for sensorineural hearing loss was 71.4% (95% CI 30.2-94.8) and the false positive rate was 0.065%. Of the subjects screened, 100% were diagnosed before the age of 3 months, but all babies began treatment after the age of 6 months. No cochlear implants were indicated. This is the first report of a universal hearing screening program in Mexico. Even though this study had a reduced sample, the findings of hearing loss rate in this study are similar to the results found in other countries.

Prevalence of auditory neuropathy/synaptopathy in a population of children with profound hearing loss

To examine the prevalence of auditory neuropathy/synaptopathy (AN/AS) in a cohort of children with profound hearing loss. From 1997 until 2004, 5190 children, aged 1-15 years, whose hearing ability was uncertain or who had risk factors for hearing impairment were investigated with subjective and objective hearing tests. Three thousand four hundred and fifteen from these children were screened for AN/AS using pure-tone audiometry, impedance measurement, transient evoked otoacoustic emissions (TEOAE) and click-evoked auditory brainstem responses (ABR). From 3415 patients who participated in an ABR and TEOAE assessment, 379 children showed absent or elevated (> or = 80 dB nHL) ABR thresholds. Within this group we found 32 cases with evidence of AN/AS via visible TEOAE and/or cochlear microphonics (CM) coupled with absent ABR. In the remaining 3036 children, AN/AS, could be ruled out by means of detectable ABR-thresholds and coherent findings in pure-tone audiometry and TEOAE assessment. This results in a prevalence of AN/AS of 0.94% within the group at risk for hearing loss, compared to 8.44% among profoundly hearing impaired children. This study shows that AN/AS is a common finding in the population of hearing impaired infants. In the majority of our AN/AS children (50%, n=16), an early audiological diagnosis was made under the age of 12 months. Therefore, clinicians and other health care professionals should generally be sensitised for AN/AS in infants, so that an appropriate treatment can promptly be initiated. Further research on clinical and pathophysiological aspects is necessary to better identify and manage patients suffering from AN/AS.

Low prevalence of hearing impairment among very low birthweight infants as detected by universal neonatal hearing screening

Objectives: To (a) study the prevalence of hearing impairment in a cohort of very low birthweight (VLBW) infants and (b) evaluate the effectiveness of transient evoked otoacoustic emissions (TEOAE) as...

Analysis of newborn hearing screening using automated auditory brainstem response

Purpose:As hearing ability affects language and cognitive development, early detection and intervention of congenital hearing defects is very important. We analyzed the result of newborn hearing screening using automated auditory brainstem response and estimated the incidence of congenital hearing defects in newborn infants in Korea. Methods:Hearing screening tests were done on 7,218 newborn infants who were delivered at Cheil General Hospital from July 1, 2004 to June 30, 2005. The first screening test was done on the second day of life with automated auditory brainstem response(AABR) using ALGO○③ Newborn hearing screener(NatusⓇ Medical Incorporated, San Carlos, USA) with 35 dB sound level. The newborn infants who did not pass the initial screening test took the second screening AABR test before discharge from the nursery. Infants who did not pass these screenings at the nursery were followed up at the Department of Otorhinolaryngology, Samsung Seoul Hospital. Results:Total 7,218 infants(83.3 percent of total 8,664 live births of the Cheil General Hospital) were screened in the nursery, and 55 of them failed to pass the newborn screening. Among 55 infants who were referred, six were lost during follow-up, and 14 were confirmed as hearing impaired. Six of them(42.8 percent) do not have any risk factors for hearing impairment. We can estimate that the incidence of hearing defects is about 1.9-2.8 per 1,000 live births. Conclusion:Automated auditory brainstem response is an effective tool to screen the hearing of newborn infants. Congenital hearing loss is more frequent than metabolic diseases on which screening tests are available in the newborn period. About 40 percent of infants who have hearing defects do not have any risk factors for hearing impairment. Therefore, universal newborn hearing screening must be recommended to all neonates

Incidence of hearing loss and importance of risk factors in the neonatal intensive care unit

Purpose:To assess the incidence of neonatal hearing loss in a neonatal intensive care unit and the relative importance of risk factors for hearing imparement in a neonatal intensive care unit which the Joint Committee on Infant Hearing(JCIH) had recommended. Methods:One thousand, two hundred and one newborns admitted to the Good Moonhwa Intensive Care Unit from May 2003 to December 2005 were assesed using the automated auditory brainstem response(AABR). The screening was performed on those aged more than 36 weeks and weighing more than 2,200 g. We divided the infants into two groups, ‘pass’ and ‘refer’. The ‘refer’ group were retested one month later, and if classified as ‘refer’ during the retest, were referred to a hearing impairment clinic. Results:From the 1,201 neonates, 1,187(98.8 percent) passed the test and 14(1.2 percent) failed. 293(24.4 percent) of the 1,201 neonates had a risk factor for hearing impairment; 282(96.2 percent) passed the test and 11(3.8 percent) failed. The group with risk factors were shown to have a higher incidence of hearing loss(P

Newborn Hearing Screening: Effectiveness, Importance of High-Risk Factors, and Characteristics of Infants in the Neonatal Intensive Care Unit and Well-Baby Nursery

In contrast to the recommendations of the Joint Committee on Infant Hearing, neonatal hearing screening programs are still not universally available, and many countries implement elective screening in high-risk newborns. To assess the failure rates of neonates in hearing screening and the relative importance of risk factors for hearing impairment, both in neonatal intensive care units and in well-baby nursery neonates. The impact on cost-effectiveness is also evaluated. In the current study, 25,288 newborns were assessed; 23,574 were full-term newborns in the well-baby nursery and 1,714 neonates were in neonatal intensive care units. All neonates had a general examination (including assessment for congenital anomalies and related history) and were assessed using transient evoked otoacoustic emissions. All newborns were older than 36 weeks at examination and thus had reliable transient evoked otoacoustic emissions. From the 23,574 full-term neonates in the well-baby nursery, 23,123 (98.1%) passed the test and 451 failed (1.9%). Fifty-three of the 23,574 neonates (0.2%) had a risk factor for hearing impairment; 44 (83%) passed the test and 9 failed (17%). Family history of congenital hearing loss and congenital anomalies were the most frequent risk factors for hearing loss. From the 1,714 neonates in neonatal intensive care units, 1,590 (93%) passed the test and 124 failed (7%). Two hundred thirty-two of the 1,714 neonates (14%) had a risk factor for hearing impairment; 205 (88%) passed the test and 27 failed (12%). In neonatal intensive care unit neonates, toxic levels of ototoxic drugs, mechanical ventilation for more than 24 hours, prematurity, and low birth weight were the most frequent risk factors for hearing loss. Congenital anomalies/syndromes were the most important risk factors for failing screening in both the neonatal intensive care unit and the well-baby nursery, as they showed the highest risk of failing hearing screening. The second most important factor in neonatal intensive care unit newborns was low birth weight, and the third was prematurity in relation to the possibility of failing hearing screening. The present study found 575 neonates failing hearing screening of 25,288 tested newborns (2.3%). The fact that 78% of newborns who failed hearing screening were in the well-baby nurseries further supports the necessity of universal hearing screening instead of selective screening in neonatal intensive care units, even with the obvious impact on cost-effectiveness. Even if limited funding lead to selective screening in neonatal intensive care units, this should not be applied to high-risk newborns but to all neonatal intensive care unit neonates. Continuous assessment of risk factors and the related possibility of failing hearing screening are of paramount importance in designing hearing screening programs and refining the respective criteria.