Hearing Screening Protocol Research Articles

The Many Faces of DFNB9: Relating OTOF Variants to Hearing Impairment.

The OTOF gene encodes otoferlin, a critical protein at the synapse of auditory sensory cells, the inner hair cells (IHCs). In the absence of otoferlin, signal transmission of IHCs fails due to impaired release of synaptic vesicles at the IHC synapse. Biallelic pathogenic and likely pathogenic variants in OTOF predominantly cause autosomal recessive profound prelingual deafness, DFNB9. Due to the isolated defect of synaptic transmission and initially preserved otoacoustic emissions (OAEs), the clinical characteristics have been termed “auditory synaptopathy”. We review the broad phenotypic spectrum reported in patients with variants in OTOF that includes milder hearing loss, as well as progressive and temperature-sensitive hearing loss. We highlight several challenges that must be addressed for rapid clinical and genetic diagnosis. Importantly, we call for changes in newborn hearing screening protocols, since OAE tests fail to diagnose deafness in this case. Continued research appears to be needed to complete otoferlin isoform expression characterization to enhance genetic diagnostics. This timely review is meant to sensitize the field to clinical characteristics of DFNB9 and current limitations in preparation for clinical trials for OTOF gene therapies that are projected to start in 2021.

How the World's Children Hear: A Narrative Review of School Hearing Screening Programs Globally.

ObjectiveSchool hearing screening may mitigate the effects of childhood hearing loss through early identification and intervention. This study provides an overview of existing school hearing screening programs around the world, identifies gaps in the literature, and develops priorities for future research.Data SourcesA structured search of the PubMed, Embase, and Cochrane Library databases.Review MethodsA total of 65 articles were included according to predefined inclusion criteria. Parameters of interest included age groups screened, audiometric protocols, referral criteria, use of adjunct screening tests, rescreening procedures, hearing loss prevalence, screening test sensitivity and specificity, and loss to follow-up.ConclusionsSchool hearing screening is mandated in few regions worldwide, and there is little accountability regarding whether testing is performed. Screening protocols differ in terms of screening tests included and thresholds used. The most common protocols included a mix of pure tone screening (0.5, 1, 2, and 4 kHz), otoscopy, and tympanometry. Estimates of region-specific disease prevalence were methodologically inaccurate, and rescreening was poorly addressed. Loss to follow-up was also a ubiquitous concern.Implications for PracticeThere is an urgent need for standardized school hearing screening protocol guidelines globally, which will facilitate more accurate studies of hearing loss prevalence and determination of screening test sensitivity and specificity. In turn, these steps will increase the robustness with which we can study the effects of screening and treatment interventions, and they will support the development of guidelines on the screening, diagnostic, and rehabilitation services needed to reduce the impact of childhood hearing loss.

Where Do We Go From Here? Some Messages to Take Forward Regarding Children With Mild Bilateral and Unilateral Hearing Loss.

Purpose This epilogue discusses messages that we can take forward from the articles in the forum. A common theme throughout the forum is the ongoing need for research. The forum begins with evidence of potential progressive hearing loss in infants with mild bilateral hearing loss, who may be missed by current newborn hearing screening protocols, and supports the need for consensus regarding early identification in this population. Consensus regarding management similarly is a continuing need. Three studies add to the growing body of evidence that children with mild bilateral or unilateral hearing loss are at risk for difficulties in speech understanding in adverse environments, as well as delays in language and cognition, and that difficulties may persist beyond early childhood. Ambivalence regarding if and when children with mild bilateral or unilateral hearing loss should be fitted with personal amplification also impacts management decisions. Two articles address current evidence and support the need for further research into factors influencing decisions regarding amplification in these populations. A third article examines new criteria to determine hearing aid candidacy in children with mild hearing loss. The final contribution in this forum discusses listening-related fatigue in children with unilateral hearing loss. The absence of research specific to this population is evidence for the need for further investigation. Ongoing research that addresses difficulties experienced by children with mild bilateral and unilateral hearing loss and potential management options can help guide us toward interventions that are specific for the needs of these children.

Sensitivity and specificity of three hearing screening protocols in the school setting

ABSTRACT Objective: to evaluate the sensitivity and specificity of three hearing screening protocols: audiometry, tympanometry, and transient evoked otoacoustic emissions (TEOAE). Methods: a cross-sectional study comprising 70 schoolchildren aged 6-14 years old (9.9 ± 2). All participants underwent a complete audiological evaluation and screening procedures. Procedures were compared regarding sensitivity, specificity, and positive and negative predictive values. Results: sensitivity and specificity were, respectively, 64.71% and 66.04% for audiometry, 64.71% and 73.58% for tympanometry, and 66.67% and 78.85% for TEOAE. The positive and negative predictive values were 37.93% and 14.63% for audiometry, 44% and 13.33% for tympanometry, and 52.17% and 12.77% for TEOAE. Conclusions: in the school setting, TEOAE stands out from the two other screening protocols, in all measures regarding sensitivity, accuracy, and predictive values.

Hearing Screening Protocol for Stroke Patients

Stroke is the most common neurological condition and a leading cause of disability; almost two-thirds of stroke survivors leave the hospital with a disability.1 Stroke can also affect all levels of the hearing pathway, from the inner ear to the central hearing tracts, and may result in various types of hearing impairment, such as peripheral hearing loss, disordered auditory processing, and cortical deafness.2 Stroke patients with hearing impairment have poor physical recovery after being discharged to the community.3 In addition, hearing loss may double the risk of developing dementia after vascular factors are controlled,4 yet it is one of the few modifiable risk factors for dementia.5 Hearing difficulties in this population can have adverse effects on patients’ communication and rehabilitation after stroke, yet identifying hearing impairment in stroke patients is often neglected.iStock/Lars Neumann, heart health, stroke, hearing.Table 1: Accuracy of Hearing Screening Tools, heart health, stroke, hearing.Figure 1: A schematic representation of a hearing screening protocol for stroke patients. Heart health, stroke, hearing.HEARING ASSESSMENT IN STROKE PATIENTS Performing a detailed audiological assessment of all stroke patients would be a laborious process and may not be practical. As such, a preliminary hearing screening program is needed. By having a hearing screening protocol in place, the full audiological assessment can be reserved for those who fail the initial hearing screening. To facilitate early identification of peripheral hearing loss and central auditory processing disorder in stroke survivors, we recently validated a two-tier hearing screening protocol using a handheld hearing screener and two validated hearing questionnaires that could be used in stroke units. In our recent article published in the Frontiers in Neurology Journal,6 we also recommended an appropriate referral model for stroke patients with hearing impairment. This study is the first step toward addressing the complex hearing needs of stroke patients in a systematic manner. Our aim was to support these patients’ communication needs and long-term recovery after stroke, and improve their quality of life. This approach may also possibly delay the onset of post-stroke dementia. HEARING SCREENING IN STROKE PATIENTS We evaluated three hearing screening tools for the identification of hearing impairment in stroke patients: (1) a handheld hearing screener for the determination of peripheral hearing loss, (2) the modified Amsterdam Inventory for Auditory Disability (AIAD), a questionnaire on specific auditory complaints and a tool for identifying auditory processing disorder, and (3) the Hearing Handicap Inventory for Elderly (HHIE), a sensitive and specific tool for identifying hearing loss. We conducted these hearing screening tests in 42 stroke patients at three to 12 months after their stroke because hearing impairment is stable at this point.7 We then performed a full audiological assessment to identify and categorize the patient's hearing profile into one of the following: (a) normal hearing, (b) peripheral hearing loss, (c) central auditory processing disorder, or (d) a combination of peripheral and central hearing impairment. We chose pure-tone audiogram as the gold standard for the handheld hearing screener and information from different comprehensive audiological tests for the hearing questionnaires.6 Finally, we calculated the sensitivity and specificity to evaluate the accuracy of these screening tools in the diagnosis of hearing impairment.6 The results are summarized in Table 1. RECOMMENDED HEARING SCREENING PROTOCOL Handheld hearing screeners are not intended to determine hearing thresholds; rather, they are used to determine the possibility of an individual presenting with hearing loss.8 Self-reported inventories are standardized questionnaires used to characterize a complex clinical picture, and use of such questionnaires to screen for hearing impairment has been an attractive option because they don't require any costly equipment. Furthermore, these hearing screening tools do not require audiology expertise and can be administered with minimal time.10 Our study found that the handheld hearing screener demonstrated the highest sensitivity (93%) and specificity (100%), making it a reliable tool in identifying stroke patients who need detailed assessment for peripheral hearing loss.6 We also found that adding the AIAD questionnaire can help identify a significant proportion of patients who need further central auditory evaluation. Thus, we recommended a hearing screening protocol for stroke patients (see Fig. 1 for stroke patients in the chronic stage). This protocol can help identify patients with high levels of perceived hearing difficulties who need additional evaluation, thereby promoting optimal outcomes from post-stroke rehabilitation. To learn more, check out our full study recently published in Frontiers in Neurology.6

Neonatal hearing test results in the Çukurova region

Objective: In this article, we aimed to present the neonatal hearing screening protocol and test results in healthy neonates in Adana City Training and Research Hospital, Adana. Method: A total of 2022 healthy newborns were scanned between November 2018 and February 2019 in our hospital with a three-stage screening protocol. Initial transient evoked otoacoustic emissions (TEOAE), followed by a second stage transient evoked otoacoustic emission and third stage automated auditory brainstem response (A-ABR) were used. If there was a referral with these two methods, clinical BERA was used. High risk newborns were defined. Results: In total, of the 2022 infants included in the study, hearing loss was detected in 34 newborns and the frequency of congenital hearing loss was 1.7%. According to our results, hyperbilirubinemia was more common in infants with hearing loss. Conclusion: Performing hearing screening tests in all newborns, raising public awareness on this issue, and legal follow-up are very important.

The Effect of Mode of Delivery on Newborn Hearing Screening Results.

Congenital hearing loss is one of the most important public health problems with a frequency of about 1-6 per 1000 live births all over the world. Although neonatal hearing screening tests are important for the timely detection and rehabilitation of hearing loss, determining the factors that may affect the screening results will contribute greatly to the development of screening programs. In this study, the effects of the modes of delivery on the results of tests in the screening program was investigated. In this study, the results of 10.575 newborns who were screened according to the National Neonatal Hearing Screening Protocol between January 2013 and May 2017 were evaluated. The screening test results of 2.653 newborns were examined retrospectively according to the type of delivery after candidates were excluded according to the exclusion criteria and risk factors for hearing loss. Of these newborns, 1.571 (59.2%) were born by normal delivery and 1.082 (40.8%) by cesarean section. Screening test results were analyzed using Pearson's Chi-square test. No statistically significant difference was observed among the 2.653 neonatal hearing screening test results in terms of mode of delivery (p>0.05). In both delivery modes, the rate of false positive was found to be high (81.9%) in the first hearing screening test of newborns, and this rate decreased in the second screening test (14.5%). The mode of delivery has no significant effect on the neonatal hearing screening results; however, the observation that neonates had been more successful in the second screening test in both groups suggests that the test protocol should be re-evaluated in terms of timing.

Detection of hearing loss in newborns: Definition of a screening strategy in Bogotá, Colombia

ObjectiveTo describe the results from the hearing screening protocol adopted in a Hospital in Colombia emphasizing the importance of performing screening on an outpatient basis, when the newborn is more than 24 h old. MethodsA prospective study at Hospital Universitario San Ignacio in Bogota, Colombia was carried out, from May 1st, 2016 to Nov 30th, 2017, the study sample included 2.088 newborns examined using transient otoacoustic emissions. ResultsWe obtained written consent from the parents of 1.523 newborns and 24 individuals (1.6%) failed the first stage of the screening, nine cases unilateral and 15 bilateral. A total of nine neonates (0,6%) failed the second screening test, six cases unilateral and three bilateral. Four (0,3%) did not return to the second test. Our false altered screening rate was 0.7%. ConclusionsIn a developing country with limited human and economic resources, in which newborn early discharge is the norm, a newborn hearing screening program linked to infants’ check-ups, that uses otoacoustic emissions after 48 h of life, seems a feasible option compare to the standard US protocol aiming to conduct hearing screening prior to discharge.

Comparison of distortion product otoacoustic emission (DPOAE) and automated auditory brainstem response (AABR) for neonatal hearing screening in a hospital with high delivery rate

IntroductionCongenital hearing loss is one of the commonest congenital anomalies. Neonatal hearing screening aims to detect congenital hearing loss early and provide prompt intervention for better speech and language development. The two recommended methods for neonatal hearing screening are otoacoustic emission (OAE) and automated auditory brainstem response (AABR). ObjectiveTo study the effectiveness of distortion product otoacoustic emission (DPOAE) and automated auditory brainstem response (AABR) as first screening tool among non-risk newborns in a hospital with high delivery rate. MethodA total of 722 non-risk newborns (1444 ears) were screened with both DPOAE and AABR prior to discharge within one month. Babies who failed AABR were rescreened with AABR ± diagnostic auditory brainstem response tests within one month of age. ResultsThe pass rate for AABR (67.9%) was higher than DPOAE (50.1%). Both DPOAE and AABR pass rates improved significantly with increasing age (p-value<0.001). The highest pass rate for both DPOAE and AABR were between the age of 36–48 h, 73.1% and 84.2% respectively. The mean testing time for AABR (13.54 min ± 7.47) was significantly longer than DPOAE (3.52 min ± 1.87), with a p-value of <0.001. ConclusionsOAE test is faster and easier than AABR, but with higher false positive rate. The most ideal hearing screening protocol should be tailored according to different centre.

Hearing impairment and hypoxia ischaemic encephalopathy: Incidence and associated factors.

To establish the local incidence of hearing loss in newborns with Hypoxic Ischaemic Encephalopathy (HIE) and to identify associated risk factors. Retrospective Cohort Study. Neonatal Intensive Care Unit (NICU) dual stage hearing screening protocol, including automated otoacoustic emissions (AOAE) and automated auditory brainstem response (AABR) testing. 57 newborns received therapeutic hypothermia for HIE. Twelve babies (21%) died. Audiology data was incomplete in 3 babies. Complete data was available for 42 babies (male n=24), 4 (9.5%) of whom had hearing impairment. The development of hearing loss was associated with abnormal blood glucose levels (p=0.006), low Apgar score at 1min (p=0.0219) and evidence of multi organ dysfunction [high creatinine (p=0.0172 and 0.0198) and raised liver transaminases (aspartate aminotransferase (AST) p=0.0012, alanine aminotransferase (ALT) p=0.0037)]. An association with gentamicin was not found. This study confirms that hearing impairment is common in term infants who have undergone therapeutic hypothermia for moderate/severe HIE. Blood glucose should be monitored carefully in these infants and developmental surveillance should include formal audiology. Further larger studies are needed to clarify the role, if any, of hypothermia per se in causation of hearing loss and to fully identify risk factors for hearing impairment in this population. The current study confirms that hearing impairment is common in term infants who have undergone therapeutic hypothermia for moderate/severe HIE. No association between gentamicin use and the development of hearing impairment was found however initial blood glucose outside the normal range was of significance. Other factors associated with hearing impairment were low Apgar scores, greater need for resuscitation and evidence of multi organ dysfunction (renal and liver failure).

Tablet-based tele-audiometry: Automated hearing screening for schoolchildren

Introduction To assess the performance of a tablet-based tele-audiometry method for automated hearing screening of schoolchildren through a comparison of the results of various hearing screening approaches. Methods A total of 244 children were evaluated. Tablet-based screening results were compared with gold-standard pure-tone audiometry. Acoustic immittance measurements were also conducted. To pass the tablet-based screening, the children were required to respond to at least two out of three sounds for all the frequencies in each ear. Several hearing screening methods were analysed: exclusively tablet-based (with and without 500 Hz checked) and combined tests (series and parallel). The sensitivity, specificity, positive and negative predictive values and accuracy were calculated. Results A total of 9.43% of children presented with mild to moderate conductive hearing loss (unilateral or bilateral). Diagnostic values varied among the different hearing screening approaches that were evaluated: sensitivities ranged from 60 to 95%, specificities ranged from 44 to 91%, positive predictive values ranged from 15 to 44%, negative predictive values ranged from 95 to 99%, accuracy values ranged from 49 to 88%, and area under curve values ranged from 0.690 to 0.883. Regarding diagnostic values, the highest results were found for the tablet-based screening method and for the series approach. Discussion Compared with the results obtained by conventional audiometry and considering the diagnostic values of the different hearing screening approaches, the highest diagnostic values were generally obtained using the automated hearing screening method (including 500 Hz). Thus, this application, which was developed for the tablet computer, was shown to be a valuable hearing screening tool for use with schoolchildren. Therefore, we suggest that this hearing screening protocol has the potential to improve asynchronous tele-audiology service delivery.

Objective Hearing Screening Measures: An Exploration of a Suitable Combination for Risk-Based Newborn Hearing Screening.

The ideal hearing screening measure is yet to be defined, with various newborn hearing screening protocols currently being recommended for different contexts. Such diverse recommendations call for further exploration and definition of feasible and context-specific protocols. The aim of the study was to establish which combinations of audiological screening measures provide both true-positive (TP) and true-negative (TN) results for risk-based hearing screening, at and across time. A longitudinal, repeated-measures design was employed. Three-hundred and twenty-five participants comprised the initial study sample. These participants comprised newborns and infants who were discharged from the neonatal intensive care unit and high care wards to "step down" wards at two public sector hospitals within an academic hospital complex. Transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and automated auditory brainstem response (AABR) were conducted at the initial and repeat hearing screening. Diagnostic audiological assessments were also conducted. Results from combinations of audiological screening measures at the initial and repeat hearing screening were analyzed in relation to the final diagnostic outcome (n = 91). Participants were classified as presenting with an overall "refer" if the outcome for any one test was "refer." The overall screening outcomes for different test combinations were compared using McNemar's test for paired data. Proportions across different test combinations were compared by the z-test for proportions. Because of the absence of participants with hearing loss in the current study sample, analysis could only be conducted in relation to TN findings (specificity) and not TP findings (sensitivity). The percentage of TN findings was highest at the repeat hearing screening using any test or combination of tests when compared with findings from the initial hearing screening. TEOAE combined with AABR (TEOAE/AABR) (p < 0.0001), DPOAE combined with AABR (DPOAE/AABR) (p < 0.0001), and the combination of all three screening measures (p < 0.0001) yielded the highest percentage specificity at the repeat hearing screening when compared with the initial hearing screening. The best specificity was noted at the repeat hearing screening. Within a resource stricken context, where availability of all screening measures options may not be feasible, current study findings suggest the use of a two-stage AABR protocol or TEOAE/AABR protocol.

Age and Other Factors Affecting the Outcome of AABR Screening in Neonates.

Although the utility of universal newborn hearing screening is undisputed, testing protocols vary. In particular, the impact of the infant's age at the time of automated auditory brainstem response (AABR) screening has not been well studied. We conducted a retrospective review of newborn hearing screening data in 6817 low-risk, term and late-preterm newborns at our large, urban, academic medical center for a 1-year period to analyze the impact of age and other factors on the screening failure rate and referral for diagnostic testing. AABR screening failure rates decreased with postnatal age over the first 48 hours; 13.3% failed at <24 hours versus 3.8% at ≥48 hours (P < .0001). Infants who were initially tested at ≥36 hours failed repeat testing more often than those who were tested at <36 hours (11.5% vs 18.9%; P = .03). Other factors that were associated with failure included being a boy and of a race other than white. Sensorineural hearing loss (SNHL) was diagnosed in 18.6% of infants who failed their final screening at ≥48 hours compared with 2.8% of those whose final screening occurred earlier (P = .03). SNHL was more likely in infants who failed their first screening bilaterally (21.2%) than unilaterally (4.4%); P = .03). Among healthy newborns, delaying AABR screening in the first 48 hours minimized failure rates. SNHL was 6 times as likely in infants who failed their final screening at ≥48 hours compared with those who were screened at <48 hours of age. In our study, we offer guidance for nursery directors and audiologists who determine hearing screening protocols and counsel families about results.

Newborn hearing screening failure and maternal factors during pregnancy

ObjectiveTemporary conductive hearing loss due to amniotic fluid accumulation in the middle ear cavity may lead to failure (false positive) in newborn hearing screening tests.The aim of this study was to identify whether amniotic fluid index has association with failure of the initial newborn otoacoustic emission (OAE) screening test. MethodsA cohort study in a tertiary hospital center (Royal Victoria Hospital, Montréal) was constructed from 70 newborns that failed the OAE test, but passed a subsequent auditory brainstem response (ABR) test, and 75 randomly selected newborns that passed initial otoacoustic emission testing. Maternal (including the amniotic fluid index in the third trimester) and newborn clinical data were extracted from medical records. Statistical association models were built to determine variables that influenced hearing screen passage or failure. ResultsThe two arms of the cohort had no significant differences in maternal or child clinical indices, including in amniotic fluid index. Calculated as individual odds ratios, maternal tobacco [95% CI of odds ratio: 0.04, 0.59, p = 0.0078], and drug use [95% CI of odds ratio: 0.0065, 0.72, p = 0.058] [borderline significance] were associated with failing the otoacoustic emission testing. ConclusionsAmniotic fluid index was not found to be associated with failure of otoacoustic emission screening in newborns. However, our study unveiled an interesting unexpected association of OAE failure with maternal smoking and/or drug use. This finding can help alleviate some of the time, cost and parental anxiety related to failed OAE screening.In selected cases of maternal smoking or drug use we might want to replace or add OAE to the ABR test in newborn hearing screening protocols, that don't perform both tests before discharge.

Clinical Experience on Hearing Screening in Twins and Triplets: A Retrospective Study.

Twin or multiple pregnancies often have neonatal complications. Common complications include low birth weight, respiratory distress, neonatal intensive care unit (NICU) admission (>5days) and low APGAR score especially on second twin. (1) To compare referral rates of newborn hearing screening in twins and triplets between risk and non-risk babies for hearing loss, (2) to determine the effects of birth order on referral rates in twins and triplets. A retrospective study was carried out from the case records of the neonates enrolled in the referral based NICU hearing screening program during April 2013 to December 2014 at Institute of Obstetrics and Gynecology, Chennai. 1405 neonates (723 males and 682 females) in the age range of 3-28days were screened during this period among which 76 were twins (38 pairs) and 9 were triplets (3 sets). We classified them further into non risk and risk babies among twins according to the Joint Committee for Infant Hearing (JCIH) recommendations. A dual step hearing screening protocol was used to screen the neonates. They were initially tested with distortion product otoacoustic emission (DPOAE) then with automated auditory brainstem response (AABR) before discharged from the hospital. Out of 76 (100%) twin babies 43 (56.58%) babies had one or more risk factors for hearing loss. Most common risk factors were low birth weight, premature birth, mechanical ventilation >5days, hyperbilirubinemia, infections, ototoxic medications and family history of hearing loss. Each risk factor was observed in equal proportion in 1st born and 2nd born twins. 12 (15.76%) risk babies and 11 (14.47%) non risk babies failed in DPOAE testing. Out of 9 triplets babies (3 set) 3 babies had risk factors for hearing loss. One baby in 2nd born babies group failed AABR screening. Referral rates were slightly higher in 2nd born twins when compared to 1st born twins in DPOAE testing. Chi square test did not reveal any significant association between referral rates with risk factors and birth order (p>0.05). The referral rates in twins are higher than the total population screened. There is some influence of birth order on the referral rates in twins. It needs to be further investigated on larger population.

Effect of gentamicin and levels of ambient sound on hearing screening outcomes in the neonatal intensive care unit: A pilot study

ObjectiveHearing loss rates in infants admitted to neonatal intensive care units (NICU) run at 2–15%, compared to 0.3% in full-term births. The etiology of this difference remains poorly understood. We examined whether the level of ambient sound and/or cumulative gentamicin (an aminoglycoside) exposure affect NICU hearing screening results, as either exposure can cause acquired, permanent hearing loss. We hypothesized that higher levels of ambient sound in the NICU, and/or gentamicin dosing, increase the risk of referral on the distortion product otoacoustic emission (DPOAE) assessments and/or automated auditory brainstem response (AABR) screens. MethodsThis was a prospective pilot outcomes study of 82 infants (<37 weeks gestational age) admitted to the NICU at Oregon Health & Science University. An ER-200D sound pressure level dosimeter was used to collect daily sound exposure in the NICU for each neonate. Gentamicin dosing was also calculated for each infant, including the total daily dose based on body mass (mg/kg/day), as well as the total number of treatment days. DPOAE and AABR assessments were conducted prior to discharge to evaluate hearing status. Exclusion criteria included congenital infections associated with hearing loss, and congenital craniofacial or otologic abnormalities. ResultsThe mean level of ambient sound was 62.9 dBA (range 51.8–70.6 dBA), greatly exceeding American Academy of Pediatrics (AAP) recommendation of <45.0 dBA. More than 80% of subjects received gentamicin treatment. The referral rate for (i) AABRs, (frequency range: ∼1000–4000 Hz), was 5%; (ii) DPOAEs with a broad F2 frequency range (2063–10031 Hz) was 39%; (iii) DPOAEs with a low-frequency F2 range (<4172 Hz) was 29%, and (iv) DPOAEs with a high-frequency F2 range (>4172 Hz) was 44%. DPOAE referrals were significantly greater for infants receiving >2 days of gentamicin dosing compared to fewer doses (p = 0.004). The effect of sound exposure and gentamicin treatment on hearing could not be determined due to the low number of NICU infants without gentamicin exposure (for control comparisons). ConclusionAll infants were exposed to higher levels of ambient sound that substantially exceed AAP guidelines. More referrals were generated by DPOAE assessments than with AABR screens, with significantly more DPOAE referrals with a high-frequency F2 range, consistent with sound- and/or gentamicin-induced cochlear dysfunction. Adding higher frequency DPOAE assessments to existing NICU hearing screening protocols could better identify infants at-risk for ototoxicity.

Speech-Language Pathologists' Use of Hearing Screening for Clients With Aphasia: Challenges, Potential Solutions, and Future Directions.

The co-occurrence of aphasia and hearing loss can lead to compounded receptive communication impairment that is significantly worse than in either disorder alone. Therefore, identifying potential hearing loss is a critical part of communication assessment for clients with neurogenic communication disorders, many of whom have aphasia. This clinical focus article explores speech language pathologists' (SLPs') hearing-screening practices with this population, identifies patterns of concern, and presents potential solutions and future research needs. SLPs completed an online survey. Data were obtained from 102 SLPs who work with adults with aphasia. Most respondents indicated that they do some form of hearing screening, although few do them in a reliable, valid manner. Awareness of American Speech-Language-Hearing Association hearing-screening guidelines was low. The most common reasons given for not conducting screenings included cost and lack of proper equipment and time. SLPs are an important resource for identifying potential hearing loss in individuals with aphasia. These data suggest that hearing screenings are being conducted only inconsistently with this population, often using nonstandardized methods. The results demonstrate a need to develop hearing-screening tools that are affordable, easily accessible, and validated for aphasia, and to raise awareness of currently available hearing-screening protocols and tools.

Universal neonatal hearing screening program in private hospital, Qatar

Background Newborn hearing screening is now the accepted standard of care in several countries and is becoming increasingly more established worldwide. The early detection of hearing loss is important to avoid complications in language development. Aim The aim of this study was to evaluate two-stage neonatal hearing screening program in a single private hospital in Doha, Qatar. Patients and methods A total number of 10 310 babies were tested from May 2011 to May 2016. A universal two-stage hearing screening (universal neonatal hearing screening) protocol was used. Transient-evoked otoacoustic emissions (TEOAEs) were used twice for hearing screening of all babies. The first-stage screening was performed at the first 2–3 days of life before discharge from the hospital, and the second-stage screening was performed after 2 months. Auditory brainstem response (ABR) was assessed later for babies who failed TEOAEs. Results Most of the studied neonates were delivered by means of caesarian section (55%) with a mean weight of 3.19±0.46 kg. All (100%) neonates attended the first-stage hearing screening, and only 27.8% of neonates attended the second stage. The most frequent risk factor was prematurity (54.6%). The percentage of high-risk babies was 19.1% from the total neonates for the 3 years recorded for high risk. 10.3% attended the second stage and only one-fourth underwent diagnostic ABR. A percentage of 0.001–0.003 hearing disorder was recorded. Conclusion Two-stage neonatal hearing screening protocol should include automated ABR and not only TEOAEs.

An effective compromise between cost and referral rate: A sequential hearing screening protocol using TEOAEs and AABRs for healthy newborns

ObjectiveThis study evaluated the efficacy of a sequential hearing screening protocol using transient evoked otoacoustic emission (TEOAE) and automated auditory brainstem response (AABR) tests in healthy newborns. DesignA TEOAE screening was performed during the first 48–72 h of life. If the infants failed, an AABR test was performed at the same time, and they were referred for a TEOAE rescreening at six weeks old. The results of screening Protocol 1 (only TEOAE) were compared with those of screening Protocol 2 (sequential TEOAE + AABR screenings for the first screening and TEOAE for the rescreening). Study sampleA total of 1062 healthy newborns were enrolled in this research. ResultsFor Protocol 1, the first screening and rescreening referral rates were 11.1% and 2.2%, respectively. In contrast, for Protocol 2, the referral rates were significant lower at 3.8% and 0.9%, respectively. Using the two protocols, six infants were diagnosed with hearing loss (0.57%). ConclusionsAdding simultaneous AABR tests for infants who fail TEOAE testing at the first screening stage can significantly reduce referral rates without increasing misdiagnosis rates. Although this sequential screening process involves slightly more time and has a higher cost than TEOAE alone, its greater accuracy compensates for this difference.

Sensitivity and Specificity of Combined Physiological Tests in Newborn Hearing Screening

Introduction: Newborn hearing screening has enabled the professionals to successfully detect a hearing loss at earliest. Successful hearing screening protocol involves a battery of tests, which should have high sensitivity and reduced false positive and negative responses. Moreover, protocol should be cost effective and less time consuming. Such protocol calls immediate implementation in screening program to detect hearing loss and certainly benefit beneficiaries to enroll in habilitation and or rehabilitation. Objective: To investigate sensitivity and specificity of individual and combined physiological hearing tests utilized in newborn hearing screening program. Method: A total of 572 ears (286 infants) were screened using high frequency tympanometry, acoustic reflex measure and transient evoked oto-acoustic emission (TEOAE). Despite all screening tests were passed auditory brainstem response (ABR) was measured at 30 dBnHL for confirmation of normal hearing. However, in ear where either acoustic reflex threshold for broadband noise or TEOAE was failed then detailed diagnostic ABR was carried out. Results: Sensitivity, specificity, false negative and false positive responses of individual test and combined physiological tests were determined. Results showed combined physiological measure revealed higher sensitivity (86%) and specificity (96%) and reduced false positive (0.3%) and false negative (1.3%) than each physiological measure. Conclusion: The protocol of combined physiological test in hearing screening accounts reduced false positive response there by decreases number of referrals. This in turn certainly reduces unnecessary parent tension regarding hearing status of their ward.