Hearing Screening Protocol Research Articles

Chirp-Evoked Auditory Brainstem Response in Children: A Review.

The aim of this study was to assess the use of the chirp stimulus to record auditory brainstem responses in the pediatric population via a traditional review. An electronic search of the literature and a hand search of the literature were conducted. Studies that utilized chirp stimuli within the pediatric population that met all of the inclusion criteria were included in this review. Qualitative synthesis and interpretation of the data were completed. Seven studies that met the inclusion criteria were included in the review. Chirp stimuli produce auditory brainstem response (ABR) waveform amplitudes in children similar to those in adults when presented at moderate to low frequency levels. Latency data from chirp stimuli are not consistent when stimulus presentation rates are altered. Test-retest reliability when using the chirp stimulus was found to be good, as were sensitivity and specificity of chirp-evoked ABRs utilized in a newborn hearing screening protocol. Reviewed studies indicated that when presented at 60 dB nHL or lower, broadband chirp-generated ABRs have larger amplitudes than click-generated ABRs in children with normal hearing. Utilization of chirp stimuli decreases test time because waveforms are easier to detect with increased synchronization. Further research should focus on correlating chirp thresholds with behavioral hearing thresholds. Given the variance of results in these select studies, future research should also evaluate latency findings and focus on developing normative data for infants with hearing impairment and normal hearing.

Sensitivity of the Automated Auditory Brainstem Response in Neonatal Hearing Screening.

In a 2-stage neonatal hearing screening protocol, if an infant fails the first-stage abstract screening with an otoacoustic emissions test, an automated auditory brainstem response (ABR)test is performed. The purpose of this study was to estimate the rate of hearing loss detected byfirst-stage otoacoustic emissions test but missed by second-stage automated ABR testing. The data of 17 078 infants who were born at Lis Maternity Hospital between January 2013 and June 2014 were reviewed. Infants who failed screening with a transient evoked otoacoustic emissions (TEOAE) test and infants admitted to the NICU for more than 5 days underwent screening with an automated ABR test at 45 decibel hearing level (dB HL). All infants who failed screening with TEOAE were referred to a follow-up evaluation at the hearing clinic. Twenty-four percent of the infants who failed the TEOAE and passed the automated ABR hearing screening tests were eventually diagnosed with hearing loss by diagnostic ABR testing (22/90). They comprised 52% of all of the infants in the birth cohort who were diagnosed with permanent or persistent hearing loss .25 dB HL in 1 or both ears (22/42).Hearing loss .45 dB HL, which is considered to be in the range of moderate to profound severity, was diagnosed in 36% of the infants in this group (8/22), comprising 42% of the infants with hearing loss of this degree (8/19). The sensitivity of the diverse response detection methods of automated ABR devices needs to be further empirically evaluated.

Prevalence and referral rates in neonatal hearing screening program using two step hearing screening protocol in Chennai – A prospective study

ObjectiveTo estimate the prevalence and referral rates in well born and high risk babies using two step hearing screening protocol with Distortion Product Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Response (AABR). MethodA prospective study was carried out on 1405 neonates (983 well born babies and 422 high risk babies) who were screened during May 2013 to January 2015 at Institute of Obstetrics and Gynecology, Madras Medical College, Chennai. All neonates were screened using two step screening protocol. They were initially tested with DPOAE. Referred babies in DPOAE were screened with AABR subsequently. ResultsAmong 1405 (100%) neonates 983 (69.96%) were well born babies and 422 (30.03%) were high risk babies. Total referral rate in DPOAE was found to be 311 (22.13%) among which 195 (13.87%) were well born babies and 116 (8.25%) were high risk babies. Out of 311 babies 31 (2.20%) babies were referred in AABR screening. In 31 babies referred in AABR 11(0.78%) were from well born group and 20 (1.42%) were from the high risk group. Further diagnostic evaluation of these babies, 2 (0.14%) were confirmed to have hearing loss. This study reveals, the prevalence of congenital hearing loss in our population is 1.42 per 1000 babies. ConclusionUsing two step protocol especially AABR along with DPOAE at the initial level of testing significantly reduces referral rates in new born screening programs. Also AABR decreases the false positive responses hence increasing the efficiency of screening program.

Neonatal Hearing Screening Programme (NHSP): At A Rural Based Tertiary Care Centre.

Deafness is the most common curable childhood handicap. It is a well recognised fact that unidentified hearing impairment can adversely affect optimal speech and language development and therefore academic, social and emotional development. Universal neonatal hearing screening programmes are implemented in many developed countries. However it is still in its early stage in India. The incidence of hearing impairment in India is 1-6 per thousand newborns screened (Paediatrics 19:155-165, 1998; Indian J Paediatr 74(6):545-549, 2007; Status of Disability in India, pp 172-185 2000). To determine the incidence of permanent hearing loss of moderate to evere variety in neonates taking care in a tertiary care rural based hospital in Gujarat. It was a non randomised observational study done for duration of 3years. All neonates born in Shri Krishna Hospital underwent screening using two stage protocols with DPOAE test and final confirmation done with BERA. Total 2534 neonates were screened out of them 52 failed and 2482 (97.94%) neonates passed in the 1st DPOAE test with 2.05% refer rate. Total 7 (2 per 1000) neonates were detected with hearing impairment. 10% neonates had one or other high risk factor. Out of high risk neonates, 1.8% were diagnosed with hearing impairment in high risk group. Overall the follow-up rate was 72.7%. Hospital based universal hearing screening of new born before discharge is feasible at a rural based tertiary care centre. Non specialist staff is invaluable in achieving a satisfactory referral rate with two stage hearing screening protocol. However, more efficacious tracking and follow up system is needed to improve the follow up rate for diagnosis.

Evaluation of the implementation of a newborn hearing screening protocol specific to children with risk indicators in a public maternity in Minas Gerais

Objective: to evaluate the results of the implementation of a specific newborn hearing screening protocol as well as to describe the protocol quality indicators and verify the occurrence of risk indicators for hearing impairment. Methods: all newborns (NB) in a public maternity belonging to the group at risk for hearing impairment and showing one or more risk indicator were included. Medical charts data from the newborn hearing screening program were compiled between May of 2011 and April of 2013. The evaluated quality indicators were: scope of examinations of newborns at risk, evasion rates for retesting, and diagnosis and follow-up in accordance with the proposed protocol. Results: 362 NBs were included. Out of the evaluated records, 258 NBs (71.3%) presented the “passed” result in the screening and 104 (28.7%) “failed”. A total of 111 NBs (30.7%) were discharged and 36 (9.9%) referred for diagnosis; 176 (48.6%) did not return to complete the evaluation, 37 (10.2%) have not yet completed the evaluation, and two (0.6%) died. Conclusion: 93.1% of NBs at risk were screened. The most prevalent risk indicator was “neonatal intensive care for more than five days of life”. The number of risk indicators found ranged from one to five per neonate. The protocol still shows a high evasion index, both for retesting and diagnosis and monitoring.

English

INTRODUCTION: For a child, hearing and speech are essential tools of learning, playing and developing social skills. External sound and speech is used by infants and children to learn their communicating skills by imitation. In absence of perception of this external stimulus, they cannot develop speech and language. This results in delayed speech/language development, social problems and academic difficulty. Hearing loss, in varying degrees, affects two in every 100 children under the age of 18. The most effective treatment is achieved through diagnosis, early intervention by fitting suitable hearing aids. An early start on special education programs helps maximize a child's hearing which will give the child best of chances for successful speech and language development. MATERIALS AND METHODS: The study carried out to determine the hearing level, prevalence of loss of hearing and to identify its causes in schools of slums of Kurnool, Andhra Pradesh, India where the population is homogeneous in terms of occupation, socio-economic status, literacy, food habits and health related beliefs and practices. The children were of 5yrs to 15yrs in age. Totally 1041 children constituted the sample frame and underwent clinical examination and audiometry. OBSERVATIONS: Out of 440 students examined for HL 102 were had different causes for HL. 22.5% of children belonged to the age group of 5 to 8 ears. Presence of wax10.2%, ASOM 5.68%, Glue ear 3.4%, CSOM 3.4% were among the common causes. 39.09% children showed a loss of more than 25dB. 66.74% of the causes were preventable and curable at a district level Hospital. CONCLUSION: Analysis showed that 16.3% of these children have low-frequency or high-frequency hearing loss of at least 20dB hearing level in 1 or both ears. Among children in elementary, middle, and high school, audiometric screening should include low-frequency and high-frequency testing to detect hearing loss. As more than 50% of the causes of HL in this group is curable, its difficulties on speech and language might be controlled and treated via appropriate hearing screening protocol and program in every educational setting. The results obtained emphasize annual hearing screening programs for school-age children in order to promote health care and to prevent social and educational problems.

Prevalence and risk factors of hearing loss among infants in Jordan: Initial results from universal neonatal screening

Objective: To determine the association of reported risk factors with hearing loss, and explore the possible contribution of other risk factors that may improve identifying Jordanian children for whom interventions should be provided. Design: A cross-sectional study was performed in 37 hospitals and mother-child clinics from different health sectors in Jordan. The hearing screening protocol was performed in three stages. Data collected as risk factors for infant hearing loss included those on the 2007 Joint Committee on Infant Hearing list as well as other factors believed to be possibly significant. Study sample: All babies born in or attending any of these hospitals or clinics were screened for hearing loss, which included a total of 63 041. Results: Of the 63 042 infants, 966 (1.5%) were confirmed to have significant hearing loss. We identified additional risk factors that were associated with hearing loss in infants. Conclusion: These preliminary data add to the understanding of the epidemiology of hearing loss in Jordan. The presence of at least one JCIH risk factor, admission to NICU for > 5 days, age, birth weight, postnatal hypoxia, and mode of delivery were independently associated with hearing loss.

A test protocol for assessing the hearing status of students with special needs

ObjectivesIndividuals with disabilities are often reported to have a high prevalence of undetected hearing disorders/loss, but there is no standardized hearing test protocol for this population. The purposes of this study were (1) to examine the hearing status of students with special needs in Taiwan, and (2) to investigate the use of an on-site hearing test protocol that would adequately detect hearing problems in this population and reduce unnecessary referrals for off-site follow-up services. MethodsA total of 238 students enrolled in two schools for special education and one habilitation center participated in the study. Most students had intellectual disabilities and some also had additional syndromes or disorders. A hearing screening protocol including otoscopy, tympanometry, and distortion product otoacoustic emissions was administered to examine students’ outer, middle, and inner ear functions, respectively. Pure tone tests were then administered as an on-site follow-up for those who failed or could not be tested using the screening protocol. ResultsOnly 32.4% of students passed. When administered alone, the referral rate of otoscopy, tympanometry, and otoacoustic emissions were 38.7%, 46.0%, and 48.5%, respectively. The integration of these subtests revealed 52.1% of students needed follow-up services, 11.8% could not be tested, 2.5% had documented hearing loss, and 1.3% needed to be monitored because of negative middle ear pressure. The inclusion of pure tone audiometry increased the passing rate by 9.9% and provided information on hearing sensitivity for an additional 8.6% of students. ConclusionHearing assessments and regular hearing screening should be provided as an integral part of health care services for individuals with special needs because of high occurrences of excessive cerumen, middle ear dysfunction, and sensorineural hearing loss. The training of care-givers and teachers of students with special needs is encouraged so that they can help identify hearing problems and reduce the negative impact of hearing disorders and hearing loss. The screening protocol needs to include subtests that examine the status of different parts of their auditory system. The addition of pure tone audiometry as an on-site follow-up tool reduced the rate of off-site referrals and provided more information on hearing sensitivity.

Hearing screening procedures and protocols in use at immunisation clinics in South Africa.

There exists a need for context-relevant research aimed at facilitating the efficacious provision of early hearing detection and intervention services in South Africa. This study aimed to determine the hearing screening procedures and protocols as well as referral protocols in use at maternal child woman's health (MCWH) immunisation clinics in South Africa. Thirty primary health care immunisation clinic managers or acting managers were interviewed in two South African sample groups. An exploratory, non-experimental,qualitative research design was employed incorporating both quantitative and qualitative information. An interview using a questionnaire was administered with all participants. The questionnaire encompassed areas such as work contexts, hearing screening contexts and information management systems, as well as quality control measures in place at these clinics.Content analysis was then used to code emergent themes into specific categories. Frequency calculations of these themes were calculated and results described qualitatively. No primary health care (PHC) clinics placed within the identified sites provided formalised new-born/infant hearing screening and none of these facilities had equipment to do so. Most sites attributed the lack of formalised hearing screening to budgetary and human resource issues, staff training in particular. Non-formalised hearing screening protocols in place demonstrated inconsistencies in application across districts and none complied with Health Professions Council of South Africa (HPCSA) clinic guidelines or any international guidelines. Results from the current study have assisted in identifying procedural and logistical assets and barriers to implementation of HPCSA clinic guidelines for early hearing detection and intervention (EHDI) at immunisation clinics in South Africa.

Contralateral Ear Occlusion for Improving the Reliability of Otoacoustic Emission Screening Tests

Newborn hearing screening is an established healthcare standard in many countries and testing is feasible using otoacoustic emission (OAE) recording. It is well documented that OAEs can be suppressed by acoustic stimulation of the ear contralateral to the test ear. In clinical otoacoustic emission testing carried out in a sound attenuating booth, ambient noise levels are low such that the efferent system is not activated. However in newborn hearing screening, OAEs are often recorded in hospital or clinic environments, where ambient noise levels can be 60–70 dB SPL. Thus, results in the test ear can be influenced by ambient noise stimulating the opposite ear. Surprisingly, in hearing screening protocols there are no recommendations for avoiding contralateral suppression, that is, protecting the opposite ear from noise by blocking the ear canal. In the present study we have compared transient evoked and distortion product OAEs measured with and without contralateral ear plugging, in environmental settings with ambient noise levels <25 dB SPL, 45 dB SPL, and 55 dB SPL. We found out that without contralateral ear occlusion, ambient noise levels above 55 dB SPL can significantly attenuate OAE signals. We strongly suggest contralateral ear occlusion in OAE based hearing screening in noisy environments.

Noise Exposure in the Neonatal Intensive Care Unit: A Prospective Study

Objectives: 1) Describe the sound pressure levels experienced by premature infants in a neonatal intensive care unit (NICU) over an entire admission, compared to neonatal standards for sound exposure by the American Academy of Pediatrics (AAP) and Journal of Perinatology (JP), as well as adult standards by the National Institute for Occupational Safety and Health. 2) Determine whether this population may be at higher risk for noise-induced hearing loss. Methods: Prospective observational outcomes study from August 2012- present. Condition Studied: noise-induced hearing loss. Subjects: Admissions to the NICU, &lt;37 weeks gestational age. Outcome Measurements: Sound pressure levels/cumulative sound exposure dosage. Independent Variables: bed type, location, number of patients per room, machine therapies. Preliminary Analyses: This dataset represents preliminary data from an ongoing study with a target enrollment of 150 over 12 months. Results: The average sound pressure level per admission ranged from 57.4 to 67.8 dBA. Neonates in enclosed beds experienced a trend toward higher decibel levels than those in open beds. Neonates on machines such as ventilators, continuous positive airway pressure (CPAP), or phototherapy were found to experience higher decibel levels. Conclusions: All infants received sound exposures that substantially exceeded AAP and JP guidelines of &lt;45 dBA and &lt;50 dBA for the NICU. Reducing NICU decibel levels should concentrate on bed design, individual alarm noise, and staff education regarding the sources and consequences of sound exposure. Newborn hearing screening protocols should consider additional testing to determine the risk of noise-induced hearing loss.

Frequency of Profound Congenital Hearing Loss in Healthy Newborn Infants in Fars Province

Introduction Deafness is one of the most important sensory disturbances at birth. Hearing loss can affect the development of speaking and learning during life. Early diagnosis and intervention improve language outcome. The current study aimed to determine the frequency of profound congenital hearing loss in healthy newborn infants in Fars province. Methods In a multicenter prospective study, from August 2010 to August 2011, 12573 newborns were screened for hearing loss prior to discharge from the wellborn nursery at nine teaching and private hospitals in Fars province. A three-stage hearing screening protocol using transient evoked otoacoustic emissions (TEOAE) screening with referral for diagnostic second TEOAE and auditory brainstem evoked response (ABER) assessment was employed. All neonates with abnormal initial TEOAE screening, followed with phone call for language outcome after one year. Newborns with hospital admission or drug administration excluded from the study.Results The overall pass rate in the initial screening was 91.8%, thus 1019(8.1/1000) neonates referred for diagnostic audiological assessments. Out of 1019 infants scheduled for follow-up study, only 619 neonates returned. Using follow-up letters and phone calls, it was managed to improve the response rate for language outcome after one year. Two infants were identified with profound bilateral congenital hearing impairment. These infants were immediately referred for cochlear implantation.Conclusion Findings of the current study showed that the frequency of profound congenital hearing loss is 0.159/1000 normal newborn infants in Fars province. The initial TEOAE has high false positive that may be due to occlusion of external ear canal by vernix in the early postnatal period.

Failure of hearing screening in high-risk neonates does not increase parental anxiety

Objective: The aim of this study was to determine whether a failure of neonatal hearing screening affected the anxiety level of parents of high-risk infants.Methods: Two hundred and eighty-eight parents of infants included in the neonatal hearing screening protocol of our Institution were tested with the Spielberger State-Trait Anxiety Inventory and with an open-question questionnaire investigating parents’ attitude to hearing problems in their child, done at the time of audiological follow-up. 105 were parents of high-risk infants who had been discharged from neonatal intensive care unit (NICU) and 183 of low-risk infants discharged from well-baby nursery.Results: No differences in anxiety levels were seen between parents of high-risk infants passing and failing neonatal hearing screening using homogeneous case-control pairs. Additionally, no differences in the level of anxiety were found between parents of high- and low-risk infants failing neonatal auditory screening.Conclusions: Failure of neonatal auditory screening does not affect the anxiety levels of parents of high-risk infants at post discharge from NICU. This finding is a key factor to be considered when evaluating the costs and benefits of tests for universal neonatal hearing screening.

Variability of State School-Based Hearing Screening Protocols in The United States

The prevalence of hearing loss has increased among United States children. As schools commonly perform hearing screens, we sought to contrast current United States school-based hearing screening protocols. State department of health and education websites were reviewed to assess school hearing screening protocols for the fifty states and the District of Columbia. Individuals listed on these websites were contacted as necessary to confirm and/or acquire relevant data. School-based hearing screening is currently required in 34/51 (67 %) states. Of these 34 states, 28 (82 %) mandate grades for screening, but only 20 (59 %) require screening beyond 6th grade. Pure tone audiometry is the most common screening method (33/34 [97 %]). A majority of states screen at 1, 2 and 4 kHz usually at 20 or 25 dB hearing level. Six states recommend or require testing at 6 or 8 kHz, which is necessary to detect high-frequency hearing loss. The results indicate that United States school-based hearing screens vary significantly. They focus on low frequencies with few testing adolescents for whom high-frequency hearing loss has increased. Disparities in hearing loss detection are likely, particularly considering the evolution of hazardous noise exposures and rising prevalence of hearing loss.

Early Identification of Young Children with Hearing Loss in Federally Qualified Health Centers

While newborn hearing screening has improved outcomes for children diagnosed with hearing loss, the screening protocol is incomplete in the critical early developmental years, particularly among underserved populations. To address this gap, 7 federally qualified health centers (FQHCs) implemented a periodic, objective infant-toddler hearing screening program during well-child visits. The study aimed to determine the ability of these primary care providers to implement the hearing screening protocol and to identify children in need of audiologic follow-up. This study represents a prospective chart review. Children aged 0 to 3 years presenting to participating clinics for well-child care visits were offered the hearing screen, which included a brief risk factor questionnaire, otoacoustic emissions (OAEs), and tympanometry. Main outcome measures were time to screen, accuracy of physician interpretation of the tympanogram results, and screening results requiring immediate audiology follow-up. Among 1965 OAE screens, 75% took <10 minutes, and 205 patients (10%) failed OAEs in at least 1 ear; based on tympanometry, middle ear effusions were present in 102 of these cases (50%), while 45 cases (22%) raised concerns for sensorineural hearing loss. Physicians accurately interpreted tympanogram results in 89% of cases. There were 5 patients identified with confirmed permanent sensorineural hearing loss. Findings demonstrate that infant-toddler hearing screening in FQHCs is feasible to conduct, and it may effectively identify cases of postnatal hearing loss. This is one of the first studies in a primary care setting using OAE technology coupled with tympanometry, allowing physicians to better triage patients for immediate audiology referral.

Developmental trends in auditory processing can provide early predictions of language acquisition in young infants

Auditory processing capabilities at the subcortical level have been hypothesized to impact an individual's development of both language and reading abilities. The present study examined whether auditory processing capabilities relate to language development in healthy 9-month-old infants. Participants were 71 infants (31 boys and 40 girls) with both Auditory Brainstem Response (ABR) and language assessments. At 6 weeks and/or 9 months of age, the infants underwent ABR testing using both a standard hearing screening protocol with 30 dB clicks and a second protocol using click pairs separated by 8, 16, and 64-ms intervals presented at 80 dB. We evaluated the effects of interval duration on ABR latency and amplitude elicited by the second click. At 9 months, language development was assessed via parent report on the Chinese Communicative Development Inventory - Putonghua version (CCDI-P). Wave V latency z-scores of the 64-ms condition at 6 weeks showed strong direct relationships with Wave V latency in the same condition at 9 months. More importantly, shorter Wave V latencies at 9 months showed strong relationships with the CCDI-P composite consisting of phrases understood, gestures, and words produced. Likewise, infants who had greater decreases in Wave V latencies from 6 weeks to 9 months had higher CCDI-P composite scores. Females had higher language development scores and shorter Wave V latencies at both ages than males. Interestingly, when the ABR Wave V latencies at both ages were taken into account, the direct effects of gender on language disappeared. In conclusion, these results support the importance of low-level auditory processing capabilities for early language acquisition in a population of typically developing young infants. Moreover, the auditory brainstem response in this paradigm shows promise as an electrophysiological marker to predict individual differences in language development in young children.

1763 Newborn Hearing Screening: The Experience of the University Hospital of Modena

Background and AimsNewborn hearing screening programs allow to identify infants with bilateral permanent congenital hearing impairment and to facilitate early intervention to minimize the consequences on language development. In our...

Auditory brainstem responses evoked by chirp and click stimuli in children

The chirp-evoked auditory brainstem response (ABR) has been found to be a more synchronous response in adults than the click-evoked ABR with more areas of the cochlea contributing to the compound ABR. ABRs evoked using delayed-model chirp stimuli have shown to compensate for the temporal dispersion of the cochlea and result in larger wave V amplitudes and better overall morphology when compared to click-evoked ABRs. To date, published research has only included adult subjects with the majority of studies completed on subjects with normal hearing. This study compares the chirp-evoked ABR to the click-evoked ABR in children to determine if the chirp-evoked stimulus is more efficient than the click-stimulus which is currently used in most newborn hearing screening protocols and pediatric diagnostic ABR evaluations. Subjects from birth to eight years of age, with normal and abnormal hearing, participated in this study. This presentation will include preliminary study findings.

Audiological Follow-up Results after Newborn Hearing Screening Program

ObjectivesTo investigate the validity of newborn hearing screening protocol using automated auditory brainstem response (AABR) with a confirmation method using click auditory brainstem response (ABR) and to evaluate changes in hearing status of infants with confirmed congenital hearing loss.MethodsNeonates in the well-baby nursery were screened by staged AABR. Subjects whose final AABR result was "refer" were tested by diagnostic click ABR and 226 Hz tympanometry within 3 months of age. Changes in hearing status of subjects with confirmed hearing loss were analyzed by follow-up ABR at 3-6 month intervals.ResultsOf the 12,193 healthy babies born during this period, 10,879 (89.22%) were screened by AABR. Of 10,879 neonates screened by AABR, 148 (1.36%) were "referred"; of these, 45 subjects showed ABR thresholds over 30 dB nHL in at least one ear. Thirty-four subjects underwent serial follow-up ABR tests, with 11 (32.4%) found to have normal ABR thresholds. Most subjects with mild to moderate hearing loss were found to be normal before 1 year of age, whereas all infants with severe or profound hearing loss were identified as having congenital hearing loss.ConclusionThe referral rate and the positive predictive value of our protocol were acceptable. We have also found here that substantial temporary hearing loss can be included in the first confirmative diagnosis. Temporary hearing loss of our study on follow-up give emphasis to need of further differentiation using the testing for bone conduction and middle ear status.

The role and importance of screening procedures in early diagnostics of hearing impairment

Objective. Aim of this study was to examine prevalence of hearing impairment in newborns, analyze risk factors and determine importance of neonatal screening method for early diagnosis. Methods. The total of 14023 newborns were tested in the period from 01/04/2004 to 31/12/2008. Both ears were examined, according to the principle of two-stage hearing screening protocols. TEAOE were applied for infants with no risk factors on the second or the third day after birth. In infants with risk factors and for retesting TEAOE and AABR were applied. Definitive audiological diagnostics in general anesthesia with ABR and ASSR test under general anesthesia were conducted in the case of three positive results in one or both ears, until the sixth month of life at the latest. Results. From a total of 14 023 newborns tested, one or more risk factors was present in 814 (5.8%) cases. In the first test negative result was recorded at 11 734 (83.7%) without risk factors and in 1475 (16.3%) positive result in one or both ears. In high-risk group (TEOAE + AABR), a negative result was recorded in 672 (82.5%) and positive in 142 (17.5%) infants in one or both ears. After three reported positive results in one or both ears, 49 children were referred for ABR and ASSR test. Unilateral or bilateral sensorineural hearing loss with varying degrees was confirmed in 23 (0.2%) children. One or more risk factors were present in 16 (70%) children. Severe bilateral sensorineural hearing loss was found in 8 patients. Six patients were included in the program of cochlear implantation. Conclusion. TEOAE and AABR are reliable, available and effective screening procedures for early detection of hearing loss in newborns.