Implementation Of Universal Hearing Screening Research Articles

Hearing impairment and its risk factors by newborn screening in north-western India.

BackgroundTo screen the newborn by Transient evoked Otoacoustic emission and to assess the incidence of hearing damage and associated risk factors.MethodThis longitudinal prospective observational study was conducted at a tertiary care hospital in India. A total of 415 babies were included in the study. All the newborns were evaluated with Transient evoked Otoacoustic emission (TEOAE) which was done by age of 1–3 days. Auditory brain stem response audiometry (AABR) was performed at the age of three months for confirming the hearing loss in the neonates those who failed the TEOAE screening. For infants proven to have significant hearing loss in one or both ears, were denoted to an ear, nose, and throat specialist for further evaluation & rehabilitation.ResultsOut of total 415 babies included in the study, 22 neonates showed abnormal TEOAE examination. Out of these 22 neonates, hearing loss was confirmed in 18 (82 %) subjects. by AABR. The following antenatal and post-natal risk factors were associated with hearing loss: ante-partum bleeding, history of maternal blood transfusion, fetal distress, prematurity, severe birth asphyxia, NICU admission for more than 24 h and Apgar score less than five at 5 min.ConclusionLate identification of hearing loss presents a substantial public health burden. Early recognition and intervention prior to 6 months of age has a significant positive impact on development. A high incidence of hearing impairment seen in our study neonatal population warrants the urgent implementation of universal hearing screening of all the newborn infants in India. NICU infants admitted for more than 24 h are to have an auditory brainstem response (AABR) included as part of their screening so that neural hearing loss will not be missed.

Clinical Practice for Children with Mild Bilateral and Unilateral Hearing Loss

Historically, children with mild bilateral and unilateral hearing loss have been reported to experience difficulties related to language and academic functioning. In the context of Universal Newborn Hearing Screening, there is an increasing focus on determining optimal clinical interventions for this population of children. The objectives of this study were to determine the prevalence of mild bilateral or unilateral hearing loss identified in a clinical population from 1990 to 2006 and to document clinical practices related to recommendations and uptake of amplification. This population-based study consisted of a detailed retrospective chart review of all children identified with mild bilateral or unilateral hearing loss in a Canadian pediatric center between 1990 and 2006. Hearing loss and patient characteristics were extracted to describe the clinical population. Amplification recommendations and uptake of amplification were documented. Clinical decisions regarding amplification practices were explored as a function of age of identification and severity of hearing loss. A total of 670 children were identified with permanent hearing loss during the 16-yr study period, of which 291 were presented with a mild bilateral or unilateral hearing loss. Detailed reviews of the 255 available medical charts showed that at diagnosis, 178 children presented with mild bilateral, 31 with mild bilateral high frequency, and 46 with unilateral hearing loss. Eighty percent of children had been referred through conventional medical processes before the implementation of universal hearing screening and 20% had been exposed to screening. The average age of identification for the entire group was 54.2 mos (interquartile range, 30.1 to 76.9 mos). Amplification was prescribed for 91.4% of children but there was considerable delay from confirmation of hearing loss to amplification for both children identified with and without screening. Overall, 54.1% received an initial recommendation for amplification and a further 37.3% received a recommendation more than 3 mos after hearing loss confirmation. Practice patterns varied according to category of hearing loss with 60.1% of children with mild bilateral hearing loss receiving an initial recommendation compared with 26.1% of those with unilateral hearing loss. Clinical decision making relative to amplification needs was also changed during the course of audiologic care. The decision to amplify was significantly related to age at identification and degree of hearing loss in the mild bilateral group but not in the unilateral group. Although, more than 90% of children received a recommendation for amplification, chart documentation revealed that less than two thirds of children consistently used their amplification devices. Use of amplification did not vary among children with mild bilateral, mild bilateral high frequency, and unilateral hearing loss. : This research suggests that there is considerable uncertainty related to clinical recommendations of intervention for this population of children. The impact of parental indecision regarding the benefits of amplification is unknown. Further studies are required to document the potential benefits and factors affecting amplification recommendations and use in the current practice environment where children with mild bilateral or unilateral hearing loss are identified early through newborn hearing screening.

Identification of hearing loss after age 18 months is not early enough.

The general development of 40 deaf and hard of hearing infants was analyzed. The infants were placed into one of two groups according to age at which hearing loss was identified: (a) before age 6 months and (b) after age 18 months. The mean age at testing was 40 months. Developmental quotients (DQs) were used to compare results regardless of the infants' age at time of testing. Infants were evaluated on the basis of their DQ scores on the Minnesota Child Development Inventory (MCDI; Ireton & Thwing, 1972). MCDI subtests include general development, gross motor, fine-motor, expressive language, comprehension-conceptual, situation-comprehension, self-help, and personal-social. Infants whose hearing loss was identified before age 6 months scored significantly higher than those whose hearing loss was identified after age 18 months in the expressive language and comprehension-conceptual subtests. The performance of the earlier-identified group supports the earliest identification of hearing loss and encourages implementation of universal hearing screening.