Neonatal Hearing Screening Program Research Articles

Investigation of a significant increase in referrals during neonatal hearing screening: A comparison of Natus ALGO Portable and ALGO 3i

Objective: Neonatal hearing screening programs in Flanders and the Netherlands use Natus ALGO screening devices. Since 2006 in Flanders and 2009 in the Netherlands, both programs have replaced the older ALGO Portable devices with the newer ALGO 3i devices. However, in both countries, ALGO 3i devices have a significantly higher rate of referrals than ALGO Portable devices. In Flanders, the refer rate has more than doubled with the switch to ALGO 3i devices. In the Netherlands, screening centers which used ALGO 3i devices also showed a significant increase in referrals. In both countries, the percentage of children diagnosed with permanent hearing loss remained approximately the same. Design: A technical comparison of both device types was carried out to identify possible causes for the increase in referrals. The stimulus output of two ALGO Portable and three ALGO 3i devices was recorded and analysed for stimulus level, spectral properties, and stimulus irregularities. Results: ALGO 3i devices stimulate at a peak level 4.6 dB lower than ALGO Portable devices, have a different stimulus spectrum and show unexplained stimulus irregularities during 4% of the stimulation time. Conclusions: A number of technical differences were found between both device types which could explain the increase in referrals.

Tympanometry with 226 and 1000 Hertz tone probes in infants

This study aimed at describing and analyzing tympanometric results obtained with 226Hz and 1000Hz probe tones; checking for correlations between tympanometry, otoacoustic emissions and otoscopic examination; describing abnormal results found in the evaluation procedures. MethodsDouble-blind and prospective study. Our sample included 70 babies, between 7 days and one month and 13 days of age, without risk indicators for hearing loss, evaluated in the State Neonatal Hearing Screening Program. Transient evoked otoacoustic emissions, otoscopic examination and tympanometry with 226Hz and 1000Hz probe tones were used as assessment tools. The study was approved by the Ethics Committee from the institution. ResultsStatistically significant differences were observed (p<0.05) in the tympanometric measures correlation and also between transient evoked otoacoustic emissions and compliance obtained with both probe tones. Most test results were within the normal range (94.28%). Three children (4.28%) were referred to diagnostic follow-up and one (1.42%) had middle ear dysfunction confirmed by otoscopy and 1000Hz tympanometry. Conclusions1000Hz tympanometry is the most reliable probe tone used to evaluate children under three months of age. More studies focusing on middle ear acoustics and mechanics are necessary to provide reliable and precise interpretation in the evaluation of middle ear functions in babies.

Mutational analysis for GJB2, GJB6, and GJB3 genes in Campania within a universal neonatal hearing screening programme

Objective: To determine the incidence of GJB2 and GJB3 mutations and of two deletions upstream of the GJB6 gene in infants of the Campania region of southern Italy. Design: DNA samples from non-syndromic hearing-impaired infants enrolled in a neonatal screening programme for sensorineural hearing loss were analysed by PCR and by direct sequencing. The audiological features of infants with biallelic GJB2 mutations were also examined to identify genotype-phenotype correlations. Study sample: Molecular analyses were carried out in 129 affected and five unaffected infants. Results: A genetic etiology of hearing loss was identified in 28% of infants, including several at environmental risk of hearing loss. Neither GJB6 nor GJB3 (a gene not previously investigated in the Campania population) mutations were found. Conclusions: This study confirms the importance of universal neonatal hearing screening. The identification of a genetic cause in infants at environmental risk indicates that such infants should be included when investigating etiology. We confirm that also in our geographical area, c.35delG homozygotes tend to have severe symmetrical hearing loss, whereas hearing impairment is milder in compound heterozygotes.SumarioObjetivo: Determinar la incidencia de mutaciones GJB2 y GJB3 y de dos deleciones corriente arriba en el gen GJB6 en niñosde la región de Campania en el sur de Italia. Diseño: Se analizaron por PCR y por secuenciación directa muestras de ADN de niños con trastornos auditivos no sindrómicos incluidos en el programa de tamiz neonatal para hipoacusias sensorineurales. Los rasgos audiológicos de niños con mutaciones bi-alélicas del GJB2 también se examinaron para identificar correlaciones genotípicas y fenotípicas. Muestra del Estudio: Se realizó un análisis molecular en 129 niños afectados y en 5 no afectados. Resultados: Se identificó una etiología genética de la sordera en 28% de los infantes, incluyendo varios con riesgo ambiental de hipoacusia. No se encontraron mutaciones en el gen GJB6 o en el GJB3 (un gene no investigado previamente en la población de Campania). Conclusiones: Este estudio confirma la importancia del tamiz auditivo neonatal universal. La identificación de una causa genética en niños con un riesgo ambiental indica que tales infantes deberían incluirse cuando se investiga la etiología. Confirmamos que también en nuestra área geográfica, los homocigotos c.35delG tienden a tener hipoacusias simétricas severas, mientras que el trastorno auditivo es más leve en heterocigotos compuestos.

Detection improvement for neonatal click evoked otoacoustic emissions by time–frequency filtering

This study employed a time–frequency filtering technique to improve click evoked otoacoustic emission (CEOAE) detection at lower frequency bands, and hence to reduce the number of referral cases in neonatal OAE screening. Using this approach the detectability of CEOAEs, in terms of lower frequency SNRs and whole wave reproducibility, was significantly improved. Evaluations of screening outcomes demonstrated this method significantly reduced the overall referral rate, by 2.5 percentage points in initial CEOAE hearing screening. This approach may have potential application in OAE technology and in neonatal hearing screening programmes.

F026 Polish Universal Neonatal Hearing Screening Program – a way to early qualification for cochlear implantation

This study, the second of a two-part investigation, assessed changes over time in functional measures of the electrically stimulated auditory system following ototoxic deafening. Guinea pigs were trained to respond behaviorally to threshold level acoustic stimuli and then unilaterally deafened and implanted with a bipolar pair of electrodes within the cochlea and a single extracochlear electrode. Using pulsatile stimuli, thresholds for the electrically evoked auditory brainstem response (EABR) and psychophysical detection were repeatedly collected from the same animals over 3-month post-implantation periods. Thresholds were obtained as a function of stimulus phase duration primarily using bipolar intracochlear stimulation. As in earlier studies, the threshold measures exhibited both intra- and intersubject variability. Analysis of group data failed to show any statistically significant changes over time in either EABR or psychophysical threshold at any fixed pulse duration. However, significant changes over time were found in the slopes of the strength-duration functions for both measures. Slopes became shallower with time, suggesting a reduction in the efficiency of stimulus current integration, a trend presumed to occur with neural degeneration. This result suggests that strenght-duration functions could be useful as a clinical diagnostic measure.

B086 Influence of polish universal neonatal hearing screening program on early cochlear implantation in Poznan, Poland

B086 Influence of polish universal neonatal hearing screening program on early cochlear implantation in Poznan, Poland

Congenitally Deaf Children's Care Trajectories in the Context of Universal Neonatal Hearing Screening: A Qualitative Study of the Parental Experiences

The objective of this study is to examine the early care trajectories of congenitally deaf children from a parental perspective, starting with universal neonatal hearing screenings. The analysis using a three-dimensional care trajectory concept is aimed at developing a basic typology of postscreening care trajectories. Children with severe/profound hearing loss, registered in the Flanders' (Belgium) universal neonatal hearing screening program, born between 1999 and 2001. Thematic content analysis of qualitative data collected retrospectively from participant's parents. Two basic types of care trajectories emerged; based on differences in care-use in the phase of further diagnosis and related parental experiences. Subtypes resulted from events related to cochlear implantation. Five trajectory phases were identified: screening, further diagnosis, care and technology, cochlear implantation, and reduction of care and were characterized by specific parental experiences such as confusion, disbelief, disappointment, and uncertainty. Those experiences relate to care professionals' acts and communication and the child's functional evolution. Early care interventions could benefit from coordinated transition between phases, parent support throughout the care trajectory, and a broad approach to deafness in professionals' communication.

Anxiety of the mothers with referred baby during Universal Newborn Hearing Screening

ObjectiveTo investigate the anxiety among mothers whom their babies have failed test results in the first stage of Universal Neonatal Hearing Screening Program. Patients and methodsA cross-sectional study was carried out on mothers whom their baby have positive test results in the first stage of Universal Neonatal Hearing Screening Program. Face to face interview was conducted to obtain data on sociodemographic profiles, knowledge about hearing loss and past medical history. Symptoms experienced by the mothers due to positive hearing test results and level of anxiety were measured by using the Malay translation Beck Anxiety Inventory questionnaire. These mothers were then given an appointment to come for the second screening six weeks after the first screening. The same questionnaire was given to them before the start of the second screening. SPSS version 11.5 was used for data entry and analysis. Wilcoxon signed Rank Test was used to compare the level of anxiety between the first and second screening. ResultsFrom a total of 78 mothers who were participated during the first screening, 50 of them have completed the study at the second screening (response rate=64%). Fifty-two percent of them knew about the hearing screening before hand. Ninety-six percent of the mothers became alert about their child response towards sounds after they knew that their child had failed the first hearing screening. During the first screening, 74% of the mothers felt mild anxiety which was decreased to 68% before the mothers undergone the second screening. Moderate anxiety was felt by 10% of the mothers during both the first and second screening. There were 8% of the mothers having severe anxiety during the first screening but have reduced to half (4%) before the mothers undergone the second screening. The anxiety level was significantly less before the second screening with the median score of 5 (IQR: 13.0) compared to after the first screening (8, IQR=14.25); p=0.001. ConclusionsThere are considerable portion of the mothers of false-positive test result during Universal Neonatal Hearing Screening Program experienced unacceptable anxiety. This group of mothers needs to be identified and given a necessary help.

Pediatric Cochlear Implantation: A Qualitative Study of Parental Decision-Making Processes in Flanders, Belgium

Factors contributing to parents' decision when they choose between cochlear implantation (CI) and traditional hearing aids for their child were examined. The subjects were children with severe/profound hearing loss, born 1999-2001, registered in the universal neonatal hearing screening program in the Flanders region of Belgium. Qualitative data collected retrospectively from parents were subjected to thematic content analysis. In their responses to professional advice, parents were segmented into 3 groups: (a) those whose primary considerations were the importance of oral language development and the relative potential of CI and traditional hearing aids; (b) those for whom alternative factors (e.g., medical risks, ethical issues) were paramount, even in the face of professional advocacy of CI; (c) those who followed professional advice against CI. The researchers conclude that care professionals should be sensitive to the impact of their advice and other factors in parental decision making.

Newborn hearing screening programme outcomes in a research hospital from Turkey

Universal neonatal hearing screening programmes are encouraged to define and manage hearing loss in early ages of life. The aim of this study is to introduce our 14-month three-step hearing screening programme results with 16 975 births in Turkey. In healthy neonates, Transient Evoked Otoacoustic Emission (TEOAE) is served as the initial screening in the first day of life. In newborns that did not meet pass criteria TEOAE was repeated in 10-day period. If the second test was 'refer' again, the screening was completed with auditory brainstem response (ABR). Additionally, ABR was performed for the neonates with neonatal intensive care unit (NICU) requirement and at high audiologic risk. Neonates who failed the screening test with ABR were referred for further evaluation. A total of 15 323 newborns and 1652 NICU infants were tested. The screening coverage was 94.4%; 14 521 neonates (94.7%) passed the first screening step (TEOAE), while 802 (5.2%) neonate failed. In total, 322 (40.1%) of the neonates out of 802 was subjected to the second TEOAE after 10 days have failed and ABR was applied. From the neonates participated the third step (ABR) totalling 1974, 43 (2.17%) of neonates obtained a 'refer' response. Out of these 43 neonates, 17 neonates were (39.5%) NICU infants. From the 43 neonates, 38 cases (88.4%) were found to have hearing impairment. The false-positive rate for first step screening with TEOAE was 4.9%; second step with TEOAE was 1.85% and for ABR was 0.25%. It is apparent that three step national hearing screening programme which has been applied for the latest years in Turkey is an accurate and non-invasive method to determine the congenital hearing loss. In the future, screening programmes could be rearranged with two steps as initial with TEOAE and retest with ABR and the coverage of the screening programme can be extended.

Detecção de perdas auditivas em neonatos de um hospital público

OBJETIVO: Analisar os resultados obtidos na triagem auditiva neonatal realizada por meio de dois procedimentos, Emissões Otoacústicas Transientes e Potencial Evocado Auditivo de Tronco Encefálico - modo automático, em uma população de neonatos saudáveis de um hospital público, considerando-se o gênero masculino e feminino e o lado em que a falha ocorreu. MÉTODOS: Foram incluídos na pesquisa neonatos de alojamento conjunto, nascidos em um hospital público, e que realizaram triagem auditiva após a alta hospitalar. Utilizou-se para triagem as Emissões Otoacústicas Transientes (EOAT) com critério passa/falha e o reteste com o Potencial Evocado Auditivo de Tronco Encefálico-modo automático (PEATE-A). RESULTADOS: Foram testados 5106 neonatos, 51,3% do sexo masculino e 48,7% do sexo feminino. Falharam 628 (12,3%) neonatos, 368 (58,6%) do sexo masculino e 260 (41,4%) do gênero feminino, sendo encaminhados para o PEATE-A. Destes, 223 (35,3%) compareceram ao exame, 199 (89,2%) passaram e 24 (10,8%) falharam; 17 (70,9%) do gênero masculino e sete (29,1%) do gênero feminino. Houve diferença estatística significante entre falha auditiva por meio das emissões otoacústicas e sexo. Encontrou-se 10% de neonatos que falharam nos dois procedimentos de triagem. CONCLUSÃO: Encontrou-se um número maior de falhas em crianças do gênero masculino no teste de emissões otoacústicas transientes. Não houve diferença entre neonatos do gênero masculino ou feminino quanto às falhas nas orelhas esquerda e direita.

Cost analysis of an Italian neonatal hearing screening programme

Aim. The objective of this study was to estimate the cost of a Universal Neonatal Hearing Screening (UNHS) programme in an Italian region.Methods. A cost analysis of a regional UNHS programme was carried out on 32,502 newborns. 31,992 (98.4%) were no audiological risk (NAR) subjects and 510 were babies with audiological risk (WAR) (1.6%). UNHS was performed on two levels. The first level involved otoacustic emission (OAE) testing on NAR subjects, while the second level involved auditory brainstem response (ABR) testing of WAR and of NAR with 2nd OAE Refer tests.Results. The cost of screening was €13.32 per screened NAR infant. The total cost (OAE+ABR) was €16.58, spreading the cost over the whole NAR population. The total cost per screened infant in the WAR population was €415.9. The average cost per detected case in the NAR population was €32,951, while in the WAR population it was €11,303.Conclusions. The cost of UNHS in our region is comparable to the cost per diagnosed case of other neonatal screening programmes, and it is justified when it allows us to intervene at an early stage. On the basis of both the cost of our regional screening programme and the incidence of hearing impairment, we can conclude that the cost-effectiveness of our programme has been demonstrated.

Cost analysis of an Italian neonatal hearing screening programme

Cost analysis of an Italian neonatal hearing screening programme

Progress Towards Universal Neonatal Hearing Screening: A World Review

This study reviewed the performance of universal neonatal hearing screening (UNHS) programs in 46 countries across North America, Europe, Asia, the Middle East, Oceania and Africa. The review was based on data collected from a 2004 survey of early hearing detection programs; responses to a 2006 survey of audiologists undertaken by the authors; a literature review of 55 articles, reports and internet sources from 1995 to 2007; and one 2006 Market Research Report. This data was compared to the UNHS benchmarks set by the Joint Committee on Infant Hearing (JCIH) in 2007. In the 21 countries where data on national screening coverage were available, the average coverage was 46% (JCIH recommends 95% or more). In the 32 countries where data on regional or local screening coverage were available, the average coverage was 64% (JCIH recommends 95% or more). In the 27 countries where data on referral rates were available, the average rate was 7% (JCIH recommends 4% or less). Finally, in the 16 countries where data on follow-up rate were available, the average rate was 63% (JCIH recommends 90% or more). These results highlight screening coverage and follow-up rate as the major inhibitors to the success of UNHS programs in many countries where UNHS programs are currently in operation. Factors contributing to these inhibitors are discussed.

Distortion product otoacoustic emissions: comparison of sequential vs. simultaneous presentation of primary tones

Distortion product otoacoustic emissions are one form of evoked otoacoustic emissions. DPOAEs provide the frequency specific information about the hearing status in mid and high frequency regions. But in most screening protocols TEOAEs are preferred as it requires less time compared to DPOAE. This is because, in DPOAE each stimulus is presented one after the other and responses are analyzed. Grason and Stadler Incorporation 60 (GSI-60) offer simultaneous presentation of four sets of primary tones at a time and checks for the DPOAE. In this mode of presentation, all the pairs are presented at a time and following that response is extracted separately whereas, in sequential mode primaries are presented in orderly fashion one after the other. In this article simultaneous and sequential protocols were used to compare the Distortion product otoacoustic emission amplitude, noise floor and administration time in individuals with normal hearing and mild sensori-neural (SN) hearing loss. In simultaneous protocols four sets of primary tones (i.e. 8 tones) were presented together whereas, in sequential presentation mode one set of primary tones was presented each time. Simultaneous protocol was completed in less than half the time required for the completion of sequential protocol. Two techniques yielded similar results at frequencies above 1000 Hz only in normal hearing group. In SN hearing loss group simultaneous presentation yielded signifi cantly higher noise floors and distortion product amplitudes. This result challenges the use of simultaneous presentation technique in neonatal hearing screening programmes and on other pathologies. This discrepancy between two protocols may be due to some changes in biomechanical process in the cochlear and/or due to higher distortion/noise produced by the system during the simultaneous presentation mode.

Neonatal screening for hearing loss: pilot study from a tertiary care centre.

Many developed countries have well established universal neonatal hearing screening programs. In India, the viability of such a program, in an already overburdened health system is indeed a challenge. This cross sectional study was undertaken to evaluate the possible burden of hearing loss among neonates born at a tertiary care hospital in Southern India. Five hundred neonates were screened with automated distortion product otoacoustic emission (aDPOAE) for hearing loss, 9.2% of whom had one or more high risk factors. Although 6.4% had hearing loss at initial assessment, only 1.6% had hearing loss on retesting with aDPOAE. Retesting with OAE before an automated Auditory brainstem response (aABR) helped to exclude patients without hearing loss. The frequency of moderate to moderately severe hearing loss in this study was 0.6%. This pilot study underscores the importance of the introduction of screening for congenital deafness in specialized centers in India, despite its challenges.

Neonatal hearing screening — the Indian experience

A neonatal hearing screening programme has been established in Pune, India. A total of 2621 babies were screened from August 2005 to August 2007 using otoacoustic emissions (OAE) followed by brainstem evoked response audiometry (BERA) for those who referred on the second OAE testing. Two hundred and forty nine babies were referred on the second OAE testing and of these only 52 came back and were further evaluated using BERA. Fifteen of these 52 babies were found to have a significant hearing loss. The significance of these results is discussed. Copyright © 2009 John Wiley & Sons, Ltd.

Validation of the Spanish parent satisfaction questionnaire with neonatal hearing screening programs

IntroductionAlthough measuring parent satisfaction has been recommended as one of the important outcome measures in assessing the effectiveness of neonatal hearing screening programs, there are few published studies investigating this issue. ObjectivesTo validate the Spanish version of the Parent Satisfaction Questionnaire with Neonatal Hearing Screening Programm (PSQ-NHSP). MethodsHundred twelve parents whose children had received hearing screening participated in this study. ResultsHigh levels of satisfaction were reported with more than 90% of parents satisfied with all aspects of the program. The psychometric properties of the Spanish version of the PSQ-NHSP were analyzed and demonstrated good internal consistency (α=.75). Construct validity was indicated by a significant positive relationship between overall satisfaction and the 3 specific dimensions in the questionnaire. DiscussionThe development of a valid and reliable parent satisfaction questionnaire is important for improving hearing screening programs.

Results of a neonatal hearing screening program in Maceió

SummarySince 1998, after we started the support group for neonatal hearing screening, many other hearing screening programs were held in Brazil. In Alagoas, the first program started in 2003, but none of its results were published. Hearing is paramount for human communication; therefore, childhood hearing loss can impair speech acquisition, emotional, educational and social development. Aim: to present the results achieved in a neonatal hearing screening program in Maceió. Materials and Methods: a retrospective analytical study was carried out in order to study the results from tests carried out from September 2003 to December 2006 in a private hospital of Maceió. Results: from a total of 2002 newborns, 1,626 fitted the inclusion criteria, 835 (51.4%) males. The hearing screening was considered appropriate in 1416 cases (87.1%), and the most frequently found age was between 16 and 30 days. Finally, 163 (10.0%) children presented risk indicators for hearing loss, and hyperbilirubinemia was the most common indicator. Conclusions: statistical results obtained from this hearing screening program show the importance of holding such programs. This study is important because it contributes to further regional or multinational studies.

Validación del cuestionario de satisfacción de los padres con los programas de cribado auditivo neonatal en español

Introduction: Although measuring parent satisfaction has been recommended as one of the important outcome measures in assessing the effectiveness of neonatal hearing screening programs, there are few published studies investigating this issue.Objectives: To validate the Spanish version of the Parent Satisfaction Questionnaire with Neonatal Hearing Screening Program (PSQ-NHSP).Methods: 112 parents whose children had received hearing screening participated in this study. Results: High levels of satisfaction were reported with more than 90 % of parents satisfied with all aspects of the program. The psychometric properties of the Spanish version of the PSQ-NHSP were analyzed and demonstrated good internal consistency (α = 0.75). Construct validity was indicated by a significant positive relationship between overall satisfaction and the three specific dimensions in the questionnaire.Discussion: The development of a valid and reliable parent satisfaction questionnaire is important for improving hearing screening programs.