Otoacoustic Emission Screening Research Articles

Prevalence and risk factors of hearing loss in high-risk neonates at a tertiary care hospital in Mumbai

Background: The present study was conducted to assess the prevalence of hearing loss using measurements of otoacoustic emission (OAE) in newborns admitted to NICU and to determine the risk factors predictive of hearing impairment in these newborns. Methods: This was a Prospective observational study conducted among 220 newborns admitted to the NICU over 18 months. Ethical clearance was obtained from the IEC. The sample size was obtained by the universal sampling technique. All candidates underwent hearing assessment in a sound-treated room in the department using a distortion product OAEs (DPOAE) test at the time of discharge. Babies who did not pass the initial screening underwent another OAE test within one month after being discharged. If they failed the test again, they were referred to an otologist for BERA. Results: Of the 226 neonates included in the study, 40 cases (17.7%) failed the initial screening. 29 cases (12.8%) failed the second OAE screening and were subjected to BERA. Risk factors included asphyxia (p≤0.001), mechanical ventilation (p<0.0004), history of ototoxic medication (p=0.004), neonates with hyperbilirubinemia requiring exchange transfusion (p=0.005), low Apgar scores (p≤0.001). Conclusions: A two-stage OAE hearing screening can be a suitable method for early detection of hearing impairment in newborns. This method has shown high prevalence of hearing loss among high-risk neonates but needs to be confirmed with diagnostic BERA. It is crucial to have universal hearing screening to detect the large number of hearing-impaired neonates in the newborn population of our country, including those who are not considered at risk.

Techniques for assessing hearing loss in infants

The ability to hear is one of the five major senses that allows us to communicate effectively with others. Unfortunately, individuals frequently take their sense of hearing for granted, and they do not know how important it is until it is lost or compromised. Hearing loss was not a top concern for the Indian government until recently. Prevention, early diagnosis, and care can prevent half of all occurrences of deafness and hearing impairment. The auditory sense is critical for a child’s brain development. This will also reduce the strain of hearing loss, preventing the loss of many potentially productive years. The most cost-effective strategy to lessen the burden of hearing loss is to screen new-borns and babies. Hearing loss is the most frequent sensory deficiency in people all over the world. The severity of hearing loss can range from mild to severe. Kapoor Set al. suggested that by screening, the condition is detected earlier than it would otherwise be diagnosed. Because of the urgent need to prevent infectious causes of mortality, neonates and new-borns are not regularly checked for any specific disease in India. The Department of Prevention of Communication Disorders of All India Institute of Speech and Hearing (AIISH) located in the Southern India, conducts infant screening for hearing disorder on regular basis in different hospitals attached to it using Behavioural Observational Audiometry, Otoacoustic Emissions (OAE) screening, and administering High Risk Register (HRR). In the year 2009-2010, a total of 12416 new-borns in 10 hospitals associated with AIISH were screened for hearing disorder. The following paragraphs deals with various issues related to the hearing screening of infants in India. Methodology of study was as we searched PubMed Central and Google Scholar for relevant articles with key words «hearing, screening, hearing loss and infants». Full-text articles were downloaded dated July 2022 to September 19, 2022. Relevance was judged according to articles describing theories of hearing screening of infants India. Conclusion. Hearing screening for new-borns is critical for detecting congenital hearing loss and providing early management. Every person has the right to live a healthy lifestyle. Hearing impairment, like communication disorders, begins early in life. Infants with hearing loss will only be able to reach their full potential as fully active, contributing, and integrated members of society if systematic early screening programmes are implemented. Hearing screening for new-borns is critical for detecting congenital hearing loss. The AABR is considered necessary for HRNHS in high-risk new-borns (prematurity, anoxia, hyperbilirubinemia) who are at risk of auditory neuropathy that cannot be detected using the OAE test. The OAE test is faster and easier to conduct, but it has a larger false positive rate than the AABR. The ideal hearing procedure is still being developed. As a result, the hearing screening technique should be adapted to the specific demands of each centre.

Assessment of Hearing Impairment in Sick Newborns: A Prospective Observational Study.

Undiagnosed neonatal hearing loss causes severe language, cognitive, and behavioral problems in children. Sick newborns who spend 48 hours in the neonatal intensive care unit (NICU) have a 10- to 20-fold increased risk of permanent hearing loss.The aim of this study is to identify hearing impairment in high-risk sick newborns who spend at least 48 hours in the NICU. The present prospective observational study was conducted at a single center.All sick neonates admitted to the NICU for a minimum of 48 hours at the JK Lon Hospital, Zanana Hospital, and Mahila Chikitsalaya, Sawai Man Singh (SMS) Medical College, Jaipur,Rajasthan, India, from June 2017 to May 2018 were considered eligible for the study.The primary outcome was the assessment of hearing loss of high-risk newborns using otoacoustic emissions at the time of discharge, six weeks of age, and automated auditory brainstem response (AABR) at three months of chronological age. The secondary outcome was to analyze the association of hearing loss with different risk factors in high-risk neonates. A total of 150 infants who had one or more risk factors were studied, 60 were female and 90 were male. No statistically significant difference in hearing loss was observed based on birth weight, sex, and gestational age.The firstdistortion-product otoacoustic emission(DPOAE) screening was done on infants at the time of discharge from the NICU. Eighty-three infants (55.33%) had "refer" on the first DPOAE and the remaining 67 (44.67%) were passed results at the time of discharge.At six weeks of life, on repeat screening with a second DPOAE test, 36% "refer"on the first screen had a"refer"result on the second DPOAE. However, 4.4% "pass" on the first screen turned out to be"refer"on the second screen. These 33 infants who had"refer"results on the second screen were subjected to testing.At 10 weeks of life, AABR wasperformedon 33 infants. Eleven infants out of 33 had sensorineural hearing loss (SNHL) on AABR. Hearing impairment with the DPOAE test was observed with risk factors neonatal hyperbilirubinemia (NHH), hypoxic ischemic encephalopathy (HIE), and very low birth weight (VLBW) and was statistically significant among all risk factors.But, no such association (between hearing impairment and risk factors) was observed with the AABR test. In our study, we found that the duration of mechanical ventilation in mean days 7.67±6.24 had statistically significant SNHL compared to the lesser duration of mechanical ventilation (p<0.001). Two-stage DPOAEdone prior to AABR is helpful in the early detection of hearing loss.

Screening for Hearing Loss in High-Risk Neonates Using Otoacoustic Emissions

Context: The development and maturation of the hearing process begin in the fetal stage and progresses up to 6 months of age. Neonatal screening is therefore an essential method to screen for hearing loss at an early age. As there is a paucity of literature on the use of otoacoustic emissions (OAEs) and brainstem evoked response (BERA) tests for screening, hence we conducted a prospective observational study to screen the high-risk neonates admitted to neonatal intensive care unit (NICU) using OAE and further BERA (wherever indicated). Aims: The primary objective was to estimate the incidence of hearing loss in high-risk neonates admitted to NICU using OAEs as a screening tool. A secondary objective was to determine the risk factors predictive of hearing impairment in these neonates. Settings and Design: It was a prospective observational study conducted in a tertiary care hospital. Subjects and Methods: The study was conducted over a period of 1 year from April 1, 2021, to March 31, 2022. Fifty neonates with high-risk factors who fulfilled the inclusion criteria were enrolled and subjected to a two-staged OAE screening test and further BERA (in neonates where overall OAE result was REFER). Statistical Analysis Used: Continuous data variables were presented as means and standard deviations. Categorical data were presented as percentages and Chi-square test was used to derive comparisons. For all statistical testing, P &lt; 0.05 was considered statistically significant. Results: Of 50 neonates enrolled in the study, 22 (44%) passed the Stage I OAE. The remaining 28 (56%) underwent Stage II OAE, out of which 17 (34%) passed the Stage II screening. Eleven neonates with overall OAE results as REFER were taken up for BERA. Three neonates (6%) had a hearing loss on BERA while in 8 (16%) BERA was normal. The overall incidence of hearing loss was 6%. The variables with a statistically significant correlation with the results of OAE were - APGAR score and perinatal asphyxia at a low APGAR score. Conclusions: The incidence of hearing loss in this study was 6%. APGAR score and perinatal asphyxia at a low APGAR score at 1 and 5 min had statistically significant correlation with the outcomes of OAE screening.

Spectrotemporal Modulation Discrimination in Infants With Normal Hearing.

Spectral resolution correlates with speech understanding in post-lingually deafened adults with cochlear implants (CIs) and is proposed as a non-linguistic measure of device efficacy in implanted infants. However, spectral resolution develops gradually through adolescence regardless of hearing status. Spectral resolution relies on two different factors that mature at markedly different rates: Resolution of ripple peaks (frequency resolution) matures during infancy whereas sensitivity to across-spectrum intensity modulation (spectral modulation sensitivity) matures by age 12. Investigation of spectral resolution as a clinical measure for implanted infants requires understanding how each factor develops and constrains speech understanding with a CI. This study addresses the limitations of the present literature. First, the paucity of relevant data requires replication and generalization across measures of spectral resolution. Second, criticism that previously used measures of spectral resolution may reflect non-spectral cues needs to be addressed. Third, rigorous behavioral measurement of spectral resolution in individual infants is limited by attrition. To address these limitations, we measured discrimination of spectrally modulated, or rippled, sounds at two modulation depths in normal hearing (NH) infants and adults. Non-spectral cues were limited by constructing stimuli with spectral envelopes that change in phase across time. Pilot testing suggested that dynamic spectral envelope stimuli appeared to hold infants' attention and lengthen habituation time relative to previously used static ripple stimuli. A post-hoc condition was added to ensure that the stimulus noise carrier was not obscuring age differences in spectral resolution. The degree of improvement in discrimination at higher ripple depth represents spectral frequency resolution independent of the overall threshold. It was hypothesized that adults would have better thresholds than infants but both groups would show similar effects of modulation depth. Participants were 53 6- to 7-month-old infants and 23 adults with NH with no risk factors for hearing loss who passed bilateral otoacoustic emissions screening. Stimuli were created from complexes with 33- or 100-tones per octave, amplitude-modulated across frequency and time with constant 5 Hz envelope phase-drift and spectral ripple density from 1 to 20 ripples per octave (RPO). An observer-based, single-interval procedure measured the highest RPO (1 to 19) a listener could discriminate from a 20 RPO stimulus. Age-group and stimulus pure-tone complex were between-subjects variables whereas modulation depth (10 or 20 dB) was within-subjects. Linear-mixed model analysis was used to test for the significance of the main effects and interactions. All adults and 94% of infants provided ripple density thresholds at both modulation depths. The upper range of threshold approached 17 RPO with the 100-tones/octave carrier and 20 dB depth condition. As expected, mean threshold was significantly better with the 100-tones/octave compared with the 33-tones/octave complex, better in adults than in infants, and better at 20 dB than 10 dB modulation depth. None of the interactions reached significance, suggesting that the effect of modulation depth on the threshold was not different for infants or adults. Spectral ripple discrimination can be measured in infants with minimal listener attrition using dynamic ripple stimuli. Results are consistent with previous findings that spectral resolution is immature in infancy due to immature spectral modulation sensitivity rather than frequency resolution.

Hearing screening outcomes in pediatric critical care survivors: a 1-year report.

BackgroundHearing loss is a potentially serious complication that can occur after surviving a critical illness. Study on screening for hearing problems in pediatric critical care survivors beyond the neonatal period is lacking. This study aimed to identify the prevalence of abnormal hearing screening outcomes using transitory evoked otoacoustic emission (TEOAE) screening in children who survived critical illness and to find possible associating factors for abnormal hearing screening results.MethodsThis study was a single-center, prospective, observational study. All children underwent otoscopy to exclude external and middle ear abnormalities before undergoing TEOAE screening. The screening was conducted before hospital discharge. Descriptive statistics, chi-square, and logistic regression tests were used for data analysis. ResultsA total of 92 children were enrolled. Abnormal TEOAE responses were identified in 26 participants (28.3%). Children with abnormal responses were significantly younger than those with normal responses with a median age of 10.0 months and 43.5 months, respectively (P<0.001). Positive association with abnormal responses was found in children younger than 12 months of age (adjusted odds ratio [OR], 3.07; 95% confidence interval [CI], 1.06–8.90) and children with underlying genetic conditions (adjusted OR, 6.95; 95% CI, 1.49–32.54). ConclusionsOur study demonstrates a high prevalence of abnormal TEOAE screening responses in children surviving critical illness, especially in patients younger than 12 months of age. More extensive studies should be performed to identify the prevalence and associated risk factors of hearing problems in critically ill children.

The Effects of Clinical Factors and Neonatal Morbidities on Hearing Screening among Neonatal Admissions.

Hearing loss is an important disorder affecting newborns admitted to NICU. A national hearing screening program using otoacoustic emission testing is an essential tool to identify hearing loss early in neonates, enabling early intervention to avoid further challenges of pediatric deafness. On the other hand, a delay of the auditory pathway maturation in preterm babies compared to term newborns has already been suggested in the literature. Taking this information into account, in this paper, we aim to identify the best time to perform NICU infant hearing screening tests. We aim to study the clinical factors and neonatal morbidities that may affect neonatal hearing screening results using otoacoustic emission test in order to decrease the false-positive test results that increase parental anxiety and increase the need for subsequent investigations. This is a prospective cross-sectional study that included 204 infants who were admitted to a tertiary referral hospital NICU unit between September 2017 and May 2018. Both transients evoked otoacoustic emissions (TEOAE), and distortion product otoacoustic emission (DPOAE) screening tests were performed in order to screen hearing loss. Our study included 204 infants, 52.9 % of which were males and 47.1 % females. There were correlations between both hyperbilirubinemia and ventilation ≥ 5 days and the failure rate of the first OAE test results among NICU infants where the P-values were (p=0.0133) and (p=0.0456), respectively. Moreover, 165 babies (80.9 %) passed the first OAE with a mean birth weight of 2759 gram and mean maternal age of 30.6 years, while 39 babies (19.1 %) failed the test with a mean birth weight of 2436 gram and a mean maternal age of 32 years. There was no statistically significant relation between both maternal age and birth weight with failure of the first screening test. Our study suggests a higher failure rate of the first OAE in NICU infants who had hyperbilirubinemia or ventilation ≥ 5 days. Therefore, our recommendation is to postpone the first phase of hearing screening for those infants until the first scheduled vaccine appointment to achieve high compliance to attendance and decrease distress to the family that can be associated with false-negative results of the test.

Application of otoacoustic emissions and brainstem evoked response audiometry in newborn hearing screening

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Newborn hearing screening was conducted in a tertiary care hospital in a step by step manner using otoacoustic emissions (OAE) and brainstem evoked response audiometry (BERA) and details were recorded.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective institutional based study was conducted. All the newborns born in the hospital over a period of 18 months from December 2018 to May 2020 were considered in the study. Healthy newborns were screened bedside within 24 hours of delivery and NICU (Neonatal Intensive Care Unit) babies were screened in the NICU. Handheld OAE apparatus was used as the initial screening tool. A total of 3 OAEs were done for babies with a “refer” result in the OAEs, which were done 1 month apart. Babies with a “refer” in the third OAE were subjected for BERA.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 14226 babies were screened at 24-48 hours of birth. Among them, 13,069 babies passed the first OAE screening in both ears. Remaining babies were referred for further follow-up. After subsequent follow-ups and successive testing, 11 babies were found to have hearing loss, which was diagnosed within 4-5 months of the child’s birth.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Universal newborn hearing screening is the need of the day. OAE is an effective screening tool for newborn hearing loss. When complemented by BERA, majority of congenitally deaf babies can be diagnosed at a very early age. This helps in early intervention.&lt;/p&gt;

Auditory manifestations in HIV-infected children at a state hospital in South Africa

Objective To determine the prevalence and risk factors for developing ear disease and hearing loss (HL) in children living with HIV/AIDS (CLWHA). Methods This was a cross-sectional survey where participants underwent an otoscopic examination and an otoacoustic emissions screening (<6-years-old) or smartphone-based pure tone audiometry (>6-years-old) test. Prevalence data were analyzed using descriptive statistics while multivariate logistic regression identified the risk factors for developing ear disease/HL. Results Forty-one participants aged 3–12-years-old (22 males and 19 females) took part in this study. Twenty participants (48.7%) presented with ear disease including otitis media (n = 9, 22%), cerumen impaction (n = 10, 23%), and tympanic membrane perforation (n = 1, 2.4%). HL was observed in 13 participants (32%). Lower CD4 count, longer duration of HIV infection, shorter duration on ART treatment, and concomitant tuberculosis (TB) infection were (p < .05) all associated with ear diseases. Conclusion A high prevalence of ear disease and HL was found in CLWHA, which indicated the need for ear and hearing screening to be incorporated into 3-monthly consultations with CLWHA; to enable early detection and intervention and prevent the associated negative impacts. A multidisciplinary team approach to the management of CLWHA, specifically the inclusion of audiologists, and the use of mHealth in resource-constrained settings is highly recommended.

Hearing Screening in Pediatric Primary Care.

1. Jordan K. Yoeli, MD*,† 2. Daniel Nicklas, MD*,† 1. *Children’s Hospital Colorado, Aurora, CO 2. †University of Colorado, Aurora, CO Screening for congenital and acquired deafness and hearing loss (HL) represents a significant responsibility for clinicians in all newborn units and medical homes. Approximately 1 to 3 infants of 1,000 born in a well infant nursery setting and 2 to 4 of 100 born in a NICU have significant bilateral HL. Outcomes in various developmental domains depend on the early recognition and subsequent intervention for HL. Developmental delay is present in 30% to 40% of children with HL; the goal of hearing screening (HS) and prompt intervention is to optimize a child’s language acquisition, cognitive development, literacy, social-emotional maturity and academic success. This article reviews the most up-to-date standards and practices to aid medical providers in the early detection and intervention for pediatric HL. In the United States, universal screening begins in the neonatal period. According to the American Academy of Pediatrics (AAP) Joint Commission on Infant Hearing (JCIH), all infants should be screened for congenital HL before 1 month of age. Most infants are screened in nursery or NICU settings, except for those born outside of a medical facility. For the latter population or for infants with no documented HS, screening should be completed by the medical home before 1 month of age. In a well nursery setting, most HSs are performed by otoacoustic emission (OAE) testing. During an OAE screen, a sensitive microphone in the ear canal records the cochlear responses (“acoustic emissions”) to acoustic stimuli, thereby testing the peripheral auditory system from the outer/middle ear (conduction zones) to the cochlear outer hair cells (sensory organ). A “pass” indicates that hearing is functional to the level of …

The effects of mode of delivery, maternal age, birth weight, gender and family history on screening hearing results: A cross sectional study

IntroductionCongenital hearing impairment is one of the principal issues that make distress to families especially those with a family history of hearing problems. Early detection of hearing impairment can make a difference regarding cognitive, attention, learning, speech, and social and emotional development of babies. Otoacoustic test emission is a very common screening test that can be used to pick up early cases and relieve family stress. We tried to evaluate the factors that may disrupt our results regarding the OAE test. MethodsA cross-sectional study included infants who were admitted to the nursery unit alone. Infants who were admitted to the NICU unit, infants with craniofacial anomalies, infants with vernix in the external auditory canal, and Infants with Stigmata associated with a syndrome known to include a sensorineural hearing loss were excluded from the study. Both transient evoked otoacoustic emissions (TEOAE) with distortion product otoacoustic emissions (DPOAE) Screening tests were performed by the same professional audiologist experienced in neonatal screening. ResultsA total of 1413 newborns (733 males and 680 females) were included in the study. Among them, 1368 babies (96.8%) passed the first OAE in both ears, while 45 babies (3.2%) didn't pass the first OAE in one or both ears.Significant correlations between the female gender and family history of congenital hearing loss with failure of the first OAE test results. Moreover, vaginal delivery (VD) infants had a 1.5-fold higher failure rates of first OAE test screening results in comparison to caesarian delivery (CD) infants. ConclusionOur study demonstrated higher failure rates of the first OAE in female infants, vaginal delivery infants, and infants with a family history of hearing impairment. It is recommended to postpone the first phase of hearing screening for those infants until the first scheduled vaccine appointment to achieve higher compliance attendance, and decrease family stress associated with false-negative results of the test.

Pitfalls in the Detection of Hearing Loss via Otoacoustic Emissions

Otoacoustic emissions (OAEs) are currently used as a valuable audiological test or as a hearing screening tool. There are many commercially available OAE recording systems that are used both for clinical practice and for research. However, there is little information in the literature comparing their performance in detecting hearing loss. The purpose of this prospective, nonrandomized, and controlled study was to evaluate the screening performance obtained from recent and older versions of the Otometrics Accuscreen OAE screening device in comparison with the Otodynamics ILO-292 OAE system, which has been used as the gold standard. Testing included otoscopic assessment, pure tone audiometry, tympanometry, and transiently evoked OAE (TEOAE) recordings. There was about a 77% agreement between the two versions of the Accuscreen device. Agreement between the two Accuscreen devices and the ILO was approximately 70% for the old and 80% for the new. The newer version of Accuscreen seems to perform better than the old, being more consistent with the reference ILO system and with the audiometry profiles of the tested subjects. In order to set robust standards for OAE evaluation and analysis, additional studies comparing different OAE hearing screening systems are needed.

UNHS: A Decade Long Feasibility and Sustenance Study from a Tertiary Care Hospital in India.

Objective The aim of this study is to estimate the incidence of hearing loss in neonates at a tertiary referral center, to assess the associated risk factors in those identified with hearing loss and to explore the challenges of starting and continuing a universal neonatal hearing screening programme in a tertiary care hospital over a decade. Materials and Methods It is a cohort prospective observational study conducted from January 2008 to January 2018. Five thousand five hundred and forty neonates underwent screening for hearing loss, of which 2688 were well babies and 2854 babies had one or more risk factors causing hearing loss. Otoacoustic emissions (OAE) is employed as the first level of screening within one month of birth. Brainstem evoked response audiometry (BERA) is done at 3months of gestational age for all the well babies who were referred on OAE testing and all the high risk babies irrespective of the result of the OAE screening. The High risk criteria are based on the set criteria by the Joint Committee on Infant Hearing (2007) and American Academy of Pediatrics (1994). Results In our study the incidence of hearing impairment is 5.41 per 1000 neonates screened. In well babies and at risk babies it is 1.49 and 9.11 per 1000 respectively.The common neonatal risk factors associated with hearing loss in our study are babies admitted to neonatal intensive care units (NICU), intrauterine growth retardation (IUGR), birth weight less than 1500g, respiratory distress syndrome (RDS) and hyperbilirubinemia. Conclusion The incidence of hearing loss in our study is comparable to that reported in literature (Bachmann KR, ArvedsonJC (1998) Early identification and intervention for children who are hearing impaired. Pediatr Rev. 1998 May; Vol. 19. No.5. pp. 155-165. http://www.ncbi.nlm.nih.gov/pubmed/9584525 Accessed from May 1998, Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9., Augustine AM, Jana AK, Kuruvilla KA, Danda S, Lepcha A, Ebenezer J, et al. (2014) Neonatal hearing screening-experience from a tertiary care hospital in southern India. Indian Pediatr. Vol. 51. No.3. pp 179-183. http://www.ncbi.nlm.nih.gov/pubmed/24277966 Accessed from Mar 2014). Hearing loss is more common in those babies with risk factors as reported in literature (Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9. http://www.ncbi.nlm.nih.gov/pubmed/21654001 Paul AK (2011) Early identification of hearing loss and centralized newborn hearing screening facility-the Cochin experience. Indian Pediatr. Vol. 48. No. 5. pp 355-359. Accessed from May 2011). Implementation of neonatal hearing screening program at a tertiary care hospital using a two tier system with OAE and BERA is a feasible but challenging service.

Outcomes of newborn hearing screening at an academic secondary level hospital in Johannesburg, South Africa.

BackgroundThe Health Professions Council of South Africa (HPCSA) issued early hearing detection and intervention guidelines, which has universal newborn hearing screening (UNHS) as one of the important goals. Despite established evidence of the importance of UNHS globally, there has been no mandated formalised and standardised implementation as yet in South Africa.ObjectivesThe aim of this study was to describe the outcomes of newborn hearing screening (NHS) in an academic secondary level hospital in Johannesburg, South Africa.MethodsThis was a prospective non-experimental feasibility study over a 3-month period, involving conducting hearing screening of 121 neonates. Audiologists conducted a risk factor assessment, otoscopic examinations and distortion product otoacoustic emissions (DPOAEs) screening on each neonate, with follow-up appointments for re-screening and diagnostic audiological assessments for all neonates with refer findings. Data were analysed using STATA intercooled version 11©, through both descriptive and inferential statistics (Fisher’s exact test), with significance established where p-values less than 0.05 were considered statistically significant.ResultsOf the 121 neonates screened, the majority (75%) were screened in the first 24 h of life. A high refer rate (47%) of the total sample was found on DPOAE screening. No maternal or neonatal risk factors were found to be significantly associated with refer findings.ConclusionFindings contribute towards the existing evidence base that raises implications for successful implementation of NHS programmes in public healthcare in South Africa. Screening protocols need to consider the timing of screening, the measures and procedures adopted in the screening protocols, as well as the follow-up strategies.

Feasibility of a hearing screening programme using DPOAEs in 3-year-old children in South Auckland

ObjectivesIn New Zealand (NZ), permanent hearing loss is associated with higher levels of socioeconomic deprivation, and is more prevalent amongst Māori and Pacific than NZ European children. Many of these hearing losses are detected through newborn hearing screening, however there is a need to screen children again later, to look for childhood hearing losses that are either late-onset, progressive, or acquired. This study evaluated the feasibility of implementing an objective screening protocol that includes otoscopy, distortion product otoacoustic emission screening (DPOAEs), and tympanometry. It also evaluated the feasibility of using Early Learning Centres (ELCs) to contact families, recruit, and test 3-year-old children from an area of high socioeconomic deprivation in Auckland, New Zealand. MethodsSixty-one 3-year-old children were recruited from ELCs within the Counties Manukau District Health Board (CMDHB) region which services the geographical area of South Auckland. The first part of the screening protocol consisted of otoscopy, DPOAEs, and tympanometry. Children identified with hearing loss and/or middle ear problems were either referred directly to Otolaryngology/Audiology at the local hospital or invited back for a re-screen 4–8 weeks later. Children who were referred from the screening were followed up to track and document their subsequent clinical pathway through the public health system. ResultsMean overall time for the screening protocol was 4.1 minutes. The combination of otoscopy, DPOAEs, and tympanometry was well accepted by the 3-year-old children. DPOAE amplitude and signal-to-noise ratio results significantly differentiated between different tympanometry results, providing support for this combination of measures to accurately screen for hearing loss and/or middle ear disease. Thirty-eight of the 61 children (62%) passed the screening protocol. Of the remaining 23 children, five were referred to the hospital after not passing the screening, but following more in-depth audiological testing, were discharged with normal hearing. Six children referred to the hospital were diagnosed with varying degrees of conductive hearing loss, and two of the six received grommet insertion surgery. The remaining 12 children who were referred to the hospital were lost to follow-up, highlighting challenges for the families to successfully navigate the current public health system. ConclusionThis study demonstrates that identifying hearing loss and ear disease in 3-year-old children in the pre-school setting is feasible. A number of barriers were identified in the current health system that contribute to a large proportion of children referred with suspected hearing loss and ear disease being unsuccessful in accessing Otolaryngology/Audiology clinical care through the local hospital.

Screening Programs for Hearing Assessment in Newborns and Children.

ObjectiveIn this study, we aimed to assess the incidence of hearing loss in the pediatric population through otoacoustic emission (OAE) and brainstem evoked response audiometry (BERA) and to analyze the possible etiological factors responsible for it.Material and methodsA retrospective observational study was conducted in the Otolaryngology (ENT) and Gynecology and Obstetrics Departments at the Jinnah Postgraduate Medical Centre and National Institute of Child Health in Karachi, Pakistan between July 2019 and October 2019. The convenient sampling technique was used to select the patients. The final sample size consisting of newborns and children was 108. Initially, screening procedures were undertaken for newborns to detect permanent or fluctuating, bilateral or unilateral, and sensory or conductive hearing loss, averaging 30-40 dB or more in the frequency region, which indicated potential issues related to speech recognition (approximately 500-4,000 Hz). The screening of newborns involved the use of non-invasive, objective physiologic measures that included OAEs and/or auditory brainstem response (ABR). The children with hearing impairment then underwent BERA; thereafter, further investigations were performed to confirm the defects found on BERA testing.ResultsOf the 108 cases, 96 had normal hearing on OAE screening, and 12 were found to have hearing loss on the OAE test. Further testing was carried out on BERA for 12 cases that had been detected to have hearing loss on OAE, and BERA showed normal hearing for five cases whereas seven were found to have hearing loss. Of the seven patients with hearing loss on the BERA test, five were diagnosed with cochlear deafness, and two had retrocochlear deafness.ConclusionOur present study concludes that in order to avoid any hearing problems in infants, OAE hearing screening and diagnostic BERA screening programs should be carried out in all the hospitals of Pakistan to assess newborn hearing at an early age.

English

BACKGROUND Hearing is one of the most important senses which constitutes the basis for acquiring language, communication, cognitive and psychosocial development. Hearing impairment in infants should be recognized as soon as possible after birth for early interventions. Hearing status of a newborn in this study is being assessed by two subsequent tests with Oto-Acoustic Emissions (OAE) followed by Brain stem Evoked Response Audiometry (BERA). We wanted to study the efficacy and role of two stage Otoacoustic Emission (OAE) test for screening high risk new-borns to detect hearing impairment. METHODS A prospective observational study was conducted from July 2014 to July 2017 at Govt. Medical College, Thrissur, Kerala. OAE screening was done in two stages for 500 high risk infants admitted in newborn intensive care unit (NBICU) during the study period. First OAE test was done on the day of admission and 2nd test was done after one month. All the infants underwent Brainstem Evoked Response Audiometry (BERA) test, a month after the second OAE test. Data was analysed for efficacy of the tests. RESULTS First OAE was passed by 290 babies i.e. 58 % whereas 210 babies (42 %) showed a result of ‘refer’ in both the ears. Second OAE tests were done after 1 month which showed a result of ‘pass’ by 460 babies (92 %) and a ’refer’ by 40 babies (8 %). All babies which underwent BERA 1 month after second OAE were included in the study; out of those babies, 10 babies showed impaired hearing and they were referred for further evaluation and intervention. In our study, OAE was 100 % sensitive in the first and second tests. Specificity of OAE was 59.1 % and 93.87 % in the first and second tests respectively. The study showed 2 % permanent congenital hearing impairment (PCHI). CONCLUSIONS OAE is an effective tool providing a quick, harmless and less expensive method for screening of hearing loss in infants, irrespective of comorbidities. No single test can detect all defects in the auditory pathway. As a primary option, a two-stage evaluation with OAE can easily detect infants who need further evaluation and early intervention. A two-stage screening with OAE will give a highly sensitive and reasonably specific test which can be easily implemented in all levels of the healthcare system. KEYWORDS High Risk Neonates, Hearing Impairment, OAE, BERA

Army recruits of Indian origin: early detection and further prevention of noise induced hearing loss by otoacoustic emission

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; There has been no study on Indian population which has tested ears prone for “noise induced hearing loss”. Also, no study on recruits of Indian origin could be found in the literature, so an attempt has been made to screen the individuals to prevent noise induced hearing loss.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Otoacoustic emission (OAE) screening is done over recruits before and after first exposure to loud noise of rifle firing in our study. Recruits were followed up at 04 hours, 24 hours, 01 month and 06 months after exposure. Individuals showing variation in OAE at 24 hours were also subjected to pure tone audiometry (PTA) at 01 month and 06 months. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 98 recruits developed ‘refer’ in OAE at initial 4 hours out of which 67 recruits recovered in 24 hours. Remaining 31 recruits (45 ears) when followed up and screened at 01 month shows ‘refer’ in OAE in 22 recruits (37 ears) and high frequency loss on PTA in 17 recruits (31 ears). At 06 months 16 recruits (28 ears) shows ‘refer’ in OAE and 12 recruits (22 ears) shows dip in high frequency in PTA.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; OAE is more sensitive tool for early detection of noise induced hearing loss. This study also correlates time and frequency involved in OAE in detecting early hearing loss as the individuals who show refer in OAE at both 04 hours and 24 hours with both 3 kHz and 4 kHz involved are more prone for noise induced hearing loss in future.&lt;/p&gt;

The Hearing Status of Preterm Infant's ≤ 34 Weeks as Revealed by Otoacoustic Emissions (OAE) Screening and Diagnostic Brainstem Evoked Response Audiometry (BERA): A Tertiary Center Experience.

To know the prevalence of hearing loss in preterm infants & to evaluate the sensitivity & specificity of otoacoustic emission (OAE) in detecting hearing loss in preterm infants ≤ 34weeks. A total of 70 preterm babies from 28 to 34weeks of gestational age were enrolled in the study. Detailed prenatal, perinatal, postnatal & family history and physical examination of the babies were carried out. First OAE was done at discharge or two weeks after birth, whichever was earlier and the second OAE assessment was done at 36-40weeks of corrected age. Diagnostic brainstem evoked response audiometry (BERA) was done in all infants at 36-40weeks of corrected age, at the time of second OAE. Neonates with hearing impairment were advised for early hearing aid amplification and were referred to the rehabilitation center for further management. The sensorineural hearing loss (SNHL) in either one of the ears was identified in 13 (18.57%) preterm babies. Bilateral profound SNHL was found in 5 (7.14%) babies. Auditory neuropathy profile was found in 7 (53.8%) out of 13 babies who had hearing loss. The sensitivity, specificity, positive and negative predictive values of second TEOAE compared with diagnostic BERA was 46.15%, 85.96%, 42.85%, and 87.5% respectively. Neonatal jaundice (p = 0.009) and history of exchange transfusion (p = 0.019) were found to be significant risk factors of hearing loss in our study. Other risk factors like mode of delivery, birth asphyxia, low APGAR score, meningitis, ototoxic drugs, and seizures were not associated with hearing loss. The prevalence of hearing loss in preterm infants < 34weeks is very high. OAE alone is not an ideal screening test for high-risk neonates ≤ 34weeks because of its low sensitivity. OAE combined with diagnostic BERA should be done in all high-risk infants preterm neonates ≤ 34weeks to identify cases of auditory neuropathy spectrum disorders.

Screening of Hearing Impairment in High-Risk Neonates: A Study at Dr. R.N. Cooper Hospital and H.B.T. Medical College

Abstract Introduction The aim of this study was to find out the prevalence of hearing impairment in high-risk neonates born in Dr. R.N. Cooper Hospital and H.B.T Medical College and establish the fact that high-risk neonates have higher prevalence of hearing impairment compared with normal population. Materials and Methods A prospective observational study was conducted over a period of 1 year starting from March 2016 and involved three-stage screening of 410 neonates admitted to neonatal intensive care unit of Dr. R.N. Cooper Municipal General Hospital and H.B.T Medical College, Vile Parle (west), Mumbai. All enrolled neonateswere screened by a three-stage screening mechanism. First otoacoustic emission (OAE-1) screening was done within 24 to 72 hours of birth. Parents of neonates referred by OAE-1 were instructed to come back within 28 days for repeat OAE test (OAE-2). Those referred by OAE-2 were asked to come back after further 2 months for brainstem-evoked response audiometry. Data collected in the study were processed using Microsoft Excel. Results and Conclusion In the current study, out of 410 neonates who were screened by a three-stage screening mechanism, five including three girls and two boys were found to be suffering from profound sensorineural hearing loss. Observed prevalence of 12.20 (or 12 on rounding off to nearest digit) per 1000 in high-risk neonates is much higher compared with the prevalence of 1 to 6 per 1000 live births in overall population as reported by the American Speech-Language-Hearing Association.