Trained Audiologist Research Articles

A New Community-to-Hospital Specialist Otology Pathway Using Telemedicine: A Pilot Study of 50 Patients.

Pathway innovation using smartphone otoscopy and tablet-based audiometry technologies to deliver ear and hearing services via trained audiologists may improve efficiency of the service. An ENT-integrated-community-ear service (ENTICES-combining community audiology management, remote ENT review and novel technologies) was piloted. We aimed to assess the efficiency and safety of ENTICES. ENTICES was a community-based and audiologist-led pathway. Patients with otological symptoms were self-referred to this service. Smartphone otoscopy and tablet-based audiograms were performed. Two otologists reviewed all decisions made in the community by audiologists based on video-otoscopy, hearing tests and chart reviews. Data on the first 50 consecutive new patients attending either consultant-led hospital otology clinics (HOC), audiologist-led hospital advanced audiology diagnostics (AAD) or ENTICES clinics were collected between 1 August 2021 and 31 December 2021. Data were collected through chart reviews and questionnaires to compare the three pathways with respect to efficiency, patient satisfaction, technology utility and safety. No audiology-led ENTICES decisions were amended by hospital otologists following remote review. Remote review of video-otoscopy with history was sufficient for a diagnosis in 80% of cases. Adding hearing tests and standardised history increased the diagnostic yield to 98%. Patient satisfaction scores showed 100% service recommendation. The cost per patient, per visit, was £83.36, £99.07 and £69.72 for AAD, HOC or ENTICES, respectively. ENTICES provides a safe ear and hearing service that patients rated highly. Thirty-two per cent of hospital otology patients were eligible for this service. For those patients, ENTICES is 20% more cost-effective and can reduce the number of clinic visits by up to 60% compared with HOC.

In-situ hearing threshold estimation using Gaussian process classification

One in six Americans suffers from hearing loss. While treatment with amplification is possible for many, the acceptance rate of hearing aids is low. Poor device fitting is one of the reasons. The hearing aid fitting starts with a detailed hearing assessment by a trained audiologist in a sound-controlled environment, using standard equipment. The hearing aid is adjusted step-by-step, following well-described procedures based on the audiogram. However, for many patients in rural settings, considerable travel time to a hearing center discourages them from receiving a hearing test and treatment. We hypothesize that hearing assessment with the patient’s hearing aid can reliably substitute the hearing test in the clinic. Over-the-counter hearing aids could be programmed from a distance and fine-tuned by the hearing aid wearer. This study shows that a patient-controlled hearing assessment via a hearing aid in a non-clinical setting is not statistically different from an audiologist-controlled hearing assessment in a clinical setting. The differences in hearing obtained with our device and the Gaussian Process are within 3 dB of the standard audiogram. At 250 Hz, the sound delivery with the hearing aid used in this study added an additional reduction of sound level, which was not compensated.

Diagnostic ability of otoacoustic emission and automated auditory brainstem response in hearing screening of high-risk newborn

Background: Early identification of hearing impairment in infants and appropriate intervention can prevent severe psychosocial, educational, and linguistic repercussions. Infants who are not identified before 6 months of age have delays in speech and language development.Methods: This was a prospective cohort study OAE and AABR were administered to high-risk neonates discharged from NICU and the diagnostic ability to pick up hearing loss was assessed by trained audiologist. Statistical analysis was interpreted by McNemar paired Chi-square test (χ2) test. Factors which correlated with deafness were interpreted by Pearson chi-square (χ2) test.Results: Among 144 babies screened, 26 failed OAE while 6 failed AABR. Referral rate was 18.1% with OAE and 4.2% with AABR. All 6 babies failed with 40db and 90 db screening. Mean duration of NICU stay had a positive correlation with AABR positivity. Babies with higher duration of NICU stay had greater probability of hearing loss. Age and gender had no significant correlation with hearing loss. Sensitivity of OAE as 16.7 % and the specificity was 81.9 %. Positive likelihood ratio with OAE was.923. Negative likelihood ratio with OAE was 1.02. One neonate out of 6 with jaundice had profound hearing loss. Conclusions: It was concluded that in high-risk neonates the diagnostic value of DPOAE for identification of hearing loss, when used alone, was limited since OAE has higher referral rate and lower specificity compared to AABR. Babies with higher duration of NICU stay had greater probability of hearing loss.

Systematic Evaluation of the T30 Neurostimulator Treatment for Tinnitus: A Double-Blind Randomised Placebo-Controlled Trial with Open-Label Extension.

Tinnitus is often triggered by cochlear damage and has been linked with aberrant patterns of neuronal activity. Acoustic Coordinated Reset (CR®) Neuromodulation is a sound therapy hypothesised to reduce tinnitus symptoms by desynchronising pathological brain activity using a portable acoustic device (the T30 neurostimulator). We report results of a pivotal trial to test the efficacy of this intervention. This two-centre, double-blind randomised controlled trial with long-term open-label extension, was undertaken between February 2012 and February 2014 in the UK. Participants were 100 adults with tinnitus as a primary complaint, recruited through hearing clinics and media advertisements. Intervention was the device programmed either with the proprietary sound sequence or placebo algorithm, fit by one of five trained audiologists. Minimisation software provided group allocation (1:1 randomisation), with groups matched for age, gender, hearing loss and tinnitus severity. Allocation was masked from participants and assessors during the trial. The primary measure of efficacy was change in tinnitus symptom severity between groups, measured using the Tinnitus Handicap Questionnaire at 12 weeks. Secondary outcomes were other measures of tinnitus symptom severity, health-related quality of life, and perceptual characteristics (pitch, loudness, bandwidth) at 12 weeks, and Tinnitus Handicap Questionnaire at 36 weeks (open-label extension). A statistician blinded to the allocation conducted an intention-to-treat analysis that employed linear regressions on minimisation variables, trial centre and intervention group, with multiple imputations for missing data. The study was registered on clinicaltrials.gov (NCT01541969). We screened 391 individuals and assigned interventions to 100 eligible participants. The primary outcome was not statistically significant between groups (mean group = −0.45, 95% CI −5.25 to 4.35; p = 0.85), nor were any of the secondary outcomes. Four adverse events occurred during the trial. Analysis of tinnitus symptom severity data collected across the 24-week open-label extension showed no statistically significant within-group changes after 12, 24, or 36 weeks treatment with the proprietary sound sequence. While individual participants may benefit from sound therapy, Acoustic CR® Neuromodulation did not lead to group-mean reductions on tinnitus symptom severity or other measures compared to placebo, or over time.

Characteristics of Hearing Impairment in Children Aged Six Months to Two Years with Global Developmental Delay

Introduction: Children with global developmental delay (GDD) are at greater risk to have hearing impairments. These impairments interfere with developmental progress or rehabilitation effects. Hearing impairments may be correctable and if so, may improve developmental outcomes. We aimed to study the incidence, characteristics and probable risk factors of hearing impairment in children aged six months to two years with GDD. Methods: In this prospective study, an auditory evaluation was carried out by a trained audiologist in children with GDD. Transient evoked otoacoustic emissions (TEOAE) and brainstem auditory evoked response (BERA) were assessed in these children. Hearing loss was classified based on Goodmann's classification. Results: Of 113 children with GDD assessed, hearing impairment was identified in 35 (30.9%) children. Of 35 children, 22 (62.8%) had isolated sensorineural hearing loss (SNHL). Conductive hearing loss was identified in four (11.5%) and combined hearing loss in nine (25.7%). Of 31 children with SNHL, hearing loss was bilateral in 25 (80.6%). In SNHL, hearing loss was profound in one (3.2%), severe in 14 (45%), moderately severe in three (9.6%), and moderate in five (16.2%). Hearing impairment was associated with 31.7% (20/63) children with cerebral palsy. Kernicterus was another predominant risk factor associated with SNHL. Metabolic disorders, otitis media, tuberous sclerosis, and metachromatic leukodystrophy were other conditions associated with hearing impairment. Conclusions: Hearing impairment is accompanied by about a third of children with GDD. The hearing impairment in children with GDD tends to severe SNHL type in about 45% and bilateral in about 80%.

EEG-based diagnostics of the auditory system using cochlear implant electrodes as sensors

The cochlear implant is one of the most successful medical prostheses, allowing deaf and severely hearing-impaired persons to hear again by electrically stimulating the auditory nerve. A trained audiologist adjusts the stimulation settings for good speech understanding, known as “fitting” the implant. This process is based on subjective feedback from the user, making it time-consuming and challenging, especially in paediatric or communication-impaired populations. Furthermore, fittings only happen during infrequent sessions at a clinic, and therefore cannot take into account variable factors that affect the user’s hearing, such as physiological changes and different listening environments. Objective audiometry, in which brain responses evoked by auditory stimulation are collected and analysed, removes the need for active patient participation. However, recording of brain responses still requires expensive equipment that is cumbersome to use. An elegant solution is to record the neural signals using the implant itself. We demonstrate for the first time the recording of continuous electroencephalographic (EEG) signals from the implanted intracochlear electrode array in human subjects, using auditory evoked potentials originating from different brain regions. This was done using a temporary recording set-up with a percutaneous connector used for research purposes. Furthermore, we show that the response morphologies and amplitudes depend crucially on the recording electrode configuration. The integration of an EEG system into cochlear implants paves the way towards chronic neuro-monitoring of hearing-impaired patients in their everyday environment, and neuro-steered hearing prostheses, which can autonomously adjust their output based on neural feedback.

Tablet and web-based audiometry to screen for hearing loss in adults with cystic fibrosis

IntroductionIndividuals with chronic lung disease (eg, cystic fibrosis (CF)) often receive antimicrobial therapy including aminoglycosides resulting in ototoxicity. Extended high-frequency audiometry has increased sensitivity for ototoxicity detection, but diagnostic audiometry...

Neonatal hearing screening- time to make a noise- experience from a private medical college in South Rajasthan

Background: Neonatal Hearing Loss has a prevalence that is twice than that of disorders like congenital hypothyroidism, phenyl ketonuria etc. Early detection of hearing impairment is vital since early intervention in form of hearing aids and speech therapy would help lead a child a normal life. The aim of the study was to set up a neonatal hearing screening program and to study the various risk factors which could be associated with hearing loss.Methods: The prospective descriptive study was carried over a period of two years. All neonates before being discharged were subjected to OAE. OAE was done on Oto Read Machine (Intra acoustic) and BERA was done on BERA eclipse machine (Intra acoustic). Babies who failed the first OAE were called back for a repeat OAE at six weeks of age. Babies who failed the second OAE were referred to a trained audiologist for BERA which was performed on BERA Eclipse machine.Results: Out of 1114 neonates screened, 285 neonates failed the first OAE and were called back at six weeks for repeat OAE. Out of the 285 babies who were called for repeat OAE, 258 turned up 27(9.47%) were lost to follow up. Out of the 258 babies who turned up, 245 passed the test while 13 failed the test. 13 Babies who had failed the second OAE screening were called back 1 month later for BERA testing. Out of the 13 babies who turned up for BERA testing, 12 passed the test and 1 failed giving us a prevalence of 0.89 per 1000 population. Of the various risk factors studied only low birth weight was found to be having significant association with hearing loss.Conclusion: Neonatal hearing screening is the need of the hour. Larger multi centric studies are required to establish the prevalence of hearing impairment among newborns.

Applying the COM-B Model to Assess the Usability of Smartphone-Connected Listening Devices in Adults with Hearing Loss.

Unlike conventional hearing aids, smartphone-connected listening devices may require limited or no input from a trained audiologist in terms of device programming and adjustment. However, there is a lack of peer-reviewed evidence assessing the real-world perspectives of people living with hearing loss toward such technological innovations. This study assessed the everyday experiences of adults living with hearing loss toward a range of smartphone-connected listening devices using the Capability, Opportunity, Motivation, Behaviour (COM-B) model as a theoretical framework. A qualitative study where participants trialed one of the following smartphone-connected listening devices for two weeks in their everyday lives: made-for-smartphone hearing aid, personal sound amplification product, and smartphone "hearing aid" app with wired earphones or wireless hearable. Individual semistructured interviews were conducted. Twenty adults (13 male and 7 female; mean age = 62.25 years, SD = 11.59) with mild-to-moderate hearing loss (mean better ear pure-tone average = 30.49 dB HL, SD = 17.51) were recruited using a convenience sampling strategy. All participants owned conventional hearing aids. The data were analyzed using an established deductive thematic analysis procedure within the context of the COM-B model. The model stipulates that for individuals to engage in a particular behavior (B), they must have sufficient capability (C), opportunity (O), and motivation (M). Capability: One of the key advantages facilitating use and adherence of smartphone-connected listening devices was the ability for participants to make fine-tune adjustments in any listening situation. Opportunity: Participants commented that these devices could address issues surrounding stigma as smartphones are ubiquitous in everyday life. Motivation: Participants consistently reported that the ability to make adjustments via a smartphone provided them with a greater sense of autonomy and empowerment. As a result, they felt more in control of their hearing loss. This study lays the foundation for further high-quality research to explore whether smartphone-connected technologies have the potential to yield optimum benefits for people living with hearing loss.

Development and evaluation of a tablet-based diagnostic audiometer

Objective: To develop and evaluate a software application capable of conducting Pure-Tone Audiometry tests in clinical practice.Design: We designed and developed a mobile software application for iPad devices that performs Pure-Tone Audiometry according to ANSI and IEC standards. The application is proposed to be operated by a trained audiologist inside a sound booth. No extra equipment is required. Hence, it updates the procedure by showing the versatility of the proposed system. Particularly, it provides manual and automated measurement, including air- and bone-conduction audiometry.Study sample: Twenty-nine participants-patients of Papageorgiou Hospital, Thessaloniki, Greece were tested, with all degrees of hearing sensitivity. Manual air- and bone-conduction Pure-Tone Audiometry was conducted inside a sound booth. Participants were tested with conventional audiometry and the audiometric application, in order to validate the tablet-based audiometer for measuring hearing thresholds.Results: The majority (90.9%) of air-conduction estimated hearing thresholds and (90.8%) of air-bone gaps were within 5 dB, compared to results obtained by conventional audiometry. Thus, threshold differences were not significant.Conclusions: The proposed audiometer is a reliable and valid tool for hearing assessment. Owing to certain limitations, mobile devices can provide a feasible substitute for conventional audiometry in clinical practice.

Usability and Online Audiological Rehabilitation

This paper describes the results from the iterative development and usability testing of an online audiological rehabilitation (OAR) program. The OAR was based on previous experience with Internet interventions and OAR. The described OAR consisted of weekly learning modules, each of which had a specific topic and contained information and learning activities. A virtual coach, a trained audiologist, led the participants through the modules. The participants' feedback was collected using the "think-aloud" method in which the participants gave their feedback in a structured manner. The early findings from the first version of the OAR showed that participants had difficulty navigating the system. As a result of the usability testing, a second major edition of the OAR program was developed, and the participants found it easier to manage and that it enhanced the learning experience. The participants appreciated the testimonial videos as well as the option to study more in-depth material for a given subject. The early findings from the usability test of the program provided useful information as to how content can be developed and delivered for optimal user accessibility within the scope of OAR.

Development of early auditory and speech perception skills within one year after cochlear implantion in prelingual deaf children

To investigate the development of early auditory capability and speech perception in the prelingual deaf children after cochlear implantation, and to study the feasibility of currently available Chinese assessment instruments for the evaluation of early auditory skill and speech perception in hearing-impaired children. A total of 83 children with severe-to-profound prelingual hearing impairment participated in this study. Participants were divided into four groups according to the age for surgery: A (1-2 years), B (2-3 years), C (3-4 years) and D (4-5 years). The auditory skill and speech perception ability of CI children were evaluated by trained audiologists using the infant-toddler/meaningful auditory integration scale (IT-MAIS/MAIS) questionnaire, the Mandarin Early Speech Perception (MESP) test and the Mandarin Pediatric Speech Intelligibility (MPSI) test. The questionnaires were used in face to face interviews with the parents or guardians. Each child was assessed before the operation and 3 months, 6 months, 12 months after switch-on. After cochlear implantation, early postoperative auditory development and speech perception gradually improved. All MAIS/IT-MAIS scores showed a similar increasing trend with the rehabilitation duration (F=5.743, P=0.007). Preoperative and post operative MAIS/IT-MAIS scores of children in age group C (3-4 years) was higher than that of other groups. Children who had longer hearing aid experience before operation demonstrated higher MAIS/IT-MAIS scores than those with little or no hearing aid experience (F=4.947, P=0.000). The MESP test showed that, children were not able to perceive speech as well as detecting speech signals. However as the duration of CI use increased, speech perception ability also improved substantially. However, only about 40% of the subjects could be evaluated using the most difficult subtest on the MPSI in quiet at 12 months after switch-on. As MCR decreased, the proportion of children who could be tested using the MPSI reduced. Within one year after CI, children develop early auditory and speech perception capabilities with time. Chinese versions of the IT-MAIS/MAIS, MESP and MPSI are useful instruments to document early auditory and speech perception skills in children after CI implantation.

Newborn hearing screening: what are we missing?

The objectives of the study were to demonstrate hearing status in newborns at first screening by Transient Evoked Otoacoustic Emissions and to find out the relationship between abnormal hearing screening and known risk factors. This study was conducted in the department of neonatology of Bangabandhu Sheikh Mujib Medical University in collaboration with department of otolaryngology and department of obstetrics and gynaecology. This prospective observational study included a cohort of 168 neonates from Neonatal Intensive Care Unit and neonatal Nursery (Minimal care unit). All were screened for hearing impairment using Transient Evoked Otoacoustic Emissions in out-patient department of otolaryngology by a trained audiologist before discharge from hospital. Risk factors analysed were according to the criteria of American Academy of Pediatrics. Of the total neonates screened, Refer rate was 32.7% irrespective of presence or absence of risk factors. Small for gestational age, in-utero infections, ototoxic medications, birth weight < 1500, sepsis/meningitis, hyperbilirubinemia were found to be significant risk factors (p < 0.0001). It can be recommended that hearing screening should be universally done for all newborns.

Audition assessment using the NIH Toolbox

The NIH Toolbox project has assembled measurement tools to assess a wide range of human perception and ability across the lifespan. As part of this initiative, a small but comprehensive battery of auditory tests has been assembled. The main tool of this battery, pure-tone thresholds, measures the ability of people to hear at specific frequencies. Pure-tone thresholds have long been considered the "gold standard" of auditory testing, and are normally obtained in a clinical setting by highly trained audiologists. For the purposes of the Toolbox project, an automated procedure (NIH Toolbox Threshold Hearing Test) was developed that allows nonspecialists to administer the test reliably. Three supplemental auditory tests are also included in the Toolbox auditory test battery: assessment of middle-ear function (tympanometry), speech perception in noise (the NIH Toolbox Words-in-Noise Test), and self-assessment of hearing impairment (the NIH Toolbox Hearing Handicap Inventory Ages 18-64 and the NIH Toolbox Hearing Handicap Inventory Ages 64+). Tympanometry can help differentiate conductive from sensorineural pathology. The NIH Toolbox Words-in-Noise Test measures a listener's ability to perceive words in noisy situations. This ability is not necessarily predicted by a person's pure-tone thresholds; some people with normal hearing have difficulty extracting meaning from speech sounds heard in a noisy context. The NIH Toolbox Hearing Handicap Inventory focuses on how a person's perceived hearing status affects daily life. The test was constructed to include emotional and social/situational subscales, with specific questions about how hearing impairment may affect one's emotional state or limit participation in specific activities. The 4 auditory tests included in the Toolbox auditory test battery cover a range of auditory abilities and provide a snapshot of a participant's auditory capacity.

Pilot Study to Evaluate Hearing Aid Service Delivery Model and Measure Benefit Using Self-Report Outcome Measures Using Community Hearing Workers in a Developing Country

Hearing loss is a major handicap in developing countries with paucity of trained audiologists and limited resources. In this pilot study trained community health workers were used to provide comprehensive hearing aid services in the community. One hundred and eleven patients were fitted with semi-digital hearing aid and were evaluated over a period of six months. They were assessed using self-report outcome measure APHAB. Results show that trained CHWs are effective in detecting disabling hearing loss and in providing HAs. APHAB can identify and pick up significant improvements in communication in daily activities and provides a realistic expectation of the benefits of a hearing aid. The model of using trained CHWs to provide rehabilitative services in audiology along with self-report outcome measures can be replicated in other developing countries.

Comparação do tempo de dois procedimentos com novas tecnologias de Potencial Evocado Auditivo de Tronco Encefálico Automático (PEATE-A)

To compare the testing time of two Automated Auditory Brainstem Response (AABR) procedures using different repetition rates and detection modes. A hearing screening using AABR was performed in 30 newborns with mean age of 21 days. Each newborn was submitted to two hearing screening procedures using different AABR equipments (Procedure 1 and Procedure 2). Procedure 1 used a repetition rate of 53 Hz and the one-sample test for response detection; Procedure 2 used a repetition rate of 90 Hz, and the q-sample test for response detection. The ABR with click stimulus was then registered as gold standard test, and the responses were analyzed by a trained audiologist. The mean time observed for Procedure 1 considering both ears was 84.8 (±53.5) seconds; for Procedure 2 the mean time was 27.9 (±20.0) seconds. The testing time of the first procedure was three times longer than the second one. Statistical analysis showed significant difference between the testing times of the procedures. The q-sample test and the repetition rate of 90 Hz used in the AABR equipment showed earlier response detection.

Screening methods for childhood hearing impairment in rural Bangladesh

The purpose of this study was to determine a feasible strategy for screening young children in rural Bangladesh for hearing impairments. Trained community health workers (CHWs) screened 4003 children between the ages of 2 and 9 years using conditioned play audiometry (CPA) and a subset of 569 of these children (ages 2-5 years), using physiologic (otoacoustic emissions [OAEs] and tympanometry). Measures of frequency and cross-tabulations are presented to describe results. Hearing screening using CPA was feasible for most children in the 6-9 years age range, but not for the younger children due to shyness and lack of cooperation. More than two thirds of the younger children were untestable on CPA. In response to this limitation, OAEs and tympanometry, requiring less cooperation on the part of the child, was implemented for a sample of younger children. Of the 569 children who received both CPA and OAE/tympanometry, 69% were untestable using CPA and 8.9% were untestable using OAE and tympanometry. These results suggest that hearing screening using CPA for older (6-9 years) and OAE/tympanometry for younger (2-5 years) children is feasible. Using the physiologic measures of OAE/tympanometry significantly reduced the number of untestable children, resulting in fewer referrals for diagnostic assessments. Thus, if only one methodology could be implemented, physiologic measure would be preferred. This is important because trained audiologists are scarce in Bangladesh. Technology is available and feasible for hearing screening in developing countries. Focus needs now to center on increasing the number of trained audiologists in developing countries to ensure better follow-up and accessibility to audiological services.

The COCHLEA: A new functional outcome measure for pediatric cochlear implant patients

Problem: Pediatric cochlear implant recipients have been historically assessed postoperatively with audiometric testing in a soundproof booth by trained audiologists. Assessment of functional outcome after cochlear implantation must also consider a number of other factors including speech perception, speech intelligibility, mode of communication, educational placement, as well as the social and psychological factors that affect one’s ability to function in the mainstream environment. No uniform tool for assessing effective functional outcome in the daily life of pediatric cochlear implant recipients has been developed. Methods: Using a cross-sectional design, the COCHLEA (Children’s Outcome for Cochlear Implant Hearing, Language, and Environmental Assessment) questionnaire, designed to measure functional outcomes in the pediatric cochlear implant population, was administered. The questionnaire was tested for reliability and validity, while investigating for any possible respondent or administrative burden. The parents of children with cochlear implants completed the questionnaire. The subjects were individuals with nonsyndromic sensorineural hearing loss (SNHL) implanted at Children’s Hospital and Regional Medical Center before 12/31/2001, aged 3–12 years. Implantation must have occurred before age 7. Non-English-speaking children/families were excluded secondary to a lack of resources. Results: Thirty-one patients were enrolled in the study. Preliminary results indicate that absolute scores of this outcome measure correlate with higher global health measures, including the Child Health Questionnaire (CHQ), and predict better audiometric scores. Conclusion: The COCHLEA functional outcome measure appears to be a reliable and valid method for assessing effective cochlear implantation. More research is necessary to determine this questionnaire’s sensitivity to longitudinal change. Significance: The COCHLEA questionnaire represents the first disease-specific functional outcome measure for the pediatric cochlear implant patient population. Ultimately it may be used to compare the effectiveness of cochlear implants and rehabilitation strategies. Support: None reported.

Hearing loss and treatment in young Down's syndrome children.

Twenty-four home-reared Down's syndrome children aged 9-32 months were assessed by trained audiologists on three separate occasions (summer, autumn and spring 1977-1978). Distraction test procedures were used; all failed to pass the screening test and 80-85% registered as having moderate to profound losses. Seventy-five per cent were categorized as having a conductive loss and some improvements were found over the test sessions as a result of surgical and decongestant treatment. Approximately 50% of the infants had been passed on similar screening procedures by the local health services. The results are discussed in relation to language development and service needs.