Universal Hearing Screening Program Research Articles

A study on hearing screening using oto-acoustic emissions in newborns delivered by normal vaginal delivery and lower segment caesarean section

Background: Hearing is one of the most complex systems of the human body and is a skill involved in the human social evolution. It has been estimated that around 900 million people by the end of 2050, will probably suffer from hearing loss. Our study aims to find out the correlation between the mode of delivery and the effect it has on newborn hearing screening. Methods: The Prospective study on 136 Newborn babies who were delivered in JLN Hospital & Research Centre, Bhilai, Chhattisgarh during October 2020 to August 2021. After obtaining detailed history all newborns underwent TEOAE screening and the data were then compared with the available literature. Results: We observed normal vaginal delivery newborns have passed the test by 97.91% and 89.58% when compared to LSCS delivered infants 97.15% and 86.36% in screening and diagnostic frequency respectively. COVID-19 infection was seen in 2.94% of pregnant mothers in the 3rd trimester. There were no babies who required BERA in our study Conclusions: Normal vaginally delivered newborns have higher pass rate in TEOAE test when compared with LSCS delivered babies. Covid-19 infection in antenatal mother can influence the outcome in 1st TEOAE tests. The pass rate in TEOAE hearing test in the screening frequency is found to be greater when compared with diagnostic frequencies. In a developing country like India, Universal hearing screening programs needs to be reached out to the most remote parts of the country, in order to identify at risk infants for hearing loss.

A cross-sectional study of neonatal hearing impairment: understanding its prevalence and risk factors in a tertiary care hospital in Kerala, India

Background: Congenital hearing loss is one of the most prevalent sensory impairments with severe consequences when undetected. The objective of neonatal hearing screening is to identify hearing impairments shortly after birth to initiate treatment as soon as possible and to allow affected children to enjoy normal development. The aim of the study was to determine the prevalence and identify the predisposing factors of HI among neonates in a tertiary care centre in Idukki district of Kerala using a universal neonatal hearing screening (UNHS) program, in an attempt to initiate early interventions in affected neonates. Methods: This was a cross-sectional study conducted in the department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala over a period of 1 year involving 646 neonates. The study excluded any newborn whose parent/guardian did not give consent for the study, or neonates with microtia grade II and above. Results: The overall prevalence of HL in neonates in our study was 3.1 in 1000 live births out of which 61% were males and 39% females. The risk factors found in our study were preterm babies, maternal age >35, low birth weight, teenage pregnancy, primigravida, and neonatal jaundice requiring blood transfusion. Conclusions: In a standard neonatal population, both at-risk and non-at-risk neonates warrant the immediate adoption of a universal hearing screening program for all neonates in India. Hence, we would like to stress the importance of identifying infants with HL, administering early treatment and performing appropriate screening tests in infants at the right time period.

Pediatricians' knowledge and attitude toward hearing loss and newborn hearing screening programs

IntroductionEarly detection of hearing loss is important to the management of infants and young children with hearing loss. Pediatricians are often the first to encounter a child suspected to have hearing loss. The objective of this study is to evaluate the knowledge and attitude of newborn hearing screening and management of hearing in among pediatricians. MethodsA cross-sectional survey-based study utilizing a validated questionnaire that was distributed to pediatricians in single tertiary academic health care institution that aims to evaluate the knowledge and attitudes related to children with hearing loss and newborn hearing screening. ResultsA total of 67 pediatricians agreed to participate and were involved in our study. Mean age was 35 years and 44.1% were males. The majority (79.4%) thought it was very important to have a newborn hearing screening program. However, two-thirds (64.7%) were unsure that there is a universal hearing screening program in the country. Never the less, the majority of the respondents (75%) were at least somewhat confident in explaining the hearing screening program process in our institution. There was a gap in the knowledge of our pediatricians with regard to the process of dealing with a newborn who failed screening program and the candidacy for cochlear implants. Also, some participants were unsure whether to refer a child with hearing impairment to an otolaryngologist or not. Most of the participants thought that physicians need more information related to permanent hearing loss. ConclusionThere are gaps in Pediatricians knowledge and awareness towards hearing loss assessment and management in newborns. This likely requires further academic collaboration between specialties to improve the care of newborns. Future research should focus on the auditory and speech outcome and rehabilitation awareness.

Cost-Effectiveness of Screening Preschool Children for Hearing Loss in Australia.

While all newborns in Australia are tested for congenital hearing loss through universal newborn hearing screening programs, some children will acquire hearing loss in their first five years of life. Delayed diagnosed or undiagnosed hearing loss in children can have substantial immediate- and long-term consequences. It can significantly reduce school readiness, language and communication development, social and emotional development, and mental health. It can also compromise lifetime educational achievements and employment opportunities and future economic contribution to society through lost productivity. The need for a universal hearing screening program for children entering their first year of primary school has been noted in two separate Australian Government hearing inquiries in the last decade. Sound Scouts is a hearing screening application (app) that tests for hearing loss in children using a tablet or mobile device, supervised by parents at home. It tests for sensorineural or permanent conductive hearing loss and central auditory processing disorder in children. In 2018 the Australian Government funded the roll-out of Sound Scouts to allow up to 600,000 children to test their hearing using Sound Scouts. This study estimated the cost-effectiveness of screening 5-year-old children for hearing loss using Sound Scouts at home, compared with no screening. A decision-analytic model was developed to estimate the incremental costs and quality-adjusted life years (QALYs) of administering Sound Scouts over a 20-year time horizon. Testing accuracy was based on comparing Sound Scouts test results to clinical test results while other parameters were based on published data. Costs were estimated from the perspective of the Australian health care system. Univariate and probabilistic sensitivity analyses were undertaken. Sound Scouts is estimated to result in an average incremental cost of A$61.02 and an average incremental increase in QALYs of 0.01. This resulted in an incremental cost-effectiveness ratio of A$5392 per QALY gained, which is likely to be considered cost-effective by Australian decision makers. Screening with Sound Scouts was found to have a 96.2 per cent probability of being cost-effective using a threshold of A$60,000 per QALY gained. Using Sound Scouts to screen five-year-old children for hearing loss (at home) is likely to be cost-effective. Screening children using Sound Scouts will result in early identification and intervention in childhood hearing loss, thereby reducing early childhood disadvantage through cumulative gains in quality of life, education, and economic outcomes over their lifetime.

Maternal COVID-19 and neonatal hearing loss: a multicentric survey.

PurposeGestational SARS-Cov-2 infection can impact maternal and neonatal health. The virus has also been reported of causing sensorineural hearing loss. The objective of this study was to determine the possible effect of maternal SARS-COV-2 infection on neonatal hearing as identified during universal hearing screening.MethodsRetrospective cohort study in two tertiary referral centers including all neonates born from November 2020 through April 1st, 2021 and undergoing the universal hearing screening program. Maternal Covid-19 infection was recorded (timing and severity) and the results of hearing screening of their neonates compared to the incidence of neonatal hearing loss results of the national universal screening program during the same period.ResultsA total of 984 neonates were included (508 males and 476 females). Sixty-three neonates were excluded due to comorbidities which could cause hearing loss. The incidence of failed responses in the community at large was 2.3%. Twenty-seven failed both steps of screening (2.9%; p < 0.2). There were 34 Covid-19 positive mothers (17 in the first trimester, 8 in the second and 9 in the third). Twenty-nine neonates failed the first screening (p < 0.00001) but on further testing only one neonate failed (2.9%).ConclusionIn this study, neonates born to Covid-19 positive mothers do not seem to have an increased risk of hearing loss. However longer follow-up of these neonates is mandatory to detect any possible delayed effects of the virus.

Assessment of the Hearing Status of School-Age Children from Rural and Urban Areas of Mid-Eastern Poland.

(1) Background: The purpose of this study was to assess the prevalence of hearing loss in school-age children from rural and urban areas of mid-eastern Poland using standard audiological tests—pure tone audiometry (PTA), impedance audiometry (IA), and otoacoustic emissions (OAEs). (2) Methods: Data were collected from a group of 250 children aged 8 to 13, made up of 122 children from urban areas and 128 children from rural areas of mid-eastern Poland. Hearing was assessed in each of the subjects by means of PTA, IA (tympanometry), and transient-evoked OAEs (TEOAEs). Otoscopy was also performed. (3) Results: There were significantly fewer abnormal results in children from urban than rural areas: they were, respectively, 10.1% and 23.1% for IA, 3% and 9.7% for PTA, and 17.3% and 31.8% for TEOAEs. For hearing-impaired ears in rural areas (failed TEOAE), hearing thresholds were, on average, 11.5 dB higher at 0.5 kHz than for children in urban areas. Comparison of each PTA result with the corresponding IA showed that all cases of hearing loss were related to malfunction of the middle ear. (4) Conclusions: The results of all three hearing tests were significantly worse in children from rural areas compared to those from urban areas. This indicates that audiological healthcare in rural areas needs improvement and that universal hearing screening programs for school-age children would be helpful.

Methodological quality of clinical guidelines for universal newborn hearing screening.

To review existing guidelines for universal newborn hearing screening (UNHS), identify those that provide comprehensive and clear recommendations on the subject, and provide a brief overview. A scoping literature review was performed in PubMed, the Guidelines International Network library, and national guideline databases to identify guidelines on newborn hearing screening developed or updated between 2004 and 2019. The quality of the guidelines was checked with the Checklist for the Quality Assessment of Guidelines (AGREE II). Six guidelines met all the inclusion criteria. All six were based on the 1-3-6 benchmark (screening completed by 1mo, audiological diagnosis by 3mo, enrolment in early intervention by 6mo). However, the guidelines varied in terms of their recommendations for the application of screening methods, role of health professionals in the screening process, and quality. Based on the AGREE II score, flexibility, adaptability, and foundation role for all other guidelines, the 2019 guidelines of the Joint Committee on Infant Hearing position statement were identified as the most appropriate to be recommended for adaptation by countries or programmes. The diversity in the existing guidance can be confusing for countries and institutions that are planning to develop universal hearing screening programmes. As more countries and organizations develop their newborn hearing screening programmes, they will need examples to emulate. This review provides an evaluation of the quality, comprehensiveness, and applicability of existing clinical guidelines that can serve as a facilitator for countries, institutions, or organizations in their planning and implementation of a UNHS programme.

Methodological aspects of testing vestibular evoked myogenic potentials in infants at universal hearing screening program

Motor development in infants is dependent upon the function of the inner ear balance organ (vestibular organ). Vestibular failure causes motor delays in early infancy and suboptimal motor skills later on. A vestibular test for newborns and infants that is applicable on a large scale, safe and cost effective is in demand in various contexts: in the differential diagnosis of early onset hearing loss to determine forms associated with vestibular failure; in early hearing habilitation with cochlear implant, indicating the vestibular predominant side; and in the habilitation of children affected by motor skill disorders, revealing the contribution of a vestibular failure. This work explored the feasibility of cervical vestibular evoked myogenic potentials (VEMP) in conjunction with newborn universal hearing screening program. VEMP was measured after the hearing tests and was evoked by bone-conducted stimuli. Moreover, stimulus delivery was regulated by neck muscle activity, with infants rested unconstrained in their parents´ arms and with the head supported by the operator´s hand. This VEMP protocol showed a high level of feasibility in terms of test viability and result reproducibility. VEMP integrated into the newborn hearing screening program may represent a practical method for large-scale assessment of balance function in infants.

Findings of a Universal Hearing Screening Program for School-Aged Children

Findings of a Universal Hearing Screening Program for School-Aged Children

Screening of high-risk newborns for hearing in MRMC using OAE and BERA

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Hearing is necessary to learn languages and speech and to develop cognitive skills. As hearing is important for normal educational and social development, hearing loss can be disastrous and for the family it can be very distressing. With early detection of hearing loss using OAE and BERA, we can ensure normal language development and help the growing child to lead a near normal life.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 500 cases- out of which 400 normal babies and 100 high risk babies are taken for the study who attend Pediatric OPD and IPD of Basaweshwara Teaching and General Hospital (BTGH) and Sangameshwar hospital attached to MRMC. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 400 cases 2 cases have impaired hearing and out of 100 cases with high risk 6 cases have hearing loss.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study highlights the need for OAE and BERA for early identification of hearing loss and that although universal hearing screening programs are warranted but most of the cases with hearing loss can be identified based on the risk factors and High-risk Screening can suffice in areas with limited resources.&lt;/p&gt;

Epidemiology of hearing loss in children of the first year of life

The aim of this study was the investigation of the epidemiology of permanent hearing impairment in the children of first year of life in the Russian Federation after the implementation of the newborn universal hearing screening program. The prevalence of hearing loss in children in the first year of life was estimated at 2.5 per 1,000 based on the official statistical data and reports of hearing rehabilitation centres in 2016. A cohort of 405 children born in 2012 was examined at the age from 0 to 4 years of life. Among them 276 children were diagnosed with permanent congenital and prelingual hearing loss. 88% of the cases were bilateral, sensorineural hearing loss confirmed in 84% of the cases. The genetic cause of hearing loss was revealed in 58% of the patients assessed for the presence of GJB2 gene mutations. In preterm infants, the permanent hearing loss was detected in 70% of the cases. The comprehensive audiological assessment before 3 months of life was conducted only in 32% of the children; this finding is not consistent with the international newborn hearing screening recommendations. Only 70% of the cases of congenital and preverbal hearing loss were diagnosed during the first year of life.

The universal newborn hearing screening program in a public hospital: The importance of the day of examination

ObjectivesNewborn hearing screening programs are already implemented in many countries worldwide. Nonetheless there is still no consensus about the most proper post-birth day of examination. The purpose of this study was to assess the most appropriate day of universal hearing screening program in a public hospital. Material and methodsA prospective cohort study was conducted in “Attiko University National Health System Hospital” and included 2494 newborns. They were examined before discharge from the hospital, using transient evoked otoacoustic emissions (TEOAEs). ResultsFrom 2494 neonates included in the study, 2129 (85.4%) bilaterally passed the screening examination, while 365 (14.6%) failed the test. Higher levels of “pass” result per day of life were presented the third (90%) and fourth (94%) day of life. These days the referral scores were lower, reaching 6% the 4th post-birth day. ConclusionAll infants should be screened for their hearing in the first days of life as otoacoustic emissions can be recorded from the first 24 h of life. If the babies stay in the maternity unit for more that 1–2 days for any reason (protocol of the maternity unit, parents leave in remote areas, etc.) we recommend the 4th day of life as the most appropriate day of examination in order to minimize the false positive (“refer”) results at the initial examination.

CZYNNIKI RYZYKA USZKODZEŃ SŁUCHU U NOWORODKÓW PRZEBYWAJĄCYCH NA ODDZIAŁACH INTENSYWNEJ TERAPII

BackgroundNeonatal intensive care unit graduates are considered to be of higher risk for hearing impairment, either auditory neuropathy or hearing loss. In this study we examine the presence of risk factors and try to identify their effect on the hearing of high-risk neonates.Material and MethodsIn this prospective cohort study we used automated auditory brainstem responses (a-ABRs) and otoacoustic emissions (OAEs) to screen 453 neonatal intensive care unit neonates who had at least one risk factor for hearing impairment.ResultsIn the initial examination, 382 (84.3%) infants passed and 71 (15.7%) failed a-ABRs. Out of those who failed, 39 newborns (55%) passed the transiently evoked otoacoustic emission (TEOAE) test, while 32 (45%) failed that test too. Re-examination was performed before their first month of age, eventually resulting in 8 newborns being diagnosed with possible hearing loss and 8 with possible auditory neuropathy. The overall dropout rate was 4.9%. Low birth-weight (p=0.016), as well as craniofacial abnormalities (p=0.03) and TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections proved to have a statistically significant correlation (p=0.05) with hearing impairment.ConclusionsBecause a significant number of children may have auditory neuropathy, ABRs and OAEs (both transiently evoked and distortion product OAEs) remain the cornerstones of any universal hearing screening program in neonatal intensive care units. An efficient tracking system is needed to reduce the number of neonates lost to follow-up. Low birth-weight, craniofacial deformities, and congenital infections appear to be the most significant factors predisposing an infant to hearing impairment.

Risk factors for hearing loss in infants under universal hearing screening program in Northern Thailand.

ObjectiveTo define the risk factors for hearing loss in infants (aged 3 months) under universal hearing screening program.Materials and methodsA total of 3,120 infants (aged 3 months) who underwent hearing screening using a universal hearing screening program using automated otoacoustic emission test between November 1, 2010 and May 31, 2012 in Uttaradit Hospital, Buddhachinaraj Hospital, and Sawanpracharuk Hospital (tertiary hospitals) located in Northern Thailand were included in this prospective cohort study.ResultsOf the 3,120 infants, 135 (4.3%) were confirmed to have hearing loss with the conventional otoacoustic emission test. Five of these 135 infants (3.7%) with hearing loss showed test results consistent with auditory brainstem responses. From the univariable analysis, there were eleven potential risk factors associated with hearing deterioration. On multivariable analysis, the risk factors independently associated with hearing loss at 3 months were birth weight 1,500–2,500 g (risk ratio [RR] 1.6, 95% confidence interval [CI] 1.1–2.6), APGAR score <6 at 5 minutes (RR 2.2, 95% CI 1.1–4.4), craniofacial anomalies (RR 2.5, 95% CI 1.6–4.2), sepsis (RR 1.8, 95% CI 1.0–3.2), and ototoxic exposure (RR 4.1, 95% CI 1.9–8.6).ConclusionThis study concluded that low birth weight, APGAR score <6 at 5 minutes, craniofacial anomalies, sepsis, and ototoxic exposure are the risk factors for bilateral hearing loss in infants (aged 3 months) and proper tests should be performed to identify these risk factors. As an outcome, under the present circumstances, it is suggested that infirmary/physicians/general practitioners/health action centers/polyclinics should carry out universal hearing screening in all infants before 36 weeks. The public health policy of Thailand regarding a universal hearing screening program is important for the prevention of disability and to enhance people’s quality of life.

Screening for Hearing Impairment in High Risk Neonates: A Hospital Based Study.

Hearing loss very early in life can have multiple deleterious effects on the new born most commonly being related to attainment of speech and language. Also, it can affect social, emotional and academic achievement of the child.Early identification of hearing impairment has been shown to improve prognosis and hence screening programs have been widely and strongly advocated. To estimate the incidence of neonatal hearing loss in high risk neonates admitted in tertiary level teaching hospital and to determine the risk factors predictive of hearing impairment in them. It was a prospective study over a period of one year. We screened high risk neonates for hearing impairment admitted to NICU using Brain stem Auditory Evoked Response (BAER).The morphology of the response and wave and interwave latencies was examined in respect to age-appropriate forms. Follow up BAER after one month was performed in cases where initial BAER was abnormal. Babies who tested abnormal on the follow-up were referred for detailed audiology diagnostic work up. A total of 200 cases comprising 118 males (59%) and 82 females (41%) were enrolled. On initial BAER testing, 18 (15.25%) males and 14 (17%) female neonates had hearing loss. Whereas 7 males (70%) and 3 females (30%) had hearing loss out of the total 10 hearing loss cases in the Follow up-BAER testing. Two out of the 6 neonates with birth weight <1500g had hearing loss in the follow up of BAER testing. Use of ototoxic medications, hyperbilirubinemia requiring exchange transfusion, perinatal asphyxia and bacterial meningitis were the major risk factors occurring in 45%, 30% and 26% and 10%. Five neonates had unilateral hearing loss and the rest five (5%) had bilateral impairment.Meningitis was the significant independent clinical risk factors for predicting hearing impairment in high risk neonates.The risk of BAER increased cumulatively with BAER abnormality rate of 4.2%, 22.2% and 33.3% with one two and three risk factors respectively. The overall incidence of hearing loss in initial BERA testing was 16%, in males it was 15.25% in males and in 17% in females,only 62.5% of neonates had a persistent abnormal BAER, with male gender a significant risk factor for this. The incidence of hearing loss increased with number of risk factors. The study highlights that although universal hearing screening programs are warranted; most newborns with a detected hearing loss can be identified based on the risk factors. Thus, a targeted approach for hearing screening may be more feasible in resource limited settings.

Assessing Parental Role as Resource Persons in Achieving Goals of Early Detection and Intervention for Children with Hearing Impairment

Early detection and intervention for any degree of hearing loss is critical to the linguistic, social and educational development of children with auditory deficit. Since parents and family members are in a position to identify hearing loss at an early stage, they can play a vital role in achieving the goals of early identification and intervention for their children. Purpose: This study was conducted to determine the age at which parents and significant others begin to suspect hearing impairmentin their children, and to advocate for using them as resource persons in the early detection of hearing loss. Method: Parents of children with hearing impairment were retrospectively surveyed and interviewed to determine the age at which suspicion, diagnosis, fitting of amplification and initiation of interventions occurred. Results: Interviews revealed the average age to be 16.5, 24.3, 31.7 and 33.4 months, for suspicion, diagnosis, fitting of amplification and initiation of early intervention for hearing loss respectively. The obtained age of suspicion is lower than the age of identification of hearing loss reported in Indian literature. The current study found delays in diagnosis and fitting of amplification, both of which are essential to initiate early remedial programmes which facilitate development of speech and language skills in children with hearing impairment. Surprisingly, it was found that these delays were caused by professional failures. Conclusion: It is emphasised that parents are in the best position to detect hearing problems in their children, and can be effectively utilised as manpower/equal partners in achieving the goal of early identification of hearing loss. The study outlines appropriate ways and means to facilitate early identification and provide effective intervention for children with hearing impairment. Implications: In the absence of a universal hearing screening programme for newborn infants, parents can be used as manpower/resource persons to identify children with hearing impairment.

BADANIA PRZESIEWOWE U NOWORODKÓW NA ODDZIAŁACH INTENSYWNEJ TERAPII

BackgroundDiagnosis of neonatal hearing impairment depends on universal hearing screening programs (otoacoustic emissions, OAEs, and/or auditory brainstem responses, ABRs). The aim of this study is to determine the prevalence of hearing impairment among high-risk newborns and identify the risk factors involved.Material and MethodsThis is a prospective cohort study on 173 newborns hospitalized in a neonatal intensive care unit (NICU) with one or more risk factors for hearing impairment. Both TEOAEs and a-ABRs were performed a few days before discharge.ResultsOn examination with TEOAEs, 170 neonates eventually passed the test and 3 failed (1 bilaterally and 2 unilaterally). All neonates were also examined with a-ABR, and 10 failed the test, 7 of which passed TEOAE and were diagnosed as having possible auditory neuropathy spectrum disease (ANSD). The remaining 3 infants who failed both tests were diagnosed as having possible hearing loss (HL). From the risk factors, only TORCH infections were clearly related to the likelihood of hearing impairment, either ANSD or HL (p=0.004). The need for mechanical ventilation was also significantly higher in newborns with possible HL, compared to those with normal results (66.7% vs. 18.4%, p=0.03).ConclusionsCombined TEOAE/ABR is the gold standard examination for NICU infants due to the increased incidence of HL, especially ANSD, in this high-risk population.

Profile of Childhood Hearing Loss in A Nigerian Teaching Hospital

Background: Childhood hearing loss in the developing world is associated with late diagnosis and rehabilitation challenges. Methods: A retrospective review of all the cases of childhood hearing loss from January 2007 to December 2011 in a tertiary health institution. Results: A total of 53 patients, with the majority (92.5%) resulted from acquired causes of which 88.7% were due to birth asphyxia. Over 73% presented with moderately severe to profound hearing loss. Only 15% had a hearing aid fitted, 22.6% will require cochlear implant, while 43.3% could not afford a hearing aid. Conclusion: Developing countries are noted for a higher prevalence of acquired and preventable causes of childhood hearing loss. Primary prevention through effective obstetric care, public enlightenment, incorporation of universal hearing screening programs into the national policies, and readily available and affordable rehabilitative facilities are advised.

Neonatal hearing screening of high-risk infants using automated auditory brainstem response: a retrospective analysis of referral rates

The past decade has seen the widespread introduction of universal neonatal hearing screening (UNHS) programmes worldwide. Regrettably, such a programme is only now in the process of nationwide implementation in the Republic of Ireland and has been largely restricted to one screening modality for initial testing; namely transient evoked otoacoustic emissions (TEOAE). The aim of this study is to analyse the effects of employing a different screening protocol which utilises an alternative initial test, automated auditory brainstem response (AABR), on referral rates to specialist audiology services. A retrospective analysis was performed of all neonatal hearing screening in Letterkenny General Hospital over 5 years, from January 2008 to December 2012, which was confined to infants possessing one or more known risk factors for permanent childhood hearing impairment. 1,163 infants were screened using AABR during this period and subsequent re-test and referral rates to specialist audiology services were examined. Of the infants screened, 50 (4.3%) failed the initial AABR. A further 16 of these (32%) failed the repeat AABR, resulting in an overall referral rate to specialist audiology services of 1.38%. Our results demonstrate strikingly low overall referral rates in this cohort, falling well below both the international benchmark and the initial results of the Irish UNHS programme. This provides a convincing argument for examining AABR as a potential alternative to TEOAE in the nationwide UNHS.

Accessibility to cochlear implants in Belgium: State of the art on selection, reimbursement, habilitation, and outcomes in children and adults

Belgium, and especially the northern region called Flanders, has been a center of expertise in cochlear implants and early hearing screening for many years. Some of their surgeons and engineers were pioneers in the development of cochlear implants and in 1998 Flanders was the first region in Europe to implement a universal hearing screening program for all neonates. The Belgian National Institute for Health and Disability Insurance has reimbursed cochlear implants in children and adults since 1994 and bilateral implantation in children under the age of 12 years since February 2010. These deaf children, screened and implanted early, achieve higher auditory, speech and language outcomes and increasing numbers are going to regular schools using fewer interpreters. In 2010, 93% of severe-to-profound deaf preschool children in Flanders had received cochlear implants and 25% had bilateral implants. Although on average twice as many adults as children are implanted a year in Belgium, we have less research data available from this adult population. Also very little is published about the growth curves and minimal rehabilitation requirements (intensity, duration etc.) after implantation for both children and adults. So, there still remain many challenges for the future.