Screening methods: current status

The Otoacoustic Emissions in the Universal Neonatal Hearing Screening: An Update on the European Data (2004 to 2024)

Background: The reported data on European universal neonatal hearing screening (UNHS) practices tend to be scarce, despite the fact that the European Union project, EUScreen, collected unofficial data from 38 collaborating European institutions. The objectives of this systematic review were as follows: (a) to identify the most recent (in a 20-year span) literature information about UNHS programs in Europe and (b) to provide data on the procedures used to assess the population, the intervention policies, and on the estimated prevalence of congenital hearing loss with emphasis on the bilateral hearing loss cases. Methods: Queries were conducted via the Pubmed, Scopus and Google Scholar databases for the time period of 2004-2024. The Mesh terms used were "OAE", "Universal Neonatal Hearing Screening", "congenital hearing loss" and "well babies". Only research articles and review papers of European origin were considered good candidates. The standard English language filter was not used, in order to identify information from non-English-speaking scientific communities and groups. Results: Very few data and reports were identified in the literature search. Eleven manuscripts were identified corresponding to eight UNHS programs. Except in Poland, most of the data refer to regional and not national programs. The screening coverage estimates of all programs exceed 90%; infants were mostly assessed by a three-stage protocol (TEOAE + TEOAE + AABR), followed by a clinical ABR test. The average prevalence (i.e., from well babies AND NICU infants) of bilateral hearing loss ranged from 0.5 to 20.94 per 1000 (Zurich sample). Infants presenting unilateral or bilateral hearing losses were first rehabilitated by hearing aids and consequently (>15 mo) by cochlear implants. Conclusions: Even though UNHS programs are well-established clinical practices in the European States, the amount of information in the literature about these programs is surprising low. The existing data in the timespan 2004-2024 corroborate the international UNHS data in terms of coverage and bilateral hearing loss prevalence, but there is a strong need to supplement the existing information with the latest developments, especially in the area of hearing loss rehabilitation.

Detection of hearing loss in newborns: Definition of a screening strategy in Bogotá, Colombia

OBJECTIVE

To describe the results from the hearing screening protocol adopted in a Hospital in Colombia emphasizing the importance of performing screening on an outpatient basis, when the newborn is more than 24 h old.

METHODS

A prospective study at Hospital Universitario San Ignacio in Bogota, Colombia was carried out, from May 1st, 2016 to Nov 30^th, 2017, the study sample included 2.088 newborns examined using transient otoacoustic emissions.

RESULTS

We obtained written consent from the parents of 1.523 newborns and 24 individuals (1.6%) failed the first stage of the screening, nine cases unilateral and 15 bilateral. A total of nine neonates (0,6%) failed the second screening test, six cases unilateral and three bilateral. Four (0,3%) did not return to the second test. Our false altered screening rate was 0.7%.

CONCLUSIONS

In a developing country with limited human and economic resources, in which newborn early discharge is the norm, a newborn hearing screening program linked to infants' check-ups, that uses otoacoustic emissions after 48 h of life, seems a feasible option compare to the standard US protocol aiming to conduct hearing screening prior to discharge.

Mothers' perspectives of newborn hearing screening programme

Background

Newborn hearing screening programs identifies newborns with hearing loss. The early identification enables prompt intervention through hearing rehabilitation. Accurate knowledge of the program and its benefit will impact on the uptake of the program by the citizenry. We hypothesized that there is a gap in the knowledge of parents on hearing screening and rehabilitation measures in Nigeria.

Aim

To determine the knowledge and perceptions of mothers of newborn children on hearing screening.

Methods

A cross sectional observational study among mothers of newborn children at immunization clinics. Semi structured questionnaire on gestational duration, mode of delivery, birth asphyxia, knowledge on hearing loss and newborn hearing screening were administered.

Results

Participants were 48 mothers with age range from 18 to 42 years. Awareness of newborn hearing screening was poor among the mothers; sources of information on newborn hearing screening were antenatal clinic, mass media and friends. The educational level of the participants had no association with awareness (p = 0.11), but the willingness to accept newborn hearing screening, was associated with socioeconomic status (p = 0.04) and the level of education (p = 0.02). The participants were not aware of factors responsible for hearing loss in childhood.

Conclusion

There is inadequate knowledge about newborn hearing screening and risk factors for infant hearing loss among the mothers, though they demonstrate willingness to accept the newborn hearing screening.

Funding

None declared.

Evaluation of universal newborn hearing screening in South African primary care

BACKGROUND

Universal Newborn Hearing Screening (UNHC) is the gold standard toward early hearing detection and intervention, hence the importance of its deliberation within the South African context.

AIM

To determine the feasibility of screening in low-risk neonates, using Otoacoustic Emissions (OAEs), within the Midwife Obstetric Unit (MOU) three-day assessment clinic at a Community Health Centre (CHC), at various test times following birth.

METHOD

Within a quantitative, prospective design, 272 neonates were included. Case history interviews, otoscopic examinations and Distortion Product OAEs (DPOAEs) screening were conducted at two sessions (within six hours and approximately three days after birth). Data were analysed via descriptive statistics.

RESULTS

Based on current staffing profile and practice, efficient and comprehensive screening is not successful within hours of birth, but is more so at the MOU three-day assessment clinic. Significantly higher numbers of infants were screened at session 2, with significantly less false-positive results. At session 1, only 38.1% of the neonates were screened, as opposed to more than 100% at session 2. Session 1 yielded an 82.1% rate of false positive findings, a rate that not only has important implications for the emotional well-being of the parents; but also for resource-stricken environments where expenditure has to be accounted for carefully.

CONCLUSION

Current findings highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. These findings argue for UNHS initiatives to include the MOU three-day assessment to ensure that a higher number of neonates are reached and confounding variables such as vernix have been eliminated.

Hearing screening using auditory steady state responses obtained by simultaneous air- and bone-conduction stimuli

INTRODUCTION AND OBJECTIVES

Minimising false positives rates is an important goal of universal newborn hearing screening programmes. An adequate way for reaching that goal could be differentiating between transient conductive hearing losses (false positives) and permanent sensorineural hearing impairments (true positives) by means of a methodology that studies electrophysiological responses obtained using both air- and bone-conduction stimuli. Our objective was to evaluate the efficiency of an automated hearing screening test based on auditory steady state responses obtained using simultaneous air- and bone-conduction stimuli.

METHODS

A sample of 80 high risk babies lees than 2 months of born were screened using the automatic screening test. A confirmatory clinical and electrophysiological evaluation was used as the gold standard.

RESULTS

The estimated diagnostic efficiency of this screening test was equivalent (100% sensitivity and 97.7% specificity) to the efficiency reported for otoacoustic emissions and automated auditory brainstem responses. The introduction of bone conduction in the screening reduced the false positive rate from 13.3% to 2.2%. The test duration was 5.3 (± 1.9)min. In 34% of babies only one repetition of the test was needed to raising the result.

CONCLUSIONS

The screening test performed quite well in this initial clinical trial, differentiating transient conductive hearing losses from permanent neurosensory impairments and improving the diagnostic efficiency of auditory steady state responses.

Test accuracy and prognostic validity of multiple auditory steady state responses for targeted hearing screening

The test accuracy and prognostic validity of Multiple Auditory Steady State Responses (MSSR) and click Auditory Brainstem Responses (cABR) was compared within the context of a targeted screening protocol. A sample of 508 high-risk babies was first screened using cABR and MSSR (500 and 2000 Hz). All children (failed/ pass) were called back at three to four years of age to determine their hearing status (pure-tone audiometry). Although both methods showed an equally good test performance in the first screen (sensitivity: 100% and specificity: 92-95%), the MSSR may have some potential advantage to identify low-frequency hearing loss. Furthermore, the confirmatory audiometry with MSSR predicted the child hearing status more accurately than the cABR. In conclusion, the MSSR can provide valuable information for the diagnosis and management of infants earlier detected by a screening protocol and further developed might be also useful as a screening test.

Neurophysiologic evaluation of brain function in extremely premature newborn infants

In extremely preterm infants, neonatal brain injury and interruption of the normal maturation of the brain result in functional impairments that appear to manifest in later life. The roots of these impairments may be evaluated in the newborn infant using neurophysiologic techniques, such as evoked potentials and event-related potentials. This paper will review the use of neurophysiologic techniques as a marker of maturational processes in the preterm and newborn brain and as a method of monitoring the development of sensory and cognitive function in preterm infants, focusing on auditory perception, discrimination, and memory. The effects of risk conditions will be reviewed.

Otoacoustic emissions

PURPOSE OF REVIEW

Otoacoustic emissions offer the practitioner a number of beneficial features as a noninvasive and objective measure of the ear's ability to process acoustic stimuli.

RECENT FINDINGS

Since their discovery, a number of clinical applications of otoacoustic emissions have been established, including their utility in the differential diagnosis of sensorineural hearing loss, in the screening of cochlear function in infants and other difficult-to-test patients, and in the monitoring of outer hair cell healthiness in patients who are exposed to potentially damaging agents or who have progressive hearing ailments.

SUMMARY

Clinical applications of OAEs have developed very rapidly and OAEs have become the standard of care, at least, for pediatric patients.