Click-evoked oto-acoustic emission measurement in preterm infants

International consensus (ICON) on audiological assessment of hearing loss in children

The prevalence of hearing loss in newborns and infants is estimated between 1 to 3.47 cases per 1000 live births. Early diagnosis and rehabilitation of congenital hearing loss are mandatory in order to achieve a satisfactory linguistic and cognitive development. Without appropriate opportunities to learn language, these children will fall behind their normal hearing peers in communication, cognition, reading and socio-emotional development. After promising results, neonatal screening for hearing loss and audiological evaluation are becoming more extensively carried out. In planning universal neonatal hearing screening programs, transient evoked otoacoustic emissions and auditory brainstem responses are the gold standard for the screening and diagnosis program. However, there is no consensus regarding the use of audiometry and other electrophysiological tests (such as auditory steady-state responses) in current practices. Several screening and audiological assessment procedures have been described and advocated all around the world. But, a systematic scheme of performing diagnosis in the pediatric audiology population is lacking. A consensus conference was held at the International Federation of Oto-rhino-laryngological Societies Congress, in June 2017, to discuss the different current practices and to identify the best neonatal hearing screening and audiological assessment management. This article is intended to provide professionals with recommendations about the "best practice" based on consensus opinion of the session's speakers, and a review of the literature on the efficacy of various assessment options for children with hearing loss.

[The hearing function in the premature infants]

The present review of the literature is focused on the morphological and functional aspects of antenatal ontogenesis of the hearing system with special reference to the peculiar features of its formation during the post-natal period in the premature infants. In this context, the results of the objective psychoacoustic investigation s are considered (including those obtained by such methods as threshold audiometry, verbal and non-verbal tests, evaluation of central auditory processing of the sound information). Also presented are the results of the objective methods of hearing investigations (acoustic impedancometry, registration of optoacoustic emission and auditory evoked potentials). The underdevelopment of the hearing system in the premature infants manifests itself as the specific functional features of all its components. Their parameters are presented with reference to dynamics of their formation. In addition, the problem of central auditory processing of the disorders that are very likely to be present in the premature infants are discussed.

Analysis of otoacoustic emissions in neonates at term and preterm

The transient evoked otoacoustic emissions (TEOAEs) have been widely used in neonatal hearing screening.

Objective

To compare the TEOAEs in newborns at term and preterm vis-à-vis the following variables: ear side, gender, frequency spectrum and gestational age.

Method

By means of a cross-sectional cohort of 66 newborns up to the 28^th day of life (41 newborns at term and 25 premature babies), we recorded TEOAEs. All the individuals did not have risk indicators for hearing loss.

Results

There was a signal/noise ratio improvement with frequency increase. No differences were observed between genders and between the ears, but there were differences among the children born at term and preterm in the frequency bands at 3 kHz and 4 kHz.

Conclusion

The TEOAEs test is important for assessing the peripheral auditory system of newborns at term and preterm, making it possible to have responses regardless of gender and gestational age.

The pathway for the transmission of external sounds into the fetal inner ear

After at least 20 weeks gestation, the human fetus in utero is able to hear and respond to external and internal (maternal) sounds. The external sounds are attenuated by maternal tissues and fluids - higher frequencies by about 20 dB, and lower frequencies are only slightly reduced. The sounds in the amniotic fluid, which completely envelops the fetus, then reach the fetal inner ear by bone conduction. The sound pressure in the amniotic fluid induces skull vibrations which are transmitted directly into the contents of the cranial cavity (brain and CSF) and from there, presumably by fluid channels connecting them, into the cochlear fluids. A further stage of conductive attenuation is probably involved in this transmission. Since the fetus in utero receives oxygen by placental diffusion (less efficient than pulmonary diffusion), the fetal inner ear is hypoxic compared to that following birth (pulmonary oxygen diffusion). This leads to a reduction in the magnitude of the endocochlear potential, to a depression of cochlear transduction and amplification, and thus to an additional sensorineural component of threshold elevation in the fetus. Upon birth, these conductive and sensorineural attenuations are removed.

Development of inner ear (cochlear and vestibular) function in the fetus-neonate

The development of function in the various receptors in the inner ear was studied in the neonatal rat, which is altricious with respect to hearing, using short latency evoked potentials, both auditory (ABR) and vestibular (VsEP). It was found that VsEPs could be recorded from all the vestibular end-organs by post natal day (PND) 8, whilst ABR could only be recorded from all animals on PND 14, showing the earlier onset of vestibular function in the inner ear. These results are discussed with relation to onset of inner ear function in the human fetus.