Role of Alternative Auditory Testing in Newborn Hearing Screens

Introduction: This study investigates the role of distortion product otoacoustic emissions (DPOAE), tympanometry, and acoustic stapedial reflex testing (ASR) and their combined potential utility in the setting of replacing classic automated auditory brainstem response (AABR) testing in newborns with referred hearing screens. This was done to determine whether these tests could be used in isolation so to reduce the follow-up burden on families and improve compliance with our screening protocols by replacing the need for additional tests, especially in a health care system with limited resources and with current travel and visitor restrictions. Method(s): Data were prospectively collected on new clinic patients with the following inclusion criteria: children 0 to 6 months old with referred newborn hearing screens via AABR from August 2020 to October 2020 at Children's Hospital of Michigan. All patients were initially rescreened with repeat AABR. ASR, DPOAE, and tympanometry data from selected patients were collected. Patients were noted to have either normal or abnormal responses from each test using preset parameters. Screening methods were then compared. Result(s): Thirty-eight children were recruited in the study including 76 ears. On repeat AABR, 13% of children and 6% of ears were referred again. Of those that failed the second AABR, 40% had abnormal tympanometry compared with 6% of those that passed. The DPOAE results correlated with AABR findings in all but 1 patient. Acoustic reflex testing was abnormal in 2.6% of patients, which all correlated with referred AABRs. Further statistical analysis is being done to evaluate for significant correlations. Conclusion(s): AABR revealed equivocal results when compared with results of DPOAE, ASR, and tympanometry. This study was limited by the number of patients included, given the current COVID-19 pandemic. Many sites lack AABR capabilities, and given our findings, these alternative auditory tests can be considered in health care settings with limited resources. With further research and greater sample size, these readily available audiologic tests may be considered as simple, reproducible, and sensitive screening alternatives.

Establishing Human and Animal Stool Testing for SARS-CoV-2 to Determine Feasibility of Fecal/Oral Transmission

The Current COVID-19 disease pandemic is caused by the Coronavirus SARS-CoV-2. SARS-related viruses in humans are generally carried by animals and human infections are only due to contact with infected animals. But in the case of SARS-CoV-2, human to human transmission is the most studied route of infection and primarily through fomites or respiratory particulates. The objective of this project was to determine feasibility of methods to test and detect infectious SARS-CoV-2 virus and viral RNA in stool. Once detected, the results were used to support the hypothesis that fecal/oral exposure to SARS-CoV2 virus is a potential route of infection in animal models and humans and an area to address in the control and prevention of COVID-19 disease.

Data quality and monitoring completion rates are similar between clinic-applied and self-applied continuous ECG monitoring patches prior to and during COVID-19

Introduction: Prior to COVID-19, ECG patches (ECGp) were applied almost exclusively in-clinic (CA) by technicians which required an office visit and fee. Since the pandemic, direct-to-patient, self-applied patch use (SA) has substantially increased, though the metrics surrounding SA are unknown. This study compares monitoring completion rates and data quality between CA and SA ECGp prior to and during COVID-19. Hypothesis: CA and SA ECGp have similar data quality and monitoring completion metrics. Methods: We performed a retrospective cohort analysis of patients prescribed an iRhythm Zio XT patch at Northwestern Memorial Hospital during the “pre-COVID” (3/1/2019-3/1/2020) and “COVID” (4/1/2020-4/1/2021) timeframes. Differences in ECGp with data available, actual vs prescribed wear time, and analyzable data between groups were assessed. ECGp without data was defined as devices which were not returned or not activated. Results: The cohort included 29,118 ECGp prescriptions;13,180 pre-COVID (45%). The cohort was 56% female with mean age of 59.3 + 17.7 years. Palpitations (29%) and atrial fibrillation (19%) were the most common indications. In the pre-COVID cohort, there were no (0%) SA ECGp and data were available for 12,932 CA patches. In the COVID cohort, 34% of ECGp were SA;data were available for 10,231 CA ECGp and 4,902 SA ECGp. Average delay between prescription and SA ECGp activation was 8.1 ± 12.2 days. Comparisons between percent analyzable data, wear times, and ECGp with data available are shown in figure 1. Conclusions: COVID-19 resulted in a rapid adoption of SA ECGp use. Compared to CA, SA was associated with an inherent delay in ECGp application and a higher proportion of ECGp without data. However, there was no difference in actual vs prescribed wear time and a small but statistically significant decrease in percent analyzable data. These differences must be balanced with the additional cost and need for in-person visit for CA vs SA. (Figure Presented).