Role of Alternative Auditory Testing in Newborn Hearing Screens

ABSTRACT

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.