Hearing screenings for preschool children: A comparison between whispered voice and pure tone audiogram tests.

INTRODUCTION: This prospective study compares the efficiency of two hearing screening tests performed on preschool children. These tests are known as whispered voice test and pure tone audiometry. METHODS: Standard hearing screenings were performed on five-year old children using a whispered voice test followed by ENT examination with pure tone audiometry. RESULTS: A total of 827 children were included in the study. Hearing loss (>25 dB) was observed in 5.8% of the evaluated children (n = 48), being bilateral in only 1.6% (n = 13) of these cases. Slight hearing impairment (hearing loss of 16-25 dB) was observed in 25.4% (n = 210) of the children, with 14.5% bilateral cases (n = 120). Interestingly, 62 children (7.5%) were under suspicion of hearing loss by their parents; however, an audiogram revealed the poor consistency of this diagnosis (sensitivity 20.8%, Cohen's kappa coefficient of 0.048). The whispered voice test (6 m distance) throwed a hearing impairment diagnosis in 807 (48.8%) of examined ears; however, its sensitivity was of only 56.5%, with a specificity of 51.6% and Cohen's kappa coefficient of 0.0254 (poor). CONCLUSION: The hearing loss incidence in preschool children coupled with the low efficacy of whispered voice tests and the parents' unreliability during the hearing impairment survey advocate for a more efficient audiometric hearing screening before beginning school attendance.

Updating the nationwide methodology for hearing screening of newborns in the Czech Republic.

Screening programs examining neonatal hearing serve to detect hearing defects, as a prerequisite for hearing rehabilitation, communication skills, and the enhancement of speech development. There are two methods through which neonatal hearing screening is carried out - the transiently evoked otoacoustic emissions (TEOAE) or the automatic BERA (AABR, automated auditory brainstem response). Positive screening means the discovery of a hearing defect (permanent hearing loss), and negative screening (normal TEOAE or the AABR results) means the absence of a hearing defect. The procedural aim is to update and adjust the neonatal hearing screening, which is determined by the Bulletin of the Ministry of Health of the Czech Republic No. 7/2012. Neonatal screening is performed at three levels: at neonatological site, at the ENT (phoniatric) rescreening site and at the ENT regional centre. The activities at each level are accurately and concretely identified including the issue of billing the performance to health insurance companies and informed consent to personal data protection (GDPR). The correct functioning of screening for hearing loss is based on the simple organization of the screening, patient examination comfort, medical recovery from it, and its economic viability. The schedule for neonatal hearing screening and rehabilitation recommends the following steps: 1. screening of a newborns hearing on the second or third day after delivery by a neonatological nurse using otoacoustic emissions, alternatively AABR for newborns at risk; 2. hearing rescreening in the third to sixth week of child`s age at the ENT rescreening site; 3. completion of hearing impairment diagnostics within three to sixth months of age at the ENT regional centre. The failure to follow the procedure above is a threat to the hearing and speech development of the child with severe permanent hearing impairment. The collaboration of ENT doctors with neonatologists and paediatricians allows for creating conditions under which the functional nationwide hearing screening of newborns can be established throughout the Czech Republic.

Variability of UV irradiance in Europe.

The diurnal and annual variability of solar UV radiation in Europe is described for different latitudes, seasons and different biologic weighting functions. For the description of this variability under cloudless skies the widely used one-dimensional version of the radiative transfer model UVSPEC is used. We reconfirm that the major factor influencing the diurnal and annual variability of UV irradiance is solar elevation. While ozone is a strong absorber of UV radiation its effect is relatively constant when compared with the temporal variability of clouds. We show the significant role that clouds play in modifying the UV climate by analyzing erythemal irradiance measurements from 28 stations in Europe in summer. On average, the daily erythemal dose under cloudless skies varies between 2.2 kJ m(-2) at 70 degrees N and 5.2 kJ m(-2) at 35 degrees N, whereas these values are reduced to 1.5-4.5 kJ m(-2) if clouds are included. Thus clouds significantly reduce the monthly UV irradiation, with the smallest reductions, on average, at lower latitudes, which corresponds to the fact that it is often cloudless in the Mediterranean area in summer.

Sensitivity of erythemally effective UV irradiance and daily exposure to uncertainties in measured total ozone.

In this study the sensitivity of the erythemally effective radiation to uncertainties in operationally measured total ozone content of the atmosphere (TOC) was estimated. For this, daily operational TOC measurements from different instruments were applied covering the period from 1997 to 1999. Measurements were gained from space by Earth Probe Satellite, Earth Remote Sensing satellite/Global Ozone Monitoring Experiment and Operational Vertical Sounder and from the ground by Dobson and Brewer spectrophotometers for the locations of Hradec Kralove (Czech Republic, 50 degrees N), Nairobi (Kenya, 1 degrees S) and Springbok (Republic of South Africa, 30 degrees S). The values were used as input parameter to model calculations of erythemally effective irradiance and daily radiant exposure. The differences due to the use of TOC from different sources were analyzed with respect to the Ultraviolet Index (UVI). The UVI was introduced as a tool for sun protection and health care. Therefore, it is of special importance to know the restriction of accuracy. As a tool of health care, the maximum uncertainties are of interest and are described in using the 95%-percentile and the maximum differences. This study shows that differences, i.e. uncertainties (95%-percentile) are in the order of 1 UVI. Independently on the location, however, extreme differences may overstep 3 UVI. For the daily dose the 95%-percentile is around 7.5 UVI hours (UVIh) but differences higher than 20 UVIh were also found.

Global forecast model to predict the daily dose of the solar erythemally effective UV radiation.

A worldwide forecast of the erythemally effective ultraviolet (UV) radiation is presented. The forecast was established to inform the public about the expected amount of erythemally effective UV radiation for the next day. Besides the irradiance, the daily dose is forecasted to enable people to choose the appropriate sun protection tools. Following the UV Index as the measure of global erythemally effective irradiance, the daily dose is expressed in units of UV Index hours. In this study, we have validated the model and the forecast against measurements from broadband UV radiometers of the Robertson-Berger type. The measurements were made at four continents ranging from the northern polar circle (67.4 degrees N) to the Antarctic coast (61.1 degrees S). As additional quality criteria the frequency of underestimation was taken into account because the forecast is a tool of radiation protection and made to avoid overexposure. A value closer than one minimal erythemal dose for the most sensitive skin type 1 to the observed value was counted as hit and greater deviations as underestimation or overestimation. The Austrian forecast model underestimates the daily dose in 3.7% of all cases, whereas 1.7% results from the model and 2.0% from the assumed total ozone content. The hit rate could be found in the order of 40%.