Maintaining acceptably low referral rates in TEOAE-based newborn hearing screening programs.

This article describes factors that can affect the refer rate for otoacoustic emission (OAE) based newborn hearing screening, including the population of infants being screened, the adequacy of probe fit, software options used, external ear conditions, screener training, and baby handling. The effect of the infant's age on screening outcomes is also discussed using results of screening for 1328 regular nursery newborns, ranging in age from 6 to 60 hours, who were screened with transient evoked otoaoustic emissions (TEOAE) prior to hospital discharge. The youngest infants (6-9 hours old) were as likely to pass (90% pass rate) as the infants who were 24-27 hours old (94% pass rate). The results of this study are consistent with reports from many TEOAE-based screening programs that have demonstrated that acceptably low refer rates (mean = 6.9%) can be obtained when appropriate screening procedures are followed.

Newborn hearing screening: comparison of a simplified otoacoustic emissions device (ILO1088) with the ILO88.

INTRODUCTION: The acceptance of universal newborn hearing screening has been affected by the availability of an accurate, cost-effective tool. Transient evoked otoacoustic emission (TEOAE) procedures have been used successfully in hospital-based programs. A modified TEOAE method, using a narrow band signal, may be capable of maintaining accuracy while reducing test time. A comparison between a simplified narrow band TEOAE screening device (ILO1088-Echosensor) and the standard ILO88 Quickscreen mode was initiated in this study. METHODS: One thousand ears of newborns in a normal nursery were tested using both devices. RESULTS: Results demonstrated that there was good agreement between the two devices. The possibility that the 5.9% discrepancy between the two screeners may be related to restrictions in the protocol that prohibited calibrating or refitting the probe during the test should be explored. DISCUSSION: The ILO1088 automated screener demonstrated good potential as a quick, accurate hearing screening device for newborns with the potential of reducing screener training and the need for off-line interpretation of the results when employed in a universal program.

Effects of exam procedures on transient evoked otoacoustic emissions (TEOAEs) in neonates.

Debris in the ear canal and ear canal collapse in newborns have been shown to interfere with recording transient evoked otoacoustic emissions (TEOAEs). The purpose of this study was to prospectively evaluate the effects of two simple ear canal cleaning procedures on the TEOAE responses of normal newborns. Three hundred and sixteen ears were studied with an initial TEOAE followed randomly by either an otoscopic exam and refit procedure or a probe refit procedure. At the time of each procedure, any superficial debris attached to the otoscope or probe were removed before the second TEOAE was repeated with identical procedures. The study sample consisted of two equal groups of ears (otoscopic exam and refit). Each group initially had equal proportions of ears with no emission, a weak emission, or a robust emission. In the otoscopic group, 12 of 51 (24%) weak emissions converted to robust emissions, 10 of 53 (19%) no emissions converted to robust emissions, and 15 of 53 (28%) no emissions improved to weak emissions. In the refit group, 20 of 50 (40%) weak emissions converted to robust emissions, 13 of 57 (23%) no emissions converted to weak emissions, and 9 of 57 (16%) no emissions improved to weak emissions. Both the otoscopic viewing procedure and the refit procedure were effective in improving the TEOAE response.

Transient evoked otoacoustic emission-based screening in typical nurseries: a response to Jacobson and Jacobson.

Jacobson and Jacobson (Int. J. Pediatr. Otorhinolaryngol. 29 (1994) 235-248) recently questioned whether TEOAE-based newborn hearing screening similar to what was recommended by the National Institutes of Health could be implemented in a typical nursery setting. They concluded that, 'the theoretical advantage of TEOAEs as a method for screening newborn babies at risk for hearing loss may not be realized in acute practice.' This article presents data based on dozens of currently operational TEOAE-based newborn hearing screening programs which demonstrate that the concerns raised by Jacobson and Jacobson are not representative of what is being experienced by operational newborn hearing screening programs.

Referral rates and cost efficiency in a universal newborn hearing screening program using transient evoked otoacoustic emissions.

Recently, a National Institutes of Health Consensus Statement recommended that all infants be screened for hearing prior leaving the birthing hospital using a two-stage screening process based on transient evoked otoacoustic emissions (TEOAEs). Although the value of identifying hearing loss before 1 year of age is widely recognized, the feasibility of universal newborn hearing screening using TEOAE is sometimes questioned because it is presumed that the technique has a high false positive rate and is not cost efficient. This paper presents new data for 4253 infants from an operational universal newborn hearing screening program using a TEOAE procedure that answers those arguments.

Universal screening for infant hearing impairment: simple, beneficial, and presently justified.

In a recent article, Bess and Paradise (Pediatrics 93 (1994) 330-334) rejected the recommendation of the National Institutes of Health that all infants be screened for hearing loss on being released from their birthing hospital. This article responds to their objections with data from the literature and operational newborn hearing screening programs. These data show that universal newborn hearing screening is practicable, effective, cost-efficient, and safe, and concludes that such programs should be implemented without further delay.

Screening all newborns for hearing loss using transient evoked otoacoustic emissions.

The importance of identifying hearing loss before 12 months of age is well established. Although recent research provides some evidence for the value of transient evoked otoacoustic emissions (TEOAEs) in newborn hearing screening, data are needed from large-scale clinical evaluations about the value of using TEOAE for screening high-risk and healthy babies. A cohort of 1850 infants from the well-baby nursery (WBN) and neonatal intensive care unit (NICU) were screened with TEOAE using a 2-stage process. Infants referred from the first stage prior to being discharged from the hospital were rescreened 4 to 6 weeks later. Those who did not pass the second-stage TEOAE screening were referred for diagnostic auditory brainstem response (ABR) and/or behavioral audiological evaluation for confirmation of hearing loss, fitting with amplification, and enrollment in early intervention programs. Eleven infants with unilateral or bilateral sensorineural hearing loss > 25 dB (a prevalence of 5.95 per 1000) and 37 with unilateral or bilateral recurrent conductive hearing loss > 25 dB (a prevalence of 20.0 per 1000) were identified from this cohort. These results suggest that TEOAE is a promising technique for screening newborns for hearing loss and should be evaluated further as a tool for universal newborn hearing screening.

Using transient evoked otoacoustic emissions for neonatal hearing screening.

The Rhode Island Hearing Assessment Project was developed to determine the feasibility of establishing a valid cost-effective method of screening newborn hearing through a universal early identification programme. In a sample of 1850 infants, sensorineural hearing loss was identified in 11 infants using transient evoked otoacoustic emissions (TEOAEs). A second sample of 1451 infants showed similar trends in hearing loss identification. TEOAE was shown to have significant potential as a newborn screening tool when used in a carefully designed hospital-based early identification programme.

Temporal integration functions in hearing-impaired children.

Temporal integration was measured indirectly by obtaining threshold-duration functions with children (8 to 12 yr) who have sensorineural hearing impairment. Thresholds were obtained by an ascending technique at three frequencies (500, 2000, and 4000 Hz) and at three durations (25, 100, and 200 msec). The threshold-duration functions were flatter than those obtained previously on normal-hearing children, and steeper than those previously on hearing-impaired adults. Implications for clinical usage of brief-tone audiometry with children are discussed.

The effects of microphone spacing on auditory localization.

The localization ability of 10 normally hearing adults was determined under varying microphone separations and varying sound source azimuths. The stimuli (white noise busts) were prerecorded, after being transduced through 'body' hearing aids and then played to the subjects over headphones. Results indicated that there was an improvement in localization ability for all azimuth conditions when the microphones were spaced wider than 12.7 cm apart (15.2-30.5 cm). The smaller the separations (5.5-12.7 cm), the poorer the localization. Localization was always poorer at 30 degrees azimuth (the smallest used) than at any of the other azimuths (0 degree, 30 degrees, 60 degrees, 90 degrees right and left), regardless of microphone spacing. Implications are made about the relation of these findings to the use of binaural body aids on infants and young children.