Prevalence of permanent childhood hearing loss detected at the universal newborn hearing screen: Systematic review and meta-analysis

Robust machine learning method for imputing missing values in audiograms collected in children

OBJECTIVE

To assess the accuracy and reliability of a machine learning (ML) algorithm for predicting the full audiograms of hearing-impaired children relative to the common approach (CA).

DESIGN

Retrospective study.

STUDY SAMPLE

There were 206 audiograms included from 206 children with sensorineural hearing loss. Nested cross-validation was used for evaluating the performance of the CA and ML. Six audiogram prediction simulations were performed in which either one or two thresholds across 0.5-4 kHz from complete audiograms in the dataset were labelled. Missing thresholds at the remaining frequencies were then predicted using the CA and ML in each simulation. The accuracy of the ML algorithm was determined by comparing the median average absolute threshold differences between the CA and ML using Wilcoxon signed-rank test. The reliability between runs of the ML was also assessed with Cronbach's alphas.

RESULTS

The median average absolute threshold differences in ML (5-8 dBHL) were statistically significantly lower than those in CA (6.25-10 dBHL) in all six simulations (p value < 0.05). The ML algorithm was also found to be reliable to predict the audiograms in all six simulations (α > 0.9).

CONCLUSION

Using the ML to predict the children's audiograms was reliable and more accurate than using the CA.

Newborn hearing screening programme based on an integrated hospital and community care system. Results of the first 4 years of activity

Since January 2012, babies born in the province of Modena, Italy, have routinely undergone hearing testing as part of a two-stage screening programme. Newborn hearing screening (NHS) has been based on an integrated hospital and community care system and this study aims to assess screening coverage, referral rates, the prevalence, type and extent of hearing loss several years into the programme. Data were collected from January 1, 2012 to December 31, 2015. Coverage was over 99% in all five facilities of the province. The ratio of "fails of the screening" to the total number of infants tested varied over the period from 1.2% to 0.9% in the third level facility, and from 0.8% to 0.4% in the other four. Although hearing loss was mainly associated with dysmorphic\syndromic diseases or a family history of hearing loss, some 23% of cases were identified with no known risk factors. We highlight the importance of the NHSP and the need for strong support from healthcare administrators to ensure high coverage. This is especially true since although the prevalence of hearing loss was higher among infants with audiological risk factors, several cases of hearing loss were found in newborns with no known risk factors.

Clinical practice guidelines on newborn hearing screening: A systematic quality appraisal using the AGREE II instrument

INTRODUCTION

Several guidelines and consensus statements have been produced and disseminated for the detection and management of newborn hearing loss. However, to date, the quality and methodologic rigor of these screening and management protocols have not been appraised.

OBJECTIVE

To identify and evaluate existing guidelines and consensus statements for the detection and management of neonatal hearing loss.

METHODS

A comprehensive search of EMBASE, MEDLINE/PubMed, SCOPUS and grey literature sources was conducted until August 2020. The quality of these guidelines was assessed by four independent reviewers using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II). Domain scores were considered satisfactory quality if they scored >60%, and intraclass correlation coefficients (ICC) were calculated to assess agreement among the appraisers.

RESULTS

Twelve guidelines were assessed for critical evaluation. Only two guidelines were classified as 'high quality', and the remaining were 'average' or 'low quality'. The 'Scope and Purpose' domain achieved the highest mean score (91.3% ± 5.8%), and lowest was 'Rigor of Development' (35.8% ± 19.1%). ICC analysis showed good to very good agreement across all domains (0.63-0.95).

CONCLUSION

These findings highlight the variability in methodologic quality of guidelines and consensus statement for the detection and management of neonatal hearing loss. These results may help to improve the reporting of future guidelines and guide the selection and use of these guidelines in clinical practice.

Cochlear Implantation in Infants: Why and How

In children with congenital deafness, cochlear implantation (CI) prior to 12 months of age offers the opportunity to foster more typical auditory development during late infancy and early childhood. Recent studies have found a positive association between early implantation and expressive and receptive language outcomes, with some children able to achieve normal language skills by the time of school entry. Universal newborn hearing screening improved early detection and diagnosis of congenital hearing loss, allowing for earlier intervention, including decision-making regarding cochlear implant (CI) candidacy. It can be more challenging to confirm CI candidacy in infants; therefore, a multidisciplinary approach, including objective audiometric testing, is recommended to not only confirm the diagnosis but also to counsel families regarding expectations and long-term management. Surgeons performing CI surgery in young children should consider both the anesthetic risks of surgery in infancy and the ways in which mastoid anatomy may differ between infants and older children or adults. Multiple studies have found CI surgery in infants can be performed safely and effectively. This article reviews current evidence regarding indications for implantation in children younger than 12 months of age and discusses perioperative considerations and surgical technique.

The Correlation Between Click-Evoked Auditory Brainstem Responses and Future Behavioral Thresholds Determined Using Universal Newborn Hearing Screening

This retrospective study was undertaken to assess the correlation between click-evoked auditory brainstem responses and behavioral hearing tests. We recruited a total of 16646 infants born in Ditmanson Medical Foundation Chia-Yi Christian Hospital, Taiwan, from 2012 to 2018 for such assessment purpose. Their data including the click-evoked auditory brainstem response (ABR), referral, and diagnostic follow-up were collected. Spearman correlation method was employed to assess the relationship between ABR and pure-tone threshold. The correlation between the click-evoked ABR that met the National Health Administration standards and the click-evoked ABR derived from estimates before and after the 2.5 years of age effectively predicted the toddlers' pure-tone audiometry (PTA) thresholds at 2-4 kHz.

Results of the Universal Neonatal Hearing Screening in a Tertiary Care Hospital in Mexico city

INTRODUCTION

Universal Neonatal Hearing Screening (UNHS) includes as its main objective, that all Newborns (NB) receive an audiological evaluation during their first month of life.

OBJECTIVE

To determine the prevalence of hearing loss in a population of healthy NB in a tertiary care hospital in Mexico City.

MATERIAL AND METHODS

A prospective cross-sectional study was designed. The period was from October 1, 2011 to May 15, 2019. UNHS was performed with a flowchart in three phases using Transient Evoked Otoacoustic Emissions and Brainstem auditory evoked potentials. Data were analyzed using descriptive statistics.

RESULTS

14,000 NB were evaluated, 28,000 ears. Gender was distributed in n = 7038 (50.3%) males and n = 6962 (49.7%) females. The mean age at the time of the first UNHS study was 48.3 ± 22.2 days. Hearing loss was confirmed in n = 31 (0.22%) NB, in 20 (64%) of the cases with hearing loss there were no documented audiological risk factors.

CONCLUSIONS

The prevalence of hearing loss was 2.2 per 1000 NB in a tertiary care hospital in Mexico City. Diagnosis and early habilitation of hearing loss in NB constitute quality indicators in health care and guarantee the best prognosis for NB with hearing loss.

Hearing Loss in Children: A Review

IMPORTANCE

Hearing loss in children is common and by age 18 years, affects nearly 1 of every 5 children. Without hearing rehabilitation, hearing loss can cause detrimental effects on speech, language, developmental, educational, and cognitive outcomes in children.

OBSERVATIONS

Consequences of hearing loss in children include worse outcomes in speech, language, education, social functioning, cognitive abilities, and quality of life. Hearing loss can be congenital, delayed onset, or acquired with possible etiologies including congenital infections, genetic causes including syndromic and nonsyndromic etiologies, and trauma, among others. Evaluation of hearing loss must be based on suspected diagnosis, type, laterality and degree of hearing loss, age of onset, and additional variables such as exposure to cranial irradiation. Hearing rehabilitation for children with hearing loss may include use of hearing aids, cochlear implants, bone anchored devices, or use of assistive devices such as frequency modulating systems.

CONCLUSIONS AND RELEVANCE

Hearing loss in children is common, and there has been substantial progress in diagnosis and management of these cases. Early identification of hearing loss and understanding its etiology can assist with prognosis and counseling of families. In addition, awareness of treatment strategies including the many hearing device options, cochlear implant, and assistive devices can help direct management of the patient to optimize outcomes.

A new approach to estimating the prevalence of hereditary hearing loss: An analysis of the distribution of sign language users based on census data in Russia

The absence of comparable epidemiological data challenges the correct estimation of the prevalence of congenital hearing loss (HL) around the world. Sign language (SL) is known as the main type of communication of deaf people. We suggest that the distribution of SL can be interpreted as an indirect indicator of the prevalence of congenital HL. Since a significant part of congenital HL is due to genetic causes, an assessment of the distribution of SL users can reveal regions with an extensive accumulation of hereditary HL. For the first time, we analyzed the data on the distribution of SL users that became available for the total population of Russia by the 2010 census. Seventy-three out of 85 federal regions of Russia were ranked into three groups by the 25th and 75th percentiles of the proportion of SL users: 14 regions-"low proportion"; 48 regions-"average proportion"; and 11 regions-"high proportion". We consider that the observed uneven prevalence of SL users can reflect underlying hereditary forms of congenital HL accumulated in certain populations by specific genetic background and population structure. At least, the data from this study indicate that the highest proportions of SL users detected in some Siberian regions are consistent with the reported accumulation of specific hereditary HL forms in indigenous Yakut, Tuvinian and Altaian populations.

Arterial spin labeling brain MRI study to evaluate the impact of deafness on cerebral perfusion in 79 children before cochlear implantation

Age at implantation is considered to be a major factor, influencing outcomes after pediatric cochlear implantation. In the absence of acoustic input, it has been proposed that cross-modal reorganization can be detrimental for adaptation to the new electrical input provided by a cochlear implant. Here, through a retrospective study, we aimed to investigate differences in cerebral blood flow (CBF) at rest prior to implantation in children with congenital deafness compared to normally hearing children. In addition, we looked at the putative link between pre-operative rest-CBF and the oral intelligibility scores at 12 months post-implantation. Finally, we observed the evolution of perfusion with age, within brain areas showing abnormal rest-CBF associated to deafness, in deaf children and in normally hearing children. In children older than 5 years old, results showed a significant bilateral hypoperfusion in temporal regions in deaf children, particularly in Heschl's gyrus, and a significant hyperperfusion of occipital regions. Furthermore, in children older than 5 years old, whole brain voxel-by-voxel correlation analysis between pre-operative rest-CBF and oral intelligibility scores at 12 months post-implantation, showed significant negative correlation localized in the occipital regions: children who performed worse in the speech perception test one year after implantation were those presenting higher preoperative CBF values in these occipital regions. Finally, when comparing mean relative perfusion (extracted from the temporal regions found abnormal on whole-brain voxel-based analysis) across ages in patients and controls, we observed that the temporal perfusion evolution was significantly different in deaf children than in normally hearing children. Indeed, while temporal perfusion increased with age in normally hearing children, it remained stable in deaf children. We showed a critical period around 4 years old, where in the context of auditory deprivation, there is a lack of synaptic activity in auditory regions. These results support the benefits of early cochlear implantation to maximize the effectiveness of auditory rehabilitation and to avoid cross-modal reorganization.

Combined hearing screening and genetic screening of deafness among Hakka newborns in China

OBJECTIVE

Hearing loss (HL) can severely impact the quality of human life. To explore strategies for clinical interventions, we investigated hearing screening coupled with genetic testing of deafness among Hakka newborns.

METHODS

The testing was performed on 4205 newborns who born in Heyuan of Guangdong province between December 2018 and November 2019. Hearing screening used otoacoustic emission(OAE) coupled with automatic auditory brainstem response(AABR). A total of 13 hot spot mutations in GJB2, SLC26A4, mtDNA, and GJB3 genes were screened using PCR accompanied by flow-through hybridization technology.

RESULTS

Among the 4205 newborns, the number of 47 individuals who failed the hearing testing accounted for 1.12％(47/4205). The genetic screening displayed that 176 individuals(4.19%,176/4205) discovered to carry more than one mutant site. The gene carrier frequency of GJB2, SLC26A4, GJB3, and mtDNA was 2.24%, 1.76%, 0.19%, and 0.07% respectively. The most carried mutations were GJB2 c.235del (2.05%), followed by SLC26A4 c.IVS7-2A > G(1.38%). A total of 216 (5.14%, 216/4205) high-risk children detected by combined hearing screening and genetic screening of deafness. Pairwise comparison (1.12% vs 4.19% vs 5.14%) showed significant differences for the positive rate of detection(χ 2 = 11.045, P < 0.001). The difference was no statistical significance between neonatal demographics information and genetic mutations using logistic regression analysis(all P > 0.05).

CONCLUSIONS

Among Hakka newborns in Heyuan, the carrier rate of GJB2 c.235delC was the highest. Combining with two screening methods will effectually increase the detection rate of neonatal deafness and play an essential role in clinical intervention.

Results of a Government-supported Newborn Hearing Screening Pilot Project in the 17 Cities and Provinces from 2014 to 2018 in Korea

BACKGROUND

The aim of this study was to present and analyze, for the first time, the results of a government-supported nationwide newborn hearing screening (NHS) pilot project in the 17 major cities and provinces of Korea.

METHODS

We analyzed a nationwide NHS database of 344,955 newborns in the pilot project from 2014 to 2018. The government supported the cost of one NHS and one diagnostic auditory brainstem response (ABR) test. Hearing loss (HL) was defined as ≥ 40 dB nHL on either side of the ABR threshold test.

RESULTS

Most NHS tests were performed in the maternity clinics (91.5%). In regions with lack of maternity clinics, the screening rate of local clinics was high (Jeju: 31.1% and Sejong: 12.9%). In most regions, automated ABR was mainly used for screening test (89.7%), but Gangwon (32.7%), Jeju (31.0%), and Jeonbuk (29.6%) performed more NHS tests using (automated) otoacoustic emissions than other regions. The mean referral rate was 1.5%, but the overall diagnostic ABR rate was low at 18.5%. The referral rates of Busan (0.6%) and Gyeongnam (0.9%) were lower than 1%, and Jeju's referral rate was 7.3%. Prevalence of HL including unilateral HL was 0.12%.

CONCLUSION

Depending on the cities and provinces, there were significant differences in the screening rates and referral rates by hospital type and NHS method. For successful early hearing detection and intervention (EHDI) and quality control, it will be necessary to support and manage EHDI according to regional NHS's characteristics and ensure that the whole country conducts EHDI as standard.

Risk factors for non-participation in the Danish universal newborn hearing screening program: A population-based cohort study

OBJECTIVE

To explore risk factors for non-participation for the Danish universal newborn hearing screening program, including socioeconomic demographic and peripartum conditions. Furthermore, the participation rate between children with medical risk factors for congenital hearing loss and healthy newborns was analyzed.

METHODS

The study was register-based and included all live births in Denmark between January 1st, 2008 and December 31st, 2011, in total 251,081 children. Potential risk factors were extracted from eight Danish national registers and analyzed via logistic regression models.

RESULTS

With respect to the participation rate, the strongest predictors of non-participation were increased maternal parity (from OR: 0.85; 95% CI: 0.82-0.89; p<0.0001 to OR: 0.43; 95% CI: 0.38-0.47; P<0.0001), low socio-economic status, including income, (from OR: 1.16; 95% CI: 1.09-1.23; p<0.0001 to OR: 1.46; 95% CI: 1.37-1.56; p<0.0001) and home birth (OR: 0.58; 95% CI: 0.42-0.80; p=0.001). Children with a medical risk factor for congenital hearing loss had a 1.97% lower participation rate. Assisted ventilation and admission to a newborn intensive care unit for > 48 hours were identified as independent risk factors of non-participation for this group (OR: 0.65; 95% CI: 0.52-0.80; p<0.0001 and OR: 0.92; 95% CI: 0.85-0.99; p=0.036, respectively).

CONCLUSION

In order to improve the participation rate, a national screening database in conjunction with a stronger collaboration between screening units and other health care professionals who are in contact with the family during the newborn period is warranted.

Sensorineural hearing loss (SNHL) as an adverse event following immunization (AEFI): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data

This is a Brighton Collaboration case definition of the term "Sensorineural Hearing Loss" to be utilized in the evaluation of adverse events following immunization. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for Lassa Fever and other emerging pathogens. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and define levels of diagnostic certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network.