Community-based newborn hearing screening program in Taiwan

Community-based assessment and rehabilitation of hearing loss: A scoping review

Although the World Health Organization (WHO) recommends the use of a Community-Based Rehabilitation (CBR) model, little is known about how CBR has been applied in the hearing healthcare setting. The purpose of this scoping review was to identify and describe studies on Community-Based Hearing Rehabilitation (CBHR) programs within the applied context. The review was conducted in September 2020 with updated searches in November 2021 according to the Joanna Briggs Institute (JBI) methodology and reported using the guidelines and checklist for Preferred Reporting Items for Systematic Reviews and Meta Analyses-Extension for Scoping Reviews (PRISMA-ScR). Fifty-nine peer-reviewed research articles were included in the review. A narrative synthesis was conducted to map out the types of CBHR programs. Studies were classified into audiological themes: awareness, screening and assessment of hearing in newborn/infants, children and adults, training of community health workers, rehabilitation, cost-effectiveness and describing the service delivery models. Further categorisation was made based on CBR aspect matrices for each study. Most of the studies come from high-income countries in North America and Europe. CBHR studies predominantly focused on creating awareness, training and hearing screenings and/or assessments in communities and evaluating effectiveness in providing knowledge and access to hearing health services in rural or underserved communities. Further work is needed to examine the outcomes and effectiveness of CBHR using controlled studies. Moreover, more work is needed in low- and middle-income countries where the application of CBHR is critical for increased access and affordability.

Our newborn hearing screening results

OBJECTIVE:

The aim of the study was to evaluate the results of neonatal hearing screening in our hospital with the help of literature and to question and reveal the risk factors to gain healthy individuals and to raise awareness for all health workers and the public who are interested in this subject.

METHODS:

A total of 16,388 newborn infants were evaluated between October 2009 and January 2018. All newborns were screened with transient evoked otoacoustic emissions (TEOAEs) test. Risk factors were investigated. The test repetition and auditory brainstem response (ABR) measurements were performed on newborns who could not pass the TEOAE test and the newborns in the risky group after 15 days.

RESULTS:

A total of 116 newborns (0.7%) were suspected to have hearing loss. Twenty-seven newborns (0.16%) were found to be in intensive care unit. Twelve newborns (0.07%) had permanent hearing loss. Then, in order: 9 newborns (0.05%) had received phototherapy and 7 newborns (0.04%) were born to consanguineous marriages. In addition, 3 newborns (0.02%) had a low birth weight and 1 newborn (0.006%) had a history of fever.

CONCLUSION:

Screening tests should be performed in all newborns for early detection of hearing loss. Even though frequency of hearing loss is higher in newborns with risk factors, the treatment should be started within 6 months, the latest, and newborns should be referred for rehabilitation and training.

Perception of 'mothers of beneficiaries' regarding a rural community based hearing screening service

A rural community-based hearing screening project was established in villages in a rural district of Tamil Nadu in South India. The goal of this project was to address early detection of hearing loss among infants and young children. Village health workers (VHW) were trained to conduct hearing screenings using an Oto Acoustic Emissions (OAE) equipment. They were also trained to provide information about ear and hearing health, and to facilitate follow up visits for diagnostic testing when required.

OBJECTIVES

The purpose of this study was to review the project by examining the caregiver perception from the mothers of children who have undergone hearing screening regarding the service provided.

METHODS

Focus group discussions (FGDs), were conducted in nine villages of the district to obtain information and perceptions from mothers. In all, 70 mothers with children less than 2 years of age, and 13 mothers with children greater than 2 years of age, participated in the FGDs.

RESULTS

Responses obtained from mothers indicated that door to door health services are rare and are primarily related to sensitizing the community regarding health camps and preventive measures for widespread diseases (like dengue fever). Door to door screening for hearing among children is unique in these villages. Mothers were familiar with the NGO which coordinated the hearing screening program. Local pre-school (Balwadi) teachers were informed about the hearing screening program and its significance. From the responses of the participants it was clear that the sensitization carried out through them in all villages was successful. It was noteworthy that mothers mentioned the result of screening as "pass/refer" as instead of "pass/fail". This outcome suggests that health workers have used appropriate terminology to convey screening results. Mothers reported test conditions to be present and therefore confirmed that valid testing was conducted by VHWs.

CONCLUSIONS

Mothers in the community accepted hearing screening services delivered by health workers. The health workers were effective in delivering the services. Pre-school teachers seemed to have played a pivotal role in communicating about the hearing screening program to the mothers. Ultimately, collaborating with local NGO facilitated acceptance and compliance due to the NGOs strong presence in the community.

Screening, rubella vaccination, and childhood hearing impairment in Taiwan

Childhood hearing impairment (CHI) is a major developmental disability, but data at the national level are limited, especially those on the changes in the prevalence over time. In Taiwan, the government began to certify disabled residents for providing various services in 1980 and maintains a registry of certified cases, which provides a rare opportunity for studying the trends of CHI prevalence. Using the registry data, we estimated the prevalence of CHI by age and severity and explored factors affecting its changes over time. From 2000 to 2011, the registered cases under 17 years old ranged from 3427 to 4075. The overall prevalence increased from 2000 to 2006, but then decreased till 2011. While the prevalence of mild CHI increased over the years, such a pattern was not observed in moderate or severe CHI. In general, the overall prevalence increased over the years in the age groups <3 years, 3-5 years, and 6-11 years (p<0.01), and the largest increase was observed in the age group <3 years, particularly after the promotion of screening by the government in 2003. The decrease after 2006 was mainly attributable to decreases in the age groups 12-14 (with a decreasing trend from 2001, p<0.01) and 15-17 years (with a decreasing trend from 2004, p<0.01). The timing was related to the implementation of a nationwide rubella vaccination program. Similar decreases had been observed in countries with rubella vaccination programs.

The effectiveness of the promotion of newborn hearing screening in Taiwan

OBJECTIVE

Hearing is a critical ability for the development of a child's speech and language. Many studies in different countries have shown the universal newborn hearing screening and early intervention has greatly reduced the negative impact caused by congenital hearing loss. The first universal newborn hearing screening program in Taiwan took place in MacKay Memorial Hospital in 1998 and was subsequently endorsed by the government. The incidence of bilateral congenital hearing impairment in Taiwan is approximately 2.6 per 1000 live birth. The aim of this paper is to analyze the age of diagnosis, hearing aid fitting, and intervention of congenitally hearing impaired children with and without hearing screening after public awareness and government endorsement of newborn hearing screening.

MATERIALS AND METHODS

There were 263 hearing impaired children participated in this study, receiving their auditory habilitation therapy at Children's Hearing Foundation from 2006 to 2010. 114 of those children went through newborn hearing screening and 149 without it. The age of diagnosis, hearing aid fitting, and auditory intervention were compared between these two groups. The age of diagnosis and intervention of congenitally hearing impaired children among different years were analyzed too.

RESULTS

The average age of diagnosis was 8.7 months, the age of hearing aid fitting was 12.4 months and age of auditory intervention was 18.8 months for the group of hearing impaired children with newborn hearing screening. For hearing impaired children without newborn screening, their average age of diagnosis was 27.5 months; age of hearing aid fitting was 31.3 months and age of auditory intervention was 40.5 months. There were significant differences in the age of diagnosis, hearing aid fitting and auditory intervention between congenitally hearing impaired children with and without hearing screening.

CONCLUSIONS

This research indicates that newborn hearing screening facilitates early identification, diagnosis and intervention of congenitally hearing impaired children in Taiwan. The age of identification, diagnosis and intervention of congenital hearing impaired children has also been reduced gradually over the years after government endorsement of newborn hearing screening in Taiwan.

The performance of distortion product otoacoustic emissions and automated auditory brainstem response in the same ear of the babies in neonatal unit

OBJECTIVE

To identify the outcomes of hearing screening using different protocols of both Distortion Product Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Response (AABR) tests in the same ear of the babies in a neonatal unit population.

METHODS

A cross-sectional study was carried out on babies who were admitted into a neonatal unit. By using a formula of single proportion and considering 20% drop out, the number of sample required was 114. The subjects were chosen by using a systematic random sampling. The infants selected were subjected to DPOAE followed by AABR tests screening at the same setting before discharge.

RESULTS

There were 73 newborns (61.6% male and 38.4% female) participated in this study with a total of 146 ears screened. Ototoxic medication was the most common risk factor followed by hyperbilirubinaemia and low birth weight. AABR had higher passing rate (82.9%) as compared to DPOAE (77.4%). The highest passing rate was achieved if the protocol of either passed DPOAE or AABR was used (90.4%). The rate was lower when auditory neuropathy spectrum disorder (ANSD) has been considered (82.9%). Hyperbilirubinaemia, prematurity, craniofacial malformation and ototoxic drugs seem to be the high risk factors for auditory neuropathy.

CONCLUSION

AABR has a higher passing rate as compared to DPOAE. However, the use of both instruments in the screening process especially in NICU will be useful to determine the infants with ANSD who may need different approach to management. Therefore, a protocol in which newborns are tested with AABR first and then followed by DPOAE on those who fail the AABR is recommended.

National newborn hearing screening program in Turkey: struggles and implementations between 2004 and 2008

OBJECTIVE

In this review, we have presented the data of our National Newborn Hearing Screening Program (NNHSP) with total 764,352 newborns those screened in last five years.

METHODS

National Newborn Hearing Screening Program (NNHSP) has been conducted in Turkey since the year 2003. National Newborn Hearing Screening Program (NNHSP) had begun at the end of 2003 only in 1 center. After birth, in the third day, Transient Evoked Otoacoustic Emissions (TEOAEs) test criteria and if necessary, auditory brain response (ABR) testing evaluation methods were applied to newborn. The children diagnosed with hearing loss were further referred for advanced treatment and rehabilitation to advanced audiologic centers.

RESULTS

After five years of carrying out the program (between 2004 and 2008) a total number of 764,352 newborns were screened for hearing impairment. In the year 2008, National Newborn Hearing Screening Program (NNHSP) had given the chance for 2136 children with various types of hearing loss (320 with unilateral and 417 with bilateral hearing loss) to detect and refer to more experienced centers for further treatment.

CONCLUSIONS

Our results indicate that the necessity of newborn hearing screening is an indispensable issue. We have been targeted to develop National Newborn Hearing Screening Program (NNHSP) till given chance to access for every newborn in Turkey in next five years.

Using benefit-cost ratio to select Universal Newborn Hearing Screening test criteria

OBJECTIVES

Current protocols presumably use criteria that are chosen on the basis of the sensitivity and specificity rates they produce. Such an approach emphasizes test performance but does not include societal implications of the benefit of early identification. The purpose of the present analysis was to evaluate an approach to selecting criteria for use in Universal Newborn Hearing Screening (UNHS) programs that uses benefit-cost ratio (BCR) to demonstrate an alternative method to audiologists, administrators, and others involved in UNHS protocol decisions.

DESIGN

Existing data from more than 1200 ears were used to analyze BCR as a function of Distortion Product Otoacoustic Emission (DPOAE) level. These data were selected because both audiometric and DPOAE data were available on every ear. Although these data were not obtained in newborns, this compromise was necessary because audiometric outcomes (especially in infants with congenital hearing loss) in neonates are either lacking or limited in number. As such, it is important to note that the characteristics of responses from the group of subjects that formed the bases of the present analyses are different from those for neonates. This limits the extent to which actual criterion levels can be selected but should not affect the general approach of using BCR as a framework for considering UNHS criteria. Estimates of the prevalence of congenital hearing loss identified through UNHS in 37 states and U.S. territories in 2004 were used to calculate BCR. A range of estimates for the lifetime monetary benefits and yearly costs for UNHS were used, based on data available in the literature. Still, exact benefits and costs are difficult to know. Both one-step (DPOAE alone) and two-step (DPOAE followed by automated auditory brainstem response, AABR) screening paradigms were considered in the calculation of BCR. The influence of middle ear effusion was simulated by incorporating a range of expected DPOAE level reductions into an additional BCR analyses

RESULTS

Our calculations indicate that for a range of proposed benefit and cost estimates, the monetary benefits of both one-step (DPOAE alone) and two-step (DPOAE followed by AABR) NHS programs outweigh programmatic costs. Our calculations indicate that BCR is robust in that it can be applied regardless of the values that are assigned to benefit and cost. Maximum BCR was identified and remained stable regardless of these values; however, it was recognized that the use of maximum BCR could result in reduced test sensitivity and may not be optimal for use in UNHS programs. The inclusion of secondary AABR screening increases BCR but does not alter the DPOAE criterion level at which maximum BCR occurs. The model of middle ear effusion reduces overall DPOAE level, subsequently lowering the DPOAE criterion level at which maximum BCR was obtained

CONCLUSION

BCR is one of several alternative methods for choosing UNHS criteria, in which the evaluation of costs and benefits allows clinical and societal considerations to be incorporated into the pass/refer decision in a meaningful way. Although some of the benefits of early identification of hearing impairment cannot be estimated through a monetary analysis, such as improved psychosocial development and quality of life, this article provides an alternative to audiologists and administrators for selecting UNHS protocols that includes consideration of societal implications of UNHS screening criteria. BCR suggests that UNHS is a worthwhile investment for society as benefits always outweigh costs, at least for the estimations included in this article. Although the use of screening criteria that maximize BCR results in lower test sensitivity compared with other criteria, BCR may be used to select criteria that result in increased test sensitivity and still provide a high, although not maximal, BCR. Using BCR analysis provides a framework in which the societal implications of NHS protocols are considered and emphasizes the value of UNHS.

Progress towards early detection services for infants with hearing loss in developing countries

BACKGROUND

Early detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region.

METHODS

A cross-sectional, descriptive study based on responses to a structured questionnaire eliciting information on the nature and scope of early hearing detection services; strategies for financing services; parental and professional attitudes towards screening; and the performance of screening programmes. Responses were complemented with relevant data from the internet and PubMed/Medline.

RESULTS

Pilot projects using objective screening tests are on-going in a growing number of countries. Screening services are provided at public/private hospitals and/or community health centres and at no charge only in a few countries. Attitudes amongst parents and health care workers are typically positive towards such programmes. Screening efficiency, as measured by referral rate at discharge, was generally found to be lower than desired but several programmes achieved other international benchmarks. Coverage is generally above 90% but poor follow-up rates remain a challenge in some countries. The mean age of diagnosis is usually less than six months, even for community-based programmes.

CONCLUSION

Lack of adequate resources by many governments may limit rapid nationwide introduction of services for early hearing detection and intervention, but may not deter such services altogether. Parents may be required to pay for services in some settings in line with the existing practice where healthcare services are predominantly financed by out-of-pocket spending rather than public funding. However, governments and their international development partners need to complement current voluntary initiatives through systematic scaling-up of public awareness and requisite manpower development towards sustainable service capacities at all levels of healthcare delivery.

A Case Study of an Emerging Community-Based Early Hearing Detection and Intervention Program: Part I. Parents’ Compliance

Purpose

This is the first of a 2-part series of articles that describe and assess an emerging community-based early hearing detection and intervention program. This study investigated parents’ compliance for accessing services for their infants at 5 levels in the process from referrals through subsequent follow-up during a 3-year period. Compliance was defined as parents’ follow-through with professionals’ recommendations and appointments for their infants’ hearing health care.

Method

Investigators retrospectively reviewed the charts of 51 infants who were referred from a regional hospital’s newborn hearing screening program to a private practice office and were seen from March 2000 to February 2003.

Results

Compliance was 100% for initial hospital inpatient screening and for outpatient rescreening but decreased throughout the referral process. All of the parents of babies with hearing loss complied, and their infants were diagnosed by age 3 months and received audiologic or otologic intervention by age 6 months. Only half of those who needed and opted for hearing aids complied and began habilitative intervention by age 6 months.

Conclusions

Although compliance for initial and follow-up screening was excellent and met goals for national benchmarks, compliance for intervention services showed room for improvement.

Maternal views on infant hearing loss in a developing country

BACKGROUND

Parental support for infant hearing loss is essential for a successful infant screening programme. However, in developing countries where unfavourable customs and beliefs towards childhood disabilities have been reported, parental support towards infant screening is uncertain and there is presently no published evidence on the subject.

OBJECTIVE

To elicit the views of mothers and would-be mothers in order to ascertain their knowledge on infant hearing loss and their attitudes towards infant hearing screening.

METHODS

A structured questionnaire consisting of 15 questions was administered to 101 mothers (mean age 31.6+/-7.3 years, range: 21-55 years) attending two community hospitals in Lagos, Nigeria. The responses were evaluated by descriptive statistics, factor analysis of the principal components and multiple regression analysis. The reliability of the two main domains (knowledge and attitude) was tested for internal consistency by Cronbach's alpha coefficient.

RESULTS

Maternal knowledge was highest for measles (73%; mean score 2.54) and ear discharge (73%; mean score 2.51) but low for birth asphyxia (37%; mean score 1.90), traditional medicine (42%; mean score 2.03) and jaundice (47%; mean score 2.09) as causes of hearing loss. Attitude towards neonatal screening was positive in majority of mothers (92%; mean score 2.84) and there was a high acceptance of hearing aids as an early intervention option (84%; mean score 2.70). Five factors (eigenvalue>1) were extracted after principal component analysis with the attitude variables loading highly and exclusively on one factor. Age was the only demographic variable that was associated with a domain (knowledge) after multiple regression analysis. The component scales for the two domains were highly internally consistent (alpha coefficients of 0.84 and 0.83).

CONCLUSIONS

Contrary to the concerns often expressed about parental support for infant hearing screening programmes in developing countries, this study suggests that current parental knowledge and attitude favour early detection and intervention of childhood hearing impairment.

Ten-year outcome of newborn hearing screening in Austria

OBJECTIVE

Current health care standards recommend that congenital hearing loss be confirmed before age three months and intervened for before age six months. This study evaluated to what extent the Austrian universal neonatal hearing screening (UNHS) program achieves this goal. The Austrian UNHS program is a hospital-based, two-stage screen based on transient oto-acoustic emissions, as promoted in 1995 in a position paper of the Austrian ENT Society.

METHODS

Retrospective chart review and data analysis. All Austrian institutions engaged in the diagnosis and treatment of childhood hearing loss were requested to provide their data on children with permanent congenital sensorineural hearing impairment registered since 1990. Children who had undergone hearing screening, were compared to those who had not. Main outcome measures were age at confirmation of and age at intervention for the hearing loss. In each group, the percentage of children, whose hearing loss was confirmed by age three months, and intervened for by age six months, was determined.

RESULTS

Data from 321 hearing-impaired children were useable. Of these children, 167 were screened and 154 were not. At age three months, a hearing loss was diagnosed in 35% of screened children, but in only 2% of unscreened. These percentages rose to 69% and 6%, respectively, at age six months and to 81% and 12%, respectively, at age one year. Intervention mostly started within less than one month after diagnosis. At age six months, 61% of screened children, but only 4% of unscreened children, had undergone intervention.

CONCLUSIONS

Hearing screening enormously increases the number of early-detected children. However, in quite a few screened children hearing loss is neither confirmed within three months after birth, nor intervened for within six months after birth. Reasons for the delay must be paid attention in order to warrant that UNHS can be as effective as possible.

A two-step scenario for hearing assessment with otoacoustic emissions at compensated middle ear pressure (in children 1-7 years old)

OBJECTIVE

Otoacoustic emissions (OAEs) are widely used for assessing congenital and early-acquired sensorineural hearing loss in young children. Middle ear pathology has a negative effect on the presence of OAEs. In this study we investigated whether measuring OAEs at compensated middle ear pressure (CMEP) resulted in a higher pass rate than at ambient pressure. Secondly, we analysed the influence of 12 different pass definitions on the pass rates.

METHODS

One hundred and eleven children (age 1-7 years, mean 4 years and 5 months) were measured twice in one session: first at ambient pressure and then at CMEP.

RESULTS

The study showed a higher pass rate of OAEs at CMEP than at ambient pressure. A two-step scenario reduced the number of fails by 18-26%, depending on the pass/fail definition used.

CONCLUSION

Measuring OAEs at CMEP results in higher pass rates. Secondly, pass/fail definitions have a large influence on pass rates and this issue deserves further attention. Further studies must be done, before this method is readily applicable to universal neonatal screening.

Is there any association between consanguinity and hearing loss

BACKGROUND

Hearing loss (HL) and its complications appear to be increasingly common in developing countries. Previous studies have supported the association between hearing loss and consanguinity.

OBJECTIVE

The aim of the present study was to determine the frequency of hearing loss and its association with consanguinity among Qatari population. In addition, correlation between hearing loss and Rhesus (Rh) blood groups has been investigated.

DESIGN

This is a cross-sectional study.

SETTING

The study conducted at the Hamad General Hospital, Hamad Medical Corporation.

SUBJECTS

Total sample of 2800 infants screened and 2277 subjects were eligible to be included in the study.

METHODS

The neonatal screening for hearing loss was conducted from January 2003 to November 2003 among all the 2800 infants born during that period. Some of them were admitted to neonatal intensive care unit (NICU). The hearing loss was screened using otoacoustic emission (Garson Stadler Incorporation, GSI-70), auditory brain stem responses (ABR) and tympanogram.

RESULTS

Out of 2277 infant screened, the prevalence of hearing loss was (119/2277) 5.2%. The prevalence of HL was more common in boys (2.7%) than in girls (2.5%). We did not find any statistical significance differences between genders with the respect of HL. Parental consanguinity was more common among HL cases compared with non-HL 60.5% versus 25.3% (p < 0.0001). Family history of hearing loss did not show any differences between the two groups. 4.2% versus 4.3%. Risk factors like caesarean section, prenatal smoking and prenatal high blood pressure did not show any significant differences between the two groups. However, admission to NICU is associated with increase prevalence of HL 8.4% versus 4.4% (p = 0.043). The present study revealed that strong correlation between hearing loss, consanguineous (r = 0.217, p < 0.01), father education level illiterate (r = 0.293, p < 0.01), mothers consanguineous (r = 0.206, p < 0.01), mothers educational level illiterate (r = 0.228, p < 0.01), mother blood group positive (r = 0.476, p < 0.01), family history of HL among first or second degree of relatives (r = 0.620, p < 0.01) and father hypertension (r = 0.570, p < 0.01). Furthermore, a significant correlation between hearing loss and Rh blood groups has been discovered.

CONCLUSION

The present study was directed at determining the prevalence and risk factors of HL in the infant population of Qatar. The data revealed that parental consanguinity was more common among hearing loss cases. There is a strong correlation between hearing loss and baby's age.