Volunteer-based universal newborn hearing screening program

Cost-effectiveness of Neonatal Hearing Screening Programs: Systematic Review

Introduction  Universal newborn hearing screening (UNHS) has been widely and strongly advocated as an early detection strategy for hearing loss in children. This intervention aims to prevent delays in speech and language development, which, in turn, has long-term beneficial effects on the social and emotional development and quality of life of individuals. However, the implementation of UNHS programs is circumstantial in different settings, for different reasons. Objectives  The present systematic review aimed to identify whether the implementation of UNHS programs are cost-effective, as well as their variations by localities. Data Synthesis  A search was conducted in seven databases: PubMed (Medline), Scopus, Web of Science, Embase, CINAHL, Lilacs, and Cochrane Library. Studies that included a cost analysis of UNHS programs were eligible for inclusion. Studies on evaluations of preschool or school-based programs only were excluded, among others. A total of 1,291 records were found. Of these, 23 articles were analyzed in full. All articles identified the cost-effectiveness of the UNHS programs implemented. Regarding the UNHS protocols, a wide variation was observed in all aspects: tests used, period established between tests and retests, professionals responsible for screening, environment, and criteria for defining hearing loss, limiting the generalization of this information. All studies presented values related to the expenses with the program, but none of them showed statistical elements for the described analyzes or any theoretical basis for such. Conclusion  It is necessary to estimate local specific issues, as well as the accuracy of the chosen tests and the NHS protocols used, so that more accurate analyzes on cost-effectiveness are possible.

National Infant Screening for Hearing Program in India: Necessity, Significance and Justification

Hearing impairment is one of the most prevalent disorder in children and adults worldwide, which not only interferes with the acquisition, development and maintenance of speech and language skills but also adversely deprive the auditory nervous system for future learning. It can have long term harmful effect on educational, social, emotional and cognitive skills in young children; restrict the vocational options and employment opportunities in adults; and can cause isolation, loneliness and depression in older adults, if remain undetected and intervened at the earliest. However, early identification and intervention is known to greatly reverse the ill effects and improve the quality of life of children and adults with hearing impairment. Current clinical means and methods to identify and intervene hearing loss are convenient, cost effective, reasonably accurate beneficial and evidenced based, can be easily employed nation-wide for early identification and intervention of hearing loss. This paper attempts to convince medical colleagues, public health care experts and policy makers by justifying the hearing, as public health issue and relevance of medical screening criteria for hearing. It also discusses the preferred model of hearing screening and intervention strategies in India.

Evaluation of unilateral referrals on neonatal hearing screening

OBJECTIVE

Examination of neonatal hearing screening practices around the world suggests that more attention is placed on infants who fail bilaterally on their hearing screen than infants who refer (fail) in one ear. Some programmes only report bilateral failures as positive hearing screens. This study investigates how limitations of the screening techniques demand continued audiologic evaluations in unilateral referrals.

SETTING

The study sample consisted of all infants born at a single academic paediatric hospital between February 1998 and February 2002.

METHODS

There were 16,007 infants screened using ALGO automated auditory brainstem response. Eighteen of the infants who failed the screen in one ear but passed in the other ear were found to have permanent hearing loss, and had their subsequent clinical course and audiologic management analysed. The final audiologic outcome after four years in both the pass and fail ear were examined.

RESULTS

One group of unilateral referrals (n = 6) had obvious anatomic reasons for the ear failing the screen (canal atresia/stenosis). There were five patients in which the ear that passed the screen was later found on more extensive audiologic evaluation to have significant hearing loss. Review of recent literature was also completed to examine the methods by which unilateral screening referrals are commonly reported and whether or not this affected follow-up diagnostic evaluation.

CONCLUSION

Infants who pass one ear and refer one ear on neonatal hearing screening still need to have thorough and prompt evaluations. In many cases, the ear that passed can be found to have significant hearing loss.

Benefits and costs of universal hearing screening programme

Hearing loss affects 1-3 out of 1000 newborns. A programme of universal newborn hearing screening (UNHS) was implemented in our ENT department in February 2000. In 2001, the programme was extended to all the hospitals of the canton Geneva. The programme is based on the recording of transient evoked otoacoustic emissions (TEOAE) from all newborns. In addition, automated auditory brainstem responses (aABR) are recorded in high-risk neonates. In the report, we compare the mean age at which rehabilitation of hearing was undertaken during a 5-year period before and after the screening programme was instituted. We also identify some causes of delayed diagnosis and intervention and the pitfalls of universal hearing screening. The price of the UNHS programme is estimated at 26 Swiss francs (17 Euros; 21 US dollars) per infant screened, including the material required, the personal involved to run the programme, and the follow-up.

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.

Comparison of currently available devices designed for newborn hearing screening using automated auditory brainstem and/or otoacoustic emission measurements

OBJECTIVE

Suitability in clinical practise of three currently available devices designed for automated newborn hearing screening, one combining evoked otoacoustic emissions (EOAE) and automated auditory brain stem response (AABR), the Echoscreen-TDA from Fischer-Zoth, and two AABR screeners, the Algo 3 from Natus and the Beraphone MB11 from Maico, were tested prospectively.

METHODS

Transiently evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE) were measured in one ear of 150 healthy newborns using the Echoscreen-TDA. Three groups of 50 subjects each were tested additionally for AABR recordings either with Echoscreen-TDA, Algo 3 or Beraphone MB11. Measurements were performed after the second day of life. The following aspects were evaluated: (a) subject-instrumentation interface (b) test time (c) costs (unit price and costs for disposable material) and (d) pass rates.

RESULTS

Connecting the subjects to the device was the easiest for EOAE measurements with the Echoscreen-TDA, followed by AABR recordings with the Algo 3 and Echoscreen-TDA and were most difficult with the Beraphone MB11. The median test time on one ear was less than 30 s for EOAE measurements and 4-5 min for AABR recordings. Costs for the equipment and for disposable material were lowest for the Echoscreen-TDA and Beraphone MB11, respectively and highest for the Algo 3. Pass rates were highest with 98% for AABR recordings using the Algo 3 and lowest with 92% for AABR recordings using the Beraphone MB11, but differences were not statistically significant.

CONCLUSIONS

All tested devices can be used for universal neonatal hearing screening. It was easier to connect the subject to the device and measurements were quicker for OAE than for AABR measurements. Echoscreen-TDA combines the two techniques and had the lowest costs for the AABR equipment. Algo 3 had the highest costs for the equipment and for disposable material, but it was highly reliable, and both ears can be tested simultaneously. Connecting the subject was the most difficult with the Beraphone MB11, but there were no disposable supply costs.