Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. Joint Committee on Infant Hearing, American Academy of Audiology, American Academy of Pediatrics, American Speech-Language-Hearing Association, and Directors of Speech and Hearing Programs in State Health and Welfare Agencies

Assessment of Deafness in Term Infants with Birth Asphyxia with Otoacoustic Emission and Brain Stem Evoked Response Audiometry: A Prospective Observational Study

To assess deafness in term infant with birth asphyxia by otoacoustic emission and brain stem evoked response audiometry. A Prospective observational study was done at Tertiary care government hospital from 15/02/2021 to 15/10/2022.Total 130 patients were included in the study by consecutive sampling method. All the patients fulfilling the inclusion criteria during the study period were included. After explaining the aims, objectives and methods of study, written informed consent was obtained from the parents to undergo Otoacoustic Emission (OAE) and Brain Stem Evoked Response Audiometry Test (BERA). Data was entered in case record form. Collected data was analysed by appropriate statistical methods. Hearing impairment was present in eight (6.15%) asphyxiated term infants. A mild degree of hearing loss was seen in three (37.5%), a moderate degree of hearing loss was seen in four (50%), severe degree of hearing loss was seen in one (12.5%) asphyxiated term infant. In asphyxiated term infants, no significant difference in hearing loss was seen with respect to gender, Obstetrics history, and type of delivery. Significant difference in hearing loss was seen in antenatal Diabetes mellitus, hypertension, family history of SNHL and APGAR Score less than 6. Severe degree of hearing loss was seen in prolonged labour and HTN mother. Significant difference in hearing loss was seen in antenatal Diabetes mellitus, hypertension, family history of SNHL and APGAR Score less than 4 and 6 in one and five minutes respectively. Severe degree of hearing loss was seen in prolonged labour and HTN mother.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-024-04736-2.

Auditory Risk Factors at Birth and Language Development at 2 Years of Age: A Longitudinal Analysis

Aim. To analyze the relationship between auditory risk factors at birth and subsequent language development in toddlerhood. Methods. Participants are 136 children from a longitudinal birth cohort follow-up at age 2 years. They were divided into 2 groups: One comprising 105 children without hearing risk factors at birth and another comprising 31 children with auditory risk factors at birth but normal hearing. Results. In children with and without risk factors, the combination of socio-emotional, socio-economic, and auditory risk factors at birth significantly predicted language development at age 2 years. Family socio-economic status had a significant impact on overall child development, even after controlling for socio-emotional development and the presence of risk factors. Conclusions. The study was conducted in an upper-middle income country with a socialized health care system. It underscores the importance of a holistic approach to early childhood language development, taking into account biological, socioeconomic, and emotional factors.

Coalition for Global Hearing Health Hearing Care Pathways Working Group: Guidelines for Clinical Guidance for Readiness and Development of Evidence-Based Early Hearing Detection and Intervention Programs

Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed.

Help-seeking behaviour of parents of children with hearing loss in India: a qualitative analysis

OBJECTIVE

The age of identification of hearing loss in children is highly influenced by the hearing help seeking behaviour of their parents, particularly in countries without universal newborn hearing screening programs. In this study, an attempt was made to identify the factors associated with help seeking behaviour in parents of children with hearing loss, and the relationship of such factors with the age of identification of hearing loss.

DESIGN

Focus group discussions based on the framework of health belief model were carried out. The discussions were transcribed and the transcripts were thematically analysed.

STUDY SAMPLE

Participants were 35 parents of children with hearing loss from the state of Karnataka in India.

RESULTS

The findings revealed 30 factors related to their awareness about hearing loss, geographical location, socio-economic status, family, and society. The factors differed between early and late help seekers.

CONCLUSIONS

Awareness, accessibility, and affordability are the key factors that influenced the hearing help seeking behaviour of the participants. Effective public awareness programs, newborn hearing screening programs, and provisions to make hearing healthcare affordable to all can reduce the age of identification of paediatric hearing loss in India.

Risk factors and hearing outcomes in infants and young children in KwaZulu-Natal, South Africa

BACKGROUND

 Targeted new-born hearing screening, based on high risk factors is recommended in the absence of universal new-born hearing screening in resource-constrained settings. The relevance of risk factors listed in the guidelines of high-income countries and used by low-middle income countries remains relatively unknown. Risk factors consistent with the epidemiological profile, evolution of risks and disease burden in these countries need to be considered.

OBJECTIVES

 This study aimed to profile the frequency of risk factors and their manifestation in hearing outcomes of young children in the KwaZulu-Natal province of South Africa.

METHOD

 A chart review of N = 1433 patients' archival audiology records was conducted, conveniently sampled from a single tertiary hospital (n = 351), a provincial assessment and therapy centre (n = 649), a university clinic (n = 291), and two schools for the deaf (n = 142).

RESULTS

 Overall, 56% of the participants presented with either a conductive, sensorineural or a mixed hearing loss; 62% of the children had between 1 and 2 risk factors present (Mean [M] = 1.1; standard deviation [s.d.] = 0.98). Admission to neonatal intensive care unit, maternal infections, bacterial and viral infections and chemotherapy, from the Joint Committee on Infant Hearing list of high risk factors were significantly associated with hearing loss (p  0.05). Known non-JCIH risks, emerging risks and other statistically significant contextually relevant risk factors were also noted.

CONCLUSION

 Understanding the profile of high risk factors in a given context has implications for prevention, early hearing identification and intervention services.Contribution: Targeted new-born hearing screening needs to be based on risk factors that are contextually relevant. This study is one of the first profiling high risk factors for hearing loss in children in KZN, the province with the second highest population in South Africa.

A Comparative Analysis of Click ABR and Multi-ASSR in Assessing Infant Hearing: A Cross-Sectional Study

Introduction: This study investigates the comparative effectiveness of Click Auditory Brainstem Response (Click ABR) and Multiple Auditory Steady-State Response (Multi-ASSR) in identifying hearing impairments in infants. Recognizing auditory issues early is crucial for a child's cognitive and language development, as emphasized by the Joint Committee on Infant Hearing (JCIH) and the American Academy of Audiology (AAA). While Click ABR is widely utilized, Multi-ASSR offers a modern technique for detailed hearing assessment. Methods: A comparative analysis was conducted on 111 infants aged 1-6 months, previously screened for hearing at a tertiary care centre. The study employed both Click ABR and Multi-ASSR to evaluate their respective efficacy in assessing infant hearing. Results: Click ABR detected normal hearing in 87.4% of the infants, slightly higher than Multi-ASSR's 84.7%. A noteworthy finding was the higher incidence of bilateral versus unilateral hearing loss, with Click ABR identifying bilateral loss in 10 infants and unilateral loss in 4, compared to Multi-ASSR, which found bilateral loss in 12 infants and unilateral loss in 5. There was a minor but significant difference in auditory thresholds between the methods, with a mean discrepancy of 1.2 dB and a significant statistical variance (t-value of 15; p < 0.001), indicating variations in sensitivity. Conclusion: Both Click ABR and Multi-ASSR are indispensable tools in paediatric audiology, each with unique advantages. Click ABR excels in efficiency, suitable for rapid assessments and early detection. In contrast, Multi-ASSR offers comprehensive frequency-specific data, facilitating thorough evaluations. Healthcare professionals must grasp these methods' strengths to optimize infant hearing screenings and enhance early intervention strategies, aligning with JCIH and AAA guidelines.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-024-04639-2.

Detecting Hearing Loss Through Targeted Surveillance: Risk Registry and Surveillance Timeframe Recommendations

PURPOSE

The purpose of this study was to inform the revision of a targeted surveillance risk registry by identifying which risk factors predict postnatally identified hearing loss (PNIHL) in children who pass newborn hearing screening and to determine whether hearing surveillance beyond the age of 1 year is warranted.

METHOD

We used retrospective analysis of the audiological outcomes of children born in the state of Queensland, Australia, between January 1, 2010, and December 31, 2019, who passed the newborn hearing screen with risk factors.

RESULTS

Approximately one third of children were lost to follow-up and could not be included in the analysis. Risk factors that predicted PNIHL in the analyzed cohort were as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infections, and family history of permanent childhood hearing loss. Severe asphyxia did not predict PNIHL but yielded some cases of significant bilateral hearing loss. Hearing loss in children with a history of prolonged ventilation was mild and/or unilateral in nature (except in cases where the hearing loss was due to an unrelated etiology). There were no cases of PNIHL in children with hyperbilirubinemia or neonatal bacterial meningitis. For the risk factors that predicted PNIHL, nearly all hearing losses were detected by 1 year of age, except for children with family history where one quarter of hearing losses had a later onset.

CONCLUSIONS

The four risk factors recommended for efficient postnatal identification of hearing loss are as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infection, and family history of permanent childhood hearing loss. Hearing surveillance through to 1 year old is sufficient except for children with a family history, where a second phase assessment is indicated. Alternative targeted surveillance protocols and models of care are required to minimize loss to follow-up.

Late-onset, progressive sensorineural hearing loss in the paediatric population: a systematic review

PURPOSE

To review possible risk factors for permanent delayed-onset, progressive sensorineural hearing loss (SNHL) in the paediatric population to recommend follow-up protocols for early detection.

METHODS

PRISMA-compliant systematic review was performed, including observational studies on the paediatric population up to 16 years old who have passed the newborn hearing screening programme (NHSP), investigating the development of late-onset, progressive SNHL. Electronic searches were performed through Medline, Embase, Cochrane, and Emcare.

RESULTS

37 studies were included. 21 showed an association between late-onset SNHL and congenital cytomegalovirus (cCMV) infection (age at hearing loss diagnosis 0.75 to 204 months, mean 45.6 ± 43.9), while 16 between late-onset SNHL and other congenital or perinatal factors, namely Neonatal Intensive Care Unit (NICU) stay, prematurity, neonatal respiratory failure, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) support, hypocapnia, hypoxia, alkalosis, seizure activity, congenital diaphragmatic hernia (CDH), inner ear malformation, and gene mutations (age at hearing loss diagnosis 2.5 to 156 months, mean 38.7 ± 40.7).

CONCLUSIONS

cCMV infection may cause late-onset SNHL, which can be missed on standard NHSP. There is, therefore, evidence to support universal screening programmes to enable detection in even asymptomatic neonates. Ongoing audiological follow-up for all children with cCMV is advisable, to enable timely treatment. In the paediatric population presenting conditions such as NICU stay > 5 days, prematurity ≤ 34 weeks gestation, severe neonatal respiratory failure, mechanical ventilation, ECMO support, and CDH surgery, an audiological follow-up from 3 months of age up to at least 3-4 years of age, and at least annually, should be recommended.

Examining Barriers to Early Hearing Diagnosis

PURPOSE

Many factors create barriers for early hearing detection and intervention (EHDI), especially those related to unfavorable social determinants of health (SDOH). The primary aim of this study was to evaluate diagnostic timing of infants at risk for congenital hearing loss in consideration of known barriers. Understanding the specific barriers to early diagnosis can inform interventions to improve timeliness of diagnosis and subsequent habilitation.

METHOD

A retrospective chart review was completed for infants referred for diagnostic audiologic testing at a tertiary urban-setting Children's Hospital from 2018 to 2021. After exclusion criteria were applied, 1,488 infants were included in the analysis. Various factors were recorded from electronic medical records including those specific to SDOH. Time to diagnosis was derived and compared across five factors of interest that have previously been shown to impact diagnostic timeline, including (a) insurance type, (b) race/ethnicity, (c) presence of middle ear dysfunction at first auditory brainstem response (ABR), (d) proximity to diagnostic center, and (e) diagnostic timing before and during/after the COVID-19 pandemic.

RESULTS

Across the study time period, 77% of infants referred for diagnostic testing had confirmed diagnosis by the EHDI benchmark of 3 months. Analysis of time to diagnosis across factors of interest revealed no clinically significant differences for insurance type, race/ethnicity, proximity to diagnostic center, or timing in reference to the COVID-19 pandemic. Presence of middle ear dysfunction on first ABR was found to significantly protract final diagnostic timing.

CONCLUSIONS

Although some known barriers for EHDI can be universal, other factors may have a differential impact on an infant's timeline to diagnosis based on their specific location, which can interact differently with additional known barriers. Understanding local challenges will serve to better guide programs in implementing facilitators that will address their specific needs for improved outcomes.

Impact of national health insurance and socioeconomic disparities on newborn hearing screening performance in South Korea: A nationwide population-based evaluation

OBJECTIVES

This study aimed to assess the impact of national health insurance coverage on newborn hearing screening (NHS) outcomes by analyzing hearing questionnaires from the National Infant Health Check-up Program (NIHCP) in South Korea.

METHODS

This study evaluated the performance and referral rates of NHS using nationwide data from 814,875 infants enrolled in the 4-month NIHCP from January 2017 to December 2019. This period encompasses the periods before and after the National Health Insurance in South Korea began covering NHS expenses in October 2018. The study also investigated household income levels to determine their relationship with participation in the NIHCP and NHS outcomes.

RESULTS

The performance of NIHCP increased year-on-year, with NHS performance rates increasing from 88.5 % in 2017 to 91.5 % in 2019. Analysis by household income level revealed that the medical benefit recipients' group had the lowest NHS performance rate of 81.9 % in 2019, whereas that of the higher income level group exceeded 90 %. The NHS referral rate remained consistent at 0.9 % nationally during the study period.

CONCLUSION

The inclusion of NHS in national insurance coverage positively influenced its performance rates across South Korea. Nevertheless, the data indicate the need for more focused and customized support for low-income families to enhance early hearing detection and interventions in newborns and infants.

Exposure to bilingual or monolingual maternal speech during pregnancy affects the neurophysiological encoding of speech sounds in neonates differently

Introduction

Exposure to maternal speech during the prenatal period shapes speech perception and linguistic preferences, allowing neonates to recognize stories heard frequently in utero and demonstrating an enhanced preference for their mother's voice and native language. Yet, with a high prevalence of bilingualism worldwide, it remains an open question whether monolingual or bilingual maternal speech during pregnancy influence differently the fetus' neural mechanisms underlying speech sound encoding.

Methods

In the present study, the frequency-following response (FFR), an auditory evoked potential that reflects the complex spectrotemporal dynamics of speech sounds, was recorded to a two-vowel /oa/ stimulus in a sample of 129 healthy term neonates within 1 to 3 days after birth. Newborns were divided into two groups according to maternal language usage during the last trimester of gestation (monolingual; bilingual). Spectral amplitudes and spectral signal-to-noise ratios (SNR) at the stimulus fundamental (F0) and first formant (F1) frequencies of each vowel were, respectively, taken as measures of pitch and formant structure neural encoding.

Results

Our results reveal that while spectral amplitudes at F0 did not differ between groups, neonates from bilingual mothers exhibited a lower spectral SNR. Additionally, monolingually exposed neonates exhibited a higher spectral amplitude and SNR at F1 frequencies.

Discussion

We interpret our results under the consideration that bilingual maternal speech, as compared to monolingual, is characterized by a greater complexity in the speech sound signal, rendering newborns from bilingual mothers more sensitive to a wider range of speech frequencies without generating a particularly strong response at any of them. Our results contribute to an expanding body of research indicating the influence of prenatal experiences on language acquisition and underscore the necessity of including prenatal language exposure in developmental studies on language acquisition, a variable often overlooked yet capable of influencing research outcomes.

Hearing impairment after asphyxia and neonatal encephalopathy: a Norwegian population-based study

The purpose of this study is to evaluate the association between perinatal asphyxia, neonatal encephalopathy, and childhood hearing impairment. This is a population-based study including all Norwegian infants born ≥ 36 weeks gestation between 1999 and 2014 and alive at 2 years (n = 866,232). Data was linked from five national health registries with follow-up through 2019. Perinatal asphyxia was defined as need for neonatal intensive care unit (NICU) admission and an Apgar 5-min score of 4-6 (moderate) or 0-3 (severe). We coined infants with seizures and an Apgar 5-min score < 7 as neonatal encephalopathy with seizures. Infants who received therapeutic hypothermia were considered to have moderate-severe hypoxic-ischemic encephalopathy (HIE). The reference group for comparisons were non-admitted infants with Apgar 5-min score ≥ 7. We used logistic regression models and present data as adjusted odds ratios (aORs) with 95% confidence intervals (CI). The aOR for hearing impairment was increased in all infants admitted to NICU: moderate asphyxia aOR 2.2 (95% CI 1.7-2.9), severe asphyxia aOR 5.2 (95% CI 3.6-7.5), neonatal encephalopathy with seizures aOR 7.0 (95% CI 2.6-19.0), and moderate-severe HIE aOR 10.7 (95% CI 5.3-22.0). However, non-admitted infants with Apgar 5-min scores < 7 did not have increased OR of hearing impairment. The aOR for hearing impairment for individual Apgar 5-min scores in NICU infants increased with decreasing Apgar scores and was 13.6 (95% CI 5.9-31.3) when the score was 0.          Conclusions: An Apgar 5-min score < 7 in combination with NICU admission is an independent risk factor for hearing impairment. Children with moderate-severe HIE had the highest risk for hearing impairment. What is Known: • Perinatal asphyxia and neonatal encephalopathy are associated with an increased risk of hearing impairment. • The strength of the association, and how other co-morbidities affect the risk of hearing impairment, is poorly defined. What is New: • Among neonates admitted to a neonatal intensive care unit (NICU), decreased Apgar 5-min scores, and increased severity of neonatal encephalopathy, were associated with a gradual rise in risk of hearing impairment. • Neonates with an Apgar 5-min score 7, but without NICU admission, did not have an increased risk of hearing impairment.

Universal newborn hearing screening program in Saudi Arabia: Current insight

Newborn hearing screening (NHS) programs are essential to identify hearing loss early in life and to improve outcomes in children. In Saudi Arabia, the national NHS program has been operational since 2016; however, few studies have evaluated its status, and none have covered all provinces across the country. This cross-sectional retrospective study provides an overview of the program's status across all provinces, focusing on screening coverage rates, referral/fail rates, and follow-up procedures. In 2021, 199,034 newborns were screened, with a coverage rate of 92.6% and an overall referral/fail rate of 1.87%. These performance measures provide a foundation for future progress and improvements. This study highlights the importance of ongoing efforts to enhance the program's effectiveness and sustainability.

Analysis of audiological outcomes of children referred from a universal newborn hearing screening program over 9 years in Beijing, China

Universal newborn hearing screening (UNHS) and audiological diagnosis are crucial for children with congenital hearing loss (HL). The objective of this study was to analyze hearing screening techniques, audiological outcomes and risk factors among children referred from a UNHS program in Beijing. A retrospective analysis was performed in children who were referred to our hospital after failing UNHS during a 9-year period. A series of audiological diagnostic tests were administered to each case, to confirm and determine the type and degree of HL. Risk factors for HL were collected. Of 1839 cases, 53.0% were referred after only transient evoked otoacoustic emission (TEOAE) testing, 46.1% were screened by a combination of TEOAE and automatic auditory brainstem response (AABR) testing, and 1.0% were referred after only AABR testing. HL was confirmed in 55.7% of cases. Ears with screening results that led to referral experienced a more severe degree of HL than those with results that passed. Risk factors for HL were identified in 113 (6.1%) cases. The main risk factors included craniofacial anomalies (2.7%), length of stay in the neonatal intensive care unit longer than 5 days (2.4%) and birth weight less than 1500 g (0.8%). The statistical data showed that age (P < 0.001) and risk factors, including craniofacial anomalies (P < 0.001) and low birth weight (P = 0.048), were associated with the presence of HL. This study suggested that hearing screening plays an important role in the early detection of HL and that children with risk factors should be closely monitored.

Neonatal bacterial meningitis: hearing screening and audiological monitoring outcomes

OBJECTIVE

This study reviewed the outcomes of universal newborn hearing screening (UNHS) and ongoing hearing monitoring in children following recovery from neonatal bacterial meningitis to determine (a) whether screening may be a suitable alternative to diagnostic audiology for detecting permanent childhood hearing loss (PCHL) and (b) whether infants who pass UNHS should be monitored throughout childhood.

DESIGN

Retrospective analysis of a UNHS database.

STUDY SAMPLE

Data were extracted from the state-wide UNHS database for all children born in Queensland Australia between 1 September 2004 and 30 June 2020 with the risk factor of bacterial meningitis (in isolation or in combination with other risk factors) identified at the time of the UNHS. This cohort included 231 children.

RESULTS

Results showed that all post-meningitic infants diagnosed with PCHL had a refer result on the UNHS or were medically excluded from screening. Additionally, no cases of PCHL were identified through the targeted surveillance program following a pass result on UNHS.

CONCLUSIONS

UNHS may be sufficient to detect PCHL in post-meningitic neonates and routine audiological monitoring may not be required for children who pass the screen.

Universal neonatal hearing screening and delayed hearing loss or late-developmental hearing loss

OBJECTIVE

To determine the percentage of children with permanent bilateral postnatal hearing loss in order to study its incidence, related risk factors, diagnosis and treatment.

METHODS

Retrospective study to collect data on children diagnosed with hearing loss outside the neonatal period in the Hearing Loss Unit of the Hospital Universitario Central de Asturias, from April 2014 to April 2021.

RESULTS

52 cases met the inclusion criteria. The detection rate of congenital hearing loss in the neonatal screening programme in the same study period was 1.5 children per thousand newborns per year, adding postnatal hearing loss results in a rate of infant bilateral hearing loss of 2.7 children per thousand (55.5% and 44.4% respectively). Thirty-five children presented risk factors for hearing loss, of which 23 were at retrocochlear risk. The mean age at referral was 91.9 (18-185) months. Hearing aid fitting was indicated in 44 cases (84.6%). Cochlear implantation was indicated in eight cases (15.4%).

DISCUSSION

Although congenital hearing loss accounts for the majority of childhood deafness, postnatal hearing loss has a significant incidence. This may be mainly due to: (1) that hearing impairment may arise in the first years of life, (2) that mild hearing loss as well as hearing loss in severe frequencies are undetectable by neonatal screening in some cases, (3) that some children may have false negative results.

CONCLUSION

postnatal hearing loss requires identification of risk factors and long-term follow-up of children with hearing loss, as it needs to be detected and treated early.

Newborn Hearing Screening with Two-Step Protocol and Risk Factor Identification: Our Experience at a Tertiary Care Centre in Eastern India

Objective

To estimate the prevalence of hearing loss and identify the high-risk factors among neonates with hearing loss.

Methods

Retrospective study done on 1054 infants in a tertiary care centre in Eastern India from 2020 to 2021 and approved by the Institutional Ethics Committee. A two-step protocol is used for screening. In the well-nursed group, OAE and BOA were performed. In the case of REFER results for automated ABR following OAE evaluation in well-nursed babies, a detailed audiological evaluation was scheduled to be carried out using diagnostic ABR within one month of age. In the high-risk group, hearing screening includes OAE, BOA, and AABR evaluations. AABR evaluation was performed as a part of the screening protocol irrespective of the results of OAE screening as PASS or REFER.

Results

In our study among 1053 neonates screened, 375 were in the risk category, and 679 were without risk factors. The overall prevalence of hearing loss in neonates was 22.78 per 1000 screened neonates and 56 per 1000 among high-risk neonates. In the high-risk group, we were able to identify 4 cases of Auditory spectrum neuropathy disorder with the use of AABR during 1st step of screening. In multivariate regression analysis, the risk factors for hearing loss identified were NICU stay (OR = 3.6, 95% CI = 1.1-12.03) and Craniofacial anomalies (OR = 55.37, 95% CI = 16.48- 186.01).

Conclusion

Early neonatal screening helps in the detection, intervention, and rehabilitation of hearing loss. The use of AABR in risk infant screening enhanced the chance of detection of auditory spectrum neuropathy disorder (ASND) cases.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03723-3.

Various aspects of hearing loss in newborns: A narrative review

Hearing loss is considered the most common birth defect. The estimated prevalence of moderate and severe hearing loss in a normal newborn is 0.1%-0.3%, while the prevalence is 2%-4% in newborns admitted to the newborn intensive care unit. Neonatal hearing loss can be congenital (syndromic or non-syndromic) or acquired such as ototoxicity. In addition, the types of hearing loss can be conductive, sensorineural, or mixed. Hearing is vital for the acquisition of language and learning. Therefore, early detection and prompt treatment are of utmost importance in preventing the unwanted sequel of hearing loss. The hearing screening program is mandatory in many nations, especially for high-risk newborns. An automated auditory brainstem response test is used as a screening tool in newborns admitted to the newborn intensive care unit. Moreover, genetic testing and screening for cytomegalovirus in newborns are essential in identifying the cause of hearing loss, particularly, mild and delayed onset types of hearing loss. We aimed to update the knowledge on the various aspects of hearing loss in newborns with regard to the epidemiology, risk factors, causes, screening program, investigations, and different modalities of treatment.

Association between in vitro fertilization-embryo transfer and hearing loss: risk factors for hearing loss among twin infants in a cohort study

Assisted reproductive technologies (ART), including in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI), are known to contribute a higher risk of birth defects; however, studies have rarely evaluated the association between IVF-ET and diagnostic hearing loss (HL). This study aimed to evaluate the prevalence of and risk factors for HL and to clarify the association between IVF-ET and HL among twinborn infants. We enrolled 1860 live-born twin neonates born at a hospital in China from January 2017 to December 2020. After multi-step hearing screening, participants were diagnosed with HL by pediatric audiologists at 6 months of age. The prevalence of hearing loss and the adjusted odds ratios (AORs) for specific risk factors were estimated using generalized estimation equation (GEE) models in twin-born infants. Characteristics and prevalence of failure for hearing screening and HL were measured in IVF-ET twin infants. IVF-ET conception and preterm birth conferred a higher risk of hearing loss, with increased adjusted odds ratios (AOR [95% confidence intervals (CI)] IVF-ET: 2.82 [1.17-6.80], P = 0.021; preterm birth: 6.14 [2.30-16.40], P < 0.001) than the control group, respectively. Among the 1860 twin infants, more IVF-ET twins failed in dual-step hearing screening (3.26%) and were diagnosed with hearing loss (2.21%) than those conceived by spontaneous pregnancy.

CONCLUSION

IVF-ET conception and premature birth were associated with a higher risk of hearing impairment. Twin infants conceived by IVF-ET tended to fail in hearing screening and be diagnosed with hearing loss. These observations provide a more comprehensive approach for the prevention and management of deafness in twin-born children.

WHAT IS KNOWN

• IVF-ET technologies conferred a higher risk of birth defects.

WHAT IS NEW

• Premature birth and IVF-ET conception were associated with a higher risk of hearing loss among twin infants. • Twin infants conceived by IVF-ET tended to fail in hearing screening and diagnosed with hearing loss.

"Association of High Risk Factors and Hearing Impairment in Infants-A Hospital Based Study"

The aim of the study was to find the association of various risk factors with permanent hearing impairment in infants. A case-control study was designed on 420 infants with permanent hearing impairment and normal hearing. The case control ratio was 1:1. Alternate sampling method was used for selecting the control group. Review of medical records and parent interview was done to collect the information of risk factors. Family history(adj. OR 7.5; 95% CI 3, 14; P = 0.000), Consanguinity (adj. OR: 4; 95% CI 2,4; P = 0.000), intra uterine infection (adj. OR 18, 95% CI: 2.3-126.5, P = 0.000), post natal infection (adj. OR 3, 95% CI: 1.3-5, P = 0.004), low Apgar score (adj.OR: 4.6, 95% CI: 1.3-15), craniofacial anomaly (OR-4.6, 95% CI: 1.4-9.5, P = 0.005) and low birth weight (adj. OR: 2.3, 95% CI: 1.2-3.8) were significantly associated with hearing impairment. Among the risk factors, intra uterine infection was having highest significant association with permanent hearing impairment. This is followed by family history, low Apgar score, craniofacial anomaly, consanguinity, post natal infection and low birth weight.

A Study of JCIH (Joint Commission on Infant Hearing) Risk Factors for Hearing Loss in Babies of NICU and Well Baby Nursery at a Tertiary Care Center

Babies in Neonatal Intensive Care Units (NICU) have an additional risk for hearing loss due to various risk factors like, prematurity, low birth weight, mechanical ventilation, hyperbillirubinemia, ototoxic drugs, low APGAR score etc. as compared to the babies from well baby nursery (WBN) who, poses risk factors mostly family history, syndromic deafness. So the present study was aimed know the risk factors responsible for hearing loss in NICU and WBN babies and to assess the incidence of deafness. A total of 800 babies from NICU (n = 402) and WBN (n = 398) underwent hearing screening from a tertiary care center. Hearing screening was done using two staged screening protocol as per JCIH guidelines with Distortion product Evoked Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Responses (A-ABR). According to DPOAE test, 311 from NICU and 383 from WBN passed the test and during second screening, 80 out of 91 from NICU and 11 out of 13 from WBN passed the DPOAE test. Further BERA was done at the 3rd month of corrected age where 6 out of 11 showed positive responses from NICU and 3 babies from WBN had profound hearing loss. Data analysis revealed that family history of deafness, anemia and hypertension in ANC, TORCH in mother, low Apgar score and hyperbillirubinemia in newborns were a major risk factor for hearing impairment. We conclude that the diagnoses of auditory disorders at early stage due to various risk factors are important since appropriate therapeutic intervention and rehabilitation would help in better development of children.

Analysis of Newborn Hearing Screening Results in South Korea after National Health Insurance Coverage: A Nationwide Population-Based Study

Newborn hearing screening (NHS) has been covered by national health insurance since October 2018 in Korea. However, the results of the NHS are not reported due to the absence of a follow-up tracking system. This study analyzed the status and the predicted referral rates of NHS after the Korean national health insurance coverage by analyzing the National Health Insurance Service database in 2019 and 2020. The NHS coverage was 91.7% of total birth in 2019 and 92.1% in 2020. The predicted referral rate of NHS calculated by the duplicated NHS cases was 1.05% in 2019 and 0.99% in 2020. However, another predicted referral rate calculated by the number of diagnostic auditory brainstem responses (ABRs) performed was 1.44% in 2019 and 1.43% in 2020. The first NHS was performed within one day of birth for 96.5% of the babies and within three days of birth for 97%. However, diagnostic ABR was adequately performed within three months of birth for only 4.3%, while 82.3% performed the test after six months which delays appropriate intervention for hearing loss. National support such as national coordinators, follow-up tracking, and data management systems are needed for early hearing detection and intervention of newborns and infants in Korea.

Three Years of Vestibular Infant Screening in Infants With Sensorineural Hearing Loss

OBJECTIVES

Although vestibular deficits are more prevalent in hearing-impaired children and can affect their development on many levels, a pediatric vestibular assessment is still uncommon in clinical practice. Since early detection may allow for timely intervention, this pioneer project has implemented a basic vestibular screening test for each six-month-old hearing-impaired infant in Flanders, Belgium. This study aims to report the vestibular screening results over a period of three years and to define the most important risk factors for abnormal vestibular screening results.

METHODS

Cervical Vestibular Evoked Myogenic Potentials with bone-conduction were used as a vestibular screening tool in all reference centers affiliated to the Universal Newborn Hearing Screening Program in Flanders. From June 2018 until June 2021, 254 infants (mean age: 7.4 months, standard deviation: 2.4 months) with sensorineural hearing loss were included.

RESULTS

Overall, abnormal vestibular screening results were found in 13.8% (35 of 254) of the infants. The most important group at risk for abnormal vestibular screening results were infants with unilateral or bilateral severe to profound sensorineural hearing loss (20.8%, 32 of 154) (P < .001, odds ratio = 9.16). Moreover, abnormal vestibular screening results were more prevalent in infants with hearing loss caused by meningitis (66.7%, 2 of 3), syndromes (28.6%, 8 of 28), congenital cytomegalovirus infection (20.0%, 8 of 40), and cochleovestibular anomalies (19.2%, 5 of 26).

CONCLUSIONS

The vestibular screening results in infants with sensorineural hearing loss indicate the highest risk for vestibular deficits in severe to profound hearing loss, and certain underlying etiologies of hearing loss, such as meningitis, syndromes, congenital cytomegalovirus, and cochleovestibular anomalies.

Cost-effectiveness analysis of hearing screening program for primary school children in southern Iran, Shiraz

BACKGROUND

Hearing loss is the second most common chronic disease, the diagnosis and treatment of which can be faster through screening. In addition, early interventions will save significant costs for the education and health systems. Therefore, the present study aimed to evaluate the cost-effectiveness of hearing screening for primary school children in Shiraz.

METHODS

This cross-sectional economic evaluation of cost-effectiveness was conducted from the perspective of the health system. The study population comprised all seven-year-old children participating in the screening program in Shiraz. The present study dealt only with direct costs. The expected costs and outcomes, as well as the ICER index were estimated using the decision tree model. The study outcomes included averted disability-adjusted life years (DALY) and true identification of hearing loss cases. The robustness of the results was evaluated using the one-way sensitivity analysis. The TreeAge 2020 and Excel 2016 software were also used to analyze the collected data.

RESULTS

The hearing screening data obtained during 6 years (2015-2020) showed that every year, an average of 22,853 children in Shiraz were examined for hearing, of which 260 were true positive (%1.1). The costs of screening and lack of screening were estimated at $30.32 Purchasing Power Parity (PPP) and $13.75 PPP per child, respectively. The averted DALY due to performing hearing screening was estimated at 7 years for each child. The ICER was positive and equal to $ 0.06 PPP for the identified cases and $ 2.37 PPP per averted DALY. The sensitivity analysis confirmed the robustness of the results.

CONCLUSIONS

According to the results, although hearing screening for primary school children had more costs and effectiveness, it was considered cost-effective. Therefore, universal screening with high quality and accuracy is recommended.

Approach and solutions to congenital hearing impairment in Cameroon: perspective of hearing professionals

OBJECTIVES

To bring out the diagnostic attitude of hearing professionals in Cameroon towards congenital hearing impairment (CHI), assess availability of tests, neonatal screening, and create a national map of availability of treatment opportunities.

METHODS

We conducted a cross-sectional online-based survey from June to December 2021, concerning ear-nose-throat (ENT) specialists, hearing care professionals, speech therapists and ENT nurses. A Google Forms online questionnaire was used to collect data, filled by eligible professionals involved in hearing care in Cameroon.

RESULTS

A total of 93 professionals working in 31 different health facilities participated. A cumulative percentage of 79.9% of ENTs were found in just two out of 10 regions. Specialists sought by ENTs for assessment of patients with CHI included neurologists/neuro-pediatricians (96.8%), pediatricians (47.6%), other ENTs (34.9%), and psychologists (3.2%). Investigations requested included auditory-evoked brainstem response (ABR; 87.3%), otoacoustic emissions recording (OAE; 71.4%), and tympanometry (66.7%). There were eight OAE and nine ABR machines in the country. Twenty-five (88.6%) out of 31 facilities with otolaryngologists did not carry out systematic neonatal screening. Reasons included unavailability of equipment (21; 84%), and administrative delays (14; 56%). Sixteen (51.6%) facilities had ENTs with additional training in otologic surgery and 11 (35.5%) were equipped to perform ear surgery. Three centers (9.7%) specialized in hearing aid provision and maintenance services. Three hospitals (9.7%) had performed cochlear implantation.

CONCLUSION

Our results show scarcity and overt unevenness in distribution of specialists, equipment and solutions to CHI in Cameroon. A serious negative health care consequence of this shortage is the unavailability of universal newborn hearing screening and implementation programs.

Communities Helping the Hearing of Infants by Reaching Parents (CHHIRP) through patient navigation: a hybrid implementation effectiveness stepped wedge trial protocol

INTRODUCTION

As the most common neonatal sensory disorder in the USA, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain timely intervention include significant communication impairment and negative socioeconomic effects. Early Hearing Detection and Intervention (EHDI) national standards dictate that all infants should be screened and diagnosed by 3 months of age and there is a need for interventions that promote adherence to timely diagnosis. Patient navigation (PN) has been shown to be efficacious to decrease non-adherence with infant hearing diagnostic care; however, PN has yet to be tested in diverse communities or implemented into real-world settings.

METHODS AND ANALYSIS

The proposed research is a community-engaged, type 1 hybrid effectiveness-implementation trial of a PN intervention aimed at decreasing infant hearing diagnosis non-adherence after failed newborn hearing screening, delivered in state-funded EHDI clinics. Guided by our community advisory board and partners, we aim to (1) test the effectiveness of PN to decrease non-adherence to receipt of infant hearing diagnosis within 3 months after birth using a stepped-wedge trial design, (2) investigate implementation outcomes and factors influencing implementation and (3) determine the cost-effectiveness of PN from the perspective of third-party payers. The study will be conducted from April 2019 until March 2024.

ETHICS AND DISSEMINATION

This protocol was approved by the University of Kentucky Institutional Review Board. Although all research involving human subjects contains some risk, there are no known serious risks anticipated from participating in this study. We will seek to disseminate our results in a systematic fashion to patients, key stakeholder, policymakers and the scientific community. Our results will impact the field by partnering with communities to inform the scale-up of this innovative patient supportive intervention to create efficient and effective EHDI programmes and maximise public health impact.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov (Pre-results phase): NCT03875339.

Does universal newborn hearing screening impact the timing of deafness treatment?

OBJECTIVE

To evaluate the impact of the Universal Neonatal Hearing Screening (UNHS) on the age at diagnosis, beginning of treatment, and first cochlear implant surgery.

METHODS

A retrospective cohort study with children up to 12 years old with bilateral hearing loss were divided into two groups: patients who underwent UNHS and the ones who didn't. The groups were compared according to their age at the beginning of the evaluation at a specialized center, at the beginning of the intervention, and, for the ones who had indication, at the cochlear implant surgery. The group who underwent UNHS was divided between the ones who passed the screening test and the ones who didn't. They were compared according to their ages at the same moments as the first two groups.

RESULTS

135 patients were included. The median age at the first appointment in a specialized center was 1.42 (0.50 and 2.50) years, at the beginning of treatment 2.00 (1.00 and 3.52) years, and the cochlear implant surgery 2.83 (1.83 and 4.66) years. Children who underwent UNHS were younger than those who didn't, at the three evaluated moments (p < 0.001). In a subanalysis, children who passed the UNHS but were later diagnosed with hearing loss reached the first appointment with a specialist and started treatment older than those who failed the tests.

CONCLUSION

Performing UNHS interfered with the timing of deafness diagnosis and treatment. However, children who passed the screening but were later diagnosed with hearing loss were the category with the most important delay.

Newborn Hearing Screening Benefits Children, but Global Disparities Persist

There is substantial evidence that newborn hearing screening (NHS) reduces the negative sequelae of permanent childhood hearing loss (PCHL) if performed in programs that aim to screen all newborns in a region or nation (often referred to as Universal Newborn Hearing Screening or UNHS). The World Health Organization (WHO) has called in two resolutions for the implementation of such programs and for the collection of large-scale data. To assess the global status of NHS programs we surveyed individuals potentially involved with newborn and infant hearing screening (NIHS) in 196 countries/territories (in the following text referred to as countries). Replies were returned from 158 countries. The results indicated that 38% of the world's newborns and infants had no or minimal hearing screening and 33% screened at least 85% of the babies (hereafter referred to as UNHS). Hearing screening programs varied considerably in quality, data acquisition, and accessibility of services for children with PCHL. In this article, we summarize the main results of the survey in the context of several recent WHO publications, particularly the World Report on Hearing, which defined advances in the implementation of NHS programs in the Member States as one of three key indicators of worldwide progress in ear and hearing care (EHC).

Receipt and Timeliness of Newborn Hearing Screening and Diagnostic Services Among Babies Born in 2017 in 9 States

CONTEXT

By providing timely services at all steps along the continuum of the early hearing detection and intervention (EHDI) process, providers may be able to lessen potential adverse effects of late identification of hearing loss on children's language development.

OBJECTIVE

To examine the timeliness of key events in the EHDI process from birth through diagnosis of hearing loss among different populations.

DESIGN

Retrospective, cross-sectional.

SETTING

Data pooled from 9 states' EHDI information systems were used to determine the extent to which timely screening and diagnosis were achieved by 754 613 infants born in calendar year 2017. Enrollment into early intervention for children diagnosed is not examined here due to incomplete data.

PARTICIPANTS

Nine state EHDI programs were selected to participate in this study for their successful experience in using EHDI-IS to collect detailed child-level data.

MAIN OUTCOME MEASURES

Age of service, rate of service receipt.

RESULTS

Median age of newborn hearing screening was 1 day, and median age of hearing loss diagnosis was 68 days. Early completion of newborn hearing screening was associated with maternal education, maternal race/ethnicity, and admission into a neonatal intensive care unit (NICU). Receiving and completing follow-up diagnostic services were associated with maternal education, maternal race/ethnicity, age of screening, and enrollment into the Women, Infants, and Children program.

CONCLUSIONS

Timely completion of the newborn hearing screening is achieved by most of the population among the participating states. Increased efforts may be considered by state EHDI programs to provide additional follow-up and education to underrepresented racial/ethnic groups, mothers with less education, and NICU infants and their families as these groups appear to be at an increased risk for delayed diagnostic testing for hearing loss.

Newborn Hearing Screening and Intervention in Children with Unilateral Hearing Impairment: Clinical Practices in Three Nordic Countries

Studies have limitedly considered children with early-identified unilateral hearing impairment (UHI), and clinical practices regarding screening, diagnostics and habilitation in this group are rarely documented. In this study, routines for newborns with UHI from screening to diagnostics and habilitation were explored in Norway, Sweden and Finland. An online survey was sent to hospitals responsible for the hearing diagnostics of children requesting information about their practices regarding congenital UHI. Responses covered 95% of the children born in the three included countries. The results revealed large variations in ways of organising healthcare and in clinical decisions regarding hearing screening, diagnostics and habilitation of children with congenital UHI. Finally, implications for policy making and research are also discussed.

Neonatal and maternal risk factors for hearing loss in children based on population-based data of Korea

OBJECTIVES

We identified the neonatal and maternal risk factors for hearing loss (HL) in children using National Health Insurance Service data of Korea.

METHODS

We retrospectively analyzed data from the National Health Insurance Service. Infants born from 2007 to 2013 were tracked to 2015. Those diagnosed with hearing disabilities or who underwent cochlear implant surgery were included in the hearing disability group. We compared the incidence of any diagnosed disability other than a hearing disability; any maternal disability at delivery; maternal age at delivery; prenatal and neonatal Toxoplasma, syphilis, rubella, cytomegalovirus, and herpes simplex infections; craniofacial anomaly; low birth weight, hyperbilirubinemia, and bacterial meningitis; neonatal intensive care unit (NICU) admission for > 5 days; exchange transfusion; and ototoxic drug use (aminoglycosides or loop diuretics), between the hearing disability and control groups.

RESULTS

The total number of newborns came to 3,164,825. Risk factors were sought in a hearing disability group (n = 847) compared to a control group (n = 2508). A diagnosed disability other than a hearing disability, which was commonly a brain lesion, the use of ototoxic drugs, NICU admission for >5 days, and a maternal disability at delivery, which was commonly a hearing disability, were significant neonatal and maternal risk factors for HL in children.

CONCLUSIONS

Accompanying brain lesions, maternal hearing disabilities at delivery, use of ototoxic drugs during the neonatal period, and hospitalization in NICU for >5 days were significant risk factors for HL in children, as revealed by analysis of population-based data.

Auditory and Language Development Assessment of Newborns Aged One to Four Years Exposed to Gestational Zika Virus Infection: A Case Series

The known neurotropism of the Zika virus (ZikV) suggests that auditory organs and their neural pathways may be affected by prenatal Zika infections. Among the possible manifestations are audiological and language disorders, but so far, the data in the literature are inconclusive. Objective: To describe early and late hearing disorders in children with Congenital Zika Virus Infection (CZVI) and evaluate the language development of this population between 14 and 47 months of age and its possible correlation with the alterations found in auditory exams. Methods: Longitudinal, prospective, observational study of newborns born in Juiz de Fora and its macroregion with confirmed diagnosis of ZikV infection during pregnancy. Participants were examined from one to four years of age for hearing using the transient otoacoustic emissions (TOAE) test, immittance testing and brainstem auditory evoked potential (BAEP), and language using the Bayley Scales of Infant Development—Third Edition (Bayley III). Results: 15 participants were included; eight (53.33%) presented alterations in at least one of the hearing tests, one had an early loss (6%) of sensorineural origin, and seven (46.67%) had a poor language performance. In the three (20%) participants whose audiological exams were altered, there was language impairment, and two (13.33%) participants had extensive malformations in the central nervous system (CNS), presented language delay, and hearing exams were within normality. Conclusion: Infants and preschoolers with CZVI may present early neurosensory loss and late hearing loss with fluctuating character. Even if there were no significant association between the audiological exams results and the Bayley III performance, in the present sample, language development was below expectations for the age in the participants who had alterations in the three audiological exams, when there is early hearing loss or extensive lesions to the CNS. The results reinforce the importance of audiological examinations, especially the BAEP morphological and auditory threshold, in monitoring cases of CZVI until at least three years of age.

Comparison between MB11 BERAphone® and ALGO2e color for hearing screening in Japanese healthy newborns

BACKGROUND

Since 2001, newborn hearing screening has been performed in Japan.

OBJECTIVE

This study compared newborn hearing screening results between the MAICO MB11 BERAphone (MB11) and the Natus ALGO2e color (ALGO) Automated Auditory Brainstem Response (AABR) devices among healthy Japanese newborns.

MATERIALS AND METHODS

From December 2014 to April 2018, 1477 healthy newborns were screened by MB11 and 267 by ALGO. Data from at-risk newborns were not included. Outcomes were 'Pass' and 'Refer' rates, specificity, false-positive rates, and assessment duration. Infants with a Refer result were examined using Interacoustics Eclipse.

RESULTS

MB11 identified 1425 (96.5%) as Pass and 52 (3.5%) as Refer. ALGO identified 263 (98.5%) as Pass and four (1.5%) as Refer. Specificity and false-positive rates were 97.7% and 2.3% for MB11 and 98.5% and 1.5% for ALGO, respectively. Using MB11, the total mean assessment time was 320.2 ± 220.7 s, with 315.6 ± 214.2 s for Pass and 628.6 ± 288.8 s for Refer.

CONCLUSIONS

MB11 is useful for hearing screening in healthy Japanese newborns and is fast and easy to operate. MB11 showed high specificity equivalent to ALGO.

Predicting hearing loss from 10 years of universal newborn hearing screening results and risk factors

OBJECTIVE

This study investigated whether demographic variables, risk factor presence or absence and universal newborn hearing screening (UNHS) results can be used to predict permanent childhood hearing loss (PCHL) in infants referred from screening.

DESIGN

Retrospective analysis of a UNHS database.

STUDY SAMPLE

Data were extracted from the state-wide UNHS database storing details of the 613,027 infants who were born in Queensland, Australia between 1 January 2007 and 31 December 2016 and participated in UNHS. This study included the 6735 children who were referred from the UNHS program for diagnostic audiology due to failing the screen in one or both ears or bypassing screening.

RESULTS

Factors with a significant positive association with PCHL that were incorporated into a logistic regression model were: female gender, non-indigenous status, family history of PCHL, craniofacial anomalies and syndromes associated with PCHL, and a bilateral refer result on screening.

CONCLUSIONS

Odds of PCHL vary among infants referred for diagnostic assessment from UNHS programs. When an infant refers on the newborn hearing screen, information about their gender, indigenous status, identified risk factors and specific screening outcome can be used to predict the likelihood of a congenital PCHL diagnosis.

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.

Quality measures of a multicentre universal newborn hearing screening program in Malaysia

OBJECTIVE

To evaluate and discuss the outcomes of the universal newborn hearing screening program conducted at four public hospitals in Malaysia.

METHOD

A retrospective analysis of the universal newborn hearing screening database from each hospital was performed. The database consisted of 28,432 and 30,340 screening results of babies born in 2015 and 2016, respectively. Quality indicators (coverage rate, referral rate, return for follow-up rate, and ages at screening and diagnosis) were calculated.

RESULTS

Overall coverage rate across the four hospitals was 75% in 2015 and 87.4% in 2016. Over the two years, the referral rates for the first screening ranged from 2.7% to 33.93% with only one hospital achieving the recommended benchmark of <4% in both years. The return for follow-up rates for each participating hospital was generally below the recommended benchmark of ≥95%. The mean age at screening was 3.9 ± 1.2 days and 3.3 ± 0.4 days, respectively. The mean age at diagnosis for 70 infants diagnosed with permanent hearing loss was 4.7 ± 0.7 months in 2015 and 3.6 ± 0.9 months in 2016.

CONCLUSIONS

Quality measures for the universal newborn hearing screening program in four public hospitals in Malaysia were lower than the required standards. Nevertheless, some quality indicators showed statistically significant improvements over the two years. Next steps involve identifying and implementing the best practice strategies to improve the outcome measures and thus the quality of the program.

Modification and verification of the Infant-Toddler Meaningful Auditory Integration Scale: a psychometric analysis combining item response theory with classical test theory

Background

Early prelingual auditory development (EPLAD) is a fundamental and important process in the speech and language development of infants and toddlers. The Infant–Toddler Meaningful Auditory Integration Scale (ITMAIS) is a widely used measurement tool for EPLAD, however it has not yet undergone a comprehensive psychometric analysis. The aim of this research was to modify and verify the psychometric properties of ITMAIS using a combination of Item Response Theory (IRT) and Classical Test Theory (CTT).

Methods

Stage 1—1730 children were retrospectively recruited to enable the application of an IRT model, specifically the graded response model, to modify the ITMAIS. Stage 2—another 450 infants and toddlers with normal hearing or permanent hearing loss before auditory intervention were recruited to verify the psychometric properties of the modified ITMAIS (ITMAIS-m) using the CTT method.

Results

Using the metric of the graded response model, by removing item 2 from the ITMAIS, ITMAIS-m demonstrated discrimination parameters ranging from 3.947 to 5.431, difficulty parameters from − 1.146 to 1.150, item information distributed between 4.798 and 9.259 and a test information score of 48.061. None of the items showed differential item functioning. ITMAIS-m was further verified in Stage 2, showing Cronbach’s α of 0.919 and item-total correlations ranging from 0.693 to 0.851. There was good convergent validity of ITMAIS-m with other auditory outcome measure (r = 0.932) and pure tone average thresholds (r ranging from − 0.670 to − 0.909), as well as a high ability to discriminate between different hearing grades (Cohen d ranging from 0.41 to 5.83).

Conclusions

The ITMAIS-m is a reliable and valid tool for evaluating EPLAD in infants and toddlers, which can be efficiently and precisely applied in clinical practice. The combined use of IRT and CTT provides a powerful means to modify psychometrically robust scales aimed at childhood auditory outcome measurements.

Analysis of the Risk Factors Associated with Hearing Loss of Infants Admitted to a Neonatal Intensive Care Unit: A 13-Year Experience in a University Hospital in Korea

Early detection of hearing loss in neonates is important for normal language development, especially for infants admitted to the neonatal intensive care unit (NICU) because the infants in NICU have a higher incidence of hearing loss than healthy infants. However, the risk factors of hearing loss in infants admitted to the NICU have not been fully acknowledged, especially in Korea, although they may vary according to the circumstances of each country and hospital. In this study, the risk factors of hearing loss in NICU infants were analyzed by using the newborn hearing screening (NHS) and the diagnostic auditory brainstem response (ABR) test results from a 13-year period. A retrospective chart review was performed using a list of NICU infants who had performed NHS from 2004 to 2017 (n = 2404) in a university hospital in Korea. For the hearing loss group, the hearing threshold was defined as 35 dB nHL or more in the ABR test performed in infants with a 'refer' result in the NHS. A four multiple number of infants who had passed the NHS test and matched the age and gender of the hearing loss group were taken as the control group. Various patient factors and treatment factors were taken as hearing loss related variables and were analyzed and compared. From the 2404 infants involved, the prevalence of hearing loss was 1.8% (n = 43). A comparison between the hearing loss group (n = 43) and the control group (n = 172) revealed that history of sepsis, peak total bilirubin, duration of vancomycin use, days of phototherapy, and exposure to loop-inhibiting diuretics were significantly different, and can be verified as significant risk factors for hearing loss in NICU infants.

Referral and Lost to System Rates of Two Newborn Hearing Screening Programs in Saudi Arabia

Congenital hearing loss has been commonly reported as a significant health problem. Lost to system (LTS) is a major challenge facing newborn hearing screening (NHS) programs. This retrospective cross-sectional descriptive study aimed to determine the referral and LTS rates after the two-stage NHS based on transient evoked otoacoustic emissions (TEOAEs) in two main hospitals in Riyadh, Saudi Arabia (SA). NHS was performed on newborns before hospital discharge. Newborns were only rescreened if NHS initially revealed a fail/refer outcome in one or both ears. Those who failed the first and second screenings or had risk factors were referred for auditory brainstem response (ABR) testing to confirm or exclude hearing loss. In total, 20,171 newborns (40,342 ears; 52% males; 48% females) were screened, of whom 19,498 (96.66%) passed the initial screening, while 673 (3.34%) failed. Of the 673 newborns, 235 (34.92%) were LTS, and 438 (65.08%) were rescreened, of whom 269 (61.42%) failed and were referred for a comprehensive audiological assessment to confirm the existence of hearing loss. The referral rate after the initial two-stage screening was equal to 1.33%. The lack of awareness of the importance of NHS among parents seems to be the major cause behind the LTS rate. The stakeholders have to work efficiently to reduce the LTS rate.

Comprehensive hearing care network for early identification and intervention in children with congenital and late-onset/acquired hearing loss: 8 years' experience in Miyazaki

OBJECTIVE

In 2010, we established the Miyazaki Comprehensive Hearing Care Network (MCHCN) for early identification and intervention in children with congenital and late-onset/acquired hearing loss with the cooperation of related administrative bodies in Miyazaki prefecture. The central roles of the MCHCN program are played by the Hearing Care Center (HCC) at the University of Miyazaki Hospital established in 2010 to facilitate audiological diagnoses, hearing aid interventions, and educational efforts, as well as linkage with the Department of Otolaryngology for surgical interventions. Herein, we aimed to present the main outcomes of the MCHCN program organized by the HCC at the University of Miyazaki Hospital.

METHODS

The MCHCN consists of two different networks, the Newborn Hearing Screening Network (NHSN) and the Pediatric Hearing Care Network (PHCN). All children suspected of having hearing loss by Newborn Hearing Screening (NHS) are referred to the HCC via the NHSN. In addition, children suspected of late-onset/acquired hearing loss by municipality-led health checkups, pediatricians, public health nurses, and childcare workers are referred to the HCC via the PHCN. Children who were born in Miyazaki prefecture between January 2010 and December 2017 and referred to the HCC for detailed hearing examination were included in this study.

RESULTS

Within the study period, 89,390 infants were born in Miyazaki prefecture, and 84,737 (94.9%) of them underwent NHS. A total of 698 infants and 182 children with suspected hearing loss were referred to the HCC via the NHSN and PHCN, respectively. Of the 880 referrals, 169 were diagnosed with hearing loss, which included 80 children with bilateral hearing loss and 89 children with unilateral hearing loss. Of the 80 children with bilateral hearing loss, 76 began wearing hearing aids and 15 had cochlear implants in the follow-up period. In children with bilateral conductive hearing loss, 4 children with bilateral middle ear anomalies underwent ossiculoplasty, following which two of these children no longer required hearing aids. Imaging assessments performed on 71 of the 89 children with unilateral hearing loss revealed that 20 of the 30 (66%) children who underwent CT exhibited ossicular anomalies and 28 out of the 48 (58%) children who underwent MRI were found to have ipsilateral cochlear nerve hypoplasia. Among the 169 children with hearing loss, no follow-up loss was observed during the period of this study.

CONCLUSION

The MCHCN that was organized at the initiative of the HCC at the University of Miyazaki Hospital has enabled the provision of comprehensive and continuous support, ranging from diagnosis to intervention, not only for children with suspected hearing loss referred based on their NHS results but also for those who pass the screening. Via this system, children with late-onset/acquired hearing loss can be identified early and can receive medical interventions tailored to the cause of their hearing loss while simultaneously avoiding a loss to follow-up.

Hearing screening outcome in neonatal intensive care unit graduates from a tertiary care centre in Singapore

BACKGROUND

We aimed to analyse the outcome of universal newborn hearing screening (UNHS) and high-risk hearing screening in neonatal intensive care unit (NICU) graduates in a tertiary care unit.

METHODS

The hearing screen programme comprises a 2-stage automated auditory brainstem response protocol followed by a high-risk hearing screen at 3-6 months. This study is a retrospective study of NICU graduates born between April 2002 and December 2009. Data on hearing screening, audiological assessment, and management were extracted from a computerized data management system (HITRACK).

RESULTS

Of 100,225 newborn infants, 2.9% were admitted to the NICU during the study period. The overall incidence of hearing loss (HL) of any type/severity was 35/1,000 infants. Of infants with HL, 92.4% had their first automated auditory brainstem response at/before 1 month of corrected age. The incidence of congenital permanent HL identified by the UNHS was 15.4/1,000. The corrected median age of diagnosis was 4.5 months (1-23.5 months). Of 2,552 NICU graduates who passed the UNHS, 75.5% were retested at 3-6 months of life. Twelve infants with permanent late-onset HL were identified, raising the overall incidence of permanent HL to 19.9/1,000; 1.1/1,000 had auditory neuropathy. Of the 92 infants with HL, 89 (96.7%) had multiple risk factors.

CONCLUSIONS

There is a high incidence of HL in NICU graduates; 22.6% were late in onset. An early rescreen in those who pass the UNHS is a beneficial step for this high risk population.

Age at Full-Time Use Predicts Language Outcomes Better Than Age of Surgery in Children Who Use Cochlear Implants

Purpose The aims of this study were to (a) determine a metric for describing full-time use (FTU), (b) establish whether age at FTU in children with cochlear implants (CIs) predicts language at 3 years of age better than age at surgery, and (c) describe the extent of FTU and length of time it took to establish FTU in this population. Method This retrospective analysis examined receptive and expressive language outcomes at 3 years of age for 40 children with CIs. Multiple linear regression analyses were run with age at surgery and age at FTU as predictor variables. FTU definitions included 8 hr of device use and 80% of average waking hours for a typically developing child. Descriptive statistics were used to describe the establishment and degree of FTU. Results Although 8 hr of daily wear is typically considered FTU in the literature, the 80% hearing hours percentage metric accounts for more variability in outcomes. For both receptive and expressive language, age at FTU was found to be a better predictor of outcomes than age at surgery. It took an average of 17 months for children in this cohort to establish FTU, and only 52.5% reached this milestone by the time they were 3 years old. Conclusions Children with normal hearing can access spoken language whenever they are awake, and the amount of time young children are awake increases with age. A metric that incorporates the percentage of time that children with CIs have access to sound as compared to their same-aged peers with normal hearing accounts for more variability in outcomes than using an arbitrary number of hours. Although early FTU is not possible without surgery occurring at a young age, device placement does not guarantee use and does not predict language outcomes as well as age at FTU.

Impact of educational (sign language/video modeling) and therapeutic (Glycyrrhiza glabra--liquorice mouth wash) interventions on oral health pertaining to children with hearing impairment: A randomized clinical trial

PURPOSE

To compare the effect of educational (sign language and video modeling) and therapeutic intervention (liquorice) on oral hygiene status of children with hearing impairment (CHI).

METHODS

Ninety-three CHI, in the age range of 5-15 years, were recruited in to the study. Children were assigned to two educational intervention groups: sign language and video modeling. Each group was again randomly divided into two: with one subgroup receiving therapeutic intervention using liquorice as a mouth wash and the other group receiving no intervention. For all children, baseline oral hygiene, gingival, and plaque index scores were recorded and oral prophylaxis was performed. Based on the subgroup to which the child was assigned, oral hygiene instructions were given on a weekly basis, whereas therapeutic intervention was performed twice daily for 28 days. Reassessment was done after the completion of interventions and after 3 months, followed by statistical analysis.

RESULTS

There was a significant mean reduction in oral hygiene, gingival, and plaque scores in all the children. The educational intervention could not influence the scores recorded, but the therapeutic intervention with liquorice led to a reduction in all the oral health parameters during the follow-up periods.

CONCLUSION

Therapeutic intervention using liquorice as mouth wash along with educational intervention can be suggested in CHI.

Meeting the Joint Committee on Infant Hearing Standards in a Large Metropolitan Children's Hospital: Barriers and Next Steps

Purpose The aim of this study was to determine how a large metropolitan children's hospital's practices align with the Joint Committee on Infant Hearing (JCIH) 1-3-6 guidelines (diagnose hearing loss by 3 months of age, fitted with hearing aids within 1 month of diagnosis, and enroll in early intervention by 6 months of age) and examine variables that have impacted meeting these guidelines. This hospital is not a birthing hospital. Therefore, the first recommendation (hearing screen by 1 month of age) was not evaluated. Method One hundred forty-one auditory evoked potential evaluations for infants under the age of 6 months were reviewed for this study. Data were only gathered for infants identified with a bilateral hearing loss ( n = 34). The following was recorded: degree of hearing loss, number of diagnostic sessions over time, the percentage of infants who transitioned to hearing aid fittings, and the age at which JCIH benchmarks were accomplished. Results Sixty-two percent of infants were diagnosed with hearing loss by 3 months of age, 48% of infants were fitted with hearing aids by 4 months of age, and the average age of infants enrolled in early intervention was 4.58 months. Seventy percent of infants were fitted within 1 month of the diagnosis of hearing loss. The identified variables that led to the hearing aids being fitted greater than 1 month after the diagnosis are as follows: cancellations/missed appointments, middle ear involvement, and mild hearing loss. Conclusions Results of this internal audit revealed opportunities for growth in better meeting and exceeding JCIH recommendations of diagnosis by 3 months of age and hearing aid fitting within 1 month of diagnosis. Adjustments in the scheduling process and appointment options have been implemented in response to these results. Additional examination of why these recommendations are not being met and what can be done to achieve them is needed.

Audiological evaluation of infants using mother's voice

OBJECTIVES

Hearing loss is a serious problem in infants and children because it may interfere with the development of typical speech, verbal language, and auditory and communication skills. By measuring hearing ability (thresholds) as early as possible, even as early as during infancy, effective treatment can be administered. These treatments may significantly reduce the handicap associated with hearing loss. However, at times during behavioral auditory tests, observers cannot determine whether or not an accurate threshold was obtained. To support the use of infant audiometry for accurate diagnosis, audiologic behavioral responses may be obtained by selecting stimuli that interest infants, e.g., their mothers' voices.

METHODS

We evaluated 30 infants who were presented to our hospital for behavioral auditory assessment in 2016. The infants' ages ranged from 4 months to 3 years and 6 months. The mean age was 1 year and 10 months ±10 months (±standard deviation). The infants' hearing thresholds for their mothers' voices and warble tones at 250-4000 Hz were measured. Auditory brainstem response (ABR) had already been evaluated in 24 infants. Relationships between mother's voice and warble tone or ABR thresholds as well as responses to the initial stimuli and stimuli at the threshold were investigated. These responses were classified into four grades (no response, uncertain response, possible positive response, and positive response), and the response to mother's voice and warble tone were subsequently compared.

RESULTS

Mother's voice thresholds significantly correlated with all warble tone thresholds. In the relationship between the mother's voice threshold and average hearing levels of 500, 1000, and 2000 Hz, two infants were outliers. In these infants, the average hearing levels were relatively higher than the mother's voice thresholds. Judging from their ABR thresholds, the mother's voice thresholds were valid and the average hearing levels were worse than their original assessed hearing ability. The responses to mothers' voices were more distinct than those to warble tones, both for initial stimuli presentation and the determined threshold.

CONCLUSIONS

Audiologic behavioral responses to mothers' voices were clearer than those for warble tones. Evaluations that use the mother's voice threshold are useful for estimating hearing levels in infants.

Vestibular Infant Screening - Flanders: The implementation of a standard vestibular screening protocol for hearing-impaired children in Flanders

OBJECTIVES

The Vestibular Infant Screening - Flanders (VIS-Flanders) project aims to implement and refine a vestibular screening protocol for all children with neonatal hearing loss in Flanders (Belgium) to limit the impact of a vestibular dysfunction on the motor, cognitive and psychosocial development of hearing-impaired children.

METHODS

Each child with a confirmed neonatal hearing loss in Flanders will undergo a vestibular screening at the age of 6 months in the reference centers involved in the neonatal hearing screening program. The cervical Vestibular Evoked Myogenic Potential (cVEMP) test will be used as a screening tool. The test is short, child-friendly, feasible at a young age and highly correlated with motor and balance performance. The results of an extensive follow-up protocol at the Ghent University Hospital will enable further refinement of the screening protocol.

RESULTS

Data collection in all reference centers has started since June 2018. This paper outlines the rationale for the screening and the set-up of this four-year project.

CONCLUSIONS

Current available literature strongly favors vestibular assessment in congenitally hearing-impaired children. A standard vestibular screening for these children should lead to early identification of vestibular deficits and subsequent prompt referral for further motor assessment and rehabilitation, in order to limit the impact of a vestibular dysfunction in developing children and improve their quality of life.

Hearing Loss in Pediatrics: What the Medical Home Needs to Know

Screening infants for hearing loss at birth is a standard in most states in the United States, but follow-up continues to warrant improvement. Understanding the definition of hearing loss, its etiology, appropriate intervention options, and knowledge of methods to optimize an infant's outcomes through the medical home can help to maximize speech and language skills.

Newborn and Infant Hearing Screening Facing Globally Growing Numbers of People Suffering from Disabling Hearing Loss

Recent prevalence estimates indicate that in 2015 almost half a billion people-about 6.8% of the world's population-had disabling hearing loss and that prevalence numbers will further increase. The World Health Organization (WHO) currently estimates that at least 34 million children under the age of 15 have disabling hearing loss. Based on a 2012 WHO report, approximately 7.5 million of these children were under the age of 5 years. This review article focuses on the importance of high-quality newborn and infant hearing screening (NIHS) programs as one strategy to ameliorate disabling hearing loss as a global health problem. Two WHO resolutions regarding the prevention of deafness and hearing loss have been adopted urging member states to implement screening programs for early identification of ear diseases and hearing loss in babies and young children. The effectiveness of these programs depends on factors such as governmental mandates and guidance; presence of a national committee with involvement of professionals, industries, and stakeholders; central oversight of hearing screening; clear definition of target parameters; presence of tracking systems with bi-directional data transfer from screening devices to screening centers; accessibility of pediatric audiological services and rehabilitation programs; using telemedicine where connectivity is available; and the opportunity for case discussions in professional excellence circles with boards of experts. There is a lack of such programs in middle- and low-income countries, but even in high-income countries there is potential for improvement. Facing the still growing burden of disabling hearing loss around the world, there is a need to invest in national, high-quality NIHS programs.