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Corazzi V, Fordington S, Brown TH, Donnelly N, Bewick J, Ehsani D, Pelucchi S, Bianchini C, Ciorba A, Borsetto D. Late-onset, progressive sensorineural hearing loss in the paediatric population: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08527-x. [PMID: 38411671 DOI: 10.1007/s00405-024-08527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
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.
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Affiliation(s)
- Virginia Corazzi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Surina Fordington
- Department of Paediatrics, Cambridge University Hospitals, Hills Road, Cambridge, UK
| | | | - Neil Donnelly
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jessica Bewick
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Diana Ehsani
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy.
| | - Daniele Borsetto
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Bowers P, Graydon K, Rance G. Evaluation of a game-based hearing screening program for identifying hearing loss in primary school-aged children. Int J Audiol 2023; 62:512-520. [PMID: 35343856 DOI: 10.1080/14992027.2022.2052981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate a tablet-based hearing screening game in primary school aged children. To examine the prevalence of middle/outer ear pathology, hearing loss and spatial processing disorder in primary school aged children. DESIGN The automated hearing test Sound Scouts was used as a screening tool, which measures hearing abnormalities through tests of speech-in-quiet/noise and tone-in-noise. Children who failed the screenings underwent follow up testing with pure tone audiometry, tympanometry, otoscopy, and the Listening in Spatialised Noise-Sentences test. Results of each test were compared to measure efficacy. STUDY SAMPLE 1256 children aged 4-13 years from 8 primary schools. RESULTS 111 children (8.84%) presented with evidence of middle/outer ear pathologies. 21 children (1.67%) had hearing loss in at least one ear. 30 children (2.52%) were diagnosed with spatial processing disorder. False positive rate was 5.01%, indicating that a relatively small proportion of the children who failed the screenings were subsequently shown to have normal auditory function. CONCLUSIONS A game based program testing sound detection and binaural speech processing can be effective in detecting undiagnosed hearing deficits, in large format school-based hearing screenings. Prevalence of hearing abnormalities in Victorian primary school aged children were established, highlighting the value of school hearing screening programs.
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Affiliation(s)
- Patrick Bowers
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Kelley Graydon
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Gary Rance
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
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Fitzgibbons EJ, Keszegi S, Driscoll C, Beswick R. Childhood hearing loss detected beyond the newborn screen. Int J Audiol 2023; 62:278-285. [PMID: 35225141 DOI: 10.1080/14992027.2022.2042606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To understand the characteristics of postnatal hearing loss (PNHL) identified via different referral pathways, to inform childhood hearing screening and referral practices. DESIGN Retrospective analysis of screening and audiology records. STUDY SAMPLE A cohort of 385 children who passed newborn hearing screening in Queensland, Australia between September 2004 and December 2017 and were later diagnosed with permanent hearing loss. RESULTS Neonatally identified risk factors facilitated detection for half the cohort, with PNHL detected earlier (average age of 31 months) and at a milder degree. PNHL was detected at an average age of 49 months via other pathways. Proportions of bilateral moderate or greater PNHL were greatest in children with significant medical circumstances (60.7%) and those with noted delays or concerns (39.2%), whereas childhood hearing screening programs detected greater proportions of unilateral moderate or greater PNHL (47.4%). CONCLUSIONS Risk-factor-based surveillance detects PNHL early but does not detect all cases. Screening children with speech and language delays, parental or professional concern, or with relevant medical circumstances (eg meningitis or chemotherapy) is warranted based on the types of PNHL detected. Further evidence may be required to justify the rollout of postnatal population childhood screening programs.
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Affiliation(s)
- E Jane Fitzgibbons
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Stephanie Keszegi
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Carlie Driscoll
- School of Health and Rehabilitation Services, University of Queensland, Brisbane, Australia
| | - Rachael Beswick
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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Kik J, Heijnsdijk EAM, Mackey AR, Carr G, Horwood AM, Fronius M, Carlton J, Griffiths HJ, Uhlén IM, Simonsz HJ. Availability of data for cost-effectiveness comparison of child vision and hearing screening programmes. J Med Screen 2022; 30:62-68. [PMID: 36205109 PMCID: PMC10149880 DOI: 10.1177/09691413221126677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE For cost-effectiveness comparison of child vision and hearing screening programmes, methods and data should be available. We assessed the current state of data collection and its availability in Europe. METHODS The EUSCREEN Questionnaire, conducted in 2017-2018, assessed paediatric vision and hearing screening programmes in 45 countries in Europe. For the current study, its items on data collection, monitoring and evaluation, and six of eleven items essential for cost-effectiveness analysis: prevalence, sensitivity, specificity, coverage, attendance and loss to follow-up, were reappraised with an additional questionnaire. RESULTS The practice of data collection in vision screening was reported in 36% (N = 42) of countries and in hearing screening in 81% (N = 43); collected data were published in 12% and 35%, respectively. Procedures for quality assurance in vision screening were reported in 19% and in hearing screening in 26%, research of screening effectiveness in 43% and 47%, whereas cost-effectiveness analysis was performed in 12% for both. Data on prevalence of amblyopia were reported in 40% and of hearing loss in 77%, on sensitivity of screening tests in 17% and 14%, on their specificity in 19% and 21%, on coverage of screening in 40% and 84%, on attendance in 21% and 37%, and on loss to follow-up in 12% and 40%, respectively. CONCLUSIONS Data collection is insufficient in hearing screening and even more so in vision screening: data essential for cost-effectiveness comparison could not be reported from most countries. When collection takes place, this is mostly at a local level for quality assurance or accountability, and data are often not accessible. The resulting inability to compare cost-effectiveness among screening programmes perpetuates their diversity and inefficiency.
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Affiliation(s)
- Jan Kik
- Department of Ophthalmology, 6993Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, 6993Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Allison R Mackey
- Division of Ear, Nose and Throat Disease, 27106Karolinska Institute, Stockholm, Sweden
| | - Gwen Carr
- Independent consultant, Manchester, UK
| | - Anna M Horwood
- School of Psychology and Clinical Language Sciences, 6816University of Reading, Reading, UK
| | - Maria Fronius
- Department of Ophthalmology, 9173Goethe University, Frankfurt am Main, Germany
| | - Jill Carlton
- School of Health and Related Research, 7315University of Sheffield, Sheffield, UK
| | - Helen J Griffiths
- School of Health and Related Research, 7315University of Sheffield, Sheffield, UK
| | - Inger M Uhlén
- Division of Ear, Nose and Throat Disease, 27106Karolinska Institute, Stockholm, Sweden
| | - Huibert Jan Simonsz
- Department of Ophthalmology, 6993Erasmus University Medical Center, Rotterdam, The Netherlands
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Faramarzi M, Babakhani Fard S, Bayati M, Jafarlou F, Parhizgar M, Rezaee M, Keshavarz K. Cost-effectiveness analysis of hearing screening program for primary school children in southern Iran, Shiraz. BMC Pediatr 2022; 22:318. [PMID: 35637460 PMCID: PMC9150379 DOI: 10.1186/s12887-022-03384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Center, Department of Otorhinolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Babakhani Fard
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Jafarlou
- Department of Audiology, School of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadreza Parhizgar
- Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Rezaee
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, Department of Health Economics, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. .,Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Neumann K, Mathmann P, Chadha S, Euler HA, White KR. Newborn Hearing Screening Benefits Children, but Global Disparities Persist. J Clin Med 2022; 11:271. [PMID: 35012010 PMCID: PMC8746089 DOI: 10.3390/jcm11010271] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 12/23/2022] Open
Abstract
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).
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Affiliation(s)
- Katrin Neumann
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, 48149 Münster, Germany; (P.M.); (H.A.E.)
| | - Philipp Mathmann
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, 48149 Münster, Germany; (P.M.); (H.A.E.)
| | - Shelly Chadha
- Blindness Deafness Prevention, Disability and Rehabilitation Unit, Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, 1211 Geneva, Switzerland;
| | - Harald A. Euler
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, 48149 Münster, Germany; (P.M.); (H.A.E.)
| | - Karl R. White
- National Center for Hearing Assessment and Management, Utah State University, Logan, UT 84322, USA;
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Cost-Effectiveness of Screening Preschool Children for Hearing Loss in Australia. Ear Hear 2021; 43:1067-1078. [PMID: 34753856 DOI: 10.1097/aud.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES While all newborns in Australia are tested for congenital hearing loss through universal newborn hearing screening programs, some children will acquire hearing loss in their first five years of life. Delayed diagnosed or undiagnosed hearing loss in children can have substantial immediate- and long-term consequences. It can significantly reduce school readiness, language and communication development, social and emotional development, and mental health. It can also compromise lifetime educational achievements and employment opportunities and future economic contribution to society through lost productivity. The need for a universal hearing screening program for children entering their first year of primary school has been noted in two separate Australian Government hearing inquiries in the last decade. Sound Scouts is a hearing screening application (app) that tests for hearing loss in children using a tablet or mobile device, supervised by parents at home. It tests for sensorineural or permanent conductive hearing loss and central auditory processing disorder in children. In 2018 the Australian Government funded the roll-out of Sound Scouts to allow up to 600,000 children to test their hearing using Sound Scouts. This study estimated the cost-effectiveness of screening 5-year-old children for hearing loss using Sound Scouts at home, compared with no screening. DESIGN A decision-analytic model was developed to estimate the incremental costs and quality-adjusted life years (QALYs) of administering Sound Scouts over a 20-year time horizon. Testing accuracy was based on comparing Sound Scouts test results to clinical test results while other parameters were based on published data. Costs were estimated from the perspective of the Australian health care system. Univariate and probabilistic sensitivity analyses were undertaken. RESULTS Sound Scouts is estimated to result in an average incremental cost of A$61.02 and an average incremental increase in QALYs of 0.01. This resulted in an incremental cost-effectiveness ratio of A$5392 per QALY gained, which is likely to be considered cost-effective by Australian decision makers. Screening with Sound Scouts was found to have a 96.2 per cent probability of being cost-effective using a threshold of A$60,000 per QALY gained. CONCLUSIONS Using Sound Scouts to screen five-year-old children for hearing loss (at home) is likely to be cost-effective. Screening children using Sound Scouts will result in early identification and intervention in childhood hearing loss, thereby reducing early childhood disadvantage through cumulative gains in quality of life, education, and economic outcomes over their lifetime.
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Cadena AC, Lindholm N, Stenfeldt K. School-based hearing screening in Sweden - An evaluation of current practices. Int J Pediatr Otorhinolaryngol 2021; 150:110938. [PMID: 34634590 DOI: 10.1016/j.ijporl.2021.110938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 09/03/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Routines for school hearing screening vary between municipalities in Sweden, and no study has been carried out to investigate how this is conducted throughout the country. The aim of the present study was to determine the extent of school hearing screening, and how it is performed in all the municipalities in Sweden. METHODS An online survey was used to collect information on school hearing screening from municipalities in Sweden (N = 290). The survey included questions on the performance of hearing screening, including stimulus level and frequencies tested, the criteria for referral for further hearing evaluation, as well as the equipment and room used for testing, and who carried out the screening. Questions were also included on experience of, and attitudes towards hearing screening. RESULTS Answers were received from 225 municipalities (response rate 78%). Universal school hearing screening was performed in 202 municipalities, while in the other municipalities hearing screening was performed when a child was evaluated due to speech delay or learning difficulties. Many different protocols were used involving different stimulus levels, frequencies, and referral criteria. The most common was testing with pure tone audiometry with a lowest stimulus level of 20 dB HL at five frequencies, 500-6000 Hz. Hearing screening was usually performed in the preparation class (6 years of age), while in other municipalities it was performed in year 1 (7 years of age). Hearing screening was usually performed once in primary school, while some municipalities carried out screening once in primary school and once in high school. More rarely, hearing screening was conducted twice in primary school. In 25 % of the municipialities, newly arrived immigrant children were screened. Difficulties in performing hearing screening were reported, such as lack of soundproof rooms, lack of time and technical difficulties. There was an opinion among the participants that identifying students with hearing loss is important, as it affects their learning ability and communication skills. and they expressed a desire for national guidelines. CONCLUSIONS Hearing screening is performed in the vast majority of municipally run schools in Sweden. The way in which screening was performed varied regarding the stimulus level and frequencies used, as well as the criteria for referral to a specialist. The attitude towards hearing screening was positive among the participants. Hearing screening of newly immigrated children is important as their previous medical history is often unknown. There is a need for national guidelines on hearing screening of Swedish schoolchildren. Efforts must continue to ensure that the same level of healthcare regarding children's hearing is provided throughout the whole of Sweden.
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Affiliation(s)
- Adriana Cuasquen Cadena
- Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Nina Lindholm
- Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karin Stenfeldt
- Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Lund, Sweden.
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Horn P, Driscoll C, Fitzgibbons J, Beswick R. Detecting Hearing Loss in Infants With a Syndrome or Craniofacial Abnormalities Following the Newborn Hearing Screen. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3594-3602. [PMID: 34403284 DOI: 10.1044/2021_jslhr-20-00699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The current Joint Committee on Infant Hearing guidelines recommend that infants with syndromes or craniofacial abnormalities (CFAs) who pass the universal newborn hearing screening (UNHS) undergo audiological assessment by 9 months of age. However, emerging research suggests that children with these risk factors are at increased risk of early hearing loss despite passing UNHS. To establish whether earlier diagnostic audiological assessment is warranted for all infants with a syndrome or CFA, regardless of screening outcome, this study compared audiological outcomes of those who passed UNHS and those who referred. Method A retrospective analysis was performed on infants with a syndrome or CFA born between July 1, 2012, and June 30, 2017 who participated in Queensland, Australia's state-wide UNHS program. Results Permanent childhood hearing loss (PCHL) yield was higher among infants who referred on newborn hearing screening (51.20%) than in those who passed. Nonetheless, 27.47% of infants who passed were subsequently diagnosed with hearing loss (4.45% PCHL, 23.02% transient conductive), but PCHL was generally milder in this cohort. After microtia/atresia, the most common PCHL etiologies were Trisomy 21, other syndromes, and cleft palate. Of the other syndromes, Pierre Robin sequence featured prominently among infants who passed the hearing screen and were subsequently diagnosed with PCHL, whereas there was a broader mix of other syndromes that caused PCHL in infants who referred on screening. Conclusion Children identified with a syndrome or CFA benefit from early diagnostic audiological assessment, regardless of their newborn hearing screening outcome.
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Affiliation(s)
- Philippa Horn
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Carlie Driscoll
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jane Fitzgibbons
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Rachael Beswick
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
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Verkleij ML, Heijnsdijk EAM, Bussé AML, Carr G, Goedegebure A, Mackey AR, Qirjazi B, Uhlén IM, Sloot F, Hoeve HLJ, de Koning HJ. Cost-Effectiveness of Neonatal Hearing Screening Programs: A Micro-Simulation Modeling Analysis. Ear Hear 2021; 42:909-916. [PMID: 33306547 PMCID: PMC8221716 DOI: 10.1097/aud.0000000000000981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Early detection of neonatal hearing impairment moderates the negative effects on speech and language development. Universal neonatal hearing screening protocols vary in tests used, timing of testing and the number of stages of screening. This study estimated the cost-effectiveness of various protocols in the preparation of implementation of neonatal hearing screening in Albania.
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Affiliation(s)
- Mirjam L Verkleij
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrea M L Bussé
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gwen Carr
- Independent Consultant in Early Hearing Detection, Intervention and Family Centered Practice, London, United Kingdom
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Allison R Mackey
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Birkena Qirjazi
- Department of Ear, Nose and Throat Diseases-Ophthalmology, University of Tirana, Tirana, Albania
| | - Inger M Uhlén
- Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Frea Sloot
- Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hans L J Hoeve
- Department of Otorhinolaryngology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Moepeng M, Singh S, Ramma L. Contextually appropriate school entry hearing screening protocol for low- and middle-income countries: A scoping review. Int J Pediatr Otorhinolaryngol 2021; 147:110788. [PMID: 34120029 DOI: 10.1016/j.ijporl.2021.110788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/30/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), where universal newborn hearing screening programmes are often not available, school entry hearing screening programmes serve as a safeguard for early detection and intervention for hearing loss in school learners. OBJECTIVE To determine a contextually appropriate school entry hearing screening protocol for LMICs. METHODS A scoping review was utilised to comprehensively search for relevant publications in the following electronic databases: Africa-Wide Information, CINAHL, Health Source: Nursing/Academic Edition, Cochrane Library, Pubmed, Scopus, and Web of Science. Studies included those that investigated school-based hearing screening protocols or programmes for LMICs among learners aged five to twelve years. The review was conducted and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. RESULTS The search yielded 1863 studies, and after removing duplicates and ineligible studies, 19 studies were selected for data extraction. Pure tone audiometry screening was the most frequently used age-appropriate hearing screening test in the reviewed studies (n = 17). Conducting pure tone audiometry screening using 1, 2, and 4 kHz frequency combination resulted in referral rates ranging from 3.2% to 21%. In studies that included 0.5 kHz to the screening frequencies, referral rates ranged from 5.8% to 56%. Screening at 25 dB HL intensity level yielded referral rates ranging from 3.2% to 10.3%. Immediate rescreening reduced overall referral rates for learners referred for audiological diagnostic testing by up to 57%. Ambient noise levels were controlled by conducting screening in quiet rooms (n = 14) and utilising screening equipment that allows for monitoring and reducing environmental noise (n = 3). CONCLUSION An ideal school entry hearing screening protocol in LMIC contexts could potentially utilise pure tone audiometry screening at 1, 2, and 4 kHz, using 25 dB HL screening intensity level with an immediate rescreen for learners with a refer result. School entry hearing screening should be conducted in a quiet room, preferably using hearing screening equipment capable of monitoring ambient noise levels to reduce false positive referrals.
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Affiliation(s)
- Meshack Moepeng
- Department of Health and Rehabilitation Sciences, Division of Communication Sciences and Disorders, University of Cape Town, South Africa; Audiology Department, Bamalete Lutheran Hospital, Botswana.
| | - Shajila Singh
- Department of Health and Rehabilitation Sciences, Division of Communication Sciences and Disorders, University of Cape Town, South Africa
| | - Lebogang Ramma
- Department of Health and Rehabilitation Sciences, Division of Communication Sciences and Disorders, University of Cape Town, South Africa
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Minimal and Mild Hearing Loss in Children: Association with Auditory Perception, Cognition, and Communication Problems. Ear Hear 2021; 41:720-732. [PMID: 31633598 DOI: 10.1097/aud.0000000000000802] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES "Minimal" and "mild" hearing loss are the most common but least understood forms of hearing loss in children. Children with better ear hearing level as low as 30 dB HL have a global language impairment and, according to the World Health Organization, a "disabling level of hearing loss." We examined in a population of 6- to 11-year-olds how hearing level ≤40.0 dB HL (1 and 4 kHz pure-tone average, PTA, threshold) is related to auditory perception, cognition, and communication. DESIGN School children (n = 1638) were recruited in 4 centers across the United Kingdom. They completed a battery of hearing (audiometry, filter width, temporal envelope, speech-in-noise) and cognitive (IQ, attention, verbal memory, receptive language, reading) tests. Caregivers assessed their children's communication and listening skills. Children included in this study (702 male; 752 female) had 4 reliable tone thresholds (1, 4 kHz each ear), and no caregiver reported medical or intellectual disorder. Normal-hearing children (n = 1124, 77.1%) had all 4 thresholds and PTA <15 dB HL. Children with ≥15 dB HL for at least 1 threshold, and PTA <20 dB (n = 245, 16.8%) had minimal hearing loss. Children with 20 ≤PTA <40 dB HL (n = 88, 6.0%) had mild hearing loss. Interaural asymmetric hearing loss ( left PTA - right PTA ≥10 dB) was found in 28.9% of those with minimal and 39.8% of those with mild hearing loss. RESULTS Speech perception in noise, indexed by vowel-consonant-vowel pseudoword repetition in speech-modulated noise, was impaired in children with minimal and mild hearing loss, relative to normal-hearing children. Effect size was largest (d = 0.63) in asymmetric mild hearing loss and smallest (d = 0.21) in symmetric minimal hearing loss. Spectral (filter width) and temporal (backward masking) perceptions were impaired in children with both forms of hearing loss, but suprathreshold perception generally related only weakly to PTA. Speech-in-noise (nonsense syllables) and language (pseudoword repetition) were also impaired in both forms of hearing loss and correlated more strongly with PTA. Children with mild hearing loss were additionally impaired in working memory (digit span) and reading, and generally performed more poorly than those with minimal loss. Asymmetric hearing loss produced as much impairment overall on both auditory and cognitive tasks as symmetric hearing loss. Nonverbal IQ, attention, and caregiver-rated listening and communication were not significantly impaired in children with hearing loss. Modeling suggested that 15 dB HL is objectively an appropriate lower audibility limit for diagnosis of hearing loss. CONCLUSIONS Hearing loss between 15 and 30 dB PTA is, at ~20%, much more prevalent in 6- to 11-year-old children than most current estimates. Key aspects of auditory and cognitive skills are impaired in both symmetric and asymmetric minimal and mild hearing loss. Hearing loss <30 dB HL is most closely related to speech perception in noise, and to cognitive abilities underpinning language and reading. The results suggest wider use of speech-in-noise measures to diagnose and assess management of hearing loss and reduction of the clinical hearing loss threshold for children to 15 dB HL.
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Eksteen S, Eikelboom RH, Launer S, Kuper H, Swanepoel DW. Referral Criteria for Preschool Hearing Screening in Resource-Constrained Settings: A Comparison of Protocols. Lang Speech Hear Serv Sch 2021; 52:868-876. [PMID: 34061576 DOI: 10.1044/2021_lshss-21-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results Fail rates for the one-frequency fail protocol was 8.7% (n = 186) and 4.3% (n = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail (p < .001; OR = 0.471; 95% confidence interval [0.385, 0.575]). Gender (p = .251) and age (p = .570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type (p = .204), gender (p = .314), and age (p = .982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 SD) and 64.9 s (55.78 SD) for the one-frequency and two-frequency fail protocols, respectively. Conclusions A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.
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Affiliation(s)
- Susan Eksteen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Robert H Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Western Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Stefan Launer
- Sonova AG, Science & Technology, Stäfa, Switzerland.,School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Australia
| | - Hannah Kuper
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Western Australia
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Borre ED, Diab MM, Ayer A, Zhang G, Emmett SD, Tucci DL, Wilson BS, Kaalund K, Ogbuoji O, Sanders GD. Evidence gaps in economic analyses of hearing healthcare: A systematic review. EClinicalMedicine 2021; 35:100872. [PMID: 34027332 PMCID: PMC8129894 DOI: 10.1016/j.eclinm.2021.100872] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hearing loss is a common and costly medical condition. This systematic review sought to identify evidence gaps in published model-based economic analyses addressing hearing loss to inform model development for an ongoing Lancet Commission. METHODS We searched the published literature through 14 June 2020 and our inclusion criteria included decision model-based cost-effectiveness analyses that addressed diagnosis, treatment, or prevention of hearing loss. Two investigators screened articles for inclusion at the title, abstract, and full-text levels. Data were abstracted and the studies were assessed for the qualities of model structure, data assumptions, and reporting using a previously published quality scale. FINDINGS Of 1437 articles identified by our search, 117 unique studies met the inclusion criteria. Most of these model-based analyses were set in high-income countries (n = 96, 82%). The evaluated interventions were hearing screening (n = 35, 30%), cochlear implantation (n = 34, 29%), hearing aid use (n = 28, 24%), vaccination (n = 22, 19%), and other interventions (n = 29, 25%); some studies included multiple interventions. Eighty-six studies reported the main outcome in quality-adjusted or disability-adjusted life-years, 24 of which derived their own utility values. The majority of the studies used decision tree (n = 72, 62%) or Markov (n = 41, 35%) models. Forty-one studies (35%) incorporated indirect economic effects. The median quality rating was 92/100 (IQR:72-100). INTERPRETATION The review identified a large body of literature exploring the economic efficiency of hearing healthcare interventions. However, gaps in evidence remain in evaluation of hearing healthcare in low- and middle-income countries, as well as in investigating interventions across the lifespan. Additionally, considerable uncertainty remains around productivity benefits of hearing healthcare interventions as well as utility values for hearing-assisted health states. Future economic evaluations could address these limitations. FUNDING NCATS 3UL1-TR002553-03S3.
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Affiliation(s)
- Ethan D. Borre
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Mohamed M. Diab
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Austin Ayer
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Gloria Zhang
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Susan D. Emmett
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Debara L. Tucci
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, United States
| | - Blake S. Wilson
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
- Department of Electrical & Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Kamaria Kaalund
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Osondu Ogbuoji
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham NC, United States
| | - Gillian D. Sanders
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Duke University Clinical Research Institute, Duke University School of Medicine, Durham NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Corresponding author at: Gillian Sanders Schmidler, PhD, Duke-Robert J. Margolis, MD, Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC 27708-0120.
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Manus M, van der Linde J, Kuper H, Olinger R, Swanepoel DW. Community-Based Hearing and Vision Screening in Schools in Low-Income Communities Using Mobile Health Technologies. Lang Speech Hear Serv Sch 2021; 52:568-580. [PMID: 33497579 DOI: 10.1044/2020_lshss-20-00089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction Globally, more than 50 million children have hearing or vision loss. Most of these sensory losses are identified late due to a lack of systematic screening, making treatment and rehabilitation less effective. Mobile health (mHealth), which is the use of smartphones or wireless devices in health care, can improve access to screening services. mHealth technologies allow lay health workers (LHWs) to provide hearing and vision screening in communities. Purpose The aim of the study was to evaluate a hearing and vision school screening program facilitated by LHWs using smartphone applications in a low-income community in South Africa. Method Three LHWs were trained to provide dual sensory screening using smartphone-based applications. The hearScreen app with calibrated headphones was used to conduct screening audiometry, and the Peek Acuity app was used for visual acuity screening. Schools were selected from low-income communities (Gauteng, South Africa), and children aged between 4 and 9 years received hearing and vision screening. Screening outcomes, associated variables, and program costs were evaluated. Results A total of 4,888 and 4,933 participants received hearing and vision screening, respectively. Overall, 1.6% of participants failed the hearing screening, and 3.6% failed visual acuity screening. Logistic regression showed that female participants were more likely to pass hearing screening (OR = 1.61, 95% CI [1.11, 2.54]), while older children were less likely to pass visual acuity screening (OR = 0.87, 95% CI [0.79, 0.96]). A third (32.5%) of referred cases followed up for air-conduction threshold audiometry, and one in four (25.1%) followed up for diagnostic vision testing. A high proportion of these cases were confirmed to have hearing (73.1%, 19/26) or vision loss (57.8%, 26/45). Conclusions mHealth technologies can enable LHWs to identify school-age children with hearing and/or vision loss in low-income communities. This approach allows for low-cost, scalable models for early detection of sensory losses that can affect academic performance.
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Affiliation(s)
- Michelle Manus
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Hannah Kuper
- International School for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Renate Olinger
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Science Centre, School of Surgery, University of Western Australia, Nedlands, Australia.,Ear Science Institute Australia, Subiaco, Western Australia, Australia
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16
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Dawood N, Mahomed Asmail F, Louw C, Swanepoel DW. Mhealth hearing screening for children by non-specialist health workers in communities. Int J Audiol 2020; 60:S23-S29. [PMID: 33043733 DOI: 10.1080/14992027.2020.1829719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare outcomes of a community-based hearing screening programme using smartphone screening audiometry operated by specialist (School Health Nurses - SHNs) and non-specialist health workers (Community Health Workers - CHWs) in school children. DESIGN This study used a two-group comparison of screening outcomes as conducted by SHNs and CHWs using smartphone screening for children in communities. STUDY SAMPLE The study included 71 CHWs and 21 SHNs who conducted community-based hearing screening on 6805 children. One thousand one hundred and fifteen hearing screening tests were conducted by the CHWs and 5690 tests by the SHNs. RESULTS No significant difference in screening outcome was evident between CHWs and SHNs using a binomial logistic regression analysis considering age, test duration and noise levels as independent variables. Final screening result was significantly affected by age (p < 0.005), duration of test (p < 0.005) and noise levels exceeding at 1 kHz in at least one ear (p < 0.005). Test failure was associated with longer test duration (p < 0.005; B: 119.98; 95% CI: 112.65-127.30). CHWs had significantly (p < 0.005) longer test durations (68.70 s; 70 SD) in comparison to SHNs (55.85 s; 66.1 SD). CONCLUSION Low-cost mobile technologies with automated testing facilitated from user-friendly interfaces allow minimally trained persons to provide community-based screening comparable to specialised personnel.
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Affiliation(s)
- Nausheen Dawood
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Faheema Mahomed Asmail
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Christine Louw
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.,Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia.,Ear Science Institute Australia, Subiaco, Australia
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Hussain S, Pryce H, Neary A, Hall A. Exploring how parents of children with unilateral hearing loss make habilitation decisions: a qualitative study. Int J Audiol 2020; 60:183-190. [PMID: 32787641 DOI: 10.1080/14992027.2020.1804080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study sought to explore the decision making needs of parents managing the hearing and communication needs of children with unilateral hearing loss. DESIGN An inductive, qualitative method was used. The data were analysed using a constant comparative approach, consistent with Grounded Theory method. STUDY SAMPLE Twenty one families participated in interviews yielding data on twenty two children. Each of these families had at least one child with unilateral hearing loss. The age range of the children varied from four months to sixteen years old. All parents were English speaking and received care from National Health Service Audiology departments across the United Kingdom. RESULTS Parents valued professionals' opinions, but information provision was inconsistent. As their children mature, parents increasingly valued their child's input. Parent-child discussions focussed on how different management strategies fit their child's preferences. Parents were proactive in obtaining professional advice, and integrating this with their own iterative assessment of their child's performance. CONCLUSIONS Decision making is an iterative process. Parents make nuanced decisions which aim to preserve a sense of what is normal for them. Clinicians need to recognise the parental view, including where it may contrast with a medicalised or clinical view.
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Affiliation(s)
- Saira Hussain
- Department of Audiology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Helen Pryce
- Department of Audiology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Amy Neary
- Department of Audiology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Amanda Hall
- Department of Audiology, School of Life and Health Sciences, Aston University, Birmingham, UK
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The results of hearing screening in refugee school children living in Şanliurfa /Turkey and the related risk factors. Int J Pediatr Otorhinolaryngol 2020; 134:110041. [PMID: 32289664 DOI: 10.1016/j.ijporl.2020.110041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/05/2020] [Accepted: 04/05/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Determining the frequency of and the risk factors for hearing loss among school-age children by comparing the results of hearing screening in children from Syrian refugee and native Turkish population. METHODS The results of the official hearing test, which was conducted by the Ministry of Health of the Republic of Turkey for schoolchildren in the first grade in the 2017-2018 academic year in the Province of Şanlıurfa, were analyzed. RESULTS A total of 23,664 children were screened; 20,603 (87.1%) were Turkish native, and 3,061 (12.9%) were Syrian refugees. The age range was between 69 and 84 months. The screening results indicated in Turkish children, sensorineural hearing loss (SNHL) in 0.26%, otitis media with effusion (OME) in 0.41%, and chronic otitis media (COM) in 0.08%. In the refugee children, the frequency of SNHL was 1.11%, OME was 0.94%, and COM was 0.62%. The rate of COM and SNHL was significantly higher in the refugee children (p < 0.001). Moreover, among those with hearing loss, the frequency of low birth weight, inflammatory diseases, and the family history of consanguineous marriage was significantly higher in refugee children compared to those in Turkish native population (p = 0.018, p = 0.003, and p = 0.022, respectively). CONCLUSION Hearing loss is a major preventable and treatable cause of developmental disorder in childhood. When untreated, hearing loss may delay speaking and prevent socio-emotional development, leading to longterm negative consequences. We believe that programs for hearing screening in schoolchildren should be expanded and that immigrants who carry several risk factors for developmental hearing loss should be included in these programs.
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Yong M, Panth N, McMahon CM, Thorne PR, Emmett SD. How the World's Children Hear: A Narrative Review of School Hearing Screening Programs Globally. OTO Open 2020; 4:2473974X20923580. [PMID: 32490329 PMCID: PMC7238315 DOI: 10.1177/2473974x20923580] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/11/2020] [Indexed: 01/12/2023] Open
Abstract
Objective School hearing screening may mitigate the effects of childhood hearing loss through early identification and intervention. This study provides an overview of existing school hearing screening programs around the world, identifies gaps in the literature, and develops priorities for future research. Data Sources A structured search of the PubMed, Embase, and Cochrane Library databases. Review Methods A total of 65 articles were included according to predefined inclusion criteria. Parameters of interest included age groups screened, audiometric protocols, referral criteria, use of adjunct screening tests, rescreening procedures, hearing loss prevalence, screening test sensitivity and specificity, and loss to follow-up. Conclusions School hearing screening is mandated in few regions worldwide, and there is little accountability regarding whether testing is performed. Screening protocols differ in terms of screening tests included and thresholds used. The most common protocols included a mix of pure tone screening (0.5, 1, 2, and 4 kHz), otoscopy, and tympanometry. Estimates of region-specific disease prevalence were methodologically inaccurate, and rescreening was poorly addressed. Loss to follow-up was also a ubiquitous concern. Implications for Practice There is an urgent need for standardized school hearing screening protocol guidelines globally, which will facilitate more accurate studies of hearing loss prevalence and determination of screening test sensitivity and specificity. In turn, these steps will increase the robustness with which we can study the effects of screening and treatment interventions, and they will support the development of guidelines on the screening, diagnostic, and rehabilitation services needed to reduce the impact of childhood hearing loss.
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Affiliation(s)
- Michael Yong
- Division of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Neelima Panth
- School of Medicine, Duke University, Durham, North Carolina, USA
| | | | - Peter R Thorne
- Section of Audiology, University of Auckland, Auckland, New Zealand.,Eisdell Moore Centre, University of Auckland, Auckland, New Zealand
| | - Susan D Emmett
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA.,Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA
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Yong M, Liang J, Ballreich J, Lea J, Westerberg BD, Emmett SD. Cost-effectiveness of School Hearing Screening Programs: A Scoping Review. Otolaryngol Head Neck Surg 2020; 162:826-838. [DOI: 10.1177/0194599820913507] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective School hearing screening is a public health intervention that can improve care for children who experience hearing loss that is not detected on or develops after newborn screening. However, implementation of school hearing screening is sporadic and supported by mixed evidence to its economic benefit. This scoping review provides a summary of all published cost-effectiveness studies regarding school hearing screening programs globally. At the time of this review, there were no previously published reviews of a similar nature. Data Sources A structured search was applied to 4 databases: PubMed (Medline), Embase, CINAHL, and Cochrane Library. Review Methods The database search was carried out by 2 independent researchers, and results were reported in accordance with the PRISMA-ScR checklist and the JBI methodology for scoping reviews. Studies that included a cost analysis of screening programs for school-aged children in the school environment were eligible for inclusion. Studies that involved evaluations of only neonatal or preschool programs were excluded. Results Four of the 5 studies that conducted a cost-effectiveness analysis reported that school hearing screening was cost-effective through the calculation of incremental cost-effectiveness ratios (ICERs) via either quality- or disability-adjusted life years. One study reported that a new school hearing screening program dominated the existing program; 2 studies reported ICERs ranging from 1079 to 4304 international dollars; and 1 study reported an ICER of £2445. One study reported that school-entry hearing screening was not cost-effective versus no screening. Conclusion The majority of studies concluded that school hearing screening was cost-effective. However, significant differences in methodology and region-specific estimates of model inputs limit the generalizability of these findings.
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Affiliation(s)
- Michael Yong
- BC Rotary Hearing and Balance Centre, Division of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jiahe Liang
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeromie Ballreich
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jane Lea
- BC Rotary Hearing and Balance Centre, Division of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian D. Westerberg
- BC Rotary Hearing and Balance Centre, Division of Otolaryngology–Head and Neck Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan D. Emmett
- Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina, USA
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Magro I, Clavier O, Mojica K, Rieke C, Eisen E, Fried D, Stein-Meyers A, Fellows A, Buckey J, Saunders J. Reliability of Tablet-based Hearing Testing in Nicaraguan Schoolchildren: A Detailed Analysis. Otol Neurotol 2020; 41:299-307. [PMID: 31851067 DOI: 10.1097/mao.0000000000002534] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Determine whether an electronic tablet-based Wireless Automated Hearing-Test System can perform high-quality audiometry to assess schoolchildren for hearing loss in the field in Nicaragua. STUDY DESIGN Cross-sectional. SETTING A school and hospital-based audiology clinic in Jinotega, Nicaragua. SUBJECTS AND METHODS Second and third graders (n = 120) were randomly selected for hearing testing in a school. Air conduction hearing thresholds were obtained bilaterally using a Wireless Automated Hearing-Test System at 1000, 2000, and 4000 Hz. Referral criteria were set at more than 25 dBHL at one or more frequencies. A cohort of children was retested with conventional audiometry in a hospital-based sound booth. Factors influencing false-positive examinations, including ambient noise and behavior, were examined. RESULTS All children with hearing loss were detected using an automated, manual, or two-step (those referred from automated testing were tested manually) protocol in the school (sensitivity = 100%). Specificity was 76% for automated testing, 97% for manual testing, and 99% for the two-step protocol. The variability between thresholds obtained with automated testing was greater than manual testing when compared with conventional audiometry. The percentage of participant responses when no stimulus tone was presented during automated testing was higher in children with false-positive examinations. CONCLUSION A Wireless Automated Hearing-Test System identified all children with hearing loss in a challenging field setting. A two-step protocol (those referred from automated testing are tested manually) reduced false-positive examinations and unnecessary referrals. Children who respond frequently when no tone is presented are more likely to have false-positive automated examinations and should be tested manually.
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Affiliation(s)
| | | | | | | | - Eric Eisen
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | | | | | - James Saunders
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Hearing screenings for preschool children: A comparison between whispered voice and pure tone audiogram tests. Int J Pediatr Otorhinolaryngol 2020; 130:109798. [PMID: 31838332 DOI: 10.1016/j.ijporl.2019.109798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/23/2019] [Accepted: 11/23/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION This prospective study compares the efficiency of two hearing screening tests performed on preschool children. These tests are known as whispered voice test and pure tone audiometry. METHODS Standard hearing screenings were performed on five-year old children using a whispered voice test followed by ENT examination with pure tone audiometry. RESULTS A total of 827 children were included in the study. Hearing loss (>25 dB) was observed in 5.8% of the evaluated children (n = 48), being bilateral in only 1.6% (n = 13) of these cases. Slight hearing impairment (hearing loss of 16-25 dB) was observed in 25.4% (n = 210) of the children, with 14.5% bilateral cases (n = 120). Interestingly, 62 children (7.5%) were under suspicion of hearing loss by their parents; however, an audiogram revealed the poor consistency of this diagnosis (sensitivity 20.8%, Cohen's kappa coefficient of 0.048). The whispered voice test (6 m distance) throwed a hearing impairment diagnosis in 807 (48.8%) of examined ears; however, its sensitivity was of only 56.5%, with a specificity of 51.6% and Cohen's kappa coefficient of 0.0254 (poor). CONCLUSION The hearing loss incidence in preschool children coupled with the low efficacy of whispered voice tests and the parents' unreliability during the hearing impairment survey advocate for a more efficient audiometric hearing screening before beginning school attendance.
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Y S, R G, Y D, Bz J, S K, V N, M K. Predicting hearing loss in children according to the referrer and referral cause. Int J Pediatr Otorhinolaryngol 2020; 128:109685. [PMID: 31610440 DOI: 10.1016/j.ijporl.2019.109685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hearing assessment in children is considered necessary in all cases involving a doubt regarding hearing acuity. Due to the fact that the number of referrals may be much greater than the actual capacity of a hearing institute, it would be desirable to have a filtering tool in order to detect the cases with higher suspicion of hearing loss. OBJECTIVE To evaluate whether anamnesis details can be used as a sorting tool for detection of highly suspicious cases of hearing loss in preschool children. The anamnesis details may be one or more of the following: the reason for performing hearing test, which caregiver indicated the need for hearing evaluation, the parent's comprehension of their child hearing, and the medical history. METHODS the parents of preschool children, who were referred to the hearing institute at Soroka university medical center, were asked to fill a questionnaire containing 18 questions. The questions referred to details such as: the reason for performing the hearing test; who suggested the existence of hearing impairment; medical history issues and questions regarding details that may indicate a risk of hearing loss. Details such as Otoscopy results were taken from the medical record of the patient. RESULTS 317 preschool and school patients were recruited to the study. Hearing loss was found in 42% of the cases. The most common reason for performing the hearing test was speech disturbance (33%). In cases which the parents were those who raised the suspicion of hearing loss - hearing impairment was found in 61% of the cases, compared to 36% when the speech therapist was the one raising the doubts and to only 18% when the kindergarten teacher was the one raising the doubt. The positive predictive value of patient that their parents suspected the hearing loss combined with pathologic otoscopy result was 82.6% when the reason for the test was hearing impairment suspicion, and 91.3% when the reason for the hearing test was speech disturbance. CONCLUSIONS Parents are the best in assessing their child's hearing followed by the speech therapist and the least sensitive is the school teacher.
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Affiliation(s)
- Slovik Y
- Otolaryngology H&N Surgery Dpt., Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel.
| | - Gorali R
- Speech & Hearing Institute at Soroka University Medical Center, Beer-Sheba, Israel
| | - Dizitzer Y
- Center for Clinical Research, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
| | - Joshua Bz
- Otolaryngology H&N Surgery Dpt., Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
| | - Kordeliuk S
- Otolaryngology H&N Surgery Dpt., Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
| | - Novack V
- Center for Clinical Research, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
| | - Kraus M
- Otolaryngology H&N Surgery Dpt., Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
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Calcus A, Tuomainen O, Campos A, Rosen S, Halliday LF. Functional brain alterations following mild-to-moderate sensorineural hearing loss in children. eLife 2019; 8:e46965. [PMID: 31570117 PMCID: PMC6828531 DOI: 10.7554/elife.46965] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/07/2019] [Indexed: 01/10/2023] Open
Abstract
Auditory deprivation in the form of deafness during development leads to lasting changes in central auditory system function. However, less is known about the effects of mild-to-moderate sensorineural hearing loss (MMHL) during development. Here, we used a longitudinal design to examine late auditory evoked responses and mismatch responses to nonspeech and speech sounds for children with MMHL. At Time 1, younger children with MMHL (8-12 years; n = 23) showed age-appropriate mismatch negativities (MMNs) to sounds, but older children (12-16 years; n = 23) did not. Six years later, we re-tested a subset of the younger (now older) children with MMHL (n = 13). Children who had shown significant MMNs at Time 1 showed MMNs that were reduced and, for nonspeech, absent at Time 2. Our findings demonstrate that even a mild-to-moderate hearing loss during early-to-mid childhood can lead to changes in the neural processing of sounds in late childhood/adolescence.
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Affiliation(s)
- Axelle Calcus
- Laboratoire des Systèmes Perceptifs, Département d’Etudes CognitivesEcole Normale Supérieure, PSL University, CNRSParisFrance
- Department of Speech, Hearing and Phonetic SciencesUniversity College LondonLondonUnited Kingdom
| | - Outi Tuomainen
- Department of Speech, Hearing and Phonetic SciencesUniversity College LondonLondonUnited Kingdom
| | - Ana Campos
- Department of Speech, Hearing and Phonetic SciencesUniversity College LondonLondonUnited Kingdom
| | - Stuart Rosen
- Department of Speech, Hearing and Phonetic SciencesUniversity College LondonLondonUnited Kingdom
| | - Lorna F Halliday
- Department of Speech, Hearing and Phonetic SciencesUniversity College LondonLondonUnited Kingdom
- MRC Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUnited Kingdom
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25
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Olusanya BO, Davis AC, Hoffman HJ. Hearing loss grades and the International classification of functioning, disability and health. Bull World Health Organ 2019; 97:725-728. [PMID: 31656340 PMCID: PMC6796665 DOI: 10.2471/blt.19.230367] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/11/2019] [Accepted: 04/13/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Bolajoko O Olusanya
- Centre for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria
| | - Adrian C Davis
- The Ear Institute, University College London, London, England
| | - Howard J Hoffman
- Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, Bethesda, United States of America
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26
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Jatto ME, Ogunkeyede SA, Adeyemo AA, Adeagbo K, Saiki O. Mothers' perspectives of newborn hearing screening programme. Ghana Med J 2019; 52:158-162. [PMID: 30602802 DOI: 10.4314/gmj.v52i3.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Newborn hearing screening programs identifies newborns with hearing loss. The early identification enables prompt intervention through hearing rehabilitation. Accurate knowledge of the program and its benefit will impact on the uptake of the program by the citizenry. We hypothesized that there is a gap in the knowledge of parents on hearing screening and rehabilitation measures in Nigeria. Aim To determine the knowledge and perceptions of mothers of newborn children on hearing screening. Methods A cross sectional observational study among mothers of newborn children at immunization clinics. Semi structured questionnaire on gestational duration, mode of delivery, birth asphyxia, knowledge on hearing loss and newborn hearing screening were administered. Results Participants were 48 mothers with age range from 18 to 42 years. Awareness of newborn hearing screening was poor among the mothers; sources of information on newborn hearing screening were antenatal clinic, mass media and friends. The educational level of the participants had no association with awareness (p = 0.11), but the willingness to accept newborn hearing screening, was associated with socioeconomic status (p = 0.04) and the level of education (p = 0.02). The participants were not aware of factors responsible for hearing loss in childhood. Conclusion There is inadequate knowledge about newborn hearing screening and risk factors for infant hearing loss among the mothers, though they demonstrate willingness to accept the newborn hearing screening. Funding None declared.
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Affiliation(s)
- Mercy E Jatto
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria
| | - Segun A Ogunkeyede
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria
| | - Adebolajo A Adeyemo
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria.,Institute of Child Health, College of Medicine, University of Ibadan, Ibadan and University College Hospital, Ibadan, Nigeria
| | - Kazeem Adeagbo
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria
| | - Orinami Saiki
- Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria
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27
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Chu YC, Cheng YF, Lai YH, Tsao Y, Tu TY, Young ST, Chen TS, Chung YF, Lai F, Liao WH. A Mobile Phone-Based Approach for Hearing Screening of School-Age Children: Cross-Sectional Validation Study. JMIR Mhealth Uhealth 2019; 7:e12033. [PMID: 30932870 PMCID: PMC6462890 DOI: 10.2196/12033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/20/2018] [Accepted: 01/21/2019] [Indexed: 01/26/2023] Open
Abstract
Background Pure-tone screening (PTS) is considered as the gold standard for hearing screening programs in school-age children. Mobile devices, such as mobile phones, have the potential for audiometric testing. Objective This study aimed to demonstrate a new approach to rapidly screen hearing status and provide stratified test values, using a smartphone-based hearing screening app, for each screened ear of school-age children. Method This was a prospective cohort study design. The proposed smartphone-based screening method and a standard sound-treated booth with PTS were used to assess 85 school-age children (170 ears). Sound-treated PTS involved applying 4 test tones to each tested ear: 500 Hz at 25 dB and 1000 Hz, 2000 Hz, and 4000 Hz at 20 dB. The results were classified as pass (normal hearing in the ear) or fail (possible hearing impairment). The proposed smartphone-based screening employs 20 stratified hearing scales. Thresholds were compared with those of pure-tone average (PTA). Results A total of 85 subjects (170 ears), including 38 males and 47 females, aged between 11 and 12 years with a mean (SD) of 11 (0.5) years, participated in the trial. Both screening methods produced comparable pass and fail results (pass in 168 ears and fail in 2 ears). The smartphone-based screening detected moderate or worse hearing loss (average PTA>25 dB) accurately. Both the sensitivity and specificity of the smartphone-based screening method were calculated at 100%. Conclusions The results of the proposed smartphone-based self-hearing test demonstrated high concordance with conventional PTS in a sound-treated booth. Our results suggested the potential use of the proposed smartphone-based hearing screening in a school-age population.
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Affiliation(s)
- Yuan-Chia Chu
- Graduate Institute of Biomedical Electronics & Bioinformatics, National Taiwan University, Taipei, Taiwan.,Information Management Office, Taipei Veterans General Hospital, Taipei City, Taiwan.,Big Data Center, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yen-Fu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ying-Hui Lai
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Yu Tsao
- Research Center for Information Technology Innovation, Academia Sinica, Taipei, Taiwan
| | - Tzong-Yang Tu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Tzer-Shyong Chen
- Department of Information Management, Tunghai University, Taipei, Taiwan
| | - Yu-Fang Chung
- Department of Electrical Engineering, Tunghai University, Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics & Bioinformatics, National Taiwan University, Taipei, Taiwan.,Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan.,Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Wen-Huei Liao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Cedars E, Kriss H, Lazar AA, Chan C, Chan DK. Use of otoacoustic emissions to improve outcomes and reduce disparities in a community preschool hearing screening program. PLoS One 2018; 13:e0208050. [PMID: 30532159 PMCID: PMC6287830 DOI: 10.1371/journal.pone.0208050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hearing loss substantially impacts pediatric development, and early identification improves outcomes. While intervening before school-entry is critical to optimize learning, early-childhood hearing screening practices are highly variable. Conditioned play audiometry (CPA) is the gold standard for preschool hearing screening, but otoacoustic emission (OAE) testing provides objective data that may improve screening outcomes. OBJECTIVES To compare outcomes of a community-based low-income preschool hearing program before and after implementation of OAE in a single-visit, two-tiered paradigm. We hypothesized that this intervention would reduce referral rates and improve follow-up while maintaining stable rates of diagnosed sensorineural hearing loss. METHODS We performed a cohort study of 3257 children screened from July 2014-June 2016. Department of Public Health data were analyzed pre- and post-implementation of second-line OAE testing for children referred on CPA screening with targeted follow-up by DPH staff. Primary outcomes included referral rates, follow-up rates, and diagnosis of sensorineural hearing loss. RESULTS Demographics, pure-tone pass rates, and incidence of newly-diagnosed permanent hearing loss were similar across years. After intervention, overall pass rates increased from 92% to 95% (P = 0.0014), while only 0.7% remained unable to be tested (P<0.0001). 5% of children were unable to be tested by CPA screening but passed OAE testing, obviating further evaluation. Referral rate decreased from 8% to 5% (P = 0.0014), and follow-up improved from 36% to 91% (P<0.0001). Identification of pathology in children with follow-up increased from 19% to over 50%. Further, disparities in pass rates and ability to test seen in Year 1 were eliminated in Year 2. CONCLUSION AND RELEVANCE In a community setting, implementation of second-line OAE screening for CPA referrals reduced referral rates, increased identification of hearing loss, reduced outcome disparities, and improved follow-up rates. This study provides lessons in how to improve outcomes and reduce disparities in early-childhood hearing screening.
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Affiliation(s)
- Elizabeth Cedars
- University of California San Francisco, Department of Otolaryngology–Head and Neck Surgery, San Francisco, CA, United States of America
| | - Hayley Kriss
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Ann A. Lazar
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States of America
| | - Curtis Chan
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Dylan K. Chan
- University of California San Francisco, Department of Otolaryngology–Head and Neck Surgery, San Francisco, CA, United States of America
- * E-mail:
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Yimtae K, Israsena P, Thanawirattananit P, Seesutas S, Saibua S, Kasemsiri P, Noymai A, Soonrach T. A Tablet-Based Mobile Hearing Screening System for Preschoolers: Design and Validation Study. JMIR Mhealth Uhealth 2018; 6:e186. [PMID: 30355558 PMCID: PMC6231828 DOI: 10.2196/mhealth.9560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 07/13/2018] [Accepted: 07/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Hearing ability is important for children to develop speech and language skills as they grow. After a mandatory newborn hearing screening, group or mass screening of children at later ages, such as at preschool age, is often practiced. For this practice to be effective and accessible in low-resource countries such as Thailand, innovative enabling tools that make use of pervasive mobile and smartphone technology should be considered. Objective This study aims to develop a cost-effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. Methods An Android-based screening app was developed. The screening protocol involved asking children to choose pictures corresponding to a set of predefined words heard at various sound levels offered in a specifically designed sequence. For the app, the set of words was validated, and their corresponding speech power levels were calibrated. We recruited 122 children, aged 4-5 years, during the development phase. Another 63 children of the same age were screened for their hearing abilities using the app in version 2. The results in terms of the sensitivity and specificity were compared with those measured using the conventional audiometric equipment. Results For screening purposes, the sensitivity of the developed screening system version 2 was 76.67% (95% CI 59.07-88.21), and the specificity was 95.83% (95% CI 89.77-98.37) for screening children with mild hearing loss (pure-tone average threshold at 1, 2, and 4 kHz, >20 dB). The time taken for the screening of each child was 150.52 (SD 19.07) seconds (95% CI 145.71-155.32 seconds). The average time used for conventional play audiometry was 11.79 (SD 3.66) minutes (95% CI 10.85-12.71 minutes). Conclusions This study shows the potential use of a tablet-based system for rapid and mobile hearing screening. The system was shown to have good overall sensitivity and specificity. Overall, the idea can be easily adopted for systems based on other languages.
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Affiliation(s)
- Kwanchanok Yimtae
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pasin Israsena
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
| | - Panida Thanawirattananit
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sangvorn Seesutas
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
| | - Siwat Saibua
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
| | - Pornthep Kasemsiri
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anukool Noymai
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
| | - Tharapong Soonrach
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
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30
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Frizelle P, Harte J, Fletcher P, Gibbon F. Investigating the effect of regional native accents on sentence comprehension in children with language impairment. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:434-446. [PMID: 28326896 DOI: 10.1080/17549507.2017.1293734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/20/2016] [Accepted: 02/04/2017] [Indexed: 06/06/2023]
Abstract
PURPOSE Research has shown that accent variation can affect typically developing (TD) children's understanding of language, as well as that of children with speech difficulties, neuro-typical adults and those with aphasia and dementia. This study aims to investigate the effect of regional native accents on sentence comprehension in children with language impairment (LI), an area not previously explored. METHOD Forty-three children with LI (mean age 6.04) and forty-five younger TD children (mean age 4.10), matched on a measure of sentence comprehension, completed a sentence comprehension task spoken in three regional accents. Instructions were spoken in the children's local Irish accent, a neutral-Irish accent and an unfamiliar Northern-Irish (NI) accent. Instructions were adapted from the Token Test and were matched on syllable length and complexity. RESULT The two groups performed similarly overall on the task. Children had significantly greater difficulty understanding instructions spoken in the NI accent than in either of the other two accents. The ability to process accent variation was significantly associated with receptive language and phonological short term memory ability. CONCLUSIONS Variation in regional accents may be negatively impacting the performance of children on language comprehension assessments. Potential effects on diagnostic or clinical decisions will require further exploration.
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Affiliation(s)
- Pauline Frizelle
- a Department of Speech and Hearing Sciences , Brookfield Complex, University College Cork , Cork , Ireland
| | - Jennifer Harte
- a Department of Speech and Hearing Sciences , Brookfield Complex, University College Cork , Cork , Ireland
| | - Paul Fletcher
- a Department of Speech and Hearing Sciences , Brookfield Complex, University College Cork , Cork , Ireland
| | - Fiona Gibbon
- a Department of Speech and Hearing Sciences , Brookfield Complex, University College Cork , Cork , Ireland
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31
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Stenfeldt K. Preschool hearing screening in Sweden. An evaluation of current practices and a presentation of new national guidelines. Int J Pediatr Otorhinolaryngol 2018; 110:70-75. [PMID: 29859592 DOI: 10.1016/j.ijporl.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/11/2018] [Accepted: 04/14/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES As the various regional authorities responsible for health care in Sweden operate independently, no knowledge was available on pre-school hearing screening available to children living in different parts of the country. The aim of this study was to carry out a survey to ascertain how preschool hearing screening was performed in the various regions of Sweden. An objective of the present paper was also to present the uniform national guidelines for pre-school hearing screening that were launched by health authorities and were based on this study. A follow-up investigation was performed to ascertain whether the new guidelines were well accepted and followed throughout the country. METHODS A questionnaire was sent to 25 physicians responsible for child health care centers in all 21 regions throughout the whole country. The questionnaire included detailed questions on hearing screening in preschool children. New national guidelines were introduced in cooperation with health authorities and providers of preventive child health care. After two and four years, questionnaires were sent to the same recipients to determine whether changes in practice in pre-school hearing screening had been implemented, and to obtain information about experiences with the new guidelines. RESULTS Sixteen of 21 regions practiced universal hearing screening of 4-yearolds. Many different protocols were used. Professionals at child health care centers expressed a need for national guidelines for pre-school hearing screening. At the two and four-year follow-ups, one more region had introduced universal hearing screening of 4-year-olds, while two regions were planning to introduce it in 2019. The new national guidelines were well accepted and used throughout the country. CONCLUSION There was a great variability in how pre-school hearing screening was performed in Sweden. Efforts are being made to provide uniform pre-school hearing screening. Cooperation between professionals in hearing health and health authorities is needed in order to broaden the use of universal pre-school hearing screening and to implement the new national guidelines.
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Affiliation(s)
- Karin Stenfeldt
- Department of Clinical Sciences, Section of Logopedics, Phoniatrics and Audiology, Lund University, Lund, Sweden.
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32
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Pitt-Byrne T. Irish School Entry Screening referral trends and cohort comparison with preschool specialist referrals. Int J Audiol 2018; 57:510-518. [PMID: 29504414 DOI: 10.1080/14992027.2018.1437284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To analyse referral cohorts from School Entry Screening, Hearing (SHS) and Vision Screening (SVS) before and after documented changes. To compare referrals to pre-school specialists with subsequent group SHS outcomes. DESIGN Randomized cohort, audit analysis of Community Nursing Developmental and SES records (CHRs), plus Audiology file review for SHS referrals. STUDY SAMPLE Six hundred and sixty-eight mainstream pupils' CHRs were analysed in four birth cohorts, post-SES, using coded anonymized records. RESULTS Significant referral rate differences existed between SHS and SVS. SHS, not SVS, referrals were impacted by nursing staff changes but not by SHS protocol changes. Preschool Audiology referrals outnumbered SHS referrals. All PCHI children with amplification were detected prior to SHS. SHS program yielded conductive hearing loss only. Similar SHS referral rates occurred for pre-school Speech Language Therapy referrals compared to children not referred; just 16% of pre-school Speech Language Therapy primary referrals were referred on to Audiology. CONCLUSIONS SHS referral percentage fell slightly; SVS referral percentage remained unchanged. Low referral rates and low SHS hearing loss yield has modest impact upon Audiology services, but audiometrically screened referrals deserve higher priority. UNHS children born after 2011 create bigger Audiology service impact. International comparisons and European SHS research collaboration are encouraged.
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Affiliation(s)
- Theresa Pitt-Byrne
- a Department of Audiology , HSE Community Audiology Service , Wexford , Ireland
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33
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Yousuf Hussein S, Swanepoel DW, Biagio de Jager L, Mahomed-Asmail F. Knowledge and attitudes of early childhood development practitioners towards hearing health in poor communities. Int J Pediatr Otorhinolaryngol 2018; 106:16-20. [PMID: 29447884 DOI: 10.1016/j.ijporl.2017.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/21/2017] [Accepted: 12/23/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Within the educational sector of low-and middle-income countries (LMICs), formal and informal early childhood development (ECD) centers are often the first point of contact for majority of children. Since early hearing detection services are mostly absent in LMICs, these ECD centers may serve as the first point of access to screenings for these children. ECD practitioner awareness regarding hearing and hearing loss is essential for the successful implementation of hearing screening programs. This study thus investigated the current knowledge and attitudes of ECD practitioners towards childhood hearing loss in a community representative of typical LMIC contexts. METHOD Purposive sampling was used to identify ECD centers and participants across a community. Thereafter, a cross-sectional quantitative survey (23 items) was adminstered amongst 82 ECD practitioners. RESULTS More than 80% of ECD practitioners correctly identified genetics and ear infections as etiological factors of hearing loss. Gaps in knowledge regarding identification techniques for children 3-6 years of age and the impact of hearing loss in the classroom were evident. ECD personnel's duration of experience had a significant effect on overall knowledge and attitude (p < .05; F (1,53) = 8.68). ECD personnel displayed a positive attitude towards children receiving a hearing test (88.3%) and almost all participants indicated the need for more information regarding hearing loss (93.5%). CONCLUSIONS This study demonstrated a general readiness amongst ECD practitioners for the implementation of ECD hearing screening programs in LMICs, however additional information and guidelines are needed to improve practitioner knowledge and attitudes.
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Affiliation(s)
- Shouneez Yousuf Hussein
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynwood Road, Pretoria, 0001, South Africa.
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynwood Road, Pretoria, 0001, South Africa.
| | - Leigh Biagio de Jager
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynwood Road, Pretoria, 0001, South Africa
| | - Faheema Mahomed-Asmail
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Lynwood Road, Pretoria, 0001, South Africa
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Fortnum H, Ukoumunne OC, Hyde C, Taylor RS, Ozolins M, Errington S, Zhelev Z, Pritchard C, Benton C, Moody J, Cocking L, Watson J, Roberts S. A programme of studies including assessment of diagnostic accuracy of school hearing screening tests and a cost-effectiveness model of school entry hearing screening programmes. Health Technol Assess 2018; 20:1-178. [PMID: 27169435 DOI: 10.3310/hta20360] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Identification of permanent hearing impairment at the earliest possible age is crucial to maximise the development of speech and language. Universal newborn hearing screening identifies the majority of the 1 in 1000 children born with a hearing impairment, but later onset can occur at any time and there is no optimum time for further screening. A universal but non-standardised school entry screening (SES) programme is in place in many parts of the UK but its value is questioned. OBJECTIVES To evaluate the diagnostic accuracy of hearing screening tests and the cost-effectiveness of the SES programme in the UK. DESIGN Systematic review, case-control diagnostic accuracy study, comparison of routinely collected data for services with and without a SES programme, parental questionnaires, observation of practical implementation and cost-effectiveness modelling. SETTING Second- and third-tier audiology services; community. PARTICIPANTS Children aged 4-6 years and their parents. MAIN OUTCOME MEASURES Diagnostic accuracy of two hearing screening devices, referral rate and source, yield, age at referral and cost per quality-adjusted life-year. RESULTS The review of diagnostic accuracy studies concluded that research to date demonstrates marked variability in the design, methodological quality and results. The pure-tone screen (PTS) (Amplivox, Eynsham, UK) and HearCheck (HC) screener (Siemens, Frimley, UK) devices had high sensitivity (PTS ≥ 89%, HC ≥ 83%) and specificity (PTS ≥ 78%, HC ≥ 83%) for identifying hearing impairment. The rate of referral for hearing problems was 36% lower with SES (Nottingham) relative to no SES (Cambridge) [rate ratio 0.64, 95% confidence interval (CI) 0.59 to 0.69; p < 0.001]. The yield of confirmed cases did not differ between areas with and without SES (rate ratio 0.82, 95% CI 0.63 to 1.06; p = 0.12). The mean age of referral did not differ between areas with and without SES for all referrals but children with confirmed hearing impairment were older at referral in the site with SES (mean age difference 0.47 years, 95% CI 0.24 to 0.70 years; p < 0.001). Parental responses revealed that the consequences to the family of the referral process are minor. A SES programme is unlikely to be cost-effective and, using base-case assumptions, is dominated by a no screening strategy. A SES programme could be cost-effective if there are fewer referrals associated with SES programmes or if referrals occur more quickly with SES programmes. CONCLUSIONS A SES programme using the PTS or HC screener is unlikely to be effective in increasing the identified number of cases with hearing impairment and lowering the average age at identification and is therefore unlikely to represent good value for money. This finding is, however, critically dependent on the results of the observational study comparing Nottingham and Cambridge, which has limitations. The following are suggested: systematic reviews of the accuracy of devices used to measure hearing at school entry; characterisation and measurement of the cost-effectiveness of different approaches to the ad-hoc referral system; examination of programme specificity as opposed to test specificity; further observational comparative studies of different programmes; and opportunistic trials of withdrawal of SES programmes. TRIAL REGISTRATION Current Controlled Trials ISRCTN61668996. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 36. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Heather Fortnum
- National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, Hearing and Otology Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Obioha C Ukoumunne
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Chris Hyde
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Mara Ozolins
- National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, Hearing and Otology Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sam Errington
- National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, Hearing and Otology Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Zhivko Zhelev
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | | | - Claire Benton
- Nottingham Audiology Services, Nottingham University Hospitals, Nottingham, UK
| | - Joanne Moody
- Cambridgeshire Community Services, Community Child Health, Ida Darwin Hospital, Fulbourn, Cambridge, UK
| | - Laura Cocking
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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Sheikh Rashid M, Dreschler WA, de Laat JAPM. Evaluation of an internet-based speech-in-noise screening test for school-age children. Int J Audiol 2017; 56:967-975. [PMID: 28936876 DOI: 10.1080/14992027.2017.1378932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate a Dutch online speech-in-noise screening test (in Dutch: "Kinderhoortest") in normal-hearing school-age children. Sub-aims were to study test-retest reliability, and the effects of presentation type and age on test results. DESIGN An observational cross-sectional study at school. Speech reception thresholds (SRTs) were obtained through the online test in a training condition, and two test conditions: on a desktop computer and smartphone. The order of the test conditions was counterbalanced. STUDY SAMPLE Ninety-four children participated (5-12 years), of which 75 children were normal-hearing (≤25 dB HL at 0.5 kHz, ≤20 dB HL at 1-4 kHz). RESULTS There was a significant effect for test order for the two test conditions (first or second test), but not for presentation type (desktop computer or smartphone) (repeated measures analyses, F(1,75) = 12.48, p < 0.001; F(1,75) = 0.01, p = 0.982). SRT significantly improved by age year (first test: 0.25 dB SNR, 95% CI: -0.43 to -0.08, p = 0.004. Second test: 0.29 dB SNR, 95% CI: -0.46 to -0.11; p = 0.002). CONCLUSIONS The online test shows potential for routine-hearing screening of school-age children, and can be presented on either a desktop computer or smartphone. The test should be evaluated further in order to establish sensitivity and specificity for hearing loss in children.
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Affiliation(s)
- Marya Sheikh Rashid
- a Clinical and Experimental Audiology, Amsterdam Public Health Research Institute , Academic Medical Center (AMC) Amsterdam , Amsterdam , The Netherlands and
| | - Wouter A Dreschler
- a Clinical and Experimental Audiology, Amsterdam Public Health Research Institute , Academic Medical Center (AMC) Amsterdam , Amsterdam , The Netherlands and
| | - Jan A P M de Laat
- b Department of Audiology , Leiden University Medical Center , Leiden , The Netherlands
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Davies HR, Cadar D, Herbert A, Orrell M, Steptoe A. Hearing Impairment and Incident Dementia: Findings from the English Longitudinal Study of Ageing. J Am Geriatr Soc 2017; 65:2074-2081. [PMID: 28734053 PMCID: PMC5637915 DOI: 10.1111/jgs.14986] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether hearing loss is associated with incident physician-diagnosed dementia in a representative sample. DESIGN Retrospective cohort study. SETTING English Longitudinal Study of Ageing. PARTICIPANTS Adults aged 50 and older. MEASUREMENTS Cross-sectional associations between self-reported (n = 7,865) and objective hearing measures (n = 6,902) and dementia were examined using multinomial-logistic regression. The longitudinal association between self-reported hearing at Wave 2 (2004/05) and cumulative physician-diagnosed dementia up to Wave 7 (2014/15) was modelled using Cox proportional hazards regression. RESULTS After adjustment for potential confounders, in cross-sectional analysis, participants who had self-reported or objective moderate and poor hearing were more likely to have a dementia diagnosis than those with normal hearing (self-reported: odds ratio OR = 1.6, 95% CI = 1.1-2.4 moderate hearing; OR = 2.6, 95% CI = 1.7-3.9 poor hearing, objective: OR = 1.6, 95% CI = 1.0-2.8 moderate hearing; OR = 4.4, 95% CI = 1.9-9.9 poor hearing). Longitudinally, the hazard of developing dementia was 1.4 (95% CI = 1.0-1.9) times as high in individuals who reported moderate hearing and 1.6 (95% CI = 1.1-2.0) times as high in those who reported poor hearing. CONCLUSION Older adults with hearing loss are at greater risk of dementia than those with normal hearing. These findings are consistent with the rationale that correction of hearing loss could help delay the onset of dementia, or that hearing loss itself could serve as a risk indicator for cognitive decline.
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Affiliation(s)
- Hilary R Davies
- Institute of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Dorina Cadar
- Institute of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Annie Herbert
- Institute of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Steptoe
- Institute of Epidemiology and Public Health, University College London, London, United Kingdom
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Ukoumunne OC, Hyde C, Ozolins M, Zhelev Z, Errington S, Taylor RS, Benton C, Moody J, Cocking L, Watson J, Fortnum H. A directly comparative two-gate case-control diagnostic accuracy study of the pure tone screen and HearCheck screener tests for identifying hearing impairment in school children. BMJ Open 2017; 7:e017258. [PMID: 28701413 PMCID: PMC5541595 DOI: 10.1136/bmjopen-2017-017258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study directly compared the accuracy of two audiometry-based tests for screening school children for hearing impairment: the currently used test, pure tone screen and a device newly applied to children, HearCheck Screener. DESIGN Two-gate case-control diagnostic test accuracy study. SETTING AND PARTICIPANTS Hearing impaired children ('intended cases') aged 4-6 years were recruited between February 2013 and August 2014 from collaborating audiology services. Children with no previously identified impairment ('intended controls') were recruited from Foundation and Year 1 of schools between February 2013 and June 2014 in central England. The reference standard was pure tone audiometry. Tests were administered at Nottingham Hearing Biomedical Research Unit or, for some intended cases only, in the participant's home. MAIN OUTCOME MEASURES Sensitivity and specificity of the pure tone screen and HearCheck tests based on pure tone audiometry result as reference standard. RESULTS 315 children (630 ears) were recruited; 75 from audiology services and 240 from schools. Full test and reference standard data were obtained for 600 ears; 155 ears were classified as truly impaired and 445 as truly hearing based on the pure tone audiometry assessment. Sensitivity was estimated to be 94.2% (95% CI 89.0% to 97.0%) for pure tone screen and 89.0% (95% CI 82.9% to 93.1%) for HearCheck (difference=5.2% favouring pure tone screen; 95% CI 0.2% to 10.1%; p=0.02). Estimates for specificity were 82.2% (95% CI 77.7% to 86.0%) for pure tone screen and 86.5% (95% CI 82.5% to 89.8%) for HearCheck (difference=4.3% favouring HearCheck; 95% CI0.4% to 8.2%; p=0.02). CONCLUSION Pure tone screen was better than HearCheck with respect to sensitivity but inferior with respect to specificity. As avoiding missed cases is arguably of greater importance for school entry screening, pure tone screen is probably preferable in this context. STUDY REGISTRATION NUMBER Current controlled trials: ISRCTN61668996.
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Affiliation(s)
- Obioha C Ukoumunne
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Chris Hyde
- Institute of Health Research, University of Exeter Medical School Luke’s Campus, Exeter, UK
| | - Mara Ozolins
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Zhivko Zhelev
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Sam Errington
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School Luke’s Campus, Exeter, UK
| | - Claire Benton
- Nottingham Audiology Services, Nottingham University Hospitals, Nottingham, UK
| | - Joanne Moody
- Community Child Health, Ida Darwin Hospital, Fulbourn, Cambridge, UK
| | - Laura Cocking
- Peninsula Clinical Trials Unit at Plymouth University (PenCTU), Plymouth University, Plymouth, UK
| | | | - Heather Fortnum
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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Frizelle P, Harte J, O’Sullivan K, Fletcher P, Gibbon F. The relationship between information carrying words, memory and language skills in school age children with specific language impairment. PLoS One 2017; 12:e0180496. [PMID: 28672043 PMCID: PMC5495434 DOI: 10.1371/journal.pone.0180496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/16/2017] [Indexed: 11/26/2022] Open
Abstract
The receptive language measure information-carrying word (ICW) level, is used extensively by speech and language therapists in the UK and Ireland. Despite this it has never been validated via its relationship to any other relevant measures. This study aims to validate the ICW measure by investigating the relationship between the receptive ICW score of children with specific language impairment (SLI) and their performance on standardized memory and language assessments. Twenty-seven children with SLI, aged between 5;07 and 8;11, completed a sentence comprehension task in which the instructions gradually increased in number of ICWs. The children also completed subtests from The Working Memory Test Battery for children and The Clinical Evaluation of Language Fundamentals– 4. Results showed that there was a significant positive relationship between both language and memory measures and children’s ICW score. While both receptive and expressive language were significant in their contribution to children’s ICW score, the contribution of memory was solely determined by children’s working memory ability. ICW score is in fact a valid measure of the language ability of children with SLI. However therapists should also be cognisant of its strong association with working memory when using this construct in assessment or intervention methods.
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Affiliation(s)
- Pauline Frizelle
- Department of Experimental Psychology, Oxford University, Oxford, England
- * E-mail:
| | - Jennifer Harte
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | | | - Paul Fletcher
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Fiona Gibbon
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
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Van der Aerschot M, Swanepoel DW, Mahomed-Asmail F, Myburgh HC, Eikelboom RH. Affordable headphones for accessible screening audiometry: An evaluation of the Sennheiser HD202 II supra-aural headphone. Int J Audiol 2016; 55:616-22. [DOI: 10.1080/14992027.2016.1214756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mathieu Van der Aerschot
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia,
- Ear Science Institute Australia, Subiaco, Australia,
- Callier Center for Communication Disorders, University of Texas at Dallas, TX, USA, and
| | - Faheema Mahomed-Asmail
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,
| | - Herman Carel Myburgh
- Department of Electrical, Electronic and Computer Engineering, University of Pretoria, Pretoria, South Africa
| | - Robert Henry Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa,
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia,
- Ear Science Institute Australia, Subiaco, Australia,
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Govender SM, Mars M. The use of telehealth services to facilitate audiological management for children: A scoping review and content analysis. J Telemed Telecare 2016; 23:392-401. [DOI: 10.1177/1357633x16645728] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately 32 million children globally present with disabling hearing loss. Despite evidence describing the negative consequences of hearing loss, there is still a lack of hearing screening programmes in South Africa. Audiologists have been exploring the use of information and communication technologies (tele-audiology) to provide services to children and it is currently being evaluated to determine its feasibility. Aims We aim to describe tele-audiology services conducted to facilitate audiological management for children in both the rural and urban context and to determine the strengths, challenges and clinical implications of such services. Methods A scoping review was conducted by searching for peer-reviewed publications from five databases. Inclusion criteria and search strategies were outlined. Results Of the 23 studies that met the inclusion criteria, reliability of automated testing was comparable to conventional testing; however, these studies were based primarily on screening programmes. Eight (35%) of the 23 papers were concordance studies evaluating feasibility and validity of tele-audiology systems when compared with conventional testing, while one study (4%) evaluated a tele-audiology service. A further four studies (17%) evaluated the feasibility of introducing telehealth methods to evaluate middle ear pathology. Tele-auditory brainstem response was investigated in three studies (13%) and another five (22%) used smartphone and/or iPad technology to screen hearing. Only two studies (9%) evaluated the feasibility of providing intervention through telehealth methods. All included studies demonstrated improved access to and coverage of rural areas. Services such as video otoscopy and synchronous (online) hearing testing in remote areas were successfully implemented. Challenges included lack of diagnostic studies, inadequate training of staff and the need to standardize protocols and procedures in order to ensure that tele-audiology services are provided in a standardized and valid manner. Conclusion Tele-audiology services are feasible and can be useful in identifying auditory pathology for children in rural and remote areas.
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Affiliation(s)
- SM Govender
- Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - M Mars
- Discipline of Telehealth, University of KwaZulu-Natal, Durban, South Africa
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Kaplan AB, Kozin ED, Remenschneider A, Eftekhari K, Jung DH, Polley DB, Lee DJ. Amblyaudia: Review of Pathophysiology, Clinical Presentation, and Treatment of a New Diagnosis. Otolaryngol Head Neck Surg 2015; 154:247-55. [PMID: 26556464 DOI: 10.1177/0194599815615871] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 10/15/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Similar to amblyopia in the visual system, "amblyaudia" is a term used to describe persistent hearing difficulty experienced by individuals with a history of asymmetric hearing loss (AHL) during a critical window of brain development. Few clinical reports have described this phenomenon and its consequent effects on central auditory processing. We aim to (1) define the concept of amblyaudia and (2) review contemporary research on its pathophysiology and emerging clinical relevance. DATA SOURCES PubMed, Embase, and Cochrane databases. REVIEW METHODS A systematic literature search was performed with combinations of search terms: "amblyaudia," "conductive hearing loss," "sensorineural hearing loss," "asymmetric," "pediatric," "auditory deprivation," and "auditory development." Relevant articles were considered for inclusion, including basic and clinical studies, case series, and major reviews. CONCLUSIONS During critical periods of infant brain development, imbalanced auditory input associated with AHL may lead to abnormalities in binaural processing. Patients with amblyaudia can demonstrate long-term deficits in auditory perception even with correction or resolution of AHL. The greatest impact is in sound localization and hearing in noisy environments, both of which rely on bilateral auditory cues. Diagnosis and quantification of amblyaudia remain controversial and poorly defined. Prevention of amblyaudia may be possible through early identification and timely management of reversible causes of AHL. IMPLICATIONS FOR PRACTICE Otolaryngologists, audiologists, and pediatricians should be aware of emerging data supporting amblyaudia as a diagnostic entity and be cognizant of the potential for lasting consequences of AHL. Prevention of long-term auditory deficits may be possible through rapid identification and correction.
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Affiliation(s)
- Alyson B Kaplan
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Aaron Remenschneider
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | | | - David H Jung
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Daniel B Polley
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Daniel J Lee
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Cost-Effectiveness Analysis of a Mobile Ear Screening and Surveillance Service versus an Outreach Screening, Surveillance and Surgical Service for Indigenous Children in Australia. PLoS One 2015; 10:e0138369. [PMID: 26406592 PMCID: PMC4583184 DOI: 10.1371/journal.pone.0138369] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/28/2015] [Indexed: 11/28/2022] Open
Abstract
Indigenous Australians experience a high rate of ear disease and hearing loss, yet they have a lower rate of service access and utilisation compared to their non-Indigenous counterparts. Screening, surveillance and timely access to specialist ear, nose and throat (ENT) services are key components in detecting and preventing the recurrence of ear diseases. To address the low access and utilisation rate by Indigenous Australians, a collaborative, community-based mobile telemedicine-enabled screening and surveillance (MTESS) service was trialled in Cherbourg, the third largest Indigenous community in Queensland, Australia. This paper aims to evaluate the cost-effectiveness of the MTESS service using a lifetime Markov model that compares two options: (i) the Deadly Ears Program alone (current practice involving an outreach ENT surgical service and screening program), and (ii) the Deadly Ears Program supplemented with the MTESS service. Data were obtained from the Deadly Ears Program, a feasibility study of the MTESS service and the literature. Incremental cost-utility ratios were calculated from a societal perspective with both costs (in 2013–14 Australian dollars) and quality-adjusted life years (QALYs) discounted at 5% annually. The model showed that compared with the Deadly Ears Program, the probability of an acceptable cost-utility ratio at a willingness-to-pay threshold of $50,000/QALY was 98% for the MTESS service. This cost effectiveness arises from preventing hearing loss in the Indigenous population and the subsequent reduction in associated costs. Deterministic and probability sensitivity analyses indicated that the model was robust to parameter changes. We concluded that the MTESS service is a cost-effective strategy. It presents an opportunity to resolve major issues confronting Australia’s health system such as the inequitable provision and access to quality healthcare for rural and remotes communities, and for Indigenous Australians. Additionally, it may encourage effective health service delivery at a time when the healthcare funding and workforce capacity are limited.
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Walker EA, Holte L, Spratford M, Oleson J, Welhaven A, Harrison M. Timeliness of service delivery for children with later-identified mild-to-severe hearing loss. Am J Audiol 2015; 23:116-28. [PMID: 24018573 DOI: 10.1044/1059-0889(2013/13-0031)] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In this study, the authors examined diagnostic and intervention services for children identified with hearing loss (HL) after the newborn period. METHOD The authors compared ages at service delivery and length of delays between service delivery steps for 57 later-identified children with HL and 193 children who referred for assessment from the newborn hearing screen (NHS). For only later-identified children, regression models were used to investigate relationships among predictor variables and dependent variables related to service delivery. RESULTS Children who referred from the NHS received follow-up services at younger ages than later-identified children. Later-identified children had significantly longer delays from HL confirmation to entry into early intervention, compared to children who referred from the NHS. For later-identified children, degree of HL predicted ages at follow-up clinical services. Children with more severe HL received services at younger ages compared to children with milder HL. Gender predicted the length of the delay from confirmation to entry into early intervention, with girls demonstrating shorter delays. CONCLUSIONS The current results lend support to the need for ongoing hearing monitoring programs after the neonatal period, particularly when children enter early intervention programs because of language/developmental delays.
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Prieve BA, Schooling T, Venediktov R, Franceschini N. An Evidence-Based Systematic Review on the Diagnostic Accuracy of Hearing Screening Instruments for Preschool- and School-Age Children. Am J Audiol 2015; 24:250-67. [PMID: 25760393 DOI: 10.1044/2015_aja-14-0065] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/01/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this article is to conduct an evidence-based systematic review on the accuracy of pure-tone or otoacoustic emission (OAE) screening for identifying hearing loss in preschool- and school-age children. METHOD A systematic search of the literature published between 1975 and 2013 was conducted. Articles meeting the selection criteria were critically appraised for quality. Selection criteria required that behavioral thresholds be measured in children failing the screen and in at least a subset of children passing the screen. Sensitivity and specificity were used to calculate positive and negative likelihood ratios that could be compared between instruments. RESULTS Eighteen studies were included in the final analysis. There was considerable variability among studies on stimulus levels, response criteria, and definition of hearing loss. Approximately half of positive and negative likelihood ratio pairs for OAEs (52%) and pure-tone screening (45%) were considered suggestive or informative for identifying hearing loss. CONCLUSIONS Both pure-tone and OAE screening can identify hearing loss in preschool- and school-age children. Studies that compared both tools in the same population concluded that pure-tone screening had higher sensitivity than OAE screening and thus was considered the preferred tool. Future research should incorporate standard stimulus levels, response criteria, and definitions of hearing loss.
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Botasso M, Sanches SGG, Bento RF, Samelli AG. Teleaudiometry as a screening method in school children. Clinics (Sao Paulo) 2015; 70:283-8. [PMID: 26017796 PMCID: PMC4418376 DOI: 10.6061/clinics/2015(04)11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/27/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare the efficacy and feasibility of teleaudiometry with that of sweep audiometry in elementary school children, using pure-tone audiometry as the gold standard. METHODS A total of 243 students with a mean age of 8.3 years participated in the study. Of these, 118 were boys, and 125 were girls. The following procedures were performed: teleaudiometry screening with software that evaluates hearing at frequencies of 1,000, 2000 and 4000 Hz at 25 dBHL; sweep audiometry screening in an acoustic booth (20 dBHL at the same frequencies); pure-tone audiometry thresholds in an acoustic booth (frequencies of 500, 1000, 2000 and 4000 Hz); and acoustic immittance measurements. RESULTS The diagnostic capacities of the teleaudiometry/sweep audiometry screening methods were as follows: sensitivity ϝ 58%/65%; specificity ϝ 86%/99%; positive predictive value ϝ 51%/91%; negative predictive value ϝ 89%/92%; and accuracy ϝ 81%/92%. Teleaudiometry and sweep audiometry showed moderate agreement. Furthermore, the use of these methods in series with immittance testing improved the specificity, whereas parallel testing improved the sensitivity. CONCLUSION Teleaudiometry was found to be reliable and feasible for screening hearing in school children. Moreover, teleaudiometry is the preferred method for remote areas where specialized personnel and specific equipment are not available, and its use may reduce the costs of hearing screening programs.
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Affiliation(s)
- Maine Botasso
- Faculdade de Medicina da Universidade de São Paulo, Department of Physiotherapy, Communications Sciences and Disorders and Occupacional Therapy, São Paulo/SP, Brazil
| | - Seisse Gabriela Gandolfi Sanches
- Faculdade de Medicina da Universidade de São Paulo, Department of Physiotherapy, Communications Sciences and Disorders and Occupacional Therapy, São Paulo/SP, Brazil
| | - Ricardo Ferreira Bento
- Faculdade de Medicina da Universidade de São Paulo, Department of Ophthalmology and Otorhinolaryngology, São Paulo/SP, Brazil
| | - Alessandra Giannella Samelli
- Faculdade de Medicina da Universidade de São Paulo, Department of Physiotherapy, Communications Sciences and Disorders and Occupacional Therapy, São Paulo/SP, Brazil
- E-mail:
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Dodd-Murphy J, Murphy W, Bess FH. Accuracy of school screenings in the identification of minimal sensorineural hearing loss. Am J Audiol 2014; 23:365-73. [PMID: 25088976 DOI: 10.1044/2014_aja-14-0014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The goal of this study was to investigate how the use of a 25 dB HL referral criterion in school screenings affects the identification of hearing loss categorized as minimal sensorineural hearing loss (MSHL). METHOD A retrospective study applied screening levels of 20 and 25 dB HL at 1000, 2000, and 4000 Hz in each ear to previously obtained pure-tone thresholds for 1,475 school-age children. In a separate prospective study, 1,704 children were screened at school under typical conditions, and a subsample had complete audiological evaluations. Referral rates, sensitivity, and specificity were calculated for each screening level. RESULTS Referral rates varied by grade and criterion level, with comparable results between the two data sets. In both studies, when the screening level increased, the sensitivity to MSHL declined markedly, whereas specificity increased in the prospective study. CONCLUSIONS Screening at 25 dB yields poor sensitivity to MSHL. Converging evidence from these diverse populations supports using the 20 dB level to help identify MSHL. Multistage screening is recommended to limit referral rates. Even at 20 dB HL, cases of MSHL may be missed. Audiologists should encourage parents, educators, and speech–language pathologists to refer children suspected of hearing difficulty for complete audiological evaluations even if they pass school screenings.
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Affiliation(s)
| | | | - Fred H. Bess
- Vanderbilt Bill Wilkerson Center, Vanderbilt University School of Medicine, Nashville, TN
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Swanepoel DW, Myburgh HC, Howe DM, Mahomed F, Eikelboom RH. Smartphone hearing screening with integrated quality control and data management. Int J Audiol 2014; 53:841-9. [DOI: 10.3109/14992027.2014.920965] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Willis S, Goldbart J, Stansfield J. The strengths and weaknesses in verbal short-term memory and visual working memory in children with hearing impairment and additional language learning difficulties. Int J Pediatr Otorhinolaryngol 2014; 78:1107-14. [PMID: 24803399 DOI: 10.1016/j.ijporl.2014.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 04/12/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare verbal short-term memory and visual working memory abilities of six children with congenital hearing-impairment identified as having significant language learning difficulties with normative data from typically hearing children using standardized memory assessments. METHODS Six children with hearing loss aged 8-15 years were assessed on measures of verbal short-term memory (Non-word and word recall) and visual working memory annually over a two year period. All children had cognitive abilities within normal limits and used spoken language as the primary mode of communication. The language assessment scores at the beginning of the study revealed that all six participants exhibited delays of two years or more on standardized assessments of receptive and expressive vocabulary and spoken language. RESULTS The children with hearing-impairment scores were significantly higher on the non-word recall task than the "real" word recall task. They also exhibited significantly higher scores on visual working memory than those of the age-matched sample from the standardized memory assessment. CONCLUSIONS Each of the six participants in this study displayed the same pattern of strengths and weaknesses in verbal short-term memory and visual working memory despite their very different chronological ages. The children's poor ability to recall single syllable words in relation to non-words is a clinical indicator of their difficulties in verbal short-term memory. However, the children with hearing-impairment do not display generalized processing difficulties and indeed demonstrate strengths in visual working memory. The poor ability to recall words, in combination with difficulties with early word learning may be indicators of children with hearing-impairment who will struggle to develop spoken language equal to that of their normally hearing peers. This early identification has the potential to allow for target specific intervention that may remediate their difficulties.
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Affiliation(s)
- Suzi Willis
- Health Professions Department, Speech Pathology & Therapy, Manchester Metropolitan University, Manchester, UK.
| | - Juliet Goldbart
- Health Professions Department, Speech Pathology & Therapy, Manchester Metropolitan University, Manchester, UK
| | - Jois Stansfield
- Health Professions Department, Speech Pathology & Therapy, Manchester Metropolitan University, Manchester, UK
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Adlard N, Kinghorn P, Frew E. Is the UK NICE "reference case" influencing the practice of pediatric quality-adjusted life-year measurement within economic evaluations? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:454-461. [PMID: 24969007 DOI: 10.1016/j.jval.2014.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/03/2014] [Accepted: 02/17/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To report findings from a systematic review, this article sought to address two related questions. First, how has the practice of UK pediatric cost-utility analyses evolved over time, in particular how are health-related outcomes assessed and valued? Second, how do the methods compare to the limited guidance available, in particular, the National Institute for Health and Care Excellence (NICE) reference case(s)? METHODS Electronic searches of MEDLINE, Embase, and Cochrane databases were conducted for the period May 2004 to April 2012 and the Paediatric Economic Database Evaluation database for the period May 2004 to December 2010. Identified studies were screened by three independent reviewers. RESULTS Forty-three studies were identified, 11 of which elicit utility values through primary research. A discrepancy was identified between the methods used for outcome measurement and valuation and the methods advocated within the NICE reference case. Despite NICE recommending the use of preference-based instruments designed specifically for children, most studies that were identified had used adult measures. In fact, the measurement of quality-adjusted life-years is the aspect of economic evaluation with the greatest amount of variability and the area that most digressed from the NICE reference case. CONCLUSIONS Recommendations stemming from the review are that all studies should specify the age range of childhood and include separate statements of perspective for costs and effects as well as the reallocation of research funding away from systematic review studies toward good quality primary research measuring utilities in children.
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Affiliation(s)
- Nick Adlard
- Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, Edgbaston, UK
| | - Philip Kinghorn
- Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, Edgbaston, UK.
| | - Emma Frew
- Health Economics Unit, School of Health & Population Sciences, University of Birmingham, Birmingham, Edgbaston, UK
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Akinpelu OV, Peleva E, Funnell WRJ, Daniel SJ. Otoacoustic emissions in newborn hearing screening: a systematic review of the effects of different protocols on test outcomes. Int J Pediatr Otorhinolaryngol 2014; 78:711-7. [PMID: 24613088 DOI: 10.1016/j.ijporl.2014.01.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/17/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Otoacoustic emission (OAE) tests are currently used to screen newborns for congenital hearing loss in many Universal Newborn Hearing Screening programs. However, there are concerns about high referral and false-positive rates. Various protocols have been used to address this problem. The main objective of this review is to determine the effects of different screening protocols on the referral rates and positive predictive values (PPV) of the OAE newborn screening test. METHODS Eligible studies published in English from January 1990 until August 2012 were identified through searches of MEDLINE, Medline In-Process, Embase, PubMed (NCBI), ISI Web of Science, and the Cochrane Central Register of clinical controlled trials. Two reviewers independently screened the data sources, using pre-defined inclusion criteria to generate a list of eligible articles. Data extracted included the number of newborns screened, age at screening, OAE pass criteria, frequencies screened, number of retests, referral rates, and the number of newborns identified with permanent congenital hearing loss. RESULTS Ten articles met the inclusion criteria, with a total of 119,714 newborn participants. The pooled referral rate was 5.5%. Individual referral rates ranged from 1.3% to 39%; the PPV from 2 to 40%. Increasing the age at initial screening and performing retests reduced the referral rate. Likewise, screenings involving higher frequencies had lower referral rates. CONCLUSION Delaying newborn hearing screening improves test results but may not be practical in all contexts. The use of higher frequencies and more sophisticated OAE devices may be useful approaches to ensure better performance of the OAE test in newborn hearing screening.
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Affiliation(s)
- Olubunmi V Akinpelu
- McGill Auditory Sciences Laboratory, McGill University, Montréal, QC, Canada
| | - Emilia Peleva
- McGill Auditory Sciences Laboratory, McGill University, Montréal, QC, Canada
| | - W Robert J Funnell
- McGill Auditory Sciences Laboratory, McGill University, Montréal, QC, Canada; Department of BioMedical Engineering, McGill University, Montréal, QC, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montréal, QC, Canada
| | - Sam J Daniel
- McGill Auditory Sciences Laboratory, McGill University, Montréal, QC, Canada; Department of Otolaryngology - Head and Neck Surgery, McGill University, Montréal, QC, Canada.
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