Assessment of Hearing Loss by OAE in Asphyxiated Newborns

Assessment of Otoacoustic Emissions (OAE) in Birth Asphyxiated Neonates

One of the congenital abnormalities encountered in newborns is hearing loss. Birth hypoxia, asphyxia, and ischemia have all been implicated as primary causes of early hearing loss or deafness. Prospective study was done on neonates in NICU having APGAR scoring of < 7 in 5th minute or neonates diagnosed with birth asphyxia. OAEs were measured from both ears from 3rd to 5th day in sound-proof chamber. MRI reports of these neonates were collected and analyzed. The neonates who did not clear the 1st OAE testing further underwent a second OAE testing between 10 and 14th days. Results were further plotted. 21.9% of neonates had hearing loss. 28.1% of mothers had infections amongst which 6.3% were of hypothyroidism. 56% of neonates with normal OAE result had normal MRI findings. 71.4% of neonates showing a 'REFER' in OAE had normal MRI reports. 44% of neonates with normal OAE result had abnormal MRI report. 7 neonates who failed 1st OAE underwent secondary OAE testing after 10-14 days. 28.6% of the neonates with abnormal OAE report had abnormal MRI findings. There is no statistical correlation between OAE findings with MRI findings of the birth asphyxiated neonates. (p value = 0.671). Hence, there exists no correlation between hearing loss and birth asphyxia.

Hearing Loss Diagnosis and Early Hearing-Related Interventions in Infants With or at High Risk for Cerebral Palsy: A Systematic Review

AIM

To synthesize published evidence regarding hearing impairment diagnosis and interventions in infants with or at high risk for cerebral palsy in the first year after birth.

METHOD

Nine databases were searched for MeSH terms up to February 2020. Included studies were published in English, enrolled infants with or at high risk for cerebral palsy, and addressed hearing evaluation/rehabilitation within the first year after birth. Quality of evidence was evaluated using RTI Item Bank and QUADAS-2.

RESULTS

Eighteen articles met inclusion criteria. Quality of the evidence ranged from low to high, revealing variability in diagnostic assessment methodologies and adherence to diagnostic schedules. Concerns for bias included lack of recognition of cerebral palsy effects and etiologies on functional hearing assessment methods and results. Two interventions (hearing aid and cochlear implantation) were identified; however, reported use was inconsistent.

INTERPRETATION

Hearing screening in infants with or at high risk for cerebral palsy requires evaluation of the entire auditory pathway preferentially using comprehensive electrophysiological panels of assessments. For infants with perinatal neural insults, pediatric neurologists are uniquely positioned to recommend adherence to systematic surveillance and comprehensive audiology assessments, regardless of comorbidities and motor impairments.

Perinatal factors influencing the neonatal hearing screening results

Background

Previous studies have indicated that the majority of cases with “failed” results related to transient evoked otoacoustic emissions (OAE) test have the normal hearing. The present study aimed to assess the possible relationships between perinatal factors and the false-positive OAE results.

Methods

A case-control study was carried out in an Iranian Hospital in 2020. Based on the OAE results on the first day of life, newborns were divided into 2 groups; Control group included subjects with “Pass” OAE results. Every neonate with “Fail” OAE result was referred for auditory brainstem response (ABR). Neonates with bilateral fail OAE but normal ABR results (false-positive OAE) were considered as the case group. All recorded data were analyzed to assess the possible correlations between maternal/neonatal factors and the false-positive OAE results.

Results

One hundred and eighty-one neonates entered the study. Of all included neonates, 87 (48.1%) cases showed bilateral fail OAE and 94 (51.9%) subjects passed the OAE test. Normal ABR results (false-positive OAE) were observed in all cases with bilateral fail OAE. Comparisons of variables affecting the OAE results showed that of all perinatal factors, neonate’s sex (p = 0.046) and cesarean section (p = 0.003) were the only influencing factors that increased the risk of false-positive OAE results.

Conclusion

Based on the results, the cesarean section delivery and neonate’s male sex increased the risk of false-positive results related to OAE test. Implementing other screening tests such as ABR or Automated ABR as the initial screening test could be suggested for such cases.

Prevalence and Risk Factors for Hearing Loss in Neonates Admitted to the Neonatal Intensive Care Unit: A Hospital Study

INTRODUCTION

Hearing loss is one of the most common congenital disabilities in neonates. The aims of this study were to investigate the prevalence of hearing loss and identify the most significant risk factor in neonates hospitalized at the Neonatal Intensive Care Unit (NICU).

METHODS

This cross-sectional study involved 530 neonates admitted to NICU Abuzar Hospital with risk factors for hearing loss based on Joint Committee of Infant Hearing (JCIH). The hearing screening tests include transient evoked otoacoustic emissions (TEOAES) and the automated auditory brain stem response (AABR). For infants with abnormal AABR and TEOAE results, the Auditory Brainstem Response (ABR) and Auditory Steady-State Responses (ASSR) tests were performed.

RESULT

Of 530 infants, 27 (5.09%) were diagnosed with different types of hearing loss. Ototoxic drugs, hyperbilirubinemia requiring exchange transfusion, asphyxia, low weight birth, Apgar score < 5, and a kinship marriage of parents were significant risk factors for hearing loss in our study population.

CONCLUSION

Due to the high prevalence of hearing loss in the NICU, it is recommended that a hearing screening program be performed for all infants admitted to the NICU. Implement a comprehensive plan for neonatal hearing screening for early detection and intervention of hearing loss is essential.

Risk Factors for Sensorineural Hearing Loss Among High-Risk Infants in Golestan Province, Iran in 2010 - 2011

Background:

Hearing impairment, as one of the most common birth defects, is a hidden disability with negative impacts on speech and cognitive development.

Objectives:

The aim of this study was to assess the prevalence of sensorineural hearing loss (SNHL) and determine the associated risk factors among infants admitted to neonatal intensive care units (NICUs) and neonatal wards of teaching hospitals, affiliated to Golestan University of Medical Sciences, Gorgan, Iran.

Patients and Methods:

In this cross-sectional study, 791 infants were recruited via non-random sampling. Demographic and clinical characteristics of the subjects were gathered, and the Automated Auditory Brainstem Response (AABR) test was performed upon admission. Afterwards, the subjects were followed-up and re-assessed, using the AABR test. For infants with abnormal AABR results, the Auditory Brainstem Response (ABR) test was performed on the day of discharge.

Results:

The mean age of the infants was 3.75 ± 4.86 days upon admission, and 56.4% of the subjects were female. The mean length of hospital stay was 9.63 ± 1.1 days; the subjects were hospitalized for 3.50 ± 10.21 days in the NICUs and 6.1 ± 5.27 days in the neonatal wards. In total, 3.4% of the infants presented with SNHL. No significant difference was found between SNHL and neonates’ age (P = 0.52), sex (P = 0.5), or sepsis (P = 0.94). However, SNHL was significantly associated with gestational age (P = 0.045), birth weight (P < 0.001), length of hospital stay (P < 0.001), pathological jaundice (P=0.033), antibiotic treatments (P = 0.007), and total serum bilirubin level (P = 0.01). Additionally, binary logistic regression analysis demonstrated the association between SNHL and these factors.

Conclusions:

In this study, the prevalence of SNHL among hospitalized neonates was similar to previous reports in Iran and other countries. Based on the findings, administration of ototoxic drugs during the neonatal period can lead to SNHL. Therefore, it seems essential to regularly screen newborns under treatment and limit the indiscriminate use of ototoxic drugs.