Hearing screening in a tertiary care hospital in India

Comparison of Otoacoustic Emission (OAE) and Brainstem Evoked Response Audiometry (BERA) in High Risk Infants and Children under 5 Years of Age for Hearing Assessment in Western India: A Modification in Screening Protocol

There are very few studies from India, which have compared Otoacoustic Emission (OAE) and Brainstem Evoked Response Audiometry (BERA) as a screening modality for detection of hearing loss in children. With the aim of establishing some guidelines regarding the protocols for hearing loss assessment and preventive measures, the present study has been undertaken to compare OAE with BERA done simultaneously, in the diagnosis of paediatric hearing loss, and also to study associated risk factors for hearing loss in children of Rural Central India. Prospective observational study was carried out on 100 children (200ears) in age group of 0-5 years. Selection was based on the inclusion and exclusion criteria. In all the 100 children detailed history was taken from the parents and were subjected to distortion product otoacoustic emissions (DPOAE). Irrespective of the pass or refer result children were subjected for BERA test. The interpretation of OAE and BERA test was as follows. Both the results of OAE refer and BERA fail were considered as confirmed HL, OAE pass and BERA fail were considered as children having Auditory Neuropathy (AN), OAE refer and BERA pass were considered as children at risk of permanent hearing loss (HL), OAE pass and BERA pass were considered as children with no evidence of HL. In the present study the male to female ratio was 1.32:1. Of the total 100 children 80% children showed presence of any one or more than one risk factors. In our study, eclampsia [7%] followed by multiparity [6%] and oligohydramnios [5%] were the most common risk factors in prenatal period. Maximum number of infants in AN profile were with Low Apgar score, children exposed to ototoxic medications, non-syndromic cardiac disorders in children [25.8% each]. Maximum number of infants in Confirmed HL profile were with congenital syndromes/ear anomalies [41.86%] followed by other risk factors. In our study, both OAE and BERA test were comparable and statistically significant with p value of 0.0001. OAE has a high specificity and positive predictive value of 93.33% and 97.22% respectively and it has a low sensitivity and negative predictive value of 67.74% and 45.65% respectively. In a developing country like India were universal screening protocols are not followed large number of children may be missed and may present late when it affects child's communication abilities. Hence, we need to modify our screening test and implement high risk screening even in the absence of any hearing or speech complaints.

The Clinical–Audiological Cross Sectional Study of Deaf-Mute Patients in a Tertiary Care Centre of Uttarakhand State and Literature Review

Deafmutism affects communication and wholesome development of an individual. India has a significant burden of deafness in the country. Even fourteen years after the launch of a National Program for Prevention and Control of Deafness in year 2006, we lack detailed data about the disability from most regions of the country. This study aims at finding out the prevalence, clinical history-examination and audiological profile of deaf-mute patients visiting the Out Patient Department (OPD) of a tertiary care institute in Uttarakhand, and compare the results with similar studies published during last 20 years from India to generate a literature review. Out of 46,049 patients that visited OPD of the institute during the given period of 24 months, 73 cases were short-listed clinically to be enrolled in the study. However, only 55 (75%) of them completed the questionnaire and audiological testing. All information was extracted from the patients/relatives with the help of a questionnaire in the Hindi language. The prevalence of deafmutism in patient presenting in our OPD in the study period was 0.3%. The history of pre-, peri- and post-natal risk factors was present in high percentage (58.2%, 78.2% and 34.5% respectively) of patients. This warrants review of our maternal and child healthcare strategies. The literature review revealed lack of uniform and standardized tool in conducting and reporting of studies on deafmutism. The questionnaire used in this study can be further improved and modified in the future as per the requirements of data collection.

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

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

Screening of Newborn Hearing at a Tertiary Care Hospital in South India

Hearing loss can have a devastating impact on the cognitive development and psychological well-being of children and their families. Newborn hearing screening should be given special attention especially in a country like ours where the burden of this disability is heavy. Screening all newborns irrespective of risk factors helps in better detection, and hence further management can be initiated at appropriate time. To implement newborn hearing screening at Vanivilas hospital and to estimate the incidence of hearing loss among the high risk groups. To create awareness about the need for detecting childhood deafness among parents and general population. To develop a centre of excellence for evaluation, intervention and rehabilitation for hearing impaired in a tertiary care hospital. Prospective study. All neonates born in Vanivilas Hospital attached to Bangalore Medical College and Research Institute underwent hearing screening using four stage protocols with otoacoustic emission (OAE) tests and final confirmation with Brainstem evoked response audiometry (BERA) tests. May 2015-May 2017. Number of newborns screened were 26,487, and 19 (0.717/1000) newborns were detected to have hearing impairment. The incidence of hearing loss among high risk group was 0.188/1000, and among the non risk group was 0.528/1000. Newborn hearing screening must be made mandatory and multi-staged protocol based screening for hearing loss should be implemented. This will make newborn screening programme more efficient and also will help in initiating treatment at an early stage so that further damage can be prevented.