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J Am Acad Audiol 2018; 29(06): 495-502
DOI: 10.3766/jaaa.16155
Articles
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Objective Hearing Screening Measures: An Exploration of a Suitable Combination for Risk-Based Newborn Hearing Screening

Amisha Kanji
*   Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
,
Katijah Khoza-Shangase
*   Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
› Author Affiliations
Further Information

Publication History

Publication Date:
29 May 2020 (online)

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Abstract

Background:

The ideal hearing screening measure is yet to be defined, with various newborn hearing screening protocols currently being recommended for different contexts. Such diverse recommendations call for further exploration and definition of feasible and context-specific protocols.

Purpose:

The aim of the study was to establish which combinations of audiological screening measures provide both true-positive (TP) and true-negative (TN) results for risk-based hearing screening, at and across time.

Research Design:

A longitudinal, repeated-measures design was employed.

Study Sample:

Three-hundred and twenty-five participants comprised the initial study sample. These participants comprised newborns and infants who were discharged from the neonatal intensive care unit and high care wards to “step down” wards at two public sector hospitals within an academic hospital complex.

Data Collection and Analysis:

Transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and automated auditory brainstem response (AABR) were conducted at the initial and repeat hearing screening. Diagnostic audiological assessments were also conducted. Results from combinations of audiological screening measures at the initial and repeat hearing screening were analyzed in relation to the final diagnostic outcome (n = 91). Participants were classified as presenting with an overall “refer” if the outcome for any one test was “refer.” The overall screening outcomes for different test combinations were compared using McNemar’s test for paired data. Proportions across different test combinations were compared by the z-test for proportions.

Results:

Because of the absence of participants with hearing loss in the current study sample, analysis could only be conducted in relation to TN findings (specificity) and not TP findings (sensitivity). The percentage of TN findings was highest at the repeat hearing screening using any test or combination of tests when compared with findings from the initial hearing screening. TEOAE combined with AABR (TEOAE/AABR) (p < 0.0001), DPOAE combined with AABR (DPOAE/AABR) (p < 0.0001), and the combination of all three screening measures (p < 0.0001) yielded the highest percentage specificity at the repeat hearing screening when compared with the initial hearing screening.

Conclusions:

The best specificity was noted at the repeat hearing screening. Within a resource stricken context, where availability of all screening measures options may not be feasible, current study findings suggest the use of a two-stage AABR protocol or TEOAE/AABR protocol.

Key Words

AABR - DPOAE - hearing - measures - newborn - objective - risk-based - screening - South Africa - TEOAE

This article was presented as a poster presentation at the Hearing across the Lifespan Conference, Lake Como, Italy, June 2–4, 2016.


This work is based on research supported, in part, by the National Research Foundation of South Africa (UNIQUE GRANT NO: 92673) and the Thuthuka Post-PhD Track Grant (TTK1206131255).


 

  • REFERENCES

  • Agresti A, Kateri M. 2011. Categorical data analysis. Heidelberg: Springer;
    Google Scholar
  • American Academy of Pediatrics, Joint Committee on Infant Hearing 2007; Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics 120 (04) 898-921
    CrossrefPubMedGoogle Scholar
  • American Speech-Language-Hearing Association (ASHA) 1997 Guidelines for Audiologic Screening. www.asha.org/policy/GL1997-00199/
    PubMedGoogle Scholar
  • American Speech-Language-Hearing Association (ASHA) 2013 Evidence-Based Systematic Review of Newborn Hearing Screening Using Behavioral Audiometric Threshold as a Gold Standard. www.asha.org/uploadedFiles/EBSR-Newborn-Hearing-Screening.pdf
    PubMedGoogle Scholar
  • Benito-Orejas JI, Ramírez B, Morais D, Almaraz A, Fernández-Calvo JL. 2008; Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs. Int J Pediatr Otorhinolaryngol 72 (08) 1193-1201
    CrossrefPubMedGoogle Scholar
  • Berg AL, Prieve BA, Serpanos YC, Wheaton MA. 2011; Hearing screening in a well-infant nursery: profile of automated ABR-fail/OAE-pass. Pediatrics 127 (02) 269-275
    CrossrefPubMedGoogle Scholar
  • Berninger E, Westling B. 2011; Outcome of a universal newborn hearing-screening programme based on multiple transient-evoked otoacoustic emissions and clinical brainstem response audiometry. Acta Otolaryngol 131 (07) 728-739
    CrossrefPubMedGoogle Scholar
  • Beswick R, Driscoll C, Kei J, Khan A, Glennon S. 2013; Which risk factors predict postnatal hearing loss in children?. J Am Acad Audiol 24 (03) 205-213
    Article in Thieme ConnectPubMedGoogle Scholar
  • British Society of Audiology (BSA) 2014 Recommended Procedure: Visual Reinformcement Audiometry. www.thebsa.org.uk/wp-content/uploads/2014/04/BSA_VRA_24June2014_Final.pdf
    PubMedGoogle Scholar
  • Can E, Verim A, Başer E, İnan N. 2015; Auditory neuropathy in late preterm infants treated with phototherapy for hyperbilirubinemia. Int J Audiol 54 (02) 89-95
    CrossrefPubMedGoogle Scholar
  • Choo D, Meinzen-Derr J. 2010; Universal newborn hearing screening in 2010. Curr Opin Otolaryngol Head Neck Surg 18 (05) 399-404
    CrossrefPubMedGoogle Scholar
  • Guastini L, Mora R, Dellepiane M, Santomauro V, Mora M, Rocca A, Salami A. 2010; Evaluation of an automated auditory brainstem response in a multi-stage infant hearing screening. Eur Arch Otorhinolaryngol 267 (08) 1199-1205
    CrossrefPubMedGoogle Scholar
  • Hall JW. 2007. New Handbook of Auditory Evoked Responses. Boston, MA: Pearson Education;
    Google Scholar
  • Hall JW, Swanepoel D. 2010. Objective Assessment of Hearing. San Diego, CA: Plural Publishing;
    Google Scholar
  • Health Professions Council of South Africa 2007 Early Hearing Detection and Intervention Programmes in South Africa, Position Statement Year 2007. www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/speech/early_hearing_detection_statement.pdf
    PubMedGoogle Scholar
  • Hergils L. 2007; Analysis of measurements from the first Swedish universal neonatal hearing screening program. Int J Audiol 46 (11) 680-685
    CrossrefPubMedGoogle Scholar
  • JCIH 2000; Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. Am J Audiol 9: 9-29
    CrossrefPubMedGoogle Scholar
  • Joint Committee on Infant Hearing (JCIH) 2008 Clarification for Year 2007 JCIH Position Statement. www.jcih.org/Clarification%20Year%202007%20statement.pdf
    PubMedGoogle Scholar
  • Martines F, Porrello M, Ferrara M, Martines M, Martines E. 2007; Newborn hearing screening project using transient evoked otoacoutic emissions: Western Sicily experience. Int J Pediatr Otorhinolaryngol 71: 107-112
    CrossrefPubMedGoogle Scholar
  • McGurgan IJ, Patil N. 2014; Neonatal hearing screening of high-risk infants using automated auditory brainstem response: a retrospective analysis of referral rates. Ir J Med Sci 183 (03) 405-410
    CrossrefPubMedGoogle Scholar
  • Moodley S, Storbeck C. 2015; Narrative review of EHDI in South Africa. S Afr J Commun Disord 62 (01) E1-E10
    PubMedGoogle Scholar
  • Olusanya BO. 2010; Ambient noise levels and infant screening programs in developing countries: an observational report. Int J Audiol 49: 535-541
    CrossrefPubMedGoogle Scholar
  • Olusanya BO, Bamigboye BA. 2010; Is discordance in TEOAE and AABR outcomes predictable in newborns?. Int J Pediatr Otorhinolaryngol 74 (11) 1303-1309
    CrossrefPubMedGoogle Scholar
  • Olusanya BO, Somefun AO, Swanepoel W. 2008; The need for standardization of methods for worldwide infant hearing screening: a systematic review. Laryngoscope 118 (10) 1830-1836
    CrossrefPubMedGoogle Scholar
  • Papacharalampous GX, Nikolopoulos TP, Davilis DI, Xenellis IE, Korres SG. 2011; Universal newborn hearing screening, a revolutionary diagnosis of deafness: real benefits and limitations. Eur Arch Otorhinolaryngol 268 (10) 1399-1406
    CrossrefPubMedGoogle Scholar
  • Salina H, Abdullah A, Mukari SZM, Azmi MT. 2010; Effects of background noise on recording of portable transient-evoked otoacoustic emission in newborn hearing screening. Eur Arch Otorhinolaryngol 267 (04) 495-499
    CrossrefPubMedGoogle Scholar
  • Sim RJ, Matthew S, Foley RJ, Robinson PJ. 2009; Initial outcomes from universal newborn hearing screening in Avon. J Laryngol Otol 123 (09) 982-989
    CrossrefPubMedGoogle Scholar
  • Theunissen M, Swanepoel D. 2008; Early hearing detection and intervention services in the public health sector in South Africa. Int J Audiol 47 (Suppl 1) S23-S29
    CrossrefPubMedGoogle Scholar
  • van Dyk M, Swanepoel W, Hall 3rd JW. 2015; Outcomes with OAE and AABR screening in the first 48 h--implications for newborn hearing screening in developing countries. Int J Pediatr Otorhinolaryngol 79 (07) 1034-1040
    CrossrefPubMedGoogle Scholar
  • World Health Organization (WHO) 2004. ICD-10: International Statistical Classification of Diseases and Related Health Problems. Vol. 2. 2nd ed. Geneva, Switzerland: World Health Organization;
    Google Scholar
  • World Health Organization (WHO) 2010 Newborn and Infant Hearing Screening. www.who.int/blindness/publications/Newborn_and_Infant_Hearing_Screening_Report.pdf
    PubMedGoogle Scholar
  • Widen JE, Folsom RC, Cone-Wesson B, Carty L, Dunnell JJ, Koebsell K, Levi A, Mancl L, Ohlrich B, Trouba S, Gorga MP, Sininger YS, Vohr BR, Norton SJ. 2000; Identification of neonatal hearing impairment: hearing status at 8 to 12 months corrected age using a visual reinforcement audiometry protocol. Ear Hear 21 (05) 471-487
    CrossrefPubMedGoogle Scholar
  • WMA 2013; WMA declaration of Helsinki - ethical principles for medical research involving human subjects. JAMA 310: 2191-2194
    CrossrefPubMedGoogle Scholar
  • Xu ZM, Cheng WX, Yang XL. 2011; Performance of two hearing screening protocols in NICU in Shanghai. Int J Pediatr Otorhinolaryngol 75 (10) 1225-1229
    CrossrefPubMedGoogle Scholar