International Journal of Pediatric Otorhinolaryngology
Newborn hearing screening project using transient evoked otoacoustic emissions: Western Sicily experience
Introduction
Hearing loss is one of the commonest disorders present at birth; the literature report a large range of childhood hearing impairment (PCHI) from 0.7 to 4.2/1000 live births [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]; it is probably due to many elements that each author studied:
- •
unilateral or bilateral hearing loss;
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severity of hearing loss;
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age, sex, ethnicity and socio-economic status in a particular population;
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presence in the group observed of prenatal and perinatal risk factors.
However, it should be mentioned that if we considered all the newborns to estimate the PCHI incidence, this value should be underestimated.
It has long been believed that an earlier identification of hearing impairment must lead to better outcomes, and currently there is a reliable evidence that this is the case in the domains of communication, educational achievement and quality of life [17], [18], [19], [20].
The reason of this way of thinking is founded on the fact that although the development of the cochlea is almost complete at birth the inner ear active mechanisms need a further maturation, a process which is related to and dependent upon auditory stimulation [21]. Thus a congenital permanent hearing impairment (PHI) is likely to result in physiological deprivation unless compensated and may result in insufficient development of the central auditory structures [22], [23].
Knowledge on the prevalence of congenital permanent childhood hearing impairment, as well as later acquired HI, forms the basis for the planning and provision of paediatric hearing health services and it is a strict requirement for the introduction of hearing screening as a public health matter.
Usually screening can be regarded as a specific medical intervention with the aim of detecting disease or a certain health condition in individuals who are not primarily suspected of having them [24]. In contrast to the usual diagnostic interventions, which are carried out when a condition is suspected or known to exist, screening is applied to a population regarded primarily as healthy; in our case the neonatal hearing screening procedure must be able to detect with adequate certainty the congenital hearing loss;
The American National Institutes of Health Consensus Statement [25] and more recently the European Consensus Statement [26] recommended the implementation of universal screening before 3 months of life.
Technological developments have led to the worldwide introduction of universal neonatal screens for hearing impairment so that the three techniques of evoked otoacoustic emissions (EOAES), automated auditory brainstem response (AABR) and a combination [27], [28], [29], [30], have now been accepted by Universal Newborn Hearing Screening (UNHS). All this techniques, that had many problems in the beginning, were developed by training and modifications of their own protocols.
Advantages of screening by TEOAES include [31]:
- 1.
a sophisticated examiner is not required to administer the test,
- 2.
actual testing time per infant ranges from 1 to 5 min,
- 3.
acoustic stimuli is non-invasive and costs less than use of disposable electrodes and ear cushions.
Screening tests do not identify deafness but underline those individuals who demonstrate a greater probability of having a hearing loss so they may be further evaluated to determine if a hearing impairment does exist, and if so, its extent. Furthermore, false-positive and false-negative results are inevitable in any economically feasible procedure.
The aim of this work is to develop a neonatal screening, based on transient evoked otoacoustic emissions (TEOAES), introducing a screen test with a low-cost protocol and need no medical control, increasing options for successful treatment.
Section snippets
Material and methods
To reduce the number of the fugitives and to have an adequate coverage (percentage of the target population who undergo the screen), we though to begin this screening program in a province (Sciacca) in which there is only a paediatric unit; the families of the babies who were born in others hospitals were informed by paediatrics about this study and decided to undergo or not undergo OAES screening.
The study was conducted in Sciacca hospital from the beginning of 2003 to our days and it was
Results
In the years 2003–2004 the number of the newborns in the Sciacca hospital was 1191 and of all 1068 underwent screening; all the infants were divided in three groups:
- (1)
resident in Sciacca;
- (2)
resident in Sciacca borderlands;
- (3)
resident out of the district of Sciacca (Table 2).
In the 2003 the newborns born in the hospital of Sciacca were 538 and the number of infants whose underwent screening was 483 (90%) with a 10% (55 neonates) of escaped.
In the 2004 the number of newborns born in the hospital of
Discussion and conclusions
Universal newborn hearing screening results in earlier diagnosis of hearing loss. The diagnosis of hearing loss within the first few months of life allows the opportunity to begin early intervention services for families with infants.
Yoshinaga-Itano, Coulter and Thomson in a study of 294 children with congenital hearing loss, found that children born in a Colorado hospital which had a newborn hearing screening program were identified earlier than those born in hospitals without UNHS programs.
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Newborn hearing screening protocols and their outcomes: A systematic review
2018, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :TEOAEs have however been reported to be the most common screening measure in NHS programmes worldwide as they are easier to conduct, have a shorter test time and are considered less expensive in terms of the need for consumables [16]. Repeated use of TEOAEs within a multi-stage screening protocol has also been reported to aid in reducing the number of more expensive, secondary level evaluations [2,17,18]. Berninger and Westling [2] also found that the specificity of TEOAE measurements increased with repeated TEOAE screening.
Speech perception outcomes after cochlear implantation in prelingually deaf infants: The Western Sicily experience
2013, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Among CI users’ characteristics instead, only daily CI use (85.71% of the cohort) resulted an important predictor of good speech improvement (p < 0.0001). Considering the high percentage (44.68%) of profound SNHL in Western Sicily, mainly related to genetic causes, it is clear that several children, who do not benefit from hearing aids, could be candidates to cochlear implantation [17–20]. Many studies have demonstrated that CI is a suitable method to manage profound SNHL in children; however, because of a high variability in speech performances among CI users, several studies were conducted to identify the main significant predictors of cochlear implantation outcomes [1,2,5,7,8,11–13,16,26–36].
Prelingual sensorineural hearing loss and infants at risk: Western Sicily report
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Audiologic profile of infants at risk: Experience of a Western Sicily tertiary care centre
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2012, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Aim project was also to develop an easy and suitable screening programme comfortable with the current objective hearing screening technologies, with high sensitivity (the proportion of the children tested with a specified condition, detected by the screening protocol) and specificity (the proportion of the children tested who do not have a specified condition who are correctly identified by the screen protocol) reducing both the number of more expensive secondary level exams and the workload of the only third level speech and hearing centre present in Western Sicily that represent the effectiveness of UNHS recommended by JCIH [2]. This study was carried out by the Department of Audiology, University of Palermo, together with the District of Sciacca, screening all the newborns of Sciacca hospital from January 2003 to date [12]. The District of Sciacca was chosen for the screening because in this province there is only a paediatric unit and the percentage of eligible newborns that were screened before hospital discharge or within the first month of life could have been, according to quality benchmarks of JCIH, >90%.
Newborn hearing screening: An outpatient model
2009, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :The outpatient model incorporates infant hearing screening into a return visit to a health care facility. Implementation of outpatient models along these lines has been conducted in South Africa [7] and Italy [13], where the initial screening was performed after discharge from the hospital in a cost-effective effort to increase the number of babies receiving hearing screening before the age of 3 months. The purpose of this study was to assess the feasibility of implementing an outpatient model of an NHS program in the city of Recife.