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Identification of neonatal hearing impairment: hearing status at 8 to 12 months corrected age using a visual
J E Widen1, R C Folsom, B Cone-Wesson
1Multicenter Consortium on Identification of Neonatal Hearing Impairment, Seattle, Washington, USA.
Insights
This study evaluated hearing in at-risk infants using visual reinforcement audiometry (VRA). Most infants showed normal hearing, with a small percentage experiencing mild to moderate hearing impairment.
Area of Science:
- Pediatric audiology
- Neonatal hearing screening
Background:
- Infant hearing impairment is a significant concern.
- Early identification and intervention are crucial for developmental outcomes.
Purpose of the Study:
- To determine the hearing status of at-risk infants at 8-12 months corrected age.
- To describe the visual reinforcement audiometry (VRA) protocol used for data collection.
Main Methods:
- A cohort of at-risk infants (NICU graduates and well-babies with risk factors) were followed.
- Visual reinforcement audiometry (VRA) was used to assess hearing thresholds for speech and pure tones (1-4 kHz).
- Data were collected for 3,134 infants using a standardized VRA protocol.
Main Results:
- Over 95% of infants were reliably tested with VRA.
- 94% of at-risk infants demonstrated normal hearing sensitivity in both ears.
- 2.2% had bilateral hearing impairment, and 3.4% had unilateral impairment; most losses were mild-to-moderate.
Conclusions:
- VRA is a feasible method for obtaining behavioral hearing data in infants.
- This study provides valuable data on the hearing status of at-risk infants at one year of age.
- The findings support the validation of newborn hearing screening methods.
Objectives:
1) To describe the hearing status of the at-risk infants in the National Institutes of Health-Identification of Neonatal Hearing Impairment study sample at 8 to 12 mo corrected age (chronologic age adjusted for prematurity). 2) To describe the visual reinforcement audiometry (VRA) protocol that was used to obtain monaural behavioral data for the sample.
Design:
All neonatal intensive care unit infants and well babies with risk factors (including well babies who failed neonatal tests) were targeted for follow-up behavioral evaluation once they had reached 8 mo corrected age. Three thousand one hundred and thirty-four (64.4%) of the 4868 surviving infants returned for at least one behavioral hearing evaluation, which employed a well-defined VRA protocol. VRA thresholds or minimum response levels (MRLs) were determined for speech and pure tones of 1.0, 2.0, and 4.0 kHz for each ear using insert earphones.
Results:
More than 95% of the infants were reliably tested with the VRA protocol; 90% provided complete tests (four MRLs for both ears). Ninety-four percent of the at-risk infants were found to have normal hearing sensitivity (MRLs of 20 dB HL) at 1.0, 2.0, and 4.0 kHz in both ears. Of the infants, 2.2% had bilateral hearing impairment, and 3.4% had impairment in one ear only. More than 80% of the impaired ears had losses of mild-to-moderate degree.
Conclusions:
This may be the largest study to attempt to follow all at-risk infants with behavioral audiometric testing, regardless of screening outcome, in an effort to validate the results of auditory brain stem response, distortion product otoacoustic emission, and transient evoked otoacoustic emission testing in the newborn period. It is one of only a few studies to report hearing status of infants at 1 yr of age, using VRA on a clinical population. Successful testing of more than 95% of the infants who returned for the VRA follow-up documents the feasibility of obtaining monaural behavioral data in this population.