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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Identification of neonatal hearing impairment: summary and recommendations
S J Norton1, M P Gorga, J E Widen
1Multi-Center Consortium on Identification of Neonatal Hearing Impairment, Seattle, Washington, USA.
Insights
Transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brain stem responses (ABRs) effectively predict neonatal hearing impairment. These auditory system measures demonstrated robustness across various infant conditions, aiding in early identification of hearing loss.
Area of Science:
- Neonatal audiology
- Hearing impairment screening
- Auditory system assessment
Background:
- Neonatal hearing impairment affects a significant number of infants.
- Early identification and intervention are crucial for optimal developmental outcomes.
- Reliable screening methods are needed to assess peripheral auditory system status in newborns.
Purpose of the Study:
- To evaluate the performance of TEOAEs, DPOAEs, and ABRs in predicting neonatal hearing status.
- To determine the accuracy of these measures in identifying hearing impairment at 8 to 12 months corrected age.
- To assess the effectiveness of a multi-center screening protocol.
Main Methods:
- A multi-center study involving 7179 infants.
- Evaluation of transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brain stem responses (ABRs) in the neonatal period.
- Visual reinforcement audiometry (VRA) at 8 to 12 months corrected age served as the gold standard.
Main Results:
- TEOAEs, DPOAEs, and ABRs performed well in predicting permanent hearing loss of 30 dB or greater.
- All tested measures demonstrated robustness regarding infant state, test environment, and medical status.
- No single test achieved perfect predictive accuracy.
Conclusions:
- The NIH Consensus Conference protocol (OAE followed by ABR if needed) is effective, with a low referral rate (96-98%).
- Specific parameters for TEOAEs, DPOAEs, and ABRs show good predictive performance based on ROC curve analysis.
- OAE accuracy is enhanced when using speech awareness threshold or pure-tone average (2.0 kHz and 4 kHz) as the gold standard.
Objectives:
This article summarizes the results of a multi-center study, "Identification of Neonatal Hearing Impairment," sponsored by the National Institutes of Health. The purpose of this study was to determine the performance characteristics of three measures of peripheral auditory system status, transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brain stem responses (ABR), applied in the neonatal period in predicting hearing status at 8 to 12 mo corrected age.
Design:
The design and implementation of this study are described in the first two articles in this series. Seven institutions participated in this study; 7179 infants were evaluated. Graduates of the neonatal intensive care unit and well babies with one or more risk factors for hearing loss were targeted for follow-up testing using visual reinforcement audiometry (VRA) at 8 to 12 mo corrected age. Neonatal test performance was evaluated using the VRA data as the "gold standard."
Results:
The major results of the study are described in the nine articles preceding this summary article. TEOAEs in response to an 80 dB pSPL click, DPOAEs in response to L1 = 65 and L2 = 50 dB SPL and ABR in response to a 30 dB nHL click performed well as predictors of permanent hearing loss of 30 dB or greater at 8 to 12 mo corrected age. All measures were robust with respect to infant state, test environment and infant medical status. No test performed perfectly.
Conclusions:
Based on the data from this study, the 1993 National Institutes of Health Consensus Conference-recommended protocol-an OAE test followed by an ABR test for those infants failing the OAE test-would result in low referral rate (96 to 98%). TEOAEs for 80 dB pSPL, ABR for 30 dB nHL and DPOAEs for L1 = 65 dB SPL and L2 = 50 dB SPL perform well in predicting hearing status based on the area under the relative operating characteristic curve. Accuracy for the OAE measurements are best when the speech awareness threshold or the pure-tone average for 2.0 kHz and 4 kHz are used as the gold standard. ABR accuracy varies little as a function of the frequencies included in the gold standard. In addition, 96% of those infants returning for VRA at 8 to 12 mo corrected age were able to provide reliable ear-specific behavioral thresholds using insert earphones and a rigorous psychophysical VRA protocol.
