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Updated: Aug 21, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Further examination of infants referred from newborn hearing screening
Tadashi Wada1, Takeshi Kubo, Tsunemasa Aiba
1Department of Otorhinolaryngology & Pediatric Otorhinolaryngology, Osaka City General Hospital, Osaka, Japan. tadazaku0524@yahoo.co.jp
Insights
Newborn hearing screening accuracy needs improvement. A two-stage process and timely follow-up can enhance detection of hearing loss in infants, ensuring early intervention.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- Universal newborn hearing screening (UNHS) is widely adopted but faces challenges in administrative systematization and accuracy.
- Early detection of hearing loss is crucial for infant development.
Purpose of the Study:
- To assess the hearing screening of referred newborn infants.
- To identify persistent problems in newborn hearing screening and follow-up.
Main Methods:
- Conventional auditory brainstem response (ABR) and other audiological tests were used.
- 98 ears from 49 infants referred from UNHS were examined over two years.
- Screening methodologies varied, including automated auditory brainstem response (AABR) and automated otoacoustic emissions (DPOAEs).
Main Results:
- Conventional ABR showed a 40.8% correspondence rate.
- A comparative analysis revealed 26.5% false-positives and 7.1% false-negatives.
- Five false-negative cases had moderate to profound bilateral hearing loss; nine infants received hearing aids.
Conclusions:
- Newborn hearing screening accuracy requires improvement through experienced examiners and refined protocols, such as a two-stage process.
- Ongoing monitoring for hearing loss is essential, even in infants who pass initial screening, due to potential false-negatives and delayed-onset hearing loss.
- Improvements in intervention systems, diagnostic follow-up, and early public support are needed, with screening recommended within the first three months, ideally at one month.
Objectives:
Universal newborn hearing screening (UNHS) is considered beneficial and is accepted worldwide. However, some problems remain, and administrative systematization has yet to be established in many countries. This study assessed the hearing screening of referred newborn infants and discusses the problems that remain.
Materials And Methods:
Over the two years from July 2001 to June 2003, 98 ears of 49 infants were judged as a "referral" from a newborn hearing screening program, and were subsequently referred to our hospital for further examination using conventional ABR and other audiological tests. The methodology used for hearing screening varied between practitioners and hospitals that utilized both different recording apparatus for AABR and/or automated DPOAEs and independent protocols.
Results:
Conventional ABR identified 21 infants with bilateral normal hearing, 12 with unilateral hearing loss, and 16 with bilateral hearing loss, and a total correspondence rate of 40.8% (20 out of 49 infants). In a comparative analysis, 26 ears out of 98 (26.5%) were determined as false-positive, seven out of 98 as false-negative (7.1%), and there was a total correspondence rate of 66.3% (65 out of 98 ears). Five of the seven false-negative cases who were referred with unilateral hearing loss exhibited moderate to profound bilateral hearing loss (moderate; one infant, severe to profound; four infants). Of the 16 infants with bilateral hearing loss, nine with more than moderate loss had hearing aids fitted at our hospital or related educational institution before most were six months old.
Conclusions:
Our results suggest the accuracy of newborn hearing screening remains an issue, but may be improved by an experienced examiner and better protocols including a two-stage process and altered timing of screening. Other ongoing health care programs need to monitor for signs of hearing loss even in the "passed" infants because of possible false-negatives and delayed-onset hearing loss. Improvement is needed in both the intervention systems and diagnostic follow-up of hospitals. Early public support is also required for infants with either severe to profound or moderate hearing loss. From the viewpoint of test conditions and puerperal parental psychological problems, it is considered that the timing of screening needs further discussion. Here it is suggested that screening should be performed within the first three months of infant's life but not be limited to before hospital discharge, and incorporated into the routine health care program for one-month-old infants without reducing efficiency.
