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Related Experiment Videos

The distraction test: the last word?

Shirley A Russ1, Zeffie Poulakis, Melissa Wake

  • 1Centre for Community Child Health, Royal Children's Hospital, Victoria, Australia.

Journal of Paediatrics and Child Health
|April 9, 2005
PubMed
Summary
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The distraction test in newborn hearing screening programs results in many false positives and negatives, failing to meet diagnostic goals. This method is not suitable for population-based infant hearing screening.

Area of Science:

  • Audiology
  • Public Health
  • Pediatrics

Background:

  • Universal Newborn Hearing Screening (UNHS) programs are widespread but require rigorous evaluation of their cost-effectiveness and logistical efficiency.
  • Few studies have rigorously assessed alternative screening strategies for infant hearing loss.

Purpose of the Study:

  • To evaluate the performance of the distraction test, a key component of the Victorian Infant Hearing Screening Program (VIHSP).

Main Methods:

  • A 1993 birth cohort in Victoria, Australia, was screened for hearing loss risk factors.
  • At-risk infants received Auditory Brainstem Evoked Response (ABR) screening; others underwent a modified distraction test at 7-9 months.
  • The cohort was followed to age 6 to diagnose congenital hearing loss and determine aid fitting, calculating screen performance metrics.

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Main Results:

  • The distraction test showed a sensitivity of 65%, specificity of 91%, and a positive predictive value (PPV) of 0.3%.
  • It yielded 8 false-negatives (0.02%) and an estimated 4265 false-positives (99%) for moderate or greater hearing losses.
  • Mean age at diagnosis was 23 months and at aid fitting was 26 months for screen failures.

Conclusions:

  • The distraction test generated numerous false positives and significant false negatives, particularly for moderate hearing losses.
  • Diagnosis and aid fitting ages for screen failures significantly exceeded established goals.
  • Evidence suggests the distraction test is not an acceptable population-based screening method for infant hearing.