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reducing false positives in newborn hearing screening program: how and why.

Hung-Ching Lin1, Min-Tsan Shu, Kuo-Sheng Lee

  • 1Department of Otolaryngology, Hearing & Speech Center, Mackay Memorial Hospital, Taipei, Taiwan. hclin59@ms29.hinet.net

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|October 20, 2007
PubMed
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The one-step automated auditory brainstem response (AABR) protocol significantly reduced referral rates in newborn hearing screening compared to transient evoked otoacoustic emissions (TEOAE) or combined TEOAE/AABR. This AABR approach also proved most cost-effective, minimizing parental anxiety.

Area of Science:

  • Audiology
  • Neonatal Care
  • Public Health

Background:

  • Newborn hearing screening is crucial for early detection of congenital hearing loss.
  • Transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) are common screening tools.
  • Optimizing screening protocols balances efficacy, cost, and parental experience.

Purpose of the Study:

  • To compare the effectiveness and cost-efficiency of three newborn hearing screening protocols.
  • Protocols evaluated: one-step TEOAE, two-step TEOAE + AABR, and one-step AABR.
  • To determine the most cost-effective protocol with minimal false positives.

Main Methods:

  • A retrospective study of 25,588 healthy newborns screened between 1998 and 2006.
  • Screening groups: TEOAE alone (n=18,260), TEOAE + AABR (n=3,540), and AABR alone (n=3,788).

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  • Data collected on referral rates, accurate identification of hearing loss, and direct/intangible costs.

    • Main Results:

    • The one-step AABR protocol achieved a significantly lower referral rate (0.8%) compared to TEOAE + AABR (1.6%) and TEOAE alone (5.8%).
    • Accurate identification rates for congenital hearing loss were not significantly different across protocols (0.42% AABR, 0.25% TEOAE+AABR, 0.45% TEOAE).
    • Total costs per screening were lowest for AABR ($7.33), followed by TEOAE + AABR ($8.60), and TEOAE alone ($10.04), with reduced parental anxiety in the AABR group.

    Conclusions:

    • One-step AABR is a highly effective protocol for newborn hearing screening, significantly reducing referral rates.
    • No significant difference in the accurate detection of congenital hearing loss was observed between the protocols.
    • The AABR protocol offers the lowest overall cost, including reduced expenditures and intangible costs associated with fewer false positives.