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Published on: January 23, 2017
Infant hearing screening: effects of timeline
P W Y Tsui1, B McPherson, E C M Wong
1Centre for Communication Disorders and Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China.
Insights
Delaying infant hearing screening assessments after initial positive results may improve specificity. Waiting longer allows for natural resolution of temporary ear conditions, potentially reducing false positives in auditory brain-stem response (ABR) testing.
Area of Science:
- Audiology
- Pediatric Medicine
- Public Health
Background:
- Universal infant hearing screening programs aim for early identification and intervention of hearing impairment.
- Concerns exist regarding the specificity of screening methods, leading to potential false positives from temporary conditions like vernix occlusion or middle ear effusion.
- False positives incur significant healthcare costs and can cause parental anxiety.
Purpose of the Study:
- To investigate the impact of infant age and the time interval between initial screening and diagnostic assessment on hearing assessment outcomes.
- To evaluate how these factors influence the identification of persistent hearing impairment.
Main Methods:
- Analysis of 317 infants with initial positive results from a two-stage distortion product otoacoustic emission (DPOAE) screening program.
- Comparison of diagnostic auditory brainstem response (ABR) results based on infant age at testing and time elapsed since DPOAE screening.
- Assessment of the proportion of infants with persistent hearing impairment, conductive loss, and moderate or greater hearing loss.
Main Results:
- Infants assessed after 50 days of age showed a significantly higher rate of normal ABR thresholds (60% vs. 24%).
- A longer time lapse (over 20 days) between DPOAE screening and diagnostic ABR assessment also correlated with a higher rate of normal thresholds (65% vs. 42%).
Conclusions:
- Delaying diagnostic ABR assessment may increase the detection of normal hearing thresholds, suggesting improved screening specificity.
- A waiting period may allow for the spontaneous resolution of transient outer and middle ear issues.
- Balancing the benefits of delayed assessment for specificity against the goals of early intervention and parental well-being is crucial for optimizing infant hearing screening schedules.
Objectives:
Universal infant hearing screening using otoacoustic emission and auditory brain-stem response audiometry is widely administered to attain the goals of early identification of, and intervention for hearing impairment. Concerns regarding screening specificity have, however, been raised. False positives may result from vernix occlusion in the ear canal or transient middle ear effusion, and can result in substantial costs to health care systems. The current study investigates the effects of age and time interval between tests on hearing assessment results.
Setting & Participants:
Three hundred and seventeen positive screens from a 2-stage distortion product otoacoustic emission (DPOAE) screening programme in Hong Kong, who subsequently received diagnostic auditory brainstem response (ABR) assessment and monitoring, were investigated.
Main Outcome Measures:
Differences in diagnostic ABR results were compared among infants of different ages at tests, and with different time lapses after DPOAE screening. The proportion of those having persistent hearing impairment, conductive loss and impairment of moderate degree or above, were also compared.
Results:
A significantly higher rate of normal ABR thresholds (60%versus 24%) was noted in infants assessed after age 50 days, and in infants diagnostically assessed with a time lapse of over 20 days post-DPOAE screening (65%versus 42%).
Conclusions:
Delaying diagnostic ABR assessment may reveal a higher percentage of normal thresholds, and hence probably higher specificity. Time delay may allow for spontaneous resolution of transient outer and middle ear conditions. However, the goals of early identification and intervention, as well as possible parental anxiety with delayed assessment, should also be considered when reviewing infant hearing screening schedules.
