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Newborn hearing screening and strategy for early detection of hearing loss in infants
Janka Jakubíková1, Zuzana Kabátová, Gabriela Pavlovcinová
1Pediatric Otorhinolaryngology Department of Medical Faculty of Commenius University and Children's University Hospital, Limbova 1, 833 40 Bratislava, Slovak Republic. jakubikova@dfnsp.sk
Insights
Universal newborn hearing screening (UNHS) in Slovakia significantly increased early detection of permanent hearing loss (PHL) in infants. This mandatory screening lowered the average age of diagnosis and identified more cases of severe bilateral hearing impairment.
Area of Science:
- Pediatric Audiology
- Public Health
- Genetics
Background:
- Congenital hearing loss affects over 80% of children with permanent hearing impairment.
- Newborn hearing screening (NHS) is crucial for early detection; without universal screening, over 30% of permanent hearing losses go unidentified.
- Established NHS methods include otoacoustic emissions (TEOAE, DPOAE) and automated auditory brainstem response (AABR).
Purpose of the Study:
- To evaluate the impact of universal newborn hearing screening (UNHS) on the early detection of hearing loss in children.
- To assess the influence of UNHS on the etiologic evaluation of hearing-impaired infants identified through screening.
- To compare hearing loss detection rates and diagnostic age before and after the implementation of mandatory UNHS in Slovakia.
Main Methods:
- UNHS was implemented in Slovakia starting May 1, 2006, utilizing two-stage TEOAE in all newborn departments.
- Screening coverage increased from 42% in 2005 to over 94% by 2007.
- Auditory Steady-State Response (ASSR) and Auditory Brainstem Response (ABR) were used for hearing threshold determination.
Main Results:
- The first year of UNHS saw a 22.8% increase in identified cases of severe permanent hearing loss (PHL).
- The average age of PHL diagnosis decreased significantly post-UNHS implementation.
- In 2007, 94% of newborns were screened, identifying 0.947/1000 newborns with severe bilateral PHL, a 35.9% increase.
- Etiologic assessment of 76 infants who failed screening revealed causes including non-syndromic genetic (25.45%), syndromic (9%), perinatal (31%), congenital CMV (7.27%), cochlear anomalies (1.83%), and unknown (25.45%).
Conclusions:
- Mandatory UNHS in Slovakia has demonstrably improved the early detection rates of permanent hearing loss in infants.
- UNHS facilitates a lower average age at diagnosis, enabling timely intervention.
- The study successfully identified various etiologies of hearing loss in infants detected through screening.
Objective:
More than 80% of permanent hearing losses (HL) in children are congenital. Newborn hearing screening (NHS) is the best method for early detection of suspected hearing loss. If the NHS is not universal more than 30% permanent hearing losses are not identified. There are various methods of NHS: otoacoustic emissions (TEOAE, DPOAE) and automatic auditory brainstem response (AABR). After hearing screening, and when hearing loss is suspected, tympanometry and audiological methods then used for determination of hearing threshold; these include ABR, ASSR or/and behavioral methods. The goal of this study is to evaluate the influence of UNHS on the early detection of hearing loss in children before and after the implementation of obligatory universal newborn hearing screening in Slovakia, and also on the etiologic evaluation of hearing impaired infants identified by screening.
Method:
In Slovakia NHS started in 1998 and was provided in ENT departments. From May 1, 2006 UNHS has been mandatory in Slovakia, using two stages TEOAE in all newborn departments in Slovakia (64 newborn departments). In year 2005--42% of newborns in Slovakia were screened, in 2006--66% newborns and in 2007--94, 99% (three small newborn departments do not yet have equipment for OAE screening). For determination of hearing thresholds ASSR are used in two ENT departments and ABR in the other four ENT departments.
Results:
Comparing the number of identified cases with bilateral severe permanent HL or deafness before and after UNHS, 22.8% more cases of PHL were identified in the first year of UNHS. Also the average age of diagnosis of PHL was lower. In the year 2007, 94% of newborns were screened. We found 0.947/1000 newborns with bilateral severe PHL (35.9%) more than before UNHS). After audiologic and etiologic assessment of the 76 infants who failed screening, 5 (6.58%) were found to have normal hearing, 16 (22.54%) had unilateral and 55 (77.46%) had bilateral SNHL. A non-syndromic genetic cause was present in 25.45% of cases, syndromic in 9%, perinatal cause (31%), congenital CMV infection in 7.27%, bilateral cochlear anomalies without other abnormality in 1.83% and unknown etiology in 25.45%.
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