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Published on: January 23, 2017
Evaluation of unilateral referrals on neonatal hearing screening
Kay W Chang1, T J O-Lee, Melissa Price
1Stanford University School of Medicine, Lucile Packard Children's Hospital, 801 Welch Road, Stanford, CA 94305-5739, USA. kay_chang@yahoo.com
Insights
Neonatal hearing screening requires thorough evaluation for infants who fail one ear. Even the ear that passes may have significant hearing loss, necessitating prompt audiology assessment.
Area of Science:
- Pediatrics
- Audiology
- Neonatal Care
Background:
- Neonatal hearing screening protocols often prioritize bilateral failures.
- Unilateral referrals (failing one ear, passing the other) may receive less attention.
- Limitations in screening techniques can impact accurate identification of hearing loss.
Purpose of the Study:
- To investigate the necessity of continued audiological evaluations for infants with unilateral referrals.
- To analyze the outcomes of infants who referred in one ear during neonatal screening.
Main Methods:
- A cohort of 16,007 infants undergoing automated auditory brainstem response (AABR) screening was studied.
- Infants with unilateral referrals were identified, and their audiological course was analyzed.
- Literature review on reporting practices for unilateral screening referrals was conducted.
Main Results:
- Eighteen infants with unilateral referrals were diagnosed with permanent hearing loss.
- Five infants whose initial screening passed in one ear were later found to have significant hearing loss in that ear.
- Anatomic abnormalities were identified in some unilateral referrals.
Conclusions:
- Infants with unilateral referrals on neonatal hearing screening require prompt and comprehensive audiological evaluations.
- Hearing loss can be present in the ear that initially passed the screening.
- Current screening practices may underestimate the prevalence of hearing loss in unilateral referrals.
Objective:
Examination of neonatal hearing screening practices around the world suggests that more attention is placed on infants who fail bilaterally on their hearing screen than infants who refer (fail) in one ear. Some programmes only report bilateral failures as positive hearing screens. This study investigates how limitations of the screening techniques demand continued audiologic evaluations in unilateral referrals.
Setting:
The study sample consisted of all infants born at a single academic paediatric hospital between February 1998 and February 2002.
Methods:
There were 16,007 infants screened using ALGO automated auditory brainstem response. Eighteen of the infants who failed the screen in one ear but passed in the other ear were found to have permanent hearing loss, and had their subsequent clinical course and audiologic management analysed. The final audiologic outcome after four years in both the pass and fail ear were examined.
Results:
One group of unilateral referrals (n = 6) had obvious anatomic reasons for the ear failing the screen (canal atresia/stenosis). There were five patients in which the ear that passed the screen was later found on more extensive audiologic evaluation to have significant hearing loss. Review of recent literature was also completed to examine the methods by which unilateral screening referrals are commonly reported and whether or not this affected follow-up diagnostic evaluation.
Conclusion:
Infants who pass one ear and refer one ear on neonatal hearing screening still need to have thorough and prompt evaluations. In many cases, the ear that passed can be found to have significant hearing loss.
