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Updated: May 17, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
[Pedaudiological diagnostics in the first year of life . Clinical follow-up, risk factors, and middle ear function]
J W Rumstadt1, A am Zehnhoff-Dinnesen, A Knief
1Klinik und Poliklinik für Phoniatrie und Pädaudiologie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Deutschland.
Insights
Early detection of hearing loss is crucial. Universal neonatal hearing screening (UNHS) can diagnose hearing loss within three months, though risk factors present challenges.
Area of Science:
- Pediatrics
- Audiology
- Neonatal Care
Background:
- The Universal Neonatal Hearing Screening (UNHS) program aims for early hearing loss detection within three months of birth.
- Evaluating the practicality and effectiveness of different screening methods is essential for timely intervention.
Purpose of the Study:
- To assess the feasibility of diagnosing hearing loss within the critical first three months of life.
- To evaluate the efficacy of automated auditory brainstem response (ABR) screening and diagnostic auditory brainstem-evoked audiometry responses in neonates.
- To identify common risk factors associated with hearing loss in newborns.
Main Methods:
- Analysis of 617 patients, including 246 referred by UNHS and 389 with identified risk factors.
- Utilized automated auditory brainstem response (ABR) screening for initial assessment, followed by diagnostic auditory brainstem-evoked audiometry responses for referred cases.
- Tympanometry at 226 Hz and 1,000 Hz was compared for specificity and sensitivity.
Main Results:
- Hearing loss was diagnosed in 18% of all children, with higher rates (24%) in UNHS referrals and 34% in those with both referral and risk factors.
- Automated ABR screening excluded hearing loss in 74% of cases; diagnostic ABR revealed elevated thresholds in 84% of further evaluated children.
- Craniofacial anomalies, premature birth (<32 weeks), and syndromes were the most frequent risk factors. Some children showed hearing improvement upon reevaluation.
Conclusions:
- Diagnosis of hearing loss within three months is achievable through UNHS, but remains challenging for infants with risk factors.
- Automated ABR is effective in screening, while diagnostic ABR is crucial for confirmation.
- Early identification and intervention, including hearing aids and treatment for middle ear effusion, are vital for affected infants.
Abstract:
The universal neonatal hearing screening (UNHS) program demands detection of hearing loss within the first 3 months of life. Practicability and different screening methods should be evaluated. Thus, 617 patients (329 m., 288 w.) were analyzed; 246 children were referred in the UNHS, 389 with risk factors. In 459 children (74%), automated auditory brainstem response (ABR) screening in our department excluded hearing loss, thereof 129 (21%) underwent diagnostic auditory brainstem-evoked audiometry responses: 20 (16%) showed normal and 109 (84%) elevated ABR thresholds. A total of 91 children (83%) received hearing aids and 11 children (10%) treatment of middle ear effusion. Hearing loss was diagnosed in 18% of all children, 24% with UNHS referral and 34% with both referral and risk factors. Craniofacial anomalies, premature birth < 32 weeks of pregnancy, and syndromes were the most frequent risk factors. Reevaluation by ABR showed an improvement to normal hearing in 3 (of 14) children. The 226 Hz compared to 1,000 Hz-tympanometry showed different specificity (95.5 vs. 85.5%) and sensitivity (32.5 vs. 57.1%). Diagnosis within 3 months is possible, but very challenging in children with risk factors.
