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Screening for sensorineural deafness by health visitors. The Steering Committee, Oxford Region Child Development
Insights
The distraction test effectively screens infants for hearing loss, but its effectiveness is limited. Many deaf infants are not identified by this high-risk screening method.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- Hearing loss screening in infants is crucial for early intervention.
- Health visitors in the UK commonly use the distraction test for infant hearing screening.
- Identifying infants at high risk for sensorineural deafness is a public health priority.
Purpose of the Study:
- To evaluate the effectiveness of the distraction test for screening hearing loss in high-risk infants.
- To assess the sensitivity and specificity of the distraction test in a UK health region.
- To determine the limitations of the current screening program for sensorineural deafness.
Main Methods:
- A retrospective study evaluating the distraction test results of high-risk infants.
- High-risk infants were defined as those weighing <2000g at birth or those weighing >=2000g and spending >24 hours in special care.
- Screening results were compared with a regional register of early childhood impairment, specifically sensorineural deafness diagnosed before age 3.
Main Results:
- The distraction test demonstrated high sensitivity (91%) but low specificity (82%) in the high-risk population.
- The screening program's effectiveness was compromised by infants missed during screening.
- A significant proportion (71%) of infants with diagnosed sensorineural deafness were not part of the identified high-risk group.
Conclusions:
- While sensitive, the distraction test as a sole screening tool for high-risk infants has limitations.
- The current screening protocol may miss a substantial number of infants with hearing loss.
- Improvements are needed to enhance the identification of all infants with sensorineural deafness, regardless of initial risk assessment.
Abstract:
Screening for hearing loss in the first year of life, using the distraction test, remains the responsibility of health visitors in most health districts in the United Kingdom. We have evaluated the screening procedure used routinely in one health region in a population of infants at increased risk of sensorineural deafness. They were infants who weighed less than 2000 g at birth or infants who weighed 2000 g or more at birth and who spent more than 24 hours in a special care nursery. The infants' responses to a distraction test were recorded by health visitors and sent to the project office. The results were compared with information from a regional register of early childhood impairment that included children in whom sensorineural deafness had been diagnosed before the age of 3 years. The register had been compiled using information from a wide range of sources. When used in this high risk population the distraction test was sensitive (91%), but nonspecific (82%). The effectiveness of the screening programme was limited, however, because there was an increased risk of deafness among infants who missed being screened by health visitors. In addition, 71% of the deaf infants on the register were not in the high risk population.