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Updated: Apr 23, 2026
An Automated System for Sound Localization Testing in Hearing-Impaired Listeners
Published on: March 13, 2026
Targeting regional pediatric congenital hearing loss using a spatial scan statistic
Matthew L Bush1, Warren Jay Christian, Kristin Bianchi
11Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA; 2Department of Epidemiology, College of Public Health, Lexington, Kentucky, USA; 3College of Medicine, University of Kentucky, Lexington, Kentucky, USA; 4Cabinet for Health and Family Services, Commission for Children with Special Health Care Needs, Louisville, Kentucky, USA; and 5Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA.
Insights
This study mapped congenital hearing loss and failed newborn screenings in Kentucky, identifying high-risk clusters in rural areas. These findings can help target interventions for hearing health disparities.
Area of Science:
- Public Health
- Epidemiology
- Pediatrics
Background:
- Congenital hearing loss impacts language development, necessitating early detection.
- Rural populations face barriers to timely diagnosis and intervention for hearing loss.
- Understanding spatial distribution of hearing loss is crucial for targeted public health efforts.
Purpose of the Study:
- To examine the spatial distribution of failed infant hearing screening tests and pediatric congenital hearing loss in Kentucky.
- To identify high-rate clusters of hearing loss and screening failures.
- To analyze hospital-based variations in screening outcomes.
Main Methods:
- Analysis of live birth and audiological data in Kentucky (2009-2011).
- Application of spatial scan statistics to identify high-rate clusters of failed newborn hearing screenings and permanent congenital hearing loss (PCHL).
- Examination of PCHL and screening failure rates based on birthing hospital and screening methodology.
Main Results:
- Four significant clusters of failed newborn hearing screenings were identified, two in the Appalachian region.
- Hospitals using two-stage otoacoustic emission testing had higher failed screening rates (p=0.009) than those using automated auditory brainstem response.
- A significant cluster of PCHL was found in Western Kentucky, with five hospitals showing higher relative risk, two in a rural area.
Conclusions:
- Spatial analysis revealed specific regions in Kentucky with high rates of congenital hearing loss and failed newborn screenings.
- Further research into causative factors for identified clusters is warranted.
- This spatial analysis method can effectively guide efforts to address hearing health disparities in high-incidence regions.
Objectives:
Congenital hearing loss is a common problem, and timely identification and intervention are paramount for language development. Patients from rural regions may have many barriers to timely diagnosis and intervention. The purpose of this study was to examine the spatial and hospital-based distribution of failed infant hearing screening testing and pediatric congenital hearing loss throughout Kentucky.
Design:
Data on live births and audiological reporting of infant hearing loss results in Kentucky from 2009 to 2011 were analyzed. The authors used spatial scan statistics to identify high-rate clusters of failed newborn screening tests and permanent congenital hearing loss (PCHL), based on the total number of live births per county. The authors conducted further analyses on PCHL and failed newborn hearing screening tests, based on birth hospital data and method of screening.
Results:
The authors observed four statistically significant (p < 0.05) high-rate clusters with failed newborn hearing screenings in Kentucky, including two in the Appalachian region. Hospitals using two-stage otoacoustic emission testing demonstrated higher rates of failed screening (p = 0.009) than those using two-stage automated auditory brainstem response testing. A significant cluster of high rate of PCHL was observed in Western Kentucky. Five of the 54 birthing hospitals were found to have higher relative risk of PCHL, and two of those hospitals are located in a very rural region of Western Kentucky within the cluster.
Conclusions:
This spatial analysis in children in Kentucky has identified specific regions throughout the state with high rates of congenital hearing loss and failed newborn hearing screening tests. Further investigation regarding causative factors is warranted. This method of analysis can be useful in the setting of hearing health disparities to focus efforts on regions facing high incidence of congenital hearing loss.
