An effective compromise between cost and referral rate: A sequential hearing screening protocol using TEOAEs and
Yingying Shang1, Wenyang Hao1, Zhiqiang Gao1
1Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.
Insights
Adding automated auditory brainstem response (AABR) tests to transient evoked otoacoustic emission (TEOAE) screenings significantly lowers newborn hearing screening referral rates. This sequential approach improves accuracy without increasing misdiagnosis, benefiting early hearing loss detection.
Area of Science:
- Neonatal audiology
- Hearing screening protocols
- Diagnostic accuracy in newborns
Background:
- Early identification of hearing loss in newborns is crucial for timely intervention.
- Transient evoked otoacoustic emission (TEOAE) is a common initial hearing screening method.
- Automated auditory brainstem response (AABR) is another established audiological assessment tool.
Purpose of the Study:
- To evaluate the effectiveness of a sequential hearing screening protocol combining TEOAE and AABR in healthy newborns.
- To compare the referral rates and diagnostic accuracy of a TEOAE-only protocol versus a sequential TEOAE + AABR protocol.
Main Methods:
- A cohort of 1062 healthy newborns was studied.
- Protocol 1 involved TEOAE screening, with AABR and TEOAE rescreening for failures.
- Protocol 2 incorporated a sequential TEOAE followed by AABR for initial screening failures, and TEOAE for rescreening.
Main Results:
- Protocol 1 had initial and rescreening referral rates of 11.1% and 2.2%.
- Protocol 2 demonstrated significantly lower referral rates of 3.8% and 0.9%.
- Both protocols identified six infants with hearing loss (0.57%).
Conclusions:
- Integrating AABR testing after initial TEOAE failure substantially reduces unnecessary referrals.
- The sequential TEOAE + AABR protocol offers improved accuracy over TEOAE alone, justifying potential increases in time and cost.
- This enhanced screening strategy aids in more efficient and accurate identification of hearing impairments in neonates.
Objective:
This study evaluated the efficacy of a sequential hearing screening protocol using transient evoked otoacoustic emission (TEOAE) and automated auditory brainstem response (AABR) tests in healthy newborns.
Design:
A TEOAE screening was performed during the first 48-72 h of life. If the infants failed, an AABR test was performed at the same time, and they were referred for a TEOAE rescreening at six weeks old. The results of screening Protocol 1 (only TEOAE) were compared with those of screening Protocol 2 (sequential TEOAE + AABR screenings for the first screening and TEOAE for the rescreening).
Study Sample:
A total of 1062 healthy newborns were enrolled in this research.
Results:
For Protocol 1, the first screening and rescreening referral rates were 11.1% and 2.2%, respectively. In contrast, for Protocol 2, the referral rates were significant lower at 3.8% and 0.9%, respectively. Using the two protocols, six infants were diagnosed with hearing loss (0.57%).
Conclusions:
Adding simultaneous AABR tests for infants who fail TEOAE testing at the first screening stage can significantly reduce referral rates without increasing misdiagnosis rates. Although this sequential screening process involves slightly more time and has a higher cost than TEOAE alone, its greater accuracy compensates for this difference.
