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Published on: June 8, 2017
An evidence based protocol for managing neonatal middle ear effusions in babies who fail newborn hearing screening
Brittany C Weber1, Scott M Whitlock1, Kaidi He1
1Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA.
Insights
A significant percentage of infants failing newborn hearing screening have middle ear disease. Diagnostic microscopy with ventilation tube placement and auditory brainstem response (ABR) testing is effective for managing these infants.
Area of Science:
- Otolaryngology
- Pediatric Audiology
- Neonatal Care
Background:
- Newborn hearing screening (NBHS) identifies infants with potential hearing loss.
- Failed NBHS necessitates further evaluation for underlying causes, including middle ear pathology.
- Otitis media with effusion (OME) is a common, yet often transient, cause of conductive hearing loss in infants.
Purpose of the Study:
- To determine the prevalence of middle ear disease in infants with failed NBHS.
- To analyze patient outcomes following intervention for middle ear pathology.
- To propose an evidence-based management protocol for newborns with OME who fail NBHS.
Main Methods:
- Retrospective review of 85 infants referred for failed NBHS.
- Diagnostic microscopic examination with myringotomy and potential ventilation tube placement.
- Intra-operative or follow-up auditory brainstem response (ABR) testing.
Main Results:
- 60% of infants presented with at least unilateral otitis media with effusion (OME).
- 76% of infants underwent myringotomy with or without tube placement.
- 20% achieved normal hearing post-intervention; 64% were diagnosed with sensorineural or mixed hearing loss requiring amplification.
Conclusions:
- Diagnostic operative microscopy with ventilation tube placement and ABR testing is an effective initial management strategy.
- This approach facilitates identification and treatment of conductive hearing loss due to OME.
- It also aids in diagnosing underlying sensorineural hearing loss (SNHL) and enables prompt aural rehabilitation.
Objectives:
To evaluate the prevalence of middle ear disease in infants referred for failed newborn hearing screening (NBHS) and to review patient outcomes after intervention in order to propose an evidence-based protocol for management of newborns with otitis media with effusion (OME) who fail NBHS.
Methods:
85 infants with suspected middle ear pathology were retrospectively reviewed after referral for failed NBHS. All subjects underwent a diagnostic microscopic exam with myringotomy with or without placement of a ventilation tube in the presence of a middle ear effusion and had intra-operative auditory brainstem response (ABR) testing or testing at a later date.
Results:
At the initial office visit, a normal middle ear space bilaterally was documented in 5 babies (6%), 29/85 (34%) had an equivocal exam while 51/85 (60%) had at least a unilateral OME. Myringotomy with or without tube placement due to presence of an effusion was performed on 65/85 (76%) neonates. Normal hearing was established in 17/85 (20%) after intervention, avoiding the need for any further audiologic workup. Bilateral or unilateral sensorineural hearing loss (SNHL) or mixed hearing loss was noted in 54/85 (64%) and these children were referred for amplification. Initially observation with follow up outpatient visits was initiated in 27/85 (32%) however, only 3/27 (11%) resolved with watchful waiting and 24/27 (89%) ultimately required at least unilateral tube placement due to OME and 14/24 (59%) were found to have at least a unilateral mixed or SNHL.
Conclusions:
An effective initial management plan for children with suspected middle ear pathology and failed NBHS is diagnostic operative microscopy with placement of a ventilation tube in the presence of a MEE along with either intra-operative ABR or close follow-up ABR. This allows for the identification and treatment of babies with a conductive component due to OME, accurate diagnosing of an underlying SNHL component and for prompt aural rehabilitation.
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