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Use of Wideband Acoustic Immittance in Neonates and Infants
Hammam AlMakadma1, Sreedevi Aithal2,3, Venkatesh Aithal2,3
1Department of Otolaryngology and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky.
Insights
Wideband acoustic immittance (WAI) offers a sensitive method for assessing infant middle ear function, improving newborn hearing screening accuracy. This technique helps reduce false positives and prioritizes infants needing further diagnostic evaluation for hearing loss.
Area of Science:
- Audiology
- Pediatric Healthcare
- Biomedical Engineering
Background:
- Universal newborn hearing screening (UNHS) is crucial for early hearing loss identification.
- High false-positive rates in UNHS are often due to temporary outer/middle ear obstructions.
- Current methods like single-frequency tympanometry are inefficient for infant middle ear assessment.
Purpose of the Study:
- To evaluate wideband acoustic immittance (WAI) as an adjunct screening tool for newborn hearing assessments.
- To demonstrate the utility of WAI, specifically wideband power absorbance (WBA), in assessing infant middle ear status.
- To provide normative data and clinical guidance for WAI implementation in pediatric audiology.
Main Methods:
- Review of research on wideband acoustic immittance (WAI) testing in newborns and infants.
- Presentation of normative data for wideband power absorbance (WBA) in young populations.
- Description of WAI assessment and interpretation methods, including test-retest reliability.
- Inclusion of clinical case studies illustrating WAI application.
Main Results:
- Wideband power absorbance (WBA) shows higher sensitivity than traditional tympanometry for assessing newborn outer/middle ear function.
- Age-graded norms support the use of WBA in young infants.
- WAI testing aids in interpreting screening outcomes and prioritizing diagnostic referrals.
Conclusions:
- Wideband acoustic immittance (WAI) is a promising tool for enhancing the accuracy of newborn hearing screening.
- Despite its benefits, the clinical adoption of WAI technology remains low.
- Further implementation and education are needed to leverage WAI for improved infant hearing healthcare.
Abstract:
With widespread agreement on the importance of early identification of hearing loss, universal newborn hearing screening (UNHS) has become the standard of care in several countries. Despite advancements in screening technology, UNHS and early hearing detection and intervention programs continue to be burdened by high referral rates of false-positive cases due to temporary obstruction of sound in the outer/middle ear at birth. A sensitive adjunct test of middle ear at the time of screening would aid in the interpretation of screening outcomes, minimize unnecessary rescreens, and prioritize referral to diagnostic assessment for infants with permanent congenital hearing loss. Determination of middle ear status is also an important aspect of diagnostic assessment in infants. Standard single-frequency tympanometry used to determine middle ear status in infants is neither efficient nor accurate in newborns and young infants. A growing body of research has demonstrated the utility of wideband acoustic immittance (WAI) testing in both screening and diagnostic settings. Wideband power absorbance (WBA), a WAI measure, has been shown to be more sensitive than tympanometry in the assessment of outer/middle ear function in newborns. Furthermore, age-graded norms also support successful application of WBA in young infants. Despite its merits, uptake of this technology is low among pediatric audiologists and hearing screening health workers. This report describes normative data, methods for assessment and interpretation of WBA, test-retest variations, and other factors pertinent to clinical use of WAI in newborns and infants. Clinical cases illustrate the use of WAI testing in newborn and infant hearing assessment.
