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Potential pitfalls of initiating a newborn hearing screening program
T J Kanne1, L Schaefer, J A Perkins
1Department of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Wash, USA.
Insights
Universal infant hearing screening using transient evoked otoacoustic emissions (TEOAE) showed good specificity but faced implementation challenges. Program deficiencies and funding issues prevented truly universal screening, impacting early detection of hearing loss (HL).
Area of Science:
- Audiology
- Neonatal care
- Public health screening
Background:
- Universal screening programs aim to detect hearing loss (HL) in infants early.
- Transient evoked otoacoustic emissions (TEOAE) are a common screening tool.
Purpose of the Study:
- To evaluate the effectiveness of a universal infant hearing screening program.
- To identify barriers to successful implementation of universal screening.
Main Methods:
- Retrospective analysis of 2289 infants screened using a 3-stage TEOAE protocol.
- Assessment of screening specificity, HL incidence, risk factors, and costs.
Main Results:
- 91.1% passed initial TEOAE screening; 26.2% of those retested failed.
- Hearing loss (HL) was identified in 11.6% of referred infants, with an overall incidence of 2.18 per 1000 newborns.
- Program deficiencies led to 10% of infants not being screened; funding and implementation issues hindered continuation.
Conclusions:
- TEOAE screening demonstrated sufficient specificity for universal application.
- Achieving truly universal screening was not possible due to program deficiencies and external factors.
- Lack of funding and implementation difficulties ultimately led to the program's discontinuation.
Objective:
To examine the efficacy of a universal screening program for infant hearing.
Design:
Retrospective analysis.
Setting:
Tertiary care center.
Patients:
We examined 2289 (90.2%) of 2537 infants born at our institution from April 1, 1995, to June 30, 1996, for hearing loss (HL).
Interventions:
We used a 3-stage protocol with transient evoked otoacoustic emissions (TEOAE) in stages 1 and 2 and diagnostic evaluation in stage 3. Infants without reproducible TEOAEs in either ear after stage 2 were referred to stage 3.
Main Outcome Measures:
Specificity of TEOAE, incidence of HL, prevalence of risk factors for HL, cost of TEOAE screening, and identification of barriers to universal screening.
Results:
Of the infants undergoing TEOAE screening, 91.1% passed stage 1. Of infants needing repeated testing, 73.7% passed and 26.2% failed. Of the 43 infants referred for diagnostic evaluation, 5 (11.6%) had HL. The combined incidence of conductive and sensorineural HL was 2.18 per 1000 newborns. The prevalence of at least 1 risk factor for HL was 10.4%. The estimated cost of TEOAE screening was $24.48 per infant. Ten percent of infants did not undergo screening due to program deficiencies.
Conclusions:
Screening with TEOAE was sufficiently specific for universal screening. However, we were unable to achieve truly universal screening. This is probably the reason for our lower incidence of sensorineural HL. We were unable to continue our universal newborn screening program, due to lack of funding, difficulties with program implementation, and our low incidence of detected HL.