Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. 663-672 (doi:10.1542/peds.2004-1688)
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A Multicenter Evaluation of How Many Infants With Permanent Hearing Loss Pass a Two-Stage Otoacoustic Emissions/Automated Auditory Brainstem Response Newborn Hearing Screening Protocol

Jean L. Johnson, DrPH*, Karl R. White, PhD{ddagger}, Judith E. Widen, PhD§, Judith S. Gravel, PhD||, Michele James, AuD, Teresa Kennalley, MA#, Antonia B. Maxon, PhD**, Lynn Spivak, PhD{ddagger}{ddagger}, Maureen Sullivan-Mahoney, MA§§, Betty R. Vohr, MD||||, Yusnita Weirather, MA¶¶ and June Holstrum, PhD##

* Center on Disability Studies, University of Hawaii, Honolulu, Hawaii
{ddagger} National Center for Hearing Assessment and Management, Utah State University, Logan, Utah
§ University of Kansas Medical Center, Kansas City, Kansas
|| Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York
Arnold Palmer Hospital for Infants and Women, Orlando, Florida
# Via Christi Regional Medical Center, Wichita, Kansas
** New England Center for Hearing Rehabilitation, Hampton, Connecticut
{ddagger}{ddagger} Long Island Jewish Medical Center, New Hyde Park, New York
§§ Good Samaritan Hospital, Cincinnati, Ohio
|||| Women and Infants Hospital, Providence, Rhode Island
¶¶ Kapiolani Medical Center for Women and Infants, Honolulu, Hawaii
## EHDI Consultant, Lexington, South Carolina

Objective. Ninety percent of all newborns in the United States are now screened for hearing loss before they leave the hospital. Many hospitals use a 2-stage protocol for newborn hearing screening in which all infants are screened first with otoacoustic emissions (OAE). No additional testing is done with infants who pass the OAE, but infants who fail the OAE next are screened with automated auditory brainstem response (A-ABR). Infants who fail the A-ABR screening are referred for diagnostic testing to determine whether they have permanent hearing loss (PHL). Those who pass the A-ABR are considered at low risk for hearing loss and are not tested further. The objective of this multicenter study was to determine whether a substantial number of infants who fail the initial OAE and pass the A-ABR have PHL at ~9 months of age.

Methods. Seven birthing centers with successful newborn hearing screening programs using a 2-stage OAE/A-ABR screening protocol participated. During the study period, 86634 infants were screened for hearing loss at these sites. Of those infants who failed the OAE but passed the A-ABR in at least 1 ear, 1524 were enrolled in the study. Data about prenatal, neonatal, and socioeconomic factors, plus hearing loss risk indicators, were collected for all enrolled infants. When the infants were an average of 9.7 months of age, diagnostic audiologic evaluations were done for 64% of the enrolled infants (1432 ears from 973 infants).

Results. Twenty-one infants (30 ears) who had failed the OAE but passed the A-ABR during the newborn hearing screening were identified with permanent bilateral or unilateral hearing loss. Twenty-three (77%) of the ears had mild hearing loss (average of 1 kHz, 2 kHz, and 4 kHz ≤40-decibel hearing level). Nine (43%) infants had bilateral as opposed to unilateral loss, and 18 (86%) infants had sensorineural as opposed to permanent conductive hearing loss.

Conclusions. If all infants were screened for hearing loss using the 2-stage OAE/A-ABR newborn hearing screening protocol currently used in many hospitals, then ~23% of those with PHL at ~9 months of age would have passed the A-ABR. This happens in part because much of the A-ABR screening equipment in current use was designed to identify infants with moderate or greater hearing loss. Thus, program administrators should be certain that the screening program, equipment, and protocols are designed to identify the type of hearing loss targeted by their program. The results also show the need for continued surveillance of hearing status during childhood.

Key Words: hearing loss • hearing screening • efficacy

Abbreviations: OAE, otoacoustic emissions • ABR, auditory brainstem response • TEOAE, transient evoked otoacoustic emissions • DPOAE, distortion product otoacoustic emissions • VRA, visual reinforcement audiometry • A-ABR, automated-auditory brainstem response • CDC, Centers for Disease Control and Prevention • RFP, request for proposals • PHL, permanent hearing loss • dB, decibel • nHL, normal hearing level • JCIH, Joint Committee on Infant Hearing • NCHAM, National Center for Hearing Assessment and Management

Accepted Dec 28, 2004.


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