Several countries have started universal neonatal hearing screening programs to detect deafness in newborns at an early age. These programs are also referred to as early hearing detection and intervention programs.
Inpatient
Performing an inpatient newborn hearing screening is the most efficient way to screen an infant. This type of screening is non-invasive and is performed close to discharge. Most hospitals will bundle this service with the newborn delivery charge.
Newborn hearing screening programs can be performed using two types of technology: OAE (Otoacoustic Emissions) and ABR (Automated Brainstem Response). These two screening methods are used by hospitals, birthing centers, and independent audiologists. Typically, the OAE is less expensive to perform and is usually performed more quickly. However, the ABR is recommended for newborns in the NICU.
During the first year of operation, the universal newborn hearing screening project successfully screened a high percentage of live births at eight hospitals. The overall fail and miss rates were 2.61% and 4.04%, respectively. These results were analyzed by geographic location and nursery type.
Newborn hearing screening can be performed in the hospital or at home by a qualified provider. It is important to screen all good newborns and re-screen any infant that fails the initial screening. If the baby has hearing loss, he or she needs early intervention services. A referral should be made to an Early Intervention Official in the county where the infant lives. This referral will facilitate follow-up by the infant’s primary healthcare provider.
Re-screening should occur before one month of age. The referral must be documented in the infant’s record. The follow-up screening should be performed by a qualified provider and should be performed on an outpatient basis.
In the United States, newborn hearing screening is not commonly reported in healthcare cost estimates. This is due to the fact that the cost of an inpatient screening is typically bundled with the newborn delivery care charge. The charges may not reflect the costs incurred by the hospital, which include resource costs. It is also important to remember that hospital charges for an outpatient hearing screening may not reflect the reimbursements to the hospital.
The New York State Department of Health has developed a comprehensive newborn hearing screening program. This program is designed to reduce the false-positive rate of screening. It includes program requirements for birthing centers and maternity hospitals.
AABR or OAE technology
AABR or OAE technology for newborn hearing screening can be used to detect cochlea and auditory neuropathy. In general, around 5% of the pediatric population have auditory neuropathy. This disorder is characterized by abnormal brain waves that occur when an infant hears a sound.
ABR, or the Automated Auditory Brainstem Response, measures the brain waves that result from an auditory stimulus. The waveform is displayed on the unit’s screen. It is the most accurate and precise screening technique available. The ABR reflects the status of the eighth cranial nerve, which is responsible for generating sound waves in the auditory system.
OAE, or the otoacoustic emissions, measures the middle ear air space and the cochlea in the inner ear. In addition, it also determines the status of the auditory nerve. Unlike the OAE, which uses a single electrode, the ABR uses electrode sensors to measure the brain waves traveling along the auditory nerve.
Both the OAE and the ABR are reliable tests. However, the OAE has a higher failure rate than the ABR. In addition, it is susceptible to moisture in the ear canal. It is therefore more likely to miss auditory neuropathies.
Because OAE screening is a fast and accurate method, it has been used for newborn hearing screening for many years. It is also inexpensive. A single-use disposable ear tip is required for each screening, which reduces the consumable cost of the screening program.
ABR is also an effective screening technique. However, the failure rate of this screening method is slightly higher than the failure rate of OAEs. It also has a higher failure rate when used in infants that are not fully awake. In addition, the frequency of false negative results is high. This contributes to unnecessary parental anxiety.
Both ABR and OAE technology for newborn hearing screening are reliable, but they have distinct advantages and disadvantages. The ABR has the highest specificity and the lowest failure rate, but it also is the most expensive screening technique.
AABR or OAE technology for newborn infant hearing screening is recommended by the Joint Committee on Infant Hearing, and each country should develop its own protocol. Regardless of the screening method, it is important that a baby is referred for diagnostic audiology assessment as soon as medically possible.
Follow-up evaluation of hearing before a baby is 3 months old
Detecting hearing loss in infants is a critical aspect of early intervention and language development. A newborn hearing screening can identify children who need help at an early age, while advanced follow-up testing can uncover problems that may be more chronic in nature.
For babies, there are two main types of hearing screening methods: a hearing evaluation and a hearing test. Each test has its own benefits, but both are safe and effective. Both may be used together or separately.
A hearing evaluation includes a medical history, a physical examination, and a series of tests. Evoked otoacoustic emissions (EOEs) are one type of test. This test is painless and measures sound waves produced in the inner ear. A tiny probe is inserted into the ear canal and an echo is recorded. This test is not a cure-all and should not be used as a substitute for a hearing test.
Another test is the Automated Auditory Brainstem Response (ABR). This test measures how the brain responds to sounds. It takes only a few minutes and does not require a prescription. It is used for all babies at UT Southwestern.
The best time to perform this test is around the first week of life. A second check is usually done around one to two weeks later.
This test may be done while the baby is sleeping. In this case, the healthcare provider will decide which tests to perform and the infant may be asked to stay swaddled. This is a good time to tell the doctor if you have any concerns about your baby’s development.
Fortunately, many babies do pass the first hearing screening, but one in three will not. If the baby does not pass, your healthcare provider will recommend more testing. They will decide which tests are necessary and whether or not the problem is permanent or temporary.
Advanced follow-up testing is recommended for all infants. Having a baby who cannot hear will slow their development and may lead to social isolation. A baby’s hearing system continues to develop throughout its lifetime. Follow-up testing will allow you to know if your baby has a permanent hearing problem, or if the problem is temporary.
Common causes of late-onset deafness
During the first months of a baby’s life, the hearing system is still developing. If the baby is not hearing properly, it will have difficulty accessing early language and may even slow down its development. Fortunately, newborn hearing screening can help to detect these issues.
Newborn hearing screening programs use transient evoked OAEs to assess a baby’s hearing. These OAEs measure sound waves that are produced inside the inner ear. Typically, these screens are conducted within the first few days of a baby’s life. However, some babies may need follow-up testing later.
There are several reasons for late-onset deafness. The most common cause is a genetic disorder associated with progressive hearing loss. Other causes include head injuries, frequent ear infections, and exposure to damaging loud noises. It’s important to know the causes of late-onset deafness so you can properly identify a child’s hearing issues.
The Joint Committee on Infant Hearing recommends that all infants with known risk factors be closely monitored for late-onset deafness. This can include infants who have a history of bacterial meningitis, preterm birth, or an extended neonatal intensive care unit stay.
The JCIH list of risk factors for hearing loss was released more than ten years ago. The committee recommends that all infants with risk factors receive comprehensive hearing screenings within the first three months of life. This is considered the benchmark for diagnosis. Several years later, the committee updated the list of risk factors for hearing loss.
Children with late-onset deafness may have acute or chronic hearing loss. Those with chronic or acute hearing loss may need follow-up screenings throughout their life. During these follow-ups, the audiologist will complete additional testing to determine whether the hearing issue is temporary or permanent. Those who have chronic hearing loss may also need early language development.
Babies who fail the first stage of newborn hearing screening may be referred for repeat testing within two to eight weeks. During this second stage, they will be examined by an OAE and an Automated Auditory Brainstem Response. This testing may be performed while the baby naps.
Despite the challenges involved in newborn hearing screening, it has improved dramatically over the past two decades. Today, many programs have adopted the Joint Committee on Infant Hearing’s list of risk factors for hearing loss. Most programs also use a two-stage approach to screening. In the first stage, newborns undergo a single or two-step OAE. The second stage involves an advanced follow-up screening within 10-12 days. These screenings may be performed by a pediatric audiologist or an otolaryngologist.
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