The decision to mandate, finance, and implement a universal newborn hearing screening (UNHS) requires the evaluation of its therapy-directed benefit by comparing (1) a procedure employing a UNHS with (2) a targeted screening for at-risk babies for neonatal hearing disorders and (3) a procedure without systematic screening. In a cohort study the outcome of the UNHS program of Hessen in 2005 with 17,439 screened newborns was analyzed. Validity, effectiveness, and efficiency were evaluated and compared to a sample of 98 Hessian and 355 German children who were detected in 2005 as hearing-impaired but not by an UNHS. The UNHS group had a PASS rate of 97.0%. Forty-nine hearing-impaired children were diagnosed at a median age of 3.1 months and treated at a median age of 3.5 months. Corresponding values for the Hessian non-UNHS group were 17.8 and 21.0 months. For Germany the median age at diagnosis was 39.0 months. The age at therapy onset correlated negatively with parameters of speech/language and psychosocial development. A targeted screening would have resulted in a low sensitivity of 65.3%. Hence, a UNHS is the most effective way to an early therapy of neonatal hearing disorders with an optimal outcome.

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Transitory evoked otoacoustic emissions (TEOAE) have been recorded in 60 ears of 31 adult volunteers with nearly normal hearing at stimulus levels ranging from 83 dB SPL peak equivalent down to the individual response threshold using linear and nonlinear recording mode. The stimulus level dependence of response incidence and amplitude has been analysed for the integral response and in time windows selecting response components of limited latency ranges. At stimulus levels above 70 dB SPL peak equivalent the TEOAE records received in linear mode are contaminated with stimulus artifacts. At moderate stimulus levels the TEOAE amplitude differs only to a small extent between the two recording modes. At low levels the linear mode turns out to be better suited for signal detection due to its inherent lower noise level. The response threshold, defined as the highest stimulus level yielding a reproducibility of at least 60%, is significantly correlated to hearing threshold. The consideration of time windowed responses yields best results with respect to incidence and threshold of responses in the latency range between 5 and 10 ms, but it does not enhance frequency specificity.