Changing Performance of the Health Visitor Distraction Test When Targeted Neonatal Screening is Introduced into a Health District

Abstract

The change in the performance of the HVDT as targeted neonatal hearing screening has been introduced has been examined for the Nottingham district. The records for all children born in the period 1984-1993 within the district and having a permanent hearing loss of > or = 50 dB in the better ear have been examined. The referral route leading to ascertainment of the hearing loss as well as the result of any screening tests were noted. The data shows an increase in the number referred prior to the HVDT, mainly as a result of neonatal screen failure. At the same time there has been a reduction in the sensitivity of the HVDT from 78% in the first half of the decade to 38% for the second half. There are also some indications of an increase in the coverage and the failure rate over the time. Possible reasons for these changes are discussed.

Screening for hearing loss in childhood: issues, evidence and current approaches in the UK

“…12 McCormick and colleagues 20 led moves to improve protocols and training for those performing the distraction test, which appeared in some areas to improve the results. 21 Meanwhile, advances in knowledge and technology were making available equipment that could reliably identify the presence or absence of outer hair cell activity from the inner ear via transient evoked otoacoustic emissions (TEOAE) 22 or electrophysiological activity from the early auditory pathways (the auditory brainstem response [ABR] -see review by Stevens, 2001 23 ). The development of this equipment from diagnostic tools to relatively simple screening tools using automated pass/fail decision criteria opened up the possibility of screening newborns, and by the early 1990s there was widespread ad hoc use of these methods to screen 'at-risk' babies -largely those from neonatal intensive care units.…”

The distraction test: The last word?

“…Wood et al . found that the introduction of targeted neonatal screening in Notttingham, UK, was associated with a reduction in distraction testing sensitivity from 78% to 36% 14 . Our 65% lies between these figures.…”

Otolaryngology outreach to Komfo Anokye Teaching Hospital: a medical and educational partnership

“…Because of poor funding and the lack of equipment, clinical audiological testing is limited to pure tone air and bone conduction threshold measures. When indicated, distortion product otoacoustic emission screening and auditory distraction testing can be performed, with the latter being used for those aged 6 to 18 months to discriminate laterality of ear-specific information 5 . Newborn hearing screens using auditory brainstem responses are unavailable at the Hearing Assessment Centre.…”