Field Sensitivity of Targeted Neonatal Hearing Screening using the Nottingham ABR Screener

Mason, Steve; Davis, Adrian; Wood, Steve; Farnsworth, Andrea

doi:10.1097/00003446-199804000-00001

Cited by 34 publications

(12 citation statements)

References 20 publications

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“…In this prospective study no false negatives were found at follow-up, which made the AABR neonatal hearing screening of great value in the total evaluation of the at-risk newborn, in which anticipation of probable disorders of neurological development is an important part of the follow-up. In a retrospective study of the Nottingham AABR screener used in a NICU population Mason et al (24) reported a sensitivity of 90% and a specificity of 93%, which compares favourably with the results of OAE screening in an equivalent group, which had a sensitivity of 80% and a specificity of 92% (24,25).…”

Section: Automated Auditory Brainstem Response Screening In the High-mentioning

confidence: 91%

Automated auditory brainstem response in neonatal hearing screening

Straaten¹

1999

SPAE

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van Straaten HLM. Automated auditory brainstem response in neonatal hearing screening. Acta Paediatr 1999; 88 Suppl 432: 76-9. Stockholm. ISSN 0803-5326 Severe congenital hearing impairment is an important handicap affecting 0.1% of apparently healthy liveborn infants and 1-2% of graduates of neonatal intensive care units. The prognosis for intellectual, emotional, language and speech development in the hearing-impaired child is improved when the diagnosis is made early and intervention is begun before the age of 6 mo. Universal screening is preferable, since about 50% of infants with hearing loss are not discovered if neonatal hearing screening is restricted to high-risk groups. The automated auditory brainstem response (AABR) screener is a dedicated hearing screening device which provides information not only about the outer/middle ear and cochlea but also about the auditory pathway up to the brainstem. AABR has an agreement with conventional auditory brainstem response up to 98%. It uses a 35 dB near hearing level click. No operator interpretation is needed and it can be used on the ward and during oxygen therapy without disturbance from ambient noise. Reported referral rates in a hospital-based screening programme at the time of discharge vary, with an average of 4%. AABR has also been used in a home-based setting, with the same results. The time necessary for screening varies with the setting, but ranges from 4 to 15 min. Initial costs range from $15 to $25 per test, which is similar to neonatal screening for metabolic diseases. In addition to individual healthcare savings, early diagnosis may lead to savings on costs of intensive speech-language intervention and educational facilities. & Auditory brainstem response, hearing screening HLM van Straaten,

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Section: Automated Auditory Brainstem Response Screening In the High-mentioning

confidence: 91%

Automated auditory brainstem response in neonatal hearing screening

Straaten¹

1999

SPAE

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“…We therefore sought 15 papers 3,7,8,26,[43][44][45][46][47][48][49][50][51][52][53] for full review. All but one 45 (published in 1981) were published between 1996 and 2014.…”

Section: Methodsmentioning

confidence: 99%

“…Four of the studies reported comparisons of two different screening tests without reference standards, [44][45][46][47] two of the studies (identified from the search on negligence) reported no cases owing to missed diagnosis of hearing impairment, 48,49 and three included general discussion of the value of hearing screens beyond the neonatal period. 8,50,51 These nine studies were not reviewed further.…”

Section: Literature Reviewmentioning

confidence: 99%

A programme of studies including assessment of diagnostic accuracy of school hearing screening tests and a cost-effectiveness model of school entry hearing screening programmes

Fortnum

Ukoumunne

Hyde

et al. 2016

Health Technol Assess

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BackgroundIdentification of permanent hearing impairment at the earliest possible age is crucial to maximise the development of speech and language. Universal newborn hearing screening identifies the majority of the 1 in 1000 children born with a hearing impairment, but later onset can occur at any time and there is no optimum time for further screening. A universal but non-standardised school entry screening (SES) programme is in place in many parts of the UK but its value is questioned.ObjectivesTo evaluate the diagnostic accuracy of hearing screening tests and the cost-effectiveness of the SES programme in the UK.DesignSystematic review, case–control diagnostic accuracy study, comparison of routinely collected data for services with and without a SES programme, parental questionnaires, observation of practical implementation and cost-effectiveness modelling.SettingSecond- and third-tier audiology services; community.ParticipantsChildren aged 4–6 years and their parents.Main outcome measuresDiagnostic accuracy of two hearing screening devices, referral rate and source, yield, age at referral and cost per quality-adjusted life-year.ResultsThe review of diagnostic accuracy studies concluded that research to date demonstrates marked variability in the design, methodological quality and results. The pure-tone screen (PTS) (Amplivox, Eynsham, UK) and HearCheck (HC) screener (Siemens, Frimley, UK) devices had high sensitivity (PTS ≥ 89%, HC ≥ 83%) and specificity (PTS ≥ 78%, HC ≥ 83%) for identifying hearing impairment. The rate of referral for hearing problems was 36% lower with SES (Nottingham) relative to no SES (Cambridge) [rate ratio 0.64, 95% confidence interval (CI) 0.59 to 0.69;p < 0.001]. The yield of confirmed cases did not differ between areas with and without SES (rate ratio 0.82, 95% CI 0.63 to 1.06;p = 0.12). The mean age of referral did not differ between areas with and without SES for all referrals but children with confirmed hearing impairment were older at referral in the site with SES (mean age difference 0.47 years, 95% CI 0.24 to 0.70 years;p < 0.001). Parental responses revealed that the consequences to the family of the referral process are minor. A SES programme is unlikely to be cost-effective and, using base-case assumptions, is dominated by a no screening strategy. A SES programme could be cost-effective if there are fewer referrals associated with SES programmes or if referrals occur more quickly with SES programmes.ConclusionsA SES programme using the PTS or HC screener is unlikely to be effective in increasing the identified number of cases with hearing impairment and lowering the average age at identification and is therefore unlikely to represent good value for money. This finding is, however, critically dependent on the results of the observational study comparing Nottingham and Cambridge, which has limitations. The following are suggested: systematic reviews of the accuracy of devices used to measure hearing at school entry; characterisation and measurement of the cost-effectiveness of different approaches to the ad-hoc referral system; examination of programme specificity as opposed to test specificity; further observational comparative studies of different programmes; and opportunistic trials of withdrawal of SES programmes.Trial registrationCurrent Controlled Trials ISRCTN61668996.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 36. See the NIHR Journals Library website for further project information.

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“…In preterm babies Brienesse could detect a click-evoked OAE in 69% of the attempts, of which 40% had a reproducibility above 40% and 44% reached a signal-to-noise ratio b3 dB (22). In a retrospective study of the Nottingham AABR screener used in a NICU population Mason et al (24) reported a sensitivity of 90% and a specificity of 93%, which compares favourably with the results of OAE screening in an equivalent group, which had a sensitivity of 80% and a specificity of 92% (24,25). It is feasible for use on the ward and in the incubator, even during nasal CPAP oxygen therapy or artificial ventilation, without disturbance from either ambient noise or technical equipment.…”

Section: Automated Auditory Brainstem Response As a Universal Screenimentioning

confidence: 96%