Universal newborn hearing screening, a revolutionary diagnosis of deafness: real benefits and limitations

Abstract

The finding that early detection of permanent congenital childhood hearing loss produces worthwhile benefit in terms of improved speech and language provides the rationale for the universal screening of newborns. The aim of the present study is to collect the current evidence with regard to the efficacy, the results and outcomes of universal hearing screening programs. An extensive search of the literature was performed in Medline and other available database sources. Study selection was based on the evaluation of the protocols used and the assessment of their efficacy in the early diagnosis of congenital hearing impairment. The initial referral rate and the rate of false positives were also evaluated. A total of 676,043 screened children have been identified in 20 studies. The average initial referral rate in these studies was 3.89%. The initial referral rate varied from 0.6 to 16.7%. The lost-to-follow-up rates varied from 3.7 to 65%. Although universal hearing screening is now widely adopted, there are still some serious drawbacks and limitations. False positives rates remain considerably high when newborns are screened with TEOAE's. The combination of TEOAE's and a-ABR provides a significantly reduced referral rate. Close cooperation between audiological centres and maternity units and a dedicated secretariat team are of paramount importance with regard to the reliability and efficacy of universal hearing screening.

Follow-Up Results of Newborns after Hearing Screening at a Training and Research Hospital in Turkey

“…Our rate of screening before 1 month of age was below 95%. The high rates of newborns lost to follow-up may be associated with the introduction of more measures in the screening program to reduce referral rates [2] . Other reasons for the high number of newborns lost to follow-up in our study may be the absence of a secretariat system to follow-up every failed newborn and remind parents regarding their future appointments, low degree of awareness regarding hearing loss in families and healthcare providers, and presentation of failed newborns' anxious parents to the tertiary hospitals because of the absence of psychological support after screening.…”

“…Some risk factors that were associated with hearing impairment, such as head trauma, and chemotherapy were excluded and consanguineous marriage was added as a risk factor [23] . Different newborn hearing screening programs have been used in different countries, but the most acceptable methods for UNHS include both the TEOAE and automated ABR tests [2,24] . Therefore, we used the TEOAE and automated ABR tests in our UNHS program.…”

“…Early identification and intervention of hearing loss is crucial for hearing-impaired newborns in terms of their speech and language development. If they are not identified early, hearing impairment may have negative impacts on their language, cognitive, social, emotional, and academic development [1][2][3] .…”

Assessment of early auditory development of very young Finnish children with LittlEARS® Auditory Questionnaire and McArthur Communicative Developmental Inventories

“…hearing impairment may go undetected because of, for example, screening device failures or they may pass the test as false positives [9,10]. Moreover, mild or unilateral hearing impairments may fail to be detected, and some hearing impairments that develop during the first months of life may be difficult to uncover [11].…”

Cost-Effectiveness Analysis of Automated Auditory Brainstem Response and Otoacoustic Emission in Universal Neonatal Hearing Screening

“…Both AABR and AOAE are non-invasive, rapid screening tests. OAE measures sounds that are produced by the cochlea to response to acoustic stimulation, and AABR measures electroencephalographic waveforms in response to clicks (12)(13)(14)(15).…”