A universal newborn hearing screening program in Taiwan

OBJECTIVE: Mackay Memorial Hospital and the Children's Hearing Foundation established a pilot universal newborn hearing screening program in November 1998. Our objective was to assess the feasibility, accuracy and cost effectiveness of implementing universal newborn hearing screening in Taiwan. METHOD: Between November 1998 and October 2000 a total of 6765 newborns were screened for hearing loss prior to discharge from the wellborn nursery at Mackay Memorial Hospital. The average age of the subjects at the initial screening test was 52 h. The program employed a three stage hearing screening protocol using transient evoked otoacoustic emmisions (TEOAE) screening with referral for diagnostic auditory brainstem response assessment. RESULTS: The mean TEOAE screening time per ear was 41.43 s. The overall pass rate at the time of hospital discharge was 93.6%. Thus achieving an acceptable referral rate of 6.4% for diagnostic audiological assessments. Nine newborns were identified with permanent bilateral hearing impairment. 26 newborns were identified with permanent unilateral hearing impairment. Infants identified with bilateral hearing loss were immediately referred to the Children's Hearing Foundation for hearing aid assessment and fitting. Infants as young as 5 weeks of age were successfully fitted with hearing instruments and enrolled in the family centered early intervention program at the Children's Hearing Foundation. CONCLUSION: The frequency of bilateral congenital hearing loss requiring amplification in this population is shown to be approximately 1 in 752 newborns. This finding is consistent with previous research, which has indicated hearing loss to be the most frequently occurring birth defect. Universal newborn hearing screening using TEOAEs proved to be a cost effective and feasible method of identifying congenital hearing loss in Taiwan. The existence of many successful screening programs worldwide and the availability of fast, objective, reliable and inexpensive hearing screening procedures means that universal newborn hearing screening is becoming the standard of care.     

A randomized controlled trial evaluating the active communication education program for older people with hearing impairment

OBJECTIVE: To evaluate the effectiveness of the Active Communication Education (ACE) program for older people with hearing impairment and to investigate factors that influence response to the program. The ACE is a group program that runs for 2 hr per week for 5 wk. DESIGN: In this double-blinded, randomized, controlled trial, 178 older people with, on average, mild to moderate hearing impairment were randomly allocated to one of two groups. Approximately half had been fitted with hearing aid/s in the past. One group (N = 78) undertook a placebo social program for the first 5 wk, followed by the ACE program. They were assessed before the social program, immediately after it, and then again immediately post-ACE. The other group (N = 100) undertook the ACE program only and were assessed before and after ACE. In addition, 167 participants were reassessed 6 mo after completing ACE. Assessments were all self-report and included two sets of measures: 1) those administered both before and after the program-the Hearing Handicap Questionnaire, the Quantified Denver Scale of Communicative Function, the Self-Assessment of Communication, the Ryff Psychological Well-Being Scale, the Short-Form 36 health-related quality of life measure; and 2) those administered postprogram only-the Client Oriented Scale of Improvement, the International Outcome Inventory-Alternative Interventions, and a qualitative questionnaire. All assessments were conducted by a researcher blinded to participants' group membership. The relationships between participant response to the ACE program and a number of client-related factors were also investigated. These factors were the participants' age, gender, hearing loss, hearing aid use, attitudes to hearing impairment (as measured using the Hearing Attitudes to Rehabilitation Questionnaire) and the involvement of significant others. RESULTS: For those participants who completed the social program initially, significant improvements were found on the Quantified Denver Scale of Communicative Function and on the Mental Component Score of the Short-Form 36 only, when pre- and postprogram scores were compared. For those who completed the ACE program, there were significant pre-to-post improvements on the Hearing Handicap Questionnaire, the Quantified Denver Scale of Communicative Function, the Self-Assessment of Communication, and the Ryff Psychological Well-Being Scale. These improvements after ACE were maintained at 6 mo. Higher scores on the Hearing Attitudes to Rehabilitation Questionnaire before the ACE program were associated with greater positive change on a number of the pre-post program measures. Using the Client Oriented Scale of Improvement, 75% of participants reported some improvement on the primary goal they wished to achieve with the ACE. Positive outcomes were also recorded with the International Outcome Inventory-Alternative Interventions. CONCLUSIONS: This research study provides evidence for the effectiveness of the ACE program and indicates that such communication programs have an important place in the audiological rehabilitation of older adults. They should be considered as an alternative or a supplement to traditional interventions such as hearing aid fitting.     

Universal newborn hearing screening program in Bulgaria

The design of a Universal Newborn Hearing Screening Program (UNHSP) depends on many factors unique to each hospital. The goal of any UNHSP is to perform a valid hearing screening on all newborn infants prior to hospital discharge. Ultimately hearing screening of all infants should decrease the age at which intervention is initiated in these who require it. It is clear that there is no "one" model for UNHSPs. Each program must carefully consider what type and severity of hearing loss it wishes to identify. Then, based on available screening tools, program philosophy, prior experience, personnel, typical maternity length of stay, etc., an appropriate protocol must be developed. We present our protocol for detection and confirmation of hearing loss, and for habilitation of deaf children. For detection the hearing loss we used the automated auditory brainstem response (ABR) delivery system (A-ABR), and we confirm this with conventional non-automated ABR delivery system (BERA). The healthy babies we screen after 6h of age using a simultaneous 35-dB nHL screening option available on the Newborn Hearing Screener ALGO-2. The neonatal intensive care unit (NICU) babies we screen prior to discharge using all options of the ALGO-2. The "refer" ALGO-2 results are immediately retested. Infants in need of an outpatient screen are recalled at age 3-4 weeks. The diagnosis "hearing loss" is determinate only by BERA and the neonatal hearing screening is the first part of program of habilitation of hearing-impaired children. The cost for UNHSP in Bulgaria is 1407 euro per case identified.     

Community-based newborn hearing screening program in Taiwan

OBJECTIVE: Congenital bilateral hearing impairment occurs in approximately 1 in every 1000 live births. Universal newborn hearing screening (UNHS) programs are the most effective method for early diagnosis. Previously, newborn hearing screenings in Taiwan were often hospital-based. Our study is a community-based program designed to test the feasibility of performing neonatal hearing screening with a pay-for-test model, and to evaluate its acceptability to parents. METHODS: From March 2000 to December 2002, two hospitals and four obstetric clinics in Tainan city participated in this study. The subjects were healthy newborns whose parents agreed to pay for otoacoustic emissions (OAE) hearing screening. They were tested in the newborn nursery before discharge. The protocol used an initial transient evoked otoacoustic emissions screening followed by a diagnostic auditory brainstem response (ABR) test. RESULTS: A total of 10,008 healthy neonates were recruited, and 5938 newborns (59.3%) were tested. Prior to hospital discharge, 5403 of the newborns (91.0%) had passed the transient evoked otoacoustic emissions test. Referral for further testing was made in 9.0% of cases (535/5938). There were 140 babies lost to 1-month follow up. Only 395 infants (73.8%) of the infants that failed their first otoacoustic emissions tests underwent a second session at the outpatient clinic, and 91 babies failed. They were referred for further auditory brainstem response testing. Ultimately, nine babies were diagnosed with sensorineural hearing loss (SNHL). CONCLUSIONS: There are difficulties in performing universal newborn hearing screening within Taiwan's health insurance system. This study was performed with the cooperation of hospitals and obstetric clinics, and was undertaken with a pay-for-screening model. Our program, with a pay-for-test model, of newborn hearing screening is feasible and was well regarded by parents in Tainan city. It could be run without the government's financial support.     

Volunteer-based universal newborn hearing screening program

OBJECTIVE: To evaluate efficacy and costs of a volunteer-based universal newborn hearing screening program. METHODS: The Lucile Packard Children's Hospital at Stanford newborn hearing screening program database was reviewed. Results and costs of the hearing screens were analyzed. RESULTS: Hearing screens were performed on 5771 newborns treated in the well-baby nursery and nine infants from this population were identified with hearing loss, seven of whom had no risks factors for hearing loss. Using volunteers to perform the first-line screen with the automated auditory brainstem response (AABR) technology, 91% of infants registered for screening were evaluated prior to discharge. An additional 4% of infants were screened as outpatients. If an infant failed the AABR on two occasions, he or she was rescreened with the AABR or transient evoked otoacoustic emissions by a licensed audiologist, often while the infant was still in the hospital. Using this algorithm, 5% of infants tested in the well-baby nursery needed additional follow-up as an outpatient. Cost analysis of this volunteer-based program reveals a per/baby screening cost of $27.41. CONCLUSIONS: A volunteer-based hearing screening program is a viable option for hearing screening in well-baby nurseries but does not result in significant cost savings during the first 2 years of the program.     

Database for a hearing conservation program

We have developed a database and an analysis program (NoiseScan) for noise-induced hearing loss (NIHL). The exposure data are based on the evaluation of the noise immission level, which includes duration, frequency content, and the use of, and the attenuation performance of, hearing protectors. The input data can handle an unlimited number of exposure periods. If the noise exposure level is not known, the program lists noise levels of comparable work places, and thus provides an estimate of exposure. Confounding medical factors that may contribute to NIHL, such as elevated serum cholesterol level, hypertension, and extensive use of pain killers, are collected. Combined exposure to agents that clearly contribute to NIHL, such as hand-arm vibration, tobacco smoking, use of aminoglycosides and exposure to solvents are also assessed. An unlimited number of audiograms can be stored, and all the data can be completed and edited following collection. The program gives the predicted hearing loss according to the ISO 1999 model based on total exposure. At present, our NoiseScan program (under continuous development in an EU research program) is suitable for the data collection of various risk factors. It can be used to determine whether the hearing loss is occupational in origin and to estimate the efficiency of hearing conservation measures. NoiseScan also predicts the development of hearing loss in individuals in 5-year periods. The goal is to improve and validate the rules by which single and combined risk factors contribute to HIHL, thus leading to more precise prediction of individual hearing loss, and for the evaluation of success of the hearing conservation programs.     

Status of newborn hearing screening program in India

Objectives

The present study is aimed at figuring out the status of new-born hearing screening program being conducted in India, estimate the use of different screening instruments used and tests practiced, study the role of various professionals involved and document the current practices of audiologists in the country.

Method

A questionnaire on “Newborn Hearing Screening Survey” was sent to 185 institutions (165 medical colleges and 20 Speech and hearing centers) all over India and the information gathered was subjected to appropriate analyses.

Results

On a 16.75% return rate of the questionnaire, almost half of the colleges have their annual birthing census more than 2000. The majority of sites (57.13%) report an average length of stay for a vaginal delivery to be more than 24 hours with 78.94% also reporting of a NICU of Level II/III type. Only 38.09% of the medical colleges have a universal Newborn Hearing screening program (NBHS) in comparison to 80% of the Speech and Hearing centers. Again 43.8% of the medical colleges who conduct NBHS program have an audiologist and majority of them work towards screening. Almost 63% of the speech and hearing centers use physiological tests like ABR, OAE or their combination to screen newborns. Both medical and speech and hearing organizations prefer that the audiologist inform and even give a written material regarding the results of the tests to the parents. Only 62.65% of the institutions refer less than 11% of their clients for further testing at the time of discharge. In 50% of the medical colleges the results of a test are reported to the parents and primary care physicians/doctors and in 37.5% of the speech and hearing centers the results are informed to the parents.

Conclusions

While keeping in mind the incidence of hearing impairment in the neonatal population of India, the results of this survey warrant the need for an urgent implementation of universal neonatal hearing screening in all the health care facilities in the country, at large.     

A home education program for older adults with hearing impairment and their significant others: A randomized trial evaluating short- and long-term effects

This paper addresses the development and effectiveness of a home education program. The program, designed for hearing-impaired elders and their significant others (SO), deals with communication strategies and speech reading. Participants were randomly assigned to a training group (hearing aid fitting?+?home education program) or a control group (hearing aid fitting). The training group included 24 hearing-impaired subjects and 24 SO's. Controls were 24 affected individuals and 22 SO's. Questionnaires addressing emotional response, communication strategies and the IOI-HA, IOI-AI and IOI-SO were used. A repeated measures analysis of variance was applied to test group differences between pre, post, and 6-months follow-up measures. Increased awareness of benefits of speech reading and improved interaction with the SO were observed in the training group only (p?<?0.05). No group difference on ‘emotional response’ was found. IOI-AI and IOI-SO demonstrated favorable attitudes towards the program. Follow-up measures showed improved quality of life and satisfaction in the training group, while a decrease was observed among the controls (p?<?0.05). Some effects differed between first-time and experienced hearing aid users. Addition of services to amplification and involvement of the SO are relevant in aural rehabilitation.     

A neonatal hearing screening research program using brainstem electric response audiometry

Results of brainstem electric response audiometry (BERA) for intensive care nursery graduates and babies from the general nursery are described. At-risk babies received both screening and more detailed BERA before hospital discharge. The latter test was repeated after four months. From 2,597 risk assessments, 421 were at risk and 379 have been tested. The specificity of 40 dB click screening is good, but its sensitivity is only moderate. Follow-up BERA detected 25 cases of hearing loss, 12 having moderate loss in at least one ear. Discrepancies between predischarge and follow-up tests occurred, especially for mild losses. There was substantial resolution of hearing loss, but also some emergent mild loss. These changes support BERA at about four months as the determinant of habilitation, as opposed to predischarge testing. Differences between click and frequency-specific BERA were found, suggesting that click evaluations alone are insufficient.     

A home education program for older adults with hearing impairment and their significant others: a randomized trial evaluating short- and long-term effects

This paper addresses the development and effectiveness of a home education program. The program, designed for hearing-impaired elders and their significant others (SO), deals with communication strategies and speech reading. Participants were randomly assigned to a training group (hearing aid fitting+home education program) or a control group (hearing aid fitting). The training group included 24 hearing-impaired subjects and 24 SO's. Controls were 24 affected individuals and 22 SO's. Questionnaires addressing emotional response, communication strategies and the IOI-HA, IOI-AI and IOI-SO were used. A repeated measures analysis of variance was applied to test group differences between pre, post, and 6-months follow-up measures. Increased awareness of benefits of speech reading and improved interaction with the SO were observed in the training group only (p < 0.05). No group difference on 'emotional response' was found. IOI-AI and IOI-SO demonstrated favorable attitudes towards the program. Follow-up measures showed improved quality of life and satisfaction in the training group, while a decrease was observed among the controls (p < 0.05). Some effects differed between first-time and experienced hearing aid users. Addition of services to amplification and involvement of the SO are relevant in aural rehabilitation.     

Infant hearing screening: program implementation and validation

Congenital and early-onset hearing losses were discovered in 6.1% of 975 Intensive Care Nursery (ICN) graduates. The methods used were neonatal screening by Crib-O-Gram (COG) and high risk register, in combination with repeated behavioral hearing tests at 1 to 3 years. This 7-year longitudinal study had follow-up hearing evaluations for a remarkably high 84% of all subjects. Significant losses that interfered with speech and language development (1000 to 8000 Hz average loss greater than 45 dB HL bilaterally) were found in 4.3% of infants. COG in combination with subsequent behavioral hearing screening was a sensitive strategy for detecting significant hearing loss: only one child was missed with this combination. Alone, COG sensitivity to significant hearing losses was 79.3%, but would have been higher had a stricter passing criterion been adopted. Behavioral hearing screenings detected bilateral hearing losses of even mild (greater than 20 dB HL) degree. Sensitivity to significant hearing losses was 82.6% and would have been improved if test frequencies greater than 3000 Hz were included in the screen. Even if screening failure occurred at 1 year of age, the age of actual confirmation of hearing loss depended on severity of the loss and ear involvement. Significant hearing losses were confirmed earlier than less severe or unilateral losses. Although behavioral screenings could be done during the first year of life, continued follow-up was required to detect progressive hearing losses.     

The prevention of noise-induced hearing loss in the school-aged population: a school educational hearing conservation program

A questionnaire assessing knowledge of hearing and hearing loss, and planned hearing conservation practices, was collected from 71 high school students before and after an educational hearing conservation program (HCP) consisting of a film, a lecture and a handout. An average increase of 16.7% correct responses from pre- to postexposure to the HCP was found. Moreover, substantial percentages of respondents stated that they now plan to use hearing protection devices and procedures, when appropriate, and about 80% stated they found the HCP helpful to them.     

The universal newborn hearing screening program of Taipei City

Objectives

To establish a hearing screening program with high coverage, low referral rate, high follow-up rate, and early intervention in Taipei City.

Methods

From September 2009 to December 2010, 85% delivery units in Taipei City, which includes 20 hospitals and 14 obstetrics clinics, were recruited into the screening program in two stages. A total of 15,930 babies were born in these participating hospitals and clinics during the program period. Among these neonates, 15,790 underwent hearing screening test with automatic auditory brainstem response (AABR). The screening was free of charge to the parents. The hearing screening examination was performed 24–36 h after birth. The same test was repeated between 36 and 60 h of age if the baby failed the first hearing test. The neonate was referred to the diagnostic hospitals for further investigations if he failed the second test.

Results

The screening coverage rate was 99.1% (15,790/15,930). The incidence of bilateral moderate to severe and unilateral hearing loss was 1.4 per 1000 (22/15,790) and 1.5 per 1000 (24/15,790), respectively. Four percent (626/15,790) of newborns failed to pass the initial screening test and 1.0% of newborns failed to pass the second screening test. Therefore, 1.0% newborns were referred for diagnostic assessments. The follow-up rate was 94.4% (151/160). Sixty-four percent (14/22) of babies with bilateral hearing loss completed the full diagnostic hearing tests within 3 months of birth.

Conclusions

The universal newborn hearing screening program is an adequate program for Taipei City with high coverage, low referral rate, and good follow-up rate. Screening fees covered by third parties, two-stage screening steps with AABR strategy, and the stringent monitoring system proved to be effective.

Level of evidence

2b, individual cohort study