Screening for secretory otitis media: evaluation of some impedance screening programs for long-lasting secretory otitis media in 7-year-old children

In an unselected cohort of 387 seven-year-old children 90% had all 9 planned impedance audiometries during their first year at school. The results from these 348 children were analyzed in different impedance screening programs, as 3 consecutive screening series, each comprising two or 3 tests at an interval of 4-8 weeks. The specificity of the ASHA and Nashville programs was too low in finding long-lasting secretory otitis media, namely about 70%, so that there were too many false positive cases. Therefore, a new impedance screening program was designed. It had about the same sensitivity (80%) but a far better specificity (95%) than the ASHA and Nashville programs. The predictive value of a positive test was 15% in the ASHA and Nashville programs, but 3 times better (48%) in the designed Hirtshals program. The Hirtshals program had a referral rate of 9% compared with the 32-36% in the ASHA and Nashville programs. The frequencies of retesting were 31% in the ASHA program, 52% in the Nashville Program and 45% in the Hirtshals program. Before general screening for long-lasting secretory otitis media can be recommended, additional information is needed.     

The paediatric otological caseload resulting from improved screening in the first year of life.

Improved test technique by health visitors has been shown to lead to higher accuracy in the screen of hearing aimed traditionally at prelingual sensorineural deafness. However, it gives greatly increased referrals of children having otitis media with effusion (OME) around the end of the first year of life. Two samples of children (n = 29 and 61) were tested in a children's hearing assessment clinic with properly documented testing techniques and trained personnel. The samples were each formed on a fixed population base, one before and one after screen improvements. This enabled characterization of two outcome groups within each sample (severe/persistent enough to refer to ENT vs discharged, despite slight hearing impairment). The average audiometric criterion for onward referral to ENT rose only very little, despite the increased assessment caseload resulting from more detections by the screen. This usefully permitted the conclusion that the number of true cases found due to the screen and assessed as lying beyond a specifiable degree of severity (average cut-off approximately 47 dB(A) or 35 dBHTL) had increased not through lower criteria for referral to ENT, but through the improvements to the screen. The increase was from approximately 0.4% to 1.3% of the base population screened. Thus a change materially enhancing the sensitivity and positive predictive value of a screen considerably enlarges the eventual otological caseload of children with middle-ear disease thought to justify concern at around the end of their first year. If done properly, screening is hence in practical terms about OME, not about prelingual sensorineural hearing impairment. This conclusion presses the urgency of evaluation and consensus on the otological management of the young child with OME.     

Validation of the language development survey (LDS): a parent report tool for identifying language delay in toddlers.

Two studies are reported demonstrating the reliability, validity, and clinical utility of the Language Development Survey (LDS; L. Rescorla, 1989) as a screening tool for the identification of expressive language delay in toddlers. In Study 1, 422 children (ages 24-26 months) were screened with the LDS in an epidemiological survey. The LDS manifested excellent concurrent validity with a brief direct screening measure of expressive vocabulary. Using the Rescorla (1989) Delay 3 cutoff of fewer than 50 words or no word combinations, 9.7% of the sample were language delayed (32 boys, 9 girls). In Study 2, 33 children identified as "at-risk" by the LDS Delay 3 cutoff and 33 typically developing children, matched on age, socioeconomic status, and gender, were seen for in-depth follow-up assessment approximately 3 weeks later. The LDS test-retest reliability was .97. The LDS correlated highly with Reynell Receptive and Expressive Language Scale scores, Bayley Mental Development Index, and Vineland Adaptive Behavior Composite. Sensitivity, specificity, positive predictive value, and negative predictive value between the screening LDS and the follow-up Reynell Expressive Language Scale were generally impressive. Finally, the at-risk group scored significantly lower than the LDS-identified typically developing group on all follow-up measures except the Child Behavior Checklist/2-3.     

Preschool hearing screening: pass/refer rates for children enrolled in a head start program in eastern North Carolina

This 4-year project investigated the pass/refer rates of preschool children in a hearing screening program. Three- and 4-year-old children who attended Head Start centers in rural, traditionally medically underserved, eastern North Carolina participated (n = 1,462). Screening procedures and pass/refer criteria were based on the Guidelines for Audiologic Screening (American Speech-Language-Hearing Association [ASHA], Panel on Audiologic Assessment, 1997). Only 54% (n = 787) of children passed the initial screening (i.e., passed all three of the screening components, which included pure-tone audiometry, tympanometry, and otoscopy), and an additional 22% (n = 323) passed the rescreening, for an overall pass rate of 76%. The initial pass rate was 90%, 71%, and 71% for otoscopy, tympanometry, and pure-tone audiometry, respectively. After the initial screening, 675 children were referred (i.e., 83%, 2%, and 15% for audiologic rescreening, medical evaluation, or both, respectively). About 71% (n = 478) received the recommended evaluation. Follow-up assessment compliance after the rescreening was poor. Slightly more than 10% of children were evaluated. The hearing status of 267 (i.e., 18.3%) children was never determined. Six (i.e., 0.5%) of the 1,195 children who completed the audiologic screening and/or received diagnostic audiologic assessment were confirmed to have hearing loss. Methodological factors that may have contributed to this high refer rate include the use of all screening techniques (pure tones, tympanometry, and otoscopy), procedural considerations in testing protocol and pass/refer criteria, and the demographic characteristics of the children screened.     

Diagnostic value of combining bilateral electrocochleography results for unilateral Ménière's disease

We defined 'an interaural difference in the summating potential/action potential (SP/AP) ratio from the ipsilateral hearing-impaired side to the contralateral normal-hearing side of > or =0.15' as a positive result for a novel 'relative criterion' for the diagnosis of unilateral Ménière's disease. A uniform result could be derived only between a positive ECoG result and the side of disease in 78.7% subjects by conventional absolute criterion (SP/AP > or =0.42). By adding the relative criterion, we found that the diagnostic value increased greatly in specificity (91.2%) and increased slightly in positive predictive rate (79.2%), but decreased greatly in sensitivity (28.8%) and decreased slightly in negative predictive rate (52.5%). In addition, we verified which ear had the disease in all positive cases.     

An abbreviated impedance bridge technique for school screening.

The hearing of 539 children were screened by conventional audiometric techniques and an abbreviated form of impedance audiometry. Otoscopic examination and estimates of the cost to accurately detect hearing loss were used as critieria for comparing the two methods. The impedance technique detected 94% of hearing disorders, the audiometric, 24%. Projections of cost included a factor for number screened. These demonstrated that the impedance technique was less expensive and approached one-sixth the cost of the audiometric technique at a rate of 10,000 children per year. A routine application of the impedance technique in an ongoing hearing conservation program (N = 2712) supported the initial conclusion that it was more effective and more easily employable than audiometric screening. One child who passed impedance screening was shown to have a 50-dB sensorineural loss. It was concluded that an abbreviated form of impedance audiometry that includes a single high-frequency screening tone is the technique of choice for school screening.     

The role of 24 h pH-recording in pediatric otolaryngologic gastro-esophageal reflux disease

The purpose of this study was to investigate the role of 24 h pH monitoring for the diagnosis of otolaryngologic including rhinologic manifestations of gastro-esophageal reflux (GER) in children and if possible to correlate the results with the efficacy of medical treatment. This is a retrospective study of 72 children from January 1997 to December 1999. The children were separated into three groups according to the main symptoms (although association of symptoms was frequent): rhinologic (n=28), laryngotracheal (n=28) and pharyngeal-otologic (n=16). With the classical gastroenterologic criterion (> or =4.2% of total time at pH < 4), the pH monitoring was positive in 56% of the patients. However, this criterion does not seem to be sensitive for otolaryngologic gastro-esophageal reflux disease (GERD) because multiple daytime short reflux episodes are often involved. Indeed, the pH monitoring was positive in 75% of the patients (82% in the rhinologic group) when a number of 40 episodes in 24h was also taken into account. The success rate of medical treatment was about 80% in case of positive pH recording. This study underlines that GER is an important factor in pediatric otolaryngologic diseases.     

From hearing screening to cochlear implantation: cochlear implants in children under 3 years of age

CONCLUSIONS: Universal hearing screening gives a deaf child earlier diagnosis and intervention with a better chance for successful management of hearing and speech development. OBJECTIVES: Universal newborn hearing screening has a major impact on early identification of deafness in children. This study evaluated the outcome of cochlear implantation in screened and non-screened deaf children. SUBJECTS AND METHODS: Group 1 comprised 9 deaf children diagnosed by screening; group 2 comprised 21 children diagnosed by traditional methods. The following parameters were evaluated: age at the time of diagnosis, age at the time of the first hearing aid fitting, age at the time of cochlear implantation. In children who had been using a cochlear implant for more than 2 years the results of audiological tests, category of auditory performance (CAP), and development and quality of speech were also evaluated. RESULTS: Hearing screening significantly reduced the age at the time of diagnosis (6.9 months vs 15.4 months) as well as the age at the time of the first hearing aid fitting (9.3 months vs 17 months) and age at the time of cochlear implantation (26 months vs 32 months). Children from the screening program had better results in speech audiometry (95% discrimination vs 84%), monosyllabic tests (62% vs 34%), CAP (level 6 vs level 5), evaluation of spontaneous speech (level 6 vs level 5), and intelligibility of speech (level 5 vs level 3.5). According to the statistical evaluation (Fisher's test) the functional results did not show significant difference.     

Pass/fail criteria in screening for otitis media in children with learning disorders

A group of 75 children with language/learning disorders were screened for middle ear problems using serial tympanometry and otoscopy. Using a fail criterion of -200 mm H2O for tympanometry, 68% of the ears identified as pathological by otoscopy were identified by two serial tympanometry screens. The concurrence of otoscopy and serial tympanometry indicated a failure rate of 18% of the ears tested. It is concluded that for children in special populations, such as those with language/learning disorders, who may need careful monitoring for identification of middle ear problems, a combination of otoscopy and a single test of tympanometry may improve the reliability of screening programs.     

Analysis of measurements from the first Swedish universal neonatal hearing screening program

This study analyses results from the first Swedish UNHS program. It includes over 33 000 measurement files from 14 287 children at two maternity wards. The screening program uses a two-stage TEOAE test procedure. A database was created in MedLog after data transformation in Word and Excel. The coverage rate was 99.1%. Bilateral pass rate after retesting was 97.0%. A unilateral pass criterion would have resulted in 1268 fewer children (9.0% of target group) for retesting and 231 fewer children (1.6% of target group) for diagnostic evaluation. When the first test was performed on the day the child was born, the pass rate was 64.8%; the pass rate increased to 89.2% when testing> or =3 days after birth. High coverage rates and pass rates were found to be possible, independent of the number of children born at the maternity ward. Learning curves were observed in the program with improvements distributed over time. Test performance was clearly better when the children were tested day two after birth or later.     

L-N-Acetylcysteine treatment is associated with improved hearing outcome in sudden idiopathic sensorineural hearing loss

Conclusions. Universal hearing screening gives a deaf child earlier diagnosis and intervention with a better chance for successful management of hearing and speech development. Objectives. Universal newborn hearing screening has a major impact on early identification of deafness in children. This study evaluated the outcome of cochlear implantation in screened and non-screened deaf children. Subjects and methods. Group 1 comprised 9 deaf children diagnosed by screening; group 2 comprised 21 children diagnosed by traditional methods. The following parameters were evaluated: age at the time of diagnosis, age at the time of the first hearing aid fitting, age at the time of cochlear implantation. In children who had been using a cochlear implant for more than 2 years the results of audiological tests, category of auditory performance (CAP), and development and quality of speech were also evaluated. Results. Hearing screening significantly reduced the age at the time of diagnosis (6.9 months vs 15.4 months) as well as the age at the time of the first hearing aid fitting (9.3 months vs 17 months) and age at the time of cochlear implantation (26 months vs 32 months). Children from the screening program had better results in speech audiometry (95% discrimination vs 84%), monosyllabic tests (62% vs 34%), CAP (level 6 vs level 5), evaluation of spontaneous speech (level 6 vs level 5), and intelligibility of speech (level 5 vs level 3.5). According to the statistical evaluation (Fisher's test) the functional results did not show significant difference.     

Comparison of hearing screening programs between one step with transient evoked otoacoustic emissions (TEOAE) and two steps with TEOAE and automated auditory brainstem response

OBJECTIVE: To compare the efficacy between one step with transient evoked otoacoustic emissions (TEOAE) and two steps with TEOAE and automated auditory brainstem response (AABR) in a newborn hearing screening program. We investigated their differences in referral rate, the accurate identification rate of congenital hearing loss (HL), and cost effectiveness. METHOD: From November 1998 to December 2004, a total of 21,273 healthy newborns were screened for HL in Mackay Memorial Hospital, Taipei. In the periods from November 1998 to January 2004 and from February 2004 to December 2004, the screening tools used were TEOAE alone (n = 18,260) and TEOAE plus AABR (n = 3,013), respectively. RESULTS: A statistically significant decrease of referral rate was achieved in the group using TEOAE and AABR as screening tools when compared with TEOAE alone (1.8% vs. 5.8%). The accurate identification rate of congenital HL was 0.45% in TEOAE protocol and 0.3% in TEOAE and AABR protocol, which was not statistically significant. The total direct costs per screening were 10.1 U.S. dollars for the program using TEOAE alone and 8.9 U.S. dollars for the TEOAE plus AABR program. The intangible cost, however, was much higher in the earlier program because of the higher referral rate. CONCLUSION: In terms of the efficacy of a hearing screening program using the one step TEOAE and two step TEOAE and AABR programs, the later significantly decreased the referral rate from 5.8% to 1.8%. No significant difference was noted between the accurate identification rates of congenital HL. The total costs, including expenditures and intangible cost, were lower in the protocol with TEOAE plus AABR.     

Effectiveness of a TEOAE-based screening program. Can a patient-tracking system effectively be organized using modern information technology and central data management?

It has been shown that detecting and treating children with hearing loss at an early age will improve their speech and language development. The implementation of universal hearing screening programs is therefore one of the major goals in pediatric audiology. One problem of present screening programs is high lost to follow-up rates. The aim of this paper was to evaluate the effectiveness of a patient tracking system based on central data management and data transmission via the internet. The screening program was organized as a TEOAE (transitory evoked otoacoustic emissions)-based three-stage procedure and covered a complete German federal state (Saarland). The measurements of the first stage took place in well-baby nurseries (WBNs) as well as neonatal intensive care units (NICUs). Measurements of the second stage were performed by pediatricians and ENT physicians on an outpatient basis. The third stage comprised diagnostic ABR (auditory brainstem response) measurements performed by pediatric audiologists. Using a central data management system we were able to identify and follow every child not screened or with negative results. The overall coverage in the first stage was 93% of all newborns. A screening result of the second stage could be obtained for 90% of the children. Four out of 3,830 children screened turned out to have a relevant hearing loss and were fitted with hearing aids. A TEOAE-based newborn hearing screening system can be organized effectively. Central data management as well as interdisciplinary organization of the follow-up are important prerequisites for the success of a hearing screening program. A follow-up system as proposed in this paper can also be implemented in AABR (automated auditory brainstem response)-based programs.     

P?daudiologische Diagnostik im ersten Lebensjahr

The universal neonatal hearing screening (UNHS) program demands detection of hearing loss within the first 3?months of life. Practicability and different screening methods should be evaluated. Thus, 617?patients (329 m., 288 w.) were analyzed; 246?children were referred in the UNHS, 389 with risk factors. In 459?children (74%), automated auditory brainstem response (ABR) screening in our department excluded hearing loss, thereof 129 (21%) underwent diagnostic auditory brainstem-evoked audiometry responses: 20 (16%) showed normal and 109 (84%) elevated ABR thresholds. A total of 91?children (83%) received hearing aids and 11?children (10%) treatment of middle ear effusion. Hearing loss was diagnosed in 18% of all children, 24% with UNHS referral and 34% with both referral and risk factors. Craniofacial anomalies, premature birth <?32?weeks of pregnancy, and syndromes were the most frequent risk factors. Reevaluation by ABR showed an improvement to normal hearing in 3 (of 14) children. The 226?Hz compared to 1,000?Hz-tympanometry showed different specificity (95.5 vs. 85.5%) and sensitivity (32.5 vs. 57.1%). Diagnosis within 3?months is possible, but very challenging in children with risk factors.     

Pilot study of universal newborn hearing screening in Japan: district-based screening program in Okayama

OBJECTIVES: Newborn hearing screening was started in Okayama Prefecture in 2001 as part of a nationwide pilot study in Japan. Nearly 50,000 infants have been screened to date, and an observational study and more than 2 years of follow-up of this population are described in this report. METHODS: Between June 2001 and March 2005 (45 months), 47,346 neonates were screened with automated auditory brain stem response systems and followed up for at least 2 years. This total corresponds to 95% of the infants born in the 44 gynecologic institutions in this district. RESULTS: After undergoing the screening process twice, 248 infants (0.52%) received referrals; 108 of them had apparent bilaterally affected hearing, and 140 had apparent unilaterally affected hearing. Among the bilateral cases, hearing impairment was diagnosed in 40 infants, for a total prevalence of hearing impairment of 0.08%. In 3 additional infants who received a bilateral pass result and 1 infant who received a unilateral pass result, hearing impairment that was progressive or of late onset was subsequently diagnosed. The positive and negative predictive values were calculated as 40% and 99.993%, respectively. CONCLUSIONS: The screening program was carefully designed to work in the Japanese society and to be well managed in Okayama Prefecture.     

M?glichkeiten und Grenzen der Fr��herkennung von Sprachentwicklungsst?rungen

Background

It is not been proven to date that children with developmental language disorders can be identified by general language screening in 2-year-old children. The goal of the present study was to determine the predictive diagnostic power of the parent questionnaire SBE-2-KT.

Methods

The language abilities of 562 children were assessed using the SBE-2-KT at the age of 2 and reassessed 1?year later using the parent questionnaire SBE-3-KT.

Results

The correlation between language scores at age 2?and 3 were moderate and highly significant (r_Sp=0.59?C0.68, p<0.001). Sensitivity, specificity, as well as positive and negative predictive values against language impairment at age 3 as a reference were 43%, 93%, 57% and 88%, respectively.

Conclusions

The possibility to identify children with language disorders at the age of 2 is limited. Almost half of the children with delayed language development at age 2 had results on language screening within the normal range at 3?years. Furthermore, nearly every second child with subnormal language scores at age 3 is not classified as a late talker at age 2. Therefore, for early identification of language disorders a general reassessment of language skills is necessary at the age of 3.     

Quantitative and qualitative follow-up outcomes from a preschool audiologic screening program: perspectives over a decade

PURPOSE: This investigation reports on quantitative and qualitative follow-up information obtained from a preschool audiologic screening program covering a 10-year period (1995 to 2004). METHOD: The audiologic screening consisted of a hearing (pure tone) and tympanometry screening. A total of 34,979 children, 3 to 5 years of age, were screened. RESULTS: Eighteen percent (6,337) of the children were referred for further hearing and/or medical ear evaluation. Of 1,421 follow-up responses received, 93% complied with the follow-up recommendations while 7% did not. Of 1,316 children in the follow-up group, outer and/or middle ear disorder in one or both ears was medically confirmed for 37%. Unilateral or bilateral hearing loss was diagnosed in 18% as conductive (12%), sensorineural (1%), mixed (0.4%), or unspecified (5%). Overall, hearing loss and/or otologic disorder was confirmed in 49% of the follow-up group, suggesting a prevalence of 1.8% in a preschool-age population. A small (n = 32) sample of unsolicited comments indicated that physicians most influenced noncompliance with hearing evaluation follow-up. CONCLUSIONS: The quantitative hearing and otologic follow-up outcome data affirm the importance of audiologic screening in the preschool population. Qualitative data suggest that some physicians may not be advocating appropriate screening follow-up services.     

The paediatric otological caseload resulting from improved screening in the first year of life

Improved test technique by health visitors has been shown to lead to higher accuracy in the screen of hearing aimed traditionally at prelingual sensorineural deafness. However, it gives greatly increased referrals of children having otitis media with effusion (OME) around the end of the first year of life. Two samples of children (n= 29 and 61) were tested in a children's hearing assessment clinic with properly documented testing techniques and trained personnel. The samples were each formed on a fixed population base, one before and one after screen improvements. This enabled characterization of two outcome groups within each sample (severe/persistent enough to refer to ENT vs discharged, despite slight hearing impairment). The average audiometrie criterion for onward referral to ENT rose only very little, despite the increased assessment caseload resulting from more detections by the screen. This usefully permitted the conclusion that the number of true cases found due to the screen and assessed as lying beyond a specifiable degree of severity (average cut-off approximately 47 dB(A) or 35 dBHTL) had increased not through lower criteria for referral to ENT, but through the improvements to the screen. The increase was from approximately 0.4% to 1.3% of the base population screened. Thus a change materially enhancing the sensitivity and positive predictive value of a screen considerably enlarges the eventual otological caseload of children with middle-ear disease thought to justify concern at around the end of their first year. If done properly, screening is hence in practical terms about OME, not about prelingual sensorineural hearing impairment. This conclusion presses the urgency of evaluation and consensus on the otological management of the young child with OME.     

Using otoacoustic emissions to screen for hearing loss in early childhood care settings

OBJECTIVE: Until recently, no objective tool has been available to help health and early childhood education providers screen young children for hearing loss. The aim of this study was to screen underserved children 相似文献