Screening for delayed-onset hearing loss in preschool children who previously passed the newborn hearing screening

Objective

The goal of this study was to investigate the prevalence of delayed-onset hearing loss in preschool children who previously passed newborn hearing screening in Shanghai, China.

Methods

Between October 2009 and September 2010, 21,427 preschool children were enrolled from five areas of Shanghai, who had passed newborn hearing screening. Children were screened for delayed-onset hearing loss with pediatric audiometers. Children with positive results in initial and re-screening tests were assessed audiologically and for risk indicators according to the Year 2007 Statement of the American Joint Committee on Infant Hearing (JCIH).

Results

During the study period, 445 children (2.08%) were referred for audiologic assessment; 16 (0.75/1000, 95% CI 0.38-1.12) had permanent delayed-onset hearing loss. Of these, five (0.23/1000) had bilateral moderate hearing loss; seven (0.33/1000) had mild bilateral hearing loss; and four (0.19/1000) had unilateral moderate or mild hearing loss. JCIH risk indicators were established for six children (6/16, 37.5%), including parental concern regarding speech and language developmental delay, neonatal intensive care unit with assisted ventilation or hyperbilirubinemia, recurrent otitis media with effusion, craniofacial malformation, and family history (n = 1 for each). The remaining ten (62.5%) had no related risk factors.

Conclusions

A significant proportion of preschool children have undiagnosed delayed-onset hearing loss. Hearing screening in preschool is recommended for an early detection.     

Progressive hearing loss after completion of cisplatin chemotherapy is common and more pronounced in children without spontaneous otoacoustic emissions before chemotherapy

Objective

High frequency hearing loss following cisplatin chemotherapy is frequent in children and often necessitates the fitting of hearing aids. During therapy, hearing is usually monitored. Post-therapeutic follow-up does not routinely include monitoring of hearing, although there are indications that hearing thresholds can decline after therapy.

Methods

Pure-tone audiograms taken from 27 children (17 males, 10 females) treated with cisplatin at Muenster university hospital (mean age 9.84 years, standard deviation 3.67 years) including an audiological follow-up at least 6 months after therapy, were analyzed retrospectively.

Results

In follow-up tests after completion of therapy, 24.1% of all ears showed an increase in mean high frequency hearing thresholds (4-8 kHz). Post-therapeutic hearing deterioration was significant at 4 kHz and significantly more pronounced in children without measurable spontaneous otoacoustic emissions (SOAE) before therapy. Post-therapeutic hearing deterioration did not occur in ears with normal pure tone thresholds (≤10 dB at all frequencies) after cisplatin therapy. No correlation was found between post-therapeutic hearing deterioration and cranial irradiation.

Conclusions

Cisplatin chemotherapy follow-up should include audiological monitoring in all children with elevated pure tone thresholds after therapy. Routine SOAE measurements taken as part of baseline audiometry before the start of chemotherapy can be taken into consideration.     

Tone burst stimulus for auditory brainstem responses: Prediction of hearing threshold at 1 kHz

Objective

To assess differences in hearing threshold estimation of four different ABR tone-bursts at 1 kHz.

Methods

Twenty-one (21) ears from 11 subjects were tested with pure-tone audiometry (PTA): 5 ears (24%) were normal hearing, 5 (24%) affected by mild hearing loss, 7 (33%) showed moderate hearing loss and 4 (19%) severe hearing loss. After PTA each subject underwent tone-burst ABR test at 1 kHz using a linear gated (L_ABR) or Blackman windowed (B_ABR) stimuli with (nn_ABR) and without ipsilateral notched noise. Stimulation rate and filters settings were unchanged.

Results

Overall correlation between PTA and all ABRs thresholds was high, ranging from 0.84 to 0.94. In normal hearing ears none of the differences was significant, except for those measured with B_nn_ABR, which showed a mean 16 dB overestimation of the pure-tone threshold (p < 0.05). In mild hearing loss group none of the differences between thresholds were significant. In moderate and severe hearing loss groups significant differences were measured with L_nn_ABR (p < 0.05) with a mean 7.5 dB underestimation of PTA.

Conclusions

Although very similar, some significant differences were found when considering specific group of patients with different degrees of hearing loss.     

Determination of hearing levels in patients with Familial Mediterranean Fever

Objective

Familial Mediterranean Fever is the most common congenital, periodic fever condition that affects over 100,000 people worldwide. In the literature, there is limited number of studies about hearing levels in children with Familial Mediterranean Fever. In the present study, we aimed to investigate hearing levels and cochlear functions by using Distortion product Otoacoustic Emission and High Frequency Audiometry (250–20,000 Hz) in pediatric patients with Familial Mediterranean Fever.

Methods

The study included 62 children with Familial Mediterranean Fever and 27 healthy children with similar age and gender. After otoscopic examination, both groups underwent audiological evaluation including High Frequency Audiometry (250–20,000 Hz) and Distortion product Otoacoustic Emissions. The results obtained were assessed among groups. In addition, these results were compared regarding colchicine use, age at the onset of disease and duration of the diseases in the Familial Mediterranean Fever group.

Results

Of the Familial Mediterranean Fever patients, 93.5% were on colchicine therapy and mean duration of colchicine use was 19.9 ± 13.9 months. The mean age at diagnosis was 6.57 ± 2.86 years (min–max: 2–14) and mean duration of disease was 23 ± 17 months (min–max: 6–84). Pure tone audiometry values, and hearing levels between 9000 and 20,000 Hz were similar and within normal range in both groups. The Distortion product Otoacoustic Emissions responses at the frequencies of 1020, 2040, 3000, 4080 and 5040 Hz were similar for both groups.

Conclusion

To the best of our knowledge, this is the first study evaluating hearing levels at the frequencies of 18 kHz and 20 kHz in children with Familial Mediterranean Fever in the literature. In children with Familial Mediterranean Fever, Pure tone audiometry values, hearing values obtained at all frequencies from 250 to 20,000 Hz, and Distortion product Otoacoustic Emissions levels were within normal range. Furthermore, hearing levels were found to be similar to those in healthy children.     

Epileptiform electroencephalogram abnormality in children with congenital sensorineural hearing loss

Objectives

This work was designed to study electroencephalogram findings in children with congenital sensorineural hearing loss and correlate these findings with the SNHL parameters as duration, etiology, severity, and type.

Methods

Ninety children with bilateral congenital sensorineural hearing loss served as the study group. They were free from any neurological disorders or symptoms that are commonly associated with abnormal electroencephalogram as convulsions or loss of consciousness. Twenty children having normal hearing with no history of otological or neurological disorders served as the control group. All children participating in the study were subjected to full medical and audiological history, otological examination, neurological examination, audiological evaluation and electroencephalogram recording.

Results

Mean age of the children in the control group was 3.56 ± 2.1 years and mean age of the children in the study group was 3.8 ± 2.2 years. While none of the control children had abnormal electroencephalogram, 38 (42.2%) of children with congenital SNHL had epileptiform electroencephalogram abnormality. The epileptiform abnormality was generalized in 14 children (36.8%), focal temporal in 17 children (44.7%) and focal other than temporal in 7 children (18.4%). According to the hemispheric side affected, the abnormality was right in 14 children (36.8%), left in 10 children (26.3%) and bilateral in 14 children (36.8%). No statistically significant predominance of specific site or side of the epileptiform abnormality was found. Similarly, no statistical significant prevalent of the epileptiform abnormality was found in relation to the age or sex of children, duration of hearing loss or etiology of hearing loss (i.e., genetic vs. neonatal insults). On the other hand, the epileptiform abnormality was statistically prevalent in children with moderate degree of hearing loss, and in children with auditory neuropathy spectrum disorder.

Conclusions

The epileptiform electroencephalogram abnormality is a common finding in children with congenital sensorineural hearing loss especially those with auditory neuropathy spectrum disorder, suggesting the affection of the central nervous system despite the absence of neurological symptoms or signs. These findings raise the question of the requirement of medical treatment for those children and the effect of such treatment in their rehabilitation.     

Study of audiovestibular dysfunction in children with systemic lupus erythematosus

Objective

Inner ear dysfunction in systemic lupus erythematosis patients has been reported but audiovestibular involvement is not well documented especially in pediatrics. This study was designed to evaluate silent audiovestibular dysfunction among SLE children.

Methods

Case control study examined in allergy and immunology clinic; pediatrics hospital and audiovestibular clinic; Ain Shams University from January 2009 to December 2010. Thirty-five systemic lupus erythematosus children (diagnosed according to American College of Rheumatology); age group 8–16 years, were randomly selected. Five of them were excluded due to one or more exclusion criteria (previous otitis media, stroke, lupus cerebritis, meningitis or encephalitis, audiovestibular symptom). Ten of them refused enrollment or could not complete full battery. Seventeen females and three males, mean age 12.9 ± 2.6 years, completed the study. Control group included 20 normal subjects, age and sex matched. Full clinical assessment, basic audiological evaluation and vestibular testing (videonystagmography VNG and computerized dynamic posturography CDP) were conducted for children included in the study.

Results

Five systemic lupus erythematosus patients had sensorineural hearing loss strongly associated with +ve antiphospholipid antibody and two had conductive hearing loss. Two children in control group had conductive hearing loss (p = 0.05). Abnormal VNG findings was significantly higher among systemic lupus erythematosus children (40%) compared to controls (0%) and associated with +ve antiphospholipid antibodies (χ² = 10, p = 0.002, Fisher exact test = 0.003). Twenty-five percentage of systemic lupus erythematosus children had abnormal CDP findings reflecting impaired balance function associated with positive antiphospholipid antibodies showing significant statistical difference compared to controls (0% affection) (χ² = 5.7, p = 0.017, Fisher exact test = 0.047).

Conclusion

Silent audiovestibular dysfunction is prevalent among systemic lupus erythematosus children especially those positive for antiphospholipid antibodies necessitating routine regular evaluation.     

Autism and peripheral hearing loss: A systematic review

Objective

To systematically review the literature describing the relationship between autism spectrum disorder (ASD) and peripheral hearing loss including literature recommendations for audiological assessment and auditory habilitation in cases where peripheral hearing loss and ASD coexist.

Data sources

Published studies indexed in MEDLINE (1948–2011).

Review methods

The search strategy identified 595 potential studies. After a review of the titles, 115 abstracts were reviewed and 39 articles were retrieved and assessed independently by at least two authors for possible inclusion. 22 articles pertained to children with ASD and peripheral hearing loss, hearing assessment in children with ASD, audiological habilitation for children with ASD or hyper-responsiveness in children with ASD. 17 further studies were garnered from the reference section of the 22 papers.

Results

Controversy exists in the literature regarding prevalence of hearing impairment among individuals with ASD. In cases where ASD and hearing impairment co-exist, diagnosis of one condition often leads to a delay in diagnosing the other. Audiological assessment can be difficult in children with ASD and test–retest reliability of behavioural thresholds can be poor. In cases where hearing impairment exists and hearing aids or cochlear implantation are recommended, devices are often fit with special considerations for the child with ASD. Hyper-responsiveness to auditory stimuli may be displayed by individuals with ASD. Evidence or the suspicion of hyper-responsiveness may be taken into consideration when fitting amplification and planning behavioural intervention.

Conclusions

Prevalence rates of hearing impairment among individuals with ASD continue to be debated. At present there is no conclusive evidence that children with ASD are at increased risk of peripheral hearing loss. A complete audiological assessment is recommended in all cases where ASD is suspected so as not to delay the diagnosis of hearing impairment in the event that hearing loss and ASD co-exist. Objective assessment measures should be used to confirm behavioural testing in order to ensure reliability of audiological test results. Fitting of hearing aids or cochlear implantation are not contraindicated when hearing loss is present in children with ASD; however, success with these devices can be variable.     

Inner ear involvement in Behçet's disease

Objective

To assess cochlear involvement and hearing loss in patients with Behçet's disease (BD).

Method

Forty-two patients with BD and 24 sex and age matched healthy subjects were included in the study. pure-tone audiometry including high frequencies (250–16000 Hz) and DPOAE were performed to all participants. Results of the audiological evaluation were compared and correlation between the audiologic status and clinical manifestations of the BD were investigated.

Results

Bilateral sensorineural hearing loss was detected in 27 (64.3%) patients. Hearing thresholds were found to be higher in patients with BD at all of the frequencies except at 500 Hz when compared to control group (p < 0.05). The difference in the hearing levels tend to increase in high frequencies. Compared with control group, distortion products and SNR of the BD patients were lower in all of the tested frequencies (p < 0.05) which indicates weaker outer hair cell motility. There was no correlation between the clinical manifestations and the audiological parameters.

Conclusion

Even having hearing levels within normal limits in speech frequencies, increased hearing thresholds in high frequencies and decreased signal–noise ratios (SNR) in distortion product otoacoustic emission (DPOAE) indicate a cochlear involvement in patients with BD.     

The effect of cleft palate repair technique on hearing outcomes in children

Objective

Otitis media with effusion causing conductive hearing loss is a problem for many children with cleft palate. This study examines the association between palate repair technique and hearing outcomes in children at 3 and 6 years post-repair.

Patients and methods

Retrospective chart review of patients with all types of cleft palate that were repaired between 2001 and 2006 at a tertiary children's hospital. Exclusion criteria included sensorineural hearing loss, ossicular chain abnormalities, and ear canal abnormalities. The primary outcome was pure tone average (PTA) from 0.5 kHz to 2 kHz.

Results

69 patients (138 ears) were analyzed. 30.4% of left ears and 31.9% of right ears had an abnormal (>20 dB) PTA at 3 years; at 6 years this significantly improved to 13.0% (p = 0.008) and 15.9% (p = 0.011). Double-reverse z-plasty was associated with the lowest median PTA of 10.0 dB (p = 0.046) at 6 years. There was no difference in median PTA between children with and without comorbid diagnoses (such as Pierre Robin Sequence, arthrogryposis) at either 3 years or 6 years (p = 0.075, p = 0.331). Multivariate model showed that extent of cleft influenced technique choice (p = 0.027), but only technique choice was associated with significant differences in PTA and only at 6 years post-repair.

Conclusion

The majority of children developed normal hearing by 6 years with palatoplasty and routine tube insertion. Double reverse z-plasty was associated with the best outcome, but is not ideal for hard palate clefts. Randomized controlled trials are needed to elucidate the relationship between technique, middle ear ventilation and time to recovery, irrespective of type of cleft.     

The risk factor profile of children covered by the Polish universal neonatal hearing screening program and its impact on hearing loss incidence

Objective

The high frequency of risk factors detected within the newborn population increases the total number of children that should receive regular follow-ups. However, in some circumstances, this could be beyond the capacity of the health system. Therefore, careful interpretation and selection of risk factors, and in particular of those factors not strictly defined, should be carried out during screening. The aim of the study was to analyse the risk factor profile of children covered by the national universal neonatal hearing screening program and to correlate it with hearing loss incidence.

Patients and methods

The analysis of records in the program database collected from 472 neonatal and well-baby units over a period of 10 years (2002–2012), focused on children with at least one risk factor. The analysis was subdivided into distribution of risk factors as well as to risk factors and hearing loss correlation.

Results

In the studied cohort of n = 137,432 children (4% of the total number of screened children) single risk factors were most frequently detected, accounting for 71% of records. The association of two or more risk factors appeared in 659 configurations (29%), with a mean of 3.1 coexisting risk factors and a maximum of 9. Hearing loss was dependent on the number of risk factors in a child, but reached its maximum with the association of 6 factors.

Conclusions

The detection of postnatal hearing loss should be continued in order to increase our understanding of hearing incidence and the role of environmental factors. To optimize screening, discussions between specialists (mostly related to the issue of risk factors detected and registered in the earliest stage of screening programs) would be beneficial.     

Aided cortical response,speech intelligibility,consonant perception and functional performance of young children using conventional amplification or nonlinear frequency compression

Objective

The aim of this study was to compare conventional processing with nonlinear frequency compression (NLFC) in hearing aids for young children with bilateral hearing loss.

Methods

Sixty-four children aged between 2 and 7 years with bilateral hearing aids were recruited. Evaluations of cortical responses, speech intelligibility rating, consonant perception and functional performance were completed with the children wearing their personal hearing aids with conventional processing. The children were then refitted with new hearing aids with NLFC processing. Following a six-week familiarization period, they were evaluated again while using their hearing aids with NLFC activated.

Results

The mean speech intelligibility rating and the number of cortical responses present for /s/were significantly higher when children were using NLFC processing than conventional processing in their hearing aids (p < 0.05). Parents judged the children's functional real life performance with the NLFC hearing aids to be similar or better than that with the children's own hearing aids in both quiet and noisy situations. The mean percent consonant score was higher with NLFC processing compared to conventional processing, but the difference did not reach the 5% significance level (p = 0.056). An overall figure of merit (FOM) was calculated by averaging the standardized difference scores between processing schemes for all measures. Regression analysis revealed that, on average, greater advantage for NLFC processing was associated with poorer hearing at 4 kHz.

Conclusions

Compared to conventional processing, the use of NLFC was, on average, effective in increasing audibility of /s/as measured by cortical evaluations, and higher ratings on speech intelligibility and functional performance in real life by parents. On average, greater benefits from NLFC processing was associated with poorer hearing at 4 kHz.     

Prediction of frequency-specific hearing threshold using chirp auditory brainstem response in infants with hearing losses

Objectives

To investigate the clinical usefulness of the LS-chirp auditory brainstem response for estimation of behavioral thresholds in young children with mild to severe hearing losses.

Methods

68 infants (136 ears) aged 6–12 months (mean age = 9.2 months) with bilateral mild to severe hearing losses were studied at Children's Hospital of Fudan University. In all cases, the children were referred for LS-chirp ABR and visual reinforcement audiometric (VRA) measurements. The low-frequency band chirp (LF-chirp) thresholds (frequency band = 0.1–0.85 kHz) were compared to the average VRA thresholds (frequency band = 0.25–0.5 kHz), whereas the high-frequency band chirp (HF-chirp) thresholds (frequency band = 1–10 kHz) were compared to the average VRA thresholds (frequency band = 1–4 kHz) using statistical correlation coefficient values.

Results

The LS-chirp ABR thresholds are very close to behavioral hearing levels. The mean differences between chirp-ABR and VRA thresholds were within 5 dB HL for all measurements. The smallest mean threshold difference (<3 dB HL) was obtained for the severe hearing loss group. The correlation coefficient values (r) were 0.97 at low-frequency and high-frequency bands. For each carrier frequency, the best correlations between chirp-ABR thresholds and VRA thresholds were obtained at VRA frequency of 0.25 kHz/LF-chirp (r = 0.98) and VRA frequency of 1 kHz/HF-chirp (r = 0.98).

Conclusions

This study demonstrates the effectiveness using chirp-ABR predicted frequency-specific thresholds, especially of low and middle frequencies. LS-chirp ABR thresholds determined behavioral thresholds in patients with severe hearing losses were better than for mild hearing losses. The use of a chirp-ABR testing ensures higher sensitivity and accuracy than that of auditory stead-state evoked response (ASSR) for measuring frequency-specific thresholds in young children.     

Audiological findings,genotype and clinical severity score in Cornelia de Lange syndrome

Objective

Cornelia de Lange syndrome (CdLS) is a rare multisystem disorder in which hearing loss (HL) has been reported. However, no data are available concerning the association between audiological findings, clinical severity score and genotype.

Methods

The study involved 44 pediatric patients aged 1–18 years with a confirmed diagnosis of CdLS, all of whom underwent a full otolaryngological and audiological examination. The presence of NIPBL and SMC1 mutations was also evaluated.

Results

According to the severity of clinical phenotypes, 12 (27.3%) children were mild, 15 (34.1%) were moderate and 17 (38.6%) were severe. Thirty-eight children (86%) had OME. Eight children had normal hearing, including one (12.5%) with a severe phenotype. Bilateral sensorineural hearing loss (SNHL) was diagnosed in 10 children (22.7%): the degree of HL was severe in 8 (80%), all with a severe phenotype. Conductive hearing loss (CHL) was present in 26 patients (59.1%), of whom 8 (30.8%) had a severe phenotype. A severe phenotype was more prevalent among the patients with moderate to severe HL (10/16, 62.5%) than among those with slight/mild HL or normal hearing (7/28, 25.0% p = 0.013). NIPBL mutations were detected in 22 patients (50%): 13 (59.1%) with truncating mutations, four (18.2%) with missense mutations, and five (22.7%) with splicing mutations. The frequency of NIPBL truncating mutations was similar in the children with SNHL and those with CHL, whereas this kind of mutation was not found in children with normal hearing.

Conclusion

Together with SNHL, CHL is an important cause of HL in children with CdLS, and can be associated with a severe phenotype. Moreover, CHL can be associated with NIPBL mutations, particularly truncating mutations. These results highlight the importance of the early identification of audiological problems in children with CdLS and their precise genetic characterization.     

Comparison between ABR with click and narrow band chirp stimuli in children

Objective

Click and chirp-evoked auditory brainstem responses (ABR) are applied for the estimation of hearing thresholds in children. The present study analyzes ABR thresholds across a large sample of children's ears obtained with both methods. The aim was to demonstrate the correlation between both methods using narrow band chirp and click stimuli.

Methods

Click and chirp evoked ABRs were measured in 253 children aged from 0 to 18 years to determine their individual auditory threshold. The delay-compensated stimuli were narrow band CE chirps with either 2000 Hz or 4000 Hz center frequencies. Measurements were performed consecutively during natural sleep, and under sedation or general anesthesia. Threshold estimation was performed for each measurement by two experienced audiologists.

Results

Pearson-correlation analysis revealed highly significant correlations (r = 0.94) between click and chirp derived thresholds for both 2 kHz and 4 kHz chirps. No considerable differences were observed either between different age ranges or gender. Comparing the thresholds estimated using ABR with click stimuli and chirp stimuli, only 0.8–2% for the 2000 Hz NB-chirp and 0.4–1.2% of the 4000 Hz NB-chirp measurements differed more than 15 dB for different degrees of hearing loss or normal hearing.

Conclusion

The results suggest that either NB-chirp or click ABR is sufficient for threshold estimation. This holds for the chirp frequencies of 2000 Hz and 4000 Hz. The use of either click- or chirp-evoked ABR allows a reduction of recording time in young infants. Nevertheless, to cross-check the results of one of the methods, we recommend measurements with the other method as well.     

Dose passive smoking induce sensorineural hearing loss in children?

Objectives

Smoking plays major role in development of vascular and respiratory serious diseases. It has been reported that negative smoker children are prone for conductive hearing impairment due to repeated attacks of Eustachian tube dysfunction and middle ear effusion. This study aims to identify negative smoking as potential risk factor for development of sensorineural hearing loss.

Study

This study was done between January 2010 and November 2012. 411 children aged 5-11 years (8.2 ± 1.5) participated in this study; they were children attending the Ear, Nose, and Throat clinic of a tertiary care hospital and their siblings. The inclusion criteria were: (i) normal speech and language, (ii) absence of any disease or condition that may cause sensorineural hearing loss, and (iii) normal middle ear function on the day of hearing assessment. They were divided into three groups according to the exposure to second-hand smoke at home; group of “no exposure” whereas no smoker in the family (131 children), group of ‘mild exposure” whereas the father was the only smoking parent and smoking was prohibited at home (155 children), and group of “heavy exposure”, whereas the mother was smoking, or the father was freely smoking at home and in the presence of his children (125 children). Audiological evaluation in the form of pure tone and speech audiometry and immitancemetry was done for the study group.

Results

Audiological evaluation revealed that the prevalence of hearing loss was 3.8%, 4.5% and 12% in the “no exposure”, “mild exposure”, and “heavy exposure” groups, respectively. Significant difference was only detected between the high exposure group and the other two groups. All children had minimal sensorineural hearing loss, i.e. threshold of frequencies showing hearing loss was 20 or 25 dB HL. The risk ratios (95% confidence interval) for hearing loss in the study subgroups were 1.18 (0.38, 3.64) for mild exposure group (p > 0.05), 3.14 (1.18, 8.3) for heavy exposure group (p < 0.05).

Conclusions

Passive smoking in childhood correlates with sensorineural hearing loss, and it is an important risk factor for development of minimal hearing loss. Strict prevention of children exposure to second-hand smoke should be encouraged by every mean.     

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     

The effect of caffeine on hearing in a guinea pig model of acoustic trauma

Objective

Caffeine is a widely consumed substance affecting the metabolism of adenosine and cellular metabolism of calcium. Noise also affects these metabolic pathways while inducing hearing loss. The aim of this study was to determine the effect of daily intake of caffeine on hearing loss after an episode of acoustic trauma in guinea pigs.

Materials and methods

In this pilot study, forty guinea pigs were randomly divided into four groups: group I (control, n = 10) received intraperitoneal saline, group II (n = 10) received intraperitoneal caffeine (120 mg/kg/day) for 14 days, group III (n = 10) was exposed to noise (tone of 6 kHz at 120 dB for one hour) and group IV (n = 10) was exposed to noise as group III and received caffeine as group II. Auditory brainstem responses were measured at four different frequencies (8, 16, 20, and 25 kHz) prior to and at intervals of 1 h, 3 days, 10 days, and 14 days after the initial treatment. On day 14, morphological analysis was performed to assess the effects of caffeine on acoustic trauma.

Results

Aggravated hearing loss was observed in group IV after 10 days of follow-up. After 14 days, one of the four frequencies (8 kHz) tested showed statistically significant greater impairment in hearing (8.2 ± 3.6 dB, p = 0.026). Auditory hair cells showed no difference while spiral ganglion cell counts were diminished in group IV (p < 0.05).

Conclusion

These findings indicate that caffeine may have a detrimental effect on hearing recovery after a single event of acoustic trauma.     

Long-term follow-up of otitis media with effusion in children: Comparisons between a ventilation tube group and a non-ventilation tube group

Objective

The objective of this study was to investigate the long-term outcomes in children with otitis media with effusion who received either medical treatment or ventilation tubes.

Methods

We retrospectively analyzed the medical records of 89 bilateral cases of otitis media with effusion in children who were recommended to receive ventilation tube insertion and were followed up for more than 5 years. Tympanic membrane was inspected by otoscopic examination. Hearing was evaluated with pure tone audiometry. The mean duration of follow-up was 8.4 years (range, 5.2–15.7 years). Twenty-three children were treated without surgery, while 22 were treated once by ventilation tube insertion and 44 were treated more than once by ventilation tube insertion.

Results

At the fifth year of follow-up, both groups of children who underwent ventilation tube insertion had more frequent tympanic membrane abnormalities than the medication group (8.7% in those treated without surgery, 72.7% in those treated once by ventilation tube insertion, and 88.6% in those treated more than once by ventilation tube insertion). Common tympanic membrane abnormalities were retraction (27.0%) and tympanosclerotic plaque (23.6%), regardless of the treatment modality. At the fifth year follow-up, the average air-conduction threshold was 10.0 dB (± 6.5 dB) in patients treated without surgery, 15.9 dB (± 11.2 dB) in patients treated once by ventilation tube insertion, and 17.8 dB (± 7.6 dB) in those treated more than once by ventilation tube insertion. The audiological difference was significant when we compared the hearing level of children treated by medication without surgery to the two ventilation tube groups.

Conclusion

Though ventilation tube insertion can resolve hearing loss quickly, there were more tympanic membrane abnormalities and a decline in hearing levels in our ventilation tube insertion group vs. the observation group measured 5 years later. Physicians should therefore be cautious when applying a ventilation tube in patients with otitis media with effusion and should explain the risks to patients who are a candidate for repeated ventilation tube insertion.     

Parent Satisfaction Questionnaire with Neonatal Hearing Screening Programs: Psychometric properties of the Persian version

Objectives

Measuring parent satisfaction with neonatal hearing screening programs is one of the most important indicators for assessing the quality and effectiveness and a useful instrument to identify service shortfalls. The aims of this study were to translate and adapt Parent Satisfaction Questionnaire with Neonatal Hearing Screening Programs (PSQ-NHSPs) to Persian language, determine the validity and reliability of this translation, and determine the level of parent satisfaction with neonatal hearing screening programs in Iran.

Methods

Translated Persian version of the original English PSQ-HNSPs was presented to 138 parents whose children had received hearing screening before discharge from hospital.

Results

The majority of parents responded strongly agree or agree to all dimensions of the questionnaire: overall satisfaction (90.6%), personnel in charge of hearing test (60.1%), and appointment activities (58%). Good internal consistency reliability (a = 0.89) and moderate test–retest reliability (r = 0.61) of the Persian version of PSQ-NHSPs were indicated. Construct validity was demonstrated by a significant positive relationship between overall satisfaction and specific dimensions in the questionnaire.

Conclusion

The Persian version of PSQ-NHSPs is a valid and reliable tool to assess the level of parent satisfaction with neonatal hearing screening programs.