ABR和DPOAE在高胆红素血症新生儿听力筛查中的应用

目的探讨听性脑干反应(ABR)及畸变产物耳声发射(DPOAE)对高胆红素血症新生儿听力筛查的临床意义,为早期干预治疗提供依据.方法对170例高胆红素血症新生儿进行ABR和DPOAE检查,对其中部分异常者6个月后复查.结果 170例患儿中,ABR和DPOAE的总异常率分别为54.12%和32.65%;血清胆红素水平越高,ABR和DPOAE异常率越高(P<0.01),ABR异常越严重(P<0.01);胆红素浓度恢复正常后6个月复查ABR和DPOAE,恢复率分别为77.12%和77.01%,其中ABR异常DPOAE正常耳较两者均异常耳容易恢复(P<0.01).结论 ABR和DPOAE联合应用对高胆红素血症新生儿听力的早期定量定位评估比单独应用更准确和全面.     

2062例婴儿的听力检查结果分析

目的探讨3～6月龄婴儿听力障碍的诊断方法。方法对2005年1月～2007年6月在上海交通大学医学院附属上海儿童医学中心就诊的2062例(4124耳)3～6月龄婴儿有选择地进行客观听力测试,包括听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)、声导抗等检查,3月龄时诊断为听力异常者6月龄时复查,收集、分析两次听力测试的资料。结果3月龄时13例(20耳)ABR异常、DPOAE正常,504例(825耳)ABR、DPOAE均异常;ABR异常的845耳中,482例(808耳)(37耳失访)6月龄时复查示:13例(20耳)ABR异常、DPOAE正常,406例(702耳)ABR、DPOAE均异常,47例(64耳)ABR、DPOAR均正常,16例(22耳)ABR正常,DPOAR异常;比较两次检查结果显示:698耳(86.4%)听力无变化,90耳(11.1%)听力改善,20耳(2.5%)听力下降;在ABR反应阈正常、DPOAE未通过者中有438耳同时行226Hz及1000Hz探测音声导抗测试,1000Hz探测音声导抗异常183耳(41.8%),226Hz探测音声导抗异常6耳(1.37%)。结论3～6月龄婴儿的听力诊断必须结合ABR、OAE检查结果综合分析判断,必要时进一步行高频声导抗检查;0～6月龄婴儿中耳功能的检查,运用1000Hz探测音声导抗比226Hz的更敏感;对确诊听力障碍者,尤其是有听力障碍高危因素者,必须密切随访,警惕听力波动及进行性的听力下降。     

听力筛查AABR未通过而TEOAE通过高危新生儿的听力追踪

目的了解听力筛查AABR未通过而TEOAE通过高危新生儿的听力变化和特点。方法 2008年至2010年对复筛时AABR未通过而TEOAE通过的23例高危新生儿在3月龄时进行听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)以及高频声导抗(high frequency tympanometry,HFT)检查,对ABR异常的患儿在6月龄时复查。结果 3月龄和6月龄时DPOAE各频率基本引出,HFT均为单峰。3月龄时23例患儿中5例双耳ABR反应阈≤35dB nHL,余18例(30耳)单耳或双耳ABR异常,其中8耳可辨出波Ⅰ、Ⅲ、Ⅴ,反应阈40～60dB nHL;15耳只引出波Ⅴ,反应阈70～97dB nHL;7耳97dB nHL声刺激下无波形引出;符合听神经病(auditory neuropa-thy,AN)诊断12例,双耳8例,单耳4例。ABR异常的18例(30耳)6月龄复查时,1耳反应阈≤35dB nHL,29耳反应阈异常,其中,6例(11耳)ABR反应阈降低,1例(2耳)反应阈升高;29耳中14耳可辨出波Ⅰ、Ⅲ、Ⅴ,反应阈40～60dB nHL;11耳只引出波Ⅴ,反应阈70～97dB nHL;4耳97dB nHL未引出波形;符合AN诊断9例,双耳4例,单耳5例。23例患儿1～2岁时电话随访,19例对声音反应良好,2例言语发育稍迟缓,2例2岁时仍不会说话,其中1例合并脑瘫,1例CT示脑白质异常,戴助听器均无效。结论本组听力筛查AABR未通过而TEOAE通过的婴儿听力发展不确定,选择治疗方案需慎重,对这类小儿应长期听力追踪至少到3岁。     

高胆红素血症新生儿血清胆红素水平与听力损失程度的相关性分析

目的：探讨高胆红素血症新生儿听力损失程度与血清胆红素水平的相关性。方法对70例足月出生、体重正常、确诊为高胆红素血症的新生儿进行血清胆红素水平及听性脑干反应（ABR）检测，并对其血清胆红素水平、黄疸出现时间与ABR反应阈进行相关性分析。结果70例患儿中ABR反应阈正常17例，异常53例，其中重度听力损失27例；当血清胆红素＜342μmol／L时，黄疸出现时间≤48小时组出现重度听力损失的比例高于黄疸出现时间＞48小时组（P＜0．05），而血清胆红素值≥342μmol／L时，黄疸出现时间≤48小时组与＞48小时组轻中度、重度听力损失者比例无明显差异。ABR反应阈异常的53例患儿中，血清胆红素水平与ABR反应阈呈正相关（r＝0．041），而黄疸出现的时间与ABR反应阈呈负相关（r＝－0．291）。结论高胆红素血症新生儿黄疸出现的时间越早听力损伤的可能性越大，血清胆红素值越高听力损失程度越重。     

350例婴幼儿多种客观听力测试方法联合诊断听力损失的临床意义

目的 探讨婴幼儿听力评估中多种客观听力测试方法联合应用的价值.方法回顾性分析2004年1月至2006年12月进行听力学诊断的350例婴幼儿病历资料,其诊断年龄为46天～3岁.平均为1岁7个月.350例患儿进行了听性脑于反应(auditory brainstem response,ABR)、40 Hz听觉相关电位(40 Hz auditory event related potential,40 Hz-AERP)、听性稳态反应(auditory steady-state response,ASSR)、畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)及鼓室导抗图测试(tympanometry).结果 350例(700耳)婴幼儿中听力损失总耳数为648耳(92.57%),其中感音神经性听力损失600耳(85.71%),传导性听力损失或混合性听力损失48耳(6.86%).听力损失的648耳中.各项检查的检出耳数分别为:ABR 605耳(93.36%),40 Hz-AERP596耳(91.98%),ASSR 622耳(95.99%),DPOAE 601耳(92.75%),226 Hz鼓室导抗图268耳(41.36%).DPOAE正常的99耳中,ABR各波消失或严重异常22耳.ABR测试中记录到声诱发短潜伏期负反应53例(93耳).完成1 000 Hz鼓室导抗图测试的103耳中存在异常的耳数为40耳.经检查诊断小儿听神经病22耳(12例),辅助诊断大前庭水管综合征53例.初步诊断婴幼儿中耳炎40耳.350例患儿的ABR的波V反应阈为:≤30dB nHL占13.57%,31～50 dB nHL占7.43%.51～70 dB nHL 占8.57%.71～90 dB nHL占13.14%,≥91 dBnHl占57.29%.结论 婴幼儿听力评估中.联合应用多种客观听力测试方法可以提高检出率.结合应用DPOAE和ABR对早期诊断听神经病有重要意义.观察ABR声诱发短潜伏期负反应有助于临床诊断大前庭水管综合征.1 000 Hz鼓室导抗图有助于婴幼儿中耳病变的诊断.     

DPOAE异常ABR反应阈正常的婴儿声导抗结果分析

目的分析DPOAE异常ABR反应阈正常婴儿声导抗特征。方法研究对象为34例(52耳)婴儿(研究组),年龄42天～10个月,男20例(33耳),女14例(19耳),均为外院听力筛查未通过,转诊后经听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)、声导抗(226和1 000Hz探测音)测试,表现为DPOAE全频异常、ABR反应阈正常。选取同期接受检查且DPOAE及ABR反应阈均正常的婴儿26例(52耳)作为对照组,年龄42天～10个月,男16例(32耳),女10例(20耳),对比分析两组对象的声导抗特征。结果对照组226Hz鼓室导抗图48耳为单峰,4耳为双峰;1 000Hz鼓室导抗图50耳为单峰,2耳为双峰。根据ABR检测结果将研究组分为三组:第一组24耳ABR反应阈及各波潜伏期均正常,226Hz鼓室导抗图21耳为A型,3耳为双峰,1 000Hz鼓室导抗图18耳为单峰,6耳为双峰,其负尾部补偿导纳(ComY-400)值为0.84±0.36,低于对照组(2.66±0.52)(P<0.05);第二组23耳ABR波I潜伏期延长,波III、V潜伏期延长或不延长,226Hz鼓室导抗图18耳为A型,2耳为B型,3耳为双峰,1 000Hz鼓室导抗图15耳为单峰,2耳为双峰,2耳为无峰,4耳为其他型,其ComY-400值为0.54±0.37,低于对照组(2.66±0.52)(P<0.05);第三组5耳仅ABR波V潜伏期延长,226Hz及1 000Hz鼓室导抗图均表现为单峰。结论 DPOAE异常而ABR反应阈正常的婴儿可表现为ABR各波潜伏期正常或异常,l 000Hz探测音鼓室导抗图表现为负尾部补偿导纳值低于正常婴儿,提示其中耳功能异常可能是导致DPOAE异常的主要原因。     

重症监护病房新生儿听力筛查结果分析——重点讨论听神经病的筛查

目的基于对我院新生儿重症监护病房(neonatal intensive care unit,NICU)新生儿的筛查,初步获得听神经病(auditory neuropathy,AN)在此类人群中患病情况的基本资料,探讨适合于我国国情的NICU新生儿听力筛查模式。方法采用自动听性脑干反应(automated auditory brainstem response,AABR)两阶段筛查方案,即:NICU新生儿在出院前或病情稳定时以AABR进行听力初筛,对未通过者发放复筛通知单,嘱出院1个月后门诊接受AABR复筛。复筛仍未通过者,于3个月内转诊到我院儿童听力中心,进行包括听性脑干反应(ABR)、畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)和声导抗测试在内的全面听力学诊断评估。如ABR波V反应阈>35dBnHL,则认为有听力损失。AN诊断依据:ABR缺失、严重异常或阈值≥70dBnHL,伴DPOAE正常和声导抗测试鼓室图呈单峰型或双峰型。结果对2007年9月—2009年4月从我院NICU出院的1343名新生儿进行了听力筛查。117例(8.7%)未通过出院前的AABR初筛,其中88例(75.2%)1月后接受了AABR复筛,22例未通过。后者经全面的听力学诊断评估,10例(7.4‰)双侧或单侧ABR阈值>35dBnHL,诊断有听力损失,其中2例(1.5‰)分别表现为双耳ABR缺失和阈值>70dBnHL,而DPOAE正常、鼓室图为单峰型以及镫骨肌声反射未引出,诊断为AN。结论本组NICU新生儿听力损失总发病率(7.4‰)及听神经病发病率(1.5‰)低于已往文献报道。本研究未发现任何可以预测AN发生的听力损失高危因素,这可能与目标人群样本量较小有关。AABR两阶段筛查法是NICU新生儿合适的听力筛查模式。     

听性脑干反应严重异常和耳声发射正常的小儿听力障碍的临床特征分析

目的探讨包含小儿听神经病在内的听性脑干反应(auditory brainstem response，ABR)严重异常，畸变产物耳声发射(distortion product otoacoustic emission，DPOAE)正常为特征的听功能障碍症侯群的病因学特征、病损部位与临床听力学特点。方法选取2002～2004年听力专科中ABR严重异常、DPOAE正常，排除中耳传导功能异常的患儿98例(168耳)入选为研究组。根据神经康复科医师的评估，作出是否伴有精神运动发育迟缓及其相关病因的诊断，统计伴有精神运动发育迟缓的研究组中听力损失高危因素的类型与比例；选择ABR严重异常、DPOAE异常、排除中耳病变的患儿46例(82耳)作为蜗性病变对照组，比较研究组与蜗性病变患儿ABR的异同点；选择健康同龄小儿40例(72耳)作为正常对照组，观察研究组与正常听力小儿ABR和DPOAE的异同点。结果①研究组98例患儿中，83.67％患儿伴有精神运动发育迟缓的临床症状，其相关的致病因素中，以新生儿高胆红素血症所占的比例最高；②103 dB强度刺激声(听力级)刺激时，无波分化的为53耳、仅能记录到波Ⅴ的7耳，90dB强度刺激声仅能记录到Ⅴ波的9耳，80dB仅能记录到Ⅴ波的4耳，共73耳(43．45％)，病损部位主要在听神经远端；103dB强度刺激声仅能记录到波Ⅰ，其他各波缺失的28耳(16．07％)，病损部位主要在低位脑干；可同时记录到波Ⅰ 波Ⅲ和(或)波Ⅴ的67耳(39．88％)，其中有16耳能引出1kHz纯音同侧镫骨肌声反射，提示耳蜗、第Ⅷ颅神经听支、低位脑干或有可能均存在不同程度的受累；③高频区DPOAE幅值正常或轻微下降，中高频区DPOAE引出率与正常对照组一致。结论新生儿高胆红素血症是包含小儿听神经病在内的ABR严重异常DPOAE正常为特征的听功能障碍症侯群的最主要致病因素，临床上应积极预防和及时治疗，以减少小儿听神经病的发生；包含小儿听神经病在内的ABR严重异常DPOAE正常为特征的听功能障碍症侯群的听力学改变具有多样性，在临床诊断上应加以注意。     

听性脑干反应严重异常和耳声发射正常的小儿听力障碍的临床特征分析

目的　探讨包含小儿听神经病在内的听性脑干反应 (auditorybrainstemresponse ,ABR)严重异常 ,畸变产物耳声发射 (distortionproductotoacousticemission ,DPOAE)正常为特征的听功能障碍症侯群的病因学特征、病损部位与临床听力学特点。方法　选取 2 0 0 2～ 2 0 0 4年听力专科中ABR严重异常、DPOAE正常 ,排除中耳传导功能异常的患儿 98例 (16 8耳 )入选为研究组。根据神经康复科医师的评估 ,作出是否伴有精神运动发育迟缓及其相关病因的诊断 ,统计伴有精神运动发育迟缓的研究组中听力损失高危因素的类型与比例 ;选择ABR严重异常、DPOAE异常、排除中耳病变的患儿4 6例 (82耳 )作为蜗性病变对照组 ,比较研究组与蜗性病变患儿ABR的异同点 ;选择健康同龄小儿4 0例 (72耳 )作为正常对照组 ,观察研究组与正常听力小儿ABR和DPOAE的异同点。结果　①研究组 98例患儿中 ,83 6 7%患儿伴有精神运动发育迟缓的临床症状 ,其相关的致病因素中 ,以新生儿高胆红素血症所占的比例最高 ;② 10 3dB强度刺激声 (听力级 )刺激时 ,无波分化的为 5 3耳、仅能记录到波Ⅴ的 7耳 ,90dB强度刺激声仅能记录到Ⅴ波的 9耳 ,80dB仅能记录到Ⅴ波的 4耳 ,共 73耳(43 4 5 % ) ,病损部位主要在听神经远端 ;10 3dB强度刺激声仅能记录到波Ⅰ     

新生儿听力普遍筛查模式的初步探讨

目的寻找适合于中国国情的新生儿听力普遍筛查模式,获得新生儿听力损失发病的基本资料.方法新生儿在出院前接受耳声发射(otoacousticemissions,OAE)测试,通过者予以出院;对未通过者在1个月后再次复查OAE,仍未通过者行听性脑干反应(auditorybrainstemresponse,ABR)检查.所有ABR检查不通过者在3个月内接受全面的听力学诊断和评估,以确定听力损失的性质和程度.耳声发射测试采用畸变产物耳声发射(distortionproductotoacousticemissions,DPOAE),通过标准1.5～6kHz的5个测试频率中的4个信噪比大于6dB.ABR通过测试的标准为波V反应阈值≤35dBnHL.结果2998例新生儿中2710位通过出院前的OAE测试,1个月后288例复查OAE,其中263例通过.需要ABR检查者共有25例,未通过者6例.经过全面的听力学诊断和评估,6例婴儿(占全体新生儿的2‰)有听力损失.结论新生儿听力普查十分必要,OAE和ABR联合应用的两步筛查法是较合适的筛查模式.     

Neonatal screening for hearing loss: pilot study from a tertiary care centre

Many developed countries have well established universal neonatal hearing screening programs. In India, the viability of such a program, in an already overburdened health system is indeed a challenge. This cross sectional study was undertaken to evaluate the possible burden of hearing loss among neonates born at a tertiary care hospital in Southern India. Five hundred neonates were screened with automated distortion product otoacoustic emission (aDPOAE) for hearing loss, 9.2% of whom had one or more high risk factors. Although 6.4% had hearing loss at initial assessment, only 1.6% had hearing loss on retesting with aDPOAE. Retesting with OAE before an automated Auditory brainstem response (aABR) helped to exclude patients without hearing loss. The frequency of moderate to moderately severe hearing loss in this study was 0.6%. This pilot study underscores the importance of the introduction of screening for congenital deafness in specialized centers in India, despite its challenges.     

Audiologic evaluation of neonates with severe hyperbilirubinemia using transiently evoked otoacoustic emissions and auditory brainstem responses

OBJECTIVES: To audiologically clarify the lesion site and to test the reliability of transiently evoked otoacoustic emissions (TEOAEs) in hearing screening of hyperbilirubinemic neonates. STUDY DESIGN: Eleven neonates with severe hyperbilirubinemia who had exchange transfusion in the neonatal intensive care unit of an academic hospital over a 3-year period were included in this study. They were tested with auditory brainstem response (ABR) and TEOAEs after exchange transfusion during hospitalization or at an immediate follow-up visit after discharge. Follow-up ABR tests were performed when infants showed significant hearing loss. METHODS: ABR and TEOAE tests were performed on the 11 neonates with severe hyperbilirubinemia after exchange transfusion. Follow-up ABR tests were carried out in 3-month intervals in the four neonates who showed abnormal or no response on initial ABR. RESULTS: Four neonates showed abnormal or no response and the other seven demonstrated normal response in ABR. All 11 neonates passed TEOAEs. Two neonates showed improvement in auditory function at 3- or 6-month follow-up ABR. CONCLUSION: The results of this study indicate that the site of lesion in hearing loss caused by hyperbilirubinemia may be at the retrocochlear location while the cochlea remains intact. TEOAEs may have limitations in evaluation of hearing in the neonates with hyperbilirubinemia.     

Newborn hearing screening: effectiveness, importance of high-risk factors, and characteristics of infants in the neonatal intensive care unit and well-baby nursery.

BACKGROUND: In contrast to the recommendations of the Joint Committee on Infant Hearing, neonatal hearing screening programs are still not universally available, and many countries implement elective screening in high-risk newborns. OBJECTIVE: To assess the failure rates of neonates in hearing screening and the relative importance of risk factors for hearing impairment, both in neonatal intensive care units and in well-baby nursery neonates. The impact on cost-effectiveness is also evaluated. SUBJECTS: In the current study, 25,288 newborns were assessed; 23,574 were full-term newborns in the well-baby nursery and 1,714 neonates were in neonatal intensive care units. METHODS: All neonates had a general examination (including assessment for congenital anomalies and related history) and were assessed using transient evoked otoacoustic emissions. All newborns were older than 36 weeks at examination and thus had reliable transient evoked otoacoustic emissions. RESULTS: From the 23,574 full-term neonates in the well-baby nursery, 23,123 (98.1%) passed the test and 451 failed (1.9%). Fifty-three of the 23,574 neonates (0.2%) had a risk factor for hearing impairment; 44 (83%) passed the test and 9 failed (17%). Family history of congenital hearing loss and congenital anomalies were the most frequent risk factors for hearing loss. From the 1,714 neonates in neonatal intensive care units, 1,590 (93%) passed the test and 124 failed (7%). Two hundred thirty-two of the 1,714 neonates (14%) had a risk factor for hearing impairment; 205 (88%) passed the test and 27 failed (12%). In neonatal intensive care unit neonates, toxic levels of ototoxic drugs, mechanical ventilation for more than 24 hours, prematurity, and low birth weight were the most frequent risk factors for hearing loss. Congenital anomalies/syndromes were the most important risk factors for failing screening in both the neonatal intensive care unit and the well-baby nursery, as they showed the highest risk of failing hearing screening. The second most important factor in neonatal intensive care unit newborns was low birth weight, and the third was prematurity in relation to the possibility of failing hearing screening. CONCLUSION: The present study found 575 neonates failing hearing screening of 25,288 tested newborns (2.3%). The fact that 78% of newborns who failed hearing screening were in the well-baby nurseries further supports the necessity of universal hearing screening instead of selective screening in neonatal intensive care units, even with the obvious impact on cost-effectiveness. Even if limited funding lead to selective screening in neonatal intensive care units, this should not be applied to high-risk newborns but to all neonatal intensive care unit neonates. Continuous assessment of risk factors and the related possibility of failing hearing screening are of paramount importance in designing hearing screening programs and refining the respective criteria.     

Risk factors for hearing loss in neonates: a prospective study

OBJECTIVES: To identify potential risk factors for neonatal hearing loss that are not included in the current variables recognized by the Joint Committee on Infant Hearing (JCIH). METHODS: A series of consecutively born neonates with risk factors for hearing loss based on the 1994 JCIH registry were screened prospectively. There were 110 subjects with hearing loss and 636 subjects without hearing loss. Data collected as potential risk factors for infant hearing loss included not only those on the JCIH list but also others that we believed to be possibly significant. The infant hearing screening was performed on each subject using auditory brain stem testing. Statistical analysis of data was performed using the chi-square test. RESULTS: In addition to the variables listed by the JCIH, we identified 11 additional risk factors that were associated with hearing loss in our neonatal population. These are: length of stay in the intensive care unit, respiratory distress syndrome, retrolental fibroplasia, asphyxia, meconium aspiration, neurodegenerative disorders, chromosomal abnormalities, drug and alcohol abuse by the mother, maternal diabetes, multiple births, and lack of prenatal care. CONCLUSION: This study identifies 11 risk factors in addition to those currently on the high-risk registry published by the JCIH for neonatal hearing loss. The inclusion of these additional risk factors in neonatal screening programs may improve the detection rate of neonates with hearing loss. Further study will be needed to determine whether inclusion of these additional risk factors in a hearing screening program can provide an efficacious alternative to the use of universal infant screening.     

Neonatal hearing screening with transient evoked otoacoustic emissions in Western Saudi Arabia

OBJECTIVE: To study the incidence of congenital hearing impairment in the Saudi population and to evaluate the need of establishing a Saudi universal neonatal hearing screening program based on transient evoked otoacoustic emission. METHODS: A total of 11986 well non-high-risk neonates were screened by transient evoked otoacoustic emission over period of 8 years from September 1996 to February 2004. The universal hearing screening was consequently done in a daily base before discharge from nursery. Those who failed the initial screening were followed up diagnostically until hearing loss was confirmed or excluded. RESULTS: From the total number of 11,986 neonates (41.4% male and 58.6% females) examined in this study 10943 (91.3%) neonates passed the first screening step while 1043(8.7%) neonates failed. From the 1043 neonates examined in the second screening step in the 5th day of life, 300 (29%) neonates failed. At the age of 5 months, all the 300 infants that failed the second screening step underwent a comprehensive audiological assessment to confirm the existence of hearing loss. The 278 infants that passed the assessment were considered as normal; while 22 failed and were confirmed to have congenital hearing loss. Of these 22 infants, 2 had unilateral sensorineural hearing loss, and the remaining 20 had bilateral sensorineural hearing loss. The incidence of sensorineural hearing loss was estimated to be 0.18% while the incidence of bilateral sensorineural hearing loss was 0.17%. No significant difference between males and females was found. The average age at confirmation of congenital hearing loss was 5.5 months. CONCLUSION: The incidence of congenital hearing loss in the western region of Saudi Arabia is relatively high compared with international figures. Hearing screening for all neonates using transient evoked otoacoustic emission should be part of the standard medical care in Saudi Arabia.     

Incidence of cochlear involvement in hyperbilirubinemic deafness

Neonatal hyperbilirubinemia remains an important cause of childhood deafness, especially in developing countries. After neonatal hyperbilirubinemia, the auditory neural pathways, cochlea, or both may be affected. In this study, we aimed to determine the incidence of cochlear impairment and the appropriate means of hearing screening in hyperbilirubinemic neonates. A retrospective review of 1,032 pediatric patients with hearing loss revealed 67 cases (6.5%) of severe hyperbilirubinemia in the neonatal period. Thirty of these patients had neonatal hyperbilirubinemia as the single identifiable risk factor for hearing loss. In 26 of 30 cases (87%), otoacoustic emissions (OAEs) were absent, whereas in the remaining 4 cases (13%), robust emissions were detected despite an absent auditory brain stem response (ABR). Auditory screening of newborns with jaundice by OAEs possesses a significant risk of undiagnosed deafness. On the other hand, if the ABR is used as the single means of screening, auditory neuropathic conditions will probably be underlooked. Therefore, we recommend dual screening of hearing by ABR and OAEs in hyperbilirubinemic newborns.     

Implementation of auditory screening in Dutch high‐risk neonates

Objective. To decrease the age at which severe to profound hearing loss is diagnosed in Dutch high‐risk neonates. At present, in the Netherlands the diagnosis is often delayed until the age of 2 or 3 years. Earlier detection is of prime importance to improve speech and language development, provided adequate intervention is started, preferably before 6 months of age. This also creates better chances for intellectual and emotional development. Patients and methods. In seven neonatal intensive care units the auditory function in high‐risk neonates is assessed bilaterally by means of a simplified ABR‐measurement. This automated ABR can be performed by a trained nurse in the ward, even in noisy settings and during oxygen therapy. The test result is independent of subjective interpretation and has a 98% correlation with standard ABR. Results. The incidence of severe to profound hearing loss is 1–2% in this group, according to the literature. Since the autumn of 1998, more than 1200 children have been screened. Preliminary findings will be discussed, with special attention to the follow‐up procedure. Conclusion. Auditory screening of high‐risk neonates is both necessary and feasible in the Netherlands. This will improve the therapeutic options for children with severe to profound hearing loss.     

Contralateral suppression of linear and nonlinear transient evoked otoacoustic emissions in neonates at risk for hearing loss

To investigate the transient evoked otoacoustic emissions (TEOAE) contralateral suppression in neonates at risk for hearing loss, 55 neonates at risk for hearing loss (risk group) and 72 full-term neonates not at such risk (control group) were bilaterally tested. In all neonates, the TEOAE were recorded in two stimulation modes (linear and nonlinear clicks), with and without contralateral acoustic stimulation. Findings revealed significant contralateral suppression of otoacoustic emissions in both groups, but the amount of TEOAE contralateral suppression was reduced for at risk group (p=0.001), supporting the hypothesis that medial olivocochlear bundle function is reduced in neonates at risk for hearing loss. The combination of contralateral acoustic stimulation and TEOAE enables easy and noninvasive study of auditory efferent function. However it should be emphasized that the reduction in TEOAE contralateral suppression in the risk group, statistically identified as a group effect, might not be detectable in individual cases. Further studies are needed in order to determine whether the lower amount of TEOAE contralateral suppression in neonates at risk for hearing loss represents a risk for developing auditory processing disorders. LEARNING OUTCOMES: The reader will be introduced to the study using auditory efferent pathway activation by contralateral acoustic stimulation (CAS), resulting in the TEOAE suppression effect. The characteristics of TEOAE suppression in the neonatal population, in which it provides evidence of the reduced medial olivocochlear system function in those at risk for hearing loss, will also be addressed.     

An auditory health program for neonates in ICU and/or intermediate care settings

Auditory screening and early identification and management of patients with hearing loss improve the development prospects of infants.ObjectiveTo analyze the outcomes produced by an Auditory Health Program in neonates managed in an intensive care unit.MethodThis prospective cross-sectional study enrolled neonates referred to the neonatal care unit at hospital CAISM/Unicamp with stays lasting for 48 hours and more within a period of 13 months.Automated monitoring of brainstem auditory evoked potentials was used in the auditory screening of neonates at the time of discharge. Children with poor BAEPs were sent to undergo audiological, otorhinolaryngological, and genetic tests.ResultsAuditory screening was performed for 84.7% of the live births; 39.7% were screened at 30 days or more of age. Diagnostic tests revealed that 63.8% of the children had normal hearing. Incidence of hearing loss was 4%; sensorineural hearing loss was observed in 1.4% of the subjects; 0.24% had auditory neuropathy spectrum disorder; and 2.2% had conductive hearing loss.ConclusionNeonatal auditory screening was not offered universally, and nor was it carried out, in many cases, within the child's first month of life. Screening must be performed before neonates are discharged and in more than one stage. A high incidence of hearing loss was observed.     

Hearing screening of infants in Neonatal Unit, Hospital Universiti Sains Malaysia using transient evoked otoacoustic emissions

The objective of this prospective study was to report on the prevalence of hearing impairment in the neonatal unit population. From 15 February 2000 to 15 March 2000 and from 15 February 2001 to 15 May 2001, 401 neonates were screened using transient evoked otoacoustic emissions (TEOAE) followed by second-stage screening of those infants who failed the initial test. Eight (2 per cent) infants failed one ear and 23 (5.74 per cent) infants failed both ears, adding up to 7.74 per cent planned for second-stage screening. Five out of 22 infants who came for the follow up failed the screening, resulting in a prevalence of hearing impairment of 1 per cent (95 per cent confidence interval [95% CI]: 0.0-2.0). Craniofacial malformations, very low birth weight, ototoxic medication, stigmata/syndromes associated with hearing loss and hyperbilirubinaemia at the level of exchange tranfusion were identified to be independent significant risk factors for hearing impairment, while poor Apgar scores and mechanical ventilation of more than five days were not. In conclusion, hearing screening in high-risk neonates revealed a total of 1 per cent with hearing loss. The changes in the risk profile indicate improved perinatal handling in a neonatal population at risk for hearing disorders.