Hearing screening in the neonatal intensive care unit: follow-up of referrals

PURPOSE: The goal of this study was to examine the rate of diagnostic testing after newborn hearing screening (NHS) referral, evaluate timeliness of follow-up, and evaluate the use of multilevel auditory brainstem response (ABR) in screening of high-risk infants. METHOD: Telephone interviews were conducted with parents of infants who had been admitted to a neonatal intensive care unit from 1999 to 2002 and referred on NHS. An ABR screen was combined with a multilevel ABR (40, 70, and 90 dB nHL) for referrals. RESULTS: Parents of 206 infants participated; 69% of the infants underwent diagnostic follow-up. Of those with follow-up, 37% had normal hearing, 38% had hearing loss, and parents were unsure of hearing test results for 25%. Follow-up by 6 months of age occurred for 13% in 1999, increasing to 31% by 2002. Infants who did not pass their screening in both ears had confirmed hearing loss in 56% vs. 25% in those who passed in 1 ear. Also, 67% of infants with bilateral pass levels of 90 dB nHL or more had confirmed hearing loss, vs. 32% in all others. CONCLUSIONS: Timely follow-up after NHS referral in our program has improved over time. Multilevel ABR may facilitate allocation of appropriate resources to track and ensure follow-up in infants at high risk for hearing loss.     

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.     

Auditory screening in neonates by means of transient evoked otoacoustic emissions: a report of 2,842 recordings.

The principal goal of an early identification program is to identify hearing impairment present at birth, in order to effect appropriate intervention as early as possible. Although recent research provides some evidence for the value of transient evoked otoacoustic emissions (TEOAEs) in neonate hearing screening, data are needed from large-scale clinical evaluations about the value of using TEOAEs for screening not only high-risk but also healthy neonates. A cohort of 1,421 neonates (2,842 ears) from the well-baby nursery was screened with TEOAEs in a 2-stage process. Neonates were referred from the first test prior to being discharged from the hospital. Those who failed were rescreened before the end of the first month. Those who did not pass the second-stage TEOAE screening were referred for diagnostic audiological evaluation for confirmation of hearing loss. Neonates transferred to a neonatal intensive care unit were not included in this study. Two neonates with bilateral sensorineural hearing loss of >40 dB hearing level were identified from this cohort. This study demonstrates the feasibility and the limitations of using TEOAEs as a universal hearing screening tool for all neonates. It confirms that the prevalence of hearing impairment in neonates has to be taken into account, even in a group of children without high-risk criteria. In France, a prevalence of 1.4 per 1,000 would represent 1,000 deaf children born every year, with reference to about 700,000 births per year. This study suggests that such universal screening programs would substantially increase the rate of early-identified infants with significant hearing impairment.     

Newborn hearing screening on infants at risk

Objectives

This article presents the results of newborn hearing screenings on infants at risk of hearing impairment at the French University Hospital of Besançon from 2001 to 2007.

Materials and methods

All newborns at risk of hearing impairment were tested according to the method recommended by the Joint Committee on Infant Hearing (JCIH): a two-step automated oto-acoustic emissions (AOAE) program, completed by an auditory brainstem response (ABR) for the positive diagnosis of hearing impairment. The screening started with AOAE on the third day of life, at the earliest. If one or both ears did not have AOAE, the infant was re-tested at which time, should the AOAE again be positive, ABR was performed. When the ABR threshold was 40 dB or more, the infant was referred to an audiologist specialized in infant deafness for diagnosis confirmation and management.

Results

Over the period, 1461 infants were screened, among whom 4.55% were diagnosed as deaf or hard of hearing. Nearly 10% of the infants were lost to follow up. Forty-six children had a sensorineural hearing impairment, of which 34 were bilateral and were managed before the age of 6 months. The risk factors for sensorineural hearing loss were (in order of statistical significance): severe birth asphyxia; neurological disorder; syndromes known to be associated with hearing loss; TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections; family history of deafness; age at the time of screening; and the association of 2 or more risk factors. However, birth weight inferior to 1500 g and premature birth before the 34th week of pregnancy did not show a statistically significant influence on sensorineural hearing loss. Craniofacial anomalies (mostly cleft palate and ear aplasia) were a significant factor for conductive hearing loss.

Conclusion

Our selected hearing screening on infants at risk allowed 60 deaf children access to early management. However, too many children were lost to follow up; which revealed that better information regarding risk of hearing loss must be provided to parents and paramedics and universal newborn screening needs to be performed. The most important result of this study is that in a population of hearing impaired children, with an impairment incidence close to what is commonly reported, the association of several risk factors proves to be a significant additional risk factor for hearing impairment.     

多地区农村的新生儿听力筛查

目的：探讨在农村地区开展新生儿听力筛查的可行性,为在全国农村地区推广此项工作提供参考依据。方法：研究对象为2004—01—2005—12出生于农村地区九个县的新生儿12638例。采用瞬态诱发性耳声发射的快速筛查程序对出生后2～7d的新生儿实施听力筛查;筛查未通过者于出生后4～6周复筛,复筛未通过者进行跟踪随访和听力学诊断性检查。结果：12638例中10845例（85．8％）新生儿接受了筛查,其中正常新生儿9963例（91．9％）,高危新生儿882例（8．1％）。初筛通过7450例（68．7％）,未通过3395例（31．3％）。拒绝筛查1793例,占14．2％（1793／12638）,其中正常新生儿833例（46．5％）,高危新生儿960例（53．5％）。未通过初筛应进行复筛的新生儿3395例,实际复筛2536例（74．7％）,未能复筛859例（25．3％）。复筛或初筛未通过应接受听力诊断120例,实际接受听力诊断79例（65．8％）,52例确诊听力损失的患儿中6例（7．6％）为双侧极重度听力损失,9例（11．4％）为重度听力损失（双耳7例,单耳2例）,11例（13．9％）为中度听力损失（双耳5例,单耳6例）,26例（32．9％）为轻度听力损失（双耳11例,单耳15例）;27例（34．2％）听力正常。本组先天性听力损失（包括单耳和双耳）的总发生率为0．5％（52／10845）,双侧听力损失的发生率为0．3％（29／10845）。正常新生儿听力损失发生率0．2％（22／9963）;高危新生儿听力损失发生率为3．4％（30／882）。13例双侧重度、极重度听力损失患儿中8例（61．5％）配戴了助听器,1例（7．7％）接受了人工耳蜗植入。结论：在农村地区开展新生儿听力筛查是必要的也是可行的。解决失访率高和转诊率低、提高高危新生儿筛查率仍是目前亟待解决的问题。     

听力筛查未通过婴幼儿的客观听力评估

目的 分析听力筛查未通过婴幼儿的客观听力学特征,为早期干预提供科学依据。方法 对听力筛查未通过患儿286例进行听力诊断性检查。采用听性脑干反应(ABR)、40Hz听觉相关电位(40Hz-AERP)、畸变产物耳声发射(DPOAE)、声导抗进行评估。结果 286例婴幼儿中双耳听力正常95例(33.22%);听力损失者191例(66.78％),其中单耳听力损失70例(24.47％),双耳听力损失121(42.31％);传导性听力损失59例(20.63%),感音神经性听力损失132例(46.15%);轻度听力损失91例(31.82%),中度43例(15.03%),重度20例(6.99％),极重度37例(12.94％)。191例听力异常者只有16例复查,占8.38％,复查结果：听力正常2例,双耳听力损失10例,单耳听力损失4例。结论 部分听力筛查未通过婴幼儿的听力可随着听觉神经系统发育的完善恢复正常;同时中耳病变也是部分婴幼儿听力筛查未通过的影响因素;客观听力学组合测试可有效评估听力筛查未通过患儿的听力特征,为听力损失的早期诊断、早期干预提供科学依据;听力异常患儿的复查率低和失访率高仍是目前亟需解决的问题。     

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.     

Infant hearing screening at immunization clinics in South Africa

OBJECTIVE: Benefits of early identification and subsequent intervention for hearing loss are not accessible to infants in developing countries like South Africa. There are no systematic screening programs and traditional platforms for newborn hearing screening, such as well-baby and intensive care nurseries, do not provide sufficient coverage due to the high incidence of births at home or in primary healthcare facilities. Primary healthcare structures, in the form of immunization clinics, have been proposed as an alternative screening platform. The current study, therefore, investigates a hearing screening program implemented at two immunization clinics in a representative South African community. METHODS: The two clinics in the current study were selected by a convenience sampling method in a community representative of large sections of the population. The hearing screening program was conducted over a 5-month period, and enrolled 510 infants (0-12 months of age). The screening protocol included Distortion Product Oto-Acoustic Emissions (DPOAE) and a high frequency probe tone (1000 Hz) tympanogram. Referral was based on one or both ears referring the DPOAE screen. Follow-up screening and diagnostic evaluations were scheduled for referred subjects. RESULTS: Coverage with DPOAE amounted to 95% of the sample ears (93% of sample subjects) compared to tympanogram coverage amounting to 94% (93% of sample subjects). OAE pass rates were 93% for the sample ears with neonatal ears indicating a higher pass rate of 95% compared to 92% for infant ears (5-52 weeks of age). Eighty-seven percent of the sample ears indicated peaked tympanograms indicative of normal middle-ear functioning and neonatal ears presented with an increased incidence of peaked tympanograms (92%). A highly significant association between the DPOAE and high frequency tympanometric result was found. Follow-up screening appointments were scheduled for 68 subjects (14% of screened sample). Only 40% returned for the second follow-up and 44% for the third follow-up. CONCLUSIONS: Immunization clinics indicate promise as infant hearing screening platforms, but identification of only bilateral hearing losses may be warranted initially to keep referral rates acceptably low. In addition to this efficient tracking systems are necessary to ensure acceptably high follow-up return rates are reached over time.     

听力筛查未通过婴幼儿的听力学特点及原因

目的探讨听力筛查未通过婴幼儿的听力学特点及原因。方法应用听性脑干反应（auditory brainstem response,ABR）、40Hz听觉相关电位（40 Hz auditory event related potential,40 Hz AERP）、畸变产物耳声发射（distortion product otoacoustic emissions,DPOAE）、鼓室声导抗及声反射方法,对126例听力筛查未通过的婴幼儿进行听力学诊断性检查,确认听力损失的程度及性质,并对听力损失婴幼儿的原因进行分析。结果126例（252耳）婴幼儿中,感音神经性聋61例（48.41%）,传导性聋48例（38.09%）,ABR反应阈值正常范围17例（13.50%）。此组患儿既往病史有母孕期感染病史21例、先兆流产9例、高龄6例、延期妊娠7例、伴全身系统疾病10例;新生儿期黄疸13例、缺氧窒息18例、早产儿及低体重8例、伴其他新生儿疾病8例、有听力损失家族史5例,颅面畸形3例,中枢神经系统疾病6例,第2胎9例。结论听力筛查未通过的婴幼儿听力评估后有不同的表现,本组感音神经性聋较传导性聋所占比例高,多数听力损失患儿伴有高危因素。     

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.     

Importance of newborn hearing screening

US Preventive Services Task Force recommends universal screening of all newborns for early detection of hearing impairment and early intervention to prevent its effects on normal development and acquisition of language skills. During comparison of universal screening of all newborns versus targeted screening of high risk cases to detect hearing impairment, it emphasized the importance of Universal newborn hearing screening (UNHS) among neonatologists, pediatricians as well as ENT specialists taking care of newborns and young children. Among those who had early versus late confi rmation of hearing loss and those who had undergone universal newborn screening versus none, better language outcomes at school age were found than those not screened. Infants identifi ed with hearing loss through universal newborn screening had earlier referral, diagnosis, and treatment than those not screened. Targeted screening of newborns with high risk criteria missed 50% of cases of hearing impairment, either because infants were hearing impaired but did not meet any of the high- risk criteria, or because they developed hearing loss after the newborn period.     

The New York State universal newborn hearing screening demonstration project: ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention

OBJECTIVE: To determine the ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention through a multi-center, state-wide universal newborn hearing screening project. DESIGN: Universal newborn hearing screening was conducted at eight hospitals across New York State. All infants who did not bilaterally pass hearing screening before discharge were recalled for outpatient retesting. Inpatient screening and outpatient rescreening were done with transient evoked otoacoustic emissions and/or auditory brain stem response testing. Diagnostic testing was performed with age appropriate tests, auditory brain stem response and/or visual reinforcement audiometry. Infants diagnosed with permanent hearing loss were considered for hearing aids and early intervention. Ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention were investigated regarding nursery type, risk status, unilateral versus bilateral hearing loss, loss type, loss severity, and state regions. RESULTS: The prevalence of infants diagnosed with permanent hearing loss was 2.0/1000 (85 of 43,311). Of the 85 infants with hearing loss, 61% were from neonatal intensive care units (NICUs) and 67% were at risk for hearing loss. Of the 36 infants fitted with hearing aids, 58% were from NICUs and 78% were at risk for hearing loss. The median age at identification and enrollment in early intervention was 3 mo. Median age at hearing aid fitting was 7.5 mo. Median ages at identification were less for infants from the well-baby nurseries (WBNs) than for the NICU infants and for infants with severe/profound than for infants with mild/moderate hearing loss, but were similar for not-at-risk and at-risk infants. Median ages at hearing aid fitting were less for well babies than for NICU infants, for not-at-risk infants than for at-risk infants, and for infants with severe/ profound hearing loss than for infants with mild/ moderate hearing loss. However, median ages at early intervention enrollment were similar for nursery types, risk status, and severity of hearing loss. CONCLUSIONS: Early ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention can be achieved for infants from NICUs and WBNs and for infants at risk and not at risk for hearing loss in a large multi-center universal newborn hearing screening program.     

Maintaining acceptably low referral rates in teoae-based newborn hearing screening programs

This article describes factors that can affect the refer rate for otoacoustic emission (OAE) based newborn hearing screening, including the population of infants being screened, the adequacy of probe fit, software options used, external ear conditions, screener training, and baby handling. The effect of the infant’s age on screening outcomes is also discussed using results of screening for 1328 regular nursery newborns, ranging in age from 6 to 60 hours, who were screened with transient evoked otoaoustic emissions (TEOAE) prior to hospital discharge. The youngest infants (6–9 hours old) were as likely to pass (90% pass rate) as the infants who were 24–27 hours old (94% pass rate). The results of this study are consistent with reports from many TEOAE-based screening programs that have demonstrated that acceptably low refer rates (mean = 6.9%) can be obtained when appropriate screening procedures are followed.     

早产儿听力筛查结果及其听力障碍危险因素

目的 分析新生儿重症监护中心(NICU)中早产儿的听力筛查结果, 探讨导致早产儿听力障碍的高危因素。方法 回顾性分析821 例不同胎龄早产儿的一般资料及听力筛查数据, 对听力筛查未通过的危险因素加以总结。结果 821 例中听力初筛未通过率61.0%, 复筛未通过率为 16.0%, 出生后 3 个月自动听性脑干反应(AABR)总未通过率为 9.4%。初筛、复筛及AABR检查未通过率及听力障碍程度随胎龄的增大呈依次降低的趋势。多因素Logistic 回归分析表明, 极低出生体质量、高胆红素血症、感染和窒息是听力初筛和复筛听力障碍的危险因素, 胎龄 > 32 周为听力初筛听力障碍的保护因素(OR=0.499, P=0.022), 极低出生体质量为听力复筛听力障碍独立危险因素(OR=2.385, P=0.038)。结论 早产儿由于机体各组织器官发育不成熟, 听力障碍高发, 胎龄越小听力损伤发生危险性越高, 听力障碍与出生体质量、高胆红素血症、感染和窒息有关, 应该对早产儿听力进行早期监测并及时随访。     

婴幼儿中耳炎的听力学特征分析

目的 分析婴幼儿中耳炎的听力学特征,探讨多种听力学测试方法在婴幼儿中耳炎的诊断和干预中的作用.方法 收集2004年12月至2007年6月由外院转入本院进行听力学诊断性检查后确诊或高度怀疑中耳炎的56例婴幼儿患者(男加例,女16例).初诊年龄为42 d至3岁,平均为5个月.患儿在完成耳鼻咽喉科常规检查后,进行了多种听力学测试方法联合诊断,包括听性脑干反应(ABR)、耳声发射(OAE)、鼓室声导抗测试(226和1000 Hz探测音),4例患儿完成了小儿行为测听.结果 56例(112耳)中有87耳诊断为中耳炎,31例为双侧,25例为单侧.56例中有49例在出生后3 d内进行了新生儿听力筛查,其中36例初筛未通过;42 d时行进一步筛查的有52例(其中有3例未行初筛直接进行了复筛),显示均为未通过.4例患儿未经过听力筛查,为家长发现听力不佳来诊.52例(104耳)进行了226 Hz鼓室声导抗测试,其中20例(28耳)鼓室图B型或c型;39例(78耳)进行了1000 Hz鼓室声导抗测试,其中38例(55耳)出现异常;56例(112耳)进行了ABR检查,其中49例(74耳)出现ABR的波I潜伏期延长;56例(112耳)进行了OAE测试,其中55例(81耳)未通过;4例(8耳)完成了小儿行为测听,均出现骨、气导差.结论 联合应用226 Hz及1000 Hz鼓室声导抗测试、ABR潜伏期及阈值测试、小儿行为测听、OAE测试多种方法能够发现婴幼儿中耳炎的特征性表现,在早期诊断中具有帮助.     

A model of two-stage newborn hearing screening with automated auditory brainstem response

Our purpose was to evaluate a two-stage newborn hearing screening program using automated auditory brainstem response (AABR) before discharge and to describe our follow-up program. This study used 4085 infants born in the Seirei-Hamamatsu and Mikatahara General Hospitals during a 2-year period. The initial screening test was performed 2 or 3 days after birth at an intensity of 35 dBnHL. For the infants who were referred from this test, the re-screening test was performed 5 or 6 days after birth. Diagnostic work-up with auditory brainstem response (ABR), otoacoustic emissions (OAE), and a conditioned orientation reflex audiometry (COR) test were performed by the age of 3-6 months. The referral rate was 1.20% (49/4085 infants) in the first test and 0.71% (29/4085 infants) in the two-stage screening. The two-stage screening procedure was able to reduce the false-positive rate from 0.83 to 0.34%. The incidence of bilateral and unilateral congenital hearing loss diagnosed by ABR was 8/4085 (0.20%) infants and 7/4085 (0.17%) infants, respectively. One infant with congenital cytomegalovirus infection, who passed the two-stage AABR tests, was diagnosed with hearing loss 1 month after birth, using ABR. The two-stage measurement of AABR is effective and time efficient due to significant decreases in the referral rate and the false-positive rate.     

听力复筛不通过的转诊婴儿听力学评估

目的评估两次听力筛查未通过转诊婴儿的临床听力学。方法对210耳两次听力筛查未通过转诊的婴儿进行听性脑干反应（ABR）、听性稳态反应（ASSR）、40 Hz听觉相关电位(40 Hz AERP)、畸变产物耳声发射（DPOAE）、声导抗（AI）等检查,并分析其结果。结果两次未通过听力筛查的210耳中,有听力损失143耳,听力损失的检出率为68.10％(143/210)。其中传导性听力损失62耳,占听力损失耳43.36%(62/143);感音神经性听力损失81耳,占听力损失耳56.64%(81/143)。确诊大前庭导水管扩大综合征（LVAS）16耳,发病率为7.62%（16/210）。诊断为类听神经病6耳,发病率为2.85%（6/210）。结论两次听力筛查未通过的听力损失检出率较高,对于听力高危因素婴幼儿的听力动态随访有待更加关注,应结合婴儿生理特点更加精准的进行听力学诊断,及其本身的生理发育特点全面评估。     

Further examination of infants referred from newborn hearing screening

OBJECTIVES: Universal newborn hearing screening (UNHS) is considered beneficial and is accepted worldwide. However, some problems remain, and administrative systematization has yet to be established in many countries. This study assessed the hearing screening of referred newborn infants and discusses the problems that remain. MATERIALS AND METHODS: Over the two years from July 2001 to June 2003, 98 ears of 49 infants were judged as a "referral" from a newborn hearing screening program, and were subsequently referred to our hospital for further examination using conventional ABR and other audiological tests. The methodology used for hearing screening varied between practitioners and hospitals that utilized both different recording apparatus for AABR and/or automated DPOAEs and independent protocols. RESULTS: Conventional ABR identified 21 infants with bilateral normal hearing, 12 with unilateral hearing loss, and 16 with bilateral hearing loss, and a total correspondence rate of 40.8% (20 out of 49 infants). In a comparative analysis, 26 ears out of 98 (26.5%) were determined as false-positive, seven out of 98 as false-negative (7.1%), and there was a total correspondence rate of 66.3% (65 out of 98 ears). Five of the seven false-negative cases who were referred with unilateral hearing loss exhibited moderate to profound bilateral hearing loss (moderate; one infant, severe to profound; four infants). Of the 16 infants with bilateral hearing loss, nine with more than moderate loss had hearing aids fitted at our hospital or related educational institution before most were six months old. CONCLUSIONS: Our results suggest the accuracy of newborn hearing screening remains an issue, but may be improved by an experienced examiner and better protocols including a two-stage process and altered timing of screening. Other ongoing health care programs need to monitor for signs of hearing loss even in the "passed" infants because of possible false-negatives and delayed-onset hearing loss. Improvement is needed in both the intervention systems and diagnostic follow-up of hospitals. Early public support is also required for infants with either severe to profound or moderate hearing loss. From the viewpoint of test conditions and puerperal parental psychological problems, it is considered that the timing of screening needs further discussion. Here it is suggested that screening should be performed within the first three months of infant's life but not be limited to before hospital discharge, and incorporated into the routine health care program for one-month-old infants without reducing efficiency.     

Subsidizing hearing aid purchase in mild to moderate pediatric hearing--pediatric status following prefectural assembly subvention

The dissemination of newborn hearing screening (NHS) has enabled those with mild to moderate hearing loss to be diagnosed in early infancy. The "handicapped independence support law", however, prevents those not determined to be physically handicapped; i.e., those with mild to moderate hearing loss-, from government assistance in purchasing hearing aids. This results either in (i) parents purchasing hearing aids at their own expense or (ii) nonpurchase of hearing aids. To redress this situation, subvention in purchasing hearing aids of mild to moderate hearing loss children has been begun by some local governments. We petitioned for such aid at the Okayama Prefecture Assembly. A society for supporting pediatric hearing difficulty in Okayama Prefecture also submitted a similar petition in September 2009, and subvention began in April 2010 for all such children in Okayama Prefecture. We report procedures and details leading to this subvention.     

听力筛查未通过婴幼儿相关高危因素及听力评估结果转归分析

目的：探讨不同高危因素下听力筛查未通过婴幼儿听力特点及其转归情况。方法：对2次听力筛查未通过而转诊我科的婴幼儿采用ABR、畸变产物耳声发射（DPOAE）、鼓室声导抗和镫骨肌反射等客观听力测试。首次听力评估异常者依照听力损失情况,建议复诊时间一般1～3个月,以不超过6个月龄为限。分析未通过听力筛查的婴幼儿在不同年龄、不同筛查结果、不同高危因素下的听力测试的特点及转归情况。结果：听力筛查不通过的802例（1179耳）中,单耳不通过组初次听力评估正常的比例为53．2％,高于双耳不通过组（39．5％）,P％0．05。而初评为重度听力异常的比例在两组问无明显差异（P〉0．05）;高胆红素血症导致的听力筛查不通过占25．8％,远高于其他已知的高危因素（P％0．05）;先兆流产组未发现有重度听力异常患儿;有耳聋家族史的婴幼儿导致重度听力损失的比例（40．9％）远高于其他高危因素,其次为同时有2种以上高危因素者（10．8％）;听力筛查不通过者中,56．9％未发现有高危因素,其中有54．7％初次评估听力异常;而有高危因素的婴幼儿中,42．3％初次评估听力为正常;所有2次评估的96例（138耳）中,轻度异常好转比例为40．9％,中度为74．3％,重度为33．3％,P％0．05。有7耳出现听力损失加重现象。各种不同高危因素导致的听力异常中,中度异常好转的比例均较轻度异常高;802例（1179耳）中,有10例（12耳）诊断为听神经病。结论：未通过听力筛查的婴幼儿围产期病史及听力损失程度和年龄等均是决定追踪随诊次数的重要因素,仍存在许多未知的听力损害高危因素,实现新生儿聋病易感基因的普遍筛查应该是今后努力的方向。