The Hearing Scale Test for hearing screening of school-age children

Objectives

This study aimed to demonstrate a new modified hearing screening method that can rapidly screen hearing and provide stratified test values for each screened ear of children.

Methods

The proposed Hearing Scale Test (HST) and pure-tone screening (PTS) were applied to 384 school-age children. PTS involved applying four test tones to each tested ear: 500 Hz at 25 dB, and 1000, 2000, 4000 Hz at 20 dB; and classifying the results as “pass” (normal hearing in the ear) or “fail” (possible hearing impairment). The HST employs ten stratified hearing scales from S₁ to S₁₀, with each hearing scale containing four test tones and where adjacent scales differ from each other by 5 dB, ranging from 0 dB (S₁) to 45 dB (S₁₀). The four test tones of hearing scale S₅ are the same hearing criteria and the median reference standard of the stimulus level in the HST. Scales S₁-S₅ on the HST are equivalent to a PTS “pass” result, while S₆-S₁₀ and no response (NR) are equivalent to a PTS “fail” result.

Results

The two screening methods produced comparable “pass” and “fail” results. In the HST, the “pass” results were further stratified as S₁ in 4 ears, S₂ in 52 ears, S₃ in 226 ears, S₄ in 272 ears, and S₅ in 169 ears, while the “fail” results were stratified as S₆ in 23 ears, S₇ in 12 ears, S₈ in 1 ear, S₉ in 2 ears, S₁₀ in 5 ears, and no response (NR) in 2 ears. The hearing screening results of the HST are interpreted as follows: scales S₁-S₅ indicate normal hearing, scales S₆ and S₇ indicate possible hearing impairment, and scales S₈-S₁₀ and NR indicate confirmed hearing impairment.

Conclusions

Conventional PTS only gives a pass/fail result for each screened ear, lacks hearing status assessment, and lacks stratified test values to be recorded for follow-up. In contrast, the HST has stratified hearing scales for each screened ear, which reflects the current hearing status and provides test values that can be recorded for follow-up.     

Effectiveness of questionnaires for screening hearing of school-age children: A comprehensive literature review

Abstract

Objective: The purpose of this study was to review the literature on the effectiveness of parent or teacher-completed questionnaires as a tool to screen school-aged children for permanent hearing loss. Design: A rapid evidence assessment was completed to provide a summary of information published between 1980 and 2013 in English or Spanish. To identify relevant publications, a database search was conducted using nine databases. Study sample: Seven studies were identified for inclusion in the review. Results: Authors of three of the studies recommended use of the questionnaire as a method for screening hearing in school-aged children, and authors of four of the studies did not recommend use of the questionnaire. However, only one of the seven studies provided good evidence that questionnaires are an effective way of identifying hearing loss among children. Conclusions: There is insufficient evidence that parent or teacher completed questionnaire screening can be reliably used to identify children in need of further hearing assessment. It is clear that more research is needed before concluding that questionnaires are an effective and low-cost tool for use to screen children for permanent hearing loss.     

4146例新生儿听力筛查分析

目的了解影响先天性听力损伤发病的因素,探讨降低听力残疾儿童发病率的有效措施。方法采用畸变产物耳声发射进行新生儿听力筛查初筛,复筛,未通过者转上级医院进行诊断、康复治疗。根据性别、出生体重、胎龄、生产方式和有无孕产期高危因素进行分组统计分析。结果新生儿先天性听力损伤的发病率为3.1‰,与遗传因素、孕期缺氧、感染和黄疸因素有关;初筛未通过率为10．7％,与出生体重、生产方式有关。结论开展婚前检查。做好遗传咨询宣传。加强孕产妇系统管理。提高产科质量,推广新生儿听力筛查技术,完善听力筛查、诊断、康复治疗体系是降低听力语言残疾发病率的有效措施。     

新生儿听力损失高危因素与听力筛查研究进展

目的随着听力筛查工作不断的推广以及听力筛查技术不断的革新,新生儿听力损失的高危因素也逐渐明确,本文就以下听力损失高危因素进行相关阐述：①低胎龄出生儿;②新生儿感染性疾病;③新生儿缺氧性疾病;④高胆红素血症;⑤耳毒性药物的影响;⑥遗传因素;⑦环境因素,并对相关高危因素损害听力机制进行阐明;探讨了目前各种听力筛查方法在听力筛查工作中的优势、不足之处以及改进方法。进而得出结论：针对有高危因素的新生儿,应严格按照听力筛查工作流程对其进行严格的筛查,同时联合耳聋基因筛查,长期对其听力进行检测和随访。     

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。     

The assessment of hearing organ of school children in Upper Silesia region

Because at present no estimated data is available concerning the frequency of hearing loss in the population of primary school children in Silesia, it has been assumed useful to carry out a research programme. An important advantage of this study is the assessment of hearing in children from Upper Silesian region, a top ranking region in Europe in industrialisation and environmental pollution.In the selected population of primary school children in the province of Silesia, hearing loss occurred in 6% of the examined pupils; in schools located in urban areas it was higher than in schools from rural areas.In the group of children aged 6-10 years conductive hearing loss occurred significantly more frequently, than main cause of that hearing loss was Eustachian tube dysfunction.The obtained results testify about the society being hardly aware of the problems related to hearing loss, which stresses the necessity of conducting screening examinations of hearing organ in children at school age, as well as improving the health care and prevention in that respect.     

Occupational hearing loss: screening with distortion-product otoacoustic emissions

Hearing assessment of applicants for occupational hearing loss compensation can be a time-consuming process. An accurate screening procedure that is sensitive to occupational hearing loss may have application in many situations. The present study developed distortion-product otoacoustic emission (DPOAE) screening criteria to identify subjects likely to meet the Hong Kong requirements for occupational hearing loss compensation, namely a bilateral sensorineural loss ≥ 40 dB HL (average of 1000, 2000 and 3000 Hz). The screening criteria of 1500 and/ or 2000 Hz, with a signal-to-noise ratio of >0 or 3 dB, yielded high sensitivity and specificity. DPOAE measures therefore have the potential to accurately indicate possible occupational hearing loss. However, DPOAEs should be used as a screening tool only, as conventional pure-tone audiometry remains the more comprehensive measure of hearing sensitivity.     

Risk factors and etiology of childhood hearing loss: a cohort review of 296 subjects

Abstract

Background: The association between the Joint Committee on Infant Hearing (JCIH) risk factors and etiology of hearing loss (HL) is not studied well in children.

Objectives: To clarify the etiologic causes and evaluate the JCIH risk characteristics of children with HL.

Methods: A retrospective study of 296 children with HL born between 2009.01 and 2013.12 in Stokholm. Demographic data, family and medical histories, audiologic results, imaging findings, and genetic results were ascertained and analyzed.

Results: In 221 with bilateral hearing loss (BHL), family history and neonatal risk indicators were the most common risks (59 each), followed by syndrome related risks. In 75 with unilateral hearing loss (UHL), craniofacial anomaly was the most common risk, followed by family history. Etiology was established in 93 with BHL, in which syndromic HL accounted for 37.2%, chromosomal aberrations for 21.3%, and environmental causes for 19.1%. Etiology was established in 35 with UHL, in which ear malformation accounted for the most (74.3%), followed by environmental causes (14.3%).

Conclusions and significance: Childhood HL can be attributed to a variety of causes with an etiology identifiable in 42.5% of BHL and 46.7% of UHL. BHL and UHL have different patterns of JCIH risk exposure and etiology.     

普遍新生儿听力筛查中确诊耳聋者颞骨CT的影像学分析

目的：探讨普遍新生儿听力筛查中确诊为耳聋的婴幼儿颞骨高分辨率CT（HRCT）的影像学表现,以及对耳聋原因诊断的作用。方法：2005年1～12月,121400名新生儿参加上海市新生儿听力筛查,1077例2次筛查阳性者转至上海市儿童听力障碍诊治中心进一步行诊断性听力检查,其中184例被确诊为先天性聋的患儿接受颞骨HRCT检查,对此资料进行分析研究。结果：184例先天性聋患儿中颞骨HRCT发现解剖畸形者58例（31．5％）,其中外耳畸形26例（44．8％）,中耳畸形21例（36．2％）,内耳畸形31例（53．4％）。内耳畸形包括Mondini畸形12例,共同腔畸形1例,前庭导水管扩大、不伴耳蜗畸形6例,前庭、半规管畸形10例,内听道异常5例。另外,单纯鼓室积液20例（10．8％）。结论：HRCT检查对婴幼儿耳聋原因的鉴别诊断和治疗有一定帮助。     

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.     

Hearing screening for Japanese children and young adults using the automated auditory brainstem response

Objective

Hearing screening programs in schools are particularly important for children because they can enable early detection of hearing problems and early intervention. However, there has been little research on this topic. The MB11BERAphone^® is a novel, accurate and efficient Automated Auditory Brainstem Response device for hearing screening in infants. The aim of this study was to investigate the validity of the MB11BERAphone^® as a hearing screening device for pre-school, school-age and young-adult individuals.

Methods

Between January 2010 and March 2012, 163 normal and hearing impaired individuals, corresponding to 321 ears from subjects aged 3–22 years 11 months at Luther Aiji Kindergarten and Nakadori General Hospital in Akita, Japan, underwent primarily conditional play audiometry or conventional audiometry followed by the Automated Auditory Brainstem Response by MB11 BERAphone^®. The statistical analysis was performed with the Predictive Analytics Software (PASW Statistics 18) and presented as the mean, standard deviation (SD) and frequency distribution. The sensitivity, specificity and false-positive and false-negative rates were estimated to analyze the validity of the MB11 BERAphone^® test over audiometry.

Results

Among the normal and hearing impaired ears, 140 were scored as “REFER” and 181 were scored as “PASS” during the hearing screening examination conducted using the MB11BERAphone^® device. The specificity was 95.1%, and the sensitivity was 96.3%. The false positive rate was 5%, and the false negative rate was 4%. The overall timing without precise measurement was less than 7 min. The individuals were divided into groups: pre-schoolers (3–5 years), school-age (6–17 years) and young-adults (18–22 years). When the audiometry and MB11BERAphone^® results were compared, no statistically significant differences (p = ns) were detected among general (pre-schoolers + school-age + young-adult), pre-school, school-age, and young-adult groups.

Conclusion

The results suggest that the MB11BERAphone^® is not only useful for newborn hearing screening but also for hearing screening in older individuals, due to the low cost of the integrated electrodes and the speed with which the examination can be performed.     

Newborn hearing screening in a developing country: Results of a pilot study in Abidjan, Côte d’ivoire

Objective

To investigate the feasibility of neonatal hearing impairment in newborn babies in Abidjan, Côte d’Ivoire.

Methods

It is a cross-sectional study in which all infants aged from 3 to 28 days, attending for Bacille Calmette-Guerin (BCG) immunization in primary care centers or hospitalized in neonatal intensive care units (NICU), between July 2007 and March 2008, were included. Screening followed a two-stage strategy with transient evoked otoacoustic emissions (TEOAE). Infants referred after the second-stage screening were scheduled for diagnostic evaluation by diagnostic auditory brainstem response (ABR). The variables analyzed were: screening coverage, referral rates; return rates for second-stage screening and diagnostic evaluation, incidence of permanent hearing loss and age at diagnosis.

Results

1306 newborns, of a total of 1495, were successfully screened, giving a screening coverage of 87.4%. The average age was 4.5 days (S.D.: 2.7), with 5.85 days (S.D.: 3.17) for the immunization group and 3.20 days (S.D.: 0.40) for the neonatal unit group. In total, 286 out of the 1306 infants (21.9%) were referred after the first-stage screening; out of which 193 (67.5%) return for the second stage. After the second-stage screening, 48 (16.8%) were scheduled for diagnostic evaluation (45 from NICU and 3 from primary care centers). The overall referral rate for diagnostic evaluation was 3.7% (48/1306). Only 18.75% of those referred (9/48) returned for evaluation, and seven of them (77.8%) were confirmed with hearing loss (2 from immunization group and 5 from neonatal unit group). The prevalence of permanent hearing loss in this screened population was 5.96 per 1000 (7/1174 babies who completed the screening) [95% I.C.: 5.62-6.30 per 1000]. The mean age at diagnosis was 22 weeks (S.D.: 8.3). The reasons for non-completed screening were, according to 62 mothers: no financial means, absence of hearing loss, fear of spouse reactions, lack of information about this test and deafness.

Conclusion

The incidence of permanent and early hearing impairment identified by this screening program was about 6 per 1000. Routine hearing screening of infants for the early detection of hearing loss is necessary in Côte d’Ivoire. It is possible to implement such a hearing screening, targeting all newborns, in primary health care centers and neonatal intensive care units.     

Organic solvents and hearing loss: The challenge for audiology

Organic solvents have been reported to adversely affect human health, including hearing health. Animal models have demonstrated that solvents may induce auditory damage, especially to the outer hair cells. Research on workers exposed to solvents has suggested that these chemicals may also induce auditory damage through effects on the central auditory pathways. Studies conducted with both animals and humans demonstrate that the hearing frequencies affected by solvent exposure are different to those affected by noise, and that solvents may interact synergistically with noise. The present article aims to review the contemporary literature of solvent-induced hearing loss, and consider the implications of solvent-induced auditory damage for clinical audiologists. Possible audiological tests that may be used when auditory damage due to solvent exposure is suspected are discussed.

Sumario

Se ha reportado que los solventes orgánicos afectan adversamente la salud humana, incluyen la salud auditiva. Los modelos animales han demostrado que los solventes pueden inducir daño auditivo, especialmente en las células ciliadas externas. La investigación en trabajadores expuestos a solventes sugiere que estos productos químicos pueden también inducir daño auditivo afectando las vías auditivas centrales. Los estudios conducidos en animales y en humanos demuestran que las frecuencias auditivas afectadas por la exposición a solventes son diferentes de las afectadas por el ruido, y que los solventes pueden actuar en sinergia con el ruido. El presente artículo pretende revisar la literatura contemporánea sobre hipoacusia inducida por solventes, y hacer consideraciones clínicas para el audiólogo sobre el daño auditivo inducido por solventes. Se discuten posibles pruebas auditivas que pueden ser utilizadas cuando se sospecha daño auditivo debido a la exposición a solventes.     

Prevalence of A1555G mitochondrial mutation in Chinese newborns and the correlation with neonatal hearing screening

Objective

To investigate the feasibility of genetic screening for deafness causative genes in the process of newborn hearing screening in China.

Methods

Total 865 newborn babies between November 2009 and March 2010 were enrolled for the simultaneous hearing and deafness causative gene screening in Tongji Hospital, Wuhan, China. Hearing screening followed a two-stage strategy with transient evoked otoacoustic emissions. Infants referred after the second-stage screening were tested by diagnostic auditory brainstem response (ABR). Genomic DNA was extracted from heel blood of newborns, and the mitochondrial 12S rRNA A1555G mutation was detected by polymerase chain reaction (PCR) based restriction fragment length polymorphism and confirmed by DNA sequencing.

Results

In hearing screening, 134 out of the 865 newborns (15.5%) were referred after the first-stage screening and 86.6% (116/134) of them returned for the second stage. After the second-stage screening, 15 who were still referred were tested by diagnostic ABR and 3 of them failed the test. On the other hand, gene screening identified 6 of the 865 newborns (0.7%) harbored homoplasmic 12S rRNA A1555G mutation although they passed the hearing screening.

Conclusion

It might be practical and effective to complement routine hearing screening in newborns with gene screening for the purpose of early diagnosis and discovery of the late-onset hearing loss.     

Neonatal Hearing Screening Programs in Europe: Towards a Consensus Development Conference

A study of 56 severely asphyxiated infants (8 hearing impaired and 46 normally hearing) was designed to identify specific markers associated with asphyxia which could be related to hearing loss. Sixteen variables, including such items as: one- and five-minute Apgar scores, muscle tone, use of a ventilator, prolonged stay in the NICU, hypoxic-ischemic encephalopathy (HIE), other organ damage, and intra-uterine growth retardation (IUGR) were considered. Results suggested four factors related to asphyxia which are often found in the presence of hearing loss, but none of these was considered a definitive marker or predictor of such a disability. A combination of HIE, seizures, associated organ damage and IUGR should be considered a strong marker for the probability of a sensorineural hearing loss.     

Comparison of TEOAE with Play audiometry for screening hearing problems in children

To evaluate the usefulness of transiently evoked otoacoustic emissions (TEOAEs) for hearing screening of children at around 3 years of age, measurements were done together with Peep show test in a group of 47 children (n=93 ears). A stimulus sound of 30 dB nHL was used as the screening intensity for the TEOAE measurement. All measurements were done with awake subjects. Twenty seven ears, all of which were revealed to have normal hearing (within 20 dB HL, assessed by Peep show test) and tympanograms, showed positive TEOAE results. Furthermore, TEOAEs were sensitive to the presence of middle ear conductive impairment, showing negative results. We conclude that, compared with Play audiometry, TEOAE measurements can not yield quantitative results, but can yield qualitative results for determining the presence of hearing impairment without sedative induced sleeping in this critical age of children.