Otoacoustic emissions as a screening test for hearing impairment in children.

Transient evoked otoacoustic emissions (TEOAEs) are low amplitude sound waves produced by the healthy cochlea. They can be recorded with a microphone in the external ear. TEOAEs are abolished by hearing losses of 30 dB or more. The feasibility of using TEOAEs as a screening test for hearing loss in children was studied. TEOAE recordings were attempted in 56 children attending an audiology clinic. Recordings were possible from both ears in 52 children; of these 104 ears, 32 had hearing deficits of 30 dB or more. Hearing status was compared with the results of six TEOAE screening criteria. All criteria had a sensitivity of 1.00. Four standard TEOAE criteria yielded specificities of 0.46-0.58. Two new criteria derived from analysis of limited frequencies from the TEOAE waveform gave specificities of 0.76 and 0.82. It can be concluded that, when appropriate pass/fail criteria are employed, TEOAEs are a feasible screening test in children.     

Otoacoustic emissions: A new method to diagnose hearing impairment in children

Otoacoustic emissions (OAEs) are epiphenomena of sensitive, amplifying processes during hearing which can be detected in persons with normal inner ear function. They originate from the cochlea and are interpreted as an energy leakage of cochlear processes, perhaps resulting from active outer hair cell movements. OAEs travel from the cochlea through the middle ear to the external auditory canal where they can be detected using sensitive miniature microphones. Transient evoked (TEOAE) tests allow to otoacoustic emissions non-invasively check the integrity of the cochlea. In the neonatal period, registration of OAEs can be accomplished during natural sleep. In infants and neonates TEOAEs can be used as screening test with a screening level at 30 dB HL in pacdiatric audiology. They are less time consuming and elaborate than auditory brainstem responses (ABR) and they are more sensitive than behavioral tests. TEOAEs are constant over long periods of time and they are reduced or absent due to various adverse influences in the inner ear. These latter characteristics may allow monitoring of the inner ear function over time e.g. during disease and/or during ototoxic therapeutic interventions. Limitations of this new method are due to the fact that TEOAEs are absent in patients with a more than 30 dB HL hearing loss. Thus a hearing threshold cannot be determined. Diseases of the inner ear which are common in early childhood (like otitis media) reduce the transfer of TEOAEs and may wrongly indicate a cochlear hearing disorder. New methods for evaluation and interpretation of TEOAE test results are currently developed which may allow to circumvent this problem. When used by an experienced examiner who is aware of the possibilities as well as of the limitations of this new method, registration of TEOAEs is a promising new tool which complements our current-armamentarium to diagnose hearing disorders in children.     

Neonatal otoacoustic emission screening and the identification of deafness.

Using transient evoked otoacoustic emissions (TEOAEs), a two stage screen with the testing of failures by auditory brainstem response (ABR), has been implemented in Whipps Cross Hospital in East London. From January 1992 to 1995, 11,606 infants received an initial TEOAE test. Once initial difficulties were resolved, coverage of district residents remained stable at 91.5%. Long term follow up of the cohort is being undertaken. Of those receiving an initial test, 13% failed in both ears. Only 1.75% of the cohort failed both stages of the TEOAE screen bilaterally. These infants were tested by ABR. The yield of infants with a bilateral permanent hearing loss of moderate or worse degree was 2/1000. The overall cost of implementing the programme was not prohibitive and the cost per hearing impaired child detected was little more than the widely accepted notional cost of identifying such children through targeted at risk screens. The screen was clearly sensitive. The priority for such universal TEOAE programmes, however, is to increase specificity without losing this sensitivity.     

Transient evoked otoacoustic emissions

Objective: The purpose of this study was to collect parametric measures of TEOAEs in normal hearing children of various age-groups and to establish a normative baseline for Transient Evoked Otoacoustic Emissions (TEOAEs).Methods: Sixty subjects were investigated in three age-groups: neonates, 0–1 month; infants, 1 month-1 year; and children, 1–6 years. Each group comprised of 20 subjects. All the subjects underwent medical examination by a pediatrician and an ENT surgeon. Screening for hearing was done by immittance testing, behavior observation and conditioned play audiometry. The TEOAEs were analyzed for the parameters of amplitude, cross-correlation (wave reproducibility) and signal-to-noise ratio (SNR).Results: There was no difference between the mean amplitudes of the right and left ears in the groups. The females in the neonates group had higher emission amplitudes than the males. The mean amplitude of the subjects in the neonates group was significantly higher than the subjects in the infants, or children groups. The cross correlation (wave reproducibility) was constant across the age. The mean SNR for all the subjects were well above 3 dB at frequencies 1.5 k, 2k, 3k and 4kHz. The neonates group showed the lowest SNR ranging between 3.47 to 9.62 dB. The infants group showed the highest SNR ranging between 6.13 to 13.11 dB.Conclusion: The TEOAEs response measures of SNR and cross correlation, at frequency bands 1.5, 2, 3 and 4 kHz, may provide more reliable outcomes than TEOAEs amplitude. Subjects in the age range of 0–1 month show lower SNRs than those in higher age ranges. The values can be used as normative data for screening and diagnostic purposes in the pediatric population.     

Outcomes of neonatal screening for hearing loss by otoacoustic emission.

AIM: To assess universal neonatal screening for bilateral hearing impairments averaging 40 dBHL or worse in the better ear, using transient evoked otoacoustic emission screening (TEOAE) testing. METHODS: A three year cohort (14,353 infants born from January 1992 to 1995) was screened and subsequently followed up by hearing surveillance methods, including a distraction test screen from 7 months of age. The entire cohort was used to evaluate the outcome of the screen. A subcohort of 8172 district residents was used to evaluate the continuing worth of the distraction test programme. RESULTS: Nineteen infants (1.3/1000) with a targeted hearing impairment failed the neonatal TEOAE test. Six profoundly deaf infants identified by the TEOAE screen, were fitted with hearing aids at a median age of 16 weeks. One remained without an aid. Of 12 infants with a moderate impairment, only seven accepted hearing aid fitting and the median age of being fitted with an aid increased to 42 weeks. By the time of the analysis 22 children with a targeted hearing impairment (1.5/1000) had been identified from the cohort. Of the three missed neonatally, one was cared for elsewhere, another had a progressive loss, and the third had central deafness. Twenty children were ascertained with a congenital peripheral deafness. Of these, eight (40%) had risk factors identifiable neonatally. Only the child with central deafness was missed by TEOAE screening and subsequently identified by behavioural tests in infancy. The TEOAE screen outperformed the distraction test in terms of processes and yield and was 25% less expensive. CONCLUSIONS: The analysis confirmed the worth within the district of the TEOAE hearing screen. It will thus be continued as a universal neonatal screen with the distraction test being retained as a selective screen in the latter half of infancy.     

Otoacoustic emissions as a screening test for hearing impairment in children recovering from acute bacterial meningitis

OBJECTIVES: To study the efficacy of otoacoustic emissions (OAEs) as a screening test for hearing impairment in children with acute bacterial meningitis. Hearing tests were performed before discharge from the hospital in an attempt to improve coverage and avoid delays in the diagnosis of postmeningitic hearing loss. METHODS: Children with bacterial meningitis were recruited from 21 centers. In the 48 hours before discharge from the hospital, all patients underwent a thorough audiologic assessment consisting of transient evoked OAEs, auditory brainstem responses (ABRs), otoscopy, and tympanometry. Hearing loss was defined as ABR threshold >/=30 dB. The results of OAE screening were compared with the gold standard of ABR threshold. RESULTS: Of 124 children recruited, we were able to perform both OAEs and ABRs on 110 children. Seven (6.3%) of the 110 children had ABR threshold >/=30 dB; 2 had sensorineural hearing loss and 5 had conductive hearing loss. At follow-up, hearing loss persisted in both cases of sensorineural hearing loss and no new cases were identified. All 7 children with hearing loss failed the OAE screening test. Ninety-four children with normal hearing thresholds passed the test, and 9 failed. Thus, the screening test had a sensitivity of 1.00 (95% confidence interval, 0.59 to 1.00), a specificity of 0.91 (0.85 to 0.97), a positive predictive value of 0. 44 (0.20 to 0.70), and a negative predictive value of 1.00 (0.96 to 1.00). CONCLUSIONS: OAE screening in children recovering from meningitis was found to be feasible and effective. The test was highly sensitive and reasonably specific. Inpatient OAE screening should allow early diagnosis of postmeningitic hearing loss and prompt auditory rehabilitation.     

先天性巨细胞病毒感染对婴幼儿听力及智力影响的研究

目的　探讨先天性巨细胞病毒 (CMV)感染对婴幼儿生长发育、听力及智力的影响。方法　对 65例先天性CMV感染儿及 82例非感染儿于新生儿期进行生长发育及听力的检测 ,并于生后 6个月至 4岁进行随访。随访内容包括 :体格检查、发育商测试及听力测试。结果　两组生长发育状况无显著性差异。感染组发育商落后8例 ,对照组仅 1例 ,二者有显著性差异。感染组新生儿期、随访时分别有 7例 9耳、9例 11耳未通过TEOAE听力测试 ,对照组均为 1例 1耳未通过 ,未通过率感染组明显高于对照组。新生儿期、随访时双耳反应能量感染组明显低于对照组。 14例进行了ABR检测 (感染组 12例 ,对照组 2例 ) ,其中感染组 9例 17耳听力异常 ,对照组 1例 1耳听力异常。结论　先天性CMV感染对婴幼儿生长发育可能无明显影响 ,但对听力、智力的损害却不容忽视     

The Milan Project: a newborn hearing screening programme

Aim: Since 1997 a newborn hearing screening programme has been implemented by the U.O. Neurologia-Neurofisiopatologia and Dipartimento di Neonatologia of the Istituti Clinici di Perfezionamento ICP in Milan for both babies with no risk and those at risk of hearing impairment. This programme was named the Milan Project. Methods: The protocol for no-risk babies consisted of three stages: in the first two stages, newborns were tested with transient click-evoked otoacoustic emissions (TEOAE), in the third one with conventional auditory brainstem responses (ABR). The first TEOAE test was performed by 36 h of age, before discharge, the second one after 15-30 d in case of referral, and the third one, by ABR, for those babies who failed the second TEOAE stage. Newborns at audiological risk were submitted to conventional ABR before the third month of corrected age. Some of this latter population was also submitted to the TEOAE test. The entire tested population (no-risk babies and newborns at audiological risk) consisted of 19 777 babies: 19 290 without risk (“no risk”) and 487 at risk (“at risk”). Results: During the course of the Milan Project, hearing impairment (ABR threshold equal to or greater than 40 dB nHL) was identified in 63 newborns (19 from the no-risk and 44 from the at-risk population), with a prevalence of 0.32%. Bilateral hearing impairment (BHI) was found in 33 newborns (10 from the no-risk and 23 from the at-risk population), corresponding to 0.17%. Among infants with bilateral hearing impairment, 30.3% had no risk factors. The prevalence of hearing impairment was determined on days 15-30 after birth.

Conclusions: The results show that the implementation of a hospital-based, universal neonatal hearing screening programme for babies with and without audiological risk is feasible and effective. The effectiveness of the programme has increased as a function of the years since its inception, with a strong decrease in the referral rate. Further improvement is obtained if the TEOAE measurements are repeated in cases of referral scoring before discharge.     

Hearing assessment by brainstem auditory evoked responses (BAER) in neonates at risk.

In the present study, brainstorm auditory evoked responses (BAER) were recorded in 68 at risk neonates discharged from the neonatal ICU of Safdarjung Hospital. The high risk group of 35 neonates included 13 neonates with multiple (3-4) risk factors and 22 neonates with single risk factors, viz., prematurity (less than 32 weeks) low birth weight (LBW) (less than 1500 g), hyperbilirubinemia requiring exchange transfusion, severe birth asphyxia, craniofacial malformations and sepsis with meningitis treated with amikacin for 3 weeks. The remaining 33 neonates were grouped in the low risk category who had only one of the following factors: prematurity (33-36 weeks)/LBW (1500-2000 g), hyperbilirubinemia requiring phototherapy, mild/moderate birth asphyxia, or sepsis treated with amikacin for 2 weeks. The test was performed at the mean conceptional age of 40.2 weeks (range 34-44 weeks) and involved determination of threshold of hearing as per presence of wave V. A normal response had wave V at 30 dB hearing level click stimulus at 50/sec from both ears or to 30 dB hearing level from one ear and 45 dB hearing level from the other ear. Thirteen neonates of the high risk group failed to produce a normal response (5 failed at 30 dB, 6 failed at 45 dB, and 2 failed at 75 dB hearing level). Forty six per cent of them had multiple high risk factors. All the low risk group neonates had normal threshold of 30 dB hearing level in the initial screening.(ABSTRACT TRUNCATED AT 250 WORDS)     

Universal neonatal hearing screening: the Siena (Italy) experience on 19,700 newborns

BACKGROUND: Hearing loss (HL) is likely to be the most common congenital abnormality in humans, with a reported prevalence of 1 to 3 per 1000 live births. Early detection and intervention is critical to prevent the adverse consequences of a delayed diagnosis on speech, language and cognitive development. As 33-50% of all congenital HLs cannot be detected in a selective hearing risk, use of universal neonatal hearing screening (UNHS) programs is expanding. AIMS: We tested the value of a UNHS protocol, based on a two-stage strategy of Transient Evoked Otoacoustic Emissions (TEOAEs) in all infants, followed by diagnostic auditory brainstem response (ABR) testing in those infants who did not meet TEOAE pass criteria and those infants at high risk for hearing loss. METHODS: TEOAES (292 DP Echoport OAE Analyzer) served as the initial screen, followed by diagnostic ABR (Amplaid MK12) in newborns that did not meet pass criteria for TEOAEs. Additionally, all infants at high audiologic risk according to the Joint Committee on Infant Hearing received a diagnostic ABR evaluation. Of 21,125 total live births, 19,700 were tested (April 1, 1998-July 31, 2006). Accuracy of the UNHS strategy in predicting congenital HL was evaluated by calculating sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: Prevalence for all HLs in the neonatal period was 1.78/1000 l.b. (35/19,700), with bilateral HL in 1.42/1000 l.b. (28/19,700) [low risk rate: 0.43/1000 l.b. (8/18,356); high risk infants rate: 14.88/1000 l.b. (20/1344)]. All the HL infants were diagnosed <3 and received intervention <6 months age. ROC curves results showed 100% sensitivity (95% C.I.: 89.0-100) and 99.3% specificity (95% C.I.: 99.2-99.4) of the two-stage strategy in detecting congenital HLs [area under the ROC curve: 0.997 (95% C.I.: 0.995-0.997)]. CONCLUSIONS: (1) The epidemiology of congenital HLs widely justifies UNHS; (2) a two-stage TEOAE and diagnostic ABR screening for congenital HL is feasible, minimally invasive and accurate in the early detection of congenital HL; and (3) a congenital HL screening strategy based exclusively on the use of TEOAEs should always consider the possibility of false negative cases.     

Feasibility of neonatal hearing screening program with two-stage transient otoacoustic emissions in Turkey

BACKGROUND: The objective of this study was to investigate the incidence of hearing loss in neonates and evaluate the feasibility of a two-stage Transient Evoked Otoacoustic Emission (TEOAE) screening test. Maternal concerns about hearing screening were also studied. METHODS: Neonatal intensive care patients and well babies were screened using a two-stage TEOAE test, which was followed by an Auditory Brainstem Response (ABR) test for those babies who failed the first test twice. RESULTS: In total, 711 neonates were screened. At the end of the two TEOAE tests, the cumulative pass rate was 99.3% and false-positive rate was 0.3%. Five neonates (0.7%) were referred for the ABR test. Sensorineural hearing loss was found in three of them (0.4%). Of these three neonates, one was from the well baby nursery and two were from the NICU population. Families generally welcomed the screening program, with no refusals. Positive test results have not caused important maternal concerns. CONCLUSIONS: Congenital hearing impairment is a prevalent disease in Turkey. The two-stage TEOAE program is suitable for the neonatal hearing screening program. In general, hearing screening tests do not cause notable maternal concerns.     

Effect of adeno-tonsilectomy on hearing threshold and middle ear pressure

Out of 50 children (100 ears) undergoing adeno-tonsillectomy, 34 ears had hearing threshold 20–50 dB (20dB is normal) and 32 ears showed negative middle ear pressure of 100 to 400 mmH₂O (100 mmH₂O is normal). Post-operatively only 7 ears had hearing threshold of 20–30 dB and negative middle ear pressure of 100 to 200 mmH₂O. Thus adenoidectomy improves eustachian tube functions.     

Universal newborn hearing screening: a 27-month experience in the French region of Champagne-Ardenne

OBJECTIVES: This article reports the creation of a Universal Newborn Hearing Screening (UNHS) program in a French region, Champagne-Ardenne, and the results of its first 27 months. MATERIALS AND METHODS: We introduced a UNHS program in all the Champagne-Ardenne maternities in order to screen all newborns in the region. We used a two-step strategy. The first test consists of automated transiently evoked otoacoustic emissions (TEOAE) and is performed before discharge by a nurse or a midwife. If TEOAE are absent in both ears (positive screening test), the baby is referred to the second test, which could be either TEOAE or automated auditory brainstem response (aABR) 15 days after discharge, by a physician in an outpatient clinic. If the retest is positive in both ears, the baby is referred to diagnostic tests in a reference centre. This procedure also applies to newborns in neonatal intensive care units but, in those cases, the first test procedure is aABR because of the higher incidence of auditory neuropathies in those units. UNHS data are recorded with the other neonatal screening tests in the Regional Neonatal Screening Center, which facilitates the follow-up of newborns. RESULTS: A total of 33 873 newborns were screened, which represents a coverage rate of 92.42%. In those babies, 33 431 had a negative first test and 429 were retested. There were 34 positive retests. Among those 34 children, 27 were actually deaf (0.08%). The median age at diagnosis was shortened from 17 months to 10 weeks. CONCLUSION: Those 27-month results demonstrate the validity of our UNHS program, which relies on the cooperation with maternities, an easy protocol and a strong follow-up procedure.     

Parental suspicion of hearing loss in children with otitis media with effusion

Objective This study aimed to evaluate the parental suspicion of hearing loss in children with otitis media with effusion (OME). As part of a population-based survey in a screening programme among 6- to 7-year-old Chinese children in Hong Kong, OME cases and controls were studied for the value of parental observations in the prediction of OME and hearing test results.Subjects and methods Prior to the otoscopic and tympanometric examination of the children on school premises, a self-administered binary-choice question was sent to the parents asking whether there was any suspicion of hearing impairment. Positive screens and randomly selected negative screens were seen in a hospital clinic for the confirmation of case and control status 2 to 3 weeks after the school screening. Aural examination under microscopy, repeated tympanometry and stapedial reflex testing, and pure-tone audiometry (PTA) were conducted, and 117 cases and 159 controls were included in this study.Results The average PTA conductive threshold levels in the individual children with OME ranged from 3.8 dB to 40.0 dB with a group mean of 17.0 dB in the better-hearing ears. Parental suspicion of hearing deficit was significantly associated with OME (p<0.001) but not PTA findings (p=0.686). The sensitivity of parent-suspected hearing impairment to detect OME however was very low (19.7%).Discussion In other words, if we had relied on parental suspicion as the first screening, at least 80% of the OME cases would have been missed. We conclude that the parental suspicion of hearing loss is inadequate for the identification of mild hearing loss as caused by OME. Health education is recommended to improve parental awareness of the disease.     

Hearing screening of high-risk newborns with brainstem auditory evoked potentials: a follow-up study

Numerous techniques have been used in attempts to find a reliable and efficient screening method for determining auditory function in the newborn. The brainstem auditory evoked potential (BAEP) is the latest method advocated for that purpose. The BAEP was evaluated as a hearing screening test in 168 high-risk newborns between 35 and 45 weeks of conceptual age. Follow-up data were obtained after 1 year (mean 17.3 months) on 134 of the infants (80%). Normal hearing was defined as a reproducible response in both ears to a 25 dB normal hearing level (nHL) click stimulus; 21 infants (12.5%) failed the initial screening test. Follow-up on 19/21 infants revealed 18 infants with normal hearing and one infant with an 80 dB nHL bilateral hearing loss substantiated. One infant with an abnormal screening test died before retesting, and the other infant was lost to follow-up but had only a unilaterally abnormal BAEP. None of the infants with a normal BAEP screening study had evidence of hearing loss on retesting. Sensitivity of the BAEP was 100%, specificity was 86%, predictive value of a positive test was 5.26%, and the predictive value of a negative test was 100%. The incidence of significant hearing loss in our population was between 0.75% (1/134 infants) confirmed, and 2.24% (3/134 infants) including infants who failed screening but were lost to follow-up. The BAEP is a sensitive procedure for the early identification of hearing-impaired newborns. However, the yield of significant hearing abnormalities was less than predicted in other studies using BAEP for newborn hearing screening.     

Onset and severity of hearing loss due to congenital rubella infection.

Of 111 children born in 1978-82 with congenital rubella infection, confirmed by the detection of rubella specific IgM shortly after birth, 68 were reported to be hearing impaired when notified to the National Congenital Rubella Surveillance Programme (NCRSP). The average age at which the diagnosis of hearing impairment was confirmed was 11.6 months. Recent audiograms showed a hearing loss that was usually uniform across all frequencies, equal in both ears and severe, averaging 93 dB across the range 250-4000 Hz. Despite the early diagnosis of congenital rubella and the known risk of deafness, only eight of 57 infants had been tested for auditory evoked responses in the first 6 months of life; all eight had severe hearing loss. Evidence of progressive hearing loss was found in only one of the 57 children. Definitive hearing tests (as distinct from screening tests) were frequently delayed until after the first birthday. Newborn babies identified as being at high risk of congenital deafness should have a full audiological assessment in early infancy.     

Low prevalence of hearing impairment among very low birthweight infants as detected by universal neonatal hearing screening

OBJECTIVES: To (a) study the prevalence of hearing impairment in a cohort of very low birthweight (VLBW) infants and (b) evaluate the effectiveness of transient evoked otoacoustic emissions (TEOAE) as a first stage in-hospital hearing screening tool in this population. STUDY DESIGN: The study group was a cohort of 346 VLBW infants born in 1998-2000 at The Sheba Medical Center. The prevalence of hearing impairment in the study group was compared with that of all other newborn infants participating in a universal newborn hearing screening programme during the same period. To evaluate the effectiveness of TEOAE, a control group of 1205 healthy newborns who had no known risk factors for hearing impairment was selected. The results and follow up of hearing screening for these infants were examined retrospectively. RESULTS: Only one VLBW infant (0.3%) was diagnosed with bilateral sensory-neural hearing loss. In addition, nine infants (2.7%) were diagnosed with conductive hearing loss. Bronchopulmonary dysplasia and low Apgar score were the most significant factors for predicting the occurrence of conductive hearing loss. The percentage of VLBW infants who successfully passed the in-hospital TEOAE screening was 87.2, compared with 92.2% in the full term control group. No false negative cases were detected on follow up. CONCLUSIONS: The study shows a low incidence of sensory-neural hearing loss in a cohort of VLBW infants and a relatively high incidence of conductive hearing loss. TEOAE screening was found to be an effective first stage in-hospital hearing screening tool in this population.     

Grommets in otitis media with effusion: an individual patient data meta-analysis

Aims: To identify subgroups of children with otitis media with effusion (OME) that might benefit more than others from treatment with ventilation tubes. Methods: An individual patient data (IPD) meta-analysis on seven randomised controlled trials (n = 1234 children in all), focusing on interactions between treatment and baseline characteristics—hearing level (HL), history of acute otitis media, common colds, attending day-care, gender, age, socioeconomic status, siblings, season, passive smoking, and history of breast feeding. Outcome measures that could be studied were mean time spent with effusion (n = 557), mean hearing levels (n = 557 in studies that randomised children, and n = 180 in studies that randomised ears), and language development (n = 381). Results: In the trials that treated both ears the only significant interaction was between day-care and surgery, occurring where mean hearing level was the outcome measure. None of the other baseline variables showed an interaction effect with treatment that would justify subgrouping. In the trials that treated only one ear, the baseline hearing level showed a significant but not pervasive interaction with treatment—that is, only with a cut-off of 25 dB HL. Conclusions: The effects of conventional ventilation tubes in children studied so far are small and limited in duration. Observation (watchful waiting) therefore seems to be an adequate management strategy for most children with OME. Ventilation tubes might be used in young children that grow up in an environment with a high infection load (for example, children attending day-care), or in older children with a hearing level of 25 dB HL or greater in both ears persisting for at least 12 weeks.     

Systematic screening of deafness at a maternity ward using evoked otoacoustic emissions: practical aspects and parental attitudes]

OBJECTIVE: Evaluation of the feasibility and parental attitudes towards a hearing screening programme using evoked otoacoustic emissions, implemented in a maternity ward in France. METHODS: A hearing screening test using transiently evoked otoacoustic emissions (TEOAE) was proposed to each baby, and an anonymous questionnaire was given to parents to assess their attitudes towards the screening procedure. RESULTS: Although the refusal of the test reached 16% (mainly during the first two weeks of the program), more than 92% of parents judged the test as being useful, and 65% wished it to be systematically done. However, nearly 35% of parents admitted to have a low level anxiety about being unnecessarily worried by the test results. One hundred and twenty-four babies were screened. Fifty three per cent of the tests have been performed in less than ten minutes, with an average of 12.2 minutes. This duration does not include delays due to programme and babies management. False positive rate (uni or bilateral fail) was 10.5% at the first stage. Repeating the test before discharge decreased the false positive rate to 6.5%. CONCLUSION: Although limited in time, this study shows that a systematic hearing screening programme using TEOAE is possible and should be done in France. False positive rate was below 7%, and the test was considered as useful by more than 90% of parents, although knowledge about deafness in childhood and its consequences were clearly insufficient.