Middle ear effusion and newborn hearing screening.

PURPOSE: Middle ear effusion (MEE) is one of the reasons for screening failure and may require prolonged follow-up due to conductive hearing loss. We aimed to examine at 1-year follow-up, the fate of MEE. METHODS: From medical charts, computerized data were collected retrospectively of newborns born in the years 2012-2013 in Rambam Health Care Campus, Haifa city, Israel, who failed the Universal Newborn Hearing Screening (UNHS), and follow-up hearing evaluation data were extracted. RESULTS: Of 9527 newborns born in 2012-2013 in our institution, 144 [1.5%] failed the UNHS, and 46 were eventually diagnosed with conductive hearing loss caused by MEE. Spontaneous MEE clearance was recorded in 12 [26%], while 26 [57%] patients had persistent effusion that required further follow-up (10 [22%] required insertion of ventilation tubes and 16 [35%] were referred for further follow-up); 8 [17%] were lost to follow-up. CONCLUSION: Congenital MEE causing conductive hearing loss and UNHS failure is persistent and resolves at lower rates than non-congenital MEE.

Do all infants with congenital hearing loss meet the 1-3-6 criteria? A study of a 10-year cohort from a universal newborn hearing screening programme in Singapore.

OBJECTIVE: To evaluate 1) the outcomes of a local universal newborn hearing screening (UNHS) programme and its audiological follow-ups at 3- and 6-month points, 2) the education outcomes of children with congenital hearing loss (CHL). DESIGN: Retrospective study that analysed data containing hearing screening, diagnosis, intervention and schooling information from electronic databases. STUDY SAMPLE: Children aged 5 to 15 years old who were born between 2004-2014 and underwent UNHS in a local hospital. RESULTS: Over a 10-year cohort, 99.4% of 29,972 newborns underwent UNHS; approximately 90% of them were screened by 1 month of age. However, only 10% of the cohort strictly fulfilled the 1-3-6 criteria recommended by the Joint Committee on Infant Hearing. Lost to follow-up (LTF) rate was highest at post-diagnosis (35%). 80% of infants who were intervened between 6 and 48 months of age went to mainstream schools. The remaining 20% had additional disabilities or family factors. CONCLUSIONS: A high UNHS coverage rate may not translate to meeting the 1-3-6 criteria. Despite ease of access to our healthcare system, LTF at post-diagnosis remained high. In the absence of additional disabilities or family factors, infants intervened during the sensitive window could still potentially make it into mainstream schools.

Twelve years of neonatal hearing screening: audiological and etiological results.

PURPOSE: Most developed countries have implemented some form of universal newborn hearing screening program. Early identification and rehabilitation of congenital hearing loss is important in functional outcome, and the need to identify the cause of hearing impairment has become clear. We aimed to evaluate audiological and etiological outcomes in a large group of patients with failed neonatal hearing screening. METHODS: We performed a retrospective chart analysis of patients who were referred to our tertiary referral center after failing neonatal hearing screening during a 12-year period (2007-2019). Screening was based on automated auditory brainstem response (AABR) or a combined approach of AABR and auditory steady-state response (ASSR) with chirp stimulus. Extensive audiometric testing was performed to confirm and determine the type and degree of hearing loss. In case of permanent hearing loss, a standardized etiological protocol was followed to determine the cause. RESULTS: Of the 802 referred newborns, hearing loss was confirmed by diagnostic ABR in 78%. Main causes of hearing loss included otitis media with effusion (56%, higher in patients screened by AABR/ASSR compared to AABR), a genetic disorder (12%), congenital cytomegalovirus infection (cCMV, 5%) and atresia/stenosis of the external ear canal (5%). Of the patients with permanent hearing loss, 15% showed changes in hearing loss severity over time. CONCLUSION: In the majority of newborns referred after failing universal neonatal hearing screening, hearing loss could be confirmed. The leading cause was reversible hearing loss due to otitis media with effusion, but hearing loss proved permanent in about 35% of referred newborns, with genetics as predominant cause. Follow-up of congenital hearing loss patients is important as deterioration as well as improvement was observed over time.

[Epidemiological study of hearing impairments in children: prevalence, structure, amplification, and social factors]. / Epidemiologiya narushenii slukha u detei: rasprostranennost', struktura, aspekty slukhoprotezirovaniya i sotsial'nye faktory.

For the first time, a detailed epidemiological study of hearing impairments (HI) in the children's population of St. Petersburg (n=3098) was conducted. The data on the incidence of HI in children, the distribution of children depending on the degree of hearing loss, HI type, the presence of additional disorders, risk factors for hearing loss were obtained. Only 19% of children with HI were diagnosed in accordance with modern requirements of early care - at the age of 3 months. In children who underwent universal newborn hearing screening the average age of diagnosis was significantly lower than in children who were not screened. Only 54% of HI children use hearing aids (HA) or cochlear implants. Among the children who do not use HA, the main number is children with mild and moderate hearing loss, unilateral hearing loss and otitis media with effusion. A significant part of them should be considered as candidates for amplification according to current recommendations. The average interval between diagnosis and amplification was 15.7 months. Only 5% of children from the entire population of children with HI received early intervention in accordance with the modern time standard: 1 month (detection) - 3 months (diagnosis) - 6 months (amplification). The problems of organizing an effective care for HI children and the directions of its development are discussed: improving newborn hearing screening; introduction the system of informing the citizens and doctors of related specialties (pediatricians, neurologists) in the field of prevention, diagnosis and rehabilitation of HI in children; expansion of genetic testing of children; reducing time of waiting and improving the quality of HA provided to handicapped children.

Newborn hearing screening coverage and detection rates of hearing impairment across China from 2008-2016.

BACKGROUND: Newborn hearing screening (NHS) can reduce the economic and social burden of hearing impairment. To track the progress of the goal set by the National Program of Action for Child Development (NPACD) and to estimate the detection rates of hearing impairment, the present study examined NHS coverage in 2008-2010 and 2016 and the detection of hearing impairment across China in 2016. METHODS: Licensed medical institutions across China were surveyed in 2012 and 2018 by the National Center for Birth Defects Monitoring of China to collect data for the 2008-2010 period and for 2016 on live births, initial screening rates (total and referral), secondary screening rates (total and referral), and rates of hearing impairment diagnosis among infants who were referred in the secondary screening. To calculate universal newborn hearing screening (UNHS) coverage, the number of newborns who received NHS within 4 weeks after birth was divided by the number of live births. The detection rate of hearing impairment was calculated by combining referral rates on primary and secondary screening with the rate of diagnosis. RESULTS: National UNHS coverage increased from 29.9% in 2008 to 86.5% in 2016, with different regions showing different increases. During this period, the number of provinces with UNHS coverage over 90.0% increased from 2 to 17, with UNHS coverage in 2016 being substantially higher in eastern provinces (93.1%) than in western provinces (79.4%). In 2016, the detection rate of hearing impairment across the country was 0.23% (95% CI 0.15-0.25%), and it varied from 0.17% in western provinces to 0.22% in central provinces and 0.28% in eastern provinces. The lowest rate was 0.02% in Heilongjiang Province and the highest rate was 0.63% in Hainan Province. CONCLUSIONS: National UNHS coverage increased substantially from 2008 to 2016, although provinces and regions still showed differences. The detection rate of infant hearing impairment in China is comparable to that in other countries. A national individual-level information system is urgently needed in China to facilitate the integration of screening, diagnosis and treatment of infant hearing impairment, which may also lead to a more accurate estimate of the detection rate.

ASSESSMENT OF UNIVERSAL NEWBORN HEARING SCREENING AND INTERVENTION IN SHANGHAI, CHINA.

OBJECTIVES: The aim of this study was to evaluate the universal newborn hearing screening (UNHS) and intervention program in Shanghai, China. METHODS: This study included the quantitative analyses of the UNHS-Shanghai database in 2002-12 and qualitative assessment of the program. The Otoacoustic Emissions and the Automated Auditory Brainstem Evoked Responses tests were conducted in screening. The costs and benefits were calculated based on the number of participants in each stage. The short-term and long-term periods were defined as from birth to 15 years of age or to death (82-year-olds), respectively. Sensitivity analyses were conducted. RESULTS: A total 1,574,380 newborns were included, representing 93.6 percent of all eligible babies in Shanghai during the study period. The prevalence of newborn hearing loss was 1.66‰. The short-term/long-term program costs were ¥488.5 million (US$75.52 million)/¥1.08 billion (US$167.12 million), and the short-term/long-term program benefit was ¥980.1 million (US$151.53 million)/¥8.13 billion (US$1.26 billion). The program benefit was greater than its cost if the proportion of hearing-loss children enrolled in regular schools was no less than 41.4 percent of all hearing impaired children, as well as if the wage growth rate ranged from 3 percent to 8 percent. Qualitative results also suggested that stakeholders strongly supported this program. CONCLUSIONS: The universal newborn hearing screening and intervention program in Shanghai is justified in terms of the resource input in the long run, although there is still room for further improvement with respect to educational rehabilitation and a better infrastructure system.

Economic evaluation of long-term impacts of universal newborn hearing screening.

OBJECTIVE: Little is known about the long-term efficacious and economic impacts of universal newborn hearing screening (UNHS). DESIGN: An analytical Markov decision model was framed with two screening strategies: UNHS with transient evoked otoacoustic emission (TEOAE) test and automatic acoustic brainstem response (aABR) test against no screening. By estimating intervention and long-term costs on treatment and productivity losses and the utility of life years determined by the status of hearing loss, we computed base-case estimates of the incremental cost-utility ratios (ICURs). The scattered plot of ICUR and acceptability curve was used to assess the economic results of aABR versus TEOAE or both versus no screening. STUDY SAMPLE: A hypothetical cohort of 200,000 Taiwanese newborns. RESULTS: TEOAE and aABR dominated over no screening strategy (ICUR = $-4800.89 and $-4111.23, indicating less cost and more utility). Given $20,000 of willingness to pay (WTP), the probability of being cost-effective of aABR against TEOAE was up to 90%. CONCLUSIONS: UNHS for hearing loss with aABR is the most economic option and supported by economically evidence-based evaluation from societal perspective.

Hearing Screening for Congenital CytoMegaloVirus-Exploring Parents' Experiences of Completing Targeted Congenital Cytomegalovirus Screening at the Time of Their Infants' Newborn Hearing Screening.

Background/Objectives: Congenital cytomegalovirus (cCMV) is the leading infectious cause of sensorineural hearing loss and neurodevelopmental disabilities, with prompt detection (<21 days of life) required to enable accurate diagnosis and anti-viral treatment where clinically appropriate. International guidelines recommend cCMV screening for infants who do not pass their Universal Newborn Hearing Screening (UNHS). This study aimed to explore parental experiences of targeted cCMV screening through the UNHS in Victoria, Australia between 2019 and 2020 (HearS-cCMV study). Methods: A qualitative study comprising 18 semi-structured interviews with parents who took saliva swabs from their infants who did not pass their UNHS. A maximum variation sampling strategy was used with data analysed using thematic analysis. Results: Four themes described 18 parents' experiences of cCMV screening: (1) parents' lack of CMV awareness prior to cCMV screening; (2) overall positive experience; (3) varied understanding of CMV post screening; and (4) parents were glad to screen their infant for cCMV. Enablers of targeted cCMV screening included the swab being simple and non-invasive, being easier to complete in the hospital than at home, and the screening being well delivered by the staff. Barriers included a potential increase in anxiety, especially with false positives, and the timing of cCMV screening coinciding with their infant not passing UNHS being difficult for some parents. Conclusions: Parent experiences of targeted cCMV screening were positive. Increasing public knowledge of cCMV and training staff members to complete the CMV swab would reduce the risk of false positives and associated parental anxiety. This would facilitate successful routine targeted cCMV screening.

Results and patient satisfaction from an early access infant hearing detection clinic.

INTRODUCTION: National recommendations in the United States specify that all infants with hearing impairment should be identified by 3 months of age. Infants who fail universal newborn hearing screening (UNHS) require follow up testing after hospital discharge. Follow up testing may be difficult to obtain in some communities within the ideal time frame. A rapid access multidisciplinary clinic was established for failed UNHS. The objective of this study is to report outcomes and patient satisfaction from an early access hearing detection clinic. METHODS: Infants that failed UNHS were seen in the multidisciplinary clinic between 1/1/19 and 2/28/22. Patients underwent automated auditory brainstem response (ABR) and distortion product otoacoustic emissions testing and consulted with an otolaryngology nurse practitioner. Failed results were followed by diagnostic ABR. Surveys were administered at the beginning and end of the appointment. RESULTS: In total, 169 infants were seen at a mean age of 8.4 weeks (95%CI 7.5, 9.4). Repeat testing was abnormal in 38 (22.4%). Diagnostic ABR was performed at an average age of 13.7 weeks (n = 34, 95% CI: 10.8, 16.6) and led to a diagnosis of hearing loss in 18 infants. Twenty-seven parents completed surveys at the initial visit. Anxiety level among patients with normal repeat testing (n = 20) decreased from 1.9 to 1.2 (p = .002), while anxiety level among those with abnormal repeat testing (n = 7) was not statistically different before and after (2.1 vs 2.7, p = .2). Satisfaction level was 3.7 ± 0.7 (scored 1-4). All parents reported having a better understanding of their child's hearing problem after the visit. DISCUSSION: This novel nurse practitioner-led early hearing detection clinic enabled timely diagnosis of hearing loss and reassurance to families without hearing loss. Age at hearing loss diagnosis compares favorably to published cohorts.

Follow-up of infants with mild-to-moderate sensorineural hearing loss over three years.

OBJECTIVE: To observe and analyse the hearing outcome in infants with mild-to-moderate sensorineural hearing loss (SNHL) who failed universal newborn hearing screening (UNHS). METHODS: This retrospective cohort analysis included infants with mild-to-moderate SNHL and with complete etiological diagnosis and followed up over three years. RESULTS: Out of 96 infants with mild-to-moderate SNHL 72 were stable (75%). Only one case was normal (1.04%), ten cases were improved (10.42%), and 13 were deteriorated (13.54%). The pathogenic mutation of GJB2 was the most common cause (50/96, 52.08%), and most of them were homozygous or complex heterozygous mutations of p.V37I (44/50, 88%). There were 11 cases (11.49%) with large vestibular aqueduct syndrome (LVAS) and nine cases (9.38%) with perinatal risk factors. Infants with GJB2 pathogenic mutation and those without certain etiology mostly had unchanged hearing levels, accounting for 84% (42/50) and 84.61% (22/26), respectively. Hearing deterioration in LVAS was associated with seven cases (63.64%). There was no difference in types of outcomes in perinatal risk factor infants, who were more likely to improve than the other groups, but there were three cases (33.3%) deteriorated to profound hearing loss. Comparison of outcomes of different etiologies showed statistically significant difference (Chi-square = 28.673, p = 0.000). CONCLUSION: Normal and improved hearing in infants with mild-to-moderate SNHL was rare before the age of three, unlike in many previous studies, and appropriate intervention is recommended. However, intervention should be adjusted according to the hearing outcomes because of the possibility of improvement or deterioration. The etiological diagnosis of infants with mild-to-moderate SNHL would be helpful for predicting the outcome and managing intervention.

Implementation of Newborn Hearing Screening in Albania.

Newborn hearing screening (NHS) was implemented in Albania in four maternity hospitals in 2018 and 2019. Implementation outcome, screening outcome, and screening quality measures were evaluated. Infants were first screened by midwives and nurses before discharge from the maternity hospital and returned for follow-up screening. Acceptability, appropriateness, feasibility, adoption, fidelity, coverage, attendance, and stepwise and final-referral rates were assessed by onsite observations, interviews, questionnaires, and a screening database. A post hoc analysis was performed to identify reasons for loss to follow up (LTFU) in a multivariate logistic regression. In total, 22,818 infants were born, of which 96.6% were screened. For the second screening step, 33.6% of infants were LTFU, 40.4% for the third, and 35.8% for diagnostic assessment. Twenty-two (0.1%) were diagnosed with hearing loss of ≥40 dB, six unilateral. NHS was appropriate and feasible: most infants are born in maternity hospitals, hence nurses and midwives could perform screening, and screening rooms and logistic support were supplied. Adoption among screeners was good. Referral rates decreased steadily, reflecting increasing skill. Occasionally, screening was repeated during a screening step, contrary to the protocol. NHS in Albania was implemented successfully, though LTFU was high. It is important to have effective data tracking and supervision throughout the screening.

Effect of Neonatal Hearing Screening on Early Diagnosis of Sensorineural Hearing Loss.

The aim of the study to screen the neonates for earlier diagnosis of sensorineural hearing loss and to assess the relationship between the hearing loss in newborns along with the high risk factors. A prospective, cohort, observational analytical study done at department of ENT,MGMMC & MYH INDORE (M.P.) carried out during 2018-2019 over 200 neonates who were randomly selected screened by OAE & BERA before their discharge from the hospital and after stabilizing high risk neonates. Out of 200 neonates, sensorineural hearing loss found to be in 4 neonates (2%) and hearing impairment seen 13.8 times more in high risk neonates as compare to the low risk neonates. The core goal of the study was to emphasize the importance of universal newborn hearing screening for early diagnosis & intervention in newborns & Neonates in terms of auditory rehabilitation as every child is precious and hearing is their fundamental right.

Use of Wideband Acoustic Immittance in Neonates and Infants.

With widespread agreement on the importance of early identification of hearing loss, universal newborn hearing screening (UNHS) has become the standard of care in several countries. Despite advancements in screening technology, UNHS and early hearing detection and intervention programs continue to be burdened by high referral rates of false-positive cases due to temporary obstruction of sound in the outer/middle ear at birth. A sensitive adjunct test of middle ear at the time of screening would aid in the interpretation of screening outcomes, minimize unnecessary rescreens, and prioritize referral to diagnostic assessment for infants with permanent congenital hearing loss. Determination of middle ear status is also an important aspect of diagnostic assessment in infants. Standard single-frequency tympanometry used to determine middle ear status in infants is neither efficient nor accurate in newborns and young infants. A growing body of research has demonstrated the utility of wideband acoustic immittance (WAI) testing in both screening and diagnostic settings. Wideband power absorbance (WBA), a WAI measure, has been shown to be more sensitive than tympanometry in the assessment of outer/middle ear function in newborns. Furthermore, age-graded norms also support successful application of WBA in young infants. Despite its merits, uptake of this technology is low among pediatric audiologists and hearing screening health workers. This report describes normative data, methods for assessment and interpretation of WBA, test-retest variations, and other factors pertinent to clinical use of WAI in newborns and infants. Clinical cases illustrate the use of WAI testing in newborn and infant hearing assessment.

Risk Factors Associated With Hearing Impairment in Infants and Children: A Systematic Review.

The purpose of the present systematic review was to synthesize evidence on associated risk factors of hearing loss (HL) in children. Evidence-based research articles on HL published between January 2013 and December 2022 using PubMed, Cochrane, and Scopus databases were searched. The study included children between zero and three years of age who have permanent bilateral/unilateral HL (BHL/UHL) by employing case-control studies, randomized controlled trials, nonrandomized studies, prospective or retrospective cohort studies, and studies with or without comparison groups. The Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and cross-sectional studies were used to rate the quality of the chosen studies. The studies that would be considered were reviewed by two independent authors, and a third author was contacted if there was a dispute. A preliminary literature search uncovered 505 articles from the electronic search and 41 studies by hand searching. Duplicate records were eliminated, leaving 432 records. The abstract and title were read, and 340 studies were eliminated. There were 92 articles in total that qualified for full-text screening. Among these, 75 articles were disregarded since they lacked information or failed to assess the risk factors for HL. The qualitative synthesis, therefore, included 17 articles. Most often, cross-sectional study designs were used in the studies that were reviewed, which were then followed by longitudinal studies. Three of the studies that were reviewed used a prospective cohort design. The quality of all the included studies was rated to be good. The current review revealed that the primary statistically significant risk factors for HL included ventilator support; craniofacial anomalies; low birth weight (LBW); forceps delivery; loop diuretics; meningitis; asphyxia; intensive care; consanguinity; sepsis; Apgar scores between 0 and 4 at one minute; toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes (TORCH) infections; and hyperbilirubinemia.

Critical Issues in the Management of Newborn Hearing Screening in the Time of COVID-19 in Umbria, Italy.

Hearing impairment is the most frequent of the sensorial defects in humans, and if not treated promptly, can severely impair cognitive and spoken language skills. For this reason, a universal newborn hearing screening (UNHS) has been established. The purpose of our study is to examine, by means of a retrospective analysis, the results of the UNHS program in the Umbria region during the spread of COVID-19 (2020-2021), comparing the same data from the years 2011-2012, to understand if the program has improved. Our study has shown how the coverage rate of well born babies' (WB) screening has significantly increased to currently meet the JCIH benchmark. The percentage of WB referrals significantly decreased in 2020-2021, another indicator of the screening program's greater efficiency in Umbria. However, a critical issue has emerged: the percentage of those lost to follow-up is greater than 30%, well above the benchmark. As far as the COVID-19 pandemic has certainly had a significant impact, it is necessary to carefully monitor those who do not access the diagnostic level. To emphasize the importance of a proper screening program, it will be helpful to strengthen the computerized data collection system and create an information network between audiologists, pediatricians and families.

Exploring Parent Support Needs during the Newborn Hearing Diagnosis Pathway.

Universal newborn hearing screening (UNHS) facilitates early detection of permanent congenital hearing loss in newborns. In recognition of specific needs among parents, support services have been established within some UNHS programs, including the Victorian Infant Hearing Screening Program (VIHSP). Despite this, there is limited research about how to best support parents in the context of well-established UNHS programs. This project aims to retrospectively explore parental support needs between the newborn hearing screen and enrolment into early intervention services. We used semi-structured interviews with parents three- to- six-months post confirmation of their newborn's diagnosis of bilateral moderate-profound sensorineural hearing loss. Data were analysed using inductive content analysis. Thirteen parents of ten children were interviewed. Parents described high satisfaction with the support they received. Some parents felt unprepared for a diagnosis of hearing loss, having been reassured that transient causes such as middle ear fluid caused the hearing screen result. Parents reported mixed responses regarding the value of parent-mentor support along the pathway and some parents described needing additional psychological input to adjust to their child's diagnosis. These findings provide insights into how a well-established UNHS program, VIHSP, supports parents along the hearing diagnosis pathway and how support can be further enriched.

Follow-up on children with suspected bilateral congenital hearing loss identified through universal newborn hearing screening program in Taiwan: A national-based population study.

OBJECTIVE: This investigation was to ascertain the performance of the UNHS in Taiwan. METHODS: The predefined questionnaire was delivered on the phone in 2016. The descriptive analysis was applied to the research data. 941 neonates in birth cohorts 2013-2014 who were documented as a bilateral referral in the national UNHS tracking system were targeted. The respondents were either caregivers or family members. RESULTS: 40.3% of 941 children were lost to follow-up, and 66.24% of 363 children were diagnosed with SNHL. 45.15% of 163 children used hearing amplification device(s). 77.46% of hearing amplification device users and 7.51% of non-users participated in the auditory training courses. By six months of age, 38.51% and 22.58% of children diagnosed with bilateral SNHL commenced the hearing amplification device fitting and the auditory training courses, respectively. CONCLUSIONS: More efforts are needed to enhance the performance of the UNHS to achieve national goals stated in the 2014 Taiwan UNHS Revised Guidelines and the well-known benchmarks set by the JCIH in 2007. The development of an electronic tracking system for storing and sharing information on the follow-up on children with congenital hearing loss was as significant as the improvements in the understanding of early hearing detection and intervention of the public and stakeholders.

A Study of JCIH (Joint Commission on Infant Hearing) Risk Factors for Hearing Loss in Babies of NICU and Well Baby Nursery at a Tertiary Care Center.

Babies in Neonatal Intensive Care Units (NICU) have an additional risk for hearing loss due to various risk factors like, prematurity, low birth weight, mechanical ventilation, hyperbillirubinemia, ototoxic drugs, low APGAR score etc. as compared to the babies from well baby nursery (WBN) who, poses risk factors mostly family history, syndromic deafness. So the present study was aimed know the risk factors responsible for hearing loss in NICU and WBN babies and to assess the incidence of deafness. A total of 800 babies from NICU (n = 402) and WBN (n = 398) underwent hearing screening from a tertiary care center. Hearing screening was done using two staged screening protocol as per JCIH guidelines with Distortion product Evoked Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Responses (A-ABR). According to DPOAE test, 311 from NICU and 383 from WBN passed the test and during second screening, 80 out of 91 from NICU and 11 out of 13 from WBN passed the DPOAE test. Further BERA was done at the 3rd month of corrected age where 6 out of 11 showed positive responses from NICU and 3 babies from WBN had profound hearing loss. Data analysis revealed that family history of deafness, anemia and hypertension in ANC, TORCH in mother, low Apgar score and hyperbillirubinemia in newborns were a major risk factor for hearing impairment. We conclude that the diagnoses of auditory disorders at early stage due to various risk factors are important since appropriate therapeutic intervention and rehabilitation would help in better development of children.

Delayed cochlear implantation in congenitally deaf children-identifying barriers for targeted interventions.

OBJECTIVES: Age of cochlear implantation (CI) is an important predictor of language development in those with congenital sensorineural hearing loss. Despite universal newborn hearing screening initiatives and the known benefits of early CI, a subset of congenitally deaf children continue to be evaluated for cochlear implants later in childhood. This study aims to identify the barriers to early cochlear implantation in these children. METHODS: A retrospective review was conducted for all pediatric cochlear implants aged 3 years or older performed at a single academic institution between 2013 and 2017. Children implanted before the age three, those with a prior unilateral cochlear implant, and those with progressive or sudden hearing loss were excluded. Variables included newborn hearing screen results, age at hearing loss diagnosis, time of initiation and documented benefit of hearing aids, age of implantation, pre/post-implantation evaluation scores, and reason for delayed referral for cochlear implantation. RESULTS: Thirty-one patients were identified meeting these inclusion criteria. Twenty-one children were subject to UNBS in the U.S. Fourteen of those children failed their newborn hearing screening. Average age at implantation was 6.2 years. Four reasons were identified for increased age at cochlear implantation. Two categories represent delays related to (1) Amplification continually prescribed even though the range of hearing loss and speech development assessment suggests CI may have been more appropriate well before referral (N = 13) (2) Patients were not subject to newborn hearing screening and/or timely diagnosis of their hearing loss (N = 8). In other cases, patients were appropriately fit with hearing aids until evidence that they derived limited benefit and then referred for CI (N = 8). Lastly, in a few cases, records were indeterminate with regards to the timing and appropriate diagnosis of their hearing loss (N = 2). CONCLUSION: Understanding the reasons for delayed cochlear implantation in congenitally deaf children might allow the development of targeted interventions to improve outcomes. Specifically, those children who were not referred before age 3 despite use of amplification with limited benefit offer one potential target population for earlier CI.

Experience, Challenges and Outcome of Implementing Universal New Born Hearing Screening in a Medical College Hospital Set Up.

In India, newborn hearing screening programs have been implemented as a part of research studies since early 1970s. Amongst the previously reported programs most are from the southern region and very few are from the west and the northern region of the country. There is a lack of evidence of such program in other region of the country. 1. To study the outcome, experience, and challenges faced during the implementation of the universal newborn hearing screening program in a medical college set up of Raipur, Chhattisgarh. 2. To determine the prevalence of hearing impairment with a two tier screening protocol with Otoacoustic emission and Auditory Brainstem Response. The Prospective Non randomised study was carried out between December 2017 and December 2019. A total of 1200 neonates delivered at the medical college, Raipur were screened using the two tier screening protocol. In our study, the prevalence of hearing loss was 2 per 1000 live births for bilateral hearing loss and 1 per 1000 live births for unilateral hearing loss. Implementing universal newborn screening in a vast country like India is a challenging task because of a high birth rate, diverse socio-economic and cultural background with limited resources. Though several hospitals and clinics have implemented the UNHS program, yet there is a dearth of literature regarding the program outcome, success, challenges, and lessons learnt. Therefore best practices of such evolved programs should be in public domain.