Factores de riesgo para hipoacusia asociados a alteraciones auditivas en neonatos ingresados a la Unidad de Cuidados Intensivos del Hospital Dr. Rafael Ángel Calderón Guardia, San José, Costa Rica, 2018-2019 / Risk factors for hearing loss associated with hearing alterations in neonates admitted to the Intensive Care Unit of the Hospital Dr. Rafael Ángel Calderón Guardia, San José, Costa Rica, 2018-2019

Resumen Introducción: en Costa Rica, aproximadamente la mitad de los niños nacidos por año presenta factores de riesgo para hipoacusia, esto ocasiona pérdidas auditivas de diversa etiología que pueden manifestarse antes, durante o después del nacimiento. Lo anterior da lugar a resultados alterados en pruebas de tamizaje auditivo neonatal, tales como las emisiones otoacústicas y los potenciales evocados auditivos automatizados. Objetivos: se propuso determinar la relación entre los factores de riesgo para hipoacusia y las alteraciones auditivas en neonatos, a partir de referencias de ingreso a la Unidad de Cuidados Intensivos (UCI) y de la base de datos del TANU, entre los años 2018 y 2019, en el Hospital Dr. Rafael Ángel Calderón Guardia. Metodología: la investigación adoptó un enfoque cuantitativo. Se realizaron medidas de tendencia central y de dispersión, pruebas de independencia y correlación de Pearson, y un modelo de regresión logística. Resultados: existe una relación entre los factores de riesgo para hipoacusia y las alteraciones auditivas en el tamizaje. Se encontraron elementos significativos como anoxia, infecciones intrauterinas, síndromes, malformaciones asociadas a hipoacusia, ototóxicos, estadía en UCI mayor a cinco días, peso menor a 1500 g, edad en días e infecciones intrauterinas, los cuales predicen resultados de refiere en las pruebas de tamizaje. Conclusiones: es necesario llevar a cabo un seguimiento audiológico a los neonatos que presenten factores de riesgo para hipoacusia e implementar mejoras en cuanto al manejo de antecedentes y pruebas auditivas aplicadas.

Abstract Introduction: In Costa Rica, approximately half of the children born annually have risk factors for hearing loss, generating hearing loss of various etiologies that can manifest before, during or after birth. This leads to altered results in neonatal hearing screening tests, such as otoacoustic emissions and automated auditory evoked potentials. Objective: it was proposed to determine the relationship between risk factors for hearing loss and hearing disorders in neonates, based on ICU admission references and the TANU database, between 2018 and 2019, at the Dr. Rafael Ángel Calderón Guardia. Methodology: the research adopted a quantitative approach. Measures of central tendency and dispersion, tests of independence and Pearson's correlation, and a logistic regression model were performed. Results: there is a relationship between risk factors for hearing loss and auditory alterations in screening. Significant factors were found such as anoxia, intrauterine infections, syndromes, malformations associated with hearing loss, ototoxics, stay in the ICU greater than five days, weight less than 1500 g, age in days and intrauterine infections, which predict results of "refer" in screening tests. Conclusion: on the one hand, to carry out an audiological follow-up to neonates who present risk factors for hearing loss, and, on the other hand, to implement improvements in regard to the management of antecedents and hearing tests performed on neonates.

Prevalence, risk factors and causes of hearing loss among adults 50 years and older in Santiago, Chile: results from a rapid assessment of hearing loss survey.

OBJECTIVE: Among a representative sample of adults aged 50 years and older too (i) determine the prevalence of hearing loss, (ii) evaluate probable causes and risk factors of hearing loss, and (iii) assess the association between hearing loss measured by audiometry and self-report. DESIGN: A population-based survey of adults aged 50 and older in Santiago, Chile using the Rapid Assessment of Hearing Loss (RAHL) survey. STUDY SAMPLE: 538 participants completed a questionnaire, which included questions on socio-demographic and health characteristics and self-reported hearing loss. Hearing and possible cause of hearing loss was assessed using pure tone audiometry (0.5-4.0 kHz), tympanometry, and otoscopy. RESULTS: The prevalence of any level of hearing loss in adults aged 50 years and older was 41% (95% CI 33.2, 49.2). In terms of aetiologies, 89.3% of ears with mild or worse hearing loss were classified as sensorineural. Otoscopy was abnormal in 10.7% of subjects with impacted earwax being the most common finding (4.4%) followed by chronic otitis media (3.5%). Hearing aid usage was 16.6%. Older age, lower socioeconomic position, lack of education, and solvent exposure were significantly associated with hearing loss. CONCLUSION: Hearing loss among individuals aged over 50 years was common in Santiago, Chile.

Tamizaje auditivo universal neonatal en Hospital Clínico La Florida Dra. Eloísa Díaz Insunza: Experiencia 2015-2021 / Universal newborn hearing screening at Hospital Clínico La Florida Dra. Eloísa Díaz Insunza: Experience 2015-2021

Introducción: La hipoacusia congénita es una patología frecuente entre los recién nacidos con gran impacto en su calidad de vida si no es diagnosticada y tratada precozmente. Para su pesquisa, se recomienda, internacionalmente, el tamizaje auditivo universal neonatal (TAUN), que desde 2014 se aplica en el Hospital Clínico La Florida Dra. Eloísa Díaz Insunza (HLF). Objetivo: Describir la experiencia del programa de TAUN del Servicio de Otorrinolaringología HLF. Material y Método: Estudio descriptivo, retrospectivo. Se incluyó a todos los recién nacidos vivos (RNV) del establecimiento entre 2015 y 2021, evaluados de acuerdo con el protocolo del programa. Resultados: Fueron evaluados 17.804 RNV. Se obtuvo una cobertura de 97,1% y tasa de referencia de 0,98%. Se confirmaron a 21 pacientes con hipoacusia sensorioneural (HSN), obteniéndose una tasa de HSN de 1,5 cada 1.000 RNV. Conclusión: La tasa de incidencia de HSN congénita fue similar a la estimada a nivel mundial. El programa de TAUN HLF cumple con estándares internacionales en cuanto a cobertura, tiempo de evaluación del tamizaje y tasa de referencia. El trabajo multidisciplinario, mejoría de tecnología y registro adecuado de pacientes, son las principales fortalezas. La dificultad de seguimiento durante horario inhábil y presencia de sólo un profesional con dedicación exclusiva, son aspectos a perfeccionar.

Introduction: Congenital hearing loss is a frequent pathology among newborns with great impact on their quality of life if it is not diagnosed and treated early. The Joint Committee on Infant Hearing recommends universal newborn hearing screening (UNHS) and has been applied at the Hospital Clínico La Florida Dra. Eloísa Díaz Insunza (HLF) since 2014. Aim: To describe the experience of UNHS program at the Otolaryngology Service of the HLF. Material and Method: Descriptive, retrospective study, including all newborns of the HLF between 2015 and 2021. They were evaluated according to the protocol proposed in the program. Results: 17804 newborns were evaluated. Coverage of 97,1% and a referral rate of 0,98% were obtained. Twenty-one patients with sensorineural hearing loss (SNHL) were confirmed, obtaining a SNHL rate of 1.5 per 1000 live births. Conclusion: The incidence rate of congenital SNHL is similar to that estimated worldwide. The UNHS program in HLF complies with international standards in terms of coverage, timing and referral rates. Multidisciplinary work, improved technology and adequate patient registration are the main strengths of the program. The difficulty of follow-ups during the weekends and the presence of only one full-time professional are aspects that can be improved.

Hearing impairment in children living with HIV in Haiti.

OBJECTIVE: To identify the prevalence of hearing impairment and associated risk factors in children living with human immunodeficiency virus (HIV) in Haiti. METHODS: A validated smartphone-based platform with pure-tone audiometry was used to screen 341 HIV-infected children for hearing impairment in Port-au-Prince, Haiti from March 2019 to September 2020. If screening was failed, a more comprehensive pure-tone audiometric evaluation was administered. Demographic, otologic, and HIV-related data were obtained through caregiver surveys and medical charts. Statistical analysis included univariate and multivariate logistic regression. RESULTS: Sixty (18%) of 341 HIV-infected children (ages 7-18 years) had hearing impairment. Of those failing their hearing assessment, 17 (28%) had moderate and 5 (8%) had severe or profound hearing loss. Hearing impairment was associated with frequent ear infections (OR 3.37; 95% CI 1.76-6.46; p < 0.001) and family history of hearing loss (OR 5.12; 95% CI 2.14-12.23; p = 0.001) but not viral load (OR 1.00; 95% CI 0.73-1.02; p = 0.28) or antiretroviral therapy duration (OR 0.96; 95% CI 0.79-1.17; p = 0.66). Only 35% of caregivers correctly perceived their child's hearing loss. CONCLUSIONS: Hearing impairment occurs at a higher prevalence in HIV-infected children in Haiti than what is expected for those living without HIV. Frequent ear infections were significantly associated with hearing loss while antiretroviral therapy duration was not. Despite their potential ototoxicity, antiretroviral therapies should be continued and may decrease incidence of otitis media. Low caregiver perception of hearing loss emphasizes the need for routine hearing screening for HIV-infected children.

Pesquisaje auditivo universal en recién nacidos de provincia Guantánamo, 2020-2021 / Triagem auditiva universal em recém-nascidos na província de Guantánamo, 2020-2021 / Universal newborn hearing screening in Guantanamo province, 2020-2021

RESUMEN Introducción: El pesquisaje auditivo neonatal es la evaluación que permite detectar o sospechar pérdidas auditivas, abordándose mediante un plan de habilitación o rehabilitación. Objetivo: Determinar la cobertura del pesquisaje auditivo universal en la provincia de Guantánamo, en el contexto epidemiológico de la COVID-19, durante el periodo marzo 2020 a marzo 2021. Método: Se realizó un estudio descriptivo, retrospectivo y de corte transversal. El universo estuvo constituido por 5 999 recién nacidos vivos. Las variables estudiadas fueron: sexo, recién nacidos con y sin factores de riesgo, y las emisiones otoacústicas, cuyos resultados permitieron la evaluación de cobertura. Se definió el indicador estándar (95 %) y el tiempo en que se realizó las primeras emisiones otoacústicas. Se estableció como indicador el porcentaje de recién nacidos pesquisados antes de un mes de vida. Resultados: De los 5 999 nacimientos, el 51,7 % correspondió al sexo masculino y el 48,3 perteneció al sexo femenino. Al 100 % de los recién nacidos sin factores de riesgo (5 838) se les realizó la primera exploración, mientras que a aquellos con factores de riesgo (151) no se les pudo realizar al 0,2 % (10). La pesquisa de los recién nacidos sin factores ocurrió entre 1 y 3 días de nacidos. Nunca se realizaron pesquisas después de los 30 días de nacido en los que presentaron factores de riesgo. La cobertura fue de 99,8 % y el índice de referencia de 0,2 %. Conclusiones: El Programa de Pesquisaje Auditivo Universal en la provincia de Guantánamo en el contexto de la COVID-19 muestra cumplimiento en el indicador de cobertura.

ABSTRACT Introduction: Universal neonatal hearing screening is a test that enables to identify or suspect hearing loss, performed via habilitation or rehabilitation plan. Objective: Determine the coverage of universal hearing screening in the epidemiological context of COVID-19 in Guantánamo province, during the period of march 2020 to march 2021. Method: A descriptive, retrospective cross-sectional study was carried out. A total of 5 999 newborns (as Universe) were involved in the study. Variables used were as follow: sex, newborns with or without risk factors, and otoacoustic emissions, which outcomes allowed for the evaluation of universal hearing screening coverage. The standard indicator (95%) and the time at which the first otoacoustic emissions were made were defined. The percentage of newborns detected before one month of life was established as indicator. Results: The 51.1% of the 5 999 newborns were male and 48.3% were female. The 100% of newborns (5 838) without risk factors underwent to the first examination, meanwhile, among those with risk factors (151 newborns) 0.2% (10) could not be tested. Screening of newborns without factors occurred between 1 and 3 days after birth. Screening was never performed after 30 days of birth in those who presented risk factors. Coverage was 99.8% and the reference rate was 0.2%. Conclusions: Universal Hearing Screening Program application in the context of COVID-19 pandemic in Guantanamo province shows a fulfillment in the coverage indicator.

RESUMO Introdução: A triagem auditiva neonatal é a avaliação para detectar ou suspeitar de perda auditiva, que é abordada por um plano de habilitação ou reabilitação. Objetivo: Determinar a cobertura da triagem auditiva universal na província de Guantánamo, no contexto epidemiológico da COVID-19, durante o período de março de 2020 a março de 2021. Método: Foi realizado um estudo descritivo, retrospectivo, transversal. O universo consistia de 5 999 recém-nascidos vivos. As variáveis estudadas foram: sexo, recém-nascidos com e sem fatores de risco, e emissões otoacústicas, cujos resultados permitiram a avaliação da cobertura. O indicador padrão (95%) e o momento em que as primeiras emissões otoacústicas foram feitas foram definidos. O indicador foi definido como a porcentagem de recém-nascidos examinados antes de um mês de idade. Resultados: Dos 5 999 nascimentos, 51,7% eram homens e 48,3% eram mulheres. 100% dos bebês sem fatores de risco (5.838) foram examinados pela primeira vez, enquanto aqueles com fatores de risco (151) não puderam ser rastreados por 0,2% (10). A triagem de recém-nascidos sem fatores de risco ocorreu entre 1 e 3 dias após o nascimento. A triagem nunca foi realizada após 30 dias de nascimento naqueles com fatores de risco. A cobertura foi de 99,8% e a taxa de base foi de 0,2%. Conclusões: O Programa Universal de Triagem Auditiva na província de Guantánamo no contexto da COVID-19 mostra a conformidade com o indicador de cobertura.

Eficacia del «Programa de tamizaje auditivo neonatal universal¼ de la Caja Costarricense del Seguro Social en la detección de sordera en niñas y niños, entre 2016 y 2018 / Effectiveness of «Universal Newborn Hearing Screening program¼ of Caja Costarricense del Seguro Social, in detecting deafness in children, from 2016 to 2018

Resumen Introducción: el tamizaje auditivo es un método de detección y su propósito es intervenir de forma temprana para reducir las consecuencias negativas de una eventual afección auditiva en el desarrollo integral del infante. Costa Rica ha implementado en el sistema de salud público un programa de tamizaje auditivo neonatal universal, donde se examina todo niño o niña antes del primer mes de vida. Aunque se han percibido múltiples beneficios, es importante demostrar con evidencia científica si cumple sus objetivos. Metodología: se analizó la eficacia del «Programa de tamizaje auditivo neonatal universal» (TANU) de la Caja Costarricense de Seguro Social, a partir de la información registrada de 37 656 infantes evaluados entre los años 2016 y 2018, mediante el contraste empírico con las técnicas descriptivas de distribución de frecuencias de variables, y las pruebas inferenciales chi cuadrado y análisis de varianza (ANOVA). Resultados: en cuanto a la edad al momento del examen, el 71 % de la muestra tenía entre 0 y 3 días. Su desempeño a través del tiempo y la extensión a distintos centros de salud ha sido satisfactorio, así mismo, la cantidad de infantes valorados ha sido hasta del 98 % de la población. Conclusiones: el programa TANU es eficaz en la mayoría de aspectos analizados, destaca la identificación de factores de riesgo y la detección temprana de afecciones auditivas, sin embargo, se proponen mejoras en relación con el manejo de la información.

Abstract Introduction: Hearing screening is a detection method, its objective is to provide an early intervention that allows reducing the negative consequences of an eventual hearing impairment, in the integral development of the infant. Costa Rica has implemented a universal neonatal hearing screening program in the public health system, where the hearing of every child born in the country is examined before the first month of life. Although multiple benefits have been perceived, it is important to demonstrate with scientific evidence if it accomplishes its objectives. Methodology: the effectiveness of the Universal Newborn Hearing Screening Program in Costa Rica was analyzed, based on the information recorded from 37,656 children evaluated since 2016 to 2018, through empirical contrast using both descriptive techniques: frequency distribution of variables, as well as the use of inferential tests: chi square and analysis of variance (ANOVA). Results: 71 % of the sample was between 0 and 3 days old at the moment of being examined. Its performance over time and extension to different health centers has been satisfactory, likewise, the number of infants evaluated has been up to 98 % of the population. Conclusions: the TANU program is effective in most of the aspects analyzed, the identification of risk factors and the early detection of hearing disorders are outstanding, however, improvements are proposed in relation to the handling of information.

Does universal newborn hearing screening impact the timing of deafness treatment?

Abstract Objective: To evaluate the impact of the Universal Neonatal Hearing Screening (UNHS) on the age at diagnosis, beginning of treatment, and first cochlear implant surgery. Methods: A retrospective cohort study with children up to 12 years old with bilateral hearing loss were divided into two groups: patients who underwent UNHS and the ones who didn't. The groups were compared according to their age at the beginning of the evaluation at a specialized center, at the beginning of the intervention, and, for the ones who had indication, at the cochlear implant surgery. The group who underwent UNHS was divided between the ones who passed the screening test and the ones who didn't. They were compared according to their ages at the same moments as the first two groups. Results: 135 patients were included. The median age at the first appointment in a specialized center was 1.42 (0.50 and 2.50) years, at the beginning of treatment 2.00 (1.00 and 3.52) years, and the cochlear implant surgery 2.83 (1.83 and 4.66) years. Children who underwent UNHS were younger than those who didn't, at the three evaluated moments (p < 0.001). In a subanalysis, children who passed the UNHS but were later diagnosed with hearing loss reached the first appointment with a specialist and started treatment older than those who failed the tests. Conclusion: Performing UNHS interfered with the timing of deafness diagnosis and treatment. However, children who passed the screening but were later diagnosed with hearing loss were the category with the most important delay.

Does universal newborn hearing screening impact the timing of deafness treatment?

OBJECTIVE: To evaluate the impact of the Universal Neonatal Hearing Screening (UNHS) on the age at diagnosis, beginning of treatment, and first cochlear implant surgery. METHODS: A retrospective cohort study with children up to 12 years old with bilateral hearing loss were divided into two groups: patients who underwent UNHS and the ones who didn't. The groups were compared according to their age at the beginning of the evaluation at a specialized center, at the beginning of the intervention, and, for the ones who had indication, at the cochlear implant surgery. The group who underwent UNHS was divided between the ones who passed the screening test and the ones who didn't. They were compared according to their ages at the same moments as the first two groups. RESULTS: 135 patients were included. The median age at the first appointment in a specialized center was 1.42 (0.50 and 2.50) years, at the beginning of treatment 2.00 (1.00 and 3.52) years, and the cochlear implant surgery 2.83 (1.83 and 4.66) years. Children who underwent UNHS were younger than those who didn't, at the three evaluated moments (p < 0.001). In a subanalysis, children who passed the UNHS but were later diagnosed with hearing loss reached the first appointment with a specialist and started treatment older than those who failed the tests. CONCLUSION: Performing UNHS interfered with the timing of deafness diagnosis and treatment. However, children who passed the screening but were later diagnosed with hearing loss were the category with the most important delay.

Monitoramento audiológico de lactentes em diferentes programas de triagem auditiva neonatal: uma revisão sistemática / Audiological monitoring of infants in different newborn hearing screening programs: a systematic review

RESUMO Objetivos Buscar na literatura informações quanto aos aspectos que guiam o monitoramento audiológico infantil, descrevendo os procedimentos utilizados, a idade em que são realizados, qual a população monitorada e os países que mais estudam sobre o assunto. Além de discutir a importância dessa etapa e a eficácia desses aspectos. Estratégia de pesquisa A revisão foi conduzida com base nas recomendações PRISMA e registrada na plataforma PROSPERO. Os estudos foram pesquisados nas bases de dados eletrônicas Medline (Pubmed), Web of Science e SciELO, com os descritores hearing, neonatal screening e follow up. Critérios de seleção Foram incluídos estudos que descrevessem o monitoramento audiológico. Não foram empregados filtros do ano de publicação, tampouco para os idiomas dos mesmos. Resultados Foram encontrados 432 artigos e 21 foram incluídos nesse estudo, sendo que a maioria foi produzida em países desenvolvidos. O Potencial Evocado Auditivo de Tronco Encefálico e a Avaliação Comportamental foram os procedimentos mais utilizados. Quanto a idade e população, a maioria realiza o monitoramento até os três anos e em crianças com Indicadores para a Deficiência Auditiva. Conclusão Os estudos demonstraram que não há padrão entre os protocolos para a realização do monitoramento audiológico, porém foi possível identificar que as pesquisas apresentam uma maior concordância quanto a idade em que tal monitoramento acontece e qual a população que deve ser monitorada. Entretanto, embora haja discordâncias, os métodos de avaliação utilizados pelos estudos são eficazes para a detecção de perdas auditiva de caráter leve, progressivo e/ou tardio, além dos casos de falso negativo.

ABSTRACT Purpose To search the literature for guidelines on infant's audiological monitoring, most commonly used procedures, the age at which they are performed, which population should be monitored and the countries that study the subject the most. Besides, the importance and effectiveness of these measures will be discussed. Research strategy The review was conducted based on the PRISMA recommendations, registered on the PROSPERO platform. The studies were searched for in the electronic databases Medline (Pubmed), Web of Science and SciELO, using the descriptors hearing, neonatal screening and follow up. Selection criteria studies reporting the audiological monitoring were included. No filters on year and language of publication were used. Results A total of 432 articles were found and 21 were included in this study, mostly produced in developed countries. The Auditory Brainstem Response and the Behavioral Assessment were the most frequently used procedures. As to age and population, most infants are subjected to audiological monitoring up to three years of age and have Risk Factors for Hearing Loss in their clinical history. Conclusion The studies pointed that there is no standard among the protocols for performing audiological monitoring, but it was possible to identify agreement as to the age at which such monitoring takes place and which population should be monitored. However, although there is some disagreement, the assessment methods used in the studies are effective in detecting mild, progressive and/or late hearing loss, in addition to false negative cases.

Cochleopalpebral reflex: sensitivity and specificity in the auditory screening of newborns discharged from the neonatal intensive care unit / Reflejo cocleopalpebral: sensibilidad y especificidad en el tamiz auditivo de recién nacidos egresados de una unidad de cuidados intensivos neonatales

Abstract Background: The sensitivity and specificity of the clinical audiological evaluation in newborns are debatable compared to neurophysiological methods of a hearing evaluation. This study aimed to determine the sensitivity and specificity of the cochleopalpebral reflex as a clinical test for hearing screening in newborns. Methods: A case-control study was designed. Newborns discharged from a neonatal intensive care unit (NICU) were included. Brainstem evoked auditory potentials were recorded. A wooden rattle was used to explore the cochleopalpebral reflex. The sensitivity and specificity of the cochleopalpebral reflex were calculated. Continuous data were analyzed with Student's t-test, with statistically significant p-values < 0.05. Results: We selected 450 newborns who were divided into two groups: group A, with bilateral sensory neural hearing loss (n = 150), and group B, with normal hearing (n = 300). Group A showed a significantly lower gestation age at birth (p = 0.005) compared to group B (32.5 ± 2.6 vs. 34.4 ± 3.5 weeks). In group A, the cochleopalpebral reflex's sensitivity was 80% using the wooden rattle. In group B, the specificity was 98%. Conclusions: The NICU discharged newborns' clinical hearing evaluation is not enough to exclude hearing loss. Although it may be the only diagnostic tool for hearing loss in some settings, its limitations should be considered.

Resumen Introducción: La sensibilidad y la especificidad de la evaluación audiológica clínica en recién nacidos son cuestionables en comparación con los métodos neurofisiológicos de evaluación auditiva. El objetivo de este estudio fue determinar la sensibilidad y la especificidad del reflejo cocleopalpebral como prueba clínica de tamizaje auditivo en recién nacidos. Métodos: Se diseñó un estudio de casos y controles en el que se incluyeron recién nacidos egresados de una unidad de cuidados intensivos neonatales (UCIN). Se les efectuaron potenciales auditivos evocados de tallo cerebral. Para la exploración del reflejo cocleopalpebral se utilizó una matraca de madera. Se calcularon la sensibilidad y la especificidad del reflejo cocleopalpebral. Los datos continuos se analizaron con la prueba t de Student y se consideraron estadísticamente significativos los valores de p < 0.05. Resultados: Se seleccionaron 450 recién nacidos y se dividieron en dos grupos: el grupo A (n = 150) con hipoacusia sensorineural y el grupo B (n = 300) con audición normal. El grupo A mostró una diferencia significativa (p = 0.005) en cuanto a la edad de gestación al nacer en comparación con el grupo B (32.5 ± 2.6 vs. 34.4 ± 3.5 semanas). En el grupo A, la sensibilidad del reflejo cocleopalpebral fue del 80% utilizando la matraca de madera. En el grupo B se encontró una especificidad del 98%. Conclusiones: La evaluación del reflejo cocleopalpebral como prueba clínica de tamizaje auditivo en una población de recién nacidos egresados de una UCIN no es suficiente para descartar la pérdida de la audición. Aunque puede ser la única herramienta de diagnóstico para evaluar la pérdida de la audición en algunos casos, es importante considerar sus limitaciones.

Outcomes of a universal neonatal hearing screening program of 9941 newborns over a one-year period in Campinas, Brazil.

OBJECTIVES: To characterize the outcomes of a universal neonatal hearing screening program in Brazil. METHODS: Retrospective documentary analysis of the hearing screening of the neonates born in the hospital from August 2019 to July 2020. The universal neonatal hearing screening program performed the examination of TEOAE in newborn without risk factors for hearing loss and TEOAE and aABR in neonates with risk factors for hearing loss. RESULTS: 9941 neonatal records were studied, 9088 newborns (91,42%) with no risk factors for hearing loss and 849 newborns (8.54%) with risk factors for hearing loss. 4 newborns (0.04%) had hearing loss in the group without risk factors and 16 newborns (1.88%) in the group with risk factors. In retesting those newborns who failed the UNHS test stage, we had 4 newborns (0.04%) without risk factors and 2 newborns (0,24%) with risk factors who evaded and did not return to service. CONCLUSION: It was possible to survey the outcomes of one year of the UNHS service and observe that the coverage rate of the service was 99.96%. The use of the combined methodology guaranteed a number of forwardings for less returns. Through this study, it was possible to observe that this service complies with the quality indicators recommended by the guidelines.

Cochleopalpebral reflex: sensitivity and specificity in the auditory screening of newborns discharged from the neonatal intensive care unit.

BACKGROUND: The sensitivity and specificity of the clinical audiological evaluation in newborns are debatable compared to neurophysiological methods of a hearing evaluation. This study aimed to determine the sensitivity and specificity of the cochleopalpebral reflex as a clinical test for hearing screening in newborns. METHODS: A case-control study was designed. Newborns discharged from a neonatal intensive care unit (NICU) were included. Brainstem evoked auditory potentials were recorded. A wooden rattle was used to explore the cochleopalpebral reflex. The sensitivity and specificity of the cochleopalpebral reflex were calculated. Continuous data were analyzed with Student's t-test, with statistically significant p-values < 0.05. RESULTS: We selected 450 newborns who were divided into two groups: group A, with bilateral sensory neural hearing loss (n = 150), and group B, with normal hearing (n = 300). Group A showed a significantly lower gestation age at birth (p = 0.005) compared to group B (32.5 ± 2.6 vs. 34.4 ± 3.5 weeks). In group A, the cochleopalpebral reflex's sensitivity was 80% using the wooden rattle. In group B, the specificity was 98%. CONCLUSIONS: The NICU discharged newborns' clinical hearing evaluation is not enough to exclude hearing loss. Although it may be the only diagnostic tool for hearing loss in some settings, its limitations should be considered.

Procedimiento para el pesquisaje auditivo universal en la población neonatal, Cuba, 2018 / A Procedure for Universal Hearing Screening in the Neonatal Population, Cuba, 2018

Introducción: El pesquisaje auditivo neonatal es una de las técnicas más utilizadas para realizar el diagnóstico precoz y oportuno de las pérdidas auditivas que llevan a una discapacidad. Objetivo: Diseñar el procedimiento para la pesquisa auditiva universal en la población neonatal cubana. Métodos: Estudio de desarrollo tecnológico, realizado de enero a diciembre de 2017. Se seleccionaron expertos mediante la autoevaluación y el coeficiente de competencia de Kappa, quienes participaron en el diseño a través de la técnica de grupos nominales, para el análisis de los problemas que limitan el pesquisaje auditivo universal y las potencialidades científicas, organizativas y funcionales de la red de servicios de atención a los desórdenes auditivos. Con posterioridad valoraron el procedimiento de forma individual y se aplicó la técnica de grupos nominales para lograr consenso. La revisión bibliográfica permitió valorar los aciertos y dificultades de otros procedimientos establecidos en otros contextos. Resultados: Se obtuvo como resultado el procedimiento para el pesquisaje auditivo universal, estructurado en tres componentes: pesquisaje, diagnóstico y rehabilitación. Conclusiones: El procedimiento diseñado para la detección universal precoz neonatal de las pérdidas auditivas en la población neonatal cubana estandariza los procesos de prestación de servicios de salud, mediante la gestión integral para prevenir y controlar, en forma oportuna, los eventos que afectan la salud auditiva(AU)

Introduction: Neonatal hearing screening is one of the most widely used techniques for early and timely diagnosis of hearing losses that lead to disability. Objective: To design the procedure for universal hearing screening in the Cuban neonatal population. Methods: Technological development study carried out from January to December 2017. Experts were selected through self-evaluation and the Kappa competence coefficient. The experts participated in the design through the nominal groups technique, in view of the analysis of the problems limiting universal hearing screening and the scientific, organizational and functional potentialities of the healthcare network for hearing disorders. Subsequently, they assessed the procedure individually and the nominal groups technique was applied to achieve consensus. The bibliographic review allowed to assess the accomplishments and difficulties of other procedures established in other settings. Results: The procedure for universal hearing screening was obtained as a result, structured in three components: screening, diagnosis and rehabilitation. Conclusions: The procedure designed for universal early neonatal screening of hearing loss in the Cuban neonatal population standardizes the processes of providing healthcare, through comprehensive management to prevent and control, timely, events that affect hearing-related health(AU)

Registro de emisiones otoacústicas transientes basado en microcontroladores de alto rendimiento / Transient Otoacoustic Emissions Register based on High Performance Microcontrollers

La hipoacusia tiene una incidencia notable entre los recién nacidos. Una intervención temprana durante el período de maduración auditiva permite minimizar los efectos en el desarrollo intelectual del infante. Se propone el desarrollo de un Registrador de Emisiones Otoacústicas Transientes como parte de un sistema de cribado neonatal basado en microcontroladores de alto rendimiento. La prueba consiste en aplicar periódicamente un estímulo tipo chasquido para obtener la respuesta coclear. Se promedian las señales adquiridas y se aplica la Transformada Rápida de Fourier. El espectro obtenido es dividido en bandas de media octava para analizar la correlación y la relación señal-ruido. Si estos parámetros son mayores que los umbrales de referencia en la mayoría de las bandas, se considera al paciente apto para el desarrollo normal. El firmware fue implementado sobre el procesador STM32F405 y evaluado con el simulador Baby Isao; obteniéndose una sensibilidad del 87.5 por ciento y una especificidad del 93.75 por ciento(AU)

Hearing loss is highly incident among newborns. Early intervention during the period of auditory maturation allows adequate levels of intellectual development to be achieved. The development of a Transient Otoacoustic Emissions Recorder is proposed as part of a neonatal screening system based on high-performance microcontrollers. The test consists of periodically applying a click stimulus to obtain the cochlear response. The acquired signals are averaged and the Fast Fourier Transform is applied. The spectrum obtained is divided into half-octave bands to assess the correlation as well as the signal-noise ratio. If these parameters are greater than the reference thresholds in most of the bands, the patient is considered suitable for normal cognitive development. The firmware was implemented on the STM32F405 processor and evaluated with the Baby Isao simulator; obtaining a sensitivity of 87.5 percent and a specificity of 93.75 percent(AU)

Acompanhamento audiológico de lactente com risco para sífilis congênita: relato de caso / Audiological follow up of an infant affected by congenital syphilis: case report

Objetivo: descrever o acompanhamento audiológico de uma criança com exame sorológico positivo para sífilis. Caso Clínico: E.G.M.L, com sorologia positiva para sífilis, com dois dias de vida, obteve resultado "falha" na Triagem Auditiva Neonatal, com Emissões Otoacústicas Evocadas Transientes. Encaminada para o ambulatório da Clínica Escola de Fonoaudiologia, da Universidade Estadual da Bahia, retornou com quatro meses, quando realizou reteste das Emissões Otoacústicas Evocadas Transientes, que permaneceram ausentes; também se submeteu à imitanciometria, onde foram obtidas curvas timpanométricas "pico único". A avaliação da condução nervosa com Potencial Evocado Auditivo do Tronco Encefálico do Tronco Encefálico mostrou-se normal na orelha esquerda, com limiares eletrofisiológicos presentes até a intensidade de 50 dB. Porém, houve despertar do sono e não foi possível avaliar a orelha direita. Em nova reavaliação, aos oito meses, a condução nervosa pelo mesmo processo apresentou normalidade na orelha direita. As condições nutricionais de E.G.M.L. eram então críticas, com desnutrição acentuada. O atendimento no âmbito audiológico foi temporariamente suspenso e houve encaminhamento para o setor de fisioterapia e nutrição da Universidade do Estado da Bahia. Discussão: o levantamento de questões audiológicas, em grupos de risco para alterações auditivas, visa à reabilitação e à garantia das condições ideais de comunicação. Neonatos com detecção precoce de alterações auditivas são candidatos ideais à amplificação e reabilitação. Conclusão: crianças com risco para sífilis congênita precisam ser avaliadas na Triagem Auditiva e acompanhadas no seguimento. Entretanto, algumas vezes torna-se difícil conscientizar a família. Essa continuidade é importante para assegurar a integridade dos sentidos e, no caso da audição, para favorecer o desenvolvimento adequado da criança.

Objective: to describe the audiologic follow-up of a child testing positive in the serological test for syphilis. Case: E.G.M.L. has positive syphilis serology and within two days of life presented a Newborn Hearing Screening result considered fail and Transient-evoked Otoacoustic Emissions (TEOAE). She was referred to the outpatient clinic of the Clinical School of Speech-Language Therapy of State University of Bahia (UNEB) to where she returned after four months to submit to a retest of TEOAE which remained absent and an immittance test that presented a single-peaked tympanometric shape. The evaluation of nerve conduction related to Auditory Brainstem Response (ABR) was normal in the left ear presenting thresholds up to 50 dB. However, as she awakened, it was not possible to assess the right ear. However, in a new reassessment, which only occurred when she was at eight months of age, the nerve conduction related to ABR was normal in the right ear. The nutritional status of E.G.M.L at eight months of age was critical, she was severely undernourished. The hearing care service was temporarily suspended, then she was referred to the UNEB physiotherapy and nutrition sector. Discussion: the purpose of the survey on audiological issues among infectious risk groups is to make an early diagnosis of hearing disorders in order to promote rehabilitation and improve communication functions. Neonates with hearing loss at such a young age are the best candidates for amplification and rehabilitation. Conclusion: Children at risk for congenital syphilis need to be evaluated in terms of Hearing Screening and to be monitored, even though it sometimes becomes difficult to convince the family about that. It is important to keep this process in order to assure the integrity of the senses, especially in terms of the audiologic system, and to promote the adequate development of the child.

Results of the Universal Neonatal Hearing Screening in a Tertiary Care Hospital in Mexico city.

INTRODUCTION: Universal Neonatal Hearing Screening (UNHS) includes as its main objective, that all Newborns (NB) receive an audiological evaluation during their first month of life. OBJECTIVE: To determine the prevalence of hearing loss in a population of healthy NB in a tertiary care hospital in Mexico City. MATERIAL AND METHODS: A prospective cross-sectional study was designed. The period was from October 1, 2011 to May 15, 2019. UNHS was performed with a flowchart in three phases using Transient Evoked Otoacoustic Emissions and Brainstem auditory evoked potentials. Data were analyzed using descriptive statistics. RESULTS: 14,000 NB were evaluated, 28,000 ears. Gender was distributed in n = 7038 (50.3%) males and n = 6962 (49.7%) females. The mean age at the time of the first UNHS study was 48.3 ± 22.2 days. Hearing loss was confirmed in n = 31 (0.22%) NB, in 20 (64%) of the cases with hearing loss there were no documented audiological risk factors. CONCLUSIONS: The prevalence of hearing loss was 2.2 per 1000 NB in a tertiary care hospital in Mexico City. Diagnosis and early habilitation of hearing loss in NB constitute quality indicators in health care and guarantee the best prognosis for NB with hearing loss.

Community health worker-based hearing screening on a mobile platform: A scalable protocol piloted in Haiti.

OBJECTIVE: To establish the feasibility of a systematic, community health worker (CHW)-based hearing screening program that gathers Health Insurance Portability and Accountability Act-compliant electronic data (otoscopic images of tympanic membrane and audiometric evaluation) on a smartphone in an effort to streamline treatment options in resource-limited communities. METHODS: This is a cross-sectional study in which four schools were screened in Port-au-Prince, Haiti, during in April 2018. A total of 122 subjects (61% female) aged 5-17 years underwent an initial brief audiometric screen followed by a more comprehensive air conduction audiometric evaluation if they failed their initial screen. Participants with more than 35-dB loss in any frequency on their comprehensive audiometric evaluation received endoscopic otoscopy. RESULTS: Seventy-five percent of subjects (91/122) passed their initial screen. Of those who failed, 9% (4/44 ears) had a severe or profound hearing loss on comprehensive evaluation. Abnormal otoscopic findings (11/36 ears, 31%) included are cerumen impaction (n = 6), myringosclerosis (n = 3), tympanic membrane perforation (n = 1), and tympanic membrane retraction (n = 1). The average duration of the initial testing was 100 seconds (SD = 74 seconds), whereas the duration of comprehensive testing was 394 seconds (SD = 175 seconds). Extrapolating from these data, we estimate that a group of seven trained CHWs could gather formal audiologic and otologic data points for 100 children per hour using this protocol. CONCLUSIONS: A systematic approach that utilizes local resources (CHWs) and existing infrastructure (cell phones and the Internet) can significantly reduce the burden of hearing healthcare specialists while simultaneously facilitating early diagnosis and management of disabling hearing loss in low-resourced settings. LEVEL OF EVIDENCE: Level 4.

Prevalencia de hipoacusia en una población escolar con síndrome de Down de Bogotá, Colombia / Prevalence of hearing loss in a population of schoolchildren with Down syndrome from Bogotá, Colombia

Introducción: Los niños con síndrome de Down presentan mayor prevalencia de alteraciones de la capacidad auditiva, secundaria a variaciones anatómicas y fisiológicas. En Colombia, no se realiza tamizaje auditivo universal, y no hay datos sobre la prevalencia de hipoacusia en esta población. El propósito de este estudio fue determinar la frecuencia y tipo de estas alteraciones en nuestra población por medio de evaluación audiológica.Pacientes y métodos: Se realizó un estudio de corte trasversal en dos instituciones especializadas en el acompañamiento y terapia de familias de niños con síndrome de Down en Bogotá D. C., Colombia. Entre octubre de 2017 y septiembre de 2018, se realizó audiometría comportamental y/o tonal e impedanciometría en 40 y en 37 niños respectivamente. Los sujetos asistían a las instituciones dos veces por semana y estaban integrados en diferentes grados escolares hasta quinto de primaria. Se estimó la prevalencia y se describieron las características, antecedentes clínicos e hitos del desarrollo del lenguaje. Resultados: Se obtuvo una muestra de 40 niños (22 mujeres) con edades entre 6 y 18 años (media: 11,23). Se encontró antecedente de otitis en 19 sujetos e hipoacusia de leve a moderada en 17 niños, predominantemente, conductiva. Hubo retraso en hitos del desarrollo del lenguaje, en apariencia, no asociado a hipoacusia.Conclusiones: En una muestra de niños con síndrome de Down en Bogotá, se encontró una alta prevalencia de hipoacusia, consistente con resultados de estudios previos. Estos datos resaltan la necesidad de un control estricto de la capacidad auditiva basado en parámetros y guías estandarizadas.

Introduction: Children with Down syndrome have a higher prevalence of hearing disorders, secondary to anatomical and physiological variations. No universal hearing screening is implemented in Colombia, so there are no data available on the prevalence of hearing loss in this population. The objective of this study was to determine the frequency and type of such disorders in this population based on hearing tests.Patients and methods: This was a cross-sectional study conducted at two institutions specialized in accompanying and supporting the families of children with Down syndrome in Bogotá, D.C., Colombia. Between October 2017 and September 2018, a behavioral and/or pure-tone audiometry and an impedance audiometry were done in 40 and 37 children respectively. Subjects attended the institutions twice a week and were integrated at school, up to fifth grade. Prevalence was estimated and characteristics, clinical history, and language developmental milestones were described.Results: The sample was made up of 40 children (22 girls) aged 6-18 years (mean: 11.23). A history of otitis was found in 19 children and of mild to moderate hearing loss, in 17, predominately conductive. A delay in language developmental milestones was observed, apparently not associated with hearing loss. Conclusions: A sample of children with Down syndrome from Bogotá showed a high prevalence of hearing loss, consistent with the results of previous studies. These data stress the need for a strict control of hearing status based on standardized parameters and guidelines.

Prevalence of hearing loss in a population of schoolchildren with Down syndrome from Bogotá, Colombia. / Prevalencia de hipoacusia en una población escolar con síndrome de Down de Bogotá, Colombia.

INTRODUCTION: Children with Down syndrome have a higher prevalence of hearing disorders, secondary to anatomical and physiological variations. No universal hearing screening is implemented in Colombia, so there are no data available on the prevalence of hearing loss in this population. The objective of this study was to determine the frequency and type of such disorders in this population based on hearing tests. PATIENTS AND METHODS: This was a cross-sectional study conducted at two institutions specialized in accompanying and supporting the families of children with Down syndrome in Bogotá, D.C., Colombia. Between October 2017 and September 2018, a behavioral and/or pure-tone audiometry and an impedance audiometry were done in 40 and 37 children respectively. Subjects attended the institutions twice a week and were integrated at school, up to fifth grade. Prevalence was estimated and characteristics, clinical history, and language developmental milestones were described. RESULTS: The sample was made up of 40 children (22 girls) aged 6-18 years (mean: 11.23). A history of otitis was found in 19 children and of mild to moderate hearing loss, in 17, predominately conductive. A delay in language developmental milestones was observed, apparently not associated with hearing loss. CONCLUSIONS: A sample of children with Down syndrome from Bogotá showed a high prevalence of hearing loss, consistent with the results of previous studies. These data stress the need for a strict control of hearing status based on standardized parameters and guidelines.

Introducción: Los niños con síndrome de Down presentan mayor prevalencia de alteraciones de la capacidad auditiva, secundaria a variaciones anatómicas y fisiológicas. En Colombia, no se realiza tamizaje auditivo universal, y no hay datos sobre la prevalencia de hipoacusia en esta población. El propósito de este estudio fue determinar la frecuencia y tipo de estas alteraciones en nuestra población por medio de evaluación audiológica. Pacientes y métodos: Se realizó un estudio de corte trasversal en dos instituciones especializadas en el acompañamiento y terapia de familias de niños con síndrome de Down en Bogotá D. C., Colombia. Entre octubre de 2017 y septiembre de 2018, se realizó audiometría comportamental y/o tonal e impedanciometría en 40 y en 37 niños respectivamente. Los sujetos asistían a las instituciones dos veces por semana y estaban integrados en diferentes grados escolares hasta quinto de primaria. Se estimó la prevalencia y se describieron las características, antecedentes clínicos e hitos del desarrollo del lenguaje. Resultados: Se obtuvo una muestra de 40 niños (22 mujeres) con edades entre 6 y 18 años (media: 11,23). Se encontró antecedente de otitis en 19 sujetos e hipoacusia de leve a moderada en 17 niños, predominantemente, conductiva. Hubo retraso en hitos del desarrollo del lenguaje, en apariencia, no asociado a hipoacusia. Conclusiones: En una muestra de niños con síndrome de Down en Bogotá, se encontró una alta prevalencia de hipoacusia, consistente con resultados de estudios previos. Estos datos resaltan la necesidad de un control estricto de la capacidad auditiva basado en parámetros y guías estandarizadas.

Contribution of Congenital Cytomegalovirus Infection to Permanent Hearing Loss in a Highly Seropositive Population: The Brazilian Cytomegalovirus Hearing and Maternal Secondary Infection Study.

BACKGROUND: The exact contribution of congenital cytomegalovirus infection (cCMVI) to permanent hearing loss (HL) in highly seropositive populations is unknown. We determined the contribution of cCMVI to HL and estimated the effectiveness of newborn hearing screening (HS) in identifying neonates with CMV-related HL. METHODS: A total of 11 900 neonates born from a population with ≥97% maternal seroprevalence were screened for cCMVI and HL. cCMVI was confirmed by detection of CMV-DNA in saliva and urine at age <3 weeks. RESULTS: Overall, 68 (0.6%; 95% confidence interval [CI], 0.4-0.7) neonates were identified with cCMVI. Of the 91 (0.8%) newborns who failed the HS, 24 (26.4%) were confirmed with HL, including 7 (29.2%; 95% CI, 17.2-59.3) with cCMVI. Another newborn with cCMVI passed the HS but was confirmed with HL at age 21 days. Of the 62 neonates with cCMVI who underwent a complete hearing evaluation, 8 (12.9%; 95% CI, 6.7-23.4) had HL and most (7/8; 87.5%; 95% CI, 46.6-99.7) were identified by HS. The rate of CMV-related HL was 8 per 11 887 neonates (0.7 per 1000 live births). The prevalence ratio of HL among neonates with cCMVI compared to CMV-uninfected neonates was 89.5 (95% CI, 39.7-202.0). No late-onset cCMVI-related HL was detected during a median follow-up of 36 months. CONCLUSIONS: cCMVI is an important cause of HL in childhood in all settings. Integrating targeted cCMVI screening among neonates who fail a HS could be a reasonable, cost-effective strategy to identify newborns with early-onset cCMVI-related HL.