Although migrant workers account for the majority of newborns in Beijing, their children are less likely to undergo appropriate universal newborn hearing screening/rescreening (UNHS) than newborns of local non-migrant residents. We hypothesised that this was at least in part due to the inadequacy of the UNHS protocol currently employed for newborn babies, and therefore aimed to modify the protocol to specifically reflect the needs of the migrant population. A total of 10,983 healthy babies born to migrant mothers between January 2007 and December 2009 at a Beijing public hospital were investigated for hearing abnormalities according to a modified UNHS protocol. This incorporated two additional/optional otoacoustic emissions (OAE) tests at 24–48 hours and 2 months after birth. Infants not passing a screening test were referred to the next test, until any hearing loss was confirmed by the auditory brainstem response (ABR) test. A total of 98.91% (10983/11104) of all newborn children underwent the initial OAE test, of which 27.22% (2990/10983) failed the test. 1712 of the failed babies underwent the second inpatient OAE test, with739 failing again; thus significantly decreasing the overall positive rate for abnormal hearing from 27.22% to 18.36% ([2990–973 /10983)]; p = 0). Overall, 1147(56.87%) babies underwent the outpatient OAE test again after1-month, of whom 228 failed and were referred for the second outpatient OAE test (i.e. 2.08% (228/10983) referral rate at 1month of age). 141 of these infants underwent the referral test, of whom 103 (73.05%) tested positive again and were referred for a final ABR test for hearing loss (i.e. final referral rate of 1.73% ([228-38/10983] at 2 months of age). Only 54 infants attended the ABR test and 35 (0.32% of the original cohort tested) were diagnosed with abnormal hearing. Our study shows that it is feasible and practical to achieve high coverage rates for screening hearing loss and decrease the referral rates in newborn babies of migrant workers, using a modification of the currently employed UNHS protocol.

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Assessment of the feasibility and coverage of a modified universal hearing screening protocol for use with newborn babies of migrant workers in Beijing

Audiological characteristics were investigated in 81 ears of 53 infants with abnormal transient evoked otoacoustic emission (TEOAE) and normal auditory brainstem response (ABR). The relationship between ABR and other hearing testing methods, including 40Hz auditory event-related potential (40Hz-AERP), auditory steady state response (ASSR), distortion product otoacoustic emission (DPOAE), tympanometry, and acoustic reflex, was analyzed. Of the 81 ears, 18 ears (22.2%) were normal, while 63 ears (77.8%) were abnormal according to the tests. Testing of the 40 Hz AERP (36 ears) and ASSR (45 ears) revealed that 14 ears (38.9%) and 27 ears (60.0%) were abnormal, respectively. Testing of DPOAE in 68 ears revealed that 50 ears (73.5%) were abnormal. Testing of tympanometry in 50 ears and acoustic reflex in 47 ears revealed that 9 ears (18%) and 27 ears (57.4%) were abnormal, respectively. The present data suggests that the hearing of infants cannot be sufficiently evaluated with ABR only and that it must be evaluated with integrative audiological testing methods.

Audiological characteristics of infants with abnormal transient evoked otoacoustic emission and normal auditory brainstem response.

Background: Tympanometry is one of the most important audiological tests for the assessment of neonatal hearing screening programs. This test is usually done using a 226 Hertz probe tone; however, in infants less than 6 months of age, using this probe tone frequency is not reliable due to the different characteristics of the middle ear compared to adults. The purpose of this study was to assess the obtained tympanometric data in neonates 1 to 14 days with normal hearing using 226, 678, 800 and 1000 Hertz frequency probes tones. Materials and Methods: In this cross-sectional study, 30 neonates aged 1 to 14 days who were diagnosed as normal in hearing aspect with using otoacoustic emissions test, were assessed by tympanometry. Tympanometric tests were performed using 226, 678, 800 and 1000 Hertz frequency probe tones for both ears. For data analysis, the T-paired method has been used. Results: With using 226 Hertz frequency probe tone, incidence of unusual double peak tympanograms was observed in 65% of cases, which with increasing frequency of the probe tone, this percentage was decreased. There was also a statistically significant difference between the static admittance peak compensated in two 226 and 1000 Hertz frequency probes tones. Conclusion: In neonates with normal hearing and without any risk factors for hearing loss, the 1000-Hertz Tympanogram shows a better middle ear status than the 226-Hertz tympanogram.

Comparison of High Frequency and Low Frequency Tympanometry Findings in Normal Neonates

Congenital ear malformations include auricular malformation, external ear canal atresia, middle ear malformation and inner ear malformation.

Common Ear Diseases

Objective:To investigate the clinical audiological characteristics of children referred from maternal and child institutions and analyze the high risk factors of hearing loss, so as to provide scientific basis for further improvement of children's ear and hearing care. Methods:The subjects of this study were 868 children who were referred by maternal and child institutions in Beijing to the otology outpatient of Beijing Tongren Hospital, Capital Medical University for hearing diagnosis. All subjects underwent acoustic immittance, auditory brainstem response, distortion products otoacoustic emission and other audiological tests. Children were divided into groups according to the age of diagnosis: 0-<3 months group（242 cases）, 3-<6 months group（328 cases）, 6-<12 months group（180 cases）, ≥12 months group（118 cases）, the results of hearing diagnosis, hearing loss degree and types, the relationship between high risk factors and hearing loss in each group were compared and analyzed. Results:The age of diagnosis of 868 children was（7.13±8.29） months. 488 cases with hearing loss accounted for 56.22% and 380 cases with normal hearing accounted for 43.78%. Proportion of different degree of hearing loss of 792 ears from high to low was as follows: mild, 366 ears（46.21%）; moderate, 214 ears（27.02%）; severe, 151 ears（19.07%）; profound, 61 ears（7.70%）. There were statistically significant differences in the proportion of different hearing loss degree among 0-<3 months group, 3-<6 months group, 6-<12 months group and ≥12 months group（P<0.001）. Pairwise comparison between groups showed that the proportion of mild hearing loss of 0-<3 months group was higher than that in the other three groups（P<0.05）, there was no significant difference of moderate hearing loss among all groups（P>0.05）, the proportion of severe hearing loss of ≥12 months group was higher than that of 0-<3 months group（P<0.05）. The proportion of profound hearing loss with 0-<3 months group was lower than the other three groups（P<0.05）. In 792 ears with hearing loss, sensorineural hearing loss accounted for 67.42%, conductive hearing loss accounted for 20.71% and mixed hearing loss accounted for 11.87%. Among 98 cases with high risk factors for hearing loss, 58 cases（59.18%） were diagnosed with hearing loss. The incidence of hearing loss with high risk factors ranked from high to low was: craniofacial malformation（93.75%）, family history/congenital genetic syndrome（61.11%）, neonatal intensive care unit（NICU） hospitalization（46.43%） and others（20.00%）. Conclusion:Referrals from maternal and child institutions play an important role in the early detection of children with mild to moderate sensorineural hearing loss. Children with craniofacial malformation, family history/congenital genetic syndrome, hospitalization history of NICU and other high risk factors have a high incidence of hearing loss and should be attached with great importance.

[Analysis of clinical audiological characteristics in 868 children referred from maternal and child institutions].

Objective
To study the audiological characteristics of newborns and infants who failed hearing screening 


Methods
One hundred and six infants failed hearing screening received follow-up study with routine audiological evaluations （auditory brainstem response, distortion product otoacoustic emission, tympanometry and visual reinforcement audiometry） 


Results
Sixty-five infants （613% ） of this group were normal hearing subjects and 39（368%） of the infants had hearing loss Two cases （19%） received follow-up by phone Fifteen cases （142%）with conductive hearing loss and 24 cases （226%） with sensorineural hearing loss Thirteen（123%）,14（132%） , 6（57%） , and 6（57%）cases were found to be mild , moderate, severe and profound hearing loss respectively Diagnosis of hearing loss in the thirty- nine infants conducted a prevalence of 0264% （39/14 785） of congenital hearing loss （both binaural and monaural） The hearing level of those cases with severe and profound hearing loss basically did not change, but that of cases with mild and moderate hearing loss changed 


Conclusions
Early identification and intervention of infants with severe and profound hearing loss by 6 months of age were successful Infants with mild and moderate hearing loss should be followed up to six or eight months and received routine audiologic evaluations


Key words: 
Neonatal screening; Evoked potentials, auditory, brain stem; Deafness; Audiometry, evoked response

[Follow-up study for newborns and infants who failed hearing screening].

OBJECTIVE To discuss the multiple-frequency probe tones tympanograms and the normal ranges of admittance, susceptance and conductance in normal newborns. METHOD Tympanometries with 226 Hz, 678 Hz and 1000 Hz probe tones were obtained from newborn infants with normal TEOAE and DPOAE(55 infants, 110 ears), analysed multiple-frequency prone tones tympanograms and values of admittance, susceptance and conductance by using GSI-33 middle ear analyzer. RESULT 226 Hz tympanograms for admittance, susceptance and conductance main were W-shaped, the percentages were 90.0%, 99.1% and 85.5%. 678 Hz tympanograms for admittance, susceptance and conductance main were single-peaked, the percentages of single-peaked type were 62.7%, 77.3% and 62.7%, and the percentages of W-shaped type were 34.6%, 20.9% and 31.8%, had a little three-peaked type. 1000 Hz tympanograms for admittance, susceptance and conductance main were single-peaked, and percentages were 96.4%, 99.1% and 97.3%, and had a little W-shape type but no three-peaked type. There were significant differences between admittance and susceptance, susceptance and conductance in 226 Hz and 678 Hz probe tones tympanogram. There were significant differences between admittance and susceptance, susceptance and conductance, admittance and conductance in 1000 Hz probe tones tympanogram. CONCLUSION Multiple-frequency probe tones tympanograms and the normal ranges of admittance, susceptance and conductance of normal newborn infants is obtained, and 1000 Hz probe tone tympanometry is a sensitive test for function of middle ear in newborn infants.

Lei Shi

Papers

[Follow-up study for newborns and infants who failed hearing screening].

[The normal values of multiple-frequency tympanometry in normal newborns].