An effective compromise between cost and referral rate: A sequential hearing screening protocol using TEOAEs and AABRs for healthy newborns.

http://hub.hku.hk/bitstream/10722/184716/1/Content.pdf

Development of a Mandarin Expressive and Receptive Vocabulary Test for children using cochlear implants

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.

noted as serous or mucoid. Analyzed by t-test and ROC curve. Results: Mean peak static acoustic admittance (Y tm ) value of patient and control groups were 0.25 ml and 0.52 ml (p<0.01); and mean RF value were 570 Hz and 1043 Hz respectively (p<0.01). Mean peak Y tm value of mucoid and serous groups were 0.14 ml and 0.34 ml (p<0.01); and mean RF value were 478 Hz and 643 Hz respectively (p<0.05). Conclusions: MFT was effective in differentiating normal ears from ears with OME. RF values below 650 Hz were highly specific in the diagnosis of OME. 226 Hz peak Y tm was better than MFT for differentiating mucoid OME from serous OME.

The Value of Multifrequency Tympanometry in the Management of Otitis Media with Effusion

Objective
To investigate the children with hearing loss from the age 0 to 6, and discuss the found age, found way and audiological characteristics. 


Methods
General information of found age and found way of 265 children, were investigated with self-made questionnaire and routine audiological evaluations, and then made statistical analysis. 


Results
The average （x±s） found age for the children with hearing loss was （23.21±10.02）months, and the first average coming age was （28.01±13.41） months. The found age of girls[（27.11±13.13）months] was 6. 1 months later than the boys＇[（21.03±12.32）months] and the countryside children [（28.27±11.09）months] later than the city＇s[ （19.52±13.05）months] 8.65 months in the average found age. The found age of children who were found with speech disability was later than others. As the heating loss degree of children went milder, the found age might later. 


Conclusions
The popularization of knowledge in preventing from heating loss must be strengthened. It is also necessary to popularize newborn hearing screening and early intervention while to enhance the parents＇ consciousness.


Key words: 
Children, hearing loss; found age; found path; investigated; statistic

Analysis of the found age and way for children age 0 to 6 with hearing loss

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 investigate the sensitive factors which were used in routine audiological tests to find out otitis media with effusion （OME） in newborn infants. Methods Subjects of this study were 48 infants,including 31 males and 17 females, who failed in the universal newborn heating screening. The age ranged from 1.5 to 12 months with the average age of 4. 3 months. All subjects accepted temporal bone CT and routine audiological assessments, including air-conduction and bone-conduction auditory brainstem response（ABR）, 40 Hz-auditory event related potential （40 Hz-AERP）, distortion-product otoacoustic emission （DPOAE）, acoustic reflex, tympanometties using 226 Hz and 1000 Hz probe tone. Nine factors were statistically analyzed using Kappa test, Univatiate Х^2 test and multivariate condition Logistic stepwise regression analysis, which included the results of acoustic immitanee, the air-conduction and bone- conduction ABR thresholds,the difference between air-conduction and bone-conduction ABR thresholds, the latency of ABR wave Ⅰ , duration between ABR wave Ⅰ and Ⅴ, 40 Hz-AERP thresholds, amplitudes and thresholds of DPOAE, and acoustic reflex thresholds （ ART）. Results Seventy-seven ears were diagnosed with OME, and 19 ears were normal. CT scan of temporal bone was set as a comparative standard. Kappa test indicated that the results of tympanometry with 1000 Hz probe tone （ Kappa = 0. 745, P < 0. 001 ）, the air-conduction ABR threshold（ Kappa = 0. 453 ,P < 0. 001 ）, the latency of ABR wave Ⅰ （ Kappa = 0. 430, P < 0. 001 ）, the threshold of 40 Hz-AERP （ Kappa = 0. 582, P < 0. 001 ）, and DPOAE （ Kappa = 0. 495, P < 0. 001 ） had agreement with the results of temporal bone CT on evaluating the function of middle ear. Univariate analysis indicated that sensitive factors of middle ear function in newborn infants were tympanometry with 1000 Hz probe tone （P < 0. 001 ）, ART （P < 0. 001 ）, the air-conduction ABR threshold （P <0. 001 ）, the difference between air-conduction and bone-conduction ABR thresholds（ P < 0. 001 ）, the latency of ABR wave Ⅰ （P < 0. 001 ）, the threshold of 40 Hz-AERP（P < 0. 001 ） and DPOAE （ P < 0. 001 ）. And multivariate conditional Logistic stepwise regression model showed that tympanometry with 1000 Hz probe tone（P < 0. 001 ） and 40 Hz-AERP threshold （ P = 0. 004） can be substituted into Logistic stepwise regression equation. Conclusion Tympanometry with 1000 Hz probe tone and are sensitive factors to find out OME in newborn infants. The air conduction ABR threshold, ABR wave Ⅰ latency, 40 Hz-AERP threshold and DPOAE could reflect the middle ear function of newborn infants effectively.

Key words: 
Otitis media with effusion; Infant; Acoustic impedance tests; Evoked potentials, auditory,brain stem; Tomography,X-ray computed

Comparison of sensitivity of audiological tests to identify otitis media with effusion in newborn infants

Objective
The presnt study was to evaluate the audiological characteristics of infants with normal auditory brainstem response thresholds in click and abnormal transiently evoked otoacoustic emissions. Relationships between test results of distortion product otoacoustic emissions（DPOAE） and other hearing testing methods were also evaluated. 


Methods
The participants consisted of eighty-nine infants, with a total of 123 ears. All participants' TEOAE screening results were abnormal but diagnostic click ABR results were normal. The participants were classified into the following groups based on the test results from distortion product otoacoustic emissions： group A （normal all-frequency）, group B （abnormal lowfrequency）, group C （abnormal high-frequency ）, and group D （abnormal all-frequency）. Results Obtained from these groups were compared to results of other hearing tests including the latency of ABR waveI , 40 Hz auditory event related potential （40 Hz AERP）, 226 Hz and 1000 Hz tympanometry, and acoustic reflex. 


Results
In six hearing tests in the 123 ears, seven ears （5.7%） were normal, while 116 ears （94.3%） were abnormal. No significantly differences were detected between boys （93.9%） and girls （95.1%）, as well as between left （93.1%） and right ears （95.4%）. The proportion of abnormal test results ranked as follows：59 ears in group D （48.0%）, 34 ears in group B （27.6%）, 20 ears in group A （16. 3% ）, and 10 ears in group C （8. 2% ）. The highest abnormal rates in groups A, B and D were acoustic reflex, which were 40.0% for group A, 55.9% for group B and 66. 1% for group D respectively. The highest abnormal rate in group C was the latency of ABR wave I （50.0%）. Distribution of low- frequency hearing loss in each group was mainly mild. However, one ear in group B was moderate hearing loss, six ears in group D were moderate hearing loss, and one ear in group D was severe hearing toss. 


Conclusions
The present study showed that, of which infants with normal thresholds of ABR failed the hearing screening, comprehensively audiology assessment is needed. And of which infants with normal DPOAE in full frequency or abnormal in high frequency region or low frequency region need to be followed up.


Key words: 
Neonatal screening; Hearing tests; Evoked potentials, auditory, brain stem; Otoacoustic emissions, spontaneous

Xiao-qing Tang

Papers

Analysis of the found age and way for children age 0 to 6 with hearing loss

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

Comparison of sensitivity of audiological tests to identify otitis media with effusion in newborn infants

[Audiology characteristics in newborns and infants who failed in the hearing screening by transiently evoked otoacoustic emissions: 89 cases study].