NEW BORN HEARING SCREENING

HEARING LOSS

Incidence
Over all: 1-3 per 1000 live births

In NICU: 2-4 per 100 NICU Graduates.

 Etiology
1. Genetic
A) mutation in connexin 26

B) As part of syndromes
- alport syndrome
- wardenberg syndrome
- pendred syndrome
- usher syndrome
2. Non genetic
- secondary to injury to developing auditory system
- infection , hypoxia, ischemia, oto toxic medication,
hyperbilirubinemia, metabolic disease.

,
 THE HIGH RISK REGISTER

 Family history of hereditary childhood sensorineural

hearing loss.
 TORCH infections.
 Craniofacial anomalies.
 Low birth weight.
 Hyperbilirubinaemia at the level of exchange
transfusion.
 Bacterial Meningitis.
 Ototoxic medications.
 Mechanical ventilation for more than 5 days.
 Syndromes known to include conductive or
sensorineural hearing loss.
 SCREENING TESTS

1. AABR (automated auditory

brainstem response )

2. OAE (Oto acoustic emissions).

 BERA
Potentials recorded form ear
and vertex in response to brief auditory
stimulation to assess the conduction
through auditory pathway up to the
midbrain.
Waveform compononents.
waves generators
wave I -- viii nerve
wave II -- cochlear nucleus
wave III -- superior olivary n.
wave IV -- lateral leminiscus
wave V -- inferior coliculi

Auditory brainstem response evaluation

(sensitivity 90% Specificity 70-90%)
 Normal BERA
 classic baep consists of 5-8 vertex positive
peaks
 initial 5 are of clinical interest
 obligate BAEP waves are 1,3,5.
 2,4,6,7, can absent in some normal
subjects, but absence of any obligate wave

is abnormal.
Abnormal BERA
 Absolute latency interaural difference wave (IT5) –
prolonged
 I-V interpeak interval interaural difference-
prolonged
 Absolute latency of wave V- prolonged as compared to

normative
data.
Absolute latencies and interpeak intervals latencies I-
III, I-V, III-V- prolonged as compared to normative

data
 Absent auditory brainstem response in involved ear.
 Recording electrodes
V

E1 E2
NEONATAL NEUROLOGICAL DISEASE AND PROBABLE
REGION OF INVOLVEMENT

HIE Cochlea, cochlear nucleus, inf.

Colliculus.
Hyperbilirubine Cochlear nucleus, inf. Colliculus, +/-
mia 8th N. and cochlea
Meningitis 8th N.

Congenital viral 8th N. , cochlea.

infection
ICH Cochlea.
 OAE
 sounds which arise in the ear canal when
(paradoxical) the TM received vibration
transmitted backwards through the middle
ear from the cochlea.

 first measurement reported in 1978 by David

Kemp from the institute for laryngologist
and otology
 The 4 types of otoacostic emission
are as follows.
1. SOAEs (spontaneous otoacoustic emission) – sound emitted
without an acoustic stimulation.

2. TOAEs (transient otoacoustic emission) - sound emitted in

response to an acoustic stimuli of very short duration,
usually clicks but can be tone bursts.

3. DPOAEs (distortion product otoacoustic emission)- sound

emitted in response to 2 simultaneous tones of different
frequencies.

4. SFOAEs sustain-frequency otoacoustic emission)- sound

emitted in response to a continuous tone.
Cont……

For infant hearing screening both

DPOAEs and TOAEs used.

RECORDING
-- insert a soft probe tip in the ear canal

to obtain a hermetic seal, similarly to

immittamse audiometry.
 FACTORS THAT CAN BE AFFECT
OTOACOUSTIC EMISSIONS
 poor probe tip placement or poor seal.

Cerumen occluding the canal or blocking a probe part

Vernix caseosa in neonates

Debris and foreign body in outer ear canal

Uncooperative patients
 OAE vs BERA
 more easy to perform
 rapid 2-10 min. vs 1.5 hrs for ABR
 less expensive

sensitivity Specificity

BERA 97-100% 86-96%

OAE 84% 92%

 NEWBORN HEARING SCREENING
EFFICACY OF EARLY IDENTIFICATION AND
INTERVENTION.
-The implementation of universal screening programmed

has caused the definition of early identifation as early

as 3 months with intervention by 6 months.
- Diagnostic OAE and ABR testing is recommended for
any infant who does not pass the second screening
session. Both tests are necessary to differentially
diagnose
Auditory an infant’s
structure hearing impairment.
OAEs BERA
Outer ear Yes yes
Middle ear Yes Yes
Inner ear Yes Yes
Auditory nerve No Yes
Auditory Brainstem No Yes
 Flow chart for infant with
hearing loss
(failed screening for BERA,OAE)

Repeat after 2 wks

normal Diminished hearing

Cont…
 Mild, mod, deafness Mod, sev, to profound
deafness

H . Aid/ speech therapy h. Aid speech therapy

Aided audiometry and h. aid

Rpt. Test 3 months, exclude

progressive hearing loss.

Inadequate help Adequate help – cont. re-hab.

Cochlear implants
THANK YOU