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INFANT HEARING IMPAIRMENT SCREENING WITH TEOAE TECHNOLOGY

This article was originally published in The Gray Sheet

Executive Summary

INFANT HEARING IMPAIRMENT SCREENING WITH TEOAE TECHNOLOGY should be conducted on all newborns within the first three months of life, a National Institutes of Health panel recommended March 3 at the conclusion of a three-day consensus development conference. The sole supplier of transient evoked otoacoustic emissions (TEOAE) technology in the U.S. is Otodynamics, which markets the devices under the Analyzer brand name. The panel says in its consensus statement: "In order to detect those children born with moderate, severe and profound hearing impairment, we recommend universal newborn screening by three months." The panel added that "because of the accessibility of babies in the newborn nursery, such screening is best accomplished prior to hospital discharge." Between 3% and 10% of the newborn population in the U.S. currently is screened, according to Thomas Mahoney, director of the Bureau of Communicative Disorders at the Utah State Department of Health, who was a speaker at the conference. The panel suggests that a two-stage procedure for testing newborns will produce optimal results. During the first stage, TEOAE testing would be used with the objective of eliminating "all babies with normal hearing sensitivity." The test has approximately a 90% accuracy rate, according to Otodynamics. The panel recommends subsequent testing with auditory brainstem response (ABR) audiometry if TEOAE evaluation finds that the infant's hearing loss is greater than a predetermined failure rate. Otodynamics introduced the Analyzer in 1989. The Analyzer is a noninvasive device used to examine the function and the integrity of the cochlea. A probe with two transducers that is placed in the ear measures the cochlear response to instant broad band pulses emitted by the device. The test usually is administered for approximately $25, and TEOAEs can be detected in both ears in under five minutes. ABR audiometry has been the standard objective test to determine hearing loss for the past twenty years. Due to the expense of ABR ($75-$100 per screening) and the skilled interpretation required if the test is not automated, only infants identified as high-risk for hearing impairment currently are routinely tested. Although automated ABR has been developed, "false positives" associated with ABR coupled with its high cost makes the method impractical for widespread screening, the panel states. The panel also recommends that all children recovering from bacterial meningitis be referred for diagnostic audilogic assessment and that parental concern about hearing should be a sufficient reason for initiating a formal hearing evaluation.
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