I. Definition

  1. Newborn Hearing Screening

II. Types: Screening

  1. Automated Auditory Brainstem Response (ABR)
    1. Tests auditory path from ear canal to low Brainstem
    2. Headphones on newborn's ears emit soft clicks
    3. Forehead,neck electrodes measure brain wave response
    4. Computer interpretation results in pass or fail/refer
  2. Transient Evoked Otoacoustic Emissions (OAE or TEOAE)
    1. Tests peripheral auditory system (esp. Cochlea)
    2. Headphones on newborn's ears emit soft clicks
    3. Microphone in ear canal measures Cochlear response
      1. Cochlea hair cells generate echo response to sound
    4. Computer interpretation results in pass or fail/refer

III. Epidemiology: Incidence of Newborn SNHL in United States

  1. Incidence: 5000 infants per year in U.S.
  2. Prevalence: 1 to 3 per 1,000 U.S. newborns

IV. Protocol: Initial Testing

  1. Test all newborns meeting testing criteria
    1. See Indications below
    2. Thirty states in U.S. require universal screening
  2. Two-stage testing at birth hospitalization
    1. ABR or OAE repeated twice
  3. Repeat failed tests 2 to 8 weeks after initial testing

V. Protocol: Subsequent Testing

  1. Low-risk children: Hearing screening pre-kindergarten
  2. High-risk children (See Risk Factors below)
    1. Repeat Hearing Testing every 6 months until age 3

VI. Efficacy: ABR or OAE

VII. Indications for ABR or OAE testing

  1. Neonatal Intensive Care Unit Admission for 2 days
  2. Family History of Hearing Loss
  3. Hyperbilirubinemia requiring Exchange Transfusion
  4. Birth Weight <1500 grams
  5. Bacterial Meningitis
  6. Severe perinatal distress
    1. Low APGAR Scores
      1. Five minute APGAR: <3
      2. Ten minute APGAR: <7
    2. Perinatal Seizures
  7. Congenital infections
    1. Cytomegalovirus
    2. Toxoplasmosis
    3. Bacterial Meningitis
    4. Syphilis
    5. Rubella
    6. Herpes Simplex Virus
  8. Anatomic abnormalities of the head, ear, or Palate
    1. Iris heterochromia
    2. Ear or auricle malformation (e.g. Skin Tag, dimple)
    3. Cleft Lip or Palate
    4. Tympanic Membrane abnormality
    5. Asymmetric facial features
    6. Microcephaly
  9. Syndrome associated with Hearing Loss
    1. Usher's Syndrome
    2. Waardenburg's Syndrome (Hypertelorism, pigmentation)
    3. Down Syndrome
    4. Neurodegenerative Disorder (e.g. Hunter syndrome)
    5. Demyelinating disease (e.g. Charcot-Marie-Tooth)
  10. Persistent Pulmonary Hypertension
  11. Ototoxic Medication exposure
    1. Prolonged Diuretics with Lasix
    2. Excessive Aminoglycoside (e.g. Gentamicin) exposure
      1. Prolonged use >5 days or elevated serum levels
      2. Combined with Lasix for more than 5 days
    3. Excessive Vancomycin exposure
      1. Prolonged use or elevated serum levels
  12. Hyperventilation to pH >7.55 for more than 12 hours
  13. Clinical suspicion of Hearing Loss
  14. Maternal Cocaine abuse or Alcohol Abuse

VIII. Resources

  1. USPSTF Guide to Clinical Preventive Task Force
    1. http://www.ahrq.gov/clinic/uspstfix.htm
  2. National Center on Birth Defects
    1. http://www.cdc.gov/ncbddd
  3. National Institute on Deafness
    1. http://www.nidcd.nih.gov/health/hearing
  4. National Dissemination Center Children with Disability
    1. http://www.nichcy.org

Images: Related links to external sites (from Google)

Ontology: Auditory brainstem electric response audiometry (C0430666)

Concepts Diagnostic Procedure (T060)
ICD10 96173-00
SnomedCT 171934002, 252616000
English ABR-Aud brainstem resp audiom, Aud brainstem elec resp audiom, BSER-Brainst elec resp audiom, BSER-Brainst evok resp audiom, BSERA-Brainst evok resp audgrm, Electric auditory brainstem response audiometry, ABR - Auditory brainstem response audiometry, Auditory brainstem electric response audiometry, BSER - Brainstem electric response audiometry, BSER - Brainstem evoked response audiometry, BSERA - Brainstem evoked response audiogram, Auditory brainstem electric response audiometry (procedure)
Spanish Auditory brainstem electric response audiometry, audiometría de respuesta eléctrica del tronco encefálico (procedimiento), audiometría de respuesta eléctrica del tronco encefálico

Ontology: Oto-acoustic emission test (C0430673)

Concepts Diagnostic Procedure (T060)
SnomedCT 252623004
English OAE-Otoacoustic emission test, Oto-acoustic emission test, OAE - Oto-acoustic emission test, Oto-acoustic emission test (procedure), Otoacoustic emissions test
Italian Test otoacustico di emissioni
Japanese 耳音響放射検査, ジオンキョウホウシャケンサ
Czech Test otoakustické emise
Hungarian Otoakusztikus emmisszió viszgálat
Spanish prueba de emisión otoacústica (procedimiento), prueba de emisión otoacústica, Audiometría tonal
Dutch oto-akoestische emissietest
French Test d'émissions otoacoustiques
Portuguese Audiometria tonal
German otoakustischer Emissionstest

Ontology: infant screening for hearing loss (C2049698)

Concepts Finding (T033)
English infant screening for hearing loss, infant screening for hearing loss (physical finding)