Hearing screening may not detect all infants with hearing loss

1. In this study, many infants who failed otoacoustic emission (OAE) screening but subsequently passed auditory brainstem response (ABR) screening were ultimately diagnosed with hearing loss

Evidence Rating Level: 2 (Good)   

Study Rundown: For prompt hearing loss detection, many countries now mandate newborn hearing screening. Most use a 2-stage system of OAE followed by ABR for infants who fail OAE or are at high risk for hearing loss. Failing OAE but passing ABR is generally not felt to require further follow-up. This use of the second stage automated ABR is an attempt to minimize the number of unnecessary referrals for formal testing.

In the current study, examiners followed a cohort of neonates receiving 2-stage hearing screening. All neonates who failed OAE or were admitted to the NICU for more than 5 days received an automated ABR. Furthermore, all those failing OAE regardless of automated ABR results were referred for formal diagnostic ABR. A quarter of infants who failed OAE but passed automated ABR were subsequently diagnosed with hearing loss using diagnostic ABR, accounting for half of all diagnosed cases of hearing loss.

The study is limited by the examination of only infants at a single center and the lack of comparison between different automated ABR machines. In addition, follow-up was not completed in all cases. Despite these limitations, results do suggest caution be used in the interpretation of normal hearing screens, especially in high-risk infants.

Click to read the study, published today in Pediatrics

Relevant Reading: Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs

In-Depth [prospective cohort]: This study included 17 078 infants born between January 2013 and June 2014 in Tel Aviv who underwent newborn hearing screening. A total of 133 infants failed OAE, of which 90 passed automated ABR. Twenty-two of those 90 (24%) who failed of OAE but passed subsequent ABR tests were later diagnosed with hearing loss, comprising 52% of all infants in the cohort diagnosed with hearing loss. In addition, moderate to profound hearing loss (>45 dB) was diagnosed in 8 out of the 22 (36%). Two infants who passed both OAE and ABR screening were diagnosed with auditory neuropathy; these infants had been referred for further testing because of a prolonged NICU stay. Follow-up was completed in 71% of cases.

Image: PD

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