Why does preschool hearing screening play an important role in identifying hearing loss? Don't we already have newborn hearing screening?

These are actually two completely different hearing screening programs. UNHS(universal Newborn Hearing Screening) has been carried out in the United States for nearly twenty years. The earliest appearance of newborn hearing screening can be traced back to the 1980s. The technical development of automatic auditory brainstem response (ABR) and otoacoustic emission (OAE) also laid the foundation for the popularization of newborn hearing screening. Many studies have shown that early intervention has a great positive effect on permanent hearing loss.

I thought newborn hearing screening could detect all children with hearing loss.

Unfortunately, in fact, even in the United States, not all children with hearing loss can get standard early intervention. Not every region can follow the principle of "1.3.6" for continuous hearing screening, but there must be many other reasons why newborn hearing screening cannot cover all children with hearing loss. The principle of 1.3.6 is that all newborns should be screened for hearing within one month after birth. If they fail, they should have a detailed hearing examination within three months. If children are determined to have hearing problems, they should take hearing intervention measures within six months.

Neonatal hearing screening is indeed a good procedure, but still not all children with hearing loss can be found. In the United States, for example, for various reasons, less than 5% of newborns are not screened for hearing. The main reasons are: parents refused to conduct newborn hearing screening, the hospital was negligent, and the newborn was transferred to other places before the screening was completed; Another common reason is that some newborns are born at home, which is increasing year by year. Although the proportion of missing newborn hearing screening is very small, the number of children born every year is very large, and even a small proportion of children who may cause a lot of hearing loss are not found in time.

Even those children who failed to pass the normal newborn hearing screening, some of them failed to have a hearing review after 3 months or to have a hearing intervention within 6 months. There are also some children who passed the neonatal screening at birth, but later suffered from hearing loss.

Fortnum and his colleagues (200 1) pointed out that the number of children with hearing loss after birth is also very large. About 50% of the 9-year-old children with hearing loss he investigated passed the newborn hearing screening that year. Studies by Bamford and his colleagues (Bamford et al., 2007) and White (2007) also show that the incidence of hearing loss in school-age children is about 6- 10/ 1000, while that in newborns is 3-1000. However, Grote (2000) shows that the American neonatal hearing screening program may fail to detect 10% to 20% of infants with hearing loss. Therefore, even babies who pass the newborn hearing screening cannot guarantee that there will be no possibility of hearing loss.

There are many factors that may lead to hearing loss after birth. Joint Committee on Infant Hearing (JCIH) stated (JCIH, 2007) that both progressive and delayed hearing loss may occur in children. Possible causes include family genetic history, intensive care for more than 5 days after birth, pregnancy or postpartum infection, some nervous system diseases, head injury, medication and other syndromes. After newborn hearing screening, there is no prescribed hearing screening, which means that a large number of children with hearing loss cannot find and intervene hearing loss in the first time.

Progressive hearing loss: it is pointed out that the hearing level is normal at birth, and then hearing gradually appears. Hearing loss can occur in one ear or both ears, and at first it can occur in high frequency loss or low frequency loss. Generally, it begins with mild hearing loss and gradually increases.

Delayed hearing loss: sudden hearing loss caused by hearing system dysfunction. It may be one ear, or it may be two ears.

As early as 1980s, there were guidelines for hearing screening for school-age children, and pure tone audiometry is one of the most recommended tests. The American Phonetic and Linguistic Hearing Association (Asha) put forward a detailed pure tone audiometric screening standard in the 64-page guide published in 1997. The listening results of the game at 1000, 2000 and 4000hz are less than 20 dB HL.

20 1 1 the American audiological association (AAA) recently released a guide for hearing screening for preschool children, which once again affirmed the importance of pure tone audiometry and pointed out that pure tone audiometry is the gold standard for hearing screening.

However, for those younger children, not everyone can complete the game or behavior test completely. Especially those children under 3 years old.

Halloran and pediatrician colleagues (Halloran, Wall, Evans, Harding and; Woolley, 2005) reflects the difficulties of pure tone audiometry in preschool children in practical situations. The article shows that only about 45% of children under 3 years old can complete the hearing screening, while 2/kloc-0 children with mild developmental retardation have successfully completed the pure tone audiometry, but the passing rate is only 67%. In other words, pure tone audiometry (behavioral audiometry and game audiometry) can really reflect children's listening condition, but for those children under 3 years old, the efficiency of pure tone audiometry is not high.

In addition, the environment requirements of pure tone audiometry are relatively high, and children's age, cognitive level and language ability will affect the real results of pure tone audiometry.

In the follow-up study, Halloran, Harding and Wall (2009) more directly pointed out the role of pure tone audiometry in preschool children's hearing screening. Research shows that pure tone audiometry is only 50% sensitive and 78% specific for preschool children.

Donna Halloran finally pointed out that although pure tone audiometry is the gold standard in audiology examination, other examinations, such as otoacoustic emission, should be taken as the main indicators to judge the screening results in preschool children's hearing screening.

Many studies on otoacoustic emission and preschool children's hearing screening show that otoacoustic emission has a high effect on hearing screening. (For example, Foster, Aizerman, Hisler and amp Jeroso, 2065438+03; Cressman, Bevilacqua, Dai, cressman, and. Hall, 20 13). As an objective examination, otoacoustic emission is not affected by behavioral factors such as age, cognitive status and language ability. The test does not need an absolutely quiet environment, and the whole test time is much shorter than pure tone audiometry.

Moreover, otoacoustic emission can also indicate the abnormality of hair cells in middle ear and cochlea (Dhar &; Hall, 20 12). And it is much easier to do otoacoustic emission test on preschool children than on infants.

There are three main differences between newborn hearing screening and preschool hearing screening, 1. Preschool children who have not passed otoacoustic emission should check tympanogram to find out whether there is any problem with middle ear function. If you have middle ear problems, it is recommended to seek medical advice immediately. 2. Follow-up examination of preschool children, it is recommended that children under 4 years old have acoustic reflex examination. Acoustic reflection test with broadband noise as stimulus sound. Broadband noise acoustic reflection can provide a quick and objective cue for those results with normal tympanogram (Hall, Berry &; Olson, 1982).3. Pure tone audiometry can be used for further examination for children over 4 years old who have not passed otoacoustic emission examination but have normal tympanogram. (Jaeger & Hayes,1976; Hall, 2016a; Hall, 20 16b)

Of course, if children can complete pure tone audiometry, pure tone audiometry is still the gold standard in audiology examination (Jin Wen et al., 20 14).

Summary:

At present, an unacceptable number of newborns have not received neonatal hearing screening, and there is no problem in the follow-up examination of those who fail neonatal screening. In addition, a large proportion of preschool hearing loss patients get hearing loss after neonatal screening. Therefore, it is very important and urgent to suggest a systematic hearing screening for preschool children. At present, otoacoustic emission examination may be one of the most effective audiological examinations in this age group.

refer to

American Audiology Association (AAA). (20 1 1). Clinical practice guide for children's hearing screening. Retrieve from www.audiology.org

American Audiology Association (AAA). (20 13). Clinical practice guidelines for pediatric amplification. Retrieve from www.audiology.org

American Academy of Pediatrics, Newborn and Infant Hearing Working Group. (1999). Hearing loss in newborns and infants: detection and intervention. Pediatrics,103,527–530.

American Speech Language Listening Association (ASHA). 1997。 A guide to hearing screening. Rockville, Maryland: ASHA.

Bamford, J., Fortnum, H., Bristow, K., Smith, J., Vamvakas, G., Davies, L ... Hinde, S.(2007). The current practice, accuracy, effectiveness and cost-effectiveness of entrance hearing screening. Health technology assessment, 1 1, 1- 168.

Dahl, S., & Hall, J.W. III. (20 12). otoacoustic emission: principles, procedures and. Agreement. Santiago: Pluralistic publishing.

Fortner, H.M., Sommerfield, A.Q., Marshall, D.H., Davis, A.C .j. m. bamford(200 1). Prevalence of hearing impairment in permanent children in Britain and its influence on newborn hearing screening: a definitive study based on questionnaire. British medical journal, 323, 536-554.

Foster, t, Aizerman, w, schler, l. Geroso，A.(20 13)。 Using otoacoustic emission to screen children's hearing loss in primary health care institutions. Pediatrics, 132( 1), 1 18-23. doi: 10. 1542/peds . 20 12-3868。

Gorga, M.P., Nelly, S.T., Allridge, B., Hoover, B., & Redna, J.( 1997). From laboratory to clinic: a large-scale study of distortion product otoacoustic emissions in normal hearing and hearing loss ears. Ears and ears. Listening,18,440-455.

Grotte, J.(2000). Neonatal hearing impairment screening. The Lancet, 355,513-514.

Hall, j.w. iii. (20 14) Introduction to audiology today. Boston: Pearson Education Company.

Hall, j.w. iii. (20 16a)。 Effective and efficient pre-school hearing screening: the key to successful early hearing testing and intervention (EHDI). Journal of Early Hearing Detection and Intervention, 1, 1- 12. doi: 10. 15 142/T3XW2F。 Retrieved from: mons.usu.edu/jehdi/vol1/ISS1/3/

Hall, j.w. iii. (20 16b)。 The principle of cross-examination in pediatric audiology: a 40-year prospect. Journal of audiology and otology, 20(2), 1-9.

Hall, j.w. iii. , Berry, G.A., & Olson, Kansas (1982). Identification of severe hearing loss by acoustic reflection data: clinical experience of some new guidelines. Scandinavian audiology, 1 1, 25 1-255.

Dr Halloran, Dr Wall, Dr Evans, Dr Harding, M. Woolley (2005). Hearing screening of healthy children during visiting. Archives of Pediatrics and Adolescent Medicine, 159( 10), 949-955. doi: 10. 100 1/arch pedi . 159. 10.949

Halloran, Ph.D., Harding, M.D. Wall (2009). Effectiveness of pure tone hearing screening for healthy children. Archives of Pediatric and Adolescent Medicine, 163(2), 158- 163. Doi:10.1001/Department of Pediatrics .2008.526.20010000000001

Joint committee on infant hearing. (2007). Position Statement of the Joint Committee on Infant Hearing in 2007: Principles and Guidelines for Early Hearing Testing and Intervention Program. Pediatrics,120,898-921.

J.j., J.F. Hayes, D.( 1976). Principles of cross-examination in pediatric audiometry. Archives of Otolaryngology,102,614-420.

Cressman, B.M., Bevilakwa, E., Dai, K., cressman, N.V., & Hall, J.W. III, (20 13). Preschool hearing screening: comparison between distortion product otoacoustic emission and pure tone protocol. Journal of Educational Audiology, 19, 49-57.

, Wei, Lu, Yun, Lin, Gan Yasheng, Tong, Meng Meifeng, Hong,&Hao Wei (20 14). A new hearing screening system for preschool children. International Journal of Pediatric Otolaryngology, 78,290-295.

K.R. White (2007). Early intervention for children with permanent hearing loss: ending the EHDI revolution. Comments by Walter, 106(3), 237-258.

The author introduces:

Cosmo, AIC, a lifelong hearing researcher, holds a bachelor's degree in audiology from Zhejiang University of Traditional Chinese Medicine and a master's degree in clinical audiology from Southampton University in the United Kingdom. He has worked in the PLA General Hospital (30 1 Hospital), Singapore Health connexion Farrer park and other domestic and foreign medical institutions. As an audiologist, I have experienced countless patients and provided professional audiological diagnosis and hearing aid (hearing aid and cochlear implant) fitting services for children and adults.

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