Community based universal neonatal hearing screening by health visitors using otoacoustic emissions
M Owena c, M Webba, K Evansb
a Department of
Paediatrics, Gloucestershire Royal NHST, Great Western Road, Gloucester
GL1 3NN, UK, b ENT Department, Gloucestershire Royal NHST, c Department of Community
Paediatrics, Severn NHS Trust, Rikenel, Montpellier, Gloucester
GL1 1LY, UK
Correspondence to: Dr Owen, Department of Paediatrics, Gloucestershire Royal NHST, Great Western Road, Gloucester GL1 3NN, UK Roger.owen1{at}virgin.net
Accepted 9 October
2000
OBJECTIVES
To carry
out a pilot study to test the feasibility of health visitors (HVs)
performing neonatal otoacoustic emissions (OAE) hearing screening in
the community using Echoport ILO288 and to evaluate its acceptability
to parents and HVs.
DESIGNProspective
cohort study.
SETTINGLocal health centres and babies' homes in urban and
rural settings in West Gloucestershire.
PARTICIPANTSTwelve
HVs, 683 babies, and their parents.
MAIN OUTCOME
MEASURESCoverage rate, age at testing, referral
rate for formal audiology testing, and parental anxiety scores.
RESULTSOf the 683 babies registered with the study HVs, 99% (675) were tested, with a
median age at first test of 18 days. Parental consent for the study was
refused for six of the eight not tested. Taking a unilateral pass as a
screening pass (for comparison with other studies), 4% (27/675) failed
the first OAE test, and 1.9% (13/675) failed a second OAE test
performed by the HV within a further two weeks and were referred for
formal audiology testing. One baby (0.15%) was found to have a
moderate sensorineural hearing loss on brain stem auditory evoked
responses, giving a false positive rate of 1.7% (12/675). Some 18%
(120/675) were tested at home, of which 80% (96/120) were combined
with another planned reason for HV contact. In all, 82% (555/675) of
tests were carried out in health centre clinics, of which 47%
(260/555) were combined purpose visits. Mean parental anxiety scores
(possible range 0-5) were 0.86, 2.27, and 3.45 before the first test,
first retest, and audiology test respectively. The median time taken
for one HV to complete testing was 12.2 minutes (range 3-65), compared with the 15 minutes currently allocated for two HVs to perform distraction testing. Based on the results of questionnaires, the test
was very well received by parents and HVs alike.
CONCLUSIONHVs are
able to perform OAE testing in the neonatal period at home and in local
health centre clinics. They achieve high population coverage rates and
low false positive rates. Universal neonatal hearing screening by HVs
using OAE testing is feasible, well received, and could be less
demanding of HV time than the current distraction testing. This model
of universal neonatal hearing screening should be considered by the
National Screening Committee.
Keywords: hearing; screening; health visitors; otoacoustic emissions
© 2001 by Archives of Disease in Childhood
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