UNHS (UNIVERSAL NEONATAL HEARING

SCREENING)

Dr. Ghulam SaqulainM.B.B.S., D.L.O, F.C.P.S

Head of Department of E.N.TCapital Hospital

Hearing ScreeningThe early detection and confirmation of deafness in babies

is vital b/c it enables earlier intervention and professional support for very young deaf children and their families, in particular it enables families and professionals to work together with the child before a substantial language and communication deficit builds up.

Hearing screening for newborns before they leave the hospital or maternity center is now becoming a common practice . Without such programs, the average age of hearing loss identification is between 12 to 25 months and even later in underdeveloped countries

UNHS can detect deafness within 48 hrs of child birth.An evidence consensus is developing in the world of

paediatric audiology that Universal Neonatal hearing Screening (UNHS) is a suitable, feasible and acceptable cost-effective strategy for early detection of permanent childhood hearing impairment (PCHI)

Should we screen the high risk infants only?In Most studies 50 hearing imp. per 100000

“Low Risk Infants”Thus a equitable solution is required.

Universal Neonatal Screening

Who Should be Screened?

Which Screening Test

Currently, acceptable methodologies for physiologic screening include evoked otoacoustic emissions and auditory brainstem response, either alone or in combination.

Transient evoked otoacoustic emissions (TEOAE) and the automated auditory brainstem response (AABR) have been tested in several UNS programs in developed countries.

Both tests have their own drawbacks and advantages:

TEOAETEOAE, also known as cochlear echoes, are low intensity

sounds originating from the outer hair cells in the cochlea and can be elicited in response to click presented to the ear through a light weight probe

This detection by a microphone within the same probe is a simple and rapid clinical test for the normal functioning of the middle and inner ear.

TEOAE testing is quick, sensitive to cochlear pathology and involves only a small probe in the outer ear, which makes it very acceptable to parents and babies.

Some 2 to 3.6% screen positive.

ABRABR is an electrical response to auditory stimuli which

is usually recorded with three surface scalp electrodes.It is well established to measure function of eighth

cranial nerve and auditory pathway in the brainstem.So it is potentially sensitive to auditory neuropathy

(accounting for 1.8% of PCHI) and equally rare central deafness which are not target of screen.

Some 3.1 to 4 % screen positive.

ESSENTIAL ELEMENTS TO AN EFFECTIVE UNHSP

Intervention

Identification

Tracking and follow-

up

Initial ScreeningEvaluation

UNHSP

Summary Based on consensus statement of strong research evidence, UNHS

should be performed for all newborns before 1 month of age and abnormal test results confirmed by full audiology evaluation by 3 months of age.

Based on some research evidence, children enrolled in EHDI programs perform significantly better than their later-detected peers on tests of vocabulary skills and intellectual development, to the point of approaching children whose auditory capacity is normal.

Based on strong research evidence, the most important risk factors for SNHL in the first 28 days after birth are low Apgar scores, positive family history, in utero infections, hyperbilirubinemia at levels requiring exchange transfusion, respiratory distress, prolonged mechanical ventilation, and symptoms indicative of syndromic hearing loss.

Universal Newborn HearingScreening (UNHS)

Screen babies before 1 month of ageDiagnose HL by 3 months of ageAppropriate intervention by 6 mos.Culturally-competent family supportAll newborns have “medical home”