REVIEW PAPER
CONDUCTIVE HEARING LOSS WITHIN UNIVERSAL NEWBORN HEARING SCREENING PROGRAMS: A SYSTEMATIC REVIEW
Alison Collins 1, 2, A-F  
,   Rachael Beswick 2, A,D-E,   Carlie Driscoll 1, A,D-E,   Joseph Kei 1, E
 
More details
Hide details
1
Hearing Research Unit for Children, Division of Audiology, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia
2
Children’s Health Queensland Hospital and Health Service, Child and Youth Community Health Service, 10 Chapel Street, Nundah 4012, Queensland, Australia
A - Research concept and design; B - Collection and/or assembly of data; C - Data analysis and interpretation; D - Writing the article; E - Critical revision of the article; F - Final approval of article;
CORRESPONDING AUTHOR
Alison Collins   

Alison Collins, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia; email: s4222972@student.uq.edu.au, tel. +61 401 822 382
Publication date: 2020-04-07
 
J Hear Sci 2019;9(3):24–36
 
KEYWORDS
ABSTRACT
Background:
Universal Newborn Hearing Screening (UNHS) attempts to identify children with a permanent, bilateral, moderate or greater hearing loss at birth. However, children who are referred from UNHS programs may have conductive hearing loss (CHL), sensorineural, or mixed hearing loss. The aim of this review was to investigate the prevalence, sub-classifications, audiological diagnosis, and medical management of CHL within UNHS programs.

Material and Methods:
A systematic literature search was completed in the scientific databases PubMed, CINAHL, and Embase. Studies were reviewed with reference to the inclusion criteria, then graded to assess the internal and external validity, leaving 25 studies for review.

Results:
The prevalence of conductive hearing loss ranged from 0.4% to 64.5%. ‘Genetic’ and ‘Permanent’ were the only two sub-classifications of CHL identified, with no uniform terminology evident. Given CHL is not a target condition of UNHS, audiological assessment was consistent with the diagnosis of Permanent Childhood Hearing Loss (PCHL). There was little evidence of audiological review, onward referrals, or medical management for CHL within UNHS programs. Of the evidence obtained, no alternative pathway was found for children identified with CHL through UNHS.

Conclusions:
In view of the limited evidence for CHL within UNHS, further investigation into the prevalence, sub-classification, and appropriate management of CHL within a UNHS program is recommended to better guide evidence-based assessment and management of these children.

FUNDING
This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.
 
REFERENCES (73)
1.
American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 Position Statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 2007; 120(4): 898–921.
 
2.
Uus K, Bamford J. Effectiveness of population-based newborn hearing screening in England: ages of interventions and profile of cases. Pediatrics, 2006; 117(5): e887–93.
 
3.
O’Connor A, O’Sullivan PG, Behan L, Norman G, Murphy B. Initial results from the newborn hearing screening programme in Ireland. Ir J Med Sci, 2013; 182(4): 551–6.
 
4.
Spivak L, Sokol H, Auerbach C, Gershkovich S. Newborn hearing screening follow-up: factors affecting hearing aid fitting by 6 months of age. Am J Audiol, 2009; 18: 24–33.
 
5.
Tsui P, McPherson B, Wong E, Ng I. Infant hearing screening: effects of timeline. Clin Otolaryngol, 2008; 33: 108–12.
 
6.
Pereira P, Martins A, Vieira M, Azevedo M. Newborn hearing screening program: association between hearing loss and risk factors. Pró-Fono Revista de Atualização Científica, 2007; 19(2): 267–78.
 
7.
Mehl A, Thomson V. Newborn hearing screening: the great omission. Pediatrics, 1998; 101(1): 1–6.
 
8.
Nelson HD, Bougatsos C, Nygren P. Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation. Pediatrics, 2008; 122(1): e266–76.
 
9.
Yoshinaga-Itano C, Johnson CD, Carpenter K, Brown A. Outcomes of children with mild bilateral hearing loss and unilateral hearing loss. Sem Hear, 2008; 29(2): 196–211.
 
10.
McKay S, Gravel J, Tharpe M. Amplification considerations for children with minimal or mild bilateral hearing loss and unilateral hearing loss. Trends Amplif, 2008; 12(1): 43–54.
 
11.
Tharpe A, Bess F. Identification and management of children with minimal hearing loss. Int J Pediatr Otorhinolaryngol, 1991; 21: 41–50.
 
12.
Pichichero ME. Otitis media. Pediatr Clin North Am, 2013; 60(2): 391–407.
 
13.
Pereira P, Azevedo M, Testa J. Conductive impairment in newborn who failed the newborn hearing screening. Braz J Otorhinolaryngol, 2010; 76(3): 347–54.
 
14.
Taylor P, Michael I, Marks K et al. Cost of treating otitis media in Australia. Expert Rev Pharmacoeconomics Outcomes Res, 2009; 9(2): 133–41.
 
15.
Paradise JL, Feldman HM, Campbell TF et al. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. New Engl J Med, 2007; 356(3): 248–61.
 
16.
Golz A, Netzer A, Westerman ST, Westerman LM et al. Reading performance in children with otitis media. Otolaryngol Head Neck Surg, 2005; 132(3): 495–9.
 
17.
Gouma P, Mallis A, Daniilidis V, Gouveris H, Armenakis N, Naxakis S. Behavioral trends in young children with conductive hearing loss: a case-control study. Eur Arch Otorhinolaryngol, 2011; 268(1): 63–6.
 
18.
Raz Y. Conductive hearing loss. In: Alper CM, ed. Advanced Therapy of Otitis Media. PMPH, 2004.
 
19.
Musheer Hussain SS. Conductive Hearing Loss. Queen’s Medical Centre, Nottingham; 2008.
 
20.
Eggermont JJ. Types of Hearing Loss. Hearing loss causes, prevention and treatment. UK: Elsevier Ltd: Academic Press; 2017. p. 129–73.
 
21.
de Jong T, Toll MS, de Gier HHW, Mathijssen MJ. Audiological profile of children and young adults with syndromic and complex craniosynostosis. Arch Otolaryngol Head Neck Surg, 2011; 137(8): 775–8.
 
22.
Stewart R, Gallagher D, Leyden P. Diagnosis and management of conductive hearing loss in children with trisomy 21. J Paediatr Child Health, 2018; 54(11): 1242–5.
 
23.
Bevilacqua MC, Alvarenga Kde F, Costa OA, Moret AL. The universal newborn hearing screening in Brazil: from identification to intervention. Int J Pediatr Otorhinolaryngol, 2010; 74(5): 510–5.
 
24.
Aithal S, Aithal V, Kei J, Driscoll C. Conductive hearing loss and middle ear pathology in young infants referred through a newborn universal hearing screening program in Australia. J Am Acad Audiol, 2012; 23(9): 673–85.
 
25.
Wroblewska-Seniuk K, Dabrowski P, Greczka G, Szabatowska K, Glowacka A, Szyfter W, et al. Sensorineural and conductive hearing loss in infants diagnosed in the program of universal newborn hearing screening. Int J Pediatr Otorhinolaryngol, 2018; 105: 181–6.
 
26.
Tsui P, McPherson, B, Wong E, Ng I. Infant hearing screening: effects of timeline. Clin Otolaryngol, 2008; 33: 108–12.
 
27.
Boone RT, Bower CM, Martin PF. Failed newborn hearing screens as presentation for otitis media with effusion in the newborn population. Int J Pediatr Otorhinolaryngol, 2005; 69(3): 393–7.
 
28.
Ministry of Health. Universal Newborn Hearing Screening and Early Intervention Programme (UNHSEIP) 2017. Final report on the implementation of quality improvements. New Zealand: Ministry of Health; 2017. Available from: https://www.nsu.govt.nz/public....
 
29.
Holster IL, Hoeve LJ, Wieringa MH, Willis-Lorrier MS, de Gier HHW. Evaluation of hearing loss after failed neonatal hearing screening. J Pediatrics, 2009; 155(5): 646–50.
 
30.
Baldwin M. Choice of probe tone and classification of trace patterns in tympanometry undertaken in early infancy. Int J Audiol, 2006; 45(7): 417–27.
 
31.
Son EJ, Park YA, Kim JH, Hong SA, Lim HY, Choi JY et al. Classification of trace patterns of 226- and 1000-Hz tympanometry in healthy neonates. Auris Nasus Larynx, 2012; 39(5): 455–60.
 
32.
Aithal S, Kei J, Driscoll C, Khan A. Normative wideband reflectance measures in healthy neonates. Int J Pediatr Otorhinolaryngol, 2013; 77(1): 29–35.
 
33.
Prieve BA, Vander Werff KR, Preston JL, Georgantas L. Identification of conductive hearing loss in young infants using tympanometry and wideband reflectance. Ear Hear, 2013; 34: 168–78.
 
34.
Keefe DH, Sanford CA, Ellison JC, Fitzpatrick DF, Gorga MP. Wideband aural acoustic absorbance predicts conductive hearing loss in children. Int J Audiol, 2012; 51(12): 880–91.
 
35.
Roush J, Henderson F. Medical and audiological management of otitis media: consensus and controversy. Sem Hear, 1995;16(1): 105–12.
 
36.
Garnell J, Martin G. Early detection and intervention on infant hearing loss. In: Dupont JP, editor. Hearing Loss: Classification, causes and treatment. ProQuest Ebook Central: Nova Science Publishers, Inc.; 2011. p. 189–212.
 
37.
Women’s and Children’s Health Network. Universal Newborn Hearing Screening (UNHS) Program South Australia Protocol. South Australia: Children’s and Youth Health; 2016. Available from: http://www.cyh.com/SubContent.....
 
38.
Healthy Hearing Program. Audiology Diagnostic Assessment Protocol. Queensland: Children’s Health Queensland; 2016. Available from: https://www.childrens.health.q....
 
39.
Ontario Infant Hearing Program. Audiology Assessment Protocol. Version 3.1. Toronto; Otologic Function Unit: Mount Sinai Hospital; 2008. Available from: https://www.mountsinai.on.ca/c....
 
40.
Bower CM, St John R. The otolaryngologist’s role in newborn hearing screening and early intervention. Otolaryngol Clin North Am, 2014; 47(5): 631–49.
 
41.
Daudia A, Yelavich S, Dawes PJ. Long-term middle-ear ventilation with subannular tubes. J Laryngol Otol, 2010; 124(9): 945–9.
 
42.
Steele DW, Adam GP, Di M, Halladay CH, Balk EM, Trikalinos TA. Effectiveness of tympanostomy tubes for otitis media: a meta-analysis. Pediatrics, 2017; 139(6): 1–12.
 
43.
De Beer BA, Schilder AG, Ingels K, Snik AF, Zielhuis GA, Graamans K. Hearing loss in young adults who had ventilation tube insertion in childhood. Ann Otol Rhinol Laryngol, 2004; 113: 438–44.
 
44.
Dempster JH, Browning GG, Gatehouse SG. A randomized study of the surgical management of children with persistent otitis media with effusion associated with a hearing impairment. J Laryngol Otol, 2007; 107(04): 284–9.
 
45.
Paradise JL, Feldman HM, Campbell TF et al. Effect of early or delayed insertion of tympanostomy tubes for persistent otits media on developmental outcomes at the age of three years. The New England Journal of Medicine, 2001; 344(16): 1179–87.
 
46.
Windle PE. The systematic review process: an overview. J Perianesth Nurs. 2010; 25(1): 40–2.
 
47.
Meade MO, Richardson WS. Selecting and appraising studies for a systematic review. Annals of internal medicine, 1997; 127(7): 531–7.
 
48.
Jones T, Evans D. Conducting a systematic review. Australian Critical Care, 2000; 13(2): 66–71.
 
49.
Harris R, Helfand M, Woolf S et al. Current methods for the U.S. Preventive Services Task Force: A review of the process. Am J Prev Med, 2001; 20: 21–35.
 
50.
Beswick R, Driscoll C, Kei J. Monitoring for postnatal hearing loss using risk factors: A systematic literature review. Ear & Hearing, 2012; 33(6): 746–56.
 
51.
Ducat WH, Kumar S. A systematic review of professional supervision experiences and effects for allied health practitioners working in non-metropolitan health care settings. J Multidiscip Healthc, 2015; 8: 397–407.
 
52.
Letts L, Wilkins S, Law M, Stewart D, Bosch J, Westmorland M. Guidelines for critical review form: qualitative studies (version 2.0). McMaster University; 2007.
 
53.
Bielecki I, Horbulewicz A, Wolan T. Risk factors associated with hearing loss in infants: an analysis of 5282 referred neonates. Int J Pediatr Otorhinolaryngol, 2011; 75(7): 925–30.
 
54.
Jordan VA, Sidman JD. Hearing outcomes in children with cleft palate and referred newborn hearing screen. Laryngoscope, 2014; 124(9): E384–8.
 
55.
Liu Z, Liu L. Hearing screening and diagnosis in a large sample of infants in Central China. J Med Screen, 2013; 20(1): 21–6.
 
56.
Colella-Santos MF, Françozo M, do Couto CM, Lima M, Tazinazzio T, Castilho A, et al. Audiological and genetics studies in high-risk infants. Braz J Otorhinolaryngol, 2011; 77(6): 784–90.
 
57.
Karzon RK, Cho Lieu JE. Initial audiologic assessment of infants referred from well baby, special care, and neonatal intensive care unit nurseries. Am J Audiol, 2006; 15: 14–24.
 
58.
Colella-Santos MF, Hein TA, de Souza GL, do Amaral MI, Casali RL. Newborn hearing screening and early diagnostic in the NICU. Biomed Res Int, 2014; 2014: 845308.
 
59.
Doyle KJ, Rodgers P, Fujikawa S, Newman E. External and middle ear effects on infant hearing screening test results. Otolaryngol Head Neck Surg, 2000; 122(4): 477–81.
 
60.
Doyle KJ, Kong YY, Strobel K, Dallaire P, Ray RM. Neonatal middle ear effusion predicts chronic otitis media with effusion. Otol Neurotol, 2004; 25: 318–22.
 
61.
Chen SJ, Yang EY, Kwan ML, Chang P, Shiao AS, Lien CF. Infant hearing screening with an automated auditory brainstem response screener and the auditory brainstem response. Acta Paediatr, 1996; 85: 14–8.
 
62.
Mehl AL, Thomson V. The Colorado newborn hearing screening project, 1992–1999: on the threshold of effective population-based universal newborn hearing screening. Pediatrics, 2002; 109(1): E7.
 
63.
Lin HC, Shu MT, Lee KS et al. Comparison of hearing screening programs between one step with transient evoked otoacoustic emissions (TEOAE) and two steps with TEOAE and automated auditory brainstem response. Laryngoscope, 2005; 115(11): 1957–62.
 
64.
McPherson B, Smyth V. Hearing screening for school children with otitis media using otoacoustic emission measures. Asia Pacific Journal of Speech, Language and Hearing, 2013; 2(1): 69–82.
 
65.
Driscoll C, Kei J, Mcpherson B. Outcomes of transient evoked otoacoustic emission testing in 6-year-old school children: a comparison with pure tone screening and tympanometry. Int J Pediatr Otorhinolaryngol, 2001; 57: 67–76.
 
66.
Szabo C, Langevin K, Schoem S, Mabry K. Treatment of persistent middle ear effusion in cleft palate patients. Int J Pediatr Otorhinolaryngol, 2010; 74(8): 874–7.
 
67.
Cavalcanti H, Melo L, Buarque L, Guerra R. Overview of newborn hearing screening programs in Brazilian maternity hospitals. Braz J Otorhinolaryngol, 2014; 80(4):346–53.
 
68.
Gondim L, Balen S, Zimmermann K, Pagnossin D, Fialho I, Roggia S. Study of the prevalence of impaired hearing and its determinants in the city of Itajai, Santa Catarina State, Brazil. Braz J Otorhinolaryngol, 2012; 78(2): 27–34.
 
69.
Olzowy B, Deppe C, Arpornchayanon W, Canis M, Strieth S, Kummer P. Quantitative estimation of minor conductive hearing loss with distortion product otoacoustic emissions in the guinea pig. J Acoust Soc Am, 2010; 128(4): 1845–52.
 
70.
D’haenes W, Dhooge I, Maes L et al. The clinical value of the multiple frequency 80-Hz auditory steady-state response in adults with normal hearing and hearing loss. Arch Otolaryngol Head and Neck Surg, 2009; 135(5): 496–506.
 
71.
Friderichs N, Swanepoel DW, Hall J. Efficacy of a communitybased infant hearing screening program utilizing existing clinic personnel in Western Cape, South Africa. Int J Pediatr Otorhinolaryngol, 2012; 76: 552–9.
 
72.
Cox L, Toro M. Evolution of a universal infant hearing screening program in an inner city hospital. Int J Pediatr Otorhinolaryngol, 2001; 59: 99–104.
 
73.
Szyfter W, Wróbel M, Radziszewska-Konopka M, Szyfter-Harris J, Karlik M. Polish universal neonatal hearing screening program: 4 year experience (2003–2006). Int J Pediatr Otorhinolaryngol, 2008; 72: 1783–7.
 
eISSN:2084-3127
ISSN:2083-389X