Titel

1
Why early identification of HL ?
Early intervention is possible only after early
identification Early intervention allows more
effective habilitation of HL
2
Methods of early identification

• Screening
• High level of suscpicion
• Continuous education of health care professionals
• Increasing public awareness

3
Screening

• Specific medical intervention
• Aim Detection of disease or disability earlier
  that without screening
• More effective intervention after screening than
  without screening

4
Screening

• Population
• Screening primarily healthy population
• Diagnostic disease suspected
• Ratio of benefit to risks must be judged
  differently
• Usually no quantifying results

5
Screening
screening test

fail
pass
inefficient screening
disease present
disease not present
disease present
disease not present
6
Screening
assessment of hearing (Audiometry)

• Methods
• subjective
• objective

• Clinical use
• screening
• diagnosis
• quantification

7
Screening
Test OAE or AEP

fail
pass
inefficient screening
disease present
disease not present
disease present
disease not present
8
TEOAE always present
TEOAE always missing
9
TEOAE
TEOAE missing
10
Number of ears with severe SNHL
n36 Passcriteria SNR ? 5 dB in parenthesis ?
7dB
Pass rates in a test cavity DPOAE measurements
(n96) L1 65 / L2 55 dB SPL
11
DPOAE
12
CEOAEs stimulus level 90 dB SPL peak
CEOAEs stimulus level 83 dB SPL peak
13
OAE Screening
OAE present!
no OAE
no OAE
no OAE
14
Use of OAE Screening

• Global screening of peripheral hearing function
• No screening of neural function
• Newborn hearing screening

15
screening for HL neonates

fail
pass
inefficient screening
disease present
disease not present
disease present
disease not present
true pos.
false pos.
false neg.
true neg.
1-3/1000
1-3
?
97-99
16
Neonatal hearing screening inSwitzerland

• 2. - 4. day
• Aim covering all birth
• Organization and supervision pediatricians
• Measurements nurses, midwifes
• Follow up pedaudiological services of otology
  departments

17
Neonatal hearing screening inSwitzerland

• TEOAEs on day 2 - 4 1 ear pass screening
  passed
• Fail on both sides TEOAEs repeated before
  discharge
• Second fail pedaudiological examination 4 weeks
  later (appointment at discharge)
• Pedaudiological examination OAE measurements, if
  failed again ? AEP in natural sleep

18
Neonatal hearing screening inSwitzerland
Veraguth, Pieren, Schmid, Vischer, 2004
132 obstetric departments 3/4 with neonatal
hearing screening
19
Neonatal hearing screening inSwitzerland
Veraguth, Pieren, Schmid, Vischer, 2004
Births per year and NNH-screening
20
Neonatal hearing screening inSwitzerland
Veraguth, Pieren, Schmid, Vischer, 2004
1999-2003 50000 births 98.5 pass, 1.5 fail
21
Neonatal hearing screening inSwitzerland
Veraguth, Pieren, Schmid, Vischer, 2004
Follow up of 751 fails 1 in 1000 baby with HL
identified
22
Diagnosis of HL

• Type of hearing loss
• Conductive
• Sensorineural cochlear?
• Etiology of HL
• Degree of HL (audiometry)
• Degree of disability
• other handicaps
• Psychosocial background