Screening strategies for neonatal hearing loss: Which test is best?

Objective: The objective of this study was to evaluate the accuracy and cos t effectiveness of three different methods of hearing screening in newborns . Design: A prospective, randomized cohort design was used. One hundred and f ive newborns were tested in this preliminary study. Setting: The study was conducted in a tertiary care hospital setting in bot h the well baby and special care nurseries. Methods: Consenting subjects had their hearing tested using automated audit ory brainstem response (AABR), distortion-product otoacoustic emissions, an d click-evoked otoacoustic emissions. The time to perform the tests was rec orded and the cost of each test was calculated. Main Outcome Measures: The main outcomes measured were the time taken to pe rform each rest, the pass/fail rate for each test, and the estimated cost o f the tests. Results: In this small cohort of patients, we found that AABR was the most accurate test, but it took longer to perform and was more expensive than ei ther of the otoacoustic emission rests. However, the sensitivity and specif icity of otoacoustic emissions were less than that of AABR. Test time decre ased as the examiner gained experience, and we anticipate that experience w ill also result in better accuracy for the otoacoustic emission tests. Conclusions: Hearing screening in a hospital-based newborn population is bo th feasible and cost effective. Although AABR was more expensive, its bette r accuracy must be considered. As technology improves, the cost of all thre e tests will diminish. More robust conclusions cannot be made based on this small patient population.