Community based universal neonatal hearing screening by health visitors using otoacoustic emissions

Objectives-To carry out a pilot study to test the feasibility of health vis itors (HVs) performing neonatal otoacoustic emissions (OAE) hearing screeni ng in the community using Echoport ILO288 and to evaluate its acceptability to parents and HVs. Design-Prospective cohort study. Setting-Local health centres and babies' homes in urban and rural settings in West Gloucestershire. Participants-Twelve HVs, 683 babies, and their parents. Main outcome measures-Coverage rate, age at testing, referral rate for form al audiology testing, and parental anxiety scores. Results-Of the 683 babies registered with the study HVs, 99% (675) were tes ted, with a median age at first test of 18 days. Parental consent for the s tudy 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 b y 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 hearin g loss on brain stem auditory evoked responses, giving a false positive rat e of 1.7% (12/675). Some 18% (120/675) were tested at home, of which 80% (9 6/120) 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 (pos sible range 0-5) were 0.86, 2.27, and 3.45 before the first test, first ret est, and audiology test respectively. The median time taken for one HV to c omplete testing was 12.2 minutes (range 3-65), compared with the 15 minutes currently allocated for two HVs to perform distraction testing. Based on t he results of questionnaires, the test was very well received by parents an d HIVs alike. Conclusion-HVs are able to perform OAE testing in the neonatal period at ho me and in local health centre clinics. They achieve high population coverag e rates and low false positive rates. Universal neonatal hearing screening by HVs using OAE testing is feasible, well received, and could be less dema nding of HV time than the current distraction testing. This model of univer sal neonatal hearing screening should be considered by the National Screeni ng Committee.