Hearing loss in early childhood and infancy often goes undetected because it exhibits no obvious indication and symptoms. The primary aim of newborn hearing screening is to detect permanent hearing loss. Since otoacoustic emissions (OAE) and automated auditory brainstem response (AABR) are sensitive to hearing loss, they are often used as screening tools. On the other hand, these screening tests can be affected by transient outer ear and middle ear conditions that are often present at birth. This is an especially characteristic state of affairs for NICU neonates. These false positive results may render screening programmes inefficient and can lead to increased parental anxiety. Wideband acoustic immittance (WAI) has shown potential for accurate assessment of middle ear function in neonates, and is therefore recommended as an adjunct tool for newborn hearing screening programmes. The main aim of the study was to determine the feasibility of using WAI in NICU neonates in terms of tone and click stimuli. Testing was conducted in the NICU units of three private hospitals in Pretoria. As part of the selection criteria all the neonates had to pass both DPOAE and AABR screenings before they were included in the study. In total, 56 NICU infants (106 ears) with a gestation age of between 32 and 37 weeks and a mean gestational age of 35.6 weeks who passed both DPOAE and AABR hearing screens in one or both ears were selected. For WAI measurements there were two measurements, one for each channel in the probe (chirp and tone stimuli). Normative regions were defined across the wideband reflective spectrum for both tone and chirp stimuli and for integrated frequency ranges. The chirps and tone stimuli compared relatively well with each other at the 90th percentile with the same amount of reflectance across all frequencies. The median reflectance reached a minimum of 0.67 at 1-2 kHz but increased to 0.7 below 1 kHz and 0.72 above 2 kHz for the tone stimuli. For chirp stimuli the median reflectance reached a minimum of 0.51 at 1-2 kHz but increased to 0.68 below 1 kHz and decreased to 0.5 above 2 kHz. Results of this study identified WAI patterns that had not previously been reported in the literature. High reflective values were obtained across all frequency ranges, especially in the frequency ranges below 3 kHz and above 4 kHz. The age of the neonates when tested (mean gestational age 35.6 weeks, with a standard deviation of 1.6) might have influenced the results. The neonates in this study were of a very young age compared to the ages of the infants in previous studies on WAI. Environmental noise in NICU might have influenced the results. Additional research is required to investigate WAI testing in ears with and without dysfunction. / Dissertation (M Communication Pathology)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / M Communication Pathology / Unrestricted

Background: Distortion product otoacoustic emissions (DPOAEs) are a promising screening technique for the early detection of subtle noise induced cochlear function changes. Objectives: To determine the applicability of DPOAEs as a health surveillance technique for the early detection of noise induced hearing loss (NIHL) in workers at a steel manufacturing industry. Methods: DPOAEs were recorded in 20 participants with no history of occupational noise exposure and 20 participants exposed to noise in the steel manufacturing industry. Participants were not exposed to noise for at least 48 hours prior to testing. All participants were male with normal audiometric thresholds of ?15 dB HL. The DPOAE presence and response amplitude levels for different frequencies were compared between the two groups. The study further evaluated the short-term test-retest repeatability of DPOAE measurements, and also compared the total test duration of performing DPOAEs to the duration of screening audiometry. Results: The noise exposed group had statistically significantly lower DPOAE response amplitudes than the control group for all the tested frequencies; (p&#0600.001) at 2002 to 4004 Hz, and (p=0.01, p=0.001) at 6348 and 7996 Hz respectively, suggesting more cochlear damage in the noise exposed group due to early outer hair cell damage. DPOAEs showed very good reproducibility, and the average duration of performing a set of DPOAEs was significantly shorter (461 ± 68.2 seconds) than the duration of performing audiometry (591 ± 76.9 seconds), p&#0600.001. Conclusion: DPOAEs appeared to be a sensitive technique in detecting noise induced subtle cochlear function changes. DPOAEs could be used as a health surveillance technique for the early detection of NIHL in the steel manufacturing industry. / Dissertation (M Communication Pathology)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / M Communication Pathology / Unrestricted

Approximately 80% of the adult and elderly population ≥65 years have not been assessed or treated for a hearing loss, despite the effect a hearing loss has on communication and quality of life (World Health Organization [WHO], 2013a). In South Africa, many challenges to the health care system exist of which access to ear and hearing health care is one of the major problems. This study aimed to develop and validate a smartphone-based digits-in-noise hearing test for South African English towards improved access to hearing screening. The study also considered the effect of hearing loss and English speaking competency on the South African English digits-in-noise hearing test to evaluate its suitability for use across native (N) and non-native (NN) speakers. Lastly, the study evaluated the digits-in-noise test’s applicability as part of the diagnostic audiometric test battery as a clinical test to measure speech recognition ability in noise. During the development and validation phase of this study the sample size consisted of 40 normal-hearing subjects with thresholds ≤15 dB across the frequency spectrum (250 – 8000 Hertz [Hz]) and 186 subjects with normal-hearing in both ears, or normal-hearing in the better ear. Single digits (0 – 9) were recorded and spoken by a N English female speaker. Level corrections were applied to create a set of homogeneous digits with steep speech recognition functions. A smartphone application (app) was created to utilize 120 digit-triplets in noise as test material. An adaptive test procedure determined the speech reception threshold (SRT). Experiments were performed to determine headphones effects on the SRT and to establish normative data. The results showed steep speech recognition functions with a slope of 20%/dB for digit-triplets presented in noise using the smartphone app. The results of five headphone types indicate that the smartphone-based hearing test is reliable and can be conducted using standard Android smartphone headphones or clinical headphones. A prospective cross-sectional cohort study of N and NN English adults with and without sensorineural hearing loss compared pure-tone air conduction thresholds to the SRT recorded with the smartphone digits-in-noise hearing test. A rating scale was used for NN English listeners’ self-reported competence in speaking English. This study consisted of 454 adult listeners (164 male, 290 female; range 16 – 90 years), of which 337 listeners had a best ear 4 frequency pure-tone average (4FPTA; 0.5, 1, 2 and 4 kHz) of ≤25 dB hearing level (HL). A linear regression model identified three predictors of the digits-in-noise SRT namely 4FPTA, age and self-reported English speaking competence. The NN group with poor self-reported English speaking competence (≤5/10) performed significantly (p<0.01) poorer than the N & NN (≥6/10) group on the digits-in-noise test. Screening characteristics of the test improved with separate cut-off values depending on self-reported English speaking competence for the N & NN (≥6/10) group and NN (≤5/10) group. Logistic regression models, that include age in the analysis, showed a further improvement in sensitivity and specificity for both groups (area under the receiver operator characteristic curve [AUROC] .962 and .903 respectively). A descriptive study evaluated 109 adult subjects (43 male, 66 female) with and without sensorineural hearing loss by comparing pure-tone air conduction thresholds, speech recognition monaural performance score intensity (SRS dB) and the digits-in-noise SRT. An additional nine adult hearing aid users (4 male, 5 female) was utilized in a subset to determine aided and unaided digits-in-noise SRTs. The digits-in-noise SRT was strongly associated with the best ear 4FPTA (r=0.81) and maximum SRS dB (r=0.72). The digits-in-noise test had high sensitivity and specificity to identify abnormal pure-tone (0.88 and 0.88 respectively) and SRS dB (0.76 and 0.88 respectively) results. There was a mean signal-to-noise ratio (SNR) improvement in the aided condition that demonstrated an overall benefit of 0.84 dB SNR. A significant individual variability between subjects in the aided condition (-3.2 to -9.4 dB SNR) and unaided condition (-2 to -9.4 dB SNR) was indicated. This study demonstrated that a smartphone app provides the opportunity to use the English digits-in-noise hearing test as a national test for South Africans. The smartphone app can accommodate NN listeners by adjusting reference scores based on a self-reported English speaking competence. The inclusion of age when determining the screening test result increases the accuracy of the screening test in normal-hearing listeners. Providing these adjustments can ensure adequate test performance across N English and NN English listeners. Furthermore, the digits-in-noise SRT is strongly associated with the best ear 4FPTA and maximum SRS dB and could therefore provide complementary information on speech recognition impairment in noise in a clinical audiometric setting. The digits-in-noise SRT can also demonstrate benefit for hearing aid fittings. The test is quick to administer and provides information on the SNR loss. The digits-in-noise SRT could therefore serve as a valuable tool in counselling and management of expectations for persons with hearing loss who receives amplification. / Thesis (PhD)--University of Pretoria, 2017. / National Research Foundation (NRF) / Speech-Language Pathology and Audiology / PhD / Unrestricted

Hearing impairment has been hailed a silent epidemic. Early Hearing Detection and Intervention (EHDI) models of service delivery have therefore been proposed for infants in South Africa so that they may be provided with timely, and appropriate audiological, educational and medical intervention. Neonatal hearing screening in South Africa is currently primarily conducted at Primary Health Care (PHC) clinics. The main objective of the study was to determine whether the neonatal hearing screening services provided at PHC clinics in the City of Johannesburg (CoJ) adhere to the guidelines, norms and standards as outlined by the Integrated National Disability Strategy [INDS] (1997), the Health Professions Council of South Africa [HPCSA] Position Statement (2007) on EHDI and the PHC Package (2002). This was achieved through a non-experimental, descriptive, survey research design. Nurses employed at PHC clinics and children who attended the PHC clinics formed the two participant groups. Data was collected via a self-administered questionnaire, a retrospective data compilation form and observations. Descriptive statistical measures were used to describe the information obtained during data collection. Results indicate that nurses employed within the CoJ PHC clinics do not comply with the proposed neonatal hearing screening practices as outlined in the INDS and the PHC Package. Context specific barriers, including limited knowledge, service delivery gaps, and workload inequities have been identified as contributory factors to the variations and inconsistencies of protocol adherence by PHC nurses. Effective referral systems are important to ensure that these children are provided with appropriate services within the critical period for language development. The optimisation of current governmental hearing screening protocols are thus a feasible, temporary measure until such time that EHDI programmes be mandated at a governmental level.

The Special Olympics Healthy Athletes initiative promotes wellness of the athletes with intellectual disabilities and education for medical professionals. Healthy Athletes has created a hearing screening program, Healthy Hearing, to help athletes with intellectual disabilities get the otological and audiological care they need. This program promotes a healthy hearing lifestyle and educates medical professionals regarding the need of health care for the intellectually disabled population. The physiologic, otologic, and audiologic abnormalities often occurring in the intellectually disabled population bring special attention for the need to determine the prevalence rate of hearing loss among the athletes participating in Special Olympics events. Investigation of the prevalence of hearing loss in 1450 athletes participating in the 2004 Summer Games and Fall Sports Classic and 2005 Fall Sports Classic in Utah, USA and the 2005 World Winter Games in Nagano, Japan was made. A total pure-tone failure rate of 31.1% among athletes in all four games was found, however follow-up was recommended for 34.7% of athletes. Athletes were found to have a greater prevalence of cerumen management problems than the general population and 34% of those passing the pure-tone hearing screen needed cerumen removal. Due to inherent audiological and otological complications found in individuals with intellectual disabilities, regular cerumen management and sensory testing for athletes are recommended.

No description available.

Made available in DSpace on 2016-04-27T18:12:25Z (GMT). No. of bitstreams: 1 Maria Cecilia Castello Silva Pereira.pdf: 1279959 bytes, checksum: a564e8fdd94e7d865a3f94b246d6aff0 (MD5) Previous issue date: 2007-10-09 / Introduction: The Newborn Hearing Screening Program have been responsible for anticipating the sensorineural and conductive hearing loss diagnoses for the last few years. This study refers to the experience of a hearing screening starting before the hospital discharge in the Neonatal Intensive Care Unit (NICU) and also to the orientation to the Well-baby Nursery screening after the discharge. Aims: Describe a Newborn Hearing Screening Program in a maternity hospital of the privative network in Salvador, from 2000 to 2006, considering the historical context, the process of implementation, the changes through the years, as well as the hearing findings and the relation with the quality criteria proposed by the Joint Committee on Infant Hearing 2000.Method and Material: This is a retrospective, cross-sectional study. 4997 newborns and infants were screened through the use of Echocheck, the otoacoustic emissions equipment and through the observation of the cochlear-palpebral reflex. The results were divided in four groups: AI = NICU and screening in the pre-discharge; AII = NICU and screening in the post-discharge; BI = Well-baby Nursery and screening in the pre-discharge; BII = Well-baby Nursery and screening in the post-discharge. Results: A description of the evolution and implementation process of the hearing screening from 2000 to 2006 was done; in relation to the audiological findings, the hearing screening results described were the ones from 2001 to 2006. There was an assessment of 38,9% of the newborns and infants in 2001, and 79,5% in 2006. According to the pre-discharge service analyses, the group AI/BI had from 8,1% to 11,2% of fails; in the post-discharge service analyses, the group AII/BII maintained the fail index in 2,6%. As final results of the AI/BI group, from the total of 1739 screenings, there were 21 confirmed cases of hearing alterations, being 20 conductive(6,1:1000) and 4 sensorineural (1,2:1000). Conclusion: The data indicates that the service before the discharge to the NICU and a gradual extension to the Well-baby Nursery is workable, ever since the protocol is continuously adjustable. Although the AI/BI group was the third part of the sample it represented a higher prevalence of hearing alterations. These show the importance of the hearing screening before the hospital discharge, so a higher number of congenital hearing problems can be assessed / Introdução: Nos últimos anos, os programas de Triagem Auditiva Neonatal (TAN) têm sido responsáveis por antecipar o diagnóstico das deficiências auditivas sensorioneurais e condutivas, quando ambas estão presentes ao nascimento. O presente estudo relata uma experiência de triagem auditiva iniciada antes da alta hospitalar na UTI Neonatal e de orientação para triagem no Berçário Comum após a alta. Com o passar dos anos, o programa estendeu-se para atendimento também no Berçário Comum. Objetivos: Descrever um programa de Triagem Auditiva Neonatal em uma maternidade da rede privada de Salvador, no período de 2000 a 2006, no que se refere ao seu contexto histórico, ao processo de implantação e às modificações ocorridas ao longo dos anos; também são discutidos os achados audiológicos e a relação com os critérios de qualidade propostos pelo Joint Committee on Infant Hearing, de 2000. Material e método: trata-se de um estudo retrospectivo, de caráter transversal. Foram triados 4997 neonatos e lactentes com emissões otoacústicas, equipamento Echocheck, e observação do reflexo cócleo-palpebral. Os sujeitos foram divididos em quatro grupos: AI= UTI Neonatal e triagem na pré-alta; AII= UTI Neonatal e triagem na pós-alta; BI= Berçário Comum e triagem na pré-alta; BII= Berçário Comum e triagem na pós-alta. Resultados: Foi descrito o processo de evolução e implantação da triagem auditiva no período de 2000 a 2006. Quanto aos achados audiológicos, foram descritos os resultados da triagem auditiva de 2001 a 2006. Houve cobertura em 38,9% dos neonatos e lactentes em 2001, chegando a 79,5% em 2006. Na análise dos atendimentos na pré-alta, o grupo AI/BI apresentou índices de falha de 8,1% a 11,2%; na análise de atendimentos na pós-alta, no grupo AII/BII, os índices de falha mantiveram-se em 2,6%. Como resultados finais, no grupo AI/BI, do total de 1739 triagens, houve 21 casos confirmados de alterações auditivas, sendo 17 condutivas (9,8:1.000) e quatro sensorioneurais (2,3 :1000). No grupo AII/BII, do total de 3256 triagens, houve 24 casos confirmados de alterações auditivas, sendo 20 condutivas (6,1:1000) e quatro sensorioneurais (1,2 :1000). Conclusão: os dados indicaram que o atendimento antes da alta para UTI Neonatal e sua extensão gradual para o Berçário Comum são viáveis, desde que o protocolo seja continuamente ajustado. Embora representasse a terça parte da amostra, o grupo AI/BI apresentou uma prevalência maior de alterações auditivas, evidenciando a importância da TAN antes da alta hospitalar para o diagnóstico precoce de alterações auditivas congênitas

The aim of my thesis is to summarize all the information regarding newborn and infant hearing screening programmes, to find out about the awareness of mothers-to-be and to give account on the possibilites of the further professional development of the infant hearing screening. The theoretical part consists of the definitions of terminology relating to this topic, the historical development of the hearing screening and the latest findings and current level of knowledge of the issue both in the Czech Republic and abroad. The practical part of my master's thesis aspires to detect the awareness of expecting mothers and non-professionals through a questionnaire survey. Apart from the results of the survey the practical part also contains an interview with a specialist. Besides the research analysis, I have also focused on informing the target group about the prospects and significance of the newborn and infant hearing screening tests as this is a current issue now. KEYWORDS: Newborn Otoacoustic emissions Hearing screening Hearing loss Early detection

Newborn hearing screening in the Czech Republic Abstract The aim of this diploma thesis is to summarize the important and actual information about a newborn hearing screening and its related topics. The theoretical part of this thesis contains the contemporary knowledge of the issue, the definition of terms for a comprehensive setting of issue in the context, illustrates the current state of knowledge of the issue in the Czech Republic in the comparison to some European and world countries and reveals some more directly and inextricably related topics. The practical part is based on the knowledge of the theoretical part. The practical part focuses on identification of the level of awareness of newborn hearing screening among pregnant women, which was investigated by a questionnaire. This part also analyzes, evaluates and discusses the results and suggestions for practice. The task of the practical part was not only to identify the research data, but also to provide information to expectant mothers about the possibilities and significance of the newborn hearing screening by appropriate form, as this topic is very current for the general public. Key words: early care early diagnosis hearing impairment newborn hearing screening otoacoustic emissions rehabilitation of hearing impairment

Made available in DSpace on 2016-04-27T18:11:56Z (GMT). No. of bitstreams: 1 Taise Argolo Sena.pdf: 595972 bytes, checksum: 7693a80adc39a593cccdae56ded0102f (MD5) Previous issue date: 2012-02-14 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: The Automated Auditory Brainstem Response (AABR) is an important tool to make Newborn Hearing Screening. However, some aspects that make it more difficult to exam, like time and intensity of acoustic stimulus, must be taken into consideration. Aim: Analyze the results of Newborn Hearing Screening with Automated Auditory Brainstem Response with new technologies that use the detection method in the frequency domain and stimulus repetition rate at 93Hz. Methodology: The Automated Auditory Brainstem Response was made at 200 newborns (93 female and 107 male), at 30 and 35dBnHL. Subsequently all newborns were submitted to the Auditory Brainstem Response (ABR) Diagnostic Mode, as golden standard test. Results: The sensibility and specificity were calculated through Fisher Exact Test taken into consideration the ABR Diagnostic Mode. The sensibility found at AABR at 35dBnNA was 100% and the specificity was 100%, at the intensity of 30dBnNA the sensibility found was 100% and the specificity was 97.23%. The average time to make the automated exam was 28.3 seconds in the 35 dBnHL and 32.9 seconds in the 30 dBnHL. The time was analyzed considering the state of consciousness of the newborn, based on the Brazelton Scale classification. It was possible to notice that when the newborn was quieter the examination time was quicker. Conclusion: The AABR made at frequency domain with stimulus repetition rate at 93Hz shows high sensibility and specificity, with relative short time to get the results. The state of consciousness influences the execution time of the exam. / Introdução: O Potencial Evocado Auditivo de Tronco Encefálico Automático (PEATE-A) é uma ferramenta importante para realização da Triagem Auditiva Neonatal. Entretanto, alguns aspectos que dificultam a realização do exame, como o tempo e a intensidade do estímulo acústico, devem ser levados em consideração. Objetivos: Analisar os resultados da Triagem Auditiva Neonatal com Potencial Evocado Auditivo de Tronco Encefálico Automático, com novas tecnologias que utilizam método de detecção no domínio da frequência e taxa de repetição do estímulo a 93Hz. Metodologia: O Potencial Evocado Auditivo de Tronco Encefálico Automático foi realizado em 200 neonatos (93 do sexo feminino e 107 do masculino), nas intensidades de 30 e 35dBnNA. Em seguida, todos os neonatos foram submetidos ao exame de Potencial Evocado Auditivo de Tronco Encefálico (PEATE) Modo Diagnóstico, como teste padrão ouro. Resultados: A sensibilidade e especificidade foram calculadas por meio do Teste Exato de Fisher, levando em consideração o resultado do PEATE Modo Diagnóstico. A sensibilidade encontrada para o PEATE-A na intensidade de 35dBnNA foi de 100% e a especificidade de 100%; para a intensidade de 30dBnNA a sensibilidade encontrada foi de 100% e a especificidade, de 97,23%. O tempo médio de realização do exame automático foi de 28,3 segundos para a intensidade de 35 dBnNA e de 32,9 segundos para a intensidade de 30dBnNA. O tempo também foi analisado de acordo com o estado de consciência do neonato, conforme a classificação da Escala de Brazelton. Foi possível observar que quanto mais quieto o neonato, mais rápido o tempo de realização do exame. Conclusão: O PEATE-A realizado no domínio da frequência com taxa de repetição em 93Hz apresenta alta sensibilidade e especificidade, com tempo consideravelmente curto para a determinação da resposta. O estado de consciência influencia no tempo de execução do exame