Journal of Medical Screening > Volume 16, Number 1 > Pp. 17-21

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Original Articles

Evaluation of unilateral referrals on neonatal hearing screening

Kay W Chang  , MD, Stanford University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, and Lucile Packard Children's Hospital at Stanford Division of Pediatric Otolaryngology-Head and Neck Surgery, California, USA

T J O-Lee , MD, Stanford University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Lucile Packard Children's Hospital at Stanford Division of Pediatric Otolaryngology-Head and Neck Surgery, California, and University of Nevada School of Medicine, Division of Otolaryngology-Head and Neck Surgery, Nevada, USA

Melissa Price , AuD, Director of Neonatal Hearing Screening Program, Lucile Packard Children's Hospital at Stanford Division of Pediatric Otolaryngology-Head and Neck Surgery, California, USA

Correspondence to: Kay Chang M.D., Associate Professor of Otolaryngology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 801 Welch Road, Stanford, CA 94305-5739, USA; kay_chang{at}yahoo.com

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Objective Examination of neonatal hearing screening practices around the world suggests that more attention is placed on infants who fail bilaterally on their hearing screen than infants who refer (fail) in one ear. Some programmes only report bilateral failures as positive hearing screens. This study investigates how limitations of the screening techniques demand continued audiologic evaluations in unilateral referrals.

Setting The study sample consisted of all infants born at a single academic paediatric hospital between February 1998 and February 2002.

Methods There were 16,007 infants screened using ALGO automated auditory brainstem response. Eighteen of the infants who failed the screen in one ear but passed in the other ear were found to have permanent hearing loss, and had their subsequent clinical course and audiologic management analysed. The final audiologic outcome after four years in both the pass and fail ear were examined.

Results One group of unilateral referrals (n = 6) had obvious anatomic reasons for the ear failing the screen (canal atresia/stenosis). There were five patients in which the ear that passed the screen was later found on more extensive audiologic evaluation to have significant hearing loss. Review of recent literature was also completed to examine the methods by which unilateral screening referrals are commonly reported and whether or not this affected follow-up diagnostic evaluation.

Conclusion Infants who pass one ear and refer one ear on neonatal hearing screening still need to have thorough and prompt evaluations. In many cases, the ear that passed can be found to have significant hearing loss.

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