Hearing Norton Sound: a community randomised trial protocol to address childhood hearing loss in rural Alaska

IntroductionThe population in rural Alaska experiences a disproprionately high burden of infection-mediated hearing loss. While the state mandates school hearing screening, many children with hearing loss are not identified or are lost to follow-up before ever receiving treatment. A robust, tribally owned healthcare system exists in Alaska, but children with hearing loss must first be identified and referred for existing infrastructure to be used. This trial will evaluate a new school hearing screening and referral process in rural Alaska, with the goal of improving timely identification and treatment of childhood hearing loss.Methods and analysisComparative effectiveness community randomised trial testing digital innovations to improve school hearing screening and referral in 15 communities in the Norton Sound region of northwest Alaska, with data collection from October 2017 to February 2020. All children (K-12) attending school in Bering Strait School District with parental informed consent and child assent will be eligible (target recruitment n=1500). Participating children will undergo both the current school hearing screen and new mobile health (mHealth) screen, with screening test validity evaluated against an audiometric assessment. Communities will be cluster randomised to continue the current primary care referral process or receive telemedicine referral for follow-up diagnosis and treatment. The primary outcome will be time to International Statistical Classification of Diseases, 10th Revision, ear/hearing diagnosis from screening date, measured in days. Secondary outcomes will include: sensitivity and specificity of current school and mHealth screening protocols measured against a benchmark audiometric assessment (air and bone conduction audiometry, tympanometry and digital otoscopy); hearing loss prevalence; hearing-related quality of life; and school performance (AIMSweb). Intention-to-treat analysis will be used.Ethics and disseminationThis study has been approved by the Institutional Review Boards of Alaska Area, Norton Sound and Duke University and is registered on clinicaltrials.gov. Results will be distributed with equal emphasis on scientific and community dissemination.Trial registration numberNCT03309553; Pre-results.

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Societal costs of permanent childhood hearing loss at teen age: a cross-sectional cohort follow-up study of universal newborn hearing screening

BMJ Paediatrics Open ◽

10.1136/bmjpo-2017-000228 ◽

2018 ◽

Vol 2 (1) ◽

pp. e000228 ◽

Cited By ~ 2

Author(s):

Maria Chorozoglou ◽

Merle Mahon ◽

Hannah Pimperton ◽

Sarah Worsfold ◽

Colin R Kennedy

Keyword(s):

Hearing Loss ◽

Hearing Screening ◽

Newborn Hearing Screening ◽

Cross Sectional ◽

Societal Costs ◽

Follow Up Study ◽

Universal Newborn Hearing Screening ◽

Newborn Hearing ◽

Childhood Hearing Loss

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Hearing Norton Sound: mixed methods protocol of a community randomised trial to address childhood hearing loss in rural Alaska

BMJ Open ◽

10.1136/bmjopen-2018-023081 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023081 ◽

Cited By ~ 3

Author(s):

Susan D Emmett ◽

Samantha Kleindienst Robler ◽

Joseph J Gallo ◽

Nae-Yuh Wang ◽

Alain Labrique ◽

...

Keyword(s):

Hearing Loss ◽

Mixed Methods ◽

Focus Groups ◽

Randomised Trial ◽

Trial Registration ◽

Community Leaders ◽

Stakeholder Groups ◽

Study Results ◽

Rural Alaska ◽

Childhood Hearing Loss

IntroductionChildhood hearing loss has implications for school achievement, economic outcomes and quality of life. This study will engage rural Alaska communities in research to improve the school hearing screening and referral process, partnering with stakeholders to develop a locally derived, evidence-based solution to improve timely identification and treatment of childhood hearing loss.Methods and analysisMixed methods community randomised trial in 15 communities in the Norton Sound region of northwest Alaska. Data collection will span from April 2017 until February 2020. Qualitative and mixed methods components are described in this protocol and the community randomised trial in the companion protocol. Focus groups and community events will be held leading up to the randomised trial to obtain community perspectives on childhood hearing loss in Alaska and elicit community input during trial protocol refinement (exploratory sequential stage). Stakeholder groups, including parents, children, teachers, school administrators and community health aides, will participate, along with community leaders, tribal leaders and community members. The randomised trial will be combined with qualitative, semi-structured interviews to elicit stakeholder perspectives on the intervention (explanatory sequential stage). The five stakeholder groups described above will participate in interviews. The study will conclude with additional focus groups and community events to discuss results and provide community insight for future implementation. Concluding focus groups will include policymakers, healthcare administrators, and tribal and community leaders in addition to the stakeholder groups. Informed consent and child assent will be required. Recordings will be transcribed and deidentified, with only stakeholder group recorded. Analyses will include categorical coding as well as narrative and thematic analysis.Ethics and disseminationThe Hearing Norton Sound study has been approved by the Institutional Review Boards of Alaska Area, Norton Sound, and Duke University, with trial registration on clinicaltrials.gov. Study results will be distributed with equal emphasis on scientific and community dissemination.Trial registration numberNCT03309553; Results.

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How the World’s Children Hear: A Narrative Review of School Hearing Screening Programs Globally

OTO Open ◽

10.1177/2473974x20923580 ◽

2020 ◽

Vol 4 (2) ◽

pp. 2473974X2092358

Author(s):

Michael Yong ◽

Neelima Panth ◽

Catherine M. McMahon ◽

Peter R. Thorne ◽

Susan D. Emmett

Keyword(s):

Hearing Loss ◽

Sensitivity And Specificity ◽

Screening Test ◽

Hearing Screening ◽

Screening Tests ◽

Loss To Follow Up ◽

Screening Programs ◽

Test Sensitivity ◽

Childhood Hearing Loss

Objective School hearing screening may mitigate the effects of childhood hearing loss through early identification and intervention. This study provides an overview of existing school hearing screening programs around the world, identifies gaps in the literature, and develops priorities for future research. Data Sources A structured search of the PubMed, Embase, and Cochrane Library databases. Review Methods A total of 65 articles were included according to predefined inclusion criteria. Parameters of interest included age groups screened, audiometric protocols, referral criteria, use of adjunct screening tests, rescreening procedures, hearing loss prevalence, screening test sensitivity and specificity, and loss to follow-up. Conclusions School hearing screening is mandated in few regions worldwide, and there is little accountability regarding whether testing is performed. Screening protocols differ in terms of screening tests included and thresholds used. The most common protocols included a mix of pure tone screening (0.5, 1, 2, and 4 kHz), otoscopy, and tympanometry. Estimates of region-specific disease prevalence were methodologically inaccurate, and rescreening was poorly addressed. Loss to follow-up was also a ubiquitous concern. Implications for Practice There is an urgent need for standardized school hearing screening protocol guidelines globally, which will facilitate more accurate studies of hearing loss prevalence and determination of screening test sensitivity and specificity. In turn, these steps will increase the robustness with which we can study the effects of screening and treatment interventions, and they will support the development of guidelines on the screening, diagnostic, and rehabilitation services needed to reduce the impact of childhood hearing loss.

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Hearing Screening

Pediatric Care Online ◽

10.1542/aap.ppcqr.396019 ◽

2016 ◽

Keyword(s):

Hearing Loss ◽

Social Development ◽

Hearing Screening ◽

Routine Screening ◽

Childhood And Adolescence ◽

Congenital Hearing Loss ◽

Speech Impairment ◽

Progressive Hearing Loss ◽

Key Points ◽

Children With Hearing Loss

Key Points The goal of screening is to identify children with hearing loss as early as possible to prevent language and speech impairment and its detriment to educational and social development. Routine screening for newborns is justified, given how common congenital hearing loss is. All children should be tested in the first month after birth, and any child identified as having hearing loss should be receiving intervention before 6 months of age. Routine screening should continue throughout childhood and adolescence to identify patients with acquired or progressive hearing loss.

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Hearing Screening of Newborns using Distortion Product Otoacoustic Emissions

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2021.v29i2.478 ◽

2021 ◽

Vol 29 (2) ◽

pp. 189-195

Author(s):

Vybhavi MK ◽

Srinivas V

Keyword(s):

Hearing Loss ◽

Otoacoustic Emissions ◽

Screening Tool ◽

Hearing Screening ◽

Distortion Product Otoacoustic Emissions ◽

Profound Hearing Loss ◽

Distortion Product ◽

Lost To Follow Up ◽

Evoked Response Audiometry

Introduction The present study was devised to estimate the prevalence of neonatal hearing loss and document the importance of using DPOAE as a screening tool for identifying hearing loss in newborns. Materials and Methods This hospital based descriptive study was conducted from August 2018 to August 2019. A total of 928 newborn babies were included in the study. These newborn babies were subjected to hearing screening by distortion product otoacoustic emissions (DPOAE) at 24-72 hrs after birth. For pass cases, no further testing was done. For refer cases, repeat testing with DPOAE was done within 15-30 days. Newborns with refer result on repeat DPOAE testing were subjected to Brainstem evoked response audiometry (BERA) within 3 months to confirm hearing loss. Results Nine hundred and twenty eight newborn babies were screened by DPOAE. 851 newborns passed the first DPOAE hearing screening and 77 newborns gave refer result. 21 newborns were lost to follow-up. 56 newborns underwent repeat DPOAE testing and 5 newborns were referred for BERA. Amongst the 5 newborns who underwent BERA testing, one newborn was diagnosed with bilateral profound hearing loss. Hence, the prevalence of hearing loss of 1.08 per thousand newborn babies was estimated in this study. Conclusion Hearing screening of newborns using DPOAE followed by BERA in refer cases to confirm hearing loss is useful for early detection followed by timely intervention and rehabilitation.

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Hearing Screening of High-Risk Newborns with Brainstem Auditory Evoked Potentials: A Follow-up Study

PEDIATRICS ◽

10.1542/peds.73.1.22 ◽

1984 ◽

Vol 73 (1) ◽

pp. 22-26 ◽

Cited By ~ 1

Author(s):

Dorothy A. Shannon ◽

Jacob K. Felix ◽

Allan Krumholz ◽

Phillip J. Goldstein ◽

Kenneth C. Harris

Keyword(s):

Hearing Loss ◽

High Risk ◽

Predictive Value ◽

Screening Test ◽

Normal Hearing ◽

Hearing Screening ◽

Auditory Evoked Potential ◽

Hearing Level ◽

Lost To Follow Up

Numerous techniques have been used in attempts to find a reliable and efficient screening method for determining auditory function in the newborn. The brainstem auditory evoked potential (BAEP) is the latest method advocated for that purpose. The BAEP was evaluated as a hearing screening test in 168 high-risk newborns between 35 and 45 weeks of conceptual age. Follow-up data were obtained after 1 year (mean 17.3 months) on 134 of the infants (80%). Normal hearing was defined as a reproducible response in both ears to a 25 dB normal hearing level (nHL) click stimulus; 21 infants (12.5%) failed the initial screening test. Follow-up on 19/21 infants revealed 18 infants with normal hearing and one infant with an 80 dB nHL bilateral hearing loss substantiated. One infant with an abnormal screening test died before retesting, and the other infant was lost to follow-up but had only a unilaterally abnormal BAEP. None of the infants with a normal BAEP screening study had evidence of hearing loss on retesting. Sensitivity of the BAEP was 100%, specificity was 86%, predictive value of a positive test was 5.26%, and the predictive value of a negative test was 100%. The incidence of significant hearing loss in our population was between 0.75% (1/134 infants) confirmed, and 2.24% (3/134 infants) including infants who failed screening but were lost to follow-up. The BAEP is a sensitive procedure for the early identification of hearing-impaired newborns. However, the yield of significant hearing abnormalities was less than predicted in other studies using BAEP for newborn hearing screening.

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First national results of the evaluation of the neonatal hearing loss screening programme in France

European Journal of Public Health ◽

10.1093/eurpub/ckz186.188 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Doncarli ◽

H Tillaut ◽

V Goulet

Keyword(s):

Hearing Loss ◽

Screening Programme ◽

National Level ◽

Hearing Screening ◽

Newborn Hearing Screening ◽

Universal Newborn Hearing Screening ◽

Newborn Hearing ◽

Set Up ◽

Bilateral Deafness

Abstract Background The French newborn hearing screening programme set up in 2014 aims to identify affected children as early as possible to allow appropriate care. Our goal was to evaluate the implementation of this programme at the national level. Methods The programme consist in a screening using a test (T1) and a retest (T2) in the maternity hospital in all newborns. In some region, a delayed test (T3) is performed afterwards in children for whom it was not possible to confirm normal hearing. Children suspected of deafness subsequently enter the diagnosis phase. We defined evaluation indicators after stakeholders consultation. We developed a web application to collect aggregated data on live births. We estimated the rate of coverage, refusal, children suspected of hearing loss at the end of the screening phase and the prevalence of bilateral deafness. Results In 2015, one year after the initiation of the programme, the coverage rate was already very high (88%) and even more so in 2016 (96%). Parental acceptance was very good (refusal: 0.1%). By the end of 2016, 19 out 27 regions had added a T3. The rate of suspicion of bilateral hearing loss was decreased by using a T3 (1.4% vs 0.9%). Bilateral deafness rate, estimated after a 2-years follow up, was 1.3‰ although it was estimated only on 51.5% of suspected children for whom diagnosis data had been transmitted. Conclusions The objective of a 90% coverage set by the French ministry of health has been met after 2 years of operation of the program. T3 appears useful in relieving diagnostic structures from false positives. Our estimated prevalence of bilateral deafness could be more accurate if data collection was improved but is consistent with prevalence reported in North America. Key messages The universal newborn hearing screening program has been successfully set up in France in terms of coverage. Future work should focus on improving the collection of follow up data to better characterise diagnosed children.

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Teacher Prescreening for Hearing Loss in the Developing World

Ear Nose & Throat Journal ◽

10.1177/0145561319880388 ◽

2019 ◽

pp. 014556131988038

Author(s):

Justin R. Shinn ◽

Asitha D. L. Jayawardena ◽

Ankita Patro ◽

M. Geraldine Zuniga ◽

James L. Netterville

Keyword(s):

Hearing Loss ◽

Cohort Study ◽

Referral Rate ◽

Hearing Screening ◽

Resource Limited Settings ◽

Identification Rate ◽

Resource Limited ◽

Screening Efficiency ◽

Children With Hearing Loss ◽

Universal Hearing Screening

The goal of this prospective cohort study was to characterize the ability of teachers to identify schoolchildren at risk of hearing loss in order to maximize hearing screening efficiency in low-resource settings. At 4 semirural schools in Malindi, Kenya, preselected schoolchildren perceived as hearing impaired were compared to children thought to have normal hearing using portable audiometry. Eight of 127 children (54% male) failed hearing screening, all of who were identified by schoolteachers as having a high risk of hearing loss. Thus, for every 5 children prescreened by schoolteachers, an average of 1 child would be identified as having hearing loss. Overall, teacher prescreening had a 100% hearing loss identification rate and a 20% referral rate. In conclusion, in resource-limited settings, where universal hearing screening is challenging, teachers can effectively identify children with hearing loss for early intervention.

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