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

OBJECTIVE The objective of this study was to evaluate the accuracy and cost effectiveness of three different methods of hearing screening in newborns. DESIGN A prospective, randomized cohort design was used. One hundred and five newborns were tested in this preliminary study. SETTING The study was conducted in a tertiary care hospital setting in both the well baby and special care nurseries. METHODS Consenting subjects had their hearing tested using automated auditory brainstem response (AABR), distortion-product otoacoustic emissions, and click-evoked otoacoustic emissions. The time to perform the tests was recorded and the cost of each test was calculated. MAIN OUTCOME MEASURES The main outcomes measured were the time taken to perform each test, the pass/fail rate for each test, and the estimated cost of 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 either of the otoacoustic emission tests. However, the sensitivity and specificity of otoacoustic emissions were less than that of AABR. Test time decreased as the examiner gained experience, and we anticipate that experience will also result in better accuracy for the otoacoustic emission tests. CONCLUSIONS Hearing screening in a hospital-based newborn population is both feasible and cost effective. Although AABR was more expensive, its better accuracy must be considered. As technology improves, the cost of all three tests will diminish. More robust conclusions cannot be made based on this small patient population.