OAE are an ideal test for this purpose. Results may be obtained in a matter of seconds. This non-invasive test may be performed by nursing personnel or trained volunteers and may be done in the intensive care or well baby nursery using portable equipment.

IA was one of the first dealers in the country to sell products to measure OAE. We are able to help our clients establish screening protocals, create follow up procedures, analyze the test data and assess the cost of newborn hearing screening programs.

Our product offerings in the area of OAE include systems from Otodynamics that measure the transient OAE, the distortion product OAE or both. Distortion product OAE may also be measured with the Capella from Madsen Electronics and the Scout from BioLogic Systems.

Newborn Hearing Screening
Significant, permanent hearing loss at birth is the most common congenital disability of the nearly 4 million babies born annually in the United States. Approximately 4 in 1000 or 16,000 babies will suffer from this condition, which will often go undetected until the child is 2, 3, or even 5 or 6 years of age. The negative impact of this delayed identification on speech, language, congnitive, and social development is astounding. The economic burden imposed on society is often overlooked.

These statistics have been known for decades. Yet, it has only been within the past several years that a concerted effort has been underway to implement the goal of screening the hearing of all newborns at birth. No longer is it appropriate to debate teh efficacy of universal newborn hearing screening program. The debate should be over when the program is started, not if.

It is estimated that there are over 200 hospitals with universal newborn hearing screening (UNHS) programs. Several states have passed legislation mandating UNHS programs and many more have introduced similar legislation. Some hospitals have decided to initiate programs without a mandate.

What has spurred the recent exponential increase in UNHS programs? It's probably a combination of several factors including:

Improved testing technology
Easy to use instruments that automatically "interpret" test results
Relatively inexpensive cost per test (approximately 10% the cost of identifying children with PKU, hypothyroidism, or sickle cell anemia using metabolic disorder screening programs)
Acknowledgement that early identification and intervention enhance speech, language, social and cognitive development
Reduced cost to educate children with hearing impairment identified later in life
Community Interest
The recommendations of the NIH Consensus Conference
Recommendations from the American Academy of Pediatrics, American Academy of Audiology, the Joint Committee on Infant Hearing, and the Healthy People 2000

Evoked Otoacoustic Emissions
It is now possible to screen an infant's hearing in the well baby and special care nursery using either transient or distortion product OAE instruments at an average time of 75 seconds/ear. Disposable supplies cost less than $1.00 per baby.

The sensitivity of OAE screening methods is reported to be nearly 100% (99.99%). The chance of having a false negative result based upon a sensitivity of 99.99% is approximately 1 in 16,000.

Referral rates for OAE screening programs nationally average 7-8% at birth admission discharge. If a second stage OAE screening is conducted, the final referral rate is typically less than 2% (1% as reported by the Rhode Island Hearing Assessment Project).

The key to using OAE instruments for screening neonates is quality training emphasizing proper probe insertion techniques. Testers can be trained to properly insert the test probe and recognize signs that are consistent with a poorly fit probe (most of the newer OAE devices will automatically stop when the probe is inappropriately inserted). If a satisfactory probe fit is achieved and the test environment is controlled for noise interference, then a valid measurement is likely to be obtained.

Several sytems are now available that provide immediate feedback alerting the tester of a PASS, REFER, of TECHNICAL FAILURE result.

Auditory Brainstem Response
ABR testing has long been a proven method for assessing the neural integrity of the auditory system. Diagnostic ABR is considered the "gold" standard in the overall assessment of the auditory system. Diagnostic ABR, however, is not an acceptable infant hearing screener since it must be administered by highly trained personnel, is too time consuming, requires expensive equipment and, therefore, it too costly to implement on a large scale.

Screening ABR instruments address these issues quite effectively. These instruments are automated, portable, and less expensive. Only a short period of time is required to train personnel on electrode placement and equipment operation. (We should emphasize that automation of the screening test in no way eliminates the need for an experienced audiologist to supervise and oversee the screening program).

Acquired test data is analyzed and compared to an algorithm within the software of the test instrument. If a favorable comparison is obtained within an acceptable period of time, the a "PASS" is obtained. Conversely, if the acquired results do not compare favorably to the algorithm, then a "REFER" message appears.

Screening ABR instruments are now available that operate completely in an automated screening format, but with the option of reviewing the acquired ABR data to confirm acceptable analysis on the part of the system software. This is not the "black box" approach used by older technology which offers no flexibility or review options.

IA and Infant Hearing Screening
IA is the leading distributor of products designed for infant hearing screening in Pennsylvania, New Jersey, upstate New York, Delaware, and West Virginia. Our product line includes instruments from the following manufacturers:

Bio-Logic Systems
Etymotic Research
Intelligent Hearing Systems
Madsen
Otodynamics
SonaMed Corporation

Many newborn hearing screening programs need assistance in tracking the status of procedures and protocols. There is a tracking software available from OZ Systems.

OZ is able to track what babies have been tested, the results, the caregiver information, letters that need to be printed and sent, follow-up visits, progress of your program and numerous other important documentation.