سود و زیان برنامه غربالگری جهانی شنوایی

Hearing loss affects 1–3 out of 1000 newborns. A programme of universal newborn hearing screening (UNHS) was implemented in our ENT department in February 2000. In 2001, the programme was extended to all the hospitals of the canton Geneva. The programme is based on the recording of transient evoked otoacoustic emissions (TEOAE) from all newborns. In addition, automated auditory brainstem responses (aABR) are recorded in high-risk neonates. In the report, we compare the mean age at which rehabilitation of hearing was undertaken during a 5-year period before and after the screening programme was instituted. We also identify some causes of delayed diagnosis and intervention and the pitfalls of universal hearing screening. The price of the UNHS programme is estimated at 26 Swiss francs (17 Euros; 21 US dollars) per infant screened, including the material required, the personal involved to run the programme, and the follow-up.

A hearing screening programme in children started in our department in 1980. It was limited to high-risk newborns as defined by the Joint Committee on Infant Hearing [1] (adapted later on to the Year 2000 Position Statement), using auditory brainstem responses (ABR). In 1999, following the guidelines edited by the Joint Committee on Infant Hearing and also of the European Consensus Development Conference [2], a national universal neonatal hearing screening (UNHS) programme was implemented in Switzerland. It started in our Department on 1 February 2000 in partnership with the Department of Paediatrics and Neonatology. In 2001, it was extended to all the hospitals of the canton Geneva, covering 350,000 inhabitants. During its first 2 years, the screening was based on the recording of the transient evoked otoacoustic emissions (TEOAE) from all the neonates older than 24 h. In addition, since 2002 automated auditory brainstem responses (aABR) have been recorded in high-risk newborns. The aim of this study is (1) to evaluate the influence of the UNHS programme on the age at which the rehabilitation of hearing is started in children with hearing loss; (2) to analyse the causes of delayed diagnosis and/or delayed intervention; (3) to evaluate the costs of the programme.

Today, it is known that an early rehabilitation of deafness offers the child the best chances to develop normally [5]. The recording of the otoacoustic emissions has drastically changed the method of evaluating the hearing in newborns and infants. The test is easy to perform, non-invasive, and reliable making possible a systematic universal neonatal hearing screening. This study shows that the time elapsed for the diagnosis and the rehabilitation has been reduced since the application of the UNHS programme at our institution. We deliberately chose to base our analysis on the time at which the infant received a hearing aid or a cochlear implant rather than the time of the diagnosis. The former is precise, while the later extends over some months, between the first tests suggesting a deficit, and the final evaluation confirming the deafness. In most cases, the delay between the definite diagnosis and the rehabilitation was inferior to 2 months, but it was sometimes longer, mainly due to parents denying the necessity of a hearing aid for their child. The results of the study show that the age of hearing aid fitting in newborns with hearing loss has been reduced by a factor 2 since the implementation of the UNHS programme. In average, the age at which a hearing aid is fitted is now 20 months. It is even lower, ranging from 4 to 8 months in children whose parents are cooperative, do fully understand the problem of their child and do not deny the need of amplification. These results are encouraging and correspond to the expected benefits when the strategy recommended by the Joint Committee on Infant Hearing [6] and the European Consensus Development Conference [2] are adopted.