Newborn hearing screening

The newborn hearing screening (NGHS) is part of the newborn screening and comprises the examination for congenital hearing disorders in newborns in a sieve test. The aim of these screening examinations is to examine as many newborns as possible. An early detection of hearing impairment improves the chances of stimulating the residual hearing, which is present in around 98% of cases, during the «critical period» of language acquisition.

Essential components of the NGHS are

• the examinations themselves,
• the recording and tracking of suspicious test results (so-called tracking) by screening centers
• Delivery to professional confirmation diagnostics
• If necessary, the provision of hearing aids to hard of hearing children and initiation of (re) habilitation.

The examination is so simple that it can also be carried out by non-medical personnel (e.g. in the neonatal ward).

history

The need for an early discovery of congenital hearing loss was discovered by audiologists in the 1960s and research results were published on it (e.g. Ciwa Griffiths ), as it was recognized that the children's speech and hearing development improved through early hearing aid fitting. In many countries the NGHS has been carried out for a long time. B. in Belgium, Denmark, Cuba, the USA. The NGHS is legally anchored in 46 countries around the world (as of 2009). In 1998, at the European Consensus Development Conference on Neonatal Hearing Screening in Milan in May 1998, a consensus statement on the implementation of a universal NGHS was drawn up. In 2009, the WHO also dealt with the topic at a meeting in Geneva in order to harmonize procedures internationally.

Germany

In Germany, an interdisciplinary statement on the NGHS in Germany was adopted in 2004, but until 2009 there was only a few organized NGHS in some regions. The state of Hesse was a pioneer in the implementation, in which a comprehensive, structured NGHS was introduced in 2006 using a screening identification number. Later, parts of Bavaria, Hamburg, Schleswig-Holstein and North Rhine-Westphalia were added in their own, mostly privately financed projects. Until January 1, 2009, hearing screening in Germany was therefore a voluntary service. B. the maternity hospitals, which were either offered as a free service or billed as an individual health service (IGeL) via the fee schedule for doctors (GOÄ) or made possible through sponsorship in some regions. After the child guideline of the Federal Joint Committee (G-BA) was changed on June 19, 2008, the investigation has been a standard benefit nationwide for those with statutory health insurance since January 1, 2009, but regular remuneration was only paid 21 months later from October 1, 2010 through the introduction of billing numbers in the uniform evaluation standard (EBM). So far, no binding remuneration agreement has been reached with the statutory health insurance companies for the inpatient area.

Austria

As early as 1995, with the Millstadt concept, a universal NGHS for Austria was proposed by the Austrian ENT Society. However, it only included a unilateral hearing measurement for healthy newborns, only high-risk newborns were examined on both sides. The results have been officially recorded in the mother-child pass since 2003 . A study ten years after the introduction of the NGHS could u. a. confirm a lowered detection age for hearing disorders after the introduction of the NGHS.

Switzerland

Since the late 1990s, newborn hearing screening has become more and more widespread in Switzerland. In 1999, a working group of the Commission for Audiology and Experts of the Swiss ORL Society, in cooperation with the Swiss Societies for Pediatrics and Neonatology, developed a recommendation for carrying out hearing screening in all newborns. A measurement of the otoacoustic emissions (OAE) is carried out for newborns in hospital, which can be repeated if necessary before leaving the hospital. The screening test is passed if the OAE detection is positive in at least one ear.

A survey of all 118 clinics in which children are born nationwide showed that in 2008 more than 80% of newborns in Switzerland were screened for hearing. 2% of the children had failed the screening and had to undergo a pediatric audiological follow-up examination.

A prerequisite for the comprehensive implementation of the hearing screening in Switzerland is the assumption of the examination costs as a mandatory service of the health insurance companies ( basic insurance ).

United States

In addition to Ciwa Griffiths , the audiologist Marion Downs (1914-2014), who teaches at the University of Colorado Boulder , has been advocating general newborn hearing screening since the early 1960s. For 30 years she tried to convince the professional world to introduce the test in hospitals and to provide infants with hearing aids when a hearing loss became apparent.

Frequency of congenital hearing disorders

The prevalence in mature newborns is 2–3: 1000, in risk groups (e.g. premature babies, with certain diseases or problems during pregnancy , childbirth or the perinatal period ) approx. 10 times higher (20–30: 1000) .

Comprehensive newborn hearing screening makes sense because undetected hearing impairments that exist at birth lead to developmental disorders, especially language development. It enables an intervention (therapy, etc.) in the «critical phase» up to the eighth month of life , which is decisive for optimal spoken language development.

According to an examination in Hesse in 2005, the mean age when congenital hearing loss was detected was 39 months without previous NGHS, and 3 months with NGHS.

Methods

There are two internationally recognized methods of doing this screening in newborns:

1. Otoacoustic Emissions ( OAE )
2. early acoustic evoked potentials ( BERA , AEP)

The advantages and disadvantages of both methods are described many times in the medical literature, especially with regard to medical, methodological and economic aspects, briefly summarized here:

• OAE : the measurement can be carried out relatively quickly, problematic in louder ambient noises, it only covers a part of the possible forms of hearing loss (only one common type of cochlear hearing loss), middle ear problems can trigger a noticeable result, thus simulating or disguising an inner ear hearing loss .
• BERA as AABR (automated form of BERA) with somewhat greater material consumption and a somewhat longer measurement duration. This covers all peripheral types of hearing loss and also neural hearing loss; AABR also runs the risk of getting incorrect results for middle ear problems.

Implementation in Germany

As is customary internationally, the hearing threshold is set at 35 dB (HL); any higher value is considered conspicuous and must be further clarified. In Germany, both ears must always be measured.

The G-BA resolution on the child guideline stipulates whose responsibility, within which deadlines, and by which methods the examinations must be carried out. The stipulation is that 95% of all newborns are examined, with a maximum of 4% being primarily suspicious (based on the prevalence of congenital hearing disorders). It is the task of the doctor carrying out the child preventive medical check-up "U3" to check whether an examination has taken place and to initiate it immediately if necessary. The background to these requirements is the aim of detecting hard of hearing newborns at an early stage and then providing them with hearing aids at an early stage so that development, in particular speech development, can proceed as normally as possible.

According to the G-BA decision, only specialists in phoniatrics and pediatric audiology and ENT specialists with pedaudiology are permitted to perform confirmation diagnostics. The scientific societies and professional associations of the two specialist groups involved in Germany have developed a two-stage aftercare concept. Using a network of diagnostic centers, in the first stage of diagnostics (FU-1), after an unsuccessful initial examination, either a hearing impairment is ruled out as quickly as possible and close to home, or - if the results continue to be abnormal - the patient is referred to a FU-2 center, which then, with the appropriate equipment and expertise, can take on further support including the provision of hearing aids. For this purpose, binding competence and equipment standards have been established for the individual diagnostic levels (FU-1 and FU-2).

literature

• Sebastian Hoth, Roland Mühler, Katrin Neumann , Martin Walger: Objective audiometry in childhood . Springer, Berlin / Heidelberg 2014, ISBN 978-3-642-44935-2 .
• Daniel Tibussek: Influence of early childhood hearing disorders on the maturation of the early acoustic evoked potentials (FAEP). Inaugural dissertation. Cologne 1999, DNB 956662722 .

Web links

• Information from Deutsche Kinderhilfe eV / Early Childhood Hearing Action on NGHS in Germany
• ENT Clinic University Hospital Zurich: Newborn hearing screening in Switzerland

Individual evidence

1. ↑ The ENT specialist Viktor Urbantschitsch (1847–1921) referred to his research results in 1895, which showed that the residual hearing of deaf children could be stimulated with specific spoken language training (ortho-phonetic and ortho-acoustic exercises), thereby improving hearing ability . Although Urbantschitsch's successes were questioned, they led to unisensory hearing education with electronic hearing aids and from this to auditory-verbal therapy. Susann Schmid-Giovannini began in Vienna in 1949 to develop an auditory-verbal therapy using the Urbantschitsch method.
2. ↑ Summary in German ( Memento from September 20, 2015 in the web archive archive.today )
3. ^ Neonatal and infant hearing screening. Current issues and guiding principles for action . Outcome of a WHO-Informal consultation held at WHO Headquarters, Geneva, Switzerland, November 9th-10th, 2009. Geneva, World Health Organization; 2010
4. ^ Interdisciplinary consensus conference for newborn hearing screening. In: ENT. 52 (11), Nov 2004, pp. 1020-1027. PMID 15492906
5. ↑ K. Neumann, M. Gross, P. Böttcher, HA Euler, M. Spormann-Lagodzinski, M. Polzer: Effectiveness and efficiency of a universal newborn hearing screening in Germany . In: Folia Phoniatr Logop . tape 58 , no. 6 , 2006, p. 440-455 , PMID 17108701 .
6. ^ Decision text of the G-BA
7. ↑ Viktor Weichbold, Doris Nekahm-Heis, Kunigunde Welzl-Müller: Ten Years of Newborn Hearing Screening in Austria. An evaluation . In: Wiener Klinische Wochenschrift . tape 117 , no. 18 , 2005, p. 641-646 , doi : 10.1007 / s00508-005-0414-z .
8. ^ German Medical Science: Current status of newborn hearing screenings in Switzerland
9. ↑ [1]
10. ↑ Consensus paper of the DGPP (PDF 273kB)
11. ↑ Information page with details on FU qualifications, map of FU positions

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !