Can Automated Auditory Brainstem Response Be Used As An Initial Stage Screening Test in Newborn Hearing Screening Programs?

Objectives: Generally, newborns have been tested according to the method recommended by the Joint Committee on Infant Hearing all around the world: a two-stage automated transient evoked oto-acoustic emissions (ATEOAE) program, completed by an automated auditory brainstem response (AABR) for the positive diagnosis of hearing impairment. However, there are still some controversies on this two-stage method. In this study, we used ATEOAE and AABR in combination as an initial stage screening protocol to investigate if we could reduce the disadvantages of routinely performed screening procedure. Materials and Methods: A total of 1,978 neonates were screened for hearing impairment during the study period prospectively. 1,917 of them were tested with both ATEOAE and AABR in the first day of their life. If newborns did not meet pass criteria for any of the tests, both tests were repeated in 10-day period. Results: Out of 1,917 neonates, 202 (10.53%) were failed the initial ATEOAE, and 37 (1.97%) failed the initial AABR. 158 of the 202 neonates that failed the ATEOAE and all neonates that failed AABR was subjected to the second test. Four (2.5%) neonates failed second ATEOAE, and three (1,89%) failed second AABR. All four neonates were referred for further audiologic evaluation, and three of them, whose AABR were negative, were diagnosed as having congenital hearing loss. Conclusion: As a first stage screening method AABR has the lowest false positive rate, referral rate and high specificity. Therefore, we recommend that all universal newborn hearing screening programs should consider revising their protocols to decrease expenses in terms of time and money.Wo