Early intervention is possible only after early identification

1. Why early identification of HL ? Early intervention is possible only after early identification Early intervention allows more effective habilitation of HL

2. Methods of early identification • Screening • High level of suscpicion • Continuous education of health care professionals • Increasing public awareness

3. Screening • Specific medical intervention • Aim: Detection of disease or disability earlier that without screening • More effective intervention after screening than without screening

4. Screening • Population: • Screening: primarily healthy population • Diagnostic: disease suspected • Ratio of benefit to risks must be judged differently • Usually no quantifying results

5. Screening screening test + “fail” “pass” inefficient screening disease present disease not present disease present disease not present

6. Screening assessment of hearing (Audiometry) • Methods: • subjective • objective • Clinical use: • screening • diagnosis • quantification

7. Screening Test: OAE or AEP + “fail” “pass” inefficient screening disease present disease not present disease present disease not present

8. TEOAE „always“ present TEOAE „always“ missing

9. TEOAE + TEOAE missing

10. Number of ears with severe SNHL n=36 Passcriteria: SNR  5 dB; [in parenthesis  7dB] Pass rates in a test cavity “DPOAE” measurements (n=96); L1 = 65 / L2 = 55 dB SPL

11. DPOAE

12. CEOAEs stimulus level 90dB SPL peak CEOAEs stimulus level 83dB SPL peak

13. OAE Screening OAE present! no OAE no OAE no OAE

14. Use of OAE: Screening • Global screening of peripheral hearing function • No screening of neural function • Newborn hearing screening

15. screening for HL neonates + “fail” “pass” inefficient screening disease present disease not present disease present disease not present “true pos.” “false pos.” “false neg.” “true neg.” 1-3/1000 1-3% ? 97-99%

16. 2. - 4. day Aim: covering all birth Organization and supervision: pediatricians Measurements: nurses, midwifes Follow up: pedaudiological services of otology departments Neonatal hearing screening inSwitzerland

17. Neonatal hearing screening inSwitzerland • TEOAEs on day 2 - 4 : 1 ear pass = screening passed • Fail on both sides: TEOAEs repeated before discharge • Second fail: pedaudiological examination 4 weeks later (appointment at discharge) • Pedaudiological examination: OAE measurements, if failed again ⇨ AEP in natural sleep

18. Neonatal hearing screening inSwitzerland Veraguth, Pieren, Schmid, Vischer, 2004 132 obstetric departments 3/4 with neonatal hearing screening

19. Neonatal hearing screening inSwitzerland Veraguth, Pieren, Schmid, Vischer, 2004 Births per year and NNH-screening

20. Neonatal hearing screening inSwitzerland Veraguth, Pieren, Schmid, Vischer, 2004 1999-2003: 50‘000 births 98.5 % pass, 1.5 % fail

21. Neonatal hearing screening inSwitzerland Veraguth, Pieren, Schmid, Vischer, 2004 Follow up of 751 fails 1 in 1000 baby with HL identified

22. Diagnosis of HL • Type of hearing loss: • Conductive • Sensorineural: cochlear? • Etiology of HL • Degree of HL (audiometry) • Degree of disability • other handicaps • Psychosocial background