Hearing screening in children - state of the art
Article Abstract:
The general principles of medical screening, referred to as the 10 Wilson-Jungner principles, focus on the need for acceptable and relatively accurate tests that will predict a disease at an early stage in the absence of symptoms. They also refer to the need for effective treatments, and various ethical and practical issues for screening the general public. Four additional principles concern: (1) the balance between harm and benefits of medical screening; (2) guidelines concerning the disclosure of screening results and counseling programs; (3) periodic review of screening arrangements; and (4) stratified analysis of the balance of costs, benefits, and risks from screening, assessment, and treatment. Severe loss of hearing before the development of speech fulfills the criteria required for the screening of a medical disorder. In addition, studies have shown that early detection and management of hearing loss with hearing aids is beneficial to the development of speech and intellect. The most important principles influencing the medical screening for hearing loss concern the availability of suitable screening tests, audiological assessment, and effective treatments. Five major problems associated with screening for hearing loss in infants aged seven to nine months and children aged one to four years include: compliance of health care workers who test for hearing loss with audiometric procedures (tests of hearing ability); uneven distribution of services to test hearing, particularly in deprived areas and among older children; increased rates of hearing loss among children of problem families, who tend to have less access to services for hearing impairment; previous detection of hearing loss by relatives or professionals, making the screening process unnecessary; and a high incidence of ear infections between the ages of six months and six years, which complicates the screening process. The effectiveness of screening in reducing the age at which hearing loss can be detected, the problems associated with screening for hearing loss in newborns, and issues associated with establishment of a screening program are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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Screening for sensorineural deafness by health visitors
Article Abstract:
Deafness in infants under the age of one often goes undetected unless extensive screening is performed. Screening for hearing impairment remains the responsibility of health workers using the hearing distraction test. In order for this test to be reliable, the children must be capable of sitting and have sufficient neck and trunk control to turn toward sounds used to test hearing. District health workers were used to determine the validity of this technique as a sensitive means of measuring sensorineural deafness. The test has been previously described as inaccurate. The accuracy of this test was assessed in 64,881 infants. Factors were identified that would limit the effectiveness of a community-based hearing program. The risk of sensorineural deafness is considered higher among children who weighed less than 2,000 grams (4.4 pounds) at birth and those who required special care for longer than 24 hours. The results of screening infants in this high-risk group were compared with information compiled on children diagnosed with sensorineural deafness before age three. Overall, 18.3 percent, or 752 infants, failed the distraction test. The test was found to be sensitive, in that it detected 91 percent of the children with deafness, but it was not specific, in that it could only distinguish deafness from other possibilities 82 percent of the time. Early provision of hearing aids improves intellectual, social, and emotional development. Neonatal testing is expensive and has not been applied to the entire population. Late detection of deafness requires that improved reliability is needed for the distraction test. Immature infants that cannot give the required motor response to the test will fail the test and will need to be retested. Health visitors should continue to use the distraction test; however, special care is needed since the test can be nonspecific. Screening should not be done only on infants that require special care after birth, since a high proportion of deaf children will be missed. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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Early identification of hearing loss: screening and surveillance methods
Article Abstract:
Hearing impairment can have a serious effect on a child's social and psychological development, as well as on his or her education and language development. Although there is little hard evidence, there seems to be little reason to doubt that early identification of children with hearing problems provides the greatest opportunity to compensate for their loss. The traditional method for testing the hearing of infants is the distraction test, in which different sounds are tested for their ability to distract the infant and make him or her orient towards the sound. For developmental reasons, the test cannot be performed before six to seven months of age. Unfortunately, the distraction test has been far from effective; many cases of hearing impairment are not identified and numerous cases of ear infection are referred for more auditory analysis. The reason for the unsatisfactory performance of the screening is not certain. It seems that the distraction test itself is adequate, but needs to be included as part of an overall program of hearing screening. Such a program would include earlier screening for children at high risk, such a premature infants, and immediate screening for infants when parental concern is expressed. Furthermore, an effective program should include parental education, so that parents may become aware of some of the subtle ways of recognizing hearing impairment and some of the principles of raising a hearing-impaired child. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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