Influence of screening devices and protocol on audiological outcome of 25 years of universal neonatal hearing and vestibular screening in Flanders

Abstract

Background: Congenital hearing loss has been linked with life-long deficits in speech and language abilities and children with vestibular deficits show delayed development of gross motor milestones. Aim and scope of the research: To analyze if the universal neonatal hearing screening (UNHS) and vestibular screening program in Flanders meet the current guidelines and benchmarks of the position statements from the Joint Committee on Infant Hearing and how big the impact of screening devices and strategy is. Methods: The UNHS is organized since 1997 by a Flemish public child care organization and performed by trained nurses. It is based on a two-step screening with Automated Auditory Brainstem Responses and in case of absent responses (named ‘refer’), audiological and medical diagnostic are done in one of 21 certified centers. Vestibular screening started in 2018 around the age of 6 months with cervical Vestibular Evoked Myogenic Potentials (cVEMP) for all children with confirmed permanent hearing loss. Results: The coverage of the UNHS from 1998 till 2020 was 96,3 % (range 91,1 – 98%). There was a bilateral refer for 0,27 % of the infants and unilateral refer for 0,37 %. A sensorineural or mixed hearing loss > 40 dB was diagnosed in 32 % of the referred infants, a conductive hearing loss which often resolved over time in 39 %, a normal hearing in 25% and 4,7 % were lost in follow-up for the diagnostic evaluation. There was an effect of the screening device on the detection of conductive hearing losses and false-positive cases. The incidence was higher with the MAICO MB Classic® device compared to the ALGO® devices. The incidences of sensorineural or mixed hearing loss were independent of the screening device and remained relatively stable over the years. A vestibular deficit was found in 9,5 % of all children with sensorineural hearing loss. The incidence was significantly higher in infants with severe or profound hearing loss (p=0,003) Conclusion: The Flemish UNHS has a high coverage, low referral rate and low loss of follow-up rate. Strict monitoring and follow-up by a central organization are essential for optimal results. Long-term follow-up remains a challenge.