4. Screening methods around the world

As part of a hearing evaluation, child's healthcare provider will do a complete medical history and physical exam. In addition, there are many different types of hearing tests. Some of them may be used on all ages, while others are used based on child's age and level of understanding. Moreover, a variety of objective tools have been developed for screening tools. Hearing screening test should be conducted in a quiet area where visual and auditory distractions are minimal.

#### 4.1. Questionnaires

Newton et al. [21] developed an eight-item questionnaire for hearing screening of children in Kenya. This tool is based on typical behavioral reaction to sound and communication ability. The main aim of this questionnaires was to identify children who may have bilateral hearing loss of a moderate degree or greater. It was designed for children of 3–8 years old and completed by teachers, parents, or community nurses, but authors recommended this tool for use only when administered by community health nurses. This questionnaire showed a high sensitivity of 100% but lower specificity of 75%. In addition, all young patients were invited to have an evaluation by ear-nose-throat physician and to have pure-tone audiometry completed.

Olusanya [22] created a questionnaire to screen children at school entry in Nigeria, Lagos. In this study was compared audiometry to results of questionnaires, otoscopy, and also tympanometry for each child. First step was a full physical exam on the children and then the parents were interviewed using a structured questionnaire that explored past medical/developmental history and family history of hearing loss. The parent questionnaire showed high specificity of 94% but low sensitivity of only 10%. The author noted that given limited resources in developing countries there is a need for a low-cost method that requires minimal training and that a questionnaire is a feasible approach. Moreover, the authors recommended the use of the questionnaire for mass screening when administered by trained teachers.

Samelli et al. [23] developed a 14-item questionnaire to identify children at risk for screening in Sao Paulo in Brazil. This tool is dedicated to children of 2–10 years old. In this study, a parentcompleted questionnaire was compared with the results of an audiological assessment. Conduction analyses show that this questionnaire from all of the children identified only with permanent severe-to-profound hearing loss. This tool showed low sensitivity of 44% and specificity of 87%. Researchers recommended the questionnaire for use in healthcare settings.

To conclude, all questionnaires were designed as a tool to identify children with hearing problems so that appropriate treatment and/or intervention could be provided; there were differences in the extent of hearing loss being targeted by the questionnaire. The purpose of population-based hearing screening is to identify those who need further testing from those who do not, with a minimum of false positives (failing the questionnaire when hearing is normal) and false negatives (passing the questionnaire when hearing loss exists).

#### 4.2. Evoked otoacoustic emission

profound) based on the pure-tone threshold does not predict handicap or success in school. Some children have severe hearing loss; however, their speech is comprehensible and they get good grades. But on the other hand, other children with mild hearing loss and lack of family support exhibit considerable academic failure. Therefore, any hearing impairment, no matter how mild, needs to be assessed in order to assert confidently attention to any barrier of

Children with unilateral hearing loss (UHL) appear to have an increased rate of grade failures, need for additional educational assistance, and perceived behavioral issues in the classroom. Possible risk factors include lower cognitive ability, right-ear hearing loss, and severe-to-profound hearing loss. Speech and language development may be delayed in some children with

As part of a hearing evaluation, child's healthcare provider will do a complete medical history and physical exam. In addition, there are many different types of hearing tests. Some of them may be used on all ages, while others are used based on child's age and level of understanding. Moreover, a variety of objective tools have been developed for screening tools. Hearing screening test should be conducted in a quiet area where visual and auditory distractions are minimal.

Newton et al. [21] developed an eight-item questionnaire for hearing screening of children in Kenya. This tool is based on typical behavioral reaction to sound and communication ability. The main aim of this questionnaires was to identify children who may have bilateral hearing loss of a moderate degree or greater. It was designed for children of 3–8 years old and completed by teachers, parents, or community nurses, but authors recommended this tool for use only when administered by community health nurses. This questionnaire showed a high sensitivity of 100% but lower specificity of 75%. In addition, all young patients were invited to have an evaluation by ear-nose-throat physician and to have pure-tone audiometry completed. Olusanya [22] created a questionnaire to screen children at school entry in Nigeria, Lagos. In this study was compared audiometry to results of questionnaires, otoscopy, and also tympanometry for each child. First step was a full physical exam on the children and then the parents were interviewed using a structured questionnaire that explored past medical/developmental history and family history of hearing loss. The parent questionnaire showed high specificity of 94% but low sensitivity of only 10%. The author noted that given limited resources in developing countries there is a need for a low-cost method that requires minimal training and that a questionnaire is a feasible approach. Moreover, the authors recommended the use of the questionnaire for

Samelli et al. [23] developed a 14-item questionnaire to identify children at risk for screening in Sao Paulo in Brazil. This tool is dedicated to children of 2–10 years old. In this study, a parentcompleted questionnaire was compared with the results of an audiological assessment.

UHL, but it is unclear if children "catch up" as they grow older.

4. Screening methods around the world

mass screening when administered by trained teachers.

learning.

116 An Excursus into Hearing Loss

4.1. Questionnaires

Physiologic test specifically measures outer hair cell response to presentation of a click stimulus (transient evoked OAEs). The test is that acoustic signals generated from within the cochlea travel in a reverse direction through the middle-ear space and tympanic membrane out of the ear. OAEs use a tiny, flexible plug that is inserted into the baby's ear. Sounds are sent through the plug. A microphone in the plug records the otoacoustic emissions (responses) of the normal ear in reaction to the sounds. There are no emissions in a baby with hearing loss. This test is painless and usually takes just a few minutes, while the baby sleeps.


#### 4.3. Automated auditory brainstem response

Auditory brainstem responses (ABR) are measures of electrical events generated within the auditory brainstem pathway. These ABRs are used to assess brainstem function at different levels of the auditory pathway and are typically evoked by rapid multi-frequency clicks or chirps. Small metal discs with thin electrodes (wires) are placed on the baby's scalp, and then send signals to a computer to record the results. One objective physiologic means of screening hearing is the automated ABR. This instrument measures cochlear response in the 1- to 4-kHz range with a broadband click stimulus in the ear. While the baby sleeps, clicking sounds are made through tiny earphones in the baby's ears. As in OAEs, this test is painless.


#### 4.4. Play audiometry

Behavioral test of auditory thresholds in response to speech and frequency-specific stimuli is presented through earphones and/or bone vibrator. This test is dedicated to children of 2–4 years old. A test that uses a special audiometer which is able to transmit sounds at different volumes and pitches into child's ears. This test is modified slightly in the toddler age group and made into a game. The toddler is asked to do something with a toy (such as touch or move a toy) every time when a sound is heard through earphones. Air-conduction hearing threshold levels of greater than 20 dB at any of these frequencies indicate possible hearing impairment. This test relies on the cooperation of the child, which may not always be given.

admitted there soon after birth using OAE and second, screen babies who are not born in a

Hearing Screening around the World http://dx.doi.org/10.5772/intechopen.73535 119

In 2011, 97.9% of babies born in the United States had their hearing screened in the first few

In Europe and England, two models are used: first, in hospital before discharge, if discharge takes place before the test is completed, a letter is sent asking the mother to attend an appointment for the screening test and second, in some areas, the test is done at home by a

Although newborn hearing screening programs have greatly improved outcomes for those diagnosed with hearing loss in the immediate newborn period, there is no objective universal screening protocol in place during the critical early development years [28]. Unfortunately, school-age children are rarely screened for hearing loss during routine clinical examination, and health authorities pay little attention to audiometric evaluation particularly in primary schools.

One of the priority activities of the Institute of Physiology and Pathology of Hearing in Kajetany is a screening program for children of all ages. The Institute team, in collaboration with numerous national centers, has laid the groundwork for screening programs and developed methods, procedures, and devices for carrying out them. He was the coordinator and producer of many programs. Based on this, two screening models have been created—newborn

The foundation on which the modern screening system was based was a research program for 150,000 newborns with funds in 15 neonatal and infants' centers in Warsaw. It was realized in 1992–1994 under the direction of Professor Maria Góralowna, and we cooperate with the team Diagnostic-Therapeutic and Rehabilitation Center "Cochlear Center" headed by Professor

In the years 1995–1998, under the direction of Professor H. Skarżyński, a grant awarded to the Minister of Health, "Development of a unified screening program for neonates with hearing defects" was implemented. As part of the program, methods and procedures for screening hearing in newborns were developed, as well as their models - universal and intended for newborns at risk. At the end of the project, a draft of the Minister of Health was prepared for

In 1998, the grants were awarded the team award of the Minister of Health first degree. Another important initiative was implemented in 1996-1998, when the Institute of Physiology and Pathology of Hearing participated in the European program "European Concerted Action AHEAD (Advancement of Hearing Assessment Methods and Devices). This program aimed to develop a

In 1998, in Milan, a consensus on universal screening of hearing in newborns in Europe was

hospital; screening is carried out using a brief questionnaire and behavioral testing.

weeks of life according to Centers for Disease Control and Prevention (CDC) [29].

5.1. Comprehensive approach to hearing screening in Poland

common European position on hearing screening for newborns.

signed. The signature on the Polish side was by Professor H. Skarżyński.

health visitor nurse.

and school-age children.

H. Skarżyński.

5.1.1. Newborn hearing screening

hearing screening in neonates.


#### 4.5. Pure-tone audiometry

Behavioral test measuring auditory thresholds in response to frequency-specific stimuli is presented through earphones for children of 4 years and older. A test that uses a audiometer which is able to produces sounds at different frequently and intensity into child's ears. The child usually wears some type of earphones. Each ear should be tested at 500, 1000, 2000, and 4000 Hz. Results greater than 20 dB at any frequencies indicate possible hearing loss. In this age group, the child is simply asked to respond in some way when the tone is heard in the earphone. In that test, the most important is the cooperation of the child.

