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Neonatal screening for hearing impairment
  1. Colin R Kennedy
  1. Department of Child Health, Southampton General Hospital, Southampton, UK
  1. Dr Kennedy, Mailpoint 21, Child Health, Southampton General Hospital, Southampton SO51 OQJ, UK crk1@soton.ac.uk29/06/00

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Scope of this discussion

Hearing impairment in childhood may be conductive or sensorineural or a combination of the two (mixed) with additive effects. Impairments affect one or both ears, vary from mild to profound in degree, and may be congenital, acquired, transient, fluctuating, recurrent, progressive, or permanent. Screening positive for hearing impairment at any age leads firstly to the need for follow up tests, including an estimation of hearing threshold levels, and secondly, if these are elevated, to a medical evaluation to determine whether or not the hearing loss is permanent. Bilateral congenital permanent childhood hearing impairment (PCHI) of moderate or greater degree can be expected to lead to major deficits in the development of language as well as secondary effects on the child and the family. This is largely avoidable with early intervention,1-2 thus providing the rationale for neonatal screening. Consideration of this rationale and its practical implications is the focus of this article. This is timely as Yvette Cooper, UK government minister for Public Health, announced on 22 June 2000 that the government had decided in principle to introduce universal neonatal screening (UNS) and that districts are invited to apply to be part of a 20 site pilot starting perhaps at the end of 2000.

Epidemiology of childhood hearing impairments

PCHI is sensorineural except for a small number of cases of atresia. Bilateral PCHI ⩾ 40 decibels relative to hearing threshold level (dB HTL) affects 133 (95% confidence interval 122 to 145) per 100 000 children, of whom about 55% have moderate losses and the remainder are divided equally between severe (70–94 dB HTL) and profound (⩾ 95  dB HTL) losses.1-3 About 112 per 100 000 of these are congenital, which in this context means prenatal or perinatal in onset with the remainder being either postnatally acquired, most commonly after meningitis, progressive, or late onset, …

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