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Slide1: 

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

Slide2: 

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

Screening: 

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

Screening: 

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

Screening: 

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

Screening: 

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

Screening: 

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

Slide8: 

TEOAE „always“ present TEOAE „always“ missing

Slide9: 

TEOAE missing TEOAE +

Slide10: 

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

DPOAE: 

DPOAE

Slide12: 

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

OAE Screening: 

OAE Screening no OAE no OAE no OAE OAE present!

Use of OAE: Screening: 

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

Slide15: 

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

Neonatal hearing screening in Switzerland: 

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

Neonatal hearing screening in Switzerland: 

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 Neonatal hearing screening in Switzerland

Neonatal hearing screening in Switzerland: 

Veraguth, Pieren, Schmid, Vischer, 2004 132 obstetric departments 3/4 with neonatal hearing screening Neonatal hearing screening in Switzerland

Neonatal hearing screening in Switzerland: 

Veraguth, Pieren, Schmid, Vischer, 2004 Neonatal hearing screening in Switzerland Births per year and NNH-screening

Neonatal hearing screening in Switzerland: 

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

Neonatal hearing screening in Switzerland: 

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

Slide22: 

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