J. JEWEL ET AL. 213
4.2. TEOAE vs BERA as Initial Screening
Method
Otoacoustic emissions are the most sensitive tests for
screening although it may have to be combined with o t h er
tests for complete diagnosis [13]. However it may give
false results in the presence of debris or vernix in the ex-
ternal audi tory canal o f n ewborn b ab ies. Brainstem Evoked
Response Audiometry (BERA), though highly reliable,
requires high technical expertise, which is more expen-
sive as opposed to TEOAE. Also BERA makes use of a
cumbersome machine whilst the TEOAE screener is a
portable machine. It also requires sedating the infant be-
cause of the lengthy procedure. TEOAE, on the other
hand does not assess the cortical pathway for hearing. It
may also give false results in ne onates with auditory neu-
ropathy. However, it is an excellent tool as an initial
screening method.
The relative advantages and disadvantages of a two-
stage (OAE/BERA) protocol for newborn hearing screen-
ing need to be considered carefully for individual cir-
cumstances. Transient Evoked OtoAcoustic Emissions
(TEOAE) are a non-invasive and inexpensive test that
can be done in the nursery setting with little expertise
and a shorter time as compared to BERA. Different stud-
ies have revealed TEOAE sensitivity as high as 95% -
98% and a specificity of 80% - 85% [14,15]. Therefore,
TEOAE cannot completely replace BERA as a screening
modality, but can on ly complement it. In location s where
getting infants to return for outpatient screening and test-
ing is very difficult, and the substantially lower failure
rate that will likely be achieved by using both OAE and
BERA at the same sitting has significan t advantages. In a
setting like ours, this may not be very practical, but has
to be considered wherever possible.
4.3. Problems and Limitations of Study
One problem we faced was getting a noiseless surround-
ing in the nursery setting. The babies had hence to be
transported to the audiology room for testing which in-
creased the discomfort for the relatives. Some babies
woke up during transit, increasing the time taken for the
test.
To improve the follow-up rate, we coincided the im-
munization visit with that of screening. Performing a test
on that day was a little time consuming because one has
to wait for the baby to go to natural sleep.
A hearing screening equipment facility in every hos-
pital with a maternity unit today may not be an eco-
nomically viable proposition. In this backgrou nd, a prac-
tical interventional model was conceived in the city of
Cochin (which has 20 hospitals with maternity units) in
January 2003. A program with centralized screening fa-
cility, where a screener would operate out of one hospital,
to cater to the different hospitals of the city was success-
fully implemented with the co-operation of IAP [16].
This is a viable and cost effective model for the whole
country.
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