title: Identification of neonatal hearing impairment: hearing status at 8 to 12 months corrected age using a visual reinforcement audiometry protocol.
abstract: OBJECTIVE
  1) To describe the hearing status of the at-risk infants in the National Institutes of Health-Identification of Neonatal Hearing Impairment study sample at 8 to 12 mo corrected age (chronologic age adjusted for prematurity). 2) To describe the visual reinforcement audiometry (VRA) protocol that was used to obtain monaural behavioral data for the sample.
  
  
  METHODS
  All neonatal intensive care unit infants and well babies with risk factors (including well babies who failed neonatal tests) were targeted for follow-up behavioral evaluation once they had reached 8 mo corrected age. Three thousand one hundred and thirty-four (64.4%) of the 4868 surviving infants returned for at least one behavioral hearing evaluation, which employed a well-defined VRA protocol. VRA thresholds or minimum response levels (MRLs) were determined for speech and pure tones of 1.0, 2.0, and 4.0 kHz for each ear using insert earphones.
  
  
  RESULTS
  More than 95% of the infants were reliably tested with the VRA protocol; 90% provided complete tests (four MRLs for both ears). Ninety-four percent of the at-risk infants were found to have normal hearing sensitivity (MRLs of 20 dB HL) at 1.0, 2.0, and 4.0 kHz in both ears. Of the infants, 2.2% had bilateral hearing impairment, and 3.4% had impairment in one ear only. More than 80% of the impaired ears had losses of mild-to-moderate degree.
  
  
  CONCLUSIONS
  This may be the largest study to attempt to follow all at-risk infants with behavioral audiometric testing, regardless of screening outcome, in an effort to validate the results of auditory brain stem response, distortion product otoacoustic emission, and transient evoked otoacoustic emission testing in the newborn period. It is one of only a few studies to report hearing status of infants at 1 yr of age, using VRA on a clinical population. Successful testing of more than 95% of the infants who returned for the VRA follow-up documents the feasibility of obtaining monaural behavioral data in this population.
authors.affiliation: Multicenter Consortium on Identification of Neonatal Hearing Impairment, Seattle, Washington, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Widen
authors.forename: R C
authors.initials: RC
authors.lastname: Folsom
authors.forename: B
authors.initials: B
authors.lastname: Cone-Wesson
authors.forename: L
authors.initials: L
authors.lastname: Carty
authors.forename: J J
authors.initials: JJ
authors.lastname: Dunnell
authors.forename: K
authors.initials: K
authors.lastname: Koebsell
authors.forename: A
authors.initials: A
authors.lastname: Levi
authors.forename: L
authors.initials: L
authors.lastname: Mancl
authors.forename: B
authors.initials: B
authors.lastname: Ohlrich
authors.forename: S
authors.initials: S
authors.lastname: Trouba
authors.forename: M P
authors.initials: MP
authors.lastname: Gorga
authors.forename: Y S
authors.initials: YS
authors.lastname: Sininger
authors.forename: B R
authors.initials: BR
authors.lastname: Vohr
authors.forename: S J
authors.initials: SJ
authors.lastname: Norton
mesh_terms: D000367:Age Factors; D001299:Audiometry; D005500:Follow-Up Studies; D006311:Hearing Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007363:Intensive Care Units, Neonatal; D015997:Neonatal Screening; D010775:Photic Stimulation