title: Comparison of hearing screening programs between one step with transient evoked otoacoustic emissions (TEOAE) and two steps with TEOAE and automated auditory brainstem response.
abstract: OBJECTIVE
  To compare the efficacy between one step with transient evoked otoacoustic emissions (TEOAE) and two steps with TEOAE and automated auditory brainstem response (AABR) in a newborn hearing screening program. We investigated their differences in referral rate, the accurate identification rate of congenital hearing loss (HL), and cost effectiveness.
  
  
  METHODS
  From November 1998 to December 2004, a total of 21,273 healthy newborns were screened for HL in Mackay Memorial Hospital, Taipei. In the periods from November 1998 to January 2004 and from February 2004 to December 2004, the screening tools used were TEOAE alone (n = 18,260) and TEOAE plus AABR (n = 3,013), respectively.
  
  
  RESULTS
  A statistically significant decrease of referral rate was achieved in the group using TEOAE and AABR as screening tools when compared with TEOAE alone (1.8% vs. 5.8%). The accurate identification rate of congenital HL was 0.45% in TEOAE protocol and 0.3% in TEOAE and AABR protocol, which was not statistically significant. The total direct costs per screening were 10.1 U.S. dollars for the program using TEOAE alone and 8.9 U.S. dollars for the TEOAE plus AABR program. The intangible cost, however, was much higher in the earlier program because of the higher referral rate.
  
  
  CONCLUSIONS
  In terms of the efficacy of a hearing screening program using the one step TEOAE and two step TEOAE and AABR programs, the later significantly decreased the referral rate from 5.8% to 1.8%. No significant difference was noted between the accurate identification rates of congenital HL. The total costs, including expenditures and intangible cost, were lower in the protocol with TEOAE plus AABR.
authors.affiliation: Department of Otolaryngology, Hearing and Speech Center, Mackay Memorial Hospital, Taipei, Taiwan. hclin59@ms29.hinet.net
authors.forename: Hung-Ching
authors.initials: HC
authors.lastname: Lin
authors.forename: Min-Tsan
authors.initials: MT
authors.lastname: Shu
authors.forename: Kuo-Sheng
authors.initials: KS
authors.lastname: Lee
authors.forename: Guan-Min
authors.initials: GM
authors.lastname: Ho
authors.forename: Tzu-Yu
authors.initials: TY
authors.lastname: Fu
authors.forename: Sharon
authors.initials: S
authors.lastname: Bruna
authors.forename: Grace
authors.initials: G
authors.lastname: Lin
mesh_terms: D003362:Cost-Benefit Analysis; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000151:congenital / Q000175:diagnosis* / Q000503:physiopathology; D006320:Hearing Tests; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000191:economics / Q000379:methods*; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity