title: Initial audiologic assessment of infants referred from well baby, special care, and neonatal intensive care unit nurseries.
abstract: OBJECTIVE
  The purpose of the study was to evaluate the effectiveness of a 2-hr initial audiologic assessment appointment for infants referred from area universal newborn hearing screening (UNHS) programs to a clinical audiology department in an urban hospital.
  
  
  METHODS
  A prospective auditory brainstem response (ABR)-based protocol, including clicks, frequency-specific tone bursts, and bone-conducted stimuli, was administered by 10 audiologists to 375 infants. Depending on the ABR findings, additional test options included distortion product otoacoustic emissions (DPOAEs), high-frequency tympanometry, and/or otologic examination.
  
  
  RESULTS
  In 88% of the 2-hr test sessions, at least 4 ABR threshold estimates were obtained (i.e., bilateral clicks and either a 500- or 1000-Hz tone burst and a 4000-Hz frequency tone burst for the better ear). The incidence of hearing loss was significantly different across nursery levels: 18% for Level I (well baby), 29% for Level II (special care), and 52% for Level III (neonatal intensive care unit). Hearing loss type was defined at the initial assessment for 35 of the 51 infants with bilateral hearing loss based on bone-conduction ABR, latency measures, DPOAEs, high-frequency tympanometry, and/or otologic examination.
  
  
  CONCLUSIONS
  Our findings indicate that a 2-hr test appointment is appropriate for all nursery levels to diagnose severity and type of hearing loss in the majority of infants referred from UNHS. Examination by an otolaryngologist within 24-48 hr further defines the hearing loss and facilitates treatment plans.
authors.affiliation: St. Louis Children's Hospital, One Children's Place, Room 3S23, St. Louis, MO 63110, USA. roannekk@bjc.org
authors.forename: Roanne K
authors.initials: RK
authors.lastname: Karzon
authors.forename: Judith E Cho
authors.initials: JE
authors.lastname: Lieu
mesh_terms: D000158:Acoustic Impedance Tests; D000161:Acoustic Stimulation; D000704:Analysis of Variance; D001300:Audiometry, Evoked Response / Q000379:methods* / Q000592:standards; D001309:Auditory Threshold / Q000502:physiology*; D001844:Bone Conduction / Q000502:physiology; D003939:Diagnostic Techniques, Otological; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D005260:Female; D034381:Hearing Loss / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology; D011446:Prospective Studies; D012017:Referral and Consultation; D015203:Reproducibility of Results; D013997:Time Factors