title: Improving newborn hearing screening: Are automated auditory brainstem response ear inserts an effective option?
abstract: OBJECTIVE
  Universal newborn hearing screening is an established practice among Hong Kong public hospitals using a 2-stage automated auditory brainstem response (AABR) screening protocol. To enhance overall efficiency without sacrificing program accuracy, cost reduction in terms of replacing the initial ear coupler-based screening with a more economical ear insert-based screening procedure was considered. This study examined the utility of an insert-based AABR initial screening approach and the projected cost-effectiveness of a combined probe-based plus follow-up ear coupler AABR screening procedure.
  
  
  METHODS
  Following prenatal maternal consent, newborn hearing screening was conducted with 167 healthy neonates using a cross-sectional, repeated measures study design. The neonates were screened with AABR sequentially; using ear coupler and ear probe (insert) procedures, in both ears, with two different but comparable AABR instruments. Testing took place in the antenatal ward of a department of obstetrics and gynaecology, at a large public hospital.
  
  
  RESULTS
  With the specific combination of instruments deployed for this study insert-based AABR screening generated a five-fold higher rescreen rate and took an additional 50% screening time compared to coupler-based AABR screening. Although the cost of consumables used in a 2-stage AABR screening protocol would reduce by 9.87% if the combined procedure was implemented, the findings indicated AABR screening when conducted with an ear probe has reduced utility compared with conventional ear coupler screening.
  
  
  CONCLUSIONS
  Significant differences may occur in screening outcomes when changes are made to coupler method. Initiating a 2-stage AABR screening protocol with an ear insert technique may be impracticable in newborn nurseries given the greater number of false positive cases generated by this approach in the present study and the increased time required to carry out an insert-based procedure.
authors.affiliation: Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Kit Tsui-Yan
authors.initials: KT
authors.lastname: Chan
authors.affiliation: Ear, Nose and Throat Department, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China.
authors.forename: Eddie Chi Ming
authors.initials: EC
authors.lastname: Wong
authors.affiliation: Department of Paediatrics, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China.
authors.forename: Chi Wai
authors.initials: CW
authors.lastname: Law
authors.affiliation: Ear, Nose and Throat Department, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China.
authors.forename: Hou Ming
authors.initials: HM
authors.lastname: Chong
authors.affiliation: Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong SAR, China. Electronic address: dbmcpher@hku.hk.
authors.forename: Bradley
authors.initials: B
authors.lastname: McPherson
mesh_terms: D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D005260:Female; D034381:Hearing Loss / Q000175:diagnosis*; D006320:Hearing Tests / Q000295:instrumentation*; D006723:Hong Kong; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000295:instrumentation*; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology*; D015203:Reproducibility of Results
keywords: Cost effectiveness; Electrophysiological; Hearing screening; Neonatal