Neonatal otoacoustic emission screening and the identification of deafness.

Using transient evoked otoacoustic emissions (TEOAEs), a two stage screen with the testing of failures by auditory brainstem response (ABR), has been implemented in Whipps Cross Hospital in East London. From January 1992 to 1995, 11,606 infants received an initial TEOAE test. Once initial difficulties were resolved, coverage of district residents remained stable at 91.5%. Long term follow up of the cohort is being undertaken. Of those receiving an initial test, 13% failed in both ears. Only 1.75% of the cohort failed both stages of the TEOAE screen bilaterally. These infants were tested by ABR. The yield of infants with a bilateral permanent hearing loss of moderate or worse degree was 2/1000. The overall cost of implementing the programme was not prohibitive and the cost per hearing impaired child detected was little more than the widely accepted notional cost of identifying such children through targeted at risk screens. The screen was clearly sensitive. The priority for such universal TEOAE programmes, however, is to increase specificity without losing this sensitivity.