Early identification and treatment of hearing impairments in children may improve language development

Article Outline

• Question
• Design
• Data Sources
• Study Selection
• Outcomes
• Main Results
• Conclusions
• Commentary
• Reference
• Copyright

Wolff R, Hommerich J, Riemsma R, Antes G, Lange S, Kleijnen J. Hearing screening in newborns: systematic review of accuracy, effectiveness, and effects of interventions after screening. Arch Dis Child 2010;95:130-5.

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Question 

Does universal newborn hearing screening result in improved developmental outcomes?

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Design 

Three systematic reviews of non-randomized controlled studies of diagnostic accuracy of screening tests, screening versus no screening, and therapeutic effect of early versus later treatment.

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Data Sources 

Eleven bibliographic databases, including standard literature databases and the Cochrane database.

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Study Selection 

Seventeen studies (diagnostic: 9, screening: 2, and treatment: 6). All studies apart from one treatment study showed major quality deficits.

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Outcomes 

Diagnostic accuracy of the screening tests and developmental outcomes for the therapeutic studies.

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Main Results 

The studies comparing screening versus no screening showed an improvement of speech development of children in the screening group compared with the group without screening. Eight diagnostic studies comparing otoacoustic emissions with auditory brainstem response showed sensitivities (and specificities) between 50% (49.1%) and 100% (97.2%). Early treatment was associated with better language development in comparison with children with later treatment.

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Conclusions 

In general, there is a lack of high-quality evidence regarding all elements of newborn hearing screening. Early identification and early treatment of children with hearing impairments may be associated with advantages in language development. Other patient-relevant parameters, such as social aspects, quality of life, and educational development, have not been adequately investigated.

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Commentary 

This systematic evidence review was commissioned by the German Institute of Quality and Efficiency in healthcare to determine whether universal newborn hearing screening (UNHS) results in better outcomes in children with newborn hearing loss. Unlike a previous systematic review published by the United States Preventive Services Task Force,¹ studies that involved high-risk or other selective screening strategies were not included. The authors of this study concluded that evidence supports the assumption that UNHS leads to earlier identification of children with hearing loss. A two-stage screening process with otoacoustic emissions (OAE) followed by auditory brainstem response (ABR) for those who fail their OAE may yield the best diagnostic accuracy. In addition, early intervention leads to improved language development for children with hearing impairments. Similar to the report by the USPSTF, these authors found limited studies on the potential risks of UNHS programs. In the United States, most hospitals and birthing centers have instituted universal newborn hearing screening programs and estimates are that up to 93% of infants born in the United States are now screened for hearing loss. Cochlear implants and other treatment modalities are increasingly available to infants and young children with moderate to severe hearing loss. Future studies may determine if early identification through UNHS leads to long-term improvements in communication, education, and social outcomes for children born with impaired hearing. In the meantime, it is clear that early identification of hearing loss is improved by universal screening and that early intervention leads to improved language outcomes in preschool to school-aged children with hearing impairment.

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Reference 

1. US Preventive Services Task Force. Universal screening for hearing loss in newborns: US Preventive Services Task Force recommendation statement. Pediatrics. 2008;122:143–148
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