Universal Neonatal Hearing Screening (UNHS) enables early detection of deafness within 48 hours of birth, allowing for earlier intervention before language development is significantly impacted. While some argue screening should only target high-risk infants, studies show 50 cases of hearing impairment per 100,000 low-risk infants, indicating all newborns should be screened. Accepted screening methods include otoacoustic emissions testing, which is quick and minimally invasive, and auditory brainstem response testing, which is more sensitive but more complex. An effective UNHS program must include initial screening, evaluation of abnormal results, tracking and follow-up to ensure appropriate intervention by 6 months of age.

1. UNHS
(UNIVERSAL NEONATAL HEARING
SCREENING)
Dr. Ghulam Saqulain
M.B.B.S., D.L.O, F.C.P.S
Head of Department of E.N.T
Capital Hospital

2. Hearing Screening
The early detection and confirmation of deafness in babies is vital b/c it enables
earlier intervention and professional support for very young deaf children and their
families, in particular it enables families and professionals to work together with
the child before a substantial language and communication deficit builds up.
Hearing screening for newborns before they leave the hospital or maternity center
is now becoming a common practice . Without such programs, the average age of
hearing loss identification is between 12 to 25 months and even later in
underdeveloped countries

3. UNHS can detect deafness within 48 hrs of child birth.
An evidence consensus is developing in the world of paediatric audiology that
Universal Neonatal hearing Screening (UNHS) is a suitable, feasible and
acceptable cost-effective strategy for early detection of permanent childhood
hearing impairment (PCHI)

4. Should we screen the high risk infants only?
In Most studies 50 hearing imp. per 100000 “Low Risk Infants”
Thus a equitable solution is required.
Universal Neonatal Screening
Who Should be Screened?

5. Which Screening Test
Currently, acceptable methodologies for physiologic screening
include evoked otoacoustic emissions and auditory brainstem
response, either alone or in combination.
Transient evoked otoacoustic emissions (TEOAE) and the
automated auditory brainstem response (AABR) have been
tested in several UNS programs in developed countries.
Both tests have their own drawbacks and advantages:

6.  TEOAE
 TEOAE, also known as cochlear echoes, are low intensity sounds originating
from the outer hair cells in the cochlea and can be elicited in response to click
presented to the ear through a light weight probe
 This detection by a microphone within the same probe is a simple and rapid
clinical test for the normal functioning of the middle and inner ear.
 TEOAE testing is quick, sensitive to cochlear pathology and involves only a
small probe in the outer ear, which makes it very acceptable to parents and
babies.
 Some 2 to 3.6% screen positive.

7.  ABR
ABR is an electrical response to auditory stimuli which is usually recorded
with three surface scalp electrodes.
It is well established to measure function of eighth cranial nerve and auditory
pathway in the brainstem.
So it is potentially sensitive to auditory neuropathy (accounting for 1.8% of
PCHI) and equally rare central deafness which are not target of screen.
Some 3.1 to 4 % screen positive.

8. ESSENTIAL ELEMENTS TO AN
EFFECTIVE UNHSP
Intervention
Identification
Tracking
and follow-
up
Initial
ScreeningEvaluation
UNHSP

9. Summary
 Based on consensus statement of strong research evidence, UNHS should be performed for
all newborns before 1 month of age and abnormal test results confirmed by full audiology
evaluation by 3 months of age.
 Based on some research evidence, children enrolled in EHDI programs perform significantly
better than their later-detected peers on tests of vocabulary skills and intellectual
development, to the point of approaching children whose auditory capacity is normal.
 Based on strong research evidence, the most important risk factors for SNHL in the first 28
days after birth are low Apgar scores, positive family history, in utero infections,
hyperbilirubinemia at levels requiring exchange transfusion, respiratory distress, prolonged
mechanical ventilation, and symptoms indicative of syndromic hearing loss.

10. Universal Newborn Hearing
Screening (UNHS)
Screen babies before 1 month of age
Diagnose HL by 3 months of age
Appropriate intervention by 6 mos.
Culturally-competent family support
All newborns have “medical home”