Audiologic Clinical Practice Patterns: Infant Assessment

The purpose of the present study was to report the current clinical practice patterns for assessment of infants after a referred newborn hearing screening within the context of available guidelines and to examine how the advent of newer stimuli, technology, and/or instrumentation has changed clinical practice patterns for audiologic infant assessment. A mixed-method survey that included both quantitative and qualitative questions was disseminated to pediatric audiologists in 2017. Quantitative data were analyzed via descriptive statistics while qualitative questions were analyzed via content analysis and combined with associated quantitative data. Lastly, infant assessment test battery categorization was completed to ascertain the extent to which providers were using recommended protocols. Results revealed appreciable variability in the test batteries employed by facilities evaluating infants. Additionally, a sizable portion of facilities are not using test batteries recommended by sources of guidance for evidence-based practice, suggesting a possible need for adopting a standardized protocol in the United States. Factors that potentially contribute to these results are reviewed as well as proposed next steps toward improving adherence to recommended guidelines. Acronyms: ABR = automated brainstem response; ANSD = auditory neuropathy spectrum disorder; ASSR = auditory steady state response testing; DPOAE = distortion product otoacoustic emissions; EHDI = Early Hearing Detection and Intervention; JCIH = Joint Committee on Infant Hearing; OAE = otoacoustic emissions Disclosure: The authors have no relevant disclosures to report. Acknowledgements: The authors would like to thank the audiologists who took the time to complete the survey for this study. Correspondence concerning this article should be addressed to: Ursula M. Findlen, PhD, Division of Clinical TherapiesAudiology Department, 700 Children’s Drive, Columbus, OH 43205. Email: ursula.finden@nationwidechildrens.org; Phone: (614) 722-6526. Over the past decade, the rate of infants screened for hearing loss at birth, receiving diagnostic testing, and enrolled in EI services have all increased significantly (Subbiah, Mason, Gaffney, & Grosse, 2018). Although the screening rate quickly approached ceiling levels shortly after newborn hearing screening became universal in most states in 2005, successful completion of diagnostic testing and enrollment in early intervention services for children with confirmed hearing loss continues to lag behind (Grosse et al., 2017). One factor that might contribute to differences in follow-up rates across early hearing detection and identification (EHDI) programs is variability in how programs are executed across the United States. For screenings, each individual state mandates when testing occurs (solely as inpatient or allowing an outpatient screening) and the type of testing that occurs, which typically depends upon risk factors for hearing loss. Decisions for screening protocols are often based on recommendations from the Joint Committee on Infant Hearing, which allows for some variability in screening depending upon certain factors (JCIH, 2007). Despite the variability in how screening occurs from both a logistical and testing paradigm perspective, state EHDI systems have successfully achieved a high rate of screening prior to one month of age, with national data increasing from 85.1% in 2006 to 98.6% in 2016 (Subbiah et al., 2018). A potential reason for these success rates may be that defined screening procedures and protocols merely exist. However, the high level of success seen at the screening step of EHDI programs has not translated to the diagnostic step of the process. Within the same time period, the percentage of infants receiving diagnostic assessment prior to three months of age increased from 19.8% in 2006 to 36.6% in 2016 (Subbiah et al., 2018). Although the overall percentage of infants receiving diagnostic assessment in general reached a high of 56.6% in 2016, state EHDI programs continue to struggle with executing the diagnostic step of the EHDI process. Reasons for delays between initial diagnostic testing and confirmation of hearing loss have included a need for multiple tests to confirm hearing status, recurrent middle ear issues, and near-normal hearing at initial testing or fluctuant hearing loss noted on serial tests (Fitzpatrick, dos Santos, Grandpierre, & Whittingham, 2017; Holte et al., 2012). Parents who have gone through the EHDI system have reported that multiple tests were needed for confirmation