The second level of Audiological Screening: Is it worth it to be held in classrooms in the child›s development offices of primary care organizations?
Authors:   Head of the Center to improve medical care, Republican Center for Health Development, Imanova Zhazira , Ainekovа Zhadyrа ,   Chief Specialist of the Department of Health Services Integration of Center for Health Care Improvement, Republican Center for Health Development,, Tulepbekovа Nailya ,   Assistant of the Chair of ENT of Diseases of the Kazakhstan-Russian Medical University, Head of the Department of Surdology of the City Clinical Hospital No. 5, Freelance children›s audiologist of the Public Health Department of Almaty
Published: September 2020

order of the Minister of Health of the Republic of Kazakhstan “On Approvals of Screening Organization Rules” dated September 9, 2010 No. 704 (Order No. 704) [1], it must be administered to all newborns and young children (up to three years old inclusively) by recording otoacoustic emission and / or transient-evoced otoacoustic emissions (ROE and / or TEOAE). The success of newborn hearing screening programs and screening programs for young children lies in early diagnosis and treatment of children with hearing loss. To accomplish one of the goals of “Health for All in 2000”, as the part of the National Program for Health Promotion and Disease Prevention, in 1990 the United States made decision to reduce the age of hearing screening, after what children with significant hearing loss were identified no more than until 12 month of age [2,3]. In 2007 Centers for Disease control and prevention (CDC) started to collect monitoring and follow-up data for audiological screening on newborns in the United States, data collection included information on the receipt of services in accordance with the goals of Early Hearing Detection and Intervention (EHDI): hearing screening before 1 month, diagnostics and audiological assessment up to 3 months of age for children with the “Refer” result on screening, as well as registration of children with hearing loss who received early surgery up to 6 months, who directly received help in the framework of the state program EHDI [4]. After receiving encouraging results on audiological screening, newborn screening and audiological assessment are widely conducted around the world. However, there is no consensus regarding the use of audiometry and other electrophysiological tests in current practice nowadays. Several procedures and methods are described and promoted around the world, but there is no systematic diagnostic scheme in the pediatric audiology [5]. In Spain there were analyzed the data of screening of 156 122 newborns, 151 258 of them – 96.9% were in group with no risk of hearing impairment and 4864 or 3.1% were in group with risk. As a result only 410 or 0.26% were sent to consultation, 213 or 0.14% from group with no risk and 197 or 24.7% from group with hearing risk. 7452 or 4.7% were determined as false results, including 6951 or 4.5% from the no risk group and 501 или 10.3% from the group with risk factors and 53 or 0.03% false-negative results. The sensitivity of the screening was 88.5%, specificity – 95% [6]. In Poland the analysis was carried out based on the results of a 10 years (2003-2013) following parameters were assessed: the coverage by the program (the percentage of children enrolled in an hearing screening program from the birth), the results of hearing program on a different levels and the degree of hearing loss, herewith the percentage of children enrolled in the hearing screening program from the birth was 96,0% from all live births, the coverage of children needed follow-up diagnostic was 8,5% from the study population, among them 55.8% were given consultation at the audiological centers, the level of the hearing loss estimated as 0.3%. The most number of children with hearing loss were found in the group with the factors of hearing loss, 58.2% of them were given hearing aids, 34.0% were referred to surgical treatment, 7.8% - to further rehabilitation. The results of estimation of the hearing screening program confirmed its effectiveness [7]. Retrospective analysis of hearing screening of 4 645 823 born from April 1, 2004 till March 31, 2013 in UK revealed that 97.5% passed screening at the age of 4/5 week and 98.9% passed full screening after 3 month [8]. The analysis revealed following results: bilateral hearing loss was detected in cohort of newborns 12/13, the average age – 9 days at the completion of screening, 30 days – on admission for the subsequent period, 49 days at confirmation, 50 days – at applying for the early intervention and 82 days before the selection of hearing aids. The average age of identification and confirmation of final diagnosis was within the first 6 month of child’s life [9]. In one of the regions of Canada were revealed limitations of newborn hearing screening. So, 182 or 43.5% of children out of 418 born since 2003 till 2013 with identified hearing impairment had congenital hearing loss, herewith 30 or 16.5% of them revealed 3 month later from initial audiological assessment till establishing final diagnosis. The average age of first estimation and confirmation of hearing impairment of 30 children was 3.7 months, the problem of establishing diagnosis at 22 children or 73.3%, 15 of them had middle ear dysfunction, at 9 children with problems in genetic anamnesis. Thus, it was concluded that despite progress in the early detection of hearing loss, there are a number of children selected for early assessment with a belated confirmation of the final diagnosis and not receiving early rehabilitation arrangement [10]. Thereby, the newborn hearing screening provides a high level of sensitivity and specificity. In USA and Europe there is no multi-level organization of newborn hearing screening, specifically the 2nd level of screening is not conducted at child development rooms which is the part of healthcare organizations providing primary health care not carried out. The aim. This Policy brief is intended for political decision-makers on issues related to the national screening program in order to make a scientifically-based and effective decision, as well as for interested healthcare professionals and the public with the aim of expanding knowledge in the field of audiological screening of newborns and young children. Key messages Audiological screening of newborns and young children by the registration method only of the ROE or TEOAE is carried out at 3 levels in the Republic of Kazakhstan, the Russian Federation, while in the USA and in Europe it is not performed. There is no scientific evidence for the effectiveness of multi-level screening for detecting hearing impairment by clinical outcomes, and therefore it is impossible to determine the balance of the benefits and harms of screening. There are no randomized screening, diagnostic, or controlled clinical trials reporting clinical or cost-effectiveness.