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Table of Contents
Year : 2000  |  Volume : 2  |  Issue : 1  |  Page : 18-20

screening for newborn well babaies by transient evoked otoacoustic emissions in Jeddah, Saudi Arabia

1 Department of Paediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
2 Department of Otorhinolaryngolgoy, King Abdulaziz University, Jeddah, Saudi Arabia
3 Department of Audiology, Dr. S.Fakeeh Hospital, Jeddah, Saudi Arabia

Date of Web Publication6-Jul-2020

Correspondence Address:
MD, FRCSC K Alnoury
Associate professor Department of ORL King Abdulaziz University P.O.Box. 6615, Jeddah 21452
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-8491.289071

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Objectives: To investigate the use of Transient Evoked Otoacoustic Emissions (TEOAE) as a screening tool for hearing in well babies.
Subjects and Methods: Three thousand well babies were screened in three stages using TEOAE in the first two days after birth.
Results: Out of 3000 infants screened, 94.3% passed the 1st screening. During the 2nd screening, 166 babies out of 170 passed the test. Four infants (0.13%) failed the test. These were found, to have bilateral profound hearing loss by auditory brainstem response at 6 months of age.
Conclusion: The use of TEOAE is recommended in universal screening programmes for the new-borns.

Keywords: TEOAE, TEOA, otoacoustic emissions, hearing loss, screening, new-born.

How to cite this article:
Habid H, Jifrey A, Jamal M, Alnoury K. screening for newborn well babaies by transient evoked otoacoustic emissions in Jeddah, Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg 2000;2:18-20

How to cite this URL:
Habid H, Jifrey A, Jamal M, Alnoury K. screening for newborn well babaies by transient evoked otoacoustic emissions in Jeddah, Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2000 [cited 2021 May 5];2:18-20. Available from: https://www.sjohns.org/text.asp?2000/2/1/18/289071

  Introduction: Top

Hearing loss in children is a handicap, which if left unidentified and untreated results in delayed speech and language development. This will result in emotional, social and academic difficulties. The American Academy of Paediatrics published a “position statement” in 1982, which recommended that screening of infants at high risk of hearing impairment should be completed by 3 months and rehabilitation begun by age of 6 months.[1] However, the high-risk based approach had failed to identify more than 50% of infants with hearing loss.[2],[3] Severe congenital hearing impairment is an important handicap affecting 0.1% of live-bom infants and 1-2% of graduates of Neonatal Intensive Care Units (NICU).[4] [Table 1] The development of rapid, reproducible and cost-effective methods of hearing screening has revolutionised new-born hearing screening. Furthermore, selective screening based on high-risk criteria failed to detect half of all infants with congenital hearing loss .[5]
Table 1: The incidence of bilateral hearing loss in the largest published series and oue series

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The use of TEOA (Transient evoked otoacoustic emissions) has emerged as the preferred means of large-scale screening of new-born.[6] The sensitivity of newborn screening, if done in two stages, is demonstrated to be at or near 100% .[5] It is recommended that all newborns be tested with evoked otoacoustic emissions. A final confirmation with auditoiy brainstem response test is recommended for the those who have failed.[6] This study was designed to investigate the use of TEOAE as screening tool for hearing loss in newborn babies.

  Subjects and Methods: Top

Subjects: Three thousand new-born well were screened by TEOAE in the first two days after birth. This was a hospital based study conducted at

Dr.S.Fakeeh Hospital in Jeddah, Saud. Arabia^ Babies admitted to the N1CU were el uded )rom this study since the high incidence of bilateral profound hearing loss (BPHL) in (he high risk group is well documented. Screening was done in tnree stages. Stages 1 and 2 by TEOAE m 6 weeks intervals and stage 3 by Automated Auditory Brainstem Response (AABR) at 6 months.


TEOAEs were conducted in a quiet room in the nursery by audiology technicians or trained nurses seven days a week using evoked otoacoustic emissions machine, (ILO 92 by Otodynamics, Hatfield, UK) linked to personal computer. Infants were tested before discharge from the hospital. For those who failed to respond, a second stage sreen- ing was done in 6 weeks after a full ENT examination. When there was no evidence of conductive hearing loss (CHL) due to pathology in the external auditory meatus (EAM) or otitis media, a TEOAE was done at 3 months and confirmed by auditory brain stem response (ABR) at 6 months. Screening was conducted in a quiet room in the nursery using Quick screen option. The click was 0.3 Pascal’s equal to 83.5 dB SPL. The default position mode included a series of four stimuli, three were in the same level and popularity and the fourth was three times greater in level and reversed in polarity.

  Results Top

There were 55% males and 45% females in this study group. The sample included about 80% Saudis And 20% of different nationalities. Out of the 3000 infants screened, 2830 (94.3%) passed the 1st screening. During the second screening sessions, 166 (97.6% of total ) passed and only 4 patients failed [Figure 1]. Those who failed were proved to have BPHL by auditory brain stem response at the age of 6 month. The overall prevalence of hearing loss in this study was 4 infants out of 3000 i.e. 0.13%. Consanguinity was a common feature in all of the four Saudi infants.
Figure 1: TEOAES in failed infant

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  Discussion Top

Normal hearing in early infancy is essential for social and emotional deve!onment Hearing impairment leads to sensory deprivation with failure to develop communication skill which in turn leads to learning problems.[7] Even relatively mild hearing losses of 35-40 dB could mean that the child misses approximately 50% of normal daily conversation with all the subsequen consequences.[8] Early detection of hearing loss is of primary importance to minimise the consequences and to introduce therapeutic measures as early as possible. A screening test is a measure which attempts to sort out apparently healthy peo- pie who may have a disorder from those who do not (Table I ).

Universal screening is highly recommended to all new-born by the National Institute of Health (NIH) in the USA and by the consensus statement of the audiologists in Europe.[9] The conventional auditory brainstem evoked response is the gold standard used for testing hearing .[ 10,11 ] It reflects the activity of the auditory pathway from the distal auditory nerve to the midbrain. However, it is time consuming and needs technicians who must be highly trained and an experienced audiologist is needed to interpret the results. Moreover, it is a costly procedure and should be reserved to those special high risk infants or for those who failed other methods of hearing screening. However, AABR is suitable for large-scale screening^ 12] Otoacoustic emissions are sounds generated in the cochlea that can be measured in the external auditory canal as described by Kemp,[13] They can be spontaneous (SOAEs) or evoked (EOAES).Sublclasses of EOAEs include TEOAEs and distortion product OAEs (DPOAEs). TEOAE are objective, non-invasive, amenable to automated control, repeatable and precise. They are present in all normal ears and frequency specific. They do not require highly trained personnel. It can be elicited by low to moderate test sounds and automated interpretation is possible.[10] TEOAE are elicited by brief acoustic stimuli such as clicks or tone bursts. Distortion product OAEs can be used for testing high risk groups, but this method has drawbacks. Most notably, the interpretation of DPOAEs results is at present subjective and requires experience.[14]

Statistical data from the Ministry of Health in Saudi Arabia reported 412,819 deliveries during 1996.[15] A survey of childhood hearing impairment in Saudi Arabia reported a prevalence of 13.09%[14] with higher incidence in the western province (14.68%) and in the southern province (20.6%). It was reported that children of first cousins and relatives were affected (16.5% and 12.42% respectively).[14]

The number of hearing impaired will be much higher with the high risk group and in geographical areas where higher incidence of cosanguinity is prevalent. In the southern province first cousin parents were 39.51%.[14]

The cost of not identifying hearing impairment in one person may reach one million dollars in the USA.[16] Thus uuniversal hearing screening is considered a standard care in developed countries and saves hundreds of millions of dollars every year.

  Conclusion Top

Neonatal screening of all new-born using Transient Evoked Otoacoustic Emissions is an easy worthwhile and effective way of detecting hearing loss as early as possible. It is cost effective and should be universal and the standard medical care in Saudi Arabia. It should not be restricted to high risk groups.


We thank Dr. Solimán Fakeeh and Dr. Mazen Fakeeh for their great help and support for the clinical research and cooperation with King Abdulaziz University.

  References Top

American Academy of Paediatrics - position statement. Joint Committee on infant hearing. Pediatr 1982;70:496-7.  Back to cited text no. 1
Elssmann SF, Matkin ND, Sabo MP. Early identification of congenital sensorineural hearing impairment. Hear J 1987;40: 13-17.  Back to cited text no. 2
Mauk G W.White KR,Mortensen LB.Behrens TR. The effectiveness of screening programs based on high risk char acteristics in early identification of hearing impairment. Ear Hear 1991;12: 312-319.  Back to cited text no. 3
Oudesluys-Murphy AM. et al. Neonatal hearing screening. Europ J Paediatr 1996;155:429-435.  Back to cited text no. 4
Mehl AL,Thomson V. Newborn hearing screening: The great omission. Pediatr 1998;101:11-6.  Back to cited text no. 5
Magit AE. Hearing screening in the newborn. Current Opinions Otolaryngol Head Neck Surg 1994;2:472-476.  Back to cited text no. 6
Elliot LL, Armbruster VB. Some possible effects of the delay of early treatment of deafness. J Speech Hear Resear 1967;10:209-224.  Back to cited text no. 7
Bebout JM. Paediatric hearing aid fitting: a practical overview. J Hear 1989;42:13-15.  Back to cited text no. 8
Europen consensus Statement on Neonatal Hearing Screening European Consensus Development Conference on Neonatal Hearing Screening 15-16 May 1998, Milan, Italy  Back to cited text no. 9
Cox LC. The current response testing in neonatal populations. Paediatr Resear 1984;18:780-783.  Back to cited text no. 10
Jacobson JT, Jacobson CA, Spahr RC. Automated and conventional ABR screening techniques in high-risk infants. JAmAcadem Audiol 1990;1: 187-195.  Back to cited text no. 11
Mason J A, Hermann KR. Universal infant screening by AABR. Pediatr 1998; 101 (i): 221-8  Back to cited text no. 12
Kemp DT, Stimulated acoustic emissions from within the human auditory system. J Acoust Soc Am 64:13861391, 1978.  Back to cited text no. 13
Zakzouk S.Daghistani K, Jamal T, Al-Shaikh A, Hajjaj M. A survey of childhood hearing impairment. Saudi Med J 1999;20(I0):783-87.  Back to cited text no. 14
Annual Health Report, Ministry of Health, Kingdom of Saudi Arabi 1999.  Back to cited text no. 15
Northern JL, Downs MP. Hearing in children. (4”1 ED) Williams & Wilkins, Baltimore, pp. 1-31,1991.  Back to cited text no. 16
White KR, Vohr BR,Behrens TR. Universal newborn hearing screening using transient evoked otoacoustic emissions: results of the Rhode Island Hearing Assessment Project. Semin Hear I999;28(4):181-184.  Back to cited text no. 17
Aidan D,Avan P,Bonfiles P. Auditory screening in neonates by means of transient evoked otoacoustic emissions:A report of 2842 recording. Ann ORL 1999; 108:252-31.  Back to cited text no. 18


  [Figure 1]

  [Table 1]


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