Neumann, K., Euler, H. A., Chadha, S., White, K. R., & The International Newborn and Infant Screening Group (2020). A survey on the global status of newborn and infant hearing screening. Journal of Early Hearing Detection and Intervention, 5(2), 63-84. >> other Source

Abstract: Objective: Assess the global status of newborn/infant hearing screening (NIHS) and its effectiveness in early detection and intervention of permanent childhood hearing loss (PCHL). Design: Individuals potentially involved with NIHS in 196 countries/territories (in the following text referred to as countries) received a questionnaire about coverage, strategies, and outcomes of country-specific NIHS programs. Study Sample: Questionnaires from 158 countries were returned. Results: Thirty-eight percent of the world’s population were reported to have no/minimal screening, 33% reported screening more than above 85% of the babies (hereafter referred to as universal newborn hearing screening [UNHS]). Mean living standard of countries with UNHS was 10 times higher than in countries with NIHS coverage that was less than 10%. Average age at diagnosis of PCHL was 4.6 months for screened children and 34.9 months for non-screened children. Average age at start of intervention was 6.9 months for screened children and 35.2 months for non-screened children. Methods used for screening included otoacoustic emissions (OAE) in 57% of countries, automated auditory brainstem response (AABR) in 11%, and two-step OAE-AABR in 30%. On average, 4.5% of the infants failed the screening and 17.2% of those children were reported as lost-to-follow-up. The prevalence of PCHL identified in NIHS programs ranged from 0.3–15.0 per 1,000 infants with a median of 1.70. Conclusions: Newborns with PCHL are more likely to benefit from early identification and intervention in countries where NIHS is done. There is a need to invest in NIHS programs, including data collection, in low-income countries.

Hey, C., Fessler, S., Hafner, N., Lange, B. P., Euler, H. A., & Neumann, K. (2014). High prevalence of hearing loss at the Special Olympics: Is this representative of people with intellectual disability? Journal of Applied Research in Intellectual Disabilities, 27, 125-133.

Abstract: The Healthy Hearing (HH) programme at the Special Olympics (SO) revealed hearing disorders in between 16 and 40% of athletes. However, it is not clear whether this prevalence represents the entire population with intellectual disability. Therefore, this study compares the status of SO athletes with an intellectual disability (ID) to students with ID at a special needs school. The HH screening was performed in 637 athletes (mean age 27.1 years, range 9.7-70.6 years) during the 2008 German SO Summer Games and in 198 special needs students (mean age 12.7 years, range 6.7-20.0 years). 22% of athletes and 18% of students failed the HH screening. Approximately 60% of the total participants received recommendations for further follow-up and treatment, without between-group differences. The results of the HH screening at SO events are assumed to be representative of children and adolescents with ID in special needs schools.

Böttcher, P., Gramß, M., Euler, H. A. und Neumann, K. (2009) Kostenanalyse des universellen Neugeborenen-Hörscreenings für Kliniken am Beispiel Hessens HNO, 57, 21-28.

Abstract: Background The implementation of a universal newborn hearing screening (UNHS) in Germany in 2009 requires a realistic cost calculation for health insurance companies and participating clinics Material and methods Screening costs from 60 Hessian clinics were analyzed over 2.5 years whereby 94,203 children had been screened either with a 2-step (TEOAE, AABR) or a 1-step procedure (AABR). Results The TEOAE-AABR screening at EUR 13.16 per child was more cost-efficient. For a population with a high rate of at-risk babies a sole AABR device with screening costs of EUR 16.87 presents a more efficient alternative. High quality of screening performance and qualification of screening staff markedly reduced total cost. Overhead costs for tracking, quality assurance, control of completeness, and securing structural screening requirements, considered as essential screening costs, were calculated at EUR 4.00 per child. The total costs in Hesse would therefore be EUR 17.16 per child for TEOAE-AABR screening and EUR 20.87 per child for an AABR screening. Conclusion In a mixed calculation which can be cautiously extrapolated from the Hessian data for Germany as a whole, costs would be EUR 18.40 per registered child.

Zusammenfassung: Hintergrund Die Einführung eines hauptsächlich klinikbasierten universellen Neugeborenen-Hörscreenings (UNHS) in Deutschland ab 2009 erfordert eine realitätsnahe Kostenanalyse für Krankenkassen und Kliniken. Material und Methoden Die Screening-Kosten von 60 hessischen Kliniken wurden über 2,5 Jahre analysiert. 94.203 Kinder wurden mit einem TEOAE-AABR-Kombinationsverfahren oder mit AABR allein untersucht. Ergebnisse Das Kombinationsverfahren war mit 13,16 EUR pro Kind das kostengünstigere Verfahren. Für Einrichtungen mit einem hohen Anteil an Risikokindern stellt ein alleiniges AABR-Gerät bei Screening-Kosten von 16,87 EUR die wirtschaftlichere Variante dar. Hohe Durchführungsqualität des Screenings und Qualifikation der Untersucher reduzieren die Gesamtkosten. Overhead-Kosten für Tracking, Qualitäts-, Vollständigkeitskontrolle und Sicherung der strukturellen Voraussetzungen des Screenings als unverzichtbarer Kostenbestandteil wurden mit 4,00 EUR pro Kind errechnet. Die Gesamtkosten für ein TEOAE-AABR-Screening würden in Hessen damit 17,16 EUR pro Kind betragen, die für ein AABR-Screening 20,87 EUR. Fazit In einer für Deutschland hochgerechneten Mischkalkulation entstünden Kosten von 18,40 EUR pro erfasstem Kind.

Neumann, K., Hey, C., Baumann, U., Montgomery, J., & Euler, H. A., Hild, U. (2009). Eine hohe Prävalenz von Hörstörungen bei den Special Olympics belegt die Notwendigkeit von Hörscreenings für Personen mit geistiger Behinderung. In M. Wegner & H.-J. Schulke (Hrsg.), Kieler Schriften zur Sportwissenschaft (S. 6 - 17). Universität Kiel: Sport-Thieme GmbH.

Hild, U., Hey, C., Baumann, U., Montgomery, J., Euler, H. A., & Neumann, K. (2008). High prevalence of hearing disorders at the Special Olympics indicate need to screen persons with intellectual disability Journal of Intellectual Disability Research, 52, 520-528. Download Paper

Abstract: BACKGROUND:Persons with intellectual disabilities (ID) are at increased risk for hearing impairment which often remains undetected. If left untreated, such hearing impairments may worsen the social and communicative problems of these persons. The aims of this study are to determine the prevalence of hearing impairment, to specify type and degree of hearing loss, and to evaluate the sensitivity and specificity of the screening in this population. METHODS: During the German Special Olympics Summer Games 2006, 552 athletes with ID had their hearing screened according to the international protocol of Healthy Hearing, Special Olympics. This screening protocol includes otoscopy, measurement of distortion product otoacoustic emissions, and - if necessary - tympanometry and pure tone audiometry (PTA) screening at 2 and 4 kHz. Additionally, 195 athletes underwent a full diagnostic PTA. The results of the screening and diagnostic PTA were compared. RESULTS: Of the 524 athletes who completed the screening protocol, 76% passed and 24% failed it. Ear wax was removed in 48% of all athletes. 42% of the athletes were recommended to consult an otolaryngologist or an acoustician. Of the 99 athletes whose screening-based suspicion of a hearing loss was confirmed with diagnostic PTA, 74 had an undetected hearing loss. The correlation (Cramer's V) between screening and diagnostic PTA was .98. The sensitivity of the screening was 100% and the specificity 98%. DISCUSSION: The screening reliably detects hearing disorders among persons with ID. The prevalence of hearing impairment in this population is considerably higher than in the general population, and the proportion of undetected hearing impairments is large, even among people with only mild and moderate ID, as examined in this study. Therefore, a screening is highly recommended, and special attention from caregivers and professionals as well as regular hearing assessment and standard therapy programmes are required for persons with ID.

Neumann, K., Preibisch, C., Spreer, J., Raab, P., Hamm, J., Euler, H. A., Lanfermann, H., Helbig, S., & Kiefer, J. (2008). Testing the diagnostic value of electrical ear canal stimulation in cochlear implant candidates by functional magnetic resonance imaging. Audiology and Neurotology, 13, 281-292.

Abstract: Prior to cochlear implant (CI) surgery in children, the integrity of the auditory pathway is sometimes assessed by electrical ear canal stimulation (ECS). However, the evaluation of reactions as auditory is subjective. To test the prognostic value of ECS, functional magnetic resonance imaging (fMRI) was performed during ECS vicariously in 18 adult CI candidates. Activation of the primary auditory cortex was detected in 9 of 16 cases when auditory sensations during ECS occurred, and tended to be more bilaterally distributed in CI candidates than in normal-hearing controls. ECS sensations only tended to correlate with fMRI activations. However, solely frequency discrimination during electrical stimulation predicted CI outcome, but neither other auditory sensations nor fMRI activations did so satisfactorily, which limits the diagnostic value of these measures. Instead, preoperative residual hearing (nonamplified and amplified) was a robust predictor for CI benefit.

Neumann, K., Dettmer, G., Euler, H. A., Giebel, A., Gross, M., Herer, G., Hoth, S., Lattermann, C., & Montgomery, J. (2006). Auditory status of persons with intellectual disability at the German Special Olympic Games. International Journal of Audiology, 45, 83-90.

Abstract: Among persons with intellectual disability, the prevalence of hearing impairments is high. During the German Special Olympics Summer Games 2004, a hearing screening was conducted on 755 athletes with intellectual disabilities. Obligatory screening included ear inspection and recording of otoacoustic emissions, and optional screening included tympanometry and brief pure-tone audiometry. 38.0% of the athletes failed the screening. 53.0% needed ear wax removal. 56.1% of the fails indicated sensorineural hearing loss and 13.6% indicated mixed hearing loss. 12.5% of the fails were caused by unremovable ear wax, 1.4% by ear canal affections, and 16.4% by middle ear problems. Left ear fails were more frequent than right ear fails. A peripheral hearing disturbance can thus be expected in every third subject. The high failure rate, a considerable percentage of previously undetected profound hearing loss (1.1%), and the frequent need for ear wax removal, suggest that nearly half of persons with intellectual disabilities need regular otological or audiological consultations.

Neumann, K., Gross, M., Böttcher, P., Euler, H. A., Spormann-Lagodzinski, M., & Polzer, M. (2006) Effectiveness and efficiency of a universal newborn hearing screening in Germany. Folia Phoniatric et Logopaedica, 58, 440-455.

Abstract: The decision to mandate, finance, and implement a universal newborn hearing screening (UNHS) requires the evaluation of its therapy-directed benefit by comparing (1) a procedure employing a UNHS with (2) a targeted screening for at-risk babies for neonatal hearing disorders and (3) a procedure without systematic screening. In a cohort study the outcome of the UNHS program of Hessen in 2005 with 17,439 screened newborns was analyzed. Validity, effectiveness, and efficiency were evaluated and compared to a sample of 98 Hessian and 355 German children who were detected in 2005 as hearing-impaired but not by an UNHS. The UNHS group had a PASS rate of 97.0%. Forty-nine hearing-impaired children were diagnosed at a median age of 3.1 months and treated at a median age of 3.5 months. Corresponding values for the Hessian non-UNHS group were 17.8 and 21.0 months. For Germany the median age at diagnosis was 39.0 months. The age at therapy onset correlated negatively with parameters of speech/language and psychosocial development. A targeted screening would have resulted in a low sensitivity of 65.3%. Hence, a UNHS is the most effective way to an early therapy of neonatal hearing disorders with an optimal outcome.

Neumann, K., Berger, R., Euler, H. A., Ahr, A. & Gall, V. (2004). Neugeborenen-Hörscreening-Verfahren mit frühen akustisch evozierten Potentialen. Zeitschrift für Audiologie, 43, 10-21.

Euler, H. A. (2003) A psychologist's look at health-related quality-of-life assessment in children. Measuring the immeasurable? Proceedings of a Conference on Quality of Life in Deaf Children (pp. 45-53). Oxford, UK: Hughes Associates.