1. Review and management of children identified with a transient conductive hearing loss within the context of a newborn hearing screening program
Alison Collins
Senior Audiologist, Healthy Hearing Program, Children’s Health Queensland
PhD Candidate, University of Queensland

2. Universal Newborn Hearing Screening (UNHS)
Aim: Identify infants and children with bilateral moderate or greater permanent childhood hearing loss (PCHL).
Infant
HEARING SCREEN
Provide rehabilitation to reduce the long-term impacts on speech and language.
There is currently work looking at the identification and management of unilateral and mild hearing loss in the context of a universal newborn hearing screening program. There has been little to no work examining conductive hearing loss.
Few policies or pathways exist that guide the management of these children in the context of a universal screening program.
Unilateral Hearing Loss
Mild Hearing Loss
Conductive Hearing Loss

3. Conductive Hearing Loss
Otitis Media (OM) is highly prevalent in children <3 years of age.
OM is a major cause of a conductive hearing loss (CHL).
Neonatal episodes of CHL may indicate chronic recurrence.
Auditory processing problems
Speech and language delay
Social and emotional challenges
Anxiety and depression disorders
Poor social, educational and vocational outcomes
Many of the risks of long-standing conductive hearing loss mirror those of a mild to moderate permanent hearing loss. Why are we then not looking at this closely?

4. Conductive Hearing Loss within UNHS
Identification and management is varied with little guidance provided in the literature.
Research is beginning to suggest CHL may be more prevalent than PCHL within a UNHS (e.g. Aithal, Aithal, Kei, & Driscoll, 2012)

5. Review Aims Question 1: What is the prevalence of CHL within UNHS?
Question 2: What is the classification of CHL within UNHS?
Question 3: What is the Audiological Management of CHL within UNHS?
Question 4: What is the ENT management of CHL within UNHS?

6. Inclusion/Exclusion Criteria
Search Strategy
601
68 Duplicates
533
Title Review
292
Abstract Review
42 PubMed
10 CINHAL
41 Embase
Inclusion/Exclusion Criteria
Some of the inclusion criteria included:
Children referred through universal newborn hearing screen.
Some of the exclusion criteria:
Children not referred fro audiology assessment under UNHS 19
+5 Reference List 24

7. Quality Assessment
Evidence Quality
Internal Validity
External Validity
One article excluded due to poor external and internal validity
Adequate evidence quality
Adequate external and internal validity ratings.
USPSTF = First an overall measure of evidence strength was determined from the research design to yield high quality studies with minimum risk of error (Jones & Evans, 2002).
McMaster = This form was selected as it can be used as an appraisal of both qualitative and quantitative studies and has application in reviews of comparable health care programs, including newborn hearing screening, thereby increasing its application to the research question (Beswick et al., 2012; Ducat & Kumar, 2015; Letts et al., 2007).
External Validity the plausibility of the study, similarities in study population, test conditions and social and/or environmental factors

8. Question 1: What is the prevalence of CHL within UNHS?
18 Articles 13 3 2
UNHS Population
Ranged from – 64.47%.
Larger samples = lower prevalence of CHL.
Conductive Hearing Loss within UNHS
Ranged from 13 – 22.7%.
Samples ranged from 173 – 1,696.
Higher prevalence of CHL than PCHL.
NICU Population
Ranged from – 36.84%.
Small sample sizes (n=38).
Screened Population:
These were incidental findings from a screened population
Signification variation of prevalence of CHL from 0.38 – 64.47% - this pretty much tells us nothing.
Significaiton variation on partipant numbers
Often compared to prevalence of Permanent Hearing Loss.
Conductive Hearing Loss within UNHS
Three articles specifically looked at conductive hearing loss within a universal screening program. All three reported considerably greater prevalence of CHL, particularly on comparison to PCHL. The sample sizes of these articles can be seen below. I kept these separate as the results were remarkable on comparison to the screened population and raises questions as to the testing and classification of CHL in these articles. (does the purpose of the article have an influence on prevalence? CHL is typically not considered so could be underreported or could be overresported in these articels?)

9. Question 2: What is the classification of CHL within UNHS?
5 Articles 2 1 1
A pattern of audiological results
A permanent hearing loss
False positive from hearing screen 1
A permanent hearing loss if hearing amplification is prescribed

10. Question 3: What is the Audiological Management of CHL within UNHS?
18 Articles 15 1 3
Tests Conducted
Otoscopy
TEOAEs
Tympanometry
DPOAE
ABR (Click and/or TB)
A-ABR
ASSR
Behavioural assessment
Pneumatic Otoscopy
Audiological Follow up
6-8 weeks review
Onward Referral
Medical Physician
Onward specialist referral (ENT).

11. Question 4: What is the ENT management of CHL within UNHS.
3 Articles 1 1 3 1
Oral antibiotics
Watch and wait
Visual Inspection (including pneumatic otoscopy)
Surgical Drainage (with or without ventilation tubes)
Very much incidental findings.

12. Future Considerations
Further investigation into the prevalence of CHL.
Clear classification of CHL.
Guidelines and protocols for audiology assessment are required.
Further investigation into the role of ENT in the early identification of conductive hearing loss within a universal screening program.
Further investigation (this may warrant review of definition of CHL)
Classification (at which point on the screening care pathway is this needed)
High agreement (91%) between tymp and pneumatic otoscopy – Doyle, kon, Stribel, Dallare and Ray, 2004).

13. How is conductive hearing loss managed within a UNHS?1
Systematic Literature Review:
Prevalence of CHL
Classification of CHL
Audiological Management
ENT Management 2
Prevalence of CHL within QLD Healthy Hearing Program:
Risk Factors GA
Indigenous Status 3
Audiological Management within QLD Healthy Hearing Program:
Tests conducted
Onward referral
Number of Appointments 4
ENT Management within QLD Healthy Hearing Program:
Chart Review
Assessment/treatment
Onward referral
Number of Appointments 5
Policies, Pathways and Recommendations for the identification and management of CHL within UNHS

14. Review and management of children identified with a transient conductive hearing loss within the context of a newborn hearing screening program
Alison Collins, PhD candidate, University of Queensland
Senior Audiologist, Healthy Hearing Program, Children’s Health Queensland