The aim of the study is early screening program to determine the prevalence of hearing loss and the associated risk factors in newborn infants by using Oto-acoustic emission (OAE). This is cross section study done in Medical city hospital in the audiological department from Feb.2023 to July 2023, screening of 532 infant was done, it included all the newborn babies. It takes approximately 30 minutes for the test, after which the audiologist can share the test results. In this study there is a significant association between (consanguinity, ototoxic drugs, NICU admission, kernicterus, and mode of delivery) and hearing loss.

In this study there is no significant association between (congenital anomalies , family history of hearing loss, smoking ,maternal age ,infant age and gender, otitis media , infants birth weight, RDS ,birth asphyxia, prematurity ) and hearing loss.

Keywords: hearing loss, auditory spectrum disorder, otoacoustic emissions, Oto-Acoustic emission (OAE) device

To early detect of the number or percentage of infants with hearing loss.

To detect the associated risk factors with the hearing loss.

Hearing loss is a partial or total inability to hear.¹ Hearing loss may be present at birth or acquired at any time afterwards.^2,3 Hearing loss can happen when any part of the ear or auditory (hearing) system is not working in the usual way.

According to source

Conductive hearing loss

Hearing loss caused by something that stops sounds from getting through the outer or middle ear. This type of hearing loss can often be treated with medicine or surgery.

Sensorineural hearing loss

Hearing loss that occurs when there is a problem in the way the inner ear or hearing nerve works.

Mixed hearing loss

Hearing loss that includes both a conductive and a sensorineural hearing loss.

Auditory neuropathy spectrum disorder

Hearing loss that occurs when sound enters the ear normally, but because of damage to the inner ear or the hearing nerve, sound isn’t organized in a way that the brain can understand.

According to hear loss degree

Mild hearing loss

A person with a mild hearing loss may hear some speech sounds but soft sounds are hard to hear.

Moderate hearing loss

A person with a moderate hearing loss may hear almost no speech when another person is talking at a normal level.

Severe hearing loss

A person with severe hearing loss will hear no speech when a person is talking at a normal level and only some loud sounds.

Profound hearing loss

A person with a profound hearing loss will not hear any speech and only very loud sounds.

Hearing loss can also be described as

Unilateral or Bilateral: Hearing loss is in one ear (unilateral) or both ears (bilateral).

Pre-lingual or Post-lingual: Hearing loss happened before a person learned to talk (pre-lingual) or after a person learned to talk (post-lingual).

Symmetrical or Asymmetrical: Hearing loss is the same in both ears (symmetrical) or is different in each ear (asymmetrical).

Progressive or Sudden: Hearing loss worsens over time (progressive) or happens quickly (sudden).

Fluctuating or Stable: Hearing loss gets either better or worse over time (fluctuating) or stays the same over time (stable).

Congenital or Acquired/Delayed Onset: Hearing loss is present at birth (congenital) or appears sometime later in life (acquired or delayed onset).

Otoacoustic emission is a non-invasive, rapid, and appropriate method for assessing cochlear function. The OAE test is used to find out how well the inner ear, or cochlea, works. It measures otoacoustic emissions, or OAEs. These are sounds given off by the inner ear when responding to a sound. Early detection of hearing loss in the infant is an essential step in preventing family, social, welfare, speech, language and cognitive problems. The importance of early hearing screening has been recognized for many years and follows two primary goals. Its short-term goal is early detection of hearing loss and its long-term goal is to improve speech, language, and cognitive development.⁴

This is a cross sectional study was done in Medical city hospital in the audiological department from Feb.2023 to July 2023, screening of 532 infant was done, it included all the newborn babies, infants below one year who their families had wariness for the hearing, all infants that was admitted to neonatal intensive care units (NICUs),both sex was included in the study from day 1 up to 1 year by using Oto-Acoustic Emission (OAE) device for screening of any hearing loss detection. The OAE test which is used is noninvasive small probe to be inserted in the ear. A series of tones or clicking sounds are presented to the infant by the technicians. The test takes place in a small sound booth. It takes approximately 15-30 minutes for the test, after which the audiologist can share the test results. This procedure has been done after taking consent from the parent.

Inclusion criteria

Newborn infants (up to 1 year), who their families had wariness for the hearing loss and approved to participate in our study.

Exclusion criteria

Parents` refusal to participate in this study at any time.

Infants older than 1 year of age.

Infants who had congenital abnormality in the external auditory canal or the auricles, ex. Microtia.

Dead infant later.

The researcher was attending the audiological department about 5 days a week, direct face to face interview (Researcher and the infant's parents) was done after explaining the aim of the study and acquiring his\her approval. The OAE test which is used is noninvasive small probe to be inserted in the ear. A series of tones or clicking sounds are presented to the infant by the technicians. The test was taken place in a small sound booth. It takes approximately 15-30 minutes for the test, after which the audiologist read the test results and report it.

Tools

The infants was assessed by taking a short history from their parents , concentrating on Joint Committee on Infant Hearing (JCIH) criteria which is used for the identification of risky infants to have hearing impairment and all the records had been reported in a questionnaire paper, which was designed in a way that the data can be easily reached.

Instruments

Oto-Acoustic emission (OAE) Device: Advanced OAE techniques need a sound attenuating booth, but useful OAEs can be done in a quiet office environment.

The audiologist reported the test results by filling a sheet, that include infant`s informations (Name, Age , OAE Test result ).

Infant age classified into:

1-30 days

31-180 days

181-365 days

Infant gender: Male or Female

Mode of delivery: Either the infant was a product of Normal Vaginal Delivery or Caesarian Section.

Obstructed labor: Either the infant suffered a labor dystocia (which is a failure to progress due to mechanical problems ,a mismatch between fetal size or more accurately the size of the presenting part of the fetus and the mother's pelvis, although some mal-presentation notably a brow presentation or a shoulder presentation).⁵

NICU Status: Either the infant was admitted to neonatal intensive care unit for the following causes or not:

A\Birth asphyxia: Either the infant suffered from failure to establish breathing at birth or not.

B\RDS: Either the infant suffered from respiratory distress syndrome or not.

C\Prematurity: Either the infant was born alive before 37 weeks of pregnancy or not.

D\Kernictrus: Or bilirubin encephalopathy, is bilirubin-induced neurological damage, which is most commonly seen in infants. It occurs when the unconjugated bilirubin (indirect bilirubin) levels cross 25 mg/dL in the blood from any event leading to decreased elimination and increased production of bilirubin.⁶

Either the infant suffered (Yes) or No.

Otitis media: Either the infant was with OME (an infection of the middle ear that causes inflammation (redness and swelling) and a build-up of fluid behind the eardrum) or not.

Congenital anomaly: Either the infant was born with congenital anomaly (Waardenburg syndrome,Down syndrome ,Pendred syndrome ,Usher syndrome ,etc.) or not.

Neonatal birth weight: Either classified into,⁷

Low birth weight: birth weight below 2.5 kilograms at birth.

Normal birth weight: birth weight ≥2.5 kg < 4.0 kg.

Large for age (macrosomia): birth weight ≥ 4.0 kg.

Sometimes prescribed to babies to treat serious infections or birth complications. The most common ototoxic medications are a family of antibiotics called aminoglycosides, with names such as gentamycin, tobramycin, kanamycin, and streptomycin.

Either the infant was given such drugs (Yes) or No.

Regarding maternal use of such drugs, the majority didn’t recall the drug's name prescribed for them so it was removed from the questionnaire and the result.

Use of alcohol: Due to social issues this variable was removed from the questionnaire and the analysis.

Data analysis carried out using the statistical package of SPSS-26 (Statistical Packages for Social Sciences- version 26).

Quantitave data was presented by mean and standard deviation.

Qualitative data was represented by numbers and percentages.

Chi square test was used to assess the statistical difference among the different categories. When not applicable, Fisher Exact test was applied.

The level of P value equal or less than 0.05 was considered to be statistically significant.

Study duration

From February 2023 to July 2023.

Pilot testing

A Pilot test was implemented on a sample that includes 10 infants and their parents, to estimate the time needed for the interview, questionnaire filling and the auditory testing. These infants and parents were excluded from the study sample.

In this study the participants were the infants from day 1 to one year of age , total number was 532 infants were screened for hearing loss by using OAE, from the total number 306 infants male which represents about 60% and female 226 which represent about 40%, majority were of normal birth weight , about 50% were admitted to NICU due to different causes (prematurity ,low birth weight, birth asphyxia ,kernicterus , and RDS), 13% suffered from otitis media ,14% took ototoxic drugs and 12% were with congenital anomalies. At the end of this study the results of 28 infants out of 532 infants were refer (means failure of the test) about 5.3% and 504 infants pass the test about 94.7%. (Table 1 Figures 1 JCIH criteria).

Figure 1 Distribution of the participants according to OAE status.

In this study sample size which was included in the OAE test was 532 infants who were attending audiological department and NICU from day 1 to 1 year of age, 504 of them pass the OAE test and 28 infants refer (not pass the test).

In this study there is a significant association between (consanguinity, ototoxic drugs, NICU admission, kernicterus, and mode of delivery) and hearing loss.

In this study there is no significant association between (congenital anomalies , family history of hearing loss, smoking, maternal age, infant age and gender, otitis media, infants birth weight, RDS, birth asphyxia, prematurity) and hearing loss.

I would like to express my great thanks to my seniors for their kind help in the study.

I would like to express my thanks to my colleagues for their kind help in the study.

The authors declare that they have no conflicts of interest related to the present work.

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