Good test–retest reliability of high frequency (≥8 kHz) pure-tone audiometry (HFPTA) is essential to detect significant changes in hearing threshold caused by ototoxicity. While the test–retest reliability of HFPTA in adults has been extensively studied, such investigations in children are scant. This study aimed to evaluate the test–retest reliability of the HFPTA in normal-hearing children with particular reference to the criteria for ototoxicity. Participants were 125 children aged between 4 and 13 yr, with normal hearing in the 0.25 to 4 kHz range and normal tympanometric findings. The participants were divided into three age groups, 4 to 6 yr (16M; 16F); 7 to 9 yr (22M; 30F); and 10 to 13 yr (24M; 17F), for investigating possible age effects in the test–retest reliability of HFPTA. The instrumentation for the HFPTA procedure was an Interacoustics AC40 audiometer with Koss R/80 high-frequency headphones, calibrated to meet Australian standards. Hearing thresholds at 8, 9, 10, 11.2, 12.5, 14, and 16 kHz were measured in a sound-treated chamber using a modified Hughson-Westlake procedure with a 5 dB step size. Testing began with an ear and test frequency selected at random; the subsequent test frequencies were randomly selected. After acquisition of hearing threshold data at all frequencies, the other ear was tested using the same procedure. After the first HFPTA test, the headphones were removed and carefully replaced. A second HFPTA test was performed with the ear order reversed. The order of testing the ear for the next participant was reversed. Good test–retest reliability of HFPTA was achieved with no significant difference in mean HFPTA thresholds across test and retest conditions for all age groups. An age effect in the test–retest reliability of HFPTA was evident with the 4- to 6-yr-old, 7- to 9-yr-old, and 10- to 13-yr-old children demonstrating normal variability of thresholds (within ±10 dB) in 89.9%, 93.0%, and 97% of ears tested, respectively. When the variability of test–retest thresholds was assessed at each frequency, the 4 to 6 yr group showed significantly lower percentage of normal variability at 14 kHz. In identifying significant deterioration of hearing thresholds across test–retest conditions in relation to the ASHA (1994) ototoxicity criteria, the three age groups (youngest to oldest) demonstrated false-positive rates of 24.6%, 11%, and 7.6%, respectively. Overall, this study demonstrated high test–retest reliability of HFPTA in all but the 4 to 6 yr group. With a false-positive rate of 24.6% for ototoxicity for the youngest group, it is recommended that the HFPTA should not be used alone in assessing the possibility of a genuine threshold shift for this age group. If possible, the HFPTA should be supplemented with an objective test of auditory function to confirm the diagnosis. For children aged 7 yr or older, the HFPTA test is promising as a useful tool to identify hearing impairment in the extended high-frequency range (>8 kHz). However, interpretation of HFPTA findings in serial testing for monitoring hearing in a child should be made with due attention being given to the frequency of the stimulus, age of the child, and the associated nonzero false-positive rates.

The aim of this study was to investigate whether there was evidence-based support for targeted surveillance programs using a risk-factor registry to detect postnatal hearing loss or whether other programs were available that may be more effective than targeted surveillance. Particularly, it addressed questions that arose along the targeted surveillance pathway, including: (1) the risk factors used to determine a referral, (2) referral frequencies, (3) the relationship between risk factors and a postnatal hearing loss, and (4) other systems that may be more efficient than the use of risk factors. A systematic literature review was completed in peer-reviewed and non-peer-reviewed databases. Publications were obtained using the databases MEDLINE, Cumulative Index of Nursing and Allied Health Literature, and Excerpta Medica on line, and by inspecting the reference lists of relevant articles and expert-committee papers. Quality assessment ratings and data extraction were completed by the research team. In total, 40 articles met the inclusion criteria and were included in this review. The outcomes drawn from these studies were inconclusive as they were based on small sample sizes and largely from single sites only. With this in mind, from the information obtained: (1) gestational age, low-birth weight, toxoplasmosis, other infections, rubella, cytomegalovirus (CMV), herpes simplex virus infections, craniofacial anomalies, respirator support, and the administration of aminoglycosides were the more commonly reported risk factors in programs; (2) referral frequency for monitoring appointments was approximately 3%; and (3) CMV, extracorporeal membrane oxygenation, congenital diaphragmatic hernia, and persistent pulmonary hypertension of the newborn were associated with postnatal hearing loss, whereas, preauricular skin tags and ear pits, low-birth weight, and toxoplasmosis were not. The review also identified that second-phase universal screening programs, CMV screening, and genetic screening should be explored as potential additions or alternatives to targeted surveillance using risk factors. Further large-scale, population-based research on available programs for the detection of postnatal hearing loss should be conducted to improve present practice and assist with the development of evidence-based guidelines for hearing monitoring.

Introduction Parenting a child with hearing loss may be accompanied by high stress levels and several challenges. Objectives The present systematic review was performed to compile the existing literature pertaining to parental stress in parents of children with hearing loss and coping strategies. Data synthesis The databases searched include PubMed/Medline, Scopus, Cochrane Library and Cumulative Index to Nursing, and Allied Health Literature. The systematic review was designed and performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines. The screening for studies was performed independently by two researchers. Methodological quality appraisal was done using the Mixed methods appraisal tool. Twenty-eight studies were identified and included in the present review, which discussed the stress factors and coping mechanism associated with having child with hearing loss reported by parents. The factors leading to stress were thematically classified into parent/family-related factors, child-related factors, and professionals/service-related factors. The coping strategies were thematically classified into improved support systems and better professional resources. Conclusion The present systematic review was an attempt at exploring the various stress causing factors among parents of children with hearing loss. The various coping strategies would help in better planning services for these parents and helping to lessen the stress.

Background:Although newborn hearing screening programs have been introduced in most states in Australia, the prevalence of conductive hearing loss and middle ear pathology in the infants referred through these programs is not known.Purpose:This study was designed to (1) evaluate the prevalence of conductive hearing loss and middle ear pathology in infants referred by a newborn hearing screening program in north Queensland, (2) compare prevalence rates of conductive hearing loss and middle ear pathology in indigenous and nonindigenous infants, and (3) review the outcomes of those infants diagnosed with conductive hearing loss and middle ear pathology.Research Design:Retrospective chart review of infants referred to the Audiology Department of The Townsville Hospital was conducted.Study Sample:Chart review of 234 infants referred for one or both ears from a newborn hearing screening program in north Queensland was conducted. A total of 211 infants attended the diagnostic appointment. Review appointments to monitor hearing status were completed for 46 infants with middle ear pathology or conductive hearing loss.Data Collection and Analysis:Diagnosis of hearing impairment was made using an age-appropriate battery of audiological tests. Results were analyzed for both initial and review appointments.Results:Mean age at initial diagnostic assessment was 47.5 days (SD = 31.3). Of the 69 infants with middle ear pathology during initial diagnostic assessment, 18 had middle ear pathology with normal hearing, 47 had conductive hearing loss, and 4 had mixed hearing loss. Prevalence of conductive hearing loss in the newborns was 2.97 per 1,000 while prevalence of middle ear pathology (with or without conductive hearing loss) was 4.36 per 1,000. Indigenous Australians or Aboriginal and Torres Strait Islander (ATSI) infants had a significantly higher prevalence of conductive hearing loss and middle ear pathology than non-ATSI infants (35.19 and 44.45% vs 17.83 and 28.66%, respectively). ATSI infants also showed poor resolution of conductive hearing loss over time with 66.67% of ATSI infants reviewed showing persistent conductive hearing loss compared to 17.86% of non-ATSI infants. Medical management of 17 infants with persistent conductive hearing loss included monitoring, antibiotic treatment, examination under anesthesia, and grommet insertion.Conclusions:Conductive hearing loss was found to be a common diagnosis among infants referred through screening. ATSI infants had significantly higher rates of middle ear pathology and conductive hearing loss at birth and showed poor resolution of middle ear pathology over time compared to non-ATSI infants. Future research using a direct measure of middle ear function as an adjunct to the automated auditory brainstem response screening tool to distinguish conductive from sensorineural hearing loss may facilitate prioritization of infants for assessment, thus reducing parental anxiety and streamlining the management strategies for the respective types of hearing loss.

Based on a study sample of 1071 primary school children (5.3–11.7 years), 10.2% of the children were found to have conductive hearing loss in 1 or both ears. Binaural speech comprehension scores of a subset of 540 children were analyzed. The results showed that children with bilateral conductive hearing loss had the lowest mean scores of 60.8–69.3% obtained under noise conditions. These scores were significantly lower than the corresponding scores of 69.3–75.3% obtained by children with possible middle ear disorders but no apparent hearing loss, 70.5–76.5% obtained by children with a unilateral conductive hearing loss and 72.0–80.3% obtained by their normally hearing peers. This study confirms that young children, who are known to have poorer speech understanding in noise, show further disadvantage when a bilateral conductive hearing loss is present.