Assessment strategy following newborn screen

[incus]

I am very interested to know what tests people are doing in what order when a baby is referred for audiology assessment from newborn hearing screening (let's say well babies for simplicity).


Do you do click ABR first? or HF tonepip ABR?

Do you do OAEs and then tymps initally before ABR?
If so would you discharge (and not do ABR) if you found normal results?

See poll

For myself I have always done click ABR first, unless baby is not settling when I would then get whatever i could - starting with OAEs and tymps.

[incus]

Come on people don't be shy!
:P
The poll is anonymous and anyway there are no right and wrong answers!

[Ali]

For myself I have always done click ABR first, unless baby is not settling when I would then get whatever i could - starting with OAEs and tymps.

This is a very important. As more than likely the referral would be due to a failed OAE, I would like to do an OAE to see if it was a false +ve. But, it would still be important to do the click ABR. I suppose what you actually end-up doing is all to do with how squirmy the baby is. Oh, and then there are also the time constraints.

Tymps are a totally different story. The usual 220Hz tymps are not very useful in neonates, so HF tymps (>660Hz) would have to be used.

[Ghanbari @]

I have already voted.
I am running a program at the moment.
The Flowchart of the program is as follows:
TEOAE Screening
OAE Clinical/Diagnostic
HF Tympanometry
Click ABR
Frequency Specific ABR
Other AEPs
Further Medical Evaluation
It is essential to do the Clinical/Diagnostic OAE evaluation right after screening for every referral.
Rahim

[Dayalan]

I have listened to David Stapells several times. The message is click ABRs are not useful in getting infromation about hearing thresholds. Tone ABRs and ASSR provide the best measurement. is there any reason why we cannot give up clicks?
dayalan

[Ghanbari @]

Dear Dayalan,
Thank you for your attention and a short note.
In our program we do not use Click ABR for threshold estimation. It is usually used for neural response evaluation. This can be done by less experienced (in this field) audiologists.
We do use Frequency Specific ABR (using tone burst) to estimate the hearing thresholds when applicable.
Rahim

[Dayalan]

Thanks. Although I strongly favour David Stapells recommendation I would also like to read from the other's publications.
I am referring to Hurley, RM, Hurley, A and Berlin, CI (2005)
Development of Low frequency Tone Burst versus the Click Auditory Brainstem response
Journal of the Academy of Audiology, 16, Numer 2, February 2005 pp 114-121.
It says "Often (has that been checked recently?)ABR testing employs clicks to asess high frequency hearing... and adds it is a predictor of average (of what?) hearing loss.
Italics mine.
dayalan

[incus]

Clicks are still used for newborn screening and most follow up assessments in the UK. I think everyone recognises the shortcomings of clicks, being broadband, so tonepip (and BC) ABR and ASSR testing are now increasingly coming into use as audiologists recognise the need. However the NHSP programme in England accepts click ABR as the first test in assessment, with freq specific tests if required . Not ideal maybe but we are where we are and there is a steep learning curve with many changes going on at once.

I understand click ABR thresholds relate to average hearing across 1-8kHz, probably predominantly from the HF end. The problem of course is a HF loss may still show a response from the 1k region and hence get missed.

[Guy]

When viewing the above posts please note the dates these were posted. In England, guidance changed in 2010 from clicks to 4kHz tone pips as the primary stimulus for diagnostic ABR testing, upon which the discharge criterion (30dBeHL) is based.