Ms. Kibby received her master's degree in Audiology with honors from California State University, Long Beach, and is currently pursuing her doctorate at the University of Florida. She completed her clinical fellowship and spent seven years at Texas Children's Hospital in Houston, where she trained for her pediatric specialty.
Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Dr. Bredenkamp recieved his medical degree from the University of California, San Francisco School of Medicine. He then went on to serve a six year residency at the University of California, Los Angeles School of Medicine in the department of Surgery.
Both tests have advantages and disadvantages when used for screening, and
depending on the program and experience of the audiologist, either one can be
utilized successfully. The OAE is easy and cost-effective. However, the
false-positive rate (for example, an infant fails a hearing test but actually has
normal hearing) may be higher for an OAE than for an ABR. The false-positive rate for ABR testing is approximately 4% when testing is done during the first
three days of life. The false positive rate for OAE testing is 5%-21% for testing done during the first
three days of life. This large variation between ABR and OAE testing is commonly felt to reflect the OAE testing device's increased sensitivity to residual amniotic fluid and vernix that is commonly found in the neonate's ear canal.
The two tests,
however, rely on different mechanisms of hearing for the screening. For in-depth
testing and a complete hearing evaluation of infants, these tests work best
together as a complement to each other.
What does it mean when an infant does not pass the hearing screen?
A newborn who fails an initial hearing screen may not necessarily have a
permanent hearing loss or a hearing loss at all. There are many possible reasons
why an infant may fail a hearing screening test. One common reason is that
fluid from the birth may still be present in the ear canal. This fluid blocks
the sound stimulus, preventing it from reaching the inner ear, and therefore
causes the newborn to fail. Similarly, fluid in the middle-ear space behind the
eardrum (a common site for infection in children) can also block the sound
stimulus and lead to a false failed test. After these problems resolve, the
infant usually passes the rescreen. Therefore, it is important to have at least
one week between the initial hearing screen and the rescreen to allow the newborn
a chance to "dry out."
Another possible reason for a false failure is excessive noise or movement
from the infant during the test. The responses that are recorded with an ABR or
OAE are very, very small. Any movement or crying from the infant can prevent the
equipment from detecting the response. Therefore, it is important that the
newborn is quiet or sleeping for the hearing screen. Feeding the infant just
prior to the screening is often very helpful. Although neither test is painful,
they are novel experiences for the newborn and can be momentarily upsetting.
If it becomes evident that an infant has a hearing loss, then a full
diagnostic exam is necessary to determine the type and amount of hearing loss.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Hearing loss (deafness) may be present at birth or it may manifest later in life. Deafness may be genetic or due to damage from noise. Treatment of deafness depends upon its cause.
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