Newborn and infant hearing screening outcomes at a tertiary paediatric hospital in the Western Cape, South Africa.
Silva Kuschke, Cheri Van Zyl, Mmakgotso Mokete and 1 others
Mean age at hearing-loss diagnosis was 15.6 months, well past the 3-month international benchmark. 45.2% were referred on first screening, but 40% of those who had diagnostic testing were found to have normal hearing.
Key findings
1The mean age at diagnosis of hearing loss was 15.6 months, well beyond the internationally recommended 3-month diagnosis target and the locally adapted 8-month target.
245.2% of children were referred on initial screening, but the referral rate dropped to 1.1% on repeat screening, where AABR was used in nearly 60% of cases.
3Among the 110 children who had diagnostic testing, nearly 40% showed normal hearing bilaterally, and approximately one in five had conductive hearing loss.
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What it does not show
Single-site descriptive review at one tertiary hospital; findings cannot be generalised to the rest of South Africa or to primary-care settings. Only 511 of 7871 children (6.5%) had documented screening results, so the sample is a small and non-random subset of those seen. Purposive, convenience-based sampling means the children included are not representative of all children in the Western Cape. Age of suspicion and diagnosis was recorded for only 92 of the 511 children. About 20% of ears had an undetermined hearing-loss type, limiting the diagnostic picture. No intervention was tested; the study describes what happened, not what works. The hospital does not perform its own neonatal screening, so the data reflect what happens after referral rather than the screening event itself.
Declared interests
The authors declared no financial support for the research, authorship, or publication.
The easy way to misread this
Do not read the 45.2% initial referral rate as meaning nearly half of screened children have a hearing loss. 40% of those who went on to diagnostic testing had normal hearing in both ears. The authors attribute the high referral rate to OAE false positives caused by middle-ear effusions at the older screening age (mean 16.3 months), not to true hearing impairment.
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