Critical analysis of three newborn hearing screening protocols.

BACKGROUND: having knowledge about the validity of procedures for newborn hearing screening (NHS) is fundamental, once the purpose of these programs is to identify all newborns with hearing loss at an acceptable cost.

AIM: to estimate the specificity and the false-positive rate of NHS protocols using transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR).

METHOD: participants were 200 newborns who were submitted to a hearing screening test between March and July 2006. Three protocols were analyzed: protocol 1, NHS was carried out in two steps using TEOAE; protocol 2, NHS was carried out in two steps using AABR; and protocol 3, NHS was carried out in one step, using the two procedures - testing with TEOAE followed by a retest with AABR for all the newborns who did not pass the TEOAE testing.

RESULTS: although there was no statistically significant difference when comparing the referral rates to audiological diagnosis obtained in protocols using TEOAE and AABR, the protocol using TEOAE referred four times more newborns. Protocol 3 presented the highest referral rate, with a statistically significant difference when compared to protocols 1 and 2.

CONCLUSIONS: the false-positive rate and consequently specificity were better for the protocol using AABR, followed respectively by the protocol using TEOAE and using both TEOAE and AABR.