Orzan Eva, Pizzamiglio Giulia, Marchi Raffaella, Muzzi Enrico, Monasta Lorenzo, Torelli Lucio, Feresin Agnese
Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy.
Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
Front Pediatr. 2021 Mar 12;9:564662. doi: 10.3389/fped.2021.564662. eCollection 2021.
Despite the successful implementation of newborn hearing screening (NHS), a debate is emerging as to what should be the best means of enabling timely diagnosis and intervention for preschoolers with educationally significant sensorineural or conductive hearing impairment (HI) missed at the time of NHS or occurred after birth. Our study aims to document the proportion and characteristics of HIs diagnosed in children in need of audiologic assessment, in order to outline the optimization areas of an operational framework for auditory surveillance during preschool age. The referral routes and outcomes of 730 audiological assessments performed in 3 years within the framework of the early hearing identification program in Trieste (Italy) were retrospectively analyzed. Among 570/595 completed evaluations, an HI was diagnosed in 114 children, 73.7% of which presenting an exclusively conductive HI due to middle ear effusion. HIs were found in 36/141 who failed NHS, and 60/385 preschoolers who were referred by the primary care pediatrician's surveillance activity during well-child visits, with diagnostic yield of 25.5 and 15.5%, respectively. Ongoing preschool surveillance in primary care setting integrated into a NHS program is feasible to conduct and may effectively identify HIs that missed NHS or were related with a risk factor. New triage instruments and protocols for immediate audiology referral could allow to obtain the diagnosis of educationally significant conductive and sensorineural HIs ahead of the development concern and in the same way reduce patient mobility, thus optimizing timing efficiency and economic impact of the program.
尽管新生儿听力筛查（NHS）已成功实施，但对于如何以最佳方式及时诊断和干预在NHS时漏诊或出生后出现的、对学龄前儿童具有教育意义的感音神经性或传导性听力障碍（HI），仍存在争议。我们的研究旨在记录需要听力评估的儿童中被诊断出的HI的比例和特征，以便勾勒出学龄前儿童听力监测操作框架的优化领域。回顾性分析了在的里雅斯特（意大利）早期听力识别计划框架内3年进行的730次听力评估的转诊途径和结果。在570/595次完成的评估中，114名儿童被诊断出患有HI，其中73.7%仅因中耳积液而患有传导性HI。在NHS未通过的36/141名儿童和在健康儿童就诊期间由初级保健儿科医生的监测活动转诊的60/385名学龄前儿童中发现了HI，诊断率分别为25.5%和15.5%。将初级保健机构中的持续学龄前监测纳入NHS计划是可行的，并且可以有效地识别错过NHS或与危险因素相关的HI。新的分诊工具和立即转诊听力检查的方案可以在出现发育问题之前诊断出对教育有重要意义的传导性和感音神经性HI，同时减少患者的就医次数，从而优化该计划的时间效率和经济影响。
