Issues in early identification of hearing loss.

In a general hospital, an early detection research program based on a high risk register and brain stem electric response audiometry (BERA) using click and frequency-specific stimuli identified 631 at-risk neonates from the well baby nursery and the neonatal intensive care nursery (ICN). BERA tests were done before discharge and four months later; comparison of outcomes revealed substantial discrepancies. From the follow-up test, 51 cases of mild to severe hearing loss were identified. Experience from the research program has raised some issues relevant for establishment of service programs. Evaluation of all babies (general nursery and ICN) is justified on the basis of yield but is resource consuming; strategies for minimizing work load are discussed. Risk factor criterion levels affect case loading and yield. Frequency-specific BERA identifies cases which would not be detected by click stimuli and which raise management questions. Deferral of testing to four months is feasible and desirable.