Investigating the prevalence of auditory neuropathy at birth and the cost-effectiveness of universal screening for auditory neuropathy

This project consisted of a comprehensive review of the literature with regard to incidence and prevalence of auditory neuropathy/auditory dys-synchrony (AN/AD) and screening for such in well baby clinics and in neonatal intensive care units (NICU). This project also provides an analysis to determine the cost-effectiveness of universally screening for AN/AD versus only screening high risk or infants from the NICU. It is estimated that approximately 11% of at-risk or NICU infants identified with severe or profound hearing loss have AN/AD. The prevalence of AN/AD within the well baby population is significantly lower, perhaps a fraction of a percent. AN/AD may cause severe speech and language delays and make audition very difficult, particularly in noise. With early identification and specific remediation for AN/AD the prognosis is improved for speech and language development. Previous research has shown that screening for peripheral hearing loss with transient evoked otoacoustic emissions or distortion product otoacoustic emissions (TEOAE/DPOAE) is important and cost-effective. The problem is, otoacoustic emissions alone are not capable of identifying AN/AD. Examining both preneural and neural responses in the ear identifies AN/AD. This is accomplished best by employing TEOAE/DPOAE in conjunction with auditory brainstem response (ABR) testing. The results of this study show that it is more cost-effective to just screen NICU infants for AN/AD than to screen universally for AN/AD.