Since the National Institutes of Health (NIH) Consensus Development Conference on Early Identification of Hearing Loss in Infants and Young Children recommended that all newborns be screened for hearing loss before being discharged from the hospital, there has been a dramatic increase in the number of hospitals doing newborn hearing screening. If that rate of increase continues, as expected, newborn hearing screening will be the standard of care in this country by the year 2000.

The rapid expansion of universal newborn hearing screening programs has brought into focus questions about the most appropriate technique for newborn hearing screening. Through the 1980's, the approach recommended by most people (including the Joint Committee on Infant Hearing [JCIH], the American Speech-Language-Hearing Association [ASHA], and the American Academy of Audiology [AAA]) was to identify children who were at risk for hearing loss (this comprised approximately 10% of the population) and to use conventional auditory brainstem response (ABR) to determine whether those children had hearing losses. However, data from multiple studies showing that only about half of all children with congenital hearing loss exhibited any of the risk factors, coupled with the emergence of new techniques for screening, has caused most people to abandon the risk factor approach to newborn hearing screening. Instead, the vast majority of newborn hearing screening programs are now using automated auditory brainstem response (AABR), distortion product otoacoustic emissions (DPOAE), or transient evoked otoacoustic emissions (TEOAE). Equipment in each of these categories is currently being used in successful newborn hearing screening programs. But which technique is best?

Although this is probably the most frequently asked question by people considering the implementation of a hospital-based newborn hearing screening program, the fact that there are so many different programs being conducted successfully with equipment in each of these categories suggests that the answer to the above question is not simple or straight forward. Indeed, because the characteristics of these techniques are so heterogeneous, there is probably not a definitive answer about which type of equipment is best. Individual hospitals will have to continue making their own decision, and there may well be situations where one type of equipment is best for the situation of one hospital, while a different type of equipment is best for the situation of another hospital.

The purpose of this brief document is to outline some of the issues that should be considered in selecting equipment. It would be good if there were definitive information for each of those issues. Unfortunately, such definitive information does not exist for many of these issues. What we have are results of a few studies and a lot of opinions based on clinical experience. This information has been supplemented by the experience NCHAM staff have had in working the various units in a clinical setting. It should be noted, however, that to maintain our objectivity and independence, NCHAM receives no financial support from manufacturers of newborn hearing screening equipment for this website or our technical support and training activities.

The following reference table summarizes the research evidence and the clinical experience related to various types of newborn hearing screening equipment to help people select equipment to use in their own newborn hearing screening program.