Smartphone-based device screens infants for hearing loss
Key takeaways:
- A smartphone-based device performed comparably to a traditional otoacoustic emission probe for screening.
- The researchers hope the app can be a low-cost option for low- and middle-income countries.
A low-cost otoacoustic emission probe and smartphone app performed as well as commercially available devices for hearing loss screening in infants aged younger than 6 months, according to a study published in Pediatrics.
“Though we cannot see it by examining the infant, failure to diagnose and treat hearing loss means that the child will have a much more difficult time learning to communicate with spoken language,” Emily Gallagher, MD, MPH, associate professor of pediatrics at Seattle Children’s Craniofacial Center, told Healio. “While we successfully screen the vast majority of newborns for hearing who are born in the United States and other high-income countries, there are many barriers to newborn screening in low- and middle-income countries.”
Commercial otoacoustic emission (OAE) and auditory brainstem response devices cost thousands of dollars each, Gallagher and colleagues noted. They developed a smartphone app that works with a $10 distortion product OAE probe as a low-cost substitute.
In their most recent study, the researchers recruited 76 infants aged younger than 6 months (59% boys; mean age, 3.1 ± 1.9 months) with a high prevalence of hearing loss or risk factors for hearing loss. They screened each infant with the smartphone device and a traditional OAE device to compare each device’s ability to identify and rule out hearing loss.
Overall, 10 infants had hearing loss in at least one ear, according to the researchers. When infants were screened with the smartphone device, 24% were referred for further testing compared with 26% with the OAE device.
Both devices detected all 10 infants with hearing loss, (sensitivity = 100%; 95% CI, 69%-100%), the authors reported. The smartphone device ruled out hearing loss in two more infants compared with the traditional OAE device (specificity = 88%; 95% CI, 78%-95%; vs. 85%, 95% CI, 74%-92%).
The researchers calculated a negative predictive value of 100% (95% CI, 94%-100%) for both devices and positive predictive values of 56% (95% CI, 31%-78%) for the smartphone app and 50% (95% CI, 27%-73%) for the OAE device.
Gallagher said the findings were consistent with previous studies that tested the smartphone OAE in different age groups from infants to adults.
“It was exciting to see that, also in this study, the smartphone OAE functioned as well as the conventional/commercial OAE in infants, since this is the age group that could potentially have the greatest benefit from the device globally,” she said.
Gallagher told Healio that her team is testing the smartphone app and distortion product OAE probe in Kenya to optimize it for use in clinics in low- and middle-income countries. Once they complete their research, they plan to make it commercially available at the lowest price possible.
“We hope that this device, when it is commercially available, will make it easier for other countries to establish hearing screening programs so that every child, regardless of where they are born, will have an equal chance to be diagnosed and treated with hearing loss as early as possible,” Gallagher said.
Perspective
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Universal newborn hearing screening has been performed for about 25 years in my home state of Maryland. I remember early in my practice when hearing screening was performed on infants only when risk factors for hearing loss were present or when there was suspicion of hearing loss by caregivers, leading to delays in diagnosis and treatment. Universal newborn hearing screening has become the cornerstone of early hearing detection and intervention, with the “1-3-6” paradigm of screening for hearing loss by 1 month of age, confirmatory diagnostic testing by 3 months of age, and intervention for those with confirmed hearing loss by 6 months of age. Nevertheless, some infants do not undergo such hearing screening, particularly in low-resource areas and when delivered outside of hospital nursery settings.
Ali and colleagues have developed and studied an open-source smartphone application to use OAE technology to screen for hearing loss. They studied a group of infants with a likely increased incidence of hearing loss and compared the results of screening using this device with commercially available OAE hearing screeners. They used prior newborn screening and/or auditory brainstem response results as their “gold standard” for hearing status in these infants. The low-cost smartphone device was extremely sensitive, but less specific, for identifying hearing loss. Most importantly, the performance was the same as the higher cost and likely less-available OAE screeners and they did not “miss” any infant with hearing loss.
Clinicians who treat children should understand that we are talking about hearing screening and not diagnostic hearing testing. Infant hearing screening has limitations, as mild, delayed-onset or progressive hearing losses can be missed. Additionally, OAE-based technology will not diagnose auditory neuropathy spectrum disorder in infants.
This smartphone-based hearing screening potentially may allow access to screening in the absence of specialized, more expensive equipment and trained personnel. Additional experience with this technique should include study of newborns (with comparison with standard newborn screening devices). Additionally, the 24% refer rate observed in this study might be reduced by a re-screen protocol because the refer rate for diagnostic audiology could be overwhelming in low-resource settings.
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