When Dr. Konradsson took over the Department of Audiology at Bispebjerg Hospital in the summer of 2003, a lot of preparatory work had already been done towards establishing neonatal hearing screening in the capital city of Denmark. However, more than a year was to pass before the green light was given, and a lot more work was to be done under Dr. Konradsson’s direction – especially with regard to the organization of screening/re-screening and the choice of screening methods and equipment.
Please describe your role in the screening pilot project?
“It was very easy for me when the government decided to fund this project since we already had the channels ready – it was simply a matter of jumping on the wagon and getting involved.”
When assessing screening methods and equipment, did you look at the experiences of any other countries?
“Absolutely, I can mention Prof. Adrian Davis from the MRC and Prof. Carl White of Utah State University. We have also been in close contact with Prof. Judith Gravel, who has been here to visit.”
In your assessment, which screening method is most suitable?
“Our aim was to find the procedure that was simple and easy to use and would give us quick answers whether or not a baby was to be investigated further. We found that the OAE method was a proper method to use for the primary screening.”
Looking back on the decision, he remarks: “it has been shown now for the first few months of the screening project that we are down to about 2% referrals, so the need for a 2-stage method is superfluous for the primary screening and not as obvious today as it was when we were talking about putting together an efficient program.”
You must be pleased by the success of the program?
“Yes, of course, but it’s also important to remember that we wanted enthusiastic and interested people to do the primary screening and so we have held one-week courses where we have tried to infect them with our enthusiasm and interest.”
“It’s important that we have good equipment and that we have clear guidelines and most of all that the people doing the primary screening are interested in the screening. I think that in our case, we’ve been lucky to be able to combine those different parameters.”
What are the different stages in the screening process?
“First, and perhaps most important, is information to the parents. They are given information leaflets and we have also made a film available on video cassette and DVD. What we are trying to do is create interest and awareness among the parents that the test is voluntary and that it’s important. They also receive the same information at the maternity unit where they are given an appointment for a PKU test and a hearing test.”
“Then there’s the test itself. We want a good refer – and if we don’t get a good refer, we make another test. So it’s a 2-stage OAE screening, after which we refer to our clinic here where we do OAE and AABR. If we don’t get a clear response after OAE, we use tympanometry to find out if there is something wrong with the ear canal or middle ear and, if that is pathological, we rely upon the normal AABR. If there is a pathological AABR test, we refer the baby for diagnostic ABR. The parents then get to see a doctor immediately.”
What about intervention which, after all, is the goal of the screening program?
“It’s been said in the literature that it’s important to start treatment with hearing aids before the age of 6 months. However, it’s also important to keep in mind that, if you have established an efficient program, you have to get your [referred] infants quickly to diagnostics after which you have established a certain suspicion of hearing impairment. It’s difficult to say to the parents, “We think your baby has bad hearing, but you’ll have to wait 4 months before we can do anything about it. I think that’s bad politics. It all has to relate to each other, the steps of screening, diagnostics, and intervention, so the parents never feel that they are ‘put on hold’.” [At Bispebjerg, parents are, from an early stage, counseled by pedagogues and psychologists, and informed about the potential strategies for treatment].
“It’s important to note that the doctor is put in a very hard position explaining to the parents of a newborn baby, which apparently there is nothing wrong with, that there possibly is a hearing impairment. As doctors, we are used to talking to parents with children, who are 1½ or more years of age where there already is a suspicion that there is something wrong with the hearing. Then we’re confirming their suspicion. But when you’re talking to the parents of a newborn baby, they don’t have any suspicion at all. This is a much harder situation.”
What criteria were applied for selection of the technology?
“We were clearly aware there was an abundance of different instruments that could be used for screening. Our chief of the technical department reviewed and tested different equipment. We were also aware that the MRC in Manchester had made extensive testing of different instruments, and we were very grateful for being able to access that information. Putting together the results from our own studies and that of Adrian Davis, we came to the conclusion that we could recommend the use of one particular instrument.”
How did the MADSEN AccuScreen match up with the required criteria?
“It was satisfactory”.
Is this why it was selected for the screening program?
“Yes”.
What’s your impression of the overall way the pilot project is going?
“It’s going extremely well for the time being, but it’s very important that quality is not something which we can count on lasting forever, but something you have to continuously work on.”
What’s your explanation for the success of this program?
“I think it’s a combination of many things especially enthusiasm and good planning. It took time to plan the project in the beginning and we had people involved in the planning who were clearly interested in making the project succeed. We were also fortunate enough to have people doing the primary screening who were genuinely interested, and we were able to give them the proper education and information on how to perform screening. Also screening is being performed at the right period, not right after birth, but just when the babies are a few days old. Last but not least, we have chosen equipment that we are able to rely upon.”
“And note that it’s not just the equipment itself, but it’s also the service being given by the manufacturer, it’s the information and the education given by the manufacturer, it’s how we have been approached and the service we have been given, it’s many things.”
Have there been any problems with the probe, which is after all the only part that actually comes into contact with the babies?
“The signals I have been getting from the screeners are that there are no particular problems with the probe. More in the other direction, that is they are pleased they’re able to disassemble the probe and clean it in a thorough way – it’s hygienic and I’m only getting positive remarks.”
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