Much of the preliminary work in preparation for the implementation of the screening pilot project in the H:S region was undertaken by a troika comprising pediatrician Dr. Klaus Boerch, speech and hearing therapist Eva K. Christensen and a technical expert, Erik Kjaerboel.
Although Erik’s entry point had focused on technology, he soon came to play a lynchpin role in the design and implementation of the project, especially in the development of practical guidelines and an effective training program. He also created a software program for centrally collating data collected from all screening sites.
Please describe your role in the screening pilot project?
“First, of course, was the equipment – there was an AccuScreen in our department. We knew it and relied on it, and I’ve seen and tested the other equipment on the market in Denmark. While technology was my point of entry, as things have developed I’ve actually been in charge of most of the practical things concerning the screening.”
How did you evaluate the equipment for the project?
“As I said earlier, we needed equipment that could perform both kinds of tests (OAE and AABR). We used the AccuScreen and were satisfied with it – it’s easier to clean than the other equipment, e.g. a PDA connected to the measuring box. I think it’s nice to have the equipment in one box – it’s easier to clean, it’s standardized.”
Why was it an important prerequisite that the equipment would be able to test both OAE and AABR?
“The literature indicates that maybe it’s better to use only AABR – that is the gold standard. But since you have 99.9% normal children, and you need to take into account the parents of the normal hearing children, you need a very simple test. At the 2nd stage, you obtain the same refer rate whether you use OAE and AABR or 2-stage AABR and AABR. But having to apply electrodes to all the children is more traumatic for the parents.”
How exactly is the screening pilot project going? What are the latest figures for pass/refer, and percentage of live births screened?
“I think it’s as good as you can expect from the first 3 months of this project. It’s OK. Of 1660 babies screened at Frederiksberg and Hvidovre hospitals, only 45 have visited us at Bispebjerg [for re-screening]. The procedure is that the primary screening locations can test most of the refers on-site straight away. Our coverage over the first 3 months has been 93%, which is quite acceptable for the 1st 3 months of a project, you can see the National Board of Health requirements were 80% coverage in the 1st year and 90% second year, and we are already above the target.”
Please
explain the differences between these different figures?
“95.1% pass after the first examination. Then it rises to 97.4 % after any re-screening at the primary screening sites. We actually have had only one child in the first three months with bilateral hearing loss.”
Note: the latest figures available for the H:S area are dated 20.09.05: a total of 4560 neonates had been screened; 70 had been referred for re-screening in the audiological department at Bispebjerg (1.5%); 3 infants diagnosed with bilateral impairment and 1 with unilateral impairment.
What’s the definition of hearing loss in one or both ears?
“35 dB. This is in fact interesting: about 90% of the children only needed one test per ear to get a pass. That’s quite good, I think.”
What is your assessment of AccuScreen performance? You have already said a few things indicating that you are satisfied with it?
“Yes. We haven’t had any problems with it.”
What about the probe – you mentioned it’s easy to clean?
“I think it’s the best probe on the market. It’s a good probe.”
What about its size, obviously the baby ear canal varies in diameter?
“Actually if you have a very narrow ear canal and the baby is sleeping, you can just hold the probe against the ear canal and you can test it anyway.”
The training program for the personnel carrying out the tests is an important and integral part of your success. Who were the actual people being trained?
“Midwives, some nurses and mostly biomedical analysts.”
Can you describe the training program?
“We planned this course in cooperation with GN Otometrics and it was a 5-day program designed to teach the role of being a screener and learning all the technical audiological aspects of the screening. Why it’s important to have healthy hearing for learning good communication, and so on. [It included] practical training with the AccuScreen and the significance of error when you don’t get a pass. We had invited 8 newborns so that they had actual hands-on training with putting the probe into the very soft ear canals. This was very important as they were quite anxious about doing the screening – especially the midwives who were used to children, but not used to doing anything with a child’s ear.
We trained a total of 57 in 3 separate courses.”
It must have been difficult to get 57 people to take a whole week out of their calendar?
“I’m not sure you need a 5-day course, maybe it can be cut down to 3 or 4 days. But 5 days is good for motivation and I think you need this. Especially for learning parent counseling.”
That’s psychology basically, isn’t it?
“Yes, we could see that from our first 3 months where we have had better results than many other projects which have been running for some time. They were just very, very positively motivated from the outset.”
We are sitting here in this very attractive room designed especially for re-screening and it’s a symptom of the program’s success that you haven’t been at all busy here?
“We knew from other projects that we could expect 5-10% referral rates, but in fact we have only had a referral rate of about 2%.”
Did you go into any details in the training program about the consequences of referral rates, high as opposed to low?
Yes, we spent a lot of time discussing this. Avoiding the anxiety of the parents, and also a bit of crisis psychology and what to expect from these parents – they have a perfect child and then someone makes them aware there may be something wrong. It’s very important, we taught them to say that it’s a fault in the measurement, it’s not that the child doesn’t hear – although there is a risk that the child doesn’t hear – but that could be because the ear is full of fat, vernix, etc. It’s a balance. We don’t want to create any unnecessary anxiety on the part of the parents.”
What is the policy here regarding intervention?
“That’s the 3rd stage of the project, the diagnostic follow-up. If we get a referral at the 2nd stage of the primary screening, we do AABR first at 35 dB and if we don’t get a response, at 45 dB. Then we perform a diagnostic ABR.”
At how young an age can you fit hearing aids?
“The first child actually has just been here to have an earmould taken. Aged 4 months. We try as early as possible, but the parents play the deciding role in doing this.”
Does the diagnostic follow-up include every test possible, e.g. middle-ear testing?
“Yes, we are in that process, although we haven’t had much experience with the 1000 Hz probe tone, but we do have the equipment now and we are going to include that in the protocol. If we have an AABR response at 45 dB and not at 35 dB, and a flat tymp, we know it might be caused by fluids – it’s very important to have that information at an early stage.”
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