Original Title: Propuesta de Programa de detección precoz de la sordera infantil en la Comunidad Autónoma del País Vasco

Authors' objectives: To analyse different strategies for the neonatal screening of deafness, detection levels, costs and coverage in order to establish an early detection programme of infant deafness in the Basque Autonomous Community.

Authors' results and conclusions: Currently, there are a number of techniques that allow the early diagnosis of infant hearing loss. These are objective audiometric tests that do not require the collaboration of the newly born child nor are they conditioned by the person who carries out the exploration. They are based on the detection of the arrival of sound to the inner ear or the auditive pathways. For a neonatal screening programme, the two main techniques are Acoustic Otoemissions (OAE) and auditory brainstem evoked potentials (PEAT). Today, the OAE is used firstly in neonatal screening, also in the quick screening of non collaborating patients of other ages and who present doubts in the performance of a conventional audiometry. PEAT tests are appropriate in those cases of newly born infants who do not pass the OAE tests, in situations where these may be produced by lesions of the central nervous system and in the location-of-injury diagnosis of different auditive and equilibrium pathologies. The cost analysis shows that the implementation of a hearing loss detection programme in neonatal infants in the Basque Autonomous Community would have an estimated cost of 13.33 EUR per child examined and 4,66

Authors' recommendations: In accordance with the above, an adequate strategy for the neonatal detection of hearing loss would be to carry out the screening programme in stages, combining the two techniques described above, OAE and PEAT. The therapeutic objective is to begin treatment of hearing loss within the first six months of life, coordinating the efforts of professionals to achieve an acceptable acquisition of language and, with this, social integration. In order to put a programme of early detection of infant hearing loss into operation, it is necessary to ensure the quality and appropriateness of the diagnostic equipment and the training of personnel who carry out the first screening, as well as those who carry out the other diagnostic and therapeutic tests. Moreover, to ensure the success of this programme, a coordination unit must be set up as well as a system to provide information on this activity. All early diagnosis programmes must allow for the different forms of treatment and monitoring of patients diagnosed with these methods. In the case of hearing loss, treatment will depend, logically, on the kind of hearing loss. But in the case of intense or severe hearing loss, this cannot be dealt with solely by means of medical treatment, but from a multidisciplinary approach. Any multidisciplinary care group must also include the parents, associations for the deaf, speech therapists, educators, audio-prosthetists, psychologists, and otorhinolaryngologists. The Otorhinolaryngology (ORL) Unit must act as coordinator of the efforts of all these professionals. The proposed treatment must be multidisciplinary, and the ORL Unit, as coordinator, must seek to draw up protocols through negotiation with Associations for the Deaf and their psychologists or psychiatrists, speech therapists interested in the rehabilitation of these children, audio-prosthetists, parents and educators. The treatment must begin, after a correct diagnosis of the disorder, by counselling the family in order to help them accept the disorder and to provide them with help to ensure the future active participation of the family throughout the process. This first step would be the responsibility of the otolaryngologist, with the aid of a psychologist. In order to monitor the activity of the programme and ensure the quality of its results, an information system must be developed to provide details on the process and on the results obtained, at pre-established intervals. The optimum use of resources, through an early diagnosis and intervention, represents a saving of the resources currently dedicated to this health problem. The costs of the programme seem to be reasonable, especially if we take into consideration the potential benefits for the development of the individual and society as a whole.

Authors' methods: A search and synthesis has been conducted of the relevant bibliography of proven quality. To do this, existing early deafness detection programmes in the State and abroad have been analysed, including documents published by Health Technologies Assessment Agencies. An estimate has been made of the required human, technical and economic resources. Finally, consultations have been conducted with Workgroup experts.

Project Status: Completed

Year Published: 2005

URL for published report: https://www.euskadi.eus/contenidos/informacion/2005_osteba_publicacion/es_def/adjuntos/2005/d_05-06_programa_cribado_sordera_infantil.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)