Dr. Ioannis Psarommatis is considered
one of the OAE and Auditory Neuropathy experts in Greece. He received his MD
degree from the University of Athens in 1987 and his resident
degree in ENT from the same University in 1997. Currently
he is an ENT surgeon at the P.A. Kiriakou Children's Hospital and a lecturer
at the Athens University.He is the author of numerous articles and books in
Greek and English language. His interests include otoacoustic emissions and
NHS and Auditory Neuropathy
Introduction
In contrast to the widely accepted recommendations, a universal country-wide
newborn hearing screening has not yet been established in Greece. I would not
try to find excuses for this wrongful delay, although there could be some (more
than 2000 islands, rural populations that traditionally have limited internal
communication with urban facilities due to a series of mountain chains on the
Greek mainland, etc). However, if we truly want to dig out the root of the
problem, we must admit that some other factors -more significant than geology
and landscape elements- play the primary role. Deficient communication among
professionals and politics are the most important ones.
Where are we today?
Fortunately, the situation is not completely disappointing. Apart from several
targeted hearing screening programs focussed on high risk infants, the first
universal hearing screening program has been running for more than six years
at the biggest Greek birth center, in Athens (“Iaso” Maternity
Clinic, approximate birth rate: 10.000/year). In this hospital, Dr Korres
and his collaborators, using TEOAEs as screening method, have achieved excellent
results which are comparable with those coming from United States of America
(Korres et all 2005,2006). Additionally, two more birth
centers of Athens have also run hearing screening for every newborn for the
last three years. “Mitera”,
with 5500 births/year (Dr Petmezakis I, Papakostas K,
Tsoukala Maria) and “Lito” Maternity
Clinic, 3500 births/year (Dr Lentari E, Drinias V) screen their babies with
TEOAEs or DPOAEs and reserve ABR for those infants who failed at the initial
test.
Besides, many other maternity and pediatric clinics in private or public hospitals
do operate selective hearing screening or they are developing plans for universal
hearing screening in the near future. Finally, NICU specialists all over Greece
have now been well informed and most units are linked with regional audiologic
referral centers for screening HR neonates.
We can roughly estimate that about 30% of live births are screened
in Greece annually according to the scheme below (see Figure 1) .
At the ENT department of “P. & A. Kyriakou” Children’s
Hospital of Athens, a targeted hearing screening for all infants at risk for
hearing loss continues to be in operation. It was first established in 1991 and since then other NICUs of state hospitals from the Athens district have
joined it. The audiologic department of “P. & A. Kyriakou” Children’s
Hospital of Athens also receives for diagnostic evaluation many infants who
fail the initial screening test.
It is our institution's policy to screen neonatal HR population with
ABR supplemented by OAEs in cases showing elevated thresholds, atypical or
absent ABR. By using this approach we want to minimize false negative
findings due to a small but real risk of pure retrocochlear lesions or auditory
neuropathy (Psarommatis et al 1997, 2006). However, the combined use of ABR
and OAEs in all HR neonates without exception may indicate an offer of costly
yet ineffective services, since for screening purposes a ‘‘normal’’ ABR
or aABR indicates a well-functioning cochlea, at least for the mid-frequencies’ range.
Having acquired considerable experience on NHS, specialists from ENT Department
of “P. & A. Kyriakou” Children’s Hospital of Athens are
continuously making efforts for informing the medical community on the necessity
of a universal NHS. This department has also proposed the implementation of
a nation-wide universal NHS offering comprehensive suggestions about who, where,
when and how this could be obtained (figure 1). The proposed by the head of
the Department, Dr Apostolopoulos, protocol was based on the recommendations
of American Academy of Pediatrics (American Academy of Pediatrics 2003) following
the “1-3-6” approach. Unfortunately, our suggestions to Greek Ministry
of Health in 1999, 2005 and 2006 have failed to trigger off the required actions
from State Health Services (Apostolopoulos 2005).
In the mean time, our Department was accepted as a full member in AHEAD, organizing
conferences and participating in a large number of scientific meetings on hearing
screening.
Europe 2008: time for action
Regardless the screening technique to be used (TEOAEs or DPOAEs or aABR), today
it is more than clear that universal hearing screening programs are not only
medically justified and feasible but absolutely necessary and beneficial
for the pediatric population, as well. European communities should be forced
to implement state-wide hearing screening programs for identifying hearing
loss in infants and guiding families to the appropriate services needed to
develop communication skills. State and medical community leaders should
first understand the problem and then make clear the direction they will
steer their societies. For an easy sleeping we can rest on some démodé suggestions
and wishes (like consensus statements on this subject). However, we must
never mistake simple motions for action. If we really want improved health
services for all children then European states should pass legislation to
require birthing hospitals to screen hearing without further delay. Sometimes
I am wondering how can European authorities enforce laws for almost everything
regulating directly or indirectly our lives throughout Europe but they “cannot” take
the required measures for a vital public health problem? Dealing with such
sensitive issues, cost should not be the only factor which will drive our
decisions.
As professor PJ Govaerts (The Eargroup, Antwerp-Deurne, Belgium) wrote in June-August
2006 Editorial, there is no need to re-discover the wheel. We can take as a
paradigm what United States of America have achieved within few years (NCHAM
2006). In 40 out of 50 States of America >90% of newborn are screened using
a physiologic test while in the rest of states the percentage varies between
76 and 90%. In 15 states ≥98% live births are screened !!!
Either 94% or 95.5% the sensitivity of hearing screening methods is, either
3.4% or 2.8% the referral rates of a screening program are, either 25 or 28 €/
newborn the cost of a screening program is, we strongly believe that the implementation
of state-wide hearing screening programs must be put into practise as soon
as possible. Today, we do have both the knowledge and the required technology
to get there. ENT Department of “P. & A. Kyriakou” Children’s
Hospital of Athens will continue to work for realizing this goal.
PS: The paragraph with title “Europe 2008:
time for action” reflects the author’s personal opinion, exclusively.
Abbreviations used:
ABR Auditory Brainstem
Responses
DPOAEs Distortion Product Otoacoustic Emissions
HR High
Risk (for hearing loss)
NHS Newborn Hearing
Screening
NICU Neonatal Intensive Care Unit
OAEs Otoacoustic Emissions
TEOAEs Transiently Evoked Otoacoustic Emissions
References
- American Academy of Pediatrics, Guidelines for Pediatric Medical Home Providers,
issued in January 2003, http://www.medicalhomeinfo.org/screening/Screen%20Materials/Algorithm.pdf ,
accessed Nov 5, 2006.
- Apostolopoulos N. Proposition for an early hearing detection-diagnosis-intervention
program. Reported to Greek Ministry of Health in June 2005.
- Korres
S, Nikolopoulos TP, Komkotou V, Balatsouras D, Kandiloros D, Constantinou
D, Ferekidis E. Newborn hearing screening: effectiveness,
importance of high-risk factors, and characteristics of infants in the
neonatal intensive care unit and well-baby nursery. Otol Neurotol. 2005;26(6):1186-90.
- Korres
SG, Balatsouras DG, Nikolopoulos T, Korres GS, Ferekidis E. Making
universal newborn hearing screening a success. Int J Pediatr Otorhinolaryngol
2006;70(2):241-6.
- National Center for Hearing Assessment and Management (NCHAM), Utah State
University, http://www.infanthearing.org/status/unhsstate.html,
accessed Nov 5, 2007.
- Psarommatis IM; Tsakanikos MD; Kontorgianni AD; Douniadakis DE; Apostolopoulos
NK: Profound hearing loss and presence of click-evoked otoacoustic emissions
in the neonate: a report of two cases. International Journal of Pediatric
Otorhinolaryngology, (1997) 39 (3) : 237-243.
- Psarommatis I, Riga M, Douros K, Koltsidopoulos P, Douniadakis D, Kapetanakis
I, Apostolopoulos N, Transient infantile auditory neuropathy and its clinical
implications, International Journal of Pediatric Otorhinolaryngology (2006)
70, 1629—1637.
Date of the Report : February 2008
Contact: Ioannis Psarommatis , MD, Ph.dAddress: CHILDREN'S
HOSPITAL OF ATHENS "P. & A. KYRIAKOU"
E.N.T. Department, Thivon & Livadias St.
115 27, Goudi, Athens, Greece.
FAX: +30-210-7790072
Email: ipsarommatis@hotmail.com
|
