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Original Article

Call for calibration standard for newborn screening using auditory brainstem responses

, &
Pages 686-691 | Received 26 Jul 2006, Published online: 07 Jul 2009
 

Abstract

The mode of stimulation employed in newborn screening of the auditory brainstem response has evolved from the clinically standardized supraaural earphone to the tubal insert earphone, to most recently a circumaural earphone developed for this test. Considered here is the need to develop a standard for calibration of such devices for newborn screening applications, in particular. At risk is the prospect of missing the milder degrees of hearing loss, assuming a goal of detecting all clinically-significant congenital hearing losses. Two commercially manufactured test instruments for automated newborn screening were scrutinized via bench testing of sound output from their respective transducers, using a variety of measurements. By convention or design, none of the measurement approaches involved a model of the newborn ear, per se. While it was concluded that the manufacturers’ method shows promise, namely as a relatively simple and potentially reliable method of calibration, concerns arose regarding output levels when measured according to both the manufacturers’ and the authors’ methods. Further work is needed to critically assess calibration methods and to establish, to the extent possible, appropriate norms and validation studies in newborns to provide a better understanding of the actual sound pressure level of the screening stimulus.

Abbreviations
ABR=

Auditory brainstem response

ABS=

Acrylonitrile butadiene styrene

B&K=

Bruel & Kjaer

ERA=

Electric response audiometry

IEC=

International Electrotechnical Commission

ISO=

International Organization for Standardization

KEMAR=

Knowles electronic manikin for acoustic research

nHL=

Normal hearing level

OAE=

Otoacoustic emission

SPL=

Sound pressure level

Abbreviations
ABR=

Auditory brainstem response

ABS=

Acrylonitrile butadiene styrene

B&K=

Bruel & Kjaer

ERA=

Electric response audiometry

IEC=

International Electrotechnical Commission

ISO=

International Organization for Standardization

KEMAR=

Knowles electronic manikin for acoustic research

nHL=

Normal hearing level

OAE=

Otoacoustic emission

SPL=

Sound pressure level

Sumario

Las formas de estimulación utilizadas en el tamiz auditivo con respuestas del tallo cerebral han evolucionado desde el auricular clínicamente estandarizado supraaural, al tubo de inserción y más recientemente, al auricular circumaural desarrollado para esta prueba. Se considera aquí la necesidad de desarrollar un estándar para la calibración de estos instrumentos y en particular, para su aplicación en el tamiz auditivo. Está en riesgo en esta perspectiva, la pérdida de casos con grados menores de pérdida auditiva si se asume la meta de identificar todos los casos con pérdidas congénitas clínicamente significativas. Se examinaron dos instrumentos comercialmente manufacturados para el tamiz automatizado de neonatos, por medio de pruebas de referencia, para examinar la salida del sonido a través de sus respectivos transductores usando varias mediciones. Por acuerdos convencionales o por diseño, ninguna de las formas de medición involucraban per-se un modelo del oído del neonato. Mientras se concluyó que era prometedor el método del fabricante, concretamente como un método relativamente simple y potencialmente confiable de calibración, surgieron preocupaciones en relación con los niveles de salida, al ser medidos tanto de acuerdo con los métodos del fabricante como con los de los autores. Se necesita trabajo adicional para evaluar críticamente los métodos de calibración y para establecer, hasta donde sea posible, normas apropiadas y estudios de validación en neonatos y para proveer a una mejor comprensión de los niveles de presión sonora actual de los estímulos usados para el tamiz.

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