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there is a history of deafness in the family; if a child’s mother had rubella or any other virus disease during a critical stage of pregnancy; if the child suffered from anoxia at birth of apraxia in a premature child, or the labor was unusually protracted, and the delivery was complicated; if a child had hemolytic disease of the newborn or was jaundice as result of premature birth mature birth or had kernicterus, in all these cases the offspring should be tested without exception at the appropriate time” (Fisch, 1957, pp. 233-234).
Hardy (1965) presented the details for a similar high-risk registry. During the next two decades, the high-risk regis- try was utilized but was only able to diagnose 50% of the affected children. These findings are summed up in the US National Institutes of Health Consensus Development Conference Statement (National Institutes of Health,
1993). By 1993, screening was dependent on the high-risk registry and some applications of the physiological tests: auditory-evoked potentials and otoacoustic emissions.
These objective quantitative assessments of hearing ability came about in the last half of the twentieth cen- tury through the application of physiological aspects of the auditory system to the diagnosing of hearing impairments in patients. These were the recording of the cochlear microphonic in humans (called electroco- chleography) (Ruben et al., 1959), application of middle ear admittance to the diagnosis of middle ear pathology (Terkildsein and Thomsen, 1959), recording of auditory brainstem responses (Jewett and Williston, 1971), and the discovery of otoacoustic emissions (Kemp, 1978).
These physiological assessments had a significant role in the establishment of hearing loss in patients who could not communicate whether they perceived sound. The most widespread use of these techniques was in the estab- lishment of hearing loss in newborns and young children.
The application of the physiological advances, including measurements of the auditory brainstem response and evoked otoacoustic emissions, was first clinically applied to the testing of newborn infants and reported by Kennedy et al. (1991). A combination of physiological tests consist- ing of automated otoacoustic emissions and automated auditory brainstem response was utilized. In 1994, Hunter et al. reported on their two-stage universal screening test of 213 infants at a large district maternity hospital in the United Kingdom. They found that a two-stage screening
protocol, first otoacoustic emissions and then, after the failure of otoacoustic emissions, an auditory brainstem response, to be the most effective.
White et al. (1993, 1994) reported their results of the two- stage screening program on infants born at Women and Infants Hospital of Rhode Island. They concluded:
“Based on a relatively large sample of 1850 infants from a WBN [well-baby nursery] and a NICU [neonatal intensive care unit], this study provides evidence that (1) hearing impaired infants can be identified based on a TEOAE [transient evoked otoacoustic emissions] screening protocol and (2) many of those infants would not have been identified using the currently recommended approach of screening only high-risk children” (White et al., 1993).
White et al.’s results were confirmed in a New York State study carried out from 1995 to 1997 that included infants from diverse social, economic, and cultural backgrounds. There were 69,761 infants evaluated from 7 different regional perinatal centers (8 hospitals) representing vari- ous socioeconomic regions. All the hospitals utilized the two-tier system rescreening both in the well-baby nurs- ery and in the neonatal intensive care units.
The two-step newborn infant hearing screening program is now a standard procedure for all newborn children in the United States (Centers for Disease Control and Prevention, 2019). The screening program has also been widely adopted in Europe. Throughout the world, it has been utilized by many but not all countries and modified in some to meet their economic, cultural, and geographic needs (Neumann et al., 2019).
Adults
Hearing loss as a consequence of exposure to noise in the workplace has been long recognized. The earliest reference to deafness resulting from exposure to noise in the workplace was published by Ramazini (1700, also see 1964) where he described hearing loss and workers in a flour mill. In his second edition in 1713, Ramazini describes the effect of ironworkers in the ghetto in Venice who, after working there for many years, became deaf.
“From this quarter there rises such a terrible din that only these workers have shops and homes there but all others flee from the highly disagreeable locality... To begin with, ears are injured by that perpetual din,
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