The placement of the AABR electrodes might be a complicated process, especially when highly skin impedances (caused by excessive lipid layers) are encountered. Data from the above study suggested that (i) the average time for AOAE responses is less than 10 s in a cooperative subject and less that 120 s (2 min) in non-cooperative subjects and (ii) the average AABR test times were less than 120 s, while longer times (600 s per ear) were required for uncooperative subjects. A previous study of our group, in the context of the regional NHS project CHEAP in Emilia-Romagna, Italy, provided evidence suggesting that in terms of time-requirements, portable ABR (Audioscreener, Viasys Accuscreen, GN-Otometrics Algo 3i, Natus) and OAE devices were converging to the same time values. The latter is outside the objectives of this paper and will not be addressed. With the introduction of the AABR protocols in the NHS programs, several issues became evident, and among those questions related to screening times and screening costs. The combined screening protocols (AOAE + AABR) targeted the identification of auditory neuropathy, most prevalent in the neonatal intensive care (NICU) environment. In the early 2002, the first fourth-generation OAE devices appeared in the market and offered the possibility to integrate information from different testing protocols such as automated OAE (AOAE) and automated ABR (AABR) responses. In this context, the aim of this chapter is to provide information on these new technological trends.Ģ. To respond to these clinical demands, several new methodologies have been introduced to the UNHS clinical practice. Within the last decade, numerous new challenges have appeared in the UNHS arena, such as (i) the need to validate the automated OAE/ABR screeners (ii) the need to qualify the responses from the automated devices (iii) the need to obtain additional information (i.e., hearing threshold) for the subject under assessment, in a short period of time and (iv) the need to integrate numerous measurements in a single portable automated device. Two important phases are considered: (i) the identification of infants with mild and moderate hearing deficits and (ii) an intervention in terms of hearing improvement (hearing aids and cochlear implants) and neural rehabilitation, aiming at the restoration of hearing and the normalization of the quality of life of the young patient. While the main objective of neonatal hearing screening (NHS) is the identification of infants with a hearing deficit (≥30 dB HL), the objectives of a UNHS program have a broader vision. The most significant contribution of OAEs is in the area of universal neonatal hearing screening (UNHS). During the last 20 years, OAE protocols have been used in many areas of audiology and hearing science. Otoacoustic emissions (OAEs) or cochlear echoes is a term coined by David Kemp in 1978, describing the transient responses from the inner ear, upon its stimulation by an acoustic click stimulus.
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