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EHDI SYSTEMSEHDI SYSTEMS

IN THE EUROPEAN AREAIN THE EUROPEAN AREA

Ferdinando GrandoriFerdinando Grandori

European Project AHEAD II European Project AHEAD II

Quality of Life Programme – European CommissionQuality of Life Programme – European Commission

[email protected]

EHDI SYSTEMSEHDI SYSTEMSIN THE EUROPEAN IN THE EUROPEAN

AREAAREA

• EHDI programs are becoming a major EHDI programs are becoming a major focus in the health care systems of the focus in the health care systems of the vast majority of the 15 countries of the vast majority of the 15 countries of the European Union (EU) and in the European Union (EU) and in the European area at largeEuropean area at large

• Slowly but steadily EHDI systems are Slowly but steadily EHDI systems are being implemented in an increasing being implemented in an increasing number of European countriesnumber of European countries

Europe – MilestonesEurope – Milestones• 1993 NIH Consensus Statement1993 NIH Consensus Statement• EC-Biomedical & Health Program - Project on EC-Biomedical & Health Program - Project on

Otoacoustic Emissions (CA-OAE) 1993-95Otoacoustic Emissions (CA-OAE) 1993-95• 1995 World Health Organisation1995 World Health Organisation• EC-Biomedical & Health Program - Project AHEAD EC-Biomedical & Health Program - Project AHEAD

1996-991996-99• 1998 European Consensus Development 1998 European Consensus Development

ConferenceConference • 1999 AAP Statement1999 AAP Statement • NHS 2000 Conference (October 12-14, 2000)NHS 2000 Conference (October 12-14, 2000)

EHDI SYSTEMS IN THE EHDI SYSTEMS IN THE EUEU

Universal Newborn Hearing Screening is Universal Newborn Hearing Screening is rapidly becoming a standard of care …..rapidly becoming a standard of care …..

THOUGH assessment and early THOUGH assessment and early

intervention are still far from being well intervention are still far from being well

establishedestablished

1 + 3 + 6 1 + 3 + 6 10 10

EHDI SYSTEMSEHDI SYSTEMS


• Methods of universal screening vary from Methods of universal screening vary from hospital to hospital, for technology hospital to hospital, for technology (TEOAE, DPOAE, ABR), for criteria and (TEOAE, DPOAE, ABR), for criteria and quality standards.quality standards.

• Nearly all recent UNHS programs makes Nearly all recent UNHS programs makes use of AOAEsuse of AOAEs

OAE-based screening OAE-based screening protocol(s)protocol(s)(well-babies)(well-babies)

First OAE testFirst OAE test

Second OAE testSecond OAE test

failpass

STOPSTOP

pass

STOPSTOP ABR testABR test

fail

pass

STOPSTOP

fail

REFERREFER

Screening protocolsScreening protocolsfor for at-risk babiesat-risk babies

• Several hospitals are using different protocols for well-babies and for babies at-risk

• ABR is used, alone or in combination with OAEs (still risk categories survive….)

EHDI SYSTEMS EHDI SYSTEMS IN THE EUROPEAN AREAIN THE EUROPEAN AREA

• The penetration of newborn screening The penetration of newborn screening differs greatly from country to country, and differs greatly from country to country, and within the same country, from area to areawithin the same country, from area to area

• About 10% of the newborns in the EU are About 10% of the newborns in the EU are currently (Feb 2002) screened for hearingcurrently (Feb 2002) screened for hearing

EHDI SYSTEMS EHDI SYSTEMS


• A bottom-up approach was followed in the largest majority of A bottom-up approach was followed in the largest majority of

the European countriesthe European countries

• Universal hearing screening is mandated - or supported - by the Universal hearing screening is mandated - or supported - by the

central health authorities, in a number countries, or regions: central health authorities, in a number countries, or regions:

Austria, Belgium (Flanders), Croatia, Czech Rep., Holland, Austria, Belgium (Flanders), Croatia, Czech Rep., Holland,

Hungary, Lithuania, Luxembourg, Netherlands, 3 Hungary, Lithuania, Luxembourg, Netherlands, 3 LaendersLaenders in in

Germany, several “Regions” of Italy (7 out of 20), 5 Germany, several “Regions” of Italy (7 out of 20), 5

“Commmunities” of Spain“Commmunities” of Spain

• In the UK (England) legislation is expected soon (200+ hospitals In the UK (England) legislation is expected soon (200+ hospitals

are just starting)are just starting)



• Ambitious programs have been implemented Ambitious programs have been implemented in nearly all the other countries of the EUin nearly all the other countries of the EU

• However, some countries are still well However, some countries are still well

behind such as France, Greece (public behind such as France, Greece (public

hospitals), Norway, Portugalhospitals), Norway, Portugal

• In many countries of central and eastern In many countries of central and eastern

Europe several EHDI programs already exist Europe several EHDI programs already exist

(Latvia, Romania, Russia, Slovenia)(Latvia, Romania, Russia, Slovenia)



• Infants Infants hearing screening programs have hearing screening programs have been in place for many many (15+) years been in place for many many (15+) years ((Denmark, Germany, Hollands, Italy, Sweden, Denmark, Germany, Hollands, Italy, Sweden, UK) with poor results.UK) with poor results.

• It is often more difficult to change It is often more difficult to change mentality/procedures than establish new mentality/procedures than establish new models…..models…..

It is often more difficult to change It is often more difficult to change mentality/procedures than establish new models mentality/procedures than establish new models …………

• This is very clearly shown by the paradigmatic This is very clearly shown by the paradigmatic examples of the Scandinavian/Nordic countries, on examples of the Scandinavian/Nordic countries, on the one hand…..the one hand…..

• and on the other hand by central and eastern and on the other hand by central and eastern European countries that have entirely re-designed European countries that have entirely re-designed their health care systems during the past 5 to 10 their health care systems during the past 5 to 10 years.years.

PolandPoland

(population: 30 mln – annual births: 380,000)(population: 30 mln – annual births: 380,000)

• After about one year of planning, a non-profit After about one year of planning, a non-profit Foundation “The Great Orchestra of Christmas Foundation “The Great Orchestra of Christmas Charity” has funded the start of EHDI programsCharity” has funded the start of EHDI programs

• Dr. Jerzy Puzio, Dr. Marzanna Radziszewska, Dr. Jerzy Puzio, Dr. Marzanna Radziszewska, The Children’s Memorial Health Institute, The Children’s Memorial Health Institute, Warsaw, PolandWarsaw, Poland

440 maternity departments440 maternity departments

46 second level audiological centers 46 second level audiological centers

7 audiological centers for intervention 7 audiological centers for intervention

ALL OUR BEST WISHES OF A SUCCESSFUL START



PolandPoland400+ maternity departments400+ maternity departments

45+ second level audiological centers 45+ second level audiological centers

7 audiological centers for intervention 7 audiological centers for intervention

OUR BEST WISHES!OUR BEST WISHES!

EHDI SYSTEMS EHDI SYSTEMS IN THE EUROPEAN AREAIN THE EUROPEAN AREA

England England The National Screening Committee TrialThe National Screening Committee Trial

20 Sites, or Health Districts, incorporating 20 Sites, or Health Districts, incorporating

30+ hospitals 30+ hospitals

The conception was a rather long lasting process, The conception was a rather long lasting process,

but a national EHDI system is under way nowbut a national EHDI system is under way now

QUALITY STANDARDS OF QUALITY STANDARDS OF SCREENING PROTOCOLSSCREENING PROTOCOLS

• Quality standards are still lacking for

the various screening protocols.

• Only very few screening devices have been clinically validated in large scale trials aimed at evaluating the performances of the new automatic algorithms.

FUTURE RESEARCHFUTURE RESEARCH

• optimize screening technologies

• screening criteria for well- and at-risk babies

• strategies/technologies for early assessment (particularly methods for diagnostic ABR)

• strategies for early fitting

• criteria for implantation in very young infants (how young? bilateral? Brainstem?)

FUTURE OF EHDI SYSTEMS IN THE FUTURE OF EHDI SYSTEMS IN THE EUEU

• Successful implementation of EHDI systems will crucially depend on availability of a new generation of professionals

• This is not surprising because EHDI systems were an undemanded need (Adrian Davis)

Euro-survey: AHEAD IIEuro-survey: AHEAD II

ByBy

Steering groupSteering group

F. Grandori (project leader)F. Grandori (project leader)

L. Collet (France)L. Collet (France)

M. Moro (Spain)M. Moro (Spain)

A. Parving (Denmark)A. Parving (Denmark)

K. Schorn (Germany)K. Schorn (Germany)

I. Uloziene (Lithuania)I. Uloziene (Lithuania)

K. Welzl-Müller (Austria)K. Welzl-Müller (Austria)

LAST UPDATE: Nov. LAST UPDATE: Nov. 20012001

Objectives - to achieve Objectives - to achieve information on:information on:

• Age at identification of HI – childrenAge at identification of HI – children• Assessment - methodsAssessment - methods• Protocols for etiological evaluationProtocols for etiological evaluation• National recommendations/guidelines on National recommendations/guidelines on

surveillance programmessurveillance programmes• Links to educational systemLinks to educational system• Employment of hearing therapists in EHDIEmployment of hearing therapists in EHDI• Employment of physicians/audiologists in Employment of physicians/audiologists in

the educational systemthe educational system

Procedure:Procedure:

• 221 questionaires mailed to 221 questionaires mailed to delegates attending NHS-2000 – delegates attending NHS-2000 – Milan and to those in our mailing Milan and to those in our mailing listslists

• N = 56 responses returned to A. N = 56 responses returned to A. ParvingParving

• Descriptive analysisDescriptive analysis

Responses: N=56~27 countriesResponses: N=56~27 countriesCOUNTRYCOUNTRY NN IsraelIsrael 33

AustriaAustria 11 ItalyItaly 55

BelgiumBelgium 22 LithuaniaLithuania 11

CroatiaCroatia 11 LuxemburgLuxemburg 11

Czech Rep.Czech Rep. 55 NorwayNorway 22

DenmarkDenmark 22 PolandPoland 11

EnglandEngland 11 RomaniaRomania 11

FinlandFinland 11 SlovakiaSlovakia 11

FranceFrance 33 SloveniaSlovenia 11

GermanyGermany 11 SpainSpain 55

GreeceGreece 22 SwedenSweden 11

HollandHolland 33 SwitzerlandSwitzerland 22

HungaryHungary 11 TurkeyTurkey 11

IrelandIreland 22 WalesWales 11

Methods for assesment of Methods for assesment of hearing level/thresholdhearing level/threshold

BOABOA 2424

VRAVRA 2525

Peep showPeep show 1111

Play aud.Play aud. 3535

ECoGECoG 77

ABRABR 4444

OAEOAE 3636

Perform: N=51

Time lapse from assesment to HA-Time lapse from assesment to HA-fittingfitting

NN %%

1mths1mths 1212 23.523.5

2mths2mths 1616 31.431.4

3mths3mths 1111 21.621.6

Missing data: N=12~23.5% (poor communication)

Screening Screening infancy/childhoodinfancy/childhood

YESYES NONO nrnr

Screening Screening

< 12 < 12 monthsmonths

44 44

(86.2%)(86.2%)44

(7.8%)(7.8%)33

(5.8%)(5.8%)

Screening Screening atat

1-4 years1-4 years

2525

(49.0%)(49.0%)1010

(19.6%)(19.6%)1616

(31.3%)(31.3%)

School School entranceentrance

3131

(60.8%)(60.8%)88

(15.6%)(15.6%)1212

(23.5%)(23.5%)

Screening Screening laterlater

1919

(37.2%)(37.2%)1111

(21.5%)(21.5%)2121

(41.1%)(41.1%)

Habilitation before fitting Habilitation before fitting

ReportingReporting NN

YesYes 18 (35.2%)18 (35.2%)

NoNo 19 (37.2%)19 (37.2%)

No Resp.No Resp. 14 (27.4%)14 (27.4%)

Protocol for aetiological Protocol for aetiological evaluationevaluation

NN

Do imaging of inner earDo imaging of inner ear 3131

Do opthalmological Do opthalmological exam.exam. 3030

Do genotypesDo genotypes(predominantly connexin 26)(predominantly connexin 26)

2626

Do electrocardiogramDo electrocardiogram 2121

Using protocol: N=31/51 (N=21 missing)

Services Services (1)(1)

• Guidelines for national Guidelines for national surveillance programmes:surveillance programmes:

N=13/48 (27.1%) (N=8 miss.)N=13/48 (27.1%) (N=8 miss.)

• Guidelines for regional Guidelines for regional surveillance programmes:surveillance programmes:

N=23/47 (48.9%) (N=9 miss.)N=23/47 (48.9%) (N=9 miss.)

• Links to educational system:Links to educational system:• Reporting Reporting yesyes: N= 38/47 (80%) : N= 38/47 (80%) (N=9 miss.)(N=9 miss.)

• N=29/38 (76.3%) Have hearing N=29/38 (76.3%) Have hearing therapists ”employed ” in EHDItherapists ”employed ” in EHDI

• N=16 (42.1%) Have physicians/ N=16 (42.1%) Have physicians/ audiologists ”employed” in audiologists ”employed” in educational systemseducational systems

Services Services (2)(2)

2nd INTERNATIONAL CONFERENCE ON2nd INTERNATIONAL CONFERENCE ONNEWBORN HEARING SCREENINGNEWBORN HEARING SCREENINGDIAGNOSIS AND INTERVENTIONDIAGNOSIS AND INTERVENTION

Como Lake, Italy, May 30 – June 1st, 2002Organisers: Ferdi Grandori & Deborah Hayes

www.biomed.polimi.it/NHS2002www.biomed.polimi.it/NHS2002

TOPICSNewborn hearing screening

Audiological assessment of infants

Medical and surgical intervention for hearing loss

Genetics of hearing loss

Strategies for aural habilitation

Hearing aids and cochlear implants

Psychophysical measures of auditory function

Physiologic measures of audiological function

Language development, cognition and deafness

Neuromaturation

Auditory neuropathies

Perspectives of the Deaf community

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