# Reliability of nurse-administered infant hearing screening using otoacoustic emissions

## TL;DR

This study shows that nurses can reliably screen infants for hearing loss using a specific test, which could help identify hearing issues much earlier in South Africa.

## Contribution

The study demonstrates that nurse-administered infant hearing screening using DPOAE is reliable and can be integrated into immunization programs.

## Key findings

- Nurses showed almost perfect agreement with audiologists in administering DPOAE screening tests.
- 13 out of 50 infants failed the DPOAE screening and were referred for further evaluation.
- The findings suggest nurse-administered screening can help reduce the age of identifying congenital hearing loss.

## Abstract

In South Africa (SA), congenital hearing loss (HL) is identified at around 30 months of age, which is later than local standards of identification by 6 weeks, mainly because of limited access to infant and newborn hearing screening (INHS). Thus, there is a critical need to explore other models of providing early detection such as nurse-administered INHS.

This study aimed to determine the reliability of nurse-administered INHS.

This was a repeated-measures study where 50 infants scheduled to receive their 6-week immunisation were independently screened by two nurses and an audiologist using distortion product otoacoustic emissions (DPOAE). Data were analysed using Cohen’s kappa, using Stata v18 for Macintosh.

Thirteen (n = 13, 26%) infants failed DPOAE screening tests, of which four were male and nine (n = 9) were female. All participants who failed the screening were referred to the hospital for further evaluation and intervention as needed. Further analysis revealed an almost perfect agreement between audiologist- and nurse-administered screening (k = 0.81, p < 0.001).

Findings from this study demonstrate that nurses can consistently screen and identify babies with congenital HL using DPOAE screening tests. Furthermore, these findings pave the way for incorporating nurse-administered DPOAE screening into immunisation programmes, with the potential to increase access to INHS and reduce the age of identification of congenital HL to acceptable standards. Large-scale research is recommended to explore the implementation of this nurse-administered INHS in other contexts.

This study contributes to the growing body of evidence on INHS in SA.