BrazJOtorhinolaryngol.2014;80(5):369---370
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
www.bjorl.org
EDITORIAL
Overview
of
neonatal
hearing
screening
programs
in
Brazilian
maternity
hospitals
夽
Panorama
dos
programas
de
triagem
auditiva
neonatal
em
maternidades
brasileiras
Approximately25yearsago,afewisolatedpioneersbegan performing neonatal hearing screening, initially in a few private hospitals and later in private practice in Brazil, using objective screening methods (evoked otoacoustic emissions[OAEs]andbrainstemauditoryevokedpotentials [BAEPs/ABR]).Initially,screening wasdirectedatchildren whohadariskfactoraccordingtotheJointCommitteeon InfantHearingandsubsequently,afteralmosttenyears,it wasextendedtoallnewborns.Duringmostofthetime,one ofthegreatestdifficultieswastoconvincepediatriciansof theneed toperformthistest in childrenwithout anyrisk factors.
Local,state,andfederal-leveldemandsforthetesttobe obligatorywereinitiatedbyotorhinolaryngologistsand audi-ologists,whichweresuccessfulononlyrareoccasions.Most ofthetime,thetestwasindicatedbyapediatricianduring aprivateconsultationorconsultationthroughhealth insur-ance,which,however,didnotcoverthetestprocedure.
After much effort at the several governmental levels, FederalLaw12,303ofAugustof2010madethetest obliga-toryandfreeofchargeinmaternityhospitals.Almostfour years have passed and we still we still have difficulties achievingthegoalofauniversalnewbornhearingscreening (UNHS)program.
In 2012, after seeking collaboration through rep-resentatives of the Brazilian Association of Otorhino-laryngology and Cervical-Facial Surgery, the Brazilian Society of Otology, the Brazilian Society of Pediatrics, the Brazilian Society of Audiology and Speech Therapy, the Brazilian Academy of Audiology, and the Ministry of Health, the latter released the document entitled
夽
Pleasecitethisarticleas:PizaMT.Overviewofneonatalhearing screeningprogramsinBrazilianmaternityhospitals.BrazJ Otorhi-nolaryngol.2014;80:369---70.
‘‘Guidelinesonnewbornhearingscreeningcare’’,available at http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes atencao triagemauditivaneonatal.pdf.
Thisdocumentdidnotincludeseveralconcernsregarding
hearingscreening,suchastheimplementationofanational
database,trainingteamsforscreening,diagnosis,and
inter-vention, but at least we have begun to envision a new
scenarioinnewbornhearingcare.
Currently,inBrazil,therearehundredsofcentersthat
perform neonatal hearing screening, including hospitals
affiliatedwiththe Brazilian UnifiedHealth System, which
conductthetest freeof chargetothepatient,aswell as
privatehospitalsorclinicsthatchargeorreimbursepatients
throughhealthinsurance.Someofthesehospitalscarryout
onlythescreeningphase,whereassomeareabletoperform
diagnostictestingininfantswhofailthescreening,aswell
asothersofhighercomplexitythatalsoprovideprosthetics
orevenoffercochlearimplants.
Amajorconcerninhearingscreeningservicesisthe
rel-ativelyhighnumber ofchildren whofailthe test,leading
toa considerable number of retests, and consequently,a
greaternumberwhowillneedatesttoconfirmthe
diagno-sisofhearingloss.Ithasbeenobservedthatthisnumberis
highatthebeginningofscreeningimplementationand,over
time,thenumber offalsepositivesdecreases,as
examin-ersacquiregreaterskill.Infantswhofailthescreeningtest
twiceshouldbereferredtoadiagnosticcentertobebetter
assessed.
Fortunately,inmostcases,theproblemliesinthemiddle
ear.Unfortunately,wedonothaveapublicnetworkwhere
hearingassessmentbyotolaryngologistsiseasilyachieved.
Afterthemedicalevaluation,thechildmustbesubmitted
toamoredetailedassessment,suchasBAEPthresholdswith
specificfrequencyoruseofauditorysteady-statepotential,
andifhearinglossisconfirmed,thechildmustbereferred
fordiagnostictherapyandhearingaids,andwhennecessary,
cochlearimplant.
http://dx.doi.org/10.1016/j.bjorl.2014.07.003
370 EDITORIAL
Thisscenarioisslowlychangingforthebetter,onceagain
throughthepersonalinitiativeofdoctorsandaudiologists,
concerned about the devastating aspects of undiagnosed
congenitaldeafness,ratherthanthroughgovernment
inter-vention.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
MarceloRibeirodeToledoPiza(MD,MSc)
