Congenital deafness is a major pediatric problem, affecting about 1.5-3 per 1000 newborns. The early treatment through cochlear implantation and auditory rehabilitation has been a historic milestone. Early diagnosis of congenital deafness is an essential requirement to obtain the best results, which is achieved through neonatal screening, a diagnostic practice that we began systematically at the Hospital Clínico in Valencia (Spain) 30 years ago.

Second-level hospitals face peculiarities that hinder the implementation of the hearing rescreening protocol, which are not uncommon in other settings. This study analyzes the hearing rescreening process in this kind of hospital. A total of 1130 individuals were included. In this cohort, 61.07% were newborns in the hospital who failed their first otoemission test after birth (n=679) or were unable to have the test performed (n=11), then being referred to outpatient clinic. The remaining 38.93% were individuals who were born in another hospital with their first test conducted in the outpatient clinic (n=440). A high amount of rescreenings were made outside the recommended time frame, mainly in children referred from another hospital. There was a high rate of lost to follow-up especially with otolaryngologist referrals. Neonatal Hearing screening in second level hospitals is difficult because of the staffing and time constraints. This results in longer than recommended turnaround times and interferes with the timely detection of hearing loss. This is particularly serious in outpatients. Referral of children with impaired screening to out-of-town centers leads to unacceptable loss of follow-up. A legislative support for all these rescreening issues is necessary. We discuss these findings and propose some solutions.

In patients with unilateral tinnitus with normal hearing, several studies have compared the ipsilateral and contralateral ears; however, few studies have investigated its relationship with the duration of tinnitus. We compared the auditory brainstem response and otoacoustic emission parameters between ipsilateral and contralateral ears in adults with unilateral tinnitus and normal hearing. This retrospective review included 84 patients with unilateral tinnitus and normal hearing who underwent auditory brainstem response and otoacoustic emission; they were categorized according to the duration of tinnitus. The latencies and amplitudes of waves I, III, and V, and V/I ratio of both ears in auditory brainstem response, and the results of distortion-product otoacoustic emission and transient evoked otoacoustic emission were examined. The auditory brainstem response parameters, distortion-product otoacoustic emission parameters, and transient evoked otoacoustic emission parameters between the ipsilateral and contralateral ears along the duration of tinnitus were analyzed. Moreover, the failure rates of both distortion-product otoacoustic emission and transient evoked otoacoustic emission between the ears along with the duration and the effects of the variables on the amplitude and latency of each wave were examined. Although there was little significant difference between the ipsilateral and contralateral ears, laterality seemed to have an effect on wave I latency in the multiple linear regression analysis. The distortion-product otoacoustic emission failure rate of the ipsilateral ear was higher than that of the contralateral ear in all patients. However, there was no remarkable difference between the ears in the distortion-product otoacoustic emission and transient evoked otoacoustic emission parameters throughout the duration. We found that outer hair cells and the distal portion of the cochlear nerve are possible pathologic lesions in tinnitus with normal hearing and cochlear synaptopathy could be suspected. Further studies, including those on inner hair cells and higher central cortex, are needed.