Abstract

Objective. Early detection and prompt intervention of permanent hearing impairment (PHI) can only be achieved through universal newborn hearing screening (UNHS) in the first month of life. The most common screening protocols worldwide involve a combined approach with transient evoked otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR). Our study aims to evaluate the proportion of infants with PHI in a population with discordant outcome TEOAEs/AABR through audiological follow-up.
Methods. The present study enrolled 637 healthy babies who failed TEOAEs at birth and were referred for a secondary level audiological evaluation with TEOAEs and AABR. Ninety babies with discordant outcome (TEOAEs refer/AABR pass) underwent audiological retest adding tympanometry and clinical click-evoked auditory brainstem response.
Results. PHI was confirmed in 12 babies (7 bilaterally and 5 unilaterally) and the degree was mild to moderate in 8 and in 4 babies, respectively. There were no risk factors for delayed onset of hearing loss in half of PHI.
Conclusions. The discordant TEOAEs refer/AABR pass suggests that follow-up should be recommended independently of risk factors for PHI to avoid misleading diagnosis of mild or late-onset hearing loss.

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Rita Malesci - Audiology Section, Department of Neuroscience and Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy; Hearing and Balance Unit, Federico II University Hospital, Naples, Italy

Chiara Quatrano - Audiology Section, Department of Neuroscience and Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy

Valeria Del Vecchio - Hearing and Balance Unit, Federico II University Hospital, Naples, Italy. Corresponding author - valeria.delvecchio@unina.it

Giovanni Freda - Audiology Section, Department of Neuroscience and Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy

Antonella Castaldi - Audiology Section, Department of Neuroscience and Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy

Francesco Nunziata - Department of Pediatrics, Santobono Pausilipon Hospital, Naples, Italy

Pietro Buono - Department of Maternal and Child Health, General Directorate for Health, Naples, Italy

Anna Rita Fetoni - Audiology Section, Department of Neuroscience and Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy; Hearing and Balance Unit, Federico II University Hospital, Naples, Italy

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Copyright (c) 2026 Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale

How to Cite
Malesci, R., Quatrano, C., Del Vecchio, V., Freda, G., Castaldi, A., Nunziata, F., Buono, P., & Fetoni, A. R. (2026). The impact of a two-stage newborn hearing screening protocol for early diagnosis of hearing loss. ACTA Otorhinolaryngologica Italica, 46(1), 58–66. https://doi.org/10.14639/0392-100X-N2895
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