SCFHS Audiology Complete Review Guide 2026–2027

4. Automated ABR screening uses clicks at about 35 dB nHL with a pass/refer result; the non-inverting electrode sits on the high forehead, and quiet sleep is the best infant state.
5. Common causes of a false refer on OAE are vernix or debris in the canal and high ambient noise, so screening after 24 hours of age in a quiet room is preferred.
6. Protocol: inpatient refer, then rescreen of both ears before 1 month, then diagnostic evaluation if either ear still refers. An infant readmitted with hyperbilirubinaemia needing exchange transfusion gets an ABR rescreen before discharge.
7. More risk indicators: in-utero infections such as rubella and other TORCH agents, prolonged aminoglycoside therapy, temporal-bone fracture, platinum chemotherapy, and craniofacial anomalies.
8. A child with a risk indicator who passed screening needs at least one diagnostic assessment timed by the risk (by 9 months for many). Bacterial meningitis needs prompt evaluation because of the risk of cochlear ossification.
9. Consanguineous marriage, common in Saudi Arabia, raises the risk of autosomal recessive hearing loss; a family history of permanent childhood hearing loss is a risk indicator needing follow-up.
10. Programme quality: a low inpatient refer rate (below about 4%) is a good sign. Loss to follow-up is the main challenge; data tracking and explaining the result and next step to parents reduce it.
11. BOA responses are unconditioned and variable, so they are called minimal response levels, not thresholds. A startle (Moro) response usually needs 65 to 80 dB or louder.
12. VRA relies on a head turn that matures at about 5 to 6 months. The speaker sits at 90°, the toy or video lights up only after a correct response, no-signal control trials catch false positives, and one low and one high frequency (500 and 2000 Hz) are tested first.
13. Conditioned play audiometry (2.5 to 5 years): the child does a play task such as dropping a block on hearing the sound. For children with developmental delay choose by developmental age, and for preterm infants by corrected age.
14. Normal hearing in children is often defined as thresholds of 15 dB HL or better; minimal loss (16 to 25 dB HL) or unilateral loss can affect school performance.
15. Cross-check principle (Jerger and Hayes): behavioural results are confirmed by independent tests such as tympanometry, OAE and ABR. Example: absent OAEs, normal tympanograms and 50 dB thresholds point to sensorineural loss.
16. The speech awareness threshold is the lowest level at which speech is detected, not recognised, and is about 5 to 10 dB better than the SRT. Picture tests such as WIPI and ESP are closed-set; the Ling Six Sounds (/m, oo, ah, ee, sh, s/) check speech-frequency access with devices.
17. Otitis media with effusion is the most common cause of conductive loss in young children; watchful waiting is about 3 months in a child without risk factors, with ventilation tubes for persistent cases. It is more common in Down syndrome and cleft palate because of Eustachian-tube dysfunction.
18. cCMV-related hearing loss can be late-onset or progressive and needs monitoring until about age 6; valganciclovir may be offered to newborns with symptomatic cCMV within the first month.
19. Syndromes to link: Pendred (goitre with enlarged vestibular aqueduct, SLC26A4), Usher (retinitis pigmentosa), Jervell and Lange-Nielsen (long QT, so an ECG is needed). Enlarged vestibular aqueduct causes fluctuating, progressive loss, so head trauma should be avoided.
20. Amplification: fitting before 6 months gives the best outcomes, using DSL v5 or NAL-NL2 with a measured RECD because small canals produce higher SPL. Unoccupied classroom noise should be 35 dBA with reverberation of 0.6 s or less (ANSI S12.60), and cochlear implants are labelled from 9 months.

Common mistakes in this chapter

• ✕ Passing an OAE screen does not rule out auditory neuropathy, because outer hair cells can work while the neural pathway is abnormal. That is why NICU infants are screened with AABR.
• ✕ A unilateral refer on rescreen still needs a full diagnostic evaluation, and the rescreen covers both ears. Repeating the screen until a pass appears is discouraged because it increases false negatives.
• ✕ Sound-field VRA reflects only the better ear. For ear-specific results, use insert earphones.
• ✕ A 226 Hz probe in an infant under 6 months can show a normal-looking peak despite effusion; the correct choice is a 1000 Hz probe.
• ✕ A flat Type B tympanogram has three readings by ear-canal volume: normal volume means effusion, large volume means perforation or a patent tube, small volume means wax or the probe against the canal wall.
• ✕ A newborn pass does not guarantee normal hearing later: late-onset or progressive loss (for example from cCMV) needs surveillance, and parental concern about hearing or speech calls for prompt assessment.
• ✕ Congenital CMV must be tested within 21 days of birth. After that, congenital and postnatally acquired infection cannot be told apart.
• ✕ In auditory neuropathy, ABR thresholds do not predict hearing, so hearing aids are fitted to behavioural thresholds; a cochlear implant may help if aided speech perception stays poor.