Sensitivity and specificity of otoacoustic emission and automated auditory brainstem response tests in universal neonatal hearing screening programme in Malta

Abstract

The aim of this study was to evaluate the effectiveness of the Universal Neonatal Hearing Screening Programme in the Maltese Islands between October 2021 and October 2022. A retrospective, cross sectional, non-interventional quantitative research design was employed. The study population consisted of 4,427 newborns delivered in Malta and Gozo during the one-year study period. The results demonstrated that 93% of newborns across both islands were screened, indicating near universal programme coverage and alignment with established standards for accessibility and early hearing detection. The prevalence of confirmed neonatal hearing impairment was 0.21%, corresponding to approximately 2.1 cases per 1,000 live births. Performance evaluation of the screening modalities showed that the Automated Auditory Brainstem Response (AABR) test achieved a sensitivity of 90% and a specificity of 96%, while Otoacoustic Emissions (OAE) testing demonstrated a sensitivity of 80% and a specificity of 91%. Although AABR exhibited higher diagnostic accuracy, the combined use of AABR and OAE improved overall screening effectiveness and population coverage. In conclusion, a staged dual-testing approach incorporating both AABR and OAE enhances diagnostic accuracy and supports the primary objective of early and universal identification of neonatal hearing impairment.