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745
Subject Expert, Department of Multiple Disability and Rehabilitation, Dr Shakuntala Misra National Rehabilitation University, Mohaan Road,
Lucknow-226017, UP, India.
**
Director technical and Professor, Dr S.R.Chandrasekhar Institute of Speech and Hearing, Lingarajapuram Bangalore 560084, India.
I. INTRODUCTION
International Journal of Scientific and Research Publications, Volume 6, Issue 5, May 2016
ISSN 2250-3153
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International Journal of Scientific and Research Publications, Volume 6, Issue 5, May 2016
ISSN 2250-3153
Figure III: TEOAE finding of ear with vernix and without vernix
in stage 2
Figure IV: TEOAE fails in ears without and with vernix, in stage
one and two.
False positive TEOAE finding.
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Table II shows 78 out of the 79 ear that failed in first stage but
subsequently passed in the second stage, constituted the false
positive rate of TEOAE, i.e., 34.8%. Of these false positive
TEOAE, 93.6% were those who had some amount of vernix.
This high false positive result affects the specificity.
Table II: Performance
(?)
Hearing Hearing Loss Total
Loss Present
Absent
0(false
145
(true 145
TEOAE Pass
negative)
negative)
78
(false 79
TEOAE Refer 1
positive)
Total
1
223
224
DISCUSSION
If hearing screening in well newborns is to be performed before
hospital discharge, most infants will be tested before they reach
48 hrs.of age. Very few authors have studied the prevalence of
vernix in this age group of neonates. Cavanaugh (1987) (cited in
Thornton et al, 1993) studied 81 healthy neonates, reported
vernix obscured ear canal in 56% ear of neonates < 24 hours,
24% ears of neonates aged 24 to 48 hrs.and 19% ears of neonates
aged 48 to 72 hrs. Balkony et al (1978) (cited in Thornton et al,
1993) observed infants 24hrs. Partial obstruction was found in
all infants 24 hrs.after birth. Eavey (1993) studied 44 infants
in NICU, reported vernix in 24 out of 88 ears. Levi et al (1997)
tested 65 full term normal neonates, and found 15.4% (20/130
ears) that failed TEAOE had completely occluded ear canals. In
the present study vernix was found present in 52.2 % of the ears,
which was comparable to those observed by Cavanaugh (1987).
Doyle et al (1997) tested 200 healthy newborns between the ages
of 5 to 120 hrs.with mean age of 24.1 hrs. They observed 13%
ear with completely occluding vernix and 32% non-occluding
vernix. In the present study 30.8% had completely occluding
12.9% had partially occluding and 8.5% non-occluding vernix.
Doyle et al reported 14.3% occluding vernix in < 24 hour old and
11.7% occluding vernix in > 24 hour old while in present study
35.4% of those 24 hours had completely occluding vernix and
22.2% of those 24 to 48 hours old had completely occluded
vernix.
Doyle, Rodger, Fujikawa & Newman (2000) tested 200,
5 to 48 hrs.old healthy newborns, and reported 28% neonates had
vernix that obscured ear canal. They reported reduced completely
occluding as well as non-occluding vernix whereas in the present
study the completely occluding vernix is found to reduce with
age while partially occluding vernix is more in 48 to 72 hours old
neonates than in neonates younger than 24 hours. This may be
explained as a process of clearance of vernix, in which the
completely occluding vernix might first reduce into partially
occluding and subsequently resulting in a clear ear canal.
The majority of sites (n = 12 sites (57.13%)) report an
average length of stay for a Vaginal delivery to be more than 24
h (between 24 and 48 h) (Kumar and Mohapatra, 2011). Thus out
of the neonates included in this study, 84.8% were younger than
or equal to 48 hours of age. In neonates younger than 24 hours,
37.2% had occluding vernix while 5.9% had non occluding
vernix. In neonates 24 to 48 hours 34.7% had occluding vernix
while 13.8% had non occluding vernix. However the occluding
vernix was completely absent after 15 days and non-occluding
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International Journal of Scientific and Research Publications, Volume 6, Issue 5, May 2016
ISSN 2250-3153
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pass rates of
TEOAE Pass
Rate
After
vernix
cleaning
91%
78.5% both
ear & 21.5%
one ear
98% at fourth
screen
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International Journal of Scientific and Research Publications, Volume 6, Issue 5, May 2016
ISSN 2250-3153
repeated
TEOAE
screening 4 times
Doyle et al (1997)
studied 200 healthy
new-borns, of 5 to 48
hrs.
Doyle et al (2000)
studied 200 newborns of age 5 to 48
hrs.
79%
84%
12.5%
(14
ears)
with
vernix passed
I.
SUMMARY & CONCLUSION
The presence of varying degrees of vernix among newborn were
studied before discharge and 15 days from the time of first
screen. It is recommended that by making guidelines for cleaning
of ear as for eyes, the effect of vernix on hearing screening by
TEOAE can be reduced. . Further studies are needed to
standardize a procedure for safe cleaning of vernix from ear
canal of neonates. Since the occurrence of vernix significantly
reduces after 15 days, hence screening can be done 15 days after
the first screen, resulting in low false positive value.
Further studies should investigate whether the high initial refer
rate is attributable to vernix or middle ear effusion. Further
research should continue studying the effects of vernix on other
physiological hearing screening test like DPOAE, Since Doyle
et al (2000) refute recommending cleaning procedure due to the
risk involved, it would be useful to device a noninvasive medical
methods (ear drops) for cleaning.. The factors for this variation in
prevalence of vernix based on birth method needs to be studied
further.
Appendix 1: Risk indicators associated with permanent
congenital, delayed-onset, or progressive hearing loss in
childhood.
Risk indicators that are marked with a are of greater concern
for delayed-onset hearing loss.
1. Caregiver concern regarding hearing, speech, language, or
developmental delay.
2. Family history of permanent childhood hearing loss.
3. Neonatal intensive care of more than 5 days or any of the
following regardless of length of stay: ECMO, assisted
ventilation, exposure to ototoxic medications (gentimycin and
tobramycin) or loop diuretics (furosemide/Lasix), and
hyperbilirubinemia that requires exchange transfusion.
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Clinician signature
Parent/guardian signature
Date -
Place-
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International Journal of Scientific and Research Publications, Volume 6, Issue 5, May 2016
ISSN 2250-3153
750
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International Journal of Scientific and Research Publications, Volume 6, Issue 5, May 2016
ISSN 2250-3153
Acknowledgement
I wish to express my sincere gratitude to Prof. R. Rangasayee for
his innovative ideas, excellent guidance, foresight and strong
support throughout my study. I wish to thank Dr. Arun Kumar,
Head of Department, Department of Neonatology, IPGM&ER,
SSKM Hospital, West Bengal, for allowing me and helping me
in all possible way to collect data from their department. My
special thanks goes to Dr. Abhinav Srivastava, Senior Resident
(Otolaryngologist), Department of ENT, Government medical
college, Hardwani, for giving his valuable time and training me
to observe vernix in the ear canals of neonates. I thank all the
nursing staff of IPGME&R for teaching me to handle neonates. I
would thank all the little ones and their parents for sparing their
time and participating in the study. My sincere thanks to Prof. J.
C, Sharma for his credible help in statistical analysis.
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AUTHORS
First Author Ankita Kumari, Subject Expert, Department of
Multiple disability and Rehabilitation, Dr. Shakuntala Misra
National Rehabilitation University, Mohaan Road, Lucknow226017, Uttar Pradesh India. Email idankitaa.kumari@gmail.com
Second Author R.Rangasayee, Director technical and
Professor, Dr S.R.Chandrasekhar Institute of Speech and
Hearing, Lingarajapuram Bangalore 560084, India. Email idrangasayee2002@yahoo.co.in
Correspondence Author Ankita Kumari, Email idankitaa.kumari@gmail.com, akumari_dsmnru@dsmnru.ac.in ,
Ph no. 9450601073, 9565696570
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