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Neurotolog
A udiology
Abstracts
Audiol Neurotol 2013;18(suppl 1):3–31
DOI: 10.1159/000355423
Polish Universal Neonatal Hearing
Screening Program – 10 Years of
Experience: Early Intervention –
The Benefits and Why ‘Early’ Is Still
Not a Standard Practice
Witold Szyfter
1
, Maciej Wróbel
1
, Michał Karlik
2
,
GrażynaGreczka
1
1
Department of Otolaryngology and Oncological
Laryngology Poznan University of Medical Sciences,
Poznan, and
2
Department of Foniatric and Audiology,
Poznan University of Medical Sciences, Poznan, Poland
Introduction: The Polish Universal Neonatal Hearing
Screening Program is one the more successful programs in
Europe with respect to structure, maintenance and number
of newborns identified with hearing loss. This has been
made possible through careful planning and successful fund
raising efforts. Preparation for the program began in 2000
after a meeting of experts confirmed its value, and in 2001
costs were calculated and financial support was gained so
that by 2002 the program was introduced in our country of
38.5 million people. The program was made possible
through citizens’ initiatives with the help of The Great
Orchestra of Christmas Charity Foundation, a well-known
and recognized charity foundation in Poland with its leader
Jurek Owsiak. Since 2003, with the additional support from
national institutions such as the Ministry of Health, the
National Health Foundation and huge efforts by representa-
tives of medical specialities (neonatology, otolaryngology
and audiology), it has been possible to implement the pro-
gram in Poland [Szyfter et al., 2008].
Methods and Subjects: The Polish Universal Neonatal
Hearing Screening Program is based on three levels that
represent principles of early detection, diagnosis and inter-
vention. Hearing screening (Level I) is performed with oto-
acoustic emissions testing (OAE) and a questionnaire aimed
at identifying the 13 risk factors defined by the Joint
Committee on Infant Hearing published in 2000. It is
administered in all neonatal and well-baby units across
Poland; currently in 422 departments. Children that do not
meet the pass criteria of the screening; i.e., who receive the
result ‘refer’ for at least one ear after OAE testing and/or are
identified as having at least one of the risk factors listed in
the questionnaire, are directed to one of 69 Level 2 laryngo-
logical and audiological centres responsible for hearing
evaluation and diagnosis and, if indicated, to appropriate
intervention at Level III centres of which there are 24. Data
collected from all levels are registered and stored in a central
database. Maintaining the program is made possible
through charity funding (Great Orchestra of Christmas
Charity Foundation), as well as by reimbursements from the
National Health Insurance System for in- and outpatient
procedures.
By May 2013, there were 3,920,743 children registered in
the Program. Comparing those numbers to the Central
Statistical Office [http://www.stat.gov.pl/gus/index_ENG_
HTML.htm], the number of children in the database repre-
sents 96% of the newborn population. On average, 8.8%
(326,515) of the screened children who did not meet the
pass criteria were referred for further hearing evaluations
(see table. 1). A subsequent 47% (152,927 children) were
diagnosed and registered within the Program’s consultation
centres. Results in the year 2012 increased, reaching 51%.
The median age of diagnosis during the analyzed period
was 83 days (interquartile range, IQR = 68 days; quartile
deviation, Q.D= 34 days). Confirmation of the diagnosis
was usually obtained by the first or second follow-up visit.
Results: A hearing problem was defined as any hearing
impairment greater than 20 dBHL. It was diagnosed in
9,872 children, which represents 29% of the entire popula-
tion during the studied period. Thorough evaluation was
obtained in the group of 6,293 children diagnosed with
hearing impairment in the consultation centres of the
Program. The study group was limited only to those with
full audiological data. Within this group, any permanent
hearing impairment defined as 20 dB or worse for the better
ear was observed in 1.57% of the cases. Out of that group,
2,924 (46.5%) of the children suffered from bilateral hearing
impairment and further analysis revealed that severe to pro-
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