Influence of screening devices and protocol on audiological outcome of 25 years of universal neonatal hearing and vestibular screening in Flanders

Main Article Content

Christian Desloovere Bart Van Overmeire Sam Denys Nicolas Verhaert Elke Loos Maaike Deschoemaeker


Background: Congenital hearing loss has been linked with life-long deficits in speech and language abilities and children with vestibular deficits show delayed development of gross motor milestones.

Aim and scope of the research: To analyze if the universal neonatal hearing screening (UNHS) and vestibular screening program in Flanders meet the current guidelines and benchmarks of the position statements from the Joint Committee on Infant Hearing and how big the impact of screening devices and strategy is.

Methods: The UNHS is organized since 1997 by a Flemish public child care organization and performed by trained nurses. It is based on a two-step screening with Automated Auditory Brainstem Responses and in case of absent responses (named ‘refer’), audiological and medical diagnostic are done in one of 21 certified centers. Vestibular screening started in 2018 around the age of 6 months with cervical Vestibular Evoked Myogenic Potentials (cVEMP) for all children with confirmed permanent hearing loss.

Results: The coverage of the UNHS from 1998 till 2020 was 96,3 % (range 91,1 – 98%). There was a bilateral refer for 0,27 % of the infants and unilateral refer for 0,37 %. A sensorineural or mixed hearing loss > 40 dB was diagnosed in 32 % of the referred infants, a conductive hearing loss which often resolved over time in 39 %, a normal hearing in 25% and 4,7 % were lost in follow-up for the diagnostic evaluation.

There was an effect of the screening device on the detection of conductive hearing losses and false-positive cases. The incidence was higher with the MAICO MB Classic® device compared to the ALGO® devices. The incidences of sensorineural or mixed hearing loss were independent of the screening device and remained relatively stable over the years.

A vestibular deficit was found in 9,5 % of all children with sensorineural hearing loss. The incidence was significantly higher in infants with severe or profound hearing loss (p=0,003)

Conclusion: The Flemish UNHS has a high coverage, low referral rate and low loss of follow-up rate. Strict monitoring and follow-up by a central organization are essential for optimal results. Long-term follow-up remains a challenge.

Article Details

How to Cite
DESLOOVERE, Christian et al. Influence of screening devices and protocol on audiological outcome of 25 years of universal neonatal hearing and vestibular screening in Flanders. Medical Research Archives, [S.l.], v. 10, n. 7, july 2022. ISSN 2375-1924. Available at: <>. Date accessed: 08 aug. 2022. doi:
Research Articles


1. Morton CC, Nance WE. Newborn hearing screening – a silent revolution. N Engl J Med. 2006;354(20):2151-2164.
2. Willems PJ. Genetic causes of hearing loss. N Engl J Med. 2000;342:1101-1109.
3. Joint Committee on Infant Hearing. 1994 Position Statement. Int J Pediatr Otorhinolaryngol. 1995;32 :265-74. doi: 10.1016/0165-5876(95)90066-7.
4. Verhaert N, Willems M, Van Kerschaver E, Desloovere C. Impact of early hearing screening and treatment on language development and education level: evaluation of 6 years of universal newborn hearing screening (ALGO) in Flanders, Belgium. Int J Pediatr Otorhinolaryngol. 2008;72(5):599-608. doi: 10.1016/j.ijporl.2008.01.012. Mar 4, 2008.
5. Van Kerschaever E. Universal neonatal hearing screening in Flanders reveals socio-demographic risk factors for hearing impairment. B-ENT. 2013;9 Suppl.21:3-8.
6. Joint committee on infant hearing. Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. Am J Audiol. 2000;9:9-29.
7. Joint Committee on Infant Hearing. Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs. JEHDI.2019;4(2):1-44.
8. Desloovere C, Verhaert N, Van Kerschaver E, Debruyne F. Fifteen years of early hearing screening in Flanders: impact on language and education. B-ENT. 2013;Suppl 21:81-90.
9. Martens S, Dhooge I, Dhondt C et al. Vestibular Infant Screening (VIS)-Flanders: results after 1.5 years of vestibular screening in hearing-impaired children. Sci Rep. 2020;10(1):21011. doi: 10.1038/s41598-020-78049-z. Dec 3, 2020
10. Lammens F, Verhaert N, Devriendt K, Debruyne F, Desloovere C. Aetiology of congenital hearing loss: a cohort review of 569 subjects. Int J Pediatr Otorhinolaryngol. 2013;77(9):1385-91. doi: 10.1016/j.ijporl.2013.06.002. Jul 5, 2013.
11. Acke FR, De Vriese C, Van Hoecke H, De Leenheer EM. Twelve years of neonatal hearing screening: audiological and etiological results. Eur Arch Otorhinolaryngol. 2021 doi: 10.1007/s00405-021-07060-5. Aug 31, 2021.
12. Boudewyns A, van den Ende J, Declau F et al. Etiological work-up in referrals from neonatal hearing screening: 20 years of experience. Otol Neurotol. 2020;4:1240-1248. doi: 10.1097/MAO.0000000000002758
13. Joint committee in infant hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921. doi: 10.1542/peds.2007-2333.
14. Neumann K, Mathmann P, Chadha S, Euler HA, White KR. Newborn hearing screening benefits children, but global disparities persist. J Clin Med. 2022;11:271.doi: 10.3390/jcm11010271. Jan 5, 2022.
15. Bussé AM, Mackey AR, Hoeve HL et. Assessment of hearing screening programmes across 47 countries or regions I: provision of newborn hearing screening. Int J Audiol. 2021;60(11):821-830. doi: 10.1080/14992027.2021.1886350. Mar 10, 2021.
16. Mackey AR, Bussé AM, Hoeve HL et al. Assessment of hearing screening programmes across 47 countries or regions II: coverage, referral, follow-up and detection rates from newborn hearing screening. Int J Audiol. 2021;60(11):831-840. doi: 10.1080/14992027.2021.1886351. Mar 9, 2021.
17. Kanji A, Khoza-Shangase K, Moroe N. Newborn hearing screening protocols and their outcomes: a systematic review. Int J Pediatr Otorhinolaryngol. 2018;115:104-109. doi: 10.1016/j.ijporl.2018.09.026. Sep 25, 2018.
18. Korver AM, van Zanten GA, Meuwese-Jongejeugd A, van Straaten HL, Oudesluys-Murphy AM. Auditory neuropathy in a low-risk population: a review of the literature. Int J Pediatr Otorhinolaryngol. 2012;76(12):1708-11. doi: 10.1016/j.ijporl.2012.08.009. Aug 31, 20212.
19. Hofmann M, Luts H, Poelmans H, Wouters J. Investigation of a significant increase in referrals during neonatal hearing screening: a comparison of Natus ALGO Portable and ALGO 3i. Int J Audiol.2012;51(1):54-57.
20. World Health Organization. World Report on Hearing; World Health Organization: Geneva, Switzerland, 2021. Available online:
21. Butcher E, Dezateux C, Cortina-Borja M, Knowies RL. Prevalence of permanent childhood hearing loss detected at the universal newborn hearing screen: systematic review and meta-analysis. PLoS ONE. 2019;14(7):e0219600. doi: 10.1371/journal.pone.0219600. eCollection 2019 Juli 11, 2019.
22. Ravi R, Gunjawate DR, Yerraguntla K, Lewis LE, Driscoll C, Rajashekhar B. Follow-up in newborn hearing screening - A systematic review. Int J Pediatr Otorhinolaryngol. 2016;90:29-36. doi: 10.1016/j.ijporl.2016.08.016. Aug 26, 2016.
23. Fitzgibbons EJ, Driscoll C, Myers J, Nicholls K, Beswick R. Predicting hearing loss from 10 years of universal newborn hearing screening results and risk factors. Int J Audiol. 2021;60:1030-1038. doi: 10.1080/14992027.2021.1871975. Feb 16, 2021.
24. Verbecque E, Marijnissen T, De Belder N et al. Vestibular (dys)function in children with sensorineural hearing loss: a systematic review. Int J Audiol. 2017;56(6):361-381. doi: 10.1080/14992027.2017.1281444. Feb 13, 2017.