Stavros Hatzopoulos

Background: China and India represent a large proportion of the Asian birth cohort and have produced extensive but heterogeneous evidence on neonatal hearing screening. This scoping review summarizes studies published between 2005 and 2025 on otoacoustic-emission-based neonatal hearing screening programs in these countries, with emphasis on program implementation, screening coverage, the prevalence of congenital and bilateral hearing loss, follow-up, and intervention pathways. Methods: Searches were conducted in PubMed, Scopus, and Google Scholar using predefined keywords. Studies reporting screening protocols, coverage, prevalence, or follow-up outcomes were included. The standard English language filter was used. A total of 19 papers were considered for this review. Results: The data from the two assessed Asian states show two clearly different screening implementation profiles. In China, universal hearing screening has evolved into a large-scale and increasingly standardized system, supported by technical specifications and regional or municipal databases. The reported screening coverage was 85.8% in early rural programs, 93.6% in Shanghai, and 97.9% in Liuzhou. National institutional surveys indicate that UNHS has now been substantially implemented in many regions. Reported hearing loss prevalence estimates generally ranged from 1.66 to 3.43 per 1000 newborns, although follow-up and regional equity remain problematic, especially in rural settings. In India, the evidence is dominated by tertiary-hospital feasibility studies rather than a uniformly implemented national program. Reported hearing loss prevalence estimates varied more widely, from 0.29 to 5.60 per 1000 screened newborns, largely reflecting differences in study design, screening timing, referral completion, and population risk profile. Across both countries, OAE-based two-stage or sequential OAE + AABR protocols reduced referral rates and improved case identification, but loss to follow-up remained a recurrent limitation. Conclusions: China and India provide complementary models of neonatal hearing screening expansion. China demonstrates the effects of system-level scale-up, whereas India highlights the feasibility and constraints of hospital-based implementation in a highly diverse healthcare environment. Future priorities include stronger follow-up systems, harmonized reporting standards, and broader dissemination of outcome data through peer-reviewed publications.

Background: China and India represent a large proportion of the Asian birth cohort and have produced extensive but heterogeneous evidence on neonatal hearing screening. This scoping review summarizes studies published between 2005 and 2025 on otoacoustic-emission-based neonatal hearing screening programs in these countries, with emphasis on program implementation, screening coverage, prevalence of congenital and bilateral hearing loss, follow-up, and intervention pathways. Methods: Searches were conducted in PubMed, Scopus, and Google Scholar using predefined keywords. Studies reporting screening protocols, coverage, prevalence, or follow-up outcomes were included. The standard English language filter was used. A total of 19 papers were considered for this review. Results: The data from the two assessed Asian states show two clearly different screening implementation profiles. In China, Universal hearing screening has evolved into a large-scale and increasingly standardized system, supported by technical specifications and regional or municipal databases; The reported screening coverage was 85.8% in early rural programs, 93.6% in Shanghai, and 97.9% in Liuzhou, while national institutional surveys indicate that UNHS has been substantially implemented in many regions. Reported Hearing Loss prevalence estimates generally ranged from 1.66 to 3.43 per 1,000 newborns, although follow-up and regional equity remain problematic, especially in rural settings. In India, the evidence is dominated by tertiary-hospital feasibility studies rather than a uniformly implemented national program. Reported Hearing loss prevalence estimates varied more widely, from 0.29 to 5.60 per 1,000 screened newborns, largely reflecting differences in study design, screening timing, referral completion, and population risk profile. Across both countries, OAE-based two-stage or sequential OAE+AABR protocols reduced referral rates and improved case identification, but loss to follow-up remained a recurrent limitation. Conclusions: China and India provide complementary models of neonatal hearing screening expansion: China demonstrates the effects of system-level scale-up, whereas India highlights the feasibility and constraints of hospital-based implementation in a highly diverse healthcare environment. Future priorities include stronger follow-up systems, harmonized reporting standards, and broader dissemination of outcome data through peer-reviewed publications.

Background: Although significant progress has been made in Neonatal Hearing Screening (NHS) over the past two decades, the available data on Universal Neonatal Hearing Screening (UNHS) practices across Asia remain limited. The aim of this scoping review was therefore twofold: (a) to identify and synthesize the most recent literature (within the past 20 years) concerning NHS/UNHS programs in Asian states, and (b) to summarize evidence on screening procedures, the intervention strategies, and the estimated prevalence of congenital hearing loss (HL), with particular attention to cases of bilateral impairment. Methods: In line with previous reports from our group on the screening practices in Europe and in Africa, queries were conducted via the PubMed, Scopus and Google Scholar databases for the time window of 2005–2025. The Mesh terms used were “Otoacoustic Emissions (OAE)”, “Universal Neonatal Hearing Screening”, “congenital hearing loss”, “well babies” and “ASIA”, as well as all 50 Asian state names. Only research articles and review papers were considered as good candidates. The standard English language filter was used. Results: To maintain homogeneity in terms of state area and population, the studies conducted in China and India were excluded from this report and will be the focus of a dedicated paper. Data from 31 papers were considered, reflecting the neonatal hearing practices of 17 Asian states, of which in 12, UNHS programs are considered mandatory. Conclusions: The information on the Asian NHS is limited to a low percentage of Asian states. The available data strongly suggest that audiologists and other hearing professionals, involved in regional or national screening initiatives, should collect systematically and disseminate the screening information through peer-reviewed scientific publications. The latter will contribute to a broader understanding of program effectiveness and will facilitate international benchmarking.

Background: The reported data on ECG screening are focused on the last two decades. The objectives of this review were bifold: (i) to identify, within a timespan of twenty years, the most recent literature data on cardiac screening in children and adolescents and (ii) to provide data on the procedures used. Methods: Queries were conducted using PubMed, Scopus, and Google Scholar databases for the time window of 2005–2025. The mesh terms used were “ECG”, “Universal Screening”, “Cardiac Pathologies”, “Heart Rate”, and “Sports Pre-participation Evaluation”. Only research articles and review papers were included. The standard English language filter was used. Successively, only research articles were selected. Results: Data from 14 papers were considered, reflecting the lack of information about subjects <16 years of age. Conclusions: The information on objective ECG screening measures is quite scarce, and it is an urgent need to introduce a multidisciplinary approach to differentiate between ECG physiological changes due to growth and ECG pathological changes due to early pathology.

Background: The objectives of this scoping review were (a) to identify the most recent (in a 21-year span) literature information about hearing intervention programs in Africa and (b) to provide data on the intervention practices, policies and the factors prohibiting the larger diffusion of the hearing technologies in the African states. Methods: Queries were conducted via the PubMed and Scopus databases for the time window from 2005 to 2025. The mesh terms used were “hearing aids”, “cochlear implants”, and “hearing intervention Africa”. Only research articles and review papers were considered as good candidates. The standard English language filter was not used, so as to also identify information from non-English-speaking scientific communities and groups. Results: Data from eight papers were considered, reflecting the hearing intervention practices of six African states. These reports, although integral in themselves, examine different aspects of children’s hearing identification and grouping the information was not entirely feasible. It is assumed that since there are no organized or centralized NHS programs in the African states, the primary driver of hearing identification appears to be parental vigilance. The cochlear implant intervention is not very diffused mainly due to complex economic factors of the weak African economies. Anecdotal data refer to cultural bias versus hearing intervention technology, but this information needs further elucidation. Conclusions: The information on the African programs on hearing intervention policies is quite scarce, as in the case of African NHS. Within this context, it is very important to convince audiologists and ENTs from the African localized programs to publish their data in mainstream channels so that new information can be assessed.

Background: The reported data on African universal neonatal hearing screening (UNHS) practices tend to be quite scarce, despite the developments in hearing screening the last two decades. The objective of this systematic review was (a) to identify the most recent (in a 20-year span) literature information about NHS/UNHS programs in Africa and (b) to provide data on the procedures used to assess the population, the intervention policies, and on the estimated prevalence of congenital hearing loss with an emphasis on bilateral hearing loss cases. Methods: Queries were conducted via the PubMed, Scopus, and Google Scholar databases for the time window of 2004–2024. The mesh terms used were “OAE”, “universal neonatal hearing screening”, “congenital hearing loss”, “well babies”, and “Africa”. Only research articles and review papers were considered as good candidates. The standard English language filter was not used, to identify information from non-English-speaking scientific communities and groups. Results: Data from 15 papers were considered, reflecting the neonatal hearing practices of nine African states. No country-wide NHS programs were reported. The various screening realities are implemented within big urban centers, leaving the residents of rural areas unassisted. For the latter, proposals based on tele-medicine protocols have been suggested. The data on HL prevalence are also incomplete, but the available data refer to rates from 3 to 360 subjects per 1000. These data cannot be taken at face value but within the small sample size context in which they were acquired. Regarding the causes of HL, very few data have been reported; consanguinity is the most attributed factor, at least in the Sub-Saharan African states. For the majority of the programs, no data were reported on hearing loss prevalence/incidence or on any strategies to restore hearing. Conclusions: The information on the African neonatal hearing screening are quite scarce, and it is an urgent need to convince audiologists from the African localized programs to publish their hearing screening data.

Background: The reported data on European universal neonatal hearing screening (UNHS) practices tend to be scarce, despite the fact that the European Union project, EUScreen, collected unofficial data from 38 collaborating European institutions. The objectives of this systematic review were as follows: (a) to identify the most recent (in a 20-year span) literature information about UNHS programs in Europe and (b) to provide data on the procedures used to assess the population, the intervention policies, and on the estimated prevalence of congenital hearing loss with emphasis on the bilateral hearing loss cases. Methods: Queries were conducted via the Pubmed, Scopus and Google Scholar databases for the time period of 2004–2024. The Mesh terms used were “OAE”, “Universal Neonatal Hearing Screening”, “congenital hearing loss” and “well babies”. Only research articles and review papers of European origin were considered good candidates. The standard English language filter was not used, in order to identify information from non-English-speaking scientific communities and groups. Results: Very few data and reports were identified in the literature search. Eleven manuscripts were identified corresponding to eight UNHS programs. Except in Poland, most of the data refer to regional and not national programs. The screening coverage estimates of all programs exceed 90%; infants were mostly assessed by a three-stage protocol (TEOAE + TEOAE + AABR), followed by a clinical ABR test. The average prevalence (i.e., from well babies AND NICU infants) of bilateral hearing loss ranged from 0.5 to 20.94 per 1000 (Zurich sample). Infants presenting unilateral or bilateral hearing losses were first rehabilitated by hearing aids and consequently (>15 mo) by cochlear implants. Conclusions: Even though UNHS programs are well-established clinical practices in the European States, the amount of information in the literature about these programs is surprising low. The existing data in the timespan 2004–2024 corroborate the international UNHS data in terms of coverage and bilateral hearing loss prevalence, but there is a strong need to supplement the existing information with the latest developments, especially in the area of hearing loss rehabilitation.

Introduction: Newborn hearing screeners via otoacoustic emissions (OAEs) have become the standard in audiological clinical practice. Despite the application of OAE protocols for more than 3 decades, there has been no consensus on the standardization of the recorded responses. Usually, manufacturers based the scoring criteria of the OAE responses on small scale samples and in many cases on data published in the literature. Since there are no standards in the OAE probe construction, the resulted OAE responses are quite different between OAE screeners. The project evaluated the scoring criteria used in the Interacoustics Sera OAE screener. Methods: Eight hundred and eleven infants were initially screened by the Accuscreen OAE screener for a Pass or a Fail outcome. Seven hundred and ninety-two infants resulted as Pass were re-evaluated with the Sera transient-evoked OAE (TEOAE) and distortion-product OAE (DPOAE) protocols. Results: In terms of screening efficiency, the DPOAE protocol performed better, showing results very similar to the Accuscreen performance (Fail %: 2.4 vs. 2.3). The data showed that the recordings of the TEOAE responses were more prone to noise corruption. Using 10^th percentile normative distribution values, DPOAE-optimized scoring criteria were estimated as 3.1, 7.9, 9.9, and 8.9 dB for the tested frequencies of 2.0, 3.0, 4.0, and 5.0 kHz. Unfortunately, the TEOAE signal-to-noise (S/N) data resulted as too noisy (despite relatively large TEOAE responses); therefore, the TEOAE responses were considered as scoring criteria candidates. The latter were estimated as 4.61, 6.35, 7, 1 and 3, 35 dB at 1.4, 2.0, 2.8, 4.0 kHz. Conclusion: It is possible to improve the screening efficiency of the DPOAE Sera protocol using optimized scoring criteria, aiming the correct identification of at least 90% of all normal hearing subjects. The Sera TEOAE protocol needs further investigation to identify the source of the noise, which lowers significantly the reported S/N ratios. The collected OAE data confirm that there are differences among the responses obtained by various screeners; therefore, an OAE probe standardization is necessary.

Testing of ChatGPT has recently been performed over a diverse range of topics. However, most of these assessments have been based on broad domains of knowledge. Here, we test ChatGPT’s knowledge of tinnitus, an important but specialized aspect of audiology and otolaryngology. Testing involved evaluating ChatGPT’s answers to a defined set of 10 questions on tinnitus. Furthermore, given the technology is advancing quickly, we re-evaluated the responses to the same 10 questions 3 and 6 months later. The accuracy of the responses was rated by 6 experts (the authors) using a Likert scale ranging from 1 to 5. Most of ChatGPT’s responses were rated as satisfactory or better. However, we did detect a few instances where the responses were not accurate and might be considered somewhat misleading. Over the first 3 months, the ratings generally improved, but there was no more significant improvement at 6 months. In our judgment, ChatGPT provided unexpectedly good responses, given that the questions were quite specific. Although no potentially harmful errors were identified, some mistakes could be seen as somewhat misleading. ChatGPT shows great potential if further developed by experts in specific areas, but for now, it is not yet ready for serious application.