الفهرس 
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Abstract
Hearing loss is common sensory disability, National hearing screening should be done to all infants.
1- Otoscopic examination of ears is mandatory step in screening programme.
2-OAE evaluation: The first OAE evaluation is best to be done at the end of first week (with TSH screening), it better to be linked with the birth certificate to obligate parents to do the test. Retest of the OAE results in the primary health care units 2 weeks later before referral to the audio-vestibular unit to ensure Cleaning of vernix, it showed good specificity and sensitivity.
3-ENT referral for consultation Referral to ENT for consultation before to the audio-vestibular unit to treat the middle ear effusion and avoid over referral.
4-ABR examination ABR should be done to all cases so as not to miss cases of auditory neuropathy , and better to do it at the end of 6 months to avoid false positive result of delayed maturation.
Recommendations
1) ENT consultation before referral to the audio-vestibular unit to treat the middle ear effusion to avoid over referral.
2)The first OAE evaluation at the end of first week (with TSH screening).
3)OAE should be done twice , firstly at the end of first week if failed repeat it after one month , referral if failed for the second time.
4) ABR should be done to all cases so as not to miss cases of auditory neuropathy , and better to do it at the end of 6 months to avoid false positive result of delayed maturation.
Summary
Early detection of hearing loss and opportune medical intervention could result in improvement of social, communication and educational development. Universal newborn hearing screening (UNHS) program is an essential practice and the gold standard for early diagnosis of hearing impairment in newborns and children (Farhat et al 2015 and Khozashangase et al.,2015).
Hearing impairment can be prevented in half of the cases via primary interventions. Also, by using methods such as hearing aids, cochlear implants, speech-language therapy, and educational and social support, the difficulties of the disease could be diminished (Ghafoori et al.,2009).According to the Early Hearing Detection and Intervention (EHDI) program, which addresses the early intervention in addition to screening program based on the “1-3-6” plan, all neonates should be screened no later than 1 month of age. Then, any hearing loss diagnosis should be confirmed no later than 3 months of age, and finally, early intervention services should be implemented for children with an identified hearing impairment no later than 6 months of age (Ching et al.,2013).
First, all healthy newborns were screened (during taking TSH sample in the first week of life in the primary health care center) with transient evoked otoacoustic emissions (TEOAE) test. Anyone who failed to pass the examination was referred to the next stage within one month of age. In this step, the subjects were screened again by the same test, if failed to pass the examination was referred to the next stage within three months of age by auditory brainstem response (ABR) test for confirmation of hearing disorder. Cases with a hearing loss were referred to the second level of screening for diagnostic testing ( christiansen et al.,2002).