Clinical Experience on Hearing Screening in Twins and Triplets: A Retrospective Study

  • B. I. Sasireka
  • V. Jaya
  • S. S. VigneshEmail author
  • R. Muthukumar
Opinion Article


Twin or multiple pregnancies often have neonatal complications. Common complications include low birth weight, respiratory distress, neonatal intensive care unit (NICU) admission (>5 days) and low APGAR score especially on second twin. (1) To compare referral rates of newborn hearing screening in twins and triplets between risk and non-risk babies for hearing loss, (2) to determine the effects of birth order on referral rates in twins and triplets. A retrospective study was carried out from the case records of the neonates enrolled in the referral based NICU hearing screening program during April 2013 to December 2014 at Institute of Obstetrics and Gynecology, Chennai. 1405 neonates (723 males and 682 females) in the age range of 3–28 days were screened during this period among which 76 were twins (38 pairs) and 9 were triplets (3 sets). We classified them further into non risk and risk babies among twins according to the Joint Committee for Infant Hearing (JCIH) recommendations. A dual step hearing screening protocol was used to screen the neonates. They were initially tested with distortion product otoacoustic emission (DPOAE) then with automated auditory brainstem response (AABR) before discharged from the hospital. Out of 76 (100%) twin babies 43 (56.58%) babies had one or more risk factors for hearing loss. Most common risk factors were low birth weight, premature birth, mechanical ventilation >5 days, hyperbilirubinemia, infections, ototoxic medications and family history of hearing loss. Each risk factor was observed in equal proportion in 1st born and 2nd born twins. 12 (15.76%) risk babies and 11 (14.47%) non risk babies failed in DPOAE testing. Out of 9 triplets babies (3 set) 3 babies had risk factors for hearing loss. One baby in 2nd born babies group failed AABR screening. Referral rates were slightly higher in 2nd born twins when compared to 1st born twins in DPOAE testing. Chi square test did not reveal any significant association between referral rates with risk factors and birth order (p > 0.05). The referral rates in twins are higher than the total population screened. There is some influence of birth order on the referral rates in twins. It needs to be further investigated on larger population.


Twins Dual step hearing screening Risk babies Triplets Birth order Hearing loss 



The present study is carried out in a state Government organization (Madras Medical College, Tamil Nadu) as a part of routine Hearing Screening Program.

Compliance with Ethical Standards

Conflict of interest

All authors of the present study declare that we have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all mothers/care givers of the participants included in the study.


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Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  • B. I. Sasireka
    • 1
  • V. Jaya
    • 2
  • S. S. Vignesh
    • 2
    Email author
  • R. Muthukumar
    • 2
  1. 1.Institute of Obstetrics and Gynecology, Government Hospital for Women and ChildrenMadras Medical CollegeChennaiIndia
  2. 2.Institute of Speech and Hearing – Upgraded Institute of OtorhinolaryngologyMadras Medical College and Rajiv Gandhi Government General HospitalChennaiIndia

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