PubMed Health⌕ Search

Biomedical subjects

Joseph E Kerschner

Publications and source records attributed to Joseph E Kerschner.

At least 19 recordsLinked to original sources
PubMed2006

Direct detection of bacterial biofilms on the middle-ear mucosa of children with chronic otitis media.

CONTEXT: Chronic otitis media (OM) is a common pediatric infectious disease. Previous studies demonstrating that metabolically active bacteria exist in culture-negative pediatric middle-ear effusions and that experimental infection with Haemophilus influenzae in the chinchilla model of otitis media results in the formation of adherent mucosal biofilms suggest that chronic OM may result from a mucosal biofilm infection. OBJECTIVE: To test the hypothesis that chronic OM in humans is biofilm-related. DESIGN, SETTING, AND PATIENTS: Middle-ear mucosa (MEM) biopsy specimens were obtained from 26 children (mean age, 2.5 [range, 0.5-14] years) undergoing tympanostomy tube placement for treatment of otitis media with effusion (OME) and recurrent OM and were analyzed using microbiological culture, polymerase chain reaction (PCR)-based diagnostics, direct microscopic examination, fluorescence in situ hybridization, and immunostaining. Uninfected (control) MEM specimens were obtained from 3 children and 5 adults undergoing cochlear implantation. Patients were enrolled between February 2004 and April 2005 from a single US tertiary referral otolaryngology practice. MAIN OUTCOME MEASURES: Confocal laser scanning microscopic (CLSM) images were obtained from MEM biopsy specimens and were evaluated for biofilm morphology using generic stains and species-specific probes for H influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Effusions, when present, were evaluated by PCR and culture for evidence of pathogen-specific nucleic acid sequences and bacterial growth, respectively. RESULTS: Of the 26 children undergoing tympanostomy tube placement, 13 (50%) had OME, 20 (77%) had recurrent OM, and 7 (27%) had both diagnoses; 27 of 52 (52%) of the ears had effusions, 24 of 24 effusions were PCR-positive for at least 1 OM pathogen, and 6 (22%) of 27 effusions were culture-positive for any pathogen. Mucosal biofilms were visualized by CLSM on 46 (92%) of 50 MEM specimens from children with OME and recurrent OM using generic and pathogen-specific probes. Biofilms were not observed on 8 control MEM specimens obtained from the patients undergoing cochlear implantation. CONCLUSION: Direct detection of biofilms on MEM biopsy specimens from children with OME and recurrent OM supports the hypothesis that these chronic middle-ear disorders are biofilm-related.

Adolescent↗
PubMed2006

Mucin gene cDNA sequence characterization in chinchilla middle ear epithelium.

OBJECTIVES: To identify mucin genes in chinchilla middle ear epithelium and characterize complimentary deoxyribonucleic acid (cDNA) sequences to facilitate further investigations into mucin physiology and pathophysiology on a molecular level using the chinchilla model. METHODS: Chinchilla mucin gene exploration and cDNA characterization was accomplished using reverse transcriptase-polymerase chain reactions (RT-PCR). Forward and reverse primer pairs were designed using consensus sequences available for human and rodent species. Chinchilla middle ear epithelium was harvested and primary cell cultures (CMEEC) were established. The CMEEC were explored for the expression of chinchilla mucin genes 1, 2, 4 and 5AC (cMuc1, cMuc2, cMuc4 and cMuc5AC). Identified cDNA amplicons for each of these genes was sequenced and homology compared to previously published human and rodent sequences. RESULTS: CMEEC express all four of the mucin genes cMuc1, cMuc2, cMuc4 and cMuc5AC. cDNA amplicons for each of the genes were able to be sequenced with lengths ranging from 66 to 362 base pairs. Each of the chinchilla cDNA sequences expressed significant homology with published human and rodent cDNA for these mucin genes. A cDNA sequence for the housekeeping gene, beta-actin, was also identified. CONCLUSIONS: Chinchilla middle ear epithelium grown in culture expresses the mucin genes 1, 2, 4 and 5AC, which have been identified as important in mucin regulation in the middle ear. cDNA sequences corresponding to these mucin genes were identified and may serve as important molecular tools in future studies of otitis media using the chinchilla model.

Actins↗
PubMed2006

Bilateral epistaxis in children: efficacy of bilateral septal cauterization with silver nitrate.

OBJECTIVE: To evaluate the rate of control of epistaxis in patients with bilateral complaints using silver nitrate and to assess short-term complications from this therapy. STUDY DESIGN AND SETTING: Retrospective chart review with prospective incident case identification in a tertiary referral pediatric otolaryngology practice. SUBJECTS AND INTERVENTIONS: Forty-six consecutive patients presenting to a single pediatric otolaryngologist with complaints of bilateral epistaxis received bilateral silver nitrate cauterization to the anterior septum and were seen in follow-up 2 months later to assess for control of epistaxis and complications from this therapy. RESULTS: Ninety-three percent (43/46) of patients followed-up at 2 months after therapy. About 93% (40/43) had total or near-total resolution of their epistaxis. Five percent (2/43) of patients returned to the clinic after initial successful control for a second cauterization during the period of study. No significant complications of infection, perforation, long-term crusting, tattooing or mucocutaneous or allergic reactions were identified. CONCLUSIONS: Bilateral epistaxis can be treated at a single visit with bilateral silver nitrate therapy in children. This treatment is highly effective, well-tolerated, and appears to have a low rate of complications.

Adolescent↗
PubMed2006

Ofloxacin otic drops vs neomycin-polymyxin B otic drops as prophylaxis against early postoperative tympanostomy tube otorrhea.

OBJECTIVES: To evaluate the incidence of tympanostomy tube (TT) sequelae, tube otorrhea, and tube obstruction immediately postoperatively in patients receiving TT for otitis media and to compare patients receiving postoperative otic drops with controls. DESIGN: Blinded randomized control trial. SETTING: A tertiary pediatric otolaryngology practice. SUBJECTS: The study population comprised 306 patients undergoing TT placement. INTERVENTIONS: The 306 patients were enrolled into the following 3 groups: (1) those receiving no postoperative otic drop prophylaxis (control group), (2) those receiving ofloxacin otic drops (FLOX group), and (3) those receiving neomycin sulfate-polymyxin B sulfate-hydrocortisone otic drops (COS group). RESULTS: Overall otorrhea rates postoperatively were 14.9% for the control group, 8.1% for the FLOX group, and 5.5% for the COS group. When controlling for disease severity, the rate of otorrhea was significantly higher for the control group than for both the FLOX (P = .04) and COS (P = .01) groups. Nonpatent, plugged, tube rates were added to otorrhea rates for a TT failure analysis postoperatively. The control group demonstrated a significantly greater failure rate (29.9%) than both the FLOX (12.1%) and COS (7.7%) groups. The only differences between the patients in the 2 groups receiving drops were that ofloxacin was more well liked by patients (P = .04) and caused less pain (P = .004). CONCLUSIONS: Nonpatency and otorrhea are the most frequent sequelae immediately following TT placement. Few studies have compared different treatment regimens in a randomized controlled trial. These results demonstrate that otic drops clearly provide benefit postoperatively in preventing TT plugging and otorrhea but primarily in patients who have middle ear fluid at the time of TT placement. In addition, consideration of drop choice should be based on patient tolerance and medication safety profiles.

Administration, Topical↗
PubMed2006

Management of vocal paralysis: a comparison of adult and pediatric practices.

OBJECTIVE: To compare practices of the American Broncho-Esophagological Association (ABEA) membership regarding the evaluation and management of unilateral vocal fold motion impairment (UVFMI) in adult versus pediatric populations. STUDY DESIGN AND SETTING: An 18-item adult survey and 16-item pediatric survey were administered to ABEA members. RESULTS: Seventy-six adult (31%) and 35 pediatric surveys (43%) were completed. Key differences are highlighted. With respect to etiology, the most common reported childhood cause is idiopathic; adults more often suffer iatrogenic paralysis. Children more commonly experience reflux disease, feeding difficulties, and choking. Preferred testing involves flexible laryngoscopy and chest x-ray; however, laboratory tests are carried out less often in children (51% vs 71%) and medical intervention is advocated by fewer pediatric practitioners (39% vs 57%). CONCLUSION: Significant disparities exist in the etiology, presenting symptoms, diagnostic testing, and medical treatment between children and adults with UVFMI. SIGNIFICANCE: Clinicians' perceptions regarding UVFMI may reflect the differing impact of vocal paralysis in the pediatric versus adult populations.

Adult↗
PubMed2006

Signaling pathways in interleukin-1beta-mediated middle ear mucin secretion.

OBJECTIVES: The objectives of this study were to investigate the role of the phosphatidylcholine-specific phospholipase C (PC-PLC), protein kinase C (PKC), and nitric oxide synthase (NOS) pathways during upregulation of mucin secretion by middle ear epithelium after exposure to interleukin-1beta and to examine the ability of a specific interleukin-1 receptor antagonist (IL-1betara) to block this increased secretion. MATERIALS AND METHODS: Primary chinchilla middle ear epithelial cultures were established and exposed to IL-1beta. Specific inhibitors of calmodulin, PC-PLC, PKC, and NOS pathways were used to investigate the potential role of these pathways leading to increased epithelial mucin secretion after exposure to IL-1beta. Mucin secretion was characterized by exclusion chromatography and liquid scintillation. RESULTS: Epithelial cultures exposed to IL-1beta demonstrate an increase in mucin secretion that is blocked by specific inhibitors of PC-PLC, PKC, and NOS, but not by inhibitors of calmodulin. In addition, mucin secretion stimulated by IL-1beta was reversible with use of a specific IL-1betara. CONCLUSIONS: IL-1beta stimulates mucin secretion from middle ear epithelium and its effects can be reversed by IL-1betara. PC-PLC, PKC, and NOS pathways play a role in the increased secretion of mucin in middle ear epithelial cells after exposure to IL-1beta.

Animals↗
PubMed2005

The KTP laser: an emerging tool in pediatric otolaryngology.

PURPOSE: To report the frequency and spectrum of use of the potassium titanyl phosphate (KTP) laser in a tertiary referral pediatric otolaryngology practice and to focus on a novel use for the KTP laser which has not previously been described in the literature. DESIGN: A retrospective chart review of the operative log database of a pediatric otolaryngologist in a tertiary referral setting over a seven year period. RESULTS: Out of 2886 cases, a total of 49 (1.7%) involved the use of the KTP laser. These included 7 otologic cases, 3 laryngeal cases, 31 subglottic/tracheal cases, 1 esophageal case and 7 nasal cases. One of these cases involved a previously unreported use of the KTP laser, closure of a tracheo-esophageal fistula (TEF). CONCLUSION: The KTP laser is an important operative tool in pediatric otolaryngology and new uses for this laser continue to emerge. One of these, KTP closure of a TEF offers pediatric otolaryngologists the potential for significant changes in management of this congenital problem with reduced surgical morbidity. Familiarity with the KTP laser and expertise in its use and applications is essential in providing state-of-the-art care to pediatric otolaryngology patients in a tertiary referral center.

Child, Preschool↗
PubMed2005

Maxillary osteoplastic flap technique for the treatment of pediatric pterygopalatine fossa neoplasms.

Pterygoid fossa neoplasms in children are rare. Management of these neoplasms has been challenging because of tumor vascularity, difficult surgical access and complex anatomy from which these tumors arise. Surgical approach depends upon tumor extension and ability to obtain adequate exposure for successful tumor excision. We present three cases of an approach to the pterygopalatine fossa not previously described. The technique is cosmetically superior to the lateral rhinotomy approach and it preserves blood supply by leaving a portion of the periosteum attached to the maxilla. Furthermore, it avoids permanent hypesthesia/anesthesia of the midface with mobilization of the infraorbital nerve.

Adolescent↗
PubMed2005

Disease severity in patients referred to pediatric otolaryngologists with a diagnosis of otitis media.

OBJECTIVE: This study evaluated disease severity of children referred to a pediatric otolaryngology practice with a diagnosis of otitis media (OM) before and after tympanostomy tube (TT) placement. METHODS: A retrospective review was conducted of patients referred to a pediatric otolaryngology practice from January 2000 to April 2004, with the chief complaint of middle ear effusion (MEE) and/or OM. Patients who underwent TT placement had pre- and post-operative hearing levels (HL) and bilaterality of disease analyzed. RESULTS: A total of 286 patients who underwent TT placement were included. Recurrent OM (ROM) was the most common diagnosis (42.6%), followed by OM with effusion (OME) plus ROM (ROM + OME) (31.7%) and then OME (25.7%) alone. The mean improvement in the pure tone average (PTA) hearing level was 14.8 dB in patients with OME, 9.5 dB in patients with ROM + OME and 6.3 dB in patients with ROM alone. The hearing improvements in OME and ROM + OME were statistically larger than the ROM group (P < or =0.0004). Hearing levels at 500, 1000, 2000 Hz and PTA showed statistically significant improvements in HL after tube placement in each group (P < 0.0001). Of the patients presenting with OME or ROM + OME, 70% had pre-operative findings demonstrating bilateral MEE. CONCLUSION: Most children referred for consideration of surgical management of OM have a diagnosis of ROM, or ROM in conjunction with OME, with only a small percentage having the diagnosis of OME alone. In addition, the majority of children have bilateral disease, suggesting a more severely affected patient population treated by the pediatric otolaryngologist. The results also demonstrate a significant improvement in hearing after the placement of TT. However, the long-term impact of this hearing improvement on a child's development is not known and an additional prospective study of children in this population group is warranted.

Acoustic Impedance Tests↗
PubMed2005

Fungal causes of otitis externa and tympanostomy tube otorrhea.

OBJECTIVE: To describe the occurrence of fungal organisms in the setting of otitis externa and tympanostomy tube otorrhea, review the treatment course, timing of diagnosis, organism identified and time to resolution with fungal infections. DESIGN: Retrospective review. SETTING: Pediatric otolaryngology clinic within a tertiary care hospital. PATIENTS: One hundred and sixty-six patients (ages 16 days to 18 years) with fungal organisms on ear culture. OUTCOME MEASURES: Number of prior therapies, number of office visits, time to resolution and anti-fungal therapy. RESULTS: Ear cultures positive for fungal organisms were found in 166 patients seen between 1 January 1996 and 30 September 2003 from a total of 1242 patients undergoing ear culture. Comparing the 3-year period (1996-1998) prior to the availability of fluoroquinolone ototopical drops to the 3-year period after (1999-2001), there is a statistically significant increase in the incidence of positive fungal culture (p<0.001). Otitis media was diagnosed in 72% of these children, with otitis externa comprising 25%. Approximately 3% carried a diagnosis of both otitis externa and otitis media. Candida albicans was identified in 43% of fungal organism-positive cultures. Candida parapsilosis was found in 24% of and Aspergillus fumigatus in 13%. The remainder of the cultures yielded three other Candida and three other Aspergillus species, each at less than 5%. Time to resolution ranged from 1 week to 9 months, with a median of 3.8 weeks for symptom resolution. Patients were treated with an average of 1.7 oral antibiotics and 1.1 ototopical agent before a culture was taken. CONCLUSIONS: Otorrhea due to fungal organisms occurs in the setting of refractory infection and is often discovered after multiple oral and ototopical antibacterial medications. Due to the extended treatment period required to clear fungal organism, timely diagnosis with culture for bacteria and fungus is required in patients with persistent otorrhea. An increase in incidence of fungal infections of the ear was found in the period after widespread use of ofloxacin began.

Adolescent↗
PubMed2005

Microbiology of middle ear effusions from 292 patients undergoing tympanostomy tube placement for middle ear disease.

OBJECTIVE: Otitis media is one of the most commonly diagnosed childhood illnesses. Ideally, culture directed therapy for otitis media would be available, however, the common approach is to treat infections with antibiotics that cover the most common pathogens. The objective of this study is to describe the pathogens cultured from the middle ear effusions (MEE) of patients that underwent tympanostomy tube placement for middle ear disease, compare these results with previous studies, and assess for trends suggestive of changes in the microbiology of these patients. METHODS: Patients were invited to participate after the decision to place ventilation tubes had been made. A standard anterior-inferior myringotomy was made for placement of the ventilation tube. After myringotomy, patients had their ears suctioned and all effusions were collected for microbiologic analysis. RESULTS: A total of 292 patients were enrolled in the study, a total of 270 MEE samples were taken. Haemophilus influenzae and Moraxella catarrhalis were seen in 24 of 148 (16.2%) and 15 of 148 (10.1%), respectively. Neisseria meningitidis, Staphylococcus aureus and Corynebacterium species were each identified in 11 of the 148 pathogens isolated (7.4%). Streptococcus pneumoniae was identified in 6 of the 148 isolated pathogens (4.1%). CONCLUSION: Despite a high number of non-pathogenic bacteria, and a high number of culture negative effusions, we demonstrated pathogen rates consistent with other reports in the literature. Future directions include using more specific techniques such as PCR to better understand the microbiology of middle ear effusions.

Candida↗
PubMed2005

Comparison of caregiver otitis media risk factor knowledge in suburban and urban primary care environments.

OBJECTIVE: There are many risk factors for otitis media. Some of these, such as passive tobacco smoke exposure and childcare arrangements; have the potential to be modified. The purpose of this study is to assess caregiver knowledge deficits about risk factors associated with otitis media and their willingness to modify behaviors associated with those risks. RESEARCH DESIGN AND METHODS: This study is a prospective survey study investigating knowledge deficits of parents or guardians of children ages 6-36 months about the risk factors of otitis media. The patients were consecutively drawn from a suburban and an urban pediatric practice. Any difference in survey results between these two groups was also assessed. Participants completed a survey of 21 questions with content including demographic and OM risk factor data. RESULTS: A total of 401 caregivers completed surveys, with 213 from an urban pediatric practice and 188 from a suburban practice. There was a significant difference in the ethnic distributions of the two populations. The suburban population had a significantly greater family history of ear infections, number of ear infections in the past 12 months, and number of previous ventilation tubes placed. The urban population had a significantly greater number of smokers in the household and decreased knowledge about day care as a risk for OM. The urban population's question responses suggested a greater willingness to change day care arrangements to reduce the risk of otitis media. CONCLUSIONS: Both populations demonstrated knowledge deficits regarding risk factors associated with OM and both populations exhibited willingness to modify behaviors to reduce risk. These findings demonstrate that there are opportunities for improving education regarding OM risk factors and that this education could potentially reduce risk for OM and in turn reduce the incidence of OM in children.

Adult↗
PubMed2005

Immune stimulation for the treatment of papilloma.

OBJECTIVES: There is no curative therapy for recurrent respiratory papillomatosis. Unmethylated dinucleotides of cytosine and guanine (CpG) are potent immune stimulants that have shown efficacy against tumors as monotherapy, as vaccine adjuvants, and in combination with chemotherapies. We examined the therapeutic effect of CpG oligodeoxynucleotides in the treatment of papillomavirus in a cottontail rabbit model (CRPV). METHODS: Twenty rabbits were infected with CRPV; 10 were treated with 11 weekly CpG inoculations while treatment control rabbits received intralesional saline solution. Eight rabbits (4 treatment, 4 control) were rechallenged with CRPV 17 weeks after the initial viral challenge and monitored for new papilloma development. RESULTS: Papillomas developed in all 20 rabbits (100%) within 4 weeks of infection. The diagnosis was confirmed histologically. There was no difference in the average tumor burden between the treatment and control groups after 11 weeks of CpG treatments or after 9 additional weeks of observation. There was no difference between the groups in papilloma size at the site of the injections, nor was there eradication of papillomas at remote sites in either group. No new papillomas developed in any of the 8 animals that were rechallenged. CONCLUSIONS: We have reproduced an effective mammalian papilloma model for preclinical immunotherapeutic testing. Despite the potency of CpG in triggering host immunity, CpG oligodeoxynucleotide did not show a therapeutic effect against the large papilloma burdens tested in this study. The lack of effect suggests that either enhanced papilloma antigen presentation or targeting of immune-evasive mechanisms used by the papillomas is needed to treat bulky disease with an immunotherapeutic strategy.

Adjuvants, Immunologic↗
PubMed2004

Middle ear epithelial mucin production in response to interleukin-6 exposure in vitro.

OBJECTIVES: To investigate the role of the inflammatory cytokine interleukin-6 (IL-6) in the regulation of mucin secretion by middle ear epithelia. MATERIALS AND METHODS: Primary chinchilla middle ear epithelial cultures were established and exposed to IL-6 in a dose- and time-dependent manner. Mucin secretion was characterized by exclusion chromatography and liquid scintillation. RESULTS: Epithelial cultures exposed to increasing doses of IL-6 demonstrated greater amounts of mucin secretion (p=0.018). Additionally, cultures exposed to IL-6 at 50 ng/ml showed significant increased secretion of mucin over control in time-dependent experiments at 6-, 15- and 24-h time points (p=0.003). CONCLUSIONS: IL-6 upregulates mucin secretion from cultured middle ear epithelial cells in a dose- and time-dependent manner. Elucidating the effect of specific cytokines on the regulation of mucin secretion is vital to understanding the pathophysiology of otitis media and the development of novel therapeutic strategies.

Animals↗
PubMed2004

Chinchilla middle ear epithelial mucin gene expression in response to inflammatory cytokines.

OBJECTIVES: To review the importance of mucin on a molecular level in the understanding of the pathophysiology of otitis media and to present new data demonstrating differential up-regulation of specific mucin genes during inflammation of middle ear epithelium. DESIGN: Primary chinchilla middle ear epithelial cultures (CMEECs) were established and exposed to tumor necrosis factor alpha and interleukin 1beta. Expression of chinchilla mucin genes 1, 2, 4, and 5AC was analyzed by means of reverse transcriptase-polymerase chain reaction after this exposure and compared with that of controls. Mucin secretion was also characterized by means of exclusion chromatography and liquid scintillation. RESULTS: The CMEECs exposed to interleukin 1beta and tumor necrosis factor alpha demonstrated significant up-regulation of mucin gene 2 (P = .005 and P = .007, respectively) and trends suggestive of up-regulation of mucin gene 5AC compared with the controls. These CMEECs also demonstrated significant increases in secretion of mucin compared with controls. Mucin genes 1 and 4 did not demonstrate up-regulation. CONCLUSIONS: In CMEECs, the inflammatory mediators tumor necrosis factor alpha and interleukin 1beta cause a differential up-regulation and expression of mucin genes. Elucidating the effect of specific cytokines on the regulation of mucin secretion in the middle ear is vital to understanding the pathophysiology of otitis media. A greater understanding of these mechanisms and variations between individuals and pathogens has the potential to significantly alter the approach and management of otitis media in children and lead to novel therapeutic interventions.

Animals↗
PubMed2004

STAT3 activation in recurrent respiratory papillomatosis.

BACKGROUND: The activation of signal transducer and activator of transduction (STAT) protein is thought to lead to the genesis of neoplasia by promoting cellular growth and preventing apoptosis, and by immune system modulation; STAT3 protein has also been implicated in tumor survival and propagation in recurrent respiratory papillomatosis (RRP). OBJECTIVES: To investigate the presence and activation of STAT3 protein in papilloma specimens from subjects with RRP and compare findings with those obtained from control subjects' tissue. DESIGN: Laryngeal papilloma samples were collected from 8 nonselected consecutive patients undergoing surgery for RRP, and control samples of anterior tonsillar pillar mucosa were collected from 8 patients undergoing adenotonsillectomy. After extraction, we applied gel shifting to the nuclear protein using an electromotility shifting assay kit. Quantitative analysis of the gel shifts was performed, and levels of activated STAT3 protein in RRP specimens and tissue from controls were compared. RESULTS: There was STAT3 protein activation in the nuclear extracts of all (100%) RRP specimens, which was significantly more frequent than in normal epithelial tissue from controls (P<.03). CONCLUSIONS: We conclude that STAT3 protein activation is present in RRP. However, further study is needed to determine if STAT3 protein activation is an important pathway through which human papillomavirus results in the propagation and persistence of RRP.

Blotting, Western↗
PubMed2004

Voluntary progress toward universal newborn hearing screening.

OBJECTIVES: This study assessed the prevalence of newborn hearing screening in Wisconsin between 1997 and 2001, and examined factors leading to establishment of programs and influencing the outcomes of universal newborn hearing screening (UNHS). The primary goal was to identify characteristics that might be important for states, provinces or countries that have not yet implemented UNHS programs and to examine some unique components of the Wisconsin UNHS program, that may provide direction to areas both with and without programs. METHODS: The study consisted of two cross-sectional surveys administered at two separate time points (2000 and 2001). Additional data was provided by the Wisconsin Sound Beginnings Early Detection and Hearing Intervention database. RESULTS: Between 1997 and 2001, the number of Wisconsin birthing hospitals with UNHS programs increased from two to 92 of a total of 103 and the percent of all Wisconsin newborns screened for hearing loss before 1-month of age increased from 10 to 90%. In 2001, 2.6% of screened newborns had an abnormal test requiring further audiologic evaluation, with a higher rate of referral in programs relying only on otoacoustic emission testing versus automatic auditory brainstem testing. As programs were being established, hospitals with greater number of deliveries more readily developed UNHS programs and hospitals with more deliveries were also significantly more likely to screen a greater percentage of delivered children once their programs were established. The Wisconsin Sound Beginnings program established a screening program for home birth infants in 2002 with a current screen rate of 79% for those midwives participating in this program. CONCLUSIONS: A vast majority of Wisconsin hospitals have voluntarily implemented UNHS programs. By 2001, greater than 90% of all Wisconsin newborns were screened through a UNHS program. With education, financial support and a statewide network dedicated to UNHS it is possible to establish programs even for infants born in a setting that should be considered high-risk to miss hearing screening, such as home births and hospitals that perform relatively few numbers of deliveries per year. UNHS programs need to develop coordinated systems for linking these programs to audiologic diagnostic services and early intervention programs.

Cross-Sectional Studies↗