Hearing tests are just child’s play: the sound scouts game for children entering school

Objective: To create a hearing test useable without the involvement of a clinician or calibrated equipment, suitable for children aged 5 or older. Design: The tablet-based app (Sound Scouts) includes tests of speech in quiet, speech in noise and tones in noise, all embedded in game designed to maintain attention. Data were collected to intelligibility-equalize the stimuli, establish normative performance, and evaluate the sensitivity with which Sound Scouts detected known hearing problems and identified their type. Study sample: Participants were children from age 5 to 14 (394 with normal hearing, 97 with previously identified hearing loss) and 50 adults with normal hearing. Results: With pass-fail criteria set such that 98% of children with normal hearing passed Sound Scouts, 85% of children with hearing loss failed Sound Scouts (after exclusion of children in either group who received an inconclusive result or had incomplete results). No child with four-frequency average hearing thresholds of 30?dB HL or greater in their poorer ear passed Sound Scouts. Hearing loss type was correctly identified in only two-thirds of those cases where the algorithm attempted to identify a single type of loss. Conclusions: Sound Scouts has specificity and sensitivity sufficiently high to provide hearing screening around the time children typically enter school.     

Hearing loss in urban South African school children (grade 1 to 3)

ObjectiveThis study aimed to describe the prevalence and characteristics of hearing loss in school-aged children in an urban South African population.MethodChildren from grade one to three from five schools in the Gauteng Province of South Africa formed a representative sample for this study. All children underwent otoscopic examinations, tympanometry and pure tone screening (25 dB HL at 1, 2 and 4 kHz). Children who failed the screening test and 5% of those who passed the screening test underwent diagnostic audiometry.ResultsA total of 1070 children were screened. Otoscopic examinations revealed that a total of 6.6% ears had cerumen and 7.5% of ears presented with a type-B tympanogram. 24 children (12 male, 12 female) were diagnosed with hearing loss. The overall prevalence of hearing loss was 2.2% with Caucasian children being 2.9 times more (95% confidence interval, 1.2–6.9) likely to have a hearing loss than African children.ConclusionHearing loss prevalence in urban South African school-aged children suggest that many children (2.2%) are in need of some form of follow-up services, most for medical intervention (1.2%) with a smaller population requiring audiological intervention (0.4%).     

Acceptance of internet-based hearing healthcare among adults who fail a hearing screening

Objective: This study measured help-seeking readiness and acceptance of existing internet-based hearing healthcare (IHHC) websites among a group of older adults who failed a hearing screening (Phase 1). It also explored the effects of brief training on participants’ acceptance of IHHC (Phase 2). Study sample: Twenty-seven adults (age 55+) who failed a hearing screening participated. Design: During Phase 1 participants were administered the University of Rhode Island Change Assessment (URICA) and patient technology acceptance model (PTAM) Questionnaire. During Phase 2 participants were randomly assigned to a training or control group. Training group participants attended an instructional class on existing IHHC websites. The control group received no training. The PTAM questionnaire was re-administered to both groups 4–6 weeks following the initial assessment. Results: The majority of participants were either considering or preparing to do something about their hearing loss, and were generally accepting of IHHC websites (Phase 1). The participants who underwent brief IHHC training reported increases in hearing healthcare knowledge and slight improvements in computer self-efficacy (Phase 2). Conclusions: Older adults who fail hearing screenings may be good candidates for IHHC. The incorporation of a simple user-interface and short-term training may optimize the usability of future IHHC programs for this population.     

An abbreviated impedance bridge technique for school screening.

The hearing of 539 children were screened by conventional audiometric techniques and an abbreviated form of impedance audiometry. Otoscopic examination and estimates of the cost to accurately detect hearing loss were used as critieria for comparing the two methods. The impedance technique detected 94% of hearing disorders, the audiometric, 24%. Projections of cost included a factor for number screened. These demonstrated that the impedance technique was less expensive and approached one-sixth the cost of the audiometric technique at a rate of 10,000 children per year. A routine application of the impedance technique in an ongoing hearing conservation program (N = 2712) supported the initial conclusion that it was more effective and more easily employable than audiometric screening. One child who passed impedance screening was shown to have a 50-dB sensorineural loss. It was concluded that an abbreviated form of impedance audiometry that includes a single high-frequency screening tone is the technique of choice for school screening.     

Identifying a context-effective school hearing screening test: An emic/etic framework

Objective: To identify a context-effective hearing screening test for primary schools in the Western Cape, South Africa using an emic-etic framework for test selection. Design: A sequential mixed methods design was used to: (1) Identify test properties needed to successfully screen hearing in primary school children in the Western Cape, (2) select the hearing screening test most likely to succeed in this context, and (3) assess the use of the test in context. Study sample: Three nurses, two nursing assistants, two paediatric audiologists, and 100 grade-one children participated. Results: Distortion product otoacoustic emissions (DPOAEs) were identified as the test most likely to succeed as a hearing screening test in primary school children in the Western Cape. While school nurses were able to successfully apply OAE testing in this context, its sensitivity to hearing loss in these children was 57.14%. Conclusions: The sensitivity would need to be improved before OAE testing could be used as a context-effective screening test for primary school children in the Western Cape. The study demonstrated the value of collaborative program planning using an emic-etic framework to ensure that screening tests are contextually appropriate.     

黄石市2025例学龄前儿童听力筛查结果分析

目的 探讨学龄前儿童的听力筛查方式及其可行性.方法 采用随机抽样法抽取黄石地区30所幼儿园共2 025例2~6岁儿童,以声导抗、瞬态诱发耳声发射和畸变产物耳声发射检测进行听力初筛,未通过者一个月后同法进行复筛,复筛未通过者行纯音听阈测试或行为测听、听性脑干反应(auditory brain-stem response,ABR)、听性稳态反应(auditory steady-state response,ASSR)及影像学等检查.结果 本组对象听力初、复筛总通过率为94.02%(1 904/2 025),其中初筛通过者1 842例(90.96%,1 842/2 025);183例初筛未通过者进入复筛,其中62例通过复筛(33.88%,62/183),121例未通过2次筛查(5.98%,121/2 025);最终有72例(3.56%,72/2 025)诊断为听力损失,其中,分泌性中耳炎47例;感音神经性聋22例(中度8例,重度4例,极重度10例),单耳18例,双耳4例;单侧外耳道畸形伴不同程度耳道闭锁3例,其中,2例伴双耳大前庭水管综合征.结论 耳声发射及声导抗检测可用于学龄前儿童听力筛查;黄石地区学龄前儿童听力损失的原因主要为分泌性中耳炎和不同程度的感音神经性听力损失.     

Sensitivity of ABR based newborn screening with the MB11 BERAphone

Objectives

The aim of this study is to evaluate the sensitivity of our hearing screening program. The evaluation was done using a questionnaire for parents of children who participated in the NHS for a targeted time frame of two years. A survey was accomplished to identify children who passed our screening protocol in the newborn period, but who were later identified to have hearing loss.

Methods

For the survey a one-year cohort was established in 2008 which included 500 children who received a hearing screening at our Center with the ABR newborn screener, MB11 BERAphone^®, two years before. Two hearing questionnaires were chosen for the survey. The LittlEARS questionnaire (MED-EL Medical Electronics GmbH) for investigating the hearing behavior of the children during the first two years of life and a second, custom-developed questionnaire (Würzburger questionnaire) investigating some aspects which are not included in the LittlEARS tool, such as speech/language development, general development as well as pathological factors that might eventually lead to a temporary hearing loss.

Results

Analysis of the Würzburger questionnaires revealed normal speech development for 92.9% of the children. For 4.7% male and 2.4% female children delayed speech development was reported. Although twice as many males were found, the statistical comparison showed no significant difference according to gender. The results of the LittlEARS questionnaire are identical to those of the Würzburger questionnaire in 98.3% of the investigated cases and in 1.7% of the cases slightly different results but on borderline: The LittlEAR scores showed normal auditory development for the childrens’ age but the Würzburger questionnaire results showed delayed speech development.

Conclusions

Based on the follow-up analysis and the results from the two questionnaires, no permanent hearing loss was found in any child two years after they passed the newborn hearing screening. Thus, we conclude that the sensitivity of the screening test was 100%, based on survey results 2 years post screening.     

Validating self-reporting of hearing-related symptoms against pure-tone audiometry,otoacoustic emission,and speech audiometry

Objective: To validate self-reported hearing-related symptoms among personnel exposed to moderately high occupational noise levels at an obstetrics clinic. Design: Sensitivity, specificity, and predictive values were calculated for questionnaire items assessing hearing loss, tinnitus, sound sensitivity, poor hearing, difficulty perceiving speech, and sound-induced auditory fatigue. Hearing disorder was diagnosed by pure-tone audiometry, distortion product otoacoustic emissions, and HINT (Hearing In Noise Test). Study sample: Fifty-five female obstetrics personnel aged 22–63 participated; including 26 subjects reporting hearing loss, poor hearing, tinnitus, or sound sensitivity, and 29 randomly selected subjects who did not report these symptoms. Results: The questionnaire item assessing sound-induced auditory fatigue had the best combination of sensitivity?≥85% (95% CIs 56 to 100%) and specificity?≥70% (95% CIs 55 to 84%) for hearing disorder diagnosed by audiometry or otoacoustic emission. Of those reporting sound-induced auditory fatigue 71% were predicted to have disorder diagnosed by otoacoustic emission. Participants reporting any hearing-related symptom had slightly worse measured hearing. Conclusions: We suggest including sound-induced auditory fatigue in questionnaires for identification of hearing disorder among healthcare personnel, though larger studies are warranted for precise estimates of diagnostic performance. Also, more specific and accurate hearing tests are needed to diagnose mild hearing disorder.     

Hearing thresholds,tinnitus, and headphone listening habits in nine-year-old children

Objective: Investigate hearing function and headphone listening habits in nine-year-old Swedish children. Design: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis. Study sample: A total of 415 children aged nine years. Results: The prevalence of a hearing threshold?≥20?dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8?kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones. Conclusion: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children’s hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.     

The effect of mild hearing loss on academic performance in primary school children

Objectives

To determine the prevalence of mild hearing loss and its association with academic performance among primary school children.

Patients and methods

A comparative cross sectional study was conducted on standard (grade) five school children in a state in Malaysia. Five schools were selected by using simple random sampling. There were three classes (A, B and C) of standard five in each school. Student's selection into these classes was made by respective school administration based on their final term examination in standard four. Class A was for the best academic achievers while class C was for the poorest. Ear examinations were done followed by pure tone audiometry for confirmation of the hearing status. In this study, mild hearing loss was defined as an average threshold of 20-39 dB at 0.5, 1, 2 and 4 kHz. Data analysis was done using SPSS Version 12.0 software. Chi-square test was used to determine the association between mild hearing loss and academic performance. The significant level was set at p = 0.05.

Results

From a total of 257 students, 234 have completed the examinations (response rate = 91.0%). Fifty-three percent of them were boys while 47% were girls. A hundred and forty-nine (63.7%) of them were from class A while 85 (36.3%) were from class C. The prevalence of hearing loss in our school population was 15% (95% CI: 11.0-20.0%). Thirty-two (88.9%) of them were having conductive type. Out of the total, 38.9% were having problems in both ears. The students who have poor academic performance have been shown to be significantly associated with mild hearing loss (p < 0.001).

Conclusions

There was a high prevalence of mild hearing loss among primary school children. This problem could affect their academic performance. Therefore, hearing assessment is highly recommended to be done on every child especially to those who have poor academic achievement.     

Conductive impairment in newborn who failed the newborn hearing screening

In newborn hearing screening little importance is attributed to changes in the middle ear. Children with secretory otitis in the neonatal period are at risk for developing otitis media in the first year of life.Aim: To determine if children who failed the hearing screening because of conductive hearing loss have more episodes of conductive hearing impairment during their first years of life.Materials and Methods: The study group comprised 62 children who failed the screening for conductive impairment. The control was made up of 221 who passed. Both had audiologic and otolaryngological assistance and were compared regarding the occurrence of conductive disorder. Were used the Fisher's Exact test for statistical analysis and logistic regression models. The study was prospective and retrospective.Results: Children who failed the screening by conductive disorder had more episodes of otitis media during the first year of life than those who did not fail, with statistically significant difference.Conclusion: Infants who failed the screening in the first month of life for conductive alteration are more likely to experience otitis in the first year of life. The high incidence of otitis indicates the need for joint action with otolaryngologist for diagnosis of such changes.     

Evaluation of the use of a questionnaire to detect hearing loss in babies in China.

A questionnaire was used to screen hearing of 1020 babies 6-8 months in China. All babies failing the questionnaire and 10% of those who passed were tested using auditory brainstem audiometry (ABR). Babies with unilateral or bilateral hearing thresholds 30 dBnHL or more were investigated to determine the cause of the hearing impairment. Sixty-seven failing the questionnaire were tested and 23 were confirmed to have a hearing loss, 20 with bilateral hearing impairment. The causes were: 13 otitis media with effusion (OME), one hypoxia, one genetic and five unknown. One child with an OME related hearing loss passed the screen. The sensitivity of the questionnaire was estimated to be 70%, specificity 96%.     

A test protocol for assessing the hearing status of students with special needs

Objectives

Individuals with disabilities are often reported to have a high prevalence of undetected hearing disorders/loss, but there is no standardized hearing test protocol for this population. The purposes of this study were (1) to examine the hearing status of students with special needs in Taiwan, and (2) to investigate the use of an on-site hearing test protocol that would adequately detect hearing problems in this population and reduce unnecessary referrals for off-site follow-up services.

Methods

A total of 238 students enrolled in two schools for special education and one habilitation center participated in the study. Most students had intellectual disabilities and some also had additional syndromes or disorders. A hearing screening protocol including otoscopy, tympanometry, and distortion product otoacoustic emissions was administered to examine students’ outer, middle, and inner ear functions, respectively. Pure tone tests were then administered as an on-site follow-up for those who failed or could not be tested using the screening protocol.

Results

Only 32.4% of students passed. When administered alone, the referral rate of otoscopy, tympanometry, and otoacoustic emissions were 38.7%, 46.0%, and 48.5%, respectively. The integration of these subtests revealed 52.1% of students needed follow-up services, 11.8% could not be tested, 2.5% had documented hearing loss, and 1.3% needed to be monitored because of negative middle ear pressure. The inclusion of pure tone audiometry increased the passing rate by 9.9% and provided information on hearing sensitivity for an additional 8.6% of students.

Conclusion

Hearing assessments and regular hearing screening should be provided as an integral part of health care services for individuals with special needs because of high occurrences of excessive cerumen, middle ear dysfunction, and sensorineural hearing loss. The training of care-givers and teachers of students with special needs is encouraged so that they can help identify hearing problems and reduce the negative impact of hearing disorders and hearing loss. The screening protocol needs to include subtests that examine the status of different parts of their auditory system. The addition of pure tone audiometry as an on-site follow-up tool reduced the rate of off-site referrals and provided more information on hearing sensitivity.     

Comparison between hearing screening-detected cases and sporadic cases of delayed-onset hearing loss in preschool-age children

Abstract

Objective: This study aimed to compare the diagnosis and ages of intervention for cases of delayed-onset hearing loss identified sporadically or via a preschool hearing screening program. Design: Retrospective study with the comparative analysis of two groups of children. Study sample: Cases identified from screening were selected from 34 321 preschool children who underwent screening for delayed-onset hearing loss between October 2009 and May 2011. Sporadic cases of delayed-onset hearing loss were selected from pediatric clinical records. Cases from the first group were excluded from the latter to avoid duplication. Two groups were given the same questionnaire to record risk indicators, diagnosis, and age at intervention. Results: The average age of 26 children at the time of diagnosis in the screening group (52.81 ± 13.23 months) was significantly earlier than in the 33 cases identified in the sporadic group (62.03 ± 12.86 months; p < 0.05). The age at intervention of children with bilateral moderate to severe hearing loss in the screening group (50.40 ± 10.76 months) was also earlier than in the sporadic group (62.73 ± 13.77 months; p < 0.05). Conclusions: Improved rates of early diagnosis could therefore be achieved with hearing screening for preschool children with no significant symptoms of delayed-onset hearing loss.     

Neonatal screening for hearing impairment--The Oman experience

BACKGROUND: Oman introduced universal hearing screening at a national level in 2002 after piloting it in limited regions. Authors present their experiences. METHODS: The screening had three phases. In Phase I, trained health staff of the delivery suits screened newborns by transient evoked otoacoustic emissions (TEOAE) test. In Phase II, otologists examined ears and repeated hearing tests after 6 weeks. Those who failed the repeat test were referred to a tertiary unit for the Phase III. Audiometrists tested their hearing by an Automated Auditory Brainstem Response (AABR). The rates of hearing disabled, false positive, yield and cost of screening were estimated. RESULTS: The coverage of Phase I was 66.6% (21,387/32,125) and it had significant regional variation. Two thousand two hundred and eighty-seven (10.7%) newborns were suspected with hearing impairment. We detected 262 (1.2%) children with hearing impairment. In Phase II, 55 (0.26%) neonates failed the test. In Phase III, 36 neonates were tested with ABR. Eleven were lost to follow up and eight children were advised to undergo further investigations. Ten children were found normal and 26 had hearing impairment. Six neonates had sensory-neuronal hearing loss, 17 children had otitis media with effusion and three children had atresia of the middle ear. The yield of hearing screening was 1.2/1000. The cost of screening was US$7.1/newborn. CONCLUSION: Universal hearing screening in Oman was useful but had teething problems. Proper planning, advocacy to the health staff and parents, commitment of the staff and care of the equipment are important. Such screening should be complimented with a defaulter retrieval and rehabilitation facilities for the hearing disabled.     

Hearing loss in school children. A longitudinal study of sensorineural hearing impairment

In a longitudinal study, 2325 children were hearing tested at age 7, 10 and 13 with screening audiometry. The screening level was 20 dB HL. Approximately 75% of the children passed the screening level at all ages. Hearing loss was more frequent in boys than in girls at age 13 (16%:9%). The left ear was more commonly affected than the right ear. High frequency dips increased for boys with age, but not for girls. The increasing incidence of hearing loss for boys with age is probably due to noisy leisure time activities.     

Newborn hearing screening in the limiar clinic in Porto Velho Rondônia

With the universal hearing screening we can prevent auditory disorders in children.AimTo characterize the program of neonatal auditory screening into a population of neonates.Materials and Methodslongitudinal cohort study. We surveyed the clinic's database on neonatal auditory screening in the city of Porto Velho, Rondônia.ResultsAmong the 6,889 newborns in the database, 5,700 (82.7%) passed and 1,189 (17.3%) failed the first screening. Of the group which failed 900 (75.7 %) returned for retesting. Among these, 15 (0.22 %) newborns had hearing loss confirmed. The most prevalent was neural hearing loss with 46.7% confirmed cases; they had hyperbilirubinemia as the most prevalent risk factor.Conclusionhyperbilirubinemia was the most prevalent risk factor found in the group of hearing impaired children. The prevalence of hearing loss was of 2 in 1,000 newborns. It is important to highlight the relevant association between neural hearing loss caused by hyperbilirubinemia and sensorineural hearing loss of unknown causes.     

Pre-school hearing screening: Profile of children from Ogbomoso,Nigeria

Objectives

To carry out otoscopic and audiologic examinations amongst pre-school children in Ogbomoso, Nigeria in order to identify any cases of hearing loss and to intervene where possible.

Study design and setting

Prospective audiologic evaluations of children in Nursery I and II (pre-kindergarten and kindergarten) in both private and public primary schools were carried out.

Methods

One hundred and one children (202 ears) were screened using otoscopy and pure tone audiometry.

Results

The age ranged from 3.5 to 6 years, mean age was 4.8 years (S.D. = 0.835), with a male population of 55 and 46 females (M:F ratio, 1.2:1). Otoscopic findings revealed normal findings (106) 52.4%, impacted cerumen auris, 44 (21.8%), otitis media with effusion, (28) 13.9%, perforated tympanic membrane, 24 (11.9%) and giving an otoscopic pass rate of 52.4%. Screening audiometry, on the other hand, recorded a pass rate of 78.7%. After 6–8 weeks of otolaryngologic intervention, the otoscopic pass rate improved to 88.6%, while the pass rate for screening audiometry also improved to 93.6%.

Conclusion/significance

From the study, an otoscopic pass rate of 52.9% and screening audiometry pass rate of 78.7% increased to 88.6% and 93.6%, respectively, through basic otolaryngologic interventions. The key roles played in identifying ear diseases with or without hearing impairments with the use of clinical examination (otoscopy) and audiologic evaluation in the pre-school age children has been highlighted in the study. Unfortunately, these evaluations are not performed routinely in children enrolled in both private and public primary schools in Ogbomoso, Nigeria. We advocate that the routine otoscopic examinations with screening audiometry be made available in all primary schools, in order to facilitate early detection and prompt rehabilitation of children with ear diseases and hearing impairment.     

A comparison of audiometric and objective methods in hearing screening of school children. A preliminary study

Objective

In newborn hearing screening, one exclusively applies objective hearing testing methods - based on evoked potentials and/or on otoacoustic emissions. However, when testing school children, one can consider both audiometric and electrophysiological methods. The choice of methods is determined by the aims of the program. If one wants to detect conductive hearing losses, impedance audiometry seems to be the method of choice.

Methods

The aim of this study was to compare test performance measures from audiometric and objective methods (OAEs and impedance audiometry), in the hearing screening of school children. Screening protocols were applied on a group of 190 children of about 12 years of age (6th grade of primary school).

Results

For a single application of a screening procedure, the best performance was observed in the automated four-tone audiometry, followed by the tympanometry and the TEOAE-based procedures. Screening performance was enhanced using a combination of automated and impedance audiometry. A four-tone audiometry test combined with tympanometry gives a sensitivity of 65%, and the PPV of 46%, which are reasonable values, acceptable for practical use. The use of a TEOAE protocol degrades the overall performance of screening.

Conclusions

Screening of school children is feasible with a combination of automated audiometry and tympanometry with time requirements equal to 3 min per subject.     

Evaluation of the use of a questionnaire to detect hearing loss in Kenyan pre-school children

In developing countries, there is a lack of trained personnel and testing equipment to facilitate the early detection of hearing impairment in children. A questionnaire offers a low cost option and the value of this for detecting hearing impairment in pre-school children was determined in several districts in Kenya. The questionnaire was completed by either teachers, parents/carers or community nurses. The children were subsequently tested using pure tone audiometry and visual examination of the ear by ENT Clinical Officers, who were not given prior access to the results of the questionnaire. A total of 757 (88%) questionnaires were completed. Of the 735 children, who could be tested using pure tone audiometry, four were found to have a unilateral hearing impairment and one was detected by the questionnaire. A total of 13 children had a bilateral hearing impairment >40 dB HL. All were detected using the questionnaire. There were eight males and five females with ages ranging from 4.2 to 6.9 years, mean age 5.7 years and median age 5.8 years. Eight had a sensorineural hearing impairment and two a mixed hearing impairment. Three of the children with a sensorineural hearing loss had a family history of hearing impairment. No question detected all children with a hearing impairment and some questions were more discerning than others. There was 100% sensitivity for the questionnaire when a hearing loss of >40 dB was considered, but specificity was lower at 75%. Negative predictive value was 100%, but the positive predictive value was low, 6.75%. It was concluded that a questionnaire of this nature could be usefully applied at Primary Health Care level for detecting hearing impairment at the pre-school stage. There would be need for services available for diagnosis, treatment and habilitation before a screening programme was introduced.