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Influence of age, type of audiometry and child's concentration on hearing thresholds
Insights
Conventional audiometry is generally reliable for assessing hearing thresholds in young children (3-7 years), even with concentration difficulties. Play audiometry is a useful alternative for the youngest children when conventional methods fail.
Area of Science:
- Audiology
- Pediatric Otolaryngology
- Developmental Psychology
Background:
- Limited data exists on audiometry methods and concentration effects on hearing thresholds in children aged 3-7 years.
- Otitis media with effusion (OME) is common in this age group, often necessitating hearing assessments.
Purpose of the Study:
- To investigate the impact of audiometry method and developmental concentration ability on hearing threshold reliability in young children.
- To evaluate the feasibility of conventional and play audiometry in children aged 3-7 years within the TARGET trial.
Main Methods:
- Analysis of data from 1517 children (aged 3.25-6.75 years) participating in the Trial of Alternative Regimens in Glue Ear Treatment (TARGET).
- Comparison of reliable air-conduction and bone-conduction threshold acquisition rates between conventional and play audiometry.
- Assessment of concentration levels ('fair'/'poor' vs. 'good') and their effect on thresholds for each audiometry type.
Main Results:
- 4.5% of children could not obtain reliable air-conduction thresholds, and 7.5% could not obtain reliable bone-conduction thresholds, with higher rates in younger children.
- Play audiometry showed significantly better concentration reporting (p <0.005) compared to conventional audiometry.
- Poor concentration had a slightly larger impact on thresholds with play audiometry (+5 dB) than conventional audiometry (+3 dB).
- Child's age had a minimal effect on thresholds after controlling for audiometry type, concentration, and OME presence.
Conclusions:
- Conventional audiometry can yield informative hearing thresholds in children aged 3-7 years, even with fair or poor concentration.
- Play audiometry is a recommended alternative for children aged 3-5 years when conventional audiometry is not feasible.
- These findings support the use of appropriate audiometric techniques for accurate hearing assessment in young children with OME.
Abstract:
Surprisingly little evidence is available in children between the ages of 3 and 7 years on the effect on hearing thresholds of the method of audiometry and of the developmental ability to concentrate and to respond. The Trial of Alternative Regimens in Glue Ear Treatment (TARGET) is a large, national, multi-centre trial of surgical intervention in children with otitis media with effusion (OME) that offers an opportunity to study these effects. Of 1517 children, aged between 3.25 and 6.75 years, reaching the selection stage, 4.5% were unable to give reliable air-conduction thresholds. A further 3% (i.e. 7.5% in all) could not give reliable bone-conduction thresholds. This inability was greatest in the youngest children. During air-conduction testing, a significantly greater proportion (p <0.005) of children were recorded as having only 'fair' or 'poor' concentration on conventional audiometry than with play audiometry. On the other hand, the magnitude of the effect of poor concentration, as rated 'fair/poor' versus 'good', was slightly greater on play as opposed to conventional audiometry (+5 dB versus +3 dB). Although statistically significant, the age of the child had only a very small effect on the air- or bone-conduction thresholds, once the type of audiometry, concentration and the presence of OME had been controlled for. It is concluded that adequately informative thresholds are usually obtainable by conventional audiometry in this age group, even if the concentration is recorded as 'fair' or 'poor'. However, when conventional audiometry is not feasible, play audiometry should be attempted in the 3-5-year-old age group.