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Updated: Aug 17, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Screening methods for childhood hearing impairment in rural Bangladesh
Abbey L Berg1, Hemayetunnesa Papri, Shamim Ferdous
1Department of Communication Studies/Communication Sciences & Disorders, 1 Pace Plaza, Pace University, New York, NY 10038, USA. aberg@pace.edu
Insights
Screening young children for hearing loss in rural Bangladesh is feasible using a combination of methods. Conditioned play audiometry works for older children, while otoacoustic emissions and tympanometry are better for younger ones.
Area of Science:
- Global Health
- Pediatric Audiology
- Public Health
Background:
- Hearing impairments affect millions of children worldwide, particularly in developing countries.
- Early detection and intervention are crucial for speech, language, and cognitive development.
- Rural areas in developing nations often lack access to specialized audiological services.
Purpose of the Study:
- To evaluate a practical strategy for identifying hearing impairments in young children in rural Bangladesh.
- To compare the feasibility of different hearing screening methods in this population.
Main Methods:
- Community health workers (CHWs) screened 4003 children aged 2-9 years.
- Conditioned play audiometry (CPA) was used for initial screening.
- Otoacoustic emissions (OAEs) and tympanometry were employed for a subset of younger children (ages 2-5 years).
Main Results:
- CPA was feasible for children aged 6-9 years but not for younger children due to cooperation issues.
- Over two-thirds of younger children were untestable with CPA.
- OAEs and tympanometry proved more effective, with only 8.9% of tested children being untestable, compared to 69% with CPA.
Conclusions:
- A combined approach using CPA for older children and physiologic measures (OAEs/tympanometry) for younger children is a feasible hearing screening strategy.
- Physiologic measures significantly reduce the number of untestable children, leading to fewer unnecessary referrals.
- Developing countries can leverage available technology for hearing screening, but increasing the number of trained audiologists is essential for follow-up care.
Objective:
The purpose of this study was to determine a feasible strategy for screening young children in rural Bangladesh for hearing impairments.
Methods:
Trained community health workers (CHWs) screened 4003 children between the ages of 2 and 9 years using conditioned play audiometry (CPA) and a subset of 569 of these children (ages 2-5 years), using physiologic (otoacoustic emissions [OAEs] and tympanometry). Measures of frequency and cross-tabulations are presented to describe results.
Results:
Hearing screening using CPA was feasible for most children in the 6-9 years age range, but not for the younger children due to shyness and lack of cooperation. More than two thirds of the younger children were untestable on CPA. In response to this limitation, OAEs and tympanometry, requiring less cooperation on the part of the child, was implemented for a sample of younger children. Of the 569 children who received both CPA and OAE/tympanometry, 69% were untestable using CPA and 8.9% were untestable using OAE and tympanometry.
Conclusions:
These results suggest that hearing screening using CPA for older (6-9 years) and OAE/tympanometry for younger (2-5 years) children is feasible. Using the physiologic measures of OAE/tympanometry significantly reduced the number of untestable children, resulting in fewer referrals for diagnostic assessments. Thus, if only one methodology could be implemented, physiologic measure would be preferred. This is important because trained audiologists are scarce in Bangladesh. Technology is available and feasible for hearing screening in developing countries. Focus needs now to center on increasing the number of trained audiologists in developing countries to ensure better follow-up and accessibility to audiological services.
