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Hearing screening at well-child visits
Donna R Halloran1, Terry C Wall, H Hughes Evans
1Division of General Pediatrics and Adolescent Medicine, Departments of Pediatrics and Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. dhallor2@slu.edu [corrected]
Insights
In primary care, 10% of children failed hearing screening. However, pediatricians failed to refer or recheck over half of these children, hindering early identification of hearing impairment.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- Hearing impairment is a common condition in children that can impact development.
- Early identification and intervention are crucial for managing hearing loss.
- Primary care settings offer a valuable opportunity for routine hearing screening.
Purpose of the Study:
- To determine hearing screening failure rates in primary care.
- To examine referral practices following an abnormal hearing screening test.
Main Methods:
- A convenience sample of 1061 children aged 3-19 years underwent hearing screening during well-child visits.
- Failure was defined as missing any frequency (1000, 2000, 4000 Hz) at 20-dB hearing level in either ear.
- Pediatricians determined referral decisions for children with abnormal screening results.
Main Results:
- 10% of children (96 out of 948) failed the hearing screening.
- Developmental delay was the only significant predictor of a failed screen (P = .02).
- Of those who failed, 59% received no further evaluation, 13% were rechecked, and 28% were referred.
Conclusions:
- A significant proportion of children fail hearing screenings in primary care settings.
- A substantial number of children who fail screening do not receive timely follow-up care.
- Current screening practices may be inefficient, failing to ensure proper identification and management of childhood hearing impairment.
Objectives:
To determine hearing screening failure rates in primary care settings and to examine the referral practices in response to an abnormal screening test.
Methods:
We enrolled a convenience sample of children between 3 and 19 years of age who were undergoing hearing screening during a well-child visit. A failure was defined as missing any frequency (1000, 2000, or 4000 Hz) in either ear at 20-dB hearing level. The pediatrician made the decision of whether to refer the patient for further evaluation.
Results:
Three academic and 5 private practices enrolled 1061 children. Sixty-seven children (7%) were unable to complete the screening. Of the 948 children who completed the screen, a total of 852 children (90%) passed the screening and 96 children (10%) failed. After multivariable logistic regression analysis, the only statistically significant factor predictive of a failed screen was developmental delay (P = .02). Of the 96 children who failed the hearing screening, 57 (59%) had no further evaluation, 12 (13%) were rechecked, and 27 (28%) were referred. Similar percentages were seen with children who could not be screened.
Conclusions:
Although 10% of the children failed hearing screening, pediatricians neither rechecked nor referred more than half of these children. Screening that does not result in action for those failing the screening wastes resources and fails to properly identify hearing impairment in children.
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