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Updated: Aug 7, 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
A comparison of two methods of hearing screening in the preschool population
Irene Sideris1, Theodore J Glattke
1Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20011, USA. isideris@cnmc.org
Insights
Transient otoacoustic emissions (TEOAEs) offer a more reliable preschool hearing screening method than pure tone tests, reducing referrals due to uncooperative children and improving middle ear status assessment.
Area of Science:
- Audiology
- Pediatric Healthcare
- Educational Psychology
Background:
- Preschool hearing screening is crucial for early identification of hearing loss.
- Conventional pure tone behavioral testing can be challenging with young children.
- Transient otoacoustic emissions (TEOAEs) offer an objective measure of cochlear function.
Purpose of the Study:
- To compare the effectiveness of pure tone screening versus TEOAE screening in preschoolers.
- To analyze referral rates and reasons for referral in both screening methods.
- To investigate the impact of middle ear status on screening outcomes.
Main Methods:
- Screened 200 preschool children (ages 2-5) using both pure tone and TEOAE methods.
- Recorded referral rates and reasons for referral for each screening type.
- Assessed the correlation between screening referrals and immittance screening results.
Main Results:
- Referral rates were similar between pure tone and TEOAE screenings.
- Pure tone screening referrals were primarily due to children's inability to cooperate.
- TEOAE screening had a lower rate of non-cooperation referrals (10%) compared to pure tone.
- A higher percentage of TEOAE referrals (62%) also failed immittance screening compared to pure tone referrals (44%).
Conclusions:
- TEOAE screening is more effective in preschool settings due to fewer referrals based on cooperation.
- Middle ear issues significantly impact referral outcomes in both screening methods.
- TEOAEs provide a valuable, objective alternative for preschool hearing screening programs.
Unlabelled:
The outcome of hearing screening using conventional pure tone behavioral testing was compared with the outcome employing measures of transient otoacoustic emissions (TEOAEs) in a preschool population under conditions typical of educational settings. Two hundred children ranging in age from 2 years 1 month to 5 years 10 months were screened. Nearly equal numbers of children were referred from the two types of screening activities. The majority of referrals from the pure tone screening were due to an inability to condition the children to respond. Only 10% of the children referred from the TEOAE screening received a referral due to an inability to cooperate. Approximately 44% of the children referred from the pure tone screening also failed the immittance screening, whereas 62% of those who referred from the TEOAE screening also failed immittance screening.
Learning Outcomes:
As a result of completing this activity, the learner will obtain information about vocabulary development in children with hearing loss, referral rates from preschool hearing screening programs and the influence of middle ear status on referrals.
