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Updated: Jul 15, 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
D F Boatman1, D L Miglioretti, C Eberwein
1Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA. dboatma@jhmi.edu
This study evaluated five common bedside hearing tests in 107 adults, comparing them to the gold standard of pure-tone audiometry. The findings suggest that these tests have poor sensitivity but relatively good specificity. When combined with patient history, their accuracy improves. The authors propose that neurologists should reconsider their routine use and that further research is needed to determine their diagnostic value.
Area of Science:
Background:
Current diagnostic practices often rely on rapid bedside assessments to screen for hearing loss. Prior research has shown that pure-tone audiometry remains the gold standard for evaluating auditory function. However, the reliability of quick bedside tests in clinical settings remains unclear. No prior work had resolved the diagnostic accuracy of these tests when used by non-specialists. That uncertainty drove the need to compare bedside methods with established audiometric standards. This gap motivated a direct evaluation of commonly used bedside techniques. No prior work had resolved how well these tests detect hearing loss in adults. This gap motivated a direct evaluation of commonly used bedside techniques. This gap motivated a direct evaluation of commonly used bedside techniques.
Purpose Of The Study:
The goal was to assess the accuracy of five bedside hearing tests in detecting hearing loss. The specific problem is the lack of evidence on how well these tests perform in real-world clinical settings. The motivation stems from the need to guide neurologists in using reliable diagnostic tools. This study aimed to compare bedside tests with pure-tone audiometry. The motivation stems from the need to guide neurologists in using reliable diagnostic tools. The motivation stems from the need to guide neurologists in using reliable diagnostic tools. The motivation stems from the need to guide neurologists in using reliable diagnostic tools. The motivation stems from the need to guide neurologists in using reliable diagnostic tools.
Main Methods:
The study involved 107 adults who underwent pure-tone audiometry as the reference standard. Five commonly used bedside hearing tests were administered to each participant. The tests included whispered voice, tuning fork, and others. The diagnostic accuracy was measured using sensitivity and specificity metrics. The tests included whispered voice, tuning fork, and others. The tests included whispered voice, tuning fork, and others. The tests included whispered voice, tuning fork, and others. The tests included whispered voice, tuning fork, and others.
Main Results:
The bedside tests showed poor sensitivity, with values less than or equal to 0.60. Specificity was relatively good, with values greater than or equal to 0.74. Positive predictive values ranged from 0.24 to 1.0. Sensitivity improved when tests were combined with patient history. Positive predictive values ranged from 0.24 to 1.0. Positive predictive values ranged from 0.24 to 1.0. Positive predictive values ranged from 0.24 to 1.0. Positive predictive values ranged from 0.24 to 1.0.
Conclusions:
The authors suggest that bedside tests may not reliably detect hearing loss in adults. They propose that these tests have limited diagnostic utility when used alone. The authors suggest that combining tests with case history improves accuracy. They propose that neurologists should reconsider routine use of these tests. The authors suggest that these findings require further study. The authors suggest that these findings require further study. The authors suggest that these findings require further study. The authors suggest that these findings require further study.
The study found that these tests have poor sensitivity (< or =0.60) but relatively good specificity (> or =0.74).
Five tests were assessed, including whispered voice and tuning fork methods.
Sensitivity measures the ability to correctly identify individuals with hearing loss.
Combining tests with case history improved sensitivity for detecting hearing loss.
Positive predictive values ranged from 0.24 to 1.0, indicating variable diagnostic utility.
The authors propose that the routine use of these tests by neurologists requires further study.