Related Experiment Video
Updated: Jul 14, 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
Hearing screening and middle ear measures in American Indian infants and toddlers
Lisa L Hunter1, Cynthia S Davey, Allison Kohtz
1University of Utah, Department of Communication Sciences and Disorders, 390 South, 1530 East, 1201 BEHS, Salt Lake City, UT 84112, USA. lisa.hunter@hsc.utah.edu
Insights
American Indian infants experience high rates of hearing screening failures, primarily due to otitis media (OM). Otoacoustic emissions (OAE) screening is valuable but limited in older infants, necessitating behavioral assessments for recurrent OM.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- American Indian children have a three-fold higher incidence of otitis media (OM) than the general population.
- Prospective cohort studies on otitis media with effusion (OME) and hearing loss in American Indian infants are lacking.
- This study addresses the need for data on OME, hearing loss, and hearing screening in this high-risk population.
Purpose of the Study:
- To report otoacoustic emissions (OAE) hearing screening results in relation to otitis media diagnoses in American Indian infants.
- To assess the risk for recurrent hearing screening failure and OME in this population up to age 2 years.
- To evaluate the utility of OAE screening in identifying hearing issues related to OME.
Main Methods:
- A prospective cohort of 421 American Indian infants was enrolled at birth and followed until age 2.
- Infants underwent regular assessments including pneumatic otoscopy, distortion product otoacoustic emissions (DPOAE), and tympanometry.
- Procedures were conducted by nurses trained and validated in all assessment techniques.
Main Results:
- Newborn hearing screening failure rates were 23.5%, increasing to 29.9% between 2-5 months.
- Technical failures due to noise were frequent in infants aged 6-24 months, complicating interpretation.
- OAE test results showed a significant association with OM diagnosis, strengthening with age, particularly after 6 months.
Conclusions:
- High hearing screening failure rates in early infancy were significantly associated with high otitis media rates.
- Sensorineural hearing loss was rare; most failures were linked to middle ear issues or temporary problems.
- OAE screening is valuable but limited in infants over 6 months due to noise; behavioral assessment is recommended for persistent OME.
Unlabelled:
American Indian children have three times the rate of otitis media compared to the general population, yet prospective cohort studies of OME and hearing loss have not been previously reported in American Indian infants. Between 1997 and 2003, a cohort of 421 infants was enrolled at birth from Minnesota American Indian reservations and an urban clinic and followed to age 2 years. This study reports OAE hearing screening results related to OME diagnoses, as well as risk for recurrent hearing screening failure and OME in American Indian infants and children.
Methods:
Infants were prospectively assessed at regular intervals with pneumatic otoscopy, distortion product otoacoustic emissions, and tympanometry by nurses who were trained in all procedures and validated on pneumatic otoscopy.
Results:
In the newborn period, 23.5% of infants failed hearing screening in at least one ear. Hearing screening failures increased to 29.9% from 2 to 5 months of age. Technical fail results due to excessive noise occurred frequently in infants 6-24 months of age, making interpretation of true pass and fail rates questionable in older infants. OAE test result was associated with OM diagnosis, and this relationship strengthened with age, with the strongest association above 6 months of age.
Conclusions:
A high rate of hearing screening failures occurred among American Indian infants in the first 5 months of age, and was significantly associated with a correspondingly high rate of otitis media. Only one infant out of 366 was identified with sensorineural hearing loss, thus essentially all of the hearing screening failures reflected either a middle ear origin or other temporary problems. OAE screening provided a valuable hearing screening measure in this population at high risk for recurrent otitis media, but due to excessive noise in infants 6 months and older, practical use of OAE screening is limited. Use of behavioral assessment is needed after 6 months of age, when high rates of OME persist in this population. Increased efforts to develop public and medical education, as well as screening, diagnosis and treatment programs are needed to detect and decrease recurrent OME in American Indian infants and children.
