Current practice, accuracy, effectiveness and cost-effectiveness of the school entry hearing screen

Area of Science:

• Audiology
• Public Health
• Pediatrics

Background:

• School entry hearing screening (SES) is a common practice in the UK for identifying childhood hearing loss.
• Current practices exhibit significant variability in implementation, protocols, and quality assurance.
• The effectiveness and efficiency of SES require detailed analysis to inform policy and practice.

Purpose of the Study:

• To comprehensively describe and analyze the current state of school entry hearing screening in the UK.
• To evaluate the implementation, protocols, target population, and performance data of SES programs.
• To review alternative screening tests, their performance, and economic implications.

Main Methods:

• National postal questionnaire survey of SES leads across the UK.
• Analysis of primary cohort data from London.
• Systematic review of alternative SES tests and economic evaluations.

Main Results:

• SES is widely used but implementation is inconsistent, with poor protocols and variable coverage.
• Newborn hearing screening significantly reduces the yield of SES for permanent hearing impairments.
• The pure tone sweep test demonstrates high sensitivity and specificity, but evidence on alternative tests and long-term outcomes is limited.
• Economic evaluations suggest targeted screening may be more cost-effective, but with considerable uncertainty.

Conclusions:

• A significant lack of high-quality evidence hinders evidence-based policy decisions for SES.
• Improving the quality and auditing of SES performance is crucial for identifying previously unknown permanent hearing impairments.
• Further research is needed to develop and evaluate agreed national protocols for comparable future studies and audits.