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Validity of pure-tone hearing screening at well-child visits
Donna R Halloran1, J Michael Hardin, Terry C Wall
1Division of General Academic Pediatrics, Saint Louis University, 1465 S Grand Blvd., St Louis, MO 63110, USA. dhallor2@slu.edu
Insights
Pure-tone audiometry hearing screening in primary care shows low sensitivity (50%) and poor follow-up rates, questioning its value in well-child visits. This impacts early detection of hearing loss in children.
Area of Science:
- Pediatrics
- Audiology
- Preventive Medicine
Background:
- Hearing loss is a significant concern in pediatric populations.
- Primary care settings are crucial for early detection of health issues in children.
- Pure-tone audiometry is a common screening tool for hearing loss.
Purpose of the Study:
- To evaluate the sensitivity and specificity of pure-tone audiometry for hearing screening in primary care.
- To assess the effectiveness of hearing screening protocols within pediatric practices.
Main Methods:
- A prospective cohort study was conducted across eight pediatric practices.
- 1061 children aged 3-19 years underwent pure-tone audiometry screening.
- Formal audiologic evaluations served as the gold standard for diagnosis.
Main Results:
- The sensitivity of pure-tone audiometry was 50%, and specificity was 78%.
- Only 25% of referred children completed formal audiology evaluations.
- Hearing loss was identified in 3% of children who passed screening and 6% who did not.
Conclusions:
- The study questions the utility of pure-tone audiometry screening in well-child visits due to low sensitivity and inadequate follow-up.
- Improving referral completion rates and considering alternative screening methods may be necessary.
- The findings highlight challenges in implementing effective hearing screening in primary care.
Objective:
To estimate the sensitivity and specificity of pure-tone audiometry hearing screening in the primary care setting.
Design:
Prospective cohort study.
Setting:
Eight academic and private pediatric practices.
Participants:
A subset of children from a convenience sample of 1061 children between 3 and 19 years of age were screened for hearing loss using pure-tone audiometry. Intervention Formal audiologic evaluations (gold standard) for those children referred by their primary care physician (28 children) and for a random sample of children not referred (102 children). Main Exposure Pure-tone audiometry screening.
Main Outcome Measures:
Audiologic evaluations.
Results:
A total of 28 children were referred to an audiologist for formal hearing testing after pure-tone audiometry screening during a well-child visit, at which 25 children did not pass the initial screening and 3 could not complete the screening. Of the 25 children, only 7 were evaluated by an audiologist, for a follow-up rate of 25%. One child was diagnosed as having hearing loss. Formal audiologic assessment was also performed on a random sample of 102 children who were not referred to the audiologist. For the random sample, hearing loss was identified in 2 of 76 (3%) children who passed and 1 of 16 (6%) children who did not pass pure tone audiometry screening. The sensitivity and specificity of pure-tone audiometry were 50% and 78%, respectively.
Conclusion:
In light of the increasing burden on physicians to provide preventive care, this study calls into question the value of hearing screening using pure-tone audiometry during well-child visits given the lack of follow-up after referral and the poor sensitivity.
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