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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
Otoacoustic emissions: a valid, efficient first-line hearing screen for preschool children
Larry Yin1, Christine Bottrell, Noreen Clarke
1Department of General Pediatrics, USC Keck School of Medicine, USC University Center of Excellence in Developmental Disabilities, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 76, Los Angeles, CA 90027, USA. lyin@chla.usc.edu
Insights
Transient evoked otoacoustic emissions (TEOAEs) screening by school nurses is a fast and effective method for identifying hearing impairment in at-risk preschoolers. This approach is particularly valuable for underserved communities.
Area of Science:
- Pediatric audiology
- Public health screening
- Early childhood development
Background:
- Preschool hearing is crucial for development.
- Children from low socioeconomic status are at higher risk.
- Focused screening is vital for early identification.
Purpose of the Study:
- Develop and implement TEOAEs screening for at-risk preschoolers.
- Assess the speed and tolerability of TEOAEs screening.
- Compare TEOAEs screening performance with pure tone audiometry.
Main Methods:
- 744 preschoolers underwent TEOAEs screening by school nurses.
- 142 children had both TEOAEs and pure tone audiometry.
- Data compared to evaluate test performance.
Main Results:
- 5.5% of children (41/744) had a "refer" result.
- Mean testing time was 43 seconds per ear.
- TEOAEs screening showed high sensitivity (1.00) and specificity (0.94).
Conclusions:
- TEOAEs screening by nurses is feasible, fast, and efficient.
- Passing TEOAEs screening indicates a low likelihood of hearing impairment.
- This model is highly relevant for underserved populations.
Background:
Normal hearing during the preschool years is essential for speech, language, social, emotional, and preacademic development. Children of low socioeconomic status may be particularly vulnerable to the negative effects of late identification and intervention. While a mass-screening effort focused on preschool children does not have broad support, focused screening remains important to identify children at risk. This project was conducted to address 3 primary aims: develop and implement an initial hearing screen using transient evoked otoacoustic emissions (TEOAEs) for at-risk preschoolers, verify speed and tolerability of the screen, and assess the test performance of TEOAEs screening compared to pure tone audiometry in a group of 142 preschool children.
Methods:
A total of 744 preschool children attending preschools in an underserved, urban community completed TEOAEs screening by a school nurse. A secondary cohort of 142 children was screened first by TEOAEs and then followed by pure tone audiometry and results compared.
Results:
A total of 680 children passed screening. Forty-one children (5.5%) had a "refer" result. Two-year-olds had the highest refusal rate (10.5%). Mean testing time was 43 seconds per ear. Secondary cohort analysis revealed 1 subject did not pass either TEOAEs or pure tone screening; no subject passed TEOAEs and then did not pass pure tone audiometry. TEOAEs screening test sensitivity was 1.00 (95% confidence interval 0.054-1.00) and specificity 0.94 (0.88-0.97).
Conclusions:
TEOAEs screening performed by school nurses is a fast, efficient, and feasible model. Children who pass TEOAEs screening have a very high likelihood of being free from hearing impairment. Application may be particularly relevant in underserved communities.
