Outcomes of an Early Childhood Hearing Screening Program in a Low-Income Setting
Kara D Brodie1, Abel P David1, Hayley Kriss2
1Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco.
Insights
Preschool hearing screening effectively identifies childhood hearing loss, with high completion rates. Teacher concerns correlate with final hearing status, aiding early intervention for speech and development.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- Early identification of childhood hearing loss is crucial to prevent speech, language, and developmental delays.
- Newborn hearing screening is standard, but many children develop postnatal hearing loss or are lost to follow-up.
- Preschool-based hearing screening programs offer a potential solution for identifying children with hearing impairments, but evidence on their effectiveness is limited.
Purpose of the Study:
- To evaluate the outcomes of a hearing screening program implemented in low-income, urban public preschools.
- To identify risk factors associated with hearing loss in preschool-aged children within this population.
Main Methods:
- A retrospective cohort study analyzed data from 6820 children aged 2-6 years screened between 2015 and 2019.
- A two-tiered screening approach using conditioned play pure-tone audiometry (CPA) and distortion product otoacoustic emissions (OAEs) was employed.
- Multivariate logistic regression was used to determine risk factors for hearing loss.
Main Results:
- The screening program achieved a 99.6% completion rate.
- 5.9% of children were referred for further evaluation, with a final diagnosis of hearing loss in 13.6% of those evaluated.
- The prevalence of conductive hearing loss was 2.9%, and sensorineural hearing loss was 0.2%.
- No significant association was found between primary language, race, ethnicity, sex, and referral or hearing loss rates.
Conclusions:
- Preschool-based hearing screening programs are effective in identifying early childhood hearing loss.
- Teacher concerns were found to be associated with the final diagnostic hearing status of children.
- These programs are valuable for early detection and intervention, mitigating potential developmental delays.
Importance:
Early identification of childhood hearing loss through newborn hearing screening mitigates permanent speech, language, and developmental delays, but many children are lost to follow-up or develop postnatal hearing loss. Early childhood hearing screening programs may help identify these children, but evidence on their outcomes is limited.
Objective:
To assess outcomes from a low-income, preschool-based hearing screening program and risk factors for hearing loss in this population.
Design, Setting, And Participants:
A retrospective cohort study of 6820 children aged 2 to 6 years from urban, low-income public preschools who received hearing screening from July 1, 2015, to June 30, 2019, was performed using San Francisco Department of Public Health records. A multivariate logistic regression analyzed risk factors for hearing loss. Data analysis was conducted from January 14, 2020, to April 20, 2021.
Exposures:
Annual single-visit, 2-tiered screening was implemented with conditioned play pure-tone audiometry (CPA) and distortion product otoacoustic emissions (OAEs).
Main Outcomes And Measures:
Rates of successful screening, referred screening, loss to follow-up, and hearing loss.
Results:
Of 6820 children (age, 2-6 years) screened, 3425 (50.2%) were boys, 15% were White/non-Hispanic, and 48% had English as the primary home language. A total of 403 (5.9%) children were referred for full medical or audiologic evaluation after 2-tiered CPA/OAE screening. Only 24 children were unable to complete both CPA and OAE testing for a screening completion rate of 99.6%. After medical evaluation, 114 of 403 children (28.3%) passed hearing rescreening and 55 (13.6%) were lost to follow-up. The prevalence of conductive hearing loss was 2.9% (n = 195), and the prevalence of sensorineural hearing loss was 0.2% (n = 13). Primary language, race and ethnicity, and sex were not associated with rates of referral or hearing loss.
Conclusions And Relevance:
The findings of this cohort study suggest that preschool-based screening programs can be a useful method to identify early childhood hearing loss and that teacher concerns are associated with final diagnostic hearing status.
