Accuracy and Use of the Reflexive Behavioral ("Baah") Test and Risk Factor Questionnaire for Hearing Screening in
Gienah F Evangelista1, Patrick John P Labra1, Charlotte M Chiong1,2
1Philippine National Ear Institute, National Institutes of Health, University of the Philippines Manila.
Insights
The Reflexive Behavioral "Baah" test effectively screens for infant hearing impairment in rural communities. NHSRC Questionnaires do not improve accuracy when used with the "Baah" test.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- Early detection of hearing impairment in infants is crucial for developmental outcomes.
- Rural health settings present unique challenges for audiological screening.
- Standardized and accessible screening tools are needed for widespread implementation.
Purpose of the Study:
- To evaluate the accuracy, sensitivity, and specificity of the Reflexive Behavioral "Baah" Test.
- To assess the utility of NHSRC Level 1 and Level 2 Questionnaires in detecting hearing impairment.
- To determine the effectiveness of these tools in rural community health settings.
Main Methods:
- A prospective cross-sectional study involving 103 infants under six months old.
- Screening was performed using Otoacoustic Emissions (OAE) as the standard, the "Baah" test, and NHSRC questionnaires.
- Trained health workers administered the "Baah" test and questionnaires; audiologists performed OAE.
Main Results:
- A hearing impairment prevalence of 4.9% was observed.
- The "Baah" test demonstrated high specificity (97.96%) and accuracy (96.12%), with 60% sensitivity.
- NHSRC Questionnaires showed lower performance, and their combination with the "Baah" test did not significantly enhance screening effectiveness.
Conclusions:
- The Reflexive Behavioral "Baah" test is a viable, accurate, and acceptable stand-alone tool for infant hearing screening in rural areas.
- NHSRC Questionnaires are not recommended as stand-alone or complementary tools due to increased false results.
- The "Baah" test can help identify infants at higher risk for hearing impairment in underserved communities.
Objective:
To determine the accuracy, sensitivity, specificity, positive predictive values, and use of the Reflexive Behavioral "Baah" Test and NHSRC Level 1 and Level 2 Questionnaires in detecting hearing impairment in rural health communities.
Methods:
This was a prospective cross-sectional study conducted at the rural health unit of five municipalities. Infants less than six months old were screened for hearing impairments using the OAE device (standard), the Reflexive Behavioral "Baah" test, and the NHSRC Level 1 and Level 2 Questionnaires. The "Baah" test and the filling out of the NHSRC Level 1 and 2 Questionnaires were done by trained health workers while OAE was done by an audiologist.
Results:
A total of 103 babies, with a mean age of 41.9 days at the time of testing and a male to female ratio of 1.02:1 (52 males and 51 females) were tested. A hearing impairment prevalence of 4.9% (5 out of 103) was noted. The "Baah" test showed to have a sensitivity of 60%, specificity of 97.96% and an accuracy rate of 96.12%. The NHSRC Level 1 and Level 2 Questionnaires showed sensitivity, specificity, and accuracy rate of 40%, 67.35% and 66.02%, respectively for the former and 40%, 85.71% and 83.50%, respectively for the latter. Analysis of the complimentary use of the NHSRC Level 1 and Level 2 Questionnaires with the "Baah" test also showed no significant improvement to using the "Baah" test as a stand-alone screening tool with sensitivity, specificity, and accuracy of 60%, 67.35% and 66.99%, respectively for the "Baah" test and Level 1 Questionnaire, and 60%, 83.67% and 82.52%, respectively for the "Baah" test and Level 2 Questionnaire.
Conclusion:
The Reflexive Behavioral "Baah" test is a potentially accurate, sensitive, specific, and acceptable stand-alone hearing screening test to identify infants with higher risk of hearing impairment in the rural health community setting. On the other hand, the use of the NHSRC Questionnaires as a stand-alone or complementary tool for "Baah" is unnecessary as it results to more false positive and false negative results.
