Development of school screening audiometry

It is now 50 years since serious attempts have been made to detect hearing impairment in school children, first by using the "Fading numbers gramophone audiometer" (in 1930-31) and later (in 1954) by the "Pure tone, sweep frequency, audiometric tests". There is good evidence to show (based to experience from this and many other countries) that by a properly organized screening programme, on the average, 6% of school children will be discovered to have significant hearing impairment and that without screening most of these will not be developed in this country unevenly and there are still many places where it is not practised properly or not at all. One of the reasons for this is the serious lack of understanding of the importance of screening by the authorities and, until recently, almost a complete lack of guidance by the Department of Health and Social Security. It is recommended also that systematic school-leaving audiometry should be introduced. The preventive and epidemiological significance of school leaving audiometry is stressed. Its potential importance in relation to industrial audiology is discussed. Impedance measurements are important but tests of middle-ear function should not be used as screening tests of hearing. First of all they are far too sensitive as a screening device and also it may lead to non-detection of many specific but significant sensorineural hearing losses (which are more frequent in children than generally assumed). However, it is hoped that eventually all children discovered to have a hearing loss, as a result of screening audiometry, will have a full test of middle-ear function. The two tests are complementary and not mutually exclusive.