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Spontaneous improvement in ears with middle ear disease
Insights
Swedish 4-year-olds failing initial hearing screening often normalize. Further testing revealed only 18% of referred children required specialist ENT referral, reducing unnecessary follow-ups.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- Universal pure tone screening is standard for 4-year-olds in Sweden.
- High referral rates from initial screening may lead to over-referrals.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive oto-audiological assessment program.
- To reduce false positives and negatives in pediatric hearing referrals.
Main Methods:
- Children failing pure tone screening underwent audiometry and tympanometry.
- A 3-test program with 6-week intervals was implemented.
- Failure criteria included middle ear pressure < -150 mm H2O and hearing loss > 20 dB.
Main Results:
- Only 45% of referred children showed abnormalities at the first follow-up.
- 60% of initially abnormal children normalized during the 15-20 week program.
- Ultimately, only 18% of initially screened failures required ENT referral.
Conclusions:
- The comprehensive testing protocol effectively identifies children needing further evaluation.
- This approach significantly reduces over-referral rates from initial mass hearing screenings.
- Optimized screening protocols improve resource allocation in pediatric audiology.
Abstract:
The 'healthy-baby-clinics' in Göteborg, as in all Sweden, test all 4-year-olds with pure tone screening (failure criterion greater than 20 dB). Those who fail are referred to an oto-audiological health center. In an effort to prevent over-referrals of false positives as well as under-referrals of false negatives all referred children in this study have been tested with pure tone audiometry supplemented by tympanometry. At the oto-audiological health center a test program including 3 tests with intervals of 6 weeks was initiated. Failure criteria were middle ear pressure less than - 150 mm H2O and hearing loss (HL) in the frequency range 0.125-8 kHz greater than 20 dB. In Göteborg (430,000 inhabitants) 5928 4-year-olds were tested at the 'healthy-baby-clinics' during 1980. Of these 498 (8.4%) failed in pure tone screening, 248 of which are included in the present study. At the first check in our test program, which was performed 3-8 weeks after referral, only 45% of the children were abnormal. Of these 60% normalized during the test program. Thus of the ears referred following the pure tone screening at the 'healthy-baby-clinics' only 18% remained after 15-20 weeks for referral to an ENT-doctor.