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How accurate is parent rating of hearing for children with otitis media?
R M Rosenfeld1, A J Goldsmith, J R Madell
1Department of Otolaryngology, State University of New York Health Science Center at Brooklyn and The Long Island College Hospital, 11201, USA.
Insights
Parental assessment of child hearing, while reliable, does not accurately predict hearing loss. Immittance measures are better indicators of hearing status than caregiver reports in children with ear conditions.
Area of Science:
- Pediatric Otolaryngology
- Audiology
- Child Health
Background:
- Accurate assessment of child hearing is crucial for early intervention.
- Parental perception of hearing can be a valuable indicator, but its diagnostic accuracy requires validation.
Purpose of the Study:
- To evaluate the accuracy of parent-reported hearing assessments in children.
- To compare parent assessments with objective audiological and immittance measures.
Main Methods:
- Prospective study involving 186 children (6 months-12 years) with otitis media.
- Parents used a 7-point scale to rate child hearing; objective measures included otoscopy, immittance, and audiometry.
- Test-retest reliability and correlation with audiometric thresholds were analyzed.
Main Results:
- Parental hearing assessments showed good test-retest reliability but poor correlation with audiometric results.
- Only extreme reported hearing problems correlated with significant hearing loss.
- Immittance measures predicted hearing levels and identified children at risk for hearing loss.
Conclusions:
- Parental reports are unreliable for predicting child hearing levels or changes.
- Immittance measures aid in risk stratification for hearing loss but do not replace audiometry.
- Objective measures are essential for accurate hearing assessment in children.
Objective:
To determine the accuracy of parent assessment of child hearing.
Design:
Prospective study.
Setting:
Hospital-based pediatric otolaryngology practice in a metropolitan area.
Patients:
One hundred eighty-six children aged 6 months to 12 years (median age, 3.4 years) with chronic otitis media with effusion or recurrent acute otitis media enrolled in a quality-of-life study.
Intervention:
Parents rated their child's hearing over the prior 4 weeks using a 7-point response scale. Otoscopic findings, static admittance, tympanometric width, and audiometric thresholds were recorded concurrently. Fifty children were reassessed to monitor changes in hearing.
Main Outcome Measure:
Correlation of parent hearing assessments with baseline hearing status (pure tone average for the better hearing ear) and with changes in hearing status.
Results:
The hearing loss questions had good test-retest reliability (R=0.79) but did not correlate with audiometric results (R=-0.13; P=.09). Only when caregivers reported hearing to be an "extreme problem" were median hearing levels (31 dB) significantly greater than the median response (20 dB). Conversely, static admittance and tympanometric gradient were significant predictors of hearing levels (2-way analysis of variance, P<.01) and explained 44% of the ear-specific variations. Abnormal immittance measures in both ears had an 84% predictive value for hearing loss (20-dB hearing level or poorer), and normal immittance measures in both ears had a 76% predictive value for normal hearing. Caregiver assessments of change in hearing status did not correlate with changes in audiometric results (R=0.07; P=.65).
Conclusions:
Caregiver assessments of child hearing do not accurately predict hearing levels or changes in hearing status. Immittance measures can help identify children at low or high risk for hearing loss, but cannot substitute for audiometry.