The preventive value of audiometric screening of preschool and young school-children

A systematic review of the prevalence of late identified hearing loss in childhood

OBJECTIVES

The objective of this systematic review was to assess the evidence about the prevalence of permanent hearing loss for children not identified from newborn hearing screening (NHS).

DESIGN

Articles were grouped into three categories based on the methodological approach: (1) all participants received diagnostic testing, (2) otoacoustic emission (OAE) or pure tone screening was completed and those not passing were referred for a diagnostic test, and (3) data were retrieved from archival records. Study characteristics, prevalence, and contextual factors were synthesised and narratively described.

STUDY SAMPLE

30 peer-reviewed articles.

RESULTS

Prevalence of permanent hearing loss per 1,000 children ranged from 0.32 to 77.87 (M = 7.30; SD = 16.87). Variations in the criteria for inclusion contributed to prevalence differences. Prevalence was higher when unilateral and milder degrees of hearing loss were included, and older children had higher prevalence (M = 13.71; SD = 23.21) than younger children (M = 1.57; SD = 0.86).

CONCLUSION

There is scant research on prevalence of childhood hearing loss after NHS that utilised methods to accurately differentiate between permanent and temporary hearing loss. Rigorous research is needed on the prevalence of permanent childhood hearing loss to inform strategies for monitoring, identification, intervention, and management.

Hearing loss as a sequel of secretory and acute otitis media as reflected by audiometric screening of Swedish conscripts

OBJECTIVE

Many authors have shown a small effect on hearing from middle ear disease even a long time after active disease has subsided. We wanted to see to what extent those who have had otitis media in childhood in our district have normal hearing at the age of 18 years. The aim of the present study is to find out if a history of secretory otitis media (SOM) up to 14 years of age or acute otitis media (AOM) up to 4 years of age affects hearing at conscription in an age cohort of Swedish boys.

METHODS

For a cohort of 951 boys we have good knowledge of their ear diseases up to 14 years of age from previous studies. The prevalence of elevated thresholds in audiometric screening at conscription was compared for the group of boys who had been treated with tympanostomy tubes and the group of boys with no history of ear disease. Similarly, boys with a history of ear disease but no treatment with tubes were compared to boys without history of ear disease. We also compared the prevalence of elevated thresholds for boys with a history of at least four episodes of AOM up to the age of four to those who had had no episodes up to that age.

RESULTS

Those who had been treated with tympanostomy tubes because of longstanding SOM had a significantly higher prevalence of elevated thresholds for solitary frequencies. Two treated boys had a pure tone average greater than 25 dB, one unilaterally, one bilaterally. No difference could be seen between those who had had episodes of ear disease but no treatment with tympanostomy tubes and those who had had no documented ear disease. The prevalence of elevated thresholds was not correlated to more than three treated episodes of acute otitis media up to the age of 4 years.

CONCLUSIONS

Boys who had been treated with tympanostomy tubes had a higher prevalence of having a hearing threshold above 20 dB for at least one frequency at the age of 18. Hearing handicap was not a common sequel to SOM. We can show no relation between more than three treated episodes of AOM before the age of four and screening results at the age of 18.

Hörscreening an Kindergärten: Ergebnisse einer Evaluierungsstudie

OBJECTIVE

This study aimed to evaluate the hearing screening of pre-school children at nursery schools in Tyrol, Austria.

METHODS AND SAMPLE

47 nursery schools with a total of 2199 enrolled children participated in the study. At the screening, the children were presented a series of tones at frequencies 0.5 kHz (25dB), 1 kHz, 2 kHz, 3 kHz, and 4 kHz (20 dB each) from portable audiometers. The tones were presented over headphones for each ear separately and at irregular intervals. Failure to respond to any of the frequencies was considered failure of the screening. Parents were then advised in written form to have the child examined by an ENT-specialist.

RESULTS

1832 individuals were screened (coverage: 83% of nursery school children; corresponding to at least 63% of all Tyrolean children aged 3 to 5 years). Of these, 390 failed the test (referral rate: 21% of all screened). Examination through an ENT-specialist occurred with 217 children, and this confirmed the positive test in 139 children (hit rate: 64%). In most cases, a temporary conductive hearing loss due to external or middle ear problems (glue ear, tube dysfunction, cerumen, otitis media) was diagnosed. A sensorineural hearing loss was found in 4 children (in 3 of them bilateral). The need for therapy was recognized in 81 children (4% of all screened).

CONCLUSION

Pre-school hearing screening identifies children with ear and hearing problems that need therapeutical intervention. Although the hearing problems are mostly of a temporary nature, some may require monitoring over some period. Also some children with permanent sensorineural hearing loss may be detected through this measure. Hearing screening is an efficient means of assessing ear and hearing problems in pre-school children. However, the follow-up rate needs to be improved for optimizing the efficacy.

Does early detection of otitis media with effusion prevent delayed language development?

OBJECTIVE

To consider whether earlier detection of otitis media with effusion (OME) in asymptomatic children in the first 4 years of life prevents delayed language development.

METHODS

MEDLINE and other databases were searched and relevant references from articles reviewed. Critical appraisal and consensus development were in accordance with the methods of the Canadian Task Force on Preventive Health Care.

RESULTS

No randomised controlled trials assessing the overall screening for OME and early intervention to prevent delay in acquiring language were identified, although one trial evaluated treatment in a screened population and found no benefit. The "analytic pathway" approach was therefore used, where evidence is evaluated for individual steps in a screening process. The evidence supporting the use of tools for early detection such as tympanometry, microtympanometry, acoustic reflectometry, and pneumatic otoscopy in the first 4 years of life is unclear. Some treatments (mucolytics, antibiotics, steroids) resulted in the short term resolution of effusions as measured by tympanometry. Ventilation tubes resolved effusions and improved hearing. Ventilation tubes in children with hearing loss associated with OME benefited children in the short term, but after 18 months there was no difference in comparison with those assigned to watchful waiting. Most prospective cohort studies that evaluated the association between OME and language development lacked adequate measurement of exposure or outcome, or suffered from attrition bias. Findings with regard to the association were inconsistent.

CONCLUSIONS

There is insufficient evidence to support attempts at early detection of OME in the first 4 years of life in the asymptomatic child to prevent delayed language development.

[Health checkup for 3- to 4-year-old children: results of screening tests performed in 1999 by physicians in the Maternal and Infant Welfare program in the Gironde region]

BACKGROUND

In the Gironde region, the physicians of the Mother and Infant Welfare department in charge of the 3- to 4-year-old childrens' health checkup have set up a public health approach which led to new practical methods of screening tests in 1999. These have been used to evaluate the children's health problems of that age group in the region.

POPULATION AND METHODS

This study concerned 12,421 children born in 1995, attending the nursery schools of Gironde, who underwent a health checkup (visual and hearing screening test, language and behaviour exploration) in 1999.

RESULTS

Among them, 5,208 children failed screenings. One child out of six had language disorders, one child out of seven presented amblyopia, one out of eight suffered from behavioral problems and one child out of nine from a hearing defect. Furthermore, one out of three children who failed the test had several problems.

CONCLUSION

This study has enabled us to objectify the frequency of the troubles and their association, this information being particularly useful for evaluating these children's health needs and to help improve their healthcare management.

Otitis media and academic achievements

OBJECTIVE

This is a study of whether there are any long-term differences in academic achievements between children with and without observed or treated middle ear disease in a population with a stable long-standing treatment policy.

METHODS

A birth cohort of 2156 children was previously studied through a questionnaire to the parents at 4 years of age, follow-up after audiometric screening at 4, 7, 11 and 14 years of age, and study of records from all Ear, Nose and Throats departments in the area; 2095 of these still lived in the area and received academic grades on leaving the ninth year of the state school system. We have compared these grades, and the choice of high school course for children with different experiences of otitis media.

RESULTS

A history of treatment for bilateral secretory otitis media was correlated to minor group difference in the mean of grades, but not to any significant difference in the individual grades or in the choice of further studies. Having many episodes of acute otitis before the age of four was uncorrelated to lower grades and to less tendency to continue with theoretical studies.

CONCLUSIONS

No harmful effect of middle ear disease could be shown in a large sample, suggesting that Swedish children do not suffer long-term effects on learning from otitis media.

How do we identify hearing impairment in early childhood?

This review discusses the need for universal neonatal hearing screening. Historical background is given concerning conventional childhood hearing screening programmes in western countries. Direct studies on the effects of very early habilitation programmes on speech and language development are cited. Measurement of otoacoustic emissions (OAE) as a tool for neonatal hearing screening is presented. The state of neonatal hearing screening programmes in the US and in Europe, particularly in Sweden, is discussed.

Screening for Otitis Media with Effusion to Measure its Prevalence in Chinese Children in Hong Kong

In an attempt to gain a better understanding of the prevalence of otitis media with effusion (OME) in the Hong Kong community, and to compare the characteristics of the disease here with OME as it is described in the Western literature, we screened more than 6,000 6- and 7-year-old children with both clinical and audiologic examinations. The initial positive screening rate was 5.3%. Upon further evaluation, we determined that the overall prevalence of persistent OME was 2.2%. We found that the disease pattern and natural history of persistent OME in Hong Kong children are similar to those reported in the Western literature.

Mass hearing screening in kindergarten students

OBJECTIVE

To determine the types of hearing losses identified by mass hearing screenings in the public school system.

DESIGN

Prospective observational.

PARTICIPANTS

Students enrolled in kindergarten in the public school system.

SETTING

Major metropolitan area.

MAIN OUTCOME MEASURES

(1) hearing screening tests performed by speech pathologists using an audiometer in a quiet room; (2) formal audiologic testing including pure tone audiometry, tympanograms, speech discrimination, and acoustic impedance testing in a sound proof booth.

RESULTS

140 students failed hearing screening on two separate occasions; 91(65%) underwent formal audiologic testing at Milwaukee Public School, 43% demonstrated conductive hearing losses, 14% demonstrated sensorineural losses and 43% demonstrated normal hearing.

CONCLUSION

Mass hearing screening in the school system (1) is useful for detecting transient conductive hearing losses, (2) detects a significant number of sensorineural hearing losses and (3) has a very poor follow-through by the families of those students identified with hearing loss through the screening program.

Autism and hearing loss

A group of 199 children and adolescents (153 boys, 46 girls) with autistic disorder was audiologically evaluated. Mild to moderate hearing loss was diagnosed in 7.9% and unilateral hearing loss in 1.6% of those who could be tested appropriately. Pronounced to profound bilateral hearing loss or deafness was diagnosed in 3.5% of all cases, representing a prevalence considerably above that in the general population and comparable to the prevalence found in populations with mental retardation. Hearing deficits in autism occurred at similar rates at all levels of intellectual functioning, so it does not appear that the covariation with intellectual impairment per se can account for all of the variance of hearing deficit in autism. Hyperacusis was common, affecting 18.0% of the autism group and 0% in an age-matched nonautism comparison group. In addition, the rate of serous otitis media (23.5%) and related conductive hearing loss (18.3%) appeared to be increased in autistic disorder. The study emphasizes the need for auditory evaluation of individuals with autism in order to refer those with pronounced to profound hearing loss for aural habilitation and to follow those with mild to moderate hearing loss because of the risk of deterioration.

Routine ultrasound screening in pregnancy and the children's subsequent growth, vision and hearing

OBJECTIVE

To test a hypothesis of no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood.

DESIGN

Follow up of eight to nine year old children born to women who participated in a randomised controlled trial on ultrasound screening during pregnancy.

SETTING

Nineteen antenatal care clinics run by three central hospitals in Sweden from 1985 to 1987.

POPULATION AND METHODS

Of 4637 eligible singleton pregnancies, 3265 (71%) were followed up through a questionnaire sent to their mothers. Analyses were performed both according to randomised groups and to ultrasound exposure.

MAIN OUTCOME MEASURES

Parents' report of vision and hearing tests as recorded on child's record card. Parents' report of their child's weight and height at 1, 4 and 7 years of age.

RESULTS

Reduced hearing was reported by 3.4% in the screening group compared with 3.5% in the nonscreening group (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.67-1.41). The same prevalences were found when analysed according to ultrasound exposure (OR 1.0; 95% CI 0.67-1.42). Reduced vision was reported by 6.3% in the screening group compared with 7.8% in the nonscreening group (OR 0.8; 95% CI 0.60-1.03). Corresponding figures for ultrasound exposed and unexposed were 6.2% and 8.0%, respectively (OR 0.8; 95% CI 0.58-1.00). No statistically significant differences in body weight or height at 1, 4 or 7 years of age between screened and not screened children or between exposed and unexposed were found.

CONCLUSION

This study found no association between ultrasound exposure in early fetal life and growth or impaired vision or hearing during childhood.

Pure-tone audiometric and impedance measurements in school-aged children in Finland

Pure-tone audiometric and impedance examinations were performed in 687 Finnish school children in the first, fourth and eighth grades (ages, 7, 10 and 14 years old) to study the sensitivity and usability of hearing and tympanometric screening examinations in schools. There were 138 children (20.1%) with a hearing loss > 15 dB in at least one frequency. Among these children, 103 were found to have pure sensorineural losses while 35 children had conductive losses. Of all the sensorineural losses, 118 of the cases involved slight high-frequency changes. Six children had hearing losses at speech range and all had been previously diagnosed. Six other children had 20-30 dB losses at 3-6 kHz, with 5 of these children diagnosed for the first time. Twenty-four of the children with conductive losses had middle ear effusions that were found at a 15 dB screening level for hearing. When the limit of normal tympanometric peak pressure was-150 daPa, 36 of 38 ears with middle ear effusions were found tympanometrically. Judging by the findings of the present study, we recommend that routine pure-tone audiometric screening for 7- and 10-year-old children in schools could be discontinued but should be continued for 14-year-old children. In contrast, tympanometry with a tympanometric peak pressure limit at-150 daPa should be used as a screening procedure for 7-year-old children on school entry.

The otological profile of a cohort of Dutch 7.5-8-year-olds

The otological characteristics of a birth cohort of 7.5-8-year-old Dutch children are reported. Questionnaire information was available for 1004 children, while otomicroscopic, tympanometric and pure-tone audiometric data were available for 946 children. Twenty-nine per cent of the children had been treated surgically for various ENT diseases. Fifty-five per cent of the children had normal tympanic membranes, 19% mild abnormalities, and 26% moderate to severe abnormalities. At this age the prevalence of bilateral otitis media with effusion (OME), as shown by a type B tympanogram was 2.5%, while that of unilateral OME was 7%. A pure-tone average hearing level of > or = 15 dB in the better-hearing ear was found in 4% of the children. The presence of OME was associated with a mean hearing loss of 20 dB. This study shows that structural and functional middle-ear abnormalities are highly prevalent in Dutch school children.