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Sienko A, Thirunavukarasu AJ, Kuzmich T, Allen L. An Initial Validation of Community-Based Air-Conduction Audiometry in Adults With Simulated Hearing Impairment Using a New Web App, DigiBel: Validation Study. JMIR Form Res 2024; 8:e51770. [PMID: 38271088 PMCID: PMC10853851 DOI: 10.2196/51770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/10/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Approximately 80% of primary school children in the United States and Europe experience glue ear, which may impair hearing at a critical time for speech acquisition and social development. A web-based app, DigiBel, has been developed primarily to identify individuals with conductive hearing impairment who may benefit from the temporary use of bone-conduction assistive technology in the community. OBJECTIVE This preliminary study aims to determine the screening accuracy and usability of DigiBel self-assessed air-conduction (AC) pure tone audiometry in adult volunteers with simulated hearing impairment prior to formal clinical validation. METHODS Healthy adults, each with 1 ear plugged, underwent automated AC pure tone audiometry (reference test) and DigiBel audiometry in quiet community settings. Threshold measurements were compared across 6 tone frequencies and DigiBel test-retest reliability was calculated. The accuracy of DigiBel for detecting more than 20 dB of hearing impairment was assessed. A total of 30 adults (30 unplugged ears and 30 plugged ears) completed both audiometry tests. RESULTS DigiBel had 100% sensitivity (95% CI 87.23-100) and 72.73% (95% CI 54.48-86.70) specificity in detecting hearing impairment. Threshold mean bias was insignificant except at 4000 and 8000 Hz where a small but significant overestimation of threshold measurement was identified. All 24 participants completing feedback rated the DigiBel test as good or excellent and 21 (88%) participants agreed or strongly agreed that they would be able to do the test at home without help. CONCLUSIONS This study supports the potential use of DigiBel as a screening tool for hearing impairment. The findings will be used to improve the software further prior to undertaking a formal clinical trial of AC and bone-conduction audiometry in individuals with suspected conductive hearing impairment.
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Affiliation(s)
- Anna Sienko
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Tanya Kuzmich
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Louise Allen
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
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Lopes AA, Friche AADL, Lemos SMA, Bicalho L, Silva AMM, dos Santos TS, Oliveira RCCD, Avan P, Carvalho SADS. Prevalence of hearing loss and health vulnerability in children aged 25 to 36 months: an analysis of spatial distribution. Codas 2023; 35:e20210189. [PMID: 38055408 PMCID: PMC10723582 DOI: 10.1590/2317-1782/20232021189pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/26/2022] [Indexed: 12/08/2023] Open
Abstract
PURPOSE To analyze the association between hearing loss and health vulnerability in children aged 25 to 36 months. METHODS Analytical observational cross-sectional study conducted through child hearing screening in nine day-care centers. The screening consisted of anamnesis, otoscopy, tympanometry, transient otoacoustic emissions, and pure tone audiometry. For each exam performed, the 'pass' and 'fail' criteria were established. The children's residential addresses were georeferenced and a choropleth map of the spatial distribution was built, considering the Health Vulnerability Index (HVI). The analysis of the association between the HVI and the variables sex, auditory assessment, and region area of the household was performed using Pearson's Chi-square and Fisher's Exact tests. RESULTS Ninety-five children of both sexes were evaluated, of which 44.7% presented alterations in at least one of the exams performed, being referred for otorhinolaryngological evaluation and subsequent auditory assessment. Of the observed changes, 36.9% occurred in the tympanometry and 7.8% in the transient otoacoustic emissions. Among children referred for reassessment, 9.7% were diagnosed with conductive hearing loss, 13.6% results within normal limits and 21.4% did not attend for assessment. Of the children who presented the final diagnosis of conductive hearing loss (9.7%), 1.9% were classified as low-risk HVI and 6.8% as medium-risk HVI. There was statistical significance between HVI and the child's place of residence. CONCLUSION The association between hearing loss and HIV was not statistically significant; however, it was possible to observe that 77.7% of the children with hearing loss resided in sectors with medium- risk HIV.
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Affiliation(s)
- Aline Aparecida Lopes
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
| | - Amélia Augusta de Lima Friche
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
| | - Stela Maris Aguiar Lemos
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
| | - Lorena Bicalho
- Programa de Pós-graduação em Ciências da Saúde da Criança e do Adolescente, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
| | - Artur Marins Moreto Silva
- Instituto de Geociências, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
| | - Thamara Suzi dos Santos
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
| | | | - Paul Avan
- Laboratoire de Biophysique Neurosensorielle, Université Clermont-Auvergne, France.
- Institut de l'Audition de l'Institut Pasteur - INSERM - Paris, France.
| | - Sirley Alves da Silva Carvalho
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
- Programa de Pós-graduação em Ciências da Saúde da Criança e do Adolescente, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil.
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Harkus S, Marnane V, O'Keeffe I, Kung C, Ward M, Orr N, Skinner J, Kong K, Fonua L, Kennedy M, Belfrage M. Routine ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: a national consensus statement. Med J Aust 2023; 219:386-392. [PMID: 37716709 DOI: 10.5694/mja2.52100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/23/2023] [Indexed: 09/18/2023]
Abstract
This consensus statement provides new recommendations for primary care assessment of ear health and hearing status of young Aboriginal and Torres Strait Islander children who are not known to have, or are not being actively managed for, ear health and hearing problems. Any child identified with otitis media should be actively managed. This national consensus statement extends existing treatment and management guidelines. MAIN RECOMMENDATIONS: Undertake checks at least 6-monthly, commencing at 6 months until 4 years of age, then at 5 years. Undertake checks more frequently in high risk settings for children under 2 years, when acceptable to families, or in response to parent/carer concerns. Ask parents/carers about concerns, signs, and symptoms; check children's listening and communication skills; and assess middle ear appearance and mobility. Otoacoustic emissions testing is suggested when equipment is available, primary health practitioners have capability and confidence to use the equipment, and there is local preference for its use. Video otoscopy is suggested for health promotion purposes, and/or for sharing images with other health practitioners. Audiometry should be done as per existing guidelines: when there are parent/carer concerns, signs of persistent/recurrent otitis media, or when listening and communication development is not yet on track. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Key practice changes include routine use of tympanometry, and listening and communication skills checklists. Implementation will require access to equipment and training; clear information on immediate, practical actions for families; timely pathways to referral services; and a change management process that shifts perception and tolerance of otitis media and its impacts and raises expectations that Aboriginal and Torres Strait Islander children can have healthy ears and hearing.
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Affiliation(s)
- Samantha Harkus
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Vivienne Marnane
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Isabel O'Keeffe
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Carmen Kung
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Meagan Ward
- National Acoustic Laboratories, Macquarie University, Sydney, NSW
| | - Neil Orr
- Macquarie University, Sydney, NSW
| | | | - Kelvin Kong
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
| | - Lose Fonua
- Centre for Health Equity, University of Melbourne, Melbourne, VIC
| | | | - Mary Belfrage
- Royal Australian College of General Practitioners, Melbourne, VIC
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Bower C, Reilly BK, Richerson J, Hecht JL. Hearing Assessment in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening. Pediatrics 2023; 152:e2023063288. [PMID: 37635686 DOI: 10.1542/peds.2023-063288] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/29/2023] Open
Abstract
Children who are deaf or hard of hearing (D/HH) are at high risk for permanent deficits in language acquisition and downstream effects such as poor academic performance, personal-social maladjustments, and emotional difficulties. Identification of children born D/HH through newborn hearing screening and subsequent timely early intervention can prevent or reduce many of these adverse consequences. Ongoing surveillance for changes in hearing thresholds after infancy is also important and should be accomplished by subjective assessment for signs of atypical hearing and with objective screening tests. Scheduled hearing screening may take place in the primary care setting, or via referral to an audiologist according to the Bright Futures/American Academy of Pediatrics "Recommendations for Preventive Pediatric Health Care" (also known as the periodicity schedule). This report covers hearing assessment beyond the newborn period, reviews risk factors for hearing level change, and provides guidance for providers of pediatric primary care on the assessment and care of children who are D/HH.
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Affiliation(s)
- Charles Bower
- Department of Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Brian Kip Reilly
- Division of Otolaryngology, Children's National Medical Center, Washington, District of Columbia
| | | | - Julia L Hecht
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Choe G, Park SK, Kim BJ. Hearing loss in neonates and infants. Clin Exp Pediatr 2023; 66:369-376. [PMID: 36634668 PMCID: PMC10475863 DOI: 10.3345/cep.2022.01011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 01/10/2023] Open
Abstract
Hearing in neonates and infants is crucial for their development of language and communication skills. Unless hearing loss is appropriately managed early, it can cause a significant socioeconomic burden considering its detrimental impact on the child's development and its common nature. It is also the most common congenital sensory deficit, with an approximate incidence of 1.5 per 1,000 newborns. Its etiologies are heterogeneous: genetic causes are reportedly involved in up to 80% of cases, while congenital cytomegalovirus infection is the leading environmental factor contributing to congenital hearing loss. The introduction of newborn hearing screening using automated auditory brainstem response and/or automated otoacoustic emission in many developed countries has helped detect and manage hearing loss early. Current auditory rehabilitation options such as cochlear implantation implementing cutting-edge technologies can treat almost all degrees of hearing loss, emphasizing the importance of early hearing detection and intervention. Rapidly developing genetic diagnostic technologies and future cutting-edge treatment options, including gene therapy, will shed light on the future management of hearing loss in neonates and infants.
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Affiliation(s)
- Goun Choe
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Su-Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Bong Jik Kim
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
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6
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Ting HC, Huang YY. Sensitivity and specificity of hearing tests for screening hearing loss in older adults. J Otol 2023; 18:1-6. [PMID: 36820159 PMCID: PMC9937813 DOI: 10.1016/j.joto.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives The study aimed to determine the most appropriate hearing screening test to identify disabling hearing loss for adults aged 65 years or older. Methods This study included 577 older adults. Four hearing screening tests were considered in the study, including the Hearing Handicap Inventory for Elderly Screening (HHIE-s), three single question tests, the whisper test, and the finger rub test. The sensitivity and specificity of these tests referenced to the hearing threshold of disabling hearing loss were estimated. Results Among all tests, only the single self-perception question (0.7064 for sensitivity; 0.7225 for specificity) and whisper test (0.7833 for sensitivity; 0.7708 for specificity) could obtain both sensitivity and specificity higher than 70% for adults aged ≥65 years. Conclusion Overall, we suggest using the whisper test to identify disabling hearing loss (>40 dB HL at the better ear) for adults aged 65 years or older. However, if the conditions do not permit, the single self-perception question is also acceptable. Moreover, HHIE-s might not be a good test to detect disabling hearing loss for adults aged 80 years or older.
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Affiliation(s)
- Hsin-Chen Ting
- PSA Charitable Foundation, New Taipei City, Taiwan,Department of Audiology and Speech-Language Pathology, MacKay Medical College, New Taipei City, Taiwan,Corresponding author. Department of Audiology and Speech-Language Pathology, MacKay Medical College, No.46, Sec. 3, Zhongzheng Rd, Sanzhi Dist, New Taipei City, 252, Taiwan.
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Saunders JE, Bessen S, Magro I, Cowan D, Gonzalez Quiroz M, Mojica-Alvarez K, Penalba D, Reike C, Neimczak C, Fellows A, Buckey J. School Hearing Screening With a Portable, Tablet-Based, Noise-Attenuating Audiometric Headset in Rural Nicaragua. Otol Neurotol 2022; 43:1196-1204. [PMID: 36351228 DOI: 10.1097/mao.0000000000003692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the utility and effectiveness of a noise-attenuating, tablet-based mobile health system combined with asynchronous telehealth evaluations for screening rural Nicaraguan schoolchildren for hearing loss. STUDY DESIGN Prospective population-based survey. SETTING Rural Nicaraguan communities. PATIENTS There were 3,398 school children 7 to 9 years of age. INTERVENTIONS Diagnostic automated and manual audiometry, detailed asynchronous telehealth evaluations. MAIN OUTCOME MEASURES Referral rates, ambient noise levels, and audiometric results as well as hearing loss prevalence, types, and risk factors. RESULTS Despite high ambient noise levels during screening (46.7 dBA), no effect of noise on referral rates on automated audiometry or confirmatory manual audiometry in those who failed automated testing was seen. The overall audiometric referral rate was 2.6%. Idiopathic sensorineural hearing loss (SNHL) and cerumen impaction were the most common types of hearing loss in this population with an estimated prevalence of hearing loss (all types) of 18.3 per 1,000 children. SNHL was associated with both drug exposure during pregnancy (p = 0.04) and pesticide exposure in the home (p = 0.03). CONCLUSION Hearing screening using a tablet-based, noise-attenuating wireless headset audiometer is feasible and effective in rural low-resource environments with moderately elevated ambient noise levels. The referral rate with noise-attenuating headsets was much lower than that previous reports on this population. In addition, manual audiometry resulted in much lower referral rates than automated audiometry. The confirmed hearing loss rate in this study is comparable to reports from other low-income countries that use some form of noise attenuation during screening. Pesticide exposure and drug exposure during pregnancy are potential causes of SNHL in this population.
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Affiliation(s)
- James E Saunders
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth
| | - Sarah Bessen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Isabelle Magro
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Devin Cowan
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | | | - Donoso Penalba
- Research Centre on Health, Work and Environment (CISTA) at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua
| | - Catherine Reike
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth
| | - Chris Neimczak
- Department of Medicine Dartmouth-Hitchcock Medical Center, Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Abigail Fellows
- Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth
| | - Jay Buckey
- Department of Medicine Dartmouth-Hitchcock Medical Center, Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Saunders JE, Bessen S, Magro I, Cowan D, Quiroz MG, Mojica-Alvarez K, Penalba D, Reike C, Niemczak CE, Fellows A, Buckey JC. Community health workers and mHealth systems for hearing screening in rural Nicaraguan schoolchildren. J Glob Health 2022; 12:04060. [PMID: 35938885 PMCID: PMC9359107 DOI: 10.7189/jogh.12.04060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background We aimed to investigate the effectiveness of using minimally trained community health workers (CHW) to screen schoolchildren in rural Nicaragua for hearing loss using a tablet-based audiometric system integrated with asynchronous telehealth evaluations and mobile health (mHealth) appointment reminders. Methods A population-based survey was conducted using community health workers (CHWs) to perform tablet-based audiometry, asynchronous telehealth evaluations, and mHealth reminders to screen 3398 school children (7-9 years of age) in 92 rural Nicaraguan communities. The accuracy of screening, test duration, testing efficiency, telehealth data validity, and compliance with recommended clinic visits were analyzed. Results Minimally trained CHWs successfully screened children within remote rural schools with automated audiometry (test duration = 5.8 minutes) followed by manual audiometry if needed (test duration = 4.3 minutes) with an estimated manual audiometry validity of 98.5% based on a review of convergence patterns. For children who were referred based on audiometry, the otoscopy and tympanometry obtained during telehealth evaluations were high quality (as reviewed by 3 experts) in 44.6% and 80.1% of ears, respectively. A combination of automated short message service (SMS) text messages and voice reminders resulted in a follow-up compliance of 75.2%. No families responded to SMS messages alone. Conclusions Tablet-based hearing screening administered by minimally trained CHWs is feasible and effective in low- and middle-income countries. Manual audiometry was as efficient as automated audiometry in this setting. The physical exam tasks of otoscopy and tympanometry require additional training. Mobile phone messages improve compliance for confirmatory audiometry, but the utility of SMS messaging alone is unclear in this population.
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Affiliation(s)
- James E Saunders
- Department of Surgery Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Sarah Bessen
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Isabelle Magro
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Devin Cowan
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Marvin Gonzalez Quiroz
- Research Centre on Health, Work and Environment (CISTA) at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua.,Centre for Nephrology, University College London, London, UK
| | | | - Donoso Penalba
- Department of Public Health at National Autonomous University of Nicaragua, Leon (UNAN-Leon), Leon, Nicaragua
| | - Catherine Reike
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Christopher E Niemczak
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Abigail Fellows
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Jay C Buckey
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Medicine Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Rosenfeld RM, Tunkel DE, Schwartz SR, Anne S, Bishop CE, Chelius DC, Hackell J, Hunter LL, Keppel KL, Kim AH, Kim TW, Levine JM, Maksimoski MT, Moore DJ, Preciado DA, Raol NP, Vaughan WK, Walker EA, Monjur TM. Clinical Practice Guideline: Tympanostomy Tubes in Children (Update). Otolaryngol Head Neck Surg 2022; 166:S1-S55. [PMID: 35138954 DOI: 10.1177/01945998211065662] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. All these conditions are encompassed by the term otitis media (middle ear inflammation). This guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The guideline is intended for any clinician involved in managing children aged 6 months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for otitis media of any type. The target audience includes specialists, primary care clinicians, and allied health professionals. PURPOSE The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. In planning the content of the updated guideline, the guideline update group (GUG) affirmed and included all the original key action statements (KASs), based on external review and GUG assessment of the original recommendations. The guideline update was supplemented with new research evidence and expanded profiles that addressed quality improvement and implementation issues. The group also discussed and prioritized the need for new recommendations based on gaps in the initial guideline or new evidence that would warrant and support KASs. The GUG further sought to bring greater coherence to the guideline recommendations by displaying relationships in a new flowchart to facilitate clinical decision making. Last, knowledge gaps were identified to guide future research. METHODS In developing this update, the methods outlined in the American Academy of Otolaryngology-Head and Neck Surgery Foundation's "Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence Into Action" were followed explicitly. The GUG was convened with representation from the disciplines of otolaryngology-head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. ACTION STATEMENTS The GUG made strong recommendations for the following KASs: (14) clinicians should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea; (16) the surgeon or designee should examine the ears of a child within 3 months of tympanostomy tube insertion AND should educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude.The GUG made recommendations for the following KASs: (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months' duration, from the date of onset (if known) or from the date of diagnosis (if onset is unknown); (2) clinicians should obtain a hearing evaluation if OME persists for 3 months or longer OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer AND documented hearing difficulties; (5) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do not receive tympanostomy tubes, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (6) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (7) clinicians should offer bilateral tympanostomy tube insertion in children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (8) clinicians should determine if a child with recurrent acute otitis media or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (10) the clinician should not place long-term tubes as initial surgery for children who meet criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube; (12) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (13) clinicians should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement; (15) clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes.The GUG offered the following KASs as options: (4) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable, all or in part, to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life; (9) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by a type B (flat) tympanogram or a documented effusion for 3 months or longer; (11) clinicians may perform adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction) OR in children aged 4 years or older to potentially reduce future incidence of recurrent otitis media or the need for repeat tube insertion.
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Affiliation(s)
| | - David E Tunkel
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Charles E Bishop
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Daniel C Chelius
- Baylor College of Medicine-Texas Children's Hospital, Houston, Texas, USA
| | - Jesse Hackell
- Pomona Pediatrics, Boston Children's Health Physicians, Pomona, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Lisa L Hunter
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Ana H Kim
- Columbia University Medical Center, New York, New York, USA
| | - Tae W Kim
- University of Minnesota School of Medicine/Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Jack M Levine
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | - Denee J Moore
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - William K Vaughan
- Consumers United for Evidence-Based Healthcare, Falls Church, Virginia, USA
| | | | - Taskin M Monjur
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Van den Borre E, Denys S, Zupan L, de Laat JAPM, Božanić Urbančič N, van Wieringen A, Wouters J. Language-Independent Hearing Screening - Increasing the Feasibility of a Hearing Screening Self-Test at School-Entry. Trends Hear 2022; 26:23312165221122587. [PMID: 36114643 PMCID: PMC9486290 DOI: 10.1177/23312165221122587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A tablet-based language-independent self-test involving the recognition of
ecological sounds in background noise, the Sound Ear Check (SEC), was adapted to
make it feasible for young children. Two experiments were conducted. The first
experiment investigated the SEC‘s feasibility, as well as its sensitivity and
specificity for detecting childhood hearing loss with a monaural adaptive test
procedure. In the second experiment, the SEC sounds, noise, and test format were
adapted based on the findings of the first experiment. The adaptations were
combined with three test procedures, one similar to the one used in Experiment
1, one presenting the sounds dichotically in diotic noise, and one presenting
all the sounds with a fixed signal-to-noise ratio and a stopping rule. Results
in young children show high sensitivity and specificity to detect different
grades of conductive and sensorineural hearing loss (70–90%). When using an
adaptive, monaural procedure, the test duration was approximately 6 min, and 17%
of the results obtained were unreliable. Adaptive staircase analyses showed that
the unreliable results probably occur due to attention/motivation loss. The test
duration could be reduced to 3-4 min with adapted test formats without
decreasing the test-retest reliability. The unreliable test results could be
reduced from 17% to as low as 5%. However, dichotic presentation requires longer
training, reducing the dichotic test format‘s feasibility.
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Affiliation(s)
- Elien Van den Borre
- Department of Neurosciences, Research Group ExpORL, 26657KU Leuven, Leuven, Belgium
| | - Sam Denys
- Department of Neurosciences, Research Group ExpORL, 26657KU Leuven, Leuven, Belgium
| | - Lea Zupan
- Department of ear, nose, and throat, 59057General Hospital Celje, Celje, Slovenia
| | - Jan A P M de Laat
- Department of Audiology (ear, nose, and throat), 4501Leiden University Medical Center, The Netherlands
| | - Nina Božanić Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, 37664University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, Department of Otorhinolaryngology, University of Ljubljana, Ljubljana, Slovenia
| | - Astrid van Wieringen
- Department of Neurosciences, Research Group ExpORL, 26657KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Department of Neurosciences, Research Group ExpORL, 26657KU Leuven, Leuven, Belgium
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Cadena AC, Lindholm N, Stenfeldt K. School-based hearing screening in Sweden - An evaluation of current practices. Int J Pediatr Otorhinolaryngol 2021; 150:110938. [PMID: 34634590 DOI: 10.1016/j.ijporl.2021.110938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 09/03/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Routines for school hearing screening vary between municipalities in Sweden, and no study has been carried out to investigate how this is conducted throughout the country. The aim of the present study was to determine the extent of school hearing screening, and how it is performed in all the municipalities in Sweden. METHODS An online survey was used to collect information on school hearing screening from municipalities in Sweden (N = 290). The survey included questions on the performance of hearing screening, including stimulus level and frequencies tested, the criteria for referral for further hearing evaluation, as well as the equipment and room used for testing, and who carried out the screening. Questions were also included on experience of, and attitudes towards hearing screening. RESULTS Answers were received from 225 municipalities (response rate 78%). Universal school hearing screening was performed in 202 municipalities, while in the other municipalities hearing screening was performed when a child was evaluated due to speech delay or learning difficulties. Many different protocols were used involving different stimulus levels, frequencies, and referral criteria. The most common was testing with pure tone audiometry with a lowest stimulus level of 20 dB HL at five frequencies, 500-6000 Hz. Hearing screening was usually performed in the preparation class (6 years of age), while in other municipalities it was performed in year 1 (7 years of age). Hearing screening was usually performed once in primary school, while some municipalities carried out screening once in primary school and once in high school. More rarely, hearing screening was conducted twice in primary school. In 25 % of the municipialities, newly arrived immigrant children were screened. Difficulties in performing hearing screening were reported, such as lack of soundproof rooms, lack of time and technical difficulties. There was an opinion among the participants that identifying students with hearing loss is important, as it affects their learning ability and communication skills. and they expressed a desire for national guidelines. CONCLUSIONS Hearing screening is performed in the vast majority of municipally run schools in Sweden. The way in which screening was performed varied regarding the stimulus level and frequencies used, as well as the criteria for referral to a specialist. The attitude towards hearing screening was positive among the participants. Hearing screening of newly immigrated children is important as their previous medical history is often unknown. There is a need for national guidelines on hearing screening of Swedish schoolchildren. Efforts must continue to ensure that the same level of healthcare regarding children's hearing is provided throughout the whole of Sweden.
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Affiliation(s)
- Adriana Cuasquen Cadena
- Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Nina Lindholm
- Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karin Stenfeldt
- Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences, Lund University, Lund, Sweden.
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12
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Denys S, Wouters J, van Wieringen A. The digit triplet test as a self-test for hearing screening at the age of school-entry. Int J Audiol 2021; 61:408-415. [PMID: 34120558 DOI: 10.1080/14992027.2021.1930204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The current study aimed to investigate the feasibility of the digit triplet test (DTT) as a self-test in normal-hearing children at school-entry age (5-6 years) compared to an administrator-controlled test. DESIGN AND STUDY SAMPLE Thirty-seven first grade elementary school children took part in this study. Next to a pure-tone screening, the test battery consisted of a DTT speech-in-noise screening (self-test and administrator-controlled assessment), and cognitive tests related to auditory/working memory and attention skills. RESULTS The reference-SRT ± 2SD, obtained with the administrator-controlled DTT, was -9.8 ± 1.6 dB SNR, and could be estimated with a precision of 0.7 dB. The test duration for one ear was about 4.5 min. Self-tests resulted in higher (poorer) SRTs. Only a small proportion of children performed stably across repeated self-test administrations. With about 6 min for one ear, the test duration was rather long. The influence of auditory/working memory and attentional abilities appeared to be limited. CONCLUSION Our data suggest that a self-administered DTT is not suitable for a large proportion of children at school-entry.
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Affiliation(s)
- Sam Denys
- KU Leuven, Department of Neurosciences, ExpORL, Leuven, Belgium
| | - Jan Wouters
- KU Leuven, Department of Neurosciences, ExpORL, Leuven, Belgium
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13
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Eksteen S, Eikelboom RH, Launer S, Kuper H, Swanepoel DW. Referral Criteria for Preschool Hearing Screening in Resource-Constrained Settings: A Comparison of Protocols. Lang Speech Hear Serv Sch 2021; 52:868-876. [PMID: 34061576 DOI: 10.1044/2021_lshss-21-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results Fail rates for the one-frequency fail protocol was 8.7% (n = 186) and 4.3% (n = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail (p < .001; OR = 0.471; 95% confidence interval [0.385, 0.575]). Gender (p = .251) and age (p = .570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type (p = .204), gender (p = .314), and age (p = .982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 SD) and 64.9 s (55.78 SD) for the one-frequency and two-frequency fail protocols, respectively. Conclusions A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.
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Affiliation(s)
- Susan Eksteen
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Robert H Eikelboom
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Western Australia.,Ear Sciences Centre, The University of Western Australia, Nedlands, Australia
| | - Stefan Launer
- Sonova AG, Science & Technology, Stäfa, Switzerland.,School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Australia
| | - Hannah Kuper
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Western Australia
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14
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Bussé AML, Mackey AR, Carr G, Hoeve HLJ, Uhlén IM, Goedegebure A, Simonsz HJ. Assessment of hearing screening programmes across 47 countries or regions III: provision of childhood hearing screening after the newborn period. Int J Audiol 2021; 60:841-848. [PMID: 33835906 DOI: 10.1080/14992027.2021.1897170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To inventory provision and features of childhood hearing screening after the newborn period (CHS), primarily in Europe. DESIGN From each participating country or region, experts provided information through an extensive questionnaire: implementation year, age at screening, test method, pass criteria, screening location, screener profession, and quality indicators: coverage, referral, follow-up and detection rates, supplemented by literature sources. STUDY SAMPLE Forty-two European countries or regions, plus Russia, Malawi, Rwanda, India, and China. RESULTS CHS was performed universally with pure-tone audiometry screening (PTS) in 17 countries or regions, whereas non-universal CHS was performed in eight with PTS or whisper tests. All participating countries with universal PTS had newborn hearing screening. Coverage rate was provided from three countries, detection rate from one, and referral and follow-up rate from two. In four countries, universal PTS was performed at two ages. Earliest universal PTS was performed in a (pre)school setting by nurses (n = 9, median age: 5 years, range: 3-7), in a healthcare setting by doctors and nurses (n = 7, median age: 4.5 years, range: 4-7), or in both (n = 1). CONCLUSIONS Within universal CHS, PTS was mostly performed at 4-6 years by nurses. Insufficient collection of data and monitoring with quality indicators impedes evaluation of screening.
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Affiliation(s)
- Andrea M L Bussé
- Department of Otorhinolaryngology and Head, Neck Surgery and Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Gwen Carr
- Early Hearing Detection, Intervention and Family Centered Practice, London, UK
| | - Hans L J Hoeve
- Department of Otorhinolaryngology and Head, Neck Surgery and Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - André Goedegebure
- Department of Otorhinolaryngology and Head, Neck Surgery and Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Huibert J Simonsz
- Department of Otorhinolaryngology and Head, Neck Surgery and Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
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15
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Nunes-Araújo ADDS, Balen SA, Pereira Junior A, Barbosa IR. Hearing screening in schoolchildren: accuracy of different criteria used to analyze transient evoked otoacoustic emissions. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/20212362021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to compare the accuracy of different criteria used to analyze transient evoked otoacoustic emissions in schoolchildren. Methods: an accuracy study, where an audiological assessment (audiometry, logoaudiometry, tympanometry) and transient emissions were performed with 70 schoolchildren, from the first to the fifth grade of a municipal school, in Northeastern Brazil (6-14 years, 9.9 ± 2 years), with four criteria, all with signal-to-noise ratio ≥ 3 dB, being: criterion A, in all frequency bands; B, in three consecutive frequency bands; C, in three of the five non-consecutive frequency bands; D, in 2, 3 and 4 kHz. Sensitivity, specificity, accuracy and predictive values with their respective confidence intervals of 95% were analyzed. Results: criterion A showed higher sensitivity (92.31%, 95% CI: 67-98%) and lower specificity (17.35%, 95% CI: 10-29%); criterion C higher specificity (84.21%, 95% CI: 72-91%) and higher positive predictive value (52.63%; 95% CI: 51.63-54.63). Accuracy was 82.85% (95% CI 78.23-87.47) in criterion C and 70% (95% CI: 65.38-74.62) in criterion B. Conclusion: criterion C, signal-to-noise ratio ≥ 3dB in three non-consecutive frequency bands, showed the best accuracy, being considered the best choice as a criterion for the isolated use of transient emissions as a hearing screening procedure, in schoolchildren.
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16
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Denys S, De Laat J, Dreschler W, Hofmann M, van Wieringen A, Wouters J. Language-Independent Hearing Screening Based on Masked Recognition of Ecological Sounds. Trends Hear 2020; 23:2331216519866566. [PMID: 32516059 PMCID: PMC6728675 DOI: 10.1177/2331216519866566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A language-independent automated self-test on tablet based on masked recognition
of ecological sounds, the Sound Ear Check (SEC), was developed. In this test, 24
trials of eight different sounds are randomly presented in a noise that was
spectrally shaped according to the average frequency spectra of the stimulus
sounds, using a 1-up 2-down adaptive procedure. The test was evaluated in adults
with normal hearing and hearing loss, and its feasibility was investigated in
young children, who are the target population of this test. Following
equalization of perceptual difficulty across sounds by applying level
adjustments to the individual tokens, a reference curve with a steep slope of
18%/dB was obtained, resulting in a test with a high test–retest reliability of
1 dB. The SEC sound reception threshold was significantly associated with the
averaged pure tone threshold (r = .70), as well as with the
speech reception threshold for the Digit Triplet Test
(r = .79), indicating that the SEC is susceptible to both
audibility and signal-to-noise ratio loss. Sensitivity and specificity values on
the order of magnitude of ∼70% and ∼80% to detect individuals with mild and
moderate hearing loss, respectively, and ∼80% to detect individuals with slight
speech-in-noise recognition difficulties were obtained. Homogeneity among sounds
was verified in children. Psychometric functions fitted to the data indicated a
steep slope of 16%/dB, and test–retest reliability of sound reception threshold
estimates was 1.3 dB. A reference value of −9 dB signal-to-noise ratio was
obtained. Test duration was around 6 minutes, including training and
acclimatization.
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Affiliation(s)
- Sam Denys
- KU Leuven, Department of Neurosciences, ExpORL, Leuven, Belgium
| | - Jan De Laat
- Leiden University Medical Centre, Department of Audiology, Leiden, the Netherlands
| | - Wouter Dreschler
- Academic Medical Centre, Department of ENT, Clinical and Experimental Audiology, Amsterdam, the Netherlands
| | - Michael Hofmann
- KU Leuven, Department of Neurosciences, ExpORL, Leuven, Belgium
| | | | - Jan Wouters
- KU Leuven, Department of Neurosciences, ExpORL, Leuven, Belgium
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17
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Quick N, Roush J, Erickson K, Mundy M. A Hearing Screening Pilot Study With Students With Significant Cognitive Disabilities. Lang Speech Hear Serv Sch 2020; 51:494-503. [DOI: 10.1044/2019_lshss-19-00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose
Many children with severe intellectual and developmental disabilities are at a higher risk for hearing loss than their peers who are typically developing. Unfortunately, they do not consistently participate in routine school-based hearing screenings. The current study investigated the feasibility of increasing their participation using an otoacoustic emissions protocol and documented results relative to student educational profiles.
Method
A total of 43 students with significant cognitive disabilities enrolled at a public school exclusively serving this population participated in the study. All but 9, who were excluded because of known hearing loss, were screened by a licensed audiologist assisted by audiology doctoral students. The protocol included otoscopy, tympanometry, distortion product otoacoustic emissions (DPOAEs), and teacher surveys.
Results
DPOAE screening was attempted on 33 students without previously diagnosed hearing loss and successfully completed for 26 (78.8%). Two students (4.6%) with absent otoacoustic emissions and normal tympanograms were referred for further assessment due to concerns about possible sensorineural hearing loss in one or both ears, and 10 (23.3%) had abnormal tympanograms in one or both ears.
Conclusions
Considering the high risk of sensorineural hearing loss for children with significant disabilities, it is important for them to be included in school hearing screenings. The results of this study demonstrate the feasibility of using DPOAEs for school-based hearing screenings with this population with an interprofessional team of licensed audiologists, educators, and speech-language pathologists. The results further suggest that students with significant disabilities and hearing loss may be unidentified and underserved. Given the complex needs of this population, an interprofessional practice model for hearing screenings and intervention services is recommended.
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Affiliation(s)
- Nancy Quick
- The Center for Literacy and Disability Studies, University of North Carolina at Chapel Hill
| | - Jackson Roush
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Karen Erickson
- The Center for Literacy and Disability Studies, University of North Carolina at Chapel Hill
| | - Martha Mundy
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
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Y S, R G, Y D, Bz J, S K, V N, M K. Predicting hearing loss in children according to the referrer and referral cause. Int J Pediatr Otorhinolaryngol 2020; 128:109685. [PMID: 31610440 DOI: 10.1016/j.ijporl.2019.109685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hearing assessment in children is considered necessary in all cases involving a doubt regarding hearing acuity. Due to the fact that the number of referrals may be much greater than the actual capacity of a hearing institute, it would be desirable to have a filtering tool in order to detect the cases with higher suspicion of hearing loss. OBJECTIVE To evaluate whether anamnesis details can be used as a sorting tool for detection of highly suspicious cases of hearing loss in preschool children. The anamnesis details may be one or more of the following: the reason for performing hearing test, which caregiver indicated the need for hearing evaluation, the parent's comprehension of their child hearing, and the medical history. METHODS the parents of preschool children, who were referred to the hearing institute at Soroka university medical center, were asked to fill a questionnaire containing 18 questions. The questions referred to details such as: the reason for performing the hearing test; who suggested the existence of hearing impairment; medical history issues and questions regarding details that may indicate a risk of hearing loss. Details such as Otoscopy results were taken from the medical record of the patient. RESULTS 317 preschool and school patients were recruited to the study. Hearing loss was found in 42% of the cases. The most common reason for performing the hearing test was speech disturbance (33%). In cases which the parents were those who raised the suspicion of hearing loss - hearing impairment was found in 61% of the cases, compared to 36% when the speech therapist was the one raising the doubts and to only 18% when the kindergarten teacher was the one raising the doubt. The positive predictive value of patient that their parents suspected the hearing loss combined with pathologic otoscopy result was 82.6% when the reason for the test was hearing impairment suspicion, and 91.3% when the reason for the hearing test was speech disturbance. CONCLUSIONS Parents are the best in assessing their child's hearing followed by the speech therapist and the least sensitive is the school teacher.
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Affiliation(s)
- Slovik Y
- Otolaryngology H&N Surgery Dpt., Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel.
| | - Gorali R
- Speech & Hearing Institute at Soroka University Medical Center, Beer-Sheba, Israel
| | - Dizitzer Y
- Center for Clinical Research, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
| | - Joshua Bz
- Otolaryngology H&N Surgery Dpt., Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
| | - Kordeliuk S
- Otolaryngology H&N Surgery Dpt., Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
| | - Novack V
- Center for Clinical Research, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
| | - Kraus M
- Otolaryngology H&N Surgery Dpt., Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheba, Israel
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19
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Nunes ADDS, Pereira RN, Pereira Junior A, Barbosa IR, Balen SA. Sensitivity and specificity of three hearing screening protocols in the school setting. REVISTA CEFAC 2020. [DOI: 10.1590/1982-0216/20202266519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Reiterer E, Reider S, Lackner P, Fischer N, Dejaco D, Riechelmann H, Zorowka P, Kremsner PG, Adegnika AA, Schmutzhard E, Schmutzhard J. A long-term follow-up study on otoacoustic emissions testing in paediatric patients with severe malaria in Gabon. Malar J 2019; 18:212. [PMID: 31234890 PMCID: PMC6591898 DOI: 10.1186/s12936-019-2840-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 06/17/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In a previous study, severe and cerebral malaria have been connected with acute cochlear malfunction in children, demonstrated by a decrease of transitory evoked otoacoustic emissions (TEOAEs) reproducibility. This study aims to determine whether cochlear malfunction persists for 4 years after recovery from severe malaria in a subset of the previous study's collective. Follow-up TEOAEs were performed on site (CERMEL, Hôpital Albert Schweitzer, Lambaréné, Gabon) or at the participants' homes; 33 out of 90 participants included in the initial investigation by Schmutzhard et al. could be retrieved and were re-examined, 31/33 could be included. Of the 57 missing participants, 51 could not be contacted, 1 had moved away, 4 refused to cooperate, and 1 had died. METHODS As in the initial investigation, participants of this prospective follow-up study were subjected to TEOAE examination on both ears separately. A wave correlation rate of > 60% on both ears was considered a "pass"; if one ear failed to pass, the examination was considered a "fail". The results were compared to the primary control group. Additionally, a questionnaire has been applied focusing on subsequent malaria infections between the primary inclusion and follow-up and subjective impairment of hearing and/or understanding. RESULTS The cohort's mean age was 9 years, 14 children were female, 18 male. 31 had been originally admitted with severe, one with cerebral malaria. 83.8% of participants (n = 26) presented with a TEOAE correlation rate of > 60% on both ears (the cut-off for good cochlear function); in the control group, 92.2% (n = 83) had passed TEOAE examination on both ears. Recurrent severe malaria was associated with a worse TEOAE correlation rate. Age at infection and gender had no influence on the outcome. CONCLUSIONS Cochlear malfunction seems to be persistent after 4 years in more than 16% of children hospitalized for malaria. In a healthy control group, this proportion was 7.8%. Yet, the severity of the initial TEOAE-decrease did not predict a worse outcome.
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Affiliation(s)
- Elisa Reiterer
- Department of Otorhinolaryngology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Simon Reider
- Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Lackner
- Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria
| | - Natalie Fischer
- Department of Otorhinolaryngology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Patrick Zorowka
- Department of Hearing, Speech and Voice Disorders, Medical University, Innsbruck, Austria
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (MRUG), Lambaréné, Gabon.,Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (MRUG), Lambaréné, Gabon
| | - Erich Schmutzhard
- Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Teplitzky TB, Angster K, Rosso LE, Ferruggiaro AR, Isaiah A, Pereira KD. The Role of Cognitive Evaluation in Predicting Successful Audiometric Testing among Children. Otolaryngol Head Neck Surg 2019; 160:1106-1110. [PMID: 30776957 DOI: 10.1177/0194599819832510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the role of cognitive testing in predicting age-appropriate audiometric responses among children aged 30 to 42 months. STUDY DESIGN Prospective. SETTING Tertiary care audiology clinic. SUBJECTS AND METHODS Subjects included primary English-speaking children aged 30 to 42 months. A certified pediatric audiologist performed the cognitive aspect of the Developmental Assessment of Young Children-Second Edition (DAYC-2). A second, blinded audiologist performed age-appropriate audiometry. The raw, age-equivalent, percentile, and standard DAYC-2 scores were compared by agreement between speech reception threshold (SRT) and pure tone average (PTA). Optimal DAYC-2 thresholds were also calculated for prediction of SRT-PTA agreement and assessed for sensitivity, specificity, and positive and negative predictive values. P < .05 was considered significant. RESULTS Complete data were obtained from 37 children. The mean age was 34.9 months (95% CI, 33.5-36.2), and 15 (41%) were female. Among the 37 children, 24 (65%) and 13 (35%) underwent visual reinforcement audiometry and conditioned play audiometry, respectively. SRT-PTA agreement was seen in 32 (87%) tests. Mean DAYC-2 raw score grouped by SRT-PTA agreement was 39.4 versus 33.4 for nonagreement (2.8-9.3, P < .001). The mean age-equivalent score grouped by SRT-PTA agreement was 29.6 versus 23.0 for nonagreement (2.7-10.6, P = .002). Optimal cut points based on DAYC-2 scores achieved moderate overall prediction performance (area under the curve, 0.73-0.77) with a positive predictive value of 100%. CONCLUSION The DAYC-2 is a useful screen to identify children likely to complete an age-appropriate audiogram.
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Affiliation(s)
- Taylor B Teplitzky
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Kristen Angster
- 2 Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Lauren E Rosso
- 3 School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Anne R Ferruggiaro
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Amal Isaiah
- 4 Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kevin D Pereira
- 4 Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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Emmett SD, Robler SK, Wang NY, Labrique A, Gallo JJ, Hofstetter P. Hearing Norton Sound: a community randomised trial protocol to address childhood hearing loss in rural Alaska. BMJ Open 2019; 9:e023078. [PMID: 30782695 PMCID: PMC6340015 DOI: 10.1136/bmjopen-2018-023078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/26/2018] [Accepted: 09/28/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The population in rural Alaska experiences a disproprionately high burden of infection-mediated hearing loss. While the state mandates school hearing screening, many children with hearing loss are not identified or are lost to follow-up before ever receiving treatment. A robust, tribally owned healthcare system exists in Alaska, but children with hearing loss must first be identified and referred for existing infrastructure to be used. This trial will evaluate a new school hearing screening and referral process in rural Alaska, with the goal of improving timely identification and treatment of childhood hearing loss. METHODS AND ANALYSIS Comparative effectiveness community randomised trial testing digital innovations to improve school hearing screening and referral in 15 communities in the Norton Sound region of northwest Alaska, with data collection from October 2017 to February 2020. All children (K-12) attending school in Bering Strait School District with parental informed consent and child assent will be eligible (target recruitment n=1500). Participating children will undergo both the current school hearing screen and new mobile health (mHealth) screen, with screening test validity evaluated against an audiometric assessment. Communities will be cluster randomised to continue the current primary care referral process or receive telemedicine referral for follow-up diagnosis and treatment. The primary outcome will be time to International Statistical Classification of Diseases, 10th Revision, ear/hearing diagnosis from screening date, measured in days. Secondary outcomes will include: sensitivity and specificity of current school and mHealth screening protocols measured against a benchmark audiometric assessment (air and bone conduction audiometry, tympanometry and digital otoscopy); hearing loss prevalence; hearing-related quality of life; and school performance (AIMSweb). Intention-to-treat analysis will be used. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Boards of Alaska Area, Norton Sound and Duke University and is registered on clinicaltrials.gov. Results will be distributed with equal emphasis on scientific and community dissemination. TRIAL REGISTRATION NUMBER NCT03309553; Pre-results.
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Affiliation(s)
- Susan D Emmett
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Departments of Biostatistics and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alain Labrique
- Departments of International Health and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Cedars E, Kriss H, Lazar AA, Chan C, Chan DK. Use of otoacoustic emissions to improve outcomes and reduce disparities in a community preschool hearing screening program. PLoS One 2018; 13:e0208050. [PMID: 30532159 PMCID: PMC6287830 DOI: 10.1371/journal.pone.0208050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hearing loss substantially impacts pediatric development, and early identification improves outcomes. While intervening before school-entry is critical to optimize learning, early-childhood hearing screening practices are highly variable. Conditioned play audiometry (CPA) is the gold standard for preschool hearing screening, but otoacoustic emission (OAE) testing provides objective data that may improve screening outcomes. OBJECTIVES To compare outcomes of a community-based low-income preschool hearing program before and after implementation of OAE in a single-visit, two-tiered paradigm. We hypothesized that this intervention would reduce referral rates and improve follow-up while maintaining stable rates of diagnosed sensorineural hearing loss. METHODS We performed a cohort study of 3257 children screened from July 2014-June 2016. Department of Public Health data were analyzed pre- and post-implementation of second-line OAE testing for children referred on CPA screening with targeted follow-up by DPH staff. Primary outcomes included referral rates, follow-up rates, and diagnosis of sensorineural hearing loss. RESULTS Demographics, pure-tone pass rates, and incidence of newly-diagnosed permanent hearing loss were similar across years. After intervention, overall pass rates increased from 92% to 95% (P = 0.0014), while only 0.7% remained unable to be tested (P<0.0001). 5% of children were unable to be tested by CPA screening but passed OAE testing, obviating further evaluation. Referral rate decreased from 8% to 5% (P = 0.0014), and follow-up improved from 36% to 91% (P<0.0001). Identification of pathology in children with follow-up increased from 19% to over 50%. Further, disparities in pass rates and ability to test seen in Year 1 were eliminated in Year 2. CONCLUSION AND RELEVANCE In a community setting, implementation of second-line OAE screening for CPA referrals reduced referral rates, increased identification of hearing loss, reduced outcome disparities, and improved follow-up rates. This study provides lessons in how to improve outcomes and reduce disparities in early-childhood hearing screening.
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Affiliation(s)
- Elizabeth Cedars
- University of California San Francisco, Department of Otolaryngology–Head and Neck Surgery, San Francisco, CA, United States of America
| | - Hayley Kriss
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Ann A. Lazar
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States of America
| | - Curtis Chan
- San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Dylan K. Chan
- University of California San Francisco, Department of Otolaryngology–Head and Neck Surgery, San Francisco, CA, United States of America
- * E-mail:
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Yimtae K, Israsena P, Thanawirattananit P, Seesutas S, Saibua S, Kasemsiri P, Noymai A, Soonrach T. A Tablet-Based Mobile Hearing Screening System for Preschoolers: Design and Validation Study. JMIR Mhealth Uhealth 2018; 6:e186. [PMID: 30355558 PMCID: PMC6231828 DOI: 10.2196/mhealth.9560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 07/13/2018] [Accepted: 07/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Hearing ability is important for children to develop speech and language skills as they grow. After a mandatory newborn hearing screening, group or mass screening of children at later ages, such as at preschool age, is often practiced. For this practice to be effective and accessible in low-resource countries such as Thailand, innovative enabling tools that make use of pervasive mobile and smartphone technology should be considered. Objective This study aims to develop a cost-effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. Methods An Android-based screening app was developed. The screening protocol involved asking children to choose pictures corresponding to a set of predefined words heard at various sound levels offered in a specifically designed sequence. For the app, the set of words was validated, and their corresponding speech power levels were calibrated. We recruited 122 children, aged 4-5 years, during the development phase. Another 63 children of the same age were screened for their hearing abilities using the app in version 2. The results in terms of the sensitivity and specificity were compared with those measured using the conventional audiometric equipment. Results For screening purposes, the sensitivity of the developed screening system version 2 was 76.67% (95% CI 59.07-88.21), and the specificity was 95.83% (95% CI 89.77-98.37) for screening children with mild hearing loss (pure-tone average threshold at 1, 2, and 4 kHz, >20 dB). The time taken for the screening of each child was 150.52 (SD 19.07) seconds (95% CI 145.71-155.32 seconds). The average time used for conventional play audiometry was 11.79 (SD 3.66) minutes (95% CI 10.85-12.71 minutes). Conclusions This study shows the potential use of a tablet-based system for rapid and mobile hearing screening. The system was shown to have good overall sensitivity and specificity. Overall, the idea can be easily adopted for systems based on other languages.
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Affiliation(s)
- Kwanchanok Yimtae
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pasin Israsena
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
| | - Panida Thanawirattananit
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sangvorn Seesutas
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
| | - Siwat Saibua
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
| | - Pornthep Kasemsiri
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anukool Noymai
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
| | - Tharapong Soonrach
- National Electronics and Computer Technology Center, National Science and Technology Development Agency, Klong Luang, Pathumthani, Thailand
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Govender SM, Mars M. Assessing the efficacy of asynchronous telehealth-based hearing screening and diagnostic services using automated audiometry in a rural South African school. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2018; 65:e1-e9. [PMID: 30035608 PMCID: PMC6111388 DOI: 10.4102/sajcd.v65i1.582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/21/2018] [Accepted: 03/06/2018] [Indexed: 11/17/2022] Open
Abstract
Background Asynchronous automated telehealth-based hearing screening and diagnostic testing can be used within the rural school context to identify and confirm hearing loss. Objective The aims of the study were to evaluate the efficacy of an asynchronous telehealth-based service delivery model using automated technology for screening and diagnostic testing as well as to describe the prevalence, type and degree of hearing loss. Method A comparative within-subject design was used. Frequency distributions, sensitivity, specificity scores as well as the positive and negative predictive values were calculated. Testing was conducted in a non-sound-treated classroom within a school environment on 73 participants (146 ears). The sensitivity and specificity rates were 65.2% and 100%, respectively. Diagnostic accuracy was 91.7% and the negative predictive values (NPV) and positive predictive values (PPV) were 93.8% and 100%, respectively. Results Results revealed that 23 ears of 20 participants (16%) presented with hearing loss. Twelve per cent of ears presented with unilateral hearing impairment and 4% with bilateral hearing loss. Mild hearing loss was identified as most prevalent (8% of ears). Eight ears obtained false-negative results and presented with mild low- to mid-frequency hearing loss. The sensitivity rate for the study was low and was attributed to plausible reasons relating to test accuracy, child-related variables and mild low-frequency sensory-neural hearing loss. Conclusion The study demonstrates that asynchronous telehealth-based automated hearing testing within the school context can be used to facilitate early identification of hearing loss; however, further research and development into protocol formulation, ongoing device monitoring and facilitator training is required to improve test sensitivity and ensure accuracy of results.
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Pitt-Byrne T. Irish School Entry Screening referral trends and cohort comparison with preschool specialist referrals. Int J Audiol 2018; 57:510-518. [PMID: 29504414 DOI: 10.1080/14992027.2018.1437284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To analyse referral cohorts from School Entry Screening, Hearing (SHS) and Vision Screening (SVS) before and after documented changes. To compare referrals to pre-school specialists with subsequent group SHS outcomes. DESIGN Randomized cohort, audit analysis of Community Nursing Developmental and SES records (CHRs), plus Audiology file review for SHS referrals. STUDY SAMPLE Six hundred and sixty-eight mainstream pupils' CHRs were analysed in four birth cohorts, post-SES, using coded anonymized records. RESULTS Significant referral rate differences existed between SHS and SVS. SHS, not SVS, referrals were impacted by nursing staff changes but not by SHS protocol changes. Preschool Audiology referrals outnumbered SHS referrals. All PCHI children with amplification were detected prior to SHS. SHS program yielded conductive hearing loss only. Similar SHS referral rates occurred for pre-school Speech Language Therapy referrals compared to children not referred; just 16% of pre-school Speech Language Therapy primary referrals were referred on to Audiology. CONCLUSIONS SHS referral percentage fell slightly; SVS referral percentage remained unchanged. Low referral rates and low SHS hearing loss yield has modest impact upon Audiology services, but audiometrically screened referrals deserve higher priority. UNHS children born after 2011 create bigger Audiology service impact. International comparisons and European SHS research collaboration are encouraged.
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Affiliation(s)
- Theresa Pitt-Byrne
- a Department of Audiology , HSE Community Audiology Service , Wexford , Ireland
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Dejaco D, Aregger FC, Hurth HV, Kegele J, Muigg V, Oberhammer L, Bunk S, Fischer N, Pinggera L, Riedl D, Otieno A, Agbenyega T, Adegnika AA, Riechelmann H, Lackner P, Zorowka P, Kremsner P, Schmutzhard J. Evaluation of transient-evoked otoacoustic emissions in a healthy 1 to 10 year pediatric cohort in Sub-Saharan Africa. Int J Pediatr Otorhinolaryngol 2017; 101:65-69. [PMID: 28964312 DOI: 10.1016/j.ijporl.2017.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Transient-evoked otoacoustic emissions (TEOAEs) monitor cochlear function. High pass rates have been reported for industrialized countries. Pass rates in low and middle income countries such as Sub-Saharan Africa are rare, essentially lower and available for children up to 4 years of age and frequently based on hospital recruitments. This study aims at providing additional TEOAE pass rates of a healthy Sub-Saharan cohort aged 1-10 years with data from Gabon, Ghana and Kenya. Potentially confounding factors (recruitment site, age) are taken into consideration. METHODS Healthy children were recruited in hospitals, schools and kindergartens. Inclusion criteria were age 1-10 years and normal otoscopic findings. Exclusion criteria were any sickness or physical ailment potentially impairing the hearing capacity. Five measurements per ear were performed with Capella Cochlear Emission Analyzer (MADSEN, Germany). An overall wave reproducibility of above 60% served as pass-criterion. Pass rates were compared between recruitment sites and age groups (1-5 and 6-10 years). RESULTS Overall pass rate was 87.5% (n = 264; 231 passes vs. 33 fails). Of these 84.0% of hospital recruited children passed (n = 156; 131 passes vs. 25 fails), compared to 92.6% of community recruitments (n = 108; 100 passes vs. 8 fails), which was significantly different p = 0.039). If analyzed by age groups, this difference was only observed in children younger than 6 years (p = 0.007). CONCLUSION Hospitals as recruitment sites for healthy controls seem to affect TEOAE pass rates. We advise for a cautious approach when recruiting healthy TEOAE control collectives under the age of 6 in a hospital setting. In children older than 6 years conventional pure-tone audiometry remains the standard method for hearing screening.
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Affiliation(s)
- Daniel Dejaco
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria.
| | - Fabian C Aregger
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Helene V Hurth
- Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria
| | - Josua Kegele
- Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria
| | - Veronika Muigg
- Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria
| | - Lukas Oberhammer
- Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria
| | - Sebastian Bunk
- Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria
| | - Natalie Fischer
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Leyla Pinggera
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - David Riedl
- Department of Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Allan Otieno
- Center for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Tsiri Agbenyega
- Komfo Anokye Teaching Hospital & Kwame Nkrumah University of Science and Technology l, Kumasi, Ghana
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Herbert Riechelmann
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Lackner
- Department of Neurology, NICU, Medical University Innsbruck, Innsbruck, Austria
| | - Patrick Zorowka
- Department of Hearing, Speech and Voice Disorders, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Kremsner
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria
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Sheikh Rashid M, Dreschler WA, de Laat JAPM. Evaluation of an internet-based speech-in-noise screening test for school-age children. Int J Audiol 2017; 56:967-975. [PMID: 28936876 DOI: 10.1080/14992027.2017.1378932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate a Dutch online speech-in-noise screening test (in Dutch: "Kinderhoortest") in normal-hearing school-age children. Sub-aims were to study test-retest reliability, and the effects of presentation type and age on test results. DESIGN An observational cross-sectional study at school. Speech reception thresholds (SRTs) were obtained through the online test in a training condition, and two test conditions: on a desktop computer and smartphone. The order of the test conditions was counterbalanced. STUDY SAMPLE Ninety-four children participated (5-12 years), of which 75 children were normal-hearing (≤25 dB HL at 0.5 kHz, ≤20 dB HL at 1-4 kHz). RESULTS There was a significant effect for test order for the two test conditions (first or second test), but not for presentation type (desktop computer or smartphone) (repeated measures analyses, F(1,75) = 12.48, p < 0.001; F(1,75) = 0.01, p = 0.982). SRT significantly improved by age year (first test: 0.25 dB SNR, 95% CI: -0.43 to -0.08, p = 0.004. Second test: 0.29 dB SNR, 95% CI: -0.46 to -0.11; p = 0.002). CONCLUSIONS The online test shows potential for routine-hearing screening of school-age children, and can be presented on either a desktop computer or smartphone. The test should be evaluated further in order to establish sensitivity and specificity for hearing loss in children.
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Affiliation(s)
- Marya Sheikh Rashid
- a Clinical and Experimental Audiology, Amsterdam Public Health Research Institute , Academic Medical Center (AMC) Amsterdam , Amsterdam , The Netherlands and
| | - Wouter A Dreschler
- a Clinical and Experimental Audiology, Amsterdam Public Health Research Institute , Academic Medical Center (AMC) Amsterdam , Amsterdam , The Netherlands and
| | - Jan A P M de Laat
- b Department of Audiology , Leiden University Medical Center , Leiden , The Netherlands
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Oye J, Mactaggart I, Polack S, Schmidt E, Tamo V, Okwen M, Kuper H. Prevalence and Causes of Visual Impairment in Fundong District, North West Cameroon: Results of a Population-Based Survey. Ophthalmic Epidemiol 2017; 24:394-400. [PMID: 28886257 DOI: 10.1080/09286586.2017.1313992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To estimate the prevalence and causes of visual impairment in Fundong Health District, North West Cameroon. METHODS A total of 51 clusters of 80 people (all ages) were sampled with probability proportionate to size and compact segment sampling. Visual acuity (VA) was measured with a tumbling "E" chart. An ophthalmic nurse examined people with VA<6/18 in either eye. The presence of hearing and physical impairments were assessed using clinical examination, and self-reported visual problems using the Washington Group Short Set. RESULTS In total, 4080 people were enumerated of whom 3567 were screened (response rate 87%). The overall prevalence of visual impairment was 2.3% (95% CI 1.8-3.0%) and blindness was 0.6% (0.3-1.0%). The prevalence of both blindness and visual impairment increased rapidly with age, so that the vast majority of cases of visual impairment (84%) and blindness (82%) were in people aged 50+. Posterior segment disease and cataract were the main causes of blindness and visual impairment, with refractive error also an important cause of visual impairment. Cataract surgical coverage (proportion of all cataracts that had received surgery) was relatively high (87% of people at VA<6/60). Post-surgery outcomes were poor, with 31% of operated eyes having VA<6/60. Among the 82 people with visual impairment, 22% had a physical impairment or epilepsy and 30% had a hearing impairment. Self-reported difficulties in vision were relatively closely related to clinical measures of visual impairment. CONCLUSIONS Ophthalmic programmes in Cameroon need to incorporate control of posterior segment diseases while also working to improve outcomes after cataract surgery.
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Affiliation(s)
| | - Islay Mactaggart
- b International Centre for Evidence in Disability , London School of Hygiene & Tropical Medicine , London , UK
| | - Sarah Polack
- b International Centre for Evidence in Disability , London School of Hygiene & Tropical Medicine , London , UK
| | | | - Violet Tamo
- d Centre for the Development of Good Practices in Health , Yaounde , Cameroon
| | - Marvice Okwen
- e Mbingo Baptist Hospital , Fundong , North West Region , Cameroon
| | - Hannah Kuper
- b International Centre for Evidence in Disability , London School of Hygiene & Tropical Medicine , London , UK
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Høydal EH, Lein Størmer CC, Laukli E, Stenklev NC. Transient evoked otoacoustic emissions in rock musicians. Int J Audiol 2017; 56:685-691. [PMID: 28471285 DOI: 10.1080/14992027.2017.1321788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Our focus in this study was the assessment of transient evoked otoacoustic emissions (TEOAEs) in a large group of rock musicians. A further objective was to analyse tinnitus among rock musicians as related to TEOAEs. DESIGN The study was a cross-sectional survey of rock musicians selected at random. A control group was included at random for comparison. STUDY SAMPLE We recruited 111 musicians and a control group of 40 non-musicians. Testing was conducted by using clinical examination, pure tone audiometry, TEOAEs and a questionnaire. RESULTS TEOAE SNR in the half-octave frequency band centred on 4 kHz was significantly lower bilaterally in musicians than controls. This effect was strongly predicted by age and pure-tone hearing threshold levels in the 3-6 kHz range. Bilateral hearing thresholds were significantly higher at 6 kHz in musicians. Twenty percent of the musicians had permanent tinnitus. There was no association between the TEOAE parameters and permanent tinnitus. CONCLUSIONS Our results suggest an incipient hearing loss at 6 kHz in rock musicians. Loss of TEOAE SNR in the 4 kHz half-octave frequency band was observed, but it was related to higher mean 3-6 kHz hearing thresholds and age. A large proportion of rock musicians have permanent tinnitus.
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Affiliation(s)
- Erik Harry Høydal
- a Faculty of Medicine , Norwegian University of Science and Technology , Trondheim , Norway
| | | | - Einar Laukli
- c Ear, Nose and Throat Department , University Hospital of Tromsø , Tromsø , Norway
| | - Niels Christian Stenklev
- d Ear, Nose and Throat Department , Institute of Clinical Medicine, UiT the Arctic University of Norway , Tromsø , Norway , and.,e Department of Neurosurgery , Eye and ENT Diseases, University Hospital of Tromsø , Tromsø , Norway
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Sampson J, Thompson H. Youth hearing impairment: Early detection is key. Nursing 2017; 47:52-56. [PMID: 28328777 DOI: 10.1097/01.nurse.0000512877.14257.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Janice Sampson
- At California State University, Sacramento, Janice Sampson is an assistant professor in the School of Nursing and Heather Thompson is an assistant professor in the Department of Communication Sciences and Disorders
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Winston-Gerson R, Sabo DL. Hearing Loss Detection in Schools and Early Child Care Settings: An Overview of School-Age Hearing Screening Practices. NASN Sch Nurse 2016; 31:257-62. [PMID: 27481476 DOI: 10.1177/1942602x16661362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The school nurse is the key figure in successful school screening programs. A student with unidentified and unmet health care needs is unlikely to perform at their full potential, both academically and socially. The purpose of the article is to serve as a resource, providing guidance, strategies, and a discussion of available equipment to assist with successful screening programs.
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Affiliation(s)
| | - Diane L Sabo
- Hearing Screening Program Manager, Audiology Systems, Schaumburg, IL
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33
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Bennett CL, Mihajloski T, Özdamar Ö. Signal-to-noise ratio improvement of swept-tone-generated transient otoacoustic emissions. Med Biol Eng Comput 2016; 55:69-78. [PMID: 27106751 DOI: 10.1007/s11517-016-1507-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/30/2016] [Indexed: 11/28/2022]
Abstract
In this study, we utilized the swept-tone (ST) deconvolution method for comparing the signal-to-noise ratio (SNR) characteristics of ST otoacoustic emissions (OAE) to conventionally acquired click, or transient-evoked (TE), OAE. We generated a hearing-level equalized (HLeq) ST stimulus based on normative loudness metrics at the different frequencies present in the ST. Due to noise-shaping properties of the ST deconvolution method, we anticipated a theoretical SNR gain of +4.26 dB in STOAE compared to TEOAE acquired under comparable settings. This prediction was confirmed by computer simulation. HLeq STOAE and TEOAE were then acquired from each of the 22 ears that were tested at five stimulation levels from 5 to 45 dB HL, and analyzed responses in terms of their overall SNR. We found that the overall SNR of the HLeq STOAE responses at stimulation levels at or above 15 dB HL was significantly higher than that of TEOAE by an average of +3.6 dB. Importantly, this leads to recording quality and time-saving improvements in clinical hearing screenings.
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Affiliation(s)
- Christopher L Bennett
- Music Engineering Technology, Frost School of Music, University of Miami, Founder's Hall Rm. 140, 1550 Brescia Ave, Coral Gables, FL, 33146, USA.
| | - Todor Mihajloski
- Department of Biomedical Engineering, College of Engineering, University of Miami, McArthur Annex Rm. 219, 1251 Memorial Dr, Coral Gables, FL, 33146, USA
| | - Özcan Özdamar
- Department of Biomedical Engineering, College of Engineering, University of Miami, McArthur Annex Rm. 219, 1251 Memorial Dr, Coral Gables, FL, 33146, USA
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Govender S, Latiff N, Asmal N, Ramsaroop S, Mbele T. Evaluating the Outcomes of a Hearing Screening Service for Grade One Learners in Urban Areas at Durban, South Africa. J Public Health Afr 2015; 6:529. [PMID: 28299139 PMCID: PMC5349266 DOI: 10.4081/jphia.2015.529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/15/2015] [Accepted: 04/04/2015] [Indexed: 11/23/2022] Open
Abstract
Early intervention through hearing screening can reduce the negative impact of hearing loss for children. Optimal outcomes are achieved when an appropriate screening protocol is selected, a pathway for follow up care is established, and when a hearing conservation component is included. This study aimed to describe the outcomes of a hearing screening service provided to grade one learners in urban areas at Durban. A cross-sectional design was employed. Learners (n=241) were conveniently sampled from six randomly selected schools. They were screened using otoscopy, tympanometry and pure tone audiometry. Fifty eight participants (24%) obtained a refer result, with 33% referred for diagnostic assessments, 29% for middle ear pathology and 38% for cerumen management. Findings further revealed that only 33% of referrals were followed up indicating poor compliance. Association between test results and income levels (P=0.38) as well as distance to the nearest health care facility (P=0.22) did not influence test outcomes. School aged children do present with common ear problems. Appropriate protocol selection, ensuring compliance to recommendations and education on hearing conservation are essential components of any health initiative.
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Affiliation(s)
- Samantha Govender
- Department of Audiology, University of KwaZulu-Natal, Durban, South Africa
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