Validity of Pure-Tone Hearing Screening at Well-Child Visits.

Donna R. Halloran, MD, MSPH; J. Michael Hardin, PhD; Terry C. Wall, MD, MPH
Arch Pediatr Adolesc Med. 2009;163(2):158-163.
Objective: to estimate the sensitivity and specificity of pure-tone audiometry hearing screening in the primary care setting.
Design: prospective cohort study.
Setting: eight academic and private pediatric practices.
Participants: a subset of children from a convenience sample of 1061 children between 3 and 19 years of age were screened for hearing loss using pure-tone audiometry.
Intervention: formal audiologic evaluations (gold standard) for those children referred by their primary care physician (28 children) and for a random sample of children not referred (102 children).
Main Exposure: pure-tone audiometry screening.
Main Outcome: measures Audiologic evaluations.
Results: a total of 28 children were referred to an audiologist for formal hearing testing after pure-tone audiometry screening during a well-child visit, at which 25 children did not pass the initial screening and 3 could not complete the screening. Of the 25 children, only 7 were evaluated by an audiologist, for a follow-up rate of 25%. One child was diagnosed as having hearing loss. Formal audiologic assessment was also performed on a random sample of 102 children who were not referred to the audiologist. For the random sample, hearing loss was identified in 2 of 76 (3%) children who passed and 1 of 16 (6%) children who did not pass pure tone audiometry screening. The sensitivity and specificity of pure-tone audiometry were 50% and 78%, respectively.
Conclusion: in light of the increasing burden on physicians to provide preventive care, this study calls into question the value of hearing screening using pure-tone audiometry during well-child visits given the lack of follow-up after referral and the poor sensitivity.