A comparison of audiometric and objective methods in hearing screening of school children. A preliminary study

Hearing thresholds elevation and potential association with emotional problems among 1,914 children in Beijing, China

Objectives

School-aged children may experience hearing loss and emotional problems. Previous studies have shown a bidirectional relationship between hearing loss and emotional problems in the elderly population, and we aimed to analyze the association between hearing thresholds and emotional problems in school-aged children.

Methods

Based on the Beijing Child Growth and Health Cohort (PROC) study, the hearing screenings were conducted in November 2019 using pure tone audiometry. A total of 1,877 parents completed the Strengths and Difficulties Questionnaire (SDQ) to assess children's emotional and behavioral status. We used generalized linear regression analysis to assess the potential association of emotional problems with hearing thresholds, based on multiple imputed datasets with a sample size of 1,914.

Results

The overall pass rate of hearing screening was 91.5%. The abnormal rate of SDQ total difficulties was 55.8%. Emotional symptoms were positively associated with left ear average hearing thresholds (β = 0.24, 95%CI: 0.08–0.40), and right ear average hearing thresholds (β = 0.18, 95%CI: 0.04–0.32). Conduct problems, hyperactivity/inattention, peer problems, and prosocial behaviors had no association with the pass rate of the hearing screening. Regarding emotional symptoms, boys with many fears and who are easily scared coincided with increased right ear average hearing thresholds (β = 0.67, 95%CI: 0.01–1.33). Girls having many worries, frequently feeling unhappy and downhearted were positively associated with left and right ear average hearing thresholds, respectively (β = 0.96, 95%CI: 0.20–1.73; β = 0.72, 95%CI: 0.07–1.37).

Conclusions

The co-occurrence of hearing problems and emotional problems of children aged 6–8 in Beijing attracts attention. It is important to address undiscovered hearing loss and emotional problems from the perspective of comorbidity driving factors.

Hearing Screening among First-Grade Children in Rural Areas and Small Towns in Małopolskie Voivodeship, Poland

Undiagnosed hearing deficits hamper a child’s ability to learn. Hearing screening in school aged children helps detect educationally significant hearing loss and prevents negative impacts on academic achievement. The main purpose of this study was to improve early detection and assess the incidence of hearing disorders in first-graders from rural areas and small towns in the Małopolskie Voivodeship of Poland. There were 5029 children aged 6–7 years. Hearing thresholds were measured over the frequency range 0.5–8 kHz. A result was considered positive (abnormal) if the hearing threshold was worse than 20 dB HL at one or more frequencies. The prevalence of hearing loss was estimated in terms of four-frequency hearing loss, high-frequency hearing loss, and low-frequency hearing loss. Parents filled in a brief audiological questionnaire. The analysis was performed using IBM SPSS Statistics, version 24. Of all the children, 20.5% returned a positive result and were referred for further audiological diagnoses. The estimated prevalence of hearing loss was 11.6%, made up of 6.5% with FFHL, 7.6% with HFHL, and 8.2% with LFHL. This study showed that large numbers of children in the district had hearing problems. Adoption of hearing screening in primary schools is recommended as a routine procedure within preventive pediatric health care.

Organizational Aspects and Outcomes of a Hearing Screening Program Among First-Grade Children in the Mazovian Region of Poland

Purpose The purpose of this study is to describe and assess a hearing screening program of first-grade children in Poland. The program aimed to detect hearing disorders and increase awareness among parents of hearing problems. Method A hearing screening program was conducted in all elementary schools of the biggest region in Poland. A total of 34,618 first-graders were screened. The hearing screening protocol included video otoscopy and pure-tone audiometry. The program also included an information campaign directed to the local community and educational meetings between parents and medical staff. Results The estimated prevalence of hearing loss was 11%. Unilateral hearing loss was more common than bilateral hearing loss. Mild hearing loss was more frequent than moderate (or worse) hearing loss. In otoscopy, the most common positive result was otitis media with effusion. Parents and medical staff took part in 1,608 educational meetings, broadening the parents' knowledge of how to care for hearing. Conclusions A hearing screening program not only provides data on the prevalence of childhood hearing problems but is also an avenue for providing the local community with valuable knowledge about how to care for hearing. This study demonstrated the importance for systematic monitoring of children's hearing status and of increasing awareness among parents and teachers of the significance of hearing loss. The hearing screening of children starting school should become a standard part of school health care programs.

Referral Criteria for Preschool Hearing Screening in Resource-Constrained Settings: A Comparison of Protocols

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.

The Formation of Biofilm and Bacteriology in Otitis Media with Effusion in Children: A Prospective Cross-Sectional Study

BACKGROUND

Otitis media with effusion (OME) can cause serious complications such as hearing impairment or development delays. The aim of the study was to assess the microbiological profile of organisms responsible for OME and to determine if a biofilm formation can be observed.

METHODS

Ninety-nine samples from 76 patients aged from 6 months to 12 years were collected for microbiological and molecular studies.

RESULTS

In microbiological studies, pathogenic bacteria Haemophilus influenzae (38.89%), Streptococcus pneumoniae (33.33%), and Staphylococcus aureus MSSA (27.78%), as well as opportunistic bacteria Staphylococcus spp. (74.14%), Diphtheroids (20.69%), Streptococcus viridans (3.45%), and Neisseria spp. (1.72%) were found. The average degree of hearing loss in the group of children with positive bacterial culture was 35.9 dB, while in the group with negative bacterial culture it was 25.9 dB (p = 0.0008). The type of cultured bacteria had a significant impact on the degree of hearing impairment in children (p = 0.0192). In total, 37.5% of Staphylococcus spp. strains were able to form biofilm.

CONCLUSIONS

Staphylococcus spp. in OME may form biofilms, which can explain the chronic character of the disease. Pathogenic and opportunistic bacteria may be involved in the etiopathogenesis of OME. The degree of hearing loss was significantly higher in patients from which the positive bacterial cultures were obtained.

Prevalence of tinnitus in a sample of 43,064 children in Warsaw, Poland

OBJECTIVE

Tinnitus affects both adults and children. Children rarely complain spontaneously of tinnitus, and their parents are not aware of the condition. The prevalence of tinnitus in children differs considerably between studies, and large studies are needed to reliably estimate how many children experience tinnitus symptoms. The goal of the study was to estimate the prevalence of tinnitus in a large sample of schoolchildren.

DESIGN

This study was population-based, epidemiological research, conducted in the general, paediatric population of school-age children in Warsaw, Poland. Pure-tone audiometric testing was done, and hearing thresholds were determined from 0.5 to 8 kHz. Both the children and parents answered questions about the presence of tinnitus in the child.

STUDY SAMPLE

Results from 43,064 children aged 11 to 13 years old, as well as their parents, were collected.

RESULTS

The study showed that tinnitus affected 3.1% of the children, but it was significantly more frequent (9%) in children with hearing loss. We found that 1.4% of the parents were aware of the presence of tinnitus in their children.

CONCLUSIONS

Children should be routinely asked whether they experience tinnitus and if so, they should be included in the thorough assessment and management of the condition.

Personal Music Players Use and Other Noise Hazards among Children 11 to 12 Years Old

Exposure to loud music-due to widespread personal music players (PMPs) and noisy leisure activities-are major risk factors for noise induced hearing loss (NIHL) in adolescents. However, there is little evidence of the impact of noise on the hearing of younger children. This study aimed to explore an association between PMP use and hearing, and to identify other sources of noise among children. The study sample consisted of 1032 children aged 11-12 years old. Hearing thresholds were determined from 0.5 to 8 kHz. PMP use and other noise exposures were evaluated using a survey. We found that 82% of the children had a PMP, and 78% were exposed to noise when playing computer games. An audiometric notch was documented in 1.3% of the children. Only 11.5% of the children ever used hearing protection while engaged in noisy activities. We found no convincing evidence of an association between PMP use and hearing thresholds, although our results suggest that tinnitus may be an early sign of NIHL in young children. The study shows a need to provide children, their parents, and educators with knowledge of how to take care of hearing, including how to avoid and minimize noise exposure.

Pediatric Speech Audiometry Web Application for Hearing Detection in the Home Environment

This paper describes the development of the speech audiometry application for pediatric patients in Slovak language and experiences obtained during testing with healthy children, hearing-impaired children, and elderly persons. The first motivation behind the presented work was to reduce the stress and fear of the children, who must undergo postoperative audiometry, but over time, we changed our direction to the simple game-like mobile application for the detection of possible hearing problems of children in the home environment. Conditioned play audiometry principles were adopted to create a speech audiometry application, where children help the virtual robot Thomas assign words to pictures; this can be described as a speech recognition test. Several game scenarios together with the setting condition issues were created, tested, and discussed. First experiences show a positive influence on the children’s mood and motivation.

Results of hearing screening of school-age children in Bishkek, Kyrgyzstan

Aim:

To gauge the prevalence of hearing loss in school children in Bishkek, Kyrgyzstan, and refer pupils with positive results for further diagnostic testing.

Background:

According to WHO data, hearing disorders are common in school-age children. Screening for hearing loss is an important preventative tool, helping to avoid further complications. Expenditure that supports early child development can reduce future outlay on health care and social services; it can eliminate disability problems, education deficits, and social maladaptation in later adult life.

Methods:

Pure-tone air-conduction hearing thresholds were obtained at 0.5–8 kHz. The results of the hearing screening examination were regarded as positive if pure-tone thresholds were higher than 20 dB HL in one or both ears at one or more of the test frequencies. Data were also obtained from follow-up visits of children who failed the initial screening.

Findings:

This study included 452 children aged 7–13 years old. Based on audiograms, screening showed that 123 (27.2%) of the children had hearing impairment. The study has important implications for clinical practice and health policy. There is a need for systematic monitoring of hearing status among children of this age, and parents and educators need to be made aware of the significance of hearing loss.

How the World's Children Hear: A Narrative Review of School Hearing Screening Programs Globally

Objective

School hearing screening may mitigate the effects of childhood hearing loss through early identification and intervention. This study provides an overview of existing school hearing screening programs around the world, identifies gaps in the literature, and develops priorities for future research.

Data Sources

A structured search of the PubMed, Embase, and Cochrane Library databases.

Review Methods

A total of 65 articles were included according to predefined inclusion criteria. Parameters of interest included age groups screened, audiometric protocols, referral criteria, use of adjunct screening tests, rescreening procedures, hearing loss prevalence, screening test sensitivity and specificity, and loss to follow-up.

Conclusions

School hearing screening is mandated in few regions worldwide, and there is little accountability regarding whether testing is performed. Screening protocols differ in terms of screening tests included and thresholds used. The most common protocols included a mix of pure tone screening (0.5, 1, 2, and 4 kHz), otoscopy, and tympanometry. Estimates of region-specific disease prevalence were methodologically inaccurate, and rescreening was poorly addressed. Loss to follow-up was also a ubiquitous concern.

Implications for Practice

There is an urgent need for standardized school hearing screening protocol guidelines globally, which will facilitate more accurate studies of hearing loss prevalence and determination of screening test sensitivity and specificity. In turn, these steps will increase the robustness with which we can study the effects of screening and treatment interventions, and they will support the development of guidelines on the screening, diagnostic, and rehabilitation services needed to reduce the impact of childhood hearing loss.

Spontaneous otoacoustic emissions in schoolchildren

OBJECTIVE

Spontaneous otoacoustic emissions (SOAEs) are one of the least studied types of otoacoustic emissions (OAEs). The purpose of this study was twofold: first, to determine the prevalence of SOAEs in schoolchildren, and second to test whether there was dependence between the presence or absence of SOAEs in a subject and the corresponding level of their transiently evoked OAEs (TEOAEs).

METHODS

Measurements were made on a group of normally hearing children of age 7-13 years. A technique which detects synchronized SOAEs (SSOAEs) was used in which the response to repetitive clicks (12.5/s) was analyzed in the 60-80 ms time window following each click. The matching pursuit method was used to detect SSOAEs components above the noise in this window. For comparison, TEOAEs evoked by clicks (40/s) were obtained using the standard nonlinear protocol (20 ms time window).

RESULTS

The prevalence of SOAEs was 37%, and higher in females and right ears. There was an average of 2.3 SOAEs per emitting ear. TEOAE levels were higher for ears that had SOAEs and were lower for ears that did not have any SOAEs.

CONCLUSION

Although not all normal human have SOAEs, they appear to reflect an important aspect of cochlear function. Their presence is strongly related to elevated levels of TEOAEs which are routinely used in audiological tests.

A Hearing Screening Program for Children in Primary Schools in Tajikistan: A Telemedicine Model

Background

According to the guidelines of the European Scientific Consensus on Hearing (European Federation of Audiology Societies ‘EFAS’ Congress, June 2011, Warsaw, Poland), the detection and treatment of communication disorders in early school-age children is of the highest importance. This objective was adopted by the Polish president of the EFAS Council from the second half of 2011; as a result, pilot programs on children’s hearing screening were initiated in various European countries. This paper reports data from a pilot program in Dushanbe, Tajikistan.

Material/Methods

We randomly selected 143 children from 2 primary schools. Each child was assessed by pure tone audiometry and 2 questionnaires (dedicated to parents and children). The study allowed the validation of: (i) hearing screening procedures in young children, and (ii) data collection via a telemedicine model.

Results

Hearing impairments were identified in 34 cases (23.7%) with a 50% ratio between unilateral and bilateral losses. We found a higher incidence of hearing impairment in children than that reported in previous Polish studies.

Conclusions

The data from the present study suggest that it is possible to use a telemedicine model to assess the hearing status of children and to provide a long-distance expert assistance. The latter is very important for rural areas without specialized medical services.

Criteria for detection of transiently evoked otoacoustic emissions in schoolchildren

OBJECTIVES

The aim was to compare, on the same dataset, existing detection criteria for transiently evoked otoacoustic emissions (TEOAEs) and to select those most suitable for use with school-aged children.

METHODS

TEOAEs were recorded from the ears of 187 schoolchildren (age 8-10 years) using the Otodynamics ILO 292 system with a standard click stimulus of 80dB peSPL. Pure tone audiometry and tympanometry were also conducted. Global and half-octave-band (at 1, 1.4, 2, 2.8, 4kHz) values of OAE signal-to-noise ratio (SNR), reproducibility, and response level were determined. These parameters were used as criteria for detection of TEOAEs. In total, 21 criteria based on the literature and 3 new ones suggested by the authors were investigated.

RESULTS

Pure tone audiometry and tympanometry screening generated an ear-based failure rate of 7.49%. For TEOAEs, there was a huge variability in failure rate depending on the criteria used. However, three criteria sets produced simultaneous values of sensitivity and specificity above 75%. The first of these criteria was based only on a global reproducibility threshold value above 50%; the second on certain global reproducibility and global response values; and the third involved exceeding a threshold of 50% band reproducibility. The two criteria sets with the best sensitivity were based on global reproducibility, response level, and signal-to-noise ratio (with different thresholds across frequency bands).

CONCLUSIONS

TEAOEs can be efficiently used to test the hearing of schoolchildren provided appropriate protocols and criteria sets are used. They are quick, repeatable, and simple to perform, even for nonaudiologically trained personnel. Criteria with high sensitivity (89%) were identified, but they had relatively high referral rates. This is not so much a problem in schoolchildren as it is in newborns because with schoolchildren pure tone audiometry and tympanometry can be performed immediately or at a follow-up session. Nevertheless, high referral rates lead to increased screening cost; for that reason, three less rigorous criteria with high values of both sensitivity and specificity (75% and above) are recommended.

Tone burst evoked otoacoustic emissions in different age-groups of schoolchildren

INTRODUCTION

Otoacoustic emissions (OAEs) are believed to be good predictors of hearing status, particularly in the 1-4kHz range. However both click evoked OAEs (CEOAEs) and distortion product OAEs (DPOAEs) perform poorly at 0.5kHz. The present study investigates OAEs in the lower frequency range of 0.5-1kHz evoked by 0.5kHz tone bursts (TBOAEs) in schoolchildren and compares them with emissions evoked by clicks.

METHODS

Measurements were performed for two groups of normally hearing schoolchildren. Children from 1st grade (age 6-7 years) and children from 6th grade (age 11-12 years). Tympanometry, pure tone audiometry, and OAE measurements of CEAOEs, 0.5kHz TBOAEs, and spontaneous OAEs (SOAEs) were performed. Additionally, analysis by the matching pursuit method was conducted on CEOAEs and TBOAEs to assess their time-frequency (TF) properties.

RESULTS

For all subjects OAEs response levels and signal to noise ratios (SNRs) were calculated. As expected, CEOAE magnitudes were greatest over the range 1-4kHz, with a substantial decrease below 1kHz. Responses from the 0.5kHz TBOAEs were complementary in that the main components occurred between 0.5 and 1.4kHz. In younger children, TBOAEs had SNRs 4-8dB smaller in the 0.5-1.4kHz range. In addition, CEOAEs had lower SNRs in the 0.7-1.4kHz range, by 3-5dB. TBOAEs in younger children had maximum SNRs shifted toward 1-1.4kHz, whereas in older children it was more clearly around 1kHz. The differences in response levels were less evident. The presence of SOAEs appreciably influenced both CEOAEs and TBOAEs, and TF properties of both OAEs did not differ significantly between grades.

CONCLUSION

TBOAEs evoked at 0.5kHz can provide additional information about frequencies below 1kHz, a range over which CEOAEs usually have very low amplitudes. The main difference between the two age groups was that in older children CEOAEs and 0.5kHz TBOAEs had higher SNRs at 0.5-1.4kHz. Additionally, for ears with SOAEs, 0.5kHz TBOAEs had higher response levels and SNRs similar to CEOAEs.

An Evidence-Based Systematic Review on the Diagnostic Accuracy of Hearing Screening Instruments for Preschool- and School-Age Children

PURPOSE

The purpose of this article is to conduct an evidence-based systematic review on the accuracy of pure-tone or otoacoustic emission (OAE) screening for identifying hearing loss in preschool- and school-age children.

METHOD

A systematic search of the literature published between 1975 and 2013 was conducted. Articles meeting the selection criteria were critically appraised for quality. Selection criteria required that behavioral thresholds be measured in children failing the screen and in at least a subset of children passing the screen. Sensitivity and specificity were used to calculate positive and negative likelihood ratios that could be compared between instruments.

RESULTS

Eighteen studies were included in the final analysis. There was considerable variability among studies on stimulus levels, response criteria, and definition of hearing loss. Approximately half of positive and negative likelihood ratio pairs for OAEs (52%) and pure-tone screening (45%) were considered suggestive or informative for identifying hearing loss.

CONCLUSIONS

Both pure-tone and OAE screening can identify hearing loss in preschool- and school-age children. Studies that compared both tools in the same population concluded that pure-tone screening had higher sensitivity than OAE screening and thus was considered the preferred tool. Future research should incorporate standard stimulus levels, response criteria, and definitions of hearing loss.

Auditory steady-state responses in school-aged children: a pilot study

Background

The use of Auditory Steady-State Responses (ASSRs) for auditory screening in school-aged children, particularly in children who are difficult to test and children with disabilities, has not been explored yet. This pilot study investigated the use of ASSR for auditory screening in school-aged children.

Materials and methods

A cross-sectional pilot study of 23 children aged 9 to 11 with normal-hearing thresholds and seven age-matched children with permanent moderate-to-profound bilateral hearing loss were examined. The tested carrier frequencies were 500, 1,000, 2,000, and 4,000 Hz, and the stimulus was modulated between 77 and 107 Hz. The ASSRs decreased according to the tested intensity levels of 50, 40, and 30 dB sound pressure level (SPL). Sensitivity and specificity were estimated from the responses of the children with normal hearing and those with hearing loss.

Results

For the children with normal hearing, the 2,000-Hz frequency was detected more often in both ears and at all intensity levels compared to the other frequencies. The 500- and 2,000-Hz frequencies resulted in different response patterns in both ears. The time until response detection increased in parallel with amplitude reduction, as expected. The overall time required for the test was 15 minutes, including the time spent in volunteer preparation. The sensitivity was 97% for the three intensities, and the best specificity value was 100%, which was observed at 50 dB.

Discussion

The response analysis indicated that a screening protocol for school-aged children could include 1,000, 2,000, and 4,000 Hz and that the recording of ASSRs was highly sensitive to internal and external factors. Fifty dB SPL should be considered a cut-off criterion for screening purposes because this was the intensity level with a sensitivity of 97% and a specificity of 100%.

Conclusion

The use of ASSRs might be particularly useful in school-aged children who have difficulty performing subjective hearing tests. The sensitivity and specificity data suggested that the use of ASSRs was feasible as an auditory screening tool. In order to determine a protocol for screening, future studies should include a larger sample and children with mild hearing loss.

A Prevalence Study of Hearing Loss among Primary School Children in the South East of Iran

Hearing impairment substantially affects child's ability to normally acquire the spoken language. Such negative effects create problems for the child not only in terms of communication but also in terms of achievement in school as well as social and emotional growth. The aim of this research is to study the prevalence of hearing disorders and its relationship to age and gender among primary school students of Zahedan, Iran. In this cross-sectional and descriptive analytical study, 1500 students from elementary schools were screened for hearing loss. The selection of samples was performed using multistage sampling method. Primary information was obtained through direct observation, otoscopy, and audiometric and tympanometric screenings. Data was obtained and analyzed via ANOVA test. Statistical analysis showed a significant correlation between the age and the prevalence of middle ear abnormal function. Conductive hearing loss in males and females was 8.8% and 7.1%, respectively. In addition, 1% and 0.7% of male and female students, respectively, suffered from sensorineural hearing loss. Results indicated that 20.2% of students of elementary schools in Zahedan needed medical treatment for their problems. Therefore, it is recommended that the hearing screening of school-age children should be included in annual school health programs in this region.

Hearing screening for school children: utility of noise-cancelling headphones

BACKGROUND

Excessive ambient noise in school settings is a major concern for school hearing screening as it typically masks pure tone test stimuli (particularly 500 Hz and below). This results in false positive findings and subsequent unnecessary follow-up. With advances in technology, noise-cancelling headphones have been developed that reduce low frequency noise by superimposing an anti-phase signal onto the primary noise. This research study examined the utility of noise-cancelling headphone technology in a school hearing screening environment.

METHODS

The present study compared the audiometric screening results obtained from two air-conduction transducers-Sennheiser PXC450 noise-cancelling circumaural headphones (NC headphones) and conventional TDH-39 supra-aural earphones. Pure-tone hearing screening results (500 Hz to 4000 Hz, at 30 dB HL and 25 dB HL) were obtained from 232 school children, aged 6 to 8 years, in four Hong Kong primary schools.

RESULTS

Screening outcomes revealed significant differences in referral rates between TDH-39 earphones and NC headphones for both 30 dB HL and 25 dB HL criteria, regardless of the inclusion or exclusion of 500 Hz results. The kappa observed agreement (OA) showed that at both screening intensities, the transducers' referral agreement value for the 500 Hz inclusion group was smaller than for the 500 Hz exclusion group. Individual frequency analysis showed that the two transducers screened similarly at 1000 Hz and 2000 Hz at 25 dB HL, as well as at both 30 dB HL and 25 dB HL screening levels for 4000 Hz. Statistically significant differences were found for 500 Hz at 30 dB HL and at 25 dB HL, and for 1000 Hz and 2000 Hz at 30 dB HL. OA for individual frequencies showed weaker intra-frequency agreement between the two transducers at 500 Hz at both intensity criterion levels than at higher frequencies.

CONCLUSIONS

NC headphones screening results differed from those obtained from TDH-39 earphones, with lower referral rates at 500 Hz, particularly at the 25 dB HL criterion level. Therefore, NC headphones may be able to operate at lower screening intensities and subsequently increase pure-tone screening test sensitivity, without compromising specificity. NC headphones show some promise as possible replacements for conventional earphones in school hearing screening programs.

Screening for pre-school and school-age hearing problems: European Consensus Statement

OBJECTIVES

To formulate consensus statement and policies on structured hearing screening programs in pre-school and school-age children in Europe. This consensus will be brought before the European Union's Member States as a working and effective program with recommendations for adoption.

METHODS

A distinguished panel of experts discussed hearing screening of pre-school and school-age children during the 10th Congress of European Federation of Audiology Societies (EFAS), held in Warsaw, Poland, on June 22, 2011. The panel included experts in audiology, otolaryngology, communication disorders, speech language pathology, education and biomedical engineering.

RESULTS

Consensus was reached on thirteen points. Key elements of the consensus, as described herein, are: (1) defining the role of pre-school and school screening programs in the identification and treatment of hearing problems; (2) identifying the target population; (3) recognizing the need for a quality control system in screening programs.

CONCLUSIONS

The European Consensus Statement on Hearing Screening of Pre-school and School-age Children will encourage the appropriate authorities of the various countries involved to initiate hearing screening programs of pre-school and school-age children.

Transiently evoked otoacoustic emissions in children with otitis media with effusion

Introduction. Otitis media with effusion is a common pediatric disease whose diagnosis is based on pneumatic otoscopy, pure-tone audiometry, and tympanometry. The aim of this study was to evaluate transiently evoked otoacoustic emissions in the diagnosis of otitis media with effusion as compared to tympanometry. Patients and Methods. 38 children with bilateral otitis media with effusion were studied. 40 normal children of similar age and sex were used as controls. All subjects underwent pneumatic otoscopy, standard pure-tone audiometry, tympanometry, and transiently evoked otoacoustic emissions. Results. In the group of children with bilateral otitis media, transiently evoked otoacoustic emissions were absent in 51 ears (67%). In the remaining 25 ears (33%) the mean emission amplitude was reduced, as compared to the mean value of the control group. Conclusions. Transiently evoked otoacoustic emissions should be included in the diagnostic workup of otitis media with effusion because it is a fast, reliable, and objective test. Transiently evoked otoacoustic emissions should always be used in conjunction with tympanometry, because a more meaningful interpretation of transiently evoked otoacoustic emissions measures is possible.