Accuracy of School Screenings in the Identification of Minimal Sensorineural Hearing Loss Purpose The goal of this study was to investigate how the use of a 25 dB HL referral criterion in school screenings affects the identification of hearing loss categorized as minimal sensorineural hearing loss (MSHL). Method A retrospective study applied screening levels of 20 and 25 dB HL ... Research Article
Research Article  |   December 01, 2014
Accuracy of School Screenings in the Identification of Minimal Sensorineural Hearing Loss
 
Author Affiliations & Notes
  • Jeanne Dodd-Murphy
    Baylor University, Waco, TX
  • Walter Murphy
    Texas A&M University—Central Texas, Killeen, TX
  • Fred H. Bess
    Vanderbilt Bill Wilkerson Center, Vanderbilt University School of Medicine, Nashville, TN
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication.×
  • Correspondence to Jeanne Dodd-Murphy: jeanne_murphy@baylor.edu
  • Editor and Associate Editor: Larry E. Humes
    Editor and Associate Editor: Larry E. Humes×
Article Information
Hearing Disorders / School-Based Settings / Professional Issues & Training / Research Articles
Research Article   |   December 01, 2014
Accuracy of School Screenings in the Identification of Minimal Sensorineural Hearing Loss
American Journal of Audiology, December 2014, Vol. 23, 365-373. doi:10.1044/2014_AJA-14-0014
History: Received March 14, 2014 , Revised July 9, 2014 , Accepted July 24, 2014
 
American Journal of Audiology, December 2014, Vol. 23, 365-373. doi:10.1044/2014_AJA-14-0014
History: Received March 14, 2014; Revised July 9, 2014; Accepted July 24, 2014
Web of Science® Times Cited: 3

Purpose The goal of this study was to investigate how the use of a 25 dB HL referral criterion in school screenings affects the identification of hearing loss categorized as minimal sensorineural hearing loss (MSHL).

Method A retrospective study applied screening levels of 20 and 25 dB HL at 1000, 2000, and 4000 Hz in each ear to previously obtained pure-tone thresholds for 1,475 school-age children. In a separate prospective study, 1,704 children were screened at school under typical conditions, and a subsample had complete audiological evaluations. Referral rates, sensitivity, and specificity were calculated for each screening level.

Results Referral rates varied by grade and criterion level, with comparable results between the two data sets. In both studies, when the screening level increased, the sensitivity to MSHL declined markedly, whereas specificity increased in the prospective study.

Conclusions Screening at 25 dB yields poor sensitivity to MSHL. Converging evidence from these diverse populations supports using the 20 dB level to help identify MSHL. Multistage screening is recommended to limit referral rates. Even at 20 dB HL, cases of MSHL may be missed. Audiologists should encourage parents, educators, and speech–language pathologists to refer children suspected of hearing difficulty for complete audiological evaluations even if they pass school screenings.

Acknowledgments
The Nashville study was partially funded by a grant from the Robert Wood Johnson Foundation. Invaluable support from Tennessee Lions Club Districts 12I and 12S enabled data collection on site in the Nashville Davidson County Metropolitan Schools. The Watauga County study was funded by a University Research Council grant from Appalachian State University. We thank Mary Ruth Sizer and the student examiners for their integral contributions to this investigation. We are also grateful for the cooperation and assistance of the speech–language pathologists, teachers, students, staff, and administrators of the Watauga County Schools who made the prospective study possible.
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