Journal of Epidemiology and Community Health, Vol 51, 711-715
Pure tone audiometry and impedance screening of school entrant children by nurses: evaluation in a practical setting
I Holtby, DP Forster and U Kumar
Tees Health Authority, Middlesbrough.
BACKGROUND: Screening for hearing loss in English children at entry to
school (age 5-6 years) is usually by pure tone audiometry sweep undertaken
by school nurses. This study aimed to compare the validity and screening
rates of pure tone audiometry with impedance screening in these children.
METHODS: Two stage pure tone audiometry and impedance methods of screening
were compared in 610 school entry children from 19 infant schools in north
east England. Both procedures were completed by school nurses. The results
of screening were validated against subsequent clinical assessment,
including otological examination and actions taken by an independent
assessor. RESULTS: Both methods produced broadly similar validation indices
after two stages of screening: sensitivity was 74.4% for both methods;
specificity was 92.1% and 90.0%; and predicted values of a positive test
43.2% and 37.6% respectively for pure tone audiometry and impedance
methods. Single stage screening in both methods produced higher sensitivity
but lower specificity and predictive values of a positive test than two
stage screening. Screening rates were appreciably higher with impedance
methods than with pure tone audiometry. CONCLUSIONS: In choosing the method
to be used, it must be borne in mind that the impedance method is
technically more efficient but takes longer than pure tone audiometry
screening. However, the latter method allows opportunity for other health
inquiries in these children.
Copyright © 1997 by the Journal of Epidemiology and Community Health
