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Probes and Tips - May 2009 - Reliability of Subjective and Objective Hearing Screening Methods for Young Children

the National Center for Hearing Assessment and Mangement

This newsletter provides TIPS to enhance your OAE screening and follow-up practices and PROBES about current activities so we can learn from one another's successes and challenges. Check out our website for more helpful resources:

May, 2009 issue

Tip of the Month

Comparison of Subjective and Objective Hearing Screening Methods for Young Children

We’ve been compiling a list of questions from newsletter readers and would like to answer as many as we can in this and subsequent newsletters:

Q: Some programs only use the OAE if a subjective screen (questionnaire) suggests that there is a concern. Do you have any documentation/research that shows that subjective screening doesn't identify hearing loss appropriately?

A: Research data does not support the use of informal, subjective screening strategies in identifying young children with hearing loss. One retrospective study done by Watkin, et al., found that only 25% of parents of children with significant hearing loss suspected that their child might have a hearing problem. Even more worrisome, less than 10% of parents suspected that their child had such a hearing loss during infancy. Likewise, the customary method in the United Kingdom of training home visitors to screen babies (6 – 9 months) using the Distraction Test (behavioral screen incorporating a rattle, voice and chime bar) has been shown to be far less effective than objective Otoacoustic Emissions (OAE) screening (Chan, 2004). OAE screening is rapidly replacing subjective methods because it is much more accurate and reliable.

Supporting these findings, we know that prior to objective, universal newborn hearing screening in the U.S. (using OAE or automated Auditory Brainstem Response [AABR] technology) children with hearing loss were typically not being identified until 2½ to 3 years of age (or older for children with mild losses). Most children were identified only when it became very evident they were not learning to talk. In some cases, children had actually been receiving speech therapy--without ever having had their hearing tested! In contrast, the implementation of objective screening techniques now means that many infants with hearing loss are being identified and receiving appropriate auditory habilitation and early intervention services by 6 months of age. Please select one of the following images.
A finding shared with us by one Head Start program further exemplifies the importance of objective, OAE screening: 

We identified 7 children who needed medical treatment (ear infections or wax); we identified 6 children who needed referrals for tubes or an allergist. All of these children passed our subjective screening tool.

Thanks to the advances in objective screening methods, children can now be identified reliably and receive the early and appropriate help they need.   Program personnel should always take seriously parents’ concerns about a child’s hearing (these children should be evaluated by a pediatric audiologist even if they pass the OAE screening).   However, just because a parent does not have concerns about hearing does not mean we can assume a child is hearing normally.  For that reason, an objective, OAE screening should be conducted on every child annually. 

Watkin, P.M., Baldwin, M., & Laoide, S. (1990).  Parental suspician and identification of hearing impairment.  Archives of Disease in Childhood, 65, 846-850.

Chan, K.Y. & Leung, S.S.L (2004).  Infant hearing screening in maternal and child health centres using automated otoacoustic emission screening machines:  A one-year pilot project.  Hong Kong Journal of Paediatrics, 9, 118-125.

Probe of the Month

Did you know that OAE screening is also being used widely in other countries to screen young children for hearing loss?   
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