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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.

Author Affiliations: Division of General Academic Pediatrics, Department of Pediatrics, Saint Louis University, St Louis, Missouri (Dr Halloran); Institute of Business Intelligence, Culverhouse College of Commerce, University of Alabama at Tuscaloosa (Dr Hardin), and Division of General Pediatrics, Department of Pediatrics, University of Alabama at Birmingham (Dr Wall).

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