Screening methods for childhood hearing impairment in rural Bangladesh

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The purpose of this study was to determine a feasible strategy for screening young children in rural Bangladesh for hearing impairments. Trained community health workers (CHWs) screened 4003 children between the ages of 2 and 9 years using conditioned play audiometry (CPA) and a subset of 569 of these children (ages 2-5 years), using physiologic (otoacoustic emissions [OAEs] and tympanometry). Measures of frequency and cross-tabulations are presented to describe results. Hearing screening using CPA was feasible for most children in the 6-9 years age range, but not for the younger children due to shyness and lack of cooperation. More than two thirds of the younger children were untestable on CPA. In response to this limitation, OAEs and tympanometry, requiring less cooperation on the part of the child, was implemented for a sample of younger children. Of the 569 children who received both CPA and OAE/tympanometry, 69% were untestable using CPA and 8.9% were untestable using OAE and tympanometry. These results suggest that hearing screening using CPA for older (6-9 years) and OAE/tympanometry for younger (2-5 years) children is feasible. Using the physiologic measures of OAE/tympanometry significantly reduced the number of untestable children, resulting in fewer referrals for diagnostic assessments. Thus, if only one methodology could be implemented, physiologic measure would be preferred. This is important because trained audiologists are scarce in Bangladesh. Technology is available and feasible for hearing screening in developing countries. Focus needs now to center on increasing the number of trained audiologists in developing countries to ensure better follow-up and accessibility to audiological services.