The Accuracy of the Hearing Screener Device as a Hearing Screening Tool in the School Setting for First Graders Aged 5-10 Years

Abstract

Background: Hearing loss in children if undetected can lead to delay in speech and language development, social and emotional problems, and academic difficulties. The importance of screening of school-age children to detect hearing loss cannot be overemphasized. In the Philippines, there is no single uniform program for hearing screening in school children. This study examines a device that has been proposed to be used for mass hearing screening. The device is called a hand-held hearing screener (Siemens Hear Check Navigator) that displays three colors as a result: green for pass or no hearing loss; yellow and red for fail or possible hearing loss. The objective of the study is to determine the accuracy of the hand-held hearing screener device as a hearing screening tool to be used in the school setting for first graders. Methodology: This is an analytical cross-sectional study among Grade I students conducted in three schools in Metro Manila, Philippines, during regular school days. Each child passed through five stations: collection of demographic data, otoscopy, screening with hearing screener device, screening audiometry and counseling. Ambient sound was maintained at 50 dBA or less during testing. The hearing screener device presents pure tones of 35 dbHL, 55 dbHL, and 75 dBHL at test frequencies 375 Hz, 1000 Hz, and 3000 Hz. Its results were: green light which was considered as “absence of hearing loss”, and yellow and red lights which were considered as “presence of hearing loss”. The results of the hearing screener device test were used to determine its sensitivity and specificity, using the results of the screening audiometry as gold standard. Results: A total of 418 grade one elementary school children were included in the study. The hand-held screener was found to have high specificity of 97.8% (yellow results) to 99.6% (red results) but low sensitivity of 9.1% (red results) to 16.7% (yellow results). Positive predictive values for red and yellow results are 26.1% and 50% respectively. The accuracy of the red results of the hearing screener device is 95.9% and the accuracy of the yellow results of the hearing screener is 94.2%. Conclusion: Based on this study, the hearing screener device has low sensitivity in detecting the presence of possible hearing loss in children when used in the school setting. Thus, the hearing screener device is not an ideal tool to use in the mass hearing screening of children in the school setting where there are no soundproof booths and with significant levels of ambient sound. Its excellent specificity may support its use, not for screening, but possibly for confirmation of the absence of hearing loss. For screening, its value lies in its high specificity, good accuracy rates and significant positive predictive values in detecting possible hearing loss, thus warranting a referral for a definitive hearing test. The significant level of ambient sound in this study’s conduction is a limitation and may account for the low sensitivity of the hearing screener device. More studies with fewer limitations are needed that will explore and validate the use of the hearing screener device in children in the school setting.