A hearing examination of 538 teenage boys in vocational school classes—implying future on-the-job noise exposure—showed a hearing loss (greater than 20 dB HL at any frequency) in 15% of the cases. Few correlations could be demonstrated between hearing loss and specific leisure time activities. There was, however, a correlation between high frequency hearing loss in the left ear and hereditary hearing loss. The most affected frequency was 6 kHz, suggesting a noise etiology—a suggestion emphasized by the noisy hobbies of these teenagers. It cannot be excluded that a hereditary deficiency could either manifest itself as a localized dip at 6 kHz or reveal itself as an increased vulnerability to noise, identified at young age as a high frequency dip at 6 kHz.

Early Noise-induced Hearing Loss in Teenage Boys

Otitis media with effusion (OME) is the major cause of auditory dysfunction in preschool and early-grade schoolchildren. At especially high risk are children with cleft palate/lip; some groups of mentally retarded children; children from underprivileged communities and children with severe or profound sensorineural hearing loss. In neonates the major concern is to identify those with severe sensorineural hearing loss but awareness of the likelihood of OME is also vital. The hearing loss associated with OME in its early stages may be as small as 10--15 dB and in consequence conventional hearing tests employing pure tones are inadequate is screening procedures. Acoustic impedance testing has proved to be a practicable, acceptable, sensitive and efficient method of identification of OME in infants and children. Impedance measurement cannot, as yet, provide accurate assessment of hearing loss, but this is probably not a serious drawback. The primary requirement is to detect OME in order that swift and effective treatment can be instituted.

Otitis Media and Child Development: Design Factors in the Identification and Assessment of Hearing Loss

Hearing loss and ear disorders in Malaysian school children.

Routine screening for hearing impairment in childhood is now widespread in industrial countries, although there is considerable controversy over the most efficient techniques and procedures. In most developing countries, however, routine screening programmes for hearing impairment do not currently exist. The problems involved in implementing screening programmes in developing and industrial countries are very different, and in selecting screening procedures for a particular population the following factors have to be taken into consideration: the environmental test conditions; the availability of resources for equipment and the training of testers; the local attitudes towards disability; the level of hearing impairment that may cause handicaps; and the major types of pathology causing hearing impairment. We suggest that in developing countries children should be screened at school entry using a simple field audiometer and that the external ear be inspected for the presence of a discharge. There is an urgent need to develop reliable and simple screening procedures for infants and young children; where possible, all children should be screened for severe or significant hearing impairment before the age of 2 years. No screening should, however, be implemented until appropriate follow-up services are available.

Practical screening priorities for hearing impairment among children in developing countries

The purpose of this investigation was to evaluate the sensitivity and specificity of the following acoustic-immittance protocols and their constituent measures for detection of middle-ear effusion in children: (a) tympanometric width; (b) absent ipsilateral acoustic reflex; (c) ASHA guidelines; (d) tympanometric peak pressure; and (e) static-acoustic middle-ear admittance. The middle-ear sample was composed of 82 ears of 54 subjects ranging in age from 3 to 11 years. The control (normal-hearing, normal middle-ear) sample was composed of 53 ears of 53 subjects ranging in age from 3 to 10 years. Each subject was given a complete otolaryngologic evaluation (including pneumotoscopy and/or microtoscopy) and audiologic (including acoustic-immittance) evaluation. In the group of middle ears with normal-hearing sensitivity, the sensitivity and specificity of the ASHA guidelines were 63 percent and 79 percent, respectively . An acoustic-immittance screening protocol, based on all of the individual acoustic- immittance measures, and characterized by high sensitivity and specificity, is proposed .

Acoustic-immittance screening for detection of middle-ear effusion in children.

Evaluation of a recommended program of identification audiometry with school-age children.

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Evaluation of a recommended program of identification audiometry with school-age children.