Hind S E, Atkins R L, Haggard M P, Brady D, Grinham G
MRC Institute of Hearing Research, Nottingham, UK.
Br J Audiol. 1999 Dec;33(6):403-14. doi: 10.3109/03005364000000108.
Some health authorities in the UK are discontinuing hearing screening at school entry, mainly because the pure tone sweep test is under-specific (i.e. fails too many children) and thus leads to unnecessary and costly, but unproductive, follow-up assessment. A screening method with different properties such as a questionnaire could be a more cost-effective method of mass screening children. The MRC Institute of Hearing Research has developed and evaluated through several stages such a screening questionnaire (the Childhood Middle Ear Disease and Hearing Questionnaire (CMEDHQ), containing 11 scored questions under two broad headings: history and presentation of the disease, and consultation/treatment history. In a service-based evaluation, 2860 mainstream reception-year school children from two consecutive years, attending schools in south west Cumbria in the North-West Regional Health Authority received the sweep test and the CMEDHQ. (Although predominantly designed to detect middle ear problems, the questionnaire also has some potential to detect permanent hearing loss; thus providing a useful backstop for detection of permanent losses either missed or not present in earlier infancy.) The screening CMEDHQ obtained a very high response rate (90%). Follow-up included 235 control cases as well as all pure tone sweep test failures. Analysis, by use of a definition of cases conservative with respect to the sensitivity of the questionnaire, showed that the CMEDHQ has better specificity, but slightly lower sensitivity, than the pure tone sweep test for composite system decision (where 'case' = treated at ENT; 'non-case' = pass at whatever stage was reached before discharge). Follow-up indicated that the limited method available for assessing sensitivity might give an over-favourable view of the pure tone sweep test. Possible improvement of questionnaire sensitivity by further refinements is under examination. The findings show that it is worth conducting a fully parallel multi-district cost-effectiveness comparison of the pure tone sweep test versus the CMEDHQ.
英国的一些卫生部门正在停止入学时的听力筛查，主要原因是纯音扫查测试特异性不足（即让太多儿童未通过），从而导致不必要且成本高昂但却无成效的后续评估。一种具有不同特性的筛查方法，比如问卷，可能是对儿童进行大规模筛查更具成本效益的方法。医学研究理事会听力研究所已分几个阶段开发并评估了这样一份筛查问卷（儿童中耳疾病与听力问卷（CMEDHQ）），该问卷包含11个计分问题，分为两个主要类别：疾病史和症状表现，以及咨询/治疗史。在一项基于服务的评估中，来自西北区域卫生管理局坎布里亚郡西南部两所连续年份的主流小学一年级学生2860人接受了扫查测试和CMEDHQ测试。（尽管该问卷主要设计用于检测中耳问题，但也有一定潜力检测永久性听力损失；从而为检测早期婴儿期遗漏或不存在的永久性听力损失提供有用的补充。）筛查CMEDHQ的回应率非常高（90%）。后续跟进包括235例对照病例以及所有纯音扫查测试未通过者。通过使用对问卷敏感性保守的病例定义进行分析表明，对于综合系统判定（其中“病例”= 在耳鼻喉科接受治疗；“非病例”= 在出院前任何阶段通过测试），CMEDHQ的特异性更好，但敏感性略低于纯音扫查测试。后续跟进表明，现有的有限评估敏感性的方法可能会对纯音扫查测试给出过于乐观的看法。目前正在研究通过进一步完善来提高问卷敏感性的可能性。研究结果表明，对纯音扫查测试和CMEDHQ进行全面并行的多地区成本效益比较是值得的。
