Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.
Ear Science Institute Australia, Subiaco, Western Australia.
Lang Speech Hear Serv Sch. 2021 Jul 7;52(3):868-876. doi: 10.1044/2021_LSHSS-21-00008. Epub 2021 Jun 1.
Purpose This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results Fail rates for the one-frequency fail protocol was 8.7% ( = 186) and 4.3% ( = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail ( < .001; = 0.471; 95% confidence interval [0.385, 0.575]). Gender ( = .251) and age ( = .570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type ( = .204), gender ( = .314), and age ( = .982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 ) and 64.9 s (55.78 ) for the one-frequency and two-frequency fail protocols, respectively. Conclusions A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.
目的 本研究旨在描述和比较两种在资源有限环境中用于学龄前听力筛查的筛查方案的性能。
方法 对南非使用移动健康技术实施的学龄前听力筛查项目中两种方案的性能进行了二次数据分析。两种方案均在每只耳朵中使用 25 dB HL 的 1000、2000 和 4000 Hz 的纯音测听进行筛查。第一个方案（筛查了 2147 名儿童）的失败标准是一只或多只耳朵对一个或多个频率无反应。第二个方案需要两个或更多的无反应（筛查了 5782 名儿童）。使用多变量逻辑回归模型调查了结果与方案、年龄、性别和持续时间之间的关联。
结果 单频失败方案的失败率为 8.7%（=186），双频失败方案的失败率为 4.3%（=250）。使用双频失败方案筛查的儿童失败的可能性降低了 52.9%（<0.001；=0.471；95%置信区间[0.385,0.575]）。性别（=0.251）和年龄（=0.570）对筛查结果没有显著影响。在两个方案中，至少一只耳朵在 1000 Hz 时，有 44.7%的筛查病例的噪声水平超过了允许的水平。两种方案的真阳性和假阳性病例没有显著差异。方案类型（=0.204）、性别（=0.314）和年龄（=0.982）不影响成为真阳性结果的几率。平均筛查时间分别为单频失败方案 72.8 秒（78.66）和双频失败方案 64.9 秒（55.78）。
结论 双频失败标准和对失败频率的立即重新筛查显著降低了后续服务的转诊率，而后续服务在资源有限的环境中往往负担过重。未来的方案调整还可以考虑增加 1000 Hz 的筛查水平，以尽量减少环境噪声的影响。
