Pure-tone and acoustic immittance screening of preschool-aged children: an examination of referral criteria.

Seventy-five 3- and 4-yr-old children participated in a hearing screening program that included both pure-tone and acoustic immittance measures. ASHA's guidelines for acoustic immittance screening were modified to include a rescreening of all children failing the immittance test. Results were then compared to those projected from the existing ASHA criteria and two other screening protocols. Our findings revealed a higher incidence of otologic abnormalities in preschoolers compared to school-aged children and a higher incidence of false positives, even when immittance rescreening was provided. Pure-tone audiometry was ineffective as a means of identifying otologic abnormalities. A comparison of the immittance screening protocols indicated that the ASHA guidelines are likely to result in an excessive number of false-positive medical referrals. Recommendations are made for procedural modifications aimed at improving the efficiency of this procedure.