Pure-tone assessment and screening of children with middle-ear effusion.

The purpose of this prospective investigation was to evaluate the sensitivity of pure-tone screening of children with middle-ear effusion (MEE) and to describe the short-term audiometric and otologic follow-up of children with MEE who pass versus fail a pure-tone screen. Eighty-two ears of 54 children with MEE based on pneumotoscopy/microtoscopy were investigated. A complete otolaryngologic evaluation, pure-tone screen, then complete audiologic evaluation were performed at the initial test. Retesting was done at 6-8 weeks post initial test. The sensitivity of the ASHA (1985) pure-tone screen to MEE was 54 percent when 500 Hz was excluded, 85 percent when 500 Hz was included, and 89 percent when 250 Hz was also included. Significant air-bone gaps were present in 100 percent of the MEE group that failed and in 92 percent of the MEE group that passed the screen (excluding 500 Hz). Of the cases with MEE at the initial test that returned for the retest, 53 percent to 54 percent continued to show MEE. The mean speech-recognition threshold (SRT) was in best agreement with the hearing-threshold levels at the low frequencies, regardless of the pure-tone screen outcome. The results suggest that 500 Hz, as well as 1000-4000 Hz, should be used in a pure-tone screen at 20 dB HL for detection of MEE. The results also question the assumption in the ASHA (1985) screening guidelines that passing a pure-tone screen at 1000-4000 Hz puts one at low risk for hearing impairments that "interfere with or have the potential for interfering with communication" (ASHA, 1985).