Holtby I, Forster D P, Kumar U
Tees Health Authority, Middlesbrough.
J Epidemiol Community Health. 1997 Dec;51(6):711-5. doi: 10.1136/jech.51.6.711.
Screening for hearing loss in English children at entry to school (age 5-6 years) is usually by pure tone audiometry sweep undertaken by school nurses. This study aimed to compare the validity and screening rates of pure tone audiometry with impedance screening in these children.
Two stage pure tone audiometry and impedance methods of screening were compared in 610 school entry children from 19 infant schools in north east England. Both procedures were completed by school nurses. The results of screening were validated against subsequent clinical assessment, including otological examination and actions taken by an independent assessor.
Both methods produced broadly similar validation indices after two stages of screening: sensitivity was 74.4% for both methods; specificity was 92.1% and 90.0%; and predicted values of a positive test 43.2% and 37.6% respectively for pure tone audiometry and impedance methods. Single stage screening in both methods produced higher sensitivity but lower specificity and predictive values of a positive test than two stage screening. Screening rates were appreciably higher with impedance methods than with pure tone audiometry.
In choosing the method to be used, it must be borne in mind that the impedance method is technically more efficient but takes longer than pure tone audiometry screening. However, the latter method allows opportunity for other health inquiries in these children.
英国儿童入学时（5 - 6岁）的听力损失筛查通常由学校护士进行纯音听力计扫描。本研究旨在比较这些儿童中纯音听力计筛查与阻抗筛查的有效性和筛查率。
对来自英格兰东北部19所幼儿园的610名入学儿童进行了两阶段纯音听力计筛查和阻抗筛查方法的比较。两种检查均由学校护士完成。筛查结果通过后续临床评估进行验证，包括耳科检查以及由独立评估人员采取的行动。
经过两阶段筛查后，两种方法产生的验证指标大致相似：两种方法的敏感性均为74.4%；特异性分别为92.1%和90.0%；纯音听力计法和阻抗法阳性检测的预测值分别为43.2%和37.6%。两种方法的单阶段筛查比两阶段筛查产生更高的敏感性，但特异性和阳性检测的预测值更低。阻抗法的筛查率明显高于纯音听力计法。
在选择使用的方法时，必须牢记阻抗法在技术上更高效，但比纯音听力计筛查耗时更长。然而，后一种方法为对这些儿童进行其他健康询问提供了机会。
