Can schools detect mild hearing loss? Evaluating screening accuracy and feasibility

OBJECTIVES: We evaluated the feasibility and diagnostic accuracy of screening at lower levels to detect mild hearing loss in rural school settings in Alaska. METHODS: In this prospective, observational diagnostic accuracy study, we compared performance of two pure-tone hearing screening levels (15 dB and 20 dB) against a benchmark audiometric evaluation using the former (PTA >25 dB) and updated (PTA ≥20 dB) World Health Organization (WHO) definitions of hearing loss. RESULTS: Among 318 children, a greater proportion screened positive at 15 dB than at 20 dB (18.6% vs 13.8%). Benchmark audiometry using the updated WHO definition identified mild hearing loss or greater in 4.8% of children. Sensitivity was higher for the 15 dB screen than the 20 dB screen (85.0% vs 75.0%), whereas specificity was lower (90.8% vs 94.3%). Screening at 15 dB yielded 21 more false positives and two fewer false negatives than screening at 20 dB. The updated WHO definition (PTA ≥20 dB) identified more children with mild hearing loss than the former definition (PTA >25 dB). CONCLUSIONS: Screening at 15 dB increased sensitivity and identified more children with mild hearing loss using the updated WHO definition. This improvement came with a higher number of false positives, however, highlighting the need for affordable, reliable screening technologies capable of detecting mild hearing loss in school environments with ambient noise. Use of the updated WHO definition (PTA ≥20 dB) appears better suited to identify children at risk for preventable noise- and infection-related hearing loss.