Evaluating the outcomes of a hearing screening service for grade one learners in urban areas at Durban, South Africa

Abstract

Early intervention through hearing screening can reduce the negative impact of hearing loss for children. Optimal outcomes are achieved when an appropriate screening protocol is selected, a pathway for follow up care is established, and when a hearing conservation component is included. This study aimed to describe the outcomes of a hearing screening service provided to grade one learners in urban areas at Durban. A cross-sectional design was employed. Learners (n=241) were conveniently sampled from six randomly selected schools. They were screened using otoscopy, tympanometry and pure tone audiometry. Fifty eight participants (24%) obtained a refer result, with 33% referred for diagnostic assessments, 29% for middle ear pathology and 38% for cerumen management. Findings further revealed that only 33% of referrals were followed up indicating poor compliance. Association between test results and income levels (P=0.38) as well as distance to the nearest health care facility (P=0.22) did not influence test outcomes. School aged children do present with common ear problems. Appropriate protocol selection, ensuring compliance to recommendations and education on hearing conservation are essential components of any health initiative.

How the World’s Children Hear: A Narrative Review of School Hearing Screening Programs Globally

“…Otoscopy was recommended as an important adjunct test given its usefulness in detecting obvious outer and middle ear abnormalities requiring medical follow-up. 31,34,49 It was a well-tolerated procedure that was often used prior to audiometric screening and tympanometry to yield more accurate screening results. It was also particularly helpful in regions with high prevalence of cerumen impaction.…”

“…14,29,50,61 A few authors recommended either immediately referring abnormal tympanometry results for medical follow-up or repeating screening at least 1 month later to check for resolution. 14,34,61…”

“…14,15 Potential reasons cited for poor follow-up included the inability to contact and notify parents of the screening test results, the lack of parental awareness of the medical significance of hearing loss, the cost of subsequent care, the inability of parents to miss work, and geographic barriers. 15,29,34,69 Letter mail and telephone calls were the favored modes of communication, but the majority of studies did not document or recommend guidelines for follow-up. 15,16,39,42 Other concerns related to loss to follow-up in low- and middle-income countries included shortages of specialist care and inadequate infrastructure for continued educational support.…”

“…22 Overall, there was a near-unanimous recommendation that addressing lost to follow-up is urgently needed to improve the overall effectiveness of school hearing screening programs across the world. 18,34,46…”

Prevalence of Hearing Loss and Associated Factors in School-Age Individuals in an Urban Area of Northeast Brazil

“…Other studies associated otoscopy with other assessments, such as tympanometry, 11 audiometric screening, 40 and tympanometry and pure tone audiometry. 41 None of these studies included a population of adolescents, which could be justified by the fact that conductive alterations detected during otoscopy/meatoscopy are more common in children. The higher number of children in the sample could have influenced the results, mainly regarding airway infections as risk factors, due to a higher prevalence of conductive alterations in this age group.…”