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

Abstract

Objective School hearing screening may mitigate the effects of childhood hearing loss through early identification and intervention. This study provides an overview of existing school hearing screening programs around the world, identifies gaps in the literature, and develops priorities for future research. Data Sources A structured search of the PubMed, Embase, and Cochrane Library databases. Review Methods A total of 65 articles were included according to predefined inclusion criteria. Parameters of interest included age groups screened, audiometric protocols, referral criteria, use of adjunct screening tests, rescreening procedures, hearing loss prevalence, screening test sensitivity and specificity, and loss to follow-up. Conclusions School hearing screening is mandated in few regions worldwide, and there is little accountability regarding whether testing is performed. Screening protocols differ in terms of screening tests included and thresholds used. The most common protocols included a mix of pure tone screening (0.5, 1, 2, and 4 kHz), otoscopy, and tympanometry. Estimates of region-specific disease prevalence were methodologically inaccurate, and rescreening was poorly addressed. Loss to follow-up was also a ubiquitous concern. Implications for Practice There is an urgent need for standardized school hearing screening protocol guidelines globally, which will facilitate more accurate studies of hearing loss prevalence and determination of screening test sensitivity and specificity. In turn, these steps will increase the robustness with which we can study the effects of screening and treatment interventions, and they will support the development of guidelines on the screening, diagnostic, and rehabilitation services needed to reduce the impact of childhood hearing loss.

Community-Based Hearing and Vision Screening in Schools in Low-Income Communities Using Mobile Health Technologies

“…For instance, in the United Kingdom, it is estimated that for every 10 children with a permanent bilateral hearing loss detected by newborn screening, there are approximately 5 to 9 children who would only manifest with such a hearing loss by 9 years of age (Fortnum et al, 2001). As a result, repeated hearing screening is required throughout childhood (Stenfeldt, 2018;Yong, Panth, McMahon, Thorne & Emmett, 2020).…”

“…Considering both hearing and vision loss can be accurately detected in a school-aged population provided the resources and personnel is available (Eksteen et al, 2019;Kemper et al, 2004;Mahomed-Asmail et al, 2016;Metsing, Hansraj, Jacobs, & Nel, 2018;Rono et al, 2018;Yong et al, 2020;, there is a rationale for combining hearing and vision screening to maximize efficiency, as these conditions often co-occur, however, very few studies have investigated a combined hearing and vision screening program (Eksteen et al, 2019;Kemper et al, 2004).…”

Assessment of hearing screening programmes across 47 countries or regions III: provision of childhood hearing screening after the newborn period

“…PTS also requires well-trained screeners and a screening audiometer, which needs regular calibration. All of these prerequisites may be especially scarce in lower income or more remote areas (Yong et al 2020b). The whisper test is still performed in some countries in this study, which requires no equipment and little training; however, reliability and sensitivity are poor (Pirozzo, Papinczak, and Glasziou 2003).…”

“…The earliest report of using PTS for children was published in 1955 (Ewing 1955). It has since become the standard practice for screening children aged 3 years and older (Yong et al 2020b) because of its high sensitivity and reliability (Fortnum et al 2016). PTS requires calibrated equipment, trained personnel, and a behavioural response from the child.…”

The inaugural World Report on Hearing: From barriers to a platform for change

“…21 Pre-school and school screening programmes provide an opportunity to identify hearing loss and middle ear disease in children early along their educational pathway, with near universal capture possible because of mandatory primary school education in most countries. 22 While the value of school screening is well documented, more work is needed to develop evidence-based robust models for widespread implementation. Although there is yet insufficient evidence to support universal screening programmes for hearing loss in older adults, 23 the combination of high prevalence, significant detrimental effects on health and well-being and availability of evidence-based and costeffective solutions highlight the urgent need to develop evidence on the cost-effectiveness of identifying and screening at-risk individuals in this cohort.…”