Outcomes of an Early Childhood Hearing Screening Program in a Low-Income Setting

Brodie, Kara D; David, Abel P.; Kriss, Hayley; Chan, Dylan K.

doi:10.1001/jamaoto.2021.4430

Cited by 10 publications

(12 citation statements)

References 21 publications

(51 reference statements)

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“…We found that hearing thresholds differed by sex except for the hearing thresholds of the left ear at 1,000 Hz, with higher thresholds for girls than for boys, but no sex difference in screening failure rates, which is consistent with the findings of a study on preschool children ( 39 ). This result may indicate that girls have a higher risk of hearing deterioration than boys even if they can pass the hearing screening.…”

Section: Discussionsupporting

confidence: 90%

Hearing thresholds elevation and potential association with emotional problems among 1,914 children in Beijing, China

Xiao

Amaerjiang

Wang

et al. 2022

Front. Public Health

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ObjectivesSchool-aged children may experience hearing loss and emotional problems. Previous studies have shown a bidirectional relationship between hearing loss and emotional problems in the elderly population, and we aimed to analyze the association between hearing thresholds and emotional problems in school-aged children.MethodsBased on the Beijing Child Growth and Health Cohort (PROC) study, the hearing screenings were conducted in November 2019 using pure tone audiometry. A total of 1,877 parents completed the Strengths and Difficulties Questionnaire (SDQ) to assess children's emotional and behavioral status. We used generalized linear regression analysis to assess the potential association of emotional problems with hearing thresholds, based on multiple imputed datasets with a sample size of 1,914.ResultsThe overall pass rate of hearing screening was 91.5%. The abnormal rate of SDQ total difficulties was 55.8%. Emotional symptoms were positively associated with left ear average hearing thresholds (β = 0.24, 95%CI: 0.08–0.40), and right ear average hearing thresholds (β = 0.18, 95%CI: 0.04–0.32). Conduct problems, hyperactivity/inattention, peer problems, and prosocial behaviors had no association with the pass rate of the hearing screening. Regarding emotional symptoms, boys with many fears and who are easily scared coincided with increased right ear average hearing thresholds (β = 0.67, 95%CI: 0.01–1.33). Girls having many worries, frequently feeling unhappy and downhearted were positively associated with left and right ear average hearing thresholds, respectively (β = 0.96, 95%CI: 0.20–1.73; β = 0.72, 95%CI: 0.07–1.37).ConclusionsThe co-occurrence of hearing problems and emotional problems of children aged 6–8 in Beijing attracts attention. It is important to address undiscovered hearing loss and emotional problems from the perspective of comorbidity driving factors.

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Section: Discussionsupporting

confidence: 90%

Hearing thresholds elevation and potential association with emotional problems among 1,914 children in Beijing, China

Xiao

Amaerjiang

Wang

et al. 2022

Front. Public Health

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“…To the Editor We read with great interest the article by Brodie et al, titled “Outcomes of an Early Childhood Hearing Screening Program in a Low-Income Setting.” Of primary importance, this retrospective, community-based cohort study demonstrated that preschool screening programs were a useful method for children aged 2 to 6 years from urban, low-income public preschools. Furthermore, the authors should be singularly commended for attaching importance to the value of teacher concern for hearing loss, language, or speech development.…”

mentioning

confidence: 75%

The Early Childhood Hearing Screening Program in a Low-Income Setting

Zhang

Wang

2022

JAMA Otolaryngol Head Neck Surg

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To the Editor We read with great interest the article by Brodie et al, 1 titled "Outcomes of an Early Childhood Hearing Screening Program in a Low-Income Setting." Of primary importance, this retrospective, community-based cohort study demonstrated that preschool screening programs were a useful method for children aged 2 to 6 years from urban, lowincome public preschools. Furthermore, the authors should be singularly commended for attaching importance to the value of teacher concern for hearing loss, language, or speech development. We appreciate the important information presented in this study and we would like to comment on some key issues.First, methodological concern that might lessen those conclusions should be emphasized. As the gold standard, formal diagnostic testing has not been fully implemented for all individuals. Specifically, could there be children who passed the preschool hearing screening but still develop a hearing loss later? Could there be false-negative results in identification of hearing loss?Second, as the article mentioned, 1 the study focused on children from a low-income setting, but failed to analyze the socioeconomic factors, especially the household income. It made household income a potential confounder in this study, which may have affected the reliability of the conclusion. In our opinion, the household income should also have been accounted for, because it may prove an important confounding factor. 2,3 Third, in the Figure the number of children who underwent otoacoustic emission testing should state 414, not 141, as written.Overall, the results reported by Brodie et al 1 may have important implications for future preschool screening strategies for hearing loss. However, the confounding factors of formal diagnostic testing and socioeconomic factors such as household income need further consideration when interpreting the results. We agree with the authors that further work is necessary, with a more rigorous protocol including a larger sample population, and analysis of these important factors could strengthen conclusions from this study.

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“…39,40 Furthermore, it should be noted that there are several influencing factors that affect the observation of the tympanic membrane and thus the accuracy in diagnosis during otoscopic examination, such as in the conditions when the external ear canal is partly or completely blocked by cerumen, or when children are unable or unwilling to cooperate with the examination. [41][42][43][44] Therefore, it is crucial to obtain high-quality otoscopic images as input data to ensure a reliable and accurate DL model for predicting CHL in ears with OME.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have suggested that the diagnostic accuracy for detecting OME using otoscopy is between 60% and 70%, whereas the sensitivity and specificity of tympanometry can reach to 70% to 90% for the detection of OME, but it is dependent on patient cooperation . Furthermore, it should be noted that there are several influencing factors that affect the observation of the tympanic membrane and thus the accuracy in diagnosis during otoscopic examination, such as in the conditions when the external ear canal is partly or completely blocked by cerumen, or when children are unable or unwilling to cooperate with the examination . Therefore, it is crucial to obtain high-quality otoscopic images as input data to ensure a reliable and accurate DL model for predicting CHL in ears with OME.…”

Section: Discussionmentioning

confidence: 99%

A Deep Learning Approach to Predict Conductive Hearing Loss in Patients With Otitis Media With Effusion Using Otoscopic Images

Zeng

Kang

Chen

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEOtitis media with effusion (OME) is one of the most common causes of acquired conductive hearing loss (CHL). Persistent hearing loss is associated with poor childhood speech and language development and other adverse consequence. However, to obtain accurate and reliable hearing thresholds largely requires a high degree of cooperation from the patients. OBJECTIVE To predict CHL from otoscopic images using deep learning (DL) techniques and a logistic regression model based on tympanic membrane features. DESIGN, SETTING, AND PARTICIPANTSA retrospective diagnostic/prognostic study was conducted using 2790 otoscopic images obtained from multiple centers between January 2015 and November 2020. Participants were aged between 4 and 89 years. Of 1239 participants, there were 209 ears from children and adolescents (aged 4-18 years [16.87%]), 804 ears from adults (aged 18-60 years [64.89%]), and 226 ears from older people (aged >60 years, [18.24%]). Overall, 679 ears (54.8%) were from men. The 2790 otoscopic images were randomly assigned into a training set (2232 [80%]), and validation set (558 [20%]). The DL model was developed to predict an average air-bone gap greater than 10 dB. A logistic regression model was also developed based on otoscopic features. MAIN OUTCOMES AND MEASURESThe performance of the DL model in predicting CHL was measured using the area under the receiver operating curve (AUC), accuracy, and F1 score (a measure of the quality of a classifier, which is the harmonic mean of precision and recall; a higher F1 score means better performance). In addition, these evaluation parameters were compared to results obtained from the logistic regression model and predictions made by three otologists. RESULTSThe performance of the DL model in predicting CHL showed the AUC of 0.74, accuracy of 81%, and F1 score of 0.89. This was better than the results from the logistic regression model (ie, AUC of 0.60, accuracy of 76%, and F1 score of 0.82), and much improved on the performance of the 3 otologists; accuracy of 16%, 30%, 39%, and F1 scores of 0.09, 0.18, and 0.25, respectively. Furthermore, the DL model took 2.5 seconds to predict from 205 otoscopic images, whereas the 3 otologists spent 633 seconds, 645 seconds, and 692 seconds, respectively. CONCLUSIONS AND RELEVANCEThe model in this diagnostic/prognostic study provided greater accuracy in prediction of CHL in ears with OME than those obtained from the logistic regression model and otologists. This indicates great potential for the use of artificial intelligence tools to facilitate CHL evaluation when CHL is unable to be measured.

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Outcomes of an Early Childhood Hearing Screening Program in a Low-Income Setting

Cited by 10 publications

References 21 publications

Hearing thresholds elevation and potential association with emotional problems among 1,914 children in Beijing, China

Hearing thresholds elevation and potential association with emotional problems among 1,914 children in Beijing, China

The Early Childhood Hearing Screening Program in a Low-Income Setting

A Deep Learning Approach to Predict Conductive Hearing Loss in Patients With Otitis Media With Effusion Using Otoscopic Images

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