Reliability of parental assessment of auditory skills in young children: a cross-sectional study in Italian language

Abstract

ObjectiveHearing impairments (HIs) that progress or have later onset may have specific effects on language and cognitive development, but are difficult to suspect during routine primary care visits. Family concern regarding hearing is thought to represent an important risk factor requiring audiological examination. Yet it is not clear how successful parents are in recognising the consequences or specific suspect elements of HI in young children. The aim of this study is to verify whether parents of at-risk children recognise the presence of HI through a parental questionnaire that draws attention to auditory skills development and compares them with language and communication skills.DesignObservational study.SettingFrom 2013 to 2019, parents were administered the Questionnaire on Hearing and Communication Abilities before audiological evaluation of their children at a secondary care institute.Participants309 Italian children (1–36 months old) at risk of HI.Primary and secondary outcome measuresQuestionnaire sensitivity in predicting the presence and type of HI.ResultsParents report a decrease in auditory skills for children with sensorineural HI (Χ2(2)=14.4, p=0.003), with an increased concern expressed in 59% compared with 24% in normally hearing children. Both auditory (r=−0.18, p=0.002) and comprehension (r=−0.13, p=0.057) skills weakly but negatively correlated with a diagnosis of HI. On discriminant analysis, the positive predictive value of the questionnaire was 0.78, but with low sensitivity (0.39).ConclusionsParents of children with a verified risk of HI have some capacity to recognise non-typical auditory behaviour. Thus, it is important to assess parental concerns during primary care health visits, and a targeted questionnaire on auditory abilities can complement existing screening procedures. However, given the low sensitivity of the questionnaire, we conclude that for a reliable detection of HIs that progress or have later onset an objective screening tool is always required.

Development of the national consensus statement on ear health and hearing check recommendations for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: systematic scoping review and e-Delphi

“… Primary schools, South Africa hearScreen smartphone screening app and conventional screening audiometry Diagnostic audiometry - No significant difference in performance - Smartphone screener and conventional screening demonstrated equivalent sensitivity (75%) and similar specificity (98.5% and 97% respectively) - Positive and negative predictive values 52.9% and 99.4% for smartphone screener, and 36.7% and 99.4% for conventional hearing screening. - No confidence intervals reported Ramkumar et al 2018 [ 47 ] Non-randomised comparative study 119 children (43) and young infants (76) aged 0-5 years Trained village health workers, community setting, India Distortion Product Otoacoustic Emissions (DPOAE) Tele-Auditory Brainstem Response testing - The study found acceptable validity: sensitivity of DPOAE screening was 75% (CI: 69-81) and specificity, 91% (CI: 87-95) - Negative and positive predictive values were 99% (CI: 98-100) and 27% (CI: 21-33), respectively Mealings et al, 2020 [ 44 ] Non-randomised comparative study 297 Aboriginal and Torres Strait Islander children aged 4–14 years Primary schools, Australia Sound Scouts game-based hearing test app for smartphones and tablets Pure tone audiometry, Listening in Spatialised Noise – Sentences high-cue condition - Sensitivity of Sound Scouts for average hearing loss of >20 dB HL was 41% and specificity was 89%; and for average hearing loss >30 dB HL, sensitivity at 88% and specificity at 88% - Consistent pass/fail results on Sound Scouts speech-in-noise measure and Listening in Spatialised Noise – Sentences test high-cue condition were found for 73% of children Orzan et al 2021 [ 53 ] Non-randomised comparative study 309 children aged 1-36 months Oto-rhino-laryngology and audiology unit of a medical institute, Italy Parental assessment of auditory skills using the Questionnaire on Hearing and Communication Abilities (QUAC) Audiological evaluation of children at a secondary care institute - Parents reported a decrease in auditory skills for children with sensorineural hearing loss (Χ 2 (2)=14.4, p =0.003), with increased concern expressed in 59% compared with 24% in normally hearing children - Positive predictive value was 0.78, but with low sensitivity (0.39) - No confidence intervals reported - Conclusion: parents have capacity to recognise non-typical audito...…”

Routine ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: a national consensus statement

“…Listening skills checklists vary considerably in their ability to correctly identify current hearing loss (sensitivity, 100% and 39%) and to correctly identify no current hearing loss (specificity, 75% and 93%), with positive predictive values of 7% and 78%. 38,39 A listening skills questionnaire developed for Aboriginal and Torres Strait Islander children reported normative data, but lacked information on sensitivity, specificity, and positive predictive values. 40 Very low overall certainty of evidence may relate to the emergent nature of listening skills checklists in EHHCs.…”