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

Abstract

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.