title: Evaluation of pure tone audiometry and impedance screening in infant schoolchildren.
abstract: OBJECTIVE
  The aims were (1) to evaluate impedance measurements against pure tone audiometry as a screening method for the detection of middle ear changes associated with hearing loss in infant school children; (2) to estimate the costs of the health authority of each method.
  
  
  METHODS
  The study involved two stage screening in which both methods were offered, pure tone audiometry being carried out by school nurses and impedance screening by a doctor.
  
  
  METHODS
  18 infant or primary schools in Langbaurgh, Cleveland, UK.
  
  
  METHODS
  610 previously unscreened infant school children took part in the study.
  
  
  RESULTS
  Main outcome measures were the sensitivity, specificity, and predictive value of each screening method, using clinical assessment and action as the validating technique. The sensitivity and the predictive value of a positive test in two stage impedance screening was markedly superior to that of pure tone audiometry. The specificity was similar using the two methods. In addition the impedance methods was more rapid and estimated to consume less resource as a screening procedure than pure tone audiometry.
  
  
  CONCLUSIONS
  The superiority of the use of impedance screening established in this study should be confirmed in a subsequent audit carried out purely by school nurses.
authors.affiliation: South Tees Health Authority, Poole Hospital, Middlesbrough, Cleveland, United Kingdom.
authors.forename: I
authors.initials: I
authors.lastname: Holtby
authors.forename: D P
authors.initials: DP
authors.lastname: Forster
mesh_terms: D000158:Acoustic Impedance Tests / Q000191:economics / Q000592:standards*; D001301:Audiometry, Pure-Tone / Q000191:economics / Q000592:standards*; D002648:Child; D003365:Costs and Cost Analysis; D004739:England; D006314:Hearing Loss, Conductive / Q000517:prevention & control*; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000592:standards*; D011237:Predictive Value of Tests