The paediatric otological caseload resulting from improved screening in the first year of life.
Improved test technique by health visitors has been shown to lead to higher accuracy in the screen of hearing aimed traditionally at prelingual sensorineural deafness. However, it gives greatly increased referrals of children having otitis media with effusion (OME) around the end of the first year of life. Two samples of children (n = 29 and 61) were tested in a children's hearing assessment clinic with properly documented testing techniques and trained personnel. The samples were each formed on a fixed population base, one before and one after screen improvements. This enabled characterization of two outcome groups within each sample (severe/persistent enough to refer to ENT vs discharged, despite slight hearing impairment). The average audiometric criterion for onward referral to ENT rose only very little, despite the increased assessment caseload resulting from more detections by the screen. This usefully permitted the conclusion that the number of true cases found due to the screen and assessed as lying beyond a specifiable degree of severity (average cut-off approximately 47 dB(A) or 35 dBHTL) had increased not through lower criteria for referral to ENT, but through the improvements to the screen. The increase was from approximately 0.4% to 1.3% of the base population screened. Thus a change materially enhancing the sensitivity and positive predictive value of a screen considerably enlarges the eventual otological caseload of children with middle-ear disease thought to justify concern at around the end of their first year. If done properly, screening is hence in practical terms about OME, not about prelingual sensorineural hearing impairment. This conclusion presses the urgency of evaluation and consensus on the otological management of the young child with OME.
Haggard
M P
MP
MRC Institute of Hearing Research, University of Nottingham, UK.
McCormick
B
B
Gannon
M M
MM
Spencer
H
H
D000704:Analysis of Variance; D002391:Catchment Area, Health; D002662:Child Health Services; D002675:Child, Preschool; D003152:Community Health Nursing; D004427:Ear Diseases / Q000628:therapy*; D004739:England; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis*; D006320:Hearing Tests; D006801:Humans; D007223:Infant; D010034:Otitis Media with Effusion / Q000175:diagnosis*; D012017:Referral and Consultation