title: Validity of pure-tone hearing screening at well-child visits.
abstract: OBJECTIVE
  To estimate the sensitivity and specificity of pure-tone audiometry hearing screening in the primary care setting.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Eight academic and private pediatric practices.
  
  
  METHODS
  A subset of children from a convenience sample of 1061 children between 3 and 19 years of age were screened for hearing loss using pure-tone audiometry. Intervention Formal audiologic evaluations (gold standard) for those children referred by their primary care physician (28 children) and for a random sample of children not referred (102 children). Main Exposure Pure-tone audiometry screening.
  
  
  METHODS
  Audiologic evaluations.
  
  
  RESULTS
  A total of 28 children were referred to an audiologist for formal hearing testing after pure-tone audiometry screening during a well-child visit, at which 25 children did not pass the initial screening and 3 could not complete the screening. Of the 25 children, only 7 were evaluated by an audiologist, for a follow-up rate of 25%. One child was diagnosed as having hearing loss. Formal audiologic assessment was also performed on a random sample of 102 children who were not referred to the audiologist. For the random sample, hearing loss was identified in 2 of 76 (3%) children who passed and 1 of 16 (6%) children who did not pass pure tone audiometry screening. The sensitivity and specificity of pure-tone audiometry were 50% and 78%, respectively.
  
  
  CONCLUSIONS
  In light of the increasing burden on physicians to provide preventive care, this study calls into question the value of hearing screening using pure-tone audiometry during well-child visits given the lack of follow-up after referral and the poor sensitivity.
authors.affiliation: Division of General Academic Pediatrics, Saint Louis University, 1465 S Grand Blvd., St Louis, MO 63110, USA. dhallor2@slu.edu
authors.forename: Donna R
authors.initials: DR
authors.lastname: Halloran
authors.forename: J Michael
authors.initials: JM
authors.lastname: Hardin
authors.forename: Terry C
authors.initials: TC
authors.lastname: Wall
mesh_terms: D000293:Adolescent; D001298:Audiology; D001301:Audiometry, Pure-Tone; D002648:Child; D002675:Child, Preschool; D005260:Female; D034381:Hearing Loss / Q000175:diagnosis*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011320:Primary Health Care; D012017:Referral and Consultation; D012680:Sensitivity and Specificity