title: Otoacoustic emissions: a valid, efficient first-line hearing screen for preschool children.
abstract: BACKGROUND
  Normal hearing during the preschool years is essential for speech, language, social, emotional, and preacademic development. Children of low socioeconomic status may be particularly vulnerable to the negative effects of late identification and intervention. While a mass-screening effort focused on preschool children does not have broad support, focused screening remains important to identify children at risk. This project was conducted to address 3 primary aims: develop and implement an initial hearing screen using transient evoked otoacoustic emissions (TEOAEs) for at-risk preschoolers, verify speed and tolerability of the screen, and assess the test performance of TEOAEs screening compared to pure tone audiometry in a group of 142 preschool children.
  
  
  METHODS
  A total of 744 preschool children attending preschools in an underserved, urban community completed TEOAEs screening by a school nurse. A secondary cohort of 142 children was screened first by TEOAEs and then followed by pure tone audiometry and results compared.
  
  
  RESULTS
  A total of 680 children passed screening. Forty-one children (5.5%) had a "refer" result. Two-year-olds had the highest refusal rate (10.5%). Mean testing time was 43 seconds per ear. Secondary cohort analysis revealed 1 subject did not pass either TEOAEs or pure tone screening; no subject passed TEOAEs and then did not pass pure tone audiometry. TEOAEs screening test sensitivity was 1.00 (95% confidence interval 0.054-1.00) and specificity 0.94 (0.88-0.97).
  
  
  CONCLUSIONS
  TEOAEs screening performed by school nurses is a fast, efficient, and feasible model. Children who pass TEOAEs screening have a very high likelihood of being free from hearing impairment. Application may be particularly relevant in underserved communities.
authors.affiliation: Department of General Pediatrics, USC Keck School of Medicine, USC University Center of Excellence in Developmental Disabilities, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS 76, Los Angeles, CA 90027, USA. lyin@chla.usc.edu
authors.forename: Larry
authors.initials: L
authors.lastname: Yin
authors.forename: Christine
authors.initials: C
authors.lastname: Bottrell
authors.forename: Noreen
authors.initials: N
authors.lastname: Clarke
authors.forename: Janice
authors.initials: J
authors.lastname: Shacks
authors.forename: Marie K
authors.initials: MK
authors.lastname: Poulsen
mesh_terms: D001301:Audiometry, Pure-Tone; D002675:Child, Preschool; D015331:Cohort Studies; D006311:Hearing Disorders / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening; D008507:Medically Underserved Area; D017084:Otoacoustic Emissions, Spontaneous; D011237:Predictive Value of Tests; D014505:Urban Population