title: Early identification of young children with hearing loss in federally qualified health centers.
abstract: OBJECTIVE
  While newborn hearing screening has improved outcomes for children diagnosed with hearing loss, the screening protocol is incomplete in the critical early developmental years, particularly among underserved populations. To address this gap, 7 federally qualified health centers (FQHCs) implemented a periodic, objective infant-toddler hearing screening program during well-child visits. The study aimed to determine the ability of these primary care providers to implement the hearing screening protocol and to identify children in need of audiologic follow-up.
  
  
  METHODS
  This study represents a prospective chart review. Children aged 0 to 3 years presenting to participating clinics for well-child care visits were offered the hearing screen, which included a brief risk factor questionnaire, otoacoustic emissions (OAEs), and tympanometry. Main outcome measures were time to screen, accuracy of physician interpretation of the tympanogram results, and screening results requiring immediate audiology follow-up.
  
  
  RESULTS
  Among 1965 OAE screens, 75% took <10 minutes, and 205 patients (10%) failed OAEs in at least 1 ear; based on tympanometry, middle ear effusions were present in 102 of these cases (50%), while 45 cases (22%) raised concerns for sensorineural hearing loss. Physicians accurately interpreted tympanogram results in 89% of cases. There were 5 patients identified with confirmed permanent sensorineural hearing loss.
  
  
  CONCLUSIONS
  Findings demonstrate that infant-toddler hearing screening in FQHCs is feasible to conduct, and it may effectively identify cases of postnatal hearing loss. This is one of the first studies in a primary care setting using OAE technology coupled with tympanometry, allowing physicians to better triage patients for immediate audiology referral.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA 90027, USA. pbhatia@chla.usc.edu
authors.forename: Parul
authors.initials: P
authors.lastname: Bhatia
authors.forename: Sandra
authors.initials: S
authors.lastname: Mintz
authors.forename: Barbara F
authors.initials: BF
authors.lastname: Hecht
authors.forename: Alexis
authors.initials: A
authors.lastname: Deavenport
authors.forename: Alice A
authors.initials: AA
authors.lastname: Kuo
mesh_terms: D000158:Acoustic Impedance Tests; D001299:Audiometry; D002675:Child, Preschool; D042241:Early Diagnosis; D034381:Hearing Loss / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008403:Mass Screening / Q000379:methods; D017084:Otoacoustic Emissions, Spontaneous; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires