title: Diagnostic pure-tone audiometry in schools: mobile testing without a sound-treated environment.
abstract: OBJECTIVE
  To validate diagnostic pure-tone audiometry in schools without a sound-treated environment using an audiometer that incorporates insert earphones covered by circumaural earcups and real-time environmental noise monitoring.
  
  
  METHODS
  A within-subject repeated measures design was employed to compare air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure-tone thresholds measured in natural school environments with thresholds measured in a sound-treated booth.
  
  
  METHODS
  149 children (54% female) with an average age of 6.9 yr (SD = 0.6; range = 5-8).
  
  
  RESULTS
  Average difference between the booth and natural environment thresholds was 0.0 dB (SD = 3.6) for air conduction and 0.1 dB (SD = 3.1) for bone conduction. Average absolute difference between the booth and natural environment was 2.1 dB (SD = 2.9) for air conduction and 1.6 dB (SD = 2.7) for bone conduction. Almost all air- (96%) and bone-conduction (97%) threshold comparisons between the natural and booth test environments were within 0 to 5 dB. No statistically significant differences between thresholds recorded in the natural and booth environments for air- and bone-conduction audiometry were found (p > 0.01).
  
  
  CONCLUSIONS
  Diagnostic air- and bone-conduction audiometry in schools, without a sound-treated room, is possible with sufficient earphone attenuation and real-time monitoring of environmental noise. Audiological diagnosis on-site for school screening may address concerns of false-positive referrals and poor follow-up compliance and allow for direct referral to audiological and/or medical intervention.
authors.affiliation: Department of Communication Pathology, University of Pretoria, South Africa; Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia; Ear Science Institute Australia, Subiaco, Australia.
authors.forename: De Wet
authors.initials: de W
authors.lastname: Swanepoel
authors.affiliation: Department of Communication Pathology, University of Pretoria, South Africa.
authors.forename: Felicity
authors.initials: F
authors.lastname: Maclennan-Smith
authors.affiliation: Department of Communication Pathology, University of Pretoria, South Africa.
authors.forename: James W
authors.initials: JW
authors.lastname: Hall
mesh_terms: D000158:Acoustic Impedance Tests; D001301:Audiometry, Pure-Tone / Q000295:instrumentation* / Q000379:methods; D001309:Auditory Threshold / Q000502:physiology; D001844:Bone Conduction / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D004780:Environment, Controlled; D004867:Equipment Design / Q000295:instrumentation; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000458:organization & administration; D015997:Neonatal Screening; D009622:Noise / Q000517:prevention & control; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012574:Schools