title: A test protocol for assessing the hearing status of students with special needs.
abstract: OBJECTIVE
  Individuals with disabilities are often reported to have a high prevalence of undetected hearing disorders/loss, but there is no standardized hearing test protocol for this population. The purposes of this study were (1) to examine the hearing status of students with special needs in Taiwan, and (2) to investigate the use of an on-site hearing test protocol that would adequately detect hearing problems in this population and reduce unnecessary referrals for off-site follow-up services.
  
  
  METHODS
  A total of 238 students enrolled in two schools for special education and one habilitation center participated in the study. Most students had intellectual disabilities and some also had additional syndromes or disorders. A hearing screening protocol including otoscopy, tympanometry, and distortion product otoacoustic emissions was administered to examine students' outer, middle, and inner ear functions, respectively. Pure tone tests were then administered as an on-site follow-up for those who failed or could not be tested using the screening protocol.
  
  
  RESULTS
  Only 32.4% of students passed. When administered alone, the referral rate of otoscopy, tympanometry, and otoacoustic emissions were 38.7%, 46.0%, and 48.5%, respectively. The integration of these subtests revealed 52.1% of students needed follow-up services, 11.8% could not be tested, 2.5% had documented hearing loss, and 1.3% needed to be monitored because of negative middle ear pressure. The inclusion of pure tone audiometry increased the passing rate by 9.9% and provided information on hearing sensitivity for an additional 8.6% of students.
  
  
  CONCLUSIONS
  Hearing assessments and regular hearing screening should be provided as an integral part of health care services for individuals with special needs because of high occurrences of excessive cerumen, middle ear dysfunction, and sensorineural hearing loss. The training of care-givers and teachers of students with special needs is encouraged so that they can help identify hearing problems and reduce the negative impact of hearing disorders and hearing loss. The screening protocol needs to include subtests that examine the status of different parts of their auditory system. The addition of pure tone audiometry as an on-site follow-up tool reduced the rate of off-site referrals and provided more information on hearing sensitivity.
authors.affiliation: Graduate Institute of Audiology and Speech Therapy, National Kaohsiung Normal University, Kaohsiung, Taiwan, ROC. Electronic address: chenhc@nknucc.nknu.edu.tw.
authors.forename: Hsiao-Chuan
authors.initials: HC
authors.lastname: Chen
authors.affiliation: School of Speech Language Pathology and Audiology, Chung Shan Medical University, No. 110, Section 1, Jiangou North Road, Taichung City 40201, Taiwan, ROC. Electronic address: frances@csmu.edu.tw.
authors.forename: Nan-Mai
authors.initials: NM
authors.lastname: Wang
authors.affiliation: National Women's League Foundation for the Hearing Impaired, No. 45, Cheng Hsing St., Beitou District, Taipei City 112, Taiwan, ROC. Electronic address: taipei@nwlhif.org.tw.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Chiu
authors.affiliation: School of Speech Language Pathology and Audiology, Chung Shan Medical University, No. 110, Section 1, Jiangou North Road, Taichung City 40201, Taiwan, ROC. Electronic address: audio@csmu.edu.tw.
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Liu
authors.affiliation: National Women's League Foundation for the Hearing Impaired, No. 45, Cheng Hsing St., Beitou District, Taipei City 112, Taiwan, ROC. Electronic address: taichung@nwlhif.org.tw.
authors.forename: Yi-Ping
authors.initials: YP
authors.lastname: Chang
authors.affiliation: Kaohsiung Municipal Cheng Gong Developmental Disabilities School, Kaohsiung, Taiwan, ROC. Electronic address: pyl.tn@msa.hinet.net.
authors.forename: Pei-Yu
authors.initials: PY
authors.lastname: Lin
authors.affiliation: Department of Allied Health and Communicative Disorders, Northern Illinois University, 323 Wirtz Hall, DeKalb, IL 60532, United States. Electronic address: kchung@niu.edu.
authors.forename: King
authors.initials: K
authors.lastname: Chung
mesh_terms: D000158:Acoustic Impedance Tests / Q000379:methods; D000293:Adolescent; D000328:Adult; D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006311:Hearing Disorders / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D017084:Otoacoustic Emissions, Spontaneous; D038781:Otoscopy; D015995:Prevalence; D012017:Referral and Consultation; D013334:Students; D013624:Taiwan; D055815:Young Adult
keywords: Hearing screening; Intellectual disability; Special needs; Taiwan; Test protocol