PP1118 - A Comparison of Two Hearing Screening Protocols in Community-Based Preschool Settings

Abstract:
Preschool Hearing and Speech Education – University of Pittsburgh (PHASE-UP) is a hearing screening program that partners with the Pittsburgh community to provide no-cost, comprehensive hearing screenings for local preschoolers. This poster describes a retrospective chart review of hearing screening results obtained from children seen in the PHASE-UP program from September 2018 to April 2022. The goal of this study was to compare the sensitivity and specificity of a one-criterion pass-fail DPOAE protocol (DPOAE SNR >6 dB) with a two-criteria pass-fail DPOAE protocol (DPOAE SNR ≥6 dB and DPOAE absolute ≥0 dB SPL) in children 3-6 years of age.

Summary:
The success of the universal newborn hearing screening (UNHS) has made it possible for congenitally deaf/hard-of-hearing (D/HH) children to be identified and receive intervention within the first year of life. Unfortunately, UNHS does not guarantee early identification and intervention of hearing loss in children beyond this period.

Currently, there is no universal, systematic, population-based hearing screening program to identify D/HH children before school entry. Subsequently, the Early Hearing Detection Intervention Act of 2022 (PL 117-241) and the Joint Committee on Infant Hearing (2019) support research on the feasibility of administering programs aimed at promoting early identification of and intervention for children with educationally significant hearing loss who will not be identified by UNHS.
Clinical practice guidelines recommended by the American Academy of Audiology and the American Speech-Language-Hearing Association include pure-tone audiometry and tympanometry and/or otoscopy for preschool hearing screenings.

Because of the challenges pure tone testing presents in the preschool population, distortion product otoacoustic emissions (DPOAE) have been recommended as an alternative, as they do not rely on behavioral responses. Frequently, a one criterion pass-fail protocol based on the relative difference between DPOAE amplitude and noise floor levels (e.g., signal-to-noise ratio, SNR, ≥6 dB) is employed. However, evidence suggests that the one-criterion pass-fail protocol is associated with a high false-negative screening rate.
Limited evidence is available supporting the use of a two-criteria pass-fail protocol to increase sensitivity of DPOAEs for a hearing screening, where (1) DPOAE SNRs ≥6dB, and (2) DPOAE absolute amplitude transparent;

The goal of this retrospective chart review is to compare the sensitivity and specificity between a one-criterion and two-criteria pass-fail DPOAE protocol. Results from tympanometry and/or otoscopy, DPOAEs, and conditioned play audiometric screenings obtained in the Pittsburgh Hearing and Speech Education – University of Pittsburgh (PHASE-UP) program from Sept 2018 to April 2022 were reviewed.

A pass result on the one-criterion pass-fail DPOAE protocol is when the difference between the distortion product amplitude and the noise floor (e.g., SNR) is ≥6 dB. A pass result on the two-criteria pass-fail DPOAE protocol is when the SNR is ≥6 dB and the absolute DPOAE amplitude is ≥0 dB SPL. Pure-tone audiometric screening results are used as the gold standard when comparing sensitivity and specificity of the DPOAE screening protocols. Statistical analyses involve domain analyses evaluating the sensitivity and specificity of each DPOAE protocol within each age group and within tympanometry and/or otoscopy criteria. With results scaled in order of pass, unilateral refer, and bilateral refer, the preliminary weighted Kappa statistics are .56 for agreement between the one-criterion DPOAE protocol and pure-tone audiometric screening, and .41 for agreement between two-criteria DPOAE protocol and pure-tone audiometric screening. There are fewer false negatives with the two-criteria DPOAE protocol than with one-criterion DPOAE protocol; the sensitivity is .75 for the two-criteria DPOAE protocol and .65 for the one-criterion DPOAE protocol. Conversely, test specificity is .91 for the two-criteria DPOAE protocol and .97 for the one-criterion DPOAE protocol. Implications for the results along with additional statistical analyses will be reviewed.