Changing the Paradigm for School Hearing Screening Globally: Evaluation of Screening Protocols From Two Randomized Trials in Rural Alaska.

Children younger than 7 years had significant missing data because many could not complete behavioral pure-tone testing. The study was not specifically powered to detect a particular precision for diagnostic accuracy, and no sample size justification was given. The reference standard was more comprehensive than in many screening studies, including otoscopy and tympanometry, which limits comparison with other studies. Testing was done in school rooms rather than sound-treated booths, and noise could affect behavioral pure-tone testing. The newer WHO threshold of 20 dB or greater could only be compared for older children, and in younger children responses at 20 dB may have been treated as normal when they were not. Children with missing data were more likely to be younger and to have middle ear disease, which can bias diagnostic accuracy estimates.

The study was funded by the Patient Centered Outcomes Research Institute, with additional support from a T32 training grant. The authors reported no conflicts of interest.

Do not conclude that these screening protocols have been shown to improve hearing, educational, psychosocial, or vocational outcomes. The study compared how well screening tests identified children who met a reference standard; it did not test whether screening changed those outcomes.