Accuracy of School Screenings in the Identification of Minimal Sensorineural Hearing Loss

Purpose: The goal of this study was to investigate how the use of a 25 dB HL referral criterion in school screenings affects the identification of hearing loss categorized as minimal sensorineural hearing loss (MSHL). Method: A retrospective study applied screening levels of 20 and 25 dB HL at 1000, 2000, and 4000 Hz in each ear to previously obtained pure-tone thresholds for 1,475 school-age children. In a separate prospective study, 1,704 children were screened at school under typical conditions, and a subsample had complete audiological evaluations. Referral rates, sensitivity, and specificity were calculated for each screening level. Results: Referral rates varied by grade and criterion level, with comparable results between the two data sets. In both studies, when the screening level increased, the sensitivity to MSHL declined markedly, whereas specificity increased in the prospective study. Conclusions: Screening at 25 dB yields poor sensitivity to MSHL. Converging evidence from these diverse populations supports using the 20 dB level to help identify MSHL. Multistage screening is recommended to limit referral rates. Even at 20 dB HL, cases of MSHL may be missed. Audiologists should encourage parents, educators, and speech-language pathologists to refer children suspected of hearing difficulty for complete audiological evaluations even if they pass school screenings.