Hearing test may be failing to ID older teens with problems

A hearing test given to Pennsylvania 11th graders every year may be failing to identify most of those with hearing loss, according to a study led by Penn State College of Medicine researchers.

Part of the reason, the authors say, is that the test does not measure hearing ability at higher frequencies - the very ones that teenagers are likely to have trouble hearing after frequent exposure to loud music and other noise.

State health officials say they are aware of the findings, published earlier this year in the Journal of Medical Screening, but are waiting for additional research before making any changes.

The familiar screening test involves putting on headphones and raising your hand when you hear beeps at various frequencies. It also is given annually to children in kindergarten and grades 1, 2, 3, and 7 - for whom the test may be adequate since they are less likely to have noise-induced, high-frequency hearing loss, said the study's lead author, Penn State's Deepa L. Sekhar.

Undiagnosed cases of hearing loss have implications in the classroom and beyond, said Sekhar, an assistant professor of pediatrics. Previous research has found that students with even mild untreated hearing loss are more likely to repeat a grade.

Tests may be falling short in many other states as well, because most, like Pennsylvania, require the use of beeps only up to 4,000 Hertz (Hz), she said. Musically speaking, that is quite high, near the top end of a piano, but the pitch of some consonant sounds in human speech is much higher. For instance, "s" is 5,000-6,000; "th" in "thin" is 6,000.

New Jersey requires students' hearing to be screened but doesn't specify at which frequencies.

Sekhar stressed that Pennsylvania school nurses are in no way at fault, but that changes are needed in the state-mandated method used on 11th graders.

In a group of 47 11th graders at Hershey High School, the screening correctly flagged only one out of eight students who actually had hearing loss, Sekhar and her coauthors reported in their study.

"What blows my mind is the school nurses spend so much time and effort" on screenings, she said. The test takes two minutes per student, but imagine herding hundreds of them through the process in a large high school.

Yet, fixing the test method may not be easy, said audiologist Karen L. Anderson, chair of a task force that developed childhood screening guidelines for the American Academy of Audiology. If nurses were simply to ask children to listen for beeps at higher frequencies, even those with normal hearing could have trouble perceiving them in a noisy school environment, she said.

That would lead to false positives - students incorrectly identified as possibly having hearing loss - followed by costly referrals for follow-up by audiologists or physicians.

"You're going to fail a whole lot more kids than really have an issue," Anderson said. "It's just harder to pick out a high-frequency tone unless it's perfectly quiet."

Indeed, Sekhar and colleagues conducted a separate, enhanced screening of the Hershey kids, adding high-frequency beeps. The test correctly identified everyone with actual hearing problems. But the enhanced test also incorrectly flagged about half of the students who had normal hearing.

The students' true hearing abilities were established with a comprehensive "gold standard" test, conducted in a soundproof booth at Penn State Milton S. Hershey Medical Center.

Sekhar said one solution may be to administer the enhanced screen a second time to any students who fail, then refer them for medical follow-up only if they fail twice. Other authors of the study included Tonya S. King and Ian M. Paul of Penn State and Thomas R. Zalewski of Bloomsburg University.

School nurses agree that the test may need tweaking, but feel it is helpful as is, said Cheryl Peiffer, president of the Pennsylvania Association of School Nurses and Practitioners.

"I still find it valuable, because every year I usually get one that doesn't pass the threshold and they wind up coming back with a hearing aid," said Peiffer, a nurse at Methacton High School.

Both Sekhar and Anderson, director of a website called Supporting Success for Children With Hearing Loss, agreed that another essential component is education. Many teens will turn out to have a hearing loss not severe enough to warrant a hearing aid, but figuring out the cause is important in preventing future decline.

Use ear protection in shop class or at rock concerts, they said. And do not listen to an iPod or other portable music player when mowing the lawn, at least not with earbuds. The teenager is likely to turn up the volume even higher than normal to overcome the noise, Sekhar said, thereby delivering a double whammy to the ears.

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