BACKGROUND : School-based hearing screening is likely to be the first opportunity to identify
childhood hearing loss in South Africa. Criteria for school-based hearing screening requires
balancing the targeted degree of hearing loss while ensuring that referral rates are sufficiently
low for a cost-effective and sustainable programme. The study aim was to investigate
the effect of screening intensity (loudness) levels on the referral rate and to establish
the effect of an immediate rescreen in reducing the referral rate.
METHODS : A within-subject study was conducted in two phases. Phase 1: compared the
referral rate in a counterbalanced sequence at screening levels of 20 dB HL, 25 dB HL and
30 dB HL across 1, 2 and 4 kHz for 135 children. Phase 2: determined the effect of an immediate
rescreen on referral rate for 337 children screened at 25 dB HL. If a further referral
was obtained on rescreen, diagnostic audiometry was subsequently conducted.
RESULTS : Referral rate was reduced to 6.7% from 17% when using 25 dB HL as opposed to
20 dB HL as screening intensity. Referral rate was reduced to 4.4% when employing 30 dB
HL as screening intensity. An immediate rescreen reduced the overall referral rate by more
than one-third. Diagnostic audiometry confirmed that almost half (47%) of the referred
children had a hearing loss.
CONCLUSION : A screening intensity of 25 dB HL andimmediate rescreen reduces the referral rate
significantly and will limit the burden of the screening programme on health care resources.