OBJECTIVE : To evaluate the performance of self-reported hearing loss alone and in combination with pure tone audiometry
screening in primary health care clinics in South Africa. DESIGN : Nonprobability purposive sampling was used at 2 primary
health care clinics. A total of 1084 participants (mean age 41.2 years; SD 15.5 years; range 16-97 years, 74.0% female)
were screened using self-report and audiometry screening. Those failing audiometric screening and a sample of those who
passed audiometric screening were also assessed by diagnostic pure time audiometry, to confirm or negate the finding of
a hearing loss. RESULTS : Four hundred and thirty-six participants (40.2%) self-reported a hearing loss with no significant
association with gender or race. One hundred and thirty-six participant (12.5%) self-reported hearing loss and failed
audiometry screening (35 dB HL at 1, 2, and 4 kHz). Combining self-report with a second stage audiometry screening
revealed a high test accuracy (81.0%) for hearing loss, being most accurate (86.1%) to identify high-frequency hearing loss.
CONCLUSION : While self-report of hearing loss is an easy and time-efficient screening method to use at primary health
care clinics, its accuracy may be limited when used in isolation and it may not be sufficiently sensitive to detect hearing
loss. Combining a simple audiometry screening as a second-stage screen can significantly improve overall performance and
efficiency of the screening protocol.