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Tablet Based Hearing Screening in Nicaraguan Schoolchildren: Specificity and Strategies

Lack of trained staff and accurate screening equipment, combined with high ambient noise levels in schools, make hearing screening for schoolchildren in impoverished rural communities challenging. The Creare Wireless Audiometric Hearing-Test System (WAHTS) is a highly-noise-attenuating hearing screening device controlled wirelessly by a mobile platform (tablet or smartphone). Because it requires minimal training to operate, we hypothesized that minimally-trained personnel could perform high-quality audiometry in schools using this system and produce results comparable to conventional audiometry completed in a sound-proof booth. We tested 120 Nicaraguan 2nd and 3rd graders with both an automated and manual testing protocol at 1, 2, and 4 kHz. Thresholds >25 dB HL at 1 or more frequencies were considered screening failures. A certified audiometric technician retested 101 of the children with conventional audiometry in a hospital based soundproof booth. Based on audiometry in the soundproof booth, four of the 101 children met the criteria for hearing loss. They were all detected using either an automated, manual, or combined (automated and manual) WAHTS screening protocol in the school (sensitivity=100%). Specificity was 76% for automated screening alone, 97% for manual screening alone, and 99% when a two-step process was used (those failing automated screening were tested manually). The variability of automated screening was greater than manual screening. The Stimulus Response False Positive (SRFP) rate, the number of inappropriate responses as a percentage of the total responses for each threshold, was higher in children with false positive automated screening, which suggests that the poor specificity of the automated screening is partly related to the child’s behavior. Minimally-trained personnel identified all children with hearing loss using the WAHTS in a challenging field setting. Automated screening may be used to screen children initially followed by manual screening in those who fail screening to reduce false positives and unnecessary referrals.

• Understand the challenges of hearing screening in rural low income schools
• Describe the advantages of a highly noise attenuating headset for screening
• Discuss ways to improve specificity of testing in these environments

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James Saunders (POC,Primary Presenter), Dartmouth Hitchcock Medical Center, james.saunders@hitchcock.org;
Dr. James E. Saunders is a Professor of Otology / Neurotology at Dartmouth Hitchcock Medical Center. He completed an M.D. at University of Oklahoma, Residency Training and a Research Fellowship in Otolaryngology at Duke University Medical Center, and a Research and Clinical Fellowship at the House Ear Institute in Los Angeles. Dr. Saunders has many projects related to the etiology, prevention and treatment of hearing loss in the developing world including collaborations with the WHO and the Global Burden of Disease Project. He is past Coordinator for International Affairs and Chairman of the Humanitarian Efforts Committee for the AAO-HNSF. In 1999, he co-founded Mayflower Medical Outreach, an organization that supports and trains otolaryngologists and audiologists in Nicaragua. He currently serves as the co-chair for the Coalition for Global Hearing Health, an international multidisciplinary organization devoted to education and advocacy for hearing health services in low resource areas.

ASHA DISCLOSURE: Financial - Nonfinancial -

AAA DISCLOSURE: Financial - No relevant financial relationship exists.

Odile Clavier (Author), Creare, ohc@creare.com;
Odile Clavier received her bachelor’s degree from Florida Tech and her master’s and Ph.D. from Stanford University in the department of Aeronautics and Astronautics. For her graduate research, she developed a high precision superconducting sensor for the accelerometer to be flown on the Satellite Test of the Equivalence Principle (STEP). Since joining Creare, she has been the Principal Investigator for several biomedical applications, in particular the development of hearing assessment systems, including innovative testing techniques as well a new technology for use in the field and in non-clinical environments.

ASHA DISCLOSURE: Financial - Nonfinancial -

AAA DISCLOSURE: Financial - No relevant financial relationship exists.

Jesse Norris (Co-Author), Creare, jan@creare.com;
Dr. James (Jesse) Norris graduated for the School of Biomedical Engineering and Sciences, a collaborative effort between Virginia Tech and Wake Forest University. At Creare, he is involved in hearing assessment and acoustics, image processing and dynamic signal analysis.

ASHA DISCLOSURE: Financial - Nonfinancial -

AAA DISCLOSURE: Financial - No relevant financial relationship exists.

Jay Buckey (Co-Author), Geisel School of Medicine at Dartmouth, Jay.C.Buckey.Jr@Dartmouth.EDU;
Dr. Buckey is a Professor of Medicine at the Geisel School of Medicine at Dartmouth, and has a long-standing research interest in the use of otoacoustic emissions for the early detection of hearing damage. He has worked closely with Creare LLC on projects that have evaluated otoacoustic emissions in a variety of settings, including Tanzania and Nicaragua. He is currently the Principal Investigator on a grant evaluating techniques, including otoacoustic emssions, for the early detection of noise-induced hearing loss.

ASHA DISCLOSURE: Financial - Nonfinancial -

AAA DISCLOSURE: Financial - No relevant financial relationship exists.

Isabelle Magro (Author), Giesel Medical School at Dartmouth, Isabelle.L.Magro.MED@Dartmouth.edu;
Fourth year Medical student in Otolaryngology

ASHA DISCLOSURE: Financial - Nonfinancial -

AAA DISCLOSURE: Financial - No relevant financial relationship exists.