No referral for many kids who fail hearing tests

Editor: While we're all busy patting ourselves on the back for the progress we've made in providing universal newborn hearing screening, we've been oblivious to the fact that many kids who fail hearing tests are not being referred for follow up. This news release from the St. Louis University School of Medicine tells the story!

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Pediatricians are not referring more than half of the children who fail hearing screenings for further tests, according to new research by a Saint Louis University physician. The study was published in the October issue of the Archives of Pediatrics and Adolescent Medicine.

"Doctors are doing tests that they're ignoring," says Donna R. Halloran, M.D., assistant professor of pediatrics at Saint Louis University School of Medicine, and a study author.

"Stop doing the test if you are not going to pay attention to it. Or, if you are going to do the test, pay attention to the results."

Halloran and her colleagues evaluated hearing screening results during 1,061 routine doctors' visits at three academic and five private practices in Alabama. They found that 10 percent of the children failed a hearing screening, which means that they missed reacting to at least one frequency sounded in either ear at the 20-decibel level. Of those children who failed the test, 59 percent received no further evaluation.

"My biggest problem is it's such a waste of money," says Halloran, who also is a SLUCare pediatrician at SSM Cardinal Glennon Children's Hospital. "It surprises me that in a litigious society we're ignoring screening results."

About 3 percent of the population has hearing impairment, Halloran says, which means the routine hearing screening picks up false positives.

However, if more than half of those who fail hearing screenings are not referred for in-depth evaluation by an audiologist, some children who have hearing problems might not get the help they need.

"At 4 years, they'll start to have some language delays that some people argue are not reversible," Halloran says. "A mild speech delay will be overlooked until they get into kindergarten. And even with severe hearing loss, huge improvements can be made with hearing aids."

While the study was conducted between 1998 and 2000, in 2003 the American Academy of Pediatrics revised its standards of hearing loss upwards - to 25 decibels, Halloran says. That's the equivalent, she says, to having 20:30 vision instead of 20:20, and likely fewer children would fail that screening.

However, the research brings a new question to light: How do doctors decide what to do when young patients have an abnormal screening result?

"The findings from this study are worrisome because physicians took no further action in more than 50 percent of the children who failed the hearing screening," Halloran says.

"Further evaluation or intervention must take place to allow children with possible hearing impairment to benefit from screening practices. Screening that does not result in action for those failing the screening wastes resources and fails to initiate necessary intervention for hearing loss."