Roles and Responsibilities of Audiologists

Audiologists, by virtue of academic degree, clinical training, and license to practice, are qualified to provide guidance, development, implementation, and oversight of hearing screening programs. Professional roles and activities in audiology include clinical and educational services (e.g., screening); prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Audiology (ASHA, 2018).

The following roles and responsibilities are appropriate for audiologists:

• Select screening protocols appropriate for the setting, population, and personnel.
• Select, upgrade, and calibrate screening equipment.
• Complete hearing screenings.
• Train screening personnel and monitor screening personnel competencies.
• Select and/or develop educational materials for families.
• Monitor quality assurance measures (e.g., pass/fail rates, miss rates, adherence to follow-up protocol).
• Develop and implement written policies and procedures, such as
  • infection control procedures;
  • screening techniques and process; and
  • documentation of screening results per state, district, and/or program policies.
• Communicate screening results to families; program and/or school representatives; and, as appropriate, state public health agencies (e.g., Early Hearing Detection and Intervention), primary care physicians, and diagnostic audiology centers.
• Provide counseling and education.
• Complete rescreening and diagnostic evaluations as indicated.
• Refer for medical and/or other professional services as indicated.
• Collaborate with professionals (e.g., health, education) to ensure appropriate follow-up and to monitor outcomes.
• Remain informed of research around childhood hearing screenings and childhood hearing loss.

As indicated in the ASHA Code of Ethics (ASHA, 2023), audiologists who work in this capacity should be specifically educated and appropriately trained to do so.

Roles and Responsibilities of Speech-Language Pathologists

Speech-language pathologists (SLPs) play a role in the hearing screening process and in the referral of individuals suspected of having hearing loss to an audiologist. Professional roles and activities in speech-language pathology include clinical and educational services (e.g., screening); prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016).

The following roles and responsibilities are appropriate for SLPs:

• Collaborate with audiologists in the development of screening protocols, equipment selection, and quality improvement.
• Perform hearing screenings (e.g., routine, prior to initiating speech-language services).
• Refer children who do not pass hearing screenings for audiologic, medical, and/or other professional services as indicated.
• Refer children who are unable to complete a hearing screening to an audiologist.
• Communicate screening results to families, including recommendations for timely follow-up.
• Share screening results with program and/or school representatives and, as appropriate, with state public health agencies (e.g., Early Hearing Detection and Intervention programs), primary care physicians, and diagnostic audiology centers.
• Provide counseling and education for families, educators, and other service providers.
• Collaborate with audiologists, school nurses, teachers, physicians, and/or other professionals to ensure appropriate follow-up and to monitor outcomes.

As indicated in the ASHA Code of Ethics (ASHA, 2023), SLPs who work in this capacity should be specifically educated and appropriately trained to do so.

Considerations for Target Populations

Early Childhood

Periodic screening of all children will help to identify those who were either lost to follow-up or not identified during the newborn period or those who developed hearing loss after the newborn period. Such screening includes the following activities:

• Provide ongoing surveillance and hearing screening beyond the newborn period (Bower et al., 2023; Harlor et al., 2009), with the following considerations:
  • Children ages 6 months to 3 years typically require screening with automated technology (i.e., otoacoustic emissions [OAEs]).
  • Although OAEs are considered an acceptable screening tool, pure-tone screening remains the gold standard and is ideally completed by the age of 5 years.
  • Children who cannot complete a pure-tone screening by the age of 5 years may be considered for an audiologic referral.
• Provide mandated hearing screening within 45 days of entry into Early Head Start and Head Start programs (U.S. Department of Health and Human Services, n.d.).
• Provide targeted and careful monitoring of children who are at high risk for delayed-onset hearing loss based on Joint Committee on Infant Hearing (2019) risk indicators.
• Screen a child’s hearing in response to an expressed concern (e.g., parent, teacher).
• Include hearing screening as part of any comprehensive speech-language evaluation.

The Educational Audiology Association provides guidance in the document Hearing Screening Considerations for Children With Significant Disabilities [PDF].

School Age

Hearing screening for school-age children may include the following activities:

• Screen of a child’s hearing upon initial entry or transfer into school and every year in grades K–3, grade 7, and grade 11 (ASHA, 2006).
• Screen hearing as part of educational monitoring for home-schooled or privately educated children.
• Provide annual risk assessment (and follow-up as needed) each year that the child’s hearing is not screened or assessed (Hagan et al., 2008).
• Screen the hearing of adolescents with an adapted protocol (e.g., include 6000/8000 Hz, threshold testing, the use of OAEs) for increased likelihood of identifying early high-frequency hearing loss and/or noise-induced hearing loss (Meinke & Dice, 2007; Sekhar et al., 2014).
• Provide required/mandated hearing screenings, per state guidelines.
• Screen a child’s hearing in response to an expressed concern (e.g., parent, teacher).
• Include hearing screening as part of any comprehensive speech-language evaluation.

Screening Equipment and Protocols

The selection and implementation of hearing screening protocols and equipment is guided by the specific goals of the individual hearing screening program. The target population, available personnel, and the screening environment—as well as program-specific needs and/or limitations—are important considerations. Ideally, an audiologist will be involved in selecting screening equipment, developing and implementing an appropriate screening and follow-up protocol, and providing training and technical assistance to screeners and other professionals.

Pure-tone audiometry, OAE technology, and tympanometry may all be appropriate options for inclusion in hearing screening programs. Automated versions of hearing screening tools are available and can be utilized by trained support personnel (e.g., audiologist, SLP, audiology assistant, speech-language pathology assistant, nurse, another trained screener). Evidence has been compiled regarding commonly used screening tools (Prieve et al., 2015).

The Educational Audiology Association provides guidance in the document Hearing Screening Considerations for Children With Significant Disabilities [PDF].

Otoscopy/Visual Inspection

Otoscopy completed by a trained examiner allows for visualization of the tympanic membrane and inspection of the external ear canal for drainage, foreign bodies, impacted cerumen, infection, or structural abnormalities. A screener who is not trained in otoscopy can perform a general visual inspection of the outer portion of the ear and make note of any abnormalities. The information obtained during visual inspection and otoscopy may have an important impact on screening results and/or call for the discontinuation of screening and referral to medical personnel.

Pure-Tone Screening

Pure-tone screening is typically accomplished with the use of a pure-tone audiometer. Pure-tone stimuli at octave-band frequencies are routed through supra-aural earphones or insert earphones. With younger children, pulsed- or warble-tone stimuli may be presented instead of pure tones. Some screening audiometers limit the screening frequencies and presentation levels. These audiometers will not provide the flexibility of a single-channel audiometer regarding adapting protocols for different populations (Johnson & Seaton, 2012). Factors to consider when using a pure-tone screening protocol include the following:

• Noise contamination in the screening environment may prohibit screening in any or all frequency ranges.
• It may not be possible to complete pure-tone screenings in the low-frequency range, even in a quiet environment, due to physiologic noise from the child or poor acoustics.
• For pure-tone screening to be accurate, a child must reliably respond to stimuli (i.e., by raising their hand when the stimuli are presented). Requirements to respond accurately and appropriately to the pure-tone tasks may impact or preclude participation by some children.
• For younger students or students with developmental, cognitive, or motoric challenges and/or delays, conditioned play techniques can be effective (Harlor et al., 2009; Johnson & Seaton, 2012). This type of pure-tone screening requires screeners who are specially trained in conditioned play audiometry techniques.

Pure-Tone Screening Procedure

• Complete otoscopy/visual inspection.
• Condition the child to respond appropriately using suprathreshold (e.g., 40 dB HL) stimuli prior to initiating the screening. Administer conditioning trials to ensure that the child understands the task.
• Present pure tones (typically presented at 1000 Hz, 2000 Hz, and 4000 Hz in each ear at 20 dB HL).
  • Some screening programs may choose to add 500 Hz at 25 dB HL.
  • Some screening programs for older children may choose to add 6000 Hz at 20 dB HL to identify possible high-frequency hearing loss.
• Limit testing to no more than four presentations per frequency to reduce false-positive responses (American Academy of Audiology [AAA], 2011).
• If the child does not respond at one or more frequencies, reinstruct, reposition earphones, and rescreen within the same screening period.

Pure-Tone Screening Results

An appropriate response to all presentation stimuli at screening levels in both ears results in a “pass.” A lack of response to any test frequency at screening levels in either ear results in a “fail/refer.”

OAE screening

OAEs—either transient-evoked OAEs (TEOAEs) or distortion product OAEs (DPOAEs)—are measured using a sensitive probe microphone inserted into the ear canal. OAEs are a direct measure of outer hair cell and cochlear function in response to acoustic stimulation and yield an indirect estimate of peripheral hearing sensitivity. OAEs do not technically test an individual’s hearing. Results reflect the performance of the inner ear mechanics. OAEs are not sensitive to disorders central to the outer hair cells, such as auditory neuropathy spectrum disorder, which is a neural hearing loss that leaves cochlear (outer hair cell) function intact.

When using TEOAEs, clicks or tone bursts are used as the stimuli at one level—for example, 80 dB SPL. Normal distributions for this condition for normal hearing and summary data are documented in the literature (Carter et al., 2015; Hussain et al., 1998; Liu & Wang, 2012). When using DPOAEs, pure tones are used as the stimuli. Normal distributions for this condition for normal hearing and summary data are documented in the literature (Carter et al., 2015; Gorga et al., 1997).

Factors to consider when using an OAE screening protocol include the following:

• The use of OAE technology may be appropriate for screening children who have difficulty participating in pure-tone audiometry (i.e., those who do not respond to traditional pure-tone or conditioned play techniques; Stephenson, 2007).
• Screening in quiet environments typically reduces the amount of time needed to complete an OAE hearing screening. A reasonable amount of noise may be present without interrupting the OAE screening process. OAE equipment may indicate when the screening environment is too noisy.
• It may not be possible to complete OAE screenings in the low-frequency range, even in a quiet environment, due to physiologic noise from the child or poor acoustics.
• With OAE protocols taking less time than pure-tone protocols, more children may be screened on a given day (Kreisman et al., 2013).
• OAEs will usually be absent when there is outer or middle ear dysfunction.
• OAEs may miss some cases of educationally significant mild and mild–moderate hearing loss or auditory neuropathy spectrum disorder (AAA, 2011).
• OAE protocols may result in refer rates that are higher than those of pure-tone and combined OAE/tympanometry protocols. Multiple OAE screenings may be used to limit false-positive findings and resulting medical referrals for children who receive a fail/refer result on the initial OAE screen but who do not actually need treatment (Eiserman et al., 2008).

OAE Screening Procedure

• Complete otoscopy/visual inspection.
• Place a small probe in the ear canal to deliver the sound stimuli.
• Read results. Automated OAE screening units will analyze the emission and provide a result of either “pass” or “fail/refer.” Diagnostic units will require interpretation of the findings by an audiologist. Screeners other than audiologists should not independently change the parameters of the test equipment or provide interpretation of findings.

OAE Screening Results

Screening programs that use OAE equipment often use the manufacturer’s preset stimulus and pass/fail parameters, which vary. This allows for participation by screeners who do not have the background or knowledge to adjust or interpret result parameters. When automated equipment is used, findings will be recorded as either “pass” or “fail/refer.”

Tympanometry

Tympanometry can be added to the protocols of either pure-tone or OAE screening to measure the mobility of the tympanic membrane and the status of the middle ear transmission system. During tympanometry, a probe is fit snuggly into the ear canal. Pressure between the probe and the tympanic membrane is varied between +200 dB PA and −400 dB PA. Reflected sound from the probe tone is recorded across the pressure range, and a tympanogram is created. Tympanogram results convey the status of the middle ear system and suggest conditions that may need medical attention, such as eustachian tube dysfunction, middle ear fluid, or a perforated tympanic membrane. Factors to consider when adding tympanometry to a screening protocol include the following:

• Because younger children are at increased risk of receiving a fail/refer result on the pure-tone screen due to middle ear fluid (i.e., otitis media with effusion [OME]), the addition of tympanometry may be beneficial when screening children in preschool through first grade (AAA, 2011).
• Tympanometry can assist in determining whether a rescreening or an immediate referral for medical or audiologic evaluation is indicated.
• It is appropriate to immediately refer a child for audiologic assessment if they pass tympanometry but receive a fail/refer result on pure-tone screening.

Tympanometry Screening Procedure

• Complete otoscopy/visual inspection. Make note of the presence or absence of pressure equalizing (PE) tubes.
• Place the probe in the ear canal to deliver tones, and vary the air pressure between positive and negative.
  • A 226-Hz probe tone is appropriate for children aged 6 months and older (Margolis et al., 2003).
• Read the results.

Tympanometry Screening Results

Automated equipment will report results as “pass” or “fail/refer.” When nonautomated equipment is used, the recommended referral criteria are > 250-daPa tympanometric width for children 3–12 years of age and > 275-daPa tympanometric width for children below the age of 3 years. If the use of tympanometric width is not possible, < 0.2-mmhos static compliance is recommended (AAA, 2011). Ear canal volume of > 1.0 cm³ and a flat tympanogram can indicate either patent PE tubes or tympanic membrane perforation.

Note: The presence of PE tubes may lead to a “fail/refer” result; however, this result must be confirmed with otoscopy by a trained examiner. The presence of PE tubes is not differentiated from a perforated tympanic membrane with the use of tympanometry alone.

Protocol Variations

Childhood hearing screening protocols may include the following approaches:

• pure-tone audiometry only
• pure-tone audiometry and tympanometry
• OAE screening only
• OAE screening and tympanometry

Each screening approach has distinct advantages and disadvantages. Processes vary between screening programs and school districts as do state regulations regarding hearing screening. Obtaining informed parent/guardian permission is a recommended part of any hearing screening protocol; however, extant state statutes/regulations or institutional policies supersede this recommendation.

Recommendations based on hearing screening results may include the following:

• Rescreen according to district/state/program mandates or sooner if concern is expressed.
• Rescreen after a given time period (e.g., 6–8 weeks) or after medical treatment is complete.
• Immediately refer for medical consultation.
• Immediately refer for audiologic consultation.

Considerations for Screen and Rescreen Timelines

Timelines for referral and rescreening are determined on a case-by-case basis, with consideration given to the child’s overall health, otoscopic examination findings, and individualized educational concerns. Examples of considerations regarding rescreen timelines include the following:

• When a pure-tone protocol or a pure-tone and tympanometry protocol is used, the rationale for the 6- to 8-week timeline between an initial result of fail/refer and a rescreening is based on the timeline for spontaneous recovery of middle ear effusions and the prevalence of middle ear effusions in children. The American Academy of Pediatrics (American Academy of Family Physicians et al., 2004) indicates that a child with OME and no other significant risk can be managed with watchful waiting for up to 3 months from the date of onset or diagnosis. OME after untreated acute otitis media had 59% resolution by 1 month and 74% resolution by 3 months (Rosenfeld & Kay, 2003).
• The 6- to 8-week timeline also allows the clinician to provide information about the persistence of possible middle ear effusion to the primary care provider or other medical professional.
• Some school districts choose to use a shorter 2- to 4-week timeline, which has the benefit of earlier assessment and management of those children with undiagnosed permanent hearing loss. A drawback of a shorter timeline is over-referral of children who may have a middle ear effusion in the process of resolution. Otitis media is a common health care concern prompting childhood visits to a doctor.

Program Management

There are many factors that must be considered prior to the initiation of a childhood hearing screening program. It is important to include procedures related to equipment calibration, personnel training, screening environment, universal precautions, and appropriate and timely follow-up. Consideration of the resources necessary to provide appropriate services and to maintain ongoing communications with children and their families is vital.

Equipment Calibration

Audiometric equipment must meet applicable specifications of ANSI/ASA S3.6-2018 (American National Standards Institute/Acoustical Society of America, 2018) and/or manufacturer recommendations to ensure accurate results. Exhaustive electroacoustic calibrations should be performed annually using instrumentation traceable to the National Institute of Standards and Technology. Functional inspection, performance checks, and bioacoustic checks should be conducted to verify equipment performance prior to each use. Visual inspection may be completed to identify any obvious equipment damage. All calibration activities should be conducted by a trained audiologist or an external company/individual who is properly trained in performing such tasks.

Currently, there are no ANSI standards for the calibration of OAE equipment. For this reason, there may be differences in signal calibration, calculation of the noise floor, and response determination algorithms between manufacturers. These differences could impact the level of hearing loss that can be detected during screening.

Personnel Training

Screening programs with the supervision of an educational audiologist and more uniform protocols may “result in more accurate screening results, a better system for referrals, and proper diagnoses” (Richburg & Imhoff, 2008, p. 41). It is important that all screeners receive thorough initial training and refresher training as needed to maintain screening skills and knowledge. It may be beneficial for the results of new screeners to be validated by experienced screeners until they become more comfortable with the equipment and screening process. While screening programs often necessitate flexibility and adaptability, adherence to the policies and procedures that were chosen or developed for a specific program is essential.

See the ASHA Assistants Program for information on the training, educational standards, and roles/responsibilities of these professionals.

Screening Environment

Test environments for pure-tone screening should be free from visual distractions and interruptions and should meet the specifications detailed by the American National Standards Institute/Acoustical Society of America (2023) regarding allowable ambient noise. Calibrated phone applications offer one mechanism to assess ambient noise. An alternative approach is to use a biologic noise level check prior to the commencement of hearing screening. This has been defined as the ability to establish hearing thresholds at least 10 dB below the screening level (e.g., 10 dB HL for screening conducted at 20 dB HL) at all frequencies for a person with known normal hearing. Results of this approach may not necessarily reach ANSI standards.

Universal Precautions

Adherence to universal precautions and appropriate infection control procedures during screenings is essential. Instrumentation that comes into physical contact with the child must be cleaned and disinfected after each use (and per manufacturer’s instructions), and clinician handwashing between patients should be routine. Disposable equipment, such as probe tips, should be discarded after each use. For more information, see the ASHA page on infection control resources for audiologists and speech-language pathologists.

Follow-Up and Referral Procedures

Appropriate follow-up for screening programs includes the rescreening of those children who did not pass the initial screen and the screening of children who were absent during the initial screen, as well as proper referrals for medical, audiologic, or educational evaluations (Johnson & Seaton, 2012).

Documentation and Recommendations

Screening documentation generally includes identifying information, comprehensive results, and recommendations, including the need for rescreening and appropriate referrals (ASHA, 2006).

Notification

Local, state, and federal regulations may vary regarding parent/guardian notification and permission for a child to participate in hearing screening. Parents/guardians may be informed in writing prior to the screening date to give them the opportunity to express any preference for their child not to be screened, to request that they provide any important background information regarding the child’s hearing, and to inform them of the type of follow-up communication they can expect. Parent/guardian notification materials may include basic information about the process and purpose of hearing screening, as well as information about the educational impact of hearing loss. See the ASHA resource on health literacy.

Screening and Rescreening Forms

Recordkeeping methodology will be determined, in part, by the setting and/or material availability. Options include student-specific paper forms, classroom-specific paper forms, or computer database entry, among others. Screening form use and type may be determined by the policies of each program/school/district with respect to the compilation and maintenance of child/student health records.

Result Reporting

Proper documentation of screening results may include reporting to the program/school, reporting to the parents/guardians, and receiving information back regarding follow-up recommendations (Johnson & Seaton, 2012). When providing results to parents/guardians whose child is referred for medical or audiologic follow-up, the screener may give the parents/guardians a feedback form to give to the provider and then return to the program/school. Providing screening results to program/school personnel (e.g., health specialists, nurses, teachers, administrators, SLPs) will facilitate the proper follow-up and/or accommodations appropriate for the student. It may be beneficial to notify the parents/guardians after any result of fail/refer on a screening, even if a rescreening is planned, so that they can be involved in any decision making regarding next steps. See the ASHA resource on health literacy.

Program Evaluation

Various quality indicators can be measured to determine the effectiveness of a screening program. It is important to collect data, such as the number of children screened, the number of children who did not pass the initial screen and/or rescreening, the number of children referred for medical or audiologic follow-up, the number of children seen for professional follow-up, and the number of children diagnosed with and/or treated for hearing disorders. Other quality indicators may include how quickly children move through the recommended protocol and the number of provider reports returned following a referral, as well as parent/guardian satisfaction. Such data can be used to “document need for the hearing screening program, identify over or under referrals that can target equipment or training needs, help track loss to follow-up, and clarify other issues that impact the efficiency and effectiveness of a hearing screening program” (AAA, 2011, p. 46).

Laws and Regulations

• Most states have hearing screening requirements pertaining to school-age children. It is important to check with your state for the most current information on its policies and regulations.
• Local Head Start and Early Head Start programs must comply with the Head Start Program Performance Standards and are monitored by the Administration for Children and Families under the U.S. Department of Health and Human Services.
• The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program is the child health component of Medicaid. EPSDT provides access to screening, diagnostic, and treatment services for Medicaid-enrolled children. The Health Resources and Services Administration provides information on the coordination between EPSDT and Title V Maternal and Child Health Services.
• The Individuals with Disabilities Education Act (IDEA) Part B includes hearing screening in the audiology services provided. IDEA Part C requires that audiologists and SLPs who identify hearing loss or language delays in children younger than the age of 3 years initiate a referral to the Part C program “as soon as possible” but not more than 7 calendar days after identification.

ASHA Resources

• ASHA Assistants Program
• CPT Coding for Otoacoustic Emissions: Frequently Asked Questions
• Current IDEA Part B Final Regulations (2006)
• Current IDEA Part C Final Regulations (2011)
• Health Literacy
• Hearing-Related Topics: Terminology Guidance
• Infection Control Resources for Audiologists and Speech-Language Pathologists
• Resource Guide for Educational/Pediatric Audiologists
• School-Age Hearing Screening
• State School Hearing Screening Requirements
• Understanding the Individuals with Disabilities Education Act (IDEA)

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

• Early Hearing Detection & Intervention Pediatric Audiology Links to Services (EHDI-PALS)
• Educational Audiology Association (EAA)
  • EAA: Hearing Screening Considerations for Children With Significant Disabilities [PDF]
• Health Resources and Services Administration: Early Periodic Screening, Diagnosis, and Treatment
• National Center for Hearing Assessment and Management: Early Childhood Hearing Screening
• National Institute on Deafness and Other Communication Disorders
• Safe Listening Devices and Systems: A WHO-ITU Standard [PDF]
• U.S. Department of Health and Human Services: Head Start Policy and Regulations

American Academy of Audiology Subcommittee on Childhood Hearing Screening. (2011). American Academy of Audiology: Childhood hearing screening guidelines [White paper].

American Academy of Family Physicians, American Academy of Otolaryngology-Head and Neck Surgery, & American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. (2004). Otitis media with effusion. Pediatrics, 113(5), 1412–1429. https://doi.org/10.1542/peds.113.5.1412

American National Standards Institute/Acoustical Society of America. (2018). Specification for audiometers (ANSI S3.6-2018).

American National Standards Institute/Acoustical Society of America. (2023). Maximum permissible ambient noise levels for audiometric test rooms (Rev. ed.) (ANSI S3.1-1999).

American Speech-Language-Hearing Association. (2006). Preferred practice patterns for the profession of audiology [Preferred practice patterns]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of practice]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2018). Scope of practice in audiology [Scope of practice]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. https://www.asha.org/policy/

Bower, C., Reilly, B. K., Richerson, J., Hecht, J. L., & Committee on Practice & Ambulatory Medicine. (2023). Hearing assessment in infants, children, and adolescents: Recommendations beyond neonatal screening. Pediatrics, 152(3), e2023063288. https://doi.org/10.1542/peds.2023-063288

Carter, L., Williams, W., & Seeto, M. (2015). TE and DP otoacoustic emission data from an Australian cross-sectional hearing study. International Journal of Audiology, 54(11), 806–817. https://doi.org/10.3109/14992027.2015.1046505

Centers for Disease Control and Prevention. (2023, January). 2020 summary of national CDC EHDI data. https://www.cdc.gov/ncbddd/hearingloss/2020-data/01-data-summary.html

Eiserman, W. D., Shisler, L., Foust, T., Buhrmann, J., Winston, R., & White, K. (2008). Updating hearing screening practices in early childhood settings. Infants & Young Children, 21(3), 186–193. https://doi.org/10.1097/01.IYC.0000324548.54693.fc

Gorga, M. P., Neely, S. T., Ohlrich, B., Hoover, B., Redner, J., & Peters, J. (1997). From laboratory to clinic: A large scale study of distortion product otoacoustic emissions in ears with normal hearing and ears with hearing loss. Ear and Hearing, 18(6), 440–455.

Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). American Academy of Pediatrics.

Harlor, A. D. B., Jr., Bower, C., Committee on Practice and Ambulatory Medicine, & the Section on Otolaryngology-Head and Neck Surgery. (2009). Hearing assessment in infants and children: Recommendations beyond neonatal screening. Pediatrics, 124(4), 1252–1263. https://doi.org/10.1542/peds.2009-1997

Hussain, D. M., Gorga, M. P., Neely, S. T., Keefe, D. H., & Peters, J. (1998). Transient evoked otoacoustic emissions in patients with normal hearing and in patients with hearing loss. Ear and Hearing, 19(6), 434–449.

Johnson, C. D., & Seaton, J. B. (2012). Educational audiology handbook (2nd ed.). Plural.

Joint Committee on Infant Hearing. (2019). Year 2019 position statement: Principles and guidelines for early hearing detection and intervention programs. Journal of Early Hearing Detection and Intervention, 4(2), 1–44.

Kreisman, B. M., Bevilacqua, E., Day, K., Kreisman, N. V., & Hall, J. W., III. (2013). Preschool hearing screenings: A comparison of distortion product otoacoustic emission and pure-tone protocols. Journal of Educational Audiology, 19, 48–57. www.edaud.org/journal/2013/5-article-13.pdf [PDF]

Liu, J., & Wang, N. (2012). Effect of age on click-evoked otoacoustic emission: A systematic review. Neural Regeneration Research, 7(11), 853–861.

Margolis, R. H., Bass-Ringdahl, S., Hanks, W. D., Holte, L., & Zapala, D. A. (2003). Tympanometry in newborn infants—1 kHz norms. Journal of the American Academy of Audiology, 14(07), 383–392. https://doi.org/10.1055/s-0040-1715757

Meinke, D. K., & Dice, N. (2007). Comparison of audiometric screening criteria for the identification of noise-induced hearing loss in adolescents. American Journal of Audiology, 16(2), S190–S202. https://doi.org/10.1044/1059-0889(2007/023)

Niskar, A. S., Kieszak, S. M., Holmes, A., Esteban, E., Rubin, C., & Brody, D. J. (1998). Prevalence of hearing loss among children 6 to 19 years of age: The Third National Health and Nutrition Examination Survey. JAMA, 279(14), 1071–1075. https://doi.org/10.1001/jama.279.14.1071

Office of Special Education Programs. (2023). 44th annual report to Congress on the implementation of the Individuals with Disabilities Education Act, 2022. U.S. Department of Education, Office of Special Education and Rehabilitative Services. https://sites.ed.gov/idea/files/44th-arc-for-idea.pdf [PDF]

Prieve, B. A., Schooling, T., Venediktov, R., & Franceschini, N. (2015). An evidence-based systematic review on the diagnostic accuracy of hearing screening instruments for preschool- and school-age children. American Journal of Audiology, 24(2), 250–267. https://doi.org/10.1044/2015_AJA-14-0065

Richburg, C. M., & Imhoff, L. (2008). Survey of hearing screeners: Training and protocols used in two distinct school systems. Journal of Educational Audiology, 14, 31–46. www.edaud.org/journal/2007-2008/4-article-07-08.pdf [PDF]

Rosenfeld, R. M., & Kay, D. (2003). Natural history of untreated otitis media. The Laryngoscope, 113(10), 1645–1657. https://doi.org/10.1097/00005537-200310000-00004

Sekhar, D. L., Zalewski, T. R., Ghossaini, S. N., King, T. S., Rhoades, J. A., Czarnecki, B., Grounds, S., Deese, B., Barr, A. L., & Paul, I. M. (2014). Pilot study of a high-frequency school-based hearing screen to detect adolescent hearing loss. Journal of Medical Screening, 21(1), 18–23. https://doi.org/10.1177/0969141314524565

Stephenson, M. (2007). The effect of classroom sound field amplification and the effectiveness of otoacoustic emission hearing screening in school-age children. New Zealand Health Technology Assessment Technical Brief, 6(3), 1–60.

U.S. Department of Health and Human Services. (n.d.). Head Start policy and regulations: 45 CFR §1302.42 (b)(2). https://eclkc.ohs.acf.hhs.gov/policy/45-cfr-chap-xiii/1302-42-child-health-status-care

Acknowledgments

Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Childhood Hearing Screening page:

• Karen Anderson, PhD, CCC-A
• Lisa Cannon, AuD, CCC-A
• Paul Farrell, AuD, CCC-A
• Tara Guinn, AuD, CCC-A
• Jeffrey Hoffman, PhD, CCC-A
• Cynthia McCormick Richburg, PhD, CCC-A
• Caleb McNiece, AuD, CCC-A
• Aparna Rao, PhD, CCC-A
• Kathleen Riley, AuD, CCC-A
• Jane Seaton, MS, CCC-A/SLP
• Donna Smiley, PhD, CCC-A

Several ASHA documents were consulted during the development of the Childhood Hearing Screening Practice Portal page. ASHA thanks the members of the Ad Hoc Committee on Screening for Impairment, Handicap, and Middle Ear Disorders (Technical Report on Audiologic Screening); the members of the Working Group on Audiology Services in Schools (Guidelines for Audiology Service Provision in and for Schools); and the members of the Panel on Audiologic Assessment (Guidelines for Audiologic Screening) whose work was foundational to the development of this content.

Members of the Ad Hoc Committee on Screening for Impairment, Handicap, and Middle Ear Disorders were Robert Nozza (chair), Judith Gravel, Joan Martilla, Michael Nerbonne, Diane Scott, Thayne Smedley, and Jo Williams (ex officio). Guidance on the report was provided by Jean Lovrinic, vice president for governmental and social policies (1991–1993).

Members of the Working Group on Audiology in Schools were Merrill Alterman, Gail Rosenberg, Paula Schauer (working group facilitator), and Evelyn J. Williams (ex officio). Serving as monitoring vice president was Susan J. Brannen, vice president for professional practices in audiology (2001–2003).

The Panel on Audiologic Assessment was led by Chie Craig (chair). The pediatric working group included Deborah Hayes (coordinator), Kathryn Beauchaine, Stefanie Bronson, Robert Nozza, Anne Marie Tharpe, and Judith Wilson. The adult working group included Sabina Schwan (coordinator), Gary Jacobson, and Wayne Olsen. Evelyn Cherow served as ex officio. Larry Higdon served as the monitoring executive board officer.

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Childhood hearing screening [Practice portal]. https://www.asha.org/Practice-Portal/Professional-Issues/Childhood-Hearing-Screening/