Purpose This study aimed to describe and compare the performance of two screening protocols used for preschool hearing screening in resource-constrained settings. Method Secondary data analysis was done to determine the performance of two protocols implemented during a preschool hearing screening program using mobile health technology in South Africa. Pure-tone audiometry screening at 25 dB HL for 1000, 2000, and 4000 Hz in each ear was used by both protocols. The fail criterion for the first protocol (2,147 children screened) constituted a no-response on one or more frequencies in either ear. The second protocol required two or more no-responses (5,782 children). Multivariate logistic regression models were used to investigate associations between outcomes and protocol, age, gender, and duration. Results Fail rates for the one-frequency fail protocol was 8.7% (n = 186) and 4.3% (n = 250) for the two-frequency fail protocol. Children screened with the two-frequency fail protocol were 52.9% less likely to fail (p < .001; OR = 0.471; 95% confidence interval [0.385, 0.575]). Gender (p = .251) and age (p = .570) had no significant effect on screening outcome. A percentage of cases screened (44.7%) exceeded permissible noise levels in at least one ear at 1000 Hz across both protocols. True- and false-positive cases did not differ significantly between protocols. Protocol type (p = .204), gender (p = .314), and age (p = .982) did not affect the odds of being a true-positive result. Average screening time was 72.8 s (78.66 SD) and 64.9 s (55.78 SD) for the one-frequency and two-frequency fail protocols, respectively. Conclusions A two-frequency fail criterion and immediate rescreen of failed frequencies significantly reduced referral rate for follow-up services that are often overburdened in resourced-constrained settings. Future protocol adaptations can also consider increasing the screening levels at 1000 Hz to minimize the influence of environmental noise.

中文翻译：

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资源受限环境中学龄前听力筛查的转诊标准：方案比较。

目的 本研究旨在描述和比较在资源受限环境中用于学前听力筛查的两种筛查方案的性能。方法 进行了二次数据分析，以确定在南非使用移动健康技术的学龄前听力筛查计划中实施的两种协议的性能。两种协议均使用 1000、2000 和 4000 Hz 的 25 dB HL 纯音测听筛查。第一个协议的失败标准（筛选了 2,147 名儿童）构成对任一只耳朵的一个或多个频率无反应。第二个协议需要两个或多个无反应（5,782 名儿童）。多变量逻辑回归模型用于研究结果与方案、年龄、性别和持续时间之间的关联。结果 单频失败协议的失败率为 8.7% (n = 186)，双频失败协议的失败率为 4.3% (n = 250)。使用双频失败方案筛查的儿童失败的可能性降低 52.9%（p < .001；OR = 0.471；95% 置信区间 [0.385, 0.575]）。性别 (p = .251) 和年龄 (p = .570) 对筛查结果没有显着影响。在两种协议中，至少有一只耳朵在 1000 Hz 时超过了允许的噪音水平（44.7%）。真阳性和假阳性病例在协议之间没有显着差异。方案类型 (p = .204)、性别 (p = .314) 和年龄 (p = .982) 不影响成为真阳性结果的几率。对于单频和双频失败协议，平均筛选时间分别为 72.8 秒（78.66 SD）和 64.9 秒（55.78 SD）。结论 两个频率失败标准和失败频率的立即重新筛选显着降低了后续服务的转诊率，这些服务在资源有限的环境中经常负担过重。未来的协议改编还可以考虑增加 1000 Hz 的屏蔽级别，以最大限度地减少环境噪声的影响。