Hearing Screening Result Interpretation and Follow-up

The criterion for pure tone audiometry screening referral is the lack of response to any screening tones in one or both ears during the 14 to 21-day.

Next Steps

Depending on their role and practice site policy, the screener identifies next steps, to ensure follow up occurs for positive screen results.

Refer to the Pure Tone Audiometry Screening Algorithm

Other Considerations

• If the child is unable to follow directions, refer to the play audiometry section for recommendations on rescreening.
• If the child is unable to perform play audiometry rescreen:
  • For children three years of age, rescreen within six months.
  • For children four years or older, rescreen within 30 days.
• If the child has a REFER result (misses one or more tones) after immediate rescreen (refer to pure tone screening procedure), schedule the child for rescreening in 14 to 21 days.
• If the child has a REFER result (misses one or more tones) on the 14 to 21 day rescreen, refer the child to their primary care provider for middle ear clearance.
• If the primary care provider provides middle ear clearance or within 8 to 10 weeks, rescreen the child's hearing.
• If the screener determines it would benefit the referral, threshold screening** may be performed.

*Determining if the child may have middle ear fluid requires advanced training that may be beyond the skill of some screeners.

**Performing threshold screening requires advanced training that may be beyond the skill of some screeners.

Documentation of Pure Tone Screening

• For each ear, note the results of the pure tone hearing screening and tympanometry (if performed).
• Document each frequency screened in a manner that indicates the decibel it was screened at and whether the result was a PASS or REFER.
• Use consistent notations with a key indicating which symbols or words denote PASS and REFER so that results are clear to caregivers/guardians and providers.
• If excess ambient noise caused the elimination of screening at 500 Hz, document this in the 500 Hz section of the form.
• Make any pertinent notes under "Comments," such as if the child has a head cold or congestion. If the child does not appear to understand the pure tone audiometry screening procedure after employing play audiometry techniques, check the "Question Validity" or "Unable" box.
• Check the "PASS" or "Normal" box if the child is able to hear all four tones in each ear.
• Document if and why pure tone audiometry is deferred.

Example: If the child was unable to be screened via standard hand-raising pure tone audiometry or play audiometry, document this and your plan to rescreen as consistent with your screening program or MDH recommendations.

Child and Teen Checkups Documentation

Provide complete documentation of the hearing screening. Although no specific documentation forms are required for C&TC, age specific C&TC documentation forms are available for your convenience. For more information, refer to C&TC Documentation Forms for Clinics and Providers.

For detailed information about documentation procedures, refer to the Hearing Screening Manual (PDF) on page 30.

Hearing screening does not replace a medical or audiological evaluation or make definitive statements about a child's hearing. Screening results provide basic information on a child's hearing status, which can be used to inform referral and follow-up. Provide parents with verbal communication via an interpreter as needed, in addition to written information in their native language regarding the necessity of the referral. It is important to ensure the parent or guardian has signed, with informed consent, a release in accordance with the referring or consulting organization's policies and procedures, allowing sharing of information between both agencies. It is recommended that PASS/REFER terminology replace pass/fail terminology previously used to indicate a child who does or does not need further follow-up. Fail terminology has negative connotations for children and families. Education staff should be informed of diagnosis and treatment so adjustments, if necessary, can be made in the child's education program. Refer to Hearing referral letter (PDF) for a sample letter.

A screening program's success depends on the program's capacity to track children who do not pass the initial screening through subsequent follow-up steps, as outlined in the program's written protocol. The protocol should include a plan for how children will be tracked and flagged for rescreening, describe what screening results documentation will be provided to parents and primary care providers, and identify who will explain the screening results to families. In addition, the protocol should have a plan to ensure follow-up has taken place. Programs should periodically review pass rates, monitor, and evaluate the program's compliance with their established screening protocol and review recommended follow-up sequence and timing.