Early identification of hearing loss (HL) is a challenge in low- and middle-income countries due to the limited number of hearing care providers. It is a factor that prevents people from getting the hearing interventions they need to potentially prevent permanent hearing damage. In recent years, tablet and smartphone audiometry has provided a more accessible way to screen for hearing loss. However, the effectiveness of screening is still limited in developing countries.
A group of researchers recently explored another resource for maximizing the effectiveness of hearing screening: teachers.
In the study “Teacher Prescreening for Hearing Loss in the Developing World”, published in Ears, Nose and Throat Journal, the researchers found that “teachers can effectively identify children with hearing loss for early intervention” in resource-limited settings.
TEACHERS IDENTIFY “AT RISK” CHILDREN
“Teachers have been shown to be able to identify children at risk for mental health and autism problems; reduced visual acuity; and poor attention, executive function and coping skills, ”the researchers said, citing previous studies. They therefore sought to “characterize the ability of teachers to identify children at risk for HL”.
In four semi-rural schools outside Malindi, Kenya, teachers were asked to pre-identify children they considered to have hearing difficulties among a group of children aged 2 to 16. Teachers had no formal training in NS screening. They based their identification “on subjective concerns of HL, inattention, learning difficulties, low participation in class, poor speech and disobedience.”
Forty children were pre-identified by teachers as “at risk” for HL. Using portable audiometry tools, the hearing of these pre-identified children was then compared to that of children believed to have normal hearing.
The eight children who were audiometrically found to have hearing loss belonged to the group pre-identified by teachers. This meant that the teacher screening had a 100% hearing loss identification rate.
The eight children also represented a 20 percent benchmark rate of the teacher preselection.
CHALLENGES AND TOOLS IN THE SUPERVISION OF TEACHERS
The idea of asking teachers to screen for hearing loss came from the lead author’s own experience.
“This aspect of our studies arose out of the experience of the older partially deaf professor as a child,” explained James L. Netterville, MD, with The hearing diary. “I was a bit of an unruly kid in class because I missed a lot of what the teachers were saying. I told the [research] team, it would be wise to simply ask teachers who they think may have hearing difficulties, as teachers on the whole are keen observers of the children in their class.
Currently chair of the Department of Otolaryngology – Head and Neck Surgery at Vanderbilt University Medical Center in Tennessee, Netterville conducted the study with Justin R. Shinn, MD, of the Department of Otolaryngology. laryngology from the University of Texas Southwestern and Asitha Jayawardena, MD, from the Department of Otolaryngology at Children’s Minnesota.
“Of course, there are still challenges to overcome [the teacher prescreening] approaching, ”Jayawardena said. “Although teachers have a unique insight into the communication skills of their students, they are already under strain on their time, especially in developing countries where children of all ages and levels can share a single classroom. . “
Jayawardena noted that teachers and other local stakeholders can use portable audiometry devices to “enable fairly reliable screening of a fraction of the class.”
“Portable audiometry is necessary during field screening; the infrastructure to provide sound booth audiometry simply does not exist in many countries, ”he said. “Portable audiometry can quickly and fairly reliably identify children who need further testing. Otherwise, these children will never have the opportunity for a formal assessment or review of potential treatment options, which in itself can have significant harms for the child, the family and the local economy.
The researchers hope their study could be replicated in a larger population and eventually lead to targeted screenings in schools that may not have the capacity to effectively screen for hearing loss in children.
“Teachers… can intervene immediately by implementing appropriate positioning in the classroom and developing alternative educational models,” they wrote in the document. “In addition, identifying and educating teachers about NS in the classroom is likely to produce a favorable response to include and educate those children at risk for intellectual retardation and poor performance.”
Jayawardena added, “The ultimate goal would be to create a lasting, soulful, teacher-initiated hearing counseling program for children at risk of hearing loss. The implications of this pilot study are very exciting! “