HOW ACCURATE IS PARENT RATING OF HEARING FOR CHILDREN WITH OTITIS-MEDIA

Objective: To determine the accuracy of parent assessment of child hea ring. Design: Prospective study. Setting: Hospital-based pediatric oto laryngology practice in a metropolitan area. Patients: One hundred eig hty-six children aged 6 months to 12 years (median age, 3.4 years) wit h chronic otitis media with effusion or recurrent acute otitis media e nrolled in a quality-of-life study. Intervention: Parents rated their child's hearing over the prior 4 weeks using a 7-point response scale. Otoscopic findings, static admittance, tympanometric width, and audio metric thresholds were recorded concurrently. Fifty children were reas sessed to monitor changes in hearing. Main Outcome Measure: Correlatio n of parent hearing assessments with baseline hearing status (pure ton e average for the better hearing ear) and with changes in hearing stat us. Results: The hearing loss questions had good test-retest reliabili ty (R = 0.79) but did not correlate with audiometric results (R = -0.1 3; P = .09). Only when caregivers reported hearing to be an ''extreme problem'' were median hearing levels (31 dB) significantly greater tha n the median response (20 dB). Conversely, static admittance and tympa nometric gradient were significant predictors of hearing levels (2-way analysis of variance, P < .01) and explained 44% of the ear-specific variations. Abnormal immittance measures in both ears had an 84% predi ctive value for hearing loss (20-dB hearing level or poorer), and norm al immittance measures in both ears had a 76% predictive value for nor mal hearing. Caregiver assessments of change in hearing status did not correlate with changes in audiometric results (R = 0.07; P = .65). Co nclusions: Caregiver assessments of child hearing do not accurately pr edict hearing levels or changes in hearing status. Immittance measures can help identify children at low or high risk for hearing loss, but cannot substitute for audiometry.