AUDIT OF CLINICAL JUDGMENTS AND ACTIONS IN AN AUDIOLOGICAL INVESTIGATION OF SCHOOL ENTRANT CHILDREN SCREENED POSITIVE FOR HEARING-LOSS

117 children attending an aural clinic after screening positive by one or both of two tests for hearing loss at school entry, 43 (36.8%) wer e either seen again for review or listed for surgery. Clinical finding s which were significantly associated with either being reviewed or li sted for surgery, as opposed to being discharged, were the presence of conductive or sensory neural hearing loss, pronounced negative pressu re, reduced compliance volume or absent stapedial reflexes on impedanc e testing and the presence of an abnormal tympanic membrane associated with effusion on otoscopy. This population of children were then foll owed up through their school medical records over 4y to determine what proportion of those discharged from the clinic had subsequently requi red some form of surgical intervention due to a hearing problem. Note was also taken of all those actually receiving surgery or long term re view for sensory neural hearing loss, these cases being designated as true positives in the aural clinic assessment process. This assessment , albeit of a 'high-risk group', gave rise to a sensitivity of 88.9% a nd a specificity of 68.0%.