Alternatives in screening at school entry: comparison of the childhood middle ear disease and hearing questionnaire (CMEDHQ) and the pure tone sweep test

Some health authorities in the UK are discontinuing hearing screening at sc hool entry, mainly because the pure tone sweep test is under-specific (i.e, fails too many children) and thus leads to unnecessary and costly, but unp roductive, follow-up assessment. A screening method with different properti es such as a questionnaire could be a more cost-effective method of mass sc reening children. The MRC Institute of Hearing Research has developed and e valuated through several stages such a screening questionnaire (the Childho od Middle Ear Disease and Hearing Questionnaire (CMEDHQ), containing II sco red questions under two broad headings: history and presentation of the dis ease, and consultation/treatment history. In a service-based evaluation, 28 60 mainstream reception-year school children from two consecutive years, at tending schools in south west Cumbria in the North-West Regional Health Aut hority received the sweep test and the CMEDHQ. (Although predominantly desi gned to detect middle ear problems, the questionnaire also has some potenti al to detect permanent hearing loss; thus providing a useful backstop for d etection of permanent losses either missed or not present in earlier Infanc y.) The screening CMEDHQ obtained a very high response rate (90%). Follow-u p included 235 control cases as well as all pure tone sweep test failures. Analysis, by use of a definition of cases conservative with respect to the sensitivity of the questionnaire, showed that the CMEDHQ has better specifi city, but slightly lower sensitivity, than the pure tone sweep test for com posite system decision (where 'case' = treated at ENT; 'non-case' = pass at whatever stage was reached before discharge). Follow-up indicated that the limited method available for assessing sensitivity might give an over-favo urable view of the pure tone sweep test. Possible improvement of questionna ire sensitivity by further refinements is under examination. The findings s how that it is worth conducting a fully parallel multi-district cost-effect iveness comparison of the purl tone sweep test versus the CMEDHQ.