Question
ASHA guidelines recommend a screening level of 25 dB HL from 1000 through 4000 Hz for adult hearing screenings. I cannot find recommended criteria for adult hearing screening failure that would warrant a referral for a complete audiogram. For example, I would not think to refer a 75 year old male who failed to respond at 25 dB HL at 4000 Hz only. Are there any recommended criteria that would warrant a referral for a complete audiological evaluation?
Answer
Guidelines For Audiologic Screening were developed by the ASHA Panel on Audiologic Assessment and adopted as ASHA policy by the Legislative Council in 1996 (LC16-96). The Panel recommended that hearing screenings for adults should occur every 10 years up to age 50 and every three years thereafter.
The Panel also recommended a three-component screening protocol for adults. This should include screening for hearing disorder, hearing impairment and hearing disability. Prior to the hearing screening, a case history and visual inspection of the ear is advised to identify persons with significant otologic history or obvious anatomic abnormalities of the ear. The pure tone hearing screening should to be conducted at 25 dB HL for 1000, 2000 and 4000 Hz in each ear. The Panel recognized the fact that there would be a higher referral rate for older adults using 25dB HL pass/fail criteria. However, a uniform screening level of 25 dBHL was adopted because hearing impairments exceeding 25 dB can affect communication regardless of age. The Panel noted that even mild hearing loss can have an impact on health and well-being of the individual.
Screening for hearing disability is the third component in the screening guidelines. The guidelines recommend using self assessment measures that are known to have strong internal consistency/ reliability and test-retest reliability (e.g. HHIE-S, Ventry and Weinstein, 1983 and SAC, Schow and Nerbonne, 1982). The combination of screening for disorder, impairment, and disability provides more useful information for the purposes of counseling and referral than using the results of the pure tone screening alone. If an individual does not pass the screening for both hearing impairment and disability, then a complete audiologic evaluation is advised
For further information regarding the ASHA Guidelines for Hearing Screening, please go to our website at www.ASHA.org.
Sharon Beamer, AuD,CCC-A and Anne Oyler, MA, CCC-A are Associate Directors for Audiology Professional Practice at ASHA and can be reached sbeamer@asha.org and aoyler@asha.org.