Assessment of hearing screening programmes across 47 countries or regions III: provision of childhood hearing screening after the newborn period

Figures & data

Figure 1. The cumulative number of participating countries or regions implementing newborn hearing screening (NHS) and universal childhood hearing screening (CHS) with pure-tone audiometry screening (PTS) according to the reported year of implementation. Information on implementation year was available for 28 NHS and 11 universal CHS programmes. All programmes with universal CHS used PTS. PTS started as early as 1950 with a slow spread across participating countries or regions. Only four implemented new programmes since 2000. Two programmes implemented PTS after NHS. No information was included about the use of other methods for CHS (e.g. the distraction test) in these countries. The first NHS programme was implemented in 1994 with a rapid increase from 1995 to 2010.

Table 1. Age at screening, test methods, pass criteria, screening profession and location for the 17 countries or regions performing universal childhood hearing screening with pure-tone audiometry screening (PTS).

Country and region	Age (years)	Test methods	Pass criteria			Screener profession	Location
			Intensity	Frequencies	Ears
Austria, Upper Austria	4–5	PTS	25 dB	500–4000 Hz	Both	SLT	Kindergarten
Belgium, Flanders	5–6	PTS	30 dB	1000 and 4000 Hz	Both	Nurse	Pre-school
Bulgaria	7	PTS	40 dB	Not indicated	Both	Various	Child health clinic
England (UK)	4–5	PTS	25 dB 30 dB	1000–4000 Hz and 500 Hz	Both	Nurse, Audiologist	Kindergarten, School
Faroe Islands	7	PTS	20 dB	Not indicated	Both	Nurse	School
Finland	4–5/6^a	PTS	20 dB	250–4000 Hz	Both	Nurse	Child health clinic
France	3–4/6^a	PTS	30 dB	500–4000 Hz	Both	School physician	School
Germany	4	PTS	30 dB	500–6000 Hz†	Both	Paediatrician’s staff	Child health clinic
Hungary	5	PTS	25 dB	Not indicated	Both	Nurse	Kindergarten
Ireland	4-5	PTS (rescreen)	25 dB	1000–4000 Hz	Both	Nurse	School
Israel	6	PTS	20 dB 25 dB	1000–4000 Hz and 500 Hz	Both	Nurse, Audiologist	School
Latvia	5–6	PTS + speech	20 dB	Not indicated	One	GP, ENT	Child health clinic
Luxembourg	5–6	PTS (rescreen)	20 dB	Not indicated	Both	SLT	Kindergarten
Netherlands	5–6	PTS (rescreen)	30 dB	500–4000 Hz	Both	Nurse, Assistant	School, Health clinic
Serbia	6–7	PTS + tymp +  tuning fork	25 dB	Not indicated	Both	Audiologist	Child health clinic
Sweden, Stockholm	4/6^a	PTS (rescreen)	25/20^a dB	500–4000 Hz^b	Both	Nurse	Child health clinic/school^a
Switzerland	4/6^a	PTS (rescreen)	30 dB	Not indicated	Both	GP, Paediatrician	Child health clinic

PTS was accompanied by other tests in two countries. In countries where the test method indicated a rescreen, children who do not meet pass criteria would return for a rescreening test, and if pass criteria are still not met, they would then be referred for diagnostic assessment. Pass criteria for PTS were described in terms of the intensity (dB HL), the screening frequencies (Hz), and whether responses were required in only one or both ears. With two exceptions, responses were required for all specified frequencies at the corresponding intensity to qualify a pass. SLT: speech-language therapist; GP: general practitioner; ENT: ear, nose, throat specialist; PTS: pure-tone audiometry screening; tymp: tympanometry.

^aThe second screen in countries where screening is performed at two different ages.

^bA referral is made if pass criteria are not met in 2 or more frequencies.

Table 2. Description of childhood hearing screening after the newborn period among 8 countries or regions that offered non-routine or non-universal screening.

Country and region	Age (years)	Test methods	Screener profession	Location	Details of non-universal childhood hearing screening
Czechia	–	–	–	–	No nationally regulated programme; differences in provision and protocol across regions
Estonia	6–8	Whisper	Physician	Child health clinic	No nationally regulated programme; screening by physician may be performed based on parental concern
India	–	Screening camps	–	–	No routine screening; screening camps have been performed in some states during which all children and adults of any age are being offered screening. Some ENT specialists screen children when there is a suspicion of hearing loss
Moldova, Chisinau	6–8	PTS + tymp (30–35 dB)	GP, ENT	Kindergarten, school	No routine screening; screening is organised through projects that are carried out within a limited timeframe on a limited number of children
N. Macedonia, Skopje	5–6	PTS (30 dB)	SLT	ENT/hearing clinic	Children in Skopje may come into the ENT or hearing clinic for testing
Poland	–	–	–	–	No centralised information; screening exists only in some regions or local areas
Romania	6	Whisper	School physician	School	No nationally regulated programme; screening may be performed as a school-entry test
Slovenia	5–6	PTS (30 dB), whisper, other	Paediatrician, nurse	Child health clinic	No nationally regulated programme; differences in provision and protocol across regions

A dash indicates that the Country Representative did not supply information. Test methods were the whisper test or pure-tone audiometry screening (PTS). Pass intensity for PTS, indicated in brackets (in dB HL) were provided by three countries or regions. PTS was accompanied by tympanometry in one country. All other participating countries not listed in Table 2 or 3 reported that childhood hearing screening was not performed. SLT: speech-language therapist; GP: general practitioner; ENT: ear, nose, throat specialist; PTS: pure-tone screening; tymp: tympanometry.