Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.—Ms Niskar and colleagues1 chose to define hearing loss as an average threshold in either ear greater than 15 dB hearing level (dB HL) for either low tones (0.5, 1, and 2 kHz) or high tones (3, 4, and 6 kHz). Although this choice was not explicitly justified, the authors imply that children with hearing worse than this "need intervention at home and school to prevent hearing loss from impairing their development." They go on to urge screening using these frequencies (and presumably this intensity criterion) from elementary through high school and contrast this policy with the common policy of screening at 1, 2, and 4 kHz. As of 1985, the policy of the American Speech Language Hearing Association (ASHA) recommended using 1, 2, and 4 kHz, plus 0.5 kHz if ambient noise levels were low enough, with referral when thresholds were greater than 20 dB HL.2,3 Adoption of the criteria of Niskar and colleagues would increase costs (more frequencies tested, more children referred, need for sound-treated rooms to test 0.5 kHz) without any evidence offered in their article that incremental benefits would accrue, in terms of better outcomes or even detection of more children with potentially remediable disorders, compared with the 1985 ASHA policy.2 Thus, their policy recommendation, based on a population prevalence study with a questionable case definition and no data to show efficacy of intervention, seems unjustified.
Dobie RA. Hearing Loss Among Children. JAMA. 1998;280(7):602. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-7-jbk0819-j