Classification of audiograms by sequential testing: reliability and validity of an automated behavioral hearing screening algorithm.

In 1990, CAST (classification of audiograms by sequential testing) was proposed and developed as an automated, innovative approach to screening infant hearing using a modified Bayesian method. The method generated a four-frequency audiogram in a minimal number of test trials using VRA (visual reinforcement audiometry) techniques. Computer simulations were used to explore the properties (efficiency and accuracy) of the paradigm. The current work is designed to further test the utility of the paradigm with human infants and young children. Accordingly, infants and children between 6 months and 2 years of age were screened for hearing loss. The algorithm's efficacy was studied with respect to validity and reliability. Validity was evaluated by comparing CAST results with tympanometric data and outcomes of staircase-based testing. Test-retest reliability was also assessed. Results indicate that CAST is a valid, efficient, reliable, and potentially cost-effective screening method.