Running head: Hearing Screening in Early Childhood

Objective. Until recently, no objective tool has been available to help health and early childhood education providers screen young children for hearing loss. The aim of this study was to screen underserved children <= 3 years of age for hearing loss using Otoacoustic Emissions (OAE) technology and to systematically document multi-step screening and diagnostic outcomes. Methods. A total of 4519 children, <= 3 years of age in 4 states were screened by trained lay screeners using portable OAE equipment set to deliver stimuli and measurement levels sensitive to mild hearing loss as low as 25 decibels (dB) hearing level. The screening and follow-up protocol specified that children not passing the multi-step OAE screening be evaluated by local physicians and hearing specialists. Results. Of the 4519 children screened as a part of the study, 257 (6%) ultimately required medical or audiological follow-up. One hundred and seven children were identified as having a hearing loss or disorder of the outer, middle or inner ear requiring treatment or monitoring. Of these 107 children, 5 had permanent bilateral and 2 had permanent unilateral hearing loss. The 7 children with permanent hearing loss included 4 who had passed newborn screening, 2 who were not screened at birth and 1 who did not receive follow-up services after referring from newborn screening. Conclusions. OAE screening, using a multi-step protocol, was found to be a feasible and accurate practice for identifying a wide range of hearing-health conditions warranting monitoring and treatment among children <= 3 years of age in early childhood care programs. Future studies are needed to: 1) further examine barriers to effective OAE screening in early childhood care settings, and 2) explore the value of extending early childhood OAE hearing screening into health care clinics and settings where young children receive routine care. Screening for Hearing Loss 3