The diagnostic accuracy of hearing tests and cost effectiveness of school-entry hearing screening programmes

Chief investigator

Dr Heather Fortnum (Retired)

Study team

Mara Ozolins

Professor Rod Taylor (University of Exeter)
Professor Christopher Hyde (University of Exeter)
Dr Obi Ukoumunne (University of Exeter)
Vasilis Nikolaou (University of Exeter)
Claire Benton (Nottingham University Hospitals NHS Trust)
Joanne Moody (Cambridge University Hospital Foundation Trust)
Ann Allardice (NHS County Health Partnership, Nottingham)


NIHR Health Technology Assessment programme

Study period


Finding out if a child has problems with their hearing is important for development and education. Screening babies when they are born finds most of them but hearing problems can start at any age. Many parts of the UK screen children for hearing problems when they start school but others have stopped doing this. We wanted to see whether having the screen was better or worse than not having it. We also wanted to see what was the best test to use.

We compared the screening test that is most commonly used (pure-tone screening, PTS) with a hand-held device (HearCheck) which might be quicker to use but which hasn't been used in schools before. These devices were compared by 75 children with identified hearing loss from 14 audiology centres, and 240 children without previously identified hearing loss from 164 schools in the Nottingham area. They were also compared in a school setting by three school nurses in seven schools in East Nottingham, seeing 191 children over 22 sessions.

We found the two tests were equally good at finding children with hearing problems but that school nurses preferred to use PTS.

We compared an area which has a school screen (Nottingham) with an area that doesn't (Cambridge). We found that more children were referred for further testing in the area that didn't have the screen but there was little evidence of a difference between the areas in terms of finding the children with problems.

We found that not having the screen when children start school is as good as having it in terms of finding children with problems and is probably better value but there has to be another system in place to find children. That will depend on parents and health professionals noticing promptly when a child might have hearing problems.

The current project protocol is available on the NIHR HTA website