Telephone Hearing Screening
ASHA Committee on Audiologic Evaluation
About this Document
The ASHA Committee on Audiologic Evaluation has been directed by the ASHA Executive Board to examine the issues surrounding telephone hearing screening. The following constitutes the report of the committee to the board on this matter. The members of the committee include Sandra Gordon-Salant, chair, Evelyn Cherow, ex officio; Margaret F. Carlin; John D. Durrant; Thomas E. Fowlkes; Thomas A. Frank; Gregg D. Givens; Michael P. Gorga; Sharon A. Lesner; Robert H. Margolis; and Laura A. Wilber. This report does not represent official Association policy. The ASHA Executive Board approved the report in August 1988, for publication in Asha for dissemination to the membership (EB 118-88).
The American Speech-Language-Hearing Association (ASHA) has long endorsed efforts concerning public education and awareness of hearing loss, as well as efforts to develop procedures to identify hearing impairment. This document presents many concerns of the members of the ASHA Committee on Audiologic Evaluation regarding the propriety of telephone hearing screening. Until these concerns are resolved, the telephone hearing screening protocol should be viewed as a questionable procedure, the accuracy and effectiveness of which have yet to be proven. This is consistent with the goal that hearing health care services should be provided in a professional, reliable, and economically efficient manner.
Hearing screening is used to identify persons who may have hearing impairments that potentially interfere with communication or that potentially are medically significant. A screening program can be considered useful if its effectiveness has been demonstrated in a randomized trial (Cadman, Chambers, Feldman, & Sackett, 1984). In general, the results of randomized trial studies of hearing screening programs are not available. In the absence of such direct evidence of effectiveness, other criteria can be used to evaluate a screening program. These include (a) effective treatments must be available; (b) the burden of suffering must warrant the screening; (c) there must be a good screening test; (d) the program must reach those who could benefit from it; (e) the health system must be able to cope with the recommendations of the screening program; and (f) those identified by the screening must comply with the recommendations.
The American Speech-Language-Hearing Association has adopted Guidelines for Identification Audiometry ( Asha, 1985). Those guidelines recommend that “hearing screening should be conducted or supervised by an audiologist” using calibrated audiometers in acoustic environments that have ambient noise levels that do not interfere with test results. The committee recommends that when a hearing screening program is implemented, it should comply with those or subsequent guidelines. Hearing screenings that do not comply with the ASHA guidelines currently are being conducted via the telephone in almost every major geographical location in the United States. The committee is concerned that telephone hearing screening may not be warranted on the basis of the aforementioned criteria and other considerations listed below.
The rationale for telephone hearing screening is to provide the public with a convenient and private means of hearing screening offered at no cost or for a minimal fee. Further, telephone hearing screening alerts the public about hearing loss, serves as a referral source, and functions as a promotional tool Currently, telephone hearing screening is being used and sponsored by service organizations, hospitals, speech and hearing clinics, physicians, audiologists, speech-language pathologists, and hearing aid dealers.
Even though ASHA supports efforts directed toward public education and awareness of hearing loss, the Committee on Audiologic Evaluation has several concerns about the efficacy, validity, reliability, and propriety of conducting hearing screening via the telephone. These concerns include the following:
Effectiveness: To date, there are no published research data describing the effectiveness of telephone hearing screening tests. Consequently, the accuracy and effectiveness of telephone hearing screening tests have not been determined.
Variables: There are several variables that may limit the accuracy of telephone hearing screening results. These variables include, but are not limited to, variability in electroacoustic characteristics among telephone models and transmission lines (frequency response, output, automatic gain control circuitry, signal-to-noise ratio, and side-tone feedback), ambient noise in listening environment, and variability in coupling force and position of the telephone relative to the listener's ear. Further, the performance characteristics of telephone answering machines, which are used to conduct these procedures, are not standardized for hearing screening.
Test Signal Level: The telephone output level for a specific telephone is not constant upon repeated administrations of the test.
Test Signal Frequency: The telephone hearing screening test signal frequencies are limited to frequencies below 3000 Hz.
Instructions: Some individuals who participate in a telephone hearing screening may not hear or understand the instructions or recommendations.
Legality: In at least one jurisdiction (Texas), telephone hearing screening would violate state laws governing the practice of audiology.
In summary, the telephone hearing screening procedure is characterized by numerous limitations that restrict its potential usefulness. As a consequence, telephone hearing screening should be viewed with caution until its validity and efficacy are demonstrated.
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American Speech-Language-Hearing Association. (1985, May). Guidelines for identification audiometry. Asha, 27, 49–52.
Cadman, D., Chambers, L., Feldman, W., & Sackett, D. (1984). Assessing the effectiveness of community screening programs. Journal of the American Medical Association, 251, 1580–1585.
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© Copyright 1988 American Speech-Language-Hearing Association. All rights reserved.
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