The Early-Childhood Hearing Screening Program in a Low-Income Setting—Reply

In Reply We thank Drs Zhang and Wang for their interest and commentary on our article.1 They have raised some important points. As you mentioned, in this protocol, children who passed the 2-tiered hearing screening did not proceed with formal audiologic evaluation to determine the true sensitivity and specificity of the hearing screening against this gold standard. Therefore, we are unable to calculate a true prevalence or incidence of hearing loss within this sample. Given the high proportion of successful screening completion (99.6%) and follow-up (86.4% of those referred), we hypothesize that the prevalence identified in the study approaches the true prevalence of the population; however, it is an underestimate given that we did not formally test all children who passed their screening. There are known challenges with performing hearing screening in this age group and obtaining adequate follow-up.2,3 Therefore, our objectives were to determine the overall proportion of children who were able to complete the screening and obtain adequate follow-up using this screening protocol. However, as Drs Zhang and Wang have mentioned, this study design is not adequate to evaluate the true sensitivity and specificity of the screening technique.

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