At the crossroads of screening and diagnostic audiometry

You may be an audiologist considering providing screening services to bring more patients into your practice. You may be a doctor interested in adding hearing testing to your service, or branching out into occupational health. Whichever the case, a common consideration is options that either screening or diagnostic options may offer. In order to make the right decision it is important to know the difference between the two.

The crossroad many practitioners find themselves at is choosing between a screening or diagnostic audiometer. Some audiometers may be suitable for both, while others are limited to screening only. The equipment you choose to invest in will likely be with you for years to come and considering the cost of audiometers, making the right decision upfront is vital.

Some practitioners entice potential patients into their practices with an offer of ‘’free hearing tests or screening’’. This offer is sometimes also extended to schools and old age homes. In this case it may seem logical to choose a screening audiometer, or is it?

To get to the bottom of this and hopefully provide some valuable input into your decision making process, let's get back to basics.

 

What is screening audiometry?

Hearing screening applies to a large population with no apparent signs and symptoms of a hearing related disorder. Screening separates a group that has a specific disease to a clinically normal group. Screening audiometry only identifies whether an individual has a hearing loss or not. Of note is that this type of hearing assessment may be performed outside of a sound-treated booth. However, with the improvement of technology this is changing - check out Boothless Audiometry VS Audiometry Without A Sound Booth. The only information one can get is regarding one’s difficulty hearing audiometry generated sounds in that specific environment.

Screening tests are done considering the premise that early diagnosis can lead to early intervention. This improves the chances of avoiding comorbidities and any irreversible symptoms. Ideally, screening audiometry should be easy with little to no patient preparation prior to testing. It takes a few minutes to be carried out and causes minimum to no discomfort to the patient being tested. Regardless of the simplicity of screening audiometry, high sensitivity is key to ensure that no cases of hearing loss are missed. The device should also have high specificity in order to correctly identify those patients without a hearing loss thus avoiding false referrals.

 

What is diagnostic audiometry?

Diagnostic audiometry is the standard in identifying and quantifying hearing disorders and their likely cause. It forms a bigger part in assisting the clinician to identify which part of the auditory system may be affected. Treatment or management of hearing-related disorders relies heavily on reliable, accurate and valid audiometric results. Diagnostic audiometry is generally conducted in a sound-treated room, to ensure that external noise does not interfere with the testing. This ensures that the patient is able to hear the softest sounds being presented. These instruments provide the clinician with more details related to the disease that the patient possibly has. The diagnostic audiometer has to have high specificity in order to avoid false-positive results.

As a result, typical diagnostic audiometry will be used in conjunction with other audiological instruments. This helps to reduce false positive and false negative cases. The full diagnostic assessment helps identify whether the patient has normal hearing, conductive, sensorineural or mixed hearing loss.

 

What is the difference?

Key differences of the above mentioned tests are tabulated below.


 

Screening

Diagnostic

Purpose

Early detection of disease or risk factors associated with disease.

Establish presence or absence of disease, severity and cause.

Targeted population

Large population of apparent asymptomatic and those at risk of disease.

Asymptomatic patients with positive screening test results, or symptomatic patients to get a diagnosis.

Test time

Generally conducted with a few minutes.

Longer than screening test time, as it may take longer to find accurate diagnoses.

Test cost

Free or inexpensive.

Slightly high cost. This may be justified by establishing a diagnosis.

Test method

Simple and easy to use by clinician or less trained staff.

May be complex, generally conducted by skilled clinician to establish a diagnosis.

Results

Essentially indicates suspicion of disease and warrants confirmation from diagnostic test.

Results show definite diagnosis.


The above mentioned have different functionalities, but a common goal. Diagnostic audiometry cannot replace screening audiometry. Screening is quick and efficient in the detection of hearing loss in a large population. On the other hand, screening cannot substitute diagnostic audiometry due to its limited scope.

 

KUDUwave screening and diagnostic audiometers

The KUDUwave Prime screening audiometer and the KUDUwave Plus diagnostic audiometer are fantastic devices with different functionalities. They can be easily upgraded to include additional functionality too. A Prime can become a Pro. etc. An added benefit is that neither neglect the importance of noise attenuation during audiometry testing.
Both the KUDUwave screening and diagnostic devices come standard, with noise attenuation capabilities that outperform standard sound booths and reduce false positive cases due to excessive noise.

Whatever your decision, ensure that what you are investing in offers the flexibility you may need in future without having to replace equipment outright. Your equipment will need to grow with you and in the ever changing domain of audiometry, being left behind is equal to being left out. 

 

Hlolo Ramatsoma

Written by Hlolo Ramatsoma

Hlolo is a clinical, research & support Audiologist at eMoyo. He is involved in many parts of the business, from consulting to R&D to supporting and training customers. He earned his BSc in Audiology from the University of Cape Town and is an experienced clinical audiologist specialized in ototoxicity monitoring, product specialist and training audiologist.

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