Diagnostic pure-tone audiometry in schools: Mobile testing without a sound-treated environment

Purpose: To validate diagnostic pure-tone audiometry in schools without a sound-treated environment using an audiometer that incorporates insert earphones covered by circumaural earcups and real-time environmental noise monitoring. Research Design: A within-subject repeated measures design was employed to compare air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure-tone thresholds measured in natural school environments with thresholds measured in a sound-treated booth. Study Sample: 149 children (54% female) with an average age of 6.9 yr (SD 5 0.6; range 5 5-8). Results: Average difference between the booth and natural environment thresholds was 0.0 dB (SD 5 3.6) for air conduction and 0.1 dB (SD 5 3.1) for bone conduction. Average absolute difference between the booth and natural environment was 2.1 dB (SD 5 2.9) for air conduction and 1.6 dB (SD 5 2.7) for bone conduction. Almost all air- (96%) and bone-conduction (97%) threshold comparisons between the natural and booth test environments were within 0 to 5 dB. No statistically significant differences between thresholds recorded in the natural and booth environments for air- and bone-conduction audiometry were found (p > 0.01). Conclusions: Diagnostic air- and bone-conduction audiometry in schools, without a sound-treated room, is possible with sufficient earphone attenuation and real-time monitoring of environmental noise. Audiological diagnosis on-site for school screening may address concerns of false-positive referrals and poor follow-up compliance and allow for direct referral to audiological and/or medical intervention.