Variability of state school-based hearing screening protocols in the United States.

The prevalence of hearing loss has increased among United States children. As schools commonly perform hearing screens, we sought to contrast current United States school-based hearing screening protocols. State department of health and education websites were reviewed to assess school hearing screening protocols for the fifty states and the District of Columbia. Individuals listed on these websites were contacted as necessary to confirm and/or acquire relevant data. School-based hearing screening is currently required in 34/51 (67 %) states. Of these 34 states, 28 (82 %) mandate grades for screening, but only 20 (59 %) require screening beyond 6th grade. Pure tone audiometry is the most common screening method (33/34 [97 %]). A majority of states screen at 1, 2 and 4 kHz usually at 20 or 25 dB hearing level. Six states recommend or require testing at 6 or 8 kHz, which is necessary to detect high-frequency hearing loss. The results indicate that United States school-based hearing screens vary significantly. They focus on low frequencies with few testing adolescents for whom high-frequency hearing loss has increased. Disparities in hearing loss detection are likely, particularly considering the evolution of hazardous noise exposures and rising prevalence of hearing loss.