School entry screening programme for hearing impairment in the Maltese Islands

Abstract

School-hearing screening programmes are essential for identifying late-onset and undiagnosed childhood hearing loss (HL), whilst trying to alleviate the effects undetected HL has on a child’s holistic development. To the researcher’s knowledge, there has been no local research that explored the development and/or implementation of school-entry hearing screening programmes in schools. This study aimed to develop and pilot a hearing screening programme targeting pre-school children. The results of this study aimed to support the WHO continuum of care approach (WHO, 2025). Attempts were also made to measure the programme’s reliability and validity. The study’s participants were 29 kindergarten pupils from three local church schools. The hearing screening programme was implemented using otoscopy, pure-tone audiometry (PTA) and oto-acoustic emissions (OAEs). Participants with a "refer" result were referred for diagnostic hearing assessment. Attendance at diagnostic appointments was encouraged through multiple contacts with the families. The overall referral rate for diagnostic hearing assessment was 6.7%, with a referral uptake rate of 100%. Sensitivity and specificity measures were not obtained during this study due to the small sample size and the lack of a test re-test design, given the time limitation to complete this study. No statistically significant associations were found between gender and screening outcomes. This pilot study represents a novel and foundational effort to establish an initial framework and examine the possible viability of implementing it as a hearing screening tool for Maltese Kindergarten students. Lessons learnt from this study can potentially guide large-scale studies on school hearing screening programmes, whilst serving as a driving force for its introduction and implementation within the local context.