Hearing screening is often seen as straightforward – quick, efficient and easy to implement. But in practice, it is one of the areas where small mistakes have significant consequences.
A missed referral can delay diagnosis. A false refer can overwhelm systems and frustrate patients. Poor protocols can reduce trust in the entire programme. In South Africa where screening often forms the first point of access to hearing care getting this right is not optional. It is essential.
The challenge is that screening is often delegated or rushed with minimal preparation, inconsistent protocols and limited understanding of purpose. This leads to poor quality results and inconsistent outcomes.
The shift that needs to happen is that we shouldn’t look at screening as a “light version” of diagnostics. It is a critical decision point. Screening determines who enters the care pathway.
The solution
The challenge is that screening is highly sensitive to noise, movement and distractions. Common issues include testing in noisy wards or rooms, poor probe fit (OAEs) and child movement.
The consequence is false REFER results, unnecessary follow-ups and reduced efficiency.
The solution
The challenge is that a PASS is often interpreted as “Normal hearing” and a REFER is often interpreted as “Hearing loss”. Both are incorrect.
The reality is that screening tells us that PASS → likely normal function (with limitations) and REFER → requires further investigation. It is not a diagnosis.
The risk translates into false reassurance, missed conditions (e.g. neural hearing loss) and/ or poor patient communication.
The fix:
Standardise your messaging: PASS = “The screening result is within expected limits, but if there are concerns, further testing is still important.” REFER: “This result means we need to investigate further — it does not confirm hearing loss.”
The challenge is that screening works only if patients move to the next step. In reality patients often don’t return, referrals are lost and/or no tracking system exists.
The consequence is that early identification fails and the impact of screening is lost.
The fix:
Build a simple follow-up system:
Screening without follow-up is not a programme. It is a missed opportunity.
The challenge is that screening becomes a number, a result and a task completed instead of a gateway to improved outcomes.
The shift that is needed is that screening should always link to early intervention, communication development and functional outcomes.
The fix:
Ask: “What happens after this screening?” It is important to ensure:
In South Africa screening is often the first and only point of access, resources are limited and systems must be efficient. Poor screening leads to wasted resources, delayed care and reduced trust.
Good screening improves access, strengthens systems and changes outcomes
(World Health Organization, 2021).
The most common misconception in hearing screening? That OAE and AABR are interchangeable. They are not. They answer different clinical questions, assess different parts of the auditory system, and should be used strategically, not interchangeably. Understanding this distinction is what separates basic screening from clinically effective screening programmes.
As audiologists, we are trained to care deeply for each patient we see. We refine our assessments. We improve our counselling. We strive to provide the best possible care in every consultation.
