hearing screening in filipino schoolchildren: the accuracy of the hearing screener device
DESCRIPTION
Report on the January 2014 National Institutes of Health (NIH) ForumTRANSCRIPT
-
Hearing Screening
in Filipino
Schoolchildren
The Accuracy of the Hearing Screener Device
Report on the January 2014 Forum
-
Contents
3| About PNEI & NIH 7| Presentation of Studies
4| Speakers 10| Conclusions& Recommendations
6| Introduction 11| Authors Message
Partner Organizations
-
HEARING SCREENING IN FILIPINO SCHOOLCHILDREN JANUARY 2014 3
About PNEI
Since 2001, the Philippine National Ear Institute (PNEI), under the National Institutes of Health
(NIH), has championed the health and stability of hearing of Filipinos. Aside from providing
epidemiological and integrated research on hearing, balance, and communicative disorders, it
also aims to provide an environment that will facilitate further research and education in such
clusters as surveillance, treatment, prevention, and rehabilitation of hearing and balance
disorders.
Guided by objectives ranging from the initiation of innovative research to the formulation of
policies and programs geared towards the betterment of the health sciences sector in the
country, the PNEI spearheads several research efforts in the often overlooked field of hearing
and balance. In view of these objectives and its vision, it has also conducted research on the
feasibility and accuracy of a new hearing screening device. Filipino schoolchildren were the
subjects of this research, as the growing importance of checking for hearing loss as early as
possible has been identified by the PNEI. This growing importance, and the entirety of the
research, is expounded upon in the NIH forum of January 2014.
Ongoing research projects of the PNEI include TB infection in acute otitis media (chronic
inflammation of the ear, particularly in infants and young children), different forms of acute
otitis media and their clinical implications, dizziness and a practical approach to their
management, anatomy and physiology of the vestibular system and their clinical correlation,
and the role of immune modulators in the treatment of common ENT (Ear, Nose and Throat)
infection.
About NIH
The National Institutes of Health (NIH) was founded by the UP Board of Regents on January 26,
1996 for the development of UP Manilas research facility, and to serve as a hub of local
researchers and research organizations in the fields of health and medicine. It was made into a
national health research center through the implementation of Republic Act (R.A.) 8503, or
more commonly known as the Research and Development Act of 1998" on February 13, 1998
during the term of President Fidel V. Ramos.
The organization envisions itself to be the country's recognized authority in health research
and development and the key source of critical health information for national development in
the Philippines and Southeast Asia (Historical Highlights-NIH, 2005.). It aims to fullfill such
vision through its "Partnership for Better Health" framework which entails specific actions such
as influencing of policy makers in the enactment of health laws, policies and guidelines which
improve delivery of quality health programs, providing health organizations relevant health
-
HEARING SCREENING IN FILIPINO SCHOOLCHILDREN JANUARY 2014 4
research and development and improving their health service delivery, development of
capabilities of health researchers and health research institutions, etc. (The Organization-
NIH, 2005).
At present, NIH has numerous partner organizations and study groups which continue to help it
achieve its vision through presenting significant outputs for the crafting of national health
policies and programs.
Speakers
DR. GENEROSO T. ABES
Generoso T. Abes, MD, MPH established the Philippine National Ear
Institute (PNEI) through the UP Board of Regents resolution and
through R.A.9245. He has been the director of the institute since the
date of its establishment in 2004. Among his accomplishments as the
PNEI director are the establishment of Newborn Hearing Screening
Reference Center (NHSRC) and the legislation of R.A. 9709, also known
as the law on Universal Newborn Hearing Screening and Intervention
Act of 2009.
He was also appointed as the Chairman of the Department of Otolaryngology of the UP College
of Medicine (UPCM) and the Philippine General Hospital (PGH) from January 2001 to December
2006. Rendering 32 years of service as faculty in UPManila, Dr. Abes also chaired the
Curriculum Committee of UPCM from1999 to 2003 and was able to establish the Master of
Clinical Audiology program, in partnership with the Department of Otolaryngology of the UPCM
and the UP College of Allied Medical Professions (UP CAMP). Moreover, he was able to publish
58 articles on otolaryngology (medical specialty concerned with the study of the ears, nose and
throat; also referred to as otorhinolaryngology), four of which were published in international
journals, and gave lectures on various topics under otolaryngology both on the local and
international level.
DR. TERESA LUISA I. GLORIA-CRUZ Teresa Luisa I. Gloria-Cruz, M.D., MHPed obtained her doctorate degree in 1992 and earned her masters degree in Health Professions Education in 2002 both from UP Manila. She has also been a member of the UP faculty as a Clinical Associate Professor in the College of Medicine since 1998 and has been working as a Research Assistant Professor of the NIHsince 2000. Dr. Gloria-Cruz is an attending otorhinolaryngologist in the Department of ENT of the UP-PGH Medical Center since 1998 and in Asian Hospital and Medical Center.
-
HEARING SCREENING IN FILIPINO SCHOOLCHILDREN JANUARY 2014 5
Among her published works are journals on various topics under otolaryngology and a manual on the Treatment of Acute Diseases and Injuries of the Ear, Nose and Throat. Her responsibilities in the university includelecturing, handling small group discussions, and conducting research activities. These research outputs are reported in the monthly forum held by the NIH. DR. ELLA CECILIA G. NALIPONGUIT
Dr. Ella Cecilia G. Naliponguit is the Director of the School Health and Nutrition Center of the Department of Education (DepEd) and is responsible for evaluating, approving, and managing public health programs, policies, and designs and health program management in public schools in the Philippines. Representing the education sector, Dr. Naliponguit works in partnership
with other government and non-government organizations responsible for devising health policies and public health programs for school children.
DR. MARIA RINA T. REYES-QUINTOS
Dr. Maria Rina T. Reyes-Quintos is an otolaryngologistspecializing in audiology, a branch of
medicine which centers on the study of hearing and hearing disorders. As an attending
physician in private and public hospitals such as the PGH and The Medical City, Dr. Reyes-
Quintos treats patients with different hearing disorders, using such procedures as pure tone
audiometry, a process used to test tonal purity and hearing acuity for sound intensity and pitch
variations; play audiometry videonystamography or VNG (a medical test used to determine the
causes of a patients dizziness or balance disorders), and other types of hearing tests.
Dr. Reyes-Quintos is also involved in various researches in her field of study. Some of her well-
known research and article publications include an article in ACTA MEDICA PHILIPPINA entitled
When do Aided Auditory Thresholds reach the Speech Spectrum after Cochlear Implant Switch
on?which was published in 2012, and a journal article entitled Otoscopic and Audiologic
Findings in an Ati Community in Boracay which was published in 2007 and was written with
other research authors.
-
HEARING SCREENING IN FILIPINO SCHOOLCHILDREN JANUARY 2014 6
Introduction
Aiming to draw attention from both health and educational sectors, the National Institutes of
Health (NIH) Research Dissemination and Utilization (RDU) presented the Philippine National
Ear Institutes (PNEI) latest findings on the accuracy of hearing screening device forFilipino
schoolchildren in the monthly forum held last January 16, 2014.
The forum was held at SentroOptalmologico Jose Rizal Auditorium ofthe Philippine General
Hospital (PGH). Attendees include delegates from various health sectors and the education
sector, advocates of different health institutions and centers and Health Sciences students of UP
Manila.
Among the topics discussed in the program were the PNEIs latest research findings on the
hearing screening conditions and programs in Filipino elementary schools, implications of
hearing loss to students school performance, and an assessment of the accuracy of the hand-
held hearing screener in detecting the presence and possibility of hearing loss among
schoolchildren in the country.
This report, in line with the NIHs continuous effort to gain public awareness and interest in the
institution and its activities summarizes the PNEIs efforts to improve the hearing screening
programs in Philippine schools. Furthermore, this report aims to assist the NIH RDU program in
presenting the latest research findings of the NIHs institutionsand centers to different health
sectors in the country.
-
HEARING SCREENING IN FILIPINO SCHOOLCHILDREN JANUARY 2014 7
Presentation of Studies The Need for Early Hearing Screening
The Philippine National Ear
Institute (PNEI) has long
been an advocate of hearing
health of schoolchildren in
the Philippines. This
advocacy has led the
institution to dedicate much
of its research in coming up
with solutions towards the
increasing cases of hearing
loss among schoolchildren.
Dr. Generoso Abes
emphasized the need for
addressing the different concerns regarding hearing loss in schoolchildren. The study is
anchored in two key research areas: 1) New-born hearing screening and 2) Hearing screening
in Grade 1 pupils. There are four reasons identified that show the value of the two key research
areas:
1. High prevalence of hearing loss in the population group
2. Preventability and treatability of usual causes
3. High impact on learning and speech development on patients affected by hearing loss
4. Nonexistence of programs for hearing screening among the population group
To fulfill the PNEIs vision, No Filipino should be deprived of a functional sense of hearing and
balance, researchers like Dr. Teresa Luisa Gloria-Cruz has conducted studies that can help in
the early detection of hearing loss among schoolchildren in the Philippines. Hearing loss has
been a primary concern for the researchers in the PNEI because of the accompanying effects of
such condition towards the academic performance of the mentionedpopulation group.Hence,
research author Dr. Gloria-Cruz saw the importance of detecting early-childhood hearing loss
among schoolchildren. Research has shown that one child in 1000 is born with profound
deafness, that two children in 1000 will acquire deafness in early childhood, and that nearly
100% of all children will undergo a period of hearing loss from birth to 11 years. The conducted
study showed that 15% of the sample failed the hearing test.
-
HEARING SCREENING IN FILIPINO SCHOOLCHILDREN JANUARY 2014 8
Further results in these studies have shown that children with unilateral hearing loss (hearing
loss in one ear) and those with minimal hearing loss is associated with less satisfactory
scholastic performance, as well as emotional and social difficulties.
In view of all these, the PNEI conducted several researches to devise an accurate, relevant, and
safe mass hearing screening program suitable for schools.
A. Collaboration-training-service-research
The PNEI, in line with its objective of creating a suitable mass hearing screening program for
schoolchildren in the country, worked with the Department of Education (DepEd) in 2004 for a
program entitled, Education for All 2015. The program aims to provide early childhood
preventive health and nutrition services by training school nurses regarding preventive health
care in the school setting.
However, there is no established national hearing-screening program for schoolchildren, unlike
in developed countries where pure audiometry and tympanometry (a test used to detect middle
ear disorders) are common standards for hearing-screening programs in schools.
One of the problems identified in the research is the lack of government-initiated provisions
regarding hearing screening. In addition to this, there is also a lack of equipment and skilled
personnel that are needed to meet the required standards for such provisions.
To address these concerns, the PNEI method of hearing screening in schoolchildren was
devised. It is a practical, effective, and feasible approach in ear examination which uses a pen
light and a particular method of hearing screening using a 512 hertz tuning fork. This was
proposed to be used for mass screening of children in the school setting. In 2004, this became
a nationwide advocacy of the PNEI, in partnership with DepEd,reaching various parts of the
country.
Two studies were published in line with the training program. The first research came up in
2007, Gloria Cruz TL, Chiong CM, Chan AL, Llanes EG, Reyes-Quintos MR, Abes GT. Training of
nurses on Ear Examination and Hearing Screening in the School Setting. Southeast Asian J.
Tropical Med. Public Health 38(1): 188-194. It was followed by a second phase of the same
research published in 2010.
Both studies presented the same result regarding the effectiveness of the training program
designed for school nurses. Furthermore, the two researches indicated that the program is a
feasible tool for the detection of common ear conditions or screening of children in the school
setting. However, limitations of the program include its inability to detect mild cases of hearing
loss that would also have a latter effect on a childs academic performance.
-
HEARING SCREENING IN FILIPINO SCHOOLCHILDREN JANUARY 2014 9
B. Collaboration-Service-Research
The PNEI, together with Manila Archdiocesan and Parochial Schools Association (MAPSA),
devised another program that aimed to provide service missions for hearing health, conducted
in one school for each of three areas in Metro Manila- Quiapo, Pasayand Pasig.
The study resulted in the publication of a third research, HEARING SCREENING IN FILIPINO
SCHOOL CHILDREN: The Accuracy of the Hearing Screener Device, which was the topic of this
forum. It aimed to determine the devices feasibility as a hearing screening tool to be used in
schools with reference to its sensitivity, specificity, and positive predictive value, with pure tone
audiometry as the standard.
Subjects of the study included 418
Grade 1pupils, comprising 238 males
and 180 females ages 5-10,on an
ordinary school day. Each student
underwent five phases namely, the
collection of demographic data,
otoscopy (visual examination of the
eardrum and auditory canal),
screening with hearing screener
device, screening audiometry, and
counselling. The hearing screener
device result can be categorized
according to the color of light it
produces. Green light indicates absence of hearing loss, while yellow and red lights indicate
mild and severe case of hearing loss, respectively.
Results showed that the hand held hearing screening device has a high specificity of 97.8%
(yellow results) to 99.6% (red results), which implies that the device is accurate at determining
individualswithout hearing loss. However, low sensitivity of the device in red (9.1%) and yellow
(16.7%)results indicate that it failed to determine individuals who have moderate to severe
hearing loss. Positive predictive values that indicate the ratio of individuals who scored positive
on hearing loss to those who suffered from such condition, are 26.1% and 50% for red and
yellow results, respectively. The accuracy of the hearing screener device for red results is
95.9% and 94.2% for yellow results.
The low sensitivity of the hearing screening device indicates its ineffectiveness to be used for
mass hearing screening in schools. The setting of the experiment, an ordinary school day with
an ambient noise level of 52.8 decibels, posted a limitation to the device in detecting mild
hearing loss. The handheld screening device is recommended for use in a soundproof
environment, having not more than 40 decibels of ambient noise. It is, therefore, not suitable
for mass hearing screening program in a school setting. Another hearing screening device with
high sensitivity must be considered for conducting another study. Among the factors that must
be considered in choosing another of such tool are safety, portability, ease of use, high
-
HEARING SCREENING IN FILIPINO SCHOOLCHILDREN JANUARY 2014 10
specificity, good accuracy rates, and positive predictive values. The PNEI also recommends the
generation of a better hearing screening program as a national health policy.
Conclusions and
Recommendations The two studies presented in the NIH-RDU forum provided an overview of the condition of the
hearing screening program among schoolchildren in the Philippines. The studies also reported
the current efforts of the PNEI and the evaluation of the actions the institution has taken.
The PNEIs collaboration with DepEd and MAPSA helped the institution work on its advocacy for
hearing health of schoolchildren in the Philippines. The first program which focused on the
training of school nurses and other members of the school stafffor hearing screening of
schoolchildren was found to be effective and feasible for mass hearing screening in a school
setting. The suggested hearing screening procedure with the use of a penlight and 512 hertz
tuning fork was feasible considering factors such as public safety, portability and ease of use.
However, results also showed that continuous and greater efforts must be done to compensate
for the programs limitation in determining moderate hearing loss among schoolchildren.
The presented hearing screening device was proven ineffective for mass hearing screening
among schoolchildren. The devices low sensitivity for determining both mild and severe hearing
loss posted a limitation to its capability of providing appropriate results. Furthermore, the
recommended environment for the use of such device made it not suitable for hearing
screening in an ordinary school setting.
Findings from the two studies indicate
the need forthe NIH and the PNEI to
conduct further studies and devise more
programs that would suit the condition of
elementary schools in the Philippines.
Through such, the PNEI in partnership
with public and private organizations
would be able to recommend a national
standardized program for hearing
screening of schoolchildren for
government policy.
-
HEARING SCREENING IN FILIPINO SCHOOLCHILDREN JANUARY 2014 11
Authors Message
Hearing is a requisite to virtually every activity. It is therefore important to ensure that hearing
health and an environment conducive to its maintenance are provided for. What is the ideal age
to check for hearing loss? Is the current technology for checking for hearing loss adequate, or is
new technology feasible and necessary? These are the major questions whose answers were
provided by the Philippine National Ear Institute (PNEI) during the January 2014 forum of the
National Institutes of Health (NIH). The insights and information articulated in this forum
proved useful as reference for research of the same mold to be undertaken in the future, as
well as to those in attendance seeking clarification on the matter of hearing health and much-
needed orientation on trends in the health sciences, particularly in the Philippines.
Paul Martin Anthony C. Cenizal Group Representative BA Organizational Communication University of the Philippines Manila
From left to right: Crichelle Mendiola, Justine Vigonte, Kristel Artates and Paul Cenizal
-
References Medical Definitions
Audiology. (n.d.). In Merriam-Websters online medical dictionary. Retrieved from
http://www.merriam-webster.com/medlineplus/audiology
Audiometry. (n.d.). In Merriam-Websters online medical dictionary. Retrieved from
http://www.merriam-webster.com/medlineplus/audiometry
Key Hearing. (n.d.). Videonystagmography. Retrieved from
http://www.keyhearing.com/Videonystagmography_vng.aspx
Medline Plus-National Institutes of Health, USA. (2013). Tympanometry. Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/003390.htm
Otitis media. (n.d.). In Merriam-Websters online medical dictionary. Retrieved from
http://www.merriam-webster.com/medlineplus/otitis
Otolaryngology. (n.d.). In Merriam-Websters online medical dictionary. Retrieved from
http://www.merriam-webster.com/medlineplus/otolaryngology
Otoscopy. (n.d). In Merriam-Websters online medical dictionary. Retrieved from
http://www.merriam-webster.com/medlineplus/otoscopy
Information regarding the organizations and speakers
Department of Education. (n.d.). Ella Cecilia G. Naliponguit.
Retrieved from http://www.deped.gov.ph/index.php/issuances/deped-
Memos/2013-1/document/dms2013169pdf?format=raw
The Medical City. (n.d.). Ma. Rina T. Reyes-Quintos, MD.Retrieved from
http://www.themedicalcity.com/services/clinical_departments/otolaryngology/
medical_staff
Medical Observer. (2005). Dr. Teresa Luisa Gloria-Cruz. Retrieved from http://medicalobserverph.com/tag/dr-teresa-luisa-l-gloria-cruz/
National Institutes of Health-University of the Philippines Manila. (2005). Historical
-
Highlights. Retrieved from http://nih.upm.edu.ph/about-nih/historical-highlights
National Institutes of Health-University of the Philippines Manila. (2005). The Organization. Retrieved from http://nih.upm.edu.ph/about-nih/organization
National Institutes of Health-University of the Philippines Manila. (2005). Philippine National Ear Institute. Retrieved from http://nih.upm.edu.ph/institute/philippine- National-ear-institute
University of the Philippines Manila. (n.d.). Currciulum Vitae: Generoso T. Abes, MD, MPH. Retrieved from http://www.upm.edu.ph/downloads/ announcement/CV%20Abes.pdf
Images
Childrens Health. [Photograph]. (n.d). Retrieved February 25, 2014 from http://www.nih.gov/about/explore/images/cards/Health-Childrens-Health-3b.jpg
Department of Education. [Logo]. (n.d). Retrieved February 28, 2014from
http://www.philippinenews.com/images5/07.13/DepEd1.png
Department of Health. [Logo]. (n.d). Retrieved February 28, 2014from
http://www.pinoypages.ph/wp-content/uploads/2012/06/doh-logo.jpg
Dr. Ella Cecilia Naliponguit. [Photograph]. (n.d). Retrieved February 25, 2014 from http://m.c.lnkd.licdn.com/mpr/pub/image-nuhoDfvX5/ella-cecilia-naliponguit.jpg
Dr. Generoso T. Abes. [Photograph]. (n.d). Retrieved February 25, 2014 from http://www.asianhospital.com/wp-content/themes/ahmc/md/large/generoso-t- abes.jpg
Dr. Teresa Luisa Gloria-Cruz. [Photograph]. (n.d). Retrieved February 25, 2014 from http://www.health-tourism.com/_resources/doctors/182/dr-teresa-luisa-gloria- cruz.jpg
National Institutes of Health. [Logo]. (n.d). Retrieved February 28, 2014from
http://ihg.upm.edu.ph/sites/images/links/NIH%20Logo.jpg
-
Philippine Medical Association. [Logo]. (n.d). Retrieved February 28, 2014from
https://www.philippinemedicalassociation.org/images/logo.png
Philippine National Ear Institute. [Logo]. (n.d). Retrieved February 28, 2014 from
http://nih.upm.edu.ph/sites/default/files/PNEI.png
University of the Philippines Manila. [Logo]. (n.d). Retrieved February 25, 2014 from
http://upload.wikimedia.org/wikipedia/en/2/29/Up_manila_logo.jpg
UP MANILA NATIONAL INSTITUTES OF HEALTH. [Header]. (n.d). Retrieved February 25, 2014 from http://commcapsule.files.wordpress.com/2
UP Manila-PGH. [Logo]. (n.d). Retrieved February 25, 2014 from
http://upm-cassc.com/wp-content/uploads/2011/08/UPM-P.General-Hospital.jpg
-
National Institutes of Health (NIH)
University of the Philippines Manila
623 Pedro Gil Street, Ermita, 1000 Manila
nih.upm.edu.ph