The results suggest that with further improvement in terms of its sensitivity and specificity, it may be feasible to use the automated hearing screening test system to conduct routine school hearing screenings.

Objectives: To establish the reliability and validity of an automated hearing screening test system for preschoolers and to investigate the risk factors for hearing loss. Methods: The study used a cross-sectional design in a comparative study of subjects. The automated hearing screening test was performed in 6231 preschoolers (3-7 years old) from 41 kindergartens in Shanghai, China. Sensitivity and specificity of the automated test were investigated with subjects who failed the screening test and a group of control subjects. Results: Six hundred and forty-seven children were referred for diagnostic audiological assessment after the automated puretone screening test. Using the conventional pure-tone audiometry as the ''gold standard,'' the sensitivity and specificity of the automated hearing screening test increased from 0.33 and 0.15 in the youngest age group to 0.95 and 1.00 in the oldest age group, respectively. There was no statistically significant gender effect, but there was an age effect ( 2 ¼ 22.96, p < 0.01). In the univariate analysis of 104 cases and 201 controls, significantly elevated odds ratios (OR) for hearing loss were correlated with universal newborn hearing screening test results (OR ¼ 28.15, p < 0.01), parental suspicion of hearing loss (OR ¼ 10.10, p < 0.05), and attendance at preschool before the age of five (OR ¼ 0.51, p < 0.05). Conclusions:The results suggest that the automated hearing screening test system can be used in screening programmes for preschoolers aged older than five years.