The American Academy of Audiology endorses detection of hearing loss in early childhood and school-aged populations using evidence-based hearing screening methods. Hearing loss is the most common developmental disorder identifiable at birth and its prevalence increases throughout school-age due to the additions of late-onset, late identified and acquired hearing loss. Under identification and lack of appropriate management of hearing loss in children has broad economic effects as well as a potential impact on individual child educational, cognitive and social development. The goal of early detection of new hearing loss is to maximize perception of speech and the resulting attainment of linguistic-based skills. Identification of new or emerging hearing loss in one or both ears followed by appropriate referral for diagnosis and treatment are first steps to minimizing these effects. Informing educational staff, monitoring chronic or fluctuating hearing loss, and providing education toward the prevention of hearing loss are important steps that are needed to follow mass screening if the impact of hearing loss is to be minimized. 

Key Points

Summary of Hearing Screening Recommendations

Pure Tone Screening 

  1. Perform biological check on pure tone screening equipment prior to daily screening. 
  2. Screen populations age 3 (chronologically and developmentally) and older using pure tone screening. 
  3. Perform a pure tone sweep at 1000, 2000, and 4000 Hz at 20 dB HL. 
  4. Present a tone more than once but no more than 4 times if a child fails to respond. 
  5. Only screen in an acoustically appropriate screening environment. 
  6. Lack of response at any frequency in either ear constitutes a failure. 
  7. Rescreen immediately. 
  8. Use tympanometry in conjunction with pure tone screening in young child populations (i.e., preschool, kindergarten, grade 1). 
  9. Screen for high frequency hearing loss where efforts to provide education on hearing loss prevention exist. 
  10. Minimum grades to be screened: preschool, kindergarten, and grades 1, 3, 5, and either 7 or 9.

Tympanometry Screening 

  1. Calibrate tympanometry equipment daily. 
  2. Tympanometry should be used as a second-stage screening method following failure of pure tone or otoacoustic emissions screening. 
  3. Use defined tympanometry screening and referral criteria: a 250 daPa tympanometric width is the recommended criterion. If it is not possible to use tympanometric width then 0.2 mmhos static compliance can be used as the criterion. A final choice for failure criterion is negative pressure of >-200 daPa to -400 daPa; however, it is not appropriate for this criterion to stand alone to elicit a referral. 
  4. Young child populations should be targeted for tympanometry screening. 
  5. Use results of pure tone or OAE and tympanometry rescreening to inform next steps. 


  1. Rescreen with tympanometry after a defined period: after failing the immediate pure tone rescreening and in 8–10 weeks for children failing pure tone or OAE screening and tympanometry. 
  2. Do not wait to perform a second stage screening on children who fail pure tone screening only. 


  1. Use only for preschool and school age children for whom pure tone screening is not developmentally appropriate (ability levels < 3 years). 
  2. Calibrate OAE equipment daily. 
  3. Maintain primary DPOAE levels at 65/55 dB SPL. 
  4. Select DPOAE or TEOAE cut-off values carefully. 
  5. Default settings may not be appropriate. 
  6. Screening programs using OAE technology must involve an experienced audiologist. 
  7. Children failing OAE should be screened with tympanometry. 

Get Involved

Whether serving on a clinical document development panel or participating as peer reviewers, volunteers have regular chances to deepen their engagement with the Academy and make important contributions benefiting the field of audiology. If you are interested in clinical document development, please volunteer to express interest and submit a CV to the Academy’s guidelines staff by email.

To view the list of guidelines and strategic documents in development and to learn more about the Academy’s clinical document development process, visit the Academy’s Practice Resources website. Information from interested members is accepted on an ongoing basis, and members will be contacted as clinical document volunteer openings occur.

Share this

Related Content

American Academy of Audiology Position Statement on Early Identification of Cytomegalovirus in Newborns

This position statement is endorsed by the American Cochlear Implant Alliance and the National CMV Foundation. The American Academy of Audiology recommends early identification of congenital cytomegalovirus (cCMV) through screening to allow for appropriate early diagnosis, intervention, and monitoring for congenital, progressive, and delayed-onset hearing loss in infants with cCMV.

Read More

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Developed by the American Academy of Otolaryngology–Head and Neck Surgery. Endorsed by the American Academy of Audiology.

Read More

Clinical Guidance Document: Assessment of Hearing in Infants and Young Children

This clinical guidance document describes recommended practices for the assessment of auditory function in children. The most appropriate protocol will be individualized for each child based on their developmental and/or chronological age and other relevant factors.

Read More