Hearing Screening E-Learning Course

Hearing Screening E-Learning Course

Results Interpretation and Follow-Up

Rescreen and REFER Criteria

The criterion for pure tone audiometry screening referral is the lack of response to any of the screening sounds in one or both ears during the 14 to 21-day rescreen as outlined in the Pure Tone Audiometry Screening section. For more information, refer to the pure tone audiometry screening algorithm in hearing screening training manual.

Other Considerations

  • If the child is unable to follow directions, refer to the play audiometry section for recommendations on rescreening.
  • If the child is unable to perform play audiometry rescreen:
  • For children three years of age, rescreen within six months.
  • For children four years or older, rescreen within 30 days.
  • If the child has a REFER result (misses one or more sounds) after immediate rescreen (refer to pure tone screening procedure), schedule the child for rescreening in 14 to 21 days.
  • If the child has a REFER result (misses one or more sounds) on the 14 to 21 day rescreen, refer the child to their primary care provider for middle ear clearance.
  • If the primary care provider provides middle ear clearance or within 8 to 10 weeks, rescreen the child's hearing.
  • If the screener determines if would be of benefit to the referral, threshold screening** may be performed.

*Determining if the child may have middle ear fluid requires advanced training that may be beyond the skill of some screeners.
**Performing threshold screening requires advanced training that may be beyond the skill of some screeners.

Pass/Refer Criteria

C&TC Hearing Screening PASS/REFER Criteria (For both standard pure tone and play audiometry)

Procedure Pass Refer Follow-up
Risk assessment and Hearing History PASS: No positive response to hearing history questions REFER: A positive response in the history for a child who has never been evaluated Further evaluation by primary care provider.
External and Internal Visual Inspection PASS: Normal appearance of all structures; no observed ear distress or complaints of pain when the pinna or the tissue around the ear is being REFER: Any abnormality that has not been previously evaluated. Further evaluation by primary care provider
Pure Tone Audiometry Screening (Initial Screen) PASS: Pass a child who responds to all sounds REFER: Child who does not hear one or more sounds after screening Schedule re-screening in 14-21 days. If child does not pass re-screen, conduct further evaluation for medical diagnosis and treatment. Consider further audiological testing as appropriate.
Pure Tone Screening (Re-Screen in 14-21 days) PASS: Pass a child who responds to all sounds REFER: Child who does not hear one or more sounds after re-screening. Conduct further evaluation for medical diagnosis and treatment and consider further audiological testing as appropriate.
Tympanometry* PASS: Pass a child who has Type A tympanogram

REFER: Child who has a Type B, C, or other tympanogram results outside the MDH recommended parameters

Schedule a follow-up for a timely assessment by an audiologist and referral to, or notification of, the child's primary care provider.

*not covered in this training, but may be performed if there are personnel trained in its use

Note: You must answer the following questions to continue with the course.

Question 1: One should perform an immediate rescreen when:





Question 2: Referral to a primary care provider is indicated when:





Question 3: Results should be communicated to parents in their own language by:







This concludes Rescreen and REFER Criteria segment of the Results Interpretation and Follow-Up section. You may continue on to the Documentation segment, or return to the Table of Contents. If you do not plan to complete the entire web training, please fill out the evaluation form, C&TC Children's Hearing Screening Web-Based Training Evaluation.


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