Project Summary  

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Many children growing up in rural Alaska get frequent ear infections. As a result, they may experience hearing loss, which can cause speech and language delays. Children with hearing loss may also have trouble in school and drop out of school early. Hearing loss can also cause problems that extend into adulthood, such as difficulty finding a job. It is important to identify and treat childhood hearing loss quickly to prevent these problems and keep children in school.

A state law in Alaska requires children to be screened for hearing loss at school. However, the current screenings might not detect all hearing loss, and many students do not get needed follow-up care.

Researchers want to know how well a new school-based screening and referral process works to identify children with hearing loss.

Who can this research help?

This research can help health system and school officials in remote areas decide if the new screening and referral process is an effective way to identify and treat hearing loss.

What is the research team doing?

The research team is working with schools in 15 communities in northwest Alaska, with approximately 1,800 children eligible to take part. Parents sign a consent form for their children to take part, and children verbally agree to take part on the day of screening.

In all 15 communities, school staff screen children for hearing loss using the schools’ current method. In addition, research staff who are not trained audiologists screen children with a new cell-phone-based (mHealth) screen. Audiology research staff perform full hearing testing similar to what children would receive in an audiology clinic, so the study team can compare these results with those of the first two methods.

Researchers are dividing the communities into two groups by chance. In the first group, schools send parents a letter if their children need further hearing screening, which is the same referral process that schools have used in the past. The letter includes a request for the parent to bring the child to the clinic for more testing. In the second group, the school and clinic work together to schedule children who need further hearing screening for a telemedicine appointment at the clinic. An adult chaperone takes the child to the clinic. Parents can attend the visit but are not required to if the child is in third grade or above. At the clinic, a community health aide works with audiologists and ear, nose, and throat specialists by telemedicine to do follow-up testing.

If parents do not want their children to take part in the project, schools send parents a letter if their children’s school screening results show possible hearing loss. This screening and referral process is the same as they would have received before the project began.

The research team wants to know

• How long it takes for children with hearing loss to get a diagnosis
• If treatment for hearing loss leads to any changes in children’s future hearing loss, hearing-related quality of life, and school performance
• How well the current school hearing screen and the new mHealth screen detect hearing loss

Children, parents, audiologists, teachers, health providers, and hospital and school administrators are working with the research team to plan the study. The research team is holding focus groups with children, parents, teachers, community health aides, and school and health administrators to learn about their experiences with the study.

Research methods at a glance

Design Elements	Description
Design	Randomized controlled trial
Population	Children ages 4–21 attending school in 15 communities in Northwest Alaska
Interventions/ Comparators	Communities randomized to expedited telemedicine intervention: Local schools and clinics collaborate to schedule children who need further hearing screening for a telemedicine consultation at the clinic. All children receive regular and mHealth screening. Communities randomized to usual care: Schools send parents of children who need further hearing screening a letter. The letter includes a request for the parent to bring the child to the clinic for evaluation. All children receive regular and mHealth screening.
Outcomes	Primary: time to diagnosis Secondary: change in prevalence of hearing loss, change in hearing-related quality of life, and change in school performance; sensitivity and specificity of screening protocols
Timeframe	9-month follow-up for primary outcome

Journal Articles

More on this Project  

Videos

This Simple Test Can Help Kids Hear Better (Susan Emmett | TEDGlobal 2017)

NOTE: This talk was presented at an official TED conference. View the video and more on the TED website.

_{The video above is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License. It is attributed to TED Talks. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/.}

Project Details

Principal Investigator

Samantha Kleindienst, AuD, PhD^

Other Principal Investigator

Susan Emmett, MD, MPH

Project Status

In progress; Data collected

Project Title

Addressing Childhood Hearing Loss Disparities in an Alaska Native Population: A Community Randomized Trial

Board Approval Date

December 2016

Project End Date

February 2021

Organization

Norton Sound Health Corporation

Year Awarded

2016

State

Alaska

Project Type

Research Project

Health Conditions  

Ear, Nose, and Throat Diseases

Hearing Loss

Intervention Strategies

Care Coordination
Screening Interventions
Technology Interventions
Telemedicine

Populations

Racial/Ethnic Minorities
Rural
Children -- 18 and under

Funding Announcement

Addressing Disparities

Project Budget

$2,072,765

Study Registration Information

HSRP20181356

NCT03309553