Completion Rates of Screening Examinations for Hearing Among Preschool-Aged Children

Importance Preschool hearing screening is critical for early identification of hearing loss, yet factors associated with screening completion are not well described. Objective To evaluate completion rates of pure-tone audiometry (PTA) and otoacoustic emission (OAE) screening among preschool children in the community and identify factors, including child characteristics and screener-child language concordance, associated with completion. Design, Setting, and Participants This multicenter prospective cohort study across 204 preschools in 15 California counties included a population-based sample of 7035 children who underwent screening from November 7, 2023, to December 3, 2025. Exposures Child age (≤48 months vs >48 months), preferred home language, teacher-reported communication concerns (eg, speech, language, or hearing), and screener Spanish proficiency (low vs high). Main Outcomes and Measures Completion of PTA and OAE screening in both ears. Odds of completion were estimated using logistic regression, adjusted for age, screener experience, and teacher-reported concerns. Ratios of estimated probabilities were used to compare Spanish- and English-speaking children across screener proficiency levels. Results Among 7035 children screened (median age, 47 [IQR, 39-54] months; 3583 [50.9%] male; 4780 [67.9%] preference for English and 2683 [38.1%] preference for Spanish), OAE was completed in 6745 children (95.9%), whereas PTA was completed in 4601 (65.4%). Teacher-reported concerns included speech (1039 children [14.8%]), language (577 children [8.2%]), and hearing (298 children [4.2%]). Children 48 months or younger (odds ratio [OR], 0.17; 95% CI, 0.15-0.19), those with speech concerns (OR, 0.44; 95% CI, 0.36-0.53), and those with non-English home language preference (OR, 0.84; 95% CI, 0.74-0.94) had lower odds of PTA completion. For OAE, younger age (OR, 0.38; 95% CI, 0.29-0.50) and speech concerns (OR, 0.39; 95% CI, 0.28-0.55) had lower odds of completion; non-English home language preference was not associated with OAE completion (OR, 1.04; 95% CI, 0.80-1.35). Spanish-speaking children whose screeners had high Spanish proficiency had higher estimated PTA completion than those with low-proficiency screeners, achieving parity with English-speaking children in the high-proficiency group (ratio of estimated probabilities, 0.96; 95% CI, 0.91-1.02), while Spanish-speaking children had lower estimated probability of completion than English-speaking children when evaluated by low-proficiency screeners (ratio of estimated probabilities, 0.87; 95% CI, 0.80-0.94). Screener language proficiency was not associated with OAE completion. Conclusions and Relevance In this prospective cohort study of 7035 preschoolers, PTA completion rate was significantly lower than that for OAE and varied by age, speech concerns, and home language, whereas OAE completion was consistently high. High Spanish proficiency by the screener was associated with higher PTA estimated probability of completion among Spanish-speaking children, supporting the importance of language-concordant screening in early childhood hearing assessment.