How accurate is parent rating of hearing for children with otitis media?

Objective: To determine the accuracy of parent assessment of child hearing. Design: Prospective study. Setting: Hospital-based pediatric otolaryngology practice in a metropolitan area. Patients: One hundred eighty-six children aged 6 months to 12 years (median age, 3.4 years) with chronic otitis media with effusion or recurrent acute otitis media enrolled in a quality-of-life study. Intervention: Parents rated their child's hearing over the prior 4 weeks using a 7-point response scale. Otoscopic findings, static admittance, tympanometric width, and audiometric thresholds were recorded concurrently. Fifty children were reassessed to monitor changes in hearing. Main Outcome Measure: Correlation of parent hearing assessments with baseline hearing status (pure tone average for the better hearing ear) and with changes in hearing status. Results: The hearing loss questions had good test-retest reliability (R = 0.79) but did not correlate with audiometric results (R = -0.13; P = .09). Only when caregivers reported hearing to be an "extreme problem" were median hearing levels (31 dB) significantly greater than the median response (20 dB). Conversely, static admittance and tympanometric gradient were significant predictors of hearing levels (2-way analysis of variance, P < .01) and explained 44% of the ear-specific variations. Abnormal immittance measures in both ears had an 84% predictive value for hearing loss (20-dB hearing level or poorer), and normal immittance measures in both ears had a 76% predictive value for normal hearing. Caregiver assessments of change in hearing status did not correlate with changes in audiometric results (R = 0.07; P = .65). Conclusions: Caregiver assessments of child hearing do not accurately predict hearing levels or changes in hearing status. Immittance measures can help identify children at low or high risk for hearing loss, but cannot substitute for audiometry.