Screening infants and young children for hearing loss: examination of the CAST procedure.

A computer-mediated visual reinforcement audiometry (VRA) screening procedure, the Classification of Audiograms by Sequential Testing (CAST), was used with 59 infants and young children who received both CAST screening and conventional audiologic assessment. Approximately one-third of the children had normal hearing, one-third had conductive hearing loss, and the remaining one-third had previously diagnosed sensorineural hearing loss. The sensitivity and specificity of CAST were calculated and the relationship between the predicted CAST pattern and the child's actual audiogram was examined. CAST outcome was also considered along with the results of tympanometry and pneumatic otoscopy to formulate proposed follow-up strategies. CAST appears to be a useful tool for the behavioral screening of infants and young children: one component of a screening program designed to maximize the efficient identification and follow-up of infants and children with hearing loss.