Health visitor screening versus vigilance: outcomes of programmes for detecting permanent childhood hearing loss in west Berkshire.

The Health Visitor Distraction Test (HVDT) screen for hearing was replaced in West Berkshire in 1989 with a vigilance programme incorporating a questionnaire. The detection of permanent congenital deafness (bilateral > 50 dB HL) for all children born since 1984 has been audited to compare the two regimes. Sixty-two cases met the criteria, giving an ascertainment of 1.0 per 1000. Performance was similar under the two systems for severe/profound losses (> 70 dB HL), but there was a longer tail of late-detected moderate losses (50-70 dB HL) under the vigilance regime. The sensitivity of the Health Visitor questionnaire in referring those with permanent hearing loss was very similar to that of the HVDT (39% compared with 42%). Coverage for the questionnaire was approximately 87%, but only 78% for the known cases. Referral rate was lower under the vigilance programme, at approximately 3%. The results suggest that a vigilance programme is likely to perform as well as the HVDT but no better. Despite subsequent modifications to the vigilance programme, the poor pickup of moderate losses probably indicates the limitations of parental and professional observation in detecting partial hearing problems. The evidence adds support to the recent recommendations for universal neonatal screening.