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In the last annual report the value was stressed of the gramophone audiometer for the
detection of hearing defects in elementary school children, and an extension of its use was
recommended. The Council considered the matter and approved a scheme put forward which
comprised the full-time services of one nurse to do the actual testing and perform other duties
connected with the work ; and the services of an otologist for two sessions a week, to deal with
the clinical examination of " failed " children, and the treatment where possible, of those cases
in need of treatment, for the purpose of relieving the hearing defect. With this " unit" it is
hoped that about 30,000 children may be dealt with each year. A second unit will be formed
in April, 1935, and a third in April, 1936. When all three units are in full working order it is
computed that about 90,000 children will be tested during each year.
Audiometer.
Certain difficulties existed in the efficient working of this scheme, but an effort is being made
to surmount them.
The first difficulty arises after test II, when it becomes necessary to make a clinical examination
of the " failed " children. Hitherto this examination has been conducted at one of the
special aural clinics, and a notice was sent to parents requesting their attendance with their
children for the clinical examination. It was found that a not inconsiderable proportion of such
children failed to attend, which considerably reduced the value of the work done. This
difficulty has been overcome by arranging for the examination to take place in the schools. The
parents are invited to be present with their children and the care committee worker of the school
is also asked to be present. Should the otologist, at this examination, find any defect to exist
which seemed to account for the loss of hearing, and to be of the opinion that some form of
treatment would be likely to relieve the condition, the position is, there and then, explained to
the parent, whose acquiescence in the treatment is asked for. The care committee worker then
follows the case up, and when treatment is completed, notifies the nurse, who then arranges
for test III, to see if the treatment obtained has produced the desired result. For the purpose
of conducting test III the nurse asks the head teacher of the school of any child concerned, to
arrange for the child to attend at the school in which the nurse happens to be carrying out the
audiometric testing, which as a rule can be arranged at a school in the neighbourhood.
Hitherto, not only did many children fail to attend the clinical examination at the special
aural clinic, but of those who did attend many failed to obtain the treatment recommended,
the result being that the number available for test III was only a small proportion of those who
failed in test II. With the new plan, it is found that a considerably higher percentage of
children are obtaining treatment and the real object of the work, viz., the detection and alleviation
of defects of hearing in their earlier stages, thus preventing in many cases the onset of permanent
loss of hearing, is being attained to a material extent. There is, of course, a percentage of parents
who, unaware of any hearing defect in their child, are not willing to have the treatment recommended,
but doubtless as the object of this work is more understood and appreciated by parents,
this number will grow less.
There are a number of pitfalls in the testing which are revealed by experience, such as
extraneous noises, inattention of the children, imperfect application of the telephone to the
ear, which tend to vitiate the results obtained, but a careful watch is being kept for these,
and means of eliminating them sought for. It is not proposed to deal in great detail with this
now, but the matter will be fully discussed in the report next year, when more experience will
be available.
The new scheme was only started on 5th November, 1934, consequently the numbers for
that year are not large.
Only children in the senior departments are being tested at present, but as many as forty
children can be tested at a time. Special tests have been devised by the Research Committee
working at the London School of Hygiene and Tropical Medicine, for the testing of children of
the infant departments. These consist of a series of pictures of familiar objects in sliding frames,
e.g. cow, ball, which are spoken by the voice from the gramophone record and on hearing the
names of these objects the child presses on the appropriate frame and eliminates the picture
from view. When the child no longer does this correctly, the point has been reached where
his hearing fails. As in the records for testing the older children, the record is graded in
decibels. Only a few children can be tested at a time by this method. It is in use in Tottenham
and works quite successfully.
Whatever objections may be advanced against the gramophone audiometer, none can be
regarded as serious, and indeed most that have been put forward are quite remediable by careful
attention to conditions of testing. In any case it is without equal as a method of sorting out
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