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examined clinically and the parent was invited to be present. If the aurist at this examination
found any defect which accounted for the loss of hearing for which treatment was
indicated, the position was explained to the parent, whose agreement was obtained to
the prescribed treatment which might be given at one of the special ear inspection centres
or at a minor ailment centre. The case was then followed up by the school care committee,
who notified the nurse when the treatment was completed in order that a third
test could be made.
Many of these children with hearing defects were found to have abnormal conditions
of the nose, which were wholly or in part responsible for the defect of hearing. These
cases also were referred to the school treatment centres where amongst other methods of
treatment ' diastolisation ' was undertaken.
The 'audiometer unit' scheme was at first confined to the North Western Division.
The 'audiometer unit' consisted of one gramophone audiometer, one full-time nurse
and an otologist giving two sessions (one for clinical examination and one for treatment)
weekly.
To obtain a correct diagnosis of the hearing capacity of children, referred as deaf
or suffering from defective hearing to such an extent that special education was required,
a pure-tone audiometer was purchased and used mainly at the County Hall. It was also
used for recording periodically the condition of the auditory function of the children
in the deaf and partially deaf schools.
By 1939 there was a gramophone audiometer in use in each of the five divisions, and
the working arrangements provided for the testing of pupils of 7 years of age and over
within a period of five years. The war interrupted the scheme but it was partly resumed
in 1947.
There is now a gramophone audiometer in each of the nine divisions. The work is
carried out by eight school nursing sisters each using a gramophone audiometer in the
schools. Pupils failing in two consecutive gramophone tests are referred to the audiology
clinic at a local school treatment centre for pure tone testing by the same sister (except
in the case of those sisters who use a portable pure-tone audiometer and who can therefore
carry out pure-tone testing at the schools). Any pupils failing their pure tone test
are referred to an otologist. The sisters are engaged exclusively on this work, being
responsible for the clinical work, home visits, transport of equipment, arrangements
with schools, pure tone sessions and attendance at audiology sessions. Since the gramophone
test implies that the pupils must be old enough to write from dictation, the tests
are carried out on entrance to junior schools at the age of 7+ years.
The great advantage of the gramophone audiometer is that it allows group testing,
so that, out of a large body of children, it is possible quickly to select those whose hearing
loss is such that further individual tests on the pure-tone audiometer is desirable.
Furthermore, the gramophone audiometer shows actual response to speech. There may,
however, be normal hearing for speech and yet considerable losses outside the speech
frequencies. The gramophone audiometer cannot reveal all defects (of medical importance)
which are shown up clearly by the pure-tone audiometer. On the other hand, the
pure-tone audiometer does not give a clear picture of likely response to speech.
As it is desired to have routine audiometer tests carried out at as young an age as
possible, investigation is now being made into the possibility of the use of the pure-tone
sweep technique on entrants to schools at the age of 5+ years. (Other hearing tests
involve the use of percussion sounds, pitch pipes, etc.)
Many cases of suspected hearing defect are referred to the Principal School Medical
Officer by school doctors (through the divisional medical officers) or may be brought
to light as a result of a statutory E.S.N, examination. Many other cases are referred to
him direct by hospitals. A few cases are referred by parents and private doctors, and some
are disclosed as a result of an examination under the Mental Deficiency Acts.
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