Which action will most effectively control the problem of overreferral in school screening programs that use impedance/immittance measurements?

• A. Obtaining the measurements in a professional sound-insulated room
• B. Including 500 Hz in the audiometric screening procedure
• C. Retesting immediately those who did not pass the first screening
• D. Waiting three to five weeks to retest those who did not pass the first screening

Answer: (D)

The idea being tested is how to reduce false positives in school screening that uses impedance/immittance measurements. Impedance testing checks how the middle ear is functioning, and results can be influenced by temporary factors such as a recent cold, fluid in the middle ear, earwax, or even suboptimal test conditions. If you retest immediately after a failed pass, those temporary conditions are still likely present, so you’ll keep flagging many children who don’t have a lasting problem—leading to overreferral.

Waiting three to five weeks gives time for transient issues to clear, so the follow-up result more accurately reflects whether there is a persistent middle-ear problem. This approach substantially lowers unnecessary referrals while still identifying kids who truly need further evaluation. Improving the testing environment or adjusting test frequencies can help quality, but they don’t address the tendency for temporary conditions to produce false positives the way a delayed retest does.