Table 5 Final Ear Health and Hearing Check recommendations presented with GRADE rating of certainty of evidence, ratings of expert agreement and feasibility, and strength of recommendations
| Â | Strength of recommendation | Certainty of evidence | Level of expert agreement | Expert feasibility rating | |
|---|---|---|---|---|---|
Domain: Parent and carer-reported history, concerns, signs, and symptoms | |||||
 1. | Ask parents/carers about: a) their child’s ear health (recent and longer term); b) any concerns about their child’s ear health, hearing, or communication | Strong | Low | 96% | 92% |
Domain: Listening and communication skills | |||||
 2. | From the age of six months, review children’s listening and communication skills development with parents/carers using appropriate questionnaires or checklists | Strong | Very low | 98% | 88% |
Domain: Ear health | |||||
 3. | Examine appearance of the ear canal and ear drum, and assess movement of the ear drum and middle ear using either simple otoscopy plus tympanometry OR pneumatic otoscopy | Strong | Low | 93% | 82% |
 4. | Use of video otoscopy is suggested for health promotion purposes with parents/carers, and/or for sharing images with other healthcare practitioners | Conditional | Low | 96% | 71% |
Domain: Hearing sensitivity | |||||
 5. | Otoacoustic emissions (OAE) testing is suggested to confirm or exclude normal or near-normal hearing when: - equipment is available - primary health practitioners have capability and confidence to use it - there is a local preference for using OAE testing | Conditional | Low | 84% | 75% |
 6. | Audiometry is recommended as per Otitis Media Guidelines [16] when: - there are parent/carer and/or practitioner concerns about ear health, hearing, or communication, and/or - the child’s listening and communication development are not yet on track, and/or - there is a persistent or recurrent middle ear condition | Strong | -- | -- | -- |
Timing of routine Ear Health and Hearing Checks | |||||
 7. | Following newborn hearing screening, Ear Health and Hearing Checks are recommended at least 6 monthly until the age of 4 years, and then one check at 5 years old | Strong | Low | 88% | 67% |
 8. | It is suggested that Ear Health and Hearing Checks be undertaken more frequently than 6 months: - in high-risk settings, and/or - for children aged under two years, and/or - when it is acceptable to families, and/or - in response to parent/carer concerns | Conditional | Low | 88% | 64% |