Teenagers are routinely given hearing tests at school, but those tests aren’t very good at identifying high-frequency hearing loss, which comes from headphones and loud noises, according to a report from Penn State University.

The American Academy of Pediatrics, in partnership with the Bright Futures children’s health organization, sets standards for pediatric preventive care and recommends screening adolescents with subjective questions and then following up with objective tests for those found to be at high risk of hearing loss.

But the screening questions are not specifically developed for children or adolescents, who are traditionally poor self-reporters of hearing status.

A study in 2010 using data from the National Health and Nutrition Examination Survey showed that one in five adolescents aged 12 to 19 has hearing loss. Most have high-frequency hearing loss, which could be related to increasing hazardous noise exposures from personal listening devices, concert-going, ATV-riding, and hunting with firearms.

For a new study, published in the Journal of Medical Screening, eleventh grade students at a Pennsylvania high school answered the 10 Bright Futures screening questions and additional questions assessing other potential risk factors for adolescent hearing loss.

They also took the Pennsylvania state-mandated hearing test—the hearing screening where children raise their hand when they hear a tone—and a test developed by the researchers to better detect high-frequency noise-related hearing loss. Some children underwent additional standard hearing testing in a soundproof booth.

Neither the Bright Futures questions nor the additional questions were tailored specifically to adolescent hearing loss. In addition, the Pennsylvania school hearing test was found to have a sensitivity of 13 percent for adolescent hearing loss while the study-designed hearing test had 100 percent sensitivity.

Most school hearing tests currently used in most states screen for low-frequency hearing loss, which is seen more often in younger children due to frequent ear infections and fluid in the ear. But these tests often miss high-frequency loss. A Penn State scientist is working to develop an objective hearing screening test specifically for adolescents with more high-frequency tones above 3,000 Hertz. These tones are typically affected by hazardous noise exposure. A testing protocol requiring adolescents to fail twice instead of once will reduce false positives.

“The onset of high-frequency hearing loss is often very insidious and the symptoms are often very subtle,” says the PSU scientist. “It’s important to identify hearing problems at any age because of the impact it can have on all different areas of life, including academic success, workplace advancement, and social relationships.”

Students with mild hearing loss are more likely to repeat a grade. Also, it’s estimated that people with hearing loss lose between $220,000 and $440,000 in earnings over a lifetime.

The study failed to find an association between typical adolescent noise exposures and hearing loss. The challenge could be the fact that genetics and duration of exposure are additional factors that affect an individual’s risk of hearing loss.

“You could be listening at a lower volume for an extended period of time, and that can be as bad as a high-volume sound for a short period of time,” says the PSU researcher.