Hearing screenings in Simpson County schools reveal unseen needs beyond standard tests
By Erica D. Walker MSc, ScD
JA Guest Writer
Standard hearing screenings are failing rural communities, and we now have data showing where.
In 2023, our researcher Toni Holloway spent the year driving between six schools in Simpson County with a tablet and a set of headphones. She tested 109 people: students at Mendenhall High School, Mendenhall Junior High, and New Covenant Learning Academy, and the adults who work alongside them – teachers, administrators, cafeteria staff, librarians, nurses.
The hearing tests came back reassuring. Ninety-three percent had hearing within normal limits.
If we had stopped there, we would have packed up and left.
Instead we paired every screening with a 19-question survey, and a very different picture emerged.
Sixty-nine percent of the people who use headphones told us they listen at high volume. Eighty-one percent wear no hearing protection at all. Forty-one percent said they have ringing in their ears – a symptom the World Health Organization identifies as a warning sign that deserves attention before any loss shows up on a test. Nearly half said they have trouble following a conversation in a noisy room. And more than one in five had never had a hearing test in their lives before that day.
Here is the number that matters most. Among the participants whose hearing tests came back completely normal, 40 percent still reported ringing in their ears, and 42 percent said their hearing had slipped. A screening program built around the hearing test alone would have told every one of those people they were fine.
That gap is not unique to Simpson County. Audiologists cluster in higher-income urban counties, and across the most rural 57 percent of counties in this country there is not a single audiologist affiliated with the national professional association. When care is that far away, a test that comes back normal tends to end the conversation rather than start one.
We want to be careful about what this study does and does not show. It was a pilot: 109 people in one county, and the symptoms are what people told us on paper, not conditions we could confirm with a medical exam. Some of that ringing is likely ordinary, the kind that follows a loud night. Some of it may be early damage in a place the standard test does not look. There is no way to tell which without following these students and staff over time, and that is the study we would like to do next.
What we can say is that the screening worked. It took about fifteen minutes. It needed no sound booth and no specialist in the room. Every participant got their results the same day on a printed card, along with a guide to safe listening volumes and, for the younger students, an activity book in English, Spanish, and Chinese. Anyone whose test flagged something received a list of local audiologists to call.
That model can go anywhere. What it found in Simpson County was need that the hearing test alone recorded as normal.
We are grateful to the students, families, teachers, and staff of the participating schools, who made this work possible, and to the Department of Audiology at Jackson State University, which reviewed our screening protocol.
One practical note for parents. If your child says their ears ring after a concert or a long stretch with earbuds in, that is worth paying attention to, even if a hearing test says everything is fine.
Check out the full study to see how lightweight, survey-backed tools can change what rural public health outreach detects: https://link.springer.com/article/10.1186/s12889-026-29104-3.
