Audiology and hearing health professionals in developed and developing countries (2002), Lyn et al. (1998), and Swart et al. (1995), impacted cerumen is one of the most common ear diseases and causes of hearing loss, with prevalence rate between 7.4% and 63%. Additionally, otoscopy does not require a great deal of expertise beyond basic training and is useful to refer a child when the tympanic membrane cannot be visualized due to occlusion of the external auditory meatus by cerumen. Pure-tone audiometry screening, in which there is typically no attempt to find threshold, has been found to accurately assess hearing status in children six years and older, when trained health workers
Substance theory bundle theorist objects to the notion of a thing with no properties, claiming that such a thing is inconceivable and citing John Locke, who described a substance as "a something, I know not what." To the bundle theorist, as soon as one has any notion of a substance in mind, a property accompanies that notion. The indiscernibility argument from the substance theorist targets those bundle theorists who are also metaphysical realists. Metaphysical realism uses the identity of "universals" to compare and identify particulars. Substance theorists say that bundle theory is incompatible with metaphysical realism due to the identity of indiscernibles: