pediatrics quiz 1

3/1000 of all newborns

will have hearing loss in the US

5/1000 of all newborns

will have hearing loss world wide

10/1000

school age children have hearing loss

19%

what is the percentage of 12-19 year olds with some hearing loss?

distribution of HL in US

4.7 million children, 33 million adults

childhood includes individuals between

0-18 years old

childhood subgroups

neonates, infants, toddlers, preschoolers, kindergarteners, grade schoolers, tweens, adolescents, teens

key concept 1

adults use residual hearing to continue to communicate, kids use residual hearing to learn to communicate

key concept 2

children require unique accommodations and are different from adults

key concept 3

children change over time, they are different each year you see them!

pediatric audiologist

specializes in hearing healthcare of children between 0-18 years; identify hearing loss, provide intervention services, monitor for changes, contribute to intervention team, provide counseling to family

how late were children being identified with severe-profound HL in the mid-90s?

as late as 30 months

9 points of high risk

family history of HL, findings known with SNHL/CHL, in-utero infection, craniofacial abnormalities, very low birth weight, hyperbili, ototoxic meds for longer than 5 days, mechanical vents 5-10 days, severe asyphyxia, APGAR scores of 0-3 at 10 min

what is very low birth weight

<1500 grams (3.25 lbs)

hyperbilirubinemia

can cause damage to OHC and strains cochlea, can turn into kernicterus which may cause brain damage and permanent HL

requirements for a condition to warrant mass screening

condition must be sufficiently frequent in population to be screened, must be serious/fatal without intervention, must be treatable or preventable, effective follow-up program must be possible

Joint Committee on Infant Hearing minimums for early intervention programs

thoughtful selection of tech, equipment calibration appropriate, protocols for training screeners, protocols for screening, quality assurance, staffing specifications, discharge/transfer plans, audiology oversight

1-3-6 plan

all newborns will be screened by 1 month, diagnostic audio eval by 3 months, identified and have intervention by 6 months

JCIH suggested protocol

target HL at >30 dB HL (500,1000,2000,4000), use OAEs and/or ABR

OAEs

takes ~5-10 min per ear, lower cost, evaluates >1500 Hz, no detection of neural dysfunction

ABRs

takes ~10-20 min per ear, higher cost, 1000-8000 Hz, will detect neural dysfunction

limitations of NBHS

mild isolated low freq and steeply sloping HL may be missed, progressive HL missed

screening for school age children

annually beginning kindergarten through 3rd, 7-11th grades too

quality indicators for screening

% of newborn infants who complete screening by 1 month, don’t pass hospital based screening, don’t pass initial+following screenings, don’t pass initial screening then pass rescreen

recommended benchmark for screening

>95% by 1 month

quality indicators for confirmation of HL

% of infants who don’t pass initial birth screening + subsequent rescreening, complete audio eval by 3 months

recommended benchmark for confirmation of HL

90% by 3 months

quality indicators for early intervention

% of infants who are diagnosed w/ HL and get amplification w/in 1 month of confirming hearing status and have parents who signed IFSP no later than 6 months old

recommended benchmark for early intervention

90% by 6 months

cost effectiveness

hospital/program determines this by # of births, availability of trained personnel, ability of families to complete testing, services available to family

in a GOOD PROGRAM

1.5-5% of babies referred for further testing with a plan and process to track them

states who meet 1-3-6 aim for

1-2-3

goal of audiologic assessment

to quantify residual hearing for purpose of diagnosis, treatment, and habilitation

objective measures

require no conscious contribution from patient, hearing is assumed based on physiological activity that is coincident with auditory stimulation

subjective measures

require conscious response from patient, hearing is confirmed by overt response to stimulation of auditory system

types of objective tests

acoustic immittance, OAEs, ABR

types of subjective tests

behavioral observation, visual reinforcement audiometry, conditioned play audiometry

VRA

form of operant conditions where child is conditioned to make overt response to sound-orienting movement, reinforcer is a visual image

CPA

form of operant conditions where child is conditioned to play in response to sound; advancing to next step in a game

valid tests meet these three criteria:

duration of test is appropriate for age group, child is able to tolerate test, task is appropriately challenging for age group

pavlovian conditioning

process of shaping behavior so it occurs under specific conditions, stimulus [reward] response, reward is ultimately taken away but behavior continues

operant conditioning

use of rewards to modify behavior in response to stimulus, reward never goes away!!

Moore, Wilson, and Thompson found that

children need a reinforcer to reliably and accurately response during the VRA testing

Primus and Thompson found that

children will habituate (older faster than younger), habituation not affected by consistent/intermittent reinforcement, habituation reduced with novel reinforcers, type of stimuli had no effect on consistency of response

operant conditioning can be used for children IF

technique works for majority of population, must yield results that are precise and relevant for treatment, technique must be quick and cost effective

four main purposes of audiologic assessment

obtain measure of peripheral hearing sensitivity that rules out/confirms HL, confirm status of middle ear, assess auditory functioning using speech measures, observe/interpret auditory behaviors

cross check principle

several appropriate behavioral and electrophysiologic tests must be used to determine extent of child’s auditory function

importance of behavioral info

provides important supplement from electrophys, should be done as early as possible (7-9 months)

selecting test protocol

based on chronological age, corrected age, or developmental age

when should you use questionnaires

depends on what you’re looking for, can be mixed and matched to use at different times based on patient needs

necessary steps before pedi assessment

eval physical status, choose test room setup, take case history

case history

developmental info, observe child and build rapport, observe between child and family, obtain insights from family

birth/prenatal history

previous pregnancies, illnesses, medications, passed NBHS, complications during pregnancy/birth, delivery method, birth weight, length of hospitalization

health history

family history, sicknesses, immunizations, meningitis/viruses, drugs, feeding/swallowing, seizures/head injuries

hearing history

parent/child’s thoughts on hearing, responding to sounds, TV/phone/tablet usage, fluctuating hearing, any amplification?

speech and language history

age of babbling/first words/sentences, verbal requests without visual cues, how do they communicate, change in speech and language recently?

developmental history

motor milestones, age of visual response to parents, walking clumsy, feeding/eating, age of toilet training

social history

child autonomy, social skills, favorite toys/objects, behavioral problems, any changes in behavior

educational history

current school and type of program, school changes and why, special services

special services history

early intervention, school services or outside of school, SLP/hearing/OT/PT/psych etc