Hearing Final

hearing age groups

• newborns and infants birth to 6 months

• infants and toddlers 7 months to 2 years

• preschool age 3-5

• school age 5-18

ASHA recommends to screen children or infants for outer or Middle Ear disorders

as needed, requested or mandated or when the child has a condition that could place them at risk

typical procedures for screening for outer and middle ear disorders

optional case history, visual exam of outer ear, acoustic emittance testing

why do we pay particular attention to Om (otitis media)

OM is very prevalent in children bc of medical and developmental concerns that happen when it goes untreated

who can screen infants birth to 6 months

licensed audiologist with ABR or OAE

when do you conduct the first regularly scheduled screening program for children

in the fall in conjunction with screening for hearing impairment

should infants and children that are followed by a physician for middle ear disorder be screened

No

should infants in child care programs be screened for middle ear disorders at routine visits by PCP

yes

procedure for screening for OM and ME disorders

• case history

• visual inspection of pinna

• otoscopy

• screening tympanometry

• follow up

why is there uneccesarily high referral rates for middle ear disorders

because there is no clear cut definition for pass/refer for middle ear screening procedures

ASHA recommends to screen children ages 7 months to 6 years old if

if they have had acute Omicron before 6 y/o, if they have been bottle fed, if they have a history of craniofacial anomalies, if they are something like eskimo with lots of OMs, if they spend a lot of time in daycare, or if they are frequently around cigarette smoke

referral/follow up strategies

• inform parents ASAP

• clearly define professional roles

• notify parents, physicians, school

• specifiy what happens after screening

for informed consent,

existing state statutes and regulations will supersede informed consent

what are you looking for upon visual inspection/otoscopy

is there anything blocking sound from getting through, landmarks like cone of light or annulus

pure tone screening

• screen at 1000, 2000 and 4000 Hz for both adults and kids

• present each frequency and record responses

• use portable audiometer

what dB do you screen adults with with pure tone screening and portable audiometer

25 db. use traditional or insert headphones

what dB do you screen kids with with Pure tone screening and portable audiometer

20 dB, use traditional or insert headphones

pure tone pass

if a response is obtained at least twice

pure tone screening for kids

• play audiometry

• 3-6 years old

• drop the block in the bucket when you hear a birdie

record a CNT or could not test if

if client was not able to be trained on the task due to developmental concerns

pure tone screening for adults

have them raise their hand or push a button when they hear the noise

who can perform play audiometry

SLP, AUD, or support personnel under them

all infants with hearing impairment should be identified before __ and receive intervention by ___

3 months, 6 months

children are considered to be at risk for HI if

• family history

• in utero infections

• craniofacial anomalies

• low birth weight

ABR

• auditory brainstem response

what is ABR

a physiological measure of peripheral auditory function through the brainstem and provides info on the integrity of the 8th cranial nerve; pass if reliable response is present at 35 dB for both ears

EVOAE

-evoked otoacoustic emission; pass if reliable response is present at 35 dB for both ears

who can screen infants and toddlers 7 months to 2 years

certified AUD

VRA

visual reinforcement audiometry; do under headphones if possible at 1000, 2000 and 4000 at 30 dB

who can screen preschoolers age 3-5

SLP, AUD, or support personnel

how to screen preschoolers age 3-5

• condition them to the task beforehand

• always get parental consent

• present at least 2 presentations per test stimulus

• screen under headphones at 1000, 2000 and 4000 at 20 dB

• rescreen 1-3 months after initial screening

who can screen school age children age 5-18

SLP, AUD, or support personnel

when to screen school age children 5-18

upon entrance and annually from K-3 and 7-11 as needed, requested, or mandated

two purposes for screening disability in children

1. allows for referral of those children that exhibit milestones in development

2. part of audiological management

who can screen for disability in children birth to 18

SLP, AUD, physician, nurse, educator

screening instruments for infants and toddlers

The Communication Screen, Early Language Milestone Scale, The Fluharty Preschool Speech and Language Screening Test

screening instruments for preschool population

The Communication Screen, Compton Speech and Language Screening Evaluation, The Physician’s Developmental Quick Screen for Speech Disorders

screening instruments for school age population

The SIFTER

when do you report screening results

when more than a pass or refer is needed to explain your findings

ASHA guidelines for screening for adults

• screen for disorder, impairment or disability

• include case history, visual inspection, pure tone screening, screening of self assessment of hearing disability

can pure tone screening be used to screen for hearing disability

No, just hearing impairment

when screening for hearing disorder, make a medical referral if

• you see cerumen impaction, ear infection, or TM perf

if patient passes hearing disorder screen, the next screen for hearing impairment should utilize

pure tone screens

patient is referred with a failure of two test conditions

1. failure of one frequency in each ear

2. fails two frequencies in one ear

why is referral rate higher for 60 and up

due to declining hearing sensitivity due to age

screen every __ through age 50 and every __ years after

decade; 3

hearing disability screening instruments

SAC or HHIES

SAC

self assessment of communication

HHIES

hearing handicap inventory of the elderly screening version

what is the SAC

10 item questionnaire that samples the client’s perception of the extent of the communication problem that originates from hearing loss

what does SAC pertain to

pertains to communication difficulty

what is the HHIES

10 item questionnaire that attempts to quantify the perceived emotional and social affects of the hearing loss

what does the HHIES pertain to

pertains more to hearing loss

what screening protocol of we do for newborns and infants birth to 6 months

ABR or OAE

screening level is considered a pass if

response is present at 35 dB or lower for both ears. refer if no response

what screening protocol do we use for toddlers 7m-2 y

BRA or play audiometry

what screening protocol do we use for children age 5-18

conventional audiometry or CPA

neurodevelopment disorders

• cerebral palsy

• learning disability

• ADD

• epilepsy

teacher checklists are used to

monitor a child’s responses to auditory stimuli once it has been determined that he has normal hearing sensitivity. can be used in conjunction with annual hearing screening

various teacher checklists include

the functional communication measure and the hearing questionnaire

Early Auditory Skill Development for Special Populations

obtains info regarding how the child uses their hearing at home, school and other places

five stages of auditory skill development

1. sound awareness

2. localization

3. accurate localization

4. sound compression

5. early auditory comprehension

OAE will tell you if

if you have normal cochlear function

tymp will tell you if

if you have normal middle ear function

screening measures that do not require a response from patient

tymp and OAE; for use with people with developmental disorders

who can screen toddlers 7 months to 2 years

licensed audiologist with OAE and BOA

who can screen preschool age children age 3-5 years

AUD, SLP or support personnel using play audiometry

who can screen school age children 5-18 years

AUD, SLP, or support personnel using conventional hearing screening

who can screen adults age 18 and up

AUD, SLP or support personnel using tymp, OAE, pure tone,

SLPs screening protocol for outer middle and inner ear

tymp, OAE, pure tone, otoscopy

what does AShA recommend in terms of screening for adults

screening for disorder, impairment or disability

disorder

the actual hearing loss

impairment

how much HL impacts their daily life

when screening for hearing disorder what are we trying to identify

physical anomalies on the ear, drainage, etc.

what do we use when screening for disability with adult

use the HHIES and/ or the SAC

hearing scales (HHIES and SAC) enable people to realize

if their hearing is interfering with their communication, social and emotional functions

if a refer is indicated for the hearing disability screen and for the impairment screen, what is recommended

a full AUD evaluation

Tommy is five years old and is in SPED at your school. Tommy is nonverbal and has downs syndrome. what is your screening protocol to screen his hearing?

perform the screening in a quiet familiar room. I would explain the procedure to him using gestures and nonverbal cues. I would perform BOA and an otoscopy

BOA

behavioral observation audiometry; watches for changes in their behavior upon hearing the presented sounds. best in use for small children and people with developmental disorders

how would you screen Daniel, 35 years old, does not respond when given directions?

BOA

what percent of children diagnosed with hearing loss also have vision deficits, cerebral palsy, mental retardation, autism, etc.

25-40%