Audiology Screening Notes

Biological Check

  • Involves running through own thresholds at 3 frequencies in both ears.
  • Wiggle wires to check for loose connections.
  • Important to check equipment to avoid false thresholds.
  • Ensures kids aren't referred unnecessarily due to malfunctioning equipment.
  • Determines appropriate level, considering factors like air conditioning.

Do's and Don'ts for Screenings

  • Do: Have the child sit at a 90-degree angle from you.
  • Don't: Look up when pressing the button to avoid associating head movement with the sound.
  • Use varied patterns to prevent the child from anticipating the sound.
  • Hold the sound for 1-2 seconds to test hearing, not pattern recognition.
  • Do: Use an otoscope to check for wax, redness, swelling, or active ear infections before testing.

Sweep Screen Procedure

  • Start at 1000 Hz in the right ear.
  • Progress to 2000 Hz, then 4000 Hz in the right ear.
  • Continue to 2000 Hz, then 1000 Hz in the left ear.
  • Avoid testing at 500 Hz during the initial screening to save time.
  • Aim for reliable thresholds, but limit testing time to around 5 minutes per child.
  • Strive for a balance between speed and thoroughness.

Pass/Fail Criteria

  • If the child passes the initial sweep screen (1000, 2000, 4000 Hz) in both ears, they pass the screening.
  • If the child fails even one frequency, conduct a threshold test for the failed frequencies.
  • If thresholds are within 25 dB, the child passes.
  • If thresholds are at 30 dB at one frequency, it's also a pass.
  • If the child doesn't pass the initial threshold screening, retest within 2-6 weeks, including testing at 500 Hz.

Referral Criteria After Retesting

  • If thresholds remain at 30 dB or higher at two or more frequencies after retesting, refer.
  • If any frequency registers at 40 dB or higher, refer.
  • Testing at 500 Hz provides additional low-frequency information, especially after an initial failure.
  • Speech sounds primarily fall within 1000-4000 Hz, hence the initial focus on these frequencies.

Reliability Check

  • Re-educate the patient, reiterate the instructions, and retest.

Criteria for Passing the Threshold Test

  • Thresholds within 25 dB result in an immediate pass.
  • A threshold at 30 dB at just one frequency also results in a pass.
  • Failing is defined as two frequencies in one ear exceeding 30 dB or any frequency exceeding 40 dB. Retest in 2-6 weeks, including 500 Hz.

Referral Criteria

  • Immediate referral is necessary without screening for active ear infections (redness, pain, discharge, unusual smell).
  • Referral after re-screening (2-6 weeks) is required if thresholds are at 30 dB or more at two or more frequencies (including 500 Hz) or if one frequency is at 40 dB or higher.
  • Avoid delaying referral beyond six weeks to prevent prolonged hearing impairment.
  • The rescreen will determine if it's an ear infection. If it hasn’t cleared up by then, then they need to see an ENT anyway, so the rescreen will tell you that. Referral is also needed if there is sensorineural hearing loss. The audiometers being used only test for conduction.