Chapter 24 – Hearing and Immittance Screening

The Purpose of Screening

  • Hearing screening program- intended to ______those who may have (or are likely to have) hearing problems
  • Should create two distinct groups:
  • Normal results (“______”)
  • Abnormal (need referral or further testing)
  • Parameters used to evaluate screening programs:
  • ______- the ability of the screening procedure to identify the target population accurately (correctly identify those individuals who actually have hearing loss)
  • ______- the ability of the procedure to not identify those who truly do not have the disorder the program is designed to identify (pass those who are normal)
  • A good screening program will be:
  • Highly sensitive- keeps ______l rates low
  • Highly specific- avoid missing affected individuals
  • To improve efficiency, it is often necessary to re-screen those who do not pass on the first screen (a second step before referral)

Incidence and/or Prevalence Considerations

  • Data from effective programs provides information on:
  • prevalence- true positives + false negatives all divided by the total number screened (percent who have the problem)
  • used to evaluate identification programs
  • incidence- how often the problem occurs
  • lack of national screening standards makes it impossible to determine accurate prevalence/incidence rates (2 examples on page 481)
  • must use caution when comparing rates from different studies because of variability in ______and ______methods

State and/or Federal Mandates for Screening

-currently there are no ______mandates

-most states regulate this process for ______and ______through either education or health departments

-state-to-state regulations vary greatly

Screening Procedures

-______alone is not effective for identifying all hearing losses

-Developmental ______:

  • as part of a test battery, useful for obtaining functional information regarding auditory development

-High risk register

  • HRR identifies______for hearing loss in neonates and infants and outlines follow up screenings and monitoring
  • Prior to universal newborn hearing screening, this was the primary tool used for referral
  • Helps identify children at risk for progressive hearing loss that may pass a screening at birth

-History

  • Helps identify children who show symptoms of delayed development

-Visual Inspection of Ear

  • Look for ______from ear canal and structural ______that may suggest a need for further screening, follow up
  • Look at tympanic membrane, ear canal and check for foreign ______

-Auditory Brainstem Response

  • ABR is an ______procedure used for hearing screening
  • Also AABR (automated)
  • Soft clicks are presented to the ear while electrodes placed carefully in the head record the brainstem’s response to sound
  • Primarily detects hearing loss greater than ____ dB
  • Can be used to estimate thresholds
  • Often requires ______for the child to be still

-Otoacoustic Emissions

  • Measures the integrity of the ______hair cells in the cochlea
  • Auditory stimulus is presented through external ear and the probe measures the “echo” that is produced in response
  • Two ways to elicit:
  • Transient Evoked OAEs (TEOAEs)
  • Brief pulse of sound (either click or ______)
  • Measures the response in the quiet period following the sound presentation
  • Frequency range of 500 to 5000 Hz
  • Generally detect hearing loss >30dB
  • Distortion Product OAEs (DPOAEs)
  • ______continuous tones of different frequencies are presented simultaneously
  • Results in an emission that is a distorted copy and hence a new frequency of the sounds first presented
  • Distortion product analyzed through signal analysis
  • Frequency range of 1000 to 8000 Hz
  • Generally detect hearing loss of >30dB
  • ______floor has a great effect on both types of OAEs
  • Abnormal middle ear conditions usually result in absent OAEs
  • Quick, simple, do not require a booth

-Puretone Screening

  • Most-used ______method
  • Individual responds to pure tones presented through headphones, inserts, or bone oscillator
  • General frequency range: 500 to 8000 Hz (bone stops at 4000 Hz)
  • Level: 20 to 25 dB
  • Noise levels in the ______present a significant problem

-Acoustic Immittance

  • Accurate and reliable equipment
  • Basic measures of tympanometry:
  • ______(pressure of middle ear cavity)
  • Static ______(mobility of eardrum)
  • Ear canal ______(important for assessing PE tube function)
  • Acoustic ______
  • Good procedure due to high incidence of middle ear disease and the negative effect it has on school performance
  • Controversial
  • Physician disagreement on proper treatment
  • Criteria not well developed or validated

-Behavioral Observation

  • Includes:
  • ______(BOA)
  • infants behavior is observed during the presentation of a variety of moderate to high intensity noises
  • observer watches for responses such as startling, blinking, localization to sound, eye widening, cessation of activity
  • high false-negative rate
  • ______(VRA)
  • condition responses at higher level (50 dB)
  • once conditioned, drop to lower level (20dB) for testing
  • when child turns to sound source, immediately reinforce
  • generally, reinforcement involves a light-up, moving toy

Screening Protocols

-two important considerations:

  • screening programs should be designed specifically for the intended population in order to maximize ______and ______
  • ______must be involved in this process to ensure that proper procedures are used

-Infant/toddler screening

  • Currently there is no population-based program for this age group
  • Those with consistent medical care may have screenings as part of their follow-up and monitoring
  • Important to screen at this age because of otitis media
  • Recommended screening guidelines for OM:
  • ______of acute OM is before 6 months of age
  • Infants who are______- fed
  • Infants and children with ______abnormalities or symptoms that generally occur with ______
  • Ethnic populations that have documented higher occurrence of OM (______and ______)
  • Infants or children in ______day care
  • Those exposed to excessive______smoke
  • Those diagnosed with sensorineural HL, developmental disorders/delays, learning disability, or behavior disorders

-Preschool screening

  • Generally coordinated through school districts or education agencies
  • Not a population-based screening
  • Programs usually conduct periodic screening throughout the year to identify children with disabilities or those who are at risk for learning problems
  • Head Start
  • Publicly funded preschool program
  • Has written guidelines for pure tone screening

-School Age

  • ______programs usually provide hearing screening
  • Most logical time for screening because children are all ______
  • Generally offered when children enter school system for ______, sometimes other grades are targeted as well
  • At-risk populations continue to be screened through ______school
  • Screening among teenagers is important for ______hearing loss
  • Procedures and follow-up criteria differ greatly by district and program
  • School-age screening programs should include education on hearing ______

-Children with Health, Developmental, and Other Disabilities

  • These children are at ______risk for hearing problems
  • Hearing problems can ______other disabilities
  • Hearing should be monitored ______along with middle ear status
  • Screening can be challenging with developmental disabilities and traditional methods may not be appropriate
  • OAEs are very useful here

Organization and Management of the Screening Program

-It is important that these programs are properly managed and monitored

-The personnel (nurses, volunteers, paraprofessionals) should be assigned to ______tasks. Those conducting the actual screening should be trained.

-Equipment should be routinely ______and ______

-Proper infection______procedures should be used

-Screening environment should be chosen to meet appropriate standards for ______noise

-Follow-up must be well established (including rescreening, referrals, etc.)

-______should be maintained for the screening program

  • This is important for evaluating program success
  • Data may also be useful if a child has a future problem