TOWN OF FAIRFIELD PUBLIC HEALTH NURSING. MANUAL: School Health APPROVED BY: Board of Health School Medical Advisor

Transcription

1 TOWN OF FAIRFIELD PUBLIC HEALTH NURSING MANUAL: School Health APPROVED BY: Board of Health School Medical Advisor POLICY: Audiometric Screening DATE REVISED AND APPROVED: , , I. Purpose POLICY Audiometric screening is provided to identify students with suspected hearing impairment so that appropriate medical and/or educational evaluation and interventions can be implemented to minimize adverse effects of auditory disabilities on speech, language, educational, and social/emotional development. II. Screening Methods All students to be screened shall receive pure tone air conduction screening to determine ability to hear pure-tones at set frequencies and intensities. This screening test does not indicate type or degree of hearing loss. The pure tone screening identifies students in need of further evaluation. Students shall be screened in each ear at the following frequencies and decibels: 1000 Hz at 20 db 2000 Hz at 20 db 4000 Hz at 25 db

2 2. III. Population To Be Screened A. Students in grades pre-k who are at least four years old by January 1 st of the current school year, kindergarten and grades 1,3,4 and 5. B. Students who have an audiological evaluation by an audiologist or audiogram on record that was done on or after July 1 st of the current school year will not be screened. C. Students who are known to have a permanent hearing loss will not be screened but should obtain annual audiological and/or medical monitoring as appropriate. IV. Screening Personnel An Audiometric Aide trained in screening techniques may perform pure tone screenings and re-screenings. Nurses who have received training and Speech- Language Clinicians may also carry out these procedures based upon the needs of particular students or schools. V. Referral A student who fails to respond to one or more of the puretone screening frequencies in either ear, fails the pure-tone screening. A rescreening will be administered to those who fail the initial screening. Those who fail will be referred for further evaluation to their private physician for further evaluation. VI. Documentation Results of pure-tone screening will be recorded on the student s Health Record. Referrals made to the student s private physician and results of referral follow-up will be recorded on the student s Health Record.

3 3. PROCEDURE: Audiometric Screening I. Equipment Needed A. Quite room and sound meter. B. Audiometer C. Table or desk D. Two chairs E. One electrical outlet if battery power not available for audiometer. F. Class lists and appropriate forms G. Blocks and container for students under 6 years of age. H. Zephyrine wipes or other appropriate cleanser for cleaning headphones. II. Care of Audiometer - Test working condition of audiometer prior to each testing period, report malfunctions to Nursing Supervisor. Plug in and warm audiometer for about ten minutes before testing. Test on self first (or on someone with normal hearing). The screener should be able to hear each of the screening frequencies in each ear and should not hear any other noise, clicks, or static. - Transport machines flat on floor of car to prevent rocking or falling while car is in motion. - Audiometer will be calibrated annually. A statement showing the date and result of the last calibration should be kept with each audiometer. - Learn proper packing procedure.

4 4. III. Differences Between Audiometers There are minor operational differences between audiometers depending on model. See related instructions with each machine. IV. Performing Pure Tone Air Conduction Screening A. Inspect audiometer for defects such as cracked or frayed cords, or loose cords, or broken earphones. B. Screening shall be performed in an acoustic environment sufficiently quiet for a person with normal hearing sensitivity to hear the screening tones. Check noise level of room on day testing is to be done. Noise level should be such that a person with normal hearing can hear all screening tones. Measure ambient noise with sound meter, if available. If ambient noise level exceeds 49.5 decibels, an alternate screening location will be needed. Conduct biological and listening check of audiometer by having a person with normal hearing listen to all screening tones to validate their audibility. Identify any static or mechanical noises which indicate a possible defect in the audiometer. C. Screening environment should be well lit and have minimal visual distraction. Pull down shades and blinds to decrease visual stimuli, when necessary. D. Turn Audiometer on. E. Instruct the child as follows: You will hear some little beeps. Listen very carefully. When you hear the beep, put your hand up (demonstrate). For children under 6 years of age, some form of play audiometry yields more reliable results than does hand raising. Therefore, for this age group instructions are: When you hear a beep, put the block in the cup. Remember, listen, and when the sound is there, put the block in the cup. For first graders, kindergarteners, and pre-kindergarteners, have a brief practice session before beginning the test. Place the earphones on top of the audiometer facing the children: Turn the frequency dial to 1000 Hz and the intensity dial to 100 decibels. Demonstrate, then have the children do it with you and then by themselves.

5 5. F. Seat student with back to audiometer. The child should be seated so that he/she cannot see the examiner s face nor any of the buttons or dials on the audiometer. The examiner may want to have the kindergarten and preschool child seated facing to the left or to the right of the examiner. This would allow the examiner to observe the child s face during the testing procedure and give the examiner cues as to whether or not the child is hearing the tone or not. All other children should be sitting or standing facing away from the examiner. G. Place headset securely but comfortably on student s head, making sure ear cushions are not obstructed from making contact by hair, clothing, earrings, glasses, hairpins, etc. Check to be sure that the RED or GREY earphone is placed over the RIGHT EAR. Suggested techniques for helping preschool children be comfortable with the screening procedure include presenting the procedure as a game, and/or telling them they are going to be a pilot when you put the headphones on them.

6 6. H. To begin screening, set the frequency dial at 1000 Hz, present the tone at 40 db and 30 db to test the student s understanding of the instructions, and then proceed with the screening. Present the tones in the following sequence for efficient hearing screening: RIGHT EAR LEFT EAR 40dB at 1000Hz (training) 30dB at 1000Hz (training) 20dB at 1000Hz (begins test) 20dB at 2000Hz 25dB at 4000Hz 25dB at 4000Hz 20dB at 2000Hz 20dB at 1000Hz Allow 1-2 seconds for tone presentation. If student does not respond, repeat tone immediately with a longer tone presentation. When the student responds by raising his/her hand or the student does not respond, move on to next screening tone. It is important to vary the length of tone presentations and intervals between them, so that the child does not begin to respond to a definite pattern. It is also important that the tone presentations be neither too short nor too long. It is very important that the examiner not provide the child with any cues as to the presence of tone. For example, the screening procedure is invalid if the tester asks the child if he/she heard the tone.

7 7. I. When testing of student is completed, wipe head phones with benzocolium chloride (trade name Zephyrine) before testing the next student. J. Record results of initial pure-tone screening on class list as follows: + indicates pass. If the student fails to hear any of the tones, record the first digit of the missed frequency e.g., if student fails to hear the tones at 1,000Hz and 2,000Hz, record 1, 2. Note: Results must be recorded individually for the right and left ears. Enter names, grades, screening results of all students who fail the initial puretone screening on hearing screening work sheet. Also record names and grades of all students who were absent for initial screening on hearing screening worksheet. Inform school nurse of any students who were unable to reliably participate in the screening procedure. K. Rescreening Rescreening should be done within two weeks of the initial screening. Rescreen indicated students and record results on hearing screening work sheet. Complete the Hearing Screening Record form for students who fail rescreening. L. Record results of all pure-tone screenings on student s Health Record. For students who receive rescreening, the results of the rescreening, not the initial screening, are recorded.

8 8. V. Specific Responsibilities of Personnel Involved In Hearing Screening Program 1. Audiometric Aide or Nurse Conducting Screening a. Notifies schools of screening dates. Requests principal establish appropriate screening location. Upon arrival at school, sets up screening schedule with principal and teachers. b. Obtain DO NOT SCREEN list from school nurse. c. Obtains class lists from nurse. d. Performs pure tone screening of appropriate students and records results on class lists. Enters names, grades, and results for all failures of initial screening and all students absent for initial screening on hearing screening worksheet. e. Schedules and performs pure-tone rescreening for all failures of initial screening. f. Records results of rescreening on class list and on hearing screening worksheet. Also, record results of screening for students who were absent for initial screening on class list and on hearing screening worksheet. g. For students who failed rescreening fills out Hearing Screening Record form and gives these forms to school nurse. h. Record results of hearing screening for all students on student s Health Record. i. Completes statistical data and gives it to school nurse. j. Schedules follow-up visit to schools to complete screenings for students who were absent and who are newly registered and in need of screening.

9 9. 2. School Nurse a. List children who are not to be screened on DO NOT SCREEN LIST. This includes children with known permanent hearing loss, those who are unable to be screened, those who have or are scheduled to have a documented audiometric evaluation or audiogram on record this school year, i.e., on or after July 1 st, and those whose parents have stated that they do not wish to have their child screened. School nurse should confer with school Speech and Language Clinician to determine students unable to be screened and those who have or are scheduled to have audiometric evaluation or audiogram this year. b. Make medical referrals for students who fail second screening or who are unable to be screened and do not have a record this year of an audiological evaluation or audiogram. Send parent referral cover letter, physician referral form, and copy of Hearing Screening Record (file original in student s record). Record date of referral in nurse s screening book and on student s Health Record. It is preferable to mail referrals to parents rather than sending referrals home with students. If parent requests child not be screened, document this on student s Health Record. Request parent provide written statement to this effect, including reason, and file statement in student s Health Record. c. When the physician s referral form is returned, enter the date and result in screening book and on the student s Health Record, and file the form in the student s Health Record. d. Notify teachers of outcome of medical referrals or audiological evaluations/audiograms that indicate a hearing impairment. As needed, participate in planning accommodations, evaluations and interventions for students. e. If no physician report is received in about six weeks, send parent reminder letter. Note date and results of follow-up contacts on student s Health Record. f. File audiological reports received from Speech/Language Clinician, school Audiologist, or other sources in student s Health Record. SHM/Vol. 1/Sec. 8 Audiometric Screening/A. Policy and Procedure Audiometric Screen