Pediatric Hearing Screening Training for the PCA. Gouverneur Healthcare Services 227 Madison Street New York, NY 10002

Transcription

1 Pediatric Hearing Screening Training for the PCA Gouverneur Healthcare Services 227 Madison Street New York, NY 10002

2 Preface The purpose of any hearing screening program is to ensure early identification of hearing loss. Hearing loss that is not diagnosed can have a negative impact on a child s speech and language development. Therefore, early diagnosis is crucial to facilitate early intervention and (re)habilitation.

3 Preface At present, there is a Universal Newborn Hearing Screening program in New York State. This program enables early identification of hearing loss and therefore early intervention which may include use of hearing aids and speech/language therapy through the Early Intervention Program.

4 Preface The scope of this training is specific to children age 3 and older. Children younger than 3 and children with specific risk factors are referred directly to the Audiology Service by the child s PCP. There are diagnostic tools available to the audiologist for testing newborns and children under the age of 3.

5 Preface It is imperative that these children be referred in a timely manner for audiologic assessment so that hearing loss be diagnosed early and intervention is immediate. Children with known hearing loss and/or speech-language delay are not screened but referred to the Audiology Service by the child s PCP.

6 The Ear The ear is divided into 3 parts: 1. The outer ear. 2. The middle ear. 3. The inner ear.

7 The Outer Ear Made up of external ear and the ear canal until the ear drum (tympanic membrane). Sends sound energy to the middle ear. Outer ear problems: 1. Missing ear canal. 2. Narrow ear canal. 3. Excessive ear wax. 4. Foreign objects stuck in the ear canal (beads, popcorn, insects, etc.)

8 The Middle Ear The middle ear is the space between the tympanic membrane (ear drum) and oval window of the inner ear. It contains 3 bones the smallest bones in the body: the malleus (hammer), the incus (anvil) and the stapes (stirrup). The Eustachian tube, which connects the ear to the throat, opens into the middle ear.

9 The Middle Ear The vibrating eardrum transmits energy, together with the 3 middle ear bones to the oval window. Middle ear problems: 1. Fluid in the middle ear space (which may or may not be infected). 2. Hole in the ear drum (perforation).

10 The Inner Ear The inner ear is a fluid-filled bony structure. It contains the cochlea which is associated with hearing. The inner ear also has a membranous portion. which includes 3 semicircular canals which are associated with balance. The cochlea contains hair cells which vibrate. It is the movement of these hair cells that is measured in newborn screenings. These hair cells are damaged when the ear is exposed to loud sounds.

11 The Inner Ear Inner Ear Problems may be caused by: 1. Heredity. 2. Noise exposure. 3. Other trauma. 4. Maternal rubella. 5. Certain medications. 6. Certain illnesses, e.g. meningitis.

12 Types of Hearing Loss Conductive: Problem in the outer and/or middle ear. Sensorineural: Problem in the inner ear. Mixed: Combination of conductive and sensorineural hearing loss.

13 Hearing Screening Procedure: Equipment and Environment An audiometer is used to perform hearing screenings. The audiometer produces sounds that are measured in frequencies called Hertz (Hz). The intensity (loudness) levels of the sounds produced by the audiometer are measured in decibels (db) of hearing level (HL). The environment: test room should be quiet and free of distractions.

14 Hearing Screening Procedure: Biological Check Before screening a child, a biological check should be performed. A hearing screening should be performed on a staff member whose hearing is normal. Results of the biological check are recorded in a log. If the one or both headphones are not working, the supervisor should be notified. Headphones from another audiometer may not be used as each set of headphones is calibrated to a specific audiometer. (Calibration for screening audiometers is once a year.)

15 Hearing Screening Procedures: Two procedures are used: Play Audiometry and Standard Audiometry. Play: Children who are 3 and 4 years old and sometimes older children who do not understand the standard audiometry procedure. Standard: Children who are 5 and older.

16 Hearing Screening Procedures-Play Audiometry: Stage One (Pre-test) Step PCA prepares the room before the child arrives. 2. All supplies: headphone covers, toys are by the audiometer. Step Seat the child. 2. Present a 90dBHL tone at 2000Hz. 3. Present the tone 2 more times so as to arouse the child s interest and curiosity. Step Demonstrate to the child what you want him/her to do: Present the tone at 90dBHL at 2000Hz and drop a toy in the bucket. 2. Repeat this procedure 2 more times. This demonstrates to the child: Every time you hear the sound drop the toy in the bucket.

17 Hearing Screening Procedures- Play Audiometry: Stage One (Pre-test) Step Perform Step 3 with the child by guiding the child s hand to the bucket and dropping the toy when the tone is presented. 2. Perform this procedure 2 more times Step Give the toy to the child, present the tone and see if the child drops the toy in the bucket independently. 2. If the child can do this, move on to Stage 2.

18 Hearing Screening Procedures-Play Audiometry: Stage 2 (Pre-test) Prepare the audiometer: 1. Change the frequency dial to 1000Hz. 2. Change the intensity dial to 50dBHL. 3. Place the headphones on the child s ears: Red headphone on right ear/blue headphone on left. 4. Start the test with the right ear.

19 Hearing Screening Procedures-Play Audiometry: Stage 2 (Pre-test) Step Give a toy to the child and hold his/her hand. 2. Present the tone. 3. Guide the child s hand to the bucket. 4. Drop the toy into the bucket as the tone is presented. 5. Repeat this procedure 1-2 more times.

20 Hearing Screening Procedures-Play Audiometry: Stage 2 (Pre-test) Step Give the toy to the child. 2. Present the tone. 3. If the child drops the toy in the bucket independently 2 times, move on to Stage 3.

21 Hearing Screening Procedures-Play Audiometry: Stage 3. Change the intensity dial to 20dBHL. This is the intensity level used for the actual hearing screening. Present the tones at 1000, 2000, 4000Hz and then again at 1000Hz. If testing in a soundproof room, 500Hz is also presented. When screening of the right ear is complete, move to the left ear. Remove the headphones when the screening is complete and record the results.

22 Hearing Screening Procedures- Standard Audiometry Used when performing a hearing screening on older children. Procedures are similar to those used in play audiometry. Caregiver/child are told that a hearing assessment will be performed. Instructions are verbalized to the child: Please raise your hand when you hear the sound even if it is very soft. Present the tone, initially at 50dBHL at 1000Hz; if the child raises his/her hand, set intensity dial to 20dBHL and proceed as in play audiometry. When the screening is completed, record the results.

23 Hearing Screening Procedures- Recording the Results Pass: The child passes the screen if (s)he responds to all tones presented at 20dBHL at all frequencies. Fail: The child fails the screen if (s)he does not respond to the 20dBHL tone at any one frequency for one or both ears. Could Not Test (CNT): A child is reported as CNT if (s)he does not complete the pre-test (Stages 1 and 2) Test results are recorded in MISYS. If paper form is used to record results, a check is circled for pass, an x for fail, and CNT for could not test.

24 Hearing Screening Procedures- Referrals to Audiology Service Children who fail the screening or are could not test are referred to the Audiology Service for further testing. All referrals are made by the child s PCP.

25 Acknowledgments This manual and hearing screening protocol are based on the hearing screening training program developed by the late Voldie McCarthey, PhD of the New York City Department of Health. Thanks to Stephen Catullo, MA, MBA, CCC/SLP of the South Manhattan Network for his assistance in revision of this manual.