Background and Justification

Transcription

1 Best Practices in Birth to Five Hearing Screening REGION V 2017 REGION V LEADERSHIP AND PROFESSIONAL DEVELOPMENT CONFERENCE Randi Winston-Gerson, AuD, CCC-A Hearing Screening Program Manager 1 Learning Objectives Background and justification for early childhood screening An overview of OAE and audiometry screening Risk Factors for Late Onset and Progressive Hearing Loss Middle Ear and Tympanometry Best Practice Guidelines and Protocols Strategies for Successful Screening Troubleshooting Parent Education and Communication Resources New Hearing Screening Technology 2 Background and Justification 3 1

2 Hearing Loss Per 10,000 Compared to Other Congenital Conditions Newborn Hearing Screening and Beyond The EHDI (Early Hearing Detection and Intervention) national goals specify that all babies are screened prior to1month of age, diagnosed with hearing loss prior to 3 months of age and enrolled in early intervention programs prior to 6 months of age Studies have shown that Infants who are diagnosed with hearing loss and begin receiving early intervention services before 6 months of age have significantly better outcomes in language, speech, and socialemotional compared to children who begin receiving therapies after 6 months of age 5 Newborn Hearing Screening and Beyond > 96% of babies born in the United States are screened for hearing loss before one month of age Approx 60% of babies who do not pass the newborn hearing screening are lost to follow-up and don t get the follow up testing needed Some children have hearing losses that occur after the newborn period (late onset or progressive hearing loss) Subjective methods of screening children before age 3, eg. noise makers and paper screen questionnaires are not efficient in detecting mild, moderate or unilateral hearing loss 6 2

3 Important Facts about Hearing in Children Hearing loss is an invisible condition and can develop at any age 50% of infants born with hearing loss don t have risk factors for hearing loss Between birth and school age, hearing loss doubles 35% of children have repeated ear infections which can impact a child s hearing Mild or unilateral hearing loss may not be obvious but is educationally significant and can effect a child s ability to develop normal speech and language 7 Impact of Hearing Loss Two little girls with no known cognitive or developmental conditions The first one was identified late before newborn hearing screening and the awareness of early identification The second one was identified at birth 8 Spring is my favorite season. The sun shines bright. The flowers begin to grow. I like spring. 9 3

4 10 How OAE Screening Works 11 Early Childhood Hearing Outreach: ECHO The ECHO Initiative is a collaboration between Maternal and Child Health Bureau The Federal Administration for Children and Families-Head Start Bureau National Center for Hearing Assessment and Management For more information and resources go to:

5 Kidshearing.org 13 ECHO: How OAE Screening Works

6 Anatomy as it Relates to OAE Screening OAEs do not screen beyond the cochlea 16 Middle ear and Tympanometry 17 Middle Ear and Tympanometry A measure of middle ear function Is not a test of hearing Will cause child to refer on OAEs and often refer on puretone screening 18 6

7 Tympanometry and Otitis Media Otitis media is an infection of the fluid in the middle ear The most common cause of temporary hearing loss Common cause of sick days, emergency room visits and antibiotics Will cause child to refer on OAEs and often refer on pure tones Sample Tympanograms TYPE A TYPE B TYPE C Image courtesy of Brad Ingrao, MSEd, CCC-A, FAAA / EDEN-The Electronic Deaf Education Network / Jen Duffey M.S., CCC-A Screening a child with PE Tubes Screening can be conducted on ears with PE Tubes It is a small tube placed in the eardrum that provides ventilation and drains fluid trapped in the middle ear space Eardrum The screening result should be a pass if the PE Tubes and cochlea are functioning properly 21 7

8 Screening Responsibly: Know the Limitations of OAEs Do not tell you why the child does not pass Do not tell you how much of a hearing loss may be present Is effected by outer and middle ear problems May not pick up all hearing losses that have unusual configurations Will not pick up on hearing losses that happen along the auditory nerve to the brain IF A CHILD PASSES THE SCREENING, BUT CONCERNS STILL EXIST, REFER TO A PEDIATRIC AUDIOLOGIST 22 Risk Factors for Late Onset and Progressive Hearing Loss 23 JCIH 2007 Risk Factors: jcih.org Caregiver concerns regarding speech or developmental delay Family history of permanent childhood hearing loss NICU care of more than 5 days or any other following regardless length of stay: ECMO, assisted ventilation, ototoxic med, hyperbilirubenemia requiring blood transfusion Low Birth Weight < 1500 grams In utero infection: CMV, herpes, rubella Physical findings that are associated with a syndrome known to include SNHL or permanent CHL Craniofacial anomalies Syndromes associated with hearing loss Neurodegenerative disorders Culture positive postnatal infections associated with SNHL: meningitiis Head Trauma Chemotherapy 24 8

9 Late Onset and Progressive HL Most common risk factors for late onset or progressive loss are: Cytomegalovirus (CMV) Cranio-facial Anomalies Meningitis Head Injury Family History of congenital hearing loss 25 Unilateral and Mild Hearing Loss Studies show that unless early identification and management occurs, children with mild and moderate hearing loss on average achieve one to four grade levels lower and Studies have shown that approximately 37% of children with unilateral hearing loss are at risk for failing a grade Tharpe, Guidelines and Protocol 27 9

10 Overview of Age Appropriate Screening Guidelines Birth to Three Ideal for children, birth to 3 because it does not require a behavioral response OAEs are not a true test of hearing Babies in the NICU for > 5 days are at a higher risk for neural losses, therefore OAEs must be used responsibly 28 Overview of Age Appropriate Screening Guidelines Approximately Age Three and Older Pure tone/audiometry screening: considered the gold standard because it is a comprehensive screen of the auditory system Use OAEs only for children for whom you are unable to condition or obtain a behavioral response 29 ECHO: OAE Protocol in Detail 30 10

11 ECHO: OAE Protocol in Detail 31 ECHO: OAE Documentation Form 32 Strategies for Successful Screening 33 11

12 ECHO: Strategies For Successful Screening 34 Strategies for Successful OAE Screening: Preparing to screen Ready the equipment Visual inspection Sound check Plugged in or fully charged Ready the Room Quiet environment Toys to distract children A familiar, comforting adult Convenient chairs Infection Control Container to keep used probes Gloves or hand sanitizer to use between children Antibacterial wipes to clean equipment in between screenings 29 Strategies for Successful OAE Screening: Preparing to screen OAE Birth to 3 Screening What to Bring to Successfully Screen! When screening young children, be well prepared. Along with making sure your equipment is charged and working properly, there are a number of items that will help the screening run smoothly. Consider investing in a plastic caddy type of container or basket with a handle and assembling a screener s kit with the following items: Plenty of probe/ear tips (include a few adult sizes so you can check equipment by testing yourself). Extra probe replacement nozzles/probe tubes/probe tips Baggies for dirty probe tips Alcohol packets Antibacterial hand gel Pen Screening/Reporting forms An assortment of quiet innovative toys that can be disinfected such as: Books Bubbles Role of tape Plastic balls Windmills Light up spinning wands Stickers Mini Etch a Sketch Cartoon Bandages Puppets 29 12

13 Strategies for Successful OAE Screening: Probe Fit Integrity 1.Visual inspection of ear 2.Pick an ear tip that looks slightly larger than the ear canal 3.Position yourself on the side and just behind the ear you are screening 4.Clip the cord to the child s clothing closest to the ear you are screening 5.If you are using a foam tip, fully compress before placing in ear 29 Strategies for Successful OAE Screening: Probe Fit Integrity 6. With one hand pull back on the pinna to fully open the canal 7. With the other hand, gently insert the probe deep in the canal and twist slightly 8. When the child settles, let go of the probe 9. Perform the Tug Test 10.The probe should be secure and stay in place on it s own 11.Before screening the opposite ear, always check the probe to ensure there is no wax or debris blockage 29 Strategies for Successful OAE Screening: Probe Fit Integrity 1.Visual inspection of ear onote the size of the canal opening owhen NOT to screen Significant wax blockage or loose wax draining from ear Fluid or drainage from the ear Blood Open sore Foreign object in the ear canal 29 13

14 Strategies for Successful OAE Screening Probe Fit Integrity 29 Strategies for Successful OAE Screening Probe Fit Integrity 29 Hand s-on Demonstration NCHAM 14

15 Troubleshooting 43 Troubleshooting Noisy room Noisy child Probe fit Probe blocked with wax Other error messages on the screen 44 Strategies for Successful OAE Screening Challenge Child is non-compliant, afraid and unwilling to allow screening Solutions 1. Have a very familiar adult accompany the child for the screening, e.g. a parent, caretaker or teacher 2. Have the child sit in the adults lap facing away or toward with adult with arms swaddling the child s gently and lovingly swaddling 3. Let the child know you want to play and special listening game and ask for their help in holding the game and pressing the buttons 4. Keep some innovative quiet toys and distractors on hand... Bubbles, stickers, band aids, roll of tape, old cell phone, crayons and coloring book 5. If still unsuccessful, try screening during the child s nap! 45 15

16 Strategies for Successful Screening Challenge Noisy / high artifact error messages Solutions 1. Find a quieter area to screen. Ideally, screening should be conducted in a quiet room. Take children out of a noisy room and into a quiet room to screen 2. Check probe fit to ensure probe is securely placed in the ear 3. If child has a cold or upper respiratory condition, 4. Check for probe blockage. Wax, debris can create noise or interference 46 Rescreening Know when to re-attempt screening When a child is moving When there is excessive internal or external noise If you aren t sure about your probe fit If the probe is blocked 47 Audiometry Screening Process 48 16

17 Conditioning 49 Winston-Gerson, Sabo, 2016 Screening Process 50 Winston-Gerson, Sabo, 2016 Parent Education and Communication 51 17

18 Screening Results As you know, all children participating in our program receive a hearing screening. We are pleased to offer this as a helpful resource in caring for your child s hearing health. The results of your child s hearing screening are as follows: Your Child s Left Ear: Your Child s Right Ear: After reviewing your child's hearing screening results, we are recommending that a more detailed examination be scheduled with a doctor. Some children may not pass the hearing screening due to wax blockage in the ear canal or a mild, undetected middle ear infection. It is therefore important that your child s ears be examined by a doctor as soon as possible. Please make an appointment as soon as possible. If you have questions or concerns, please call us at. Let us know if you need any help in making this follow-up appointment. 52 Educating Parents on Ear Wax Removal Important Facts About Cleaning Your Child s Earwax! Randi Winston-Gerson, AuD, CCC-A, FAAA Doctor of Audiology Is it normal for my child to have earwax? Earwax is NORMAL and is meant to be in your child ears: o It protects the inside parts of the ear from dust and dirt o Sometime earwax can be seen on the outside part the ear canal How should I clean it? Cotton Swabs or Q-tips should NEVER be used to clean earwax in your child s ears: o Putting a cotton swab/q-tip or any sharp object in the ear canal can damage your child s ears and can push wax further inside the ear. This will cause it to harden and block off the inside of the ear from working properly o If you can t see it, leave it! o Most of the time earwax you can see on the outside is normal and should gently be cleaned with a damp warm cloth. What should I do if there is always earwax coming out of my child s ears? Sometimes too much earwax is produced, which can plug the ears and cause a hearing loss: o If you look inside the ear and there is large block of wax that plugs the ear canal and doesn t come out on its own o If you think your child always has too much earwax coming out of their ears Contact your child s doctor who can flush out the wax in the office or recommend over-the counter ear drops to soften the wax so if falls out on it own. A good resource for more information is: 53 Know Your State Reporting Requirements All state EHDI programs have reporting mandates Results must be reported to the Contact your state Early Hearing Detection and Intervention (EHDI) program or visit infanthearing.org to obtain your state specific profile 54 18

19 Resources 55 EHDI-PALS Links to Pediatric Audiology Services A national web-based directory of facilities that offer pediatric audiology services to young children who are younger than five years of age ehdipals.org 56 Community Funding Resources Every community has funding and grant initiatives for children with special health care needs and/or developmental disabilities Do a google search for resources in your community...ie funding opportunities for children with developmental delays in your city The Lion s and Rotary clubs Grant Template on ECHO Website ng-to-implement.php 57 19

20 Screening and Follow-up Resources (Pediatric Audiologist s) (ECHO Website) (NCHAM Website) 58 Madsen ALPHA and ALPHA PLUS PATH SENTIERO Handheld portable devices, such as the Alpha and PATH Sentiero, are ideal for birth to 5 screening 60 20

21 Madsen Alpha Entertainment Value 61 Madsen Alpha New Technology to Maximize Screening outcomes User friendly Large Touch Screen Child mode to engage child Built in probe quality check PE tubes and perforations Updated lightweight probe design Low cost disposables 62 Alpha = Basic version One pre-defined DPOAE protocol testing 2-5 khz using db SPL Simple touch screen and navigation Prints to label printer Stores 50 tests 63 21

22 Alpha+ = Enhanced features Ability to add demographic/patient information 8 predefined DPOAE protocols including a TEOAE protocol Stores 250 tests Results can be printed from a PC with a Print to PDF tool or label printer 64 Probe Check Convenience 65 Eartip Selection for ALPHA and Sentiero 66 22

23 Alpha Resources: OAE is Fun 67 PATH Sentiero Handheld Screener Combination device with OAEs and audiometry in one handheld, portable lightweight device making it easy to go from child to child 68 PATH Sentiero 69 23

24 PATH Sentiero: Combined Technologies 70 PATH Sentiero The VIP Probe: Provides light for a more accurate positioning Unique feature is especially helpful in dark rooms Allows for continuous monitoring to ensure a proper fit and seal 71 Resources: audiologysystems.com/alpha 72 24

25 Questions? 73 25