PACIFIC Pre- EHDI Mee.ng March 3, 2012

Transcription

1 Guam Early Hearing Detec>on and Interven>on Project (Guam EHDI) Tele Audiology PACIFIC Pre- EHDI Mee.ng March 3, 2012 St. Louis, Missouri

2 Will 30 minutes enough to cover the following aspects: Hardware and somware requirements. Staff and professional requirements. Benefits Outcomes.

3 PILOT PROJECT: PROVIDING INFANT DIAGNOSTIC AUDIOLOGICAL EVALUATIONS TO BABIES IN GUAM VIA TELEAUDIOLOGY In Partnership with Children s Hospital Colorado Presentation Taken from Sue Dreith, Au.D. And Deborah Hayes, Ph.D. Bill Daniels Center for Children s Hearing Children s Hospital - Colorado

4 GOALS OF THIS PRESENTATION Explain the current process of iden.fying infants and young children with hearing loss Discuss pilot project of teleaudiology in providing diagnos.c assessments to babies in Guam

5 Types of Hearing Loss Conduc.ve Hearing Loss Hearing loss caused by something that stops sounds from getng through the outer or middle ear. Treatment: medicine, surgery, or hearing aids. Sensorineural Hearing Loss Hearing loss that occurs when there is a problem in the way the inner ear or hearing nerve works. Treatment: hearing aids or cochlear implant. Mixed Hearing Loss Hearing loss that includes both a conduc.ve and a sensorineural hearing loss. Treatment: surgery and/or hearing aids. Auditory Neuropathy Hearing loss that occurs when sound enters the ear normally, but because of damage to the inner ear or the hearing nerve, sound isn't organized in a way that the brain can understand. Treatment: Varies Adapted from:

6 A Few Sta.s.cs Significant hearing loss the most common sensory disability, that is present at birth (congenital disability). Of approximately 4,000,000 infants born in the US and its territories each year, about 12,000 will have congenital hearing loss (2-3 babies per 1,000 babies born). Unless babies are screened for hearing loss at birth, hearing loss will remain undetected un.l the baby s development is delayed. Easy- to- use, cost- effec.ve screening techniques are available to detect infants at- risk for congenital hearing loss.

7 AUDITORY DEVELOPMENT Babies begin to learn their na.ve language in the earliest months of life; newborns can differen.ate their mother s voice from that of other females By 6 months, normally- hearing infants are beginning to become specialists in their na.ve language; they can appreciate the speech sounds in their own language that are dis.nct from speech sounds in other languages By 30 months, normally- hearing children have recep.ve vocabulary exceeding 300 words

8 EFFECTS OF HEARING LOSS Hearing loss in children results in significant language delay and speech disorder Before early iden.fica.on and interven.on, children with hearing loss had a point discrepancy between verbal and performance intelligence scores; reading skills and academic achievement levels in these children plateaued at about the 4th grade (9-10 year old) level

9 EARLY vs LATER INTERVENTION Infants with hearing loss and normal cogni.on who receive interven.on before age 6 months achieve language quo.ents commensurate with their cogni.ve quo.ents Yoshinaga- Itano, Pediatrics, 1999 maintain age- appropriate expressive language skills through the preschool years Yoshinaga- Itano, J Perinatology, 2000

10 Steps to Early Iden.fica.on Newborn Hearing Screening ~ screening an infant for hearing shortly ajer birth (up to three screening if needed; this process should be completed by age 1 month) Pass ~ the infant s responses met criteria for no further tes.ng Refer ~ the infant s responses did not meet criteria; further tes.ng required; infant is at risk for hearing loss, not confirmed with hearing loss

11 Steps to Early Iden.fica.on Diagnos.c audiological assessment for infants who refer on newborn hearing screening (this process should be completed by age 3 months) Pass ~ the infant s hearing has been measured within the normal hearing range Iden.fied ~ the infant s hearing is not within the normal hearing range and the degree and type of hearing loss has been iden.fied

12 Steps to Early Iden.fica.on Medical and otologic assessment (this process should be completed by age 3 months) Iden.fy e.ology of hearing loss and possibility of other condi.ons needed treatment Determine poten.al medical and/or surgical treatments, Authoriza.on for hearing aid fitng

13 Components of Diagnos.c Audiological Assessment: Birth to Six Months Child and family history Click- evoked auditory brainstem response (ABR) A frequency- specific assessment using auditory evoked poten.als (either tone- burst ABR or Auditory Steady State Response {ASSR}). When permanent hearing loss is detected, frequency- specific assessment is needed to determine the degree and configura.on of hearing loss. Distor.on product or transient evoked otoacous.c emissions (OAEs). Tympanometry using a Hz probe tone. Clinician observa.on of the infant's auditory behavior. However, behavioral observa.on alone is not adequate for determining whether hearing loss is present in this age group, nor is it adequate for hearing aid fitng.

14 What is ABR? Auditory brainstem response (ABR; BAER; A- ABR) ~ an auditory evoked poten.al; electrical response of the nervous system to sound; measured from surface electrodes apached to the head (like an EEG). Robust response, present at about 28 weeks gesta.on; unaffected by sleep or seda.on; predictable matura.onal course; sensi.ve to hearing loss in middle and inner ear as well as neural conduc.on abnormali.es in the brainstem.

15 ABR FROM A NEWBORN Response from the VIIIth nerve Response from structures in the brainstem * *a moderately-loud acoustic signal

16 What are OAEs? Otoacous.c emissions (OAEs) ~ sounds generated in the inner ear by movement of the sensory cells in response to sound; part of the normal hearing process; detected by a miniature microphone sealed in the external ear canal. Robust response; present in newborns; sensi.ve to hearing loss in the middle and inner ear. Affected by amnio.c fluid and/or debris in the external or middle ear.

17 OAE FROM A NEWBORN

18 How Can Teleaudiology be used to perform Diagnos.c Audiological Assessments? University of Guam CEDDERS has purchased diagnos.c audiological equipment Children s Hospital Colorado has long- standing experience in infant diagnos.c assessments and infant auditory habilita.on Telecommunica.on systems make it possible to control Guam CEDDERS equipment over the internet from a laptop in Colorado Research demonstrates equivalency of ABR and OAE tes.ng conducted over the internet to live tes.ng

19 Issues in Teleaudiology Prac.ce Personnel ~ Children s Colorado cer.fied audiologists who will conduct tes.ng are in process of obtaining Guam licensure Equipment ~ Guam CEDDERS diagnos.c audiology equipment is state- of- the art and equivalent to Children s Colorado equipment Internet connec.vity and control is being tested on this visit Liability and Malprac.ce Children s Colorado audiologists have liability and malprac.ce coverage for services conducted via telehealth prac.ce Informed consent will be obtained from parents prior to tes.ng

20 Issues in Teleaudiology Prac.ce Privacy and confiden.ality No iden.fying informa.on will be visible to the tes.ng audiologist in Colorado; Guam CEDDERS personnel will be the only individuals to know the infant s name, DOB or other iden.fying informa.on Clinical Standards ~ all tes.ng will be conducted using accepted clinical standards for infant diagnos.c audiological evalua.ons and will follow Joint Commipee on Infant Hearing (2007) guidelines whenever possible Candidacy Criteria ~ infants who refer on Guams newborn hearing screening program will be candidates for teleaudiology evalua.on; op.mum age range is 1 4 months old

21 Issues in Teleaudiology Prac.ce Family Sa.sfac.on ~ families will be survey to assess their sa.sfac.on with the teleaudiology service Clinicial Sa.sfac.on ~ tes.ng clinicians and GUAM CEDDERS support personnel will be surveyed to assess their sa.sfac.on with the teleaudiology service Reimbursement ~ this pilot project is offered at no charge to GUAM CEDDERS or families through the generous support of a grant from Daniels Fund and ScoTsh Rite Founda.on of Colorado

22 Challenges in Teleaudiology Internet connec.on fails Noise (acous.c or electrical) interferes with test environment Baby doesn t sleep Diagnos.c equipment breaks down Coordina.on of audiologist, audiometrist, and family schedule given the.me zone difference Family support from a distance Who will share results of the test with the family? Who will provide follow- up services for infant s diagnosed with hearing loss? If successful, how can Guam sustain this project beyond the pilot period?

23 SUMMARY The proposed pilot project between University of Guam CEDDERS and Children s Hospital Colorado will inves.gate the use of teleaudiology to provide infant diagnos.c audiological assessments. Significant up front planning and coordina.on 18 months in dura.on At no cost to University of Guam CEDDERS or families in Guam Provide a how to manual for both University of Guam CEDDERS and Children s Hospital Colorado for conduc.ng future teleaudiology projects If successful, can Guam replicate through request for proposal or other mechanism to sustain the service?

24 Thank you for coming J