Anatomy of the Ear. Hearing Screening and Audiometer Tutorial. The speaker has no conflict interest to declare

Transcription

1 Hearing Screening and Audiometer Tutorial The speaker has no conflict interest to declare of This program did not receive any commercial support Anatomy of the Ear 1

2 Types of Hearing Loss Conductive Sensorineural Mixed Conductive Hearing Loss Due to any dysfunction of the outer and/ or middle ear, May be congenital or acquired If left untreated, may result in a reduction of hearing at all frequencies Ability to understand speech relatively unimpaired if made loud enough (decibels) Sensorineural Hearing Loss Due to impairment of inner ear Sounds cannot be perceived or analyzed properly resulting from abnormality of the hair cells in the cochlea. or the nerve pathways from inner ear to brain High pitched sounds are often affected which impacts ability to understand speech Most notable are high frequency consonant sounds such as "f. s, tho k, P. h. ch, sh" Loudness or decibels has nothing to due with inability to hear 2

3 Causes of Hearing Loss, Conductive Infection or inflammation of middle ear (otitis media is most common cause) Excessive cerumen build-up in external auditory canal Foreign body Congenital malformation of outer or middle ear Otosclerosis-a disease affecting the stapes ossicle of the middle ear, Sensorineural Congental Damage to developing embryo by disease or drugs Acquired Anoxia at birth Disease. injury, toxic effects of drugs, fever Head injury Exposure to intense noise vascular disturbances Meniere's Disease (fluids in the inner ear are affected causing hearing loss and dtzztness Treatment of Hearing Loss Conductive Medical/surgical intervention Treat infection Remove cerumen or foreign body Management if permanent Hearing aids Sensoineural Medical intervention Very limited - except in treatment of vascular dysfunction Management Hearing aids and auditory trainers Speech reading and auditory training Sign language Cued speech Comparison of Conductive and Sensorineural Hearing Loss May speak softly Ability to understand speech relatively unimpaired if loud enough Tend to have same degree of hearing loss at all frequencies High tolerance for loud sounds May speak excessively loud Typically have trouble understanding speech sounds as sounds are distorted Hear low frequency sounds better than high frequency Greater intolerance of loud sounds 3

4 Mixed Hearing Loss, Both conductive and sensoineural components, Combination of causes and symptoms reflective of both types What is an Audiogram?, A graphic representation one's hearing thresholds of AUDIOGRAM -1~l-lL-~ -."Q~'f--T-T ~~--! 1"-.. Understanding Frequencies (Hz), Thresholds are the AUDIOGRAM softest sounds one "~=,.'c can hear at a -i~,'" '" 2'i"-'~":"'''- -~''---'''I''--~i specific frequency 10 (pitch) ~gh'<-.f:>-'-+=fn-~h ''----kctl..l:?~----i, F req uencies or t ~o f-! -I-4'l-!lm!f~ijCL.io+...,,-"h"--+-==f pitches are graphe~ ~~I-I +-~-Of--"~-l--+=-=j==-j from left to right ~ 70',"-"''''' low pitches on the SOH-+--+-r---'--' left 90 H---k'-c-+--I---+'~---'+----i High pitches on the right 4

5 Understanding Loudness is graphed from top to bottom in hearing level (db) Soft sounds at the top Loud sounds at the bottom Hearing Levels (db) AUDIOGRAM Audiogram of Familiar sounds A SI) Degrees of Hearing Loss compared to db of Common sounds, Profound: > 91 db HL, Severe: db HL, Moderately Severe: db HL, Moderate: db HL, Mild: db HL Slight: db HL Normal Hearing: 0-15 db HL 5

6 Hearing Loss Simulation httll!_wwj!\f.,yq!jnt!;j~"_c:<lrn/wakfiijir, 1&.Y-=~NQg.GVWsg I Understanding the Hearing Loss ~Slight to Moderate Hearing Loss Difficulty hearing faint or distant speech Needs favorable seating May benefit from speech reading instruction May benefit from hearing aid, Moderate to Moderately Severe Hearing Loss Conversational speech is just audible at distance of 3--5 feet Use of hearing aid, auditory trainer, speech reading, favorable seating Speech language therapy to aid the student in the communication skills ually requires 504 and/or IEP Understanding Hearing loss (cant.) Severe Hearing Loss May hear a loud sound from about one foot away With use of a hearing aid and other listening devices, may recognize some speech sounds and detect environmental sounds Speech language therapy will aid the student in communication skills Requires S04/IEP 6

7 Understanding Hearing Loss, Profound Hearing Loss May not be able to detect presence of even very loud sounds, except by vibration Does not rely on hearing as primary channel for communication May use amplification, plus all other services but may not be successful in producing adequate oral speech and language Requires S04/IEP Audiometers C\ ~...,-c;.,'c;..,--- 7

8 School Hearing Screening Protocol Plug in/turn on audiometer and let it warm up for 10 minutes before using., Seat child facing away from screener/ audiometer Screener puts head phones on student Right = Red left = Blue Instruct student to raise hand when he/she hears sound, informing child that the sound will become more faint Start with Right ear, always! 8

9 School Hearing Screening Protocol, Set Audiometer at the following threshold to start: Right ear Frequency Hz Loudness - 50 db Start test - Right ear, as 1000 Hz Instruct student to raise hand when he hears the sound Push "tone" button - hold for 1-2 seconds Starting at 50 db "trains" the student to hear the sound Reduce Loudness to 30 db, press tone Reduce Loudness to 20 db, press tone - this is the "Objective" level School Hearing Screening Protocol, Increase Frequency to 2000 Hz while maintaining loudness at 20 db Press tone If student does not raise hand, i.e. hear the sound, increase db by 10 to 30 db, etc until student recognizes sound - record finding (right ear, 2000 Hz, 40 db) Increase frequency to 4000 Hz, starting at current decibel level, then decrease, if needed to objective level of 20 db School Hearing Screening Protocol Change to screening left ear on audiometer Maintain frequency of 4000 Hz, 20 db Then decrease to 2000 Hz at 20 db Then decrease frequency to 1000 Hz, at 20 db Test complete, Note: Student does not need to raise same hand as side sound is heard For younger students, consider making this a game - "cars in the garage - beep of the horn" 9

10 Care of your Audiometer Instrument very sensitive to Temperature Movement/jarring Moisture Dust Therefore Maintain in warm, clean, dry environment Apply dust cover when not in use, Pure Tone Audiometers required annual calibration by a certified technician 10

11 Tips about the Headphones, Eliminate any obstructions that could interfere with placement of the earphone cushion on the ear (i.e, hair, earring, eyeglasses, hearing aids, etc.)., Adjust the headband so that the earphone cushions are centered over the ears (RED on the right ear, BLUE on the left) and the receivers line up with the ear canals. The headband should rest firmly over the center of the head and place firm pressure on both ears. From the Operating Instructions Manual for the Maico MA 39 Pure Tone Audiometer An unvarying and uniform explanation to the person being tested will provide test results that are consistently high in reliability. An explanation for pure tone or baseline audiometry might be expressed as follows: "I am going to place these headphones on your ears. You will hear a whistle or beeping sound that may be loud or soft. Whenever you hear or think you hear one of these sounds, raise your hand (or press the response switch button) and lower your hand (or release the button) when you do not." 11

12 Cleaning Instructions from the Operating Instructions Manual for the Maico MA 39 Pure Tone Audiometer, First, disconnect the power cord before cleaning., Clean the instrument. headphones, and other accessories with a soft cloth dampened with a little warm, soapy water. Do not use alcohol to clean., The ear cushions of the headphones can be detached for cleaning. To remove, gently pull the cushion away from the headphone. To re-assemble, press it back onto the headphone Make sure that the sound outlet hole sits exactly in the middle of the earphone.,,' \."-' ~~1H~~~~iJlillii]#~G 2U04 Have a "Cheat Sheet" 1000 HZ 4[20 DECfBELS ~,- 2000HZ AT 20 DECIBELS 4000HZ ArlO DECIBELS 1;~&{~:lrf~"i k'may P"'S~TI/f seanx-r If.SlI<OJ1' AR!>.(! ~+-- 1!. I~~ ~E.~=--=i:. ::.~~ ~~-~~:..:J j 12

13 Referral Most nurses typically rescreen prior to referral Give specific information in the referral form so the Primary Care Physician and Audiologist know what your findings were, dates of screening and if you rescreened Annie Sargent School in North Andover Screening Area (note Epi-pens on the wall!) Compiled by Katie Vozeolas RN BSN NCSN Director of Nursing Services Isham Health Center - Phillips Academy kvgzeo@s@ando~&-~; kvozeolasrdivenzon. net March