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NEWBORN HEARING SCREENING
TRAINING PACK for SCREENERS
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Other Related Documents
Training Pack for Screeners (Version 2)
December 2010
Scottish Newborn Hearing Screening Managers‟
Network
Screeners‟ Competency Framework
Document History
Version
Date
1
2005
Authors
Newborn Hearing Screening Implementation Group
Document Future
Anticipated Action
Review by Scottish Newborn Hearing Screening Managers‟ Network
2
When
2015
Every week in Scotland,
one or two babies
are born deaf.
If we can find these babies
while they are still only a few
weeks old, we can help them
and their parents right from
the very start.
Helping deaf babies and
their families right from the
start is the best way to
reduce the impact of
deafness.
The best way to find babies
who are born deaf early
enough is to test all babies
immediately after they are
born……….
....…….NEWBORN HEARING SCREENING
3
CONTENTS
Section 1: Theory
1.1
How do we hear? – anatomy and physiology
5
1.1.1
The ear
5
1.1.2
What is sound?
6
1.1.3
How do we hear sounds?
7
1.2
What is hearing loss?
7
1.2.1
Level of hearing loss
7
1.2.2
Types of hearing loss
8
1.2.3
Who are we trying to find when we screen?
9
1.3
What is screening?
9
1.3.1
Principles of screening – does newborn hearing screening fit the criteria?
10
1.4
Otoacoustic emission tests (OAE)
12
1.4.1
What is an OAE?
12
1.4.2
How to record an OAE
12
1.5
Automated auditory brainstem response tests (aABR)
13
1.5.1
What is an aABR?
13
1.5.2
How to record an aABR
14
Section 2: Practical Guidance
2.1
Introduction
15
2.2
Pre-screen preparation, discussion and consent
15
2.3
Performing the screen
16
2.4
Post-screen administration
17
Section 3: Practical screening exercises
3.1
Pre-test preparation – Discussion exercise
18
3.2
Discussion and consent – Role playing exercise
19
3.2.1
Information for parents prior to OAE screening
19
3.2.2
Information for parents prior to aABR screening
21
3.3
OAE testing – practicing on adults
22
3.4
OAE testing – practicing on babies
22
4
3.5
aABR testing – practicing on adults
23
3.6
aABR testing – practicing on babies
23
3.7
Discussing OAE results with parents – Role playing exercise
23
3.7.1
OAE pass result
23
3.7.2
OAE refer result
24
3.8
Discussing aABR results with parents – Role playing exercise
24
3.8.1
aABR pass result
25
3.8.2
aABR refer result
26
3.9
Baby handling skills
27
Section 4: Training Log
4.1
Theory section
28
4.2
Practical section
29
Section 5: Assessment
30
Section 6: Overview of knowledge and skills
33
5
Section 1: Theory
1.1
How do we hear? – Anatomy and physiology
1.1.1
The Ear
The human ear has three parts; the outer ear, the middle ear and the inner ear.
The outer ear consists of the pinna, (the bit that can be seen at the side of the head) and the
ear canal, which runs in as far as the tympanic membrane (eardrum).
The middle ear is beyond the tympanic membrane. It is an air-filled space crossed by three
bones (ossicles) called the malleus, incus and stapes that are also known as the hammer, anvil
and stirrup. The last of the middle ear bones, the stapes, pushes into the oval window beyond
which is the inner ear.
6
The inner ear is a fluid-filled space with two parts: the cochlea or hearing organ and the semicircular canals or balance organs. The cochlea is a spiral structure, fluid-filled and lined with hair
cells. The cochlea connects with the auditory nerve that leads into the brain.
1.1.2
What is sound?
Sound is a pressure wave; something that creates sound makes the air vibrate. This vibration, or
sound wave, travels through the air and enters the ear. If the air vibrates very fast, then the
sound is high (like a flute or whistle). If the air vibrates less, then the sound is lower (like a
bassoon or ship‟s foghorn). How high or low a sound is (its frequency) is measured in Hertz (Hz
for short).
If the air vibrates a lot then the sound is loud. If the air only vibrates a little then the sound is
quiet. How loud or quiet a sound is (its intensity or loudness) is measured in decibels (dB for
short).
7
1.1.3
How do we hear sounds?
The pinna of the outer ear gathers sound and channels it along the ear canal to the eardrum.
The sound wave causes the eardrum to vibrate and this vibration passes through the middle ear
via the ossicles. The stapes or stirrup bone is pushed against the oval window making the fluid
within the cochlea move. This movement of the fluid excites the hair cells within the cochlea,
setting off a chemical reaction that creates electrical impulses. These impulses travel along the
auditory nerve to the brain where they are perceived as sound.
1.2
What is hearing loss?
1.2.1
Level of hearing loss
A person with normal hearing can hear a sound of 20dBHL or quieter across most frequencies. If
a sound has to be louder than 20dBHL for a person to hear it then they are said to have a
hearing loss. The level of hearing loss can be classified as mild, moderate, severe or profound.
Mild (quietest sound heard: 21-40dB). A person with a mild hearing loss will have difficulty
following conversation if the speaker is more than six feet away or if there is noise in the
background.
Moderate (quietest sound heard: 41-70 dB). A person with moderate hearing loss would be able
to hear if the speaker is speaking loudly about 3 to 5 feet away. They will also have trouble
hearing with background noise and may need to wear a hearing aid to hear conversation.
Severe (quietest sound heard: 71-90 dB). A person with a severe hearing loss would be able to
hear someone's voice if the speaker shouts from one foot away. Without a hearing aid the
person would not be able to understand speech and only be able to hear some loud sounds (a
siren, for example).
Profound (quietest sound heard: 91 dB or more). A person with a profound hearing loss is only
able to hear very loud sounds. With hearing aids they would probably be able to hear loud
sounds, like perhaps a telephone ringing or a name being called but it would be difficult to
understand speech. With training, their ability to understand some speech may improve.
8
To illustrate how much of everyday sounds a hearing impaired person may miss, compare level
of loss with values in the table below:
dBHL
1.2.2
0
Faintest sound heard by human ear
30
A whisper, a quiet library
60
Normal conversation
80
Hair dryer
90
Lawnmower, heavy traffic
100
Chainsaw or pneumatic drill
110
Sound produced by a cheap sound system
115
Rock concert
120
Starting point for some humans to feel pain
130
Music played by some headphones
140
Jet engine nearby, sound produced by some expensive stereo speakers
150
Eardrum rupture
Types of hearing loss
Conductive hearing loss is caused by outer/middle ear problems and is the most common type
of hearing loss in young children. It results in an interruption of the transmission of sound
pressure waves on their pathway through the outer and middle ear mechanism to the inner ear
or cochlea. This type of hearing loss is often responsive to medical or surgical treatment, but
seldom creates losses of more than 60dBHL. However, in children who are learning to speak
this level of loss can be significant.
Sensori-neural hearing loss results from damage to the sensory mechanism or cochlea. This
type of hearing loss can also result from damage to neural elements and pathways such as the
auditory nerve or the hearing processing part of the brain.
Mixed loss occurs when both sensori-neural and conductive losses combine.
9
1.2.3
Who are we trying to find when we screen?
By screening newborns, our aim is to find babies born with a significant hearing loss in both ears
(bilateral). „Significant‟ means more than 40dB of loss, i.e. infants with moderate, severe or
profound losses. These infants are said to have PCHI:
P
C
H
I
permanent
congenital
hearing
impairment
(will not get better)
(born with it)
Every week in Scotland, one or two babies are born with PCHI. About 40% of babies with PCHI
have additional needs. Identifying PCHI early allows us to help the baby and the family early and
gives the baby the best chance of compensating for their hearing loss.
1.3
What is screening?
Screening is:
“The practice of investigating apparently healthy individuals with the object
of detecting unrecognised disease and intervening in ways that will improve
the prognosis”
Examples of screening programmes in adults:



Breast cancer screening
Cervical cancer screening
Colorectal cancer screening
Examples of screening programmes in newborns (newborn blood spot test):



Congenital hypothyroidism screening
Phenylketonuria screening
Cystic Fibrosis screening
10
Newborn hearing screening allows us to sort infants into three groups:
1. Infants who have passed their hearing screen and have no risk factors for developing hearing
loss (this is about 97% of infants screened).
2. Infants who have not passed their hearing screen and need to have further hearing
assessments to establish their hearing status.
3. Infants who have passed their hearing screen but have risk factors for developing hearing
loss in the future and therefore require follow up (known as targeted follow up).
1.3.1
Principles of screening – does newborn hearing screening fit the criteria?
“The condition screened for should pose an important health problem”
Infants with hearing loss have significant problems with speech and language, which can give
problems with communication skills and education leading to employment and social problems,
and increased risk of mental illness.
“The natural history of the condition should be well understood”
Extensive research means that hearing loss and the best ways of dealing with it are well
understood.
“Treatment of the problem at an early stage should be of more benefit than
treatment started at a later stage”
It is well documented that infants who are diagnosed early and dealt with appropriately develop
better speech and language skills than those diagnosed after six months of age. The previous
national hearing screen, the health visitor distraction test, performed at about eight months, was
too late to provide the most benefit.
“There should be a suitable test or examination”
The test used should be:
a)
Simple
b)
Easy to use
c)
Have high sensitivity (a perfect test would not miss any infants with PCHI)
d)
Have high specificity (a perfect test would not fail any healthy infants)
e)
Cost effective
f)
Have a low risk to benefit ratio.
Two tests have been developed for screening newborn hearing, both of which fulfil these criteria.
11
“The tests or examinations should be acceptable to the population”
It is important that as many babies as possible are screened for hearing loss. The proposal to
test the majority of babies whilst still in the Maternity Units should allow for this to happen.
However there will be a reasonable percentage of babies that are not tested whilst in the
Maternity Unit or will require follow-up appointments. It is important that the tests are explained
appropriately to the parents to encourage them to attend further appointments at the hospital or
local clinics.
“For diseases of late onset, screening should be repeated at intervals determined
by the natural history of the disease”
Some children develop hearing loss during the first few years of life. Of course, a newborn
hearing test will not be able to pick up a hearing loss that that has not yet developed, but it does
provide the opportunity to give parents information about late-onset loss.
“There should be adequate facilities available for the diagnosis and treatment of
any abnormalities detected”
It is understood as imperative that for newborn hearing screening to succeed, local familyfriendly services are needed. These services include Audiology, education, social work and
speech and language therapy. All services are involved in the newborn hearing screening
programmes.
“The chance of physical or psychological harm should be less than the chance of
benefit”
Physical harm is a very minor concern – neither of the tests used are painful. However, some
infants will fail a hearing screen test, but later be found to hear normally. Parents can
understandably become very anxious about this, and screeners will be required to handle these
situations sensitively.
“The cost of case finding including diagnosis and subsequent treatment should
be economically balanced against the benefit it provides”
Research has shown marked benefits in diagnosing children with hearing loss early. It has also
been suggested that the cost of finding each case of PCHI by newborn hearing screening is
significantly lower than the previous method of hearing screening (the health visitor distraction
test at eight months).
12
1.4
Otoacoustic emission tests (OAE)
1.4.1
What is an OAE?
When sound enters the ear a normal functioning cochlea creates and emits an „echo‟. This
„cochlear echo‟ is the otoacoustic emission or OAE for short. This can also be thought of as the
noise generated by the cochlea as it is "working". Ears with even a mild hearing loss do not emit
OAEs. Therefore, if the OAE is present (recordable), this indicates the ear is working normally. If
the OAE is absent (not recordable), this indicates a problem with the hearing pathway anywhere
from the outer ear to the cochlea*.
1.4.2
How to record an OAE
An OAE system has a soft, rubber-tipped probe attached by a length of lightweight cable to a
computer. Testing involves gently but firmly placing the probe into a baby‟s outer ear.
The probe contains a tiny loudspeaker that sends clicking sounds into the ear. The probe also
contains a tiny microphone which checks that the clicks are the correct loudness, and listens for
the OAE. The computer analyses the sounds picked up by the microphone and automatically
decides whether an OAE is present - a “PASS” result or absent – a “REFER” result. Sometimes
the recording conditions are not ideal and the computer cannot decide if the OAE is absent or
present – an “INVALID” result. The equipment may indicate that the surroundings are too noisy.
Extremely rarely, infants are born with hearing problems in their brain, but have a normally working cochlea. These infants may
pass OAE screening, but still have a hearing problem.
*
13
OAEs can be reliably recorded in newborn babies from birth, but it is best to try to delay testing
until as soon as possible before the baby goes home. This is because when very young the
baby‟s ears can sometimes be blocked with debris or fluid from the birth which makes it difficult
to get a pass result. Sometimes babies still have very floppy ear canals which can prevent the
sound reaching the cochlea or prevent the echo reaching the microphone in the probe. Again,
this will make it difficult to get a pass result.
Between one and three newborns in every ten have a refer result with their first OAE. If this
happens the OAE should be repeated leaving a gap of at least 4 hours between tests whenever
possible. This allows time for fluid or debris in the ear to clear. Many babies will have a clear
response on the second OAE. Most infants take about one minute to get a pass result on each
ear.
The most important pointers for successful OAE testing are:
1. Make sure the parents understand the test, and are happy. Relaxed parents means relaxed
baby
2. Make sure the testing room is as quiet as possible
3. Make sure the baby is very settled, preferably sleeping
4. Make sure the probe is inserted properly and not blocked
1.5
Automated auditory brainstem response tests (aABR)
1.5.1
What is an aABR?
When sound reaches the cochlea, the cochlea converts it into electrical signals. When the
cochlea sends these electrical signals to the brain the first part of the brain they reach is called
the brainstem. Three sensors are placed on the baby‟s forehead, nape of neck and shoulder.
These pick up the signals at the brainstem. This does not hurt the baby – the sensors pick up
signals, they do not put anything into the baby‟s head. If these sensors are plugged into a
computer, the computer can judge whether the brainstem has responded to the sound being
played into the ears.
If the aABR is present (clear response) this indicates that the ear and auditory pathway are
working normally. If the aABR is absent (no clear response), this indicates a problem with the
hearing pathway anywhere from the outer ear to the brainstem. Sometimes the screening
14
conditions are not ideal because the baby is moving around too much or there is background
noise. The equipment may prompt you to abandon screening or settle baby.
1.5.2
How to record an aABR
An aABR system has three wires which connect to disposable sensors placed on the baby‟s
forehead, nape of neck and shoulder. Special small earmuffs play clicks into the ear. The
sensors and earmuffs connect to a computer, which records the response.
Once the infant has been prepared for testing the computer checks the sensors are making
good contact with the baby‟s skin. It then plays the clicks into the ear while recording the
electrical activity picked up by the sensors. The computer analyses the electrical activity and
automatically decides whether the aABR is present (a “clear response” result) or absent (a no
clear response result).
aABRs can be reliably recorded in newborn babies from birth (34 weeks gestational age).
Sometimes a baby‟s ears can be blocked with fluids from the birth, or they can still have very
floppy ear canals which prevent the sound reaching the cochlea. This can make it difficult to get
a clear response result. If a premature baby is being screened, it is best to wait and screen the
baby when they are near their due date.
Once the baby has been prepared for the test, it can take up to 15 minutes to get a pass result
on each ear, but can be much quicker.
The most important pointers for successful aABR testing are:
1. Make sure the parents understand the test, and are happy. Relaxed parents means relaxed
baby
2. Make sure the baby is very settled, preferably sleeping
3. Make sure the testing room is reasonably quiet
15
Section 2: Practical Guidance
2.1 Introduction
Each time each baby is screened, there are five separate stages:
Pre-screen preparation: logging baby‟s details, identifying baby‟s location and readiness for
screening
Discussion and consent: explaining test to parents, giving leaflets, taking consent
Performing test
Discussion of results: explaining meaning of the results, what happens next, helping to reduce
anxiety, providing further leaflets
Post-test administration: logging baby‟s results and arranging diagnostic testing if necessary
2.2
Pre–screen preparation, discussion and consent
Hearing Screeners must follow the following steps before carrying out a hearing screen:

Obtain all the necessary information about the mother and baby before approaching the
parent/s

Check with the appropriate staff whether it is appropriate/convenient to approach the
mother

Establish own identity to parent/s

Establish baby and parent/s identity

Introduce the Newborn Hearing Screen and check that it is convenient to discuss the
screen with the parent/s

Try to establish a rapport in order to give reassurance and gain parental trust and
confidence

Ensure parent/s are aware screening service is being offered to all parents

Provide parent/s with information including:
o
Appropriate written information about hearing screening
o
An explanation of why the screen is being offered
o
An explanation of the screening procedure
o
Details of the steps involved in the screening process
o
Possible outcomes and potential actions
16

Answer any questions about the screen as promptly as possible within role, knowledge
and responsibilities

Refer all questions outside responsibility or knowledge, or any concerns in relation to
mother or baby`s health and wellbeing to relevant member of staff immediately

Obtain consent/decline from person with parental responsibility following agreed
protocols;
2.3
o
for screening to take place
o
for data access and transfer
Performing the screen
When performing the screen the hearing screener must:

Ensure security, privacy and quiet as much as possible while screen is taking place

Adhere to appropriate national and local hygiene and infection control protocols

Handle the baby in a comfortable and safe manner at all times (baby to be handled as
little as possible by screener)

Ensure that the baby`s clothing is adjusted as appropriate before and after screening

Screen the baby using nationally approved equipment and national protocols

Inform parent/s what is happening throughout the procedure where possible and involve
them throughout the procedure where appropriate

Accurately document all appropriate parent and baby details, including screen outcomes
when completed, in the appropriate records, including IT systems where used, in a timely
manner. Confidentiality to be maintained at all times.

Give parent/s appropriate information at the end of the procedure and remind them of the
next steps

Follow the appropriate procedures when screen results obtained for:
o
Clear responses from both ears
o
No clear response/s from one or both ears
17
2.4
Post-screen administration
The Hearing Screener must ensure the following tasks are completed after carrying out a
newborn hearing screen:

The hearing screen record on eSP should be updated with the screening results and the
outcome set. This should be carried out as soon as possible after the baby has been
screened

If a baby has been referred to Audiology, local protocol for “Referral to Audiology “ must
be followed. The baby‟s GP and Health Visitor should be informed as soon as possible of
the referral to Audiology.

The hearing Screen result must be notified to the local Child Health Information System
according to local procedures either by post or electronically.

The hearing screening result should be documented in the baby‟s hospital record if
required by local procedures.

The parent(s) must be given a copy of the hearing screen result.
18
Section 3: Practical Screening Exercises
Exercise 3.1
Pre-test preparation – Discussion exercise
Topics to discuss:

Importance of correctly identifying infant (e.g. baby Smith becomes Ann Brown)

Contact with midwives on ward

Logging infant details prior to testing– knowing which babies are missed

Waiting for premature babies to reach due date
Notes:
19
Exercise 3.2
Discussion and consent – Role playing exercise
It is important that parents are fully informed about the screen. It is also important that this
information is given to the parents in a consistent manner and the phrases and sentences (as
given below) are used. Screeners should work within the boundaries of their knowledge. If
parents ask questions not covered in the screener's training then the screening coordinator
should speak to the parents.
In pairs or threes, use this role playing exercise, to practice approaching parents to discuss the
hearing screen and taking consent. Some parents may have heard about the hearing screen
before, but many may not have heard, or may have forgotten. Use the phrases in section 2.2.1
to help you.

Knock before entering.

Ask if you have come at a good time, and don‟t try to talk over a crying baby or while mum is
trying to deal with visitors or her baby. You can come back in half an hour.

Always wear an ID badge

Always introduce yourself

Briefly explain the role of newborn hearing screening

Briefly explain what the test involves and when you would do it (immediately/in an
hour/tomorrow)

Briefly explain what happens after the test

Give parents a leaflet to read (may have been given in ante-natal period)

Explain you need a consent form signed

Give the parents an opportunity to ask questions

Some parents may be happy to consent immediately, while others may want some time to
read things through, or discuss the screen with the baby‟s father or other family member.
20
Questions for parent role-player to ask:

Does it hurt?

How long will it take?

My last baby had their hearing checked by the Health Visitor

When will I get the results?

Can I stay with my baby?
Sometimes parents will refuse to have the screen. It is important to make sure they understand
why the screen is offered while their baby is a newborn, and are given the opportunity to discuss
the screen with the screening manager. If parents refuse the test then this must be documented.
3.2.1 Information for parents prior to OAE screening – example of what to say
At [this hospital], we offer a hearing screen to all newborn babies. Although the risk of your baby
having a hearing impairment is very small, by screening all newborns we can find those who are
deaf early, and offer help to them and their families right from the start.
The test we use is called an Otoacoustic emission test or OAE for short. We place a small, soft
rubber probe just inside your baby‟s ear. This does not hurt, although often babies wriggle as we
place the probe.
If you‟re happy for [baby‟s name] to have the test, I could do it [today/just now/tomorrow]. If
he/she is sleeping, it should only take ten minutes or so.
If we get a clear response, that‟s good news. If we can‟t get a clear response, it doesn‟t
necessarily mean your baby has a hearing loss, its usually because the baby is still very new, or
is unsettled and we‟ll retry the test later.
This leaflet explains more about the test we do, and has a number on the back with my name so
that you can find out more if you would like to.
I‟ll ask you to sign a consent form which will be kept with your baby‟s hospital notes.
21
3.2.2 Information for parents prior to aABR screening – example of what to say
At [this hospital], we offer a hearing screen to all newborn babies. Although the risk of your baby
having a hearing impairment is very small, by screening all newborns we can find those who are
deaf early, and offer help to them and their families right from the start.
The test we use is called an automated ABR test. An aABR system has sensors placed on the
baby‟s forehead and behind their ears. Special small earphones play clicks into the ear.
If you‟re happy for [baby‟s name] to have the test, I could do it [today/just now/tomorrow]. If
he/she is sleeping, it should only take ten minutes or so.
If we get a clear response, that‟s good news. If we can‟t get a clear response, , it doesn‟t
necessarily mean your baby has a hearing loss, it can be because the baby is still very new, or
is unsettled and we will simply retry the test later. If we are unable to get a clear response from
the second test then we will ask you to come into our clinic for a more thorough test.
This leaflet explains more about the test we do, and has a number on the back with my name so
that you can find out more if you would like to.
I‟ll ask you to sign a consent form which will be kept with your baby‟s hospital notes.
22
Exercise 3.3 OAE testing – practicing on adults
In groups of three, practice testing one another. Don‟t worry if you can‟t get a pass result –
adults are hard to pass compared to infants. The adult being tested should sit comfortably with
head, neck and shoulders relaxed. Use tape to stop the weight of the cable pulling the probe out
of the ear. Each person should obtain bilateral printouts from two different adults.
During the test, the person being tested can mimic a baby waking up by moving their face and
head, or mimic the probe falling out – the tester should watch to see what effect this has on the
system.
Follow appropriate equipment protocol outlined for piece of equipment to be used in this practice
session.
Exercise 3.4 OAE testing – practicing on babies
Initially, your training supervisor will discuss the test with the baby‟s parents and ask them for
permission to practice OAEs. All practice babies will already have passed an OAE performed by
a trained screener.
Once you have practiced on twenty pre-screened “practice babies”, you will perform the screen
yourself, including pre-screen preparation, discussion and consent, performing the test,
discussing the result and post-screen administration.
It is best to screen a sleeping baby, but they can be screened in their parent‟s arms, in a car
seat, or anywhere they are happy and settled. Taking time to ensure a settled baby (i.e. waiting
until after feeds, or letting them have their nappy changed) will save time in the end.
Follow appropriate equipment protocol outlined for the piece of equipment to be used in this
practice session.
23
Exercise 3.5 aABR testing – practicing on adults
Follow appropriate equipment protocol outlined for piece of equipment to be used in this practice
session.
Exercise 3.6 aABR testing – practicing on babies
Follow appropriate equipment protocol outlined for piece of equipment to be used in this practice
session.
Exercise 3.7 Discussing OAE results with parents – Role playing exercise
It is important that parents are fully informed about the screen results. It is also important that
this information is given to the parents in a consistent manner and the phrases and sentences
(as given below) are used. Screeners should work within the boundaries of their knowledge. If
parents ask questions not covered in the screener' training then the screening manager should
speak to the parents.
In pairs or threes, practice explaining the test results with parents for both pass and refer results.
3.7.1
OAE pass result – example of what to say
We‟ve measured a positive response on both ears and your baby has therefore passed their
hearing screen, so that‟s good news.
A very small number of children hear well when they‟re born, but develop problems as they get
older. This checklist [give parents leaflet] might help guide you if you‟re unsure. If you ever have
any concerns about their hearing, please take them to see your GP or contact your Health
Visitor. Babies and children can have their hearing checked at any age.
Screeners should also give information about local 2 nd Tier Audiology services and the methods
by which these services can be accessed.
24
Questions for parent role-player to ask:

Will he/she still have a distraction test?

Does that mean he/she can hear?
3.7.2
OAE refer result – example of what to say
We‟ve not been able to get a pass result on the left/right/both ears. That‟s not necessarily
because your baby has a hearing loss - as I said prior to testing, usually it means baby‟s ears
still have fluid in which makes it difficult for this test to get a pass. It‟s not unusual for this to
happen.
We‟ll retest your baby with a different test called automated ABR. This involves placing sensors
on your baby‟s forehead and behind their ears and using special little headphones. It doesn‟t
hurt, and should only take about 15 minutes to do if your baby is asleep.
Screeners should, without causing undue parental anxiety, emphasize the importance of
attending follow-up appointments.
Exercise 3.8
Discussing aABR results with parents – Role playing exercise
It is important that parents are fully informed about the screen results. It is also important that
this information is given to the parents in a consistent manner and the phrases and sentences
(as given below) are used. Screeners should work within the boundaries of their knowledge. If
parents ask questions not covered in the screener' training then the screening manager should
speak to the parents.
In pairs or threes, practice explaining the test results with parents for both pass and refer results.
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3.8.1
aABR pass result – example of what to say
aABR as first test
We‟ve measured a clear response from both sides and your baby has therefore passed their
hearing screen, so that‟s good news.
A very small number of children hear well when they‟re born, but develop problems as they get
older. This checklist [give parents leaflet] might help guide you if you‟re unsure. If you ever have
any concerns about their hearing, please take them to see your GP or contact your Health
Visitor. Babies and children can have their hearing checked at any age.
Screeners should also give information about local 2 nd Tier Audiology services and the methods
by which these services can be accessed.
aABR pass following „refer‟ aABR
We‟ve measured a clear response from both sides this time, so that means your baby has now
passed their hearing screen which is good news.
There‟s no need to worry that we had to have two tries to get a pass – that doesn‟t affect the
result.
A very small number of children hear well when they‟re born, but develop problems as they get
older. This checklist [give parents leaflet] might help guide you if you‟re unsure. If you ever have
any concerns about their hearing, please take them to see your GPor contact your Health
Visitor. Babies and children can have their hearing checked at any age.
Screeners should also give information about local 2 nd Tier audiology services and the methods
by which these services can be accessed.
aABR pass following „refer‟ OAE
We‟ve measured a clear response from both sides using this test, so that means your baby has
now passed their hearing screen which is good news.
There‟s no need to worry that we couldn‟t get a pass with the first test – that doesn‟t affect the
result. It‟s just sometimes harder to get a pass with the OAE test, especially when babies are still
very young.
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A very small number of children hear well when they‟re born, but develop problems as they get
older. This checklist [give parents leaflet] might help guide you if you‟re unsure. If you ever have
any concerns about their hearing, please take them to see your GP or contact your Health
Visitor. Babies and children can have their hearing checked at any age.
Screeners should also give information about local 2 nd Tier Audiology services and the methods
by which these services can be accessed.
Questions for parent role-player to ask:

Does that mean he/she can hear?

Why did he/she fail the first test (OAE)?

Why did he/she fail the first test (aABR)?
3.8.2
aABR refer result – example of what to say
aABR protocol – „refer‟ after initial screen
We‟ve not been able to get a pass result on the left/right/both ears. That sometimes means
baby‟s ears still have fluid in them which makes it difficult for this test to get a pass. It is not
unusual for this to happen sometimes.
We‟ll retest your baby with this test tomorrow/in a few days/as an outpatient. If we still can‟t get a
pass result, we‟ll ask you to bring your baby along to our Audiology Department for a thorough
check.
Screeners should, without causing undue parental anxiety, emphasize the importance of
attending follow-up appointments.
aABR - „refer‟ after OAE „refer‟
We‟ve not been able to get a pass result on the left/right/both ears with this test either.
We‟d like you to bring your baby along to our Audiology clinic for a thorough check. This leaflet
helps explain what will happen at the clinic, and has phone numbers in case you have questions.
Many babies who don‟t pass their screening tests are found to have normal hearing when they
attend the Audiology clinic.
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Screeners should, without causing undue parental anxiety, emphasize the importance of
attending follow-up appointments.
aABR - second „refer‟
We‟ve still not been able to get a pass result on the left/right/both ears with this test.
We‟d like you to bring your baby along to our Audiology clinic for a thorough check. This leaflet
helps explain what will happen at the clinic, and has phone numbers in case you have questions.
Many babies who don‟t pass their screening tests are found to have normal hearing when they
attend the Audiology clinic.
Screeners should, without causing undue parental anxiety, emphasize the importance of
attending follow-up appointments.
Questions for parent role-player to ask:

Does that mean he/she is deaf?

Why did he/she fail both tests (OAE and aABR)?

Why did he/she fail the test twice (aABR)?

When have I to bring her to the Audiology clinic?

He/she seems to respond to my voice, so I‟m not worried. Do I still have to bring him/her?
Exercise 3.9 Baby handling skills
As part of their induction/acclimatisation period, screeners should spend some time on the wards
with midwifery staff to ensure that their baby handling skills are appropriate and the screener is
confident with handling babies. Issues which should be covered include:

Hygiene (hand washing etc)

Dealing with parents (should always be present)

Handling the baby

Sleep and feed patterns

Security
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Section 4: Training log
4.1
Theory section
At the end of the lectures, review the written notes and your additional notes and complete the table below by
entering the date. By completing this log honestly, you can help yourself identify any areas that you were unsure
about and get further help with these. Use the top line in each box initially and then use the next lines after you have
had further teaching in any area.
I didn’t
understand
anything
I understood a
little bit
How do we hear?
What is hearing loss?
What is screening?
Otoacoustic
tests (OAE)
emission
Automated
auditory
brainstem response tests
(aABR)
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I understood
about half
I understood
most of it
I understood
everything
4.2
Practical section
In the ‘Observed or practiced as role-play’ and the ‘Performed with supervision’ columns, write the number of times
you have observed or performed that task with the date. Your trainer should initial the box.
Screeners should perform a minimum of 5 tests on adults and 20 on babies before being allowed to test
unsupervised. The numbers tested should be recorded in the appropriate box.
Screeners should sign and date the ‘Screener confident of ability to perform unsupervised’ column and trainers
should sign and date the ‘Trainer approves screener’s competency to perform unsupervised’ column in all relevant
tasks before the screener can be allowed to test unsupervised.
When initially testing unsupervised, there should always be someone competent close at hand to provide assistance
if necessary.
Observed or
practiced as
role-play
Performed with
supervision
Screener confident of ability
to perform unsupervised
Pre-test preparation
Discussion and consent
– OAE
Discussion and consent
–aABR
adult OAE
baby OAE
adult aABR
baby aABR
Discussing OAE results
Discussing aABR
results
Post-screen admin
Baby handling skills
and local protocols
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Trainer: screener’s
competency to perform
unsupervised
Section 5: Assessment
All Hearing Screeners must complete the theory assessment prior to screening unsupervised.
The aim of this assessment is to gauge your understanding of each topic. We are not looking at grammar
or spelling. It is not always necessary to use complete sentences but please use your own words.
Anatomy & Physiology
1.
Name and briefly explain the function of the parts of the ear that are labelled 1 – 10 on the diagram
10
2
9
3
4
1
8
7
6
5
Name
Function
1
2
3
4
5
6
7
8
9
10
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Care of Parents and Babies
2.
Give three advantages for the early identification of hearing loss
3.
List four reasons why you may be unable to obtain a clear response on a hearing screen.
4.
Briefly describe how babies should normally be positioned in a cot prior to screening.
Otoacoustic Emissions (OAE`s)
5.
Name the two main parts of the Otoacoustic emission earpiece and describe the function of each
part.
6.
How does background noise interfere with the OAE screen and how can you optimise screen
conditions?
Automated Auditory Brainstem Responses (AABR`s)
7.
Which part of the auditory pathway is assessed using the AABR screen?
8.
What type of response is being measured and how is it picked up?
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9.
List four ways of ensuring good test conditions for the AABR.
Types of Hearing Loss
10. Which part of the ear is affected in a conductive hearing loss?
11. Which parts of the ear are affected in a sensorineural loss?
Basis Acoustics
12. Describe what you understand by sound frequency?
13. Describe what you understand by sound intensity?
After completion of the National Training Pack, Hearing Screeners should feel confident in their role
and be able to screen with minimal supervision.
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Section 6: Overview of Knowledge and Skills (EKSF)
Newborn hearing screeners are required to have a broad base of knowledge and skills covering a number of different
dimensions as detailed in this table.
Dimension
Communication
Description
Communicate with a range of people on a range
of matters
Personal & People Development
Develop own skills and knowledge and provide
information to others to help their development
Health, Safety and Security
Monitor and maintain health, safety and security of
self and others
Service Improvement
Contribute to the improvement of services
Quality
Maintain quality in own work and encourage
others to do so
Equality & Diversity
Support equality and value diversity
Legislation, policy and good practice
1. A factual awareness of the current national legislation, national guidelines and local policies and protocols which
affect work practice in relation to undertaking a newborn hearing screen using an Automated Otoacoustic
Emissions screen (AOAE) and where appropriate an Automated Auditory Brainstem Response screen (AABR)
including national and local baby-care guidelines.
2.
A factual awareness of the importance of working within own sphere of competence and seeking advice when
faced with situations outside that sphere of competence.
3. A working understanding of the importance of applying standard infection control precautions and the potential
consequences of poor practice.
4. A working understanding of:
a. the concept of informed choice
b. rationale for consent
c. parental responsibility and who has it
5. A working understanding of role in the maintenance of a safe environment.
6. A working understanding of security issues relevant to the newborn hearing screening process and care of the
newborn.
7. A working understanding of the general principles behind screening programmes.
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8. A working understanding of the typical interventions for children with hearing impairment.
9. A working understanding of the appropriate use of interpreters.
Anatomy and Physiology
1. A working understanding of the structure of the ear and the physiology of hearing.
2. A working understanding of common types and causes of hearing impairment.
Care and Support on the Individual
1.
A working understanding of what constitutes a positive family history of childhood hearing loss and how to
obtain it.
2.
A working understanding of the value of newborn hearing screening for the baby and family.
3.
A working understanding of the roles of others directly involved in the identification, management and support
of a child diagnosed with a hearing impairment.
4.
A working understanding of all personnel involved in the general care and support of newborn babies and their
parent/s.
5.
A working understanding of the Deaf community in terms of potentially different expectations and language
use.
Materials and Equipment
1.
A working understanding of the AOAE, and where appropriate AABR,
equipment in terms of:
 function
 maintenance
 routine checks
 calibrations
 data archiving
2.
A working understanding of the screening protocols.
3.
A working understanding of the equipment protocols.
4. A working understanding of national and local infection control protocols relating to screening equipment use.
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Procedures and Techniques
1.
A working understanding of what screening is and the limitations of screening.
2.
An in-depth understanding of the newborn hearing screening programme process.
3.
An in-depth understanding of the possible screening outcomes and how to deal with these.
4.
An in-depth understanding of the next stages of the screening, including referral if no clear responses
obtained.
Records and Documentation
1.
A working understanding of why all details including outcomes must be accurately documented.
2.
A working understanding of how the electronic information system works and data is electronically transferred
from screening equipment to the IT system as appropriate.
3.
A working understanding of why and how confidentiality is maintained.
4.
A working understanding of family friendly issues.
5.
A working understanding of the Newborn hearing screening information associated with the newborn hearing
screening programme.
6.
A working understanding of how and when to use the Newborn hearing screening information provided.
7.
A working understanding of immediately reporting any issues outside sphere of competence to a relevant
member of staff.
The above knowledge and skills will be assessed annually as part of the Scottish Newborn Hearing Screening
Competence Framework by the appropriate Newborn Hearing Screening Service Manager.
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