Download Chapter 24 – Hearing and Immittance Screening

Chapter 24 – Hearing and Immittance Screening
The Purpose of Screening
 Hearing screening program- intended to _________ those who may have (or are
likely to have) hearing problems
 Should create two distinct groups:
 Normal results (“_______”)
 Abnormal (need referral or further testing)
 Parameters used to evaluate screening programs:
 __________- the ability of the screening procedure to identify the target
population accurately (correctly identify those individuals who actually have
hearing loss)
 __________- the ability of the procedure to not identify those who truly do not
have the disorder the program is designed to identify (pass those who are normal)
 A good screening program will be:
 Highly sensitive- keeps __________l rates low
 Highly specific- avoid missing affected individuals
 To improve efficiency, it is often necessary to re-screen those who do not pass on the
first screen (a second step before referral)
Incidence and/or Prevalence Considerations
 Data from effective programs provides information on:
 prevalence- true positives + false negatives all divided by the total number
screened (percent who have the problem)
 used to evaluate identification programs
 incidence- how often the problem occurs
 lack of national screening standards makes it impossible to determine accurate
prevalence/incidence rates (2 examples on page 481)
 must use caution when comparing rates from different studies because of variability
in ____________ and ____________ methods
State and/or Federal Mandates for Screening
- currently there are no __________ mandates
- most states regulate this process for ___________ and ______________ through
either education or health departments
- state-to-state regulations vary greatly
Screening Procedures
- _____ ______________ alone is not effective for identifying all hearing losses
- Developmental ________________:
o as part of a test battery, useful for obtaining functional information
regarding auditory development
- High risk register
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o HRR identifies______ _____________ for hearing loss in neonates and
infants and outlines follow up screenings and monitoring
o Prior to universal newborn hearing screening, this was the primary tool
used for referral
o Helps identify children at risk for progressive hearing loss that may pass a
screening at birth
History
o Helps identify children who show symptoms of delayed development
Visual Inspection of Ear
o Look for ___________ from ear canal and structural ________________
that may suggest a need for further screening, follow up
o Look at tympanic membrane, ear canal and check for foreign __________
Auditory Brainstem Response
o ABR is an _____________________ procedure used for hearing screening
o Also AABR (automated)
o Soft clicks are presented to the ear while electrodes placed carefully in the
head record the brainstem’s response to sound
o Primarily detects hearing loss greater than ____ dB
o Can be used to estimate thresholds
o Often requires _____________ for the child to be still
Otoacoustic Emissions
o Measures the integrity of the ____________ hair cells in the cochlea
o Auditory stimulus is presented through external ear and the probe
measures the “echo” that is produced in response
o Two ways to elicit:
 Transient Evoked OAEs (TEOAEs)
 Brief pulse of sound (either click or ___________)
 Measures the response in the quiet period following the
sound presentation
 Frequency range of 500 to 5000 Hz
 Generally detect hearing loss >30dB
 Distortion Product OAEs (DPOAEs)
 ______ continuous tones of different frequencies are
presented simultaneously
 Results in an emission that is a distorted copy and hence a
new frequency of the sounds first presented
 Distortion product analyzed through signal analysis
 Frequency range of 1000 to 8000 Hz
 Generally detect hearing loss of >30dB
o ___________ floor has a great effect on both types of OAEs
o Abnormal middle ear conditions usually result in absent OAEs
o Quick, simple, do not require a booth
Puretone Screening
o Most-used __________ _________ method
o Individual responds to pure tones presented through headphones, inserts,
or bone oscillator
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o General frequency range: 500 to 8000 Hz (bone stops at 4000 Hz)
o Level: 20 to 25 dB
o Noise levels in the _________________ present a significant problem
Acoustic Immittance
o Accurate and reliable equipment
o Basic measures of tympanometry:
 _____ __________ (pressure of middle ear cavity)
 Static ____________ (mobility of eardrum)
 Ear canal ___________ (important for assessing PE tube function)
 Acoustic __________
o Good procedure due to high incidence of middle ear disease and the
negative effect it has on school performance
o Controversial
 Physician disagreement on proper treatment
 Criteria not well developed or validated
Behavioral Observation
o Includes:
 ___________ ______________ ____________ (BOA)
 infants behavior is observed during the presentation of a
variety of moderate to high intensity noises
 observer watches for responses such as startling, blinking,
localization to sound, eye widening, cessation of activity
 high false-negative rate
 __________ _________________ _____________ (VRA)
 condition responses at higher level (50 dB)
 once conditioned, drop to lower level (20dB) for testing
 when child turns to sound source, immediately reinforce
o generally, reinforcement involves a light-up,
moving toy
Screening Protocols
- two important considerations:
o screening programs should be designed specifically for the intended
population in order to maximize _______________ and ______________
o _________________ must be involved in this process to ensure that
proper procedures are used
- Infant/toddler screening
o Currently there is no population-based program for this age group
o Those with consistent medical care may have screenings as part of their
follow-up and monitoring
o Important to screen at this age because of otitis media
 Recommended screening guidelines for OM:
 _______ ________ of acute OM is before 6 months of age
 Infants who are_______ - fed
 Infants and children with ____________ abnormalities or
symptoms that generally occur with __________
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Ethnic populations that have documented higher occurrence
of OM (_______ __________ and ___________)
Infants or children in _______ day care
Those exposed to excessive_________ smoke
Those diagnosed with sensorineural HL, developmental
disorders/delays, learning disability, or behavior disorders
Preschool screening
o Generally coordinated through school districts or education agencies
o Not a population-based screening
o Programs usually conduct periodic screening throughout the year to
identify children with disabilities or those who are at risk for learning
problems
o Head Start
 Publicly funded preschool program
 Has written guidelines for pure tone screening
School Age
o ________ ________ programs usually provide hearing screening
o Most logical time for screening because children are all _________
o Generally offered when children enter school system for ____________,
sometimes other grades are targeted as well
o At-risk populations continue to be screened through _______ school
o Screening among teenagers is important for ______ ______ hearing loss
o Procedures and follow-up criteria differ greatly by district and program
o School-age screening programs should include education on hearing
_______________
Children with Health, Developmental, and Other Disabilities
o These children are at _________ risk for hearing problems
o Hearing problems can ____________ other disabilities
o Hearing should be monitored ___________ along with middle ear status
o Screening can be challenging with developmental disabilities and
traditional methods may not be appropriate
o OAEs are very useful here
Organization and Management of the Screening Program
- It is important that these programs are properly managed and monitored
- The personnel (nurses, volunteers, paraprofessionals) should be assigned to
_____________ tasks. Those conducting the actual screening should be trained.
- Equipment should be routinely ____________ and _______________
- Proper infection___________ procedures should be used
- Screening environment should be chosen to meet appropriate standards for
__________ noise
- Follow-up must be well established (including rescreening, referrals, etc.)
- _________ should be maintained for the screening program
o This is important for evaluating program success
o Data may also be useful if a child has a future problem