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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 - - - - 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 - - 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 __________ - - - 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