Download Pediatric Hearing Screening Training for the PCA

Pediatric Hearing Screening
Training for the PCA
Gouverneur Healthcare Services
227 Madison Street
New York, NY 10002
Preface
† The purpose of any hearing screening
program is to ensure early
identification of hearing loss. Hearing
loss that is not diagnosed can have a
negative impact on a child’s speech
and language development.
Therefore, early diagnosis is crucial to
facilitate early intervention and
(re)habilitation.
Preface
† At present, there is a Universal
Newborn Hearing Screening program
in New York State. This program
enables early identification of hearing
loss and therefore early intervention
which may include use of hearing aids
and speech/language therapy through
the Early Intervention Program.
Preface
† The scope of this training is specific
to children age 3 and older.
† Children younger than 3 and children
with specific risk factors are referred
directly to the Audiology Service by
the child’s PCP.
† There are diagnostic tools available to
the audiologist for testing newborns
and children under the age of 3.
Preface
† It is imperative that these children be
referred in a timely manner for
audiologic assessment so that hearing
loss be diagnosed early and
intervention is immediate.
† Children with known hearing loss
and/or speech-language delay are not
screened but referred to the
Audiology Service by the child’s PCP.
The Ear
† The
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ear is divided into 3 parts:
The outer ear.
The middle ear.
The inner ear.
The Outer Ear
† Made up of external ear and the ear
canal until the ear drum (tympanic
membrane).
† Sends sound energy to the middle ear.
† Outer ear problems:
1. Missing ear canal.
2. Narrow ear canal.
3. Excessive ear wax.
4. Foreign objects stuck in the ear canal
(beads, popcorn, insects, etc.)
The Middle Ear
† The middle ear is the space between the
tympanic membrane (ear drum) and
oval window of the inner ear.
† It contains 3 bones –the smallest bones in
the body: the malleus (hammer), the
incus (anvil) and the stapes (stirrup).
† The Eustachian tube, which connects the
ear to the throat, opens into the middle
ear.
The Middle Ear
† The vibrating eardrum transmits
energy, together with the 3 middle
ear bones to the oval window.
† Middle ear problems:
1. Fluid in the middle ear space
(which may or may not be infected).
2. Hole in the ear drum
(perforation).
The Inner Ear
† The inner ear is a fluid-filled bony
structure. It contains the cochlea which is
associated with hearing.
† The inner ear also has a membranous
portion. which includes 3 semicircular
canals which are associated with balance.
† The cochlea contains hair cells which
vibrate. It is the movement of these hair
cells that is measured in newborn
screenings. These hair cells are damaged
when the ear is exposed to loud sounds.
The Inner Ear
† Inner Ear Problems may be caused
by:
1. Heredity.
2. Noise exposure.
3. Other trauma.
4. Maternal rubella.
5. Certain medications.
6. Certain illnesses, e.g. meningitis.
Types of Hearing Loss
† Conductive: Problem in the outer
and/or middle ear.
† Sensorineural: Problem in the inner
ear.
† Mixed: Combination of conductive
and sensorineural hearing loss.
Hearing Screening Procedure:
Equipment and Environment
† An audiometer is used to perform hearing
screenings.
† The audiometer produces sounds that are
measured in frequencies called Hertz
(Hz).
† The intensity (loudness) levels of the
sounds produced by the audiometer are
measured in decibels (dB) of hearing
level (HL).
† The environment: test room should be
quiet and free of distractions.
Hearing Screening Procedure:
Biological Check
† Before screening a child, a biological check should
be performed.
† A hearing screening should be performed on a staff
member whose hearing is normal.
† Results of the biological check are recorded in a log.
† If the one or both headphones are not working, the
supervisor should be notified.
† Headphones from another audiometer may not be
used as each set of headphones is calibrated to a
specific audiometer. (Calibration for screening
audiometers is once a year.)
Hearing Screening Procedures:
† Two procedures are used: Play
Audiometry and Standard
Audiometry.
† Play: Children who are 3 and 4 years
old and sometimes older children who
do not understand the standard
audiometry procedure.
† Standard: Children who are 5 and
older.
Hearing Screening Procedures-Play
Audiometry: Stage One (Pre-test)
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Step 1.
PCA prepares the room before the child arrives.
All supplies: headphone covers, toys are by the
audiometer.
Step 2.
Seat the child.
Present a 90dBHL tone at 2000Hz.
Present the tone 2 more times so as to arouse the
child’s interest and curiosity.
Step 3.
Demonstrate to the child what you want him/her
to do: Present the tone at 90dBHL at 2000Hz
and drop a toy in the bucket.
Repeat this procedure 2 more times. This
demonstrates to the child: “Every time you
hear the sound drop the toy in the bucket.”
Hearing Screening Procedures- Play
Audiometry: Stage One (Pre-test)
†
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2.
†
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Step 4.
Perform Step 3 with the child by guiding the child’s
hand to the bucket and dropping the toy when the
tone is presented.
Perform this procedure 2 more times
Step 5.
Give the toy to the child, present the tone and see if
the child drops the toy in the bucket independently.
If the child can do this, move on to Stage 2.
Hearing Screening Procedures-Play
Audiometry: Stage 2 (Pre-test)
† Prepare the audiometer:
1. Change the frequency dial to
1000Hz.
2. Change the intensity dial to
50dBHL.
3. Place the headphones on the child’s
ears: Red headphone on right
ear/blue headphone on left.
4. Start the test with the right ear.
Hearing Screening Procedures-Play
Audiometry: Stage 2 (Pre-test)
† Step 1.
1. Give a toy to the child and hold
his/her hand.
2. Present the tone.
3. Guide the child’s hand to the bucket.
4. Drop the toy into the bucket as the
tone is presented.
5. Repeat this procedure 1-2 more
times.
Hearing Screening Procedures-Play
Audiometry: Stage 2 (Pre-test)
†
1.
2.
3.
Step 2.
Give the toy to the child.
Present the tone.
If the child drops the toy in the
bucket independently 2 times,
move on to Stage 3.
Hearing Screening Procedures-Play
Audiometry: Stage 3.
† Change the intensity dial to 20dBHL.
This is the intensity level used for the
actual hearing screening.
† Present the tones at 1000, 2000, 4000Hz
and then again at 1000Hz.
† If testing in a soundproof room, 500Hz is
also presented.
† When screening of the right ear is
complete, move to the left ear.
† Remove the headphones when the
screening is complete and record the
results.
Hearing Screening ProceduresStandard Audiometry
† Used when performing a hearing screening on older
children.
† Procedures are similar to those used in play
audiometry.
† Caregiver/child are told that a hearing assessment will
be performed.
† Instructions are verbalized to the child: “Please raise
your hand when you hear the sound even if it is very
soft.”
† Present the tone, initially at 50dBHL at 1000Hz; if the
child raises his/her hand, set intensity dial to
20dBHL and proceed as in play audiometry.
† When the screening is completed, record the results.
Hearing Screening ProceduresRecording the Results
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Pass: The child passes the screen if (s)he responds
to all tones presented at 20dBHL at all
frequencies.
Fail: The child fails the screen if (s)he does not
respond to the 20dBHL tone at any one
frequency for one or both ears.
Could Not Test (CNT): A child is reported as CNT if
(s)he does not complete the pre-test (Stages 1 and 2)
Test results are recorded in MISYS.
If paper form is used to record results, a check is
circled for pass, an “x” for fail, and “CNT” for could
not test.
Hearing Screening ProceduresReferrals to Audiology Service
† Children who fail the screening or are
“could not test” are referred to the
Audiology Service for further testing.
† All referrals are made by the child’s
PCP.
Acknowledgments
This manual and hearing screening
protocol are based on the hearing screening
training program developed by the late
Voldie McCarthey, PhD of the New York City
Department of Health.
† Thanks to Stephen Catullo, MA, MBA,
CCC/SLP of the South Manhattan Network
for his assistance in revision of this manual.
†