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Describe what preparations are
required to test hearing of schoolaged children and adolescents
Contents
Key to resources
2
Introduction
3
Child development
5
Child protection issues
6
Equipment
7
The test environment
9
Calibration
9
Performing a daily listening check
10
Cleaning and storing equipment
10
Client information
11
Summary
12
Further reading
12
Feedback to activities
13
This learning guide is based on the following resources:
Audiometry–Otoscopy–3064-7/HLSP
Certificate IV in Audiometry HLT02-8–3064-8/HLSP (Equipment)
Audiometry–Assessment A–3064-9/HLSP
Audiometry–Assessing Children–3064-11/HLSP
*Martin FN and Clark JG (2006) Introduction to Audiology (9th edn), Pearson, Boston
*Note: The pages number references provided for Introduction to Audiology
in this task guide are based on the 9th edition. If you have an earlier or later
edition of the textbook, these pages numbers may not be the same (but may
be approximate). The headings are likely to be the same or similar in the
various editions.
Describe what preparations are required to test hearing of school-aged children and adolescents
© NSW DET 2007
1
Key to resources
Resource
number
Resource title
1
Audiometry–Assessing Children–3064-11/HLSP, page 6–7, ‘Why test a
child’s hearing?’ and ‘Neonatal screening’
2
Introduction to Audiology, pages 189–193, ‘Identifying hearing loss in
infants under three months of age’, ‘Infant hearing screening’ and ‘The
history of hearing screening’
3
Introduction to Audiology, pages 165–180 and 198–202, ‘Otoacoustic
emissions (OAE)’, Auditory evoked potentials’ and ‘Behavioral testing of
children from birth to approximately two years of age’
4
Audiometry–Assessing Children – 3064-11/HLSP, pages 23–25, ‘The
tympanometer’
5
Introduction to Audiology, pages 52–56 and 149–152, ‘The pure-tone
audiometer’, ‘The speech audiometer’ and ‘Acoustic immittance’
6
Audiometry–Otoscopy–3064-7/HLSP, pages 4–5, ‘Components and function
of the otoscope’ and ‘Speculae’.
7
Certificate IV in Audiometry HLT02-8 (Equipment) – 3064-8/HLSP, pages
11-12, 23 – ‘What is an audiometer’, ‘What is a tympanometer’
8
Audiometry–Assessment A – 3064-9/HLSP, pages 6–8, ‘The audiometer’
9
Introduction to Audiology, pages 73–74, ‘Sound-isolated chambers’
10
Audiometry–Assessment A – 3064-9/HLSP, pages 5–6, ‘The test
environment’
11
Introduction to Audiology, pages 57–63, ‘Calibration of audiometers’
12
Certificate IV in Audiometry HLT02-8 (Equipment) – 3064-8/HLSP, pages
11–25
13
Audiometry–Assessing Children–3064-11/HLSP, pages 13–14, ‘Equipment is
ready’
14
Audiometry–Assessing Children–3064-11/HLSP, pages 9–12, ‘Information is
ready for use’
15
Introduction to Audiology, pages 404–407, ‘Patient histories’.
*Note: The pages number references provided above for the Martin and
Clark textbook are based on the 9th edition. If you have an earlier or later
edition of the textbook, these pages numbers may not be the same (but may
be approximate). The headings are likely to be the same or similar in the
various editions.
2
Describe what preparations are required to test hearing of school-aged children and adolescents
© NSW DET 2007
Introduction
In following this guide you will learn about what preparations are required
to perform hearing assessments for school-aged children. You will be
looking at:

child development

child protection issues

the equipment required to do a hearing assessment

the test environment

caring for your equipment

client information that is required for testing.
Go to Resource 1
Go to Audiometry–Assessing Children–3064-11/HLSP and read page 6–7
‘Why test a child’s hearing?’ and ‘Neonatal screening’.
Go to Resource 2
Go to Introduction to Audiology, and read ‘Identifying hearing loss in
infants under three months of age’, ‘Infant hearing screening’ and ‘The
history of hearing screening’, pages 189–193 in the 9th edition.
Prior to neonatal screening for hearing, the average age of detecting hearing
loss was approximately 18 months of age. The average age of detection with
universal neonatal screening is now less than six months of age.
Most neonatal hearing screening programmes in Australia use Automated
Auditory Brainstem Response Audiometry (AABR). The results from this
program are recorded as a pass or refer result for each ear. If the baby
obtains a refer result, they are sent to a diagnostic assessment centre for a
full assessment. If it is found that the baby will require hearing aids they are
sent to Australian Hearing. Australian Hearing is funded to provide hearing
aids to children and young people up to the age of 21 years.
Describe what preparations are required to test hearing of school-aged children and adolescents
© NSW DET 2007
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For more information, have a look at the following websites.
Information about Neonatal Hearing Screening:
http://www.cyh.com/SubContent.aspx?p=420
A story about a baby detected under SWISH:
http://www.smh.com.au/news/National/Early-test-for-deafness-raisesquality-of-life/2005/03/14/1110649129454.html
Information about Australian Hearing: http://www.hearing.com.au/
There are many methods to use to test children. You will be learning to test
school-aged children. Audiologists and Community Nurse Audiometrists
test the hearing of children who are younger than four years of age. Read
about the type of tests that can be used and complete Activity 1.
Go to Resource 3
Go to Introduction to Audiology, and read pages 165–180 and 198–202 (in
edition 9): ‘Otoacoustic emissions (OAE)’, Auditory evoked potentials’ and
‘Behavioral (sic) testing of children from birth to approximately two years
of age’.
Make sure you have an understanding of:
ABR: auditory brainstem response audiometry
OAE: otoacoustic emissions
BOA: behavioural observation audiometry
VRA: visual reward audiometry.
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Describe what preparations are required to test hearing of school-aged children and adolescents
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Activity 1
Describe the following tests, including when they would be used.
1
ABR: auditory brainstem response audiometry
_____________________________________________________________________
_____________________________________________________________________
2
OAE: otoacoustic emissions
_____________________________________________________________________
_____________________________________________________________________
3
BOA: behavioural observation audiometry
_____________________________________________________________________
_____________________________________________________________________
4
VRA: visual reward audiometry
_____________________________________________________________________
_____________________________________________________________________
For feedback, go to the end of this task guide.
Child development
When we talk about testing children, we often make a distinction between
developmental age and chronological age. This is because we expect certain
behaviours and abilities at different ages. Some children experience
developmental delay and are not able to do the things that you would
normally expect a child of that age to do.
Chronological age is the way we all talk about how old we are, that is, it is
the time since we were born. This is usually the same as developmental age
but for some children it will not be. Many children can perform the hearing
test with some adjustments but if a child is less than four years
developmentally, you may need to send them to a clinic that is designed to
Describe what preparations are required to test hearing of school-aged children and adolescents
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test younger children. Children with significant developmental delay should
be assessed by paediatric audiologists.
Some useful websites dealing with this topic are listed below.
‘Children–Stages of development’ (Northern Territory Government):
http://www.families.nt.gov.au/asp/index.asp?palias=Children+%2D+Stages
+of+Development&sid=5
Child Welfare Information Gateway (Washington DC, USA):
http://www.childwelfare.gov/pubs/f_stages/f_stagesb.cfm
‘Ages and stages in child development’ (University of Florida):
http://edis.ifas.ufl.edu/TOPIC_Child_Development
‘Age and stages of development in children’ (Victoria Legal Aid):
http://www.legalaid.vic.gov.au/Publications/files_cl.rdm_fact_05.pdf
‘Parenting and child health’, Children, Youth and Women’s Health
(Government of South Australia):
http://www.cyh.com/HealthTopics/HealthTopicCategories.aspx?p=122
Child protection issues
If you are in a child-related position at work, you will be required to have a
criminal record check and to complete a prohibited employment declaration
form.
Screening
Go to http://kids.nsw.gov.au/uploads/documents/wwcc_form3.pdf to
complete a checklist to determine if you will require screening. Of particular
relevance is question 5 that states that a position is not child-related if there
is always a parent, caregiver or guardian present.
The home page for the NSW Commission for Children and Young People is
at http://kids.nsw.gov.au/.
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Mandatory reporters
As an Audiometrist, we are ‘mandatory reporters, required by law to report
to DoCS if we suspect (using our professional judgment and training), on
reasonable grounds, that a child or young person is at risk of harm.
Note that a ‘mandatory reporter’ is anyone who delivers health care,
welfare, education, children's services, residential services or law
enforcement wholly or partly to children (aged under 16) as part of their
paid work—and it includes anyone who directly manages or supervises such
work.
Find out more about the responsibilities of mandatory reporters of suspected
child abuse at the DoCs website:
http://www.community.nsw.gov.au/DOCS/STANDARD/PC_101005.html
Equipment
The equipment required to assess the hearing of children is the same as that
used for assessing the hearing of adults.
Go to Resource 4
Go to Audiometry–Assessing Children–3064-11/HLSP and read pages 23–
25, ‘The tympanometer’.
Go to Resource 5
Go to Introduction to Audiology, and read pages 52–56 and 149–152, ‘The
pure-tone audiometer’, ‘The speech audiometer’ and ‘Acoustic immittance’.
Describe what preparations are required to test hearing of school-aged children and adolescents
© NSW DET 2007
7
Go to Resource 6
Go to Audiometry–Otoscopy–3064-7/HLSP and read pages 4–5,
‘Components and Function of the Otoscope’ and ‘Speculae’.
Go to Resource 7
Go to Certificate IV in Audiometry HLT02-8–3064-8/HLSP (Equipment)
and read pages 11–12 and 23, ‘What is an audiometer?’ and ‘What is a
tympanometer?’.
Go to Resource 8
Go to Audiometry–Assessment A–3064-9/HLSP and read pages 6–8 ‘The
audiometer’.
The equipment required for testing children includes:

an otoscope

speculae for the otoscope

an audiometer

a middle ear analyser

tympanometry tips.
To perform hearing assessment and speech audiometry, you will require an
audiometer. These come in various types. There are single channel, medium
and channel audiometers. The features of the audiometer will impact on the
cost. To be able to do the full range of tests, you will need a diagnostic
audiometer.
You can see many different models of audiometers on the internet. Listed
below are some websites with information about equipment.
http://www.interacoustics.com.au/Products/Audiometersmain.asp
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Describe what preparations are required to test hearing of school-aged children and adolescents
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http://www.viasyshealthcare.com/prod_serv/downloads/241_GSI_Audio_Fa
mily_Brochure.pdf
http://www.gnotometrics.com/products/hearing_assessment.htm
http://www.maico-diagnostics.com/eprise/main/Maico/US_en/_Index
The test environment
Go to Resource 9
Go to Introduction to Audiology, and read pages 73–74, ‘Sound-isolated
chambers’.
Go to Resource 10
Go to Audiometry–Assessment A–3064-9/HLSP and read pages 5–6 ‘The
test environment’.
When testing children, the ambient noise is an issue but so is the visual
nature of the room. It is best not to allow the testing area to have too many
visual distractions. This may include posters or other pictures on the walls.
It may also include toys, even those you are using for testing the child. It is
better to have only one game or toy visible to the child at one time. You will
need to make sure that any toys that you have in the test environment are
able to be packed away as some children will not be able to concentrate on
the task at hand if there are other toys.
Calibration
Go to Resource 11
Go to Introduction to Audiology, and read pages 57–63 ‘Calibration of
audiometers’.
Describe what preparations are required to test hearing of school-aged children and adolescents
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Go to Resource 12
Go to Certificate IV in Audiometry HLT02-8–3064-8/HLSP (Equipment)
and read pages 11–25.
Calibration of audiometers and middle ear analysers should take place
annually. If your equipment is not properly calibrated you cannot rely on the
results that are obtained.
It is vitally important that you remember that only the transducers that were
used to calibrate the equipment must be used. The exception to this are
insert earphones. You will have correction figures if the audiometer does not
have the capability to be calibrated with more than one set of earphones.
Performing a daily listening check
Go to Resource 13
Go to Audiometry–Assessing Children–3064-11/HLSP and read pages 13–
14 ‘Equipment is ready’.
Practise this procedure until you feel that you can do it well. Show your
supervisor how you do the listening check.
Cleaning and storing equipment
It is important to care for your equipment, as it is expensive to replace.
It would be inconvenient if you are not able to carry out assessments while
your equipment is being repaired. Therefore, you must be careful to clean
and store your equipment properly.
At this point, you may need to revise infection control procedures (go back
to task 3).
If your equipment is located in one position permanently, you may like to
cover it with a dust cover when the clinic is closed. This will reduce the
need for cleaning and help to keep dust and debris off the equipment.
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Describe what preparations are required to test hearing of school-aged children and adolescents
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Client information
Go to Resource 14
Go to Audiometry–Assessing Children–3064-11/HLSP and read pages 9–12,
‘Information is ready for use’.
Go to Resource 15
Go to Introduction to Audiology, and read pages 404–407, ‘Patient
histories’.
Activity 2
Design a paediatric case history form.
Describe what preparations are required to test hearing of school-aged children and adolescents
© NSW DET 2007
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Summary
In this topic you have learnt about the preparations required to assess the
hearing of children.
Further reading
If you wish to carry out further research, here are some urls for you to
investigate.
National Association for the Prevention of Child Abuse and Neglect:
http://www.napcan.org.au/
The website for a support group for deaf children and their families:
http://www.deafchildrenaustralia.org.au/
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Describe what preparations are required to test hearing of school-aged children and adolescents
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Feedback to activities
Activity 1
Describe these tests and when they would be used:
ABR: auditory brainstem response audiometry
OAE: otoacoustic emissions
BOA: behavioural observation audiometry
VRA: visual reward audiometry
ABR is an electrophysiological test that measures the function of cranial
nerve VIII, the acoustic nerve and lower brainstem. It is an objective test
because the client is not required to respond behaviourally. When testing
babies they may be asleep or sedated. To perform the test, electrodes are
placed on the head and sounds (clicks and tonebursts) are presented via
earphones or a bone conductor. Threshold assessment is possible. This test
can be used on a client of any age.
OAE test the function of the outer hair cells of the cochlea. The most
common OAE are the Transient evoked (TEOAE) and the Distortion
product (DPOAE). This test can be done on a client of any age as long as
they are able to remain still. It does not give threshold information and it
requires that there is no middle ear dysfunction.
BOA is a test that uses noisemakers or other stimuli that are measured by a
sound level meter. One audiologist presents the tones and the response is
observed by another audiologist and noted. Different responses are expected
from babies at different ages. This test is suitable for babies under six
months of age (ie, developmental age).
VRA is Visual reward audiometry. It is suitable for babies and toddlers
from about seven months to about three years of age. The child is
conditioned to turn (orientate) to a warble tone. When conditioning is
completed, screening levels are presented. If the child turns to the sound
they are given a visual reward, eg, a puppet in a lighted window.
Describe what preparations are required to test hearing of school-aged children and adolescents
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Activity 2
Design a paediatric case history form.
Name:
DOB:
Referred by:
Concern:
Accompanied by:
Previous hearing tests?
Y/N
Neonatal screening pass:
Y/N
School:
Academic achievement:
Speech development:
Recent illness:
Family history of hearing loss:
Other comments:
Permission is given for reports to be sent to:
Signature:
Name:
Date:
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Describe what preparations are required to test hearing of school-aged children and adolescents
© NSW DET 2007