Download Can you explain my child`s Audiological Report?

Can you explain my child’s
Audiological Report?
Karen Clark, M.A., CCC-A 1, 2
Karen M. Ditty, Au.D., CCC-A 2,4
Patti Martin, Ph.D., CCC-A 2, 3
1
UTD /Callier Center for Communication Disorders
Dallas, TX
2 National Center for Hearing Assessment and Management
Logan, UT
3
Arkansas Children’s Hospital
Little Rock, AR
ENT Specialists, PA
Houston, TX
4Texas
Faculty Disclosure Information
In the past 12 months, we have not had a significant
financial interest or other relationship with the
manufacturer of the product or provider of the
services that will be discussed in our presentation.
This presentation will not include discussion of
pharmaceuticals or devices that have not been
approved by the FDA.
Early
Interventionis
t
The Team
Medical Home
Physician
Audiologist
Family
Family
Audiological
Report
Name: Most Special
Baby
Results:
Very important
information
•Want to understand
hearing loss
•Must make decisions
for child
Early Interventionist
Audiological
Report
Name: Most Special
Baby
Results:
Very important
information
•Uses data to determine
eligibility.
•Reviews information
with parent.
•Uses information to guide
programming.
Audiologist
Audiological
Report
Name: Most Special
Baby
Results:
Very important
information
•Makes decisions based
on results
•Wants understanding
and follow through
from family
•Needs feedback from
family and EI
Audiological
Report
Medical Home Physician
Name: Most
special Baby
Results: Very
important
information
•Makes medical decisions
based on test results.
•Coordinates multidisciplinary
Medical evaluations to determine
Etiology and identify related
conditions.
The Goal
A Family-Professional partnership that
supports collaborative sharing of audiological
information.
Partnership
“..defined as a relationship of mutual respect between
two or more competent persons who have agreed to
commit and share their knowledge, skills, and
experience in meeting the needs of the child”
(SKI-HI Curriculum 2004).
Challenges to Collaborative
Sharing of Audiological Data
• Audiological information is
increasingly complex.
– Gone are the days when the EI needed
only understand simple Xs and Os on a
graph.
– Current assessment protocols leave heads
spinning with acronyms and multiple
pieces of data – tone burst ABR, click
ABR, OAE, ASSR, REM, bone, air, acoustic
reflex……
Challenges to Collaborative
Sharing of Audiological Data
• Early interventionists have widely
varied backgrounds.
– Even with training in intervention specific
to infants and toddlers who are deaf and
hard of hearing, rapidly evolving clinical
practice makes staying current a
challenge.
– Parents and early interventionists may not
know the questions to ask.
Challenges to Collaborative
Sharing of Audiological Data
• Audiologists have varying knowledge,
experience, and skill in infant assessment.
– Even when audiologists have training and skill
specific to infants, there is wide variability in the
way reports are written and results presented.
• Audiologists may have difficulty conveying
complex data in easily understood terms.
• Time – never enough for anyone.
Improved understanding of
Audiological Data within the
Partnership!
Understanding terminology!
• Do not need to know how to do the tests, but need to
know what tests are performed, and generally what
they are measuring.
• Examples:
• Immittance: Middle ear system
• Otoacoustic Emissions: Peripheral, outer hair cells,
is pre-neural
• Auditory Brainstem Response: test that can be used
to assess auditory function in infants and young
children
What should you see in an
audiological report from a Pediatric
Audiologist?
• Medical History summary
• Auditory Brainstem Response (ABR) results
which include:
– Tone Burst, Bone Conduction testing
– Auditory Steady state Audiometry
• Tympanometric results (High Frequency Probe
Tone or infants < 6 Months)
• Otoacoustic Emissions Results
• Behavioral Audiometry (when age appropriate)
• Hearing aid results, if obtained
• Specific Recommendations
Why are so many audiological tests
performed and reported?
• Cross Check Principle
Why is the Audiological Report so
Complicated?
Does the audiological report have to
be so complicated?
• NO,
• But….
– The report must be
understood by other
audiologists and
professionals with
terminology that is
legally correct.
What is the Audiologist required to
report ?
• Although there are no national
protocols or standards many states
have guidelines for their
audiologists.
–These guidelines can be obtained via the following
link on the NCHAM website:
–http://www.infanthearing.org/states/table.html
American Speech Language &
Hearing Association
• Working on a standard of care with Pediatric
Audiologists.
• Developed a draft copy of “Roles, Knowledge, and
Skills: Audiologists Providing Clinical Services to
Infants and Young Children Birth to 5 Years of Age”
http://www.asha.org/peer-review/audclinservbirthto5KS.htm
How can you interpret the
audiological report to your families?
• HEAR!
– H: History (medical and audiological)
– E: Evaluate tests that were performed
– A: Audiological summary for each ear
– R: Review Recommendations
Medical and Audiological History
• Was there a hearing screen at birth?
– Results?
• Have there been subsequent audiologicals provided
since newborn hearing screen?
– Results?
• Were there any medical complications that may put
the child “at risk” for hearing loss?
– Positive CMV screening?
– Prolonged stay in the NICU?
– Hyperbilirubinema, anoxia, or other medical complications?
• Were there any surgeries that have been performed
for chronic middle ear effusion?
– PE tubes?
Evaluate audiological tests
• Was a cross check principle used?
– If testing was not performed was an
explanation as to why put in the report?
Audiological summary for each ear
• Does the report address the hearing
status of each ear in a clear and
understandable manner utilizing
common terminology used in
audiological report writing?
– If testing was incomplete for an ear, was
an explanation provided?
Recommendations
• Are the recommendations consistent
with the test findings?
• Are timely follow up appointments
established when necessary?
• Are referrals made to the appropriate
educational facilities?
How can you explain the
audiological report to your families?
• Example 1 DOB: January 2005
• Medical History:
– Significant history includes not passing
newborn hearing screen,
hyperbilirubinemia and congenital
anomalies for he right ear.
What is important about this medical history?
How can you explain the audiological
report to your families?
• Audiological History EXAMPLE 1
• January 2005: ABR results consistent with a
moderate peripheral auditory impairment for the
frequency range 2000-4000 Hz bilaterally. A
response was observed to click stimuli via bone
conduction down to 30 dBnHL: however, could
not be replicated due to awakening of child.
• June 2005: ABR results consistent with a
moderate peripheral auditory impairment for the
frequency range 2000-4000Hz and 500 Hz for the
left ear. Further testing could not be completed
due to awakening.
• Why was this test repeated in June? Why so many
months later?
How can you explain the audiological
report to your families?
• Evaluate other assessments of the infant’s
hearing status. ( This case indicated no other
tests beside ABR were performed.)
Why would knowing immittance results be
beneficial?
When they could not complete the test the
first time, why were they unable to get
bone conduction testing the 2nd time?
Audiological summary for each ear
• EXAMPLE 1 October 2005:
– Synchronous neural responses to click
stimuli were consistent with a severe
peripheral auditory impairment for the
frequency range 2000-4000 Hz for each ear.
– Synchronous neural responses to tone
burst stimuli were consistent with a severe
peripheral auditory impairment at 500 Hz for
the left ear and a moderate peripheral
auditory impairment for the right ear at 500
Hz and 4000 Hz.
– No responses were observed to click stimuli
via unmasked bone conduction at
equipment limits (45dBnHL).
How can you explain the
Audiological report to your families?
How is the wording different from the 1st ABRs and the
October ABR?
• “ABR results consistent with a moderate peripheral
auditory impairment for the frequency range 2000-4000
Hz bilaterally.”
• “ Synchronous neural responses to click stimuli were
consistent with a severe peripheral auditory impairment
for the frequency range 2000-4000 Hz for each ear”
• Do the results mean different things?
• Was there a change in this child’s hearing status?
No suggestion as to why the change in hearing status occurred
• Why would a comment regarding change in hearing
status be beneficial?
How can you explain the
audiological report to your families?
• Example 1 Recommendations
– Be seen for Otologic evaluation due to identification of
auditory impairment. (Was this not done earlier with
the hearing loss that was identified?)
– Receive trial period with hearing aids pending otologic
clearance.
– Initiate Program for Amplification application process.
– Be seen for behavioral audiological follow-up in 3-6
months.
– Receive aural habilitative services.
– Continue to receive Early childhood intervention
services. (When was this child referred? Why was he
referred?)
HEAR
• History: Medical and Audiological
– What is significant with this child’s history?
• Evaluate tests performed:
– What battery of tests were discussed in all the
evaluations?
• Audiological summary of test results for each
ear.
– What did you learn here?
• Recommendations
– What did you learn here?
How to improve the understanding of
the Audiological Report?
• Include the following sections in your report:
– History (Medical and Audiological)
– Audiological tests performed and the results of each test for
each ear. (results should be attached to the report)
– Summary paragraph written in an easy to understand format
that summarizes the test findings.
• Functional implications of hearing loss should be
explained
• If results were inconclusive an explanation as to why
results were inconclusive should be reported here.
• If hearing status changed, a statement should be
provided.
– Recommendations
• Medical
• Educational
• Habilitation
• Follow-up appointments with a timeline whenever
possible.
Interpret that phrase!
• History
– “includes premature birth, low APGAR scores (5
@1min,6@5min,7@10min),cardiac problems
(dysplastic aortic valve), Chromosome 6-partial
deletion, dysmorphic features, low set ears,
treatment with ototoxic medication and bilateral
auditory impairment.
What would you expect to see in the
recommendations?
Interpret that phrase!
• Evaluating tests performed
–
–
–
–
Tymps: WNL, Reflexes: DNT
REM: CNT
OAE: Absent
NR to unmasked clicks
What tests were done, and what were the results?
Interpret that phrase!
• Audiological Summary
– Ad: No response to click stimuli at 80 dBnHL
observed. Results are c/w a severe to profound
peripheral auditory impairment for the freq. 2-4
kHz.
– As: Responses to click stimuli are c/w a severe
peripheral auditory impairment for the freq. 24kHz. No response observed to 500 Hz tone burst
stimuli.
What does THIS mean?
Interpret that phrase!
• Recommendations
– Appropriate educational services.
– Aural rehab
– Be seen for otologic evaluation due to
identification of auditory impairment.
– Regular audiological evaluations and monitoring.
What does THIS mean?
How do you interpret the
Audiological Report?
• Boystown National Research
hospital has an excellent
glossary for parents and
professionals to better
interpret test results.
• http://www.babyhearing.org/He
aringAmplification/Glossary/in
dex.asp
Texas Connect
• Topic Card 1.
Tests Used to Assess
Hearing Loss in Infants
and Young Children
• Topic Card 2.
Types and Causes of
Hearing Loss
http://www.callier.utdallas.e
du/txcterms.html#service
List of Acronyms
Listen-Up
• http://www.listen-up.org/htm/acronyms.htm
CDC:Early Hearing detection and Intervention
Program
• http://www.cdc.gov/ncbddd/ehdi/abbrev.htm
VA-SOTAC Resource Guide ACRONYMS
• http://www.nr.cc.va.us/cdhh/sotac%20resour
ce%20guide/acronyms.htm
Resources on the Web
• American Speech Language and Hearing Association
http://www.asha.org/peer-review/aud-clinservbirthto5KS.htm
• Joint Committee for Infant Hearing
http://www.jcih.org/history.htm
• Texas Connect
http://www.callier.utdallas.edu/txc.html
• National Center for Hearing Assessment and management
www.infanthearing.org
• Boystown national Research Hospital “My Baby’s Hearing”
www.infanthearing.org