Download RED & GRAY

Going Green
This educational offering is
joining others in an effort to save
our environment by making the
handouts available on our
website
www.arkansascsh.org.
To show respect for our
speakers and participants,
PLEASE place your cell
phone on silent or vibrate.
Should you need to answer a
call, PLEASE go outside to
hold your phone conversation.
Respect the speakers and
other participants around you
by refraining from side bar
conversations during the
session.
If it is that important, please
step outside!!!!
Respect the speakers and
other participants around you
by refraining from side bar
conversations during the
session.
If it is that important, please
step outside!!!!
The planning committee &
faculty attest that NO relevant
financial, professional or
personal conflict of interest
exists, nor was sponsorship of
commercial support obtained,
in the preparation or
presentation of this educational
activity.
School
Hearing Screening
It’s the Law!
Arkansas Code 6-18-701 states that
each school district shall employ a
physician or nurse to make such
physical examinations. The exam shall
be only such as to detect contagious or
infectious diseases or any defect of
sight, hearing or condition that would
prevent a pupil from the benefits of
school work.
Purpose of Hearing
Screening
• To screen a large number of children in a short
amount of time
• To separate those children likely to have hearing
problems from those not likely to.
• To refer those children who do not pass the
screening or who are suspect for hearing problems
Importance of Hearing
Screening
• 11-15% of school children have a hearing loss
• Impaired hearing can seriously impede learning
• Early identification and treatment can prevent or at
least alleviate many hearing problems
Children to Screen
• Grades Pre-K, K, 1, 2, 4, 6, 8
& transfer students
• Special education students &
teacher referrals
When to Screen
• NOT the first week of school
• Children entering school for the first time
– Have 90 days to screen
– Need time to adjust to school environment
• Don’t wait too long
– Cold and Flu season
– Need time for follow-up
• Recommend screening in September
– Start with older children and/or Sp. Ed. (need to screen
before IEP)
Ear Anatomy
Outer Ear
EXAMINATION WITH
AN OTOSCOPE
• Always hold the otoscope in the hand of
the same side as the ear you are about to
examine.
• Examine the good ear first.
• Be sure light is bright.
• Select correct size of ear piece.
• Do not insert tip too far in canal.
Normal Eardrum
Middle Ear
Ossicles
Inner Ear
Sound & Sound Measurement
SOUND: A pressure wave which consists of
vibrations of molecules in an elastic medium
Frequency or Pitch:
•Measured in Hertz (Hz)
•Human Range is 20 to 20,000 Hz
Intensity or Loudness:
•Measured in decibels (dB)
•Normal conversation averages 60 dB
Normal Hearing
Speech Sounds
TYPES OF
HEARING LOSS
Conductive Hearing Loss
• Absence or malformation of the pinna and/or ear
canal
– Atresia
• Obstruction of the ear canal
– Foreign object or impacted wax
• Inflammation or infection in the outer or middle ear
– External otitis or otitis media
• Perforation of the eardrum
• Otosclerosis
• Malformation of the ossicles
• Trauma
– Disarticulation and/or fracture of the ossicles
Conductive Hearing Loss
Sensorineural Hearing Loss
• Congenital
– Heredity
– Infections – Maternal rubella, CMV
– Ototoxic Drugs
• Acquired
– Infections – measles, mumps, meningitis,
chicken pox
– Ototoxic Drugs
– Trauma – blow to the head, noise
Sensorineural Hearing Loss
Central Hearing Loss
• These children will usually pass the
nurse screening test
• Difficulty understanding speech in noise
most common symptom
• Maturation a factor, usually diagnosed at
age 7 or older
• Normal or near-normal hearing
sensitivity
• ALDs and compensatory strategies often
helpful
Mixed Hearing Loss
Ear Abnormalities
Microtia and Atresia
Wax Impaction
External Otitis
Retracted Eardrum
Due to Negative Pressure
Middle Ear Fluid
Acute Otitis Media
Eardrum Perforation
PE tube
USHER SYNDROME
THREE TYPES OF
USHER SYNDROME
TYPE 1
HEARING
VISION
BALANCE
TYPE 2
TYPE 3
Profound deafness
in both ears at birth.
Moderate to severe
Hearing loss from
birth.
Normal at birth;
progressive loss in
childhood or early
teens.
Decreased night
vision before age
10.
Decreased night
vision begins in late
childhood or teens.
Varies in severity; night
vision problems often
begin in teens.
Balance problems
at birth. Slow to sit
or walk before 18
months.
normal
Normal to near-normal,
chance of later
problems.
Second Hand
Smoke
Secondhand Smoke
•
•
•
•
•
•
More ear infections and
hearing problems
More upper respiratory
infections
More bronchitis and
pneumonia
Higher rate of SIDS
More cases of asthma
More severe symptoms in
children who already have
asthma
Secondhand Smoke
• More likely to develop leukemia during
childhood
• Higher Cholesterol Levels in Adolescents
• More likely to develop lung cancer and
heart disease later in life.
Secondhand Smoke
•
Children living in
households where
more than three
packs of cigarettes
were smoked per
day were more than
four times as likely
to be hospitalized
for placement of ear
tubes.
Otitis Media
Middle Ear Infections
• 24.5 million visits to doctors’ offices yearly
• Most frequently cited reason for taking
child to the emergency room
• Most common surgery for children is a
Tympanostomy, 110,000 per year
• Health care costs are reported between $3
and $5 billion/year
Screening Procedure
Audiometer Controls
•
•
•
•
•
•
Power
Intensity Dial
Frequency Dial
Ear Selector Switch
Presentation Switch
Additional
– Warble
– Pulse
– Masking
Headphone Placement
•
•
•
•
•
•
Hair behind ears.
Remove large earrings
May want to remove glasses
Diaphragm over ear canal
Adjust head band for snug, even fit.
Head band on top of head preferred
Protocol
•
•
•
•
•
•
•
Observation
Pure Tone Screening
Play Pure Tone Screening
Rescreening
Referral
Follow-up
Annual summary
Observation
• Look for the following:
– Structural defects of the outer ear
– Obvious ear canal abnormalities
• Inflammation
• Drainage
• Foreign body/object
– Eardrum perforation
– Signs of possible otitis media
Screening Protocol
Observation
Right Ear
Left Ear
Right Ear
1000 Hz
2000 Hz
4000 Hz
1000 Hz
2000 Hz
4000 Hz
1000 Hz
20 dB
20 dB
20 dB
20 dB
20 dB
20 dB
20 dB
Play Audiometry
• Condition with headphones off
– 4000 Hz
– Highest level
• Hold hand with toy near ear
• Help drop toy until pushes against your
hand
• See if does on own
Play Audiometry cont.
• Practice with headphones on
– Lower level to 50 dB BEFORE headphones
on
– 1000 Hz
• Recondition if needed
• Lower level to 20 dB
• Follow screening protocol
Re-screening
Rescreening Protocol
Observation (Refer if appearance abnormal)
Right Ear
Left Ear
Right Ear
1000 Hz
2000 Hz
4000 Hz
1000 Hz
2000 Hz
4000 Hz
1000 Hz
20 dB
20 dB
20 dB
20 dB
20 dB
20 dB
20 dB
Hearing
• Pass Criteria:
– Observation normal—Immediate referral if not
– Responds to each frequency in each ear
– Same for screen and rescreen
• Rescreening:
– Repeat screening in 4-6 weeks
• Play audiometry
– Use with preschool, immature, shy, sp. ed, non–
English, etc.
Referral
• Refer immediately if observation shows
physical abnormality
• Refer to MD if fails rescreen
• May immediately refer if child does not
pass and there is serious concern
regarding hearing or speech/language
• Refer to MD if child passes, but there is
concern regarding hearing
Follow-up
• Send letter
• Send 2nd letter or make personal contact if
needed
• Have financial assistance information
available
• Have list of appropriate professionals
available
• Review information received back from
examining professional
• Rescreen after medical treatment
• Involve sp. ed. personnel if necessary
Do’s and Don’ts
• ALWAYS find a quiet room; screen at 20 dB
– Exception is 25 dB at 4000 only
•
•
•
•
Don’t tell to raise right or left hand
Present for at least 3 seconds
Don’t pattern
Don’t give visual cues-position audiometer
controls out of view
• Use pulsed tone if possible
• Don’t screen ear w/known hearing loss
Forms
Hearing Screening Record Sheet
Hearing Referral
Hearing Follow-up Record
Hearing Annual Summary
Resources
Ear and Hearing A Guide for School Nurses
National Association of School Nurses
EARS Team (Educational Audiology Resources Services)
Arkansas Children's Hospital 501-0680-2718
Educational Audiologist
Arkansas School for the Deaf 501-324-9826
Community Health Nurse Specialist
Mary Glasscock 501-354-2269
Practicum
Assignment