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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