Download An Audiological Management Manual for UNHS Referrals

An Audiological Management
Manual for UNHS Referrals
Antonia Brancia Maxon, Ph.D.
Karen Ditty, M.S.
Kathleen Watts, M.A.
Diane Sabo, Ph.D.
Karen Munoz, M.A.
NCHAM Technical Assistance Network
Goals of EHDI
• Identify infants with hearing loss by one month
• Diagnose hearing loss by three months
• Enroll infants in early intervention by six months
• These goals can be met only if professionals are
prepared to meet the needs of infants with hearing loss
and their families.
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Initial Step
• Infants who do not pass UNHS are referred for a
diagnostic audiological evaluation
• All audiologists have expertise in audiological
assessment, HOWEVER
• Not all audiologists are able to evaluate young
infants
• Infants must be referred to a qualified pediatric
audiologist
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Pediatric Audiologists
• Selection of pediatric audiologists should be
based on:
– the population they generally serve
– the type of equipment they have available
– their familiarity with appropriate and necessary
pediatric techniques
– their experience with specialized pediatric testing
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Through NCHAM a manual was developed
“Audiological Management After Referral from Universal
Newborn Hearing Screening”
Written by Antonia Brancia Maxon, Ph.D.,
Karen M. Ditty, M.S. and Kathleen Watts, M.A.
Editorial assistance from Diane Sabo, Ph.D. and
Karen Munoz, M.A., Karen Clark, M.A.
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Purpose of Manual
To provide information about:
• types of tests and follow-up procedures used for
infants referred from newborn screening
• personnel involved in EHDI process
• timelines for completing the process
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Purpose of Manual
• Written for:
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parents
primary care physicians
ear, nose, throat physicians
rehabilitative audiologists
early intervention providers
teachers of the hearing impaired
family service coordinators
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The remainder of the presentation
summarizes the sections of the manual
Table of Contents
I. Introduction
II. Types of Hearing Loss
Conductive
Sensorineural
Mixed
III. Audiological Diagnostic Evaluation
Initial Diagnosis
Case History
ABR
ASSR
OAEs
Tympanometry
The Audiogram
Use of residual hearing
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Table of Contents
IV. Sensory devices
Hearing Aids
FM Systems
Cochlear Implants
V. Early Intervention
Family Issues
Routine Audiological Test Battery
Visual Reinforcement Audiometry
Amplification selection, fitting and validation
Communication Choices
Individual Family Service Plans
Medical Intervention
Third party payers
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Table of Contents
VI. The Team
Pediatric Audiologist
Primary Care Physician (PCP)
Ear, Nose and Throat Physician (ENT)
Early Interventionist
Geneticist/Genetic Counselor
Other Professionals
VII. Appendices
References
Resources
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Referral to Pediatric Audiologist
• The primary care physician should be contacted so
he/she can be involved in the referral process
• Statewide centralized tracking systems are beneficial
– Reduce “lost to follow-up” numbers
– With input from pediatric audiologists - maintain record of the
hearing status of all infants referred
• Pediatric audiologist needs a connection to Part C
programs to reduce time to intervention
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Professional Team
• Pediatric Audiologist - Diagnosis
– Training and equipment for infant evaluation
– Interpret test results
• type
• degree
• configuration
– Complete diagnosis quickly
– Establish follow-up sessions
– Provide written information
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Professional Team
• Pediatric Audiologist – Hearing Aids
– Training and equipment for infant procedures
• loaner hearing aids available
• earmold fabrication available
– Establish follow-up sessions to determine appropriate
selection and fitting
– Able to provide training about hearing aids to parents
– Provide written information
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Professional Team
• Pediatric Audiologist – Habilitation
– Training and experience in typical development
– Able to work with families
• Provide information about language stimulation
• Provide information about listening training
– Able to provide parent education
• Establish appropriate goals and expectations
– Able to provide direct service to infant/toddler
• Speech, language and listening training
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Professional Team
• Primary Care Physician
– Establishes medical home
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General medical care
Ongoing monitoring and treatment of MED
Part of IFSP team
Refer for genetic follow up
• Ear, Nose, Throat Physician
– Treat medical conditions
– Provide medical clearance for hearing aid fitting
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Professional Team
• Early Interventionist
– teacher of the hearing impaired, speech-language
pathologist, rehabilitative audiologist, parent-infant
specialist
– provide listening, speech, language, communication
services
• Geneticist/Genetic Counselor
– physician conducts medical tests
– helps family determine possible genetic factors
– makes appropriate referrals
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Professional Team
• Other professionals
– To address any other conditions occurring with the
hearing loss
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Physical therapist
Occupational therapist
Developmental therapist
Ophthalmologist
• The whole team makes rapid decisions
• The whole team responds to needs of the family
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Audiological Diagnostic Evaluation
• Initial Evaluation
– Occurs within 2 weeks of referral from screening
– Pediatric audiologist determines the type, degree and
configuration of the loss
• Hearing loss is determined
– Degree of hearing loss
– Type of hearing loss
– Configuration of hearing loss
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Early Intervention
• Diagnosis results in immediate referral for early
intervention services. IDEA, Part C.
• Individual Family Service Plan (IFSP) is
developed.
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focus on residual hearing
amplification use
speech and language development
consider communication modality
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Early Intervention
• Family Issues
– services provided in “natural environment”
– family configuration is accommodated
• Use of residual hearing
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hearing aids/other sensory devices provided
listening expected
hearing levels regularly monitored
routine audiological test battery
• Communication mode selected
– family choice
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The IFSP
• Early intervention team and family develops
IFSP
• Covers all aspects of EI services needed by
child and family
– Goals and objectives with timelines
• Regular assessments to monitor progress
toward goals
• Transition plan
– moving from Part C to LEA services
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Medical Intervention
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Medical clearance for hearing aids
Monitoring for middle ear disease
PCP part of EI team
General development
Vision assessment
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Summary
• In addition to the material previously
summarized the manual contains:
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References
Websites and other resources
Glossary
Materials that can be used for dissemination
• Written
• Graphics
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