Winter 2013

1. INFANT HEARING PROGRAM: New Screener Presentation Winter 2013

2. INFANT HEARING PROGRAM: Quick review • Hearing loss at birth is more common (~2/1000) than any other disorder for which newborns are screened. • Only about half of all newborns with hearing loss have known risk indicators (5-10% of all newborn are at risk). • Targeted high-risk hearing screening violates the principles of equal access and universal rights. • Universal screening IS practicable and IS NOT costly, in light of the ensuing benefits to the child, family and society. M. Hyde, IHP Conference 2007

3. INFANT HEARING PROGRAM OVERVIEW • Screening occurs before discharge and should include a risk assessment. • Infant can be tested in crib or parent’s arms. • Infant should be sleeping or resting quietly. • Test environment should be as quiet and free from interruption as possible. • Local infection control procedures should be followed. • Privacy legislation must be followed.

4. INFANT HEARING PROGRAM OVERVIEW SCREENING M. Hyde, IHP Conference 2007

5. The AccuScreen is a touchscreen unit that has the capability to screen using Automated Distortion Product Otoacoustic Emissions (ADPOAE) or Automated Auditory Brainstem Response (AABR) or both, depending what the configuration is. • The AccuScreen is a hand-held, battery powered unit that can be charged in the docking station. The battery will be fully charged after six hours. A full charged battery will last eight hours, depending on use. ACCUSCREEN – Getting Started

6. ACCUSCREEN – Getting Started • Caring for the equipment • What pieces are disposable? • What is the easiest way to maintain equipment? • Can we prevent breaks? • -Hold equipment carefully, to avoid dropping it. • -Keep wires tidy, avoid knots. • -Insert connections into the correct ports.

7. ACCUSCREEN – Getting Started • To turn it ‘on’ press the grey button on the side of the unit, press and hold the bottom of the button to turn it ‘off’. • To remove the battery (reboot or change battery) press the battery release and the back will open. Probe Test On Battery release Battery • To self calibrate insert the probe into the back of the unit.

8. ACCUSCREEN – Getting Started • Home page • Find a Patient • Create a New Patient • View the Tests • Print the Tests • Delete Patients • Quick Test to check your hearing • Quality test to troubleshoot • Settings to change i.e. date, time, log in

9. ACCUSCREEN – New Patient • We do not store personal health information without encryption. Select New Patient to get a new ID and perform the test.

10. ACCUSCREEN – New Patient • To enter a numerical ID touch ‘123’ to switch from ‘aaa’. Touch the checkmark after you entered the desired number.

11. ACCUSCREEN - Probe Tips and Eartips • There are five sizes of disposable eartips available for use with infants; 3.7mm yellow, 4.0mm green, 4.5mm pink, 5.0mm blue and the transparent tree tip 4-7mm. • A clean eartip must always be used when placing the probe tip into the ear canal. Eartip Probe Tip

12. ACCUSCREEN – Connecting the probe tip • Click the probe tip onto the speaker cable, then slide the appropriate sized eartip on. • To remove, hold the probe tip at the top and bottom along the groves, push together then outward.

13. IHP – Stage One Screening • Babies NOT at Risk • A two step process. • Step one with ADPOAE equipment. • Step two if needed with AABR equipment. • Step two should be done as soon as possible to reduce parental anxiety.

14. IHP – Stage One Screening • DPOAEs are generated by the outer hair cells (OHCs) of the cochlea. • Normal DPOAEs usually mean that hearing is normal (at the time of screening…) • Absent DPOAEs suggest that hearing may be abnormal and further testing is needed.

15. IHP – Stage One Screening • Infants will either receive a pass or a refer result. • A pass means that the baby is hearing at this time. But, it is always important to monitor. • A refer does not necessarily mean that the infant has a hearing loss. Commonly, debris in the ear canal, fluid in the middle-ear or movements during the test will effect results. A referral to another stage of screening is needed.

16. ACCUSCREEN – ADPOAE • The hearing screening is a quick, easy, non-invasive screening test that does not involve the performance of any of the controlled acts under the Regulated Health Professions Act, 1991. • Provision of parental consent is required, unless hearing screening is performed as part of a hospital’s standard of care. • Consent to share results with the regional IHP is always required.

17. ACCUSCREEN – ADPOAE • To screen with the ADPOAE connect the cable with the blue base. • Ensure the arrows are aligned properly. • Select an appropriate eartip. • Put on the probe tip and eartip. • Select the ear for initial screen.

18. ACCUSCREEN – ADPOAE • Touch the black arrow to begin. The equipment will calibrate and then initiate screen. The screen is completed once three frequencies have a clear response.

19. ACCUSCREEN – ADPOAE • The Test Menu has tests completed and test results. The Test View shows all attempts including missed calibrations and aborted tests.

20. ACCUSCREEN – DPOAE Errors • If there is too much noise, reduce environmental noise i.e. turn off cell phones and/or check the ear for debris. You can also try a Quality Test to make sure the probe is OK.

21. ACCUSCREEN – AABR • Soft sounds are played in the baby’s ear and the brain’s electrical response is recorded using three sensors (electrodes). • The brain’s response to the sounds is automatically analyzed and interpreted by the AccuScreen.

22. ACCUSCREEN – AABR • To conduct an AABR, connect both the green and blue cords. • Make sure the arrows are aligned properly. • The red electrode goes on the right mastoid. • The black electrode goes on the left mastoid. • The white electrode is placed on the baby’s forehead (high midline).

23. ACCUSCREEN – AABR • Touch the black arrow in the Test Menu. Once impedance values are OK, the black arrow highlights. Touch to start. The testing page will appear. The test is complete when the ABR bar or Progress bar is full.

24. ACCUSCREEN – AABR Errors • If impedance values are good the color will be green. Yellow means that the connection is not as good. Red is unacceptable. A yellow reading can turn red if the electrode is loose or falls off.

25. ACCUSCREEN – Troubleshooting • Quality Test • At the start of shift a probe test should be done. Insert the probe into the test cavity at back of the AccuScreen. The test will start automatically. • Results will appear as ‘Probe OK’ or as ‘Probe failed’ with possible errors.

26. ACCUSCREEN – Troubleshooting • Loose Cord Error • If your electrodes appear attached but you still get poor impedance or loose cord errors, perform an Electrode Test to check the cables. • Attach the electrode cable wires and check with a Quality Test to make sure they give good impedance. • The Test results page will indicate the condition of the electrode cables.

27. ACCUSCREEN – Troubleshooting • Other Errors and Solutions • AABR does not start – press the black triangle to start. • Black screen – unit powered off (eject battery if needed). • Timeout during pause – AABR was paused more than two minutes. • Not Working? Contact Genie Audio • ihpsupport@genieaudio.com • Tel: 1-866-788-1830 • Request and record the RMA number. • Fax or email the completed form. Battery Start

28. SCREENING – Communicating with Parents • Pass: a pass means the baby is hearing at this time. Provide Pass brochure, get consent to send the information to their regional IHP, encourage parents to monitor speech and language development. • Pass at Risk: as above, but provide Pass at Risk brochure and stress need for surveillance follow up. • Refer: a refer does not necessarily mean the baby has a hearing loss. A referral to another stage of screening is needed. Provide and discuss the Refer pamphlet and stress the importance of the next appointment. Assess parents’ anxiety level and counsel as needed to achieve reasonable concern but not overwhelming anxiety. Do NOT dismiss a valid refer as ‘nothing to worry about’ or as ‘something the equipment always does….’.

29. SCREENING – Communicating with Parents • General Principles: • Provide consistent and accurate information. • Many babies who do not pass the screen will turn out to have normal hearing; there are several possible causes of a refer result, other than hearing loss. • Stress the importance of following through with subsequent appointments. • Offer appropriate written information, and a contact number for them to call. • Even if the baby passes the screening, stress the importance of monitoring speech and language development. If there are risk factors, emphasize the importance of the surveillance screens.

30. IHP – High Risks Family history – Hearing loss must have occurred in the baby’s parent or sibling before age 10 and been a clear case of hearing loss that involved: • Hearing aid(s) • Cochlear implant(s) • Sign language and/or • Went to a school for the Deaf • Craniofacial Anomalies (obvious): • Cleft lip and/or palate • Absent or obviously malformed pinna • Absent or tiny ear canal opening

31. IHP – NICU High Risks • Birthweight 1000 grams or less • Gestational Age 30 weeks or less • NICU Risks: 5-minute APGAR < = 3 • Severe asphyxia, hypoxia, respiratory or cardiopulmonary failure • PPHN - Persistent Pulmonary Hypertension Newborn (blood bypasses lungs) • CDH - Congenital diaphragmatic hernia (hernia causes breathing problems) • IVH - Intraventricular Hemorrhage Grade III or IV (severity of bleeding) • PVL - Peri-Ventricular Leukomalacia (damage to white matter in brain) • HIE - Hypoxic Ischemic Encephalopathy Sarnat II or III (brain injury) • ECMO - Extracorporeal Membrane Oxygenation (cardiac/respiratory support) • iNO or HFO/HFJ – Inhaled nitrous oxide or high frequency ventilation

32. IHP – NICU High Risks Viruses and Infections: CMV, CCMV (congenital) cytomegalovirus Proven TORCHES infections (Toxoplasmosis (from cat feces or meat), Rubella (German Measles), Herpes, Syphilis Proven Menigitis (Viral, Bacterial or Fungal) Congenital HIV, Measles or mumps infection Severe neonatal sepsis HBR - Hyperbilirubinemia >= 400 µmol/L or exchange (jaundice) Neonatal cancer treatment with cisplatin

33. IHP – High Risks Syndromes: Down (Trisomy 21), Stickler, CHARGE, Pendred, Enlarged Vestibular Aqueduct (EVA), Waardenburg, Usher, Branchio-Oto-Renal (BOR), Treacher Collins, OsteogenesisImperfecta (OI), Neurofibromatosis II (NF2), Alport, Crouzon, Hunter. Other high risk indicators As specified by baby’s physician

34. IHP OVERVIEW • Stage Two Community Screening • All well babies with a refer result from StageTwo will be re-screened with AABR. • Community screening two to four weeks after Stage One. • Allows time for any debris in the ears to clear. • A quiet and comfortable baby is easier to screen. • Many babies will pass the re-screen.

35. IHP – Babies at high risk • Surveillance • Any baby who has been identified as high-risk & passed an AABR. • Babies with meningitis or CCMV risk who have passed an AABR or a diagnostic ABR will start surveillance with VRA screening. • Age & type of Surveillance • 8-12 months - Surveillance VRA • 18 months - Surveillance by telephone interview

36. IHP – High Risks • Intensive Surveillance Sequence • Infants who have had meningitis or CCMV should receive surveillance ABR as soon as possible after recovery, and have three surveillance events, targeted at about four, eight, and 12 months of age. • For infants who have had meningitis, where there Is no permanent hearing loss identified within one year of recovery they will be discharged from IHP. • For infants who have had CCMV, they will continue to receive surveillance at 18 months, and play audiometry at three and five years.

37. IHP OVERVIEW • Assistive Technology • Once a permanent hearing loss is confirmed, babies can return to the audiologist for hearing aid evaluation/selection, if chosen by the family. • All requirements of the Assistive Devices Program are followed so that the parents can apply for financial support for hearing aids. • Babies will begin hearing aid use no later than six months of age.

38. IHP OVERVIEW • Family Support Worker • The family may choose to access family support services. • Services provided include: counseling, information about communication development services and local resources.

39. IHP OVERVIEW • Follow-up Supports and Services • The family will have access to IHP services until six years of age. • IHP audiologists will monitor the child’s hearing loss. • The child’s communication development progress will be monitored, within their individualized program, to promote optimal success.

40. FOR ADDITIONAL QUESTIONS CONTACT: Contact your Infant Hearing Program Coordinator or Regional Trainer