Functional Hearing Screening

1. Functional Hearing Screening Laura Chesky Hearing and Vision Early Intervention Outreach Consultant Hearing Itinerant in Plainfield Schools District #202 Developmental Therapist-Hearing Developmental Therapist-Hearing Evaluator

2. 10 volunteers!!!! • We are going to “make” an ear!

3. How Do We Hear?

4. Types of Hearing Loss *Conductive *ear wax/impacted cerumen *atresia *foreign objects *microtia *otitis media *ossicle fixation *otosclerosis *otitisexterna *collapsed ear canal *perforated ear drum *fluid in middle ear

5. Conductive hearing losses • Usually can be treated medically • Dr. can “dig out” ear wax • Ear drum can grow back (but will be less flexible) • A skin graft can be done on the ear drum • A prosthetic device can be put in place for the fixated ossicles • Pressure equalization tubes can be put in place

6. Other types of hearing loss • Mixed- problem can be any TWO parts of the hearing mechanism • Sensori-problem lies in the cochlea, hair cells affected (everything else works) • Enlarged Vestibular AcquaductSyndrom • Neural-Problem lies at the auditory nerve (everything else works) • Auditory Neuropathy/Dysynchrony • Cortical-problem lies in the brain (everything else works up to the brain) • *Central Auditory Processing Disorder

7. Otitis media • Occurs when the Eustachian tube cannot drain • Common in children because their necks are not yet elongated. Bacteria gets caught in the tube due to the dark, wet, warm conditions then causes infection • Why do children appear to “outgrow” ear infections?

8. If there are chronic ear infections then….. • Pressure equalization tubes may be put in place • Surgically inserted (“myrangotomy”) • Tubes are inserted, middle ear fluid flows out • After tubes, they are “cured”, right? • Not necessarily! Why not?

9. Think about it….. • Every time a child gets PE tubes inserted, what happens to the ear drum? All that time there was blockage, what have they missed? • How much language have they NOT heard (-ed means past tense, /s/ means plural, -ing means present tense, have they heard those function words such as ‘a’, ‘an’, ‘of’)? • How many speech sounds have they NOT heard? • How distorted have sounds been perceived by the individual?

10. Did you know…. • 1/3 of kids under age 10 have fluid in the ear at any given time? • Doctors may say, “Well, if they don’t have x amount of infections per year, then we won’t put tubes in.” • What happens to these kids with chronic otitis media? • Doctors will continue to give antibiotics. • *pros/cons?

11. Necessary discussions • At what point should PE tubes be discussed? If a child cannot be under anesthesia, what are the options? • Otolam-procedure to drain fluid • Pro-the fluid goes away, no scar tissue as with tubes • Con-fluid comes back in a shorter amount of time (6-8 weeks) VS one year when tubes are in place • Adenoidectomy • Tonsillectomy • Allergies • What happens if the middle ear fluid is not ever removed?

12. Sensorineural hearing loss (damage to hair cells in cochlea) • Heredity (93% of children with hearing loss are born to parents with normal hearing) • Syndromes • Maternal illness (CMV, German Measles) • High fever “cooks” hair cells • Oxygen support • Noise induced (incubators, ipods) • Ototoxic drugs (any of the ‘myacins’) • Head trauma • Jaundice (unknown reason but statistic correlation) • Meningitis (ossification of cochlea)

13. Impact of hearing loss • Once an individual is diagnosed with a hearing loss, one must understand the interpretation of an audiogram. The “Xs” and “Os” plotted on the audiogram provide an indication of what the person can and cannot hear • The “degree” of hearing loss affects the individual’s ability to gain information auditorially • Each degree of hearing loss will most likely impact a student educationally

14. Degrees of hearing loss

15. Degrees of hearing loss-profound

16. Degrees of hearing loss-severe

17. Spelling test!!!! • Divide your paper into 3 columns. Label them column A, B, and C. • Listen carefully and write the words • www.successforkidswithhearingloss.com • How many did you get correct?

18. Degrees of hearing loss-moderate

19. Degrees of hearing loss-mild

20. Another spelling test!!! • This is what it sounds like to a student that has fluid in the ear • These are the kids not getting services • These kids have difficulty reading because they cannot pair the sound with the letter to which it corresponds

21. Brain and Language Acquisition • By the time a child with normal hearing is 5 or 6 years old, he/she will have acquired all of the linguistic structures they will need for a lifetime. • By the age of 5 or 6, the window for optimum language learning is closing.

22. Newborn Hearing Screening • Illinois • PA 91-0067 • Hearing Screening for Newborns Act • All hospitals performing deliveries in IL shall conduct hearing screening of all newborn infants prior to discharge • Effective December 31, 2002

23. Testing options • OAE-Otoacoustic Emissions • Probe in ear • If sound wave “comes back”, no concerns • If sound wave does not “come back”, further testing is needed • Only measures loss up to cochlea • ABR-Auditory Brainstem Response • If >6 months, child must be sedated • Clicks are presented • Brain activity is measured

24. Testing options…. • Tympanometry • Measures flexibility/mobility of ear drum • Behavioral Testing • Visual Response Audiometry • Conditioned Response Audiometry • ASSR • Like ABR, must be sedated during testing • NO SINGLE TEST CAN PROVIDE ALL THE INFORMATION TO DIAGNOSE!!!!!!!

25. What makes a child eligible? • 30% delay in one or more areas of development, based on adjustment age as measured by a global instrument or a domain specific instrument • 30dB or greater at any TWO of the following frequencies: 500, 1000, 2000, 4000 and 8000 hertz or 35 dB or greater loss at any ONE of the following frequencies: 500, 1000, and 2000 hz involving one or both ears • Informed clinical judgment

26. Deafness VS Hearing Impairment • 23 Illinois Administrative Code 226.75 (only 0-21yrs) • Deafness • A hearing impairment that is so severe as to impede the processing of linguistic information through hearing with or without amplification • Hearing Impairment • An impairment in hearing, whether permanent or fluctuating, that is not severe enough to constitute deafness

27. Functional Hearing Screening Tool • See back page “Functional Hearing Screening: In Depth Health History” • All these terms should look familiar and you are aware of its implications on development • Complete FHS: In Depth Health History • Complete Functional Hearing Screening: Development By Parent Report • Parent interview • observations

28. FHS (continued) • When observing a child/interviewing a parent ask: • Is the child aware of the sound? • Eyes widening, startling • Is the child locating the sound? • Head turn, crawl/walk toward source • Is the child discriminating the sound? • The child indicates “I know it was a voice and not the doorbell.” • Is the child recognizing the sound? • The child indicates, “That’s mom’s voice!” • Is the child comprehending the sound? • Child can follow the directions of “Get your coat because we are going to Grandma’s house.” • Remember that listening is a hierarchy! To be an effective listener to obtain language skills, all these “steps” must be mastered.

29. FHS (continued) • Meaningful production • Is this child not talking because he’s not hearing? • Is this child hearing but still not talking? • If the child is comprehending language but not using it, what could be some possible reasons?

30. FHS (continued) • Use familiar and unfamiliar sounds • Present toys in quiet environment • Present toys in noisy environment • Use visual distraction • Allow caregiver to observe response • Each child may respond differently • Provide varying volumes • Avoid visual and tactile cues • Record observations after consistency is noted

31. FHS (continued) • When do I begin referral process? • If there is a discrepancy between chronological age and what the child is ACTUALLY doing • If a child misses 1-2 per age range=okay • If a child misses more than 50% of the skills in the age range, then make note of it • If you are not trusting of your results, have the parent observe and report over next few weeks

32. Health History • Identify any “Red Flags” and make an appropriate referral • Each agency may have its own referral process • DCFS • Head Start • Schools • Refer to Early Intervention if < 3 yrs old • Refer to school if > 3 years old

33. Referral • Make referral to appropriate agency • Follow up on the process • “Hey, did you get a call from the service coordinator to move forward?” or “After the school nurse called home, did you get Johnny into the ENT?” • Provide the family with support • Assist as needed as the process moves forward

34. Material suggestions for screening • Drum, bell, clicker, other instruments • Blocks/shape sorter/bucket/stack of rings • Ling cards • Pictures of corresponding instruments as sound is presented • Sound level meter (measure background noise, measure dB level of your voice as it’s presented) • Dolls, furniture to screen comprehension • Other toys in their vocabulary for them to label, talk about, etc. to screen expressive language

35. Who’s who in the field • Audiologist • Otologist, Otolaryngologist, Otorhynolaryngologist (ENT) • Developmental Therapist-Hearing • Teacher of the Deaf and Hard of Hearing • Speech-Language Pathologist • Auditory Verbal Therapist

36. Remember…. • Let’s not let these kids slip through the cracks!! • Early detection of hearing concerns is essential!!!

37. Resources • Please contact any of us at Hearing and Vision Early Outreach Program • www.morgan.k12.il.us/isd/hvc • lmchesky11@gmail.com