Hearing Screening for Health Assistants

1. Hearing Screening for Health Assistants Charlotte Branch-Briggs, BSN, RN NMDOH NE Region School Health Advocate 505-476-2714 charlotte.branchbri@state.nm.us

2. pain in ear(s) ringing / buzzing discharge from ear(s) dizziness inability to hear certain tones straining to hear conversation favoring one ear lack of response to nearby sounds need for loud volume on TV/radio inability to hear with background noise Symptoms of Hearing Loss3 to 6% of children have significant hearing problems. Early detection can prevent problems in speech, social and educational development (SHM III, pp 20-31)

3. Equipment– Pure Tone Audiometers • Sensitive electronic equipment, which must be calibrated annually to ANSI standards • Do not drop or handle roughly • Protect from extreme temperatures and humidity and dust (below 40, above 100) • Store off the floor with protective cover in place • Never eat, drink or smoke near the audiometer • Store only the earphones & cords in the storage compartment • Do not turn on and off if doing multiple screenings in one day.

4. Audiometers

5. Care of Earphones • Do not drop earphones • Protect the diaphragm from vacuum, sharp objects and liquids • Check for splits on cushions, broken wires, that they are plugged in correctly • Do not twist, wrap or knot the cords • Earphones are unique to each audiometer and may not be exchanged

6. Loudness and Pitch • Loudness of sound is measured in DECIBLES (dB) • Pitch or Tone is measured in HERTZ (Hz) • High or Low Sound

7. Types of Hearing Screening 1000 Hz 2000 Hz 4000 Hz Sweep Test Students are tested at 20 dB for frequencies • 1000 Hz • 2000Hz • 4000Hz At 20 dB

8. Types of Hearing Screenings (cont.) Threshold Test • Test the student for the same frequencies, but determine which is the lowest intensity at which the tone can be heard and record this number.

9. Fitting Earphones to Student • Earphones need to be placed on completely bare ears. Red goes on right ear. • Move hair out of the way, remove glasses • Remove earrings and combs/ ribbons which may prevent a good “seal”. • No chewing gum • Adjust the headband to fit snuggly over the head.

10. Recommended Hearing Screening Grade Levels • Pre - Kindergarten • Kindergarten • 1st grade • 3rd grade • 8th grade • New students to your district • Parent or teacher request

11. Preparing Young Children • Before hearing screening is done with pre-K or Kindergarten students, take the audiometer into the classroom and practice with the group. • Turn headphones outward toward the class sitting in a circle around you. • Set intensity at 90 dB or above, tone at 2000 Hz. • Explain to the class that they will hear a sound. When they hear the sound, raise hand. When the sound stops, lower hand. • Repeat several times with different frequencies until all the students grasp the concept.

12. Hearing Screening Procedures • Check your equipment before you start. All switches are in the correct position. No broken wires, faulty connections, plugs are plugged in. • Listen to all the frequencies yourself to be sure there are no extraneous sounds, ambient noises. • Seat one child at a time in front of you, either facing toward you or away from you. Position headphones.

13. Hearing Screening Procedures (cont.) • Avoid obvious clues: Looking up at the student, Reflections in mirrors/ windows/ eye glasses, Movements that give away tone presentation, presenting tones rhythmically • Remind student to raise his/her hand when the tone is heard. Present the tones 2-5 seconds each, right ear first, beginning with 1000 Hz, then 2000 Hz, 4000 Hz. Repeat with left ear.

14. Precautions • Do not let the student watch you operate the audiometer’s presentation controls. • Do not look at the child when the tone is presented (use peripheral vision to observe response). • Do not present the tone when there is a noise which you suspect would interfere with hearing. • Do not give any clues as to when the tone is presented: control head, eye, arm or other body movements, reflections, rhythms, shadows, etc.

15. Recording and Referral • Record the results on the student’s Health Record. • Report any failures to your school nurse– follow your districts protocols • Wait 3-4 weeks between sweep tests in case of allergies, colds, etc. • Use a referral form such as is found in SHM

17. Types of Hearing Loss Three types of hearing loss: • Conductive affects outer and / or middle ear -Most common causes: Otitis media -Correctable with treatment or surgery • Sensorineural affects the inner ear or auditory nerve -This generally cannot be corrected with surgery or medical treatment • Mixed Affects the outer/middle ear as well as the inner ear and includes significant conductive and sensorineural components. -It can be any combination of the two previous hearing losses. -The conductive portion of a mixed hearing loss can usually be corrected, but the sensorineural component is seldom reversible. **Note: Otitis media is single-most frequent cause of hearing loss in young children

18. Hearing Conservation • OSHA suggests the following safety limits of noise exposure: Noise Level Exposure Limit 90 dB 8 hours 95 dB 4 hours 100 dB 2 hours 105 dB 1 hour 110 dB 30 minutes So what pattern do you see here?

19. Suggestions for Hearing Conservation • When around harmful noises, wear hearing protection, earplugs/ earmuffs • Seek medical attention for symptoms (ringing in ears, pain, dizziness, headaches) • Do presentation on hearing conservation to classes • Recommend earplugs to band students, especially percussion section • Caution teenagers about setting the Walkman listening levels too loud (yeah, right!!)

20. Hearing Aids and Assisting Students • See NMSHM • See also NASN publication, The Ear and Hearing, p 23 • Do not screen students with hearing aids • For an Individualized Health Care Plan, NASN p 24 (be sure all students with hearing loss have an IHP) • For screening the young child and developmentally delayed, NASN p 25

21. Questions?