ASHA Guidelines for Hearing Screening - Children

1. ASHA Guidelines for Hearing Screening - Children 1997 ASHA 1997 HEARING SCREENING GUIDELINES

2. Topics • Disorder, impairment & disability • Purpose, personnel, and permission • Guidelines for screening impairment • Middle ear disorders • Birth through six months • Seven months through two years • Two years through five years • Five years through 18 years • Guidelines for screening disability - Birth through 18 years ASHA 1997 HEARING SCREENING GUIDELINES

3. Disorder, Impairment and Disability • Disorder: (see p. 8) • any anatomic abnormality or pathology • Impairment: • loss or abnormality of psychological or physiological function • Disability: • restriction or lack of ability due to an impairment • Handicap: • The extent to which the impairment or disability interferes with communication. ASHA 1997 HEARING SCREENING GUIDELINES

4. Purpose, personnel & permission • Purpose is to identify hearing loss in children that might affect . . . • Health development • Communication • Education ASHA 1997 HEARING SCREENING GUIDELINES

5. Purpose, personnel & permission • Personnel • Screening program should be supervised by ASHA certified audiologist • Personnel should have expertise and training depending on age and test procedure. • SLPs may screen ages 3-5, 5-18, and for disability ASHA 1997 HEARING SCREENING GUIDELINES

6. Purpose, personnel & permission • Permission • Informed consent • State and institutional regulations supercede informed consent. ASHA 1997 HEARING SCREENING GUIDELINES

7. Guidelines for outer & middle ear impairment • Expected outcomes (purpose) • Health & developmental problems related to ME & OE impairment • Chronic or recurrent otitis media ASHA 1997 HEARING SCREENING GUIDELINES

8. Guidelines for outer & middle ear impairment • Clinical Indications (who should be tested) • High risk groups for OE & ME impairment • See p. 16 of guidelines for specifics • All students to an educational setting six and younger should be screened. Mass screening of children seven and older not recommended. • See section III.C.1. (p.16) • Children under care of physician for for middle ear disorders may be excluded. ASHA 1997 HEARING SCREENING GUIDELINES

9. Guidelines for outer & middle ear impairment • Equipment • Otoscope • Acoustic immittance meter (i.e., tympanometer) ASHA 1997 HEARING SCREENING GUIDELINES

10. Guidelines for outer & middle ear impairment • Obtain case history if possible • Visually inspect ears to… • Determine if risk factors exist for diseases of outer or middle ear. • Determine if tympanometry can be performed ASHA 1997 HEARING SCREENING GUIDELINES

11. Guidelines for outer & middle ear impairment • Pass / Refer Criteria. • Refer to physician if … • Drainage • Visual identification of unreported structural defect • Ear canal abnormalities • Suspected perforation based on tymp. • Retest of abnormal tympanometry is still aberrant. ASHA 1997 HEARING SCREENING GUIDELINES

12. Guidelines for outer & middle ear impairment • Pass / Refer Criteria. • Refer for rescreening if … • Static immittance < 0.03 mmhos, or • Tympanic width > 200 daPa • Referral criteria may be modified to meet needs of program. • Note: rescreening occurs four to six weeks after initial screening. ASHA 1997 HEARING SCREENING GUIDELINES

13. Guidelines for outer & middle ear impairment • Inappropriate Procedures • Use of pure tone screening to identify OE or ME disorders • Otoscopic exam alone • Reflectometry • Tympanometric peak pressure (aka middle ear pressure) • Acoustic Reflexes • OAEs ASHA 1997 HEARING SCREENING GUIDELINES

14. You are not responsible for the sections on … • Birth through six months. • Seven months through two years • These two sections are found on pages 23 through 34. ASHA 1997 HEARING SCREENING GUIDELINES

15. Three to Five Years • Equipment / Environment • For all pure tone screening including 3 to 5, and 5 to 18 you should use an ANSI certified audiometer which has been calibrated within the past year. • Environment should be sufficiently quiet. See page 40 for exact noise levels • Audiometer should be checked prior to testing. ASHA 1997 HEARING SCREENING GUIDELINES

16. Three to Five Years • Expected outcomes (purpose) • Identification of preschool children at risk for hearing impairment that may affect communication and development. ASHA 1997 HEARING SCREENING GUIDELINES

17. Three to Five Years • Clinical indications (who is screened?) • Screened as needed, requested or mandated. • Screen if at risk for hearing impairment • See bottom of p. 35 and top of p. 36 for specifics. • This includes speech/language delays ASHA 1997 HEARING SCREENING GUIDELINES

18. Three to Five Years • Clinical Process • If child can perform conventional or CPA screen under earphones at … • 1, 2 and 4 kHz • 20 dB • Minimum of two presentations at each frequency to assure reliability. ASHA 1997 HEARING SCREENING GUIDELINES

19. Three to Five Years • Pass / Refer Criteria • Pass • 2 of 3 responses at each frequency for both ears. • Refer • Misses 2 of 3 presentations for any frequency in any ear. • Can not condition to task. ASHA 1997 HEARING SCREENING GUIDELINES

20. Three to Five Years • Alternate test procedures. • May screen in sound field if unwilling to wear earphones • If unable to test using CPA or conventional audiometry you may test using VRA ASHA 1997 HEARING SCREENING GUIDELINES

21. Three to Five Years • Followup • If failure is because of conditioning. • Infant toddler procedures (e.g., VRA) or audiological assessment • Audiological assessment if problem is not due to conditioning. • Confirm results 1 to 3 months following initial test. ASHA 1997 HEARING SCREENING GUIDELINES

22. Five through 18 Years • Expected outcomes (purpose) • Identification of children at risk for … • Education • Health • Development • Communication ASHA 1997 HEARING SCREENING GUIDELINES

23. Five through 18 Years • Clinical Indications (who?) • Children on initial entry to school • K-3, 7th and 11th grades • Entrance to special ed. • Grade repetition • New to school system • Absence of previous screening • Other risk factors (p. 39, III.C.) • Those under audiological management need not be screened. ASHA 1997 HEARING SCREENING GUIDELINES

24. Five through 18 Years • Clinical Process • CPA or conventional audiometry • 1, 2, 4 kHz at 20 dB HL ASHA 1997 HEARING SCREENING GUIDELINES

25. Five through 18 Years • Pass / Refer Criteria • Pass • Must pass each frequency in each ear • If they do not pass, reinstruct and rescreen immediately • Pass if they pass the rescreening. • Refer • Failure of rescreening or who have conditioning problems. • Refer to audiologist for audiological evaluation ASHA 1997 HEARING SCREENING GUIDELINES

26. Five through 18 years • Followup • Same as 3 to 5 years ASHA 1997 HEARING SCREENING GUIDELINES

27. Screening for disability (birth through 18 years) • Very general • Usually scales used to determine communication function. • See p. 43 (IV.B.) • Often speech & language screening tests • Except for the concept of disabilit,y I probably won’t ask you specific question on exam for this section. ASHA 1997 HEARING SCREENING GUIDELINES