Transcript Baby Sound Check

Provider
10 minute
Refresher Course
June 2009
Special Instructions
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● You may find it useful to refer to your
BSC Pocket Guide, Workbook and
other training materials as necessary
What is the recommended time frame
(in months) for newborns in terms of
screening, diagnosis/amplification and
early intervention?
● One, Three, Six
● Two, Four, Six
● One, Six, Twelve
Sorry!
That answer is incorrect!
Congratulations!
You are correct!
According to EDHI guidelines, the
recommended time frame for a
newborn is to be screened by 1 month,
diagnosed and fit with amplification by 3
months and enrolled in appropriate
early education by 6 months in order to
keep apace with hearing peers.
Periodic hearing screening in the
medical home is recommended to:
● Identify later onset hearing loss
● Identify progressive hearing loss
● Identify children who did not receive
a hearing screening at birth
● All of the above
Partially Correct!
That is one target goal of the BSC
program but it is not the only goal.
Please try again!
Congratulations!
You are correct!
The answer to this question is
ALL OF THE ABOVE
Because we need to catch children
that fit into all of these categories.
According to the NEW
periodicity intervals,
BSC should be conducted at:
● 2mos, 6mos, 12mos, 2 years & 3 years
● Every 6 months
● Annually
Sorry!
That answer is incorrect!
Congratulations!
You are correct!
The new protocol requires that BSC be
conducted at set intervals
corresponding to WCCs at 2m*, 6m,
12m, 2 yrs and 3 yrs.
*The 2 month BSC is necessary if the child is not
definitively known to have passed the newborn
hearing screen and does not have risk factors for
progressive hearing loss.
The three hearing screening procedures
used as part of BSC are:
● OAE, ABR and Acoustic Reflex
● OAE, Tympanometry and Acoustic
Reflex
● OAE, Tympanometry and ABR
Sorry!
That answer is incorrect!
The ABR (Auditory Brainstem Response) is not part of the BSC screening
protocol. Automated ABR (AABR or ABAER) is often used to screen the hearing
of newborns before they leave the NICU. Diagnostic ABR is frequently used by
pediatric audiologists as an evaluative tool to comprehensively define presence,
degree and type of hearing loss in infants, toddlers and young children. ABR
records the response of the auditory (VIIIth) nerve to an auditory signal such as
a click and a toneburst. ABR is used to determine cochlear sensitivity (degree
of loss) as well as neural integrity (auditory neuropathy or retrocochlear
pathology).
Congratulations!
You are correct!
FYI : The ABR (Auditory Brainstem Response) is not part of the
BSC screening protocol. Automated ABR (AABR or ABAER) is
often used to screen the hearing of newborns before they
leave the NICU. Diagnostic ABR is frequently used by
pediatric audiologists as an evaluative tool to
comprehensively define presence, degree and type of
hearing loss in infants, toddlers and young children. ABR
records the response of the auditory (VIIIth) nerve to an
auditory signal such as a click and a toneburst. ABR is used
to determine cochlear sensitivity (degree of loss) as well as
neural integrity (auditory neuropathy or retrocochlear
pathology).
The PRIMARY purpose of
Tympanometry is to:
● Determine whether there is cerumen
in the ear
● Determine whether a perforation is
present in the TM
● Rule out middle ear pathology
Sorry!
That is not the best answer!
It is rare for an ear to be completely
obstructed with wax. Even if there is a
tiny opening, it is usually possible to
conduct the tymp screening.
Sorry!
That is not the best answer!
Although tympanometry is very helpful
in determining the presence of a
patent PE tube or eardrum
perforation by showing a large ear
canal volume (ECV) measurement
(>1.0 in an infant or young child), this
is not the primary purpose of
tympanometry.
Congratulations!
You are correct!
Tympanometry is a very sensitive
measure of the presence of middle
ear fluid even when fluid cannot be
visualized through otoscopy.
The OAE screening is a test of
inner hair cell function
● True
● False
Sorry!
The otoacoustic emission is a test of
inner ear function, however the
‘echo’ is actually a product of the
motility of the outer hair cells as they
respond to a sound stimulus.
Congratulations!
You are correct!
The otoacoustic emission is a test of
inner ear function, however the
‘echo’ is actually a product of the
motility of the outer hair cells as they
respond to a sound stimulus.
An absent acoustic reflex could
result from:
● Auditory neuropathy
● A severe to profound sensorineural
(cochlear) hearing loss
● Middle ear or conductive pathology
● All of the above
Partially Correct!
True, but that is not the only answer. In
fact all of these conditions could result
in absence of the acoustic reflex.
Congratulations!
All of these can result in absence of the
acoustic reflex:
● In the case of Auditory Neuropathy, the VIIIth
nerve or synaptic junction between the nerve and
inner hair cells is impaired.
● In severe to profound sensory hearing loss, the
acoustic reflex is absent because sound cannot
be made loud enough to activate it.
● In middle ear dysfunction, the middle ear
pathology prohibits the measurement of the
acoustic reflex.
Careful study of reflex results IN CONJUNCTION WITH
OAE AND TYMPANOMETRY is crucial in making
appropriate screening referrals
In a patient less than 6 months
old, the BSC protocol calls for
● OAE and High Frequency
Tympanometry only
● OAE, High Frequency Tympanometry
and Acoustic Reflex
● OAE and Standard Tympanometry
only
Sorry!
The acoustic reflex is not reliable in
children 0-6 months of age.
Sorry!
Standard tympanometry cannot be
used in babies 0-6 months, due to the
extreme compliance of their ear
canal walls.
Congratulations!
You are correct!
In order to measure eardrum, rather
than ear canal compliance, a high
frequency probe tone (1000 Hz) MUST
be used in babies under 6 months of
age. If a 1000 Hz probe tone is not
used, middle ear effusion can be
missed.
From the list below check any conditions that
place an infant at risk for late onset, or
progressive hearing loss
● Family history of hearing loss
● In utero infection such as CMV
● NICU stay > 5 days
● Aminoglycoside treatment
● All of the above can result in
progressive hearing loss
Partially Correct!
That is one etiology of progressive or
late onset hearing loss in young
children.
Please try again!
Congratulations!
All of these are risk factors for
progressive or late onset hearing loss.
According to BSC protocol, what action is
recommended for a patient with the following results
during their first BSC screening:
Refer OAE, Refer Tymp, Absent Reflexes?
STAT referral
to JTC Audiology
Rescreen in 3
months
ENT &Audiology
referral
Sorry!
This combination of results (OAE refer and
flat tympanogram) is typical of middle ear
disorder. It is best to initially follow this child
medically for recovery from middle ear
disorder before requiring a full hearing test.
ENT and Audiology referrals would not be
indicated until the 2nd failed BSC.
Congratulations!
According to BSC protocol, rescreening in 3
months is recommended, in order to allow
sufficient time for the middle ear pathology
to resolve.
NICU babies who fail the California
Newborn Hearing Screening require
ABR follow up at a certified outpatient
infant hearing screening facility.
● True
● False
Sorry!
According to California State
guidelines, all NICU hearing screening
fails must receive follow up ABR
testing at a certified outpatient infant
hearing screening facility,
superseding any BSC screening they
receive.
Congratulations!
You are correct!
It is important that BSC does not
interfere with the established statemandated procedures.
What action is recommended for a patient
with the following results:
OAE refer, Tymp Pass, reflex refer?
● STAT referral to JTC Audiology
● ENT referral
● Rescreen in 3 months
Sorry!
This combination of results (OAE refer and
normal tympanogram) suggests a
permanent sensory deficit.
An immediate referral to audiology is
recommended.
Congratulations!
According to BSC protocol, an OAE refer and absent reflexes in
the presence of a normal tympanogram would warrant
immediate referral to audiology. This combination of results is
strongly indicative of a permanent sensory (cochlear) deficit.
How would you interpret this
tympanogram?
•Pass
•Refer
•Incomplete
Sorry!
The compliance is less than 0.2ml, so
this tymp is a refer, even though you
can still see a small peak. Shallow
tympanograms such as this are
usually associated with the presence
of middle ear fluid.
Congratulations!
You are correct! Even though the
gradient is within normal limits (less
than 250daPa), the compliance is less
than the 0.2ml cut-off. Shallow
tympanograms such as this are
usually associated with middle ear
fluid.
How would you interpret this
acoustic reflex screening?
Present
Absent
Incomplete
Sorry!
That answer is incorrect!
Congratulations!
You are correct!
The deflections on the print out are
simply a result of the baby’s
movement or crying.
This test should be redone.
What would you
recommend?
Return for
Routine BSC
Additional BSC
Tymp and
reflex testing
AGE 2
Refer for audio
and speech
Sorry!
The BSC protocol calls for additional
screening, since there are Risk Factors
checked on the BSC questionnaire.
Congratulations!
You are correct!
The risk factors checked on the BSC
questionnaire indicate the need for
further tympanometry and acoustic
reflex testing.
How would you interpret this
tympanogram?
•Pass
•Refer
•Incomplete
Sorry!
The gradient is greater than 250daPa,
so this tymp is actually a refer, even
though you can still see a small peak.
Wide tympanograms such as this are
usually associated with middle ear
fluid.
Congratulations!
You are correct! Even though the
compliance is within normal limits the
gradient is greater than the 250daPa
cut-off.
Wide tympanograms such as this are
usually associated with middle ear
fluid.
How would you interpret this Reflex
tracing?
•Present
•Absent
•Incomplete
Sorry!
That answer is incorrect!
Congratulations!
You are correct!
How would you interpret this Reflex
tracing?
•Present
•Absent
•Incomplete
Sorry!
That answer is incorrect!
The deflections
circled are the
response. The initial
spikes are artifact
Congratulations!
You are correct!
The deflections
circled are the
response. The
initial spikes are
artifact
What would you do with this
tympanogram?
Pass
Refer
Incomplete/Retest
Sorry!
Although the gradient and compliance
readings are within normal limits, this
tymp needs to be redone.
The ‘blip’ on the otherwise flat tymp is
confusing the issue, and is where
those ‘normal’ numbers are derived
from.
Congratulations!
You are correct! Even though the
compliance and gradient appear
within normal limits the tympanogram
is essentially flat, with just a ‘blip’
derived from the baby swallowing or
moving.
Thank You
for your participation in the
Baby Sound Check® Program
Congratulations!
You have successfully completed the
BSC refresher course!
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notifying BSC staff of your course
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