Transcript Hearing Screening - New Mexico School Health Manual

Hearing Screening for
Health Assistants
Charlotte Branch-Briggs, BSN, RN
NMDOH NE Region
School Health Advocate
505-476-2714
[email protected]
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Symptoms of Hearing Loss
3 to 6% of children have significant hearing problems. Early
detection can prevent problems in speech, social and educational
development
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pain in ear(s)
ringing / buzzing
discharge from ear(s)
dizziness
inability to hear certain
tones
straining to hear
conversation
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favoring one ear
lack of response to nearby
sounds
need for loud volume on
TV/radio
inability to hear with
background noise
(SHM III, pp 20-31)
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Equipment– Pure Tone Audiometers
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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.
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Audiometers
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Care of Earphones
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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
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Loudness and Pitch
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Loudness of sound is measured in
DECIBLES (dB)
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Pitch or Tone is measured in HERTZ (Hz)
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High or Low Sound
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Types of Hearing Screening
Sweep Test
Students are tested at
20 dB for frequencies
 1000 Hz
 2000Hz
 4000Hz
1000 Hz
2000 Hz
4000 Hz
At
20
dB
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Types of Hearing Screenings (cont.)
Threshold Test
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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.
Date Screened:_______1/31/2010_________________________
500 Hz
LEFT
RIGHT
1000 Hz
2000 Hz
4000 Hz
30 30 35 P
P
P
P
P
Date Screened:_______3/1/2010__________________
6000 Hz
500 Hz
1000 Hz
2000 Hz
4000 Hz
6000 Hz
DNT
LEFT
35 30 40 30
DNT
P
RIGHT
P
P
P
P
P
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Fitting Earphones to Student
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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.
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Recommended Hearing Screening Grade
Levels
Pre - Kindergarten
 Kindergarten
 1st grade
 3rd grade
 8th grade
 New students to your district
 Parent or teacher request
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Preparing Young Children
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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.
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Hearing Screening Procedures
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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.
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Hearing Screening Procedures (cont.)
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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.
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Precautions
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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.
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Recording and Referral
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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
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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
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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?
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Suggestions for Hearing Conservation
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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!!)
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Hearing Aids and Assisting Students
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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
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Questions?
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