Transcript PowerPoint Presentation - ASHA Guidelines for Hearing Screening

ASHA Guidelines for Hearing
Screening - Children
1997
ASHA 1997 HEARING SCREENING
GUIDELINES
Topics
• Disorder, impairment & disability
• Purpose, personnel, and permission
• Guidelines for screening impairment
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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
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
Purpose, personnel & permission
• Purpose is to identify hearing loss in
children that might affect . . .
– Health development
– Communication
– Education
ASHA 1997 HEARING SCREENING
GUIDELINES
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
Purpose, personnel & permission
• Permission
– Informed consent
– State and institutional regulations supercede
informed consent.
ASHA 1997 HEARING SCREENING
GUIDELINES
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
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
Guidelines for outer & middle
ear impairment
• Equipment
– Otoscope
– Acoustic immittance meter (i.e., tympanometer)
ASHA 1997 HEARING SCREENING
GUIDELINES
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
Guidelines for outer & middle
ear impairment
• Pass / Refer Criteria.
– Refer to physician if …
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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
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
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
• 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
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
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
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
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
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
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
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
Five through 18 Years
• Expected outcomes (purpose)
– Identification of children at risk for …
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Education
Health
Development
Communication
ASHA 1997 HEARING SCREENING
GUIDELINES
Five through 18 Years
• Clinical Indications (who?)
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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
Five through 18 Years
• Clinical Process
– CPA or conventional audiometry
– 1, 2, 4 kHz at 20 dB HL
ASHA 1997 HEARING SCREENING
GUIDELINES
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
Five through 18 years
• Followup
– Same as 3 to 5 years
ASHA 1997 HEARING SCREENING
GUIDELINES
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