Transcript Audiological+Assessment+and+Support - 08FACEP802C

Audiological Assessment
and Support
Linda K. Wright, AuD
Doctor of Audiology
Joint Committee on Infant Hearing
American Academy of Pediatrics – Joint
Committee on Infant Hearing
www.pediatrics.org -- then type in the
search area “Joint Committee on Infant
Hearing 2007”
http://www.jcih.org/posstatemts.htm
Updated document in October 2007
Clarifications made in February 2008
Definitions for familiarity
JCIH – Joint Committee on Infant Hearing
EHDI – Early Hearing Detection and
Intervention (re-authorization of act)
OAE – Otoacoustic Emissions
ABR – Auditory Brainstem Response
AN/AD – Auditory Neuropathy or Auditory
Dyssynchrony
JCHI looking for…
Definition of hearing losses they are
looking to identify include:
Congenital permanent bilateral, unilateral
sensory, or permanent conductive hearing loss,
neural hearing loss
Screening and Re-screening protocols
 Separate protocols for NICU and well-baby nursery
 NICU for more than 5 day admission have to undergo
automated auditory brainstem response screening
(cannot be screened and passed by OAE’s alone),
looking for all types of hearing loss – including neural
 NICU regardless of length of stay – any infant with
hyperbilirubinemia requiring exchange transfusion must
undergo screening by automated auditory brainstem
response
 NICU Infants that do not pass ABR screening, referral
direct to Audiologist for re-screen of both ears (even if
only one ear failed) and when indicated a
comprehensive diagnostic eval including ABR
Screening and Re-screening protocols,
continued…
 For infants re-admitted in the first month of life
(NICU or well baby) where the readmission is
associated with a potential risk for HL – repeat
screening before they are discharged
 All infants should receive a physiologic hearing
screening by 1 month of age (NICU’s, well-baby,
discharged before screening, transferred to
another hospital, born outside a hospital,
equipment failure)
 Most re-screenings performed at the hospital of
birth or place that physician makes a referral to
Audiology Diagnostics
 Auds with pediatric experience
 Infants who fail re-screen should receive diagnostic
testing by 3 months of age, and have at least 1 ABR
(children under 3) to confirm permanent loss
 ABR should use frequency specific tone burst stimuli by
air and bone (when indicated) to determine degree and
configuration of HL
 ABR should include click stimuli using both condensation
and rarefaction polarity to help identify neural HL
(AN/AD)
 should use 1000 Hz probe tone tympanometry (younger
infants), DP or TE OAE’s, case history, observations of
the child
Audiology Diagnostics, continued…
 Re-evals needed for those that pass the re-screen are to be determined on
an individualized basis taking into consideration things such as
 risks of delayed on-set
 environmental exposures
 any infant with even one risk factor should receive diagnostic hearing test by 24
– 30 months of age – or more frequent as determined by family, physician, etc…
 case history
 observations and behaviors of the child
Re-evals for those that pass re-screen, but it is determined they
need more additional testing…could/should include:
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Tympanometry
OAE’s
reflex’s
behavioral pure tone testing
could also include ABR if behavioral testing is unreliable or if ABR has never
been performed in the past
Audiology and Educational
follow-up
 Infants diagnosed with permanent HL (and the
family is pursing amplification) should be fit
within one month of the diagnosis
 Any child with any degree of HL (one or two
ears) should be considered eligible for early
intervention services and receive services as
soon as possible (or by 6 months of age)
 Intervention services should be provided by
professions with experience in HL (educations
for deaf/HH, Auds, SLP’s)
 Both home based and center-based options
should be available for educational follow-up
Medical Home = Primary Care Physician
for the child
 Regular monitoring of developmental
milestones, parent concerns, middle ear status,
etc…
 Children who do not pass speech/language
milestone assessments should be referred by
medical home to SLP and Auds
 Every infant with confirmed HL needs to be
referred for medical evaluation, preferably to an
ENT – cultures of blood/urine, CT scans, MRI’s,
physical examination, referral for genetics
testing (may be referred by diagnostic Aud)
Communication of screening results, diagnostic results,
referrals, etc…
Birth hospital with EHDI coordinator
should tell parents and medical home the
infant hearing screening results
Provide parents with follow-up info,
resources
Communicate in culturally sensitive means
All screenings, re-screening and
diagnostic follow-ups communicated to
medical home and EHDI coordinator
Communication of screening results, diagnostic results,
referrals, etc…
State EHDI programs have to report to
federal entities. State EHDI programs rely
on birthing hospital to provide inpatient
screening results (as with other tests that
are run on newborns), rely on Auds to
indicate re-screen results, rely on Auds to
indicate diagnostic results, rely on early
interventionists to indicate enrollment,
etc…
Support of the Family and Child
Families need to be aware of all
communication options for their child, in a
non-biased manner
All states should have a way to track the
results
Support groups for parents - Hands and
Voices National, MI H&V, AG Bell, Hearing
Loss Association of America with state and
local chapters
State of MI EHDI
 MI EHDI releases quarterly data on all births in MI,
results of hearing screenings, follow-up reports on
newborns re-screened and that receive diagnostic evals
 MI has 100% of its hospitals screening newborns for
hearing (voluntarily)
 Not all MI hospitals have the same screening equipment
(OAE’s vs. ABR’s)
 Initial screenings are performed by nurses trained in the
screening procedure
 Re-screens may or may not be performed by an
Audiologist
State of MI EHDI
 Currently the state of MI does NOT reimburse
hospitals for performing this screening, they do it
voluntarily. This is why we, and other states,
need to abide by guidelines, report/track results,
show improvement, show enrollment in early
intervention services…
 Consider supporting the re-authorization of the
EHDI act (see info from Karl White provided on
wikispaces under this weeks topic)
Stats
 At the time of the 2000 JCIH statement: 38% of infants
screened annually in the US. In 2007 – 95% of US
infants are screened annually!
 Several studies indicate variance in the prevalence of
newborns with congenital hearing loss in the United
States. The overall estimates are between 1 to 6 per
1,000 newborns. Most children with congenital hearing
loss have hearing impairment at birth and are potentially
identifiable by newborn and infant hearing screening.
However, some congenital hearing loss may not become
evident until later in childhood.
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Kemper, A.R., & Downs, S.M. (2000, May). A cost-effectiveness analysis of newborn hearing screening strategies.
Archives of Pediatric and Adolescent Medicine, 154(5): 484-488.
Cunningham, M., & Cox, E.O. (2003, February). Hearing assessment in infants and children: Recommendations
beyond neonatal screening. Pediatrics, 111(2): 436-440.
Task Force on Newborn and Infant Hearing. (1999, February). Newborn and infant hearing loss: Detection and
.
intervention. Pediatrics, 103(2): 527-530
Stats
Profound, early-onset deafness is present
in 4-11 per 10,000 children, and is
attributable to genetic causes in at least
50% of cases.

Marazita, M.L., et. al. (1993, June 15). Genetic epidemiological studies of early-onset deafness in the U.S. school-age population.
American Journal of Medical Genetics, 46(5): 486-491.
Unpublished Doctoral Project Work
 CMU student in Doctor of Audiology Program
Doctoral Project on Newborn Hearing Follow-up
Testing
 Surveyed 38 sites that were indicated by the
EHDI program as approved sites for follow-up
diagnostic hearing testing
 States – 6 - MI, 20 - OH, and 12 –IL
 A few bits of data could not be counted – so #’s
may not all add up, but just want to show some
overall positives and negatives
Positives from the
Doc project survey
 Majority of sites tested both ears – even if only one ear failed
 Majority of sites use DPOAE’s as part of their diagnostic test battery
 Majority of sites that perform tympanometry as part of the test
battery use the 1000 Hz probe tone (others use 226 or 660 Hz)
 Majority of sites also distribute pediatric hearing aids (if needed for
the family/child)
 Majority of sites fit amplification by 6 months of age (remember
newer JCIH recommends amplification fit (if desired by parent) by 1
month after diagnosis
 Majority of sites use a frequency of re-evals “every 3 months”
 Majority of sites indicate they discuss and offer other assistive
listening devices
 Majority of sites indicate they contact the physician with results
 Majority of sites indicate they notify state EHDI of the results
Negatives from the
Doc project survey
 Fifteen sites do NOT perform tympanograms as part of their battery
 A few sites indicated they do NOT have ABR equipment – yet they
were listed by the state EHDI as being an approved site for
diagnostic evaluations
 Most sites do NOT perform the frequency specific tone bursts (500 –
4000 Hz) as recommended in the 2007 statement – Most sites just
perform click stimuli
 Twelve sites indicate they do NOT perform the switch in signal
polarity to evaluate for AN/AD
 Not all sites reported they notify their state EHDI or the infants
physician
 About half of sites do NOT mention possibility of genetics testing
 About half of sites have fit children within one month of the
diagnosed hearing loss
Resources
www.mihandsandvoices.org
www.handsandvoice.org