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

2. ASHA 1997 HEARING SCREENING GUIDELINES 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

3. 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.

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

5. 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

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

7. 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

8. 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.

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

10. 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

11. ASHA 1997 HEARING SCREENING GUIDELINES 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.

12. 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.

13. 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

14. 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.

15. 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.

16. 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.

17. 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

18. 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.

19. 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.

20. 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

21. 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.

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

23. ASHA 1997 HEARING SCREENING GUIDELINES 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.

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

25. 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

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

27. 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.