1. Functional Hearing Screening
Laura Chesky
Hearing and Vision Early Intervention Outreach Consultant
Hearing Itinerant in Plainfield Schools District #202
Developmental Therapist-Hearing
Developmental Therapist-Hearing Evaluator

2. 10 volunteers!!!!
We are going to “make” an ear!

3. How Do We Hear?

4. Types of Hearing Loss
*Conductive *ear wax/impacted cerumen *atresia *foreign objects *microtia *otitis media *ossicle fixation *otosclerosis *otitis externa *collapsed ear canal *perforated ear drum *fluid in middle ear

5. Conductive hearing losses
Usually can be treated medically
Dr. can “dig out” ear wax
Ear drum can grow back (but will be less flexible)
A skin graft can be done on the ear drum
A prosthetic device can be put in place for the fixated ossicles
Pressure equalization tubes can be put in place

6. Other types of hearing loss
Mixed- problem can be any TWO parts of the hearing mechanism
Sensori-problem lies in the cochlea, hair cells affected (everything else works)
Enlarged Vestibular Acquaduct Syndrom
Neural-Problem lies at the auditory nerve (everything else works)
Auditory Neuropathy/Dysynchrony
Cortical-problem lies in the brain (everything else works up to the brain)
*Central Auditory Processing Disorder

7. Otitis media Occurs when the Eustachian tube cannot drain
Common in children because their necks are not yet elongated. Bacteria gets caught in the tube due to the dark, wet, warm conditions then causes infection
Why do children appear to “outgrow” ear infections?

8. If there are chronic ear infections then…..
Pressure equalization tubes may be put in place
Surgically inserted (“myrangotomy”)
Tubes are inserted, middle ear fluid flows out
After tubes, they are “cured”, right?
Not necessarily! Why not?

9. Think about it…..
Every time a child gets PE tubes inserted, what happens to the ear drum? All that time there was blockage, what have they missed?
How much language have they NOT heard (-ed means past tense, /s/ means plural, -ing means present tense, have they heard those function words such as ‘a’, ‘an’, ‘of’)?
How many speech sounds have they NOT heard?
How distorted have sounds been perceived by the individual?

10. Did you know….
1/3 of kids under age 10 have fluid in the ear at any given time?
Doctors may say, “Well, if they don’t have x amount of infections per year, then we won’t put tubes in.”
What happens to these kids with chronic otitis media?
Doctors will continue to give antibiotics.
*pros/cons?

11. Necessary discussions
At what point should PE tubes be discussed? If a child cannot be under anesthesia, what are the options?
Otolam-procedure to drain fluid
Pro-the fluid goes away, no scar tissue as with tubes
Con-fluid comes back in a shorter amount of time (6-8 weeks) VS one year when tubes are in place
Adenoidectomy
Tonsillectomy
Allergies
What happens if the middle ear fluid is not ever removed?

12. Sensorineural hearing loss (damage to hair cells in cochlea)
Heredity (93% of children with hearing loss are born to parents with normal hearing)
Syndromes
Maternal illness (CMV, German Measles)
High fever “cooks” hair cells
Oxygen support
Noise induced (incubators, ipods)
Ototoxic drugs (any of the ‘myacins’)
Head trauma
Jaundice (unknown reason but statistic correlation)
Meningitis (ossification of cochlea)

13. Impact of hearing loss
Once an individual is diagnosed with a hearing loss, one must understand the interpretation of an audiogram. The “Xs” and “Os” plotted on the audiogram provide an indication of what the person can and cannot hear
The “degree” of hearing loss affects the individual’s ability to gain information auditorially
Each degree of hearing loss will most likely impact a student educationally

14. Degrees of hearing loss
Sound is measured in volume (how loud or soft a sound is) and pitch (how low or high a sound is). Hearing loss is rarely straight across and doesn’t necessarily have to be the same in both ears.

15. Degrees of hearing loss-profound
Shade in from 90 and below. This is a profound hearing loss. These kids (before the Newborn Hearing Screening) were not diagnosed until about 1.5 yrs old.

16. Degrees of hearing loss-severe
Shade in 70 dB to 90 dB. Prior to Newborn Hearing Screening, these kids were not diagnosed until age 2. They will not hear speech at a conversational level.

17. Spelling test!!!!
Divide your paper into 3 columns. Label them column A, B, and C.
Listen carefully and write the words
How many did you get correct?

18. Degrees of hearing loss-moderate
Shade in 40 dB down to 70 dB. Prior to Newborn Screening, these kids were not diagnosed until age Why?

19. Degrees of hearing loss-mild
Shade in 20 dB down to 40 dB. Prior to Newborn Hearing Screening, these kids were undetected until age 6. Why was it noticed at age 6 and not earlier? These are the kids that are not getting services. A mild hearing loss can STILL impact education.

20. Another spelling test!!!
This is what it sounds like to a student that has fluid in the ear
These are the kids not getting services
These kids have difficulty reading because they cannot pair the sound with the letter to which it corresponds

21. Brain and Language Acquisition
By the time a child with normal hearing is 5 or 6 years old, he/she will have acquired all of the linguistic structures they will need for a lifetime.
By the age of 5 or 6, the window for optimum language learning is closing.

22. Newborn Hearing Screening
Illinois PA
Hearing Screening for Newborns Act
All hospitals performing deliveries in IL shall conduct hearing screening of all newborn infants prior to discharge
Effective December 31, 2002

23. Testing options OAE-Otoacoustic Emissions
Probe in ear
If sound wave “comes back”, no concerns
If sound wave does not “come back”, further testing is needed
Only measures loss up to cochlea
ABR-Auditory Brainstem Response
If >6 months, child must be sedated
Clicks are presented
Brain activity is measured

24. Testing options…. Tympanometry Behavioral Testing ASSR
Measures flexibility/mobility of ear drum
Behavioral Testing
Visual Response Audiometry
Conditioned Response Audiometry
ASSR
Like ABR, must be sedated during testing
NO SINGLE TEST CAN PROVIDE ALL THE INFORMATION TO DIAGNOSE!!!!!!!

25. What makes a child eligible?
30% delay in one or more areas of development, based on adjustment age as measured by a global instrument or a domain specific instrument
30dB or greater at any TWO of the following frequencies: 500, 1000, 2000, 4000 and hertz or 35 dB or greater loss at any ONE of the following frequencies: 500, 1000, and 2000 hz involving one or both ears
Informed clinical judgment

26. Deafness VS Hearing Impairment
23 Illinois Administrative Code (only 0-21yrs)
Deafness
A hearing impairment that is so severe as to impede the processing of linguistic information through hearing with or without amplification
Hearing Impairment
An impairment in hearing, whether permanent or fluctuating, that is not severe enough to constitute deafness

27. Functional Hearing Screening Tool
See back page “Functional Hearing Screening: In Depth Health History”
All these terms should look familiar and you are aware of its implications on development
Complete FHS: In Depth Health History
Complete Functional Hearing Screening: Development By Parent Report
Parent interview
observations

28. FHS (continued) When observing a child/interviewing a parent ask:
Is the child aware of the sound?
Eyes widening, startling
Is the child locating the sound?
Head turn, crawl/walk toward source
Is the child discriminating the sound?
The child indicates “I know it was a voice and not the doorbell.”
Is the child recognizing the sound?
The child indicates, “That’s mom’s voice!”
Is the child comprehending the sound?
Child can follow the directions of “Get your coat because we are going to Grandma’s house.”
Remember that listening is a hierarchy! To be an effective listener to obtain language skills, all these “steps” must be mastered.

29. FHS (continued) Meaningful production
Is this child not talking because he’s not hearing?
Is this child hearing but still not talking?
If the child is comprehending language but not using it, what could be some possible reasons?

30. FHS (continued) Use familiar and unfamiliar sounds
Present toys in quiet environment
Present toys in noisy environment
Use visual distraction
Allow caregiver to observe response
Each child may respond differently
Provide varying volumes
Avoid visual and tactile cues
Record observations after consistency is noted

31. FHS (continued) When do I begin referral process?
If there is a discrepancy between chronological age and what the child is ACTUALLY doing
If a child misses 1-2 per age range=okay
If a child misses more than 50% of the skills in the age range, then make note of it
If you are not trusting of your results, have the parent observe and report over next few weeks

32. Health History
Identify any “Red Flags” and make an appropriate referral
Each agency may have its own referral process
DCFS
Head Start
Schools
Refer to Early Intervention if < 3 yrs old
Refer to school if > 3 years old

33. Referral Make referral to appropriate agency Follow up on the process
“Hey, did you get a call from the service coordinator to move forward?” or “After the school nurse called home, did you get Johnny into the ENT?”
Provide the family with support
Assist as needed as the process moves forward

34. Material suggestions for screening
Drum, bell, clicker, other instruments
Blocks/shape sorter/bucket/stack of rings
Ling cards
Pictures of corresponding instruments as sound is presented
Sound level meter (measure background noise, measure dB level of your voice as it’s presented)
Dolls, furniture to screen comprehension
Other toys in their vocabulary for them to label, talk about, etc. to screen expressive language

35. Who’s who in the field Audiologist
Otologist, Otolaryngologist, Otorhynolaryngologist (ENT)
Developmental Therapist-Hearing
Teacher of the Deaf and Hard of Hearing
Speech-Language Pathologist
Auditory Verbal Therapist

36. Remember…. Let’s not let these kids slip through the cracks!!
Early detection of hearing concerns is essential!!!

37. Resources
Please contact any of us at Hearing and Vision Early Outreach Program