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Audiology Advocacy Audiologists responsibility to EHDI Mary Beth Brinson, Au.D. Stephanie Disney, M.S. CCC-A.

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Presentation on theme: "Audiology Advocacy Audiologists responsibility to EHDI Mary Beth Brinson, Au.D. Stephanie Disney, M.S. CCC-A."— Presentation transcript:

1 Audiology Advocacy Audiologists responsibility to EHDI Mary Beth Brinson, Au.D. Stephanie Disney, M.S. CCC-A

2 Presentation Points Historical Perspective Survey comparisons Audiological services comparison Pediatric Audiology Crisis Professional Organizations and Plans Au.D. solutions Case Studies Problem solving and discussion

3 Historical Perspective In 2000, Kentucky audiologists were surveyed about pediatric audiology protocols, equipment availability, training needs and resources, and community collaboration 54% of those surveyed responded (41/75)

4 Access to services by age Based on 2000 survey

5 Test Protocol Based on 2000 survey

6 Training Needs Based on 2000 survey

7 EI Training Based on 2000 survey

8 Distribution of Audiologists

9 Pediatric Audiology Crisis Paradise and Bess (1994) article: Predicted inability to provide quality follow-up from UNHS due to high numbers Speculated that there were not enough qualified professionals

10 High Risk Registry vs. UNHS High risk registry: misses estimated 50% of permanent childhood hearing loss Crisis is that theoretically we have doubled the babies entering the system Where are the additional qualified providers?


12 Audiology Test Battery Includes physiological measures Includes developmental appropriate behavioral techniques Measures that assess integrity of the auditory system Estimate for each ear type, degree and configuration of hearing loss

13 JCIH Guidelines (6 through 36 months) Family and child history Behavioral Response Audiometry (CPA, VRA)* Otoacoustic emissions Acoustic emittance measures Speech detection and recognition measures* Electrophysiologic (ABR) testing: at least once* *requires special adaptations for pediatrics

14 JCIH Guidelines (0 through 6 months) Family and child history* Frequency specific electrophysiological test (ABR or ASSR)/Bone conduction* Otoacoustic emissions Middle ear function test/ ART* Behavioral Observation Audiometry* *Requires special adaptations for pediatrics

15 Adequate confirmation of an infants hearing status cannot be obtained from a single test measure. A battery cross- checks findings of both physiological and behavioral measures. JCIH

16 Confirmation of Hearing Loss: Benchmarks Comprehensive services coordinated between the medical home, family and related professionals with expertise in hearing loss. Audiologic and medical evaluations before 3 months of age or 3 months after discharge for NICU infants Infants with diagnosed hearing loss receive and otologic evaluation The medical and audiologic evaluation process perceived as positive and supportive

17 Clinical Doctorate?

18 Percent of Audiologist who hold an Au.D. by State June % 5-9% 10-14% 15-19% 20-24% 19-25%

19 Training? Total number of NCHAM training workshops completed: 14 Total number of audiologists trained: 299 Areas workshops located: 2002 Florida 2003 Iowa, San Diego, Redondo Beach, Oakland, Chicago (CA had a separate grant) 2004 Salt Lake City, Boston, Redondo Beach, Boise Philadelphia,Redondo Beach, San Mateo, New Orleans 2005 Next one scheduled is in New Mexico

20 Credentialing? Still being developed…… Doesnt address todays needs

21 Case Studies Case Study 1

22 Risk factors include: Sepsis Ototoxic Medications Prematurity

23 Behavioral explanation, no cross check? Multi system evaluation? Notched tymp due to crying?

24 No Cross Check Parental report of cessation of babbling at 11 months RECHECK in 6 months?

25 A cross check now? Is this matching results to middle ear measures?

26 Post op tubes – Behavorial excuse for hearing loss?

27 Questionable microphonic Questionable microphonic

28 Audiological Findings Severe to Profound Bilateral SNHL Functional PE tubes Recommend immediate amplification -There are no OAEs and a lack of systemic evaluation and cross check battery

29 Ear specific? Cross check? OAEs? Fit with powerful Phonak Sonoforte 2 P3AZ HA

30 Pre Cochlear Implant Evaluation ? OAE

31 Audiological Recommendations Re-program hearing aid to new hearing loss -Only obtained thresholds at 500, 2K Re-evaluate with behavorial testing in 3 months -Parents report child has no speech -No physiologic measures planned

32 Middle ear evaluated- Tympanometry Cochlear function evaluated- OAE Neural track evaluated- ABR Frequency Specific information 90 dB 85 dB

33 Audiological Recommendations Diagnosis- Auditory Neuropathy Discontinue current amplification Consider mild gain aid Proceed with Cochlear Implant Evaluation


35 Identified with a hearing loss so late in the critical language learning period, she is at a disadvantage in the language learning process

36 Late age of identification and upcoming use of Cochlear Implant……………..

37 Stephanie: Sorry I havent followed up with you sooner, but it has been crazy!!! I got your phone message and wanted to follow up with you. You were right about the Neuropathy. Sue Windmill made the diagnosis in April!!! We consulted with Dr. Linda Hood at LSU, and Vanderbilt agreed to do the implant surgery!!! She was implanted on April 28th and switch on was May 26th. She has been in AV therapy since that time, and seems to be coming along. We have a very long way to go, and are uncertain about the full outcome at this point? I have been on the LSU website, but would love to get more information on AN if I can? Any suggestions where I might find research or other resources? Thank you again for helping us get a diagnosis. If you had not helped us, we would still be searching for the answer. I cant thank you enough. Sincerely, Christy Adkins

38 A different take on Audiologists 3 Centers in 2 states 1 Late Diagnosis

39 Case Studies Case Study 2

40 Case 1: TM Male Born August 2004 Failed UNHS bilaterally No reported risk factors Normal pregnancy and birth

41 Case 1:T.M. UNHS follow-up 8/21/04 ABR Results…

42 ABR 1Results: T.M. Right ear: 60dB

43 ABR 1Results: T.M. Artifact 90 Sweep 2000 Left ear: 60dB

44 Tympanogram 1: T.M. 4 weeks Inappropriate test settings

45 OAE 1: T.M.

46 Interpretation of 1 st ABR Actual hearing could not be determined due to childs awake state Middle ear dysfunction right ear, normal left Audiologist not confident in findings Attributed hearing loss results to high artifact Scheduled retest at 2 months of age

47 ABR 2: T.M. Left ear: 35dB

48 ABR 2: T.M. Right ear: 50dB

49 ABR 2: Results Borderline normal hearing left Possible mild hearing loss right Again, awake state interfered with tests Recommendation: Sedated ABR due to high artifact and for second opinion**

50 ABR 3: T.M. Different facility Under sedation December 2004 Child is 5 months old

51 ABR 3: T.M.

52 Bilateral moderate sensory hearing loss Earmold impressions made Early intervention referral made

53 Problems: T.M. 3 ABRs performed, 4 months for diagnosis High Artifact? < 10% 3 rd ABR with sedation: unnecessary? 2 1/2 hour trip to other facility Parents now travel for hearing aid appts.

54 Possible Remedies Correct tests were performed according to JCIH More education in modifications for neonates More experienced mentor to lend support Additional pediatric testing training (locally and nationally available)

55 Not everything that is faced can be changed, but nothing can be changed until it is faced - James Baldwin

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