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

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

How Do We Hear?

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

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

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

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?

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?

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?

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?

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?

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)

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

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.

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.

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.

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

Degrees of hearing loss-moderate Shade in 40 dB down to 70 dB. Prior to Newborn Screening, these kids were not diagnosed until age 3.5. Why?

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.

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

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.

Newborn Hearing Screening Illinois PA 91-0067 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

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

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!!!!!!!

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 8000 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

Deafness VS Hearing Impairment 23 Illinois Administrative Code 226.75 (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

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

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.

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?

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

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

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

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

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

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

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

Resources Please contact any of us at Hearing and Vision Early Outreach Program www.morgan.k12.il.us/isd/hvc lmchesky11@gmail.com