1. 1 Hearing Screening for Health Assistants Charlotte Branch-Briggs, BSN, RN NMDOH NE Region School Health Advocate 505-476-2714 charlotte.branchbri@state.nm.us

2. 2 Symptoms of Hearing Loss 3 to 6% of children have significant hearing problems. Early detection can prevent problems in speech, social and educational development pain in ear(s) ringing / buzzing discharge from ear(s) dizziness inability to hear certain tones straining to hear conversation favoring one ear lack of response to nearby sounds need for loud volume on TV/radio inability to hear with background noise (SHM III, pp 20-31)

3. 3 Equipment– Pure Tone Audiometers Sensitive electronic equipment, which must be calibrated annually to ANSI standards Do not drop or handle roughly Protect from extreme temperatures and humidity and dust (below 40, above 100) Store off the floor with protective cover in place Never eat, drink or smoke near the audiometer Store only the earphones & cords in the storage compartment Do not turn on and off if doing multiple screenings in one day.

4. 4 Audiometers

5. 5 Care of Earphones Do not drop earphones Protect the diaphragm from vacuum, sharp objects and liquids Check for splits on cushions, broken wires, that they are plugged in correctly Do not twist, wrap or knot the cords Earphones are unique to each audiometer and may not be exchanged

6. 6 Loudness and Pitch Loudness of sound is measured in DECIBLES (dB) Pitch or Tone is measured in HERTZ (Hz)  High or Low Sound

7. 7 Types of Hearing Screening Sweep Test Students are tested at 20 dB for frequencies 1000 Hz 2000Hz 4000Hz 1000 Hz 2000 Hz 4000 Hz At 20 dB

8. 8 Types of Hearing Screenings (cont.) Threshold Test  Test the student for the same frequencies, but determine which is the lowest intensity at which the tone can be heard and record this number. Date Screened:_______1/31/2010_________________________ Date Screened:_______3/1/2010__________________ 500 Hz1000 Hz2000 Hz4000 Hz6000 Hz500 Hz1000 Hz2000 Hz4000 Hz6000 Hz LEFT 30 35P DNT LEFT 35304030 DNT RIGHT PPPPP PPPPP

9. 9 Fitting Earphones to Student Earphones need to be placed on completely bare ears. Red goes on right ear. Move hair out of the way, remove glasses Remove earrings and combs/ ribbons which may prevent a good “seal”. No chewing gum Adjust the headband to fit snuggly over the head.

10. 10 Recommended Hearing Screening Grade Levels Pre - Kindergarten Kindergarten 1 st grade 3 rd grade 8 th grade New students to your district Parent or teacher request

11. 11 Preparing Young Children Before hearing screening is done with pre-K or Kindergarten students, take the audiometer into the classroom and practice with the group. Turn headphones outward toward the class sitting in a circle around you. Set intensity at 90 dB or above, tone at 2000 Hz. Explain to the class that they will hear a sound. When they hear the sound, raise hand. When the sound stops, lower hand. Repeat several times with different frequencies until all the students grasp the concept.

12. 12 Hearing Screening Procedures Check your equipment before you start. All switches are in the correct position. No broken wires, faulty connections, plugs are plugged in. Listen to all the frequencies yourself to be sure there are no extraneous sounds, ambient noises. Seat one child at a time in front of you, either facing toward you or away from you. Position headphones.

13. 13 Hearing Screening Procedures (cont.) Avoid obvious clues: Looking up at the student, Reflections in mirrors/ windows/ eye glasses, Movements that give away tone presentation, presenting tones rhythmically Remind student to raise his/her hand when the tone is heard. Present the tones 2-5 seconds each, right ear first, beginning with 1000 Hz, then 2000 Hz, 4000 Hz. Repeat with left ear.

14. 14 Precautions Do not let the student watch you operate the audiometer’s presentation controls. Do not look at the child when the tone is presented (use peripheral vision to observe response). Do not present the tone when there is a noise which you suspect would interfere with hearing. Do not give any clues as to when the tone is presented: control head, eye, arm or other body movements, reflections, rhythms, shadows, etc.

15. 15 Recording and Referral Record the results on the student’s Health Record. Report any failures to your school nurse– follow your districts protocols Wait 3-4 weeks between sweep tests in case of allergies, colds, etc. Use a referral form such as is found in SHM

16. 16

17. 17 Types of Hearing Loss Three types of hearing loss: Conductive affects outer and / or middle ear -Most common causes: Otitis media -Correctable with treatment or surgery Sensorineural affects the inner ear or auditory nerve -This generally cannot be corrected with surgery or medical treatment Mixed Affects the outer/middle ear as well as the inner ear and includes significant conductive and sensorineural components. -It can be any combination of the two previous hearing losses. -The conductive portion of a mixed hearing loss can usually be corrected, but the sensorineural component is seldom reversible. ** Note: Otitis media is single-most frequent cause of hearing loss in young children

18. 18 Hearing Conservation OSHA suggests the following safety limits of noise exposure: Noise LevelExposure Limit 90 dB8 hours 95 dB4 hours 100 dB2 hours 105 dB1 hour 110 dB30 minutes So what pattern do you see here?

19. 19 Suggestions for Hearing Conservation When around harmful noises, wear hearing protection, earplugs/ earmuffs Seek medical attention for symptoms (ringing in ears, pain, dizziness, headaches) Do presentation on hearing conservation to classes Recommend earplugs to band students, especially percussion section Caution teenagers about setting the Walkman listening levels too loud (yeah, right!!)

20. 20 Hearing Aids and Assisting Students See NMSHM See also NASN publication, The Ear and Hearing, p 23 Do not screen students with hearing aids For an Individualized Health Care Plan, NASN p 24 (be sure all students with hearing loss have an IHP) For screening the young child and developmentally delayed, NASN p 25

21. 21 Questions?