1. Can you explain my child’s Audiological Report?
Karen Clark, M.A., CCC-A 1, 2
Karen M. Ditty, Au.D., CCC-A 2,4
Patti Martin, Ph.D., CCC-A 2, 3
1 UTD /Callier Center for Communication Disorders
Dallas, TX
2 National Center for Hearing Assessment and Management
Logan, UT
3 Arkansas Children’s Hospital
Little Rock, AR
4Texas ENT Specialists, PA
Houston, TX
Added my degrees etc

2. Faculty Disclosure Information In the past 12 months, we have not had a significant financial interest or other relationship with the manufacturer of the product or provider of the services that will be discussed in our presentation. This presentation will not include discussion of pharmaceuticals or devices that have not been approved by the FDA.

3. Medical Home Physician
The Team
Early
Interventionist
Medical Home Physician
Family
Audiologist

4. Family Audiological Report Want to understand hearing loss
Name: Most Special Baby
Results:
Very important information
Want to understand
hearing loss
Must make decisions
for child

5. Early Interventionist
Audiological Report
Name: Most Special Baby
Results:
Very important information
Uses data to determine
eligibility.
Reviews information
with parent.
Uses information to guide
programming.

6. Audiologist Audiological Report Makes decisions based on results
Name: Most Special Baby
Results:
Very important information
Makes decisions based
on results
Wants understanding
and follow through
from family
Needs feedback from
family and EI

7. Medical Home Physician
Audiological Report
Name: Most special Baby
Results: Very important information
Makes medical decisions
based on test results.
Coordinates multidisciplinary
Medical evaluations to determine
Etiology and identify related
conditions.

8. The Goal A Family-Professional partnership that
supports collaborative sharing of audiological information.
Partnership
“..defined as a relationship of mutual respect between two or more competent persons who have agreed to commit and share their knowledge, skills, and experience in meeting the needs of the child”
(SKI-HI Curriculum 2004).

9. Challenges to Collaborative Sharing of Audiological Data
Audiological information is increasingly complex.
Gone are the days when the EI needed only understand simple Xs and Os on a graph.
Current assessment protocols leave heads spinning with acronyms and multiple pieces of data – tone burst ABR, click ABR, OAE, ASSR, REM, bone, air, acoustic reflex……

10. Challenges to Collaborative Sharing of Audiological Data
Early interventionists have widely varied backgrounds.
Even with training in intervention specific to infants and toddlers who are deaf and hard of hearing, rapidly evolving clinical practice makes staying current a challenge.
Parents and early interventionists may not know the questions to ask.

11. Challenges to Collaborative Sharing of Audiological Data
Audiologists have varying knowledge, experience, and skill in infant assessment.
Even when audiologists have training and skill specific to infants, there is wide variability in the way reports are written and results presented.
Audiologists may have difficulty conveying complex data in easily understood terms.
Time – never enough for anyone.

12. What's the
Answer??

13. Improved understanding of Audiological Data within the Partnership!

14. Understanding terminology!
Do not need to know how to do the tests, but need to know what tests are performed, and generally what they are measuring.
Examples:
Immittance: Middle ear system
Otoacoustic Emissions: Peripheral, outer hair cells, is pre-neural
Auditory Brainstem Response: test that can be used to assess auditory function in infants and young children

15. What should you see in an audiological report from a Pediatric Audiologist?
Medical History summary
Auditory Brainstem Response (ABR) results which include:
Tone Burst, Bone Conduction testing
Auditory Steady state Audiometry
Tympanometric results (High Frequency Probe Tone or infants < 6 Months)
Otoacoustic Emissions Results
Behavioral Audiometry (when age appropriate)
Hearing aid results, if obtained
Specific Recommendations
So you fit the criteria and know you could be that Pediatric Audiologist we need What about equipment?

16. Why are so many audiological tests performed and reported?
Cross Check Principle

17. Why is the Audiological Report so Complicated?
OAE
synchronous
Clicks AU
Bone Conduction
Immittance
dBSPL
VRA
ABR Ad
BOA As
Auditory Neuropathy
Tone Bursts
dBnHL
ASSR

18. Does the audiological report have to be so complicated?
NO,
But….
The report must be understood by other audiologists and professionals with terminology that is legally correct.

19. What is the Audiologist required to report ?
Although there are no national protocols or standards many states have guidelines for their audiologists.
These guidelines can be obtained via the following link on the NCHAM website:

20. American Speech Language & Hearing Association
Working on a standard of care with Pediatric Audiologists.
Developed a draft copy of “Roles, Knowledge, and Skills: Audiologists Providing Clinical Services to Infants and Young Children Birth to 5 Years of Age”

21. How can you interpret the audiological report to your families?
HEAR!
H: History (medical and audiological)
E: Evaluate tests that were performed
A: Audiological summary for each ear
R: Review Recommendations

22. Medical and Audiological History
Was there a hearing screen at birth?
Results?
Have there been subsequent audiologicals provided since newborn hearing screen?
Were there any medical complications that may put the child “at risk” for hearing loss?
Positive CMV screening?
Prolonged stay in the NICU?
Hyperbilirubinema, anoxia, or other medical complications?
Were there any surgeries that have been performed for chronic middle ear effusion?
PE tubes?

23. Evaluate audiological tests
Was a cross check principle used?
If testing was not performed was an explanation as to why put in the report?

24. Audiological summary for each ear
Does the report address the hearing status of each ear in a clear and understandable manner utilizing common terminology used in audiological report writing?
If testing was incomplete for an ear, was an explanation provided?

25. Recommendations
Are the recommendations consistent with the test findings?
Are timely follow up appointments established when necessary?
Are referrals made to the appropriate educational facilities?

26. How can you explain the audiological report to your families?
Example 1 DOB: January 2005
Medical History:
Significant history includes not passing newborn hearing screen, hyperbilirubinemia and congenital anomalies for he right ear.
What is important about this medical history?

27. How can you explain the audiological report to your families?
Audiological History EXAMPLE 1
January 2005: ABR results consistent with a moderate peripheral auditory impairment for the frequency range Hz bilaterally. A response was observed to click stimuli via bone conduction down to 30 dBnHL: however, could not be replicated due to awakening of child.
June 2005: ABR results consistent with a moderate peripheral auditory impairment for the frequency range Hz and 500 Hz for the left ear. Further testing could not be completed due to awakening.
Why was this test repeated in June? Why so many months later?

28. How can you explain the audiological report to your families?
Evaluate other assessments of the infant’s hearing status. ( This case indicated no other tests beside ABR were performed.)
Why would knowing immittance results be beneficial?
When they could not complete the test the first time, why were they unable to get bone conduction testing the 2nd time?

29. Audiological summary for each ear
EXAMPLE 1 October 2005:
Synchronous neural responses to click stimuli were consistent with a severe peripheral auditory impairment for the frequency range Hz for each ear.
Synchronous neural responses to tone burst stimuli were consistent with a severe peripheral auditory impairment at 500 Hz for the left ear and a moderate peripheral auditory impairment for the right ear at 500 Hz and 4000 Hz.
No responses were observed to click stimuli via unmasked bone conduction at equipment limits (45dBnHL).

30. How can you explain the Audiological report to your families?
How is the wording different from the 1st ABRs and the October ABR?
“ABR results consistent with a moderate peripheral auditory impairment for the frequency range Hz bilaterally.”
“ Synchronous neural responses to click stimuli were consistent with a severe peripheral auditory impairment for the frequency range Hz for each ear”
Do the results mean different things?
Was there a change in this child’s hearing status?
No suggestion as to why the change in hearing status occurred
Why would a comment regarding change in hearing status be beneficial?

31. How can you explain the audiological report to your families?
Example 1 Recommendations
Be seen for Otologic evaluation due to identification of auditory impairment. (Was this not done earlier with the hearing loss that was identified?)
Receive trial period with hearing aids pending otologic clearance.
Initiate Program for Amplification application process.
Be seen for behavioral audiological follow-up in 3-6 months.
Receive aural habilitative services.
Continue to receive Early childhood intervention services. (When was this child referred? Why was he referred?)

32. HEAR History: Medical and Audiological
What is significant with this child’s history?
Evaluate tests performed:
What battery of tests were discussed in all the evaluations?
Audiological summary of test results for each ear.
What did you learn here?
Recommendations

33. How to improve the understanding of the Audiological Report?
Include the following sections in your report:
History (Medical and Audiological)
Audiological tests performed and the results of each test for each ear. (results should be attached to the report)
Summary paragraph written in an easy to understand format that summarizes the test findings.
Functional implications of hearing loss should be explained
If results were inconclusive an explanation as to why results were inconclusive should be reported here.
If hearing status changed, a statement should be provided.
Recommendations
Medical
Educational
Habilitation
Follow-up appointments with a timeline whenever possible.

34. Interpret that phrase! History
“includes premature birth, low APGAR scores (5 problems (dysplastic aortic valve), Chromosome 6-partial deletion, dysmorphic features, low set ears, treatment with ototoxic medication and bilateral auditory impairment.
What would you expect to see in the recommendations?

35. Interpret that phrase! Evaluating tests performed
Tymps: WNL, Reflexes: DNT
REM: CNT
OAE: Absent
NR to unmasked clicks
What tests were done, and what were the results?

36. Interpret that phrase! Audiological Summary
Ad: No response to click stimuli at 80 dBnHL observed. Results are c/w a severe to profound peripheral auditory impairment for the freq. 2-4 kHz.
As: Responses to click stimuli are c/w a severe peripheral auditory impairment for the freq. 2-4kHz. No response observed to 500 Hz tone burst stimuli.
What does THIS mean?

37. Interpret that phrase! Recommendations
Appropriate educational services.
Aural rehab
Be seen for otologic evaluation due to identification of auditory impairment.
Regular audiological evaluations and monitoring.
What does THIS mean?

38. How do you interpret the Audiological Report?
Boystown National Research hospital has an excellent glossary for parents and professionals to better interpret test results.

39. Texas Connect
Topic Card 1. Tests Used to Assess Hearing Loss in Infants and Young Children
Topic Card 2. Types and Causes of Hearing Loss

40. List of Acronyms Listen-Up http://www.listen-up.org/htm/acronyms.htm
CDC:Early Hearing detection and Intervention Program
VA-SOTAC Resource Guide ACRONYMS

41. Resources on the Web American Speech Language and Hearing Association
Joint Committee for Infant Hearing
Texas Connect
National Center for Hearing Assessment and management
Boystown national Research Hospital “My Baby’s Hearing”