1.06 - Hearing Assessment: Infants-Toddlers-Preschoolers Flashcards
What does UNHS stand for?
Universal Newborn Hearing Screening
When was the U.S. Newborn Infant Hearing Screening and Intervention Act signed into law? What did it provide?
1999
3 years of grant funding for states to develop screening & intervention services for all newborns
What does NBHS stand for?
New Born Hearing Screenings
When did Arizona pass legislation requiring NBHS?
2007
Arizona started implementing Newborn Hearing Screening ahead of the curve due to the interest of an audiologist in the AZ Dept. of Health Services
When did President Obama sign an amendment to NBHS legislation?
2010
What are Two (Three?) Routes to the Audiologist?
Universal Newborn Hearing Screening (Newborn Hearing Screenings )
Early Hearing Detection and Intervention (EHDI)
Parent concern
What were the Total number of Actual Births in 2010?
3,885,773 Born
What percent of newborns had hearing screenings in 2010?
Hearing Screenings Performed: 98%
What percentage of newborns did not pass their hearing screening in 2010?
Percent NOT passing 1.7%
Of those newborns who did not pass the hearing screening, what percentage was diagnosed with a hearing disorder in 2010?
Percent diagnosed: 52.4%
In 2010, _____/1000 Screened had hearing loss.
1.4
______ is the most common birth defect in the United States.
Permanent hearing loss
In 2010 Arizona screened ______ of all babies born
98.4%
In 2010 Arizona had _____ births
86,679
In 2010 Arizona had _____ infants that were not screened (declined by parents, infants died, unknown)
1421
In 2010 Arizona had _____ infants who failed the initial screen but did not receive 2nd screen before discharge
389
In 2010 Arizona had _____ infants who were identified as hearing impaired
146
In 2010 Arizona had _____ infants who were lost to follow up
37
What does EHDI stand for?
Early Hearing Detection and Intervention
What are the four Goals of Early Hearing Detection and Intervention?
Hearing screening by 1 month
Diagnosis by 3 months
Amplification within 1 month of diagnosis
Intervention by 6 months of age
EHDI should be _______, meaning rights and privacy, informed choice, shared decision making, & parental consent.
Family centered
EHDI should offer _______
Access to high-quality technology
Does EHDI try to ensure that every child born with a permanent hearing loss is identified before 3 months of age and provided with timely and appropriate intervention services before 6 months of age?
Yes
Does EHDI try to ensure that every family of an infant with hearing loss receives culturally-competent family support as desired?
Yes
Does EHDI try to ensure that all newborns have a “medical home” or a primary care group that guarentees that newborns is getting all the services that they need?
Yes
Does EHDI try to ensure that effective newborn hearing screening tracking and data management systems are linked with other relevant public health information systems?
Yes
Screening is a “______” procedure
Pass/refer
What does “Pass” on a hearing screening mean?
No current concern to suspect hearing loss
What does “Refer” on a hearing screening mean?
There is reason to suspect hearing loss
What Hearing Screening tests are used on Infants and Young Children?
Objective Tests
They not require patient response/cooperations
What specific types of screening tests on Infants and Young Children?
Automated Auditory Brain Stem Response (A-Baer) (A-ABR)
Otoacoustic Emissions Testing
Tympanometry (Immintance) and Acoustic Reflexes
When are Objective Tests used?
With Infants under age six months
May be necessary for confirmation of behavioral results for older infants and young children
When are Behavioral Tests used?
Possible once child reaches six months of age
Left undetected, hearing impairments in infants can negatively impact ______, _______, and social and emotional development.
Speech and language acquisition
Academic achievement
If HL is detected, however, these negative impacts can be diminished and even eliminated through ______.
Early intervention
“Research has compared children with HL who received early intervention and amplification before 6 months of age versus after 6 months of age. By the time they enter first grade, children identified earlier are ______ years ahead of their later-identified peers in language, cognitive, and social skills.”*
1-2
Follow-up from newborn hearing screening does not occur in all children and only about ______ of infants who are referred for medical or audiological follow-up are receiving timely assessment or intervention
50%
It is estimated that by school age new cases of permanent hearing loss occur in approximately _____ per 1000 children in addition to the _____ per 1000 likely to be detected at birth
6
3
Further, an estimated ______ of pre-school children experience repeated episodes of ear infections and intermittent hearing loss, some untreated for extended periods.
35%
What is BOA?
Behavioral Observation Audiometry
What is VRA?
Visual Reinforcement Audiometry
What is CPA?
Conditioned Play Audiometry
What is Behavioral Observation Audiometry?
Audiologist watches child for behavioral change
Shows lowest level of responsiveness not hearing threshold
(Some babies may react to 20 dB HL sound levels and others will not react until 60 dB HL)
Can be highly subjective: i.e. observers expectations can basis outcome
What are the two categories for Responses to Sound?
REFLEXIVE (Startle, Limb jerks, Eye blinks)
ATTENTIVE (Quieting or increased activity, Change in breathing rate, Onset or cessation of vocalizations, Onset or cessation of crying
Eye widening, brow furrowing or expectant look, Smiling, Head turning – searching or localization)
When is Visual Reinforcement Audiometry used?
6 Months to 2 ½ years of age
What is Visual Reinforcement Audiometry?
Consists of stimulus/response conditioning
A conditioned response is a new or modified response to a previous neutral stimulus
How accurate is Visual Reinforcement Audiometry?
High accuracy when conditioning achieved
Minimal Response Levels obtained are within 10dB of true thresholds
Speech Detection Thresholds (SDT or SAT) used as a cross-check to the audiometric thresholds obtained
What is happening in Auditory Development at 0-6 weeks?
Normal hearing children startle, eye
blink or widen eyes to sounds at 40-80 dB HL
What is happening in Auditory Development at 4-7 Months?
Head turn laterally toward a sound, responds to speech at 20 dB HL tones at varying levels
What is happening in Auditory Development at 7-24 months?
Level of signals needed to elicit a head turn drops
What is happening in Auditory Development at 24+ months?
Conditioned play audiometry possible
When is Conditioned Play Audiometry used?
2 to 2 ½ and older
What is Conditioned Play Audiometry?
Child is trained to perform task in response to sound using a fun activity
Motivates child to perform listening task
Can pick a variety of games to keep child’s interest (e.g. block in bucket, peg board, puzzles, computer PowerPoint)
How is reliability in Conditioned Play Audiometry?
Good reliability when child is engaged in listening
Speech Recognition Thresholds (SRT or SAT) used as a cross-check to the audiometric thresholds obtained
What concerns the audiologist most about a child’s hearing loss?
Determining the type and degree of hearing loss
What concerns families/parents most about a child’s hearing loss?
Etiology (cause) of child’s hearing loss
Why is my child hearing impaired?
It does help them if you can come to a definitive reason, though we almost never know this!
What percent of Prelinguistic HL is Idiopathic?
25%
What does idiopathic mean?
No clue what the cause is
What percent of Prelinguistic HL is Non-genetic?
25%
What percent of Prelinguistic HL is Genetic?
50%
What percent of Prelinguistic HL with a genetic root is Non-Syndromic?
70%
What percent of Prelinguistic HL with a genetic root is Syndromic?
30%
What percentage of children w/HL do not have risk factors at birth?
50%
Is low birth weight (< 3.3 lbs.) a risk factor for newborn HL?
Yes
Is a family history of hearing loss a risk factor for newborn HL?
Yes
Are in utero infections (CMV, rubella, herpes) a risk factor for newborn HL?
Yes
Are ototoxic medications a risk factor for newborn HL?
Yes
Is a need for ventilator use for 5 days or more a risk factor for newborn HL?
Yes
Are craniofacial anomalies a risk factor for newborn HL?
Yes
What are we looking for in craniofacial anomalies?
You are looking for symmetry
Different color eyes, one ear set lower than other
Are physical manifestations consistent w/ a syndrome (Club foot, etc.) a risk factor for newborn HL?
Yes
Is bacterial meningitis a risk factor for newborn HL?
Yes
Is hyperbilirubinemia (severe jaundice) at levels that require an exchange transfusion a risk factor for newborn HL?
Yes
Are low Apgar Scores a risk factor for newborn HL?
Yes
What are Apgar Scores measuring?
A = Appearance (skin color)
P = Pulse (heart rate
G = Grimace (known as “reflex irritability”)
A = Activity and muscle tone
R = Respiration (breathing rate and effort)
When are babies given Apgar Scores? What’s the range? What score is good?
Babies are rated at one minute after birth and 5 minutes after birth
10 is the highest score, 1 is the lowest
A score of 8 or higher is considered good
Are Infections in utero (rubella, cytomegalovirus (CMV), herpes simplex virus) a prenatal, non-genetic cause of hearing loss?
Yes
Are Rh-factor complications (maternal antibodies affect RH-positive blood cells of baby) a prenatal, non-genetic cause of hearing loss?
Yes
Is prematurity a prenatal, non-genetic cause of hearing loss?
Yes
Is maternal diabetes a prenatal, non-genetic cause of hearing loss?
Yes
Is toxemia (an abnormal condition of pregnancy characterized by hypertension, fluid retention, edema, and the presence of protein in the urine) a prenatal, non-genetic cause of hearing loss?
Yes
Is anoxia (an abnormally low oxygen level in the blood) a prenatal/perinatal, non-genetic cause of hearing loss?
Yes
Is syphilis a prenatal, non-genetic cause of hearing loss?
Yes
What are two Acquired causes of HL?
Infections
Ototoxic medications
What are two Structural causes of HL
Congenital Cholesteatoma (Abnormal tissue growth in middle ear)
Inner ear malformations:
What is the genetic cause of HL we specifically covered in class?
Connexin 26
Is Connexin 26 pre or postlingual? How severe is the HL?
Pre-lingual
Mild to profound HL
What are the external signs of Connexin 26?
There are none
In 2/3 of the cases of Connexin 26, HL is ______ with no vestibular or labyrinthine ______.
Non-progressive
Abnormalities
What are the Main Risk Factors for Late Onset HL?
5
Congenital CMV Infection (Cytomegalovirus)
Meningitis or mumps
Family History of late-onset hearing loss
Head trauma, especially with basal or temporal bone fracture
Chemotherapy, especially in conjunction with radiation
What is the best way to monitor infants and young children for late-onset hearing loss.?
Monitoring and screening within the medical home
Babies with risk factors for hearing loss should be retested at ______ of age and then every six months after until age ______.
Six months
3 yrs
Parents provided with _______ handout to encourage monitoring
Hearing and language milestones
Estimated that ______ of preschool of children experience repeated episodes of Otitis Media. This can result in ______ conductive hearing loss
For children with SNHL, this will add additional hearing loss while affected.
30%
Mild-moderate
The length of illness will determine the child’s ability to “______”
Catch up
