Hearing Screenings

Question 1

What is the primary goal of a hearing screening program?

Answer 1

To identify individuals with significant or potentially significant hearing problem

Question 2

What is the goal of a newborn hearing screening?

ASHA, 1997

Answer 2

To identify children at risk for significant hearing impairment that can affect speech and language development

Question 3

What is the goal of a school-age screening?

ASHA, 1997

Answer 3

To identify children at risk for educationally significant auditory problems (i.e. hearing loss), and for medically significant auditory problems (i.e. middle ear disease)

Question 4

What is the goal of an adult hearing screening program?

Answer 4

To identify individuals with hearing impairment that can affect communication and to identify people requiring medical evaluation.

These adult screenings are not only looking for hearing impairment, but also disability from the hearing loss.

Question 5

What is the Joint Committee on Infant Hearing (JCIH)?

Answer 5

A committee that provides guidelines for newborn and infant hearing screenings

Question 6

What is the early hearing detection intervention (EHDI) board?

Answer 6

A state board that oversees and develops hearing screening programs for each state.

Some EHDI programs are more successful than others (i.e. Colorado)

Question 7

Describe the history of UNHS

Answer 7

1993–> NIH endorsed UNHS

1994–> JCIH mandated NHS for early identification and intervention of HL

1994–> Bess & Paradise questioned justification of this mandate and spurred studies on auditory deprivation

Question 8

Is UNHS successful?

Answer 8

Yes!

Earlier identification and intervention of hearing loss (Durieux-Smith et al., 2008)

JCIH reports 95% of infants being screened in 2007 up from 38% in 2000.

Question 9

Describe the protocol of a NHS.

Answer 9

Use OAE and/or ABR b/c non-invasive, quick, easy to administer, and sensitive to hearing loss.

Specified procedure for well-baby nursery and NICU babies

Well baby can use OAE or ABR

If in NICU > 5 days, Automated ABR (AABR screening)

Infants who don’t pass AABR screening, rescreening by audiologist

Rescreening should be in both ears

Question 10

What are some barriers to following recommendations outlined by JCIH 2007 for infant hearing screenings?

Answer 10

• a lack of personnel to provide timely service
• Funding
• a lack of integrated data management and tracking systems in each state
• Not enough access to services and intervention
• A lack of in-service education for professionals

Question 11

What are ways to improve follow-up for infant screenings?

Answer 11

• Educating pediatricians about the importance of following-up, even if the child has a mild/minimal hearing loss. (Bess et al., 1998) showed children with minimal hearing loss have poorer educational performance than normal hearing peers
• Improved documentation across state lines so if patients move they can still be tracked
• Pediatricians should have access to online data system in order to see if their patients have followed up

Question 12

Why screen school-aged children?

Answer 12

These children may have a temporary conductive hearing los due to middle ear pathology or they may have a delayed onset or progressive SNHL that was missed during their NHS.

High prevalence of middle ear pathologies in this age group.

Question 13

Describe the procedure for a school-aged screening

Answer 13

• Pure tone audiometry using age-appropriate behavioral tests
• Acoustic immittance screenings

Question 14

Effectiveness of school screenings

Answer 14

Validated by Serpanos & Jarmel (2007) for early identification and intervention for students with hearign los and middle ear pathology

However there is no gold standard for screening location, tester, interval, and protocol which may affect the success of such programs.

Question 15

What are the ramifications of hearing loss that go beyond communication?

Answer 15

Hearing loss can affect an adult’s ability to interact with others and results in isolation, depression, early onset dementia, falls, and cognitive decline

(Lin et al., 2011)

Question 16

What is the importance of an adult hearing screening program?

Answer 16

Rapidly aging population

It is important to diagnose and manage hearing loss early to prevent the negative consequences of hearing loss that go beyond communication.

Question 17

What are the costs of an adult hearing screening program?

Answer 17

• Personnel
• Equipment
• Calibration
• Space

May seem costly, but early identification and treatment of hearing loss may result in reduced costs in other areas of care (such as dementia) later on with less people needing treatment for other conditions.

Question 18

What are the expected outcomes of an adult hearing screening program?

Answer 18

May be successful, but need to communicate with physicians so they are making referrals to audiologists for testing.

Question 19

What are the methods for assessing/documenting program effectiveness?

Answer 19

To document the effectiveness of a screening there should be a database similar to that used for NHS to track patients and their results.

Furthermore, reports can be obtained from Medicare regarding costs in other areas as the patient ages, to show a reduction (or lack thereof) of medical expenses as a result of screening programs.

Question 20

What are the barriers to a successful adult hearing screening program?

Answer 20

• Adults don’t always comply with recommendations and typically ignore their hearing difficulties
• Cost

Question 21

How would you address the barriers of an adult screening program?

Answer 21

Communicate with the patient the importance of treating hearing loss that goes beyond communication difficulties. Better education may result in more compliance and follow-through with screenings and recommendations made.

To address cost, should develop a protocol that is time efficient, reliable, and has good sensitivity and specificity

Question 22

What tests should be completed in an adult hearing screening?

Answer 22

• Pure tone audio from 500-4000 Hz
• Acoustic immittance screening to rule out middle ear disorder
• Questionnaire like the HHIE-S to evaluate subjective hearing difficulty and emotional effects of hearing loss

OAEs have poor validity (Scudder et al., 2003)