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AUDE 6140 - Pediatric Audiology > Screening for Pediatric Population > Flashcards

Screening for Pediatric Population Flashcards

1
Q

What is a screening?

A

A screening is a quick and efficient measure, designed for implementation with large groups, to determine need for a thorough evaluation

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2
Q

What is the purpose of screening?

A

To identify individuals most likely to have a targeted disease or disorder in need of treatment
It is important to differentiate screening from diagnostic procedures
Diagnostic procedures, which are more time consuming and expensive, are applied only to a subset of individuals who are more likely to have the disorder

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3
Q

What is prevalence?

A

The number of cases of a disease existing in a population during a specified time period
Prevalence rate is the proportion of the population that has the condition at a point in time

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4
Q

What is incidence?

A

The number of new cases identified over a given period of time, typically one year
Incidence rate is often reported as a fraction of the population at risk of developing the disease or condition of interest, for example, 1 per 1,000

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5
Q

What is sensitivity?

A

Refers to the percentage of people with a given disorder who screen positive — that is, the rate of correct classification for affected individuals
It is calculated by dividing the number of true positives by all those in the screened group with the disorder (the sum of the true positives and false negatives)

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6
Q

What is specificity?

A

Refers to the test’s accuracy in correctly identifying persons whodo nothave the condition — that is, the rate of correct classification for unaffected individuals
It is calculated by dividing the number of true negatives by all those in the screened group without the disorder (the sum of the true negatives and false positives)

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7
Q

What are some types of screenings?

A

Case finding or opportunistic
Mass screening
Selective screening or targeted screening
Multiphasic screening

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8
Q

What are the requirements for a mass screening test?

A

Disorder needs to have a widespread occurrence
Adverse effects on those who have the disorder
Methods exist for identifying disorder that is quick, reliable, and acceptable to those who receive it
Disorder can be treated once it has been identified

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9
Q

How much more common is hearing loss in infants who were in the NICU than in the well nursery?

A

10x greater (prevalence)

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10
Q

When was the first mass hearing screening in the US?

A

1964
Conducted by Marion Downs and Graham Sterritt
City-wide project in Denver to test all babies born during a 12-month period

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11
Q

When was joint committee on infant hearing (JCIH) made?

A

1969
Makes recommendations about newborn hearing screening with the goal of identifying children at risk for hearing loss as early in life as possible

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12
Q

What results in a higher risk for hearing loss?

A

Family history of childhood hearing loss
Congenital perinatal infection
Anatomic malformations of head and neck
Low birth weight
High bilirubin
Bacterial meningitis
Severe asphyxia (apgar score of 0-3)

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13
Q

What was the JCIH recommendation in 1982?

A

Infants AT RISK for hearing loss should be screened by behavioral observation or electrophysiological response to sound

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14
Q

What were the JCIH recommendations in 1994?

A

Screen ALL infants (UNIVERSAL SCREENING) using electrophysiological tests & provide early intervention

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15
Q

What was the JCIH recommendation in 2000?

A

All infants with the targeted hearing loss be identified so that appropriate intervention and monitoring may be initiated
Benchmarks for hearing loss detection and intervention (1 – 3 – 6 Principle)

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16
Q

What is the 1-3-6 principle?

A

Children should be screened at 1 month
Children should receive a comprehensive evaluation by 3 months
Children should receive appropriate intervention at 6 months

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17
Q

What is the rationale for the 1-3-6 principle?

A

Identification of hearing loss by 6 months of age in combination with quality early intervention services is associated with language development at or near the typical rate of development
Recent evidence indicates that the earlier impairment is identified, and treatment begun, the greater the likelihood of preventing or reducing the debilitating/disabling effects that can result

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18
Q

What is EHDI?

A

Early hearing detection and intervention
Programs ensure that infants and children with hearing loss are found (detected) & receive help (intervention) as early as possible

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19
Q

What are the goals of EHDI?

A

Universal newborn hearing screening
Diagnostic audiology
Specialty referrals
Early intervention
Family support
Care coordination
Tracking and data management

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20
Q

What were the 2007 JCIH statements that provided guidance to the EHDI program with 8 principles?

A

Every infant has access to a physiologic hearing screening by 1 month of age
Infants who do not pass the first hearing screening or rescreening undergo audiological and medical testing to determine the presence of hearing loss by 3 months of age
Those with confirmed permanent hearing loss are enrolled in early intervention (EI) by 6 months of age, or sooner, with a straightforward, single point of entry
EHDI systems are family centered and abide by state and federal guidelines. All intervention and treatment options are provided to families
There is immediate access to high-quality technology, if needed
Communication development is monitored beginning at 2 months of age in the medical home regardless of risk factors for hearing loss
Infants and their families receive interdisciplinary intervention from professionals with knowledge of hearing loss, and those interventions/programs reflect the family’s strengths, choices, traditions, and cultural beliefs
Information systems must interface with electronic health records, and data are used to assess outcomes, including reporting the effectiveness of services at all levels (individual, practice/clinic, community, state, and federal)

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21
Q

What is a medical home?

A

The infant’s pediatrician or primary health care provider is responsible for monitoring the general health, development, and well-being of the infant beginning in the newborn nursery

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22
Q

What elements should be provided by the medial home?

A

Accessible
Family centered
Continuous
Comprehensive
Coordinated
Compassionate
Culturally competent

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23
Q

How are the 2007 recommendations different than the 2000 ones?

A

Expanded from congenital bilateral and unilateral SNHL or permanent CHL to include Neural Hearing Loss (ANSD) in infants admitted to the NICU > 5 days
Separate protocols are recommended for NICU and well-baby nurseries
NICU babies >5 days are to have ABR included as part of their screen so that neural HL will not be missed
Rescreening both ears even if only one failed initial screening
Screening results should be conveyed immediately to families so they understand the outcome and the importance of follow-up when indicated
Recommended at least one ABR as part of diagnostic eval for children under 3 for confirmation of permanent HL, in conjunction with other measures for validation of HL

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24
Q

What are the risk indicators for the JCIH 2007 recommendations?

A

Caregiver concern regarding hearing, speech, language.
Family history of permanent childhood HL.
NICU care of >5 days, or any of following regardless of length of stay : assisted ventilation, ototoxic medications, exchange transfusion, and ECMO.
Intra-uterine TORCH infections, particularly CMV
Craniofacial anomalies, especially those involving the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies
Physical findings associated with a syndrome known to include permanent HL
Syndromes associated with progressive HL such as NF, osteopetrosis, Usher’s syndrome
Neurodegenerative disorders, such as Hunter syndrome
Culture-positive postnatal infections associated with SNHL, including Bacterial or viral meningitis, herpes virus and varicella.
Head trauma especially basal skull/temporal bone fracture requiring hospitalization
Chemotherapy, Aminoglycosides…

25
Q

What is the current JCIH (2019) document?

A

States who meet the 1-3-6 benchmark (screening completed by 1 month, audiologic diagnosis by 3 months, enrollment in early intervention by 6 months) should strive to meet a 1-2-3 month timeline

26
Q

What is the issue with the 1-2-3 statement?

A

It may not be appropriate to apply this timeline to infants receiving care in the NICU.
A recommendation is made that for very preterm infants with prolonged hospitalization, a diagnostic audiologic evaluation prior to discharge from the NICU be completed

27
Q

Is the term “hearing loss” used in the 2019 JCIH statement?

A

No
Trying to move more towards hearing thresholds in the mild, moderate, severe, or profound range

28
Q

When should the screening be done?

A

Infants should have their hearing screened as close to discharge as practicable, while at the same time allowing sufficient time for a single repeat screen to be performed if the infant does not pass the first screen
Second screening should be done at least a few hours later
Infants with congenital aural atresia in one or both ears or with visible pinna/ear canal deformity should not be screened in either ear but should be referred for diagnostic audiologic evaluation immediately upon discharge
For some infants in the NICU, it may not be feasible to complete a hearing screening prior to one month of age and hearing screening should be completed when they are medically stable

29
Q

What were the well-baby screening recommendations in 2007?

A

Accomplished using either OAE or AABR, with the second (re-) screen (second in-hospital screen), conducted using either technology but rescreening using AABR is the Committee’s preferred protocol
Re-screening with OAE after failing an AABR is acceptable (for well-born only) with the caveat that a baby with ANSD will be missed using this protocol

30
Q

What is the difference for ABR recommendations in the 2007 vs the 2019 recommendations?

A

In the 2007 position statement it recommends “at least one ABR be completed as part of the complete diagnostic evaluation for children younger than 3 for confirmation of a permanent hearing loss” but this recommendation is not included in the 2019 position statement
If ear-specific information is available with a comprehensive test batteryapproach, ABR is not needed, and it will be required only when ear-specific responses cannot not be obtained

31
Q

What else do we need to know about the 2019 position statement?

A

Evaluation should not be delayed due to middle ear issues and ongoing treatment
Pediatric diagnostic evaluation is completed before three months of age and immediately following a failed newborn hearing screening
The evaluation should consist of a standardized comprehensive test battery using a cross check principle to obtain ear-specific information for air and bone conduction stimuli and to determine the type and degree of hearing loss to guide the fitting of hearing aids

32
Q

Do both ears need to pass the screening?

A

Yes, both need to to be considered a pass
Even if each ear has separately passed a screening, this does not constitute a pass outcome
Rescreening should comprise a single valid rescreen of both ears in the same session, regardless of initial screening results

33
Q

Were ear tags and pits removed as risk factors?

A

Yes
They are no longer considered to be at a higher risk or hearing loss

34
Q

What are the aspects that are in the comprehensive diagnostic evaluation for children?

A

Tymps
OAEs
Acoustic reflexes
Behaviorally testing when developmentally appropriate

35
Q

What should the parents and the PCP be advised of after passing the screening?

A

Doesn’t necessarily mean normal hearing
Only that thresholds are no greater than approximately 35 or 40 dB HL

36
Q

What is required for NBHS program coordination?

A

Regular and timely summaries of such information are critical for a successful program; therefore, the person in charge of the newborn hearing screening program needs a continual flow of information (number of babies screened, number who fail, etc.)
An efficient newborn hearing screening program will identify about 3 babies per 1,000 with permanent hearing loss

37
Q

What are some factors that have contributed to the expansion of NBHS?

A

Policy initiatives by gov, professional associations, and advocacy groups
Financial assistance from federal gov
Improvements in tech
Legislative initiatives
Lessons learned by successful programs

38
Q

What is loss to follow-up?

A

Those who do not return for necessary outpatient testing and therefore, they do not receive a recommended follow-up service after a failed newborn hearing screening; this can occur at any point in the EHDI process

39
Q

What is loss to documentation?

A

Those who have received services but results have not been reported to the EHDI program and, therefore, cannot be documented
Name changes, data mismatches, incomplete or erroneous parent contact information, and unknown PCP contributed to loss to documentation

40
Q

Why do kids fall through the cracks?

A

Inconsistent screening techniques
Loss to follow up after screening
Parental refusal to follow up on screening
Lack of access to audiology follow up
Inconsistent quality of diagnostic evaluation
Lack of communication with state EHDI program
False negatives for babies with mild loss
Lack of recognition of risk for progressive hearing problems

41
Q

How do you reduce loss to follow up?

A

Use an interpreter when needed
Provide written materials in parent’s language
Ensure an appointment for follow-up is made prior to discharge including
Verify contact information and obtain an alternate contact name and phone number
Verify the Primary Care Provider (PCP) and communicate results to him or her

42
Q

What is loss to system?

A

Combining the designations LTF and LTD
To reduce the confusion and variability in capturing this data set within and across EHDI systems
To increase the effectiveness of follow-up strategies

43
Q

What is the goal of hearing screenings beyond newborn period?

A

Identification of children at risk for hearing impairment that may affect education, health, development, communication
Children at risk for delayed or fluctuating hearing loss

44
Q

What are the ramifications of undetected hearing loss?

A

Language delay
Speech delay
Cognitive delay
Academic interference
Social and emotional adjustment
Economical impact

45
Q

What are commonly cited behaviors in school age children due to hearing impairment?

A

Has difficulty attending to spoken or other auditory information
Frequently requests repetition
Fatigues easily with listening
Gives inappropriate answers to simple questions
Appears isolated from peers

46
Q

Who should be screened according to ASHA (1997)?

A

All preschool and school-age children
Annual screening - Kindergarten to 3rd grade
Annual screening - All children in the 7th and 11th grades
Children absent from previous screenings
New entrants to school with no record of passing a hearing screening
Children who have failed a grade
Children enrolling in special education for the first time

47
Q

What are risk factors for fluctuating, delayed-onset, or progressive hearing impairment?

A

Family history of hereditary childhood hearing loss
In utero infection (CMV, rubella, syphilis, herpes, toxoplasmosis)
Neurofibromatosis type II and neurodegenerative disorders
Recurrent or persistent OME
Anatomic deformities and other disorders that affect ET function

48
Q

What is the pure tone screening protocol?

A

Pure tone sweep at 1000, 2000, and 4000 Hz at 20 dB HL.
Only screen in an acoustically appropriate screening environment (based on sound level measurements or biologic check)
Lack of response at any frequency in either ear constitutes a failure; rescreen immediately
Use tympanometry in conjunction with pure tone screening in young child populations (i.e., preschool, kindergarten, grade 1)

49
Q

What is the protocol for the tympanometry screening protocol?

A

Used as a second-stage screening method following failure of pure tone or OAE

50
Q

Are there maximum permissible ambient noise levels in the screening environment?

A

Yes

51
Q

How do you screen for hearing impairment for preschool children (3-5 years)?

A

If child can reliably participate in conditioned play audiometry (CPA) or conventional audiometry, screen under earphones (conventional or insert earphones), using 1000, 2000, and 4000 Hz tones at 20 dB HL (at least two presentations of each test stimulus)

52
Q

What is the pass/refer criteria for screening for hearing impaired children from 3-5 years?

A

Pass if child’s responses are judged to be clinically reliable at least 2 out of 3 times at the criterion decibel level at each frequency in each ear
Refer if child does not respond at least 2 out of 3 times at the criterion decibel level at any frequency in either ear or if the child cannot be conditioned to the task

53
Q

How do you screen for hearing impairment for school age children (5-18 years)?

A

Conditioned play audiometry (CPA) or conventional audiometry are the procedures of choice
Conduct screening under earphones using 1000, 2000, and 4000 Hz tones at 20 dB HL

54
Q

What is the pass/refer criteria for screening for hearing impaired children from 5-18 years?

A

Pass if responses are judged to be clinically reliable at criterion dB level at each frequency in each ear
If a child does not respond at criterion dB level at any frequency in either ear, reinstruct, reposition earphones, and rescreen within the same screening session in which the child fails
Refer children who fail the rescreening or fail to condition to the screening task

55
Q

What are acceptable modifications to the screening protocol?

A

Screening in calibrated SF
OAE (only used for preschool and school age children for whom pure tone screening is not developmentally appropriate)
ABR

56
Q

What are follow-up procedures if they fail the screening?

A

Rescreened in the same session or referred for audiologic evaluation
Hearing screening programs may choose to perform second stage screening on children failing a single frequency only in one or both ears
Children who fail two or more pure tone frequencies in one or both ears with passing tympanometry screening results should be immediately referred for audiological evaluation
Confirmation of hearing status should be obtained within 1 month (no later than 3)

57
Q

What are the two purposes for screening for disability in children (birth through 18)?

A

First, screening for hearing disability permits referral of those children who exhibit delays in the development of communication milestones (speech/language development, academic, or behavior problems)
Second, for children already identified as having hearing impairment, screening and subsequent assessment for disability should be viewed as part of overall audiological management

58
Q

What are the instruments commonly used to screen for disability by age group?

A

For the infant and toddler population: the Communication Screen the Early Language Milestone Scale (ELM) and the Physician’s Developmental Quick Screen for Speech Disorders
For the preschool population: the Communication Screen, the Physician’s Developmental Quick Screen for Speech Disorders and the Preschool SIFTER
For the school-age population: the SIFTER

59
Q

What is the goal of screening for disability?

A

Identification of children most likely to have hearing disabilities that interfere with their social, educational, vocational performance, and communication

AUDE 6140 - Pediatric Audiology (15 decks)

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