What is the primary goal of a hearing screening program?
To identify individuals with significant or potentially significant hearing problem
What is the goal of a newborn hearing screening?
ASHA, 1997
To identify children at risk for significant hearing impairment that can affect speech and language development
What is the goal of a school-age screening?
ASHA, 1997
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)
What is the goal of an adult hearing screening program?
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.
What is the Joint Committee on Infant Hearing (JCIH)?
A committee that provides guidelines for newborn and infant hearing screenings
What is the early hearing detection intervention (EHDI) board?
A state board that oversees and develops hearing screening programs for each state.
Some EHDI programs are more successful than others (i.e. Colorado)
Describe the history of UNHS
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
Is UNHS successful?
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.
Describe the protocol of a NHS.
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
What are some barriers to following recommendations outlined by JCIH 2007 for infant hearing screenings?
- 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
What are ways to improve follow-up for infant screenings?
- 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
Why screen school-aged children?
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.
Describe the procedure for a school-aged screening
- Pure tone audiometry using age-appropriate behavioral tests
- Acoustic immittance screenings
Effectiveness of school screenings
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.
What are the ramifications of hearing loss that go beyond communication?
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)
What is the importance of an adult hearing screening program?
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.
What are the costs of an adult hearing screening program?
- 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.
What are the expected outcomes of an adult hearing screening program?
May be successful, but need to communicate with physicians so they are making referrals to audiologists for testing.
What are the methods for assessing/documenting program effectiveness?
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.
What are the barriers to a successful adult hearing screening program?
- Adults don’t always comply with recommendations and typically ignore their hearing difficulties
- Cost
How would you address the barriers of an adult screening program?
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
What tests should be completed in an adult hearing screening?
- 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)
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ANSD19
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APD/Tinnitus & Hyperacusis/TBI36
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Hearing Screenings22
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Testing Non-Native Speakers5
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Vestibular Schwannomas40
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Listening Effort16
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BMLD21
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Hidden Hearing Loss20
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Genetics18
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Ototoxicity40
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SSD43
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Hybrid CI15
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Middle Ear Implants45
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Sensory Deprivation9
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Hearing Aids (Mr. Desbel)9
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References14
