WEBVTT 1 00:00:00.230 --> 00:00:01.210 Welcome, everybody! 2 00:00:01.230 --> 00:00:07.200 I am Will Eiserman, and I am the director of the early childhood 3 00:00:07.220 --> 00:00:12.210 4 00:00:12.230 --> 00:00:15.210 initiative, the ECHO initiative is housed within the National Center 5 00:00:15.230 --> 00:00:17.210 for Hearing Assessment and Management, known as NCHAM. 6 00:00:17.230 --> 00:00:23.270 At Utah State, Of which I am the associate director. 7 00:00:23.290 --> 00:00:28.270 NCHAM, currently serves as the early-hearing detection, and 8 00:00:28.290 --> 00:00:32.270 intervention National Technical Resource Center, funded through a 9 00:00:32.290 --> 00:00:38.270 cooperative agreement with Maternal and Child Health Bureau, but for -- 10 00:00:38.290 --> 00:00:43.270 more than 20 years, since 2001 -- the ECHO Initiative served as a 11 00:00:43.290 --> 00:00:47.270 National Resource Center on early hearing detection, and intervention, 12 00:00:47.290 --> 00:00:53.270 with a focus on supporting early Head Start, and Head Start program 13 00:00:53.290 --> 00:00:55.270 staff in implementing evidence-based hearing screening 14 00:00:55.290 --> 00:00:57.280 and follow up practices. 15 00:00:57.300 --> 00:01:01.280 And we're delighted today, to continue, to make our resources, 16 00:01:01.300 --> 00:01:06.280 and, other learning opportunities like this one available, to staff 17 00:01:06.300 --> 00:01:12.280 from Head Start Programs as well as to anyone in early care and 18 00:01:12.300 --> 00:01:14.910 education settings, who can put the -- this information together. 19 00:01:14.930 --> 00:01:19.910 Now, before I go any further, I just want to make sure you-all know, 20 00:01:19.930 --> 00:01:22.910 that this is being recorded. 21 00:01:22.930 --> 00:01:27.910 So, if anything distracts you from full attention today, Or if you 22 00:01:27.930 --> 00:01:30.110 think of people who would benefit from the conversation that we're 23 00:01:30.130 --> 00:01:32.110 going to have -- 24 00:01:32.130 --> 00:01:36.110 Know that this will be posted on kidshearing.org, in the next couple 25 00:01:36.130 --> 00:01:37.110 of days. 26 00:01:37.130 --> 00:01:40.110 So you can access and stream it, and scroll through it, at -- at any 27 00:01:40.130 --> 00:01:43.110 speed that you would like. 28 00:01:43.130 --> 00:01:44.110 . 29 00:01:44.130 --> 00:01:44.710 >> DR. 30 00:01:44.730 --> 00:01:47.710 EISERMAN: I want to give a shoutout to our Interpreters and 31 00:01:47.730 --> 00:01:51.710 our Captioner today, thank you for helping make this as accessible as 32 00:01:51.730 --> 00:01:52.210 possible. 33 00:01:52.230 --> 00:01:58.210 We always appreciate your amazing talents, and abilities to help us 34 00:01:58.230 --> 00:01:59.210 do that. 35 00:01:59.230 --> 00:02:00.700 Dr. 36 00:02:00.720 --> 00:02:03.700 Eiserman,: Now, we're going to -- we received hundreds of questions, 37 00:02:03.720 --> 00:02:07.820 from you, when you registered. 38 00:02:07.840 --> 00:02:11.820 And we have tried to incorporate answers to your questions, Into our 39 00:02:11.840 --> 00:02:12.820 presentation today. 40 00:02:12.840 --> 00:02:16.820 We did -- we tried our best. 41 00:02:16.840 --> 00:02:21.820 So, let's see how we do, and then, we'll open up the question -- for 42 00:02:21.840 --> 00:02:25.820 questions, And if there are remaining questions, that we didn't 43 00:02:25.840 --> 00:02:30.820 address, we'll open up a Q&A box for you to type in your question 44 00:02:30.840 --> 00:02:34.820 and we'll -- we'll address them that way. 45 00:02:34.840 --> 00:02:35.820 So... 46 00:02:35.840 --> 00:02:39.820 we hope that goes -- my -- 47 00:02:39.840 --> 00:02:42.820 my copresenter today is Dr. 48 00:02:42.840 --> 00:02:48.820 Terry Foust, AuD, CCC-A/SLP, who is a pediatric audiologist and 49 00:02:48.840 --> 00:02:52.820 speech language pathologist, who served as consultant to the ECHO 50 00:02:52.840 --> 00:02:57.120 initiative since the very beginning, Terry, thank you, and welcome! 51 00:02:57.140 --> 00:02:57.620 . 52 00:02:57.640 --> 00:03:00.620 >> your mic is off, Terry. 53 00:03:00.640 --> 00:03:01.620 Terry Foust, AuD, CCC-A/SLP: 54 00:03:01.640 --> 00:03:05.620 Thank you, and I apologize for that, and I appreciate that introduction, 55 00:03:05.640 --> 00:03:11.610 William, as William said, he and I, along with many other ECHO team 56 00:03:11.630 --> 00:03:12.620 57 00:03:12.640 --> 00:03:15.620 staff, as well as local collaborators, have provided 58 00:03:15.640 --> 00:03:21.620 training in nearly every state, with thousands of staff from early 59 00:03:21.640 --> 00:03:27.620 Head Start Head start, American Indian Alaskan native and migrant 60 00:03:27.640 --> 00:03:30.620 Head start and early care and education programs over the years 61 00:03:30.640 --> 00:03:33.220 so it's been a lot of programs and we're always encouraged, just like 62 00:03:33.240 --> 00:03:36.420 we are today. 63 00:03:36.440 --> 00:03:38.420 With the huge amount of interest that there is in 64 00:03:38.440 --> 00:03:38.920 establishing -- 65 00:03:38.940 --> 00:03:39.920 and maintaining -- 66 00:03:39.940 --> 00:03:42.570 evidence-based hearing screening programs. 67 00:03:42.590 --> 00:03:45.570 Really, so that children with hearing-related needs can be 68 00:03:45.590 --> 00:03:46.570 identified and served. 69 00:03:46.590 --> 00:03:47.070 . 70 00:03:47.090 --> 00:03:48.960 >> DR. 71 00:03:48.980 --> 00:03:52.950 EISERMAN: So our webinar today, is primarily intended for those of you 72 00:03:52.970 --> 00:03:56.950 who have already had some experience implementing 73 00:03:56.970 --> 00:03:58.960 evidence-based hearing screening practices, for children in the 74 00:03:58.980 --> 00:04:04.960 birth to 3 age range, in the three to 5 age range or both. 75 00:04:04.980 --> 00:04:07.960 And, you know, we're just delighted to see that we've had over 1500 76 00:04:07.980 --> 00:04:12.900 people register for today. 77 00:04:12.920 --> 00:04:16.900 Now, -- I -- I want to make sure you know that we're -- we're going 78 00:04:16.920 --> 00:04:20.900 to do our best to address some of the questions that you address. 79 00:04:20.920 --> 00:04:24.900 You sent to us, but, be aware that... 80 00:04:24.920 --> 00:04:30.900 If you are really new to Early Childhood Hearing Screening, you're 81 00:04:30.920 --> 00:04:34.900 welcome to stay on, you can benefit from what we're talking about: But 82 00:04:34.920 --> 00:04:36.900 next week -- 83 00:04:36.920 --> 00:04:41.900 (as slide advances) we have another webinar, which is an Introduction 84 00:04:41.920 --> 00:04:46.900 to Evidence-based, hearing Screenings so you can find that on 85 00:04:46.920 --> 00:04:48.900 kidshearing.org to register for that, if you haven't already seen 86 00:04:48.920 --> 00:04:52.900 that, and if you're really needing information, that's basic, starting 87 00:04:52.920 --> 00:04:53.900 from the beginning -- 88 00:04:53.920 --> 00:04:59.900 that's the webinar that you'll want to attend for sure, and if you know 89 00:04:59.920 --> 00:05:03.900 of others, that may benefit from that webinar, send them there as 90 00:05:03.920 --> 00:05:04.400 well. 91 00:05:04.420 --> 00:05:05.400 (Link in chat), . 92 00:05:05.420 --> 00:05:06.400 >> DR. 93 00:05:06.420 --> 00:05:07.750 EISERMAN: (Continuing). 94 00:05:07.770 --> 00:05:10.750 So, we're going to organize our time today, around -- as I said, 95 00:05:10.770 --> 00:05:14.750 many of the questions, that you submitted, and, we're going to 96 00:05:14.770 --> 00:05:18.750 present some of the information about these topics; and we're going 97 00:05:18.770 --> 00:05:23.750 to start, with a brief overview for everybody, and for those who are 98 00:05:23.770 --> 00:05:25.750 newcomers to evidence-based practices. 99 00:05:25.770 --> 00:05:31.750 Some of you have asked questions about being able to provide a basic 100 00:05:31.770 --> 00:05:34.750 rationale to parents or other colleagues on the purpose of 101 00:05:34.770 --> 00:05:37.750 hearing screening and what the recommended methods are; so, we're 102 00:05:37.770 --> 00:05:41.750 going to -- we're going to talk about that. 103 00:05:41.770 --> 00:05:42.750 That big picture. 104 00:05:42.770 --> 00:05:48.750 We're, then, going to turn our attention, to a review of issues 105 00:05:48.770 --> 00:05:52.750 pertaining to PureTone audiometry, which is the method that's 106 00:05:52.770 --> 00:05:56.750 recommended for 3 to five-year-olds, since many of you are getting 107 00:05:56.770 --> 00:06:01.750 ready for a new round of screenings in the spring, we'll go over the 108 00:06:01.770 --> 00:06:05.750 key steps you want to complete to prepare this, and that's also, in 109 00:06:05.770 --> 00:06:08.750 response, to questions that we got that -- you know, can we just 110 00:06:08.770 --> 00:06:12.220 review this -- this procedure? 111 00:06:12.240 --> 00:06:13.220 . 112 00:06:13.240 --> 00:06:17.220 We'll, then, review the steps of the procedure, and -- some of the 113 00:06:17.240 --> 00:06:22.440 questions that were raised about PureTone screening. 114 00:06:22.460 --> 00:06:28.440 After we address those questions, we'll, then, move on to a similar 115 00:06:28.460 --> 00:06:33.440 conversation around otoacoustic emissions or OAE screening -- which, 116 00:06:33.460 --> 00:06:37.440 is the method used with birth-three-year-olds and 117 00:06:37.460 --> 00:06:42.440 increasingly, with 3-five-year-olds as well. 118 00:06:42.460 --> 00:06:43.640 So, we'll be talking about -- 119 00:06:43.660 --> 00:06:45.640 about that. 120 00:06:45.660 --> 00:06:49.640 And then we'll talk about the -- 121 00:06:49.660 --> 00:06:53.640 the screening and follow up protocol and parent support, and 122 00:06:53.660 --> 00:06:57.640 how to make sure that the steps that need to be followed after a 123 00:06:57.660 --> 00:07:00.640 child is screened, particularly, when they don't pass on one or both 124 00:07:00.660 --> 00:07:02.640 ears -- 125 00:07:02.660 --> 00:07:07.640 Has to get implemented, and, some of the challenges that -- 126 00:07:07.660 --> 00:07:11.640 that go along with that. 127 00:07:11.660 --> 00:07:14.640 And then we'll wrap up by talking about some of our technical 128 00:07:14.660 --> 00:07:19.640 assistance resources that are available, so that, you know, what 129 00:07:19.660 --> 00:07:22.640 exists, and where to find them on our -- on our Web site. 130 00:07:22.660 --> 00:07:27.640 And, you know, -- one of the things, I want to say right off the bat, 131 00:07:27.660 --> 00:07:29.640 (slide advances), is.... 132 00:07:29.660 --> 00:07:33.640 We're always -- you know, we're in an interesting dilemma when we try 133 00:07:33.660 --> 00:07:38.640 to develop training resources, and learning opportunities, like this, 134 00:07:38.660 --> 00:07:44.640 To explain things as clearly and as succinctly as we can. 135 00:07:44.660 --> 00:07:45.640 And sometimes... 136 00:07:45.660 --> 00:07:49.640 I think, we inadvertently leave people with the impression that 137 00:07:49.660 --> 00:07:50.640 this is easy. 138 00:07:50.660 --> 00:07:51.140 . 139 00:07:51.160 --> 00:07:51.740 >> DR. 140 00:07:51.760 --> 00:07:54.740 EISERMAN: And then, those of you who have some challenges feel like, 141 00:07:54.760 --> 00:07:58.740 something's wrong with you. 142 00:07:58.760 --> 00:08:02.740 When, actually, -- it's really a skill-development experience that 143 00:08:02.760 --> 00:08:04.740 everybody has. 144 00:08:04.760 --> 00:08:10.740 And that it can become easy, and it can be easy with certain children; 145 00:08:10.760 --> 00:08:17.470 but all of us run into experiences where we're challenged. 146 00:08:17.490 --> 00:08:20.470 And where we have difficulty completing the screening process, 147 00:08:20.490 --> 00:08:25.470 and that's true, with PureTone audiometry, and with OAEs as well. 148 00:08:25.490 --> 00:08:31.460 And so we'll give our best shot at giving you suggestions -- but we 149 00:08:31.480 --> 00:08:32.470 150 00:08:32.490 --> 00:08:34.470 can't fix every single challenge you run into. 151 00:08:34.490 --> 00:08:38.030 We're going to do our best, So let's start off... 152 00:08:38.050 --> 00:08:43.030 by just talking about the rationale so that you have a good 153 00:08:43.050 --> 00:08:47.850 way of being able to set the context for your own screenings. 154 00:08:47.870 --> 00:08:52.850 And we always like to start with this graphic, to remind people: 155 00:08:52.870 --> 00:08:56.850 That the work of the ECHO Initiative is based on the 156 00:08:56.870 --> 00:09:01.850 recognition, that each day, young children, who are Deaf or Hard of 157 00:09:01.870 --> 00:09:04.850 Hearing, are already being served in early childhood health, and 158 00:09:04.870 --> 00:09:10.840 education settings, Often without their hearing-related needs being 159 00:09:10.860 --> 00:09:12.850 160 00:09:12.870 --> 00:09:14.650 known. 161 00:09:14.670 --> 00:09:18.650 Hearing loss, is often referred to as an "invisible condition." 162 00:09:18.670 --> 00:09:22.650 So, how can we reliably identify which children have normal hearing? 163 00:09:22.670 --> 00:09:25.650 And which may not? 164 00:09:25.670 --> 00:09:26.650 (Slide advances). 165 00:09:26.670 --> 00:09:29.320 >> DR. 166 00:09:29.340 --> 00:09:30.120 EISERMAN: (Continuing). 167 00:09:30.140 --> 00:09:31.120 >> Terry Foust, AuD, CCC-A/SLP: 168 00:09:31.140 --> 00:09:34.120 William and everybody, really the short answer to that question is 169 00:09:34.140 --> 00:09:38.120 that early care and education providers, we all can be trained to 170 00:09:38.140 --> 00:09:40.120 conduct, evidence-based hearing screening just like you see in 171 00:09:40.140 --> 00:09:42.120 these photos here. 172 00:09:42.140 --> 00:09:46.120 And, again, the ultimate outcome of hearing screening program, is that 173 00:09:46.140 --> 00:09:50.120 we can identify children, who are Deaf, or Hard of Hearing, who have 174 00:09:50.140 --> 00:09:53.250 not been previously identified. 175 00:09:53.270 --> 00:09:58.250 So the procedure on the left on your screen, that's called 176 00:09:58.270 --> 00:10:00.250 otoacoustic emissions or OAE hearing screening, and like William 177 00:10:00.270 --> 00:10:03.250 said: That's the recommended method for children, birth to three 178 00:10:03.270 --> 00:10:05.250 years of age. 179 00:10:05.270 --> 00:10:10.250 And it's increasingly being recommended for children three to 180 00:10:10.270 --> 00:10:11.250 5. 181 00:10:11.270 --> 00:10:15.250 Now, over here on the right, you'll see, the procedure PureTone 182 00:10:15.270 --> 00:10:17.650 audiometry. 183 00:10:17.670 --> 00:10:19.650 Hearing screening, and that's historically been the most 184 00:10:19.670 --> 00:10:23.650 commonly-used screening method for children 3-5 years of age and older; 185 00:10:23.670 --> 00:10:29.650 and, you'll still see that in many early care and education settings, 186 00:10:29.670 --> 00:10:32.250 and see those providers using it and so we're going to talk about 187 00:10:32.270 --> 00:10:34.250 both of those methods today. 188 00:10:34.270 --> 00:10:34.750 . 189 00:10:34.770 --> 00:10:35.350 >> DR. 190 00:10:35.370 --> 00:10:38.350 EISERMAN: Yeah, and before we jump in, Terry, I want to have you 191 00:10:38.370 --> 00:10:39.350 answer a question -- 192 00:10:39.370 --> 00:10:42.350 and Terry, it's fine if you want to keep your -- your video off now. 193 00:10:42.370 --> 00:10:45.350 But one of the questions, that we've gotten repeatedly, in the 194 00:10:45.370 --> 00:10:51.350 context of those of you, who are facing some challenges, 195 00:10:51.370 --> 00:10:57.350 particularly, with children, that might have other special needs, 196 00:10:57.370 --> 00:11:01.350 disabilities, or even language differences. 197 00:11:01.370 --> 00:11:07.350 Other than these two methods, are there any recommended methods that 198 00:11:07.370 --> 00:11:13.080 we could use for those instances? 199 00:11:13.100 --> 00:11:17.080 And -- Terry, let's just address that question right off the bat. 200 00:11:17.100 --> 00:11:18.080 Terry Foust, AuD, CCC-A/SLP: 201 00:11:18.100 --> 00:11:21.080 Yeah, you know, there really aren't, because we don't -- 202 00:11:21.100 --> 00:11:25.080 since we have the ability, to do this, physiologic-type screening or 203 00:11:25.100 --> 00:11:28.080 objective screening -- we don't want to rely on subjective methods; 204 00:11:28.100 --> 00:11:31.080 so, maybe, some of those things that might come to mind, are some 205 00:11:31.100 --> 00:11:36.080 of those things, like, ringing bells, and -- and um -- you know, 206 00:11:36.100 --> 00:11:39.080 observing reaction to sound, but -- 207 00:11:39.100 --> 00:11:45.070 We -- we have the ability to do so much better; so really, it is OAE, 208 00:11:45.090 --> 00:11:46.080 209 00:11:46.100 --> 00:11:50.080 and PureTone screening, and those should be the methods that should 210 00:11:50.100 --> 00:11:51.080 be used. 211 00:11:51.100 --> 00:11:51.680 Dr. 212 00:11:51.700 --> 00:11:55.680 Eiserman: And when you're stuck, when you actually can't get a 213 00:11:55.700 --> 00:11:59.680 screening, whether it's one or the other methods... 214 00:11:59.700 --> 00:12:04.680 There are a couple of things you can do: 1), is if you're using 215 00:12:04.700 --> 00:12:06.680 PureTone, you can try OAEs. 216 00:12:06.700 --> 00:12:12.680 You can't do it in reverse, though, if you're using OAEs on younger 217 00:12:12.700 --> 00:12:15.680 children, birth-3, PureTone is not a back up method for you. 218 00:12:15.700 --> 00:12:18.680 So that's one thing, to keep in mind. 219 00:12:18.700 --> 00:12:22.680 And the other (2), is, you know, you can try having other staff, you 220 00:12:22.700 --> 00:12:27.680 can try again, at another day; and if you still are struggling, then 221 00:12:27.700 --> 00:12:32.680 you make a referral to a healthcare -- or to a -- an audiologist, who 222 00:12:32.700 --> 00:12:36.540 will be more skillful in being able to complete the screening. 223 00:12:36.560 --> 00:12:40.540 The important thing to remember -- 224 00:12:40.560 --> 00:12:44.540 Is that, children who have a hearing loss, may be the very ones 225 00:12:44.560 --> 00:12:47.540 who are the most difficult to screen. 226 00:12:47.560 --> 00:12:53.540 So, we don't want to just write off, they were difficult to screen; and 227 00:12:53.560 --> 00:12:56.540 set them aside for another indefinite time. 228 00:12:56.560 --> 00:13:00.540 We want to make sure that those children get on the top of the list 229 00:13:00.560 --> 00:13:03.540 for follow up. 230 00:13:03.560 --> 00:13:04.540 Okay? 231 00:13:04.560 --> 00:13:08.540 So -- as some of you have asked whether or not you need to be 232 00:13:08.560 --> 00:13:12.540 certified to do screenings and that tends to be a very state-specific 233 00:13:12.560 --> 00:13:13.040 issue. 234 00:13:13.060 --> 00:13:17.040 We don't know right now, of any states that require that. 235 00:13:17.060 --> 00:13:21.040 But there are some state guidelines that can influence your practices, 236 00:13:21.060 --> 00:13:25.040 so, we would encourage you to check that out, on a state-by-state basis; 237 00:13:25.060 --> 00:13:31.040 and the best way to do that is to contact your state's early hearing 238 00:13:31.060 --> 00:13:36.040 detection and intervention coordinator, the person responsible 239 00:13:36.060 --> 00:13:40.040 for your state's newborn screening program; and you can find that link 240 00:13:40.060 --> 00:13:46.040 on our Web site -- when you look for information on finding an 241 00:13:46.060 --> 00:13:46.540 audiologist. 242 00:13:46.560 --> 00:13:52.540 It will take you to the link for your state's EHDI Coordinator, the 243 00:13:52.560 --> 00:13:57.670 Early Hearing Detection, and Intervention coordinator. 244 00:13:57.690 --> 00:14:02.670 (Slide advances) so in helping families to.... 245 00:14:02.690 --> 00:14:07.670 Really feel motivated, to follow up, That's another one of your 246 00:14:07.690 --> 00:14:11.670 questions, When children don't pass -- 247 00:14:11.690 --> 00:14:12.670 we need some... 248 00:14:12.690 --> 00:14:15.050 some information that will help them feel... 249 00:14:15.070 --> 00:14:16.050 the importance of this. 250 00:14:16.070 --> 00:14:22.050 And one way, is to share information about the incidence of 251 00:14:22.070 --> 00:14:25.050 hearing loss, and the fact that hearing loss... 252 00:14:25.070 --> 00:14:26.050 A child's hearing ability -- 253 00:14:26.070 --> 00:14:26.550 Can change. 254 00:14:26.570 --> 00:14:30.550 At any time. 255 00:14:30.570 --> 00:14:33.550 Often without us ever recognizing it. 256 00:14:33.570 --> 00:14:37.550 About three children in a thousand, (animation plays on slide), are 257 00:14:37.570 --> 00:14:41.550 born with hearing loss being Deaf or Hard of Hearing, Most newborns 258 00:14:41.570 --> 00:14:46.550 in the U.S., are now being screened, for hearing loss using 259 00:14:46.570 --> 00:14:50.550 evidence-based methods before even leaving the hospital. 260 00:14:50.570 --> 00:14:55.550 But screening at the newborn period isn't really enough because, the 261 00:14:55.570 --> 00:14:57.950 research suggests -- and this is the important point that you would 262 00:14:57.970 --> 00:15:01.950 want to convey to parents: 263 00:15:01.970 --> 00:15:06.950 That research suggests that the incidence of permanent hearing loss 264 00:15:06.970 --> 00:15:11.950 doubles between birth and school age; from that original 3 in a 265 00:15:11.970 --> 00:15:17.940 thousand at birth, to another 3 in a thousand totaling 6 in a thousand, 266 00:15:17.960 --> 00:15:18.950 267 00:15:18.970 --> 00:15:21.950 by the time children enter school. 268 00:15:21.970 --> 00:15:22.450 And so.... 269 00:15:22.470 --> 00:15:24.450 We want to stay on top of that. 270 00:15:24.470 --> 00:15:29.450 And so, when children don't pass a screening, they may have a mild 271 00:15:29.470 --> 00:15:34.450 hearing loss, they might have a more significant hearing loss, And 272 00:15:34.470 --> 00:15:39.450 we might not be able to observe it and so these screenings, are the 273 00:15:39.470 --> 00:15:41.450 way to get to that. 274 00:15:41.470 --> 00:15:42.450 (Next slide), . 275 00:15:42.470 --> 00:15:43.450 >> DR. 276 00:15:43.470 --> 00:15:45.450 EISERMAN: (Concludes). 277 00:15:45.470 --> 00:15:49.450 >> Terry Foust, AuD, CCC-A/SLP: 278 00:15:49.470 --> 00:15:53.450 Now, hearing loss, you know, we don't only screen hearing at birth 279 00:15:53.470 --> 00:15:55.450 as William mentioned we need to screen throughout early childhood 280 00:15:55.470 --> 00:15:59.450 because as he said, hearing loss can occur at any time, and it can 281 00:15:59.470 --> 00:16:03.450 occur as a result of illness, or -- 282 00:16:03.470 --> 00:16:05.450 physical trauma, or environmental or genetic factors. 283 00:16:05.470 --> 00:16:09.450 And so, when this happens, it's often referred to as "late onset 284 00:16:09.470 --> 00:16:13.450 hearing loss." And that just simply means that it occurred after the 285 00:16:13.470 --> 00:16:16.450 newborn period. 286 00:16:16.470 --> 00:16:17.470 DR. 287 00:16:17.490 --> 00:16:21.470 EISERMAN: You know, and, again, it's similar to the subtle changes 288 00:16:21.490 --> 00:16:24.470 that you might see in vision that can occur for any of us. 289 00:16:24.490 --> 00:16:29.470 A child can experience a change in hearing ability that we want to 290 00:16:29.490 --> 00:16:35.470 identify so that they have full access to language, and all of the 291 00:16:35.490 --> 00:16:37.870 information that -- that they're being exposed to, as they -- they 292 00:16:37.890 --> 00:16:41.870 learn and grow. 293 00:16:41.890 --> 00:16:43.870 Terry Foust, AuD, CCC-A/SLP: 294 00:16:43.890 --> 00:16:47.870 William I'm going to have to ask you to take this for a moment, I'm 295 00:16:47.890 --> 00:16:49.870 having a little trouble, technical trouble on my end. 296 00:16:49.890 --> 00:16:52.070 >> DR. 297 00:16:52.090 --> 00:16:54.470 EISERMAN: Sure, so, you know, screening is the first step in the 298 00:16:54.490 --> 00:16:57.470 process of identifying a disability like a hearing loss, so it's 299 00:16:57.490 --> 00:17:00.470 important to know, no screening method is 100% effective in 300 00:17:00.490 --> 00:17:06.110 identifying possible areas of concern. 301 00:17:06.130 --> 00:17:10.110 Parent and caregiver concerns always override a passing screening 302 00:17:10.130 --> 00:17:13.110 result, no matter what screening method is used. 303 00:17:13.130 --> 00:17:19.110 So, you know, -- any conversation, we have about follow up -- 304 00:17:19.130 --> 00:17:23.110 And screening should always begin with a reminder that screening 305 00:17:23.130 --> 00:17:27.110 methods aren't perfect; and that whenever a parent or caregiver, 306 00:17:27.130 --> 00:17:32.110 expresses a concern about language, or hearing -- children should be 307 00:17:32.130 --> 00:17:36.110 referred for a more thorough evaluation, even if the Child 308 00:17:36.130 --> 00:17:38.710 passed the screening. 309 00:17:38.730 --> 00:17:41.710 And that's true even with these highly-reliable hearing screening 310 00:17:41.730 --> 00:17:43.710 methods that we're talking about today. 311 00:17:43.730 --> 00:17:44.210 . 312 00:17:44.230 --> 00:17:45.010 >> DR. 313 00:17:45.030 --> 00:17:47.010 EISERMAN: (Continuing), we also want to acknowledge, right upfront 314 00:17:47.030 --> 00:17:50.010 that for any number of reasons -- 315 00:17:50.030 --> 00:17:55.010 There will be an occasional child, that you just can't manage to 316 00:17:55.030 --> 00:17:58.010 screen, as we have already alluded to; and after you've tried 317 00:17:58.030 --> 00:18:02.010 everything you can do, and you have a colleague try it, if that's 318 00:18:02.030 --> 00:18:08.010 possible -- you'll be faced with that dilemma of what to do. 319 00:18:08.030 --> 00:18:12.010 and our recommendation about that -- is that, you make a referral to 320 00:18:12.030 --> 00:18:14.010 a pediatric audiologist. 321 00:18:14.030 --> 00:18:18.010 Keep in mind some children, you may... 322 00:18:18.030 --> 00:18:22.010 have difficulty screening like I said, maybe, the very ones who have 323 00:18:22.030 --> 00:18:24.010 a hearing loss. 324 00:18:24.030 --> 00:18:27.010 So we don't want to just skip those children, just because they were 325 00:18:27.030 --> 00:18:30.010 hard to screen. 326 00:18:30.030 --> 00:18:33.010 (Slide advances), So... 327 00:18:33.030 --> 00:18:38.010 We just mentioned having a pediatric audiologist, in the 328 00:18:38.030 --> 00:18:39.010 picture. 329 00:18:39.030 --> 00:18:44.010 Now, a pediatric audiologist, if you don't know, is a professional 330 00:18:44.030 --> 00:18:49.010 who specializes in the diagnosis and nonmedical treatment of 331 00:18:49.030 --> 00:18:50.610 hearing-related, and other disorders associated with the ear, 332 00:18:50.630 --> 00:18:53.610 and the auditory system. 333 00:18:53.630 --> 00:18:57.610 A pediatric audiologist, specializes in children, so -- 334 00:18:57.630 --> 00:19:02.610 having access to a local pediatric audiologist, can really be helpful, 335 00:19:02.630 --> 00:19:07.610 and we recommend, that, all programs consult with a local 336 00:19:07.630 --> 00:19:11.610 audiologist, to help develop and oversee your hearing screening and 337 00:19:11.630 --> 00:19:14.610 follow up activities; and, to be able to take questions like you 338 00:19:14.630 --> 00:19:17.610 have sent to us -- 339 00:19:17.630 --> 00:19:22.610 Not that we mind it, but it would be nice to have somebody local, 340 00:19:22.630 --> 00:19:26.610 that you can dialogue with about these challenges. 341 00:19:26.630 --> 00:19:29.610 They can help with equipment questions you might have. 342 00:19:29.630 --> 00:19:34.610 they can consult with you, about specific children, who aren't 343 00:19:34.630 --> 00:19:35.610 passing. 344 00:19:35.630 --> 00:19:38.610 And importantly, they can be one of your resources when you need to 345 00:19:38.630 --> 00:19:40.790 refer a child for further evaluation. 346 00:19:40.810 --> 00:19:41.290 . 347 00:19:41.310 --> 00:19:41.890 >> DR. 348 00:19:41.910 --> 00:19:45.890 EISERMAN: On our Web site, kidshearing.org, you'll find a link, 349 00:19:45.910 --> 00:19:48.850 to find an audiologist. 350 00:19:48.870 --> 00:19:51.650 which should help you do just that. 351 00:19:51.670 --> 00:19:52.650 Terry, are you still connected? 352 00:19:52.670 --> 00:19:53.150 . 353 00:19:53.170 --> 00:19:54.150 >> Terry Foust, AuD, CCC-A/SLP: 354 00:19:54.170 --> 00:19:56.950 I am -- I am back, so thank you, and -- and my apologies. 355 00:19:56.970 --> 00:19:57.450 . 356 00:19:57.470 --> 00:19:57.950 >> No. 357 00:19:57.970 --> 00:19:58.950 >> Terry Foust, AuD, CCC-A/SLP: 358 00:19:58.970 --> 00:20:04.950 I did want to mention here William, and to all of us that are here, 359 00:20:04.970 --> 00:20:09.950 that some of you submitted some very specific equipment-specific 360 00:20:09.970 --> 00:20:12.930 questions about the error messages on your equipment. 361 00:20:12.950 --> 00:20:15.930 And, we would love to address those, but it would be really difficult 362 00:20:15.950 --> 00:20:20.930 for us in a group setting, since there are so many different pieces 363 00:20:20.950 --> 00:20:24.980 of equipment, probably represented by you here today. 364 00:20:25.000 --> 00:20:29.980 So, you -- you could pose those questions to the person who sold 365 00:20:30.000 --> 00:20:33.180 you the equipment. 366 00:20:33.200 --> 00:20:37.180 And they can let you know what those specific error messages are 367 00:20:37.200 --> 00:20:38.180 related to. 368 00:20:38.200 --> 00:20:39.180 Terry Foust, AuD, CCC-A/SLP: 369 00:20:39.200 --> 00:20:43.180 While the equipment distributors and salespeople, aren't really the 370 00:20:43.200 --> 00:20:48.180 folks you should look to for aggressive comprehensive training 371 00:20:48.200 --> 00:20:52.180 and program, and those skills they do have expertise for those 372 00:20:52.200 --> 00:20:55.180 particular models and so they can absolutely help you understand your 373 00:20:55.200 --> 00:20:59.180 equipment functions, and error messages, and -- and things like 374 00:20:59.200 --> 00:20:59.680 that. 375 00:20:59.700 --> 00:21:03.680 We'll address those, some of the commonality, as we go further today, 376 00:21:03.700 --> 00:21:08.680 But having access to both -- as William mentioned -- a pediatric 377 00:21:08.700 --> 00:21:12.680 audiologist, and your sales rep -- can really be helpful for different 378 00:21:12.700 --> 00:21:15.680 reasons, and so we really encourage you to have their contact 379 00:21:15.700 --> 00:21:18.680 information ready for when you need it. 380 00:21:18.700 --> 00:21:21.680 And sometimes, of course, that equipment manual is really helpful 381 00:21:21.700 --> 00:21:22.680 as well. 382 00:21:22.700 --> 00:21:23.280 DR. 383 00:21:23.300 --> 00:21:26.280 EISERMAN: Yeah, Terry, and, you know, one of the questions (an 384 00:21:26.300 --> 00:21:30.280 electronic tone), a number of you asked was related to screening 385 00:21:30.300 --> 00:21:34.280 children, with tubes, PE tubes, and, you know, do we screen these 386 00:21:34.300 --> 00:21:34.780 children? 387 00:21:34.800 --> 00:21:37.970 Do I need to do something to the equipment? 388 00:21:37.990 --> 00:21:40.970 And so, we can just get this question addressed right upfront 389 00:21:40.990 --> 00:21:43.570 right here. 390 00:21:43.590 --> 00:21:44.070 So --. 391 00:21:44.090 --> 00:21:45.070 >> Terry Foust, AuD, CCC-A/SLP: 392 00:21:45.090 --> 00:21:45.570 Yeah. 393 00:21:45.590 --> 00:21:46.170 >> DR. 394 00:21:46.190 --> 00:21:49.170 EISERMAN: Terry as our -- and, by the way, if you came on late, this 395 00:21:49.190 --> 00:21:51.570 is Terry Foust who is is a pediatric audiologist, and a speech 396 00:21:51.590 --> 00:21:53.970 language pathologist who has worked with us from the very beginning of 397 00:21:53.990 --> 00:21:55.970 our work, with the ECHO Initiative. 398 00:21:55.990 --> 00:21:56.970 Terry Foust, AuD, CCC-A/SLP: 399 00:21:56.990 --> 00:22:00.970 Yeah, thank you for that question, William 400 00:22:00.990 --> 00:22:02.370 >> Yeah, let's address that right now. 401 00:22:02.390 --> 00:22:03.620 So, yes, absolutely. 402 00:22:03.640 --> 00:22:07.620 Yes, you can -- you can and should screen children who you know, have 403 00:22:07.640 --> 00:22:11.620 PE tubes, it's really one way to find out if the tubes are, actually, 404 00:22:11.640 --> 00:22:14.980 doing the job they have been put in to do. 405 00:22:15.000 --> 00:22:17.980 Children, with PE tubes, they should pass the hearing screening, 406 00:22:18.000 --> 00:22:20.980 if those tubes are open, and working, and the rest of their 407 00:22:21.000 --> 00:22:23.980 auditory system is functioning normally. 408 00:22:24.000 --> 00:22:27.980 So, for those of you using the OAE method, you'll want to look at your 409 00:22:28.000 --> 00:22:29.410 equipment manual. 410 00:22:29.430 --> 00:22:34.410 Because there are a couple of pieces that need you to push a -- 411 00:22:34.430 --> 00:22:39.410 an extra -- there's an extra button push to adjust the setting for 412 00:22:39.430 --> 00:22:43.410 screening, an ear that has PE tubes so just be sure to check that out 413 00:22:43.430 --> 00:22:44.870 for your particular piece of equipment. 414 00:22:44.890 --> 00:22:48.870 (After a pause), like I said, some equipment will require a temporary 415 00:22:48.890 --> 00:22:50.870 adjustment and other brands do not. 416 00:22:50.890 --> 00:22:56.870 But, yes, you can, and should screen children with PE tubes, (A 417 00:22:56.890 --> 00:22:57.370 pause). 418 00:22:57.390 --> 00:22:57.970 >> DR. 419 00:22:57.990 --> 00:23:00.370 EISERMAN: Okay, so we have two screening methods we want to talk 420 00:23:00.390 --> 00:23:04.370 about today, by way of big picture: If you're responsible for children, 421 00:23:04.390 --> 00:23:07.370 who are under 3 years of age, the recommended method is OAE screening 422 00:23:07.390 --> 00:23:11.370 which you see on the left here, and if you're responsible for screening 423 00:23:11.390 --> 00:23:15.370 children, 3 years of age or older -- 424 00:23:15.390 --> 00:23:17.370 Historically -- PureTone audiometry has been considered "the 425 00:23:17.390 --> 00:23:20.370 recommended method" for this age group. 426 00:23:20.390 --> 00:23:26.370 This is that headset screening, where the Child raises a hand, or 427 00:23:26.390 --> 00:23:30.370 performs another task, each time they hear a sound that's presented 428 00:23:30.390 --> 00:23:33.370 into the ear, and you see this method on the right there. 429 00:23:33.390 --> 00:23:36.370 (A pause), Terry Foust, AuD, CCC-A/SLP: 430 00:23:36.390 --> 00:23:41.370 Now several of you asked about why some programs, are no longer using 431 00:23:41.390 --> 00:23:43.510 PureTone audiometry, with the three to 5 population. 432 00:23:43.530 --> 00:23:45.510 And switching to OAEs. 433 00:23:45.530 --> 00:23:49.510 And it's really because there's some growing recognition that 434 00:23:49.530 --> 00:23:51.510 although, the PureTone method -- 435 00:23:51.530 --> 00:23:55.510 it's been the most widely-used method historically, it may not 436 00:23:55.530 --> 00:23:59.510 always be the most feasible method to use with some of these younger 437 00:23:59.530 --> 00:24:04.510 children, so the research has shown that about 20 to 25% of children, 438 00:24:04.530 --> 00:24:09.510 in that three to 5 age group, can't be screened with PureTone 439 00:24:09.530 --> 00:24:12.510 audiometry, or this methodology because they just aren't 440 00:24:12.530 --> 00:24:13.940 developmentally able to follow the directions reliably. 441 00:24:13.960 --> 00:24:14.440 . 442 00:24:14.460 --> 00:24:15.440 >> Dr. 443 00:24:15.460 --> 00:24:17.440 Terry Foust, AuD, CCC-A/SLP: And that's really been our experience 444 00:24:17.460 --> 00:24:17.940 as well. 445 00:24:17.960 --> 00:24:23.940 So in those instances, then, OAE screenings the preferred method -- 446 00:24:23.960 --> 00:24:25.940 for those children. 447 00:24:25.960 --> 00:24:29.940 As William emphasized a moment ago, we want to screen every child, even 448 00:24:29.960 --> 00:24:32.940 the ones that we find challenging to screen, right? 449 00:24:32.960 --> 00:24:33.440 . 450 00:24:33.460 --> 00:24:34.040 >> DR. 451 00:24:34.060 --> 00:24:37.040 EISERMAN: So at a minimum, if you're establishing evidence-based 452 00:24:37.060 --> 00:24:41.040 practices for three to five-year-olds, and if you're 453 00:24:41.060 --> 00:24:46.040 considering using, or you're using PureTone screening, you'll also 454 00:24:46.060 --> 00:24:52.030 need to be equipped, and prepared to do OAEs, on that 20 to 25% who 455 00:24:52.050 --> 00:24:53.040 456 00:24:53.060 --> 00:24:55.400 can't be screened with PureTones. 457 00:24:55.420 --> 00:24:57.730 Or.... 458 00:24:57.750 --> 00:25:00.730 Alternatively, You'll need to have a means for systematically 459 00:25:00.750 --> 00:25:05.730 referring all of those children to audiologists, who can perform the 460 00:25:05.750 --> 00:25:08.130 screening. 461 00:25:08.150 --> 00:25:10.530 Which -- as a cautionary note. 462 00:25:10.550 --> 00:25:13.530 Frankly, could be -- pretty challenging, in its own right, if 463 00:25:13.550 --> 00:25:19.520 we're having to refer 20% of the children to an audiologist for a 464 00:25:19.540 --> 00:25:20.530 465 00:25:20.550 --> 00:25:22.570 screening, That might not really -- really work. 466 00:25:22.590 --> 00:25:24.570 Because, audiologists are stretched. 467 00:25:24.590 --> 00:25:26.570 Terry Foust, AuD, CCC-A/SLP: 468 00:25:26.590 --> 00:25:30.570 Yeah, I think, exactly -- and to simplify things, a bit here, I -- I 469 00:25:30.590 --> 00:25:35.570 would say more and more of us audiologists are recommending, the 470 00:25:35.590 --> 00:25:38.570 use of OAEs uniformly, with children, three years of age and 471 00:25:38.590 --> 00:25:39.070 older. 472 00:25:39.090 --> 00:25:43.070 For several reasons, it's quicker than PureTone screening, both to 473 00:25:43.090 --> 00:25:47.070 learn to do, and, actually, implement; and it's far more likely, 474 00:25:47.090 --> 00:25:51.070 to be a method that will work across the board with children in 475 00:25:51.090 --> 00:25:55.070 that 3 to 5 age group that you would be screening and it's equally 476 00:25:55.090 --> 00:25:58.270 as effective. 477 00:25:58.290 --> 00:25:58.770 . 478 00:25:58.790 --> 00:25:59.370 >> DR. 479 00:25:59.390 --> 00:26:01.770 EISERMAN: If you need some further guidance on the issues, of choosing 480 00:26:01.790 --> 00:26:03.370 PureTone versus OAEs, for this older population -- 481 00:26:03.390 --> 00:26:08.370 We have a document on our Web site, on kidshearing.org that addresses 482 00:26:08.390 --> 00:26:12.370 just that question, so go there, and look for that -- that document, 483 00:26:12.390 --> 00:26:18.370 and maybe you need to -- to hash that out with your health services 484 00:26:18.390 --> 00:26:19.660 advisory committee or whomever is involved. 485 00:26:19.680 --> 00:26:21.660 (Slide advances). 486 00:26:21.680 --> 00:26:23.200 DR. 487 00:26:23.220 --> 00:26:26.200 EISERMAN: So Terry, let's jump into PureTone screening and get 488 00:26:26.220 --> 00:26:27.400 into a little more depth here. 489 00:26:27.420 --> 00:26:28.400 >> Dr. 490 00:26:28.420 --> 00:26:31.400 Terry Foust, AuD, CCC-A/SLP: Okay, so, yeah, let's go ahead, so to 491 00:26:31.420 --> 00:26:33.290 conduct, a PureTone Screening. 492 00:26:33.310 --> 00:26:35.290 We're, first going to take a look at the ear. 493 00:26:35.310 --> 00:26:39.290 We want to make sure that there's no visible sign of infection, or 494 00:26:39.310 --> 00:26:42.090 blockage. 495 00:26:42.110 --> 00:26:44.690 Now, by the way, you'll always want to do this first, regardless of 496 00:26:44.710 --> 00:26:46.090 what screening method you're going to use. 497 00:26:46.110 --> 00:26:51.090 But after you do that, if the ear appears normal, (slide advances), 498 00:26:51.110 --> 00:26:55.090 then use the screener, or going to instruct or, what we call, 499 00:26:55.110 --> 00:26:57.090 "condition", we're going to condition or instruct the Child how 500 00:26:57.110 --> 00:27:00.090 to listen for a tone; and then, to respond, by raising a hand, or 501 00:27:00.110 --> 00:27:05.390 placing a toy in a bucket for example. 502 00:27:05.410 --> 00:27:09.390 Now, once you have observed that the child reliably responds to 503 00:27:09.410 --> 00:27:13.390 sounds that are presented, just as you instructed -- then, we start 504 00:27:13.410 --> 00:27:15.390 the actual Screening. 505 00:27:15.410 --> 00:27:17.390 So during the screening process: 506 00:27:17.410 --> 00:27:21.390 This listen-and-respond game is repeated, at least twice, at three 507 00:27:21.410 --> 00:27:22.390 different pitches. 508 00:27:22.410 --> 00:27:23.390 On each ear. 509 00:27:23.410 --> 00:27:29.390 And then you'll be noting the Child's response, or their lack of 510 00:27:29.410 --> 00:27:31.390 response, after each tone or pitch is presented. 511 00:27:31.410 --> 00:27:36.390 If the Child responds appropriately, and, consistently -- to that range 512 00:27:36.410 --> 00:27:40.200 of tones presented each ear, then the Child passes the screening. 513 00:27:40.220 --> 00:27:40.700 . 514 00:27:40.720 --> 00:27:41.300 >> DR. 515 00:27:41.320 --> 00:27:42.700 EISERMAN: All right, Terry, let me 516 00:27:42.720 --> 00:27:45.140 just put a pin in it for a second. 517 00:27:45.160 --> 00:27:51.130 [LAUGHTER], we have got several questions that came in, with the 518 00:27:51.150 --> 00:27:53.140 519 00:27:53.160 --> 00:27:55.540 registrations. 520 00:27:55.560 --> 00:27:58.540 And, about how to make this conditioning process easier, in -- 521 00:27:58.560 --> 00:28:00.540 you know, what do you do? 522 00:28:00.560 --> 00:28:06.540 How do you -- how do you make sure that children really get it? 523 00:28:06.560 --> 00:28:10.540 And especially -- and, you know, maybe this is a separate question, 524 00:28:10.560 --> 00:28:14.540 if there's a language difference between you, and the Child that 525 00:28:14.560 --> 00:28:15.540 you're screening? 526 00:28:15.560 --> 00:28:16.040 . 527 00:28:16.060 --> 00:28:17.040 >> Terry Foust, AuD, CCC-A/SLP: 528 00:28:17.060 --> 00:28:22.040 Yeah, and this is one of the things that can -- it always adds some 529 00:28:22.060 --> 00:28:24.040 variables in to the -- 530 00:28:24.060 --> 00:28:26.040 to the screening, which... 531 00:28:26.060 --> 00:28:30.040 You know, you want to really be sure that it's going to be reliable, 532 00:28:30.060 --> 00:28:35.040 but what -- what you -- you can do, is, you not only model it, but for 533 00:28:35.060 --> 00:28:38.040 example, if I'm training, if you can see on this picture here, you 534 00:28:38.060 --> 00:28:44.040 can see that I've got this child's hand in my hand; and, I am going to 535 00:28:44.060 --> 00:28:48.040 demonstrate and, actually, when I present the tone, I'm going to 536 00:28:48.060 --> 00:28:54.040 raise their hand for her or I'm going to help her drop the toy into 537 00:28:54.060 --> 00:28:57.040 the bucket; and so, I am not only verbally instructing, but I am 538 00:28:57.060 --> 00:29:00.790 physically modeling, and helping her. 539 00:29:00.810 --> 00:29:04.790 To understand the task, but then I'm going to do checks to 540 00:29:04.810 --> 00:29:08.790 make sure that our response is reliable before I would ever 541 00:29:08.810 --> 00:29:11.790 officially do the screening, and try to get those results that we 542 00:29:11.810 --> 00:29:13.790 want to get. 543 00:29:13.810 --> 00:29:14.750 DR. 544 00:29:14.770 --> 00:29:17.350 EISERMAN: And if you want to see videos of that played out in 545 00:29:17.370 --> 00:29:22.530 longer... 546 00:29:22.550 --> 00:29:28.520 format, The training that's available on -- on... 547 00:29:28.540 --> 00:29:32.620 548 00:29:32.640 --> 00:29:37.620 Heretoscreen.org is where you can find a complete, training session 549 00:29:37.640 --> 00:29:39.620 on PureTone screening that -- that walks through that. 550 00:29:39.640 --> 00:29:42.620 But, you know, those are the children, the ones that you're not 551 00:29:42.640 --> 00:29:48.610 sure, are conditioned, Those are some of that 20%, that really you 552 00:29:48.630 --> 00:29:49.620 553 00:29:49.640 --> 00:29:53.310 have to find another way. 554 00:29:53.330 --> 00:29:56.310 You don't want to just hope that they got it. 555 00:29:56.330 --> 00:29:59.660 You want to feel really confident that they're following you. 556 00:29:59.680 --> 00:30:05.650 One or two of you, actually, sent a message, saying that you had found 557 00:30:05.670 --> 00:30:06.660 558 00:30:06.680 --> 00:30:10.660 that children who had -- who you were a little unsure about, and had 559 00:30:10.680 --> 00:30:15.660 passed the PureTone, but when you did OAEs, they did not pass -- 560 00:30:15.680 --> 00:30:18.660 that's the thing, where worried about 561 00:30:18.680 --> 00:30:22.660 >> We're worried about somehow subjectively-passing a child -- 562 00:30:22.680 --> 00:30:25.660 Who really, shouldn't be passed because we're -- we're being 563 00:30:25.680 --> 00:30:29.660 generous, we're giving them the benefit of the doubt. 564 00:30:29.680 --> 00:30:32.660 We shouldn't ever be giving benefit of the doubt. 565 00:30:32.680 --> 00:30:38.660 We -- we want children to more likely refer than just pass because 566 00:30:38.680 --> 00:30:41.660 we're guessing. 567 00:30:41.680 --> 00:30:42.160 . 568 00:30:42.180 --> 00:30:42.760 >> DR. 569 00:30:42.780 --> 00:30:43.360 EISERMAN: (Continuing) okay? 570 00:30:43.380 --> 00:30:46.360 So the idea here to always remember: As much as we are 571 00:30:46.380 --> 00:30:51.360 champions of children, we don't -- we don't have an investment in them 572 00:30:51.380 --> 00:30:54.360 passing screenings, we want to get accurate results. 573 00:30:54.380 --> 00:30:54.860 Dr. 574 00:30:54.880 --> 00:30:56.860 Terry Foust, AuD, CCC-A/SLP: 575 00:30:56.880 --> 00:30:59.860 Yeah, thank you, William and maybe just to summarize on the teaching 576 00:30:59.880 --> 00:31:05.850 part, we -- we instruct, we show, we do it with them, and we try to 577 00:31:05.870 --> 00:31:06.860 578 00:31:06.880 --> 00:31:07.860 make it fun. 579 00:31:07.880 --> 00:31:08.860 so -- 580 00:31:08.880 --> 00:31:15.780 Let's -- let's go ahead and move on, so -- (pause), DR. 581 00:31:15.800 --> 00:31:18.780 EISERMAN: So you condition the Child, you've gotten to the point, 582 00:31:18.800 --> 00:31:21.780 where, okay, they really understand the game you've set up with raising 583 00:31:21.800 --> 00:31:25.780 their hand or dropping a toy, and now this is the screening process, 584 00:31:25.800 --> 00:31:26.280 . 585 00:31:26.300 --> 00:31:27.280 >> Dr. 586 00:31:27.300 --> 00:31:30.280 Terry Foust, AuD, CCC-A/SLP: Yeah, so now -- now that we feel that 587 00:31:30.300 --> 00:31:32.280 they're reliable, during the screening process, this 588 00:31:32.300 --> 00:31:37.280 listen-and-respond game -- is repeated, at least, twice, at three 589 00:31:37.300 --> 00:31:41.280 different pitches, on each ear, and then you're going to note the 590 00:31:41.300 --> 00:31:45.280 Child's response or their lack of response, after each tone is 591 00:31:45.300 --> 00:31:47.280 presented (slide advances). 592 00:31:47.300 --> 00:31:50.280 >> Now, if you take a look here. 593 00:31:50.300 --> 00:31:55.280 If the Child responds appropriately, and consistently -- to the range 594 00:31:55.300 --> 00:31:58.280 of tones presented, then the Child passes the screening. 595 00:31:58.300 --> 00:32:04.270 So you can see these checks here at these different pitches, okay. 596 00:32:04.290 --> 00:32:06.650 597 00:32:06.670 --> 00:32:11.650 and then -- what we would like to do -- is just remind you, of some 598 00:32:11.670 --> 00:32:14.650 of the things you're going to be want to be sure to address as you 599 00:32:14.670 --> 00:32:17.250 get ready to start screening a group of children, so to begin with 600 00:32:17.270 --> 00:32:20.250 -- and this goes for everyone, regardless of which method you're 601 00:32:20.270 --> 00:32:25.250 using -- be sure to refresh yourself on the resources, that we 602 00:32:25.270 --> 00:32:28.250 have at kidshearing.org. 603 00:32:28.270 --> 00:32:28.750 P. 604 00:32:28.770 --> 00:32:29.350 >> DR. 605 00:32:29.370 --> 00:32:31.350 EISERMAN: Yeah, and this is the landing page of kidshearing.org, 606 00:32:31.370 --> 00:32:31.950 where you -- 607 00:32:31.970 --> 00:32:36.950 where you're going to find a range of resources, and -- and this is 608 00:32:36.970 --> 00:32:41.950 good to go through, if you need to acquaint new staff or refresh 609 00:32:41.970 --> 00:32:45.950 yourselves, so let's just quickly look at this page (scrolling) and 610 00:32:45.970 --> 00:32:48.950 you'll see here there's planning resources, that right there, is 611 00:32:48.970 --> 00:32:53.950 where you'll find an audiologist, under the big picture resources -- 612 00:32:53.970 --> 00:32:57.950 is where you would find that document, comparing OAE, and 613 00:32:57.970 --> 00:32:59.570 PureTone, that I mentioned a moment ago. 614 00:32:59.590 --> 00:33:00.070 . 615 00:33:00.090 --> 00:33:00.670 >> DR. 616 00:33:00.690 --> 00:33:03.670 EISERMAN: There's screening equipment resources there. 617 00:33:03.690 --> 00:33:06.670 Then there's where to access training. 618 00:33:06.690 --> 00:33:12.670 Some of you have -- asked us, "Where can we go to get 619 00:33:12.690 --> 00:33:17.670 standardized, reliable training so that all of our staff are going 620 00:33:17.690 --> 00:33:20.670 through exactly the same training? 621 00:33:20.690 --> 00:33:24.670 " And that's -- you can access those links there, and those -- 622 00:33:24.690 --> 00:33:28.670 those particular training resources there, are -- 623 00:33:28.690 --> 00:33:32.670 Virtual, so they will allow you to do the training, whenever you need 624 00:33:32.690 --> 00:33:34.670 the training. 625 00:33:34.690 --> 00:33:38.980 so -- it's adaptable to time schedules. 626 00:33:39.000 --> 00:33:43.980 The -- the next set of resources, is all about preparing for 627 00:33:44.000 --> 00:33:49.980 screening; the protocol guides and forms, which we're going to go over; 628 00:33:50.000 --> 00:33:54.980 and documents for how to document your results, and -- and share 629 00:33:55.000 --> 00:33:58.980 those results with healthcare providers, and audiologists, And 630 00:33:59.000 --> 00:34:02.980 then, lastly, there's resources for tracking a group of children, and 631 00:34:03.000 --> 00:34:04.980 monitoring program quality. 632 00:34:05.000 --> 00:34:10.970 so if you haven't taken a dive into the resources, that are available 633 00:34:10.990 --> 00:34:11.980 634 00:34:12.000 --> 00:34:15.980 here, we encourage you to do that, because as we went through, you 635 00:34:16.000 --> 00:34:19.980 know, some of your questions, we realized, oh! 636 00:34:20.000 --> 00:34:23.980 If some of these folks had been on our Web site, they would find the 637 00:34:24.000 --> 00:34:26.980 answers to what they were looking for here. 638 00:34:27.000 --> 00:34:30.980 In terms of resources, that were needed. 639 00:34:31.000 --> 00:34:32.580 DR. 640 00:34:32.600 --> 00:34:35.580 EISERMAN: So -- and the other in the I want to point out here, at 641 00:34:35.600 --> 00:34:38.580 the very bottom, that last arrow, under monitoring program quality -- 642 00:34:38.600 --> 00:34:44.580 you'll see those two checklists -- OAE screening skills checklist, and 643 00:34:44.600 --> 00:34:48.580 PureTone screening skills checklist, those are really good resources, 644 00:34:48.600 --> 00:34:53.580 for refreshing, and evaluating yourself, and others -- on making 645 00:34:53.600 --> 00:34:59.580 sure that you're doing all of the steps that go along with the -- 646 00:34:59.600 --> 00:35:00.580 respective methods. 647 00:35:00.600 --> 00:35:06.580 And they look like this: This is just an example of the step-by-step 648 00:35:06.600 --> 00:35:09.580 things you do to prepare for a screening and then what you have to 649 00:35:09.600 --> 00:35:11.580 do to complete the screening. 650 00:35:11.600 --> 00:35:15.580 Take a look at these, as a good reminder. 651 00:35:15.600 --> 00:35:16.580 Now, -- 652 00:35:16.600 --> 00:35:19.580 Some of you, had asked, regarding PureTone, and we're going to -- 653 00:35:19.600 --> 00:35:22.580 we're going to wrap up PureTone here in a minute and talk about 654 00:35:22.600 --> 00:35:27.580 OAEs, but before we do that, some of you, asked about a refresher for 655 00:35:27.600 --> 00:35:31.580 how to document the results. 656 00:35:31.600 --> 00:35:37.570 And, this here, is -- a screening form that you can download on our 657 00:35:37.590 --> 00:35:38.580 658 00:35:38.600 --> 00:35:43.580 -- from our Web site that follows exactly the recommended screening 659 00:35:43.600 --> 00:35:45.980 protocol. 660 00:35:46.000 --> 00:35:46.480 . 661 00:35:46.500 --> 00:35:47.080 >> DR. 662 00:35:47.100 --> 00:35:50.080 EISERMAN: And it walks you through it step by step. 663 00:35:50.100 --> 00:35:55.080 So, we encourage you to use this because it does follow exactly the 664 00:35:55.100 --> 00:35:56.080 recommended process. 665 00:35:56.100 --> 00:35:59.080 The first step for any screening, as we said is the visual inspection 666 00:35:59.100 --> 00:36:01.080 of the ear. 667 00:36:01.100 --> 00:36:04.080 And in most cases, the Child will pass at this point. 668 00:36:04.100 --> 00:36:07.720 And you'll move on. 669 00:36:07.740 --> 00:36:10.720 (highlighting), then, we condition the Child. 670 00:36:10.740 --> 00:36:14.720 Which is that second step, (2), that Terry went over. 671 00:36:14.740 --> 00:36:20.720 If the Child can't be successfully-conditioned to provide 672 00:36:20.740 --> 00:36:24.980 that behavioral response, then you'll either try again. 673 00:36:25.000 --> 00:36:27.980 And if you still can't condition the Child: 674 00:36:28.000 --> 00:36:33.980 If you are able to do an OAE screening instead, that would be 675 00:36:34.000 --> 00:36:36.980 appropriate, and if you don't have OAE screening available -- 676 00:36:37.000 --> 00:36:41.980 or are unable to do OAE screening, then you would make a referral to 677 00:36:42.000 --> 00:36:45.180 the audiologist. 678 00:36:45.200 --> 00:36:48.180 But, assuming that the Child is successfully-screened, the 679 00:36:48.200 --> 00:36:50.180 screening process, then, begins. 680 00:36:50.200 --> 00:36:51.180 (Slide advances). 681 00:36:51.200 --> 00:36:51.980 >> DR. 682 00:36:52.000 --> 00:36:55.980 EISERMAN: And so we've got this screening conditioning the Child 683 00:36:56.000 --> 00:36:59.980 here, and Terry, I know you always have something to say when we get 684 00:37:00.000 --> 00:37:00.580 to this slide. 685 00:37:00.600 --> 00:37:01.080 >> Dr. 686 00:37:01.100 --> 00:37:06.080 Terry Foust, AuD, CCC-A/SLP: Yeah, thank you, always interject here, 687 00:37:06.100 --> 00:37:08.080 (laughing), we've received some questions about this conditioning 688 00:37:08.100 --> 00:37:13.080 process, as you mentioned, in preparation for today's webinar. 689 00:37:13.100 --> 00:37:15.080 And really, those have centered around how long that conditioning 690 00:37:15.100 --> 00:37:17.080 process should take. 691 00:37:17.100 --> 00:37:20.080 So, let's -- let's answer that. 692 00:37:20.100 --> 00:37:24.080 Children, who are going to be successfully-screened using the 693 00:37:24.100 --> 00:37:28.080 PureTone method, you should be able to screen them in about 10 to 15 694 00:37:28.100 --> 00:37:32.080 minutes max; and that includes the conditioning step. 695 00:37:32.100 --> 00:37:35.080 So really, that conditioning should not take more than five minutes, 696 00:37:35.100 --> 00:37:40.080 hopefully less, If you can't condition a child in that amount of 697 00:37:40.100 --> 00:37:44.080 time, then you probably should consider using your back up plan, 698 00:37:44.100 --> 00:37:46.680 which is either to do an OAE, hopefully right then while you have 699 00:37:46.700 --> 00:37:49.680 the Child with you there. 700 00:37:49.700 --> 00:37:53.680 Or, you could also try your PureTone screening on another day, 701 00:37:53.700 --> 00:37:55.680 if you have the flexibility to do that. 702 00:37:55.700 --> 00:37:58.680 But just remember: If you can't screen the Child, you'll either 703 00:37:58.700 --> 00:38:03.680 need to do an OAE, or, refer the Child to someone who will be able 704 00:38:03.700 --> 00:38:08.070 to successfully screen them, most likely a pediatric audiologist. 705 00:38:08.090 --> 00:38:12.070 So, as we said, earlier just remember that some children, who 706 00:38:12.090 --> 00:38:14.470 have hearing loss, could be the very ones that are most difficult 707 00:38:14.490 --> 00:38:17.360 to condition to do the screening. 708 00:38:17.380 --> 00:38:21.360 So, one way or another, we -- we want to be sure that we get every 709 00:38:21.380 --> 00:38:22.360 child screened (slide advances). 710 00:38:22.380 --> 00:38:24.660 >> DR. 711 00:38:24.680 --> 00:38:27.660 EISERMAN: So assuming that the child is successfully screened. 712 00:38:27.680 --> 00:38:30.660 The screening process then begins, (3), and you can see on the form 713 00:38:30.680 --> 00:38:36.660 here, it provides a space to record the results for each ear. 714 00:38:36.680 --> 00:38:41.660 Since PureTone screening isn't automated, the form provides a 715 00:38:41.680 --> 00:38:46.660 reminder that for each ear, up to four presentations of the tone can 716 00:38:46.680 --> 00:38:48.660 be made, at each frequency level. 717 00:38:48.680 --> 00:38:50.660 Starting at 2000. 718 00:38:50.680 --> 00:38:52.660 Then 4,000. 719 00:38:52.680 --> 00:38:55.660 Then 1,000. 720 00:38:55.680 --> 00:39:01.650 That two responses are needed for the Child to pass for a given tone. 721 00:39:01.670 --> 00:39:02.660 722 00:39:02.680 --> 00:39:04.660 The screening begins... 723 00:39:04.680 --> 00:39:09.660 by repeating the conditioning tone, One more time, and then, 724 00:39:09.680 --> 00:39:10.660 proceeding. 725 00:39:10.680 --> 00:39:16.650 (A pause), Okay? 726 00:39:16.670 --> 00:39:20.680 727 00:39:20.700 --> 00:39:25.680 Now, each child needs to have at least two successful responses out 728 00:39:25.700 --> 00:39:28.680 of no more than four attempts At each frequency level, in order to 729 00:39:28.700 --> 00:39:34.670 have an overall ear pass. 730 00:39:34.690 --> 00:39:40.160 731 00:39:40.180 --> 00:39:45.160 (Pause), Once that's recorded, the left ear, is screened in the same 732 00:39:45.180 --> 00:39:49.160 way as the right ear, recording each presentation result, as you go, 733 00:39:49.180 --> 00:39:55.160 if both ears meet the criteria for passing, then the Child's screening 734 00:39:55.180 --> 00:39:57.160 process is considered complete. 735 00:39:57.180 --> 00:40:03.150 If one or more ears, don't, however, meet the pass criteria -- then, as 736 00:40:03.170 --> 00:40:04.160 737 00:40:04.180 --> 00:40:09.160 you see here, a second screening, of the previously-nonpassing ear, 738 00:40:09.180 --> 00:40:14.030 is conducted, in approximately two weeks. 739 00:40:14.050 --> 00:40:18.030 (Animation plays on slide), . 740 00:40:18.050 --> 00:40:23.030 >> William Eiserman, Ph.D.: And then you would get those results. 741 00:40:23.050 --> 00:40:29.030 (Animation continues), Now, (slide advances).... 742 00:40:29.050 --> 00:40:33.030 Terry -- 743 00:40:33.050 --> 00:40:39.020 What if the Child does fine in responding at first? 744 00:40:39.040 --> 00:40:40.030 745 00:40:40.050 --> 00:40:46.030 But then becomes distracted or you -- or you observe somehow no longer 746 00:40:46.050 --> 00:40:49.030 engaged in this screening, and -- and say after the first couple of 747 00:40:49.050 --> 00:40:54.030 pitches, they just seem to have kind of -- 748 00:40:54.050 --> 00:40:55.030 Decompensated? 749 00:40:55.050 --> 00:40:55.830 What do you do? 750 00:40:55.850 --> 00:40:56.330 . 751 00:40:56.350 --> 00:40:56.830 >> Dr. 752 00:40:56.850 --> 00:41:01.830 Terry Foust, AuD, CCC-A/SLP: Yeah, -- you -- you really want to go 753 00:41:01.850 --> 00:41:04.830 ahead and you can suspend that screening session for the time 754 00:41:04.850 --> 00:41:08.830 being, and then you could either, like, we mentioned earlier, you can 755 00:41:08.850 --> 00:41:11.830 come back and have another screening session, with them, or go 756 00:41:11.850 --> 00:41:17.830 ahead and use your back up method, which is the OAE. 757 00:41:17.850 --> 00:41:21.830 But, again, you're going to want to be sure that we follow up and we 758 00:41:21.850 --> 00:41:24.830 get that child all the way through, even if we're able to screen it 759 00:41:24.850 --> 00:41:28.830 ourselves and we need to refer them to an audiologist for a hearing 760 00:41:28.850 --> 00:41:29.830 evaluation, . 761 00:41:29.850 --> 00:41:30.630 >> DR. 762 00:41:30.650 --> 00:41:33.630 EISERMAN: And so Terry, you have to do the same thing right, if 763 00:41:33.650 --> 00:41:36.630 there's a sudden increase in environmental noise, for example, 764 00:41:36.650 --> 00:41:40.630 that is outside of your control. 765 00:41:40.650 --> 00:41:43.630 And you can't screen it that time. 766 00:41:43.650 --> 00:41:46.630 You have to come back at another time, picking up where you left 767 00:41:46.650 --> 00:41:47.130 off. 768 00:41:47.150 --> 00:41:48.130 But you had. 769 00:41:48.150 --> 00:41:49.130 >> Terry Foust, AuD, CCC-A/SLP: 770 00:41:49.150 --> 00:41:49.630 Yeah. 771 00:41:49.650 --> 00:41:50.230 >> DR. 772 00:41:50.250 --> 00:41:52.030 EISERMAN: You have to start with conditioning again, right? 773 00:41:52.050 --> 00:41:52.530 . 774 00:41:52.550 --> 00:41:53.530 >> Terry Foust, AuD, CCC-A/SLP: 775 00:41:53.550 --> 00:41:57.530 Yes, yes, that's right, if the Child is not able to be conditioned 776 00:41:57.550 --> 00:42:00.530 again, or to remain attentive, paying attention then like I said, 777 00:42:00.550 --> 00:42:02.930 you should probably use the OAE method or refer them to an 778 00:42:02.950 --> 00:42:04.770 audiologist. 779 00:42:04.790 --> 00:42:06.770 But there's a really important point here: 780 00:42:06.790 --> 00:42:10.770 And -- I know we'll sound like a broken record -- but, again, that 781 00:42:10.790 --> 00:42:13.770 point is -- is that, sometimes, children, with hearing loss, are 782 00:42:13.790 --> 00:42:17.000 the very ones who are most difficult to screen. 783 00:42:17.020 --> 00:42:20.000 (Electronic tone), so the last thing we want to do is to abandon 784 00:42:20.020 --> 00:42:26.000 that screening process on children, who are unable to be conditioned, 785 00:42:26.020 --> 00:42:29.000 and simply conclude that they can't be screened without doing something 786 00:42:29.020 --> 00:42:29.500 else. 787 00:42:29.520 --> 00:42:32.500 So whether that is screening with OAE or making a referral to an 788 00:42:32.520 --> 00:42:35.500 audiologist, we need to follow up. 789 00:42:35.520 --> 00:42:36.500 . 790 00:42:36.520 --> 00:42:37.590 >> DR. 791 00:42:37.610 --> 00:42:40.590 EISERMAN: So if -- if we're still going through all of this kind of 792 00:42:40.610 --> 00:42:41.090 fast. 793 00:42:41.110 --> 00:42:44.090 And you feel like you're not really getting it. 794 00:42:44.110 --> 00:42:47.090 The way you need it. 795 00:42:47.110 --> 00:42:53.090 I would really suggest that you go back to our Web site, to the 796 00:42:53.110 --> 00:42:59.090 training resources, And -- and look at the PureTone training modules. 797 00:42:59.110 --> 00:43:02.090 That go through this, and pace through it at a slower pace, where 798 00:43:02.110 --> 00:43:05.090 you can start, and stop -- 799 00:43:05.110 --> 00:43:10.090 and really get this whole process nailed down. 800 00:43:10.110 --> 00:43:14.090 So, let's say we do a successfully- -- a successful screening, and we 801 00:43:14.110 --> 00:43:19.090 have one or both ears, not passing at the second screening. 802 00:43:19.110 --> 00:43:23.090 We want to make sure we indicate that on the form, and then, the 803 00:43:23.110 --> 00:43:27.090 Child is referred for a middle ear consultation, from a healthcare 804 00:43:27.110 --> 00:43:27.590 provider. 805 00:43:27.610 --> 00:43:31.590 So, they have not passed twice now over two separate screenings; they 806 00:43:31.610 --> 00:43:35.590 go to a healthcare provider, And, what's going to happen there, 807 00:43:35.610 --> 00:43:36.090 Terry? 808 00:43:36.110 --> 00:43:40.090 What -- why a healthcare provider? 809 00:43:40.110 --> 00:43:40.590 . 810 00:43:40.610 --> 00:43:41.090 >> Dr. 811 00:43:41.110 --> 00:43:44.090 Terry Foust, AuD, CCC-A/SLP: Well, because, for, you know, for any 812 00:43:44.110 --> 00:43:48.090 child who is referred for a middle ear consultation, from a -- so -- 813 00:43:48.110 --> 00:43:51.090 we want to make sure that that -- 814 00:43:51.110 --> 00:43:54.090 that middle ear system, is clear, and is processing that sound all 815 00:43:54.110 --> 00:43:55.090 the way through. 816 00:43:55.110 --> 00:44:00.150 So we want to send them to the healthcare provider, for that. 817 00:44:00.170 --> 00:44:01.850 Evaluation. 818 00:44:01.870 --> 00:44:02.850 And so.... 819 00:44:02.870 --> 00:44:07.840 For every child, that's referred for middle ear consultation from a 820 00:44:07.860 --> 00:44:10.050 healthcare provider, then we want to use the diagnostic follow up 821 00:44:10.070 --> 00:44:15.050 form that you see here, and this is where you'll document the remaining 822 00:44:15.070 --> 00:44:17.050 steps, in this child's screening and diagnostic process, starting 823 00:44:17.070 --> 00:44:21.140 with the results of the middle ear consultation. 824 00:44:21.160 --> 00:44:21.640 Dr. 825 00:44:21.660 --> 00:44:22.640 Terry Foust, AuD, CCC-A/SLP: 826 00:44:22.660 --> 00:44:25.640 So since the Child was referred to the healthcare provider, to see if 827 00:44:25.660 --> 00:44:29.640 there might be any middle ear health-related problems, that may 828 00:44:29.660 --> 00:44:32.640 have prevented the Child from passing the screening on either ear, 829 00:44:32.660 --> 00:44:37.640 during your first two screening sessions, then you want to find out 830 00:44:37.660 --> 00:44:43.640 the results of that consultation, and record them here, then once the 831 00:44:43.660 --> 00:44:46.640 healthcare provider indicates that ears are healthy and clear, then 832 00:44:46.660 --> 00:44:50.640 you're going to want to rescreen, the Child's ears, or the ears that 833 00:44:50.660 --> 00:44:56.640 have not yet passed -- and record those results. 834 00:44:56.660 --> 00:45:00.640 All children, that are referred for middle ear evaluation must -- and 835 00:45:00.660 --> 00:45:03.640 this is really important -- once they have been cleared, they have 836 00:45:03.660 --> 00:45:09.640 to receive the rescreen on any ear that hadn't previously passed. 837 00:45:09.660 --> 00:45:12.640 So, if, at this point, there's still an ear that hasn't passed, 838 00:45:12.660 --> 00:45:15.640 then the Child is referred for a complete audiological evaluation, 839 00:45:15.660 --> 00:45:19.640 And you'll want to support the family, in completing this really 840 00:45:19.660 --> 00:45:24.640 important step, and be sure to get those results, and document them 841 00:45:24.660 --> 00:45:27.730 here, In this form -- it helps you to do that. 842 00:45:27.750 --> 00:45:31.730 You'll also want to collect additional supporting documentation, 843 00:45:31.750 --> 00:45:33.730 from the audiological evaluation, especially, if a permanent hearing 844 00:45:33.750 --> 00:45:35.400 loss is identified. 845 00:45:35.420 --> 00:45:35.900 . 846 00:45:35.920 --> 00:45:36.900 >> Dr. 847 00:45:36.920 --> 00:45:40.900 Terry Foust, AuD, CCC-A/SLP: And in most cases this will include 848 00:45:40.920 --> 00:45:42.300 additional referrals for intervention services, that you'll 849 00:45:42.320 --> 00:45:47.120 want to be aware of and you want to support the family in obtaining. 850 00:45:47.140 --> 00:45:47.620 . 851 00:45:47.640 --> 00:45:48.220 >> DR. 852 00:45:48.240 --> 00:45:52.220 EISERMAN: And, you know, -- after a pause), these forms that we 853 00:45:52.240 --> 00:45:56.220 created, we did in collaboration with multiple -- 854 00:45:56.240 --> 00:45:59.970 early Head Start Head start, and Part C programs. 855 00:45:59.990 --> 00:46:03.970 Trying to come up with easiest-to-follow documentation 856 00:46:03.990 --> 00:46:08.970 strategy that would be complete, and that would help you walk 857 00:46:08.990 --> 00:46:12.970 through each of the recommended steps (slide advances), so -- 858 00:46:12.990 --> 00:46:16.970 you know, you might think you want to create your with own form, and 859 00:46:16.990 --> 00:46:22.960 you can try, but, it's tricky to come up with a -- a format that 860 00:46:22.980 --> 00:46:23.970 861 00:46:23.990 --> 00:46:28.970 really does follow all of this, so before you do your own, give a good 862 00:46:28.990 --> 00:46:32.970 look at what we've done here because we've gotten a lot of input 863 00:46:32.990 --> 00:46:36.970 on how to -- how to make this work for folks, so, let's pause for a 864 00:46:36.990 --> 00:46:42.970 moment here, and see, if we have any other -- I don't -- I don't 865 00:46:42.990 --> 00:46:48.000 think there were any other... 866 00:46:48.020 --> 00:46:48.500 PureTone-related... 867 00:46:48.520 --> 00:46:50.500 questions that we got right there. 868 00:46:50.520 --> 00:46:54.500 But -- jot them down, if there's anything missing, oh, -- you know, 869 00:46:54.520 --> 00:46:58.500 I know -- (pause). 870 00:46:58.520 --> 00:47:04.500 Now, I think -- I think we're good with that (slide advances), so 871 00:47:04.520 --> 00:47:08.500 remember, you're going to find all these resources on PureTone 872 00:47:08.520 --> 00:47:09.820 screening activities on kidshearing.org. 873 00:47:09.840 --> 00:47:11.820 so, go there, and have a look, (scrolling). 874 00:47:11.840 --> 00:47:13.820 All right. 875 00:47:13.840 --> 00:47:19.030 and that right there is where you'll find the training resources. 876 00:47:19.050 --> 00:47:20.440 And so on. 877 00:47:20.460 --> 00:47:21.440 (Next slide). 878 00:47:21.460 --> 00:47:22.240 >> DR. 879 00:47:22.260 --> 00:47:27.240 EISERMAN: Remember, also to look at the -- the PureTone audiometry 880 00:47:27.260 --> 00:47:29.940 screening skills checklist, which is at -- at the bottom. 881 00:47:29.960 --> 00:47:32.880 So, that was PureTone. 882 00:47:32.900 --> 00:47:33.850 Now.... 883 00:47:33.870 --> 00:47:38.850 Let's shift gears and talk about OAE screening, otoacoustic 884 00:47:38.870 --> 00:47:43.850 emissions screening, as we've already said, is the recommended 885 00:47:43.870 --> 00:47:46.850 evident-based practice for children, birth to three years of age, and 886 00:47:46.870 --> 00:47:51.850 -- is increasingly, being used for children, in older age brackets, as 887 00:47:51.870 --> 00:47:52.350 well. 888 00:47:52.370 --> 00:47:58.350 Terry, some people want to have a review of how the OAE screening is 889 00:47:58.370 --> 00:48:01.350 done, Can you walk us through that? 890 00:48:01.370 --> 00:48:01.850 . 891 00:48:01.870 --> 00:48:02.350 >> Dr. 892 00:48:02.370 --> 00:48:05.350 Terry Foust, AuD, CCC-A/SLP: Yeah, so we're going to start at the 893 00:48:05.370 --> 00:48:07.350 very same place we did with PureTone screening: 894 00:48:07.370 --> 00:48:09.950 We're going to, first, take a thorough look at the outer part of 895 00:48:09.970 --> 00:48:12.950 the ear. 896 00:48:12.970 --> 00:48:15.150 Again, to make sure there's no visible sign of infection, or 897 00:48:15.170 --> 00:48:15.650 blockage. 898 00:48:15.670 --> 00:48:18.650 And then, if the ear appears to be normal, and healthy -- then we're 899 00:48:18.670 --> 00:48:23.650 going to place a small probe, and we use a small probe, on which we 900 00:48:23.670 --> 00:48:26.850 have put a -- a disposable cover has been put on it or placed on it; 901 00:48:26.870 --> 00:48:31.850 we take that probe, and we, then, insert it into the ear canal. 902 00:48:31.870 --> 00:48:34.850 (Slide advances), and then, we push the button to start the automated 903 00:48:34.870 --> 00:48:36.850 screening process. 904 00:48:36.870 --> 00:48:41.850 Now, the probe sits independently, so that probe that sits 905 00:48:41.870 --> 00:48:45.850 independently, in the ear, delivers a low volume sound stimulus into 906 00:48:45.870 --> 00:48:46.850 the ear. 907 00:48:46.870 --> 00:48:51.850 Now, the cochlea, or as you can see here on your screen, that -- 908 00:48:51.870 --> 00:48:54.850 inner snail-shaped portion of the ear, a cochlea that's functioning 909 00:48:54.870 --> 00:49:00.850 normally -- it will respond to this sound by sending the signal to the 910 00:49:00.870 --> 00:49:01.350 brain. 911 00:49:01.370 --> 00:49:05.350 While also producing an acoustic emission, And this emission, is 912 00:49:05.370 --> 00:49:09.350 analyzed by the screening unit, and in approximately 30 seconds or so, 913 00:49:09.370 --> 00:49:15.340 a result will appear, it will appear either as a -- a pass, Or, a 914 00:49:15.360 --> 00:49:19.350 915 00:49:19.370 --> 00:49:20.350 refer. 916 00:49:20.370 --> 00:49:20.850 Now --. 917 00:49:20.870 --> 00:49:21.970 >> DR. 918 00:49:21.990 --> 00:49:22.970 EISERMAN: Terry, wait a minute! 919 00:49:22.990 --> 00:49:28.960 Hold on, because this is where a lot of our questions come in, we go 920 00:49:28.980 --> 00:49:30.970 921 00:49:30.990 --> 00:49:33.570 past this moment where we are putting the probe in the ear and 922 00:49:33.590 --> 00:49:37.570 letting go, and, you know, there's all these people saying, "It 923 00:49:37.590 --> 00:49:39.570 doesn't stay in the ear! 924 00:49:39.590 --> 00:49:40.070 " 925 00:49:40.090 --> 00:49:45.070 Or, "I get poor seal error 926 00:49:45.090 --> 00:49:46.070 messages! 927 00:49:46.090 --> 00:49:50.070 " "I don't think the probes are the right size! 928 00:49:50.090 --> 00:49:54.070 " This is the difficult point, in OAE screening that people are 929 00:49:54.090 --> 00:49:58.070 struggling with, and that -- I think sometimes, we can 930 00:49:58.090 --> 00:50:02.070 inadvertently make look too easy. 931 00:50:02.090 --> 00:50:08.070 So can you talk, for a minute, about some of the things, that we 932 00:50:08.090 --> 00:50:11.070 can do to get better at? 933 00:50:11.090 --> 00:50:17.060 More skillful at, getting a probe in the ear for it to have a good 934 00:50:17.080 --> 00:50:18.070 935 00:50:18.090 --> 00:50:23.070 seal, meaning, it's not going to -- it's not going to have the outside 936 00:50:23.090 --> 00:50:25.920 sound interacting, with what's going on in the inner ear. 937 00:50:25.940 --> 00:50:28.920 And for it to stay put, . 938 00:50:28.940 --> 00:50:29.920 >> Dr. 939 00:50:29.940 --> 00:50:33.920 Terry Foust, AuD, CCC-A/SLP: It is really the pain point for people, 940 00:50:33.940 --> 00:50:36.320 when we are doing OAE screening. 941 00:50:36.340 --> 00:50:36.820 . 942 00:50:36.840 --> 00:50:38.380 >> Pain for the screener! 943 00:50:38.400 --> 00:50:38.980 Not the Child. 944 00:50:39.000 --> 00:50:39.480 . 945 00:50:39.500 --> 00:50:40.480 >> Terry Foust, AuD, CCC-A/SLP: 946 00:50:40.500 --> 00:50:46.470 Exactly, for me is the screener, this is -- I should call it the 947 00:50:46.490 --> 00:50:47.480 948 00:50:47.500 --> 00:50:50.480 frustrating point, the point of frustration but there are several 949 00:50:50.500 --> 00:50:54.480 things to do, the first is with probe cover selection, so you see 950 00:50:54.500 --> 00:50:58.480 on the -- on the picture here the Black part is the probe, and, you 951 00:50:58.500 --> 00:51:02.080 can see that beige-colored foam tip that is on there. 952 00:51:02.100 --> 00:51:02.580 . 953 00:51:02.600 --> 00:51:03.580 >> Dr. 954 00:51:03.600 --> 00:51:06.580 Terry Foust, AuD, CCC-A/SLP: That's one of my first 955 00:51:06.600 --> 00:51:12.580 recommendations, is -- if you have the option for foam tips, use those, 956 00:51:12.600 --> 00:51:16.580 we find that those compressable foam tips, when they're inserted 957 00:51:16.600 --> 00:51:21.580 and expand, stay in the ear and are more stable than the other plastic 958 00:51:21.600 --> 00:51:22.080 tips. 959 00:51:22.100 --> 00:51:25.080 So that would be my first recommendation is to: Use a foam 960 00:51:25.100 --> 00:51:28.080 tip if you have it. 961 00:51:28.100 --> 00:51:33.080 The second, is, the largest-size probe tip, that will fit in the ear, 962 00:51:33.100 --> 00:51:36.610 the better. 963 00:51:36.630 --> 00:51:37.110 . 964 00:51:37.130 --> 00:51:40.110 So, too small of a probe won't be stable in the ear, it will let 965 00:51:40.130 --> 00:51:43.110 noise leak in and out; and fallout. 966 00:51:43.130 --> 00:51:46.110 We like the -- the largest one possible that will fit in that 967 00:51:46.130 --> 00:51:48.110 particular ear canal. 968 00:51:48.130 --> 00:51:51.700 The next thing, though, is... 969 00:51:51.720 --> 00:51:55.700 Is a lot of practice, the older children, of course, will tolerate 970 00:51:55.720 --> 00:51:56.700 probe placement better. 971 00:51:56.720 --> 00:52:02.690 So if you're newer to this, I would screen a lot of -- screen adults 972 00:52:02.710 --> 00:52:03.700 973 00:52:03.720 --> 00:52:08.700 and practice placement, then I would go to some of the older 974 00:52:08.720 --> 00:52:11.700 children that will tolerate it well and then move down to the younger 975 00:52:11.720 --> 00:52:15.700 children, that are more apt to put a hand up and try to pull the probe 976 00:52:15.720 --> 00:52:20.700 out or wiggly or making -- making noise, so, I -- and a key point, to 977 00:52:20.720 --> 00:52:23.700 probe placement is: 978 00:52:23.720 --> 00:52:29.700 We really don't -- we really do not want to hold the probe in place. 979 00:52:29.720 --> 00:52:35.700 As a child moves it can be pushed up against a -- an ear canal wall, 980 00:52:35.720 --> 00:52:40.700 they are made to be self-seating, and so, it's -- it needs to fit in 981 00:52:40.720 --> 00:52:44.700 that ear, and not be held in place. 982 00:52:44.720 --> 00:52:46.500 Dr. 983 00:52:46.520 --> 00:52:49.100 Eiserman: You're more likely to have success if you let go than if 984 00:52:49.120 --> 00:52:49.700 you hold on. 985 00:52:49.720 --> 00:52:50.700 >> Terry Foust, AuD, CCC-A/SLP: 986 00:52:50.720 --> 00:52:55.700 Actually, yes, yeah, so maybe, to summarize: It's -- its probe fit 987 00:52:55.720 --> 00:53:01.700 is probably the most important thing to getting a successful test 988 00:53:01.720 --> 00:53:02.700 done. 989 00:53:02.720 --> 00:53:06.700 Second: Use a foam tip, if you ask -- if it's possible, you have 990 00:53:06.720 --> 00:53:09.700 access to foam tips for your particular brand of equipment. 991 00:53:09.720 --> 00:53:13.700 I would recommend you use those, I would recommend you use the largest 992 00:53:13.720 --> 00:53:17.700 size tip that would appropriately-fit, in the Child's 993 00:53:17.720 --> 00:53:18.700 ear. 994 00:53:18.720 --> 00:53:21.700 And then I would practice -- 995 00:53:21.720 --> 00:53:25.700 practice, practice, practice, on probe placement, A lot of little 996 00:53:25.720 --> 00:53:26.700 skills that -- 997 00:53:26.720 --> 00:53:29.700 experienced screeners start to take for granted but it's how to 998 00:53:29.720 --> 00:53:32.700 approach the ear, how to approach the Child, how to have that probe 999 00:53:32.720 --> 00:53:37.120 ready to slide right in to the ear. 1000 00:53:37.140 --> 00:53:41.120 So, I don't want to under- -- 1001 00:53:41.140 --> 00:53:42.560 undersell experience, it's really important. 1002 00:53:42.580 --> 00:53:43.060 . 1003 00:53:43.080 --> 00:53:43.660 >> DR. 1004 00:53:43.680 --> 00:53:47.660 EISERMAN: And, you know, another thing that I think is a really 1005 00:53:47.680 --> 00:53:53.660 important step, in developing our skills -- is to spend time 1006 00:53:53.680 --> 00:53:57.660 screening yourself, to know what it should feel like. 1007 00:53:57.680 --> 00:54:01.660 So that it's really cutoff all that sound, where your ear has that 1008 00:54:01.680 --> 00:54:04.660 clogged sort of feeling, to it. 1009 00:54:04.680 --> 00:54:08.660 You develop a sort of kinesthetic understanding of what you're trying 1010 00:54:08.680 --> 00:54:10.660 to do on another person. 1011 00:54:10.680 --> 00:54:13.660 By doing it, first, on yourself. 1012 00:54:13.680 --> 00:54:15.660 Really getting -- and knowing -- 1013 00:54:15.680 --> 00:54:20.660 oh, I have that really pretty tight in my ear. 1014 00:54:20.680 --> 00:54:25.660 It should be that tight, in the Child that I'm screening, it can't 1015 00:54:25.680 --> 00:54:29.660 just loosely be in there, and so get to know it on yourself, where 1016 00:54:29.680 --> 00:54:33.660 you know you can wiggle it around and you're not going to hurt 1017 00:54:33.680 --> 00:54:36.370 yourself, you're not going to hurt the Child either. 1018 00:54:36.390 --> 00:54:40.700 But you're -- you're more likely to be concerned about that. 1019 00:54:40.720 --> 00:54:44.700 So -- give -- give some practice to screening yourself. 1020 00:54:44.720 --> 00:54:46.700 as well. 1021 00:54:46.720 --> 00:54:50.700 And so, you develop more of that skill. 1022 00:54:50.720 --> 00:54:56.700 (a pause), now Terry, you talked a minute ago, about how, then, we get 1023 00:54:56.720 --> 00:54:59.700 these results of either a pass, or a refer. 1024 00:54:59.720 --> 00:55:03.700 Now, some of you are printing out results, that have a lot more 1025 00:55:03.720 --> 00:55:05.700 details on it than just the pass or refer. 1026 00:55:05.720 --> 00:55:09.700 and some of you, have asked, how do I interpret that? 1027 00:55:09.720 --> 00:55:13.700 How do I know what that all means? 1028 00:55:13.720 --> 00:55:15.700 Some of you have even asked -- 1029 00:55:15.720 --> 00:55:21.700 how do I know what scores to look at, to determine, if a hearing loss 1030 00:55:21.720 --> 00:55:25.150 is significant enough to warrant interventions? 1031 00:55:25.170 --> 00:55:30.150 we need to make sure that everybody who is doing hearing screening, 1032 00:55:30.170 --> 00:55:34.030 really knows the role of screening. 1033 00:55:34.050 --> 00:55:40.030 And screening is is not to know anything more than pass or refer. 1034 00:55:40.050 --> 00:55:42.030 The idea being.... 1035 00:55:42.050 --> 00:55:44.030 Refer -- 1036 00:55:44.050 --> 00:55:47.030 Is so that, somebody else, a pediatric audiologist -- and maybe, 1037 00:55:47.050 --> 00:55:51.030 the input of a healthcare provider -- 1038 00:55:51.050 --> 00:55:56.030 Can determine what the next steps need to be. 1039 00:55:56.050 --> 00:56:00.030 And certainly, they are the ones to determine whether there is a 1040 00:56:00.050 --> 00:56:03.030 hearing loss or not, the significance of it. 1041 00:56:03.050 --> 00:56:09.030 The type of early intervention that maybe warranted, all of that, so, 1042 00:56:09.050 --> 00:56:13.030 you really don't need -- and shouldn't -- go into the weeds 1043 00:56:13.050 --> 00:56:18.030 beyond knowing a pass or a refer result. 1044 00:56:18.050 --> 00:56:19.030 (next slide). 1045 00:56:19.050 --> 00:56:19.830 >> DR. 1046 00:56:19.850 --> 00:56:22.630 EISERMAN: Now I would like to do a quick poll question for those of 1047 00:56:22.650 --> 00:56:24.630 you who are doing. 1048 00:56:24.650 --> 00:56:25.630 OAEs. 1049 00:56:25.650 --> 00:56:27.030 we're going to have a poll question. 1050 00:56:27.050 --> 00:56:29.030 Come up on the screen. 1051 00:56:29.050 --> 00:56:33.030 And first, I would like you to just take a look at this -- 1052 00:56:33.050 --> 00:56:37.030 Table that you see on your screen. 1053 00:56:37.050 --> 00:56:43.020 And try to identify the device that you are using, Mostly, by 1054 00:56:43.040 --> 00:56:47.030 1055 00:56:47.050 --> 00:56:50.030 appearance, now, some of you are probably using devices that you see 1056 00:56:50.050 --> 00:56:55.300 up here that are older models that are no longer being sold. 1057 00:56:55.320 --> 00:57:01.300 But, we're doing this question, because some of you are asking 1058 00:57:01.320 --> 00:57:06.300 about, well, what is everybody else using and what is working and what 1059 00:57:06.320 --> 00:57:06.800 isn't? 1060 00:57:06.820 --> 00:57:10.800 So to begin with -- find your device. 1061 00:57:10.820 --> 00:57:16.800 And look at the column under which your device is found. 1062 00:57:16.820 --> 00:57:21.800 for example: Under Column A, you'll see, three different devices, 1063 00:57:21.820 --> 00:57:24.800 those three devices, though, they have different names and they have 1064 00:57:24.820 --> 00:57:27.800 a slightly different appearance, are basically, the exact same 1065 00:57:27.820 --> 00:57:33.790 device with a slightly different appearance, The same is true, in 1066 00:57:33.810 --> 00:57:34.800 1067 00:57:34.820 --> 00:57:35.800 column B. 1068 00:57:35.820 --> 00:57:38.800 Those two devices, are basically, the same. 1069 00:57:38.820 --> 00:57:42.800 And then the rest of them, that you see there, are individual devices, 1070 00:57:42.820 --> 00:57:46.800 So, find your device, (An electronic tone), and... 1071 00:57:46.820 --> 00:57:52.790 tell us, Which one or ones, you're using, that you're the most -- that 1072 00:57:52.810 --> 00:57:53.800 1073 00:57:53.820 --> 00:57:55.800 you've had some actual experience with. 1074 00:57:55.820 --> 00:57:59.800 and you can say multiple ones, if there are multiples that you -- you 1075 00:57:59.820 --> 00:58:05.800 notice up here. 1076 00:58:05.820 --> 00:58:10.800 Now, Gunnar, am I going to be able to see the results? 1077 00:58:10.820 --> 00:58:11.300 . 1078 00:58:11.320 --> 00:58:15.300 >> Gunnar Thurman: This is Gunnar, I think so we'll see once I close 1079 00:58:15.320 --> 00:58:15.800 the poll. 1080 00:58:15.820 --> 00:58:16.300 >> Okay. 1081 00:58:16.320 --> 00:58:18.300 >> Gunnar Thurman: I'll let you know what they are. 1082 00:58:18.320 --> 00:58:19.300 >> William Eiserman, Ph.D.: 1083 00:58:19.320 --> 00:58:25.300 We'll give you about ten seconds more, to answer this question. 1084 00:58:25.320 --> 00:58:31.300 (A pause). 1085 00:58:31.320 --> 00:58:34.300 Okay. 1086 00:58:34.320 --> 00:58:40.300 Can you close it and see what we get? 1087 00:58:40.320 --> 00:58:44.300 Can you close it and see what we get? 1088 00:58:44.320 --> 00:58:49.300 Okay, great, so the most -- the most common clearly, are in that 1089 00:58:49.320 --> 00:58:53.300 first A column, the -- the -- 1090 00:58:53.320 --> 00:58:54.700 those three different devices you see there. 1091 00:58:54.720 --> 00:58:59.700 Okay, that's really helpful to know, All right, now -- let's ask one 1092 00:58:59.720 --> 00:59:04.700 more question using the same strategy, And, do -- there we go, 1093 00:59:04.720 --> 00:59:05.700 Thank you, (Pause). 1094 00:59:05.720 --> 00:59:10.700 >> William Eiserman, Ph.D.: 1095 00:59:10.720 --> 00:59:16.690 And this is a question that a lot of you have been asking about, 1096 00:59:16.710 --> 00:59:17.700 1097 00:59:17.720 --> 00:59:21.700 because you're struggling with things like, screening in -- in 1098 00:59:21.720 --> 00:59:24.100 noisy environments. 1099 00:59:24.120 --> 00:59:27.620 And getting too many refers or too many error messages. 1100 00:59:27.640 --> 00:59:33.610 Gunnar, I don't see the second poll question, should I? 1101 00:59:33.630 --> 00:59:35.620 1102 00:59:35.640 --> 00:59:41.620 The second poll question, there we go, now we want you to answer this 1103 00:59:41.640 --> 00:59:43.620 question about what you would recommend, not that you're using 1104 00:59:43.640 --> 00:59:48.620 but that you would recommend for screening in a natural environment, 1105 00:59:48.640 --> 00:59:51.110 that is moderately-noisy. 1106 00:59:51.130 --> 00:59:55.110 And, you know, -- if you don't have a device, that you feel good about 1107 00:59:55.130 --> 01:00:00.110 in that way, don't answer this. 1108 01:00:00.130 --> 01:00:05.110 But tell us, if you would make a recommendation that -- overall, you 1109 01:00:05.130 --> 01:00:10.110 -- you have had decent enough success, that you would make a 1110 01:00:10.130 --> 01:00:16.100 recommendation, and we'll give you about 5 more seconds to answer this 1111 01:00:16.120 --> 01:00:26.110 1112 01:00:26.130 --> 01:00:27.110 question. 1113 01:00:27.130 --> 01:00:33.100 All right, let's all right, let's see what our answers are here, ah, 1114 01:00:33.120 --> 01:00:35.110 1115 01:00:35.130 --> 01:00:41.110 interesting, so quite a few people, are recommending those first three, 1116 01:00:41.130 --> 01:00:45.110 now, you're probably wondering why don't you just tell us, William and 1117 01:00:45.130 --> 01:00:48.330 Terry, as federally-funded... 1118 01:00:48.350 --> 01:00:52.330 Agencies, we're not allowed to make, like, material recommendations, 1119 01:00:52.350 --> 01:00:53.330 like that. 1120 01:00:53.350 --> 01:00:53.830 . 1121 01:00:53.850 --> 01:00:55.250 >> DR. 1122 01:00:55.270 --> 01:00:59.250 EISERMAN: (After a pause), so this is our way, to really get the 1123 01:00:59.270 --> 01:01:03.250 perspective of those of you who are actually using these devices, in 1124 01:01:03.270 --> 01:01:05.250 those settings. 1125 01:01:05.270 --> 01:01:11.240 So, if you're having challenges, with screening successfully, in 1126 01:01:11.260 --> 01:01:13.250 1127 01:01:13.270 --> 01:01:15.450 noisy environments. 1128 01:01:15.470 --> 01:01:17.450 -- the question you should ask yourself -- 1129 01:01:17.470 --> 01:01:21.450 Where is my device on this table? 1130 01:01:21.470 --> 01:01:27.440 If it's in that A column, Gee, some people seem to have having 1131 01:01:27.460 --> 01:01:29.450 1132 01:01:29.470 --> 01:01:33.450 relatively positive experiences with this, maybe, I need to get 1133 01:01:33.470 --> 01:01:36.450 some additional technical assistance, from an audiologist, or 1134 01:01:36.470 --> 01:01:40.450 an additional screener, or -- maybe, you need to have a -- a one-on-one 1135 01:01:40.470 --> 01:01:43.450 conversation with one of us. 1136 01:01:43.470 --> 01:01:46.450 Or, maybe, reach out, to some other people who are doing -- 1137 01:01:46.470 --> 01:01:52.440 using these devices, If you're in one of the other columns, It may 1138 01:01:52.460 --> 01:01:56.450 1139 01:01:56.470 --> 01:02:02.450 suggest that, that device is really harder to have success with, Under 1140 01:02:02.470 --> 01:02:08.450 those screening conditions, And so.... 1141 01:02:08.470 --> 01:02:14.440 That can inform future purchases, we always encourage people to try 1142 01:02:14.460 --> 01:02:18.450 1143 01:02:18.470 --> 01:02:24.450 multiple people -- -- purpose -- multiple brands of equipment, 1144 01:02:24.470 --> 01:02:28.450 before you purchase, and -- to give them a good test, not under just 1145 01:02:28.470 --> 01:02:34.450 ideal circumstances, But, under less-than-ideal circumstances to 1146 01:02:34.470 --> 01:02:40.450 see if they're going to, work for you, in the way that you -- you 1147 01:02:40.470 --> 01:02:41.450 need them to. 1148 01:02:41.470 --> 01:02:45.450 So thank you, Gunnar, you can close that, close that down, Terry, did 1149 01:02:45.470 --> 01:02:50.450 you have any other insights looking at those results? 1150 01:02:50.470 --> 01:02:51.450 . 1151 01:02:51.470 --> 01:02:51.950 >> Dr. 1152 01:02:51.970 --> 01:02:54.950 Terry Foust, AuD, CCC-A/SLP: No, I don't think so. 1153 01:02:54.970 --> 01:02:59.950 I -- I think because this particular piece of equipment 1154 01:02:59.970 --> 01:03:04.950 Column A is branded by tree well-known brands it makes sense 1155 01:03:04.970 --> 01:03:08.950 there; and the availability of the foam tip for it now is -- is 1156 01:03:08.970 --> 01:03:09.450 helpful. 1157 01:03:09.470 --> 01:03:09.950 . 1158 01:03:09.970 --> 01:03:10.550 >> DR. 1159 01:03:10.570 --> 01:03:11.550 EISERMAN: Yeah. 1160 01:03:11.570 --> 01:03:12.150 So... 1161 01:03:12.170 --> 01:03:16.150 going back to our Web site, kidshearing.org, this is where you 1162 01:03:16.170 --> 01:03:17.750 find not only, the PureTone information, but, OAE-related 1163 01:03:17.770 --> 01:03:21.930 information. 1164 01:03:21.950 --> 01:03:26.450 Again, a lot of it is -- is the same. 1165 01:03:26.470 --> 01:03:30.450 Big-picture resources, finding an audiologist, We have equipment 1166 01:03:30.470 --> 01:03:35.450 information on there, that table you just saw in another format is 1167 01:03:35.470 --> 01:03:38.600 on there, to look at these different brands of equipment. 1168 01:03:38.620 --> 01:03:41.600 So, if -- if you need to get a reference from that -- that's where 1169 01:03:41.620 --> 01:03:44.600 you would go to look. 1170 01:03:44.620 --> 01:03:49.600 The training resources, are there, so -- again, we encourage you to 1171 01:03:49.620 --> 01:03:55.600 take a dive into the Web site, to see what else is available, there, 1172 01:03:55.620 --> 01:04:00.600 that can help ease some of these frustrations, that you may be 1173 01:04:00.620 --> 01:04:04.600 experiencing, (Next slide), so -- and, again, the screening skills 1174 01:04:04.620 --> 01:04:07.600 checklist, is one of those resources that we really encourage 1175 01:04:07.620 --> 01:04:13.590 you to take a look at, So.... 1176 01:04:13.610 --> 01:04:16.600 1177 01:04:16.620 --> 01:04:20.600 We also -- one of our Web site -- 1178 01:04:20.620 --> 01:04:22.600 Resources is this Listen-up! 1179 01:04:22.620 --> 01:04:28.600 Video, if you're having challenges, in just getting children to 1180 01:04:28.620 --> 01:04:31.600 cooperate, if there are children with special needs that you think, 1181 01:04:31.620 --> 01:04:35.600 need just a little bit more time to warm-up to the idea of this, check 1182 01:04:35.620 --> 01:04:39.600 out the video on there, for -- 1183 01:04:39.620 --> 01:04:42.600 under "preparing children" and you'll see this short, little 1184 01:04:42.620 --> 01:04:48.590 Listen-up Video which is just meant for entertainment purposes, 1185 01:04:48.610 --> 01:04:49.600 1186 01:04:49.620 --> 01:04:55.590 primarily, So, again, -- our Web site -- 1187 01:04:55.610 --> 01:04:56.600 1188 01:04:56.620 --> 01:05:02.600 (scrolling), And this is where you'll find, a to-do list; The 1189 01:05:02.620 --> 01:05:07.600 Listen-up video is at the bottom under "Preparing children", letters 1190 01:05:07.620 --> 01:05:11.600 to parents, letters to teachers To get everybody on board, knowing 1191 01:05:11.620 --> 01:05:15.600 what it is you're doing. 1192 01:05:15.620 --> 01:05:19.600 (A pause), DR. 1193 01:05:19.620 --> 01:05:24.600 EISERMAN: So... 1194 01:05:24.620 --> 01:05:30.590 I'm thinking about our time here. 1195 01:05:30.610 --> 01:05:32.250 1196 01:05:32.270 --> 01:05:38.240 And, I think what I would like to do, is -- (pause), open up the 1197 01:05:38.260 --> 01:05:40.250 1198 01:05:40.270 --> 01:05:44.250 floor, to see what kind of questions you have right now. 1199 01:05:44.270 --> 01:05:50.810 And -- see what else we can address. 1200 01:05:50.830 --> 01:05:56.800 So, -- can you, Gunnar, make the Q&A field available for us now? 1201 01:05:56.820 --> 01:06:01.810 1202 01:06:01.830 --> 01:06:07.800 And if you-all see that, There we go.... 1203 01:06:07.820 --> 01:06:14.810 1204 01:06:14.830 --> 01:06:19.810 Tell us if there are some questions that we haven't addressed that you 1205 01:06:19.830 --> 01:06:25.800 would like some information about. 1206 01:06:25.820 --> 01:06:27.810 1207 01:06:27.830 --> 01:06:31.810 Okay, can we put the link up to your Web site again? 1208 01:06:31.830 --> 01:06:37.800 It's -- kidshearing.org, and Gunnar, will put it into the chat. 1209 01:06:37.820 --> 01:06:41.570 1210 01:06:41.590 --> 01:06:44.570 Kidshearing.org, so -- let's see... 1211 01:06:44.590 --> 01:06:50.560 the OAE screening form, we have a screening form, and it looks just 1212 01:06:50.580 --> 01:06:51.570 1213 01:06:51.590 --> 01:06:52.570 like this. 1214 01:06:52.590 --> 01:06:58.570 You see it on your screen there, And it walks through the entire 1215 01:06:58.590 --> 01:07:03.570 screening protocol just like the PureTone screening does, as well. 1216 01:07:03.590 --> 01:07:06.570 You -- 1217 01:07:06.590 --> 01:07:10.570 You do, you start off, like, Terry said with the inspection of the 1218 01:07:10.590 --> 01:07:16.570 outer ear and then progress from there. 1219 01:07:16.590 --> 01:07:22.560 You do the OAE 1 on each ear, And it progresses from there; so, have 1220 01:07:22.580 --> 01:07:27.570 1221 01:07:27.590 --> 01:07:32.570 a -- and you can -- you can look at that on our Web site, as well; and, 1222 01:07:32.590 --> 01:07:38.570 again, there's a more detailed description of the use of that form 1223 01:07:38.590 --> 01:07:44.560 in the modules that we have on -- online. 1224 01:07:44.580 --> 01:07:50.910 1225 01:07:50.930 --> 01:07:52.910 (After a pause), so where to find letters for parents? 1226 01:07:52.930 --> 01:07:57.910 I think I'm going to go back to that Web site, so some of you -- 1227 01:07:57.930 --> 01:08:00.910 I think, I went through that a little bit quickly, huh? 1228 01:08:00.930 --> 01:08:06.900 So -- (slide advances) so on our Web site here, Under "screening 1229 01:08:06.920 --> 01:08:08.910 1230 01:08:08.930 --> 01:08:14.910 resources" you'll see preparing screeners, it's a to- do list for 1231 01:08:14.930 --> 01:08:17.310 yourselves. 1232 01:08:17.330 --> 01:08:23.310 Preparing parents is a handout for parents, in English, and Spanish, 1233 01:08:23.330 --> 01:08:24.110 Preparing teachers.... 1234 01:08:24.130 --> 01:08:26.700 And other adult assistants. 1235 01:08:26.720 --> 01:08:30.700 Preparing healthcare providers, that's a letter you could send out, 1236 01:08:30.720 --> 01:08:35.700 to healthcare providers, who may be getting referrals from your 1237 01:08:35.720 --> 01:08:37.900 screening. 1238 01:08:37.920 --> 01:08:42.900 And then, preparing children And that particular resource is found 1239 01:08:42.920 --> 01:08:47.900 -- oops, Sorry. 1240 01:08:47.920 --> 01:08:53.890 On this page, at the bottom, under "sharing letters and and sharing 1241 01:08:53.910 --> 01:08:56.900 1242 01:08:56.920 --> 01:09:02.900 resources, sharing results, preparing for screening -- that's 1243 01:09:02.920 --> 01:09:06.390 where those are. 1244 01:09:06.410 --> 01:09:07.390 Okay. 1245 01:09:07.410 --> 01:09:13.390 (a pause), DR. 1246 01:09:13.410 --> 01:09:15.580 1247 01:09:15.600 --> 01:09:19.580 EISERMAN: So on our Web site, if you -- you're looking for 1248 01:09:19.600 --> 01:09:22.580 otoacoustic emissions training information, you would see right 1249 01:09:22.600 --> 01:09:27.580 here, this is the landing page for kidshearing.org, under Access 1250 01:09:27.600 --> 01:09:30.580 Training, you'll find OAE. 1251 01:09:30.600 --> 01:09:35.580 And under each of these other bullets, you'll find information 1252 01:09:35.600 --> 01:09:40.580 specific to OAE, or, PureTone screening, (An electronic tone). 1253 01:09:40.600 --> 01:09:41.580 >> DR. 1254 01:09:41.600 --> 01:09:47.570 EISERMAN: Can you talk more about screening in a moderately-noisy 1255 01:09:47.590 --> 01:09:49.580 1256 01:09:49.600 --> 01:09:54.380 environment and the reliability of the results? 1257 01:09:54.400 --> 01:09:54.880 Terry? 1258 01:09:54.900 --> 01:09:55.380 . 1259 01:09:55.400 --> 01:09:55.880 >> Dr. 1260 01:09:55.900 --> 01:09:58.080 Terry Foust, AuD, CCC-A/SLP: Yeah, absolute, in fact I love this 1261 01:09:58.100 --> 01:10:03.080 question because that's one of the -- so let me talk about both 1262 01:10:03.100 --> 01:10:06.080 methods, though, first, with PureTone audiometry, we want as 1263 01:10:06.100 --> 01:10:09.460 quiet of a environment as possible. 1264 01:10:09.480 --> 01:10:14.460 Because, we don't want any background noise, interfering, with 1265 01:10:14.480 --> 01:10:17.460 the perception of those tones, under headphones; now, we're also 1266 01:10:17.480 --> 01:10:22.460 as equally concerned -- you know, we want as quiet of an environment 1267 01:10:22.480 --> 01:10:26.460 as possible for OAEs, but one of the beauties of it, is, is that we 1268 01:10:26.480 --> 01:10:30.460 are able to screen in natural environments, with the relatively, 1269 01:10:30.480 --> 01:10:36.450 you know -- mild or small amount of noise going on, In fact, we have 1270 01:10:36.470 --> 01:10:37.460 1271 01:10:37.480 --> 01:10:39.860 some exercises that you can do, as you screen yourself, and other 1272 01:10:39.880 --> 01:10:42.860 adults on our Web site, That will walk you through -- 1273 01:10:42.880 --> 01:10:45.860 and show you how -- 1274 01:10:45.880 --> 01:10:49.860 Noise in the environment, noise that's generated from you, or the 1275 01:10:49.880 --> 01:10:55.850 Child, affects the screening, But if you're in a moderately-noisy 1276 01:10:55.870 --> 01:10:56.860 1277 01:10:56.880 --> 01:11:01.860 environment, and, you have OAEs, I would go ahead and try to screen, 1278 01:11:01.880 --> 01:11:06.860 because if you get a good seal, and you're able to measure, that 1279 01:11:06.880 --> 01:11:11.860 emission coming back out, the way we talked about it, and, it's -- 1280 01:11:11.880 --> 01:11:14.860 able to measure that, and get a passing result -- 1281 01:11:14.880 --> 01:11:19.860 that's a reliable result and you can count on that. 1282 01:11:19.880 --> 01:11:23.790 (A pause), DR. 1283 01:11:23.810 --> 01:11:24.290 EISERMAN: Okay. 1284 01:11:24.310 --> 01:11:26.290 >> Terry Foust, AuD, CCC-A/SLP: 1285 01:11:26.310 --> 01:11:28.290 Sorry William, I was just going to that next one. 1286 01:11:28.310 --> 01:11:30.690 >> DR. 1287 01:11:30.710 --> 01:11:31.490 EISERMAN: Go for it. 1288 01:11:31.510 --> 01:11:32.490 >> Terry Foust, AuD, CCC-A/SLP: 1289 01:11:32.510 --> 01:11:34.890 Yeah, there's a question here that talks about only having access to 1290 01:11:34.910 --> 01:11:38.630 PureTone audiometry, with barriers to obtaining OAE equipment. 1291 01:11:38.650 --> 01:11:41.690 How do we handle that we don't need it mentality? 1292 01:11:41.710 --> 01:11:46.020 And so I'm thinking of that in two ways. 1293 01:11:46.040 --> 01:11:51.020 1), one is, we don't need OAE or a back up method. 1294 01:11:51.040 --> 01:11:56.020 And we -- we really do need a back up method, like we said, those 1295 01:11:56.040 --> 01:12:01.020 children that are most difficult to screen, are often the kids that 1296 01:12:01.040 --> 01:12:05.020 actually have hearing loss or are at risk for -- for having hearing 1297 01:12:05.040 --> 01:12:09.020 loss, and so -- we need to have a back up plan. 1298 01:12:09.040 --> 01:12:13.020 And so that either includes OAE, in this case, you've got barriers to 1299 01:12:13.040 --> 01:12:17.020 obtaining it so then a -- 1300 01:12:17.040 --> 01:12:20.020 A referral relationship, and consultation with a pediatric 1301 01:12:20.040 --> 01:12:26.010 audiologist that can figure out and help you outline a back up plan. 1302 01:12:26.030 --> 01:12:27.020 1303 01:12:27.040 --> 01:12:31.020 But second: If -- if the -- 1304 01:12:31.040 --> 01:12:36.020 don't need it mentality is, "We don't need OAE", I think, we can 1305 01:12:36.040 --> 01:12:39.020 talk about that in two ways -- 1306 01:12:39.040 --> 01:12:42.020 the critical aspect of having a back up plan for children, 1307 01:12:42.040 --> 01:12:47.020 especially, that 20 to 25% that we can't screen, with PureTone 1308 01:12:47.040 --> 01:12:50.020 audiometry -- what are we going to do with those? 1309 01:12:50.040 --> 01:12:54.020 And that's a high refer rate to -- to send out. 1310 01:12:54.040 --> 01:13:00.380 And then, William, we still have our mini grant... 1311 01:13:00.400 --> 01:13:02.380 Templates available, that --. 1312 01:13:02.400 --> 01:13:02.880 >> Templates. 1313 01:13:02.900 --> 01:13:05.880 >> That perhaps could reduce the barrier to obtaining an OAE. 1314 01:13:05.900 --> 01:13:10.880 We have had programs that have been successful in writing these small 1315 01:13:10.900 --> 01:13:13.880 grants, because the equipment's fairly affordable, you can get a 1316 01:13:13.900 --> 01:13:19.870 grant for under 5,000, for 5,000 or $4,000, to pay for the equipment. 1317 01:13:19.890 --> 01:13:21.620 1318 01:13:21.640 --> 01:13:27.620 We've had Lion's clubs, and sir Optimus, we have had some local 1319 01:13:27.640 --> 01:13:30.620 family foundations, we have had some corporations that have been 1320 01:13:30.640 --> 01:13:34.620 locally based in states, that responded to that grant application, 1321 01:13:34.640 --> 01:13:37.620 and have helped programs get OAE equipment. 1322 01:13:37.640 --> 01:13:39.420 >> DR. 1323 01:13:39.440 --> 01:13:42.420 EISERMAN: Yeah so Gunnar, could you post the link to that mini 1324 01:13:42.440 --> 01:13:45.420 grant template that people could use? 1325 01:13:45.440 --> 01:13:49.420 It's not plagiarism, by the way, you can just go ahead, and cut and 1326 01:13:49.440 --> 01:13:55.420 paste, and use that as a grant proposal to any charity -- 1327 01:13:55.440 --> 01:13:59.420 charitable organization, or, a potential funder to elicit funding 1328 01:13:59.440 --> 01:14:03.420 for your equipment, or supplies. 1329 01:14:03.440 --> 01:14:04.420 Terry Foust, AuD, CCC-A/SLP: 1330 01:14:04.440 --> 01:14:04.920 Yeah. 1331 01:14:04.940 --> 01:14:05.920 >> DR. 1332 01:14:05.940 --> 01:14:07.920 EISERMAN: Somebody asked the question, are we able to purchase 1333 01:14:07.940 --> 01:14:11.920 PureTone equipment if we're not a licensed audiologist? 1334 01:14:11.940 --> 01:14:12.420 Terry? 1335 01:14:12.440 --> 01:14:12.920 . 1336 01:14:12.940 --> 01:14:13.420 >> Dr. 1337 01:14:13.440 --> 01:14:15.620 Terry Foust, AuD, CCC-A/SLP: Yeah, absolutely, you should be able to 1338 01:14:15.640 --> 01:14:16.120 purchase that. 1339 01:14:16.140 --> 01:14:19.120 You know, lots of -- 1340 01:14:19.140 --> 01:14:22.650 laypeople, learn to be good screeners. 1341 01:14:22.670 --> 01:14:25.650 The only thing, would be as we mentioned earlier on in the -- 1342 01:14:25.670 --> 01:14:31.640 in the webinar, is some states may have some certification or.... 1343 01:14:31.660 --> 01:14:32.650 1344 01:14:32.670 --> 01:14:36.650 Kind of guidelines on who can perform the various screening in 1345 01:14:36.670 --> 01:14:37.650 their states. 1346 01:14:37.670 --> 01:14:42.650 Some states, though, have wonderful training for it. 1347 01:14:42.670 --> 01:14:45.450 As well -- and so you could take advantage of the training on our 1348 01:14:45.470 --> 01:14:47.450 Web site, as well as the resources in the state. 1349 01:14:47.470 --> 01:14:50.450 So, but you don't have to be licensed to purchase -- 1350 01:14:50.470 --> 01:14:55.500 actually, either equipment. 1351 01:14:55.520 --> 01:14:56.000 . 1352 01:14:56.020 --> 01:14:56.600 >> DR. 1353 01:14:56.620 --> 01:14:59.600 EISERMAN: Terry, another question, what would be your recommended 1354 01:14:59.620 --> 01:15:03.600 amount of screening attempts once a child has failed or a refer code is 1355 01:15:03.620 --> 01:15:04.100 given? 1356 01:15:04.120 --> 01:15:05.100 >> Dr. 1357 01:15:05.120 --> 01:15:10.100 Terry Foust, AuD, CCC-A/SLP: Okay, yeah, so I like to think of this 1358 01:15:10.120 --> 01:15:13.100 screening, rather than, I like to think of it in sessions, so, my 1359 01:15:13.120 --> 01:15:17.100 first time with a child, is a screening session. 1360 01:15:17.120 --> 01:15:23.100 I might get a refer, and I want to be sure that it's not kind of -- I 1361 01:15:23.120 --> 01:15:26.100 don't want to say "my fault "but kind of factors that I can control, 1362 01:15:26.120 --> 01:15:28.500 so I'm going to try again. 1363 01:15:28.520 --> 01:15:33.500 I'm going to ensure that I got good probe fit; that I was trying to 1364 01:15:33.520 --> 01:15:36.500 control, for movement, or internal-external noise that could 1365 01:15:36.520 --> 01:15:37.500 affect this. 1366 01:15:37.520 --> 01:15:41.500 So I'm going to try it again, and if I get a refer again, I may, 1367 01:15:41.520 --> 01:15:45.500 again, just assess -- is it -- is it something here that I can retry? 1368 01:15:45.520 --> 01:15:50.500 So I may try two or three times, if my result is still a refer -- 1369 01:15:50.520 --> 01:15:55.500 Then, I'm going to follow our protocol, and come back in two 1370 01:15:55.520 --> 01:15:57.500 weeks, and rescreen that child. 1371 01:15:57.520 --> 01:16:02.500 so I like to call it a session, I get a refer, if I have the ability, 1372 01:16:02.520 --> 01:16:06.500 and the -- and the Child's cooperative -- I'm going to try two 1373 01:16:06.520 --> 01:16:11.500 or three more times, just to make sure that it isn't any other 1374 01:16:11.520 --> 01:16:16.500 factors such as probe fit, noise, movement, et cetera, in the 1375 01:16:16.520 --> 01:16:17.000 environment. 1376 01:16:17.020 --> 01:16:20.280 (A pause), DR. 1377 01:16:20.300 --> 01:16:22.280 EISERMAN: Um... 1378 01:16:22.300 --> 01:16:23.280 let's see... 1379 01:16:23.300 --> 01:16:23.780 here. 1380 01:16:23.800 --> 01:16:29.780 What are some tips, Terry, for choosing the best and right probe 1381 01:16:29.800 --> 01:16:30.780 cover size? 1382 01:16:30.800 --> 01:16:31.780 . 1383 01:16:31.800 --> 01:16:32.280 >> Dr. 1384 01:16:32.300 --> 01:16:35.280 Terry Foust, AuD, CCC-A/SLP: Yeah, that's a really key question, you 1385 01:16:35.300 --> 01:16:39.280 know, when we first start the process, that very first step, when 1386 01:16:39.300 --> 01:16:44.280 we're looking in the ear, we -- and I probably neglected to say this, 1387 01:16:44.300 --> 01:16:50.270 but not only looking in that ear, for -- blockage or drainage or some 1388 01:16:50.290 --> 01:16:51.270 1389 01:16:51.290 --> 01:16:54.270 abnormality that would either say, I could or couldn't -- I should or 1390 01:16:54.290 --> 01:16:58.280 shouldn't screen -- but I'm also looking at the size of that little 1391 01:16:58.300 --> 01:17:01.280 ear canal; and, so I want to take a good look there. 1392 01:17:01.300 --> 01:17:06.280 And then, I want to go to my probe, covers, and try to make a selection 1393 01:17:06.300 --> 01:17:09.280 on how that -- that ear looked. 1394 01:17:09.300 --> 01:17:15.260 Now, we talked about foam tips, The nice thing, with foam tips, is -- 1395 01:17:15.280 --> 01:17:16.280 1396 01:17:16.300 --> 01:17:19.280 you don't have such a wide selection to pick from; usually you 1397 01:17:19.300 --> 01:17:23.540 have an adult-sized foam tip. 1398 01:17:23.560 --> 01:17:28.540 Pediatric foam tip, and maybe, if you're lucky you'll have one in the 1399 01:17:28.560 --> 01:17:29.040 middle. 1400 01:17:29.060 --> 01:17:34.040 We find that that pediatric foam tip will fit most of those little 1401 01:17:34.060 --> 01:17:39.040 ear canals in that, say, 0 to four or five-year-old group; however, 1402 01:17:39.060 --> 01:17:44.040 the other tip that I mentioned earlier is the largest size probe 1403 01:17:44.060 --> 01:17:49.040 cover that will fit in that ear so that we get a nice, snug fit, and 1404 01:17:49.060 --> 01:17:52.040 then I would try different sizes in your own ears, so that you get a 1405 01:17:52.060 --> 01:17:57.040 feel for what a snug one should feel like, and -- and, kind of look 1406 01:17:57.060 --> 01:17:59.040 -- did you pick a smaller one? 1407 01:17:59.060 --> 01:18:03.040 And you had to go up in sizes? 1408 01:18:03.060 --> 01:18:06.040 And, just get some experience with that. 1409 01:18:06.060 --> 01:18:09.040 But I -- I still, you know, -- 1410 01:18:09.060 --> 01:18:14.040 over the years of experience, feel that those compressable foam tips, 1411 01:18:14.060 --> 01:18:18.040 as they expand in the ear canal, they're more stable so that probe 1412 01:18:18.060 --> 01:18:23.040 fits -- more snuggly and tightly, it's more resistant to movement, 1413 01:18:23.060 --> 01:18:27.630 and, so, I would try that first. 1414 01:18:27.650 --> 01:18:28.630 (Pause), DR. 1415 01:18:28.650 --> 01:18:34.620 EISERMAN: All right, What would you recommend for screening 1416 01:18:34.640 --> 01:18:35.630 1417 01:18:35.650 --> 01:18:40.630 children with special needs and helping them to be more 1418 01:18:40.650 --> 01:18:41.130 comfortable? 1419 01:18:41.150 --> 01:18:41.630 . 1420 01:18:41.650 --> 01:18:42.130 >> Dr. 1421 01:18:42.150 --> 01:18:44.130 Terry Foust, AuD, CCC-A/SLP: That's such a great question. 1422 01:18:44.150 --> 01:18:47.120 I think, having a caregiver with whom the Child is really 1423 01:18:47.140 --> 01:18:52.120 comfortable with, help assist, have them hold the Child, they can even 1424 01:18:52.140 --> 01:18:55.120 keep their hands busy, they're the ones, that I'll give my toy kit to 1425 01:18:55.140 --> 01:18:59.130 and they get to present the toys and things to keep them busy, while 1426 01:18:59.150 --> 01:19:05.130 I may just back right out of sight and kind of behind, and, try to get 1427 01:19:05.150 --> 01:19:06.860 that screening. 1428 01:19:06.880 --> 01:19:10.860 But I also may -- if I have access to the Child, ahead of time, I may 1429 01:19:10.880 --> 01:19:14.860 come in and meet them, I may massage their ears. 1430 01:19:14.880 --> 01:19:17.860 Talk to them, play, I might have the probe tip and run it -- 1431 01:19:17.880 --> 01:19:23.850 bounce it like a bunny up up the arm, and into their ear without 1432 01:19:23.870 --> 01:19:24.860 1433 01:19:24.880 --> 01:19:27.860 actually screening but I may take time to familiarize them, with not 1434 01:19:27.880 --> 01:19:33.860 only myself, so they're comfortable but with the probe and the 1435 01:19:33.880 --> 01:19:36.260 equipment. 1436 01:19:36.280 --> 01:19:38.660 And, -- I would -- also, consult with the caregivers, that are 1437 01:19:38.680 --> 01:19:41.660 really familiar with that child, because, perhaps they know that 1438 01:19:41.680 --> 01:19:45.660 naptime is here, and the Child is a sound sleeper, I may choose to go 1439 01:19:45.680 --> 01:19:48.660 screen them while they're asleep. 1440 01:19:48.680 --> 01:19:52.510 So -- there's lots of little things, there, that -- that we could do. 1441 01:19:52.530 --> 01:19:57.510 Now, often we have a child that comes in and we don't have the 1442 01:19:57.530 --> 01:20:01.510 luxury of taking several days, or -- or whatever to help them become 1443 01:20:01.530 --> 01:20:05.510 familiar with this, and that is, then, when I really like to have 1444 01:20:05.530 --> 01:20:09.510 somebody that they're comfortable with, help assist us. 1445 01:20:09.530 --> 01:20:10.010 . 1446 01:20:10.030 --> 01:20:11.510 >> DR. 1447 01:20:11.530 --> 01:20:14.510 EISERMAN: So, Terry, this is a really good question -- all of 1448 01:20:14.530 --> 01:20:15.510 these are -- 1449 01:20:15.530 --> 01:20:21.510 This one, happens to open up a whole can of worms, so -- living in 1450 01:20:21.530 --> 01:20:26.510 a rural area, what do -- we do not have access to pediatric 1451 01:20:26.530 --> 01:20:28.510 audiologists, and, the pediatricians and audiologists 1452 01:20:28.530 --> 01:20:34.500 follow up for us, and -- often say the hearing is fine, yet the 1453 01:20:34.520 --> 01:20:35.510 1454 01:20:35.530 --> 01:20:39.510 parents will report that the pediatrician does the bell whisper 1455 01:20:39.530 --> 01:20:45.050 test, and says, "They're fine." Then we're stuck. 1456 01:20:45.070 --> 01:20:50.050 Between education versus medical with -- how to support families and 1457 01:20:50.070 --> 01:20:54.320 going further without a referral from a doctor... 1458 01:20:54.340 --> 01:20:57.320 how do we deal with this problem? 1459 01:20:57.340 --> 01:21:03.320 You know, -- and this is, like, I'll add: Knowing that the bell 1460 01:21:03.340 --> 01:21:08.320 and the whisper test is not a legitimate hearing screening, even 1461 01:21:08.340 --> 01:21:12.320 though there may be professionals who continue to think it is. 1462 01:21:12.340 --> 01:21:12.820 . 1463 01:21:12.840 --> 01:21:13.820 >> Dr. 1464 01:21:13.840 --> 01:21:16.820 Terry Foust, AuD, CCC-A/SLP: Yeah, this is such a challenge, when 1465 01:21:16.840 --> 01:21:22.820 there's a shortage, or there's just lack of access to the right 1466 01:21:22.840 --> 01:21:25.820 professionals, and when I say "the right professionals", I mean, not 1467 01:21:25.840 --> 01:21:28.820 only those with the training and the expertise but with the 1468 01:21:28.840 --> 01:21:32.820 understanding of screening processes, and -- and because, 1469 01:21:32.840 --> 01:21:34.820 screening, you know, -- 1470 01:21:34.840 --> 01:21:38.820 we're -- it's, like, sorting things into buckets, but what we do when 1471 01:21:38.840 --> 01:21:43.820 we screen is we're finding those, children, that -- 1472 01:21:43.840 --> 01:21:48.820 that are -- at risk, most at risk, for having a hearing loss, and then 1473 01:21:48.840 --> 01:21:54.810 we need that full evaluation and an assessment to ensure that hearing 1474 01:21:54.830 --> 01:21:55.820 1475 01:21:55.840 --> 01:21:56.820 is fine. 1476 01:21:56.840 --> 01:21:58.240 I can really.... 1477 01:21:58.260 --> 01:22:01.240 Empathize with being stuck between being education versus medical with 1478 01:22:01.260 --> 01:22:04.240 -- as you say, how to support parents, and going further without 1479 01:22:04.260 --> 01:22:10.240 a referral from their physician, We have some educational materials, 1480 01:22:10.260 --> 01:22:16.240 and we even have some letters that go from programs to medical 1481 01:22:16.260 --> 01:22:21.240 professionals on the Web site, and -- are those easily accessible, if 1482 01:22:21.260 --> 01:22:27.230 not, just know that they're on our Web site, they're written in a way 1483 01:22:27.250 --> 01:22:28.240 1484 01:22:28.260 --> 01:22:29.040 that helps.... 1485 01:22:29.060 --> 01:22:30.040 Medical providers understand the. 1486 01:22:30.060 --> 01:22:31.240 >> DR. 1487 01:22:31.260 --> 01:22:31.740 EISERMAN: Yes. 1488 01:22:31.760 --> 01:22:35.740 >> Doctor Terry Foust, AuD, CCC-A/SLP: The steps to take, the 1489 01:22:35.760 --> 01:22:37.740 process, that can also help educate them in the screening. 1490 01:22:37.760 --> 01:22:40.140 >> DR. 1491 01:22:40.160 --> 01:22:45.140 EISERMAN: Yes, on the screen right now, where you see -- where it says, 1492 01:22:45.160 --> 01:22:49.140 "screening resources", prepare for screening, and then "sharing 1493 01:22:49.160 --> 01:22:54.140 results," both of those headings have resources for healthcare 1494 01:22:54.160 --> 01:22:55.140 providers. 1495 01:22:55.160 --> 01:22:59.140 We always recommend that when you make a referral to a healthcare 1496 01:22:59.160 --> 01:23:05.140 provider, you provide some of the facts about what screening you're 1497 01:23:05.160 --> 01:23:10.140 doing; OAE or PureTone -- and what it is you're looking for them to 1498 01:23:10.160 --> 01:23:10.640 do. 1499 01:23:10.660 --> 01:23:16.640 Usually, that healthcare provider referral, is to ruleout a middle 1500 01:23:16.660 --> 01:23:20.640 ear explanation for why the Child hasn't passed yet. 1501 01:23:20.660 --> 01:23:24.640 So we want the healthcare provider to do an assessment of, whether the 1502 01:23:24.660 --> 01:23:30.630 Child might have a wax blockage or a middle ear condition that could 1503 01:23:30.650 --> 01:23:31.640 1504 01:23:31.660 --> 01:23:33.640 explain the referring result. 1505 01:23:33.660 --> 01:23:39.640 And then, if it's addressed or they don't have that, then we need to 1506 01:23:39.660 --> 01:23:43.640 rescreen the Child again, once there is no reason, we can see, 1507 01:23:43.660 --> 01:23:49.640 that the Child wouldn't pass and if they still don't pass, that 1508 01:23:49.660 --> 01:23:51.840 healthcare provider, may be key in making a referral, for an 1509 01:23:51.860 --> 01:23:52.840 audiological evaluation, . 1510 01:23:52.860 --> 01:23:55.170 >> DR. 1511 01:23:55.190 --> 01:24:00.170 EISERMAN: So, you'll see, in that referral letters, sharing results 1512 01:24:00.190 --> 01:24:06.160 -- that we have articulated the need, for why we're going to the 1513 01:24:06.180 --> 01:24:07.170 1514 01:24:07.190 --> 01:24:10.170 healthcare provider, and what it is we're hoping they can provide. 1515 01:24:10.190 --> 01:24:10.670 . 1516 01:24:10.690 --> 01:24:11.170 >> Dr. 1517 01:24:11.190 --> 01:24:12.770 Terry Foust, AuD, CCC-A/SLP: Yeah, it's really -- 1518 01:24:12.790 --> 01:24:16.770 you know, I appreciate this question, in the sense that a lot 1519 01:24:16.790 --> 01:24:21.770 of us, including our parents, that we work with, we -- we assume 1520 01:24:21.790 --> 01:24:25.770 there's -- you know, -- been an actual hearing screening done at 1521 01:24:25.790 --> 01:24:29.770 our provider's office, but they simply -- 1522 01:24:29.790 --> 01:24:33.770 they -- usually, the vast majority don't have, hearing screening, and 1523 01:24:33.790 --> 01:24:36.170 equipment. 1524 01:24:36.190 --> 01:24:39.170 They don't do a hearing screening, they check the physical structures, 1525 01:24:39.190 --> 01:24:43.170 they make sure, that -- you know, -- for the middle ear system, for 1526 01:24:43.190 --> 01:24:47.170 example, they can assess for fluid, or other middle ear health 1527 01:24:47.190 --> 01:24:49.570 conditions. 1528 01:24:49.590 --> 01:24:51.570 And perhaps, they look at wax and remove it. 1529 01:24:51.590 --> 01:24:55.570 But, it's precisely because a hearing screening isn't being done 1530 01:24:55.590 --> 01:24:58.570 in those settings is why programs like yours are so important, you're 1531 01:24:58.590 --> 01:25:04.570 actually doing that piece of it, And -- but I know it's frustrating 1532 01:25:04.590 --> 01:25:10.570 when that follow up that is so important has barriers, AndAnd -- 1533 01:25:10.590 --> 01:25:16.570 and -- I'm sorry, that that's the case. 1534 01:25:16.590 --> 01:25:18.370 DR. 1535 01:25:18.390 --> 01:25:22.370 EISERMAN: Yeah, oh, it's so challenging at times, Sometimes, 1536 01:25:22.390 --> 01:25:27.370 with children, with tubes in their ears, it's hard with the OAE probe, 1537 01:25:27.390 --> 01:25:30.370 to find where it needs to be in order for the machine to do its 1538 01:25:30.390 --> 01:25:33.420 reading. 1539 01:25:33.440 --> 01:25:34.640 any suggestions? 1540 01:25:34.660 --> 01:25:40.640 Sometimes, I need to hold it, just right for it to start the reading, 1541 01:25:40.660 --> 01:25:44.640 What do you make of that question, Terry? 1542 01:25:44.660 --> 01:25:45.640 . 1543 01:25:45.660 --> 01:25:46.140 >> Dr. 1544 01:25:46.160 --> 01:25:49.140 Terry Foust, AuD, CCC-A/SLP: Yeah, you should be able to screen 1545 01:25:49.160 --> 01:25:54.140 children with P tubes, actually, just like you would any other 1546 01:25:54.160 --> 01:25:54.640 child. 1547 01:25:54.660 --> 01:25:57.640 I don't do anything special with fitting the probe, on the job, that 1548 01:25:57.660 --> 01:26:03.640 just -- that probe fit is key for all -- all children. 1549 01:26:03.660 --> 01:26:06.640 And, so... 1550 01:26:06.660 --> 01:26:12.640 If -- if they refer with those tubes in their ears, then, it's 1551 01:26:12.660 --> 01:26:16.640 most likely, probably, due to middle ear disorder for which the 1552 01:26:16.660 --> 01:26:21.640 tubes were -- were placed, but we -- we -- it gives us also the 1553 01:26:21.660 --> 01:26:24.040 opportunity, then, to make that referral and -- and they can ensure 1554 01:26:24.060 --> 01:26:27.040 that either tubes are functioning working, or if there is still some 1555 01:26:27.060 --> 01:26:31.610 middle ear health issues, that -- that need to be addressed. 1556 01:26:31.630 --> 01:26:32.110 . 1557 01:26:32.130 --> 01:26:33.110 >> Dr. 1558 01:26:33.130 --> 01:26:36.110 Terry Foust, AuD, CCC-A/SLP: But we should be able to place the 1559 01:26:36.130 --> 01:26:38.420 probe just like we would for -- for any other child. 1560 01:26:38.440 --> 01:26:38.920 . 1561 01:26:38.940 --> 01:26:43.920 And have it function, and get that refer or pass or refer -- 1562 01:26:43.940 --> 01:26:48.920 just knowing in -- in -- the refer cases, that there's probably a 1563 01:26:48.940 --> 01:26:51.920 higher probability that it's middle-ear related. 1564 01:26:51.940 --> 01:26:52.420 . 1565 01:26:52.440 --> 01:26:53.320 >> DR. 1566 01:26:53.340 --> 01:26:57.320 EISERMAN: So this next question comes out of -- a concern, we all 1567 01:26:57.340 --> 01:27:01.320 share and that has to do with the costs. 1568 01:27:01.340 --> 01:27:06.320 Of equipment, and of these disposable, for OAE, the disposable 1569 01:27:06.340 --> 01:27:11.320 probe covers, are there any places, we can purchase less-expensive ear 1570 01:27:11.340 --> 01:27:17.310 tips, for the welsh Allen OAE screener, the cheapest is nearly a 1571 01:27:17.330 --> 01:27:18.320 1572 01:27:18.340 --> 01:27:24.320 dollar per ear tip on MEDLINE®, So, there's two pieces to this, 1573 01:27:24.340 --> 01:27:24.820 question, right? 1574 01:27:24.840 --> 01:27:29.820 Terry, the first is a cautionary one, that, you have to purchase the 1575 01:27:29.840 --> 01:27:33.820 ear tips, that, go with your particular screener, you might see 1576 01:27:33.840 --> 01:27:37.820 them for another, and think, "Oh, if I had that screener, they're 1577 01:27:37.840 --> 01:27:41.820 cheaper, I'll buy those." You can't interchange them. 1578 01:27:41.840 --> 01:27:45.820 You'll get faulty results if you do that. 1579 01:27:45.840 --> 01:27:47.820 So you really do not ever do that. 1580 01:27:47.840 --> 01:27:53.820 As far as finding cheaper sources -- Terry, what -- what advice do 1581 01:27:53.840 --> 01:27:54.820 you have? 1582 01:27:54.840 --> 01:27:55.320 . 1583 01:27:55.340 --> 01:27:55.820 >> Dr. 1584 01:27:55.840 --> 01:27:58.020 Terry Foust, AuD, CCC-A/SLP: Yeah, thank you, so making sure that 1585 01:27:58.040 --> 01:28:02.020 they are probe covers that are manufactured for your machine, but 1586 01:28:02.040 --> 01:28:06.020 then, second, I -- you -- I would do some shopping, because, they are 1587 01:28:06.040 --> 01:28:06.520 -- 1588 01:28:06.540 --> 01:28:09.780 there is some variability. 1589 01:28:09.800 --> 01:28:10.280 There. 1590 01:28:10.300 --> 01:28:16.280 So, there is -- I would -- you can look at E3 Diagnostics, you could 1591 01:28:16.300 --> 01:28:20.280 look at School Health, you could look at Booth Medical, but, there 1592 01:28:20.300 --> 01:28:23.280 -- there's, you know, various vendors that will well sell the 1593 01:28:23.300 --> 01:28:24.280 supplies, for the -- 1594 01:28:24.300 --> 01:28:26.280 for this equipment. 1595 01:28:26.300 --> 01:28:31.280 I will say, that that Column A, that you -- that it looked like the 1596 01:28:31.300 --> 01:28:36.280 majority of you were all using -- has probe covers that are sold by 1597 01:28:36.300 --> 01:28:42.270 some of these other vendors, for that specific machine, so there's 1598 01:28:42.290 --> 01:28:43.280 1599 01:28:43.300 --> 01:28:48.280 probably more pricing opportunity, to look at across those, and, 1600 01:28:48.300 --> 01:28:50.680 probably, less opportunity as you go further to the right of the 1601 01:28:50.700 --> 01:28:52.680 chart that William showed you. 1602 01:28:52.700 --> 01:28:58.670 But it is worth shopping, For -- like, a across vendors that support 1603 01:28:58.690 --> 01:28:59.680 1604 01:28:59.700 --> 01:29:03.730 otoacoustic emission screening equipment. 1605 01:29:03.750 --> 01:29:04.230 . 1606 01:29:04.250 --> 01:29:04.830 >> DR. 1607 01:29:04.850 --> 01:29:07.830 EISERMAN: We are at the bottom of the hour, which means, we have been 1608 01:29:07.850 --> 01:29:12.830 on for 90 minutes, now, and I know, many of you have other places to go, 1609 01:29:12.850 --> 01:29:13.830 and be. 1610 01:29:13.850 --> 01:29:17.830 We hope this has been helpful. 1611 01:29:17.850 --> 01:29:23.820 If we can be of further assistance, to you, feel free, to message us 1612 01:29:23.840 --> 01:29:24.830 1613 01:29:24.850 --> 01:29:29.460 through our Web site. 1614 01:29:29.480 --> 01:29:35.450 Also, note that, next week, on Tuesday, February 27th. 1615 01:29:35.470 --> 01:29:36.460 1616 01:29:36.480 --> 01:29:39.460 We have an introductory webinar, in which we will be, talking about a 1617 01:29:39.480 --> 01:29:45.570 lot of these same things, but more from a beginning perspective. 1618 01:29:45.590 --> 01:29:51.560 You're welcome to join us there, if you would like, to continue a 1619 01:29:51.580 --> 01:29:53.570 1620 01:29:53.590 --> 01:29:54.570 dialogue. 1621 01:29:54.590 --> 01:29:57.170 And encourage people that you need, who need to know more about this, 1622 01:29:57.190 --> 01:30:00.710 to attend this webinar. 1623 01:30:00.730 --> 01:30:04.710 We're really happy, that we're able to provide these services, for you, 1624 01:30:04.730 --> 01:30:08.710 we're no longer really funded to... 1625 01:30:08.730 --> 01:30:14.710 Provide training, or technical assistance, in the way we just have 1626 01:30:14.730 --> 01:30:15.710 done. 1627 01:30:15.730 --> 01:30:18.710 But because we have seen this ongoing need, We are just doing 1628 01:30:18.730 --> 01:30:24.690 this, because, we want you-all to have success, And to do whatever we 1629 01:30:24.710 --> 01:30:25.710 1630 01:30:25.730 --> 01:30:29.710 can, to help minimize some of the frustrations, that go along with 1631 01:30:29.730 --> 01:30:34.710 trying to implement evidence-based practice, just because it's 1632 01:30:34.730 --> 01:30:39.710 evidence-based doesn't mean that it's easy. 1633 01:30:39.730 --> 01:30:40.710 And so... 1634 01:30:40.730 --> 01:30:46.700 if we can -- if we can provide any other support, please let us know, 1635 01:30:46.720 --> 01:30:47.700 1636 01:30:47.720 --> 01:30:52.700 Also, know -- if you go to kidshearing.org, and look at the 1637 01:30:52.720 --> 01:30:58.710 training options, you'll find ways, to get more information about how 1638 01:30:58.730 --> 01:31:04.710 to get comprehensive training, in OAE, and PureTone screening, 1639 01:31:04.730 --> 01:31:05.710 Gunnar. 1640 01:31:05.730 --> 01:31:07.710 >> This is Terry, can I interrupt really quick? 1641 01:31:07.730 --> 01:31:08.210 . 1642 01:31:08.230 --> 01:31:09.210 >> Yeah. 1643 01:31:09.230 --> 01:31:09.710 >> Dr. 1644 01:31:09.730 --> 01:31:12.300 Terry Foust, AuD, CCC-A/SLP: I just did a price check on the last 1645 01:31:12.320 --> 01:31:17.300 question and School Health sells the ones, for the Column A, 1646 01:31:17.320 --> 01:31:22.310 equipment, 100 count for 36.99, so, School Health, could be a resource 1647 01:31:22.330 --> 01:31:25.310 for those of you that have some of that equipment. 1648 01:31:25.330 --> 01:31:27.710 >> DR. 1649 01:31:27.730 --> 01:31:29.710 EISERMAN: Oh, yeah, that's a really good price, okay, that's 1650 01:31:29.730 --> 01:31:34.710 great, before you all runoff in the -- in the chat box, there is a link 1651 01:31:34.730 --> 01:31:39.570 there, to give a quick evaluation. 1652 01:31:39.590 --> 01:31:42.570 To today's webinar, and, that will generate a certificate of 1653 01:31:42.590 --> 01:31:47.570 attendance, so, if you want to document that you were with us 1654 01:31:47.590 --> 01:31:53.570 today, go, and -- and complete that; and -- thank you, everybody, thank 1655 01:31:53.590 --> 01:31:57.570 you, to our interpreter and -- interpreters and captioner, thank 1656 01:31:57.590 --> 01:32:00.570 you, Gunnar for your background technical support, and Terry, of 1657 01:32:00.590 --> 01:32:03.570 course, as always, thank you. 1658 01:32:03.590 --> 01:32:08.570 For being so helpful, we hope we'll see some of your colleagues, next 1659 01:32:08.590 --> 01:32:12.570 week, February 27th. 1660 01:32:12.590 --> 01:32:21.580 In this same place remember this was