WEBVTT

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Well, I think we ought to get started. What do you say, Mandy and Terry?

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I agree.

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Let's go. Yeah, thank you.

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All right. Well, welcome, everybody. You are in the right place for today's webinar, Introduction to Evidence-Based Hearing Screening Practices for Children Birth

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Through school age. My name is Will Eiserman, and I am the Affiliate Associate Director at the National Center for Hearing Assessment and Management.

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Also known as NCHAM. Now, NCHAM is housed within the Institute for Disability Research, Policy and Practice at Utah State University, which is federally funded.

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Um, as a university center for excellence in developmental disabilities, with a critical nationwide focus.

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since the early 2000s, 2001, in fact, I also served as the director of the Early Childhood Hearing Outreach Initiative.

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Known as the ECHO Initiative. And for 20-some years after that, the ECHO initiative, um, has served as the National Resource Center on early hearing detection and intervention, with a focus on supporting

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Early Head Start and Head Start program staff, um, and other early care and education providers and

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implementing evidence-based hearing screening and follow-up practices. And we're delighted to continue to make our resources, other…

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learning opportunities like this one available to staff

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from Head Start programs, as well as early intervention programs, other early care, and education settings that cut across all of the different age groups for whom we need to be monitoring the hearing status. Um, so we are really delighted to have so many of you with us here today, and

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By way of reminder, today's webinar is being recorded, and it'll be posted that in the next couple of days on our website, which is kidshearing.org. So, if anything disrupts your full attention today,

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Or, if you think of people that could benefit from the information that we're talking about, whether that's your colleagues, decision makers, even parents, healthcare providers,

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anybody who is involved in monitoring and supporting the development of children, um,

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Feel free to direct them over to our website to see this webinar, as well as

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to explore the many other resources that we have there, and that we'll be pointing out as we present today. Now, I'm joined today by Dr. Terry Faust, who is a good friend and colleague of many years.

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Dr. Faust is a pediatric audiologist and speech-language pathologist who has served as a consultant and trainer and advisor to us at the ECHO Initiative since our very beginning. So, Terry, thanks for being with us again.

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Yeah, thank you so much, William. Boy, just as like William said, he and I, along with many other ECHO team staff and collaborators like you, we've provided training in nearly every state in person and then virtually, I'm sure.

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with every state and beyond. Um, we have worked with thousands of staff from many different kinds of programs, Head Start, Early Head Start, Alaskan, American Indian, Alaskan Native Migrant Head Start programs, and many other early care and education.

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Programs in schools over the years. We also have with us Mandy Jay, who is presenting with us today. She has a master's in public education and is a program coordinator for the National Center for Hearing Assessment and Management.

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Gary, let me just correct that. It's… she has a master's in public health.

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You can do that, you knew that. That was just a word clip.

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And she's awesome. public health. Yes, that's right, Mandy. I'm sorry about that. And I think one of the most important things she brings is her experience as the parent of two children who are deaf or hard of hearing, and we're really thankful to have her with us today because she brings multiple perspectives.

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Thank you, Terry and Will. I'm thrilled to be here. Thanks for having me.

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to our work.

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Um, we are very excited to have over 1,200 people registered for this webinar. It is always encourage.

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to have the huge amount of interest in evidence-based hearing screening programs so that we can

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help children who have hearing-related needs.

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um, be identified and served.

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Um, as a parent of children who are deaf, um, this is extremely important to me and very personal to me, and I appreciate all of you being here to learn more about how to serve these children and their families.

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So that's who we are. Governor, could you put the poll up for a quick second here?

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We'd like to know at least

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a little bit about who you all are in terms of the primary work setting or role

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that you are, um…

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serving in, so that we have a little bit of a sense of…

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the diversity of who you all are, and… I'm seeing quite a lot of diversity in terms of people from Head Start, Part C early intervention,

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Part B619, home visiting, uh, a couple of healthcare, several healthcare providers, a number of school nurses, and then some others, which, of course, that always makes us wonder,

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Who are those others? I wish we had an easy way to fill that in.

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But that… thank you for giving us that insight about the diversity of folks that we have here today. Okay, Gunnar, that's great. Thank you for… for…

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for giving us that chance to see

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who some of you all are.

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And thank you, Mandy and Terry, for your, um…

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Your introductions. You know, the work of the ECHO Initiative, you know what I'm gonna do? I'm gonna turn off my video so that you guys can…

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I'll focus on the more important images.

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Rather than my mug. So, the work of the ECHO Initiative is based on the recognition that every day there are children who are deaf or

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hard of hearing, meaning having some degree of hearing loss, that are being served in various early childhood, or school, or healthcare settings.

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often without their hearing-related needs being known at all.

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Hearing loss is often referred to as an invisible condition. So, the question that leaves us with is,

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How can we reliably…

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William, sorry to interrupt. We can see your background presentation again.

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Oh.

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Alright, hold on a minute.

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I have no idea what happened.

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So…

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Now I need to share again, I'm suspecting.

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Okay. Sorry, everybody, a little technical glitch here.

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It's been a while since we've had technical glitches.

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I'm sorry? Hold on one more moment.

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There we go.

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And another click here…

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Okay… am I…

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Okay, thank you.

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That looks okay to me.

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That looks great.

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So what I was saying was that, you know,

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hearing loss is often called the invisible condition.

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But how can we reliably identify which children have normal hearing?

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And which do not.

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Yeah, really, you know, William, the short answer to that question is that early care and education providers can be trained to conduct evidence-based hearing screening, just like you see in these photos here on your screen. The ultimate outcome of a hearing screening program is that we can identify children who are deaf or hard of hearing who have not been identified previously.

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Now, the procedure you see on the left-hand side of your screen, that's called otoacoustic emissions, or OAE, which we'll refer to it going forward, OAE hearing screening. And that's the recommended method for children birth to three years of age.

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And it's increasingly recommended for children 3 to 5 years of age as well. Now, on the right, you'll see the procedure pure tone audiometry hearing screening, and that's been historically the most commonly used screening method for children 3 years of age and older, which you'll still see in many early.

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Care and education settings and providers using, and so we're going to talk about both of these methods today.

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So, let me give you a quick overview of what we're going to cover today, so that you have an advanced organizer. While this presentation

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is not, is not considered a training, per se. Our goal is to provide an overview

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of what we consider the big picture of what is involved in implementing evidence-based hearing screening for children across the age spectrum, birth through school age. And we're going to start by giving you an overview of the auditory system,

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or the hearing system, which will help lay a foundation for understanding how the hearing screening methods will be talking about today,

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actually work.

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We're going to talk about why we screen for hearing loss, and what even makes it possible

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For us to be seriously engaged in systematic screening for hearing loss.

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We'll then talk about the two methods that Terry just mentioned, otoacoustic emissions and pure tone audiometry, starting with an overview of the

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OAE hearing screening process, followed by an overview of the PureTone Audiometry screening process.

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Next, we'll address the important question, so…

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What do we do next when a child doesn't pass a screening?

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We'll summarize those follow-up steps that are undertaken when a child doesn't pass a hearing screening on one or both ears, and then we're going to wrap up by showing you how to access a wider array of resources that we have available.

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on kidshearing.org, our website, that are there to support the process of developing, maintaining, and even monitoring the quality of your hearing screening program.

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And then, of course, we'll open up for questions that you might have that, um, we can be helpful in addressing. So that's where we're headed, and you can follow along our progression through these topics by referring to the left side of your screen, and since this is a recorded webinar,

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If you're… if you're actually watching this as a recording, you can jump forward or move around by just looking at that left column to see what areas you want to jump to. So, know that that's available

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for you. Mandy, why don't you talk to us a little bit here about what evidence-based hearing screening practices are?

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Yes, you're going to hear us emphasize evidence-based practice a lot throughout this webinar, because it's very important that we focus on that evidence-based practice.

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So there are 3 key components to that.

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The first one is that we want to use recommended screening methods that match the child's age and developmental level.

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Um, very important that we,

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adapt for that, for the child.

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Second, we want to implement follow-up in the recommended sequence, and within the appropriate timeframe.

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When a child does not pass in one or both ears.

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Again, we want to make sure we're looking at the follow-up there for what, um, the next steps are.

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Third, we want to document all screening outcomes, gather follow-up, diagnostic information,

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and ensure access to intervention services.

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Those three elements define evidence-based practice.

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While we understand that people focus on what the recommended methods are when aiming to implement evidence-based practice, and clearly we want to use the appropriate method

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Because that is essential.

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But screening is only as valuable as our follow-up.

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So when you are considering your practices, we want you to

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Also, have the appropriate methods for follow-up and reporting on this.

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How many children have you screened? What are their pass and refer rates?

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How many were referred for audiologic evaluation?

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How many completed the evaluation?

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How many were identified with permanent hearing loss?

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What supports are these children and their families receiving?

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We want you to look at the full picture, not just the initial screen.

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So that the effort is…

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meaningful, and does what it's supposed to do.

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Well put, Mandy. So, so let's set the stage with a quick review of the auditory or hearing system. Terry, you're our pediatric audiologist, so why don't you walk us through this?

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Yeah, thank you, William. So let's take a good look here at the ear that you see on your screen. There are 3 main parts to the auditory, excuse me, the auditory system.

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There are 3 main parts to the auditory system. The outer ear,

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The middle ear and the inner ear, or cochlea.

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As this mother's voice reaches her child's ear,

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The incoming sound causes the eardrum to vibrate,

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Which then moves three small bones in the middle ear. This movement stimulates

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Thousands of tiny, sensitive hair cells

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In the inner ear.

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From the inner ear, the sound signal is carried along special nerves,

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to the hearing centers of the brain,

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And the child experiences the sensation

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We call sound.

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So that's a little excerpt from one of our trainings, um, on

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an OAE screening. So, sorry, Terry, I forgot that I stuck that little excerpt in there, but you can continue here.

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No, that was perfect. So, um, yeah, as you take a look here, um, just like was explained, we have the outer ear, the middle ear, and the inner ear. And, um… So, as the sound travels through, you can see where those little green dots on that inner ear are, that's what's stimulated and the sound goes up through the auditory nerve, and we perceive sound. So while this is how the auditory system typically functions, there can be some exceptions.

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We can have temporary issues, like a wax blockage that you can see there. We can have fluid in the middle ear that's commonly caused by ear infections that we can discover and that we get addressed during the hearing screening process.

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But the primary target condition of the hearing screen is the functioning of that inner ear or cochlea. It's that snail-shaped portion of the ear.

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Now, in some instances, the sound will travel through the outer and the middle ear, but when it reaches the cochlea, the signal is not transmitted to the brain, and that results in what we call a sensorineural hearing loss.

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This condition is usually permanent and again, like I said, it's the primary target condition for which we are screening in all of our mass screening efforts.

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Now, we need to screen throughout childhood because hearing loss can occur at any time. It can occur as the result of illness, physical trauma, or environmental or genetic factors. And this hearing loss that happens late like this is referred to as late onset hearing loss, and that just means that it's acquired after the newborn period.

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Yeah, so, you know, it… it's commonly understood that language development is at the heart of cognitive and social-emotional development and

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academic achievement. I mean, that drives most of the practices that we see in all educational settings, from early on,

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all the way across the years in school. Think about how much emphasis is placed

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on language development in early childhood, you know, counting the words children produce, noting the first word a child says. Our emphasis on language begins almost immediately, and it remains in place across all of those years.

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It's also important to note that hearing health is at the heart of typical language development, and that if we're going to be conscientious about promoting language,

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as a part of our commitment to educational achievement.

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We should probably be equally conscientious about monitoring the status of hearing throughout childhood. If hearing is compromised,

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to any degree, then language development will ultimately be compromised as well.

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And we don't want to wait for a language delay or other observable concerns to arise

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Only then to discover that the child has developed a hearing loss.

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But that actually can, in fact, happen. And that can happen because permanent hearing loss is

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Often referred to as the invisible disability.

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Even though…

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Hearing loss, permanent hearing loss,

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You might not know this, is the most common birth condition in the United States.

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It affects 3 in 1,000 at birth.

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And then, the prevalence actually doubles by the time children enter school,

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to about 6 in 1,000. And then after that, it's…

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deeply increases to about 50 in 1,000 during the school-age years.

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231
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So, we always want to point out that while hearing loss

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233
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may be invisible.

234
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These children actually need to be seen. You know, we need to identify them so that they can thrive.

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236
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And that's… those statistics are really important for all of us to be able to use as we are garnering support for our screening efforts and our follow-up efforts, whether we're needing that support from

237
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238
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Our colleagues, from teachers, from decision makers, or from parents,

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Or even healthcare providers to whom children who don't pass are referred.

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Why is hearing loss called or referred to as an invisible condition?

241
00:21:32.868 --> 00:21:38.838
Well, it's for a variety of reasons, one of which is that hearing loss can be of any degree, just like a vision, um, impairment can be. It can be subtle, it can be mild or moderate, it's not just…

242
00:21:38.858 --> 00:21:47.850


243
00:21:47.870 --> 00:21:53.840
all, you know, either you hear or you don't. It's not like you're either… you see or you're blind. It's a broad continuum.

244
00:21:53.860 --> 00:21:56.844


245
00:21:56.864 --> 00:22:02.834
And even slight mild hearing losses can affect a child's learning.

246
00:22:02.854 --> 00:22:03.844


247
00:22:03.864 --> 00:22:09.834
Children are also able to kind of trick us. Not intentionally, but they'll follow the behaviors of their peers that lead us to believe that they're actually hearing everything clearly, when maybe they're not. They're just learning to accommodate.

248
00:22:09.854 --> 00:22:20.840


249
00:22:20.860 --> 00:22:26.839
Sometimes, when learning… when hearing loss is notified,

250
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It can also look like

251
00:22:29.853 --> 00:22:35.832
other conditions, like a possible learning disability, or a behavioral concern,

252
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or a mental health need, or being on the autism spectrum. So, we want to screen for hearing for lots of reasons, because we don't want children to be misdiagnosed, and we don't want them to be under

253
00:22:41.842 --> 00:22:51.826


254
00:22:51.846 --> 00:22:57.825
diagnosed either. And, you know, in the ECHO initiative, early on, when we were working

255
00:22:57.845 --> 00:23:03.815
Primarily with children in the birth to 3 arena in Head Start programs. We found that when children were actually identified, ultimately, with a permanent hearing loss,

256
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257
00:23:09.843 --> 00:23:15.813
Many of them were already being served by early intervention programs.

258
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259
00:23:16.834 --> 00:23:18.817
for speech and language delays.

260
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And their hearing loss had not been identified. So,

261
00:23:22.833 --> 00:23:28.803
you know, the effectiveness of speech therapy in the absence of an identified hearing loss, if that's in fact the case, is going to be minimal. So, we want to make sure that we never make assumptions that hearing has

262
00:23:28.823 --> 00:23:40.809


263
00:23:40.829 --> 00:23:46.799
been evaluated and ruled out, when in fact, we know from these statistics that the increase in the prevalence of hearing loss does nothing but go up across all of the school years.

264
00:23:46.819 --> 00:24:01.801


265
00:24:01.821 --> 00:24:07.791
So, William, you have this exactly, and that actually is the perfect place for us to take a minute right now to make sure that we're all on the same page about what a hearing screening actually is.

266
00:24:07.811 --> 00:24:14.800


267
00:24:14.820 --> 00:24:20.790
Um, think of screening as kind of a sorting process. It's a sorting process that helps us separate the children who are at risk of having a condition from those that are far less likely to have the condition. Those in that first higher risk group.

268
00:24:20.810 --> 00:24:29.793


269
00:24:29.813 --> 00:24:35.783
are then followed up with additional steps implemented by pediatric audiologists and healthcare providers to continue to refine that sorting process until we have definitively identified the small group of children with a hearing loss.

270
00:24:35.803 --> 00:24:45.787


271
00:24:45.807 --> 00:24:51.777
And really, just to be blunt, we screen because we simply can't provide a full, comprehensive audiological evaluation on each and every child.

272
00:24:51.797 --> 00:24:59.787


273
00:24:59.807 --> 00:25:00.779
Oh.

274
00:25:00.799 --> 00:25:06.769
Yeah, if we could do that, we would, right? But we can't, so we do screening instead. Screening, when it's followed by appropriate audiological assessment and intervention, can dramatically improve the

275
00:25:06.789 --> 00:25:10.774


276
00:25:10.794 --> 00:25:16.773
outcomes and options for children who are deaf or hard of hearing.

277
00:25:16.793 --> 00:25:22.763
And again, keep in mind that hearing, like vision, can be impaired along a broad continuum of severity, and even mild hearing loss can, and have very real consequences on a child's

278
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279
00:25:33.788 --> 00:25:39.758
learning and socialization. But when hearing is identified, hearing loss is identified early, we can make sure a child has access to language and information, and that this is the case across

280
00:25:39.778 --> 00:25:49.762


281
00:25:49.782 --> 00:25:51.765
the age spectrum.

282
00:25:51.785 --> 00:25:57.764
With improvements in technology, um,

283
00:25:57.784 --> 00:26:03.754
there's been dramatic improvement in our ability to identify hearing loss in children, starting with newborn hearing screening on the day they were born.

284
00:26:03.774 --> 00:26:06.758


285
00:26:06.778 --> 00:26:12.748
As a result of these improvements in hearing loss identification, children who are deaf or hard of hearing are thriving in ways that used to be rare. William, let's, um, take a look at several examples of children with severe to profound hearing loss who have had the benefits of early identification and quality intervention services.

286
00:26:12.768 --> 00:26:25.756


287
00:26:25.776 --> 00:26:26.758
Yeah, great idea.

288
00:26:26.778 --> 00:26:29.752
These children are learning, thriving, and communicating.

289
00:26:29.772 --> 00:26:35.751
They are thriving. Now, these two girls both wear hearing aids. They have…

290
00:26:35.771 --> 00:26:41.741
Um, severe hearing loss, and let's just listen to their conversation as they play with their dolls here.

291
00:26:41.761 --> 00:26:49.742


292
00:26:49.762 --> 00:26:53.748
So, we're having a party over here.

293
00:26:53.768 --> 00:26:55.741
You're gonna miss it! Okay.

294
00:26:55.761 --> 00:27:01.731
Hi, you guys talking? Ew!

295
00:27:01.751 --> 00:27:02.741


296
00:27:02.761 --> 00:27:08.740
Thanks, baby! No baby! Look, this is…

297
00:27:08.760 --> 00:27:14.730
a lot of issues cleaning on the water.

298
00:27:14.750 --> 00:27:15.741


299
00:27:15.761 --> 00:27:21.730
Hey, William, this is Daniel. I'm sorry to interrupt, but I jumped in for Gunner, uh, temporarily.

300
00:27:21.750 --> 00:27:27.729
Your, uh, PowerPoint window's covering up the video so the audience can't see the video.

301
00:27:27.749 --> 00:27:31.735
That happened again.

302
00:27:31.755 --> 00:27:32.726
How about that?

303
00:27:32.746 --> 00:27:36.732
Okay, not… yeah, now go ahead and play the video again.

304
00:27:36.752 --> 00:27:37.734
I'm so sorry.

305
00:27:37.754 --> 00:27:38.725
There you go.

306
00:27:38.745 --> 00:27:40.728
Oh, thank you!

307
00:27:40.748 --> 00:27:46.727
Oh, boy loves you!

308
00:27:46.747 --> 00:27:49.722
And I would have to clear it.

309
00:27:49.742 --> 00:27:55.712
Yeah, so that's one example. Now, in this next example, these boys' parents selected that they, um, learn, uh, sign language as they are deaf. And let's look at their language abilities.

310
00:27:55.732 --> 00:28:43.702


311
00:28:43.722 --> 00:28:49.692
And let's give you one more example. These two boys have cochlear implants. They are deaf.

312
00:28:49.712 --> 00:28:52.706


313
00:28:52.726 --> 00:28:57.703
This is not how deaf speech used to sound. Um…

314
00:28:57.723 --> 00:29:03.702
So, take a… take a look at how they are communicating.

315
00:29:03.722 --> 00:29:06.697
Jake!

316
00:29:06.717 --> 00:29:09.701
Hi, my name is Gibson.

317
00:29:09.721 --> 00:29:12.696
In different ways. One of the things that makes…

318
00:29:12.716 --> 00:29:15.700
Me? Feel special.

319
00:29:15.720 --> 00:29:21.690
I'm deaf. I'm deaf too, and deaf means that your ears can't hear.

320
00:29:21.710 --> 00:29:23.692


321
00:29:23.712 --> 00:29:29.691
And special things to show you are called Cochae Implants.

322
00:29:29.711 --> 00:29:32.686
They help us here! Cochlear and

323
00:29:32.706 --> 00:29:36.692
It's a big word, so I call it

324
00:29:36.712 --> 00:29:39.686
Oh, yeah, so Mandy, your kids,

325
00:29:39.706 --> 00:29:44.684
are among those who are thriving. You have your own story. So…

326
00:29:44.704 --> 00:29:48.680
Take a minute and tell us about the role

327
00:29:48.700 --> 00:29:51.684
that hearing screening played a newer life.

328
00:29:51.704 --> 00:29:53.687
Yes, thanks, Will.

329
00:29:53.707 --> 00:29:59.677
I am the parent of 3 girls, and the oldest 2 are deaf. They are now 25 and 21, so they are no longer children.

330
00:29:59.697 --> 00:30:03.682


331
00:30:03.702 --> 00:30:08.679
Um, but they both passed their newborn hearing screening.

332
00:30:08.699 --> 00:30:14.669
Um, it's very important to me, in my work, to say that Newborn hearing screening is critical and important, and we should do that, but my kiddos

333
00:30:14.689 --> 00:30:18.674


334
00:30:18.694 --> 00:30:20.677
fit what we're talking about today.

335
00:30:20.697 --> 00:30:25.675
that it was later, when they had late onset,

336
00:30:25.695 --> 00:30:30.672
Or perhaps it was such a mild loss at birth that it wasn't captured.

337
00:30:30.692 --> 00:30:33.667
Um, we don't know the answer to that.

338
00:30:33.687 --> 00:30:39.657
But my oldest was almost 3 when I was noticing her speech was slightly

339
00:30:39.677 --> 00:30:40.667


340
00:30:40.687 --> 00:30:42.670
delayed to…

341
00:30:42.690 --> 00:30:45.665
My nephew, who was the exact same age as her.

342
00:30:45.685 --> 00:30:49.661
And I know you're not supposed to compare, but I did compare, and that…

343
00:30:49.681 --> 00:30:51.664
helped make a difference.

344
00:30:51.684 --> 00:30:54.658
As a mom with

345
00:30:54.678 --> 00:30:57.663
No family history of hearing loss in children.

346
00:30:57.683 --> 00:31:02.660
And no background in audiology or early intervention, or anything.

347
00:31:02.680 --> 00:31:04.663
That would have made, um…

348
00:31:04.683 --> 00:31:08.659
this be something that came to my mind.

349
00:31:08.679 --> 00:31:11.654
As a possibility.

350
00:31:11.674 --> 00:31:17.644
It probably took me a little bit longer to come to the realization that I wasn't sure she was hearing.

351
00:31:17.664 --> 00:31:18.654


352
00:31:18.674 --> 00:31:24.644
And people would tell me that, well, she's stubborn and strong-willed, and she's being defiant, and she's ignoring you.

353
00:31:24.664 --> 00:31:26.656


354
00:31:26.676 --> 00:31:32.646
And as her mom, I will tell you they were 100% correct. She was. All of those things. Still is!

355
00:31:32.666 --> 00:31:33.647


356
00:31:33.667 --> 00:31:36.651
But, she also

357
00:31:36.671 --> 00:31:39.646
had some hearing loss at that point.

358
00:31:39.666 --> 00:31:43.642
And as her mom, I really had to become an advocate.

359
00:31:43.662 --> 00:31:45.644
to get her hearing screened.

360
00:31:45.664 --> 00:31:50.642
Um, because she'd had ear infections, and the pediatrician

361
00:31:50.662 --> 00:31:54.638
minimized my concern about her

362
00:31:54.658 --> 00:31:57.642
possible hearing loss.

363
00:31:57.662 --> 00:32:03.632
Eventually, I did get her in to be screened, and she was diagnosed with a mild to moderate hearing loss.

364
00:32:03.652 --> 00:32:04.643


365
00:32:04.663 --> 00:32:10.633
Um, that did progress. She, um, was profoundly deaf by the time she was around 7 years old.

366
00:32:10.653 --> 00:32:12.635


367
00:32:12.655 --> 00:32:17.632
Um, my second daughter was diagnosed at age 1.

368
00:32:17.652 --> 00:32:22.630
And she was profoundly deaf by the age of 4.

369
00:32:22.650 --> 00:32:27.627
Now, both of these young ladies are thriving and doing very, very well.

370
00:32:27.647 --> 00:32:32.625
Um, that would not have been possible without…

371
00:32:32.645 --> 00:32:35.629
Evidence-based hearing screening.

372
00:32:35.649 --> 00:32:37.622
that was able…

373
00:32:37.642 --> 00:32:43.612
to identify their loss, and then we were able to get the services that they needed in order to thrive.

374
00:32:43.632 --> 00:32:44.623


375
00:32:44.643 --> 00:32:50.613
You know, Mandy, when I hear your story, I think about all the different ways that could have gone.

376
00:32:50.633 --> 00:32:51.623


377
00:32:51.643 --> 00:32:57.613
When you started to suspect something, you might not have suspected something, or somebody might have reached a different conclusion.

378
00:32:57.633 --> 00:33:00.617


379
00:33:00.637 --> 00:33:06.607
Or it may have gone on much longer. It could… you know, we really don't want to wait until

380
00:33:06.627 --> 00:33:08.619


381
00:33:08.639 --> 00:33:14.609
there is something observable. We want to get these cases of hearing loss identified before there is evidence of

382
00:33:14.629 --> 00:33:18.614


383
00:33:18.634 --> 00:33:24.604
there being a hearing loss. So, your story is such a compelling one for all of us to keep in mind, and we really appreciate you sharing that, and the fact that those girls are thriving in so many wonderful ways.

384
00:33:24.624 --> 00:33:33.606


385
00:33:33.626 --> 00:33:37.602
Yes, and William, I just want to reiterate, you know, that…

386
00:33:37.622 --> 00:33:39.605
Not every…

387
00:33:39.625 --> 00:33:45.595
parent, um, would have noticed that if I hadn't been comparing with my nephew, who was the exact same age, I…

388
00:33:45.615 --> 00:33:47.607


389
00:33:47.627 --> 00:33:53.597
might have missed it. So, it is important that we are doing this without someone suspecting, because, um,

390
00:33:53.617 --> 00:33:54.597


391
00:33:54.617 --> 00:33:57.602
Like I said, I would have never guessed this.

392
00:33:57.622 --> 00:34:03.592
Right, and you may have had other people trying to put your worries at ease, including healthcare providers who had just said something like we've heard many times, children develop at their own pace, just wait,

393
00:34:03.612 --> 00:34:10.591


394
00:34:10.611 --> 00:34:13.596
you know, be patient, you know.

395
00:34:13.616 --> 00:34:15.599
Yes. Very much so.

396
00:34:15.619 --> 00:34:21.588
So, right, so those children, Mandy's children,

397
00:34:21.608 --> 00:34:27.587
We want to make sure that, you know, they serve as the goal for all of us,

398
00:34:27.607 --> 00:34:33.577
To make sure that all children have access to language, full and complete access to language, one way or another, regardless of whether they have a hearing loss, and no matter how significant it may be.

399
00:34:33.597 --> 00:34:42.589


400
00:34:42.609 --> 00:34:48.578
And the way to achieve that is to be fully committed to quality,

401
00:34:48.598 --> 00:34:53.586
Periodic hearing screening and follow-up.

402
00:34:53.606 --> 00:34:59.576
Yes, William, and as we mentioned previously, OAE and pure tone audiometry are the recommended methods that we're going to be talking about today. Now, the availability of OAE and pure tone screening really means that it's not appropriate, no longer appropriate, to rely solely on subjective methods.

403
00:34:59.596 --> 00:35:13.575


404
00:35:13.595 --> 00:35:19.565
These are methods that have been used in the past, such as sound makers and, like, ringing a bell behind a child's head, or depending solely on a caregiver's perception of a child's hearing. Now, don't get me wrong, observations of a child's response to sound, especially the lack of a response.

405
00:35:19.585 --> 00:35:34.567


406
00:35:34.587 --> 00:35:40.557
is helpful. Um, and we need to pay attention to how, um, children do or do not respond to their environment. But these kinds of observations.

407
00:35:40.577 --> 00:35:44.562


408
00:35:44.582 --> 00:35:50.552
Don't constitute a hearing screening. They're just far too crude and unreliable, and frankly, we can do so much better than that with our current available technology.

409
00:35:50.572 --> 00:35:52.564


410
00:35:52.584 --> 00:35:58.554
You know, it's important to note, too, that although some healthcare providers have, in fact, incorporated evidence-based hearing screening into well child visits,

411
00:35:58.574 --> 00:36:03.560


412
00:36:03.580 --> 00:36:09.550
This really isn't standard practice, especially for children under 4 years of age.

413
00:36:09.570 --> 00:36:10.551


414
00:36:10.571 --> 00:36:16.541
Yeah, it's not. You know, you'll have parents that may report with a lot of certainty that their healthcare provider did perform a hearing screening, but I think we all need to understand this, and I can't really emphasize it enough as an audiologist, that routine examinations of ears, where we physically look in and we look at maybe the.

415
00:36:16.561 --> 00:36:32.544


416
00:36:32.564 --> 00:36:38.534
you know, the middle ear, and if there's an infection or something. Um, but those kind of examinations are not hearing screening, so we don't want to mistake that as a hearing screening. It's really precisely because screening isn't happening consistently in that context or that environment that screenings.

417
00:36:38.554 --> 00:36:51.542


418
00:36:51.562 --> 00:36:54.536
And the screenings and the follow-up that you are all completing are so important.

419
00:36:54.556 --> 00:37:00.526
So, the take-home message right here is this. Unless a child's health record and medical records include documentation of

420
00:37:00.546 --> 00:37:05.533


421
00:37:05.553 --> 00:37:11.523
ear-specific hearing screening results, and the screening method within the last 6 to 12 months.

422
00:37:11.543 --> 00:37:15.538


423
00:37:15.558 --> 00:37:21.528
We should not assume a hearing screening was completed, or that the child passed.

424
00:37:21.548 --> 00:37:23.530


425
00:37:23.550 --> 00:37:29.520
Yeah, exactly. Um, and you know, William, there's another important point to remember, too. While we're talking about screening, while OAE and pure tone are highly reliable screening methods, there is no perfect screening.

426
00:37:29.540 --> 00:37:38.522


427
00:37:38.542 --> 00:37:44.512
Um, you know, math methods. So they're not perfect. And that means that there might be some rare conditions that aren't identified through these screenings. So if a parent expresses a concern about a child's hearing or their language development, just.

428
00:37:44.532 --> 00:37:54.516


429
00:37:54.536 --> 00:38:00.506
just kind of like Mandy described for herself, even if the child is received and passed a hearing screening using one of these methods, if those concerns persist, the child should be referred for an evaluation from an audiologist.

430
00:38:00.526 --> 00:38:06.514


431
00:38:06.534 --> 00:38:12.504
Yeah, because think about that. Mandy's daughter, the one… the one, the second child who was, um,

432
00:38:12.524 --> 00:38:14.516


433
00:38:14.536 --> 00:38:20.515
identified at one year of age. I mean, those children pass their newborn screenings.

434
00:38:20.535 --> 00:38:26.505
So, we… somebody could have made the assumption, good, that's all we need to be concerned about, but it isn't. We need to repeatedly be looking at screenings.

435
00:38:26.525 --> 00:38:33.504


436
00:38:33.524 --> 00:38:39.494
So, let's talk about these two hearing screening methods that are used during childhood. If you're responsible for children who are under 3 years of age,

437
00:38:39.514 --> 00:38:43.499


438
00:38:43.519 --> 00:38:49.498
really, the one and only recommended method is otoacoustic emissions, or

439
00:38:49.518 --> 00:38:55.488
OAE screening, which you see here on the left. And if you're responsible for screening children 3 years of age or older, historically, PureTone Audiometry has been considered the recommended method for this age group.

440
00:38:55.508 --> 00:39:05.492


441
00:39:05.512 --> 00:39:11.482
This is the headset screening where the child raises a hand or performs another task each time they hear a sound that's presented into one of their earphones. You see this method here on the right.

442
00:39:11.502 --> 00:39:20.495


443
00:39:20.515 --> 00:39:26.485
Yes. And William, I think this is a good time to acknowledge that there's growing recognition that for a variety of reasons, the pure tone method may not always be the most feasible method to use with some children, especially children in the 3 to 5 age range, because.

444
00:39:26.505 --> 00:39:37.480


445
00:39:37.500 --> 00:39:43.470
Our experience and the research has shown that 20-25% of the children in that 3-5 year age group can't be screened with this methodology, because they just aren't able… they just aren't developmentally able to follow the directions reliably and participate.

446
00:39:43.490 --> 00:39:55.477


447
00:39:55.497 --> 00:40:01.467
So and pure tone screening can also be difficult to complete with children who have certain developmental delays or differences, or even children that may have a language different than that from the screener.

448
00:40:01.487 --> 00:40:11.471


449
00:40:11.491 --> 00:40:17.461
Now, in those instances, you know, when pure tone screening can't be completed, OAE screening is the preferred method then.

450
00:40:17.481 --> 00:40:19.473


451
00:40:19.493 --> 00:40:25.463
So what that means is… what? At a minimum, if you're establishing evidence-based practices for 3-5 year olds or older,

452
00:40:25.483 --> 00:40:30.469


453
00:40:30.489 --> 00:40:33.464
And if you're using pure tone screening,

454
00:40:33.484 --> 00:40:38.461
You'll need to be prepared and equipped to do

455
00:40:38.481 --> 00:40:43.459
OAEs on the children who can't be screened with pure tone,

456
00:40:43.479 --> 00:40:49.449
or if you don't have access to doing OAEs, alternatively, you'd need to be able to have a means for systematically referring all of those children who you couldn't screen,

457
00:40:49.469 --> 00:40:57.460


458
00:40:57.480 --> 00:41:02.457
to audiologists who could perform the screening.

459
00:41:02.477 --> 00:41:07.455
And if you're going to rely on audiologists to cover all of those children,

460
00:41:07.475 --> 00:41:13.445
My guess is that you would be pretty challenged in finding audiologists who are available to do all of that.

461
00:41:13.465 --> 00:41:16.448


462
00:41:16.468 --> 00:41:19.453
screening.

463
00:41:19.473 --> 00:41:25.443
Yeah, and I think, um, maybe even to simplify things more and for efficiency, just like you're talking about, more and more of us audiologists are recommending the use of OAEs uniformly with all children 3 to 5 years of age and older.

464
00:41:25.463 --> 00:41:34.445


465
00:41:34.465 --> 00:41:40.435
And we're doing that because it's quicker than pure tone screening, both to learn and to do and to actually implement. And it's far more likely to be a method that'll work across the board with all children in that 3 to 5 and older age group that you'll be screening, and it's equally as effective.

466
00:41:40.455 --> 00:41:49.437


467
00:41:49.457 --> 00:41:55.427
So if you or your school or program are undecided or reconsidering which method to use, primarily for children 3 years of age and older, we encourage you to carefully review a document that we have on our website, and I'll show you where to find it in a minute. And this document compares

468
00:41:55.447 --> 00:42:11.430


469
00:42:11.450 --> 00:42:16.428
OAE screening and pure tone screening for this population.

470
00:42:16.448 --> 00:42:20.434
And so I'll show you in a minute where you can find that.

471
00:42:20.454 --> 00:42:26.424
I want to chime in here for just a minute and say, when you're making a decision on methodology, be sure to check your state and local regulations. Some states require pure tone audiometry to be used

472
00:42:26.444 --> 00:42:33.423


473
00:42:33.443 --> 00:42:37.419
before OAE is used with these older children.

474
00:42:37.439 --> 00:42:43.409
Partially because these regulations were developed before the OAE technology was widely available.

475
00:42:43.429 --> 00:42:46.423


476
00:42:46.443 --> 00:42:52.413
Yeah, I do want to just insert, you know, that our professional associations, the American Speech Language Hearing Association, the American Academy of Audiology, all do recognize and support OAE screening for older children as that backup method.

477
00:42:52.433 --> 00:43:04.410


478
00:43:04.430 --> 00:43:10.400
Um, be sure to check those regulations, and boy, we sure love you to be advocates for change if those need updated.

479
00:43:10.420 --> 00:43:11.410


480
00:43:11.430 --> 00:43:16.408
So, OAE screening, we'll talk about this method a little bit here,

481
00:43:16.428 --> 00:43:22.398
is the most appropriate method for identifying young children at risk for permanent hearing loss. First, because it's accurate, and it's feasible. Um, it doesn't require a behavioral response from the child.

482
00:43:22.418 --> 00:43:30.408


483
00:43:30.428 --> 00:43:35.406
And that allows us to screen children under 3 years of age,

484
00:43:35.426 --> 00:43:37.399
quite easily.

485
00:43:37.419 --> 00:43:43.389
It's quick and easy. Most children can be screened in just a minute or two, sometimes in as little as 30 seconds per ear.

486
00:43:43.409 --> 00:43:47.404


487
00:43:47.424 --> 00:43:53.394
It's a flexible tool that can be used in a wide variety of environments, including the classroom, the home, or healthcare setting. Look at this picture right here. Look at where this little guy is being screened at a snack table. They just take a little break to do this. They didn't have to…

488
00:43:53.414 --> 00:44:07.394


489
00:44:07.414 --> 00:44:13.384
Take him out, away from all of his friends, and walk down the hall. They didn't have to do that. They can go to where he was.

490
00:44:13.404 --> 00:44:16.387


491
00:44:16.407 --> 00:44:22.377
But most importantly, it's effective in identifying children who may have a mild hearing loss or a loss in just one ear, as well as those that have a severe bilateral loss or loss in both ears.

492
00:44:22.397 --> 00:44:29.387


493
00:44:29.407 --> 00:44:35.377
In addition, it can be helpful in drawing attention to a broader range of hearing health conditions that might need further medical attention.

494
00:44:35.397 --> 00:44:38.380


495
00:44:38.400 --> 00:44:44.370
OAE screening can also help to identify children who have a temporary hearing loss as the result of middle ear infections. And while this isn't the primary goal of OAE hearing screening, it's definitely an added benefit of screening with this method.

496
00:44:44.390 --> 00:44:54.374


497
00:44:54.394 --> 00:44:58.380
Take a look for a minute, everybody, at these photos.

498
00:44:58.400 --> 00:45:03.377
Look at the diverse settings in which this is happening. These children are being screened

499
00:45:03.397 --> 00:45:06.372
Using the OAE method,

500
00:45:06.392 --> 00:45:12.362
And you'll notice that they, as I said a minute ago, they aren't being pulled out of an environment, um, that they're already in.

501
00:45:12.382 --> 00:45:14.374


502
00:45:14.394 --> 00:45:20.373
to a foreign or strange environment. They're being screened in

503
00:45:20.393 --> 00:45:26.363
every day, educational home and healthcare environments where children are already happily spending their time,

504
00:45:26.383 --> 00:45:28.365


505
00:45:28.385 --> 00:45:31.369
And those that are doing their screening

506
00:45:31.389 --> 00:45:37.359
are often people they already know. Their children, home visitors, and health specialists. And let me just also interject here that since some of you are… a number of you are school nurses working in school-based screenings,

507
00:45:37.379 --> 00:45:47.363


508
00:45:47.383 --> 00:45:53.353
You know, if you have the ability to consider OAE screening,

509
00:45:53.373 --> 00:45:54.354


510
00:45:54.374 --> 00:46:00.344
You can imagine how many more children you can screen in a much shorter period of time if you have OAE as an option, because you don't have to, um,

511
00:46:00.364 --> 00:46:08.355


512
00:46:08.375 --> 00:46:14.354
for one, just go into a different environment. You can go to where they are.

513
00:46:14.374 --> 00:46:20.344
Yeah, in fact, the screening works best when children are familiar and they're comfortable with the adult doing the screening and where they can play with a toy. They can be held or even sleep while the screening is being conducted.

514
00:46:20.364 --> 00:46:28.345


515
00:46:28.365 --> 00:46:30.348
Terry, let's…

516
00:46:30.368 --> 00:46:36.338
go a step further now. Why don't you walk us through OAE screening and help us understand how the procedure actually works?

517
00:46:36.358 --> 00:46:42.336


518
00:46:42.356 --> 00:46:48.326
Yeah, so first of all, to conduct an OAE screening, we're going to first take a thorough look at the outer part of the ear. We're going to do that to make sure that there's no visible sign of infection or blockage. And then a small probe on which we've placed a disposable cover.

519
00:46:48.346 --> 00:46:59.331


520
00:46:59.351 --> 00:47:05.321
is then inserted into the ear canal. And that probe delivers a low-volume sound stimulus into the ear. Now, a cochlea or that inner snail-shaped portion of the ear, a cochlea that's functioning normally, it'll respond to this sound by sending the signal to the brain.

521
00:47:05.341 --> 00:47:20.332


522
00:47:20.352 --> 00:47:26.322
While at the same time also producing in an acoustic emission. This emission is analyzed by your screening unit, and in approximately 30 seconds or so, the result will appear either as a pass.

523
00:47:26.342 --> 00:47:35.325


524
00:47:35.345 --> 00:47:41.315
or as a refer. Now, every normal, healthy inner ear, or cochlea, produces an emission that can be recorded in this way.

525
00:47:41.335 --> 00:47:43.317


526
00:47:43.337 --> 00:47:49.307
Okay, so just pause for a minute. You understood that correctly. I'm just going to show this one more time.

527
00:47:49.327 --> 00:47:50.317


528
00:47:50.337 --> 00:47:53.312
that…

529
00:47:53.332 --> 00:47:59.302
That cochlea is actually emitting a sound that is measured by the microphone that is in the probe, and that is how we're able to

530
00:47:59.322 --> 00:48:04.308


531
00:48:04.328 --> 00:48:09.315
evaluate the functionality of the cochlea.

532
00:48:09.335 --> 00:48:10.307
Exactly.

533
00:48:10.327 --> 00:48:16.306
So, let's take a quick look at what an actual real-time screening can look like.

534
00:48:16.326 --> 00:48:22.296
with a youngster here. Um, they have the benefit of having two adults in this situation, which is really nice.

535
00:48:22.316 --> 00:48:24.308


536
00:48:24.328 --> 00:48:27.302
Um, but Jill, this is unedited, so…

537
00:48:27.322 --> 00:48:33.292
The woman on the right is going to insert the probe, which you see in her hand right now, into his ear. She's gonna push a button on a handheld device,

538
00:48:33.312 --> 00:48:39.300


539
00:48:39.320 --> 00:48:45.290
And when they celebrate, that's when we know they have either a pass or a refer, indicating that the screening was complete.

540
00:48:45.310 --> 00:48:48.294


541
00:48:48.314 --> 00:48:52.300
So let's watch.

542
00:48:52.320 --> 00:48:58.290
Are you ready?

543
00:48:58.310 --> 00:49:10.287


544
00:49:10.307 --> 00:49:14.293
I have a result! Well, thank you!

545
00:49:14.313 --> 00:49:20.283
Anyone put in this other year? Put it on the other ears? Let me say, let's try it out. Let's try that one!

546
00:49:20.303 --> 00:49:23.286


547
00:49:23.306 --> 00:49:27.282
Okay, very, very?

548
00:49:27.302 --> 00:49:33.272
There you see the handheld device.

549
00:49:33.292 --> 00:49:34.283


550
00:49:34.303 --> 00:49:40.282
He already did it!

551
00:49:40.302 --> 00:49:46.281
So, some of you are probably wondering, okay, how much does this kind of equipment cost?

552
00:49:46.301 --> 00:49:52.271
Terry, where are we at right now as far as, I mean, everything is always going up in price. What's the average cost for just a basic OAE device right now?

553
00:49:52.291 --> 00:49:58.278


554
00:49:58.298 --> 00:50:04.267
Yeah, it has gone up. It used to be about $3,800, and it's now about $4,100.

555
00:50:04.287 --> 00:50:07.272
Okay. Yeah, it's…

556
00:50:07.292 --> 00:50:13.262
And that's for a basic piece, a basic OAE piece of equipment, which I'd like to make the point that's exactly what you need is the basic screener equipment. This equipment will come with other modules or models that are intended for use by audiologists like myself that are designed for diagnostic purposes.

557
00:50:13.282 --> 00:50:32.259


558
00:50:32.279 --> 00:50:38.249
And these are more complicated and more expensive, and you don't need or want the more expensive or complicated models. As screeners and non-audiologists, be careful not to purchase more than you need, and get the basic screener models.

559
00:50:38.269 --> 00:50:48.253


560
00:50:48.273 --> 00:50:54.243
Yeah, so if you're seeing prices that are dramatically different from, at least right now, February of 2026,

561
00:50:54.263 --> 00:50:56.255


562
00:50:56.275 --> 00:51:02.245
different from about 41 or $4,200, then you need to question whether you're really looking

563
00:51:02.265 --> 00:51:03.256


564
00:51:03.276 --> 00:51:09.246
at just a screener-type model for lay individuals. Now, in addition to the cost of the equipment itself,

565
00:51:09.266 --> 00:51:12.249


566
00:51:12.269 --> 00:51:18.239
There's also those disposable covers that are put on the probe that is then inserted in the ear.

567
00:51:18.259 --> 00:51:20.251


568
00:51:20.271 --> 00:51:26.241
And as you might guess, they're going to charge for those things. And I just want to make it really clear, we're not equipment salespeople or anything like that. We're just telling you about

569
00:51:26.261 --> 00:51:31.238


570
00:51:31.258 --> 00:51:37.228
what the equipment is. And those covers can range from, like, a dollar to, what, $1.50 each. So, um, you'll want to make sure that you purchase enough for those.

571
00:51:37.248 --> 00:51:44.237


572
00:51:44.257 --> 00:51:46.240
Um, and have…

573
00:51:46.260 --> 00:51:51.237
Probably twice as many of those on hands as you have children to screen.

574
00:51:51.257 --> 00:51:57.236
Um, because you'll have to discard some, you might not have the right size you use

575
00:51:57.256 --> 00:52:00.231
The first, uh, at first, um…

576
00:52:00.251 --> 00:52:01.232
Oh, tell us about the other, other thing you need to buy with adult probe covers.

577
00:52:01.252 --> 00:52:07.231
Yeah, yeah.

578
00:52:07.251 --> 00:52:13.221
Yeah, you will need to plan to purchase some adult-sized probe covers as well, because during your learning process, as well as on a regular basis, you'll be testing the equipment on your own ears or on another adult, just to make sure it's functioning properly before you screen children.

579
00:52:13.241 --> 00:52:25.228


580
00:52:25.248 --> 00:52:26.220
It's a good way to check your equipment.

581
00:52:26.240 --> 00:52:32.210
Yeah. When you meet with an equipment distributor or salesperson,

582
00:52:32.230 --> 00:52:33.220


583
00:52:33.240 --> 00:52:39.210
They may mention that they will offer you training. Excuse me, and it's important that you understand that

584
00:52:39.230 --> 00:52:40.221


585
00:52:40.241 --> 00:52:46.211
That training is rarely sufficient to meet the training needs you actually have.

586
00:52:46.231 --> 00:52:48.213


587
00:52:48.233 --> 00:52:54.203
Yeah, you know, I… the training offered by, um, the salesperson is intended to acquaint you with all the various functions of the equipment, but they're not going to train you on how to screen young children under a variety of conditions, how to document your results, or communicate with parents.

588
00:52:54.223 --> 00:53:07.211


589
00:53:07.231 --> 00:53:13.201
Or what the follow-up protocol should be when a child doesn't pass. And this has really been a point of confusion for some people, so we just want to make that really clear.

590
00:53:13.221 --> 00:53:15.203


591
00:53:15.223 --> 00:53:21.193
We like to make the analogy that it's like a car salesman at a dealership who may train you on the various functions of your new car and the screen, and

592
00:53:21.213 --> 00:53:25.208


593
00:53:25.228 --> 00:53:31.198
All the buttons you can push, which is really helpful. You do want that orientation.

594
00:53:31.218 --> 00:53:32.198


595
00:53:32.218 --> 00:53:36.204
But that car salesperson is not going to teach you to drive,

596
00:53:36.224 --> 00:53:42.193
for how to parallel park, it's the same when purchasing hearing screening equipment.

597
00:53:42.213 --> 00:53:47.201
You'll need another way to learn the specifics of how to screen.

598
00:53:47.221 --> 00:53:53.191
And as we'll point out again, one way is to access an online course that we have on our website.

599
00:53:53.211 --> 00:53:55.193


600
00:53:55.213 --> 00:54:01.183
Um, and to also rely on local audiologists.

601
00:54:01.203 --> 00:54:03.195


602
00:54:03.215 --> 00:54:09.185
Yeah, if you have a local audiologist, they can then screen alongside you when you're getting started. They can give you helpful pointers. That can be a great way to get, you know, to be sure that you're getting the training that you need. And this is really true whether you need training for OAE screening.

603
00:54:09.205 --> 00:54:21.182


604
00:54:21.202 --> 00:54:25.188
Or if you need training on the other method we're going to talk about now, which is pure tone audiometry.

605
00:54:25.208 --> 00:54:31.177
Before we go on, just know that there are a variety of options in OAE screening equipment.

606
00:54:31.197 --> 00:54:36.184
Some of it is better than others. Others of it.

607
00:54:36.204 --> 00:54:41.182
Partly due to their sensitivity to noise in the environment.

608
00:54:41.202 --> 00:54:43.175
So, take…

609
00:54:43.195 --> 00:54:49.165
you know, some time. To evaluate equipment options. See if you can try them out.

610
00:54:49.185 --> 00:54:50.175


611
00:54:50.195 --> 00:54:56.165
In the environments that you would be screening in, or get expert input from those that are familiar with OAE screening equipment.

612
00:54:56.185 --> 00:54:59.169


613
00:54:59.189 --> 00:55:04.166
Also, be aware that I know you've got to be having that question about,

614
00:55:04.186 --> 00:55:08.172
How are we going to pay for this? I mean, that's a lot of money.

615
00:55:08.192 --> 00:55:10.165
Um, one of the…

616
00:55:10.185 --> 00:55:15.162
One of the things that we have available on our website is

617
00:55:15.182 --> 00:55:21.152
a mini-grant template, which is a little proposal that we've written that you can download and, uh,

618
00:55:21.172 --> 00:55:23.164


619
00:55:23.184 --> 00:55:29.154
personalize for your school or program to submit to a local charity like Alliance Club, or the Sertoma Club, and, uh, or other grant opportunities that you might have. We've written the narrative for you. You can just take it and submit it. So, um, I show you where that is when we take a little tour of our website. Because, of course, you know,

620
00:55:29.174 --> 00:55:47.160


621
00:55:47.180 --> 00:55:53.150
It's all well and good for us to tell you what best practices, but you also need money, right, to be able to purchase the right equipment to have in place.

622
00:55:53.170 --> 00:55:59.148


623
00:55:59.168 --> 00:56:04.146
Okay, so we've talked about OAE screening.

624
00:56:04.166 --> 00:56:10.136
Which serves as a backup for those doing screening with 3-5 year olds and older, but is the only method that you use for 3-5 year olds to be evidence-based.

625
00:56:10.156 --> 00:56:16.144


626
00:56:16.164 --> 00:56:22.143
Now let's shift gears, and let's talk about the pure tone screening method.

627
00:56:22.163 --> 00:56:28.133
Which, you'll really need to know, is never recommended for children under 3. And as we've mentioned earlier, it's… it has traditionally been, um, acknowledged as the most common recommended method for children 3 to 5 years of age and older.

628
00:56:28.153 --> 00:56:45.137


629
00:56:45.157 --> 00:56:51.127
You probably recognize the method either because you already use it, or because you've had your own hearing screen this way.

630
00:56:51.147 --> 00:56:52.137


631
00:56:52.157 --> 00:56:58.127
In this procedure, musical note-like tones are presented to children through their headphones.

632
00:56:58.147 --> 00:56:59.128


633
00:56:59.148 --> 00:57:05.118
And children then provide a behavioral response, like raising a hand, or dropping a toy into a bucket, to tell us that they've heard the tones.

634
00:57:05.138 --> 00:57:10.124


635
00:57:10.144 --> 00:57:15.122
Pure tone screening gives us a good idea of the functioning of

636
00:57:15.142 --> 00:57:21.112
The entire auditory system, all the way to the brain, with the child showing by way of a physical or behavioral indication, that they've perceived the sound.

637
00:57:21.132 --> 00:57:26.118


638
00:57:26.138 --> 00:57:32.108
It is a relatively affordable method with the screening equipment costing. What is it now, Terry? Is it…

639
00:57:32.128 --> 00:57:34.120


640
00:57:34.140 --> 00:57:37.115
Around 1,000, or…?

641
00:57:37.135 --> 00:57:43.105
Yeah, it's actually still in the the 800 to $1,000 range. It hasn't gone up too much. It so it's remained fairly stable in price.

642
00:57:43.125 --> 00:57:44.115


643
00:57:44.135 --> 00:57:50.105
Okay. Okay. And the equipment is durable and portable, enabling us to easily transport it and use it in a variety of locations.

644
00:57:50.125 --> 00:57:55.112


645
00:57:55.132 --> 00:58:01.102
And, like OAE screening, a wide range of individuals can be trained to perform the pure tone screening method.

646
00:58:01.122 --> 00:58:05.107


647
00:58:05.127 --> 00:58:08.111
Terry, tell us how it works.

648
00:58:08.131 --> 00:58:14.101
Yeah. Yeah. So just like screening with OAEs, to conduct a peer tone screening, we're going to do the same thing. We're going to take a look at the ear again to make sure that there's no visible sign of infection or blockage. Just like, again, like we do with OAE screening.

649
00:58:14.121 --> 00:58:26.098


650
00:58:26.118 --> 00:58:32.088
So if the ear appears normal. Now we're going to go and we're going to the screener. As a screener, you're going to instruct or condition the child how to listen for a tone and provide a response, like raising their hand or placing a toy in a bucket. Now, this step can take a little bit of time, so that we… because we want to be sure that the child is able to reliably complete the screening.

651
00:58:32.108 --> 00:58:52.097


652
00:58:52.117 --> 00:58:58.087
Once the screener is observed that the child is reliable, can reliably respond to the sounds that are presented, just like you instructed, that's when the actual screening starts.

653
00:58:58.107 --> 00:59:04.085


654
00:59:04.105 --> 00:59:10.075
Now, during the screening process, this listen and respond game is repeated. It's going to be repeated at least twice at 3 different pitches on each ear. We're going to note the child's response, or their lack of response after each tone is presented.

655
00:59:10.095 --> 00:59:19.087


656
00:59:19.107 --> 00:59:25.086
If they respond appropriately and consistently to the range of tones presented each year, the child passes the screening.

657
00:59:25.106 --> 00:59:31.076
So, there are two especially notable ways. Pure tone screening differs from OAE screening, and that is that the process requires children not only to be cooperative, but to be full participants in the process.

658
00:59:31.096 --> 00:59:44.075


659
00:59:44.095 --> 00:59:50.065
Following directions and responding reliably. As we mentioned, that means completing that initial process that we refer to as conditioning, or teaching children,

660
00:59:50.085 --> 00:59:56.072


661
00:59:56.092 --> 01:00:01.070
And then carefully determining whether or not you, as the screener,

662
01:00:01.090 --> 01:00:07.060
are getting reliable responses from them before even attempting to screen.

663
01:00:07.080 --> 01:00:08.070


664
01:00:08.090 --> 01:00:14.060
Yeah, and there's another difference as well between pure tone and OAE screening, and that's that the screening itself is not automated like OAE is. So instead, with pure tone screening, you as the screener have to manually step through the presentations of each tone, and you'll do that multiple times for each ear recording each response.

665
01:00:14.080 --> 01:00:31.055


666
01:00:31.075 --> 01:00:37.045
And then, following a very specific protocol and pass criteria, you as the screener determine whether the ear passed or not. So that's where it becomes elements of subjectivity versus being objective come in.

667
01:00:37.065 --> 01:00:47.059


668
01:00:47.079 --> 01:00:53.049
With pure tone screening, there's a considerable more potential for screener error to produce inaccurate results. So that's, um, that's why there's really a need for thorough training and oversight to make sure all screeners are adhering to the prescribed screening protocol.

669
01:00:53.069 --> 01:01:02.051


670
01:01:02.071 --> 01:01:06.047
Yeah, you know, I just want to interject that even though this procedure

671
01:01:06.067 --> 01:01:10.043
is familiar, you know, to most of us.

672
01:01:10.063 --> 01:01:16.033
It doesn't mean it's simple. It really does require a lot of adherence to very detailed steps to make sure that we are actually

673
01:01:16.053 --> 01:01:22.041


674
01:01:22.061 --> 01:01:28.031
accurately, uh, assessing or screening children's hearing. I mean, look at this example. Terry, walk us through

675
01:01:28.051 --> 01:01:31.035


676
01:01:31.055 --> 01:01:35.040
All of those manual steps.

677
01:01:35.060 --> 01:01:41.030
Yeah, so here you see a real example of it. These are the actual screening steps that need to be documented for each ear as you screen. So through the training process, you'll learn all of the steps of the conditioning and the screening process, and then all of the environmental conditions that we need to monitor and meet as we complete a child screening. Based on these results, then you as the screener will determine.

678
01:01:41.050 --> 01:02:00.028


679
01:02:00.048 --> 01:02:06.018
determine if each year passes or not. Again, like I said earlier, the device itself does not produce the result, as is the case with OAE screening.

680
01:02:06.038 --> 01:02:07.028


681
01:02:07.048 --> 01:02:13.018
Each one of these check marks that you see showing up on this form on your screen indicates an individual action that is being taken

682
01:02:13.038 --> 01:02:21.019


683
01:02:21.039 --> 01:02:27.009
and hopefully by the child. Now, I know it sounds like.

684
01:02:27.029 --> 01:02:28.020


685
01:02:28.040 --> 01:02:34.010
a bias is seeping through here. And I guess maybe there is a bias, because we've seen the success of OAE screening when that is an available option. But there's nothing wrong with pure tone screening. It's actually a very good way.

686
01:02:34.030 --> 01:02:44.014


687
01:02:44.034 --> 01:02:50.004
Okay, to screen children in this older age group as long as people have been accurately.

688
01:02:50.024 --> 01:02:51.014


689
01:02:51.034 --> 01:02:57.004
trained, and as long as those children that can't be screened with this method have another way.

690
01:02:57.024 --> 01:02:59.006


691
01:02:59.026 --> 01:03:04.996
to be screened. So, we mentioned a minute ago that we have a. We have a document, um, on our website, and this document that you see on your screen here is a comparison of the two methods, and the pros and cons, and.

692
01:03:05.016 --> 01:03:17.003


693
01:03:17.023 --> 01:03:22.993
needs related to implementing them both. Um, so I'll show you on our website here shortly where you'll find that. But if you're in a position.

694
01:03:23.013 --> 01:03:27.999


695
01:03:28.019 --> 01:03:33.998
to consider, um, OAE screening, to reevaluate where that might be.

696
01:03:34.018 --> 01:03:39.988
needed, um, either as that backup. method for children that can't be screened with pure tones, or if you have the latitude to consider possibly using OAEs. With all children.

697
01:03:40.008 --> 01:03:49.992


698
01:03:50.012 --> 01:03:55.982
This document can be a really helpful. Um, document to guide a discussion and some decision-making around that.

699
01:03:56.002 --> 01:04:02.992


700
01:04:03.012 --> 01:04:05.986
So we've given you an overview of the two methods.

701
01:04:06.006 --> 01:04:09.982
And we don't want to say, if you find yourself unable to screen.

702
01:04:10.002 --> 01:04:15.972
a child who will be when. you find yourself unable to screen a given child.

703
01:04:15.992 --> 01:04:16.983


704
01:04:17.003 --> 01:04:21.980
It is absolutely critical not to put off screening that child at a later date.

705
01:04:22.000 --> 01:04:27.970
Every day matters in this screening process. If you've tried everything, children who are unable to be screened should be referred to an audiologist to complete that screening.

706
01:04:27.990 --> 01:04:32.977


707
01:04:32.997 --> 01:04:38.967
In fact, children who are difficult to screen may be the very children we need to identify.

708
01:04:38.987 --> 01:04:39.977


709
01:04:39.997 --> 01:04:44.975
So always, always refer a child who is unable to be screened.

710
01:04:44.995 --> 01:04:50.965
Regardless of which method you use. You will occasionally have a child who doesn't pass the screening.

711
01:04:50.985 --> 01:04:51.975


712
01:04:51.995 --> 01:04:57.965
In order to be evidence-based, your screening process has to include a follow-up protocol for when the children don't pass.

713
01:04:57.985 --> 01:05:00.968


714
01:05:00.988 --> 01:05:06.958
Again, I'm gonna emphasize, our screening efforts are only as good as our ability to systematically follow up on children who don't pass the screening on one or both ears.

715
01:05:06.978 --> 01:05:10.963


716
01:05:10.983 --> 01:05:14.959
If we don't do the follow-up. Um, then.

717
01:05:14.979 --> 01:05:17.964
what's next for this child who didn't pass. It's an important piece of it.

718
01:05:17.984 --> 01:05:23.954
Yeah, it's absolutely. It's not just doing the initial screening, but the follow-up that really matters. So, let me give you a quick walkthrough of the protocol, and then you can go back and look at it more closely on our website after this webinar. Um, because this, this is going to be a quick pass-through of what it looks like.

719
01:05:23.974 --> 01:05:40.958


720
01:05:40.978 --> 01:05:46.948
Um, the percentage that we're going to give you here are from our data on over 10,000 children in that younger age group, birth to 3 years of age, on whom OAE screening was used. But this protocol pertains to.

721
01:05:46.968 --> 01:05:55.951


722
01:05:55.971 --> 01:06:01.950
All children, regardless of method, regardless of age. Um, so we expect, um.

723
01:06:01.970 --> 01:06:07.940
that children in the 4 to 5 age range or older are going to have better pass rates, because they're not as likely to have things like middle ear infections at the same rate that younger children do.

724
01:06:07.960 --> 01:06:17.944


725
01:06:17.964 --> 01:06:23.934
So, let's take a quick look at the protocol. We're going to screen 100% of the children in a given school or classroom, whatever your, um.

726
01:06:23.954 --> 01:06:28.940


727
01:06:28.960 --> 01:06:34.930
Your group is defined as being. And we expect about 75% will pass on both ears.

728
01:06:34.950 --> 01:06:39.936


729
01:06:39.956 --> 01:06:45.926
at that first screening. And. As a result, will not have the need for any further follow-up.

730
01:06:45.946 --> 01:06:47.928


731
01:06:47.948 --> 01:06:53.918
But that leaves about 25% that didn't pass on one or both years the first time you screened. And they will need to be screened within about 2 weeks.

732
01:06:53.938 --> 01:07:00.928


733
01:07:00.948 --> 01:07:06.918
Now, the interesting thing here at this point is that a good many of the children that didn't pass that first screening, they will pass the second screening.

734
01:07:06.938 --> 01:07:08.920


735
01:07:08.940 --> 01:07:13.927
It's really just about 8% of the total number, that hundred.

736
01:07:13.947 --> 01:07:19.917
Um, say, uh, if you're 8 out of 100, um, will not pass that second screening. So these children are the ones that will need to be referred to a healthcare provider for a middle air evaluation.

737
01:07:19.937 --> 01:07:26.917


738
01:07:26.937 --> 01:07:32.907
Now, once a middle ear problem has been identified and resolved, and medical clearance has been given.

739
01:07:32.927 --> 01:07:35.910


740
01:07:35.930 --> 01:07:39.916
Daniel screen this small number of children.

741
01:07:39.936 --> 01:07:41.909
a third time.

742
01:07:41.929 --> 01:07:47.899
And here's some more good news! We expect that less than 1% of that total number of children being screened will not pass that third screening.

743
01:07:47.919 --> 01:07:51.914


744
01:07:51.934 --> 01:07:57.904
And these are the kids that'll be referred for a pediatric audiological evaluation, so that we'll refer them to a pediatric audiologist to get that evaluation.

745
01:07:57.924 --> 01:08:01.909


746
01:08:01.929 --> 01:08:07.899
So, although a small subset of children will, in fact, need follow-up referral and further screenings.

747
01:08:07.919 --> 01:08:08.900


748
01:08:08.920 --> 01:08:14.890
after that initial screening. This protocol, which we've had people use in thousands and thousands of early childhood settings and schools, have found that it's a feasible protocol.

749
01:08:14.910 --> 01:08:24.893


750
01:08:24.913 --> 01:08:30.892
It helps children get the medical and audiological attention that they need.

751
01:08:30.912 --> 01:08:36.882
Well, it also minimizes unnecessary referrals. Like, if you were to refer all children right off the bat.

752
01:08:36.902 --> 01:08:38.894


753
01:08:38.914 --> 01:08:44.884
when they don't pass the first time, you'd have 25% of your kids being sent to healthcare providers. Well, that would be an undue burden on parents.

754
01:08:44.904 --> 01:08:49.891


755
01:08:49.911 --> 01:08:52.885
And on the healthcare system.

756
01:08:52.905 --> 01:08:58.875
And another way that this protocol is really helpful is because once you're underway with your screening program, you can use it to check to see if you're getting similar pass and refer percentages.

757
01:08:58.895 --> 01:09:04.883


758
01:09:04.903 --> 01:09:10.873
If you find that, um, your individual programs pass and refer percentages are significantly different than we'd anticipate at any point in this protocol.

759
01:09:10.893 --> 01:09:15.880


760
01:09:15.900 --> 01:09:21.879
then you might want to seek technical assistance. It's a good kind of quality check.

761
01:09:21.899 --> 01:09:27.869
Yeah, so we have other resources that you can look at that will describe the protocol in depth. It's a. It's an important part of the training that at least our online trainings delve into, and you'd want to make sure that however you accomplish your training needs, that.

762
01:09:27.889 --> 01:09:41.869


763
01:09:41.889 --> 01:09:47.859
This kind of a protocol is clearly understood and adopted universally by all who are engaged in your screening practices. So, um, be sure to look at this. Now.

764
01:09:47.879 --> 01:09:57.862


765
01:09:57.882 --> 01:09:59.865
There is one exception.

766
01:09:59.885 --> 01:10:03.861
to this, you know, step-by-step protocol.

767
01:10:03.881 --> 01:10:09.860
And that has to do. with when there's apparent concern.

768
01:10:09.880 --> 01:10:10.862
Terry, you want to talk about that?

769
01:10:10.882 --> 01:10:16.852
Yeah, this is, um, just right in line with what I mentioned earlier in the webinar, that whenever a parent or a caregiver expresses concern about a child's hearing or their language development.

770
01:10:16.872 --> 01:10:22.860


771
01:10:22.880 --> 01:10:28.850
That child should be referred for evaluation from a pediatric audiologist, even if they've passed a hearing screening.

772
01:10:28.870 --> 01:10:29.860


773
01:10:29.880 --> 01:10:35.850
Um, and this is true because if you recall from what we said earlier, while we have these wonderful screening methods, they're not 100% accurate or perfect. And so to be on the safe side, whenever there's an explicit concern about hearing or language.

774
01:10:35.870 --> 01:10:45.854


775
01:10:45.874 --> 01:10:51.844
Go ahead and make a direct referral. Um, and of course, you can and probably ought to still screen the child and send that result along, but make the referral regardless when a concern about hearing or language development.

776
01:10:51.864 --> 01:10:57.842


777
01:10:57.862 --> 01:10:59.845
has been raised or persists.

778
01:10:59.865 --> 01:11:04.843
Yeah, and Mandy, feel free to chime in here. You know, that includes you as.

779
01:11:04.863 --> 01:11:10.833
The screener, if. Even if you see a passing result, but something still.

780
01:11:10.853 --> 01:11:11.843


781
01:11:11.863 --> 01:11:15.839
is concerning you. make the referral.

782
01:11:15.859 --> 01:11:16.841
If a teacher. Yep, say what you have to say. Mandy, I know you have a strong feeling about this.

783
01:11:16.861 --> 01:11:21.838
Absolutely.

784
01:11:21.858 --> 01:11:27.828
I do have a strong feeling about it because, um, it's just like we've said over and over again, one day, one referral, you can make a difference in the life of this child and this family, and so.

785
01:11:27.848 --> 01:11:32.834


786
01:11:32.854 --> 01:11:36.830
Even if it, um, is you having the concern, or.

787
01:11:36.850 --> 01:11:42.829
Um, the parent, teacher, whoever, please make that referral for the sake of that child.

788
01:11:42.849 --> 01:11:48.819
Yeah. So, let's take a quick look at our website. We've referred to a number of resources that are available on kidsHearing.org, which you see on your screen right there.

789
01:11:48.839 --> 01:11:55.829


790
01:11:55.849 --> 01:12:01.819
Many free resources for you to download, adapt. We've got all sorts of things. So let's take a quick little look at what we've got there. This is the landing page for kidsHearing.org.

791
01:12:01.839 --> 01:12:08.818


792
01:12:08.838 --> 01:12:14.808
That first group of resources, where you see the pink arrow, have to do with planning resources, big picture resources, information that you can give out to your colleagues, to parents.

793
01:12:14.828 --> 01:12:23.821


794
01:12:23.841 --> 01:12:29.811
Um, talking about the overall. need an approach to early identification of hearing loss.

795
01:12:29.831 --> 01:12:32.814


796
01:12:32.834 --> 01:12:33.816
Hello, and.

797
01:12:33.836 --> 01:12:39.806
Under that, you'll see a bullet that says, find an audiologist. That's where you'll find several different directories for local, um, locating.

798
01:12:39.826 --> 01:12:45.814


799
01:12:45.834 --> 01:12:51.813
pediatric audiologists in your state, and possibly in your local community.

800
01:12:51.833 --> 01:12:57.803
If you're seeking equipment information, that's. That bullet there that says screening equipment, that's where you'll find some.

801
01:12:57.823 --> 01:13:00.806


802
01:13:00.826 --> 01:13:06.796
equipment information, what are the current different brands, what are the criteria to use when selecting equipment?

803
01:13:06.816 --> 01:13:08.798


804
01:13:08.818 --> 01:13:14.788
And also where you'll find that grant proposal template for getting some requests out to help purchase equipment.

805
01:13:14.808 --> 01:13:19.794


806
01:13:19.814 --> 01:13:25.784
or supplies. In the next category, that's where you'll find access to our online training opportunities, either for OAE.

807
01:13:25.804 --> 01:13:32.794


808
01:13:32.814 --> 01:13:38.793
or for pure tone. So, if training is a need, um.

809
01:13:38.813 --> 01:13:44.783
You give, you should give a look at that. The advantages that we can point out to the online training is that, one, you can do it whenever you want to. If you have new people that are coming in, they can do it right away. Um, you can do it as a group.

810
01:13:44.803 --> 01:13:56.790


811
01:13:56.810 --> 01:14:02.780
You can do it individually. Ideally, having an audiologist participate in some of the practice exercises once you've completed the online portions of the tutorials, is really a great idea, because then you have the benefit of their expertise.

812
01:14:02.800 --> 01:14:15.778


813
01:14:15.798 --> 01:14:21.768
to be with you alongside you, giving their helpful cues. So, the best possible scenario is to use a standardized curriculum so that everybody's hearing and getting the same information, but then you also have the benefit of an expert.

814
01:14:21.788 --> 01:14:34.777


815
01:14:34.797 --> 01:14:37.771
right in your own presence.

816
01:14:37.791 --> 01:14:43.761
The next group of resources are practical everyday resources for screening and follow-up.

817
01:14:43.781 --> 01:14:46.765


818
01:14:46.785 --> 01:14:52.755
checklist for what you need to set up a screening day with a group of children. There's a review of the protocol guide and forms that correspond with our recommended protocols so that you will document.

819
01:14:52.775 --> 01:15:01.767


820
01:15:01.787 --> 01:15:05.763
Every single, uh, possible outcome.

821
01:15:05.783 --> 01:15:07.766
And then a group of.

822
01:15:07.786 --> 01:15:13.756
of resources to help you share those results. There are letters for parents in English and in Spanish. There's a script there of.

823
01:15:13.776 --> 01:15:18.762


824
01:15:18.782 --> 01:15:24.752
What to say to parents at various points in the screening or follow-up process, as well as letters that you can send along with a referral to a healthcare provider that.

825
01:15:24.772 --> 01:15:30.750


826
01:15:30.770 --> 01:15:36.740
Um, not only explains the result of the given child you're referring, but explains very briefly.

827
01:15:36.760 --> 01:15:38.752


828
01:15:38.772 --> 01:15:43.750
what your screening approach is, and what you're needing from them.

829
01:15:43.770 --> 01:15:49.740
and the fact that you may be needing a referral from them if the child doesn't pass once you get medical clearance from the middle ear referral.

830
01:15:49.760 --> 01:15:54.746


831
01:15:54.766 --> 01:16:00.745
And then, in that last group, there are follow-up resources. There's a tracking tool, so.

832
01:16:00.765 --> 01:16:06.735
If you have a group of, let's say, 100 children you're screening, this tracking tool helps you know at any given moment.

833
01:16:06.755 --> 01:16:09.739


834
01:16:09.759 --> 01:16:15.729
How many of those children have passed? Who hasn't, and at what point in the follow-up protocol are they?

835
01:16:15.749 --> 01:16:17.741


836
01:16:17.761 --> 01:16:23.739
What is the next step? Um, and so, that can be a really helpful.

837
01:16:23.759 --> 01:16:28.737
tool in making sure that no children slipped through the cracks.

838
01:16:28.757 --> 01:16:34.727
And then there's a variety of other resources under that. So, that's kidshearing.org. So, um.

839
01:16:34.747 --> 01:16:36.729


840
01:16:36.749 --> 01:16:42.719
Lots of other resources there that we invite you to spend some time looking at. So, we're going to open up.

841
01:16:42.739 --> 01:16:44.731


842
01:16:44.751 --> 01:16:49.728
For some questions now, uh, in the chat, and um.

843
01:16:49.748 --> 01:16:55.727
you know, I really want to direct your thoughts and mine back to.

844
01:16:55.747 --> 01:16:59.723
What we saw with these children.

845
01:16:59.743 --> 01:17:05.713
And think about what the outcomes and the life-changing outcomes this represents.

846
01:17:05.733 --> 01:17:07.725


847
01:17:07.745 --> 01:17:12.723
for the children who were identified as a result.

848
01:17:12.743 --> 01:17:18.713
of somebody's screening. Now, for those of you who are screening slightly older children.

849
01:17:18.733 --> 01:17:19.713


850
01:17:19.733 --> 01:17:25.703
You probably won't be identifying children who are already profoundly deaf.

851
01:17:25.723 --> 01:17:26.714


852
01:17:26.734 --> 01:17:30.710
If they're older already, that probably would have occurred.

853
01:17:30.730 --> 01:17:36.700
Hopefully, sometime earlier on. But you very much can identify children who have a mild or moderate hearing loss.

854
01:17:36.720 --> 01:17:39.713


855
01:17:39.733 --> 01:17:44.711
Or, like in the case of Mandy's children, who had not only a mild loss.

856
01:17:44.731 --> 01:17:46.704
But one that was progressive.

857
01:17:46.724 --> 01:17:52.694
to becoming severe or to profound. So, Mandy, as a public health expert.

858
01:17:52.714 --> 01:17:55.707


859
01:17:55.727 --> 01:17:59.703
and the parent of children who are deaf or hard of hearing.

860
01:17:59.723 --> 01:18:05.693
We know the importance of hearing screening is, like, very real for you.

861
01:18:05.713 --> 01:18:06.703


862
01:18:06.723 --> 01:18:12.693
Yes, it really is. For those of you on this webinar, you may not have ever thought about it quite like this.

863
01:18:12.713 --> 01:18:14.695


864
01:18:14.715 --> 01:18:20.694
But monitoring the status of children's hearing is central to quality early childhood programs.

865
01:18:20.714 --> 01:18:25.692
It's central to the educational process across all of the school years.

866
01:18:25.712 --> 01:18:30.689
And to all of us who are committed to children's success. So.

867
01:18:30.709 --> 01:18:36.679
When children with hearing loss are identified and connected with the intervention resources that they need, they can thrive, just like the children that you've watched the videos of earlier that are pictured on the screen now.

868
01:18:36.699 --> 01:18:43.689


869
01:18:43.709 --> 01:18:49.688
And just like my daughter's. But that does depend on someone, somewhere along the way.

870
01:18:49.708 --> 01:18:52.682
Someone like you, identifying their hearing loss.

871
01:18:52.702 --> 01:18:58.681
And you can be that important person and that child in family's life.

872
01:18:58.701 --> 01:19:04.671
When you are that person, you can have the satisfaction of knowing that you were a part of an outcome that literally changed their life forever, from an educational standpoint, a social.

873
01:19:04.691 --> 01:19:08.676


874
01:19:08.696 --> 01:19:14.666
And, um, emotional standpoint. just every aspect, you can make a difference in this child's life.

875
01:19:14.686 --> 01:19:17.680


876
01:19:17.700 --> 01:19:22.677
All right, so thank you, Mandy, for always bringing that. That.

877
01:19:22.697 --> 01:19:28.667
very important point, um, forward. So we have some questions coming in, and the first question, um, Terry, is about pure tone screening.

878
01:19:28.687 --> 01:19:35.667


879
01:19:35.687 --> 01:19:41.657
Um, what are your thoughts on doing pure tone screening for 500 Hz?

880
01:19:41.677 --> 01:19:42.667


881
01:19:42.687 --> 01:19:48.657
In the Wisconsin School Nurse booklet, it recommends $500,000, 2,000, and 4,000 Hz.

882
01:19:48.677 --> 01:19:50.669


883
01:19:50.689 --> 01:19:56.668
And we have found that getting the 500Hz is pretty difficult sometimes.

884
01:19:56.688 --> 01:20:02.658
Yeah, and I think there's also another comment about 500 Hz as well. So the recommended, um, frequencies are, um, 1,000, 2,000, and 4,000, and those are recommendations made by, um, the National Associations. The reason 500 hertz usually is not included is because of background noise, what we kind of refer to as the noise.

885
01:20:02.678 --> 01:20:21.655


886
01:20:21.675 --> 01:20:24.650
floor of the environment or the room.

887
01:20:24.670 --> 01:20:30.640
And, um, low frequency noise, um, tends to over. Overpower. And so when we were, um, screening in the. That lower frequency range, um, we often get noise interference.

888
01:20:30.660 --> 01:20:41.645


889
01:20:41.665 --> 01:20:43.648
So, um.

890
01:20:43.668 --> 01:20:49.638
The next question is about OAE screening. Is the OAE screening result affected by a middle ear infection.

891
01:20:49.658 --> 01:20:54.645


892
01:20:54.665 --> 01:21:00.635
or effusion. So, maybe, Terry, I can go back to that slide, if I'm lucky.

893
01:21:00.655 --> 01:21:01.645


894
01:21:01.665 --> 01:21:02.637
You can talk about that a little bit here.

895
01:21:02.657 --> 01:21:08.627
Yeah. Yeah, so anything like a wax blockage or middle ear infusion can stop the. Our ability to measure the emission that is coming back out.

896
01:21:08.647 --> 01:21:15.636


897
01:21:15.656 --> 01:21:21.626
Um, and as we've talked, that's actually kind of one of the side. It's not the primary purpose, but one of the side benefits of screening, because we wait two weeks, we re-screen. Do you remember that.

898
01:21:21.646 --> 01:21:29.627


899
01:21:29.647 --> 01:21:34.634
approximately 25% that referred on the first screen will now be about 8.

900
01:21:34.654 --> 01:21:40.623
Um, and usually that is due to because these middle-ear conditions have cleared up.

901
01:21:40.643 --> 01:21:41.625
Um, so.

902
01:21:41.645 --> 01:21:47.615
But one of the. One of the risks related to this is that sometimes we get into a confusion around this that, okay, we get focused on, you know.

903
01:21:47.635 --> 01:21:53.623


904
01:21:53.643 --> 01:21:59.613
treating middle ear effusion and ear infection, for example, and then once the child is cleared up, we think, okay, we're done.

905
01:21:59.633 --> 01:22:01.625


906
01:22:01.645 --> 01:22:07.615
But really, we're not, because we've never evaluated the inner ear. So, even though there's a side benefit, remember.

907
01:22:07.635 --> 01:22:12.621


908
01:22:12.641 --> 01:22:17.619
that the target condition. is.

909
01:22:17.639 --> 01:22:23.609
this inner ear. And so we've got to make sure that our focus always comes back to that.

910
01:22:23.629 --> 01:22:28.615


911
01:22:28.635 --> 01:22:29.607
Yeah, thank you, William.

912
01:22:29.627 --> 01:22:35.606
with. With regards to OAE, here's another question. Given the nature of this screening.

913
01:22:35.626 --> 01:22:41.596
It appears that it can only identify hearing conditions related only to the ear, and cannot identify issues resulting.

914
01:22:41.616 --> 01:22:46.602


915
01:22:46.622 --> 01:22:52.592
Um, in communication with the temporal lobe. How does this affect how accurate OAE screening results.

916
01:22:52.612 --> 01:22:55.606


917
01:22:55.626 --> 01:23:01.596
are identifying and are at identifying hearing conditions.

918
01:23:01.616 --> 01:23:02.596


919
01:23:02.616 --> 01:23:08.586
Yeah, um, and so, um, what we're talking about is, are there problems that go beyond the inner ear, so those neural pathways and to the auditory centers of the brain? I'm going to start with a very end question, which is, um, really looks at how.

920
01:23:08.606 --> 01:23:20.593


921
01:23:20.613 --> 01:23:26.583
Often does that occur? What percentage of child hearing loss is related to conditions of the brain rather than structurally in the ear? It's a very. It's very low incidence. So, for comparison.

922
01:23:26.603 --> 01:23:31.589


923
01:23:31.609 --> 01:23:37.579
Remember, we talked about 3 per thousand in newborn screening for hearing loss? Well, these types of things are so much more rare. It's 1 to 3 per 10,000 births.

924
01:23:37.599 --> 01:23:43.587


925
01:23:43.607 --> 01:23:49.577
And so, um. it's very rare, and there is no good screening instrument or test for these disorders. Both OAE and PureTone might miss those, um, but the bottom line is, we do not want to not screen, just because the chance of missing a very rare disorder.

926
01:23:49.597 --> 01:24:06.582


927
01:24:06.602 --> 01:24:12.572
Yeah, and that's, like, the big dilemma, I guess, or I don't know if it's even a dilemma of public health screenings, which is what we're really talking about here. We screen for the most common, not for the most rare.

928
01:24:12.592 --> 01:24:21.574


929
01:24:21.594 --> 01:24:26.572
And that's true across. all aspects of health screenings.

930
01:24:26.592 --> 01:24:32.562
So, this is no different. Yes, you're right. There could be other things that could.

931
01:24:32.582 --> 01:24:33.572


932
01:24:33.592 --> 01:24:39.562
be going on, and that's why. If there is a concern, even if the child passes a screening.

933
01:24:39.582 --> 01:24:42.566


934
01:24:42.586 --> 01:24:43.567
We want to make sure there's a thorough.

935
01:24:43.587 --> 01:24:44.568
Yep.

936
01:24:44.588 --> 01:24:48.564
audiological evaluation done, so that.

937
01:24:48.584 --> 01:24:53.562
Yeah, exactly. I hope we made that point a couple times, that if, um.

938
01:24:53.582 --> 01:24:59.561
those concerns persist, even with a, um, passing result that we refer.

939
01:24:59.581 --> 01:25:04.558
Yeah. So, Terry, another question or two here. Can you describe the difference.

940
01:25:04.578 --> 01:25:10.548
in terms of usefulness of completing OAE screening versus tympanometry screening.

941
01:25:10.568 --> 01:25:11.559


942
01:25:11.579 --> 01:25:17.549
And is tympanometry ever recommended in screening young children?

943
01:25:17.569 --> 01:25:18.549


944
01:25:18.569 --> 01:25:24.539
Yeah, thank you for that question. I'm smiling because that was part of our early work with William and I, because we had actually included tympanometry in our pilot project. Um, and we found.

945
01:25:24.559 --> 01:25:31.549


946
01:25:31.569 --> 01:25:34.553
really no difference. Um.

947
01:25:34.573 --> 01:25:39.551
And so that's why tympanometry is actually not part of this protocol.

948
01:25:39.571 --> 01:25:45.541
Um, tympanometry, for those of you that are on that may not know, is a test of middle ear function.

949
01:25:45.561 --> 01:25:46.541


950
01:25:46.561 --> 01:25:52.531
And so it, um, mechanically tries to move the eardrum, and if there's fluid back there, we can't measure that movement, and then we think that there may be a fluid-filled middle ear.

951
01:25:52.551 --> 01:25:59.541


952
01:25:59.561 --> 01:26:05.531
Both resulted in the same thing within 2 weeks, things cleared up, and majority of the kids, um, that had referred passed.

953
01:26:05.551 --> 01:26:08.534


954
01:26:08.554 --> 01:26:14.524
And then those ones that went in for middle-layer evaluation. Um, so we, we found we didn't save time, efficiency, or any of those things using tympanometry, and that we found that, um, those referring on OAE were the same kids that would have referred on tympanometry.

955
01:26:14.544 --> 01:26:26.531


956
01:26:26.551 --> 01:26:32.521
So, we're getting close to the bottom of the hour, and if you all have to split, note in the chat field, um, a, uh, a link to an evaluation for us, which will also produce a certificate of attendance for your time on today's webinar, but we're going to try to hang in here for another couple of minutes to answer.

957
01:26:32.541 --> 01:26:51.518


958
01:26:51.538 --> 01:26:57.508
A few more questions. Um, and uh, be sure to note that, you know, you can find this webinar again along with lots of our resources on kidsHearing.org. So, is the. Here's the question.

959
01:26:57.528 --> 01:27:07.522


960
01:27:07.542 --> 01:27:11.518
Is there a place for the use of OAEs.

961
01:27:11.538 --> 01:27:17.508
In school settings for states. that do not have updated legislation.

962
01:27:17.528 --> 01:27:18.509


963
01:27:18.529 --> 01:27:24.499
In other words, where pure tone is still on the books. Um, and the. The.

964
01:27:24.519 --> 01:27:25.509


965
01:27:25.529 --> 01:27:30.507
Recommendation that we can make, and Terry, help me with this, is that.

966
01:27:30.527 --> 01:27:36.497
doing pure tone screening with 3- to 5-year-olds, if that's the regulation, then by all means, you know, you need to try that. But know that if you can't.

967
01:27:36.517 --> 01:27:42.505


968
01:27:42.525 --> 01:27:48.495
complete those screenings. with PureTone method, the American Academy of Audiology and.

969
01:27:48.515 --> 01:27:49.505


970
01:27:49.525 --> 01:27:55.504
the, um, American, uh.

971
01:27:55.524 --> 01:27:56.505
Yeah.

972
01:27:56.525 --> 01:28:02.495
The AAP, right? No, ASHA, the American speech-Language Hearing Association both recommend and guide that.

973
01:28:02.515 --> 01:28:04.497


974
01:28:04.517 --> 01:28:07.492
OAEs should be.

975
01:28:07.512 --> 01:28:13.482
the second step screening for when children of any age cannot be screened using the Puritone method.

976
01:28:13.502 --> 01:28:18.488


977
01:28:18.508 --> 01:28:22.494
anything more to add to that?

978
01:28:22.514 --> 01:28:28.484
Now, other than. It is just universally accepted as the. As, um.

979
01:28:28.504 --> 01:28:30.486


980
01:28:30.506 --> 01:28:31.488
Um.

981
01:28:31.508 --> 01:28:37.478
that it should be used in those cases. It's really, it's really a standard of care, and, um, you know, those, those things need to be updated.

982
01:28:37.498 --> 01:28:44.487


983
01:28:44.507 --> 01:28:50.477
Uh, there's a question here about the training access. Uh, it says that you need to have access to equipment.

984
01:28:50.497 --> 01:28:54.482


985
01:28:54.502 --> 01:29:00.472
Before completing the training. Yes, I mean, that would make sense, right? That if before you do training.

986
01:29:00.492 --> 01:29:01.483


987
01:29:01.503 --> 01:29:05.479
Um, the training that is offered on our website.

988
01:29:05.499 --> 01:29:11.469
is all very hands-on training. So, of course, you need to have either the Pure Toad or the OAE, whichever training you're doing.

989
01:29:11.489 --> 01:29:16.475


990
01:29:16.495 --> 01:29:22.465
And there's information also on, um. On selecting equipment on our website, so you'd want to look there for, um, information that would help guide the purchasing process. Once again, no, we are not selling equipment, we. That is not who we are, but we want to help you use the equipment that you purchase.

991
01:29:22.485 --> 01:29:40.461


992
01:29:40.481 --> 01:29:46.451
from other manufacturers, um, or distributors. Um. Well, I think we're past the bottom of the hour. We didn't get to everybody's questions, but you're welcome to, uh.

993
01:29:46.471 --> 01:29:55.463


994
01:29:55.483 --> 01:30:01.453
text message us through our website. If there are other questions you'd like us to address, remember that today's webinar was recorded, and so you can review it or share it with others.

995
01:30:01.473 --> 01:30:09.454


996
01:30:09.474 --> 01:30:15.444
as. Along with checking out all of the other resources that we have available there. Um, and be sure to also complete the evaluation and get your certificate of attendance for today, which is a link that's been provided.

997
01:30:15.464 --> 01:30:26.450


998
01:30:26.470 --> 01:30:32.440
in, um. And it's also here on your screen, if you don't see that in the chat.

999
01:30:32.460 --> 01:30:33.450


1000
01:30:33.470 --> 01:30:39.440
Mandy, thank you for being with us, wearing both hats as a public health expert, as well as a.

1001
01:30:39.460 --> 01:30:42.444


1002
01:30:42.464 --> 01:30:47.441
parent expert of children who are deaf or hard of hearing.

1003
01:30:47.461 --> 01:30:51.437
Being such a good reminder of the reality that.

1004
01:30:51.457 --> 01:30:57.436
You know, we will screen a lot of children who pass.

1005
01:30:57.456 --> 01:31:01.442
And when we screen children who don't.

1006
01:31:01.462 --> 01:31:05.438
And they are ultimately identified with a hearing loss.

1007
01:31:05.458 --> 01:31:10.436
Where we've participated in changing that child's life forever.

1008
01:31:10.456 --> 01:31:15.433
So, um, that's something to really hang our hats on.

1009
01:31:15.453 --> 01:31:21.432
It's also very important to note that when you screen all of those children that pass.

1010
01:31:21.452 --> 01:31:27.422
And you've done it correctly. You've helped rule out screening so that. Or hearing, so that if that child has other challenges.

1011
01:31:27.442 --> 01:31:32.428


1012
01:31:32.448 --> 01:31:37.426
You can confidently know that hearing is not the factor.

1013
01:31:37.446 --> 01:31:43.416
So, um. Both of those are. Give us some.

1014
01:31:43.436 --> 01:31:44.426


1015
01:31:44.446 --> 01:31:50.416
comfort in knowing the value of our work. Um, and Terry, thank you for your time and expertise yet again.

1016
01:31:50.436 --> 01:31:57.416


1017
01:31:57.436 --> 01:31:58.417
Yep, absolutely, thank you.

1018
01:31:58.437 --> 01:32:04.407
Yes? Yep. All right, to our technical support people in the background, thank you, as always.

1019
01:32:04.427 --> 01:32:07.411


1020
01:32:07.431 --> 01:32:13.410
And to everybody there, thank you for all the work that you do on behalf of children and families.

1021
01:32:13.430 --> 01:32:16.414
have a good rest of the day.

1022
01:32:16.434 --> 01:32:21.564
Thank you.