Okay, I think we should get ready to get started.
I want to welcome everybody to today's webinar.
And -- entitled intermediate level webinar: Building on Your
Experience with Evidence-based Hearing Screening Practices for
Children 0-5 Years of age.
I am William Eiserman, and I am the Director of the early Childhood
outreach initiative known as the ECHO initiative at the Utah State
University, the ECHO university is housed within the National Center
for Hearing Assessment and Management at Utah State university,
of which I am the associate director, And serves as the early
hearing detection, and intervention national technical resource center,
funded by, Through a cooperative agreement, with the
maternal and child health bureau; since 2001, For about 20 years, the
ECHO Initiative served as a national resource center On early
hearing detection, with a focus, specifically on supporting Head
Start, and Early Head Start programs in implementing
evidence-based hearing screening, and follow up practices, and, we're
delighted to continue to make our resources and other learning
opportunities, available to staff from Head Start programs as -- as
well as to anyone from early care and education environments, who can
put these to use.
Now, before we go any further, I want to give just a quick shoutout
to our captioners, And our captioner, and our interpreters,
today, a big thank you for them, Offering, their services in helping
us make this webinar accessible.
Today; so thank you to those of you who are offering that service.
Now, I'm joined today by Dr.
Terry Foust, AuD, FAAA, CC-SLP/A who is a longtime colleague and
friend, Who is, a pediatric audiologist, and a speech language
pathologist, who has served as a consultant and trainer with the
ECHO initiative since our very beginning.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Thank you, William, and good
afternoon, everyone, so, appreciate our time with you.
Yes, as William has said, William and I, along with many other ECHO
team staff as well as local collaborators, we've provided
training, in nearly every state with thousands of staff from early
Head Start, Head Start, American Indian, Alaskan native head start,
and migrant Head Start programs as well as many other early care and
education programs over the years.
And we are always encouraged...
Just as we are today, by the huge amount of interest that there is in
establishing evidence-based hearing screening programs.
So that children with hearing-related needs can be
identified, and served.
(After a pause).
>> DR.
EISERMAN: Okay, I'm going to turn off my video so you can look at the
more attractive things that we have prepared for you to look at today
(laughing) and our interpreters) so I'm going to turn off our -- my
video and then we will -- we will proceed.
Thanks, Terry!
(A pause), Dr.
Eiserman.
So just so that you know, today's webinar is being recorded.
So if anything disrupts your full participation in today's webinar,
you'll be able to -- to stream it again, on infanthearing.org, or
kidshearing.org; in the next couple of days, So -- and keep that in
mind, also, if there is anybody that you think would BFTD from
today's webinar that isn't attending live.
So, be aware of that.
Terry, I don't know if you're aware that your video is on, in case you
didn't intend to do that.
Just thought I would let you know.
So, today's webinar, is primarily intended for those of you who
already have some experience in implementing evidence-based hearing
screening, for children either in the birth to three range or in the
3 to 5 age range, or both.
We're delighted to have well over 800 people registered for today's
webinar.
And, many of you submitted questions, to us in advance, and
our responses to those questions, we try to oo incorporate into what
we've planed to share with you today.
We should have ample time to take additional questions if others come
up during the Presentation.
We did notice that there are a few questions that have popped up from
folks for whom evidence-based screening is new; and if that's you,
By all means, you're welcome to stay throughout today's webinar and
-- and hear what other people who have been doing this for a while
are -- are asking about, and learning about, But know that we
wanted to let you know that tomorrow, we're having an
Introductory Webinar, for those of you for whom OAE, and other
evidence-based screening, is a new topic.
So you'll -- if you go to kidshearing.org, you'll wherefind
the link to that webinar; if that suits your need more appropriately,
but, again, you're welcome to stay with us.
Now we're going to organize our time today, around, a lot of the
questions as I said, that you have sent us.
And -- we'll present some information about each of these
topics, We'll start with a brief review for our newcomers to
evidence-based hearing screening on the purpose of hearing screening,
and, what the recommended methods are.
We're, then, going to turn our....
Attention to -- to review the issues, pertaining to puretone
audiometry method, and to -- and to some of the questions that we've
gotten about screening children 3-5 years of age, using that method.
Since many of you are getting ready for a new round of screenings,
we'll go over some key steps you'll want to complete to prepare for
this.
We'll -- we'll, then, review the steps and the procedures of the
puretone screening, just to make sure that, you have those....
Covered as well.
After we do that, then we'll --
we'll switch our attention over to otoacoustic emission screening.
Which many of you are doing, and, since some of you are also
preparing for a new round of screening with a group of children
using OAEs, we'll overview the steps you'll want to complete to --
to prepare for doing OAE Screenings.
We'll, then, review that procedure.
Some helpful hints for screening, and then delve into some of your
questions about children who may be challenging the screen, or other
issues, you've brought to our attention.
We'll, then, -- that will, then, be an opportunity, for you --
for you to ask us some questions about OAE Screening.
Next, we're going to talk about the follow up protocol, which relates
to everyone regardless of which method you're using.
We'll talk to some of the issues about follow up and communication
with parents, and healthcare providers, And how to
appropriately-support the follow up actions that need to happen.
And then we'll wrap up by taking a look at some of our additional
resources that we have available, and, making sure that you know what
else is available on our Web site.
(Next slide), we're going to organize our time around this left
bar -- that you see on the left, so you can follow along which topic
we're on, and this is helpful to -- to look at, too, if you're looking
at this in the recorded format.
If you want to advance forward, you can see where in today's discussion
we are.
By looking at that left menu bar; so, you've probably seen this
graphic before.
We use it a lot to remind people that the work of the ECHO
Initiative is based on the recognition that each day, there
are young children who are Deaf or Hard of Hearing being served in
Early Childhood Education and healthcare settings, often without
their hearing-related needs being known.
Hearing loss, is often thought of as the invisible condition.
So the question for all of us, is, how can we reliably identify which
children have normal hearing and which may not?
(A pause), TERRY FOUST, AUD, FAAA, CC-SLP/A: And the short answer to
that, William, and to everybody, is that early care and education
providers can be trained to conduct evidence-based hearing screening,
just like you see here in these photos.
And 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.
So you should recognize or will recognize the procedure on the left
as otoacoustic emissions or OAE screening which is the recommended
method for children, 0-3 years of age and is increasingly recommended
for children 3 to 5 years of age as well.
Now, on the right, you'll see, the procedure puretone audiometry
hearing screening which is historically been the most
commonly-used screening method for children three years of age or
older which you'll still see in many early care, and education
providers using.
Now, as William mentioned.
We'll be talking about both of these methods today.
Keeping in mind, that hearing screening....
The hearing screening process does not diagnose a hearing loss.
But it does identify children, who need further follow-up evaluation.
Either by a healthcare provider or an audiologist with that ultimate
aim of diagnosing hearing loss, if in fact, that exists.
And then connecting those children with the intervention services that
they need.
So your screening program is the first important step in that
process.
DR.
WILLIAM
EISERMAN: Some of you have asked whether you need to be satisfied to
do screenings, and that tends to be a state-specific issue.
We don't know of any states that actually require that.
But there are some state guidelines that can influence your practice;
and so we always encourage you to check that out.
A good way to do that is by connecting with your state newborn
hearing screening office, or, what's called "the early hearing
detection, and intervention coordinator" known by the acronym
EHDI, or "[phonetic] eddy" and we have a link to those offices on our
Web site, which I'll be showing you a bit, in a bit.
If you look for "find an audiologist" on our Web site,
that's how you'll find the EHDI coordinator for your specific state
to whom you can address questions like that.
Now, some of you have also asked about how we can more effectively
encourage parents, to follow up when a child hasn't passed a
screening.
Now, one way to share -- one way to do that is to share information.
About the incidents of hearing loss and the fact that a child's hearing
ability can change at any time.
Often without us even recognizing that.
And so, let's just review some of these really helpful basic facts.
About three children in every thousand, are born with a hearing
loss, Deaf or Hard of Hearing, Now, most newborns in the U.S.
are now screened for hearing loss using evidence-based methods, most
of them before even leaving the hospital.
But screening at the newborn period isn't enough because the research
suggests that the incidence of permanent hearing loss, actually,
doubles between birth, and school-age from about three
children in a thousand, at birth, to about 6 in a thousand by the
time children enter school; so that's a really good fact for you
to have in your mind, Ready to share with parents.
To reinforce the value of following up.
TERRY FOUST, AUD, FAAA, CC-SLP/A: So we can't only screen them for
hearing loss at birth.
So, we -- we actually need to screen throughout early childhood,
because hearing loss can occur any time as a result of illness,
Physical trauma, Or environmental or genetic factors.
This is often referred to as late onset hearing loss.
Just meaning that it's --
acquired after the newborn period.
And, again, similar to subtle changes in vision, that can occur
for any of us, a child, can experience a change in hearing
ability, that we want to identify, so they have full access to
language and then all of the information that they're -- they
can be exposed to as they learn and grow.
(A pause), so screening is just that first step in the process of
identifying a disability, such as hearing loss.
Now, since no screening method is 100% effective in identifying
possible areas of concern; parent or caregiver concerns always
overrides a passing screening result.
No matter what the screening method is, that was used.
.
>> DR.
WILLIAM
EISERMAN: Yeah, any conversation we have about screening, and follow
up should always begin with a reminder that screening methods
aren't perfect; and that whenever a parent or caregiver expresses a
concern about language, or hearing -- children should be referred for
a more thorough evaluation.
Even if the Child passed the hearing screening and that's true,
even with the highly-reliable hearing screening methods we're
talking about today.
TERRY FOUST, AUD, FAAA, CC-SLP/A: And we would also --
we also want to acknowledge, right upfront that for any number of
reasons, there will be an occasional child that you just
can't manage to screen.
So, after you've tried everything you can do, and you've had a
colleague try as well, as possible; you'll be faced, then, with the
dilemma of what to do.
So here's our recommendation about that question, which some of you
have raised.
If you aren't successful screening a child, then refer the Child to
someone who can.
Often that's going to be a pediatric audiologist.
Just keep in mind sometimes the children that you may have
difficulty screening, are, actually, the very ones who have a hearing
loss.
So we don't want to skip them and just try next year.
(Next slide), DR.
WILLIAM
EISERMAN: So we just mentioned having a pediatric audiologist in
the picture.
A pediatric audiologist, if you don't know, is a professional who
specializes in the diagnosis and nonmedical treatment of
hearing-related, and other disorders associated with the ear
and the auditory system.
Terry's a pediatric audiologist, and he specializes in children, so
having access to a local pediatric audiologist can really be helpful.
We recommend that all programs consult with a local audiologist,
if at all possible to develop and oversee your screening and follow
up activities.
They can be helpful with equipment questions you might have.
Consult with you about specific children who aren't passing your
screenings, and importantly, they can be the -- they can be a
valuable resource when you need to refer a child for further
evaluation.
-- now, on our Web site, at kidshearing.org, you'll find the
link for find an audiologist.
Which should help you do just that.
And there are several different directories there, and as I
mentioned before, going to your EHDI Coordinator for your state,
the newborn hearing screening director, they can help you find
local audiologists.
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Now, I just want to also mention
here to all of us that some of you have submitted some very specific
questions about error messages that occur on your particular piece of
equipment.
And, while I -- I can so appreciate those questions, it will be
difficult for us to address specific equipment....
Messages, and things like that.
In a group setting, remotely like this, but you can pose those
questions to the person who sold you the equipment.
While equipment distributors, and salespeople --
Are not who you should look for, for the comprehensive training you
need to develop your screening program, they can absolutely help
you understand how your equipment functions, the error messages, and
things like that; so having access, as William said, to a pediatric
audiologist, And your sales rep, will really be helpful but for
different reasons.
So, we encourage you to have their contact information ready for when
you need it.
And then, sometimes, the equipment manual, which is now often online,
or mostly online, can help you as well.
>> DR.
WILLIAM
EISERMAN: Hey, Terry while we're on that topic.
Some people submitted questions about screening children with PE
tubes so let's just answer that question right now.
Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Oh, yes, yeah, let's, so, yes, you
absolutely can, and should -- screen children who you know have
PE tubes.
It's one way to, actually, find out, if the tubes are doing the job
they have put in to do.
Children with PE tubes should pass hearing screenings, if the rest of
their auditory system is functioning normally.
So for those of you that are using the OAE method, you'll want to look
at your equipment manual, just to make sure -- in some cases you
might have to push an extra button.
Or to adjust the setting for screening, an ear that has PE tubes
so be sure to check that out.
As I said, some equipment does require a temporary adjustment,
while other brands do not.
But the bottom line is: Yes, you can and should -- screen children
with PE tubes.
.
>> DR.
WILLIAM
EISERMAN: Okay, so we have two screening methods we want to talk
about today.
By way of big-picture: If you're responsible for children who are
under three years of age, the recommended method is OAE screening,
which, you see here on the left.
if you're responsible for screening children three years of age or
older, historically, puretone audiometry has been considered the
recommended method, for this age group.
This is the headset screening, where the Child raises a hand, or
performs another task each time they hear a sound, that's presented
in to one of the earphones, you see this method here on the right.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Now, several of you have asked why
some programs --
you may have noticed some programs are no longer using puretone
audiometry with the three to 5 population, and have switched to
OAEs.
And that's because there is growing recognition that although the
puretone method has been the most widely-used method historically, It
may not always be the most feasible method to use, with some of these
younger children.
The research shows that 20 to 25% of children in that three to five
age group, can't be screened successfully with this methodology.
Just because they aren't developmentally-able, to follow the
directions reliably.
And that's really been our experience as well.
So in those instances, OAE screening is the preferred method
for these children.
And as we emphasized a moment ago, we want to screen every child.
Even the ones we find challenging to screen, right?
DR.
WILLIAM
EISERMAN: So at a minimum, if you're establishing evidence-based
hearing screening practices, for three to five-year-olds, and, if
you're considering or are, using puretone screening: You'll also
need to be prepared, and equipped --
To do OAEs on that 20 or 25% who can't be screened with puretones.
Or, alternatively, you need to have some other means for
systematically-referring all of those children, that you can't
screen with puretones, to an audiologist, who can perform the
screening.
Which, frankly, can be a bit challenging, in its own right.
If you're -- if you've got 20% of the children you see that need to
be referred to an audiologist, That could be kind of tough, because,
audiologists don't have that much time to see that many children.
.
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: You know, to simplify
things, then, most -- more and more audiologists are recommending the
use of OAEs, just uniformally, with all children 3 to 5 -- three years
of age and older, and it's because it's quicker than puretone
screening, and both to learn to do, and, actually, implement.
But really, it's far more likely to be a method that can work across
the board, with all children, in the three to 5 age group you would
be screening and it's equally as effective.
>> DR.
WILLIAM
EISERMAN: So if you or your program are undecided, or you're
reevaluating this question, now that you're at the beginning of a
new school year.
About which method to use primarily for children three years of age and
older -- we want to encourage you to carefully review a document we
have on our Web site that compares OAE screening and puretone
screening with this three to five-year-old population.
It's -- it's a document that really helps you walk through the
considerations of that decision.
Now, here's an important note:
Some states do have regulations about what methods are to be used,
based on age.
Requiring puretone for children three years and older As at least,
the primary method.
So you need to check with your state if you're considering OAEs
for the three to 5 age group.
And -- and you can do that, again, by contacting your state's newborn
hearing screening program.
They'll be able to help you find those rules and regulations, if
they don't know them right off the top of their head, which they very
well may, you'll find that link on our Web site, which I mentioned.
Now, on another note: We had a question about whether there are
any other....
Recommended evidence-based practices, other than OAEs, or
puretone audiometry.
Are there other methods, Terry?
What's your answer to that
question?
>>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, there are not, these are the
two methods that have been studied, validated, and -- and in use.
.
>> DR.
WILLIAM
EISERMAN: All right, so Terry, I'm going to hand to over to you to
jump into puretone audiometry.
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: Great, thank you so
much.
So let's jump right in.
Into our first screening method, and review it.
So, to conduct puretone screening, we're going to, first, take a look
at the ear.
We want to make sure that there's no visible sign of infection, or
blockage.
Now, by the way, you'll always want to do this first, regardless of
what method you're using.
So if the ear appears normal:
(Sound of click), then use the screener, or going to instruct or
condition the Child, how to listen for a tone.
And then respond by raising a hand, or placing a toy in a bucket.
And once you have observed that the child reliably responds to the
sounds that are presented, just as you instructed, that's when the
actual screening is started.
During the screening process, this listen-and-respond game, is
repeated, at least twice, at three different pitches on each ear.
Noting the Child's response or lack of response, after each tone is
presented.
If the Child responds appropriately, and consistently, to the range of
tones presented to each ear, then the Child passes the screening.
(Next slide), .
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Now, again, as I mentioned during
the screening process, this listen-and-respond game -- is
repeated at least twice, at three different pitches on each ear.
Noting the Child's response, or lack of response, after each tone
is presented.
(A pause), now, if the Child responds appropriately, and
consistently, to that range of tones presented to each ear, the
Child passes the screening.
(A pause).
>> DR.
WILLIAM
EISERMAN: We want to remind you of some things you want to be sure to
address as you get ready to start screening a group of children, now,
to begin with --
and this goes for everybody, regardless of what method you're
using.
Be sure to refresh yourself on the resources that we've got at
kidshearing.org.
This is our landing page, (demonstrating) of kidshearing.org,
where you'll find a range of resources there, if you're needing
to acquaint new staff, or to refresh yourself, so, we'll just
have a look here, at the -- at the various resources we've got here.
Starting with big-picture resources, where to find the training, that
is available online, both for OAE, and for puretone audiometry.
Those trainings are great to do, on an annual basis, Provide you with a
certificate of completion.
And -- it's a great standardized way of making sure that everybody
is reviewing exactly the same processes for each of these
methods.
You'll find our screening resources, in the next group, where you'll
find a guide- --
A checklist for preparing to screen.
Our protocol guides and forms for documenting screening outcomes, --
information on sharing results, including referral letters, in
English, and then Spanish, Letters you can send to healthcare
providers, or audiologists, with screening results, And even some
recommended scripts about what to say when a child does or doesn't
pass -- to parents, you'll also find some follow up resources
there.
I also want to note, if those --
if there are some of you who are, actually, using, the online
training up above, there are some new modules in there that review
the documentation process and tracking process for a group of
children; so you might want to go and have a look at those, if you're
already registered for those courses.
(A pause), as you prepare for a round of screening, you'll want to
walk through these steps to make sure, you have addressed each of
these.
And you'll see here, that there are things about setting up the
environment; Doing a listening check.
On the equipment.
Just a variety of things to walk through as you -- you get ready to
-- to screen, so be sure to look at that, and, again, that's available
on our Web site.
As well.
so, you don't have to memorize any of that stuff.
Now, let's just walk through the process of screening, That you
reviewed, Terry, as a refresher, And we'll address a few questions,
some of you submitted to us.
This is the screening form that we provide for you to use, for
puretone screening; which, actually, follows the recommended protocol
exactly, step by step, and gives you an easy way to document each of
the steps, As you go.
The first step, for hearing screening, is to conduct a visual
inspection of the outer ear.
Now, in most cases the Child will pass at this point and you'll move
on to condition the Child for the screening process which, Terry
mentioned.
If the Child cannot be successfully-conditioned to provide
that behavioral response to the presentation of sounds in the
earphone another attempt to condition the -- the Child, can be
made on another day.
If the Child still cannot be conditioned, then, an OAE screening
should be conducted; or the Child should be referred to an
audiologist.
Assuming the Child is conditioned successfully....
Then the screening process begins.
(Next slide), TERRY FOUST, AUD, FAAA, CC-SLP/A: Let me just
interject here, William.
We have received some questions about the conditioning process, in
preparation for today's webinar.
Asking about how long the conditioning process should take.
So let me go ahead and answer that.
Children who are going -- who are going to be successfully-screened
using the puretone method, they ought to be able to be screened in
about 10 to 15 minutes maximum.
Including that conditioning step.
So the conditioning should not take more than five minutes, hopefully
less.
If you can't condition a child in that amount of time, them you
probably should consider using your back up plan, which is either to do
the OAE, hopefully right there, right then, while you've the Child
there.
Or you can try on another day, if you have the flexibility to do
that.
But just remember, if you can't screen the Child, you'll either
need to do an OAE, or refer the Child to someone who you'll --
who will be able to successfully-screen the Child.
Most likely a pediatric audiologist.
And as we said, earlier, remember that some children who have hearing
loss could just be the very ones who are most difficult to condition
to do the screening.
So, one way or another, we want to ensure that every child gets
screened.
(Next slide), DR.
WILLIAM
EISERMAN: Assuming the Child is successfully-conditioned, the
screening process begins.
Now, you can note that the form provides space to record the
results of each ear.
Since puretone screening isn't automated, the form provides a
reminder that for each ear up to four presentations of the tone can
be made for each frequency level starting at 2000.
Then 4,000.
Then 1,000.
And that two responses are needed for the Child to pass for a given
tone.
The screening begins by repeating the conditioning process.
(A pause), one more time.
And then proceeding.
From there, documenting the results for each presentation.
As you go.
Once you have completed the presentations across all three
frequency levels, The form reminds you how to determine if the Child
passes, for that ear.
(A pause), the Child needs to have at least two successful responses,
out of no more than 4 attempts at each frequency level, in order to
have an overall pass.
And once that's recorded, then you screen the left ear.
(Pause), and you do that in the same way, recording each
presentation, as you go.
(Pause), now, if one or more ears...
Doesn't pass, doesn't meet that criteria, like you see here on the
right (indicating), then a second screening is going to be done.
Approximately two weeks later.
And the form reminds you to do that.
Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: William, let me interject with
another question someone has raised in a previous communication to us.
The question is, what if a child does find -- does find, in
responding at first, but then becomes distracted, or you observe
they're no longer engaged in the screening.
Say, after the first couple of pitches, what do you do?
And this can absolutely happen so if it does, be sure to document as
far as you got.
And then you can do one of several things.
You could use your back up method, the OAE instead; or you can come
back to this child on another day, and continue where you left off.
Making sure, however, that you always start by repeating that
conditioning process before you continue with the actual screening
steps where you left off.
.
>> DR.
WILLIAM
EISERMAN: Terry, you would have to do the same thing, right?
-- if there is a sudden increase in the environmental noise that's
outside of your control, too, right, Terry?
If you can't continue to screen at that time, you would have to come
back in another time, picking up where you left off?
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yes, that's right, if the Child is
not able to be conditioned again, or remain tentative, then you
should probably use the OAE method, or refer the Child to an
audiologist.
And -- and I just want to emphasize an important point here.
And we've -- we've been doing that throughout today's webinar.
But, again, sometimes children with hearing loss are the very ones who
are the most difficult to screen, so the last thing we want to do, is
to abandon the screening process on those children, and just simply
conclude that they cannot be screened without doing something
else, whether that is screening with, the OAE, or making a referral
to that -- the audiologist.
.
>> DR.
WILLIAM
EISERMAN: You can guess, can't
you?
(Laughing) why we keep saying that over and over again, because that,
actually, happens a fair bit where, the very children that need the
screening result, and an ultimate referral are the ones that don't
get a completed screening and so we want to make sure that doesn't
happen.
So let's say we do, successfully, complete the screening.
And we have one or both ears not passing at the second screening.
We want to make sure we indicate that on the form, and then, the
Child is referred for a middle ear consultation, from a healthcare
provider.
.
>> Now, for any child who is referred for a middle ear
consultation from a healthcare provider you'll want to use this
diagnostic follow up form on which you'll document the remaining steps
in this child's screening and diagnostic process, starting with
the results of the middle ear consultation.
So, since the Child was referred to the healthcare provider to see if
there may be a middle ear, health-related problem that may
have prevented the Child from passing the screening on either ear
during your first two screening sessions -- you'll want to find out
the results of this consultation and record them here.
Then, once the healthcare provider indicates that the ears are healthy
and clear, then you'll want to rescreen the Child's ear or ears,
that have not yet passed, and record those results.
.
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: (Continuing)&all
children referred for a middle ear evaluation, must receive the
rescreen on any ear that did not previously pass, so if, at this
point, there is still an ear that has not passed, then the Child is
referred for a complete audiological evaluation.
And you're going to want to support the Family in completing this very
important step and be sure are to get the results, document them on
this form, you'll also want to collect any supporting
documentation of the audiological evaluation results, especially if a
permanent hearing loss has been identified.
So in most cases, this is going to include additional referrals for
intervention services that you're going to want to be aware of, so
you can support the Family in obtaining them.
DR.
WILLIAM
EISERMAN: So we do encourage you, even though we know many of you
have moved on to electronic documentation --
to look at these forms, because, they do help you walk through the
step-by-step recommended protocol, that we want to make sure gets
followed; so, have a look at those.
So let's pause here for a moment and see if those of you who are
using puretone method have any other questions about this method,
preparing to screen, conditioning, Conducting the actual screening, or
-- or documenting any of the results; and after we take a look
at any questions you might have, we're going to move on to the OAE
method.
.
>> DR.
WILLIAM
EISERMAN: (After a pause), so someone said, "I work with -- with
children birth to 5 years of age.
So, can I use OAE for everybody?
" Terry, you want to clarify that?
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, thank you for that question,
absolutely you can.
And, so, some of the advantages that -- of that will be that, you
know, in that...
in that especially three-to-5 section of the children you're
serving, there would still be, you know, that 25% we said that,
wouldn't be able to complete the screening using puretone, for
example.
So your OAE would be able to apply to them as well.
But, yes, you -- you can.
.
>> DR.
WILLIAM
EISERMAN: Somebody is asking about documenting with citations,
what we were talking about, the doubling of the frequency of
hearing loss between birth and school-age.
If you go on to our Web site, you'll find lots of background
information, and, those citations from various sources, so we
encourage you to -- to look at that.
(A pause), the next question is....
(A pause), DR.
WILLIAM
EISERMAN: What concern do you have about nonaudiologists screening
with OAEs if they're not doing otoscopy first?
Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, thank you, we're not
concerned about that.
There's actually training to be able to use otoscopy appropriately
as well; and to be able to identify the -- the features you would be
looking at.
And so, with lay screeners --
it's -- we are not using otoscopy.
And don't have concerns doing.
We just do a check of the outer ear as mentioned earlier.
And look for any deformities or drainage or any visible blockage.
But....
Almost -- I am not aware of any screening programs -- are you,
William?
-- that have actually integrated otoscopy, unless it's used by other
trained personnel.
>> DR.
WILLIAM
EISERMAN: Only if it's a healthcare provider, nurse, or
healthcare provider --
The next question -- and then we're going to move on to OAE screening
and it may be the perfect segue, is about, whether we have any
recommendations for screening children with special needs.
Using either puretone or OAEs.
and Terry, I'll let you respond, but the first thing I would say....
How great it would be to have both options available.
And, of course, that would require children who are slightly older and
developmentally-capable of doing puretone screening, But they may be
very tactally resistant to having an OAE done, which requires a probe
insertion in the ear; so, both options, can be really nice under
those circumstances.
Terry?
Any other thoughts about that?
.
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: Oh, completely agree,
wonderful to have both options.
DR.
WILLIAM
EISERMAN: So let's move on, then, to -- I'm going to just skip past
our Web site here, and we'll look at this again.
Momentarily.
Oh!
But I do want to draw attention to this: Puretone screening skills
checklist is available on our Web site, and this walks you through
each of those steps that we just went through, as we walked through
the process.
So this is always a good thing to have beside you.
Especially if you're just starting up again after you haven't done
puretone screening for a while.
It's also a really nice checklist to use for....
new screeners, if you're monitoring how well they have done after the
training.
Or for evaluation purposes, So, take a look at this checklist, and
see how it may be helpful for you and your program.
All right.
Now, -- now we're going to turn our attention to otoacoustic emissions
or OAE screening, as we have already said, this is the
recommended evidence-based practice for children birth to three years
of age, and increasingly being used for older children, as well.
Terry, talk us through this process.
.
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: Okay, so, again, we're
going to start in the same place, as we did with puretone to conduct
a noise screening, we're going to take -- first, take a thorough look
at the outer part of the ear.
Again, to make sure that there's no visible sign of infection or
blockage.
If the ear appears to be normal and healthy -- (pause).
Then a small probe on which we have placed a disposable cover, is, then,
inserted into the Child's ear canal.
And then a button is pushed to start the automated screening
process.
The probe that sits independently in the ear, delivers a low-volume
or quiet-sound stimulus into the ear.
And the cochlea or the inner snail-shaped portion of the ear
that you see here -- a cochlea that is functioning normally will
respond to this sound by sending the signal to the brain.
While, also, producing an acoustic emission, and this emission is
analyzed by the screening unit and in approximately 30 seconds or so,
a result will appear.
Either...
as a pass.
Or a refer.
So every normal, healthy inner ear produces an emission that can be
recorded in this way.
.
>> DR.
WILLIAM
EISERMAN: As you prepare for another round of screening, we want
to encourage you to refresh yourself.
About what those steps are, and -- (pause), just as we showed you with
the puretone screening.
We have a screening skills checklist for OAE screening as well,
that we would encourage you to download, and that checklist can be
used, just as it can with the puretone screening: To refresh
yourself on those steps; to walk a new screener through the process;
and to make sure that they are following all of those.
So get acquainted with what we find on our Web site, here are the
training tools and all of the other resources there related to puretone
screening.
So have a good look -- or to OAE screening so have a good look at
that, you'll see there on the --
on the bottom left, OAE skills checklist, and the puretone
screening skills checklist.
Those are under follow up resources, so, go have a look at those, and
-- and see, if they might be helpful for you.
and this is what that looks like.
Now, (pause), in addition to a list of the actual steps, you'll see a
list of supplies that you need, so be sure to go over those to make
sure that you're all set to go.
Be sure to test your equipment on yourself or others.
Importantly, on ears that typically pass, so that you're sure the
equipment is working properly, in fact, we recommend testing the
equipment on yourself, prior to every testing session.
If you haven't had the equipment calibrated in the last year or so,
you'll want to do that.
To make sure it's working properly.
Regardless of what hearing screening methods you use, you want
to make sure that you communicate with your parents and other program
staff, whose cooperation you're seeking, are clear about what
you're doing, and why.
Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Now, some of you have asked how to
prepare children for a hearing screening and our main
recommendation is to keep it fun.
Regardless of the method that you're using.
so, rather than referring to the activity as a screening, or a
hearing test, call it a listening game, and you can engage teachers
and parents in some activities that include noticing the Child's body
parts, and including their ears -- and maybe expand on the idea that
--
of what animals have ears as well.
.
>> Dr.
William Eiserman: Yeah, and if you don't know -- we have a -- a short
little video on our Web site, called "Listen up!
"
That you can use with children, if you have access to a computer, and
if this is helpful, and just setting the tone, you might want to
play it or have, even the parents play it for their kids at home.
This is a quick, little preview of that.
[ON VIDEO] [MUSIC]
DR.
WILLIAM
EISERMAN: I'll hold you in suspense of what the rest of the
little video is about.
But take a look at it, and you'll finding that hear under a variety
of other resources we have for preparing to screen; so, take a
look there.
It's right there under "preparing to screen" and that's where you'll
also find our protocol guides, and forms.
Just like you saw with the puretone form, we also have forms for
documenting the outcomes of OAE screening that follows the protocol
directly.
So....
Be sure to take a look at those, as well as the other preparing to
screen resources, That we're referring to right here.
We really did try to come up with -- as many things that people would
need, on a daily basis, and running a preschool hearing screening
program, so, certainly, before you go sit down and write a letter or
develop a form, look at -- look at our Web site, and see if it doesn't
already exist.
(Pause), Now, like many skillful tasks, competent screeners can make
look -- make OAE screening look really easy.
But, no matter how much experience you have, we promise you, you're
going to be met with challenges.
We are always challenged, and, a number of you have submitted
questions about children you struggle to screen for various
reasons, so, let's take a minute, and talk about some of those
strategies for screening, We're going to start by looking at these
pictures.
Now, the children you see in these photos, are all being screened
using the OAE method.
What do you notice about where they're being screened?
(Pause), They get pulled out into an environment that's foreign or
strange to them.
They're being screened in everyday educational or home environments,
Where the children are, for the most part, already happily spending
their time.
They're hanging out.
They're sitting in a snack table or playing with some toys in a corner,
or even in their out-door play environment; and...
those people...
Who are doing the screenings, are people they already know; they're
teachers from visitors, or health specialists, and so, there's a lot
of familiarity.
Already wrapped into this screening moment.
(A pause), DR.
WILLIAM
EISERMAN: So, in --
in fact, the screening works the best when children are familiar,
and comfortable with the adult who is doing the screening, and, where
they can play with a toy or be held, or, even sleep while the screening
is conducted.
And we're going to talk about sleep as an option in a moment.
So we have lots of options.
Now, some equipment is more effective than others when
attempting to screen in natural environments.
We know this.
But most of them -- most of these pieces of equipment, that you can
get, will work fine under these various conditions.
You may have to quiet the environment some.
But they should be able to be done in these moderately-noisy
environments.
Now, there are several keys to successful screening.
Terry, you want to go over these keys?
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, so there's four main keys to
successful screening that we want to talk about; and the first is to
ensure that you have a good probe-fit.
Second, we want to minimize movement; and then, we want to
minimize internal noise, noise generated, from the Child.
And then lastly, we want to --
minimize external noise in the nearby environment.
Now, the -- the goal with probe-fit, the goal with the proper probe
placement is that you have a really snug fit.
We want to seal out all of the noise from that background
environment, So, this means you need to select as large as possible
probe cover, so that when you insert the probe into the Child's
ear, you can totally let go of it, and it will stay in place.
So you want the largest probe cover that will fit in that canal.
In fact, you have to let go, because if you hold onto it, your
touch can actually loosen it, allowing more noise to get in and
disrupt the screening process.
The whole system is designed to be self-seated, so you don't hold
those probes in place.
So as long as you select probe covers, always aim for the biggest
one that will fit in that child's ear canal.
It's no great secret of -- aside from experience and being able to
make a good probe cover selection.
DR.
WILLIAM
EISERMAN: And you'll see in that photo there, that the hand is not
holding that probe in that little boy's ear.
But you do see that clip there.
That is reducing the tension of that cord from pulling the --
the probe out of the ear, so, that's another really helpful way,
of keeping that probe seated properly, in the ear.
Now, some brands of equipment have a compressable foam cover; which,
tends to be the easiest to achieve success, so, if your brand of
equipment has a foam cover option, You want to try those.
Especially, if you're having trouble with getting a good, snug
fit.
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Let me interject just a moment,
William.
Just a little aside about probe covers: You can only use the probe
covers that are intended, or made for your device; so even though you
may see others on the market, you just only use those made for your
specific brand of equipment; otherwise, you can get -- or will
get -- inaccurate results.
They are designed, and calibrated for their own probe covers.
.
>> DR.
WILLIAM EISERMAN: Now, Terry, some
reassurance is needed here.
Some people have raised a concern about their worries that they could
hurt a child, by inserting the probe, or that when they're helping
to support a new staff member, who is going through the process of
learning, that -- that that new staff member, is expressing that
concern.
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, we really understand that
concern.
And it's also the thing, with more experience, you'll --
promise you'll feel more comfortable about it after you've
screened lots of kids, but just be assured that these probe length
have been carefully-designed, so, that we can't insert them too far.
Now, a child with an active ear infection, they can experience --
they may experience pain with the probe insertion and that's one of
the reasons why we want to carefully-inspect the ear prior to
doing the screening, but otherwise, the probes will not go in deeply
enough to harm the Child's ear.
>> DR.
WILLIAM
EISERMAN: So --
and the videos that you see in the -- the training, and, other
resources we have on our Web site, demonstrate how to do
probe-insertion, as you see in the photo here, and -- we pulled the
outer ear back.
And then, insert the probe in the direction of the Child's nose.
And then, a little bit back with a slight twist to get it snug.
So -- and then we always do what?
We always let go.
(Laughing).
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: That's right, (laughing)
you always let it go and it should stay put.
And you also want to make sure that the cord has been clipped up -- as
you see in this picture -- up here -- to the Child's clothing.
One, to get it -- I always put it in the back to kind of get it out
of their sight; but, really, it's to keep the weight of the cord off
the probe.
So that the weight of the cord doesn't pull the probe out of the
ear.
And these are two, essential things for getting and keeping a good
probe fit.
.
>> DR.
WILLIAM
EISERMAN: Now, of course, as you screen, there will be times when
you get an error message, and we referred to this earlier.
And we can't go through all of the different error messages that --
across equipment.
But we can give you some general guidance about what to do about
error messages.
Because regardless -- of what the error message is -- you're probably
going to do, the same thing, and then try again.
(Pause), You're going to reposition the probe.
You're going to reduce external noise.
You're going to check the probe for wax and clean it off.
Or, even replace it with a new cover, if you need to.
And you're going to make sure the environment is as quiet as
possible.
And you're going to try to settle the movement down of the Child.
So it's kind of good to know that even though there are different
error messages that come up, the response to then is almost always
going to be the same.
(A pause), and then last, you're going to use unique toys, you're
going to try to distract the Child.
And you're going to just try again.
.
>> DR.
WILLIAM
EISERMAN: (Continuing), if you can't still have success, you can
always elicit the help from another screener, and then, you know, if
you really can't screen a child, as Terry has said over and over again,
then you make a referral to an audiologist.
TERRY FOUST, AUD, FAAA, CC-SLP/A: So William, we've received a number
of questions asking for suggestions on how to screen children, who are
just challenging to -- to keep still, or for whom you just can't
seem to complete a -- a screening.
So we'll go over some strategies, and then, if you have any
additional questions we can take them.
So there are several strategies that will help make a positive --
make the screening a positive experience for the children, And,
for you.
Again, I think I mentioned it earlier: You know, we really want
to create a fun feeling around the screening activity.
So we want to position the Child and yourself, and other helpers in
a way that's comfortable.
And allows the Child's behavior to be naturally-directed.
We want to use toys and distracters, and rewards effectively.
And then we want to document the screening results accurately.
So let's take a look at each of these for a moment.
So, first talking about creating that fun feeling: We want to --
we want to be sure to do that so creating a fun feeling around the
screening involves establishing rapport with the children.
So for example: You may tell a child you're going to play a
listening game and include another adult as the first person to be
screened.
Placing the probe near their ear, and asking them for example, "Can
you hear the little birdie sing?
" If you're working with a group of children, ask the teacher for
suggestions about which child might be the most cooperative and should
be screened first, so that we can set that good example, and that
tone for the other children to follow.
So they see a positive experience right upfront.
.
>> Dr.
Terry Foust: I do want to just say here -- and I think William
will agree with me --
that in our experience, this is what I think you were all so great
at.
We can teach technical skill, and which buttons to push, but that
natural ability to work well with children, is something that we have
admired when we've worked with many of you.
(Pause), .
>> DR.
WILLIAM
EISERMAN: Now when eliciting children's cooperation you still
want to tell them what you are doing, rather than asking them if
they want to participate.
Right?
TERRY FOUST, AUD, FAAA, CC-SLP/A: Oh, yeah, that's actually very
important.
We don't want to give them the opportunity to say no.
So we say -- we don't want to say, can we screen your ears or can we
test your ear?
We don't want to give them that opportunity, so you direct the
screening.
>> You may even suggest to the other children that they may have
to wait their turn, just like they would with other fun activities.
Assume it's going to be perceived as fun.
This can create the desire for them to participate, and, be next.
And be sure to use terms that describe the activity -- the
activity as "fun" and "interesting", and avoid using phrases like
"testing your ears" or "trying to be reassuring by saying it won't
hurt" or won't be painful, because, they're going to hear the word
"hurt" and "painful" and you're not going to like the response that you
get.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, (laughing), exactly, thank
you, William.
Now, in terms of positioning, you want to position yourself to the
Child -- to the side of, or slightly behind the Child because
that will give you good access to the ears to facilitate probe
insertion.
If it's possible have another adult hold the Child snuggly or keep the
Child distracted or their hands occupied with another activity.
And -- it's great to sit on the floor at their level.
I do that often.
.
>> DR.
WILLIAM
EISERMAN: Yeah, and you know what I want to insert here quick here
Terry is these strategies are the ones you need the most, when we're
talking about those littler children.
If you're the ones that are thinking about using OAEs with
three to five-year-olds -- it will be a breeze.
It's really not hard to get them to cooperate with this.
You just give them something to look at or a toy to hold and it's
not difficult.
It's these littler children that are more difficult.
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, they are, so having some good
toys as distracters is always helpful.
You want to present new or novel toys and distracters, at the moment
that you most need the Child's cooperation, so if a child loses
interest in one toy or a distracter present another one and have those
ready.
.
>> DR.
WILLIAM
EISERMAN: Sometimes a gentle caress or playful touching game can
distract the Child from the sensation of the probe in the ear.
.
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: And introduce something
that captures their attention through another sense can help
distract them from the sensation in their ear.
.
>> DR.
WILLIAM
EISERMAN: Now once complete reward the Child with praise, and if
desired, maybe a sticker or reward, making sure that the same praise
and the same reward is given no matter what the screening outcome
is.
.
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: It's also really helpful
to screen in teams, so you can have one adult manage the Child, while
the other one is focused on completing the screening.
Now, we would like to show you a variety of strategies for engaging
children in playful ways that will help you be successful.
As well as adding a few cautions about some common errors to avoid.
So a very important strategy is to keep that -- those little hands
away from the probe.
So, we want to redirect the Child to manipulate an object; or to
grasp an adult's finger or hand, but keep them busy.
And, offer the Child choices about where to sit, or what toy to play
with.
But not a choice about whether to be screened or not.
.
>> DR.
WILLIAM
EISERMAN: You can also familiarize the Child with the probe, before
attempting to insert it into the Child's ear and you can do that by
touching their leg or their arm, or their hand or their cheek with it;
pointing out how soft it is.
You may even also have the Child's help in pretending to screen a doll,
or a stuffed animal.
Sometimes, a young child will cry when the probe is inserted.
And you don't want to necessarily automatically remove the probe even
though that may be your first impulse.
Instead, let the Child relax with the probe still in the ear.
Have the -- your finger close to the start button and be ready to
push start the moment the Child is quiet.
Sometimes you can complete the -- the screening from that moment.
Even if the Child continues to be a little fussy.
.
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: Now, if a child is
uneasy about being screened but they can be soothed by using a
pacifier or giving them a snack, you can go ahead and attempt to
screen while the Child is sucking or chewing.
It does introduce noise.
As they're sucking or chewing so the result is a refer, you'll need
to repeat the screening, when the Child is not sucking or chewing.
But you can -- sometimes, still, be able to complete a screening, as it
-- as they are sucking or chewing.
Now, another strategy to consider is screening in groups.
And this can help some children who might be fearful to become --
fearful about the screening to become more comfortable with the
process.
As long as they're seeing that others are having a positive
experience.
So like we mentioned a little earlier, you always want to try to
start with a child that you or the teacher, is fairly confident will
be cooperative, and set that positive example you're hoping for.
.
>> DR.
WILLIAM
EISERMAN: Now we mentioned sleeping, sometimes children who
have been treated, repeatedly for ear infections, or, other
conditions, can be especially reluctant or resistant, and you may
need more time, to watch other children participate in the
process.
For -- to just get a little bit more comfortable with the whole
idea of it.
But another option -- and this can be used with any child, whether
they're reluctant about it or not.
Is to screen children while they're sleeping.
And so you can always do that, especially, with the -- the little
ones.
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, actually you don't even need
a reason to screen children while they're asleep.
It can be a great strategy that way.
So often used that.
Now, remember:
If you do not get a passing result, as long as the Child's cooperative,
go ahead and try the ear again.
Making sure, like we mentioned that you have good probe fit and that
you've minimized internal, external noise.
And, again, it's very important that once that screening is
complete that you be sure to document the results accurately.
.
>> DR.
WILLIAM
EISERMAN: Yeah, and in terms of documentation, this is our
screening form, which follows the -- the protocol step by step,
exactly; so if you haven't been using this or haven't been
acquainted with it, we encourage you to take a look at how it walks
through the complete process.
(Pause), so....
I want to make sure we have time to go over the protocols, so let's --
let's do that, and as soon as we -- we wrap this up, we'll open up for
questions about OAE screening, or anything we didn't address about
puretoneing, puretone-screening, now, the screening and follow up
protocol for -- for OAE screening, and puretone screening, is exactly
the same.
.
>> DR.
WILLIAM
EISERMAN: And just keep in mind that our best efforts, at screening,
are onlyworthwhile if we implement effective follow up, so take a
walk-through of the follow up protocol and see if you have any
questions about that.
(After a pause), so one of the good things to remember, is....
That the steps of the follow up protocol, are the same.
As I said, regardless of what screening method or how old the
Child is, and there's one main rule to remember: The screening and
follow up process is complete, when either the Child passes the
screening on both ears, Or the Child has been referred to an
audiologist, and you have obtained those results.
(After a pause), on the screening and follow up protocol and the
accompanying forms we've got on kidshearing.org, walk through this
process, step by step; so, if an ear passes the first screening, the
process is complete for that ear.
If the ear doesn't pass, after several attempts during the initial
screening session, We can't be sure why.
Sometimes, it's due to screener error; or a temporary condition,
like a head cold.
So, it wouldn't be practical for every child, who doesn't pass, at
that first screening to be referred to a healthcare provider, or an
audiologist.
so, several Participants have asked, Terry -- what about a head cold?
Congestion?
Can affect screening outcomes?
This is where we might see that, right?
Can -- can you go over that, Terry?
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, absolutely.
You know, -- and maybe, for example in the fall, it's cold and flu
season, and -- and so, we may temporarily have that congestion or
middle ear fluid but the -- the protocol, will walk us through that,
and get the appropriate follow up and so, my recommendation, is
follow the protocol.
.
>> DR.
WILLIAM
EISERMAN: Yeah, and so in two weeks we screen again and if the
ear passes the screening is complete for that ear.
If, however, the ear still doesn't pass the screen,ing, then further
evaluation is needed, and we expect about 8% of the children, won't
pass the second screening and, in fact, will need to have their ears
checked by a healthcare provider, using what's called timpnometry, or
pneumatic otoscopy, it's not uncommon for them to find wax
blockage.
Or fluid or information, in the middle ear has prevented the
screening of the inner ear.
From having been completed.
So, what, then, Terry?
They're at the healthcare provider.
.
>> TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, so at this point,
that's, actually, when you want to intensify your monitoring of the
Child's follow up.
So, consult closely with the healthcare provider to find out,
first, the results of the middle ear evaluation, and second: Any
treatment that's being provided.
And, again, always document the results of that middle ear
evaluation.
Now, this important point: Keep in mind since the ear hasn't yet
passed the screening we still don't know if the inner ear or the
cochlea is functioning properly.
And unfortunately, most healthcare providers do not have hearing
screening equipment, and, therefore, cannot complete the screening
process, so you'll need to confer with the healthcare provider about
when that ear should be rescreened.
And then after the middle ear evaluation:
Go ahead and conduct a rescreen, And then, if the ear passes, the
screening is complete.
If the ear still does not pass, that's when the Child should be
referred to a pediatric audiologist for evaluation.
DR.
WILLIAM
EISERMAN: Less than 1% of the children you'll be screening will
typically go this far in the process.
But, it will be helpful to inform healthcare providers, who are
involved in the middle ear evaluation step, that they may need
to make that referral to the audiologist should the ear not pass
the rescreen.
You'll want to be sure, then, to support parents, and have the
audiological evaluation completed.
To provide with audiologist with all of the screening and follow up
health related outcomes and then to obtain a complete report from the
audiologist's evaluation.
So that gives you an overview of the complete screening, and follow
up protocol, and just --
you know, remember:
All of this is on our Web site, that you can review, any time.
And -- and keep in mind, too,:
That if children pass but parents remain concerned about their
hearing or the Child's language development, always make a referral
for an audiological evaluation, that's always warranted, and it
overrides passing screening results.
All right, so we know we have a number of questions, That you are
asking, so, let's look at...
some of the questions that are coming in.
(A pause), Dr.
William Eiserman.
In someone who has been trained to use the OAE, train a new staff,
does it need to be a representative from an OAE company?
So our advice about this is that you want to make sure that
everybody gets trained exactly the same way.
That -- that you don't end up passing on information like that,
that telephone game, where, it changes a little bit, from one
person to the next; and then to the next, and then to the next.
And so, that's one of the reasons why we have a standardized
curriculum available on our Web site to make sure that that is
done.
So, we would encourage you to check out that; or, if you have a local
audiologist, or somebody in your state that offers that kind of
training to access that as a part of this.
As far as getting the training from the equipment supplier:
We kind of caution you about relying on that, as you're
training.
Because, they're not really prepared to help you develop a
screening program, or to develop screening skills.
It's kind of akin, to the way you might look at a car salesperson: A
car salesperson will show you all the functions of the car; how to
roll the windows up and down, and all of that --
All of that stuff.
The fancy features of the car.
Put But they're not going to teach you to drive or how to parallel
park, so by all means, have a listen to what the manufacturer, or
salesperson or distributor can tell you; they may get way over your
head, and show you parts you don't even need to know about the
equipment.
But you're going to need more training than what they typically
can provide.
Terry, this next question is:
Q: Does holding the OAE tip in the ear, really impact results of the
screening?
I find most of the tips, even when we try various sizes, just don't
stay in the Child's ear due to most children not being able to sit
still.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Right so two thoughts here.
My first is that, yes, it does impact the results of the
screening.
Often, when the Child moves that finger can, then, press the --
as they move, it can press that finger up against -- or the probe
up against the ear canal and actually block it and then we would
get a refer; and so, it -- they are designed to be self-seating.
And I do hear you with probe covers not staying in the probes not
staying in the Child's ear as they move.
It is one reason that as William mentioned earlier, we've found
those foam probe covers that we squish down, place in the ear and
they expand -- to be self-seating much better than more of the
plastic tips.
So if you have a foam tip option -- I would encourage you to use that
if you can.
DR.
WILLIAM
EISERMAN: The next question illustrates one of the reasons why
it can be really helpful to have an audiologist nearby, to consult
with.
But, Terry, here's the
QUESTION: On our OAE equipment, there are settings that indicate
protocol DP, where, you can....
Where it says you can pick between two S to 4S.
Do you know what that means?
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, so we're getting into
settings here that -- that, are really specific.
What we really want to do, is to use the basic screening protocol on
your equipment.
And so, this is a great question for your program audiologist, and
your -- and/or your equipment manufacturer but you want to use
the -- the basic screenscreening option that is on there; there are
all kinds of settings that change that you can change from adding
different frequencies, To length of time that it screens.
And so -- yes, that does refer to the -- the amount of time that that
probe is looking for the response.
But, again, I would -- I would confer with your program
audiologist, and/or the equipment manufacturer.
.
>> DR.
WILLIAM
EISERMAN: On our Web site, which you see right here, under "planning
resources" do you see the third one that says "screening equipment"?
We would encourage you to go look there, because we do offer some
basic specifications on what you would want to have your basic
equipment set at.
So that, you might want to refer to in addressing questions like this.
And others related to settings of your equipment.
To make sure that you're screening at the appropriate frequency levels,
et cetera.
TERRY FOUST, AUD, FAAA, CC-SLP/A: William, there's a really great
question that says, when screening a group of children, how do you
clean the probe before placing it into another child's ear to be
screened?
And that's what the probe covers, themselves, are for; so, again,
before -- you always want to look at your equipment, check it out
before you screen, and in between each child -- so look at that probe,
make sure that it's not blocked in any way, you can clean that probe
with a soft, moist cloth.
Always wiping away from the probe, the base of the probe, itself But
the part that makes contact with the Child's ear is the probe cover,
and those are one-use, disposable-only.
You can use the same probe cover for both ears of the same child,
but never the same probe cover for multiple children.
.
>> DR.
WILLIAM
EISERMAN: The next question is, can you give specific direction on
where to find the forms on the Web site?
So, yes, on the Web site, right here, kidshearing.org, if you go
under to where it says "screening resources", it's about in the
middle of your screen there --
Right -- the second area that says, protocol guides and forms.
the next question: Every once in a while, I can't get the OAE to move
from probe check screen, to the actual screening screen.
It is like the OAE doesn't know it is in an ear, what can I do to
resolve this or can it be resolved?
Is it a fail or do I try again in two weeks?
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Great question, I'm going to start
at the bottom or your last question, is it a fail?
It's not a fail, because we've actually never even moved to screen
or collected any data from the Child.
Now, having said that, it's a common probe error message that you
may get when the machine says, "I don't have -- you don't have a good
enough fit", and there's too much noise getting in, and it's not able
to progress from checking the probe fit to the actual screening; so --
so it is a common error; and usually, you want to refit and
retry; however, what I am suspecting you are -- you are
probably meaning -- is that, the machine seems to get stuck there.
And what I would do, then, is to completely shut it down, turn it
off, and then restart it.
And because sometimes occasionally machines will get stuck there.
And hopefully that will help.
If you're not able to, then, go ahead and check your equipment
operation by doing a check on yourself, and, if you can't get it
to work, then it probably needs to be seen by your equipment
manufacturer.
But --.
>> DR.
WILLIAM
EISERMAN: But we can really sympathize with those of you who
are trying to use a piece of equipment, and sometimes, it does
stuff that you just flatout don't understand.
and, that really is -- I mean, you can always e-mail us, if we can be
of help.
But it really underscores why it is so nice to have a local pediatric
audiologist, who can volunteer if possible, to help you out
occasionally, with some of these moments where they could come and
look at the equipment, or, help you with a given child, so, we just --
We really encourage, if there's any way to find that person, it's worth
building the rapport with them to have them as a consultant to your
program.
And a lot of people will work with -- with programs on a volunteer
basis.
Given all that you're trying to do for children.
(Pause), we have one more question and then, in a moment, you're going
to see in the chat field --
A survey that you can click on to give us a quick feedback on today's
webinar.
And once you do that, it will generate a certificate of
attendance for your participation in today's webinar, in case you
need to document that you've been with us today, So that will appear
in the chat, box here, in just a moment.
So, one last
QUESTION: Can a screening program -- this is kind of a review because
we have talked about this.
Can a screening program move forward with only OAE for children
under 5?
Or, is puretone always the gold standard for three to 5s?
Terry?
.
>> Dr.
TERRY FOUST, AUD, FAAA, CC-SLP/A: Yeah, great question, so it's
historically been the gold standard for three to 5, but now that we
have the option.
The gold standard really is...
to be prepared to screen every child.
And so, as we mentioned, ideally, if you have both as --
as options, wonderful.
But in order to screen every child, then, you can move forward with
only OAE for children under 5.
And then, of course, taking into account -- your -- you know, any
health advisory programs, consultation with audiologists and
your team, whatever it takes to get those approvals and your policies
and things like that.
.
>> DR.
WILLIAM
EISERMAN: If you direct your attention, again, to this
screenshot, on your screen, of our Web site, kidshearing.org.
Under that first item that says big-picture resources, under there,
you will find a document that compares OAE, and puretone
screening considerations.
For three to five-year-olds.
If that's your question, you'll want to look at that document, and,
then, make a decision with your health services advisory team, or
whomever else is designated for your program.
(After a pause), we are at the bottom of our hour, and a half.
Thank you, everybody, for your time and attention today, for these
excellent questions, More importantly, for all that you're
doing, amidst everything you have on your list.
To focus -- focus in on monitoring the hearing status of children that
you serve.
you know....
We put a great deal of emphasis on the importance of language
acquisition in young children.
And hearing receptive language, is a critical part of that.
And, you seem to understand the importance of that, this isn't just,
a requirement that needs to get checked off, doing hearing
screenings, it is an important part of making sure that all children
have optimal access to language, as they're learning language, and even
a mild hearing loss or a unilateral hearing loss, that goes unaddressed,
can disrupt that language -- that language-learning process, and
their overall development, and -- as educational readiness, So thank
you, for that, and, remember to pass that -- that idea along,
Remember to pass that idea along to your colleagues and to the parents
of the children that you serve.
Another shoutout of thank yous to our captioner, and to our
interpreters today, and to our background support folks, Thanks,
everybody, and Terry, of course, as always -- thank you!
Tomorrow: Is another webinar.
So, if you or you know of folks that are really needing to learn
about evidence-based hearing screening practice for the first
time, that's what we're covering tomorrow.
It's going to be more basic than what we talked about today.
But it will cover both OAE, and puretone screening to help people
know about the basics of developing OAE, and, or puretone screening.
So, send people our way, and if they need to register, they can go
to kidshearing.org.
All right, the link is posted in the webinar chat field to do the
quick survey and to get your certificate of attendance for today,
thanks everybody, and know, today's webinar has been recorded
and will be posted on kidshearing.org, and
infanthearing.org in the next couple of days.
Thanks everybody, And Gunnar, if we can just keep -- yeah, if you can
keep the room open for a few minutes, so people have a chance to
click on that.
That would be great.
Thank you.
(Concludes