Assistant Audiologist Workshop

Transcription

1 Assistant Audiologist Workshop BAA Conference 20th-21st November 2014 Hearing Screening

2 What is screening? From the UK National Screening Committee: Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition

3 Hearing screening Newborn hearing screening programme School entry screening Adult hearing screening

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5 What is it? The NHS Newborn Hearing Screening Programme (NHSP) offers all parents in England the opportunity to have their baby s hearing tested shortly after birth. NHSP aims to identify moderate, severe and profound permanent childhood hearing impairment (PCHI) in newborn babies.

6 Newborn hearing loss Environmental (50%) Genetic (50%) Syndromic (30%) Non syndromic (70%)

7 Environmental causes Congenital infection such as: Cytomegalovirus (CMV) Congenital rubella Toxoplasmosis Ototoxic drugs including: Certain antibiotics e.g. streptomycin Recreational substances e.g. alcohol Prematurity Asphyxiation

8 Genetic causes Syndromic: hearing loss present as part of a syndrome such as: Waardenburg s Usher s Treacher Collins Down syndrome Non-syndromic: hearing loss present in isolation Gene mutations/faults

9 Why do we screen babies? 1-2 babies in every 1000 are born with a hearing loss Most are born into families with no history of hearing loss Previous method of identifying early hearing loss was ineffective Untreated hearing loss can significantly affect speech acquisition

10 6-11 months: babbles, tries to repeat sounds heard 1½ years: 5-20 words, combines words 3-4 years: 100s of words, uses sentences, 90% of speech intelligible < 6 months: gurgling, cooing, laughing 1 year: 1-2 words, understands simple instructions 2-3 years: 50 words, uses short sentences

11 Effect of hearing loss on speech Babies progress from babbling to complex sentences in less than 4 years, provided they can hear properly Hearing impairment prevents children from hearing speech clearly and developing their own speech Hearing impairment in children can also cause problems with social interaction, learning/education & behaviour Early identification is key Identification and intervention (e.g. hearing aids) before age 6 months has a significant impact on the development of expressive and receptive language

12 How do we screen newborns? Done shortly after birth Usually tested on the ward (as an inpatient), or on outpatient clinic 2 types of screening test AOAE AABR

13 AOAE (automated oto-acoustic emission) Tests outer hair cell function of inner ear Small probe inserted into baby s ear Detects sound generated by inner ear in response to click stimulus Requires baby to be asleep/settled

14 If no response on AOAE. AABR (automated auditory brainstem response) Tests auditory pathway up to brainstem level including auditory nerve Click stimuli played into ears Records electrical responses to sound via electrodes placed around baby s head Requires baby to be asleep/settled

15 Outer ear Middle ear Inner ear Auditory nerve and brainstem AOAE AABR

16 Screening procedure Well babies tested with AOAE (AABR used if no response) Babies in intensive / special care tested with both AOAE & AABR clear responses needed in both ears to pass the screen

17 Outcomes of screening PASS No significant hearing loss detected For most babies no further action needed Some babies require targeted follow-up at later age due to certain risk factors e.g.: Syndrome associated with hearing loss Craniofacial anomaly Congenital infection See NHSP guidelines for full details

18 Outcomes of screening FAIL Can be due to several reasons such as: Fluid in baby s ear Baby unsettled Poor recording conditions Hearing loss Babies who fail screen need to be referred to audiology for further diagnostic assessment

19 Diagnostic assessment Diagnostic auditory brainstem response (ABR): non-automated version of AABR can determine degree of hearing loss can determine type of hearing loss frequency specific

20 ABR responses Responses present Responses absent

21 Role of hearing screener Informed consent Onward referrals Hearing screener Carry out screen Record / upload results

22 Importance of screener role Communication with parents Informed consent What screening involves Implications of results Why screening is important What to expect next

23 Importance of screener role Screening procedure Accurate screening technique is crucial Handling of baby Further management Identify and make arrangements for babies that require audiology referral and/or targeted follow up MDT approach: liaise with midwives, doctors, interpreters, audiology, nurses etc.

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25 What is it and why do we screen? School hearing screen offered as part of school entry health check (includes vision, height and weight) Even with a very sensitive newborn hearing screen, some cases of significant hearing loss will be missed, or will develop later a wider system is still needed in order to identify these children

26 Screening procedures Usually a screening version of pure tone audiometry with child responding via clapping, raising hand etc. Variation between regions for test protocols, frequencies tested, staff performing test, pass criteria etc. Often done in poor listening conditions Children who fail school screen may require referral to Audiology department better test environment, more in depth testing

27 Role of assistant audiologist Role may include: Organisation of local screen provision Carry out screening in schools according to local protocols Collate and report data Coordinate onward referrals if necessary

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29 Adult hearing screening campaign Promoting the case for adult hearing screening People aged 65 years and over Pilots shown to be cost-effective

30 Potential benefits of screening including hearing aids, communication advice, lip-reading, assistive devices

31 Role of assistant.. Carry out screen Assistive technology Onward referrals Contact eligible patients Raise awareness Communication tactics Provide advice

32 Further information UK national screening committee Newborn hearing screening programme Hearing screening for life campaign Health Technology Assessment Programme DoH Child Health Promotion Programme 15/ wnload/dh pdf