Hearing Screening Protocol

Transcription

1 Hearing Screening Protocol School-age hearing screenings are an integral tool in identifying children with hearing loss who were not identified at birth, lost to follow-up, or who developed hearing loss later. Without mandated routine hearing screenings in schools, students with unilateral, less severe, or late-onset hearing loss may not be identified or will be misdiagnosed and managed. Efforts to provide consistent protocols, screener training and follow-up through school-age will help ensure that children with hearing loss are identified and managed in a timely manner, and thereby minimize negative academic consequences. Source: Screening practitioners should be limited to: Audiologists holding a Certificate of Clinical Competence (CCC-A) from the American Speech- Language-Hearing Association (ASHA) and state licensure where applicable. Speech-language pathologists holding a Certificate of Clinical Competence (CCC-SLP) from the American Speech-Language-Hearing Association (ASHA) and state licensure where applicable. Support personnel under supervision of a certified audiologist. Screening shall be provided for: Kindergarten students; 1 st grade students; 3 rd and 5 th grade students with no documented hearing screening; and, Students referred to the school nurse by self, parents, and/or staff. Exceptions to routine screening include students who are under the care of/followed by a healthcare provider or an audiologist and have a recent audiogram completed. Difficult to Screen Students Students unable to follow directions of the screener and/or unable to respond to the screener with reliable responses shall be referred to the district s audiologist for testing and evaluation. The district s audiologist shall determine if a referral to an outside agency or provider is needed. Referrals, results obtained from district s audiologist and/or outside provider, and follow-up shall be documented in PowerSchool and Individual Health Record (IHR) if applicable and may also be noted on the student s health card by the school nurse or the district s audiologist. Parental/Legal Guardian Notification and Consent Routine (mass) screening: Grade levels will be listed in the student/parent handbook which is updated annually. Students who do not pass the screening: A referral letter will be sent home by the student with instructions for required action. School nurses are responsible for follow-up and documentation. Passive (opt-out) consent shall be utilized for mass screening. The Exceptional Children s Department is responsible for obtaining parental/legal guardian consent for all screening required for their program and testing purposes. During screening: Maintain infection control and observe universal precautions. Do not prompt the child to respond.

2 Make sure the student is conditioned before starting the screening protocol. Arrange the setting so that the student is at a slight angle or with his/her back to the screener; do not conduct the screening facing the student. Screening Environment Ambient noise levels in the screening environment should not exceed 49.5 decibel (db) Sound Pressure Level (SPL) at 1000 Hertz (Hz), 54.5 db SPL at 2000 Hz, and 62 db SPL at 4000 Hz when measured using a sound level meter with octave-band filters centered on the screening frequencies. These levels are derived from consideration of the American National Standards Institute (ANSI 1991) standards for pure-tone threshold testing and are adjusted for the 20 db (Hearing Level) HL screening level. The person performing the check should have normal hearing. Wearing the audiometer earphones, the screening frequency pure tones (1000 Hz, 2000 Hz, and 4000 Hz) should be heard at the screening tone level. If the tones cannot be heard at that level at any screening frequency, do not screen in that area. Listening Check of the Audiometer Prior to providing hearing screenings, a listening check of the audiometer should be performed by the examiner. The recommended procedure is as follows: 1. Examine the earphones. Check the cushions for cracks or splits. Wipe the headband pads and earphone cushions with an approved antiseptic solution. Do not allow solution to enter the opening in the center of the earphone. 2. Examine the earphone cords for breaks. Gently untwist the cords if they are tangled. 3. Examine the audiometer controls and be certain that all operate smoothly. Check that the tone presentation control works properly. 4. Perform a listening check while wearing the earphones: a. Set attenuator at 50 db, frequency selector to 1000 Hz, output selector to right ear, and press tone presentation switch. Tone should be clear. Check other screening frequencies in a similar manner. Repeat for left ear. b. Set attenuator at 30 db and output selector to right ear. Without pressing the tone presentation control, listen for "hum". None should be present. Check for "hum" at 0 db. Repeat for left ear. c. Set attenuator at 0 db and output selector to right ear. Press and release tone presentation control. No audible click should be heard upon depressing and/or releasing this switch. Do not use an audiometer that is not working properly. Screening for school-age children 5-18 years of age - ASHA Guidelines for Hearing Impairment 1. Screen via conventional audiometry or conditioned play audiometry with supra-aural or insert earphones using 1000, 2000, and 4000 Hz at 20 db HL. 2. Each tone should be presented for 1 to 3 seconds duration. 3. Minimum of 2 responses at each frequency. 4. Start screening with the right ear; however, if there is known or stated hearing loss in this ear start with the left ear. 2 Nash-Rocky Mount Public Schools Hearing Screening Protocol

3 5. After instructions are given present a tone at 1000 Hz: a. If the child, responds present tone again. b. If the child, responds go to 2000 Hz and then 4000 Hz. c. Record your results and switch ears. 6. If child does not respond at 1000 Hz at 20 db: a. Raise the tone to 40 db. b. If no response, re-instruct. c. After re-instruction, if no response go to 2000 Hz. d. If you can not get the child conditioned to respond, try a different task or try later. e. If the child does respond, proceed as described above, going back to 1000 Hz after 4000 Hz. 7. Switch output to other ear and repeat steps. Record results on appropriate forms. 8. Pass if child's responses are judged to be clinically reliable at least 2 out of 3 times at the criterion decibel level at each frequency in each ear. 9. Refer if child does not respond at least 2 out of 3 times at the criterion decibel level at any frequency in either ear or if the child cannot be conditioned to the task. Screening for Children 3-5 years of age - ASHA Guidelines for Hearing Impairment 1. Condition the child to the desired motor response prior to initiation of screening (blocks in bucket, push a button, clap hands, and/or stop the beep, etc.). 2. Start the task above threshold to assure that the child understands the task. 3. Screen via conventional audiometry or conditioned play audiometry with supra-aural or insert earphones using 1000, 2000, and 4000 Hz at 20 db HL. 4. Each tone should be presented for 1 to 2 seconds duration. 5. Minimum of 2 responses at each frequency for reliability. 6. Start screening with the right ear, if there is known or stated hearing loss in this ear, start with the left ear. 7. After instructions are given present a tone at 1000 Hz: a. If the child responds, present tone again. b. If the child responds, go to 2000 Hz and then 4000 Hz. c. Record your results and switch ears. 8. If child does not respond at 1000 Hz at 20 db: a. Raise the tone to 40 db. a. If no response, re-instruct. b. After re-instruction, if no response, go to 2000 Hz. c. If you cannot get the child conditioned to respond, try a different task or try later. d. If the child does respond, proceed as described above going back to 1000 Hz after 4000 Hz. 9. Switch output to other ear and repeat steps. Record results on appropriate forms. 10. Pass if child's responses are judged to be clinically reliable at least 2 out of 3 times at the criterion decibel level at each frequency in each ear. 11. Refer if child does not respond at least 2 out of 3 times at the criterion decibel level at any frequency in either ear or if the child cannot be conditioned to the task. 3 Nash-Rocky Mount Public Schools Hearing Screening Protocol

4 12. If Otoacoustic Emission (OAE) equipment is available and the tester has been trained by the audiologist, this testing should be attempted and used as a hearing screening pass. A pure tone screening should be attempted at a later date. Pall/Fail Criteria Pass: Response to minimum of two (2) presentations of 1000, 2000, and 4,000 Hz at 20 db, both ears. Fail: Failure to respond to one presentation of 1000, 2000, and 4,000 Hz at 20 db, in one or both ears. Re-Screen Failure to respond to one frequency in one or both ears at the above passing shall be re-screened by the school nurse within 7-10 days. Referrals to District s Audiologist 1. Students failing re-screening. 2. Any student complaining of pain in ear and/or with drainage from the ear. 3. Students who pass the hearing screen but who are referred by the teacher for complaints such as "says huh a lot", " doesn't seem to hear me," or "doesn't follow verbal instructions." Note: The student may also need a Multi-Tiered Systems of Support (MTSS) or (Behavior and Academic Intervention Team (BAIT) referral and/or screening. Documentation Samples Date Hearing Screening and Comments 11/1/2014 Pass 20 1, 2, 4000 Hz 11/1/2014 Fail R ear, re-test 11/8/2014 Fail R ear, referral to Dr. Rutledge. Parent notified letter home w/student. 11/1/2014 Pass 20 1, 2, 4000 Hz Teacher concerns* noted in classroom. Referral to Dr. Rutledge. Parent notified letter home w/student. *Document teacher s concerns/comments in narrative section of health card and IHR, if indicated. 11/1/2014 Pass 20 1, 2, 4000 Hz Teacher concerns* noted in classroom. Referral to Dr. Rutledge and to MTSS/BAIT. Parent notified letter home w/student. *Document teacher s concerns/comments in narrative section of health card and IHR, if indicated. Date Pure Tone 1000 Hz 2000 Hz 4000 Hz Comments R 20 db 20 db 20 db 11/1/2014 Passed. Add school nurse signature. L 20 db 20 db 20 db R 20 db 30 db 20 db Referred to Audiologist (Note if district s 11/1/2014 audiologist or an audiologist outside the L 20 db 20 db 20 db district). Add signature of school nurse. 4 Nash-Rocky Mount Public Schools Hearing Screening Protocol

5 Student Referrals Parent/Legal Guardian Notification 1. The parent/legal guardian shall be notified regarding a student s referral for failed hearing screening and/or other hearing/ear concerns to the district s audiologist, student s healthcare provider, ENT specialist, and/or another outside agency. The notification letter shall be sent home with the student or mailed, based upon the student s reliability. 2. A copy of the referral letter shall be placed in the student s Individual Health Record. School Nurse Coordination and Follow-up 1. District s Audiologist a. Referrals to the district s audiologist shall be made by , providing the student s name, results of initial screening and re-screening results, if applicable, and a detailed description of additional problems and/or concerns noted by the school nurse and/or teacher, parent, or support staff. Supporting documents and/or Hearing Referral Form may also be included, sent by attachments. b. School nurses shall assist the district s audiologist in sending the Audiology Referral Form to parents/legal guardians, upon request. c. School nurses will assist in communication of student referrals that are made by the MTSS or BAIT committees to the district s audiologist. d. School nurses will also assist the district s audiologist with follow-up, updates on outside referrals she has made, and other requested coordination needs. 2. Other Healthcare Providers and Agencies a. Referrals to other outside providers and/or agencies shall be made, using the using a Hearing Referral Form. b. Two (2) types of referral forms are available in English and Spanish. Hearing Referral Form that includes healthcare provider/pediatrician. Hearing Referral Form for ENT or audiologist as the only recommendations. c. School nurses will provide follow-up on hearing referrals through written and verbal contacts, documenting occurrences and results. d. School nurses will provide encouragement and assistance to parents/legal guardians when needed to assure compliance in obtaining the recommended care. e. School nurses shall make case referrals to school social workers in situations of parental negligence in obtaining medical care for students with identified needs/problems. Completed Referral Forms and Documentation of Findings 1. The bottom section of the hearing referral form should be completed by the district s audiologist, audiologist outside the district, healthcare provider, or ENT specialist and returned to the school nurse. 2. The school nurse shall document findings/results of the referral in PowerSchool and may also note on the student s Permanent Health Record. 3. The completed referral form is then filed in the student s Individual Health Record. 4. Results and recommendations of audiological reports shall be shared with the student's teachers and documented in the Individual Health Record. 5 Nash-Rocky Mount Public Schools Hearing Screening Protocol

6 Health Screening Referral by the Exceptional Children s (EC) Department 1. School nurses shall complete the Health Screening Form, provide the original to the person submitting the referral, and place a copy in the student s Individual Health Record, if applicable. 2. The school nurse shall document the results of the student s health screening in PowerSchool and may also note on the Permanent Health Record. 3. The Exceptional Children s Department or committee chair person of MTSS and/or BAIT is responsible for filing and documenting the results of student s health and/or hearing screening in the EC record. 4. The Exceptional Children s Department or committee chair person of MTSS and/or BAIT is responsible for documentation, follow-up, related coordination, and/or communication for student referrals made when the student passed the routine health and hearing screening, has no documented hearing and/or ear concerns, and is cleared by the school nurse. 5. The Exceptional Children s Department or committee chair person of MTSS and/or BAIT is responsible for notifying the school nurse and classroom teachers of such referral findings/results. Students with a Permanent Hearing Loss and/or Central Auditory Processing Disorder (CAPD) 1. Students diagnosed with a permanent hearing loss and/or Central Auditory Processing Disorder (CAPD) shall be referred to the Hearing Impaired (HI) teacher for evaluation by completing the Hearing Impaired Student Form. 2. The school nurse shall send a copy of the Hearing Impaired Student Form and audiological report to the district s audiologist by . Students with Earwax 1. Parents/legal guardians of students with significant earwax that interferes with hearing screening shall receive the Earwax Information sheet. 2. The school nurse will follow-up with the student for re-testing or compliance with the hearing referral, if applicable. 6 Nash-Rocky Mount Public Schools Hearing Screening Protocol