An introduction to hearing surveillance

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An introduction to hearing surveillance

• Contributor
• Dr F Rahman
• Derby

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Hearing SurveillanceLearning Objectives

• 1. To describe the surveillance programme
  recommended nationally.
• 2. To establish when additional hearing testing
  is required.
• 3. To select the hearing test appropriate for a
  particular child.
• 4. To assess the quality of services provided.
• Hearing Surveillance Dec 2002/Dr. Fawzia
  Rahman/Central Derby PCT

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Surveillance Check Points for Hearing/
Language/Behaviour

• Targeted neonatal screening
• 6/52 check
• 6/12 hearing screen
• ? 18 24/12 HV assessment
• ? 3 year developmental assessment
• 5 year school entrant screen sweep/
  audiogram

• Hospital
• HV Dr
• HV (HVDT)
• HV
• HV
• School nurse

Surveillance is a continuous process Hearing
Surveillance Dec 2002/Dr. Fawzia Rahman/Central
Derby PCT
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Hearing Screeningthe Tests

• Neonate POEMS/cradles
• 6-8 months Distraction
• 2 year Co-operative toy tests
• 4 year Audiogram
• not tympanogram
• Hearing Surveillance Dec 2002/Dr. Fawzia
  Rahman/Central Derby PCT

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Word pairs from McCormick Toy test

• Cup duck
• Tree key
• House cow
• Horse fork
• Plate plane
• Shoe spoon
• Lamb man Hearing Surveillance Dec 2002/Dr.
  Fawzia Rahman/Central Derby PCT

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Hearing ScreeningRecommendations

• Universal neonatal hearing screening
• Followed by targeted HVDT at 7 months for missed
  cases
• Information system strategy and co-ordination of
  a seamless service
• 40dbhl averaged better ear detected early
• RD
• Hearing Surveillance Dec 2002/Dr. Fawzia
  Rahman/Central Derby PCT

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Hearing Screening

• Neonatal screening marching on
• No national policy / quality standards
• New 15 seconds device
• School entry screening
• Snhl 1/1000 ome 300/1000
• Parent questionnaire with scores
• Hearing Surveillance Dec 2002/Dr. Fawzia
  Rahman/Central Derby PCT

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Hearing ScreeningTodays Best Buy

• Selective neonatal testing
• Universal 6-8 months hvdt automated
• School entry sweep / audiogram
• Set protocol audit of key outcome
• Opportunistic testing by experienced staff
• Hearing Surveillance Dec 2002/Dr. Fawzia
  Rahman/Central Derby PCT

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Hearing ScreeningWhat Can the Doctor Do?

• Detailed family history
• Hearing aid below 40
• Consanguinity 50 genetic
• High risk
• Cerebral palsy / syndrome / visual impairment /
  prematurity/ delay in development
• Examination
• Pinna and external auditory meatus shape
• branchial arch anomalies
• No testing at six week check
• Ask about hearing behaviour
• Hearing Surveillance Dec 2002/Dr. Fawzia
  Rahman/Central Derby PCT

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Marks story

• 4 year old referred by SLT
• At nursery, poor speech and language
• Passed HVDT and 3 year assessments
• ENT
• Family history
• Mild dysmorphic features
• Health, education, social services

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Marks story 2

• Mother and child hearing
• Hearing aids
• Back to geneticist
• Educational psychologist
• Voluntary association
• Disability living allowance
• School progress

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Quality in Hearing Screening

• Detect and fit 90 severe loss by 15 months
• Audit any late diagnoses in detail
• National Deaf Childrens Society Standards
• Hearing Surveillance Dec 2002/Dr. Fawzia
  Rahman/Central Derby PCT

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Hearing questions

• Should you attempt any kind of testing at the 6
  week check? What if mother is concerned?
• Would you test a 2 year old who has no words?
  How?
• Would you test a 3 year old with poor speech?
  How?
• Whom would you contact if you were worried about
  the hearing of a school age child?
• Hearing Surveillance Dec 2002/Dr. Fawzia
  Rahman/Central Derby PCT