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Hearing Screening for Health Assistants

Charlotte Branch-Briggs, BSN, RN

NMDOH NE Region

School Health Advocate

505-476-2714

charlotte.branchbri@state.nm.us

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Symptoms of Hearing Loss3 to 6% of children have significant hearing problems. Early detection can prevent problems in speech, social and educational development

pain in ear(s) ringing / buzzing discharge from ear(s) dizziness inability to hear certain

tones straining to hear

conversation

favoring one ear lack of response to nearby

sounds need for loud volume on

TV/radio inability to hear with

background noise

(SHM III, pp 20-31)

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Equipment– Pure Tone Audiometers Sensitive electronic equipment, which must be calibrated

annually to ANSI standards Do not drop or handle roughly Protect from extreme temperatures and humidity and

dust (below 40, above 100) Store off the floor with protective cover in place Never eat, drink or smoke near the audiometer Store only the earphones & cords in the storage

compartment Do not turn on and off if doing multiple screenings in one

day.

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Audiometers

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Care of Earphones

Do not drop earphones Protect the diaphragm from vacuum, sharp

objects and liquids Check for splits on cushions, broken wires,

that they are plugged in correctly Do not twist, wrap or knot the cords Earphones are unique to each audiometer

and may not be exchanged

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Loudness and Pitch

Loudness of sound is measured in DECIBLES (dB)

Pitch or Tone is measured in HERTZ (Hz) High or Low Sound

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Types of Hearing Screening

Sweep Test

Students are tested at 20 dB for frequencies

1000 Hz 2000Hz 4000Hz

1000 Hz2000 Hz4000 Hz

At 20 dB

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Types of Hearing Screenings (cont.)Threshold Test

Test the student for the same frequencies, but determine which is the lowest intensity at which the tone can be heard and record this number.

Date Screened:_______1/31/2010_________________________ Date Screened:_______3/1/2010__________________

500 Hz 1000 Hz 2000 Hz 4000 Hz 6000 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz 6000 Hz

LEFT

30 30 35 P DNT LEFT

35 30 40 30 DNT

RIGHT

P P P P PRIGHT

P P P P P

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Fitting Earphones to Student

Earphones need to be placed on completely bare ears. Red goes on right ear.

Move hair out of the way, remove glasses Remove earrings and combs/ ribbons which

may prevent a good “seal”. No chewing gum Adjust the headband to fit snuggly over the

head.

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Recommended Hearing Screening Grade Levels Pre - Kindergarten Kindergarten 1st grade 3rd grade 8th grade New students to your district Parent or teacher request

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Preparing Young Children

Before hearing screening is done with pre-K or Kindergarten students, take the audiometer into the classroom and practice with the group.

Turn headphones outward toward the class sitting in a circle around you.

Set intensity at 90 dB or above, tone at 2000 Hz. Explain to the class that they will hear a sound.

When they hear the sound, raise hand. When the sound stops, lower hand.

Repeat several times with different frequencies until all the students grasp the concept.

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Hearing Screening Procedures Check your equipment before you start. All

switches are in the correct position. No broken wires, faulty connections, plugs are plugged in.

Listen to all the frequencies yourself to be sure there are no extraneous sounds, ambient noises.

Seat one child at a time in front of you, either facing toward you or away from you. Position headphones.

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Hearing Screening Procedures (cont.) Avoid obvious clues: Looking up at the

student, Reflections in mirrors/ windows/ eye glasses, Movements that give away tone presentation, presenting tones rhythmically

Remind student to raise his/her hand when the tone is heard. Present the tones 2-5 seconds each, right ear first, beginning with 1000 Hz, then 2000 Hz, 4000 Hz. Repeat with left ear.

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Precautions

Do not let the student watch you operate the audiometer’s presentation controls.

Do not look at the child when the tone is presented (use peripheral vision to observe response).

Do not present the tone when there is a noise which you suspect would interfere with hearing.

Do not give any clues as to when the tone is presented: control head, eye, arm or other body movements, reflections, rhythms, shadows, etc.

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Recording and Referral

Record the results on the student’s Health Record.

Report any failures to your school nurse– follow your districts protocols

Wait 3-4 weeks between sweep tests in case of allergies, colds, etc.

Use a referral form such as is found in SHM

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Types of Hearing Loss

Three types of hearing loss: Conductive affects outer and / or middle ear

-Most common causes: Otitis media-Correctable with treatment or surgery

Sensorineural affects the inner ear or auditory nerve-This generally cannot be corrected with surgery or medical treatment

Mixed Affects the outer/middle ear as well as the inner ear and includes significant conductive and sensorineural components.-It can be any combination of the two previous hearing losses. -The conductive portion of a mixed hearing loss can usually be corrected, but the sensorineural component is seldom reversible.

**Note: Otitis media is single-most frequent cause of hearing loss in young children

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Hearing Conservation

OSHA suggests the following safety limits of noise exposure:Noise Level Exposure Limit

90 dB 8 hours95 dB 4 hours100 dB 2 hours105 dB 1 hour110 dB 30 minutes

So what pattern do you see here?

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Suggestions for Hearing Conservation When around harmful noises, wear hearing

protection, earplugs/ earmuffs Seek medical attention for symptoms (ringing in

ears, pain, dizziness, headaches) Do presentation on hearing conservation to classes Recommend earplugs to band students, especially

percussion section Caution teenagers about setting the Walkman

listening levels too loud (yeah, right!!)

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Hearing Aids and Assisting Students See NMSHM See also NASN publication, The Ear and

Hearing, p 23 Do not screen students with hearing aids For an Individualized Health Care Plan,

NASN p 24 (be sure all students with hearing loss have an IHP)

For screening the young child and developmentally delayed, NASN p 25

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Questions?