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HEARING SURVEILLANCE LEARNING OBJECTIVES by 242CpTmR

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									 An introduction to
hearing surveillance

      Contributor
     Dr F Rahman
        Derby
         Hearing Surveillance:
         Learning 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
Surveillance “Check Points” for
Hearing/ Language/Behaviour
• * Targeted neonatal                                               • Hospital
       screening
• * 6/52 check                                                      • HV & Dr
• # * 6/12 hearing                                                  • HV (HVDT)
       screen
• ? * 18 –24/12 HV                                                  • HV
       assessment
• ? * 3 year                                                        • HV
       developmental
       assessment
• # * 5 year school                                                 • School nurse
       entrant screen
       sweep/
       audiogram

Surveillance is a continuous process
Hearing Surveillance Dec 2002/Dr. Fawzia Rahman/Central Derby PCT
             Hearing Screening
                 the 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
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
        Hearing Screening
        Recommendations
• 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
• R&D

Hearing Surveillance Dec 2002/Dr. Fawzia Rahman/Central Derby PCT
        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
       Hearing Screening
       Today’s 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
  Hearing Screening:
What 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
        Mark’s story

• 4 year old referred by S&LT
• At nursery, poor speech and
  language
• Passed HVDT and 3 year
  assessments
• ENT
• Family history
• Mild dysmorphic features
• Health, education, social
  services
         Mark’s story 2

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

								
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