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HJ2008_02_p39 by shimeiyan


									                                                                 SM A L L TA L K

Tips from the swamp                                                                                                    Jace Wolfe                Jacque Rogers-Scholl
By Jace Wolfe and Jacque Rogers-Scholl

Obtaining frequency-specific assessments for young children can                          established” earmolds (see Figures 1a-c).
be like wrestling a crocodile! Even the best pediatric audiologist                           If you use personal earmolds to obtain audiometric thresholds,
has been at wits’ end attempting to evaluate an unruly 2-year-old.                       then use them also in measuring real-ear-to-coupler differences.
Read on for pointers on taming the child and getting ear-specific                            When children don’t have personal earmolds, let them feel and
audiograms from even the toughest croc!                                                  squeeze the foam eartip for themselves. Even more reassuring is
                                                                                         a safety demonstration of eartip insertion on a willing sibling or
ALL HANDS ON DECK                                                                        parent. If all else fails, send the eartips home with the family and
Behavioral assessment of auditory function works best when it’s a                        reschedule after they’ve had time to practice.
team effort. If the child is seeing a speech-language pathologist, then
enlist the SLP’s help. She or he may offer suggestions that enhance              MAKE IT FUN
the test session, such as a particular game the child enjoys (e.g., throw-       Never ask a child for permission to do something. The answer is
ing a basketball through a hoop). Also, the SLP can practice the                 invariably “NO!” So, be flexible and provide enjoyable ways to
desired conditioned response in therapy sessions, and, ideally, will             accomplish your mission. Some children never tire of dropping
accompany the child on audiologic visits.                                                          blocks into a bucket, but others lose interest
     If the child isn’t seeing an SLP, ask the fam-                                                quickly and require more alluring assignments.
ily to help. Spoken or written instructions detail-                                                    Even the most difficult children are intrigued
ing the desired conditioned response along with                                                    by dropping plastic fish into a Gatorade jug filled
a request to practice at home will familiarize                                                     with water when they hear the “beeps.” Bath-
the little one with the task at hand. The parent,                                                  tub color tints mixed in during the test can make
clinic personnel, or even a trained receptionist                                                   the game even more exciting.
can encourage the child’s cooperation. An ener-                                                        Boys tend to enjoy dropping Matchbox cars
getic, well-trained assistant is worth her weight Figure 1a. A foam tip for insert                 into a used wrapping paper tube, while girls
in gold during pediatric assessments.                     earphones is inserted into the tub-      often prefer to stick plastic jewels with Velcro
                                                          ing of the child’s personal earmold.
                                                                                                   on the back of a felt crown. Some kids like to
FEELING AT HOME IN THE SWAMP                                                                       give a “high five” to the assistant upon hearing
Although children frequently associate clinics                                                     each tone, especially if the assistant occasionally
with negative experiences, you can structure the                                                   acts as if it hurts (‘owwee, you’re strong!). A sim-
environment so it feels safe. Shedding your lab                                                    ple sticker stuck to your nose can amuse the
coat is a good place to start. Also, kid-friendly                                                  grumpiest Crocodilia.
furniture can help. High chairs for infants or an                                                      The same “games” may not work for every
inexpensive little folding table and chair designed                                                youngster, and some require a change of tasks
for little people will help youngsters feel more Figure 1b. The foam tip of the                    within a session or from session to session. Keep
comfortable and at ease.                                  insert earphone is cut off near the      an open mind and plenty of tricks up your sleeve.
     One important task is especially difficult with tubing of the earmold.                            Obtaining audiograms from toddlers requires
little ones: obtaining ear-specific data. Sound field                                              patience, dedication, and creativity. Although
testing won’t provide ear-specific assessment of                                                   some days you may feel like a combination of
hearing sensitivity, and insert earphones are firmly                                               clown, clinician, and animal wrangler, one thing’s
established as the transducer of choice for chil-                                                  for sure: As we move closer to the goal of age-
dren. Unfortunately, kids often resist the inser-                                                  appropriate speech and language for every child
tion of foam eartips. If they wear hearing aids,                                                   with a hearing loss, providing successful pedi-
you can couple insert earphones to their personal                                                  atric audiologic assessment isn’t a crock!
earmolds. However, sometimes the tubing                                                            Jace Wolfe, PhD, is Director of Audiology at Hearts for Hearing,
becomes stretched and is difficult to couple tightly                                               a non-profit foundation in Oklahoma City, and Adjunct Professor at the
to the insert earphone.                                   Figure 1c. The tubing of the             University of Oklahoma Health Sciences Center. Jacque Rogers-
     Count on the DSL folks for a creative                insert earphones is coupled to the       Scholl, AuD, is Pediatric Audiologist with the Department of Child
                                                                                                   Guidance, Tulsa County Health Department. Readers may contact the
solution to couple insert earphones to “well- tubing of the foam tip.                              authors at and

FEBRUARY 2008 • VOL. 61 • NO. 2                                              S m a l l Ta l k                                       THE HEARING JOURNAL                 39

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