The ABC’s of Pediatric Audiology USC Speech & Hearing Research Center H. Nicole Herrod-Burrows, Au.D.,CCC-A Clinical Assistant Professor Beth I. McCall, Au.D.,CCC-A Clinical Assistant Professor

Disclosures H. Nicole Herrod-Burrows, AuD, CCC-A Financial: Nicole is an Assistant Clinical Professor member of the Cochlear Implant Team in the Department of Communication Sciences and Disorders at the University of South Carolina for which she receives a salary. Non-financial: Nicole is the Secretary of the South Carolina Academy of Audiology Beth I. Hulvey, AuD, CCC-A Financial: Beth is an Assistant Clinical Professor member of the Cochlear Implant Team in the Department of Communication Sciences and Disorders at the University of South Carolina for which she receives a salary. Non-financial: None WE DO NOT CLAIM TO KNOW EVERYTHING ABOUT PEDIATRIC AUDIOLOGY AND ARE COINTINUING TO LEARN, HOWEVER WE DO LOVE OUR PEDIATRIC PATIENTS AND THE CHALLENGE THEY PRESENT!

Hearing Loss: 101

The Ear/Normal Hearing -Sound travels down the ear canal -Vibrates ear drum -Sets middle ear bones in motion -Vibrates cochlea and sets hair cells into motion -Hair cells send signal to auditory nerve -Auditory nerve sends signal to the brain

Types of Hearing Loss Conductive Hearing Loss Sensorineural Hearing Loss Outer or middle ear affected Sound is not getting to inner ear as effectively Speech sounds softer No distortion May be treated by surgery or medication Hearing Aids or BAHA Inner ear or auditory nerve affected Speech sounds softer May have distortion Abnormal loudness growth No medical treatment Hearing Aids or Cochlear Implant

The Audiogram

Interpreting the audiogram Look at the type, degree, and configuration of the pure tone tests to interpret Most people have hearing loss in more than one category Read left to right configuration using the degree and type of loss for each ear Examples: Mild to moderate SNHL Moderate CHL rising to normal hearing Moderate to profound mixed loss Normal to severe high frequency precipitous SNHL Normal to moderate high frequency SNHL in notched configuration Severe to profound SNHL in a left corner audiogram

Normal Hearing When air and bone are both in the normal hearing range

Conductive When bone is in the normal hearing range and air is outside the normal range air is at least 15 dB worse than bone / normal range

Sensorineural When both air and bone are outside the normal range air and bone are equal (within 10 dB of each other) but have hearing loss air cannot be better than bone Why?

Mixed Two components of hearing loss Sensorineural component bone is outside the normal range Conductive component air adds an additional loss of at least 15 dB more than bone

The Speech Banana and Hearing Loss

Speech Audiometry SPEECH THRESHOLDS Under headphones or in soundfield SAT speech detection / awareness threshold Threshold level (dBHL) where speech is first detected (heard but not understood) SRT speech reception / recognition threshold Threshold level (dBHL) where speech Is first/always understood

Pure Tone Testing Techniques Standard Audiometry raise hand to the stimulus ~ ages 5 and up does not require assistant

Conditioned Play Audiometry perform a play activity when hearing the puretone ex. Drop block into the bucket when hear the pure tone can require an assistant to the testing audiologist ~ a

VRA and BOA(Visual Reinforcement and Behavioral Observation Audiometry) turn head towards the location/side of the stimulus see reinforcement toy (lights or animated object) for localizing the sound usually requires an assistant to audiologist and caregiver to hold infant Usually used for ages 6 months to 3 years depending on abilities of the child

What is the condition of the test? What was tested and how was it tested? Unaided vs. Aided? Ear Specific or not? Type of transducer? Type of stimuli?

Otoacoustic Emissions(OAE) Objective test that measures the function of the outer hair cells of the cochlear Ear needs to be free of fluid, infection, cerumen impaction Child needs to be able to tolerate a probe and sit relatively still and quiet.

Auditory Brainstem Response(ABR) Objective Measure. Test Auditory Brainstem function in response to auditory stimuli to estimate hearing sensitivity or identify abnormalities of the auditory pathway Patient must be still and quiet Often completed under sedation or while sleeping

Soundfield Using VRA Responses in the soundfield using VRA were in the mild hearing loss range for at least the better hearing ear. A speech detection threshold was found in the mild hearing loss range for at least the better hearing ear. Type B tympanograms bilaterally.

Aided Audiogram Aided responses in the soundfield when binaurally aided were in the mild to moderate hearing loss ranges across frequencies tested.

Risk factors of hearing loss: Severe Depression at birth (low apgar score) Bacterial Meningitis Congenital and Perinatal Infections: TORCH INFECTIONS T-toxoplasmosis O- other infections including syphilis R-rubella C-Cytomegalovirus (CMV) H-herpes simplex virus (HSV) Elevated Bilirubin (greater than 17 mg/100ml)

Early Hearing Detection and Intervention(EHDI) EHDI was first authorized by Congress in 2000. The Universal Newborn Hearing Screening Program was mandatory for NICU babies in 1999 and all babies in 2000. Goal of Joint Committee on Infant Hearing is to screen by 1 month diagnose by 3 months and fit with amplification and enroll in Early Intervention by 6 months.

CDC National Data 2015: 3,796,042 babies were screened in the United States. 64,9078 failed the screening initially. 23,156 were diagnosed by age 3 months 2,799 were receiving Early Intervention by 6 months. Total enrolled in Early Intervention was 4,285.

CDC Statistics for S.C. in 2015 53,385 babies were screened in South Carolina. 697 babies failed the screening initially. 271 babies were diagnosed by age 3 months Only 43 were receiving Early Intervention by 6 months. Total enrolled in Early Intervention 68.

Risk factors cont… Defects of the head and neck region Family history of childhood hearing impairment Gram birth weight less than 1500 Otoxic drug usuage Prolonged Mechanical Ventilation Parent or caregiver concern

Risk factors cont… Stigmata associated with a syndrome known to cause sensorineural hearing loss -Ushers Syndrome -Waardenburg Syndrome Other things to consider- -Miconium Aspiration -History of ear problems/surgery -Tinnitus or ringing in the ears -Noise exposure

SPECIAL POPULATIONS: Autism Spectrum Developmental Delay Sensory Issues Significant Medical History Negative Experience at a previous appointment

CASE STUDIES:

Case Study 1: Normal What to expect at a normal pediatric hearing appointment at USC.

Case Study 2: Sensory Kid Sound field could not test OAE’s and get ear specific information

Case Study 3: Developmental Delay 8 year old on a 3 year old level obtained conditioned play audiometry at 5-4 K only. Obtained screening OAEs and SAT Also talk about if cannot get CPA but only OAE what to do

Case Study 4:Negative Experience or difficult to test BOA to start and ease into testing and how to do testing.

QUESTIONS? CONTACT INFORMATION: USC Speech & Hearing Research Center 1224 Sumter Street, Suite 300 - Columbia, SC 29201 T: 803.777.2642 – F: 803.253.4143 Email: herrod@mailbox.sc.edu or hulveybi@mailbox.sc.edu