2. 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

3. 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!

4. Hearing Loss: 101

5. 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

6. 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

7. The Audiogram

8. 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

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

10. 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

11. 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?

12. 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

13. The Speech Banana and Hearing Loss

14. 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

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

16. 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

17. 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

18. 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?

19. 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.

20. 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

21. 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.

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

23. 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)

24. 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.

25. 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.

26. 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.

27. 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

28. 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

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

30. CASE STUDIES:

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

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

33. 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

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

35. QUESTIONS?
CONTACT INFORMATION:
USC Speech & Hearing Research Center
1224 Sumter Street, Suite Columbia, SC 29201
T: – F: or