1. Audiology Advocacy Audiologists responsibility to EHDI
Mary Beth Brinson, Au.D.
Stephanie Disney, M.S. CCC-A

2. Presentation Points Historical Perspective Survey comparisons
Audiological services comparison
Pediatric Audiology Crisis
Professional Organizations and Plans
Au.D. solutions
Case Studies
Problem solving and discussion

3. Historical Perspective
In 2000, Kentucky audiologists were surveyed about pediatric audiology protocols, equipment availability, training needs and resources, and community collaboration
54% of those surveyed responded (41/75)

4. Access to services by age
Based on 2000 survey

5. Test Protocol
Based on 2000 survey

6. Training Needs
Based on 2000 survey

7. EI Training
Based on 2000 survey

8. Distribution of Audiologists

9. Pediatric Audiology Crisis
Paradise and Bess (1994) article: Predicted inability to provide quality follow-up from UNHS due to high numbers
Speculated that there were not enough qualified professionals

10. High Risk Registry vs. UNHS
High risk registry: misses estimated 50% of permanent childhood hearing loss
Crisis is that theoretically we have doubled the babies entering the system
Where are the additional qualified providers?

11. JCIH 2000
EHDI
GUIDELINES 8
PRINCIPLES

12. Audiology Test Battery
Includes physiological measures
Includes developmental appropriate behavioral techniques
Measures that assess integrity of the auditory system
Estimate for each ear type, degree and configuration of hearing loss

13. JCIH Guidelines (6 through 36 months)
Family and child history
Behavioral Response Audiometry (CPA, VRA)*
Otoacoustic emissions
Acoustic emittance measures
Speech detection and recognition measures*
Electrophysiologic (ABR) testing: at least once*
*requires special adaptations for pediatrics

14. JCIH Guidelines (0 through 6 months)
Family and child history*
Frequency specific electrophysiological test (ABR or ASSR)/Bone conduction*
Otoacoustic emissions
Middle ear function test/ ART*
Behavioral Observation Audiometry*
*Requires special adaptations for pediatrics
Middle ea

15. “Adequate confirmation of an infant’s hearing status cannot be obtained from a single test measure. A battery cross-checks findings of both physiological and behavioral measures.”
JCIH

16. Confirmation of Hearing Loss: Benchmarks
Comprehensive services coordinated between the medical home, family and related professionals with expertise in hearing loss.
Audiologic and medical evaluations before 3 months of age or 3 months after discharge for NICU infants
Infants with diagnosed hearing loss receive and otologic evaluation
The medical and audiologic evaluation process perceived as positive and supportive

17. Clinical Doctorate?

18. Percent of Audiologist who hold an Au.D. by State
June 2004
1-4%
5-9%
10-14%
15-19%
20-24%
19-25%

19. Training? Total number of NCHAM training workshops completed: 14
Total number of audiologists trained: 299
Areas workshops located:
Florida
Iowa, San Diego, Redondo Beach, Oakland,
Chicago (CA had a separate grant)
Salt Lake City, Boston, Redondo Beach, Boise
Philadelphia,Redondo Beach, San Mateo, New Orleans
Next one scheduled is in New Mexico

20. Credentialing?
Still being developed……
Doesn’t address today’s needs

21. Case Studies
Case Study 1

22. Risk factors include:
Sepsis
Ototoxic Medications
Prematurity

23. Notched tymp due to crying?
Behavioral explanation, no cross check? Multi system evaluation?

24. Parental report of cessation of babbling at 11 months
No Cross Check
Parental report of cessation of babbling at 11 months
RECHECK in 6 months?

25. Is this matching results to middle ear measures?
A cross check now?
Is this matching results to middle ear measures?

26. Behavorial excuse for hearing loss?
Post op tubes –
Behavorial excuse for hearing loss?

27. Questionable
microphonic
Questionable
microphonic

28. Audiological Findings
Severe to Profound Bilateral SNHL
Functional PE tubes
Recommend immediate amplification
-There are no OAE’s and a lack of systemic
evaluation and cross check battery

29. Cross check? OAE’s? Fit with powerful Phonak Sonoforte 2 P3AZ HA
Ear specific?
Fit with powerful Phonak Sonoforte 2 P3AZ HA
Cross check?
OAE’s?

30. Pre Cochlear Implant Evaluation
? OAE

31. Audiological Recommendations
Re-program hearing aid to new hearing loss
-Only obtained thresholds at 500, 2K
Re-evaluate with behavorial testing in 3 months
-Parents report child has no speech
-No physiologic measures planned

32. 90 dB 85 dB Middle ear evaluated-Tympanometry
Cochlear function evaluated- OAE
Neural track evaluated- ABR
Frequency Specific information

33. Audiological Recommendations
Diagnosis- Auditory Neuropathy
Discontinue current amplification
Consider mild gain aid
Proceed with Cochlear Implant Evaluation

35. Identified with a hearing loss so late in the critical language learning period, she is at a disadvantage in the language learning process

36. Late age of identification and upcoming use of Cochlear Implant……………..

37. Stephanie:
Sorry I haven’t followed up with you sooner, but it has been crazy!!! I got your phone message and wanted to follow up with you. You were right about the Neuropathy. Sue Windmill made the diagnosis in April!!! We consulted with Dr. Linda Hood at LSU, and Vanderbilt agreed to do the implant surgery!!! She was implanted on April 28th and switch on was May 26th. She has been in AV therapy since that time, and seems to be coming along. We have a very long way to go, and are uncertain about the full outcome at this point? I have been on the LSU website, but would love to get more information on AN if I can? Any suggestions where I might find research or other resources? Thank you again for helping us get a diagnosis. If you had not helped us, we would still be searching for the answer. I can’t thank you enough. Sincerely, Christy Adkins

38. A different take on 1-3-6 6 Audiologists 3 Centers in 2 states
1 Late Diagnosis

39. Case Studies
Case Study 2

40. Case 1: TM Male Born August 2004 Failed UNHS bilaterally
No reported risk factors
Normal pregnancy and birth

41. Case 1:T.M.
UNHS follow-up 8/21/04
ABR
Results…

42. ABR 1Results: T.M.
Right ear:
60dB

43. ABR 1Results: T.M.
Left ear:
60dB
Artifact 90
Sweep
2000

44. Inappropriate test settings
Tympanogram 1: T.M.
4 weeks
Inappropriate test settings

45. OAE 1: T.M.

46. Interpretation of 1st ABR
Actual hearing could not be determined due to child’s awake state
Middle ear dysfunction right ear, normal left
Audiologist not confident in findings
Attributed hearing loss results to high artifact
Scheduled retest at 2 months of age

47. ABR 2: T.M.
Left ear:
35dB

48. ABR 2: T.M.
Right ear:
50dB

49. ABR 2: Results Borderline normal hearing left
Possible mild hearing loss right
Again, awake state interfered with tests
Recommendation: Sedated ABR due to high artifact and for second opinion**

50. ABR 3: T.M. Different facility Under sedation December 2004
Child is 5 months old

51. ABR 3: T.M.

52. ABR 3: T.M. Bilateral moderate sensory hearing loss
Earmold impressions made
Early intervention referral made

53. Problems: T.M. 3 ABRs performed, 4 months for diagnosis
High Artifact? < 10%
3rd ABR with sedation: unnecessary?
2 1/2 hour trip to other facility
Parents now travel for hearing aid appts.

54. Possible Remedies Correct tests were performed according to JCIH
More education in modifications for neonates
More experienced mentor to lend support
Additional pediatric testing training (locally and nationally available)

55. Not everything that is faced can be changed, but nothing can be changed until it is faced -James Baldwin