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Provider 10 minute Refresher Course . June 2009. Special Instructions. Be sure to put on Slide Show view Use your mouse to select your answers Click anywhere on the slide to advance to the next question Do not use the up/down arrows, space bar, or return key to advance

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special instructions
Special Instructions
  • Be sure to put on Slide Show view
  • Use your mouse to select your answers
  • Click anywhere on the slide to advance to the next question
  • Do not use the up/down arrows, space bar, or return key to advance
  • You may find it useful to refer to your BSC Pocket Guide, Workbook and other training materials as necessary
slide3
What is the recommended time frame (in months) for newborns in terms of screening, diagnosis/amplification and early intervention?
  • One, Three, Six
  • Two, Four, Six
  • One, Six, Twelve
sorry
Sorry!

That answer is incorrect!

congratulations
Congratulations!

You are correct!

According to EDHI guidelines, the recommended time frame for a newborn is to be screened by 1 month, diagnosed and fit with amplification by 3 months and enrolled in appropriate early education by 6 months in order to keep apace with hearing peers.

periodic hearing screening in the medical home is recommended to
Periodic hearing screening in the medical home is recommended to:
  • Identify later onset hearing loss
  • Identify progressive hearing loss
  • Identify children who did not receive a hearing screening at birth
  • All of the above
partially correct
Partially Correct!

That is one target goal of the BSC program but it is not the only goal.

Please try again!

congratulations1
Congratulations!

You are correct!

The answer to this question is

ALL OF THE ABOVE

Because we need to catch children that fit into all of these categories.

according to the new periodicity intervals bsc should be conducted at
According to the NEW periodicity intervals, BSC should be conducted at:
  • 2mos, 6mos, 12mos, 2 years & 3 years
  • Every 6 months
  • Annually
sorry1
Sorry!

That answer is incorrect!

congratulations2
Congratulations!

You are correct!

The new protocol requires that BSC be conducted at set intervals corresponding to WCCs at 2m*, 6m, 12m, 2 yrs and 3 yrs.

*The 2 month BSC is necessary if the child is not definitively known to have passed the newborn hearing screen and does not have risk factors for progressive hearing loss.

the three hearing screening procedures used as part of bsc are
The three hearing screening procedures used as part of BSC are:
  • OAE, ABR and Acoustic Reflex
  • OAE, Tympanometry and Acoustic Reflex
  • OAE, Tympanometry and ABR
sorry2

The ABR (Auditory Brainstem Response) is not part of the BSC screening protocol. Automated ABR (AABR or ABAER) is often used to screen the hearing of newborns before they leave the NICU. Diagnostic ABR is frequently used by pediatric audiologists as an evaluative tool to comprehensively define presence, degree and type of hearing loss in infants, toddlers and young children. ABR records the response of the auditory (VIIIth) nerve to an auditory signal such as a click and a toneburst. ABR is used to determine cochlear sensitivity (degree of loss) as well as neural integrity (auditory neuropathy or retrocochlear pathology).

Sorry!

That answer is incorrect!

congratulations3
Congratulations!

You are correct!

FYI : The ABR (Auditory Brainstem Response) is not part of the BSC screening protocol. Automated ABR (AABR or ABAER) is often used to screen the hearing of newborns before they leave the NICU. Diagnostic ABR is frequently used by pediatric audiologists as an evaluative tool to comprehensively define presence, degree and type of hearing loss in infants, toddlers and young children. ABR records the response of the auditory (VIIIth) nerve to an auditory signal such as a click and a toneburst. ABR is used to determine cochlear sensitivity (degree of loss) as well as neural integrity (auditory neuropathy or retrocochlear pathology).

the primary purpose of tympanometry is to
The PRIMARY purpose of Tympanometry is to:
  • Determine whether there is cerumen in the ear
  • Determine whether a perforation is present in the TM
  • Rule out middle ear pathology
sorry3
Sorry!

That is not the best answer!

It is rare for an ear to be completely obstructed with wax. Even if there is a tiny opening, it is usually possible to conduct the tymp screening.

sorry4
Sorry!

That is not the best answer!

Although tympanometry is very helpful in determining the presence of a patent PE tube or eardrum perforation by showing a large ear canal volume (ECV) measurement (>1.0 in an infant or young child), this is not the primary purpose of tympanometry.

congratulations4
Congratulations!

You are correct!

Tympanometry is a very sensitive measure of the presence of middle ear fluid even when fluid cannot be visualized through otoscopy.

sorry5
Sorry!

The otoacoustic emission is a test of inner ear function, however the ‘echo’ is actually a product of the motility of the outer hair cells as they respond to a sound stimulus.

congratulations5
Congratulations!

You are correct!

The otoacoustic emission is a test of inner ear function, however the ‘echo’ is actually a product of the motility of the outer hair cells as they respond to a sound stimulus.

an absent acoustic reflex could result from
An absent acoustic reflex could result from:
  • Auditory neuropathy
  • A severe to profound sensorineural (cochlear) hearing loss
  • Middle ear or conductive pathology
  • All of the above
partially correct1
Partially Correct!

True, but that is not the only answer. In fact all of these conditions could result in absence of the acoustic reflex.

congratulations6
Congratulations!

All of these can result in absence of the acoustic reflex:

  • In the case of Auditory Neuropathy, the VIIIth nerve or synaptic junction between the nerve and inner hair cells is impaired.
  • In severe to profound sensory hearing loss, the acoustic reflex is absent because sound cannot be made loud enough to activate it.
  • In middle ear dysfunction, the middle ear pathology prohibits the measurement of the acoustic reflex.

Careful study of reflex results IN CONJUNCTION WITH OAE AND TYMPANOMETRY is crucial in making appropriate screening referrals

in a patient less than 6 months old the bsc protocol calls for
In a patient less than 6 months old, the BSC protocol calls for
  • OAE and High Frequency Tympanometry only
  • OAE, High Frequency Tympanometry and Acoustic Reflex
  • OAE and Standard Tympanometry only
sorry6
Sorry!

The acoustic reflex is not reliable in children 0-6 months of age.

sorry7
Sorry!

Standard tympanometry cannot be used in babies 0-6 months, due to the extreme compliance of their ear canal walls.

congratulations7
Congratulations!

You are correct!

In order to measure eardrum, rather than ear canal compliance, a high frequency probe tone (1000 Hz) MUST be used in babies under 6 months of age. If a 1000 Hz probe tone is not used, middle ear effusion can be missed.

slide29
From the list below check any conditions that place an infant at risk for late onset, or progressive hearing loss
  • Family history of hearing loss
  • In utero infection such as CMV
  • NICU stay > 5 days
  • Aminoglycoside treatment
  • All of the above can result in progressive hearing loss
partially correct2
Partially Correct!

That is one etiology of progressive or late onset hearing loss in young children.

Please try again!

congratulations8
Congratulations!

All of these are risk factors for progressive or late onset hearing loss.

slide32

According to BSC protocol, what action is recommended for a patient with the following results during their first BSC screening: Refer OAE, Refer Tymp, Absent Reflexes?

STAT referral

to JTC Audiology

Rescreen in 3 months

ENT &Audiology referral

sorry8
Sorry!

This combination of results (OAE refer and flat tympanogram) is typical of middle ear disorder. It is best to initially follow this child medically for recovery from middle ear disorder before requiring a full hearing test. ENT and Audiology referrals would not be indicated until the 2nd failed BSC.

congratulations9
Congratulations!

According to BSC protocol, rescreening in 3 months is recommended, in order to allow sufficient time for the middle ear pathology to resolve.

slide35

NICU babies who fail the California Newborn Hearing Screening require ABR follow up at a certified outpatient infant hearing screening facility.

  • True
  • False
sorry9
Sorry!

According to California State guidelines, all NICU hearing screening fails must receive follow up ABR testing at a certified outpatient infant hearing screening facility, superseding any BSC screening they receive.

congratulations10
Congratulations!

You are correct!

It is important that BSC does not interfere with the established state-mandated procedures.

slide38
What action is recommended for a patient with the following results: OAE refer, Tymp Pass, reflex refer?
  • STAT referral to JTC Audiology
  • ENT referral
  • Rescreen in 3 months
sorry10
Sorry!

This combination of results (OAE refer and normal tympanogram) suggests a permanent sensory deficit.

An immediate referral to audiology is recommended.

congratulations11
Congratulations!

According to BSC protocol, an OAE refer and absent reflexes in the presence of a normal tympanogram would warrant immediate referral to audiology. This combination of results is strongly indicative of a permanent sensory (cochlear) deficit.

sorry11
Sorry!

The compliance is less than 0.2ml, so this tymp is a refer, even though you can still see a small peak. Shallow tympanograms such as this are usually associated with the presence of middle ear fluid.

congratulations12
Congratulations!

You are correct! Even though the gradient is within normal limits (less than 250daPa), the compliance is less than the 0.2ml cut-off. Shallow tympanograms such as this are usually associated with middle ear fluid.

sorry12
Sorry!

That answer is incorrect!

congratulations13
Congratulations!

You are correct!

The deflections on the print out are simply a result of the baby’s movement or crying.

This test should be redone.

what would you recommend
What would you recommend?

Return for Routine BSC

Additional BSC Tymp and reflex testing

Refer for audio and speech

AGE 2

sorry13
Sorry!

The BSC protocol calls for additional screening, since there are Risk Factors checked on the BSC questionnaire.

congratulations14
Congratulations!

You are correct!

The risk factors checked on the BSC questionnaire indicate the need for further tympanometry and acoustic reflex testing.

sorry14
Sorry!

The gradient is greater than 250daPa, so this tymp is actually a refer, even though you can still see a small peak.

Wide tympanograms such as this are usually associated with middle ear fluid.

congratulations15
Congratulations!

You are correct! Even though the compliance is within normal limits the gradient is greater than the 250daPa cut-off.

Wide tympanograms such as this are usually associated with middle ear fluid.

sorry15
Sorry!

That answer is incorrect!

congratulations16
Congratulations!

You are correct!

sorry16
Sorry!

That answer is incorrect!

The deflections circled are the response. The initial spikes are artifact

congratulations17
Congratulations!

You are correct!

The deflections circled are the response. The initial spikes are artifact

sorry17
Sorry!

Although the gradient and compliance readings are within normal limits, this tymp needs to be redone.

The ‘blip’ on the otherwise flat tymp is confusing the issue, and is where those ‘normal’ numbers are derived from.

congratulations18
Congratulations!

You are correct! Even though the compliance and gradient appear within normal limits the tympanogram is essentially flat, with just a ‘blip’ derived from the baby swallowing or moving.

thank you for your participation in the baby sound check program
Thank Youfor your participation in theBaby Sound Check® Program

Congratulations!

You have successfully completed the BSC refresher course!

Please click this link to send an email notifying BSC staff of your course completion and we will email you a certificate.

smintz@jtc.org