Provider 10 minute Refresher Course - PowerPoint PPT Presentation

Provider10 minuteRefresher Course

June 2009

• 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

• One, Three, Six
• Two, Four, Six
• One, Six, Twelve

That answer is incorrect!

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.

• Identify later onset hearing loss
• Identify progressive hearing loss
• Identify children who did not receive a hearing screening at birth
• All of the above

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

Please try again!

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.

• 2mos, 6mos, 12mos, 2 years & 3 years
• Every 6 months
• Annually

That answer is incorrect!

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.

• OAE, ABR and Acoustic Reflex
• OAE, Tympanometry and Acoustic Reflex
• OAE, Tympanometry and ABR

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).

That answer is incorrect!

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).

• Determine whether there is cerumen in the ear
• Determine whether a perforation is present in the TM
• Rule out middle ear pathology

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.

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.

You are correct!

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

• True
• False

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.

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.

• Auditory neuropathy
• A severe to profound sensorineural (cochlear) hearing loss
• Middle ear or conductive pathology
• All of the above

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

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

• OAE and High Frequency Tympanometry only
• OAE, High Frequency Tympanometry and Acoustic Reflex
• OAE and Standard Tympanometry only

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

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

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.

• 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

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

Please try again!

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

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

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.

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

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

• True
• False

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.

You are correct!

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

• STAT referral to JTC Audiology
• ENT referral
• Rescreen in 3 months

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

An immediate referral to audiology is recommended.

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.

Pass

Refer

Incomplete

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.

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.

Present

Absent

Incomplete

That answer is incorrect!

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.

Return for Routine BSC

Additional BSC Tymp and reflex testing

Refer for audio and speech

AGE 2

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

You are correct!

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

Pass

Refer

Incomplete

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.

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.

Present

Absent

Incomplete

That answer is incorrect!

You are correct!

Present

Absent

Incomplete

That answer is incorrect!

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

You are correct!

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

Pass

Refer

Incomplete/Retest

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.

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.

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