December, 2017       

Probes & Tips header
ECHO Initiative Events

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New Live Webinars:

Introductory Webinar:
Planning Evidence-Based Hearing Screening Practices for Children
0-3 Years of Age
Tuesday, Jan. 16th, 2018
1:00-2:00 p.m. Eastern   

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  New 2018 
OAE Training
Web Class:
Four Sessions :
February 5th, 8th,
12th, and 15th, 2018
1 p.m. EDT
ECHO Initiative
Link to Previous Recorded Webinars:

If you've missed any of 
our previous webinars, 
click here to access our library of previously recorded webinars.

New to 
OAE Screening? 

I f your program is new to OAE screening, or if you have added new staff who need instruction on OAE 
screening practices,  
visit our 
where staff can view instructional video modules and access the corresponding 
Quick Links


Find more helpful hints from previous issues of

 Probes and Tips 

and many other
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Tip of the Month
Reducing Refer Rates
This month's newsletter is more detailed than most, but we
want to respond to a wide range of questions from programs seeking advice on how to reduce their hearing screening refer rate. When screening staff are skilled at using Otoacoustic Emissions (OAE) equipment, and are comfortable working with young children, the pass rate from the initial screening should be 75% or higher. If your screening program is new and/or your screeners are inexperienced, it may take some time to achieve this. But if you find that your refer/can't test rate is consistently above 25%, work through the sequence of steps (and video links) provided below to troubleshoot the problem:   
1.  Check your equipment. Most equipment should be calibrated annually to ensure that it is working properly, and that any software updates have been installed. Equally important, get into the habit of doing a "biologic check" regularly--which simply means screening yourself or another adult whose hearing is normal. (Remember to use an adult-size probe cover). If you don't consistently get the passing outcome you expect, your equipment may need to be repaired or replaced. Also, check to make sure the probe tip is not blocked with wax each time you remove it from an ear canal. Excess wax will usually be cleared by changing the disposable probe cover, but occasionally wax will get down inside the probe nozzle opening. Refer to your specific equipment's user manual for instructions on cleaning or changing the probe nozzle.
2.  Become thoroughly familiar with how your equipment performs under different screening conditions. This is a critical step that people often skip when selecting equipment and learning to use it after purchase. Not all OAE equipment brands function equally well in all screening environments. Equipment distributors may only demonstrate the equipment in a very quiet room on a compliant adult--which is not comparable to screening an active child in an educational or home setting! It is a good idea to tell an equipment vendor that you want to see how the equipment works in your own screening environment (preferably for a week or two) before making a purchase. If possible, try out several different brands to determine which one performs best in your screening setting.  
Once you own a specific piece of equipment, systematically assess how noise and probe fit affect the error messages you see and Practice screening adults the results you get. With another adult, in tentionally experiment with how external (environmental) noise and internal noise (movement or sound genera ted by the person being screened) affect your equipment's performance. For example, note what happens if you fail to clip the cord to a collar and the weight of the cord pulls the probe partially out of the ear. Notice how a loose probe fit can cause an error message, or a refer result, and how a snug probe fit can increase your ability to get a pass, eve n when there is some noise present. Also, be aware that the error messages the equipment provides do not al ways accurately pinpoint the problem. The equipment is attempting to analyze internal noise, external noise and probe fit. The problem may actually be some combination of these conditions, and your own experience with the equipment is central to resolving a barrier to successful screening. 
If your equipment has a foam tip option, this often creates a Good probe fit more stable seal in the ear canal, and more effectively blocks noise. Although foam covers are usually more expensive  than plastic ones, they conform to different ear canals in a way that often makes it easier to select the correct size, get a snug fit, and a passing result. The cost may be balanced by savings in terms of minimizing screening time and tips discarded while attempting to find the correct size.
3.  Take steps to minimize external noise in the environment. If your equipment is sensitive to noise, you'll need to take extra care in managing the screening environment. This may mean finding a dedicated spot in the quietest corner of the room in which to conduct screening. It may also mean talking with teachers about how to engage other children in the room in quiet activities while you are screening. Whether screening in a home or school environment, make sure that any equipment that produces sound, such as a fan or a TV, is turned off, or the volume is turned down. Minimizing external noise is always a good idea, but is critical with some OAE equipment.
4.  Think creatively about how to minimize child movement and internal noise. Once you know your specific equipment's capabilities and limitations, you can turn your attention to eliciting a child's cooperation. Toddlers  can be especially challenging to screen, and there is no single approach that will work with all children. There are, however, a range of strategies to try. Start by screening the mos t cooperative child first, setting an example. This can prompt others to be curious and want a turn.  
Elicit the assistance of an adult that the child trusts to help. Train this teacher or helper to hold a child snugly and to direct their attention and hands(!) to a quiet and intere Keep child's hands busy sting toy. You can ask a child w hich toy they would like to play with, but do NOT ask the child's permission to conduct the screening. Instead, use a positive and playful tone to tell the child that he or she will get to play a "listening game." Telling a child that you are going to "check" their hearing or that it "won't hurt" usually has the unwanted effect of making a child feel there is something to avoid! Probe insertion that is done gently, firmly, and expertly should not hurt! Keep your language positive, reassuring and fun, and have a variety of novel toys to support this as an enjoyable activity.  
Never attempt to hold the probe in the child's ear.  This is likely to press the probe opening against the ear canal and cause a refer.  If a child indicates a high degree of sensitivity to even having an ear touched, you may need to wait to screen until after a health care provider has examined the child to determine whether an active ear infection is present. Also, keep in mind that children who have had repeated ear infections have had painful experiences related to ear examinations, so it can take some gentle coaxing over time for them to trust you and the screening process. Gently screening children during nap time is also an option to try.
5.  Consider the timing of screening. This relates to both time of day and time of year. Hearing screening requires the child's cooperation, so attempting the screening during the hours that children are likely to be calm and happy will be easier for everyone. Conversely, screening during time periods when children are likely to be irritable or tired is likely to result in fewer passing results. If children are hungry before lunch, or tired at the end of the day, they are less likely to tolerate the screening process. If you must screen when a child is hungry, you may need to be prepared to offer a snack. Although chewing or sucking can make it difficult for the equipment to assess the inner ea r response, keeping the child content is essential. If you get a passing result while the child is having a snack, it i s reliable. If you don't get a passing result-you'll have to try to again when the child is not chewing or sucking.
The time of year that screening is conducted can also make a difference in you refer rate. If many children are suffering from head colds and are congested, they are less likely to pass the screening. If you can conduct screenings when most children are in good health, it will increase the number who pass.  
Our Video Tutorial Modules 6 - 9 illustrate many of the points above in greater detail, so be sure to view, or review them, as you continue to improve your screening practices. 
Probe of the Month
What have you found to be the most effective in reducing your screening program refer rate? 

Let us know at:    
And, as always, share with anyone you think would benefit from our resources.     

 ECHO - Headstart

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Probes and Tips is a newsletter from the ECHO Initiative that provides monthly TIPS

to enhance early childhood hearing screening and follow-up practices and PROBES

 about current activities so we can learn from one another's successes and challenges.