June, 2019        

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ECHO Initiative Events

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Tuesday, June 18, 2019
2-3 p.m. ET
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Tuesday, Aug. 15, 2019
2-3 p.m. ET 
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Tuesday, Aug. 20th, 2019
2-3 p.m. ET
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Thursday, Aug. 22nd 2019 
2-3 p.m. 
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ECHO Initiative
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Tip of the Month
No Need to Add Middle Ear
Screening Procedure  

Early care and education programs using Otoacoustic Emissions (OAE) to screen children's hearing sometimes ask whether they should add another procedure, such as tympanometry, to assess whether a child has fluid in the middle ear or "otitis media."  The short answer to that question is usually " no." For most programs, adding such a  procedure increases cost and complexity that does not "pay off" in terms of more accurate or timely diagnosis.   
If the goal of your hearing screening program is primarily to identify children who may have a permanent hearing loss, and to make Good probe fit appropriate and timely referrals for audiologic evaluation and treatment, this can be accomplished by using OAE equipment and adhering to the recommended screening protocol.   
To explain the rationale a little further, let's consider the  case of a child who did not pass the initial OAE screening on one ear. We don't know for sure if the "refer" result was because the cochlea (inner ear) was not responding to the sound stimulus or if something interfered with the screening (i.e., internal or external noise, fluid in the middle ear, etc.) Although a small number of early childhood hearing screening programs may have skilled nurses doing the OAE screening who can also conduct tympanometry, the "next step" needed in the overall screening process would not be altered by adding this information.  
Even if a screener has the equipment and training to document the presence of middle-ear fluid, the best course of action is usually to wait for two weeks and conduct another OAE screening. Here's why: If the original "refer" result was due to a common cold and temporary fluid in the middle ear, allowing this brief recovery period may allow the middle ear to clear, so that an accurate OAE screening can be completed. Most OAE screening programs that have well-trained lay screeners find that about 90% of children will pass either the first or second OAE screening without requiring referral t o a health care provider. This protocol avoids over-referral and helps health care providers to focus their time and efforts on the 10% who do need further evaluation.
For the subset of children who do not pass the second OAE screening, a visual inspection of the ear, along with tympanometry or pneumatic otoscopy, should be part of the health care provider's evaluation. The screening Tympanometry program needs to consult with the provider to find out about the diagnosis along with any planned treatment. This is important because most health care providers do not have OAE equipment and cannot complete the hearing screening. So when any outer or middle ear problems have been resolved, the screening program must conduct an OAE rescreen. At this point, if the child does not pass, referral to a pediatric audiologist is needed to determine if a child has a condition affecting the inner ear - possibly a permanent hearing loss.
Overall, whether an early childhood screening program has the capacity to supplement OAE screening with tympanometry is not central to the quality of hearing screening that can be provided. What is critical is having screeners who:  
  • are well-trained to conduct the OAE procedure;
  • adhere to the protocol;
  • make accurate and timely referrals; and
  • communicate clearly with the other professionals who have a role in the diagnostic and treatment process.
If your screeners already have the capacity to conduct tympanometry, and your local audiologist and health care provider partners support you in the use of the equipment and the interpretation of the results, there are ways this information can be integrated into the OAE screening process. However, most programs do not need to take on the burden of adding this procedure in order to provide high quality hearing screening to young children.   
Probe of the Month
Have any other questions about how to focus your hearing screening resources and efforts?   
If so, let us know at:   
And, as always, share www.KidsHearing.org 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.