Current hearing screening programme

1
Current hearing screening programme

• Neonatal identification and testing of risk
• Universal neonatal screening gradually being
  introduced
• HV/GP Surveillance 6/52 check
• PCHR information on hearing behaviour
• HV DT 7-9 months still used in some reas
• HV Surveillance especially language development
  18 - 24/12 and 3 years
• School entry sweep test 4½-5 years

2
Hearing difficulties in childhood quiz

• Contributor
• Dr C M Ni Bhrolchain
• Huntingdon

3
Hearing screening review

• Average age at identification 18 months
• 25 identified after age of 3
• Recommendations
• Universal neonatal screening
• Rapid Tier III Audiology assessment for failures
• Rapid fitting of aids
• HV surveillance and targeted distraction testing
  for those missed

4
Why?
Early identification is believed to assist speech
and language acquisition and chance of coping in
mainstream education
5
Neonatal Screening

• Behavioural Screening still sometimes used
  (Auditory Response Cradle)
• Electrical Response Audiometry (Auditory
  Brainstem Evoked Responses) ABR
• Oto-acoustic emissions (OAE)

6
Universal Screening Pathway
7
Targeted screening selection

• SCBU for 48 hours or more
• FH. Congenital deafness
• Abnormalities of head and neck
• Intra-uterine infection
• Consanguinity
• Approximately 7 of neonatal
• population

8
Distraction test screening

• All babies at 7 9 months
• Set at approximately 30 dB (sound level meter)
• Behavioural test so indicates all pathways are
  intact
• Training issues make the test unreliable in many
  places
• 6 10 will need referral for further assessment
  (national average)

9
Distraction testing pathway
Screen
Fail
Pass
Discharge
Concern
No concern
HV
Refer Paediatric Audiology
Repeat 1/12
HV
Pass
Fail
Discharge
10
Implementing universal neonatal programme

• Universal Neonatal Screen aims for
• 90 coverage
• 95 on re-test
• 85 sensitivity
• 10 false positive
• 1 audit
• Continue health visitor surveillance (not
  testing)
• Targeted distraction test
• Monitor age at identification

11
Also needs

• Coordinated programme (named person/committee)
• Joint commissioning of services across health,
  education, social services
• Programme manager
• Transition phase where both systems overlap for 9
  months
• May also abolish school entry in time

12
Tests for older children

• Speech discrimination (McCormick Toy Test)
• Free field audiometry
• Performance testing
• Pure tone audiometry

13
Sweep test at school entry

• All school entrants (coverage often gt 95)
• Set at 20 - 25 dB
• Failures re-tested
• 2nd fail referred to Audiology
• About 5 referred (national average)

School nurses will do audiometry on referral from
GP