Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 173 - CONTROL OF COMMUNICABLE DISEASE › Chapter 7 - SCHOOL HEALTH SCREENING, PHYSICAL EXAMINATION AND VISUAL EVALUATION › Attachment 173-7-2A - HEARING SCREENING COMPETENCIES

Current through June 17, 2024
HEARING SCREENING (PURETONE AUDIOMETRY)
				  COMPETENCIES
Essential Steps for Accurate Measurement
COMPETENCY
KEY POINTS
1. Assess environment for ambient background noise
								that will disrupt screening.
Conduct screening in an environment with minimal
								visual and auditory distractions. Ambient noise levels must be sufficiently low
								to allow for accurate screening. If a suitable environment cannot be located
								for screening, the screening results are not valid. The parameters of screening
								should NOT be changed in order to accomplish screening at sound levels other
								than 20dB.
For screening environments, ambient noise levels
								should not exceed 49.5 dB at 1000 Hz, 54.5 dB at 2000 Hz, and 62 dB at 4000 Hz
								when measured using a sound level meter with octave-band filters centered on
								the screening frequencies. These levels are derived from consideration of ANSI
								(1991) standards for pure-tone threshold testing, and are adjusted for the 20
								dB screening level.
In practical terms, if the screener is unable to
								hear all screening frequencies at 20dB, the screening environment should be
								reassessed. Of the first 20 children screened, if 2 or more do not pass (i.e.
								no-pass rate of 10% or higher), the screening environment should be reassessed
								for excessive ambient noise.
2. Assemble equipment in desired location.
The audiometer should be on for five minutes
								(minimum) prior to use. A table and two chairs are required. The student should
								be positioned to face away from the machine, within view of the screener. The
								student should not be able to see the examiner's hands or movements.
3. Check the audiometer:
[TICK] Check cords, cushions, and headbands for
								excessive wearing or cracking.
[TICK] Check dials and switches for alignment and
								ease of movement.
[TICK] Listen for the tone through each
								earphone.
[TICK] With the audiometer set for continuous tone,
								slide the entire length of the cords between the thumb and index finger noting
								any change in output signal.
[TICK] Gently shake the cords. There should be no
								static, hum, or interruption of the signal.
[TICK] Make sure when tone is directed to one
								earphone, no sound is heard from the other earphone.
[TICK] Make sure a steady tone is present at all
								frequencies. With the tone switch in "normal-off" position, press the
								interrupter switch several times to make sure the tone is present each
								time.
[TICK] Listen to the frequencies at 20 dB to make
								sure the tones are audible to the screener with normal hearing.
The audiometer should always be stored with the
								cords loosely bundled into the box. Wrapping the cords around the head phones
								damages the wires and will affect the instrument.
The audiometer should be professionally serviced
								and calibrated on an annual basis (minimum).
4. Give simple but complete instructions to the
								student: "Listen very carefully. You will hear one tone at a time, sometimes
								very soft and sometimes louder. When you hear a sound, raise your hand so I can
								see you have heard that sound, then put your head down and wait for the next
								sound."
While many students are "trained" to do so, it is
								not necessary (or significant) for the validity of the screening that the
								student raises only the hand on the side he or she hears the sound. For the
								purposes of screening, the student and the screener agree on the reliable
								signal the student will make indicating he or she has heard a sound.
5. Place earphones comfortably and securely on the
								student's head: red earphone on the right, blue on the left. The center of the
								ear pad should be centered over the opening of the ear.
Push hair behind ears. Make sure headbands or other
								hair decorations, eyeglasses, and/or earrings are not interfering with the
								correct placement of the earphones.
Head Lice Precautions
Use of the audiometer for one student after another
								may provide a mechanism for physical transport of head lice between students.
								In school settings where head lice are known to be a concern, the school nurse
								may consider conducting school wide head checks prior to the screening
								activity, conducting head checks concurrently with the screening, using a
								shower cap barrier for each child, and/or having supplies to physically clean
								(with damp cloth and disinfectant) head phones between children.
6. Offer a test sound of 40 dB at 4000 Hz to
								confirm the student demonstrates understanding of the instructions.
Set the tone switch in the "normal-off" position so
								the tone will sound only when the screener presses the interrupter
								switch.
7. Proceed with offering screening tones as follows
								each delivered separately to the right and left, all at 20 dB, for 2 seconds'
								duration (say, "hearing test" to yourself).
Vary time intervals and sequence between tones.
								Each tone may be offered up to three times to determine response.
Testing frequencies are: 1000 Hz, 2000Hz, 4000
								Hz.
Pass if the child's responses are judged to be
								clinically reliable at least 2 out of 3 times at the criterion decibel level at
								each frequency in each ear.
Work quickly, offer praise. Children with hearing
								problems may "Pass" due to anticipating patterning by the screener.
It is not necessary to continue screening in order
								to determine the decibel level at which the student does indicate hearing the
								sound ("threshold screening".)
It is sufficient for the purposes of screening to
								identify whether the student does or does not indicate hearing at desired
								frequencies at 20 dB.
8. Record results.
The screening procedure identifies the child
								apparently not hearing the given frequencies at 20 decibels.
Record results by identifying for the Right and
								Left sides the results for each frequency at 20dB: P (pass) or NP (not
								passed).
For example:
R: 1000/P L: 1000/P
R: 2000/P L: 2000/NP
R: 4000/NP L: 4000/P
9. Identify the student who should be rescreened,
								if available, and/or parent notified.
The student who misses any of the frequency tones
								at 20dB should be rescreened and, if missed tone or tones persist, referred for
								further evaluation by physician or audiologist.
Rescreening should be performed 2-4 weeks following
								the initial screen. The rescreening validates the initial finding and also
								allows resolution of transient congestion or inflammation which might
								temporarily affect hearing - while not allowing excessive delay before further
								evaluation if indicated.
Referrals may be made either to a community medical
								provider or community audiologist of the parent/guardian's preference, or to
								the district audiologist. Post treatment screening is indicated to obtain the
								final outcome of the screening process.
Additional information and resources are available
				  from the DHHS School Health Program, 402-471-
1373
.