What is the best way to identify potential Hearing &
Vision issues? MDCH can help.
Early On Webinar - June 20, 2013
Tiffany Kostelec, MDCH Consultant for Early On
Jennifer Dakers, MDCH Hearing Consultant
Dr. Rachel Schumann, MDCH Vision Consultant
Dr. Michelle Garcia, MDCH EHDI Loss to Follow-up
Consultant




MDE purchased OAE and Sure Sight screening equipment in 2003

Intent – provide objective screening that results in valid & reliable hearing and vision status.

Prevent – late identified hearing & vision problems. Subjective screening (paper & pencil questionnaire) only i.d. 50% of those with problems.
Update new staff/Refresh previously trained staff.
Trends in Use/Non-Use




Repair Issues
Troubleshooting Issues
Calibration Issues
Training Issues



MDCH Hearing and Vision screening Program

Equipment.



Is screening important?
Available trainings.
Let’s work together.
MDCH EHDI Program.

What is EHDI?



EHDI National and State goals
EHDI stats.
How can you help?

Screening is the first step in identifying infants and toddlers that may have a hearing or vision loss

Public Act 368 of 1978, Part 93
Hearing and Vision Rules
R325.3274 – Frequency of Screening



Rule 4. (1) Hearing and vision screening of preschool children shall be done at least once during the ages of 3 to 5 years.
Rule 4. (2) Hearing screening of school-aged children shall be done at least in grades K, 2, and 4, or screening shall be done biennially starting at age 5 and continuing at least to age 10.
Infants and toddlers are unfortunately not included in this law.
Hearing and Vision
Screening Requirements*
Pre-school X X
Kindergarten X
1 st Grade X
2 nd Grade X
3 rd Grade X
4 th Grade X
5 th Grade X
7 th Grade X
9 th Grade X
*Some local health departments may schedule screenings at different intervals. Call your local health department for more information.

What is OAE screening?
o An objective method that screens hearing in a range of sound frequencies critical for normal speech and language development o OAE screening can help to detect sensorineural hearing loss occurring in the cochlea o It can also call attention to issues in the outer & middle ear. (fluid, wax)


Does not require a behavioral response from the child

Is quick and painless

Can be conducted by anyone who is trained to use the equipment and is skilled in working with children

o Perform an initial screening of both ears on every child
(birth to three years of age) who has been found eligible for Part C.
o Any ear not passing the initial (1st OAE) screening is screened again (2 nd OAE) within approximately 2 weeks of the first screen.
o If the ear does not pass the 2nd OAE screen, the child must be evaluated by a health care provider to determine whether there is an outer or middle ear condition
(blockage, fluid, structural anomaly, etc.) interfering with accurate completion of the OAE screening. Treatment or monitoring may be needed.

o
Once the health care provider gives medical clearance, indicating that there are no conditions present that would impede an accurate screening,
an OAE rescreen is conducted again.
o
If the ear does not pass this OAE rescreen, the child should be referred to a pediatric audiologist for a diagnostic evaluation. This referral is usually made by a health care provider in coordination with the
Early On ® program.

When the pathway through the ear is clear
(no blockage or fluid), the OAE response is a reliable indication that the inner ear (cochlea) is functioning normally





If the equipment does not pick up a sufficient cochlear response, the ear will not pass the screening.
If blockage or fluid in the hearing pathway impedes the sound going to the cochlea or the response coming back out, the ear will not pass the screening.
OAE screening is designed to identify children whose cochlear function may be permanently impaired, but it will also help identify children who may have a temporary hearing loss due to otitis media (middle ear infection) or excessive wax buildup in the ear canal.
When a child doesn’t pass, further professional evaluation is required to determine the source of the problem and possible treatment.





Probe falls out during screening
Too much noise in area
Baby was moving, vigorously sucking, or crying
Probe appears blocked when removed from the ear


Remember your goal is not to pass every baby. A baby with hearing loss may falsely pass with multiple screenings. Screening repeatedly is not cost effective or an efficient use of time.


Cleaning the Probe.

“Old” gold faced unit-Remove tubing and microphone from probe, push cleaning tool through metal tubes.

“Newer” blue faced unit-Remove and replace probe nozzle if necessary: use fingernail to “unlock” clip, gently pull off.
Install new nozzle onto probe body.

Storing the Equipment.

Place a clean ear tip on probe after each test and before storing equipment to help reduce dust build-up in probe.

Calibration: Performed annually by company. Is usually available at the annual Early On Conference.

Public Act 368 of 1978, Part 93
Hearing and Vision Rules
R325.3274 – Frequency of Screening



Rule 4. (1) Hearing and vision screening of preschool children shall be done at least once during the ages of 3 to 5 years
Rule 4. (2) Vision screening of school-aged children shall be done at least in grades 1,3,5,7 and 9 or done biennially starting at age 6 for those not in a formal education program
Infants and toddlers are not included in this law
Hearing and Vision
Screening Requirements*
Pre-school X X
Kindergarten X
1 st Grade X
2 nd Grade X
3 rd Grade X
4 th Grade X
5 th Grade X
7 th Grade X
9 th Grade X
*Some local health departments may schedule screenings at different intervals. Call your local health department for more information.

Screening with the SureSight™ o An objective method that screens vision, beginning at 6 months of age, for infants and toddlers o The SureSight™ screens for common refractive vision problems including near and farsightedness, astigmatism
(asymmetrical focus), and unequal power between the eyes


Minimal cooperation is needed, making it effective for young children

Lights and sounds engage children’s attention

It is quick and painless

Can be conducted by anyone who is trained to use the equipment and is skilled in working with children


MDCH consultants can provide



 full-day trainings on the use and care of the OAE or the SureSight opportunities for supervised practice on young children
Training for those who will regularly use the equipment
Minimum 6/maximum 10

Contact Tiffany Kostelec at kostelect@michigan.gov if you are interested in scheduling a training

Partnering with neighboring ISD’s helps meet the minimum number to host a training


Our MDCH vision and hearing consultants can provide tips during training to help ensure that the screening of infants and toddlers is valid and reliable

Practice makes perfect. Plan to use the tool regularly!

Practicing on co-workers, children, grandchildren, neighbors, and others, can help you feel more comfortable before you screen on-site with a family


MDCH would appreciate receiving data to:

 show the value of screening the 0-3 population
(prevalence of identified H & V issues)
Justify MDCH staff time providing free trainings throughout Michigan

Quarterly data would include:





The number of children screened
The number who passed the screening
The number of children who failed the screening
The number of children who were referred for evaluation
The number of children who are receiving treatment

Michigan Department of
Community Health: Early
Hearing Detection and
Intervention (EHDI)

What is the Early Hearing Detection and
Intervention (EHDI) Program?
(Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and
Intervention Programs.)

 All newborns will be screened for hearing loss no later than 1 month of age, preferably before hospital discharge.
 Those not passing screening should have a comprehensive audiologic evaluation no later than
3 months of age.
 All infants identified with hearing loss will receive appropriate early intervention services no later than
6 months of age.

o
98% babies screened no later than 1 month of age.
o
52% diagnosed no later than 3 months.
o
166 babies with permanent hearing loss in
2011.
o
41% Intervention no later than 6 months.

Birth
Year
Referred LTF
2007 1925 1176 61.1%
2008 1639 954 58.2%
2009 1518 800 52.7%
2010 1531 833 54.4%
2011 1557 822 52.8%
*Number and percent of infants lost to follow-up after refer from final hearing screen: MI
EHDI Data, 2007-2011.


Effective communication of results to families has an influence on follow up behaviors.

Balance between reassurance and importance of follow-up with medical professional and possible follow-up testing.

“Your child may or may not have a hearing loss…but let’s be sure about it.
If further testing shows hearing loss, the earlier we get started helping the child, the better.”

“Your baby did not pass the hearing screening test today. This does not necessarily mean that your baby has a hearing loss. It only means that he or she needs further testing. It is VERY important for you to take your baby for follow up testing to be sure about your baby’s hearing. Let’s see if we can schedule that appointment before you leave today.”

“Your baby has passed the newborn hearing screen. However, your baby’s hearing status can change at any time, so I am providing you with a brochure that talks about how normal babies develop. If you are ever worried that your baby cannot hear, talk to your baby’s doctor right away and ask your doctor for a referral for a hearing test.”




Undiagnosed Hearing Loss in Infants is a “Neurodevelopmental
Emergency”.
Mandated Screenings Should Include
1 Year of Age & 2 Years of Age.
Local Health Departments Could be
Referral Sites with Additional Staff,
Equipment, and Money.

 Despite progress related to newborn hearing screening, approximately 10% of newborns in the US are not screened at birth, and 30-50% of infants who do not pass their newborn hearing screening are lost to follow-up.
 Estimated incidence of sensorineural hearing loss in the US triples between birth and the school-age years, from 1 in 300 to 3 in 300.
 Hearing loss can occur at any time in a child’s life. Progressive and late-onset may occur at any time throughout early childhood.
 Approximately 35% of preschool children will have repeated ear infections before 3 years of age, nearly always resulting in fluctuating conductive hearing loss.
 Without regular, physiologic screening, hearing loss is often impossible to detect.
 Children with unidentified hearing loss are often identified with speech and language delays, described as having behavioral disorders or learning disabilities.

Where’s Your Audiologist?
If you don’t already have a connection with a pediatric audiologist in your community, you can call Michelle Garcia at 517-335-8878 or contact her at garciam@michigan.gov
to receive help in finding one!


2006

Mandated reporting: Public Act 31 of 2006 (SB 794).
Medical professionals must report to the state:


All hearing screenings on children less than
twelve months of age; and
All diagnosed hearing loss in children under three years of age.

By working together we can give all babies born in Michigan a better chance at success.