Hearing Screening E-Learning Course

Hearing Screening E-Learning Course

Pure Tone Audiometry Screening

A picture of little girl and an audiologist. She is seated so she cannot see the audiologist and the audiometer.

For information on the audiometer, refer to Audiometer Use, Care and Calibration.

Ages

3 through 20 years of age

Purpose

To identify children with suspected hearing loss

Description

A standard series of pure tones at set decibels presented to the child using pure tone audiometry

Equipment

Pure tone audiometer (for operating instructions refer to Audiometer Use, Care, and Calibration)

Facilities

Quiet room or area free from visual distractions

Procedure set-up

  • Identify the child by name.
  • Explain the procedure.
  • Avoid using the term fail when speaking to the child; for terminology guidelines refer to Communicating results and follow-up.
  • Position the child so they cannot see the front of the audiometer.
  • Lay headphones on the table, facing the child. Set audiometer to 2000 Hz and maximum volume, and have the child practice raising either hand when a sound is heard.
  • Refer any child who is unable to hear the sound at maximum volume to their primary care provider.
  • Perform a visual inspection of the ears.
  • Set decibel dial to 40dB and frequency dial to 1000 Hz.
  • Place the red headphone on the child’s right ear and the blue headphone on the left ear and ensure the headphones fit snugly on the child’s head.

Screening Children ages 3 through 10

  • Set selector switch to “Right” and present 40dB at 1000 Hz.
  • Turn dial to 20dB and present sounds at 1000, 2000, and 4000 Hz.
  • Turn selector switch to “Left” and present sounds at 4000, 2000, and 1000 Hz.
  • Set dial to 25dB and present sound at 500 Hz *; next, turn selector switch to “Right” and present sound at 500 Hz *.
  • Present sounds for one to two seconds; you may present the sound twice consecutively if needed for each screening frequency.
  • Document screening results.

Screening Children ages 11 through 20

  • Set selector switch to "Right" and present 40 dB at 1000 Hz.
  • Turn dial to 20dB and present tones at 1000, 2000, 4000, and 6000 Hz.
  • Turn selector switch to "Left" and present tones at 6000, 4000, 2000, and 1000 Hz.
  • Set dial to 25dB and present tone at 500 Hz*; next, turn selector switch to "Right" and present tone at 500 Hz*.
  • Present tones for one to two seconds; you may present the tone twice consecutively if needed for each frequency.
  • Document screening results.

Considerations

  • Pure tone audiometry screening should take place in a very quiet room.
  • Perform an Environmental noise level check before performing screenings in any environment.
  • Pause the screening if any distracting noise occurs.
  • If the child does not appear to understand the directions, stop, take the head phones off, and reinstruct the child.
  • If the child did not hear one or more sounds in either ear, perform an immediate rescreen by repeating the entire pure tone series, preferably with a different screener and audiometer.
  • If the child is unable to screen due to issues such as behavior or equipment malfunction, stop and document “unable to screen.”
  • For children who are difficult to screen, refer to play audiometry on the next page.

Pass

A child who responds to all four sounds in each ear (25dB at 500 Hz; 20dB at 1000, 2000, and 4000 Hz) does not require rescreening or referral.

Rescreen

If you work in a clinic setting:

If the child does not respond to one or more sounds, perform and immediate rescreen. If the child still misses one or more tones, refer to health care provider for immediate evaluation of the middle ear.

  • If the child has factors which might impact hearing (fluid in middle ear, ear infection, etc.), then rescreen after the middle ear condition is cleared or in 8 - 10 weeks.
  • If the child has no visible middle ear condition, refer to audiology for immediate evaluation of hearing.

If you work in a community setting:

If the child does not respond to one or more sounds on the immediate rescreen, schedule the child for pure tone audiometry rescreening in 14 to 21 days; refer to the Rescreen and REFER criteria in this manual for further information.

*The 500 Hz sound may be eliminated when the environmental noise level is too high.

Immediate Rescreen:

If the child lacks a response at any frequency in either ear:

Screen the remaining frequencies. Perform an immediate rescreen after all of the sounds have been presented, for an immediate rescreen, repeat the entire pure tone sweep (not just the missed sound). In a screening environment with multiple screeners, it is preferably done with a different screener and audiometer. Remove headphones from the child’s head and carefully replace them over the ears. Do not repeat the pure tone sweep more than twice.

Pass

The child must respond to all eight sounds (four in each ear) in order to have a Pass on the screening

Referral Criteria: Pure tone audiometry sweep screening referral criteria is a lack of response to any screening sounds of 500 Hz at 25 dB and 1000 Hz, 2000Hz, 4000 Hz at 20 dB after the immediate rescreen.

Note: Make any pertinent notes under Comments on in the form such as if the child has a head cold or congestion.

Summary:

The order of presentation of sounds is as follows:

Right Ear
1000 Hz at 40 dB (conditioning sound)
1000 Hz at 20 dB
2000 Hz at 20 dB
4000 Hz at 20 dB

6000 Hz at 20 dB (for ages 11 and up)

Left Ear
6000 Hz at 20 dB (for ages 11 and up)

4000 Hz at 20 dB
2000 Hz at 20 dB
1000 Hz at 20 dB
500 Hz at 25 dB

Right Ear
500 Hz at 25 dB

Top Six Tips for Hearing Screening

Posture for screening

Make sure that the screening area is quiet. Background noises, especially fans or heating systems, can cause distractions for the person being tested.
Ensure that the audiometer is calibrated.

Sit the child (as in picture) so they cannot see the audiometer or the tester's face.

Prior to placing the audiometer headphones on the child, be sure that the child understands the instructions by conditioning the child to raise his/her hand or to put a toy in the box when he/she hears each sound.

The screener and parent/caregiver accompanying the child should avoid nonverbal cues or facial expressions that could give away the correct responses.

For missed audiometric sounds at any frequency, do an immediate re-screen by repeating the entire pure tone sweep (not just the missed sound) preferably with a different screener and audiometer.

Note: You must answer the following questions to continue with the course.

Question 1: During a hearing screening, a child raised his hand after some of the sounds were presented; when other sounds were presented he just looked at the screener and smiled. The smiles can be construed as a passing response.


Question 2: MDH recommended pure tone audiometry screening frequencies are:




Question 3: Which two decibel (dB) levels are recommended when performing pure tone sweep screening?






This concludes the Pure Tone Audiometry Screening segment of the Hearing Screening Procedures Section. You may return to the Table of Contents or continue with the next segment, Play Audiometry Procedure. If you do not plan on completing the entire web training, please fill out the evaluation form, C&TC Children's Hearing Screening Web-Based Training Evaluation.


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