Hearing Screening Online Training Program

Child and Teen Checkups (C&TC) Documentation of Hearing Screening

Complete documentation of the hearing screening must be provided. Although no specific documentation forms are required for C&TC, age specific C&TC documentation forms are available for your convenience from the Department of Human Services. For more information on C&TC documentation, or to download the documentation forms, please visit the Department of Human Services website.

On the C&TC age-specific documentation forms, you will find the following information.

Hearing
Right Ear Left Ear
500
1000
2000
4000
500
1000
2000
4000
               

__Normal __Abnormal __Question validity/retest

Comments:

Staff Initials______

Hearing concerns __No ___Yes (explain)


Documentation of Subjective Screening

How do I perform a subjective screening?

Hearing Concerns Section

The primary care provider usually performs the subjective screening as a part of the health history. The information gained through the subjective hearing screening may be documented in the hearing concerns section or the child health history section of the medical record.

Make a note regarding any hearing concerns such as pain or drainage. If any of these conditions are present, DO NOT PROCEED with the audiometric portion of the screening and have a primary care provider see the child. Document any parental concerns of a child’s hearing or risk factors for hearing loss.

When screening children aged 0 to 24 months, you may provide the My Child’s Hearing Checklist for the parent to complete. My Child's Hearing Checklist is available from the MDH Universal Newborn Hearing Screening (UNHS)/Early Hearing Detection and Intervention (EHDI) Program website in Somali, Hmong, Spanish, and English. Any concerns from this checklist should be documented in the patient’s medical chart.

Documentation of Objective Screening (through standard pure tone audiometry and play audiometry):

Document the results as follows:

Right Ear Left Ear
(Hz) 500
1000
2000
4000
500
1000
2000
4000
(DB) 25/
20/
20/
20/
25/
20/
20/
20/

Document the results of the pure tone audiometric screening. Write the first decibel level that the child was being tested for each of the corresponding frequencies (Hz) (i.e., 20 dB at 1000 Hz, 2000 Hz, and 4000 Hz; and 25 dB at 500 Hz). If 500 Hz was eliminated due to excess ambient noise, document this in the 500 Hz section of the form. Then write P (pass) if the child heard it or leave it blank if the child did not hear a tone. For example, if the child responded to 25 dB in the right ear at 500 Hz and did not respond to 20 dB at 1000 Hz, your documentation would look like the following:

500
1000
25/P
20/

If a child does not hear the tone at the appropriate decibel and frequency level, test the remaining frequencies. After all of the tones have been presented, return to the missed tones for an immediate re-screen. If the child continues to be unable to hear the tones, document that the child has not passed the screening by checking the “Abnormal” box and writing “RS” for Re-Screen in the box for the tone that was missed. Make any pertinent notes under Comments such as if the child has a head cold or congestion.

For example:

1000
20/RS

Re-screen after 10-14 days:

It is always advisable to wait to re-screen a child’s hearing until 10 to 14 days after the initial screening if the child did not pass the immediate re-screening; a temporary illness, lack of understanding, fatigue, apprehension, or allergies may have caused the child to not pass the initial screening.

If the child does not pass audiometric screening at the 10-14 day re-screen document by writing an 'R' (refer) at the appropriate frequency, i.e.,

1000
20/R

It is advisable for the child to be seen for further evaluation by a primary care provider.


If the child does not appear to understand the audiometric procedure, or keeps raising his or her hand even when a tone is not presented, check the ‘Question Validity’ box.

The screener should check the “Normal” box if the child is able to hear all eight tones.

If pure tone audiometry is deferred, document the reason.

Example: If the child was not able to be tested via standard hand-raising pure tone audiometry or play audiometry, document this and re-screen the child in two to three weeks.



This concludes this section of the training; you may continue on to the next section, Newborn Hearing Screening, or return back to the Table of Contents.

If you are not planning 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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