Continuing Education

Revised Guidelines for School Hearing
Conservation Program

The Audiology Committee of the Indiana Speech-Language-Hearing Association has revised the guidelines and recommendations for hearing programs in the schools. The intent of the revision is to assist persons involved with such programs in program improvement and standardization and to align existing recommendations with those of national Audiology organizations. These guidelines and recommendations address qualifications of personnel, testing criteria, type and condition of equipment used, follow-up procedures and other pertinent aspects of such programs. It should be noted that these guidelines are recommendations rather than requirements. Optimal but obtainable conditions have been set forth. It is recognized that in some cases school personnel are currently providing services that exceed existing guidelines while other cases the revised guidelines may represent goals for program development. It is also recognized that local conditions may dictate variations in theses recommendations although it is hoped that these guidelines will be implemented whenever possible in local programs.

INDIANA SPEECH-LANGUAGE-HEARING ASSOCIATION AUDIOLOGY COMMITTEE

INDIANA SPEECH-LAUNGUAGE-HEARING ASSOCIATION
Revised Guidelines for School Hearing Conservation Programs Audiology Committee
2001

Hearing screening has been conducted in schools in Indiana since the 1930s. Today this activity is part of a very important set of procedures which constitute a hearing conservation program.

Screening is only one component of a hearing conservation program. A well balanced program will include audiological assessment, medical evaluation and treatment, audiological treatment, and program development and management. It is pointless to identify people who have hearing impairments unless there is concurrent follow-up to handle their audiological, educational, and medical needs.

The Goal of a Hearing Conservation Program
The goal of a hearing conservation program is to prevent hearing loss, conserve, resources, educate the public and identify persons who have hearing problems that interfere with or have the potential for interfering with communication or educational progress.

SECTION 1: QUALIFICATIONS AND DUTIES OF PERSONNEL

A. Supervisor of the Hearing Conservation Program
1. It is recommended that an audiologist supervise hearing conservation programs.
2. The hearing testing program in each school corporation shall be under the direction of an audiologist.
3. Qualifications
a The person shall hold a valid Indiana Certificate from the Indiana Professional Standards Board as an Educational Audiologist; or
b The person shall hold a valid State of Indiana License in Audiology from the Health Professions Bureau.
4. Duties
a The audiologist shall be responsible for organizing, coordinating, and implementing a systematic program for conducting hearing screenings in the school.
b The audiologist shall keep and maintain records, initiate referrals and follow-up procedures, and prepare and submit reports.
c The audiologist shall report screening results to school personnel and parents.
d The audiologist shall provide, or arrange for the provision of, audiological treatment needed to remediate any hearing problems.
e The audiologist will develop an educational plan for students and teachers that emphasizes prevention.

SECTION 2: ADMINISTRATION OF HEARING CONSERVATION PROGRAMS

A. Students to be Screened
It is recommended that audiometric screening be administered to:
1. All students in kindergarten through fourth grade, and students in seventh and tenth grades should be screened annually. (Law requires first, fourth, seventh, and tenth grades be tested annually).
2. All students who were identified as having a hearing problem the previous year. Students with recurrent or chronic ear problems will require periodic audiometric monitoring.
3. All students newly enrolled in the school system/building.
4. All students who missed the original screening day will be screened within 60 school days.
5. Students specifically referred for screening because of a suspicion of hearing impairment.
6. Students who have, or have had, a physical disability or an illness frequently associated with hearing impairment (i.e. cleft palate, meningitis, head trauma).
7. Students enrolled in Communications programs.
8. Students enrolled in Special Education other than homebound.

B. Hearing Screening Not Required
No Student shall be required to submit to a hearing screening if written objections by the parent or the guardian is submitted to the proper school authorities.

SECTION 3: TEST EQUIPMENT AND STANDARDS

A. Equipment Standards
1. Audiometric test equipment shall meet all specification set forth in “Specifications for Audiometers”, ANSI S3.6-1996 by the American National Standards Institute, Inc., 1430 Broadway, New York, NY 10018.
2. Acoustic immittance instruments shall meet manufacturer’s specification and equipment safety.

B. Calibration and Maintenance
1. Equipment Check
A daily listening check should be performed to determine improper functioning of the equipment such as distortion and intermittence. If so, the instrument shall not be used until it is functioning properly.
2. Minimum Annual Calibration
a Calibration and any necessary repairs shall be made at least annually.
b The person or company performing the calibration shall be required to furnish data which specify:
1. how closely the equipment meets the specifications.
2. precisely what maintenance or repair procedures were performed on the equipment to achieve these results.
3. The school corporation shall maintain a continuing record of such calibration and repair and keep the latest calibration certificate on file.

C. Minimum Test Specifications
The test environment for both screening and threshold testing shall be sufficiently quiet to allow determination of at least a 20 dB hearing screening level re ANSI-1996 (S3.6) at each of the test frequencies. Ambient noise levels should not exceed 49.5 dB SPL at 1000 Hz, 54.5 dB SPL at 2000 Hz, and 62 dB SPL at 4000 Hz when measured using a sound level meter with octave-band filters centered on the screening frequencies (ASHA 1997).
SECTION 4: HEARING SCREENING

A. Test Frequencies
Hearing screening shall be conducted at 1000, 2000, and 4000 Hz.
B. Screening Level
Screening shall be conducted at no greater than 20 dB HL re ANSI-1996 (s3.6).
C. Failure Criterion
Failure of the screening consists of a response poorer than 20 dB at any frequency in either ear.
D. Re-screening
1. All failures should be re-screened within two weeks using the same frequencies, levels, and failure criterion.
2. Failures upon re-screening should be referred for an audiologic evaluation by an audiologist.

SECTION 5: ACOUSTIC IMMITTANCE SCREENING PROTOCOL

The purpose of screening is to assist in the identification of hearing impairment that may interfere with educational progress. For screening purposes, acoustic immittance is intended to monitor each student’s middle ear status. Refer to current ASHA Guidelines (1997) for the most current information.

A. Acoustic immittance screening program should be conducted by an audiologist.
B. Acoustic immittance should be done in conjunction with the hearing screening.
C. Otoscopic inspection should precede acoustic immittance.
D. Acoustic Immittance Screening Pass-Fail Criteria
For acoustic immittance screening purposes, eardrum mobility and ear canal volume are the only factors to be considered. Failure shall consist of eardrum mobility lower than the manufacturer’s norms for the particular acoustic immittance instrument for canal volume size between .3 and .9 cm (1.0-2.5 cm may be appropriate for older students). If the ear canal volume is less than.3 cm, the examiner should retest due to the possibility of improper placement of probe tip in the ear canal or excessive accumulation of cerumen. If the canal volume exceeds 2.5 cm and no measurable eardrum mobility is recorded, medical evaluation may be appropriate. (Caution: Students who have P.E. tubes could have volumes exceeding 2.5 cm and no measurable eardrum mobility). When acoustic immittance failure occurs in conjunction with a pass on a hearing screening, follow-up acoustic immittance is recommended at least two weeks after the initial acoustic immittance test.

SECTION 6: CRITERIA FOR REFERRAL

A student shall be referred for an audiological evaluation if one or more of the following criteria is met:

A. Failure on the second hearing screening;
B. Pass on hearing screening and failure on two acoustic immittance screenings (see Section 5), performed at least two apart.

SECTION 7: FOLLOW-UP PROCEDURES

A. Audiological and/or Medical
All students who fail the second screening will be referred for audiological and/or medical examinations. Students with diagnosed hearing loss should have annual audiological evaluations with reports in their school files.
1. Within a reasonable time, parents shall be provided with:
a Notification that:
1. their child failed a hearing screening and/or an acoustic immittance screening and;
2. they should consult an audiologist or appropriate physician
b a report of the screening results and recommendations
c a referral response for which is to be completed by the appropriate examnare and returned to the school audiologist
2. If parents fail to provide proof of a medical or audiological examination, the appropriate school authorities will be notified.

B. Educational Needs
1. An individualized education program (I.E.P.0 meeting should be conducted to consider program revisions for the hearing impaired student.
2. All relevant teachers and school personnel shall be notified of the hearing loss and informed of the problems and needs of the hearing impaired student.
3. It is the responsibility of the audiologist to inform the appropriate personnel of any changes in the status of the hearing loss.
4. If the hearing loss persists or changes, the student’s educational program should be revised as needed.

SECTION 8: RECORDS AND REPORTS

A. Student’s Audiological Report
1. A complete and continuing record of all auiometric tests and related recommendations for follow-up and rehabilitation shall be maintained by the audiologist as part of each student’s permanent hearing record.
2. Each student’s record shall clearly indicate:
a. the date the student’s hearing was screened
b. the type of screening: screening, second screening, or acoustic immittance screening
c. the ear passed or failed on each screening given

B. School Audiological Report
1. Results of screening, audiological testing, and medical information shall be made available to appropriate school personnel.
2. The student’s hearing loss may be recorded in a permanent file according to school policy.
3. A class list of grades screened, with pass/fail indicated, shall be filed with the audiologist supervisor.
4. A yearly report shall be filed with the Board of Health.
5. Complete hearing records should accompany transferring students according to school policy.
6. Complete hearing screening recoreds should be kept for a minimum of 5 years.

SECTION 9: INFECTION CONTROL FOR SCHOOL AUDIOMETRIC TESTING

The purpose of these guidelines is to reduce risk of contracting or spreading disease through inappropriate infection control procedures during audiometric screening. Audiologists and Speech-Language-Pathologists who work in the schools are at risk for being exposed (or exposing others) to contagious diseases such as cytomegalovirus (CMV), human immunodeficiency virus (HIV), Hepatitis B (HBV), and Herpes Simplex.

Although audiologists and speech-language pathologists are at risk for occupational exposure of blood-borne pathogens, the risk for contacting and transmitting HIV, HBV, and other communicable diseases is low. However, every person should be considered potentially infectious and infection control procedures should be implemented.

The presence or absence of the AIDs virus in cerumen has yet to be demonstrated. Preliminary data suggest that he virus may not be present at all or, if present, in low concentrations. Until questions about cerumen are resolved, routing Center for Disease Control (CDC) secretion precautions should be more than adequate. The following precautions are recommended:

1. Begin all audiometric testing procedures with an otoscopic inspection of the circumaural region and ear canal. If the skin is intact and no blood is present, gloves would not be required. If blood or lesions are found, then one minute of vigorous hand washing followed by the use of gloves is required.
2. Audiometric and/or acoustic immittance testing should be postponed if blood or drainage is visible upon otoscopic inspection. Medical evaluation of the problem is recommended. Any instrument that comes in contact with body fluid(s) should be sterilized or discarded.
3. Earphones need not be cleaned after each use if not contaminated by blood or bodily fluids. If contaminated, disinfect with a 1:100 solution of household bleach to water.
4. Disposable materials such a speculums should be used whenever possible and never reused.
5. Nondisposable clinical materials such as acoustic immittance probe tips and speculums may be cleaned with a commercially available disinfectant or a 1:100 solution of household bleach to water. Materials need to be completely cleaned and dried before being reused. This may require the purchase of additional materials in order to allow for adequate cleaning and drying time.
6. The most effective methods demonstrated of preventing the spread of infectious disease is vigorous hand washing for at least 30 seconds with antiseptic or germicidal soap under running water.

These guidelines are only general and are not inclusive. They are meant to increase awareness and to encourage use of appropriate risk management procedures. For more complete information, consult the references listed or contact your school administrators.

REFERENCES

AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION (1990, December). Committee on Quality Assurance. Report Update: AIDS/HIV: Implications for Speech-Language Pathologists and Audiologists. ASHA. 32 (12) 46-48.

American Speech-Language-Hearing Association. (1996). Specifications for audiometers (ANSI S3.6-1996). New York: Acoustical Society of America.

American Speech-Language-Hearing Association. (1997). Guidelines for Audiologic Screening. ASHA Fulfillment Operations, Maryland.

Ballachanda, B., Roeser, R., Kem, R. (1996). Control and prevention of Disease Transmission in Audiological Practices. American Journal of Audiology. 5 (1). 74-82.

The Audiology Committee of the Indiana Speech-Language-Hearing Association has been working for several years to revise guidelines and recommendations for hearing conservation programs in the schools. These guidelines and recommendations concern qualifications or personnel, testing criteria, types and condition of equipment to be used, follow-up procedures, and other pertinent aspects of such programs. The committee states that these guidelines are recommendations, not requirements. Optimal but obtainable conditions have been set forth.