Infant Hearing Screening Essay Example
Infant Hearing Screening Essay Example

Infant Hearing Screening Essay Example

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  • Pages: 14 (3617 words)
  • Published: December 17, 2017
  • Type: Research Paper
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The purpose of this assignment is to assess the advantages of screening tests for infant hearing and the efforts made by the Child Health Surveillance program. It will show how these tests are integrated into a comprehensive health promotion program for children and caregivers, while also evaluating their effectiveness within a community setting.

This assignment will examine a particular case involving twenty-two-month-old twins. The twins were initially assessed by their Health Visitor at eight months old and were referred to an Audiologist for a hearing test. Regrettably, the twins did not attend this appointment on two occasions. As a result, the Health Visitor reassessed the twins at twenty-two months using the Schedule of Growing Skills (SOGS). During this evaluation, it became apparent that the twins faced difficulties in various areas, including Hearing and Language skills. Consequently, the Health Visitor once again recommended


them to see an audiologist for additional hearing tests. This assignment will comprehensively analyze both the process and outcomes of these tests.

The Children's National Service Framework (NSF) was implemented by the government in 1998 to enhance the health and well-being of children aged from birth to nineteen. In 2002, the Child Health Promotion Programme was introduced as a replacement for the UK's Child Health Surveillance program under the Children's NSF. This novel initiative adopts a systematic approach to evaluate the unique requirements of children and their families, incorporating childhood screening.

Child Health Surveillance refers to a program that involves screening tests and checks on a child's development. Its purpose is to assist families in raising healthy children through the provision of support and educational advice on health promotion (Hall 2003).

Health promotion focuses on strategies an

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actions to prevent illness, as it is widely acknowledged that prevention is preferable to treatment. Health Promotion is defined in various ways, with the World Health Organization (1994) defining it as empowering individuals to take control of their health and enhance it (WHO, 1994). Conversely, Ewles and Simnet (2003) assert that it involves improving the health of both individuals and communities, by promoting, supporting, and prioritizing health at personal and public levels.

As part of the pre-registration nursing assignment criteria, one of the practice outcomes is health promotion. This offers a chance to personally review the assessment procedures for children showing signs of hearing loss and respond to their needs using an appropriate child health promotion approach backed by theory. This assignment will also cover the importance of hearing tests, the various types of tests used, and their procedures. Additionally, the author will briefly examine the causes of hearing loss.

During my placement with a Health Visitor, I provided assistance during a visit to a family in order to conduct a SOGS assessment on twin boys who were twenty-two months old and appeared to have some developmental delay. The SOGS assessment is a valuable tool utilized by professionals to assess the developmental levels of young children. It entails a series of questions directed at the child's caregiver, regarding the child's ability to perform specific tasks such as walking, talking, pointing at objects, waving, and saying goodbye. The Health Visitor also observes the child and performs simple tests using toys such as building bricks. This is exactly what occurred during the SOGS assessment with the twins.

To adhere to the professional guidelines of the N.M.C's professional code of

conduct (2004) and the Data Protection Act (1998), the twins will be referred to as Bill and Ben, and their mother will be referred to as Jane. Confidentiality will be upheld, and any information shared will not disclose the identity of specific wards, individuals, or localities (Dimond, 2005; Nursing and Midwifery Council, 2004).

Bill and Ben underwent the Newborn Hearing Screening test at two days old, but their results were uncertain, leading to further testing. However, they missed their initial appointment and were referred again after their six-week developmental check. Unfortunately, they also missed this second appointment due to moving houses. As a result, the twins now have unresolved hearing issues at twenty-two months old. According to Hodgkin (2002), both parents are responsible for prioritizing their child's best interests. After conducting the SOGS test, the Health Visitor and I have created an action plan for the twins and referred them to an audiologist once again.

During the appointment, Jane was informed that I, a student nurse on a four-week placement with the Health Visitor, could be excluded from the twins' assessment if she wished. However, Jane was fine with me being present as the Health Visitor conducted the SOGS assessment on Bill and Ben. It is important to note that the Nursing and Midwifery Council emphasizes the need for obtaining consent before providing any treatment or care. The nurse must ensure that valid consent is obtained from a legally competent individual, given voluntarily and based on informed consent (NMC 2004).

During the assessment, it was clear that the twins were achieving significantly lower scores than expected for their age. Specifically, in areas like Hearing, Speech, and Language, they

were scoring at a level that is normally reached by six-month-old babies. The test revealed that neither Bill nor Ben was able to walk, and Jane informed the Health Visitor that they had only been crawling for the past month. Additionally, they did not seem to react when their mother entered or exited the room, and they showed no response to either myself or the presence of the Health Visitor in the room.

Once the assessment was done, the Health Visitor voiced concerns about the twins' hearing and developmental progress. She sought permission from Jane to refer both Bill and Ben to different health professionals, including a Psychologist, Speech and Language therapist, and an Audiologist for hearing tests. I was truly impressed by the Health Visitor's professionalism and her ability to reassure Jane throughout the entire process.

During my time at the audiology department in a local community hospital, I learned that some patients were not showing up for their appointments. The audiologist explained that infant hearing screening tests are not mandatory, but the department has a strict policy of not tolerating missed appointments. Consequently, patients will not be automatically given a new appointment. However, the audiologist clarified that this does not mean appointments cannot be scheduled; patients or their health visitors can still book another appointment if desired.

Fortunately, the Health Visitor managed to secure appointments for the twins to undergo hearing tests the next week, and I was able to accompany them. Both boys underwent ABR tests, which revealed severe hearing loss in both Bill and Ben. Consequently, the twins were promptly referred to the main Audiology department for additional examinations.

There is no definitive answer to

the question of 'what is the definition of health?'. However, numerous attempts have been made by individuals (Blaxter, 1990) to define it. Health is subjective as each person has their own interpretation of what it encompasses (Kiger, 1995). The promotion of health involves various activities, but its primary goal is to improve the overall health of a population by empowering individuals, groups, and communities with knowledge to make informed decisions about their well-being (Ewles and Simnett 2003).

Nurses have a crucial role in the health team as they help patients/clients achieve optimal health. Educating individuals about the importance of being healthy and understanding the causes of physical and psychological illnesses is important. Although nurses may not always be recognized as effective health promoters, this is due to their shift towards a more holistic approach rather than traditional medical models. However, Health Visitors stand out because of their specialized training in addition to their nursing or midwifery qualifications. They are trained to assess the health needs of individuals, families, and the wider community with the main goal of promoting good health and preventing illness in the community.

According to the NMC (2004), nurses have the responsibility of assisting patients and carers in accessing essential health and social care, as well as providing them with information and support. Additionally, they are required to advocate for their interests.

The child health promotion programme includes childhood screening, specifically Hearing Screening. The Government aims to ensure that all children have the best start in life and provides various strategies for hearing screening. The Department of Health highlights the importance of early detection of deafness and hearing impairment as it improves language and communication

skills, leading to better educational achievement and quality of life (DOH 2004, p.1).

In the UK, infants' hearing has been assessed using the Infant Distraction Test (IDT) for over thirty years. This screening is carried out when infants are between six and eight months old by two trained individuals (McCormick 2002). The IDT is a behavioral hearing test that relies on infants' ability to locate sounds by turning their heads towards them, starting at six to eight months old (Weir 1985).

John Bowis, the Minister for Health in 1994, stated that a review would be conducted to assess the screening arrangements for identifying children with permanent hearing loss in the UK. The purpose of the review was specifically to explore the potential role of UNHS (Bamford et al 2001).

Two years later, the review conducted by Davies et al in 1997 was finalized and made public. The findings suggested the implementation of UNHS (Universal Newborn Hearing Screening) and the gradual elimination of the existing eight-month Infant Distraction Test (IDT). In their publication, Bamford et al in 2001 elucidate the pivotal factors considered for this recommendation. They emphasize that approximately 800 infants in England are born annually with a persistent bilateral hearing impairment that could be detected at birth. However, the current screening programs are able to identify only a small proportion of these children by the time they reach one year of age.

According to Bamford et al (2001), one of the recommendations emphasizes the importance of earlier identification in order to assess progress, make management decisions earlier, and intervene before developmental deficit occurs.

According to Stevens (1998), the expense of Universal Newborn Hearing Screening (UNHS), including subsequent appointments, is

approximately ?14,000 per 1,000 births when compared to the cost of Infant Distraction Test (IDT) which amounts to around ?25,000 per 1,000 children.

Davies (2003) highlights that the decision to implement UNHS was supported by evidence showing its superiority and efficiency compared to IDT. Moreover, Davies (2003) suggests that early intervention accompanying UNHS significantly improves language and communication skills.

There has been a lot of discussion lately about the future of the IDT. Some suggest that in areas where UNHS has been in place for over eight months, the IDT should be abandoned (Hall 2004). Currently, most parts of the UK have phased out the IDT. Instead, newborn babies are now screened within their first two days of life using a more advanced and accurate method to detect hearing loss. The majority of infants will undergo this screening. The implementation of UNHSP began in 2001/2 and is set to be fully completed by 2005/6 (Bamford et al 2001).

The NHSP, also called the Oto-Acoustic Emissions test (OAE), is a quick and simple test conducted in the baby's first few days to check if the outer hair cells of the cochlea are responding normally. This test poses no harm to the baby (Rademacher 2004). It is usually done when the baby is settled or sleeping and takes just a few minutes. Parents and guardians are encouraged to be present during this test. The procedure involves placing a small probe inside the outer part of the baby's ear, which generates a gentle clicking sound. A computer measures this sound (Rademacher 2004).

In the case of Bill and Ben, both twins underwent the OAE test within two days of their birth. However,

the test results did not provide a clear enough response. As a result, they were referred to undergo an Auditory Brainstem Response Test (ABR) to obtain more accurate information about their hearing (Rademacher 2004). This test is conducted at the audiology clinic in local hospitals, where three small sticky pads are attached to the baby's head and neck. Additionally, small headphones are placed over their ears. A computer then measures and records the function of the auditory nerve and its connections in the lower part of the brain. Furthermore, a cochlea microphonic test is performed to assess the functioning of the hair cells within the cochlea (Rademacher 2004).

Regrettably and without explanation, the twins did not show up for their first follow-up appointment for this specific testing. Karzon (2006) conducted a study to assess the efficiency of assessment appointments for infants referred from the UNHS test.

10 audiologists conducted a study on 375 babies using the ABR test as the main method. Depending on the ABR findings, additional test options including Otoacoustic emissions and high-frequency tympanometry were also utilized.

In 88% of the test sessions, a minimum of 4 ABR threshold estimates were obtained, according to the results. The incidence of hearing loss varied significantly across nursery levels: 18% for well baby, 29% for special care baby, and 52% for neonatal intensive care unit babies (Karzon 2006).

According to Karzon (2006), the results suggest that test appointments are suitable for every stage of nursery education in determining the degree and nature of hearing impairment in most infants referred from the UNHS.

As children's nurses, our role is to advocate for our most vulnerable children (McHale 2003) and educate parents about

the benefits of getting their babies' hearing screening done. This is done with the aim of reaching the government targets.

Advocacy is a crucial aspect of children's nursing, as adults possess greater knowledge and decision-making capabilities than children and babies. It is the responsibility of children's nurses to advocate for them, which requires strong argumentation skills, persistence, and clear communication devoid of bias (Hall & Ellimon 2003).

According to records, after the twins' six-week check-up with the doctor, there were concerns about their development, particularly in terms of hearing responses. Bill and Ben were once again referred to the Audiologist for hearing tests. Sheridan (2004) states that at six weeks of age, babies should react to loud noises with a startled response. For instance, when a small bell is gently rung, the baby's movements momentarily stop. The baby may also move their eyes and head towards the sound. According to the twins' records, neither Bill nor Ben exhibited any of these responses at six weeks old. However, because of the parents' circumstances involving a house move, the twins missed their second appointment with the audiologist. This further delayed addressing the suspected hearing issues identified during the six-week check-up. The concerns about the twins' hearing were not addressed again until they reached twenty-two months old, when the Health Visitor and Student Nurse conducted the SOGS assessment with Bill and Ben.

After receiving permission from the parents, the twins were once again sent to the Audiology clinic. The Health Visitor managed to schedule an appointment for the following week at a local community hospital. With consent granted, the student nurse was allowed to be present during the hearing tests for

both twins. The Audiologist conducted individual ABR tests on each twin. The results showed that Bill and Ben both had severe hearing loss. Jane, their mother, was informed about this discovery and was told that they would now need to go to the Audiology department in the main hospital for further testing in order to determine what caused their hearing loss.

The author cannot present evidence of the outcome because the twins are still being tested to determine the cause and extent of their hearing loss. Elssmann (1987) states that hearing loss generally falls into two categories: conductive and sensorineural.

A conductive hearing loss occurs when there is an obstruction or malfunction in the middle ear that hinders the movement of sound waves (Karchmer 1999). The middle ear requires a consistent supply of air to function properly, and this airflow is typically regulated by the Eustachian tube, which connects the middle ear to the back of the throat (Ross 2004). However, in children, this tube is narrower and less inclined, resulting in reduced efficiency. If the Eustachian tube becomes clogged, air cannot enter the middle ear. As a result, fluid is generated by cells lining the middle ear. This fluid can vary from a watery substance to a more viscous one and obstructs the middle ear, making it harder for sound to pass through to the inner ear. This condition is commonly known as Glue Ear (Seikel 2005).

An individual may experience a sensorineural hearing loss when there is a malfunction in the cochlea or hearing nerve, also referred to as the inner ear. This malfunction can occur due to damage in the pathway that carries sound impulses

from the hair cells in the inner ear to the auditory nerve and ultimately the brain (Kezirian 2001). There are various potential factors that can cause this, including Acoustic Trauma to the hair cells, which is an injury resulting from exposure to loud noises (Karchmer 1999).

Mumps or Measles viruses can cause viral infections in the inner ear, while drugs like aspirin, quinine, and antibiotics can also affect the hair cells. Moreover, viral infections like Rubella and the Shingles virus can lead to auditory nerve infections. Furthermore, infections or inflammation of the brain or its covering, such as Meningitis, can also result in viral infections in the inner ear (Seikel 2005).

It is possible for certain people to be unaware of their hearing issues because of factors such as age or the slow progression of the problem. This applies even to newborns who are not able to perceive any irregularities at this early stage. It is vital to identify and address hearing loss in infants right from the moment they are born, since speech and language skills start developing immediately after birth (Moeller 2000).

Rimell (2004) proposes that deaf and hard of hearing children can attain comparable levels of speech and language development to their hearing peers through early intervention, either at birth or before twelve months old. Nevertheless, if these children are not identified until a later age, their speech and language development is likely to lag behind that of their hearing peers.

Kennedy (2006) conducted a study on 120 children who had permanent hearing impairment. These children, with an average age of eight years, were divided into two groups. The first group consisted of 61 children who

underwent initial screening at birth using the UNHSP. The second group included 57 children who were only identified as having hearing impairment when they were screened between 6 and 8 months old using the IDT.

In Kennedy's (2006) study, it was discovered that children who underwent screening through the UNHS exhibited enhanced language skills. However, no significant difference in speech abilities was observed between the two groups.

While visiting the family of the twins, the Health Visitor helped me gain a greater understanding of the significance of assessments such as the SOGS. These evaluations are crucial for gaining a comprehensive understanding of the whole family.

After completing the assessment, the Health Visitor discussed options with Jane and involved me in finding ways to improve the family's health and well-being. Jane is new to her current location, has no nearby family, and her husband works away during the week. Because she doesn't drive and finds it difficult to use the twins double buggy, she hasn't integrated into her new community well. I suggested Jane attend a mother and toddler group to help develop her twins' interactive skills, but she didn't think there was one nearby. Jane mentioned that she only left the house with Bill and Ben when her husband was home on weekends. In a positive outcome, the Health Visitor provided Jane with information about a mother and toddler group within walking distance of her home.

Jane's relationship with her twins seemed distant because they primarily communicated non-verbally. Both boys were unable to speak and struggled to understand verbal communication. One assessment question aimed at testing their comprehension involved asking them to retrieve their shoes, but neither Bill nor

Ben demonstrated any understanding of the command. It is believed that their lack of understanding and responsiveness may be due to missing two previous appointments for hearing tests. At twenty-two months old, they have now been diagnosed with severe hearing loss. If left untreated, this hearing loss could have lasting negative effects on their language development, communication skills, confidence, and social abilities.

During the SOGS assessment, the Health Visitor was calm and reassuring with Jane despite her missed appointments with the Audiologist and failure to make arrangements for the twins' follow-up appointment. Additionally, it seemed like she could have put in more effort to learn about playgroups.

Later at the office, I had a conversation with the Health Visitor and came to the realization that Jane might be experiencing depression. She did not feel capable of taking the twins out on her own. However, now that we have implemented a care plan for Jane and the twins and have received proper support from healthcare professionals, I am hopeful about the future and potential development of the twins. There is no reason why they cannot catch up with their hearing peers eventually (Davies 2003).

In the future, I suggest that the Midwife ensures that all babies, particularly those born outside of hospitals where the Newborn Hearing Screening test is not typically done, receive the test. Additionally, I recommend that the Health Visitor ensures that any missed follow-up appointments are attended or rescheduled.

In conclusion, the role of health promotion and the Health Visitor has been found to increase awareness of health promotion. During this assignment, the author has examined the advantages of infant hearing screening and discovered that the Government

has established goals to ensure that every child receives the optimal beginning in life. Early identification of deafness and hearing impairment can enhance language and communication skills to a level similar to that of a child with normal hearing.

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