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Probes and Tips - January 2009 - Facilitate the middle ear consultation

the National Center for Hearing Assessment and Mangement

This newsletter provides TIPS to enhance your OAE screening and follow-up practices and PROBES about current activities so we can learn from one another's successes and challenges. Check out our website for more helpful resources: www.infanthearing.org/earlychildhood

January, 2009 issue

Tip of the Month 

Facilitate the Middle Ear Consultation and Conduct an OAE Rescreen

When a child’s ear has not passed the first and second OAE screening (over a 1- 2 week period), the next step is a middle ear evaluation commonly performed by a health care provider (HCP) to determine whether there are observable, medical problems affecting the middle or outer ear. 

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Provide the health care provider with:
1.    The child’s ear-specific OAE screening results completed to date.

2.    A brief outline of the protocol you are following and a description of OAE screening.  Some health care providers are not familiar with the use of OAE screening during early childhood.

A document entitled, "HCP Referral Letter" is a sample letter to health care providers that you can download, personalize and send with each referral.  It includes a place to provide ear-specific OAE results and a review of your protocol.  This letter is available at:

http://tinyurl.com/HCPreferralLetter

A document entitled, "OAE Overview for HCP's"  is an overview of OAE screening written for health care providers. We recommend you download and send this document with each referral to a health care provider.  It is available at:

http://tinyurl.com/OAEoverviewforHCPs

3.    A specific request for a middle ear evaluation to be performed using tympanometry or pneumatic otoscopy.  Ask to be notified with the results and to be given guidance when the middle ear is clear so that you know when it is time to rescreen the non-passing ear(s) – the next part of the protocol you are implementing.

Provide parents with:
1.    A copy of all of the information above for them to present to the health care provider themselves.

2.    Encouragement about the importance of following through on the middle ear evaluation.

3.    A request to notify you when the referral appointment has been made and when the appointment has taken place. Tell the parent that you will contact them the day after the scheduled appointment to find out the results.

4.    A reminder of the appointment the day before.

5.    A call the day after the appointment is completed to find out the results.

Following the appointment, it is critical to find out the results from the consultation so that you know WHEN TO RESCREEN. 

•    If the middle and outer ear were found to be clear (or if wax or blockage was successfully removed from the ear canal), you should conduct the OAE Rescreen immediately. 

•    If the result was fluid or an ear infection in the middle ear, it is best for the child’s ear to be evaluated by the health care provider approximately 4 weeks after treatment to determine if the ear is clear so that you can proceed with the OAE Rescreen.  If it is not possible to get the ear re-evaluated by the health care provider, go ahead and perform the OAE Rescreen 6 weeks after the middle ear evaluation took place. 

Rescreening after the ear consultation clear is ALWAYS NECESSARY!  The OAE screening process is NOT complete until you Rescreen and get a passing result.  If the ear still does not pass at this point, a complete evaluation from a pediatric audiologist is needed.  
Remember, most health care providers do not perform OAE screenings, so the rescreening is your responsibility.
  
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Probe of the Month

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