Nursing Care for Disability Prevention (Audiology / Hearing Screening)

Under supervision

- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council

 Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate

Prepared by 

The first years of life are critical for developing key skills for children who are deaf or hard of hearing. It is a vital phase for language development, making it essential to invest in this period to benefit the child and avoid future challenges. Furthermore, early intervention positively impacts academic performance. Research indicates that low academic achievement among the deaf and hard of hearing, especially in reading and writing, underscores the necessity of early intervention programs.

Hearing loss is categorized into two types:

• Deafness (Deaf child): A child with a hearing loss of 70 dB or more, which impedes speech comprehension through hearing alone, with or without the use of a hearing aid.
• Hard of Hearing (Hard of hearing child): A child with a hearing loss ranging between 35-69 dB, which causes difficulty—but not a disability—in speech comprehension through hearing alone, with or without the use of a hearing aid.

Classification of Hearing Loss

Hearing loss is classified based on three criteria:

1. Age of Onset:
• Pre-lingual hearing loss (before the development of speech and language).
• Post-lingual hearing loss (after the development of speech and language).
2. Site of Lesion:
• Conductive Hearing Loss: Dysfunction in the outer or middle ear (pinna, ear canal, eardrum, or ossicles).
• Sensorineural Hearing Loss: Dysfunction in the inner ear (cochlea, auditory nerve).
• Mixed Hearing Loss: Dysfunction involving the outer, middle, and inner ear.
• Central Hearing Loss: Dysfunction of the auditory pathways in the brainstem or the auditory centers in the brain.
3. Degree of Hearing Loss (measured in decibels - dB):
• Very Mild: 25–40 dB.
• Mild: 41–55 dB.
• Moderate: 56–70 dB.
• Severe: 71–90 dB.
• Profound: 91 dB and above.

Causes of Deafness and Hearing Loss

• Hereditary factors: Chromosomal abnormalities or parental genes.
• Prenatal and Perinatal factors: Maternal rubella, meningitis, Rh factor incompatibility, premature birth, maternal use of drugs/alcohol, mercury poisoning, and birth trauma or anoxia (oxygen deprivation) leading to nerve cell damage.
• Other causes: Childhood diseases (measles, mumps, meningitis), outer ear obstructions (excessive wax), eardrum perforation (due to foreign objects, loud noises, or trauma), middle ear infections (otitis media), and congenital malformations.

Symptoms of Hearing Loss

• Complaints of ear pain, frequently asking others to speak louder or repeat themselves, and tilting the head toward the speaker.
• Ear discharge or excessive wax buildup.
• Speech errors, inconsistent voice tone, and cupping the hand around the ear.
• Preference for sign language, redness of the pinna, lack of response to loud sounds, or tinnitus.

Prevention

Prevention involves medical, psychological, and social measures:

• Level 1 (Primary): Preventing causative factors (vaccination, prenatal care, ear hygiene, avoiding noise).
• Level 2 (Secondary): Early detection, diagnosis, and medical treatment of ear conditions, and providing appropriate hearing aids.
• Level 3 (Tertiary): Comprehensive rehabilitation (medical, educational, vocational) to achieve social and psychological integration.

Program Steps:

1. Screening: Conducted in the first week of life (ideally with thyroid screening) using Otoacoustic Emissions (OAE). If failed, it is repeated after 1–2 weeks.
2. Procedure: Performed by a trained nurse in a quiet room, testing each ear separately (max 3 attempts per ear).
3. Timeline: Screening must be completed within 28 days.
4. Documentation: Results are recorded in the designated register.
5. Referral: If the child fails the second test, they are referred to a specialized audiology clinic in a public hospital.

Requirements:

• Training nurses on OAE device usage and data recording.
• Providing OAE devices and designated testing rooms.
• Educating families on the importance of early detection and ensuring follow-up through supervisors.

Otoacoustic Emissions (OAE) Device

 Field Monitoring and Follow-up Form

Monitor/Supervisor Name: ........................................ Primary Health Care Unit (PHCU): .......................... Month: .......................................................................

Additional Notes:

Monitor’s Comments and Recommendations: ......................................................

Monitoring and Follow-up Form User Guide

1. Registering children in the general screening log:

• Good: Immediate registration for all children.
• Acceptable: Immediate registration for some; delayed for others.
• Unacceptable: Not all children are registered.

2. Complete and accurate use of the screening tool:

• Good: Screening is age-appropriate; all sections are completed during the screening session.
• Acceptable: Developmental milestones for other age groups are used and/or the decision is finalized later.
• Unacceptable: Not all sections are completed (i.e., preliminary data, risk factors, developmental milestones, decision).

3. Recording screening results in the designated registers:

• Good: Immediate, accurate recording for all children in the correct registers.
• Acceptable: Accurate recording for all children in the correct registers, but at a later time.
• Unacceptable: Not all children are recorded, or the recording is inaccurate/in the wrong registers.

4. Ratio of screened infants to total outpatients:

• Good: > 75%.
• Acceptable: 25% – 75%.
• Unacceptable: < 25%.

5. Percentage of positive cases among those screened:

• Good: 5% – 20%.
• Acceptable: 1% – 5% or 20% – 30%.
• Unacceptable: < 1% or > 30%.

6. Physician review of positive cases:

• Good: Physician reviews all positive cases and signs them personally.
• Acceptable: Physician reviews approximately half of the positive cases and delegates the rest to nursing staff.
• Unacceptable: Physician is unavailable, or present but does not review cases.

7. Systematic implementation of the screening process:

• Good: Children enter the screening area one by one.
• Acceptable: No more than (5) children enter the screening area, organized in a queue.
• Unacceptable: More than (5) children in the screening area and/or no organized queue.

8. Maintaining children's screening forms:

• Good: All forms are perfectly organized in the appropriate files (Referral, Follow-up, Negative).
• Acceptable: All forms are filed appropriately (Referral, Follow-up, Negative) but are not perfectly organized.
• Unacceptable: All or some forms are not filed in the appropriate folders.