Hearing and Audiology testing within Schools
- 26 July 2020
We received a question on our blog about hearing screening within schools by school nurses ... ('How to ask a question').
'I am trying to understand if school nurses would routinely test hearing of students or only if they think they have a hearing problem. If you do test hearing, how do you do it?'
Here's our response...
The tasks and scope of school nurses varies greatly within NZ. Factors that contribute to the variation include the funding stream (is the position funded through Health or Education?), by employer (could be individual school, PHO, NGO or DHB), by contract, by decile, and roll of school to name a few!
So therefore due to the variation, there is no consistency of tasks performed by a school nurse. That is important to bear in mind when it comes to a specific task within school health services. While one nurse may conduct thorough hearing screening using an audiometer, another might rely on whisper testing.
Hearing is a fundamental requirement to succeed in learning. Basic hearing screening occurs as a universal service in NZ at birth, and again as part of the B4 School Checks. Further screening may occur at secondary school, but is not currently part of a universal service delivery model.
The most rudimentary screening assessment used within school health is the whisper test. For more information on the test itself and effectiveness, this article provides a nice overview and summary. The main advantage of this test is that it requires no cash outlay and can be performed without any equipment. However, its accuracy is dependent upon the technique, and whether surrounding noise minimisation can be achieved. This is not easy to achieve in a primary care/school setting!
For many years, Bay Audiology supported hearing screening in schools by providing schools with a handheld single screener with four sounds of different hertz. It could be activated by pushing an external button, first screening one ear, and then the other. Students would respond when they heard a sound, which could be monitored by the nurse observing the external light which flashes when a sound is played. These screeners became harder to access roughly about 5 years ago, as we understand they ceased production. Some schools still use these, but they do not last forever, so are slowly becoming extinct.
A more advanced option (which look more like a set of audio headphones) with similar function can be purchased from various suppliers, but these can start at a purchase price of around $100. A sophisticated Audiometer can cost several thousand dollars, and while some individual schools may purchase these they are not available to all schools due to the cost and whether a potential user is sufficient familiar or trained to use the audiometer if purchased.
More recently, screening Apps on mobile devices have evolved; some of these are free, and some have a financial commitment attached. Some schools use these with varying accuracy and success.
Any noted hearing difficulty should be investigated with an otoscope for possible causes such as wax impaction, infection/effusion. Referrals are commonly made to Ear Clinics local to the school, or audiology services. Referral pathways vary, and are dependent on what services are available within the local community.
For secondary schools who are funded by health (Mainly Decile 1-5 schools), a hearing assessment, (along with a vision assessment, Height and weight and BMI calculation, and a HEADSS assessment) is routinely performed by the School Nurse on students at Year 9.
While national best practice for hearing screening within SBHS is scant, we would consider best practice at this point in time would include:
-Recognising the important role hearing has for students to succeed academically
-Screening with the most proficient tool available to the School Health Team
-Competence in Auscultation (Ears made easy offer great courses) by the SBHS team
-Establishing links with the local hearing service to ensure a smooth referral pathway for students who need it
-Ensuring Teaching staff understand what the hearing screening pathway is, so if they have students who they suspect have hearing difficultly, or are struggling academically, they know how to access screening assessment for students.
In the future, we would hope to see a best practice guide for SBHS developed in partnership with Audiology services as the experts, which best supports a universal screening programme in secondary schools.
We are interested to hear what you do in your school in terms of assessing students hearing, and whether you feel this meets student need? Please feel free to comment below :)
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- Karen Pullar
- 3 Aug 2020
- 8:40 pm
Hi, I'm an audiologist and read with interest your response to the question: "I am trying to understand if school nurses would routinely test hearing of students or only if they think they have a hearing problem. If you do test hearing, how do you do it?" FYI - each DHB's Public Health Service employs "Heaing Vision Testors" (HVT) who provide pre-school, schools and community-based hearing and vision testing services. Hearing and Vision testers visit pre-school, primary and intermediate schools on a regular basis to carry out screening tests on all children. Schools also can ask HVT to assess specific children for whom they have concerns. HVTs use audiometers and tympanometers to measure hearing levels and analyse middle ear function. The purpose of the hearing screen is to detect the presence of hearing impairment (the child will be referred to the Audiology Department at the hospital for a full diagnostic hearing test) or otitis media effusion (the child will be referred to the Community Ear Nurse Service for an assessment). This brochure may be useful: https://www.healthed.govt.nz/system/files/resource-files/HE2276_Keeping%20an%20eye%20on%20your%20child%27s%20hearing.pdf Kind regards Karen
- Donna Southorn
- 10 Aug 2020
- 3:01 pm
Hearing assessment in schools is an area that I feel needs further investigation. I am nursing in low decile schools with a 25% student turn over every year, with many students who are new to NZ and have never been screened. I get frustrated that we are not able to access HVT data to find out if a teenager has been tested, and what their results were. I have no tools apart from an otoscope and the whisper test, and if I'm lucky there are GP or hospital records that can give me some history. Then getting audiology assessments takes ages due to waiting lists. Meanwhile our kids are getting further and further behind in their learning. A few years ago I worked in a youth justice residence where we had the Bay Audiology Screener, which picked up quite a high number of students requiring further testing, they then facilitated direct referral for full audiology assessment. It is ironic that there are good tools and fast referral once kids are failing at school and getting into trouble, yet we cant offer the same to our kids who are just starting out in high school.
- Sue Collier
- 13 Nov 2020
- 8:18 am
I am the chairperson of the National Vision Hearing Technicians Society. I am also currently a practicing VHT in the BOP DHB. If you have any questions regarding our service please email me at firstname.lastname@example.org