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Early Childhood Intervention

Introducing Music 2 My Ears Hearing/Screening Kit

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Professional Screening Techniques

For Infants (Birth to 5 Months)

Select an available quiet room.  Let the baby lie on an examining table or in someone’s lap with whom he or she feels comfortable.  Fixate his or her attention on the stringed diversion ball.

With the free arm, hold the Bulb Horn 18-36 inches from the baby’s ear.  (Be sure to point the horn end away from the baby’s ear)  As soon as the baby is quiet and watching the Diversion Ball, squeeze the bulb firmly, once.  If any of the three responses noted below are observed, it is considered a pass.

Response

In these early months the only response that can be depended on is a reflexive response to loud sound.  The auditory reflexes that can be expected at this age are:

  1. A startle, jump-like response reflex immediately following the sound.
  2. An eye-blink, sudden constriction of the eyelids immediately following the sound.
  3. An arousal from sleep within two seconds of the sound, which is an eye movement accompanied by a movement of any limb.
  4. The baby may also cry at the initial startle.

Interpretation

One ear sufficiently passing is a pass on this test.  The intensity of the sound may not differentiate ears.  Pass indicates no severe hearing loss.  It does not ensure that a mild to moderate hearing loss under 50 to 60 dB may exist.  Mark your observation on the Score Card.

 

One-Person Technique

Accurate Presentation of the Sound-Makers

With the baby seated on the lap with whom he or she is familiar, kneel or stand at a 45 degree angle from his front vision.  Engage his or her attention with the Stringed Diversion Ball about 18 inches in front of his eyes with your left hand.  Lean over as far as you can toward the ball, as you prepare to present the first sound-maker on the right ear with your right hand.  The child may try to look back and forth from the ball to you so stay as close to the ball as possible.  Make a mental note whether the child can track the movement of the ball successfully.  Present the sound-makers in the following order:

Squeeze Ball (vinyl squeeze toy).  This sound-maker gives off a high frequency whistle or wind-like sound.  It measures at 35-39 dB with a high frequency pattern of 1750-2400 Hz.  Making sure that the room is quiet and the child’s attention is toward the Stringed Diversion Ball, hold the Squeeze Ball on the lower level out from child’s right ear approximately 18-36 inches, but hidden from child’s front view.  Point the squeaker hole upward placing the first and middle finger on each side of the squeaker hole, then place thumb on the bottom of the ball and squeeze gently, twice.  It will give off a slight whisper sound.  The harder the squeeze the louder the whistle, so make sure it is a gentle, consistent squeeze.  If there is no response, wait a moment and try again.  Make your observation, record it on the Score Card and go to the next sound-maker.

Chick-Ita.  The Chick-Ita is universally used to make sand sounds in percussion music.  It is a very small maraca-type instrument.  The pellets falling against the wooden shell gives off a light rustling sound like sand in a bottle.  It measures 40-42 dB with a low frequency pattern of 200-1000 Hz.   Hold the Chick-Ita on the upper level 18-36 inches out from the child’s right ear.  Shake the instrument back and forth two times gently, wait and observe child’s response.  Make your observation, record it on the Score Card and go to the next sound-maker.

“New” Cricket.  The Cricket gives off a very faint clacking-type sound.  When the wooden beads rap against each other it measures at a consistent 36-39 dB with a low frequency spectrum of 200-1000 Hz.  Hold the Cricket on the lower level 18-36 inches out from child’s left ear.  Gently shake it a couple of times and stop.  Make your observation, record it on the Score Card and go to the next sound-maker.

Bell.  The Bell is a small brass bell from India that consistently rings at 37-40 dB with a high frequency spectrum of 5400-5800 Hz.  Hold the Bell on the upper level 18-36 inches out from the child’s left ear ringing it once using a rapid succession of ‘ding-a-ling-a-ling’ then stop.  Make your observation and record it on the Score Card.  This should complete the screening process unless presenting the Bulb Horn is necessary for special needs children.

Bulb Horn.  The Bulb Horn is used specifically for startling newborns or infants; however it can be used on special needs children as discussed in the information sheet “Beyond Two Years”.  Hold the Bulb Horn out 18-36 inches from either ear, always pointing the horn opening away from the child’s ear.  Give the bulb a swift squeeze.  Make your observation and record it on the Score Card.  You can repeat this test on the opposite side if there is doubt, but wait a few minutes.  You should observe, a jump-like movement; an eye-blink immediately following the sound; or in older children, an immediate attempt to locate the sound source.  The Bulb Horn can also be used as a double-check system test if other results are in question.

 

Interpretation

 

*      Visual tracking of the Stringed Diversion Ball should be seen if the child is to be passed for visual-motor integrity.

 

*      A head turn toward the sound should be seen for every sound-maker on each side in order for the child to be passed for normal hearing.  A “did not respond” check on the Score Card is a possible hearing failure or should be rechecked after an ample amount of time.

 

*      A head turn in the direction opposite to the sound is also a possible hearing failure.  (Indicates possible monaural loss)

 

Expected Responses:

 

*      At birth auditory responses are largely reflexive.  In a very quiet environment one may see an eye-blink or eye-widening response to the softer sound-makers, but these responses are not standardized.  The only reliable response is a startle or eye-blink to the louder Bulb Horn

 

*       At 3-4 months the infant may begin to turn his or her head toward a sound, but this response also is not yet reliable.  (A rudimentary head turn should be observed.)

 

*      By 4 months the infant will begin to turn his or her head toward the sound source in a wobbly way. (4-7 months – localization to side only.)

 

*      By 7 months there will be a direct turn toward the side.  It will not be a direct localization of the sound at the lower level, however; it will only be a turn toward the side.

 

*      Between 7 and 9 months the infant will begin to find the sound source on the lower level, locating it directly by 8 to 9 months.  The infant will not yet look directly at a sound on a higher plane (above eye level).  (Localizes to side and indirectly below.)

 

*      By the end of 13 months the infant will be able to localize sounds directly in any plane.  Full maturation of the child’s auditory development has been attained. (13-16 months – Localizes to side, below and indirectly above.)

 

*      At 16 to 21 months, the child localizes directly all signals to side, below and above.

 

*      At 21- 24 months, the child locates directly a sound at any angle.

 

*      The same responses will be seen in the 13 to 36 months period – localizing on all planes.  Other factors begin to enter into the testing in this period and must be considered.  For example, a 2 to 3 year old may hear the sound but will inhibit the orienting response if he or she suspects the examiner is making the sound.  Skill and experience must prevail with this age group.

 

(The above-expected responses are reprinted with permission from “Hearing in Children”, by J. Northern and M. Downs.)

 

 

 

 

 

 

 

Two-Person Technique

 

The child can be sitting in a highchair, at a small table or just in a small chair.  For smaller children they can be sitting on the lap of someone who is familiar to them, but their attention must not be on the person holding them. 

 

Have one person sit in front of the child (at the child’s level) and keep his or her eyes focused in front by means of holding the Stringed Diversion Ball, moving it slowly around in a 160° arc or transferring it quietly from one hand to the other.  Observe the child closely.  He or she should be able to track the ball visually from side to side.  If he or she does not – make a note of it on the Score Card comments section.

 

The other person should stand or kneel behind the child with the sound-makers handy.  This person presents the sound-makers at a 45-degree angle from the child’s ear (upper or lower level according to the procedure under One-Person Technique or on the Score Card).  Make sure the child cannot see the instruments with his or her peripheral vision.  Make your observation as stated in One-Person Technique and record it on the Score Card.    

 

Interpretation

 

*      Visual tracking of the Stringed Diversion Ball should be seen if the child is to be passed for visual-motor integrity.

 

*      A head turn toward the sound should be seen for every sound-maker on each side in order for the child to be passed for normal hearing.  A “did not respond” check on the Score Card is a possible hearing failure or should be rechecked after an ample amount of time.

 

*      A head turn in the direction opposite to the sound is also a possible hearing failure.  (Indicates possible monaural loss

 

*      Expected Responses:

 

*      At birth auditory responses are largely reflexive.  In a very quiet environment one may see an eye-blink or eye-widening response to the softer sound-makers, but these responses are not standardized.  The only reliable response is a startle or eye-blink to the louder Bulb Horn

 

*       At 3-4 months the infant may begin to turn his or her head toward a sound, but this response also is not yet reliable.  (A rudimentary head turn should be observed.)

 

*      By 4 months the infant will begin to turn his or her head toward the sound source in a wobbly way. (4-7 months – localization to side only.)

 

*      By 7 months there will be a direct turn toward the side.  It will not be a direct localization of the sound at the lower level, however; it will only be a turn toward the side.

 

*      Between 7 and 9 months the infant will begin to find the sound source on the lower level, locating it directly by 8 to 9 months.  The infant will not yet look directly at a sound on a higher plane (above eye level).  (Localizes to side and indirectly below.)

 

*      By the end of 13 months the infant will be able to localize sounds directly in any plane.  Full maturation of the child’s auditory development has been attained. (13-16 months – Localizes to side, below and indirectly above.)

 

*      At 16 to 21 months, the child localizes directly all signals to side, below and above.

 

*      At 21- 24 months, the child locates directly a sound at any angle.

 

*      The same responses will be seen in the 13 to 36 months period – localizing on all planes.  Other factors begin to enter into the testing in this period and must be considered.  For example, a 2 to 3 year old may hear the sound but will inhibit the orienting response if he or she suspects the examiner is making the sound.  Skill and experience must prevail with this age group.

 

(The above-expected responses are reprinted with permission from “Hearing in Children”, by J. Northern and M. Downs.)

 

 

 

1828 S. Fourth St.   |   Hartsville, SC  29550   |   843-900-m2me (6263)


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