Recommendations for clinical care guidelines on the management of Otitis Media in Aboriginal and Torres Strait Islander Populations

Section E: Audiological Assessment and Management

Enhance hearing, communication and access to relevant information

Page last updated: 14 October 2011

Enhance hearing, communication and access to relevant information

StrategyRecommendation and GradingEvidence StudiesEvidence -Based Guidelines
When to Perform Audiology AssessmentGPP: Tell families/caregivers that hearing assessment is recommended for the following reasons:
  • confirmation of middle ear condition
  • diagnosis of degree and type of hearing loss
  • recommendation for ongoing clinical care
  • monitoring the outcomes of interventions on the peripheral hearing system
  • planning hearing and communication (re)habilitation.

Audiological assessment contributes different information at each stage in the disease process and the treatment progress.
Choice of Audiology AssessmentGPP: Tell families/caregivers that hearing can be evaluated at any time after birth. The type of assessment depends upon the:
  • age of the child
  • disease stage/state
  • treatment, referral or (re)habilitation objective(s)
  • access to skills and equipment.

Valid hearing assessment requires a quiet test environment.
Screening and SurveillanceGPP: Hearing screening at school entry in populations with near-universal OM and CHL is not recommended. Hearing screening in older asymptomatic children (single pass/fail assessment) is not recommended.

Regular surveillance (with appropriate testing when indicated) is preferred to school entry screening.
GPP: Put the children with recurrent, persistent and chronic OM conditions on a review register. These children should be assessed as recommended in these guidelines specific to the OM diagnosis.
Signs of Hearing LossGPP: Tell families/caregivers that the most obvious clue to the presence of the hearing loss is a history of OM. Hearing loss may have been present for some time before noticeable signs are observed and reported. IV135I~A14
GPP: Observe and ask questions about hearing behaviors:
  • Babies and toddlers with hearing loss might not respond to quiet voices, might not startle in response to loud sounds and might speak later or less clearly than their peers.
  • A child or adult with a mild or moderate hearing loss might appear to ‘hear when they want to’ or intermittently. Such a loss is particularly affected by:
  • the presence of background or competing noise
  • use of second language
  • new and unfamiliar speakers
  • new and unfamiliar words or concepts
  • being at a distance from the speaker.

Hearing loss in cross cultural settings can lead to inappropriate assumptions. People might judge a person with hearing loss to be ‘inattentive’, ‘uninterested’, ‘rude’ or ‘stupid’.
Effects of Hearing LossGPP: Tell families/caregivers that hearing loss affects verbal and written communication. It is associated with:
  • impaired first language acquisition
  • impaired second (and later) language acquisition
  • inability to follow complex verbal instructions and understand complex verbal information
  • poor auditory attention – inability to sustain attention
  • slow progress at school leading to limited literacy and numeracy
  • poor educational outcomes and subsequent limited access to post-secondary education and training
  • high rates of unemployment or low employment status
  • impaired social relationships.
Enhancing Language AcquisitionGPP: Encourage families/caregivers to:
  • provide a high level of language stimulation to babies and toddlers
  • encourage early attempts at speaking
  • encourage early attempts at writing
  • tell stories and read to young children
  • participate in their children’s early learning at child care centre and pre-school.

Children with hearing loss often benefit from a quiet environment and additional language stimulation.
Recommended Educational and Rehabilitation SupportGPP: Tell people working with children (e.g. in child care centres, kindergartens, schools) about the high rates of hearing loss and factors affecting hearing in educational settings.IV113I~A20
Recommended Educational and Rehabilitation Support continuedGPP: Tell caregivers and teachers that for children with ongoing mild hearing loss averaging <35dB, the most common forms of intervention include:
  • sound-field amplification systems in the classroom
  • preferential seating and use of complimentary visual information.
GPP: Tell caregivers and teachers that for children with ongoing mild to moderate hearing loss averaging >35dB, the most common forms of intervention include:
  • sound-field amplification systems in the classroom
  • personal hearing aid
  • visual cues (lip-reading, body language and hand talk), raised speech volume (amplification) and contextual cues in the classroom
  • auditory training
  • language stimulation and speech correction at home and school.
GPP: Tell caregivers and teachers that children with severe and profound hearing loss averaging >65dB must urgently receive:
  • personal hearing aid
  • auditory training
  • intensive speech therapy
  • support from teachers of the deaf for the development of all language skills.
GPP: Tell families that they can enhance their children’s learning at school by providing support at home.

Written ENT specialist advice is required to advise whether there are any medical contraindications to the fitting of personal amplification.
Recommended Educational and Rehabilitation Support continuedIn the choice of hearing device audiologists will consider the following factors:
  • presence of discharge
  • stability of middle ear
  • parent/caregiver/child wishes
  • the impact of the hearing loss on the child’s life
  • other medical and cultural factors.
Communicating with a Hearing Impaired PersonGrade C: If talking to a hearing impaired person, make sure that you speak slowly and clearly after gaining their attention in well-lit conditions. Health educators should use visual prompts and cues and public address systems if available. III115;116I~A15
GPP: Use listening devices to assist communication with hearing-impaired patients.
GPP: Speak in the patient’s language (or use interpreters) to communicate important messages. Try to establish why communication is breaking down e.g. hearing, language or cultural differences?
Speech TherapyGPP: Refer to a speech pathologist all children suspected of speech and language delay (see list of behaviours to observe under ‘Diagnosis of OM’).
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