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Online-EHDI Case 1 (Case Questions without Answers)

Case 1: A Healthy Newborn That Does Not Pass the Hearing Screen

Part 1

History: Jamiel Sweager comes for his first well child visit at 2 weeks of age. He was a 7 lb 8 oz baby boy, born at term to a 27 year old woman after an uncomplicated pregnancy, labor, and delivery. His parents report that they are worried because they were told in the hospital that Jamiel failed his newborn hearing screening bilaterally. They are confused about why this test was done in the first place and what they should do now. Mrs. Sweager becomes very tearful during the visit as the discussion proceeds.
1. What would you tell them about Universal Newborn Hearing Screening (UNHS)? 

2. What are the steps in Universal Newborn Hearing Screening (UNHS)?  

3. What would you advise them to do at this time?

4. How would you respond to Mrs. Sweager’s emotions?

Click <HERE> to view the answers to Part 1

Part 2

Jamiel returns for his 2-month well child visit. Mrs. Sweager says that after your visit she returned to the hospital where the baby was born and he had a second Otoacoustic Emissions (OAE) testing. He did not pass that test. He was referred to an audiologist who did a diagnostic Auditory Brainstem Response (ABR) test. The test revealed that Jamiel has a bilateral moderate to severe Sensorineural Hearing Loss (SNHL) with greater loss in the high frequencies. Another visit with the audiologist is planned in 2 weeks for a hearing aid fitting. His mother said she is doubtful about the accuracy of the tests. Jamiel often makes some cooing sounds and he startles with loud noises, such as when the family dog barks or an ambulance with its siren on goes past their house. However, she no longer feels as sad and overwhelmed as she had been earlier.

Jamiel is otherwise doing well. He eats with gusto and follows a regular sleep schedule. He smiles socially. Physical examination reveals a well developed, well nourished 2 months old. Height, weight and head circumference are all 50-75%. The physical exam is entirely normal. She asks how this type of hearing loss might affect her child. She is worried about her ability to afford hearing aids, especially if the child pushes them off and loses them.
1. What are the implications of a moderate to severe sensorineural hearing loss (SNHL)?

2. How do you interpret the cooing and startles?

3. How can you help this child and family at this time?

4. What are options for funding hearing aids?

Click <HERE> to view the answers to Part 2          

Part 3

Jamiel and Mrs. Sweager return for a scheduled 6-month well child visit. He is wearing hearing aids on both ears. His mother reports that when he got the aids, 2 months ago, she saw increased interest in sounds in the environment, including her voice. He now reliably turns to the source of sound. He is enrolled in early intervention services. A speech and language pathologist and/or hearing therapist comes to the family’s home once a week to work with Jamiel and Mrs. Sweager on receptive and expressive language skills. She is pleased with his progress because he seems to respond to his name specifically and has begun to babble “baba”. In response to your question about how well he tolerates the aids, she mentions that he never attempted to take them off of his ears. In all other ways, he is developing normally and growing well. His physical examination remains normal.

1. How do you assess the progress in this case to date?

2. What do you do next?

3. What type of communication options would you suggest and recommend to this family? (i.e. verbal v. sign language v. total communication)

Click <HERE> to view the answers to Part 3


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