Always check screening equipment before using it. Never use equipment that is not functioning properly. Do not screen hearing using any equipment with an expired calibration date.

Before any screening, always make certain the child does not have draining or bloody ears. If this is observed, do not screen the child. A medical referral is indicated if the child is not already receiving treatment.

For students who are difficult to test, unable to respond to pure tone audiometry, or do not understand instructions, refer to Appendix D; Observational Screening for Hearing Problems.

Conventional Pure Tone Audiometry Screening

Description–Electronic device capable of generating discrete tones of varying frequency (pitch) and intensity (loudness).

Age ranges–Children whose developmental age is 3 years or older.

1. Listening Check of the Audiometer

Prior to providing hearing screenings, the examiner should perform a listening check of the audiometer. The recommended procedure is as follows:

1. Plug in the audiometer (if electrical). Turn the power on and leave the unit on for the day.
2. Examine the earphones. Check the cushions for cracks or splits.
3. Examine the earphone cords for breaks. Gently untwist the cords if they are tangled.
4. Examine the audiometer controls and be certain that all are functioning.
5. Perform a listening check while wearing the headphones:
   1. Set the level at 50 dB, frequency selector to 1000 Hz, output selector to right ear, and press the tone presentation switch. Tone should be clear with no noise present. Check other screening frequencies in a similar manner.
   2. Set the frequency selector to 1000 Hz and output selector to the right ear. While pressing the tone presentation control, slowly rotate the dial from 0 dB to 50 dB. Listen for abrupt increases in loudness or “dead spots.” If either of these conditions is present, service the instrument before further use.
   3. Set the level at 0 dB, then press and release tone presentation control. No audible click should be heard upon depressing and/or releasing this switch.

2. Pure Tone Audiometry Screening Sequence

1. Seeing the child’s eyes and facial expression is helpful in determining the accuracy of the responses. However, it is important that the child does not see the tester’s hands, the audiometer, or the screening record form.
2. After giving instructions, the screener should place the earphones on the child. The red earphone covers the right ear and the blue earphone covers the left ear. Place earphones over bare ears (remove glasses and earrings, move hair out of the way). Adjust the earphone headband so that each earphone fits snuggly against the ear.
   1. Start screening the right ear (if the child reports greater hearing problems in the right ear, begin with the left ear).
   2. Pre-set 1000 Hz at 40 dB.
      1. If there is no response, re-instruct.
      2. If the child continues to not respond, re-screen at a later time. If again he/she does not respond, he/she is considered to have not passed the screening. Mark the screening form appropriately.
      3. If there is a response, proceed as described below.
   3. Move the dial to 20 dB.
      1. Present the tone three times at this level noting the child’s response or lack of such.
      2. Mark the screening form appropriately for the right (left) ear at 1000 Hz.
   4. Change frequency selector to 2000 Hz and present tone at 20 dB. Follow procedure used for 1000 Hz and record results.
   5. Change the frequency selector to 4000 Hz and present the tones at 20 dB as described above. Record the results.
   6. Switch audiometer output to left (right) ear and then repeat steps three through five. Be certain to record results.

It is not appropriate to make any adjustment for a noisy environment (ambient noise level above 20 dB (sound pressure level 49.5 at 1000 Hz). You should not increase the decibels above 20 for the screening.

3. Results

• If the child does not respond at the recommended screening level at any frequency in either ear; immediately remove headphones, reinstruct the child, reposition, and rescreen. If other screeners are available, you may want to have another screener perform the screening.
• If the child continues to miss at any frequency in either ear, rescreen the child in 14-21 days. If the child fails the rescreening, refer the student for further evaluation.
• The following information should be recorded in the child’s health record:
  • The results of the screening and any rescreening;
  • Notification of parents about the need to seek an evaluation from a medical or audiological professional; and
  • Results of the professional evaluation and recommendations.

4. Special Considerations for Pure Tone Audiometry

• Avoid exaggerated, noisy depression of the tone presentation switch; the child may see or hear this and respond to the movement or sound rather than the tone. A minimum amount of pressure and movement is required to operate the switch.
• Avoid establishing a rhythm of tone presentation. Vary the length of the tones and the interval between the tones.
• Avoid looking down at the audiometer and then up at the child every time a tone is presented.
• Do not ask the child during the screening, “Did you hear it?”
• Expect the child to respond to the tone with the specified response (i.e. raise hand, drop block). Be very cautious about accepting changes in facial expression or “smiles” as responses to the tones. Reinstruct the child as to the required response. If the lack of reliable response persists, discontinue screening. If this is the child’s first screening, schedule him/her for a rescreening. If this is the child’s second screening, refer him/her to an audiologist for assessment.
• Do not allow the child to chew gum during the screening.