Napping in car testing for OAE & Acoustic Reflexes

Non-sedated Testing Little Ones
While They are Napping in Car - carseat or at home

Background: Once in awhile a child presents from whom we can only obtain very little or no audiological information (won't condition in booth and is very touch sensitive), yet we would love to get at their ears to obtain acoustic reflexes and OAE's as a possible alternative to needing sedated ABR testing. E.G., the presence of ipsi-lateral acoustic reflexes at 2-separate frequencies, (1000Hz & 2000Hz or other combination) in each ear, rules out auditory dys-synchrony/auditory neuropathy.

Possible Solution: Most little children are notorious for sleeping well in the car. I have successfully tested the few children who need this per year by arranging a time for them to arrive asleep in the family car outside our building. Here's a few - perhaps obvious - tips:

• child a bit worn out before the car trip to your office
• no other children in the car
• advise family that hooded jackets, turtle neck sweaters interfere with access to ears
  
• child not up against a door, i.e. in center of back seat so you can get to each ear with the car/van door closed
• full tummy or snack on trip to your office
• family keeps child awake until about 5-10 min before arriving at your office (if they sleep too long on the way, they will likely wake up when you open the car door)
• have family call you on their cell phone when they arrive with child asleep, or 2nd adult rider comes in to let you know they have arrived
  
• while inserting probe tip, child may reach up in sleep. Be ready to gently place child's arm down, while stroking their head or temple gently as they go right back to sleep
• if successful in one ear and child wakes up while you are turning head to other side, drive around a little and they may go back to sleep to obtain results for other ear - or can obtain other ear results in the same fashion another day.
  

What to take to the car/home with you:

• hand-held, battery-operated tympanometer with acoustic reflexes. The Interacoustics MT-10 will do 4 ipsi-frequencies, at your pre-set dB level with visually readable tracings of acoustic reflexes.

• hand-held, battery-operated OAE

• take a few extra size tips for both tymps and OAE's
  
• notepad for recording results - e.g, recalling log numbers if needed

• otoscope

• bring your non-spillable bubbles along (see bubble distraction post below) because even though this may not have worked with the child on previous visit while awake in your office, it can work in their own environment (their family car or at home while trying to nap)

Instant Recall of all 4 frequency results - Acoustic Reflex Thresholds

Robin Morehouse - Clinical Professor Extraordinaire
Teaches us a Trick or Four

You too can speed up your testing without writing everything down as you go

How aptly and gently Robin pointed out to a few students in clinic one day the following trick and tip. As the students painstakingly looked back and forth from the immittance unit to their clipboard, wrote down, one-by-one, each Acoustic Reflex Threshold (ART) they had obtained (on the GSI-33, now replaced by the GSI Tympstar), he suggested and felt certain they could recall the 1st three of those thresholds, finish the 4th one, and then quickly write them all down before moving onto the next in the battery of tests an active child would need. But what about the 4th ART? Being the last one, it was right there still on the screen.

Perhaps you can find other ways to apply this principle. . .

Clinical inspirations gleaned from Marion Downs & Chuck Berlin

Follow your Clinical Intuitive Gut Until Proven Otherwise

Marion Downs, as most of us know is an extraordinary leader in our field, perhaps even the Founder of Pediatric Audiology as we know it.

I have come to know Marion and Love her spirit, however before I really knew her personally she inspired me in many ways through presentations I attended, videos I saw in grad school, and her publications.

One thing I observed time and time again, is how Marion would propose a protocol for testing or amplifying children that she had learned through her experience or had been led to by her intuition. "No" she often calmly explained, the research wasn't necessarily there, but she went for it and it often made a difference. Years later, researchers typically proved what Marion had been espousing.

Check out the Research Pages at: The Marion Downs National Center for Infant Hearing

By the way, to get a copy of Marion's Book,
Shut Up and Live! (You Know How)

send a $20 dontation to:
Marion Downs Hearing Center
Attn: Sandra Gabbard
1792 Quentin Street, Unit 2
Aurora, CO  80045

"Do the experiment!"

Dr. Charles I. Berlin ("Chuck") would often try to show me something or explain a clinical or experimental standard that might or might not be easy to comprehend. If teaching this concept with his hands didn't do the trick (Have you seen Chuck's demo of hair-cell function or how low and high frequencies relate to mass and stiffness?), then Chuck would espouse "Do the experiment!"

Hey, remember trying to learn masking? One simple example of this was Chuck suggesting to experiment with how much narrow-band masking it really took to mask a warble tone in my own ear. Then Chuck would walk away while I 'did the experiment'.

So, even years later, when insert earphones started to become the standard for testing (sure hope you use them E-A-R Tones), there were graphs published by Etymotic about the minimum and maximum inter-aural attenuation they provided for each frequency, i.e., when to mask - much less often it turns out, of course. Did I check it out and do the experiment with a patient with a dead ear on one side and normal hearing on other? Ya, you betchya!

And when we needed a velcro head-band for attaching the bone conductor to young children, of course I had to know how tight to put on the headband to match thresholds with the standard, metal, spring-loaded, bone conduction head-band. We used a few willing adults to determine that.

Taken together, Marion's teaching by example of
going with your clinical intuition
and Chuck's teaching of doing the experiment, are great models for learning and improving the way we do pediatric audiology every day.

One more thing, after you've tried something that works and/or done the experiment, please share it here for all of us to learn by. Thanks!!