5.1.3. System of integrated communication operations "SZOK"®

In the years 1998–2001, in the framework of the Government Action Plan for Disability Achievement, in which several dozen centers participated, hearing screening were disseminated and enriched. Alternative diagnostic, therapeutic, and rehabilitation facilities have been created for future screening programs. In 70 centers, more than 60,000 newborns and infants were examined.

In 1999, the team of the Institute of Physiology and Pathology of Hearing collaborated with Brigham Young University of the United States and University of Michigan. M. Curie-Skłodowska from Lublin conducted pioneering screening of hearing in various regions of the country in a group of about 6000 children and adolescents in school age. Studies have shown

As part of the implementation of various programs (e.g., the Ministry of Health—the "Program for the Care of Persons with Hearing Loss in Poland"—the Mazovian Regional Health Service, the Ministry of National Education and Sport) conducted by the Institute of Physiology and Hearing Pathology in the years 2000–2006 in cooperation with the dozens of centers around the country, modern multimedia tools are developed for hearing screening. To use the program "I hear …" has trained over 3500 people and screened many centers. In cooperation with the Gdansk University of Technology, highly specialized systems such as "I can hear…," "I can see…," and "I can speak…" have been developed. About 16 million people from

Since 2007, a hearing screening program has been launched in Warsaw for children in class VI. Since 2011, the program also includes children in first grades. In total, these programs have

In the years 2008–2011, the programs were conducted by the Institute of Physiology and Pathology of Hearing in cooperation with the Contribution Fund of Social Insurance of Farmers and the Agricultural Insurance Fund Social screening in rural centers and small

In 2008, new multimedia tool—Platform for Sense Examination—used in screening was developed by the Institute of Physiology and Hearing Pathology in cooperation with the Institute of Sensory Organs. In addition, local screening programs were implemented, within the Ministry of National Education, which involved around 500 psychological and pedagogical clinics

In June 2007, the Institute team organized an exhibition at the European Parliament in Brussels. "HEAR-VISION-SPEAK" is the basis of communication and integration of the young generation of Europe. The exhibit was accompanied by a series of lectures, and numerous audiophiles and audiologists were examined by MEPs. The abovementioned actions aimed to

The exhibition was an introduction to further European activity. More than 3 years of negotiations and preparations resulted in the signing of the European Consensus on Audiology, Vision and Speech Screening in preschool and school children on June 22, 2011. There was great support during the Polish Presidency and an important argument for the adoption of the

draw Europeans' attention to the major social problem of communication disorders.

5.1.2. School-aged children hearing screening

120 An Excursus into Hearing Loss

62 countries have used the Internet.

throughout the country.

that every 5 children aged 6–18 have hearing problems.

covered up to now more than 56,000 children in Warsaw.

towns. Within these programs, nearly 300,000 children were studied.

Every large-scale project involving children or adults is a great opportunity for early detection of congenital or acquired defects. In response to social needs related to the early detection of birth defects and acquired by detection and prevention, the Institute of Physiology and Hearing Pathology was involved in the implementation of the project, which was named System of Integrated Communication Operations "SZOK"®.

The project's innovation is the use of a system to assist patients with remote diagnosis and to transfer the results of their research to the health services sector. Integrating patient data into the "SZOK"® system will allow for quick service and thus shorten patient waiting times for visits to IFPS or other specialized facilities and as a comprehensive patient medical base. The system can also be successfully used in other healthcare and other medical fields. It is a unique solution in the field of telemedicine and e-health and is an excellent starting point for the Center for Screening.

Moreover, a standard for the transmission of audiological screening results has been implemented in the "SZOK"® system, which is developed within the Institute's project, so that it is adapted to obtain research results from other institutions and collect them in one place (Figure 1).

Figure 1. System of integrated communication operations "SZOK"®.

#### 5.1.4. Platform for sense organ examination

In 2008, new multimedia tool used in screening—Platform for Sense Organs Screening—was developed by the Institute of Physiology and Hearing Pathology in cooperation with the Institute of Sensory Organs(Figure 2).

are of the same frequency, while the third tone is of a different frequency. There are just two different frequencies used in this test: one is a high-frequency sound and the other a

6. Test module DPT: This is a duration pattern test. Test consists of sequences of three tones, one of which differs from the other two in the sequences by being either longer or shorter.

7. Test module GIN: This test allows assessment of the potential of perception of gaps in noise. During the test, the noise is presented with constantly emerging gaps of varying lengths.

Large-scale hearing screening experience called for a European Scientific Consensus agreement, which was defined and signed during the European Federation of Audiology Societies (EFAS) meeting in 2011 under auspices of the Institute of Physiology and Pathology of Hearing. As a result of this, a number of pilot hearing screening programs were started in various countries. Countries in which the team from the Institute of Physiology and Pathology of

> Number of tested children

Universal Newborn Hearing Screening

Hearing Screening around the World http://dx.doi.org/10.5772/intechopen.73535 123

in this country

5.2. Protocol used in the hearing screening in school-age children around the world

Hearing in Kajetany conducted hearing screening were presented in the Table 1.

Children's age

Armenia 6–9 200 No information Azerbaijan 6–8 200 No screening program Cameroon 5–15 220 No screening program Columbia 6–8 150 In some district Congo 6–8 200 No screening program Ivory Coast 6–8 130 No screening program Kazakhstan 7–8 212 No screening program Kyrgyzstan 6–7 300 No screening program Moldova 6–7 179 No information Nigeria 4–7 200 Pilot project

Romania 6–7 130 No screening program Russia 6–12 166 No screening program Rwanda 6–15 195 No screening program Senegal 6–10 200 No screening program Tajikistan 7–8 143 No screening program Tanzania 6–11 200 No screening program Ukraine 6–11 184 No screening program

Table 1. Overview of hearing screening around the world conducted by the Institute Physiology and Pathology of

low-frequency sound pattern test.

Country in which IFPS conducted

hearing screening

Hearing.

conducted by world hearing Centre in Kajetany, Poland

The platform is built around an Internet network solution, interfacing a central computer system and a series of portable computers (remote client devices) equipped with audiometric headphones and a response-button interface. The platform allows the user to conduct the following tests:


Figure 2. Platform for sense organs examinations.

are of the same frequency, while the third tone is of a different frequency. There are just two different frequencies used in this test: one is a high-frequency sound and the other a low-frequency sound pattern test.


#### 5.2. Protocol used in the hearing screening in school-age children around the world conducted by world hearing Centre in Kajetany, Poland

5.1.4. Platform for sense organ examination

Institute of Sensory Organs(Figure 2).

hearing threshold levels not exceeding 80 dB HL.

following tests:

122 An Excursus into Hearing Loss

child.

the tested person.

Figure 2. Platform for sense organs examinations.

or both ears.

In 2008, new multimedia tool used in screening—Platform for Sense Organs Screening—was developed by the Institute of Physiology and Hearing Pathology in cooperation with the

The platform is built around an Internet network solution, interfacing a central computer system and a series of portable computers (remote client devices) equipped with audiometric headphones and a response-button interface. The platform allows the user to conduct the

1. Audiometric testing: This feature allows the user to perform air conduction audiometric testing for each ear separately, in a tone frequency range from 250 to 8000 Hz, and for

2. Speech screening: The speech test is carried out to obtain reliable information on: (1) the quality of verbal behavior of the child and (2) the degree of speech development (or of any potential delays) and any pathological linguistic phenomena occurring in the speech of the

3. Audiological survey: This module allows the user to conduct a general survey regarding the hearing, sight, and speech of a patient. The surveys were developed by specialists based on years of experience in specific areas, and they provide reliable information on

4. Test module DDT: This is a dichotic listening test. During the test, pairs of sounds are presented to each ear and the task of the tested subjects is to repeat what they heard in one

5. Test module FPT: This is a frequency pattern test. The test items are sequences of three tone bursts that are presented to one or both ears. In each of the sequences, two tone bursts Large-scale hearing screening experience called for a European Scientific Consensus agreement, which was defined and signed during the European Federation of Audiology Societies (EFAS) meeting in 2011 under auspices of the Institute of Physiology and Pathology of Hearing. As a result of this, a number of pilot hearing screening programs were started in various countries. Countries in which the team from the Institute of Physiology and Pathology of Hearing in Kajetany conducted hearing screening were presented in the Table 1.


Table 1. Overview of hearing screening around the world conducted by the Institute Physiology and Pathology of Hearing.

School-entry hearing screening is especially important. That screening may actually be the first point of access to detect childhood hearing impairment.

Pure-tone audiometry (PTA) was performed using the modern platform elaborated by the Institute of Sense Organs and is fundamental for the inexpensive and universal screening in large populations of children—a platform for sense organs' screening. In addition, PTA was performed using SZOK described previously. The threshold for air conduction in the frequency range of 500–8000 Hz was determined. For abnormal test results, a hearing threshold

Hearing Screening around the World http://dx.doi.org/10.5772/intechopen.73535 125

The proposed screening procedure allows the detection not only of children with hearing loss but also of those with other hearing disorders, such as tinnitus. According to data study conducted by the team, led by Professor H. Skarżyńskiego, the incidence of tinnitus in school-

Moreover, the Institute of Physiology and Pathology of Hearing has their own truck that they are currently using for running a rural hearing health study—called Mobile Hearing Center. Inside, the truck functions as a regular audiology clinic, only on a much smaller scale. The larger of the two booths has a typical audiology setup with video-otoscopy. They were able to conduct assessment of the external and middle ears. The smaller booth is strictly used for testing adults. It may appear to be a small space; however, it is relatively spacious inside for the patient. Currently, we conduct only hearing screening, but in future, they hope to have Internet on the truck, so when they encounter a situation (e.g., with video otoscopy), they can evaluate the patient remotely. In that case, it would be a combination of two delivery types. Right now, it is a completely contained mobile audiology clinic, delivering the same level of service as you would expect in a brick-and-mortar clinic, except that they are able to bring

The positive impact of early identification and intervention for children with hearing loss is well established, and the primary care provider plays a vital role in screening children who require such services. Without prompt intervention, hearing loss in early childhood can cause significant delays in speech development, socioemotional growth, and school achievement.

Acute Otitis Media—painful type of ear infection. It occurs when the area behind the eardrum

Auditory Brainstem Response (ABR)—neurologic test which gives information about the inner ear and brain pathways for hearing. The ABR is performed by pasting electrodes on the head—similar to electrodes placed around the heart when an electrocardiogram is run—and

value of 25 dB and above was used for at least one frequency in at least one ear.

age children is approximately 13–37.7% [30].

hearing care services to the local community.

6. Summary

Index of technical terms

called the middle ear is inflamed and infected.

recording brain wave activity in response to sound.

Prior to testing, the children's parents were informed of the testing procedures and provided their written consent. The results of the audiometric tests were supplemented by the results of the questionnaire completed by the parents. This questionnaire included questions concerning data on the potential causes of the child's hearing problems, medical history, possible presence of tinnitus, and any presence of learning difficulties.

A hearing screening protocol used by a team from the Institute of Physiology and Pathology of Hearing in Kajetany, while screening in different countries includes three steps (Figure 3).

The first step is video-otoscopy. In this test, the specialist otolaryngologist views the middle ear on the monitor. This is the most accurate visual cure repair method and structure of the outer ear. This examination allows the diagnose change in the outer and middle ear such as excessive earwax, acute or chronic otitis media, fungal infection and changes in the tympanic membrane.

Second step is otoacoustic emission (OAE). It is an objective method of assessment—technically not a test of hearing but rather a reflection of inner ear mechanism. OAEs are sounds detected in the external ear canal that are generated by the outer hair cells within the cochlea. If the otoacoustic emission is absent, then we perform the third step—pure-tone audiometry.

Figure 3. Schema of hearing screening protocol in school-age children used in the institute physiology and pathology of hearing.

Pure-tone audiometry (PTA) was performed using the modern platform elaborated by the Institute of Sense Organs and is fundamental for the inexpensive and universal screening in large populations of children—a platform for sense organs' screening. In addition, PTA was performed using SZOK described previously. The threshold for air conduction in the frequency range of 500–8000 Hz was determined. For abnormal test results, a hearing threshold value of 25 dB and above was used for at least one frequency in at least one ear.

The proposed screening procedure allows the detection not only of children with hearing loss but also of those with other hearing disorders, such as tinnitus. According to data study conducted by the team, led by Professor H. Skarżyńskiego, the incidence of tinnitus in schoolage children is approximately 13–37.7% [30].

Moreover, the Institute of Physiology and Pathology of Hearing has their own truck that they are currently using for running a rural hearing health study—called Mobile Hearing Center. Inside, the truck functions as a regular audiology clinic, only on a much smaller scale. The larger of the two booths has a typical audiology setup with video-otoscopy. They were able to conduct assessment of the external and middle ears. The smaller booth is strictly used for testing adults. It may appear to be a small space; however, it is relatively spacious inside for the patient. Currently, we conduct only hearing screening, but in future, they hope to have Internet on the truck, so when they encounter a situation (e.g., with video otoscopy), they can evaluate the patient remotely. In that case, it would be a combination of two delivery types. Right now, it is a completely contained mobile audiology clinic, delivering the same level of service as you would expect in a brick-and-mortar clinic, except that they are able to bring hearing care services to the local community.
