TECHNOLOGY Pure tone audiometry and tympanometry

Otoscopic/
Visual Inspection n = Action
n = Results
Signs of impacted n = Referral
cerumen, foreign body, Unremarkable results
infection

Immediate referral for

medical consultation Pure tone Screen

Pass Fail/CNT

Rescreen according to district/ • Immediately reinstruct, reposition

state/program mandates or Pure tone–Pass earphones and rescreen pure tones
sooner if there is caregiver or Tympanometry–Pass • Tympanometry
teacher concern

Pure tone–Fail/CNT Pure tone–Pass Pure tone–Fail Pure tone–CNT

Tympanometry–Fail Tympanometry–Fail Tympanometry–Pass Tympanometry–Pass

Rescreen in 6–8 wks*

Immediate referral for Pure tone–Pass or Fail Pure tone–Fail/CNT Immediate referral for
with tympanometry
medical consultation Tympanometry–Fail Tympanometry–Pass audiologic consultation
& pure tones

Rescreen pure tones

and tympanogram Immediate referral for Rescreen and refer for audiologic
Fail
4 weeks* after medical medical consultation evaluation as necessary
treatment complete
*See “Considerations for Timelines” in Practice Portal content
44193
TECHNOLOGY Pure tone audiometry only

n = Action
Otoscopic/Visual
Inspection n = Results
n = Referral

Pure tone Screen

Pass Fail/CNT

Rescreen according to district/state/ Immediately reinstruct,

program mandates or sooner if there reposition earphones
is caregiver or teacher concern and rescreen

Fail CNT

Pass Rescreen in Immediate referral for

6–8 weeks* audiologic evaluation

Fail

Immediate referral for medical consultation

Rescreen after medical treatment complete and refer

for audiologic evaluation as necessary

*See “Considerations for Timelines” in Practice Portal content

11070
TECHNOLOGY OAE only

n = Action
Otoscopic/Visual
Inspection n = Results
n = Referral

Signs of impacted
Unremarkable
cerumen, foreign body,
results
infection

Immediate referral for

medical consultation Screen with OAE

Pass Fail

RESCREEN OAEs in
4 weeks*

Fail

Immediate referral
for medical
Rescreen according to district/state/ consultation
program mandates or sooner if there
is caregiver or teacher concern OAE rescreen 4 weeks*
after medical treatment
complete.

Pass Fail

Immediate referral
for medical
consultation

Rescreen and refer for audiologic

evaluation as necessary

*See “Considerations for Timelines” in Practice Portal content

11070
TECHNOLOGY OAE and tympanometry

Otoscopic/ n = Action
Visual Inspection
n = Results
n = Referral
Signs of impacted Unremarkable
cerumen, foreign body, results
infection

Immediate referral for Screen with OAE

medial consultation

Pass Fail

Immediate screen with

tympanometry

Pass Fail

Rescreen with OAE Rescreen in 4 weeks*

and refer for w/OAE and tympanometry
audiologic evaluation
Rescreen according to
if needed
district/state/program
mandates or sooner Tympanometry–Pass Tympanometry–Fail
if there is caregiver or OAE–Fail OAE–Pass
teacher concern
Immediate referral Immediate referral
for audiologic for medical
evaluation consultation
Rescreen OAE and tymps
Pass 4 weeks* after medical
treatment completed

Immediate referral Immediate referral

Tympanometry–Pass Tympanometry–Fail for medical
for audiologic
OAE–Fail OAE–Pass consultation
evaluation

Rescreen and refer for audiologic evaluation

as necessary

*See “Considerations for Timelines” in Practice Portal content

11070