Recommendations and Referrals - Quick Reference (June 2022)

Continuing Education Credit
- STARS - 1.0 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Two factors that negatively impact a deaf/hard-of-hearing child's ability to discriminate sounds include:
- Background Noise and Increased Pitch
- Background Noise and Distance
- Distance and Increased Intonation
The suprasegmental aspects of speech include:
- Pitch
- Intonation
- All of the above
- Stress
A child responding to auditory stimuli by choosing the correct target based on syllable differences is an example of:
- Discrimination
- Detection
- Comprehension
A child responding to auditory stimuli by searching for the sound source is an example of:
- Detection
- Discrimination
- Comprehension
The use of a pause prior to the production of a key word is an example of:
- Acoustic Highlighting
- Intonation
- Detection
A child responding to auditory stimuli by following a 2-step direction is an example of:
- Discrimination
- Detection
- Comprehension

Continuing Education Credit
- STARS - 1.0 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Two factors that negatively impact a deaf/hard-of-hearing child's ability to discriminate sounds include:
- Background Noise and Increased Pitch
- Background Noise and Distance
- Distance and Increased Intonation
The suprasegmental aspects of speech include:
- Pitch
- Intonation
- All of the above
- Stress
A child responding to auditory stimuli by choosing the correct target based on syllable differences is an example of:
- Discrimination
- Detection
- Comprehension
A child responding to auditory stimuli by searching for the sound source is an example of:
- Detection
- Discrimination
- Comprehension
The use of a pause prior to the production of a key word is an example of:
- Acoustic Highlighting
- Intonation
- Detection
A child responding to auditory stimuli by following a 2-step direction is an example of:
- Discrimination
- Detection
- Comprehension

Continuing Education Credit
- STARS - 1.0 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Upon entering kindergarten, children with hearing loss may not have the same amount of general knowledge as their classmates who have typical hearing.
- True
- False
Redundancy means that a child must SAY a word over and over in order for that word to become a part of his or her vocabulary.
- True
- False
Phonological awareness corresponds to the ability to understand that words are made up of sounds.
- True
- False
Hearing, learning, and literacy are not connected.
- True
- False
Upon entering kindergarten, children with hearing loss may not have as large of a vocabulary as their classmates who have typical hearing.
- True
- False
The filtering effect of hearing loss refers to hearing some speech sounds more clearly than others.
- True
- False
Consonants are important to speech perception because they
- Carry a wallet
- Carry a pail of water
- Carry the "intelligibility" of speech
- Carry the "power" of speech
Children with normal hearing may have better access to auditory information in the classroom than children with hearing loss.
- True
- False
One-Three-Six (1-3-6) refers to the importance of:
- Completion of screening for hearing loss by one (1) month of age, diagnosis by three (3) months of age, and enrolled in appropriate intervention by six (6) months of age
- Grade levels most important in the development of literacy skills
- For each one (1) vocabulary word a child acquires, s/he must be exposed to the word in context three (3) times every six (6) weeks
- Grade levels that should have hearing screening
By third grade, classroom instruction requires that a student
- Sequence, remember, and recall information
- Wear school uniforms
- Ride the bus to school
- Learn calculus
CAPTCHA

Continuing Education Credit
- STARS - 1.0 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Upon entering kindergarten, children with hearing loss may not have the same amount of general knowledge as their classmates who have typical hearing.
- True
- False
Redundancy means that a child must SAY a word over and over in order for that word to become a part of his or her vocabulary.
- True
- False
Phonological awareness corresponds to the ability to understand that words are made up of sounds.
- True
- False
Hearing, learning, and literacy are not connected.
- True
- False
Upon entering kindergarten, children with hearing loss may not have as large of a vocabulary as their classmates who have typical hearing.
- True
- False
The filtering effect of hearing loss refers to hearing some speech sounds more clearly than others.
- True
- False
Consonants are important to speech perception because they
- Carry a wallet
- Carry a pail of water
- Carry the "intelligibility" of speech
- Carry the "power" of speech
Children with normal hearing may have better access to auditory information in the classroom than children with hearing loss.
- True
- False
One-Three-Six (1-3-6) refers to the importance of:
- Completion of screening for hearing loss by one (1) month of age, diagnosis by three (3) months of age, and enrolled in appropriate intervention by six (6) months of age
- Grade levels most important in the development of literacy skills
- For each one (1) vocabulary word a child acquires, s/he must be exposed to the word in context three (3) times every six (6) weeks
- Grade levels that should have hearing screening
By third grade, classroom instruction requires that a student
- Sequence, remember, and recall information
- Wear school uniforms
- Ride the bus to school
- Learn calculus

Continuing Education Credit
- STARS - 1.5 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other*
Employment Setting*

Immittance Quiz Introduction
These questions will help assess your familiarity with ear anatomy and the journey of sound.
Immittance equipment currently in Wyoming's Child Development Centers is appropriate for use with children:
- 9 months of age or older
- 3 months of age or older
- 3 years of age or older
What does immittance screen?
- The status of the cochlea
- The status of the Auditory Pathway
- The status of the middle ear system
Immittance screening can also provide information regarding:
- Vision
- Impacted ear wax, perforated eardrums, and P.E. tubes
- Hair cells in the cochlea
True or False: Immittance also screens for hearing acuity.
- True
- False
True or False: A person with profound, bilateral sensorineural hearing loss can pass immittance screening.
- True
- False

The Eustachian Tube & Air Pressure in the Middle Ear
These questions will help assess your familiarity with the eustachian tube, negative middle ear pressure, P.E. tubes, additional conditions or circumstances that may affect immittance screening results, occlusion, and perforations of the eardrum.
The job of the Eustachian tube is to:
- Regulate the inner ear
- Ventilate the middle ear cavity and equalize air pressure in the middle ear cavity so that it is equal to that of the environment in which a person is found
- Divert sound energy
Negative middle ear pressure can cause:
- The eardrum to be pushed outward, into the ear canal.
- The Ossicles to crumple in upon themselves.
- The eardrum to be pulled inward, away from its natural or more "neutral" position.
If negative middle ear pressure in the middle ear cavity continues for a period of time, what may be eventually drawn from the mucosal lining as a result?
- More oxygen
- Hair cells
- Fluid
The accumulation of fluid in the middle ear space is called:
- Occlusion
- Effusion
- Ossicular Flooding
True or False: A physician determines if fluid and/or infection is present, not the screener.
- True
- False

Understanding Immittance Screening
These questions will help assess your familiarity with immittance screening, otoscopy, probe tip fit, and tips for obtaining and maintaining a good seal.
True or False: Immittance screening requires a response from the child and background noise will affect the screening results.
- True
- False
True or False: If screening an infant or toddler, you may want them to sit on a familiar lap.
- True
- False
It is recommended that you:
- Not ask the child for permission to begin immittance screening.
- Ask the child for permission to begin immittance screening.
- Inform the child the immittance screening will not hurt before beginning the screening.
Otoscopy refers to what?
- A field of specialty within the practice of audiology.
- Visually inspecting the ear canal, its size and direction, and the eardrum with an otoscope.
- A surgical procedure.
If a foreign object or drainage is visualized during otoscopy:
- Note the findings and proceed with the screening.
- Do not proceed with the screening and make a referral to the child's primary care physician.
- Tell the child to clean out his or her ears.

Understanding Immittance Screening Results: Tympanometry & Acoustic Reflexes
These questions will help assess your familiarity with how immittance results are derived, tympanometry and tympanograms, ear canal volume, middle ear pressure, tympanic membrane compliance, and acoustic reflexes.
Immittance screening equipment may also help determine ______________.
- If any fluid in the middle ear is infected; if the inner ear is functioning properly.
- If the eardrum is present; if all three Ossicles are in the correct place; if the auditory cortex is functioning properly.
- If wax is occluding the ear canal; if there is a perforation of the eardrum; if ventilation tubes are working properly.
True or False: Understanding the relationship between Ear Canal Volume, Tympanic Membrane Compliance, and Middle Ear Pressure will be critical to understand immittance results.
- True
- False
A large Ear Canal Volume may reflect:
- A perforation of the eardrum or an open P.E. tube.
- That the eardrum is missing.
- An abnormally large ear canal.
True or False: Values for both Middle Ear Pressure and Tympanic Membrane Compliance do not rely upon movement of the Tympanic Membrane.
- True
- False
True or False: For tympanograms with very low Tympanic Membrane Compliance (0.1ml or less) the absence or presence of the acoustic reflex is used to determine if the results are a pass or a refer.
- True
- False

Immittance Pass/Fail Criteria & Wyoming Developmental Screening Include Hearing Screening
These questions will help assess your familiarity with immittance pass/fail criteria.
Which of the following are the three components of a developmentally appropriate hearing screening for Wyoming children (ages 1-5)?
- Otoscopy, Pure Tones or Otoacoustic Emissions (OAEs), Immittance
- Otoscopy, Pure Tones, Otoacoustic Emissions (OAEs)
- Otoscopy, Noise Makers, Immittance
Which of the following will not cause an ear canal volume to be large?
- An open Pressure Equalization (P.E.) Tube
- Impacted Ear Wax
- A perforated eardrum
What is the acceptable range for Middle Ear Pressure to be considered a pass for Immittance screening?
- +100 daPa to -250 daPa
- -250 daPa to -400 daPa
- +200 daPa to +100 daPa
True or False: When conducting a hearing rescreen, you only need to conduct the hearing screening component(s) that were failed.
- True
- False
True or False: When conducting a hearing rescreen, you only need to rescreen the ear that did not pass the previous screening(s).
- True
- False
True or False: If a child fails immittance and passes Pure Tones or Otoacoustic Emissions (OAEs) on two separate screenings, it is appropriate to make a medical referral.
- True
- False
True or False: If a child fails immittance and passes Pure Tones or Otoacoustic Emissions (OAEs) on two separate screenings, it is appropriate to make an audiological referral.
- True
- False
Which of the following ventilates the middle ear space and equalizes middle ear pressure?
- The Ear Canal
- The Eustachian Tube
- The Tympanic Membrane
Another name for the ear drum is _______________.
- The Cochlea
- The Ear Barrier
- The Tympanic Membrane
"TMC" stands for what?
- Tympanic Motion Condition
- Tympanic Membrane Compliance
- The Mechanical Component

Continuing Education Credit
- STARS - 1.5 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise, you are welcome to view the video and take the quizzes, but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Immittance Quiz Introduction
These questions will help assess your familiarity with ear anatomy and the journey of sound.
Immittance equipment currently in Wyoming's Child Development Centers is appropriate for use with children:
- 9 months of age or older
- 3 months of age or older
- 3 years of age or older
What does immittance screen?
- The status of the cochlea
- The status of the Auditory Pathway
- The status of the middle ear system
Immittance screening can also provide information regarding:
- Vision
- Impacted ear wax, perforated eardrums, and P.E. tubes
- Hair cells in the cochlea
True or False: Immittance also screens for hearing acuity.
- True
- False
True or False: A person with profound, bilateral sensorineural hearing loss can pass immittance screening.
- True
- False

The Eustachian Tube and Air Pressure in the Middle Ear
These questions will help assess your familiarity with the eustachian tube, negative middle ear pressure, P.E. tubes, additional conditions or circumstances that may affect immittance screening results, occlusion, and perforations of the eardrum.
The job of the Eustachian tube is to:
- Regulate the inner ear
- Ventilate the middle ear cavity and equalize air pressure in the middle ear cavity so that it is equal to that of the environment in which a person is found
- Divert sound energy
Negative middle ear pressure can cause:
- The eardrum to be pushed outward, into the ear canal.
- The Ossicles to crumple in upon themselves.
- The eardrum to be pulled inward, away from its natural or more "neutral" position.
If negative middle ear pressure in the middle ear cavity continues for a period of time, what may be eventually drawn from the mucosal lining as a result?
- More oxygen
- Hair cells
- Fluid
The accumulation of fluid in the middle ear space is called:
- Occlusion
- Effusion
- Ossicular Flooding
True or False: A physician determines if fluid and/or infection is present, not the screener.
- True
- False

Understanding Immittance Screening
These questions will help assess your familiarity with immittance screening, otoscopy, probe tip fit, and tips for obtaining and maintaining a good seal.
True or False: Immittance screening requires a response from the child and background noise will affect the screening results.
- True
- False
True or False: If screening an infant or toddler, you may want them to sit on a familiar lap.
- True
- False
It is recommended that you:
- Not ask the child for permission to begin immittance screening.
- Ask the child for permission to begin immittance screening.
- Inform the child the immittance screening will not hurt before beginning the screening.
Otoscopy refers to what?
- A field of specialty within the practice of audiology.
- Visually inspecting the ear canal, its size and direction, and the eardrum with an otoscope.
- A surgical procedure.
If a foreign object or drainage is visualized during otoscopy:
- Note the findings and proceed with the screening.
- Do not proceed with the screening and make a referral to the child's primary care physician.
- Tell the child to clean out his or her ears.

Understanding Immittance Screening Results: Tympanometry and Acoustic Reflexes
These questions will help assess your familiarity with how immittance results are derived, tympanometry and tympanograms, ear canal volume, middle ear pressure, tympanic membrane compliance, and acoustic reflexes.
Immittance screening equipment may also help determine ______________.
- If any fluid in the middle ear is infected; if the inner ear is functioning properly.
- If the eardrum is present; if all three Ossicles are in the correct place; if the auditory cortex is functioning properly.
- If wax is occluding the ear canal; if there is a perforation of the eardrum; if ventilation tubes are working properly.
True or False: Understanding the relationship between Ear Canal Volume, Tympanic Membrane Compliance, and Middle Ear Pressure will be critical to understand immittance results.
- True
- False
A large Ear Canal Volume may reflect:
- A perforation of the eardrum or an open P.E. tube.
- That the eardrum is missing.
- An abnormally large ear canal.
True or False: Values for both Middle Ear Pressure and Tympanic Membrane Compliance do not rely upon movement of the Tympanic Membrane.
- True
- False
True or False: For tympanograms with very low Tympanic Membrane Compliance (0.1ml or less) the absence or presence of the acoustic reflex is used to determine if the results are a pass or a refer.
- True
- False

Immittance Pass/Fail Criteria and Wyoming Developmental Screening Include Hearing Screening
These questions will help assess your familiarity with immittance pass/fail criteria.
Which of the following are the three components of a developmentally appropriate hearing screening for Wyoming children (ages 1-5)?
- Otoscopy, Pure Tones or Otoacoustic Emissions (OAEs), Immittance
- Otoscopy, Pure Tones, Otoacoustic Emissions (OAEs)
- Otoscopy, Noise Makers, Immittance
Which of the following will not cause an ear canal volume to be large?
- An open Pressure Equalization (P.E.) Tube
- Impacted Ear Wax
- A perforated eardrum
What is the acceptable range for Middle Ear Pressure to be considered a pass for Immittance screening?
- +100 daPa to -250 daPa
- -250 daPa to -400 daPa
- +200 daPa to +100 daPa
True or False: When conducting a hearing rescreen, you only need to conduct the hearing screening component(s) that were failed.
- True
- False
True or False: When conducting a hearing rescreen, you only need to rescreen the ear that did not pass the previous screening(s).
- True
- False
True or False: If a child fails immittance and passes Pure Tones or Otoacoustic Emissions (OAEs) on two separate screenings, it is appropriate to make a medical referral.
- True
- False
True or False: If a child fails immittance and passes Pure Tones or Otoacoustic Emissions (OAEs) on two separate screenings, it is appropriate to make an audiological referral.
- True
- False
Which of the following ventilates the middle ear space and equalizes middle ear pressure?
- The Ear Canal
- The Eustachian Tube
- The Tympanic Membrane
Another name for the ear drum is _______________.
- The Cochlea
- The Ear Barrier
- The Tympanic Membrane
"TMC" stands for what?
- Tympanic Motion Condition
- Tympanic Membrane Compliance
- The Mechanical Component

Continuing Education Credit
- STARS - 1.5 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise, you are welcome to view the video and take the quizzes, but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Immittance Quiz Introduction
These questions will help assess your familiarity with ear anatomy and the journey of sound.
Immittance equipment currently in Wyoming's Child Development Centers is appropriate for use with children:
- 9 months of age or older
- 3 months of age or older
- 3 years of age or older
What does immittance screen?
- The status of the cochlea
- The status of the Auditory Pathway
- The status of the middle ear system
Immittance screening can also provide information regarding:
- Vision
- Impacted ear wax, perforated eardrums, and P.E. tubes
- Hair cells in the cochlea
True or False: Immittance also screens for hearing acuity.
- True
- False
True or False: A person with profound, bilateral sensorineural hearing loss can pass immittance screening.
- True
- False

The Eustachian Tube and Air Pressure in the Middle Ear
These questions will help assess your familiarity with the eustachian tube, negative middle ear pressure, P.E. tubes, additional conditions or circumstances that may affect immittance screening results, occlusion, and perforations of the eardrum.
The job of the Eustachian tube is to:
- Regulate the inner ear
- Ventilate the middle ear cavity and equalize air pressure in the middle ear cavity so that it is equal to that of the environment in which a person is found
- Divert sound energy
Negative middle ear pressure can cause:
- The eardrum to be pushed outward, into the ear canal.
- The Ossicles to crumple in upon themselves.
- The eardrum to be pulled inward, away from its natural or more "neutral" position.
If negative middle ear pressure in the middle ear cavity continues for a period of time, what may be eventually drawn from the mucosal lining as a result?
- More oxygen
- Hair cells
- Fluid
The accumulation of fluid in the middle ear space is called:
- Occlusion
- Effusion
- Ossicular Flooding
True or False: A physician determines if fluid and/or infection is present, not the screener.
- True
- False

Understanding Immittance Screening
These questions will help assess your familiarity with immittance screening, otoscopy, probe tip fit, and tips for obtaining and maintaining a good seal.
True or False: Immittance screening requires a response from the child and background noise will affect the screening results.
- True
- False
True or False: If screening an infant or toddler, you may want them to sit on a familiar lap.
- True
- False
It is recommended that you:
- Not ask the child for permission to begin immittance screening.
- Ask the child for permission to begin immittance screening.
- Inform the child the immittance screening will not hurt before beginning the screening.
Otoscopy refers to what?
- A field of specialty within the practice of audiology.
- Visually inspecting the ear canal, its size and direction, and the eardrum with an otoscope.
- A surgical procedure.
If a foreign object or drainage is visualized during otoscopy:
- Note the findings and proceed with the screening.
- Do not proceed with the screening and make a referral to the child's primary care physician.
- Tell the child to clean out his or her ears.

Understanding Immittance Screening Results: Tympanometry and Acoustic Reflexes
These questions will help assess your familiarity with how immittance results are derived, tympanometry and tympanograms, ear canal volume, middle ear pressure, tympanic membrane compliance, and acoustic reflexes.
Immittance screening equipment may also help determine ______________.
- If any fluid in the middle ear is infected; if the inner ear is functioning properly.
- If the eardrum is present; if all three Ossicles are in the correct place; if the auditory cortex is functioning properly.
- If wax is occluding the ear canal; if there is a perforation of the eardrum; if ventilation tubes are working properly.
True or False: Understanding the relationship between Ear Canal Volume, Tympanic Membrane Compliance, and Middle Ear Pressure will be critical to understand immittance results.
- True
- False
A large Ear Canal Volume may reflect:
- A perforation of the eardrum or an open P.E. tube.
- That the eardrum is missing.
- An abnormally large ear canal.
True or False: Values for both Middle Ear Pressure and Tympanic Membrane Compliance do not rely upon movement of the Tympanic Membrane.
- True
- False
True or False: For tympanograms with very low Tympanic Membrane Compliance (0.1ml or less) the absence or presence of the acoustic reflex is used to determine if the results are a pass or a refer.
- True
- False

Immittance Pass/Fail Criteria and Wyoming Developmental Screening Include Hearing Screening
These questions will help assess your familiarity with immittance pass/fail criteria.
Which of the following are the three components of a developmentally appropriate hearing screening for Wyoming children (ages 1-5)?
- Otoscopy, Pure Tones or Otoacoustic Emissions (OAEs), Immittance
- Otoscopy, Pure Tones, Otoacoustic Emissions (OAEs)
- Otoscopy, Noise Makers, Immittance
Which of the following will not cause an ear canal volume to be large?
- An open Pressure Equalization (P.E.) Tube
- Impacted Ear Wax
- A perforated eardrum
What is the acceptable range for Middle Ear Pressure to be considered a pass for Immittance screening?
- +100 daPa to -250 daPa
- -250 daPa to -400 daPa
- +200 daPa to +100 daPa
True or False: When conducting a hearing rescreen, you only need to conduct the hearing screening component(s) that were failed.
- True
- False
True or False: When conducting a hearing rescreen, you only need to rescreen the ear that did not pass the previous screening(s).
- True
- False
True or False: If a child fails immittance and passes Pure Tones or Otoacoustic Emissions (OAEs) on two separate screenings, it is appropriate to make a medical referral.
- True
- False
True or False: If a child fails immittance and passes Pure Tones or Otoacoustic Emissions (OAEs) on two separate screenings, it is appropriate to make an audiological referral.
- True
- False
Which of the following ventilates the middle ear space and equalizes middle ear pressure?
- The Ear Canal
- The Eustachian Tube
- The Tympanic Membrane
Another name for the ear drum is _______________.
- The Cochlea
- The Ear Barrier
- The Tympanic Membrane
"TMC" stands for what?
- Tympanic Motion Condition
- Tympanic Membrane Compliance
- The Mechanical Component

Continuing Education Credit
- STARS - 1.5 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other*
Employment Setting*

Immittance Quiz Introduction
These questions will help assess your familiarity with ear anatomy and the journey of sound.
Immittance equipment currently in Wyoming's Child Development Centers is appropriate for use with children:
- 9 months of age or older
- 3 months of age or older
- 3 years of age or older
What does immittance screen?
- The status of the cochlea
- The status of the Auditory Pathway
- The status of the middle ear system
Immittance screening can also provide information regarding:
- Vision
- Impacted ear wax, perforated eardrums, and P.E. tubes
- Hair cells in the cochlea
True or False: Immittance also screens for hearing acuity.
- True
- False
True or False: A person with profound, bilateral sensorineural hearing loss can pass immittance screening.
- True
- False

The Eustachian Tube & Air Pressure in the Middle Ear
These questions will help assess your familiarity with the eustachian tube, negative middle ear pressure, P.E. tubes, additional conditions or circumstances that may affect immittance screening results, occlusion, and perforations of the eardrum.
The job of the Eustachian tube is to:
- Regulate the inner ear
- Ventilate the middle ear cavity and equalize air pressure in the middle ear cavity so that it is equal to that of the environment in which a person is found
- Divert sound energy
Negative middle ear pressure can cause:
- The eardrum to be pushed outward, into the ear canal.
- The Ossicles to crumple in upon themselves.
- The eardrum to be pulled inward, away from its natural or more "neutral" position.
If negative middle ear pressure in the middle ear cavity continues for a period of time, what may be eventually drawn from the mucosal lining as a result?
- More oxygen
- Hair cells
- Fluid
The accumulation of fluid in the middle ear space is called:
- Occlusion
- Effusion
- Ossicular Flooding
True or False: A physician determines if fluid and/or infection is present, not the screener.
- True
- False

Understanding Immittance Screening
These questions will help assess your familiarity with immittance screening, otoscopy, probe tip fit, and tips for obtaining and maintaining a good seal.
True or False: Immittance screening requires a response from the child and background noise will affect the screening results.
- True
- False
True or False: If screening an infant or toddler, you may want them to sit on a familiar lap.
- True
- False
It is recommended that you:
- Not ask the child for permission to begin immittance screening.
- Ask the child for permission to begin immittance screening.
- Inform the child the immittance screening will not hurt before beginning the screening.
Otoscopy refers to what?
- A field of specialty within the practice of audiology.
- Visually inspecting the ear canal, its size and direction, and the eardrum with an otoscope.
- A surgical procedure.
If a foreign object or drainage is visualized during otoscopy:
- Note the findings and proceed with the screening.
- Do not proceed with the screening and make a referral to the child's primary care physician.
- Tell the child to clean out his or her ears.

Understanding Immittance Screening Results: Tympanometry & Acoustic Reflexes
These questions will help assess your familiarity with how immittance results are derived, tympanometry and tympanograms, ear canal volume, middle ear pressure, tympanic membrane compliance, and acoustic reflexes.
Immittance screening equipment may also help determine ______________.
- If any fluid in the middle ear is infected; if the inner ear is functioning properly.
- If the eardrum is present; if all three Ossicles are in the correct place; if the auditory cortex is functioning properly.
- If wax is occluding the ear canal; if there is a perforation of the eardrum; if ventilation tubes are working properly.
True or False: Understanding the relationship between Ear Canal Volume, Tympanic Membrane Compliance, and Middle Ear Pressure will be critical to understand immittance results.
- True
- False
A large Ear Canal Volume may reflect:
- A perforation of the eardrum or an open P.E. tube.
- That the eardrum is missing.
- An abnormally large ear canal.
True or False: Values for both Middle Ear Pressure and Tympanic Membrane Compliance do not rely upon movement of the Tympanic Membrane.
- True
- False
True or False: For tympanograms with very low Tympanic Membrane Compliance (0.1ml or less) the absence or presence of the acoustic reflex is used to determine if the results are a pass or a refer.
- True
- False

Immittance Pass/Fail Criteria & Wyoming Developmental Screening Include Hearing Screening
These questions will help assess your familiarity with immittance pass/fail criteria.
Which of the following are the three components of a developmentally appropriate hearing screening for Wyoming children (ages 1-5)?
- Otoscopy, Pure Tones or Otoacoustic Emissions (OAEs), Immittance
- Otoscopy, Pure Tones, Otoacoustic Emissions (OAEs)
- Otoscopy, Noise Makers, Immittance
Which of the following will not cause an ear canal volume to be large?
- An open Pressure Equalization (P.E.) Tube
- Impacted Ear Wax
- A perforated eardrum
What is the acceptable range for Middle Ear Pressure to be considered a pass for Immittance screening?
- +100 daPa to -250 daPa
- -250 daPa to -400 daPa
- +200 daPa to +100 daPa
True or False: When conducting a hearing rescreen, you only need to conduct the hearing screening component(s) that were failed.
- True
- False
True or False: When conducting a hearing rescreen, you only need to rescreen the ear that did not pass the previous screening(s).
- True
- False
True or False: If a child fails immittance and passes Pure Tones or Otoacoustic Emissions (OAEs) on two separate screenings, it is appropriate to make a medical referral.
- True
- False
True or False: If a child fails immittance and passes Pure Tones or Otoacoustic Emissions (OAEs) on two separate screenings, it is appropriate to make an audiological referral.
- True
- False
Which of the following ventilates the middle ear space and equalizes middle ear pressure?
- The Ear Canal
- The Eustachian Tube
- The Tympanic Membrane
Another name for the ear drum is _______________.
- The Cochlea
- The Ear Barrier
- The Tympanic Membrane
"TMC" stands for what?
- Tympanic Motion Condition
- Tympanic Membrane Compliance
- The Mechanical Component

Continuing Education Credit
- STARS - 1.0 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Upon entering kindergarten, children with hearing loss may not have the same amount of general knowledge as their classmates who have typical hearing.
- True
- False
Redundancy means that a child must SAY a word over and over in order for that word to become a part of his or her vocabulary.
- True
- False
Phonological awareness corresponds to the ability to understand that words are made up of sounds.
- True
- False
Hearing, learning, and literacy are not connected.
- True
- False
Upon entering kindergarten, children with hearing loss may not have as large of a vocabulary as their classmates who have typical hearing.
- True
- False
The filtering effect of hearing loss refers to hearing some speech sounds more clearly than others.
- True
- False
Consonants are important to speech perception because they
- Carry a wallet
- Carry a pail of water
- Carry the "intelligibility" of speech
- Carry the "power" of speech
Children with normal hearing may have better access to auditory information in the classroom than children with hearing loss.
- True
- False
One-Three-Six (1-3-6) refers to the importance of:
- Completion of screening for hearing loss by one (1) month of age, diagnosis by three (3) months of age, and enrolled in appropriate intervention by six (6) months of age
- Grade levels most important in the development of literacy skills
- For each one (1) vocabulary word a child acquires, s/he must be exposed to the word in context three (3) times every six (6) weeks
- Grade levels that should have hearing screening
By third grade, classroom instruction requires that a student
- Sequence, remember, and recall information
- Wear school uniforms
- Ride the bus to school
- Learn calculus

Continuing Education Credit
- STARS - 1.0 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Upon entering kindergarten, children with hearing loss may not have the same amount of general knowledge as their classmates who have typical hearing.
- True
- False
Redundancy means that a child must SAY a word over and over in order for that word to become a part of his or her vocabulary.
- True
- False
Phonological awareness corresponds to the ability to understand that words are made up of sounds.
- True
- False
Hearing, learning, and literacy are not connected.
- True
- False
Upon entering kindergarten, children with hearing loss may not have as large of a vocabulary as their classmates who have typical hearing.
- True
- False
The filtering effect of hearing loss refers to hearing some speech sounds more clearly than others.
- True
- False
Consonants are important to speech perception because they
- Carry a wallet
- Carry a pail of water
- Carry the "intelligibility" of speech
- Carry the "power" of speech
Children with normal hearing may have better access to auditory information in the classroom than children with hearing loss.
- True
- False
One-Three-Six (1-3-6) refers to the importance of:
- Completion of screening for hearing loss by one (1) month of age, diagnosis by three (3) months of age, and enrolled in appropriate intervention by six (6) months of age
- Grade levels most important in the development of literacy skills
- For each one (1) vocabulary word a child acquires, s/he must be exposed to the word in context three (3) times every six (6) weeks
- Grade levels that should have hearing screening
By third grade, classroom instruction requires that a student
- Sequence, remember, and recall information
- Wear school uniforms
- Ride the bus to school
- Learn calculus
CAPTCHA

Continuing Education Credit
- STARS - 1.0 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Two factors that negatively impact a deaf/hard-of-hearing child's ability to discriminate sounds include:
- Background Noise and Increased Pitch
- Background Noise and Distance
- Distance and Increased Intonation
The suprasegmental aspects of speech include:
- Pitch
- Intonation
- All of the above
- Stress
A child responding to auditory stimuli by choosing the correct target based on syllable differences is an example of:
- Discrimination
- Detection
- Comprehension
A child responding to auditory stimuli by searching for the sound source is an example of:
- Detection
- Discrimination
- Comprehension
The use of a pause prior to the production of a key word is an example of:
- Acoustic Highlighting
- Intonation
- Detection
A child responding to auditory stimuli by following a 2-step direction is an example of:
- Discrimination
- Detection
- Comprehension

Continuing Education Credit
- STARS - 1.0 credit hour
Thank you for participating in the Immittance Training course. If you are registered to receive Continuing Education Units (CEUs), you must complete the post-quiz to attain your certification for this course from the Wyoming EHDI program. A grade of 90% or better will be considered passing. Otherwise you are welcome to view the video and take the quizzes but you will not receive credit for doing so.
STARS ID # (if applicable):*
Name
First Last
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Job Title*
Job Title - Other
Employment Setting*

Two factors that negatively impact a deaf/hard-of-hearing child's ability to discriminate sounds include:
- Background Noise and Increased Pitch
- Background Noise and Distance
- Distance and Increased Intonation
The suprasegmental aspects of speech include:
- Pitch
- Intonation
- All of the above
- Stress
A child responding to auditory stimuli by choosing the correct target based on syllable differences is an example of:
- Discrimination
- Detection
- Comprehension
A child responding to auditory stimuli by searching for the sound source is an example of:
- Detection
- Discrimination
- Comprehension
The use of a pause prior to the production of a key word is an example of:
- Acoustic Highlighting
- Intonation
- Detection
A child responding to auditory stimuli by following a 2-step direction is an example of:
- Discrimination
- Detection
- Comprehension

Wyoming EHDI

Recommendations and Referrals – Quick Reference (June 2022)

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Immittance Quiz Introduction

The Eustachian Tube & Air Pressure in the Middle Ear

Understanding Immittance Screening

Understanding Immittance Screening Results: Tympanometry & Acoustic Reflexes

Immittance Pass/Fail Criteria & Wyoming Developmental Screening Include Hearing Screening

Immittance Quiz Introduction

The Eustachian Tube and Air Pressure in the Middle Ear

Understanding Immittance Screening

Understanding Immittance Screening Results: Tympanometry and Acoustic Reflexes

Immittance Pass/Fail Criteria and Wyoming Developmental Screening Include Hearing Screening

Immittance Pre-Quiz

Step 1 of 6

Immittance Quiz Introduction

The Eustachian Tube and Air Pressure in the Middle Ear

Understanding Immittance Screening

Understanding Immittance Screening Results: Tympanometry and Acoustic Reflexes

Immittance Pass/Fail Criteria and Wyoming Developmental Screening Include Hearing Screening

Immittance Post-Quiz

Step 1 of 6

Immittance Quiz Introduction

The Eustachian Tube & Air Pressure in the Middle Ear

Understanding Immittance Screening

Understanding Immittance Screening Results: Tympanometry & Acoustic Reflexes

Immittance Pass/Fail Criteria & Wyoming Developmental Screening Include Hearing Screening

Audition / Hearing and Learning Pre-Quiz

Step 1 of 2

Audition / Hearing and Learning Post-Quiz

Step 1 of 2

Auditory Skill Development Pre-Quiz

Step 1 of 2

Auditory Skill Development Post-Quiz

Step 1 of 2