Referrals for a SLP? How often?

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I was in my Language Development class, a CSD major, and was wondering how often you guys make a referral for a SLP in case there might be a problem with their language development. Say the Pediatrician sends a kid with fluid in their ears and you discover some hearing loss. Would you automatically ask for a referral or ask the Ped to do it? I was just curious about a situation like this.

Originally Posted by Heatwave

I was in my Language Development class, a CSD major, and was wondering how often you guys make a referral for a SLP in case there might be a problem with their language development. Say the Pediatrician sends a kid with fluid in their ears and you discover some hearing loss. Would you automatically ask for a referral or ask the Ped to do it? I was just curious about a situation like this.

Well, in that particular case, I'd just put tubes in the kid's ears.

We send lots of people to Speech path, most commonly adults for voice and swallowing issues.

Originally Posted by OtoHNS

Well, in that particular case, I'd just put tubes in the kid's ears.

We send lots of people to Speech path, most commonly adults for voice and swallowing issues.

Well I mean yeah, that's the reason they were sen't to an ENT. I'm talking about after and you see any hearing loss due to having the liquid in the ears. I'm talking about during the developmental years where the child is developing language. Would it be uncommon to send the kid to a speech path because their language might be impaired? Just as a precautionary movement?

Originally Posted by Heatwave

Well I mean yeah, that's the reason they were sen't to an ENT. I'm talking about after and you see any hearing loss due to having the liquid in the ears. I'm talking about during the developmental years where the child is developing language. Would it be uncommon to send the kid to a speech path because their language might be impaired? Just as a precautionary movement?

Once the tubes are placed the fluid isn't in the ears anymore. There shouldn't be further concerns about their hearing/speech-language development. If there are other issues we would send them along but this is a fixable cause of hearing loss.

Agree with Oto, we send a ton of people to SLP-mainly adults after big surgeries or if they have a functional voice issue.

Originally Posted by Pir8DeacDoc

Once the tubes are placed the fluid isn't in the ears anymore. There shouldn't be further concerns about their hearing/speech-language development. If there are other issues we would send them along but this is a fixable cause of hearing loss.

Agree with Oto, we send a ton of people to SLP-mainly adults after big surgeries or if they have a functional voice issue.

Obviously this answers my question... and I don't understand why anyone wouldn't send a kid to a SLP JUST IN CASE. Assessments are free, so I don't see how prescribing one couldn't hurt. Does anyone here focus on a lot of pediatric cases (which is what I kind of want to do when I get out of residency)? I'm not saying send them to a SLP because there might be FURTHER hearing loss, I am saying send them to a SLP because the hearing loss they had when the fluid was in their ears may have negatively impacted their development. And I get the adult thing- Voice therapy, VCD, tubes being down throats from surgeries, but 6 months to any child between the ages of 0 and 5 is considerably long when we are discussing language development.

Originally Posted by Heatwave

Obviously this answers my question... and I don't understand why anyone wouldn't send a kid to a SLP JUST IN CASE. Assessments are free, so I don't see how prescribing one couldn't hurt. Does anyone here focus on a lot of pediatric cases (which is what I kind of want to do when I get out of residency)? I'm not saying send them to a SLP because there might be FURTHER hearing loss, I am saying send them to a SLP because the hearing loss they had when the fluid was in their ears may have negatively impacted their development. And I get the adult thing- Voice therapy, VCD, tubes being down throats from surgeries, but 6 months to any child between the ages of 0 and 5 is considerably long when we are discussing language development.

I'm not in the habit of sending people for evaluation "just in case". You either have a hearing loss and associated speech delay or you don't. If you do then you get referred. No evaluation is free. They get paid just like anyone else for their time.

Plus generally speaking it would be a bad idea on the part of the pediatrician or the oto to let a kid have fluid for 6 months. Although you would be surprised how little conductive loss some kids have from serous effusions.

Originally Posted by Pir8DeacDoc

I'm not in the habit of sending people for evaluation "just in case". You either have a hearing loss and associated speech delay or you don't. If you do then you get referred. No evaluation is free. They get paid just like anyone else for their time.

Plus generally speaking it would be a bad idea on the part of the pediatrician or the oto to let a kid have fluid for 6 months. Although you would be surprised how little conductive loss some kids have from serous effusions.

But how do you know there isn't a speech delay unless you assess the kid? And a large majority of assessments are free and will be covered by the insurance company. The therapy after the assessment might not be covered but at least in NY almost all assessments are covered or mostly covered. Maybe this is just something I have to wrap my head around and forget about. There are many more things an oto has to worry about than a kids development. Right?

I love it when pre-meds argue with residents & attendings about how to do our jobs.

Originally Posted by Heatwave

But how do you know there isn't a speech delay unless you assess the kid? And a large majority of assessments are free and will be covered by the insurance company. The therapy after the assessment might not be covered but at least in NY almost all assessments are covered or mostly covered. Maybe this is just something I have to wrap my head around and forget about. There are many more things an oto has to worry about than a kids development. Right?

This may come as a total shock to a SLP but given that I went through 9 years of education after college to be an ENT, it's really not that hard to do an assessment myself in the clinic to determine if there is a delay present. In addition, I have the recommendations of the pediatrician who has been following the kid for a much longer period of time, so I too do not send kids "just in case." There's no such thing as a just in case if you're an educated and reasonably caring ENT.

The vast majority of SL delays from OM will clear within 3 months of tube placement. Those that don't, I will refer to a SLP. Kids who do not have hearing loss but clearly have SL delays get sent by me all the time to SLP.

Originally Posted by Heatwave

but 6 months to any child between the ages of 0 and 5 is considerably long when we are discussing language development.

Also, read the literature. 10,000 kids in Germany followed for OME for 10 years. Greatest study in the history of the world on OME and risk of SL delays.

Used to be that any kid with an OME longer than 3 months got tubes automatically. This study changed that and made 3 months of fluid alone a relative indication for tubes. It clearly showed that there was no long term risk to hearing or speech/language development if the MEE never caused hearing loss. However, if it did cause hearing loss then the SL risks were quite dramatic. Therefore, the absolute recommendation for tubes for persistent MEE is OME lasting 3 months or more with a conductive hearing loss.

Why? 50% of kids will have a MEE one month after an AOM. However, 90% of kids will be clear within 3 months. Of those that haven't cleared, 70% will continue to have a MEE throughout the next 12 months. Therefore, if you have a CHL at 3 months from an OME, it's 70% likely that you'll have it for a year.

Last, the age is 3, not 5. The vast majority of speech and language synapses are formed by 3yo. Kids who develop delays prior to 3 have a much higher risk of delays lasting well into their adolescence. Kids who develop delays after 3 have a significantly higher chance of reversing their delay in months rather than years.

Originally Posted by maxheadroom

I love it when pre-meds argue with residents & attendings about how to do our jobs.

I wasn't arguing about how someone should do their job, I was simply asking a question and when that question was answered I asked why. I hadn't understood why until Resxn answered my question of why. So I want to thank him for the answer.

Originally Posted by Heatwave

And a large majority of assessments are free and will be covered by the insurance company.

I'll bet you don't even realize why this statement is so incredibly stupid.

Originally Posted by Fah-Q

I'll bet you don't even realize why this statement is so incredibly stupid.

...thank you for contributing your STIMULATING response and adding to this conversation. I appreciate the feedback. What I meant was that many assessments will BE free because insurance companies may cover them. I was hoping that a forum with many highly intelligent people would churn out more mature responses but I guess I expected too much out of the internet.

The point remains, nothing is free. We have a responsibility to practice cost conscience medicine. It's over referring and over testing that makes healthcare so expensive.

Originally Posted by Heatwave

What I meant was that many assessments will BE free because insurance companies may cover them.

You're getting eviscerated because you are equating no cost out of pocket to the patient at the time of the visit as being the same as free.

That kind of assumption is what makes medicine so misunderstood, insurance companies so powerful, and the politicians able to twist the issue to their whim.

If every kid got a "just in case" evaluation at the SLP, the cost of insurance premiums would rise because the insurance company is not going to eat the extra cost of more payments to SLP's, they will pass it on to the consumer. The SLP is not going to do an eval for free--they're going to get paid either by salary with a corporation billing for them or by their own office billing. The end result is that even if a patient has met their deductible, their deductible either now or in the future will be higher or their premiums either now or in the future will be higher. One way or another, it will be paid for, it will not be free.

I've heard others make the argument that it can be done through the school district's SLP's for free--insurance won't pay. Guess what? Your taxes will go up. If you need more SLP's to do more kid evals then you have to cover that cost. Where does that come from? Property taxes usually, but in some states a portion is from income taxes.

THERE IS NO SUCH THING AS A FREE VISIT

Healthcare in the US is expensive and assuming it's free (or even not making the assumption but calling it free when it's not) is either ignorant, irresponsible, or ignoble.

Originally Posted by Heatwave

What I meant was that many assessments will BE free because insurance companies may cover them.

You still don't get it. Please see resxn's explanation.

Just to reiterate, nothing is free. The insurance company might pay (maybe, many of them don't just pay unless there is a reason for it, and even when there is a reason some still will fight not to pay) and then the cost gets spread among all of us, so we ALL pay.