Hearing Aid Client We Dream About! Plus: Aids for Athletes?

I observed a man who had experience with an older hearing but needed an update. He had came in previously to get set up for the hearing aid in his right, better ear. His visit today was to receive the aid. I did not see the beginning part of the aid fitting. I observed the clinician retesting puretones and word recognition for results with the new hearing aid. The thresholds changed a bit in the higher (speech) frequencies. Word recognition was 82%. The clinician did an unaided test for discrim. to show the client the difference in speech reception. The undaided result was 33%, which was quite a difference from 82%. The client was very satisfied! He described how he could now hear "rustles" and sounds he hadn't before.
The next step was for the clinician to teach the client how to operate the aid. The client was informed about taking off and putting on the aid, different cases used for different situations, how to care for aid, and how and when to change the battery. The clinician also informed the client of when to be seen again.
One of the main concerns from the client was exposure to wind creating unwanted results. He informed the clinician that his old aid was rather uncomfortable when exposed to wind. He is an avid golfer. This posed a question for me: Do they make hearing aids specifically for athletes? Some of the main concerns for athletes using hearing aids is moisture exposure and high movement knocking aid around or creating feedback. The website listed in sources below provides great information based for athletes. I learned that they have dry aid kits to use, aids can be sealed to help with moisture exposure, and waterproof aids can be purchased (very pricey!). Modifications can also be made to prevent misplacement of the aid from the ear due to physical activity. Modifications can also be made to prevent feedback (Shafer, 2004).
http://www.asha.org/about/publications/leader-online/archives/2004/041005/041005d.htm

Sources:

Shafer, D. N. (2004, Sept. 21). Game plans for Athletes with hearing loss. The ASHA Leader,
pp.23, 36.

Hearing Evaluation-PE Tube Scarring

I observed a client who, overall, had all normal results as a conclusion for an annual hearing evaluation. During case history, the client revealed that he/she was taking medications for cholesterol, allergies, and acid reflux. No significant changes were noticed with hearing.
The clinician first performed otoscopy. When looking in the right ear, a large amount of scar tissue was noticed. The client revealed that PE tubes were used at a young age in both ears. The results were similiar in the left ear. PE tubes are usually placed when problems with fluid buildup occur in the middle ear space (Martin & Clark, 2006). Tympanometry was normal for both ears.
Puretone results were as follows: Right ear - 250Hz=0dB, 500Hz=5dB, 1kHz=5dB, 2kHz=0dB, 3kHz=10dB, 4kHz=5dB, and 8kHz=15dB / Left ear - 250Hz=0dB, 500Hz=10dB, 1kHz=5dB, 2kHz=5dB, 3kHz=10dB, 4kHz=15dB, 6kHz=10dB, and 8kHz=15dB. The clinician explained the normal results to the client.
The following website contains information dealing with otoscopy and otoscopic results. It also has little quizzes and such! Great resource: www.aap.org/otitismedia/www/vc/ear/rvw/rvw17.cfm

Martin, F. N. & Clark, J. G. (2006). Introduction to audiology (9th ed.). Boston: Pearson
Education, Inc.

Surprising Results for Musician

What results would one expect from a drum musician of say, 15 years? After hearing the case history for this client, I was sure I would see some sort of hearing loss due to noise exposure. Fortunately for the client, no hearing loss was present. Otoscopy and tympanometry both revealed normal results in both ears. The client's puretone results are as follows: Right ear = 250Hz-15dB, 500Hz-10dB, 1kHz-15dB, 2kHz-10dB, 3kHz-0dB, 4kHz-5dB, 6kHz-5dB, 8kHz-10dB / Left ear = 250Hz-10dB, 500Hz-10dB, 1kHz-10dB, 2kHz-5dB, 3kHz-0dB, 4kHz-5dB, 6kHz- -5dB, 8kHz-0dB. As you see, the client's results for puretone thresholds were completely normal. The clinician showed the client the audiogram and thoroughly explained the normal results. The clinician also sent the client home with good hearing protection. Good forms of hearing protection include ear plugs, ear muff, or both ear plugs and muffs simultaneously (ASHA, n.d.). The following website contains links that provide useful information for hearing conservation: http://www.asha.org/about/membership-certification/divs/hearinglinks.htm

Hearing protection. (n.d.). Retrieved November 3, 2007, from http://www.asha.org/public/hearing/disorders/hearing_protect.htm

Behavioral Testing with Children

I observed a three year old child who had come from a speech screening. I noticed his speech to be very delayed and suspected apraxia. Overall, his hearing proved to be normal. To determine thresholds, the clinician first started using blockdropping as a behavior response to hearing the tone. The clinician had issues conditioning the child. In my opinion, the child was developmentally too young for the test. Allan Diefendorf (2002) describes that the cutoff age for condtioned play audiometry is 3 years and above. Although this child was chronologically age three, his developmental age seemed below that level. Next, they used the WIPI (Word Intelligibility by Picture Identification) test with the child. This method was much more successful. The following website outlines pediatric testing. http://www.asha.org/docs/html/GL2004-00002.html


References:
Diefendorf, A. O. (2002). Detection and assessment of hearing loss in infants and children. In J. Katz (Ed.), Handbook of clinical audiology (pp. 479). Baltimore: Lippincott Williams & Wilkins.

Know the facts... about ear wax!

I observed an older gentleman with high frequency hearing loss in both ears. He has two aids, one for each ear, but of course, only wears them occasionally. He has not noticed a major change in his hearing. He was taking medication for pneumonia and takes blood pressure medication regularly. He has had noise exposure due to his career.
Otoscopy revealed a large amount of wax in the right ear which caused the canal to be almost completely occluded. The left ear also showed wax but just a reasonable amount. Otherwise, the view was normal. Both tympanograms were normal.
Puretone results were as follows: Right ear- 250Hz = 25dB, 500Hz=25dB, 1000Hz=30dB, 2000Hz=35dB, 3000Hz=50dB, 4000Hz=55dB, 6000Hz=65dB, 8000Hz=65dB/ Left ear- -250Hz=20dB, 500Hz=20dB, 1000Hz=20dB, 1500Hz=35dB, 2000Hz=50dB, 3000Hz=50dB, 4000Hz=75dB, 6000Hz=95dB, and 8000Hz = no response.
The clinician explained the audiogram and gave the gentleman extra hearing protection. The clinician also suggested that the client possibly update his aids. It was also advised that having the wax removed may result in some change in hearing. Large amounts of cerumen can affect hearing through air conduction. (Roeser & Roland, 1992). The following website offers a pretty slideshow about a presbycusis study : http://www.asha.org/NR/rdonlyres/5D95975D-CA40-487A-B532-E3DA7B2305C4/0/FrisinaPresentation.pdf

Roeser, R.J. & Roland, P. (1992, November). What audiologists must know about cerumen and cerumen management. American Academy of Audiology, 1, 27-35.

Getting results from individuals with severe handicaps!

This week, I observed a situation which I had not yet experienced. I observed a clinician working with a severely handicapped older client who did not have an appointment. The clinician did a great job in preparing for the client on the spot.
First, the clinician performed an otoscopic examination. The clinician was informed from the guardian of the client that the client might hit. The client did not want anything in his ears and kept grabbing the clinicians arm. The clinician was very patient and calm, which I believed made the exam run smoother. The clinician was able to get the otoscopic views and noted that both ears were normal. Tymponometry was not able to be performed because the client would not allow the clinician to put anything in his ears at that point.
The clinician then used VRA to determine speech thresholds. VRA has been noted to be a good technique to use with clients who have mental handicaps (Ray, 2002). The clinician was able to get a 20dB response at 1000Hz and a 25dB response at 2000Hz. The results may not have been completely accurate due to many inconsistent responses. Also, the clinician had issues maintaining conditioning. The clinician deemed that the clients hearing appeared withing normal limits.
The clinicians supervisor noted that the importance of reading the clients files before they arrive can help prepare and follow through testing.

I found this website that I think would be beneficial for all of us to bookmark. The website is a dictionary for terms and conditions related to mental handicaps. This website would be great for a quick research before a client comes in to better understand their condition.
http://www.questia.com/library/book/dictionary-of-mental-handicap-by-mary-p-lindsey.jsp


References:
Ray, C. (2002). Mental retardation and/or developmental disabilities. In J. Katz (Ed.),
Handbook of clinical audiology (pp. 75). Baltimore: Lippincott Williams & Wilkins.

Speech Diagnostics for Children

I observed a child of 7 years going through otoscopy, tympanometry, OAEs, and puretone testing. The client came from a speech therapy session and was sent to rule out either hearing loss and/or CAPD. Due to time constraints, CAPD testing was not completed. It may take place at a later date.
The child was very extroverted and participatory. During the otoscopy and tympanometry testing, the clinician did a wonderful job of getting the client excited for the tests which aided in participation of instructions. The clinician gave a really good example of how positive manipulation of a child is a necessity in audiological testing. The following website gives some tips in working with children. http://www.asha.org/about/publications/leader-online/archives/2003/q4/031021d1.htm
All testing showed normal results. The clinician was unable to get the OAE test completed in the left ear. The testing for central auditory processding disorders was not completed. A central auditory processing disorder is a complication in the auditory pathways in the central nervous system that creates problems with understanding, attention, and memory (Bellis, 2007). The following website provides good information for pediatric CAPDs. http://www.asha.org/public/hearing/disorders/understand-apd-child.htm

References:
Bellis, T. J. (2007). Understanding auditory processing disorders in children. Retrieved October 2, 2007 from the American Speech and Hearing Association (ASHA).

Annual Hearing Evals.

Yearly hearing evaluations for those who may be exposed to noise on a daily basis. Today, I observed a client who works in an environment where noise may affect hearing thresholds if prevention is not taken.
First, a case history was taken from the client. The client informed us that he/she has a history of hearing loss in the family. He/she also has high blood pressure. When asked if a change in hearing was noticed, the client responded that he/she did not notice any change.
Otoscopy was then performed. The outer ears, canals, and tympanic membranes of both ears appeared normal. The clinician next performed tympanometry. The clinician first attempted to get a seal in the right ear but was having much trouble. She switched to the other ear to prevent soreness in the clients right ear. After obtaining normal results in the left ear, the clinician then switched to the right year again and received normal results. The clicinian also tested acoustic relfexes contralaterally at 1000Hz and received 90 in the right ear and 85 in the left.
The clinician finally performed puretone air conduction testing for both ears. The audiograms revealed high frequency hearing losses in both ears. The audiogram had not changed much since the clients last visit.
The clincian explained the audiogram to the client. The supervisor then asked the client if he/she was using appropriate preventative measures when being exposed to noise. The client said that he/she was following procedures for work. The supervisor also mentioned that this type of loss may be the result of the normal aging process. The website listed at the end of the blog briefly explains how the cochlea changes resulting in high frequency losses as a person ages ("The cause...). The supervisor mentioned that communication should not be affected, and the client agreed that communication was fine. The supervisor and clicnician encouraged the client to continue using hearing protection. I found the following website which actually contains a long list of helpful sites to review hearing conservation. http://www.asha.org/about/membership-certification/divs/hearinglinks.htm The client was finished until next year!

The cause of hearing loss in adults. (n.d.). Retrieved September 25, 2007, from http://www.asha.org/public/hearing/disorders/causes_adults.htm

Testing a Toddler - What a Difference with Age Difference!

My previous blog described a hearing screening for a child of three years. I got the priveledge of observing another hearing screening but this time for a child of four and half years of age. The difference in behavior was tremendous. All results proved normal.
Otoscopy was first performed with all major landmarks visible including the cone of light. Both eardrums appeared healthy and normal. The child was a little nervous at first, but the clinician excited the child by mentioning that his/her ear "would be on TV!" The child became somewhat interested.
Tympanometry was then performed. The child was not all that comfortable about the testing. The clinician told the child that his/her ear would become an artist and "draw mountains." This helped but not much. The child did behave very well even though he/she did not appear to be comfortable. Both tymp. results were normal.
Otoacoustic emission testing was next performed. The child was not fond of this test. He/she complained that it was painful. The clinician assured the child and parent that no harm was being done and that the test would be very short. Both OAEs proved normal. I was excited to see this test because I had never been exposed to it previously. The clinician helped with informing me that OAE testing shows the function of the outer hair cells. I researched OAE testing and found an article from ASHA that stated that if the results proved to be absent or reduced, this was an indication of outer hair cell damage (Lonsbury-Martin)! I found this test interesting! (For more information on OAE testing, visit this website http://www.asha.org/about/publications/leader-online/archives/2005/050322/f050322a.htm )
Puretone testing showed normal audiograms. This is where behavioral problems occured. The child became restless, began moving the earphones off, and quit paying attention at times which made accuracy recording more difficult. The clinician did a great job adjusting to the behavior and refocusing the child. Speechtesting also was somewhat difficult due to the child becoming restless. All results did prove to be normal. The clinician informed the speech therapist and parents that the auditory system appeared to be fine.
This observation was very helpful. I first learned that a small age difference can show a major change in behavioral issues. The three year old was much more difficult to test compared to the four and a half year old. Parental methods may have also made a difference of course, but the maturity level definitely showed. I was also excited to see an OAE test. Hopefully, I will get much more experience with this testing!

Lonsbury-Martin, B. L. (2005, March 22). Otoacoustic emissions: Where are we today? The ASHA Leader, p. 6-7, 19.

The Task of Testing a Toddler! (More Difficult than Saying this Title Ten Times Fast!)

My experience that I am about to discuss is a situation that all audiologists will one day have to overcome: screening a child! When I was first informed that a child of three years would be the client in my observation, I was so excited! I had never observed a child in the audiological setting. I must admit, I was unaware of the true talent one must possess to accomplish such tasks on a child of such young age.
The child was referred by an SLP for a screening to rule out hearing loss as a cause for delayed speech and language. The child enterred with the father. The child seemed very attached to the parent but was all smiles! The clinician first tested the child to receive minimal response levels using 25dB intensity in warble tone frequencies of 500Hz, 1000Hz, 2000Hz, and 4000Hz. A block dropping conditioning activity was used to help elicit a response. The activity consisted of dropping small toy bears in a cup as the sound is heard. The child presented consistent results with rare false positives. The child would also show a giant grin when the sound was heard which further implied that the sound was being heard. The results suggested that the child's hearing was normal. The clinician could not evaluate sensitivity to speech due to equiptment malfunction.
The clinician then performed otoscopy and tympanometry on the child. Both tests revealed normal results. The clinician informed the father of the patient that there were no signs of middle ear disease.
What did I learn from this observation? First, I learned that there is certain lingo that must not be used while testing a child. It was suggested by an audiologist that any term relating to pain should be left out. If the child were to be exposed to this idea, the child may not participate as easily due to a fearful mentality. I also learned that a good way to get a child to participate in the testing is to involve interesting toys for the child to take their minds off of testing procedures such as otoscopy and tympanometry.
Below is a link for a webpage through ASHA that provides information for pediatric screenings. There is a ton of useful information. There is also pass and referral criteria listed which will help explain the decision making processes in screenings!
http://www.asha.org/docs/html/GL1997-00199.html#sec1.3

Ear Mold Impressions for those with Abnormalities

Today would have been my first day of observing in the clinic, but no patients were scheduled during my time. I did find a very interesting article dealing with ear mold impressions on ears with abnormalities. The article discusses six cases in which ear mold impression material entered the middle ear and/or mastoid cavities requiring surgical removal.
The first patient went to a hearing aid distributer to be fit and ended up in a world of medical trouble concerning the ear. The patient had a perforation in his left tympanic membrane. The ear mold impression entered through the perforation, filled the middle ear space (surrounded ossicles), and even entered the eustacian tube. Tympanoplasty and rebuilding of the ossicles took place, but the patient resulted in a mixed loss.
The second patient suffered from an attic retraction pocket in the left ear. The ear mold material became attached in the pocket. An ENT tried to get the material out with no success. The patients hearing had decreased. A CT scan revealed issues in the middle ear and mastoid. A tympanomastoidectomy was recommended, but the patient said no and never returned.
Patient 4 had undergone a mastoidectomy. Precautions were taken to avoid issues, but the ear mold material did get lodged in the mastoid cavity. The material was able to be removed, and no major problems occured.
Patient 5 acquired a perforation in the tympanic member from the impression material. The material was also touching the ossicles. The patient did not want surgery. They ended up getting cholesteotoma. Many more complications occured creating major problems. After surgeries and management, the patients TM healed, but significant hearing loss occured.
Patient 6 had PE tubes. The material went through the PE tubes into the middle ear. A surgery was performed, but the perforation left in the TM did not heal. A second surgery proved to be successful.
In most cases, fitting ear molds results in little complications. One must be aware of pre-existing conditions which could complicate the procedure. I felt this article was very interesting. I have listed the information for the article below if you wish to read for yourself!

Jacob, A., Morris, T.J., & Welling, B. (2006). Leaving a lasting impression: Ear mold
impressions as middle ear foreign bodies. Annals of Otology, Rhinology, & Laryngology, 115
(12), 912-916.

Hi. My name is Gina Groves. I hope you like my posts. Feel free to comment. I am "all ears!"