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
Tuesday, September 25, 2007
Tuesday, September 18, 2007
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.
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.
Tuesday, September 11, 2007
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
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
Wednesday, September 5, 2007
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.
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.
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