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).