I observed a male client in his 70s that came in with an interesting history. Sometime before 5 years ago, the client experienced many intense spells of vertigo. After consulting a physician, he was diagnosed with Menieres Disease. The spells were bad enough that the client went through either a vestibular nerve section or a labyrinthectomy, which I did not get from the client. IA vestibular nerve section is a severence of the vestibular section of the vestibulocochlear nerve, and a labyrinthectomy is removal of the vestibular organ ("Meniere's Disease", 2001). Overall, the vestibular system of the right side was nonfunctioning. He also complained that he now staggers a bit since the surgery. The client also complained of issues with hypertension, macular degeneration, hemochromatosis, colin cancer, and an allergy to codine. He has had exposure to noise through hunting. He has been wearing an Audibel CIC for four years and is now interested in a Unitron WiFi CROS.
Otoscopy was normal for both ears. Tymps were unable to be performed due to the inability to get a seal by the clinician which was okayed by the supervisor. Speech recognition scores were 30dB for the right ear, and no response for the left, dead ear. Word recognition scores were 96% at a sensation level of 35dB in the right ear and nontestable for the left ear. The right MCL was 65dB, and the right UCL was 85dB. Puretone testing revealed the left ear to be dead and the right ear to have a mild to profound sensorineural sloping loss. The clinician then ordered the Unitron WiFi CROS. A Unitron 6 ITE was ordered for the right ear with a WiFi mic ordered for the left ear. The total cost was around $1300. Earmold impressions were then taken with both systems in the ITE form.
I found this client to be very interesting. I look forward to his fitting when the CROS comes in. I listed the following websites which have good information on Menieres disease and the Unitron WiFi CROS aid.
Meniere's = http://www.entnet.org/healthinfo/balance/meniere.cfm
Unitron = http://www.unitronhearing.us/ccus/about_us/news_us/news_wifimicite_us.htm
Meniere's Disease. (2001). Retrieved February 27, 2008, from http://www.nidcd.nih.gov/health/balance/meniere.asp
Wednesday, February 27, 2008
Wednesday, February 20, 2008
Audiology Student Diagnosis Own Vestibular Schwannoma
Due to no appointments to observe today, I found a pretty interesting article concerning vestibular schwannomas. The author of this article and also an audiologist, Renee M. Muto, diagnosed herself with a rare vestibular schwannoma (VS) (aka: acoustic neuroma). The woman began to notice unilateral tinnitus in the left ear in March 1992. Muto next noticed bouts of lightheadness (dizziness). The symptoms lasted for over a month until Muto suggested to herself that it may be a serious issue. In April of 1992, Muto had an audiologic evaluation performed. Her audiogram revealed normal hearing as she had in graduate school. Although, there was a 10-15dB sensorineural drop in the left ear which was not present in the right. Speech testing was not valid due to her experience with the word lists and immittance testing came out normal. Muto also obtained an ENG test which showed normal vestibular functioning. In May 1992, she had an ABR test done which she could compare to her normal results from graduate school. An ipsilateral recording of the left ear showed many waves past wave I to be delayed with the ILD for wave V being abnormal. Knowing that all the symptoms and test results suggested a VS, she contacted a neurologist who performed an MRI specific for the IAC.
The MRI revealed a intracanicular vestibular schwannoma. Muto was shocked and felt difficulty explaining this to others since she was an audiologist herself and did not make a big deal out of her symptoms. After consultation with an otologist and neurosurgeon Muto opted for surgery with particular concern for hearing preservation (retrograde). She did much research herself but found most help from another VS survivor. She strongly encourages this contact because the person who had overcome this problem with the same methods gave her much information based on the experience that books or specialists couldn't do. Muto mentioned that during her surgery, her colleagues had actually done the intraoperative monitoring which she had once done herself.
After the surgery, in the hospital, Muto experienced severe vertigo and nausea later accompanied by a major headache. She learned that the inferior and superior vestibular nerves were severed during surgery. Her main concern at the time was with hearing. She noticed that there was a significant loss and later found from an audiologic evaluation that her loss was profound in her left ear. Research shows that there is a better chance of preserving hearing with small tumors which confused Muto because her tumor was rather small. Other less significant factors could have played a role though. Muto tried hearing aids with no luck. The headaches continued without much help from medications. She also experiences slight balance problems though the right vestibular system has mostly compensated for the left side.
Overall, this article is great at explaining from an audiologists and clients perspective, the feelings and affects of a VS. Muto stresses the importance of postoperative counseling. It is important for us as audiologists to give the clients as much information as possible!
Reference:
Muto, R. (1994). Acoustic neuroma case review: An audiologit's self-portrait. American Journal of Audiology, 3, 32-36.
The MRI revealed a intracanicular vestibular schwannoma. Muto was shocked and felt difficulty explaining this to others since she was an audiologist herself and did not make a big deal out of her symptoms. After consultation with an otologist and neurosurgeon Muto opted for surgery with particular concern for hearing preservation (retrograde). She did much research herself but found most help from another VS survivor. She strongly encourages this contact because the person who had overcome this problem with the same methods gave her much information based on the experience that books or specialists couldn't do. Muto mentioned that during her surgery, her colleagues had actually done the intraoperative monitoring which she had once done herself.
After the surgery, in the hospital, Muto experienced severe vertigo and nausea later accompanied by a major headache. She learned that the inferior and superior vestibular nerves were severed during surgery. Her main concern at the time was with hearing. She noticed that there was a significant loss and later found from an audiologic evaluation that her loss was profound in her left ear. Research shows that there is a better chance of preserving hearing with small tumors which confused Muto because her tumor was rather small. Other less significant factors could have played a role though. Muto tried hearing aids with no luck. The headaches continued without much help from medications. She also experiences slight balance problems though the right vestibular system has mostly compensated for the left side.
Overall, this article is great at explaining from an audiologists and clients perspective, the feelings and affects of a VS. Muto stresses the importance of postoperative counseling. It is important for us as audiologists to give the clients as much information as possible!
Reference:
Muto, R. (1994). Acoustic neuroma case review: An audiologit's self-portrait. American Journal of Audiology, 3, 32-36.
Wednesday, February 13, 2008
Update in Aids
An older man (around 65-70 years old) came in for a hearing aid consultation. He had a bilateral sensorineural moderate to severe loss, probably due to presbycusis. He had older linear hearing aids and was ready for an update!
First, the clinician performed speech testing. The SRT for the right ear was 30dB and the left was 35dB. The WR score for the right ear was 88% with the left ear being 80%. There was a significant change in discrimination in the clients left ear. It went from 68% from a previous testing session to 80%. The MCL for the right ear was 70dB and for the left ear was also 70dB. The LDL was 90dB for the right ear and also 90dB for the left ear.
The clinician and supervisor then lead the client into a different room to discuss different possibilities for aids. The supervisor recommended the Widex Micro Flash. This aid is a 5 channel open fit BTE, which allows for the lower frequencies to be heard more normally due to the canal being more naturally open. The clinician informed the client that each aid would cost $795 plus shipping and handling of $13. The aids can be fully refunded within 30 days of use. The shipping and handling costs are non-refundable. This brought up an interesting situation for the client. The client's daughter, in Venezuala, just had a baby. He and his wife had intentions to see the baby in Venezuela as soon as their health was in top shape. This brought on problems because the clinician explained that it was necessary for the client to be around for those 30 days, not only for adjustments, but in case the aid needed to be refunded. For this reason, the aids were not ordered today. The client decided to talk to his wife about the timing issue and come back in to order when the timing could be worked out. The client also had a few other questions concerning feedback, volume control, and the ability to feel the aid being worn. The supervisor and clinician helped sort out these questions.
The Widex website gives complete information on the Widex Flash Micro for professionals and consumers. (http://www.widex.com/) Click on "Products" and then "Flash." I also found a great website through eMecidine that explains hearing aids on a level better for our clients (and helpful for WVU first year grad. students!). Check it out! http://www.emedicine.com/ent/topic478.htm
First, the clinician performed speech testing. The SRT for the right ear was 30dB and the left was 35dB. The WR score for the right ear was 88% with the left ear being 80%. There was a significant change in discrimination in the clients left ear. It went from 68% from a previous testing session to 80%. The MCL for the right ear was 70dB and for the left ear was also 70dB. The LDL was 90dB for the right ear and also 90dB for the left ear.
The clinician and supervisor then lead the client into a different room to discuss different possibilities for aids. The supervisor recommended the Widex Micro Flash. This aid is a 5 channel open fit BTE, which allows for the lower frequencies to be heard more normally due to the canal being more naturally open. The clinician informed the client that each aid would cost $795 plus shipping and handling of $13. The aids can be fully refunded within 30 days of use. The shipping and handling costs are non-refundable. This brought up an interesting situation for the client. The client's daughter, in Venezuala, just had a baby. He and his wife had intentions to see the baby in Venezuela as soon as their health was in top shape. This brought on problems because the clinician explained that it was necessary for the client to be around for those 30 days, not only for adjustments, but in case the aid needed to be refunded. For this reason, the aids were not ordered today. The client decided to talk to his wife about the timing issue and come back in to order when the timing could be worked out. The client also had a few other questions concerning feedback, volume control, and the ability to feel the aid being worn. The supervisor and clinician helped sort out these questions.
The Widex website gives complete information on the Widex Flash Micro for professionals and consumers. (http://www.widex.com/) Click on "Products" and then "Flash." I also found a great website through eMecidine that explains hearing aids on a level better for our clients (and helpful for WVU first year grad. students!). Check it out! http://www.emedicine.com/ent/topic478.htm
Wednesday, February 6, 2008
"I don't hear perfectly still. If I have to wear these d**m things, I want them to work!"
High expectations? I think so! I saw a client today that came in for a hearing evaluation and hearing aid consultation. The man looked to be in his fifties. After careful look at his previous audiogram, the man had a moderate sloping sensorineural loss bilaterally. He is currently wearing Oticon Deltas in both ears.
The clinician asked the client what he noticed to be an issue with his aids. The client responded that it had been a while since he had everything checked, and he still wasn't hearing "the same that everyone else is hearing." He complained of missing some voices and having issues with watching television. He also mentioned that he had 10mm domes and would rather have 8mm.
First, the clinician listened to the aids to see if anything seemed to be off. The clinician stated that the aids sounded fine. The clinician also noticed that the domes had been altered. After asking the client about the domes, he responded that he wanted them to be smaller so he cut them himself.
The clinician then perfomed otoscopy on the client. The right ear was fine, but the left ear was almost if not completely occluded with wax. The clinician and supervisor informed the client that the wax would need to be removed, preferably by a professional, before any further testing could be performed. The clinician instructed the client to make another appointment after the wax was removed. I found an article from ASHA that has some really great information on cerumen management and it's importance for audiologists to be familiar with the issue (Rosser & Roland, 1992). I thought it was odd, but the client stated that he heard better in his left ear which wouldn't make sense with the wax occlusion unless his hearing had significantly changed elsewhere in the audiologic system.
The clinician also informed the client that the 8mm domes would be ordered for him. After inspection of the client's file, it was determined that the client was actually wearing 8mm domes which would need to be addressed during his next appointment. The next step is to wait for the client to return to get more information from the hearing evaluation.
I thought it was important to note that it is the clinicians job to be sure that clients have realistic expecations for their aids. This client was not satisfied, I believe, because he expected the aids to allow him to have normal hearing. The following website gives some great information on hearing aid fittings for adults. http://www.asha.org/docs/html/GL1998-00012.html
Roeser, R. & Roland, P. (1992, November). What audiologists must know about cerumen and cerumen management. American Journal of Audiology, 1, 27-35.
The clinician asked the client what he noticed to be an issue with his aids. The client responded that it had been a while since he had everything checked, and he still wasn't hearing "the same that everyone else is hearing." He complained of missing some voices and having issues with watching television. He also mentioned that he had 10mm domes and would rather have 8mm.
First, the clinician listened to the aids to see if anything seemed to be off. The clinician stated that the aids sounded fine. The clinician also noticed that the domes had been altered. After asking the client about the domes, he responded that he wanted them to be smaller so he cut them himself.
The clinician then perfomed otoscopy on the client. The right ear was fine, but the left ear was almost if not completely occluded with wax. The clinician and supervisor informed the client that the wax would need to be removed, preferably by a professional, before any further testing could be performed. The clinician instructed the client to make another appointment after the wax was removed. I found an article from ASHA that has some really great information on cerumen management and it's importance for audiologists to be familiar with the issue (Rosser & Roland, 1992). I thought it was odd, but the client stated that he heard better in his left ear which wouldn't make sense with the wax occlusion unless his hearing had significantly changed elsewhere in the audiologic system.
The clinician also informed the client that the 8mm domes would be ordered for him. After inspection of the client's file, it was determined that the client was actually wearing 8mm domes which would need to be addressed during his next appointment. The next step is to wait for the client to return to get more information from the hearing evaluation.
I thought it was important to note that it is the clinicians job to be sure that clients have realistic expecations for their aids. This client was not satisfied, I believe, because he expected the aids to allow him to have normal hearing. The following website gives some great information on hearing aid fittings for adults. http://www.asha.org/docs/html/GL1998-00012.html
Roeser, R. & Roland, P. (1992, November). What audiologists must know about cerumen and cerumen management. American Journal of Audiology, 1, 27-35.
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