Construction worker...Avid Hunter.... No hearing protection?

I observed a client in his 50s who had not been tested for around 20 years. His main complaint was that he has been having trouble hearing in conversation, especially in background noise. He mentioned that he notices that he relies a lot on lipreading. He notes that his right ear is worse and has ringing in it that comes and goes. The hearing loss and ringing have been going on for a while now. He has a history of otitis media. He has a definite history of noise exposure from 37 years in contruction and hunting. He did not wear hearing protection until the past two years.
Otoscopy revealed normal results with all visible landmarks noticed. Tympanometry revealed normal results which is significant due to his history of otitis media. Puretone testing revealed a mild to moderate severe sensorineural loss with a noise notch for the right ear. Results for the left ear were similiar, but the loss ranged from mild to moderate, not as bad. SRTs for both the left and right ears were 25dB. Discrimination was at 82% for the right ear and 96% for the left ear.
In the case history, the client informed the clinician that if his hearing was bad enough that he would consider hearing aids. One of the main issues was that the client did seem to think that his hearing was really bad. Therefore, with his degree of loss, the clinician informed the client that aids may benefit him, but that it was his choise depending on how bad he considered his loss. The client decided that he would like to consider it and then get back to them.
I find it hard to believe that people do not take the two seconds to use hearing protection. Of course, they all have their reasons, but I believe it is partially our fault. Why you ask? Hearing protection isn't stressed enough. Most people do not truly understand or think about how debilitating hearing loss can be. For this reason, I conclude that we as audiologists need to take a stand for hearing protection! According to a document from ASHA, their are seven roles for us to play in occupational hearing protection: 1-Assess noise exposure, 2-Assessing clients occupational environment (controlling for noise), 3-Suggestion of hearing protection and training for use, 4-Audiometric assessment and followup, 5-Informing staff about hearing loss due to noise exposure, 6-Keeping records for noise exposed clients, 7-Asssessing how effective the noise protection program is (American Speech Language Hearing Association, 2004).
Also, for the hunter, Cabelas offers a ton of options for hearing protection and such! You should definately check out this site! http://www.cabelas.com/cabelas/en/templates/index/index-display.jsp?id=cat20801&navAction=jump&navCount=1&cmCat=MainCatcat20712&parentType=category&parentId=cat20712

References:
American Speech-Language-Hearing Association. (2004). The Audiologist's Role in
Occupational Hearing Conservation and Hearing Loss Prevention Programs [Technical
Report]. Available from www.asha.org/policy.

Eager Client with Needed Aid Adjustments

I observed a client who came in for a hearing evaluation and to pick up new domes that he had ordered. The clients primary concern was that he feels that his hearing had worsened and that his aids needed adjustments. It had been a year since his last hearing evaluation (audiogram).
Otoscopy was normal in the right ear. The left ear showed a significant amount of wax, but the tympanic membrane was visible. Also, both left and right immitance measures were within normal limits.
Unaided puretone results revealed a mild to moderate sloping sensorineural hearing loss bilaterally. As noted from the clients previous audiogram, thresholds had significantly increased in the higher frequencies. The right SRT was 50dB with word recognition at 100%. The left SRT was 30dB with word recognition at 92%.
The clinician used the NOAH software to turn up the clients aids. The clinician used normal conversational speech as an example for the client to listen to and judge if there was still adjustment needed.
The client also had a few concerns with how the aids fit. First, he felt as if his left aid wasn't fitting correctly. He complained of trouble with the tubing. The clinician tried a longer tube but this still did not work. Due to his aid being Oticon Delta BTEs (open fit), the receiver was in the tubing therefore he had to use the tubing he had. The following website has downloads which help consumers with the Oticon Deltas. http://www.oticon.com/com/OurProducts/ConsumerProducts/Delta/Downloads/index
He also requested some sort of connector between the aids that would be strapped across the back of his head. The clinician was not aware of this type of device being available. I did find a website with different accessories for hearing aids. I would not find a lot of accessories directly through hearing aid designer websites. The following site had some really creative accessories. Some had even been mentioned by professors like a dryer for the aids and even Otoclips. Check it out! http://www.adcohearing.com/haa_hear_aid_acc.html

Audiologic Assessment of Children with Down Syndrome

My blog today is not from direct observation. I researched an article titled, "Audiologic Assessment of Children with Down Syndrome." The author, Jack Kile, explains that the diagnosis of hearing loss among children who are affected by Down Syndrome tends to be delayed because the lack of responsiveness is generalized to developmental problems. The author makes note that assessing and treating these clients early is "critical." The hearing loss associated with Down Syndrome can usually be treated or helped with amplification.
Children with Down Syndrome are usually considered difficult to test. This article presents tips associated with testing these children.
The first issue presents with structural abnormalities. In cases of abnormal pinnas, Kile recommends the use of insert earphones to prevent difficulties with placement over the abnormal pinna and to prevent collapsing of the canals. These children also tend to have stenosis of the canal and an abundance of earwax. Concerning the wax, it is recommded that cerumen management be addressed before the client actually comes for a hearing test. The stenosis of the canal will affect tympanometric results. Values may be different for ear canal volumes. Also, skull differences can create issues with the bone conduction trandsducer. The band should be fitted tightly around the head which may be malformed. Kile notes that children with Down Syndrome also typically show a higher prevalence of middle ear disease as shown through Type B tymps. Studies also show that there may be differences in the inner ears of the children shown by ABRs differening from children without Down Syndrome.
The next section of the article dealt with testing modifications based on the child's level of development and their capabilities which can be observed or noted from parental information. The author suggests hands on social interaction to keep these individuals participating. The author also mentions that VRA is a difficult task with those who have Down Syndrome due to their poor sound localization. The clinician should be flexible in working with these children during VRA, especially because behavioral methods are not suggested. It is suggested that more responses could be obtained using rhythmic signals. Children with Down Syndrome tend to be echolalic which can be useful for testing. An audiologist may be able to get the child to repeat the stimuli when it is presented. Also, visual fixation tends to be more lengthy for a child with Down Syndrome. The mother should not be in line of sight and all possible visual distractors not used for testing, should be removed from the testing area. Also, due to a possiblitly of delayed responses, plenty of time should be alotted between presentation of stimuli. Response modes should be as effortless as possible to overcome hypotonia issues. Overall, testing should be adjusted for children with Down Syndrome.
The author then went into detail about how results differ for children with Down Syndrome as compared to children without. Kile noted that there can be a difference of as much as 10dB. He also mentioned that otitis media is the most common problem for children with Down Syndrome but that a sensorineural component is apparent. As an end to this article, Kile explains the need of research to definitively determine the root of the sensorineural loss. He suggests the use of more electrophysiogical methods. I think this article is very intersting and could beneficial to those audiologists who typically test difficult to test clients.

Good site for understanding Down Syndrome:http://www.nlm.nih.gov/medlineplus/downsyndrome.html

Article Citation:
Kile, J. (1996, March). Audiologic assessment of children with Down Syndrome. American
Journal of Audiology, 5, 44-52.