Gina's Audiology Blog

Hearing Conservation in Hunter Education Programs

2008-04-16T06:48:00.000-07:00

How many people do we see a day with high frequency hearing loss due to noise exposure (noise notch!)? Hearing conservation is not taken seriously enough, and those who expose themselves to noise routinely are experiencing it's wrath! This blog is based on an article "Hearing Conservation in Hunter Education Programs" written by Dr. Charles M. Woodford (formerly a West Virginia University professor in the audiology department) and Dr. Norman J. Lass (currently a West Virginia University professor). This article dealt mostly with determining how much hearing conservation is preached in hunter education programs in the United States and Canada. A questionnaire was sent out to all hunter education directors in all 50 states and 12 Canadian provinces. The studied showed that the directors who teach these education programs, mostly, have not been properly trained. Only 87% actually provide hearing conservation details in their training programs. The study also showed that there is little information on hearing conservation in hunter education training manuals. The authors of the work suggest a training session for these hunter education directors to be completely aware of hearing conservation so as to provide this information to their students (hunters.)
I actually went on the West Virgina DNR website to see if I could find anything about hearing conservation in education courses, but not to my surprise, I found nothing. West Virginia is a popular hobby of youth and adults in West Virginia. I do not believe that hunters realize the effect that hearing loss can have on their lives. They stick to the here and now, hunt as they wish with no hearing protection, and suffer later. I know a family from "back hills West Virginia" that has at least six members who hunt. All of them are over age 40, and all of them have hearing loss to the extent that it affects their communication. When I mention hearing protection to them concerning their hunting habits, they act like it won't really help. They also don't believe that their hearing loss comes from their hunting habits. From this experience, I believe ignorance is bliss for many. Education is the best way to reach these folks, and as an audiologist, it is our job to be the educators. Hopefully, with all the Baby Boomers living to be very old, the necessity for hearing conservation will be visible, not only to audiologists, but to others.
Here is the link for the West Virgina DNR:
http://www.wvdnr.gov/

The following website is through Cabelas. They offer many forms of hearing protection.
http://www.cabelas.com/cabelas/en/templates/index/index-display.jsp?id=cat20801&navAction=jump&navCount=1&cmCat=MainCatcat20712&parentType=category&parentId=cat20712

Reference:
Woodford, C.M. & Lass, N.J. (1994, July). Hearing conservation in hunter education programs. American Speech-Language-Hearing Association.

Conductive loss or equipment malfunction?

2008-04-09T08:04:00.000-07:00

The client I observed today was a female in her late teens/early twenties. Her case history revealed noise exposure and intermittent tinnitus. Her noise exposure is from a history of playing the saxophone since the third grade. She still currently plays in a band. She notes that her tinnitus comes from both ears and is not a continuous noise. She did not report any instances of dizziness.
Otoscopy was normal for both ears. Tympanometry showed a normal type A tympanogram for both ears with all measures being within normal limits. From this point, testing was somewhat inconsistent. First speech testing was done. SRTs from the right ear first revealed 55dB. A restest also showed 55dB. The left ear was tested with a 15dB result. Puretone testing was then done. Puretone results showed a mild conductive loss in the left ear. SRTs were done again to show 5dB in the right ear and 15dB in the left ear. Discrimination was normal. The supervisor suggested that otosclerosis may be the cause. Otosclerosis in its early stages may show a conductive loss for frequencies between 250Hz and 1000Hz which was shown in this case (Hughes & Pensak, 2007) The client was referred to an ENT for an evaluation for the conductive component.
Technical problems may also have been an issue. The supervisor made this suggestion after the client had left. A thorough daily listening check may have helped assess this. Some testing did show that narrowband noise was not coming in until around 20-30dB.

The following site is a good reference for otosclerosis. The site is from the Boys Town Hospital. http://www.boystownhospital.org/Hearing/info/genetics/syndromes/otos.asp

References:
Hughes, G. B. & Pensak, M. L. (2007). Clinical otology. New York: Thieme Publishers, Inc.

BiCROS WiFi Aid.... Interesting Case!

2008-04-02T07:54:00.000-07:00

The client I saw in this observation I had seen a few weeks before for a hearing aid evaluation. The client was now being seen for the hearing aid orientation because his aids had arrived at the clinic. During the previous session, the client stated that he had Meniere's disease and had the eighth nerve severed in his left ear due to extreme attacks of vertigo. The left ear, therfore, was dead as shown through testing. Puretone and speech testing were performed. MCLs and UCLs were also obtained. Amplification was then discussed. The client wanted a Unitron BiCROS system with a Unison 6 for the right ear, better ear, and a WiFi microphone for the left ear. The clinician and the client discussed this option, and it was determined that this aid would be an option for him. The aids were ordered. It should be noted that the molds were ordered through Microsonic, and the client was charged an additional $80 during the session.

This session was for the hearing aid orientation. Steps were first taken before the client was brought to the fitting room. Due to the clinician and supervisors being new to the aid, the team gathered to discuss how the aid worked and how to program it. The team then programmed the aid. The Unifit programming software through Unitron was used for programming. Program 1 was set for "Quiet/Match Target" using a BiCROS and digital wide dynamic range compression (WDRC). Program 2 was set for "Group/Party Noise" using BiCROS and ASP noise suppression. Program 3 was set for "Acoustic Telephone" using a BiCROS and linear limiting. This program requires the T-coil to be activated.

The client was then brought to the fitting room. The tubing was cut and adjusted to fit the clients molds with the aid and microphone. It was noticed that the mold for the right ear did not come with a vent. The supervisor then lowered the gain for the lower frequencies to make up for this so the clients voice did not sound as "boomy." The clinician then began to inform the client about the hearing aid. The clinician instructed the client to pay attention to how the aid sounded while the system was being explained; therefore, adjustments could be made if necessary. The client was informed about the 30 day return policy (shipping cost not refundable). The clinician also informed the client that he may return for adjustments but would definately need to return annually to check for hearing changes in his left ear. The accessories were then explained. The aid came with different cases, a warranty card, a user manual, a cleaning brush, and an extra battery door. The clinician also gave the client a DryAid kit to keep moisture out of the product. Next, the beeps for different settings and a low battery were testted to be sure the client was hearing the beeps. The settings for the programming were saved in the database and the aid and mic. The clinician then explained to the client how to change the battery, the volume control, and switch programs. The clinician then opened the user manual to the front page and wrote down the contact information for the clinic, information on the different programs, and the type of battery that the client would need. This makes this information easily accessible for the client. The warranty was then discussed. The warranty is for 3 years, while loss and damage are only covered for one.
This is definately the most interesting case that I have seen thus far. Due to the aid being unfamiliar to many, I have included the website for the Unitron aid and WiFi mic (BiCROS system). http://www.unitronhearing.us/ccus/professionals/products_us/accessories/wifimic.htm That website actually describes how the WiFi microphone works in the system. The actual aid is the Unison 6 through Unitron.
I also found the DryAid kit very interesting. I had not seen these before. The following website shows a Dry Aid kit. http://www.azhearing.com/cgi-bin/shopper.cgi?preadd=action&key=SDA

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

2008-03-19T18:09:00.001-07:00

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

2008-03-13T13:10:00.000-07:00

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

2008-03-05T10:05:00.000-08:00

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.

Menieres with Vestibular System Now Inactive... Very Interesting!

2008-02-27T12:53:00.000-08:00

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

Audiology Student Diagnosis Own Vestibular Schwannoma

2008-02-20T07:11:00.000-08:00

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.

Update in Aids

2008-02-13T07:34:00.000-08:00

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

"I don't hear perfectly still. If I have to wear these d**m things, I want them to work!"

2008-02-06T07:29:00.000-08:00

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.

Hearing Aid Evaluation

2008-01-30T10:58:00.000-08:00

I oberserved a man who appeared to be in his early fifties. The client had come in two years earlier for a hearing evaluation but had not seen anyone since. His past audiogram showed a moderate sloping loss in his left ear and normal hearing in his right ear. The supervisor noticed that the asymmetrical loss did not show a noise notch which would then require medical clearnance in case of acoustic neuromas. First, the supervisor instructed the clinician to do a full up to date hearing evaluation to see if anything had changed.
A case history revealed that the client has been exposed to noise through shooting guns at a range and for hunting. The client revealed that he has problems with conversation in some situations.
Otoscopy was normal in both ears with just a little wax in the clients left ear. Tymps were both normal for each ear.
The next step was speech testing. The SRT for the right ear was 25dB and the left ear was 20dB. Word recognition was 96% for the right ear and 88% in the left ear.
The audiogram revealed a barely mild loss in the right ear in the higher frequencies. The left ear had a moderate to severe loss sensorineural loss. A noise notch suggests noise exposure (Katz, 2002).
Overall, the supervisor and clinician suggested an openfit Widex flash micro for the left ear, and the client decided to go with the suggestion. They are not in the process of ordering an aid.

The following website shows ASHAs guidelines for fitting someone with a hearing aid! http://www.asha.org/docs/html/GL1998-00012.html

Rappaport, J. M. & Provencal, C. Neuro-otology for Audiologists. In
J. Katz (Ed.), Handbook of clinical audiology (pp. 159-173). Baltimore: Lippincott Williams & Wilkins.

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

2007-11-13T17:34:00.000-08:00

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

2007-11-06T18:20:00.000-08:00

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

2007-11-02T13:01:00.000-07:00

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

2007-10-24T16:49:00.000-07:00

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!

2007-10-16T18:46:00.000-07:00

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!

2007-10-11T08:27:00.000-07:00

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

2007-10-02T08:47:00.000-07:00

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.

2007-09-25T17:15:00.000-07:00

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!

2007-09-18T15:46:00.001-07:00

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!)

2007-09-11T20:07:00.000-07:00

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

2007-09-05T19:49:00.000-07:00

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.

2007-08-17T10:49:00.000-07:00

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