Hearing Conservation in Hunter Education Programs

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?

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!

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?

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.

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

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