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

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

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

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

I observed a three year old child who had come from a speech screening. I noticed his speech to be very delayed and suspected apraxia. Overall, his hearing proved to be normal. To determine thresholds, the clinician first started using blockdropping as a behavior response to hearing the tone. The clinician had issues conditioning the child. In my opinion, the child was developmentally too young for the test. Allan Diefendorf (2002) describes that the cutoff age for condtioned play audiometry is 3 years and above. Although this child was chronologically age three, his developmental age seemed below that level. Next, they used the WIPI (Word Intelligibility by Picture Identification) test with the child. This method was much more successful. The following website outlines pediatric testing. http://www.asha.org/docs/html/GL2004-00002.html


References:
Diefendorf, A. O. (2002). Detection and assessment of hearing loss in infants and children. In J. Katz (Ed.), Handbook of clinical audiology (pp. 479). Baltimore: Lippincott Williams & Wilkins.

Know the facts... about ear wax!

I observed an older gentleman with high frequency hearing loss in both ears. He has two aids, one for each ear, but of course, only wears them occasionally. He has not noticed a major change in his hearing. He was taking medication for pneumonia and takes blood pressure medication regularly. He has had noise exposure due to his career.
Otoscopy revealed a large amount of wax in the right ear which caused the canal to be almost completely occluded. The left ear also showed wax but just a reasonable amount. Otherwise, the view was normal. Both tympanograms were normal.
Puretone results were as follows: Right ear- 250Hz = 25dB, 500Hz=25dB, 1000Hz=30dB, 2000Hz=35dB, 3000Hz=50dB, 4000Hz=55dB, 6000Hz=65dB, 8000Hz=65dB/ Left ear- -250Hz=20dB, 500Hz=20dB, 1000Hz=20dB, 1500Hz=35dB, 2000Hz=50dB, 3000Hz=50dB, 4000Hz=75dB, 6000Hz=95dB, and 8000Hz = no response.
The clinician explained the audiogram and gave the gentleman extra hearing protection. The clinician also suggested that the client possibly update his aids. It was also advised that having the wax removed may result in some change in hearing. Large amounts of cerumen can affect hearing through air conduction. (Roeser & Roland, 1992). The following website offers a pretty slideshow about a presbycusis study : http://www.asha.org/NR/rdonlyres/5D95975D-CA40-487A-B532-E3DA7B2305C4/0/FrisinaPresentation.pdf

Roeser, R.J. & Roland, P. (1992, November). What audiologists must know about cerumen and cerumen management. American Academy of Audiology, 1, 27-35.

Getting results from individuals with severe handicaps!

This week, I observed a situation which I had not yet experienced. I observed a clinician working with a severely handicapped older client who did not have an appointment. The clinician did a great job in preparing for the client on the spot.
First, the clinician performed an otoscopic examination. The clinician was informed from the guardian of the client that the client might hit. The client did not want anything in his ears and kept grabbing the clinicians arm. The clinician was very patient and calm, which I believed made the exam run smoother. The clinician was able to get the otoscopic views and noted that both ears were normal. Tymponometry was not able to be performed because the client would not allow the clinician to put anything in his ears at that point.
The clinician then used VRA to determine speech thresholds. VRA has been noted to be a good technique to use with clients who have mental handicaps (Ray, 2002). The clinician was able to get a 20dB response at 1000Hz and a 25dB response at 2000Hz. The results may not have been completely accurate due to many inconsistent responses. Also, the clinician had issues maintaining conditioning. The clinician deemed that the clients hearing appeared withing normal limits.
The clinicians supervisor noted that the importance of reading the clients files before they arrive can help prepare and follow through testing.

I found this website that I think would be beneficial for all of us to bookmark. The website is a dictionary for terms and conditions related to mental handicaps. This website would be great for a quick research before a client comes in to better understand their condition.
http://www.questia.com/library/book/dictionary-of-mental-handicap-by-mary-p-lindsey.jsp


References:
Ray, C. (2002). Mental retardation and/or developmental disabilities. In J. Katz (Ed.),
Handbook of clinical audiology (pp. 75). Baltimore: Lippincott Williams & Wilkins.

Speech Diagnostics for Children

I observed a child of 7 years going through otoscopy, tympanometry, OAEs, and puretone testing. The client came from a speech therapy session and was sent to rule out either hearing loss and/or CAPD. Due to time constraints, CAPD testing was not completed. It may take place at a later date.
The child was very extroverted and participatory. During the otoscopy and tympanometry testing, the clinician did a wonderful job of getting the client excited for the tests which aided in participation of instructions. The clinician gave a really good example of how positive manipulation of a child is a necessity in audiological testing. The following website gives some tips in working with children. http://www.asha.org/about/publications/leader-online/archives/2003/q4/031021d1.htm
All testing showed normal results. The clinician was unable to get the OAE test completed in the left ear. The testing for central auditory processding disorders was not completed. A central auditory processing disorder is a complication in the auditory pathways in the central nervous system that creates problems with understanding, attention, and memory (Bellis, 2007). The following website provides good information for pediatric CAPDs. http://www.asha.org/public/hearing/disorders/understand-apd-child.htm

References:
Bellis, T. J. (2007). Understanding auditory processing disorders in children. Retrieved October 2, 2007 from the American Speech and Hearing Association (ASHA).