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
Wednesday, February 13, 2008
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.
Wednesday, January 30, 2008
Hearing Aid Evaluation
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.
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.
Tuesday, November 13, 2007
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.
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.
Tuesday, November 6, 2007
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.
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.
Friday, November 2, 2007
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
Hearing protection. (n.d.). Retrieved November 3, 2007, from http://www.asha.org/public/hearing/disorders/hearing_protect.htm
Wednesday, October 24, 2007
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.
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.
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