Eleventh Observation

An older lady came into the clinic because her HA was “not as good as it used to be.” She has had her HA for about four years now. The client had been to the clinic before, but her HA is from a private dealer from the area and brand was a company only allowing a single dealer in a certain area. Our clinic does not have the cables, due to the circumstances, so we could not manipulate the settings. As stated above, nor did we have the previous audiograms.
The visit began with a case history. The Hx revealed the client is on several meds. It also revealed two close relatives have hearing loss, her late father and sister. The losses thought to be due to aging rather than genetics. The client was a school teacher, so a NIHL would not be as expected if her occupation was more industrial.
The next step was video otoscopy, both EACs were clear of debris. Tymps revealed Ad bilaterally. Next, SRTs and WRs were recorded. SRT was 55 dB for the right ear and 65 dB for the left ear. WR was 80 dB in the right ear and 85 dB in the left ear but the % was calculated later. PT result was a generally flat, moderate to severe SNHL bilaterally.
Due to the age of the old HA, the clinician and supervisor recommended two HAs. The supervisor made known the client has the option of going back to the private dealer or ordering new HAs from our clinic. The client decided to get them through our clinic. Due to the clinic closing over break, the client is going to wait for it to reopen. While the client was in the clinic, I cleaned the client’s husband’s HAs. The cleaning removed cerumen from the outer shell as well as from the vent.

I selected a link to different cleaning options/tools to be used at home rather than having to visit a clinic. At the clients’ age, it may be just as well to visit the clinic for a good cleaning.
http://www.adcohearing.com/haa_hear_aid_acc.html

Tenth Observation

Upon reading the Advance for Audiologist magazine given to us through our inboxes, I found a great little article about Oticon’s new guidelines for HA distribution. Oticon will no longer accept orders from HA dealers not dealing directly with the consumer. Dealers over the internet, by mail, and by catalogue will no longer be able to order HAs from Oticon. The article states other brands have similar policies regarding indirect sales. As we know, such sales have adverse effects on the impression of HAs many users get when dealing with such distributors. Restricting sales to such distributors is another step in the right direction to ensure all clients seeking help find it from qualified and professional people.Free online hearing test? http://lloydhearingaid.com/shopping/audiogram_steps.asp Come on now.

This article is from
(2008). Oticon sets new hearing aid distribution guidelines. Advance for Audiology, 10(1), 16.

Ninth Observation

I reviewed a product by Oticon called the Amigo. The Amigo is a FM system for inside the classroom and outside of the classroom. The Amigo set out to accomplish the downfalls of the older FM systems. Older systems couldn’t verify they were working properly and young users tend not to be good indications of the system working. Older systems were arduous to configure requiring additional hardware and cables lengthening the time to troubleshoot.
The Amigo stepped in to solve these problems. The Amigo is a body worn FM system allowing for the use of the system outside of the classroom. Though while in the classroom, the teacher can easily and visually see if the system is working as it should. LED lights built into the child’s receiver ensure the system is transmitting and the receiver is doing its part as well. The Amigo was built with children in mind too. The system is built to withstand accidental drops, moisture, and over/under charging. Furthermore, the cover over the LCD display is the same material as used for bulletproof glass. The Amigo has taken extra steps to ensure clarity too. Before transmission, the Amigo reduces the noise level and balances the voice level. If no speech is detected, the system goes into a mute mode. The configuration of the unit was design to be a breeze. All programming between receiver and transmitter is done wirelessly without any additional hardware, and of course wires. Oticon seems to have a pretty nice unit on their hands. The apparent ease of use should make this a popular piece.

http://www.oticonusa.com/Oticon/Consumers/Products/Amigo.html

Eighth Observation

My eighth session was another CAPD case. The young female was referred by disability services for a CAPD eval. The client has trouble focusing in external noise and usually needs more time take test.
The client’s video otoscopy was fine and tymps were Type A’s bilaterally. The puretone thresholds were within normal limits though the right ear was slightly lower. SRT was 10 db for the left ear and 20 db for the right ear. WR was 100% in both ears.
CAPD portion of the assessment included SCAN-A and the AFT-R tests. I had to leave at this time due to time running over into another class.

The link below is for the same website as the Scan-A test above, but for the AFT-R test. I discussed this test in my case presentation in Assessment.http://www.capdtest.com/aftr.cfm

Seventh Observation

This article has some very interesting and unbelievable cases involving ear mold impression material find its way into the middle ear. There are 6 different cases in the article; I’m reviewing the first case. A 75 y o m went to a non audiologist for SN hearing loss (presbycusis). The client was in there for a HA. The non audiologist filled the EAC and the middle ear with the ear mold impression material. The material perforated the TM and flowed into the middle ear cavity. The material then encased ossicular chain and flowed into the orifice of the eustachian tube. An audiological evaluation revealed a conductive hearing loss due to the material and the ossicles encased in it. A CT scan visual demonstrated the material in the EAC and middle ear. To remove the material, the incus and stapes were removed. Tympanoplasty and ossicular reconstruction were preformed to lessen the loss. The client was still left with a conductive component of hearing loss and was then fit for loss.
The other cases are very interesting; sadly the second case was from the same dispenser as the first case.
http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=14&hid=6&sid=aa2e41c7-e5f2-4bb6-8298-3c2cf5d16e01%40sessionmgr7

Sixth Observation

An 88yr old male came in complaining his hearing aid was dead. The battery was changed and then tested, sure enough the HA was dead. The clinician called Siemens to check if the HA was under warranty as the HA was purchased in Cleveland, OH. The HA was under warranty. A request form was sent to the client’s previous clinic for the client’s information. The Siemens rapir form was filled out accordingly and placed in the Siemens box. The repaired HA is expected back in about a week.

The link provided below discusses an up and coming technology from Siemens, the HA logs data from the user and learns the preferences of the user. The HAs also offer a three directional microphone for directional sensitivity.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=15&hid=6&sid=aa2e41c7-e5f2-4bb6-8298-3c2cf5d16e01%40sessionmgr7

Fifth Observation

My fifth observation was a hearing aid check. The hearing aid was clear and functional. I found an interesting article about the history of hearing aids. It is a relatively brief overview, but it is arranged chronologically. The article also has some nice pictures of the older technologies.
A summary of the article is as follows…
The article dated electrical HAs back to the 19th century. The 1950s began the speech processing and speech analyzing technologies we have seen evolve and improve through the years. The 1960s introduced the minicomputer which allowed the computing power to be downsized to a more manageable size. Shortly after, 1975 was the year compression of multiple channels was introduced. The 80s introduced the pioneering technology of digital, by the end of the 80s an all digital HA had become consumer friendly by price and size. The article expressed excitement in wireless technologies such as Bluetooth for use hearing aids. The possibility of using remote microphones to improve listening conditions would be another step in the right direction for hearing aids. The digital clarity allows for unlimited possibilities.

The article is a good read and pretty interesting to see the milestones of HAs.
http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=13&hid=6&sid=aa2e41c7-e5f2-4bb6-8298-3c2cf5d16e01%40sessionmgr7

Fourth Observation

For this observation I found an article for educational programs about hearing loss and prevention. In our EDP class a quick poll was taken of the class about how many of us had been educated about hearing loss, maybe 2 people raised their hands.
This article discusses a 35 min presentation given to students in a 4th grade class and a 7th grade class. The presentation covered hearing, hearing loss, and hearing loss prevention. Before the presentation, all of the 478 4th grade students and the all of the 550 7th grade students were given a questionnaire to get a baseline of education and awareness. Half of the students in each class attended the 35 minute seminar and then immediately were given a questionnaire to test the knowledge and attitudes of hearing and hearing loss prevention. Three months after the post test, a follow up test was given to assess retention.
The results from the post test revealed the 4th graders gained significant knowledge and attitudes towards prevention. The follow up test revealed the knowledge and attitudes remained from the presentation. The 7th graders also had great results from the post test, but the follow up test showed the 7th graders retained the knowledge, but their attitudes returned to baseline.
It seems the study shows early education may prove to create attitudes early as they may follow through with their actions based on their attitudes. Though the 7th graders didn’t retain their attitudes, their knowledge is still there. This may prove to help curve their attitudes toward protecting their hearing.

Here is a link to the article: http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=9&hid=6&sid=aa2e41c7-e5f2-4bb6-8298-3c2cf5d16e01%40sessionmgr7
It is not as long as it seems, the appendix is long and shows all the tests and documentsa used.

Third Observation

A young woman came into the clinic referred by the disabilities department. Her main complaint was she needs extra time on the test. Also, she seems to miss notes when presented orally. Case history found the client had PE tubes and chronic ear infections, with the latest one being more than 5 years ago as she could remember.
Video otoscopy was performed revealing scarred TMs which are consistent with tubes. Tymps were bilaterally As. Reflexes and decay were okay ipsilaterally and contralaterally. The clinician also performed PT, SRT, and WR. SRTs were tested using the CID-1 list. Descrim was tested with the NU-8. Right ear was 100% and the left 100%. The next test was the SCAN-A. All test were WNL. The following link is to an audiologist’s website. As audiologist, I think it is important to advocate/advertise for our services. We are not hearing aid dealers, we have specialized skills.
http://www.judithpaton.com/

Second Observation

A young man came into the clinic referred for possible CAPD by the disabilities department. The case history found he is a young veteran and experiences some tinnitus. He said the test take a little longer for him to do than others in the class.
First otoscopy was performed. The clinician performed tymps, reflexes, and decay bilaterally, ipsilaterally, and contralaterally, all of which were normal. The clinician also performed PT, SRT, and WR. SRTs were tested using the CID-1 list. Descrim was tested with the NU-8. Right ear was 96% and the left 100%. The next test was the SCAN-A. At this time I had to leave for class.
The following link is a website anybody can visit. I used this link so, as audiologists, we know the type of information available to people outside of our profession. Also, it is a pretty decent description of the SCAN-A test.
http://www.capdtest.com/scan_a.cfm

First Observation

A man came in complaining of feedback while using an Oticon Delta hearing aid. Expectedly, he was getting feedback when his aid was near an object. The supervisor explained feedback is normal when near objects. The supervisor and clinician replaced the client’s dome first. Next, they used the Genie fitting software in an aided sound field to try a few tweaks to improve the feedback. The client was happy with the results of the refitting. He has enjoyed great benefit from his hearing aid. He said he has been hearing sounds he hasn’t heard in years. He also ordered another pack of domes.
The link is to Oticon’s newest fitting software. One hearing aid model has wireless connectivity for MP3 players, cell phones, and other wireless capable devices. The new version of the software touts this new capability. It is just the updated software of what’s in the clinic.

http://www.oticonusa.com/Oticon/Professionals/professional_products/Epoq/Genie_2007_1.html