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

Eleventh Observation 11-15-07

For this week, I'm posting links to similar articles from the Bureau of Labor Statistics and ASHA. These articles are a run down of the audiology profession. They describe the training, job outlook, earnings, and so on. These are nice references and also good motovation when you're thinking about all the hard work ahead of you.

ASHA article would seem to be more accurate since they have a greater focus on audiology than the national government would. For instance the ASHA article says faster than average job growth while the Gov't website says average. Also, the ASHA has earnings divided between doctoral level audiologists versus the lesser degrees. Bigger bucks $$, I think we all atleast would rather agree with ASHA's website.

Bureau of Labor Statistics: http://www.bls.gov/oco/ocos085.htm

ASHA: http://www.asha.org/students/professions/overview/audiology.htm

Enjoy the articles!

Tenth Observation 11-7-07

The following is an article comparing NIHL between elementary music teachers, high school band directors, and vocal/choir directors. The article brought to my attention that some band rooms achieve dB levels above working conditions that require noise protection. Therefore, some musical members are exposed to these conditions without hearing protection. The study took in account the age differences of the subjects as well as exposure from experience. Many of the subjects were susceptible to presbycusis. In summary of the article, they found the levels of noise exposure to be higher than acceptable, they believe the exposure compounds presbycusis rather than causes NIHL. It is a pretty neat article, not a bad read.

Cutietta, R.A., Klich, R.J., Royse, D., & Rainbolt, H. (1994). The incidence of noise-induced hearing loss among music teachers. Journal of Research in Music Education, 42 (4), 318-330. Retrieved November, 19, 2007, from JSTOR.

Ninth Observation 10-31-07

I found this cool article on stimulating the vestibular system of infants and its affect and effect on motor development. The study used sinusoidal waves as stimulation as well as spinning in a rotating chair. The results were significant for the testers. Furthermore, oblivious to the study groups, parents and day care providers noticed a difference and reported so in a survey. For example, twins within the study were split ; one going to a control group and one going to the experimental group. The one in the experimental group was sitting up before the twin of the control group. The results of the study lead them to believe the stimulation matures the vestibular system quicker, which in turn, allows motor movements dependent of the maturation to develop faster. Example, hand to mouth coordination.

Clark, D.L., Kreutzberg, J.R., Chee, F.K.W. (1976). Vestibular stimulation influence on motor development in infants. Science, 196 (4295), 1228-1229. Retrieved November, 18, 2007, from JSTOR database.

Eighth Observation 10-24-07

I found a short and sweet article about cerumen management using the Water Pik. The Water Pik is a dental device that shoots a fine stream of water to achieve a similar effect of flossing. Audiologist and otoligist can use the Water Pik to break free the cerumen in the EAC. The Water Pik allows the user to change water pressure intensities. This feature allows just enough pressure as needed to break the cerumen off the walls of the EAC. This article is from the mid 70's, but i believe it still applies to today's clinical audiology.

Laren, G. (1976). Removing cerumen with a Water Pik. The American Journal of Nursing, 76 (2), 264-265. Retrieved November, 18, 2007, from JSTOR database.

Seventh Observation 10-17-07

Today, a male in his late 20s came into the clinic. The client participated in the hearing screenings by the 1yr speech grads. The client's results came back normal, but he came into the clinic to have an evaluation regardless. The sessions began with a case hx of the client. The case case hx revealed the client hunted. The client said he did not use protection, but I'm not sure if that included target shooting also. Hunting without ear protection is reasonable, but target practice without protection is not. With hunting, very few shots are taken. While target shooting, many shots are fired. Next, video otoscopy was used to view the EAC and TM. EACs showed acceptable amounts of cerumen, but small amounts of blood from the client using cotton swabs. Tympanometry showed a normal curve for the client's right ear, but a very slightly shifted curve to the left. The clinician said it was still normal. The final step of the battery was puretone audiometry. The client's thresholds all fell within normal limits. Before the client left, the clinician showed and explained the audiogram to the client.

I found a little article about using leupeptin to prevent hearing loss. In summary, they injected chinchillas with leupeptin in one cochlea but left the opther alone. Then, they exposed the chinchillas to 48 hours of 100dB and 105dB of noise. The chinchillas' injected cochleas were left relatively undamaged while the other was nearly destroyed.

All ears: potential help for noise-induced hearing loss. (1999). Enironmental Health Perspectives, 107 (9), A448-A449. Retrieved October 19, 2007, from JSTOR database.

Sixth Obeservation 10-10-07

My sixth observation was of a DPS employee. A middle aged female came in for the required HE. The session started with the client filling out a case Hx. The case Hx showed the client does use hearing protection when shooting fire arms and other noisy hobbies. The client was then sat down for the video otoscopy. The otoscopy showed normal TMs with an acceptable amount of wax. Next was the tympanometry. The client's TMs moved accordingly for a normally functioning ear. The next step in the HE was puretone audiometry. The test proved normal. Finally, the client was shown the audiogram from her last visit and then it was compared to this visit. The audiograms were in complete agreement, as any threshold differences were with in normal clinical error.

Here is a simple little article about protecting your hearing. While we assume most of it as common sense, audiologist need to make sure our clients are aware of the things you can do to protect your hearing. One thing i learned from the article is a temporal bone fracture can damage your hearing or even puncture the TM. Cool article, it would be a nice article to have around a clinic while a client is waiting.

Fritscher-Porter, K. (2002). Portect your hearing. Vibrant Life, 18, (5), 36. Retrieved October 13, 2007, from LexisNexis Academic database.

Fifth Observation 10-3-07

There was no one scheduled for my time slot, so i read an article about presbycusis instead. I remember in class Dr. Payne said that there was no proof old age caused hearing loss because they found in some tribes that are not around high levels of noise, the elders don't have losses.
I found a pretty neat article that focused on the contributions of genetics and the environment on AC thresholds. The study looked at the frequencies of 500Hz to 4000Hz and the SRT of the better ear (BE). The study only used female twins with the mean age of 68. The prevalence of HL, noise exposure, HA usage, auditory diseases, and accidents were made known. One experienced audiologist did all the testing to standardize the clinical aspect. Some twins had good hearing while others had poor hearing, so the hearing range was represented. A study done with mice found that the age related loss was genetic. Thus, inheriting hearing genes was more significant than once thought.
In summary, the study found that a family history of age related loss was more likely to cause a hearing loss. People with a family Hx of HL benefit more from the use of hearing protection. Genes play a significant role in HL. Example, a damaging noise to one person may not damage another's hearing. Genes affect susceptibility. This study did not try to identify the genes that cause genetic losses, but may be a good basis for research. The results found in the article should not be directly generalized to other populations per the author of the article.

My thoughts: I was really impressed with the article. I thought it was neat to think of genes as the culprit for age related losses. The article also made me wonder how can some noises be damaging to one's hearing, but not another's. Great article, i would suggest reading it.

Viljanen, A., Era, P., Kaprio, J., Pyykko, I., Koskenvuo, M., & Rantanen, T. (2007). Genetic and environmental influences on hearing in older women. The journals of gerontology. Series A, Biological sciences and medical sciences, 62A(4), 447. Retrieved October 1, 2007, from http://biomed.gerontologyjournals.org.www.libproxy.wvu.edu/cgi/reprint/62/4/447?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=genetic&searchid=1&FIRSTINDEX=0&volume=62&issue=4&resourcetype=HWCIT.

Fourth Observation 9-26-07

My fourth observation was another speech diagnoistic client. The session began with a case history of the client. The client's case history revealed mild asthma and high allergies. Next, the client sat in the booth for OAE testing. The clinician stayed in the booth with client as the supervisor performed the OAE test. The surpervisor used the Scout 6 program for the OAE. After the OAE, the surpervisor performed SRTs using the carrier phrase, "point to your ____". The SRTs proved to be within normal limits. During this, the clinician stayed in the booth with the client. Next, the surpervisor tried to use the VRA to get thresholds, but the client was being a little fussy, so the surpervisor decided to do a warble tone screening to get a good estimate of the client's hearing level. Next, the clinician did tympanometry. The right ear's TM gave a normal curve, while the left ear's TM showed a shift of the curve. The type C curve suggested negative pessure. The battery of ytest concluded that the child had normal hearing and should be able to proceed in the speech cliinc. I've been lucky to see children since we dont get many children in the clinic. Even though this little guy was a little fussy, it was a good experince.

Third Observation

My third observation was a child coming down from the speech clinic to have her hearing tested. The speech clinician came down with the client. The audiology clinician did a brief case history of the client to get some information. The clinician started with PTs. The clinician ask the young client to put the monkeys in the bucket when she heard the tone. Next, the clinican became to test SRTs. I believe the NU22 word list was used. Next, the client was asked if she wanted to see her ear drum on the TV. As the client sat down, the client saw the pigs on the shelf and wanted to hold them, so the client held them as the clinican used the video otoscope. The client gleemed when she saw her ear drum on the TV and was eager to see her other one on there too. Both TMs appeared to be normal. Finally, the clinician told the client they were going to "make mountains" on the blue screen (tympanogram). Both TMs produced normal curves. The clinician had normal hearing and the SRTs agreed. The child's conduct was perfect and was a pleasant client. The client met back with her speech clinician and the audiology clinician explained everything was good to go. The client and speech clinican went on back to the speech clinic.