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.

Second Observation 9-12-07

My second observation of the semester was scheduled to observe hearing conservation client. The client came in earlier in the day, so I missed the session. I asked my supervisor if it would be a good idea to have the connections between the clinician and the client's booth diagrammed to show which transducers were connected to which wires. I drew a diagram showing the configuration of both the suite's configuration as well as the the single booth's. The reason for doing this was in the event someone, maybe a child, happened to unplug a few of them, referring to the diagram would eliminate the guess and check method of figuring out which transducer goes where. This would also cut down on the need to have to go back and forth from the booths if the connector were unplugged for maintenance purposes. As you look inside either booth, there is a panel for several different inputs. The suite's panel is different than the single booth's panel in number and types of connections. Internally, the panels are different too. The suite's configuration is straight through. I use that term because when you plug in a connector on one side of the panel, it connects straight through to the panel on the other side. Example, the top left jack in the clinician's booth becomes the top right jack on the client's side. In the single booth, the connection configuration stays the orientation whether you are in the clinician or the client's view. Example, the top left jack on the clinician's side is also the top left jack while you are in the booth experiencing the client's view.
Just in case you ever need it, I believe my supervisor put it in the the dark, plastic folders hanging on the clinician's side of the the suite booth.

First Observation 9/5/07

I observed the same client as Chrissy. My observation slot was directly following Chrissy's, and I was allowed to observe with her. The client I observed was a female in her sixties or seventies. Her chief complaint was the loudness of her own voice, from the occlusion effect. The client was in the clinic to receive her new hearing aids. She previously had bilateral HAs, but she did not always use the both of them at the same time. The clinician used the Quick SIN test. Quick SIN's goal is to determine the clients ability to hear with varying levels of noise while listening to speech sentences. Each sentence contains keywords the clinician is looking for the client to repeat. This test was performed aided and unaided during the session.
Next, the client received her new HAs. Her previous set of HAs and her new set of HAs are in the ear HAs. The client's HAs were hooked to the computer to be programmed accordingly. The software used to program the hearing aids was Oticon Tego Pro. The programming or prescription consisted of trial and error to get the HAs the way the client wanted them. After the Rx was completed, the HAs were hooked to the computer again for a feedback test. The Feedback Manager uses various tones and can auto-correct the feedback issues one ear at a time. The client was retested with her new HAs and Rx. To her delight, the client said the new HAs were, "Really different".
Then, clinician explained how to use the new HAs as they had a three memory function for different listening situations. The first setting was for everyday listening, the second was for noisy environments, and the third was to be used while on the telephone. Next, the clinician explained the cleaning and care of the HAs. The clinician knew the client was familiar with HAs, but did it as a refresher or a review.
Next, the clinician performed the Abbreviated Profile of Hearing Aid Benefit (APHAB) test. This test consist of several questions of everyday experiences regarding her HAs and then the client's scores will be compared to previous APHAB test and kept on record for future APHAB test.
Finally, the session finished with the contract of the HAs. This includes the trial period allowed in case the client decides she does not like them.

I linked an article/website allowing ng anybody to download the APHAB test. There are files of the test as well as how to score them. I never heard of the test, so I assumed most of you have not either, which is why I thought it would be a good resource.

http://www.ausp.memphis.edu/harl/aphab.html

Abbreviated profile of hearing aid benefit (APHAB). (n.d.). Retrieved September 9, 2007, from http://www.ausp.memphis.edu/harl/aphab.html