Clinic Week # 12

This week, I didn't see anything exciting since it was the last week of clinic :) I decided to blog about my friend who is living in New York City.

She is a 26 year old female. She had been sick for a few weeks, cold, sinuses, etc and finally talked herself into going to the doctor. She thought she has a sinus infection. By the time she got an appointment with the ENT, the entire right side of her face was swollen and tender. She went to the ENT who told her that she DID NOt have a sinus infection and everything looked good. He did however test her acoustic reflexes. She did not have any reflexes in either ear. After these test results, the ENT referred her for an full audiologic evaluation and a CT scan. The results of her CT scan were normal, and she has not been able to get an appointment with the audiologist (at the time I wrote this blog).

I found this article titled the Prevalence and audiological characteristics in individuals with auditory neuropathy/auditory dys-synchrony. The results showed that 1 in 348 had auditory dys-synchrony. But, only 1 in 183 when only the individuals with permanent sensory and neural hearing loss had auditory dys-synchrony. Around 60% of the individuals had no measurable speech scores. In the methods section part of the criteria for identifying a aud. neuropathy was no evidence of a space occupying lesion on a neurological examination (i.e. MRI or CT scan).

As clinicians is it important for us know when to refer and what "red flags" we should be aware of. Hope you like it, check it out :)


Kumar, U., Jayaram, M. (2006) Prevalence and audiological characteristics in individuals with auditory neuropathy/auditory dys-synchrony. International Journal of Audiology, 45, 360-366.

http://web.ebscohost.com/ehost/pdf?vid=16&hid=109&sid=e96a8942-9c85-4d8d-8101-9dbf40198a15%40sessionmgr108

Week # 11
This week in Clinic I was retesting a female student. She had been in our clinic before and her puretone air and bone conduction thresholds left us wondering. She is a student and is also a member of the band. She originally seeked a hearing evaulation because of the loud environment she is in so often due to the band. She has played an instrument since elementary school. At the time of her first appointment, our clinic was having a little equipment problems and so a second audiological evaluation was recommened.

During this second audiologic evaluation, threholds were found to be within the normal limits bilaterally. SRT scores were in great agreement with PTA and word recognition scores were 100% in both ears. She was encouraged to wear hearing protection while playing and was given a few pairs to take with her. She was also reassured that the first results were due to the malfucnion of our equipment and that her hearing results looked perfect.

I found this artilce that has to do with malingering or non-organic hearing loss. This is not a case study more of a guide and what we can do as clinicians. I thought it was interesting. Since we were are all worried about this patient and some had concerns that she was possibly faking, I thought this went well with this patient. Thankfully, for our patient, everything turned out OK in the end.

Check it out, i hope you like it :)

Austen, S., & Lynch, C. (2004) Non-organin hearing loss redefined: understanding, categorizing, and managing non-organic behavior. International Journal of Audiology, 8, 449-457.

http://web.ebscohost.com/ehost/pdf?vid=5&hid=109&sid=e96a8942-9c85-4d8d-8101-9dbf40198a15%40sessionmgr108

Week #10

I searched a journal article on cochlear implants since we have been talking about our new cochlear implant class for the fall.  

The link will not post in the blog (I've had to redo this blog 4 times because blogger keeps kicking me out) So you'll have to search for the author and/or title in Ebsco Host, it should come right up. Sorry!

Plyer, P., Bahng, J., & vonHapsburg, B. (2008) The acceptance of background noise in adult cochlear implant users.  Journal of Speech, Language & Hearing Research, 51, 502-515

The title is The acceptance of background noise in adult cochlear implant users.  This study looked at 9 adult CI users, and 15 normal hearing adults.  The HINT (Hearing in noise Test) was given to both groups and a ANL (acceptable noise level) was determined by taking the average of two trials.  The APHAB (Abbreviated profile of hearing aid benefit) and a questionnaire was given to the adult CI user group only.  

It results found that the ANL was not significantly different for either group, the ANL were not correlated with the HINT results for either group, the ANL was not correlated with the APHAB, and and ANL was significantly correlated with the overall CI benefit on the satisfaction questionnaire.  

Hope you like it, check it out :) 

Clinic - Week 9

Today a male came for his hearing aid orientation. He was receiving a Unitron BiCross Amplification system with a WiFi Mic and a Unison 6 behind-the-ear hearing aid.

Background Information: The client had severe dizziness and vertigo about five years ago. His symptoms got so bad that he was afraid to drive. He was diagnosed with Meniere’s disease and had surgery on his left ear in which his 8th nerve was severed. His symptoms have almost entirely disappeared. He is a hunter and also has some hearing loss is in right ear. He was seen in our clinic in February 2008 in which amplification was discussed. He had researched on his own and knew what type of system he wanted.

Hearing Aid Orientation: A Unitron BiCross Amplification system with Wifi Mic and a Unison 6 BTE hearing aid was programmed in NOAH. He was instructed on the use and care of his hearing aid. He was also shown how to change the battery and clean out the microphones if they get blocked. A DryAid kit to store his hearing aids in overnight to help prevent moisture problems. The warranty and 30 day trial period was explained to him and he was encouraged to return before the 30 day trial period ended if he wanted to exchange or return the hearing aids. Three programs were made. Program 1 was set for normal everyday conversation (Quiet/Match Target), Program 2 was used for noisy situations (Group/Party Noise), and Program 3 was set for telephone use (Acoustic Telephone).

He was encouraged to wear his new hearing aids in all different situations. He was encouraged to return at any time if he noticed any problems or felt that his hearing aid needed further adjustment.

This article assesed 91 people with severe to profound asymmetrical hearing loss to assess their satisfaction using CROS or BiCROS. There were 43 men and 48 men. There age ranged from 41 to 89. At the end of 30 day trial period 66 patients elected to keep their hearing aids and 25 people returned them. Acceptance were high for both the CROS and the BiCROS. SOme reasons that people returned their hearing aid was that it was not better than their previous hearing aid, the device was too complicated, it was too expensive, use of device was hindered by otorrhea or otalgia, and the cord was bothersome.

Check it out!!!
http://web.ebscohost.com/ehost/pdf?vid=3&hid=109&sid=580dcd59-3911-4528-a598-a28f1bae81dc%40sessionmgr109

Clinic - Week 8

I was sick this week and was not in clinic.

Clinic - Week 7

This week in clinic I didn't see anything too exciting so I decided to look up an article on cochlear implants. This title of this article is From hearing screening to cochlear implantation: cochlear implants in children under 3 years of age and it was published in 2008.

As we all know, the importance of newborn hearing screening can not only detect those who need further testing but also expedite the process of amplification and if necessary, cochlear implant evaluation. This article took 2 groups; the first group was diagnosed by screening and the second group was diagnosed by traditional methods. The following was assessed: age at the time of diagnosis, age at the time of the first hearing aid fitting, and age at the time of cochlear implantation.

The results clearly showed that the children from group one (newborn hearing screening group)
had a significantly younger age of the time of diagnosis (6.9 months vs 15.4 months), age at the time of the first hearing aid fitting (9.3 months vs 17 months) and age at the time of cochlear implantation (26 months vs 32 months).

Not only will newborn hearing screening reduce the time before followup and intervention but it will also help eliminated differences in communication, and speech and language. I thought this was a great study but only a small number of patients were sampled. Only 9 in group 1 and only 21 in group 2.

Hope you like it, check it out!
http://web.ebscohost.com/ehost/detail?vid=5&hid=101&sid=8fc70c53-7a00-4dea-9dec-992aa98698e2%40sessionmgr109

Clinic - Week # 6

This week in clinic I didn't seen anything exciting, so I deiced to research a article and post something on a topic we don't see everyday.

I looked up Goldenhars syndrome. This is a rare, sporadic syndrome that was founded in the 1950's. Characteristics of this syndrome malformation of the ear, auricular appendices, vertebral anomalies, occulomotor problems, hemifacial microsomia, and agenesis and hypolasia of the mandible. Some other characteristics could be cleft lip and palate, central nervous system, and visceral anomalies.

Diagnosis is hard because not enough information is readily available from previous cases. Some chromosomes have been identified and a suggested disturbance of neural crest cells could be the cause of the disease. Environmental factors such as drugs and maternal diabetes have also been suggested as causes of the disease.

Clinical relationship: Patients with Goldenhars could have microtia and appendices of the ear, mandibular hypoplasia, palpebral alteration, lateral facial clefts (look for a conductive hearing loss associated with clefting problems), and renal problems.

Here is a case study of an 11 year-old, white, female with Goldenhars. She presented with facial asymmetry, hypoplasia of the mandible, dermoid epibulbar tumor on the left eye, and birthmarks on the upper lip and palate. No mental problems were detected during testing. The mother reported used of an anti-convulsive drug (Comital) because of epilepsy prior to knowing of the pregnancy. After, the drug was changed to Phenobarbital Gardenal which is more suitable for use during pregnancy. Dental development was normal, and an x-ray of the skull and vertebral column did not show any abnormalities. Hypoplasia of the mandible was seen on the left side and absence of the coronoid process was observed.

The case study mentioned that this condition is controversial because of the complexity and the broad clinical aspects.

Check it out!!

http://www.scielo.br/pdf/bdj/v14n1/v14n1a13.pdf

Clinic Week # 5

This week in clinic I saw an adult male who came in for his hearing aid orientation. Twenty years ago he wore an ear level tinnitis masker and wanted something similar that would help mask his high frequency tinnitis. A few weeks ago he was seen in our clinic for a hearing evaluation and at that time decided to purchase hearing aids. He purchased bilateral Oticon Delta's. Today his Oticon Delta's were programmed using NOAH and Genie. His left hearing aid was reprogrammed after he said that is sounded too loud. He was instructed on the use and care and his new hearing aids and how to change the batteries. He was reminded of the 30-day trial period and instructed to return to our clinic before that date if he wanted to return the hearing aids.

The Client Orientated Scale of Improvement (COSI) was administers and his specific need was to help mask his tinnitis. The COSI will be readministered when the patient returns. The QuickSIN speech-in-noise test was also administered and his mean score improved from 12.8 to 4.5 signal-to-noise loss. This suggests that the hearing aids were helping him understand speech, especially high frequency sounds.

Later that day, the patient returned to our clinic because he was describing his right hearing aid as "hissing" and "sounding like water on the ground." He thought his wife had left her car door open. The gain was decreased for soft sounds at 1.5 k Hz and the Maximum Power Output (MPO) was increased by 3 dB. After these adjustments the client said the sound had stopped.

This patient brought in articles to share with us on stem cell research and how they are trying to find a way to re-grow the hair cells in the inner ear and in effort to help those with significant hearing loss. I thought this was a neat topic and wanted to tie it in with this patient as my journal link. This article is from the Hearing Exchange. The University of Michigan has a 22 million dollar grant that will fund 5 top researchers, each in the amount of $200,000 for a three year study. In order to make the cells grow again, the researchers need to a successful method to plant and grow the stem cells in the inner ear. They hope to accomplish this in animals, and then later in humans. Recently they used gene techniques to regenerate hair cells in guinea pigs. The hair cells were missing but other supporting cells remained.

I'm listing a few website on this topic. Check them out, it's pretty cool stuff !!! Just think if they could find a way to actually regenerate the hair cells in the inner ear !!!!

http://www.hearingexchange.com/blog/?p=68

http://www.sciencedaily.com/releases/2007/04/070405170200.htm

Week # 4

This week in clinic I saw a 5-year-old male who was diagnosed with Angelman syndrome, which is a neurodevelopmental disorder. Angelman syndrome is a genetic disorder and although was probably present at birth, this client was just diagnosed at the age of 4. Some characteristics of Angelman syndrome are inappropriate laughter, communication deficits, and neurological disorders.

This client came to us for a hearing evaluation as part of an overal AAC evaluation. Speech Awareness Thresholds (SAT) in the soundfiled were found to be withing the normal limits. Noise makers ranging from a high pitched bell and squeeker toy to a low pitched drum were used and responses were found to be 5 dB. Otoscopy revealed clear canals and the tympaic membrane was visible and appeared to be intact bilaterally. Tympanograms revealed normal, Type A tympanograms bilaterally. Overall, ear specific information could not be obtained, but hearing appeared to be within the normal limits at least in the better ear.

This article assess the preferences of of individuals with Angelmans syndrome using a modified version of the Choice Assessment Scale. The scale was reported from 105 parents or caregivers of individials with Angelmans syndrome. The fvie categories in the modified version of the scale were Edibles, Tangibles, Activities, Sensory, and Escape/Avoidance. Twelve items related to water were added to the scale. Results were that Angleman syndrome was indeed characterized by a strong interest in water related items. Activity and sensory items were preferred over food, drinks, or tangibles. High mean scores were found for items including taking a bath, riding a bus, swimming, and interaction with staff and receiving praise.

Check it out :)
http://web.ebscohost.com/ehost/pdf?vid=10&hid=114&sid=d3e97f35-fad5-4673-b048-1923b39bb995%40sessionmgr102

Week # 3

This week in clinic I fit an adult male with a BTE Wide. He had been to our clinic and had his hearing tested ~3 years earlier and amplification was dicussed at that time, but no decission was made. Earlier this semester he came back for another heaving evaluation and amplificaton was again discussed. At this time, he decided to purcahse a hearing aid. He hunts and one of his main complaints was that he cannot hearing the animales while hunting (he couldn't tell which direction the noise from the animals were coming from) He also mentioned trouble hearing in noise and understanding normal conversation. He wanted to wear his hearing aids while hunting and was advised NOT to do so. The hearing in his right ear was within normaly limits, therefore only one hearing aid for his left ear was recommended.

During the hearing aid orientation, the hearing aid was programmed using the HighPro box and the Widex program in Noah. The pateint was also instructed on the use and care of his new hearing aid and how to change the battery. He practiced putting the hearing aid on and taking it off. He also wore glasses and was advised to be careful when removing the glasses so he didn't send his hearing aid flying off. Again, it was recommended to NOT wear the hearing aid while hunting. Another option was mentioned to the client that he could purchase from Cabelas.

This article looked at different adults and compared their social and occupational activies and the amount of hearing loss they had. The aim was to estimate the magnitude of hearing loss compared to sex, age, and activities. Puretone audiometry was done as well as a questionnare asking about noise exposure. For men, reported occupation noise exposure had been going on for years, as well as farming, forestry, and fishing. Women reported more houseword activities and less hearing loss. The relationship between age and hearnig loss was linear.

We see so many clients with noise induced hearing loss and I thought this compared a lot of different variable such as age, genger, work, leisure activities, etc. Check it out :)

http://web.ebscohost.com/ehost/detail?vid=18&hid=108&sid=0ad66298-30dd-4e9e-acb8-ddb5fd4fa21e%40sessionmgr102