Clinic - Week 8

This week in clinic was kind of slow. Our last patient did not show up, so I decided to do a speech in noise test with the undergraduates who were there observing. We did the QuickSin speech in noise test. I had heard of this test, and only had done it once. So, it was good practice to use the CD and go through the test battery. Three different sets of sentences were used. The first group of test sentences was the regular list, with the changing signal-to-noise ratio getting harder as each sentence was presented. The second list was a high pass sentence list, in which the speakers voice changed. And the third list was a low-pass sentence list.

The student did very good at the beginning, but as the signal-to-noise ratio changed and made the test harder, some words were then missed. As the test went on and I was looking at the sentences and knew what the target words were, I still found it hard to pick out the words in the sentences. The sentences had a medium level of predictability, making it hard to guess what was coming next. While some of the sentences made sense, others did not at all.

I found this journal which talks about another speech in noise test, called the Speech in Noise (SIN). This article evaluates the list equivalency and the test-retest reliability. They gave the test to 20 normal listeners and 20 listener with a sloping SN hearing loss. There are lots of charts that make the results easy to see. It is similar to the QuickSin that I used in clinic. It provides another example of speech in noise testing that we should become familiar with. Also, check out who wrote it. Lundeen would be proud !! haha! Hope you like it :)

Bentler, R. (2000) List equivalency and test-retest reliability of the speech in noise test, American Journal of Audiology, 9, 84 - 100.

http://aja.asha.org/cgi/reprint/9/2/84?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=speech+in+noise+test&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Clinic - Week 7

This week in clinic I saw a client who was refered from the SPA 270 screening for a full hearing evaluation. The client did not recall which part of the screening was not passed. Reports of having difficutly hearing in background noise were made. Also, the client reported working at a lawn care business for the past 10 years. Hearing protection has never been worn. A hearing evaluation had never been done.

Video otoscopy was normal, the tympanic membrane was visible and appeared intact. Immittance testing also revealed normal, Type A tympanograms bilaterally. Puretone air conduction testing revealed that his hearing was within the normal limits.

The results were explained to this client. Possible reasons the screening was not passed was because the testing might have taken place in a noisy environment and the screening was not a true measure of the clients hearing. I feel that this is an important thing to rememeber especially when testing infants. So many infants are testing in a noisy, nursery at the hospital which is not a good environment for these tests to take place.

I found this article that talked about the referral of infants and the importance of a timely follow-up. It also lookes at the results of using ABR with infants. CHECK IT OUT :)

http://aja.asha.org/cgi/reprint/15/1/66?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=referrals+&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Lieu, J., Karzon, R., Mange, C. (2006) Hearing screening in the neonatal intensive care unit: follow-up of referrals, American Journal of Audiology, 15, 66-74.

Clinic - Week 6

This week in clinic was kind of slow as a lot of the people scheduled during my time did not show up. The only people I saw were DPS. I did see one patient who worked in the office of DPS and therefore this person was not part of the hearing conservation program. The patient scheduled the appointment on their own. Otoscopy and tympanograms revealed normal findings. Although when puretone testing was done a sloping, mild to severe loss was the outcome. The patient reported no recreational hobbies such as target shooting, etc and seemed to have an unexplained hearing loss.

Once the results were explained, it was then reported that the patient sometimes had trouble understanding in the presence of background noise and often had to ask people to repeat themselves. It was also mentioned " I don't have trouble hearing people, I just can't understand what they are saying."

At this time further questions began about the patients medical history, previous employment, hobbies and activities, etc. We were trying to understand such a severe loss that seemed unexplainable for a person who had never had their hearing tested before or noticed any difficulty. After about 30 minutes of talking with the patient it was revealed that they had been to the POC a week earlier and the same results were found and the discussion of amplification had happened (with the recommendation of getting bilateral hearing aids). My patient did not believe them and was coming to our clinic for a second opinion. The patient also revealed enjoying going to Nascar races and had been to many in their lifetime!

I was completely shocked at the information that starting to be revealed after specific questions had been asked regarding hearing, hearing protection, previous jobs, etc during the case history and during the first 30 minutes of talking with the patient!!

At this time the patient was not ready for amplification and really didn't want to talk about it. It was recommend that she think about it and could return in a week and we would be happy to continue talking about amplification. With the severity of the loss annual hearing evaluations were also recommended. I found out today how the importance of case history and spending 30 minutes and getting to know your patient can affect the outcome of the results!

This article talks about the importance of counseling and learning to listen to your patient. Most audiologists did not have training in counseling and I think is it a VERY important part of the rehabilitation process and understanding your patients needs. I also picked this article because it was written by one of my professors that I had in Pittsburgh, Dr. Kris English! Check it out!

English, K., Mendel, L., Rojeski, T., & Hornak, J. (1999). Counseling in Audiology, or Learning to Listen: Pre- and Post-Measures From an Audiology Counseling Course, American Journal of Audiology, 8, 34 - 39.

http://aja.asha.org/cgi/reprint/8/1/34?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=counseling&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Clinic - Week 5

This week in clinic I saw an 86 year old female. She was accompanied by her son and daughter-in-law. She has been a hearing aid wearer for 6 years. Her old Siemens LifeSound hearing aids do not seem to be giving her enough amplification and therefore are not providing her enough help in understanding and hearing speech. She came in to see what options we could give her. When looking back in her file, we found she had not been given a hearing evaluation in 6 years so that was immediately put on the list of "things to do" A listening check was done and her right aid appeared to be weak and was intermittent. She had purchased extended warranty that was up in December, so the decision to send this aid back while still under warranty was made.

Next, a hearing evaluation was done. Her thresholds had shifted ~15 dB at most frequencies. Her loss was now a moderate sloping loss. At this time the discussion of purchasing new hearing aids came about. Her old aids were not digital and could not be "reprogrammed" to her new audiogram. She was excited for new aids and the decision to get them was made. Earmolds were made bilaterally and new Widex aids were ordered. I am looking forward for her to return for the hearing aid orientation and programming. I like to be able to follow a patient through this entire process so hopefully I will get to see her again :)

We also talked to her about the changes in her new hearing aid, for example that it would not have a volume control and it could be further reprogrammed should her hearing loss change again over the next five years. I found this article talking about compression and automatic gain control which also goes along with what we have been talking about it Dr. Lundeen's amplification. Hope you like it :)

Hickson, L. (1994) Compression amplification in hearing aids, American Journal of Audiology, 3, 51-65.

http://aja.asha.org/cgi/reprint/3/3/51?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=volume+control+and+hearing+aids+&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Clinic - Week 4

This week in clinic i saw a 7 year old male who was brought in by his mother. He had been seen at the Clingburg center about 2 week prior. His mother reported he did have some ear infections as a young child. His mother also reported that he had trouble following directions or attending to speech and/or directions in the presence of background noise. His mother also reported he had trouble following directions at school when is teacher gave multiple instructions (do this, and then this, and then this). His mother reported no family history of hearing loss or any ear related surgeries or impairments.

Immittance revealed normal, Type A tympanograms puretone threshold results were within the normal limits bilaterally. The SCAN-C, Auditory Fusion Test, and the SSW were given. He did well on the first 2 tests and had scores within the normal range for his age group. The SSW results did show some difficulty when memory and attention. Some recommendations given were seating placement in the classroom, having the teacher write key words on the board before starting a new subject, gaining his attention before talking, a possible FM system, etc. The report was writting and a copy can be sent to the school for IEP follow-up, etc.

This was my first APD testing and I enjoyed it. As you all know I love working with children and really enjoyed this child. It was a long test and he did well throughout testing. We became friends by the end of the day and I really enjoyed working with him :)

This artilce talks about the use of 4 commonly selected APD tests given to 3rd graders. The SCAN is part of the test battery, which is what we use a lot in the clinic. The results explained that a multi-test battery should be given. Check it out :)

Domitz, D., Schow, R. (2000). A new CAPD battery--multiple auditory processing assessment: factor analysis and comparisons with SCAN, American Journal of Audiology, 9, 101-111.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=5&hid=2&sid=a601b1c8-4749-43f6-bcf3-ccbbf257f9fa%40sessionmgr9