September 27, 2007

This week I was able to see quite a few clients in the clinic. One client I saw was a man who worked construction and wore his hearing aids all the time. He had come to the clinic over the summer because one of his aid had broken and he came back this week for the same problem. At first, we thought we would be able to patch the aid, but after inspecting the damage, the hairline fracture in the shell was too long for us to fix and still help the client. I made a new ear mold for this man and we sent the mold and the hearing aid back to Oticon so it could be re-cased. This man reminded me a lot of my dad, and how he would probably take care of his aids.

I found an article about hearing aid maintenance that I thought was pretty interesting. While the article studied students, I think it is applicable to most hearing aid users. In the article, they studied children between the ages of 6-19 years who were trained to monitor their own hearing aids. The results from this study showed that the students had improved hearing aid function when they were actively involved in a hearing aid maintenance program. This study helped to show just how important it is to discuss cleaning and maintenance of the hearing aid with our clients.

Reference:
Lipscomb, M., Von Almen, P., and Blair, J.C. (1992). Students as active participants in hearing aid maintenance. Language, Speech, and Hearing Services in Schools 23, 208-213.
http://lshss.asha.org/cgi/reprint/23/3/208?maxtoshow=

September 20, 2007

This week was the busiest week I have had since clinic started. Yesterday I saw 3 of the 4 clients scheduled. Two of the clients were DPS and I had one little girl. All of the clients had thresholds within normal limits. We did not obtain thresholds for the little girl, but instead obtained minimum response levels. We noticed the two DPS officers had a noise notch at 6000 Hz. Due to this finding, we recommended they continue to use hearing protection whenever they were exposed to loud sounds. For the two DPS officers, we did use otoacoustic emissions testing.

Since otoacoustic emissions are a bit of a mystery to me, I thought I would look up an article to help me understand.
The article I found was about the effects of aging and hearing loss on distortion product otoacoustic emissions. In the article, they were trying to demonstrate the rate of change in DPOAE amplitude with age in relation to hearing loss in an adult population. The researchers did a cross-sectional observation study involved the Framingham Offspring Cohort. The results from their study showed that women had a mean hearing threshold-adjusted loss in high-frequency DPOAE amplitude of 0.6, 2.1, 2.6, and 1.1 dB/per decade at the f2 frequencies of 1, 2, 4, and 8 kHz. The men showed no effect of age on the DPOAE amplitude independent of hearing loss.

Reference:
Cilento, B.W., Norton, S.J., Gates, G.A. (2003). The effects of aging and hearing loss on distortion product otoacoustic emissions. Otolaryngology-Head and Neck Surgery 129 (4), 382-389.

If you would like to read this article, please check out the following link:
http://web.ebscohost.com/ehost/detail?vid=7&hid=8&sid=594518b8-36fc-4c5c-85b1-9fb232472d9b%40sessionmgr108

September 10, 2007

This week wasn't too busy in the hearing clinic. Monday afternoon I saw a client who was having problems with her hearing aid. She received her aid in April. She had one dead ear and the thresholds in the other ear were about 60-70 dB. The client also had symptoms of otosclerosis and had a family history of female hearing loss.
Her chief complaint on the day of the hearing aid check was that she no longer heard the second "beep" when the aid was switching programs. She was also having difficulties hearing male voices. We made several programming adjustments to the threshold knee and to the gain output. The client seemed pleased with the adjustments and was told to come back if she had any other questions.
The client also taught me a valuable lesson in infection control. I noticed some open wounds on her arms and some redness in her ear canal, so I decided to use gloves when handling her hearing aid. After talking with the client, she told me she had a bacterial infection and was on medicine to clear it up. I am so glad that I used gloves to handle her aid and I definitely cleaned everything once we finished up. Infection control!!!

So since the client had the symptoms of otosclerosis, I wanted to find an article about it's treatment. The researchers in this article wanted to evaluate the functional results of stapes surgery and to compare the effectiveness of small fenestra stapedotomy with that of a total stapedectomy in improving hearing in patients affected by otosclerosis. The researchers found that the group who underwent the stapedectomy had a slightly greater air-bone gap post-surgery than those who had the stapedotomy. the the results were not statistically significant. The results showed no significant differences in thresholds between the two groups post-surgery. Group A's improvement after the surgery at 4000 Hz went from 56.60 to 47.66 dB (early post-operative assessment) and finally to 52.98 dB (late post-operative assessment). According to the study, the results showed that the technique of microtomy of the oval window was able to improve the hearing thresholds of these patients, especially at the higher frequencies.

Reference:

Marchese, M.R., Paludetti, G., De Corso, E., & Cianfrone F. (2007). Role of stapes surgery in improving hearing loss caused by otosclerosis. The Journal of Laryngology & Otology. 121, 438-443.

If you would like to read this article, please go to:
http://web.ebscohost.com/ehost/detail?vid=5&hid=112&sid=c6dc561c-92a5-4318-8a77-dca884a689b1%40sessionmgr108

September 6, 2007

I didn't have clinic on Monday due to Labor Day; however, Wednesday proved to be a busy day even though no one was scheduled. We performed listening checks and the mic still was not working. One of our client's had brought in his hearing aids because they needed to be repaired. After listening to both aids, we noted the right aid was not working at all and the left aid was working intermittently. The gentleman had also brought in an older aid he had which was weak, so that one was sent away to be repaired as well.
Later in the day we had a woman come into the clinic who had purchased new hearing aids. She had originally purchased Deltas, but what not happy with them, so instead she had ordered bilateral ITC's. We administered the QuickSin with and without the new hearing aids and some improvement was noted. We did have to make some programming adjustments because the client felt the aids were too loud, especially the left aid. After some adjustment, she stated they sounded comfortable. After the second administration of the QuickSin, the APHAB was used to discuss different environments in which she has the most difficulty and what noises she considers to be too loud. The patient will return for a follow-up appointment in two weeks.

I found an interesting article on the effects of providing and withholding postfitting fine-tuning adjustments on outcome measures in novice hearing aid users. This was a pilot study conducted at the University of Louisville. Their study examined the subject-based hearing aid performance measured through tests of speech recognition in noise, sound quality, and benefit. The participants in the study were all first time hearing aid users with moderate high-frequency hearing losses. They studied these individuals over a 5 month postfitting period of time. The researchers made adjustments to the hearing aids during the postfitting based upon the participants' complaints and observations. The group performance was evaluated using the COSI, two versions of the APHAB, a Satisfaction scale, a Sound Quality tool, and the SIN test. The results from this study showed no statistically significant difference in the control and treatment groups performance and perceived benefit during the postfitting sessions. As discussed in the article, the researchers stated the data showed no measurable advantage from postfitting adjustments of 10 dB or less to hearing aids with a wide dynamic range.

Reference:

Cunningham, D.R., Williams, K.J., & Goldsmith, L.J. (2001). Effects of providing and withholding postfitting fine-tuning adjustments on outcome measures in novice hearing aid users: A pilot study. American Journal of Audiology, 10, 1-11.

If you would like to read this article, follow this link:
http://aja.asha.org/cgi/reprint/10/1/13?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=Outcome+measures&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT