April 24, 2008

This was the last week of clinic. I got to go to the POC on Monday for a "field trip". It was really interesting to go there and observe the audiologist in action. I was able to see one of the audiologist perform VRA with an 8 month old baby. The baby had SAT down to about 20 dB, which was excellent! I also saw another audiologist evaluate a 50 y/o woman who had normal hearing except at 8000 Hz, where she had a mild hearing loss. Overall, it was a pretty interesting morning!

Since I haven't tested any infants, I wanted to find an article about hearing evaluations with this population. In the article I found, the authors discussed the use of insert earphones with VRA to obtain ear and frequency specific information. In the article, they emphasized the use of 2 audiologists to perform VRA. As we have learned in class, while this may be the best option, it is often not cost or time effective. The paper also discussed how the tester operating the audiometer can signal the other tester when a stimulus is being presented.

Reference:
Jayarajan, V., Nandi, R., Caldicott, B. (2005). An innovation in insert visual reinforcement audiometry in children. The Journal of Laryngology & Otology, 119. 132-133.

If you would like to read this article, please use the following link:
http://web.ebscohost.com/ehost/detail?vid=7&hid=4&sid=761196e6-dea3-4d35-9cdc-eafed9718b74%40SRCSM2

April 17, 2008

This week was kind of a slow week since clinic is wrapping up for the semester. I saw a couple hearing aid checks mostly.

I did see one man who has been coming to the hearing clinic for years. He is 23. His mother stated that he wasn't hearing as well as she thought, so she made an appointment for him to come in for his annual hearing evaluation. His hearing had not changed and he said he was happy with his current hearing aid settings. We replaced the tubing bilaterally.

I found an article that dealt with the representational abilities and hearing status in child/mother dyads. In this study, the researchers looked at expressive and receptive language in symbolic play activities. The study was conducted on normal hearing and deaf children who had normal hearing and deaf mothers. As reported by the mothers, hearing children of both hearing and deaf mothers produced more words than deaf children with hearing or deaf mothers. Hearing children were also able to comprehend more words than the deaf children born to either parent. The findings from this study showed that there are many implications of hearing status in communication exchanges between mother and child.

Reference:
Bornstein, M.H., Selmi, A.M., Haynes, O.M., Painter, K.M., and Marx, E.S. (1999). Representational abilities and hearing status in children/mother dyads. Child Development. 70(4). 833-852.

If you would like to read this article, please copy and paste the following link into your browser.
http://wf2la1.webfeat.org/EgusJ1117/url=http://www.jstor.org/stable/pdfplus/1132245.pdf

April 10, 2008

I saw one client this week. He was a 4 year old boy who was here for a Speech Diagnostic. The mother expressed she was very concerned due to his lack of vocalizations. She thought he might have autism. We had to use VRA with this child which was very abnormal. He was very fussy, and would not keep headphones or inserts on. Therefore, we had to use soundfield to evaluate his hearing. His thresholds were within normal limits; however, we cannot determine any ear specific information.

In APD this week, we were discussing how some individuals with and APD may not be able to take a foreign language class because of the processing difficulties. In our handout it stated that some individuals may be able to learn ASL instead.

I wanted to find an article about the correlation of and APD and difficulty in learning a foreign language. I found an article that discusses college students with LLD and the phonological core as risk for failure in foreign language classes. In the article, they said that deficits in the native langauge skills as well as phonological processing skills may cause the difficulties in learning a foreign language. They evaluated the students through word recognition testing, spelling, foreign-language aptitude, pig-latin, and nonword repetition. These tests were able to successfully determine students at risk for having difficulty in a foreign language class. The authors of this article suggested that implementing a program that would take into account these difficulties would allow students, who otherwise would not be able to learn a foreign language, the opportunity to learn a second language.

Reference:
Downey, D.M., and Snyder, L.E. (2000). College students with LLD: The phonological core as risk for failure in foreign language classes. Topics in Langauge Disorders 21(1). 82-92.

If you would like to read this article, please copy and paste the following link into your browser:
http://web.ebscohost.com/ehost/pdf?vid=16&hid=8&sid=df0efaf3-21ca-4d06-94be-615fdc061c64%40SRCSM2

April 3, 2008

This week I saw a college student referred from Disability Services. He had hearing thresholds within normal limits and an unremarkable case history. When asked about difficulties he had in school, he said that his only real difficulty was with his Japanese class. I thought he would have more problems in school than he claimed. The SCAN results were abnormal and the AFT-R results were very abnormal. His results on the SSW did not fit into any of the classifications.

I found an article on Auditory Temporal Processing Performance of Young Adults with Reading Disorders. In order to examine these students, they administered the Frequency and Duration Patterns Tests as well as the frequency difference limens for short and long duration tones. They found that the students who had the reading disorders had a significantly higher rate of errors on the duration patterns test than the control group. No differences were noted in the frequency patterns test. This study provided evidence of the relationship between lower level temporal processing skills and decoding efficiency.

Reference:
Walker, M.M, Shinn, J.B., Cranford, J.L., and Givens, G.D. (2002). Auditory temporal processing performance of young adults with reading disorders. Journal of Speech, Language, and Hearing Research 45(3). 598-605.

If you would like to read this article, please use the following link:
http://jslhr.asha.org/cgi/reprint/45/3/598?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=Auditory+processing+disorders&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=2/1/2000&resourcetype=HWCIT

March 20, 2008

On this day in the clinic I saw a man who came in to have his hearing re-evaluated. He currently wore bilateral hearing aids that he relied on quite heavily. He was interested in purchasing new hearing aids. He had a mild sloping to severe sensorineural hearing loss bilaterally. He wanted an open-fit behind the ear hearing aid to fit his loss and it had to use a size 10 battery. He also wanted a volume control. After much searching, we finally found one hearing aid that met all of his specifications and would provide enough amplification for his hearing loss.

I found an article about the contribution of high frequencies to speech recognition in quiet and noise with varying degrees of high frequency sensorineural hearing loss. In this article, they were wanting to determine the contributio of audible high frequency information to the speech understanding performance. They studied 36 elderly hearing impaired patients and 24 normal hearing patients. They tested these listeners under different band pass conditions. They eamined the monosyllabic word-recognition performance using both whole-word scoring and phoneme scoring. The results of this study should that when the spectrally shaped speech was used in both conditions, the individuals with hearing loss performed equivalently in the differnt bandwidth condtions and demonstrated no change in the word recogntion performance between the midband and broadband conditions. The normal group did show improvement in speech understanding which was attricutable to higher frequencies for the broadband condition in both the unshaped and shaped conditions.

Reference:
Amos, N.E. and Humes, L.E. (2007). Contribution of high frequencies to speech recognition in quient and noise in listeners with varying degrees of high-frequency sensorineural hearing loss. Journal of Speech, Language, and Hearing Research 50(4). 819-834.

If you would like to read this article, please copy and paste the following link into your browser:
http://jslhr.asha.org/cgi/reprint/50/4/819?maxtoshow=

March 14, 2008

This week, I only saw one client. He was a 9 year old little boy being tested for auditory processing disorder. The child had previously been diagnosed with Tourette's syndrome, although no noticeable tremors or verbalizations were noted. The child had type C tymps bilaterally. Pure tone testing revealed a mild hearing loss in the left ear and a moderate loss in the right ear. It was very difficult to test this child because he would respond when no stimulus was presented and only wanted to respond if my supervisor was the one talking to him. Due to the lack of cooperation, it was determined not to continue with the APD testing.

One thing was was very interesting about this child was his speech...he did not really open his mouth to talk and when he did it was very nasal. He had frequent ear infections and also had PE tubes. I was thinking about what might have caused this...my niece had some of the same problems, which were attributed to enlarged adenoids. So, I wanted to find an article that correlated the two.

The study I examined was on the use of adenoidectomy and adenotosillectomy. They found that the overall success rate after surgery was 85.1% for the resolution of middle ear effusion. This shows that these surgeries are an effective means for the treatment of persistent otitis media with effusion.

Reference:

Abdul-Baqi, K.J., Shakhatreh, F.M., and Khader, Q.A. (2001). Use of adenoidectomy and adenotonsillectomy in children with otitis media with effusion. Ear, Nose, and Throat Journal (80), 9. 647-650.

If you would like to read this article, please use the following link: http://web.ebscohost.com/ehost/pdf?vid=2&hid=15&sid=d0f9c35b-c293-4b9b-9b1c-295697020330%40sessionmgr9

March 3, 3008

Today I saw two clients. One came into the client to purchase hearing aids. He had previously been seen at an ENT and was not satisfied with the service there, so he came to our clinic to purchase hearing aids. The client seemed to not be satisfied with the fees we charged in our clinic; however, he did purchase hearing aids.

The second man I saw was a 92 year old gentleman. His sons typically bring in his hearing aids since he is in a nursing home, but they felt his hearing had changed dramatically, so it was necessary to bring him in. I did a quick AC threshold search and discovered that the thresholds in his left ear had gotten significantly worse, he now had a severe to profound hearing loss across the tested frequency range. We changed the programming of his hearing aids as much as possible to maximize the benefit he could receive. We discussed the change with the client and his son and recommended he immediately seek medical attention to rule out any medical causes for the dramatic change in his hearing.

The man was very vocal about his hearing loss and ther was a lot of anxiety and frustration on the part of his son as well as the client. I found an article about the effects of hearing loss on mental health and subjective wel-being. In this article, the author's objective was to estimate the effects of hearing loss on symptoms of anxiety, depression, self-esteem and subjective well-being. The author studied individuals from 20-101 years old. The author found the effects of hearing loss to be most significant in the younger and middle age groups as opposed to the older age group. They also found that as long as the low frequencies were not impaired, that the middle and high frequency hearing losses did not effect mental health perceptions. I thought this was a pretty interesting article, and this may help us understand and better deal with our younger hearing impaired clients.

Refernce:
Tambs, K. (2004). Moderate effects of hearing loss on mental health and subjective well-being: Restuls from the nord-trondelag hearing loss study. Psychosomatic Medicine 66 (5) 776-782.

If you would like to read this article, please copy and paste the following link in your browser:
http://www.psychosomaticmedicine.org/cgi/reprint/66/5/776?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=psychological+effects+of+hearing+loss&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=1/1/2000&tdate=3/31/2008&resourcetype=HWCIT

February 28, 2008

Last week was a pretty busy week. Monday I had several client's needing hearing aids or experiencing problems with their hearing aids. I did a complete HE/HAE with one woman who was really excited about getting hearing aids to see if they would help her. She lived at home by herself, but she watched HGTV all the time and said she had problems hearing her favorite TV show. I had another woman who needed her earhooks replaced bilaterally. Those were the most difficult earhooks to replace ever, you really had to push to get them to snap on. After we fixed the earhooks, the client told us about how much she relied on her hearing aids and how much benefit she received. She did stated she stil had problems in certain listening environments. We talked to her about the newly formed AR classes and she will actually be attending my sessions!

I found this article on the Multimedia Hearing Handicap Inventory. The article discussed the reliability and clinical utility of the inventory. The purpose of this study was to evaluate the test-retest reliability, the internal consistency, and the listners reactions to the design and functional utility of the inventory. After administering this inventory to 51 adults, they found high test-retest reliability and internal consistency.

Reference:
Holcomb, S.S., and Punch, J.L. (2006). Multimedia hearing handicap inventory: Reliability and clinical utility. American Journal of Audiology (15) 1:3.

If you would like to read this article, please click on the following link:
http://aja.asha.org/cgi/reprint/15/1/3?maxtoshow=

February 21, 2008

This week I didn't see too many intersting clients. I did orient a man with his new hearing aids. He had been a previous hearing aid user, but stated he wanted new hearing aids. We had to make several adjustments to his hearing aids before he felt they were sounding rich and full.

Since I have blogged about hearing aids a million times, I wanted to find an article that was a little more interesting. I found an article on evaluating patients with dizziness and unsteadiness using a team approach. The author began by discussing some general facts about dizziness and vertigo. At the clinic being described, they only saw client who were referred by a physician. Patient's themselves could not set up an appointment so they were trying to eliminate clients shopping for a "cure". The assistant director of he clinic speaks with the referring physician to determine what questions they want answered. They also speak with the client to go over some basic case history questions. Once they have spoke with the client, they then determine what types of evaluation will need to be completed (audiological evaluation, balance evaluation, etc). The author went on to discuss four case studies from their clinic. This article was pretty interesting and provided a glimpse of how one site evaluates their client's and in turn what services are provided.

Reference:
Handelsman, J.A. (2005). Evaluating patients with dizziness and unsteadiness: A team approach. The ASHA Leader, pp. 6-7, 21-22.

If you would like to read this article, please copy and paste the following link in your browser:
http://www.asha.org/about/publications/leader-online/archives/2005/050208/f050208a.htm

February 14, 2008

This week I saw few clients on Monday, but clinic was canceled today. I saw a really adorable 5 year old as part of her speech diagnostic on Monday. During the case history, the mother said that the little girl had PE tubes when she was a baby and they had dropped out around 10 months-1 year. The little girl had type B tymps in the left ear and type C in the right. Her pure tone air conduction thresholds reflected this, with the left ear thresholds being 5-10 dB poorer than the right ear. We recommended that the mother seek medical advice on how to alleviate the fluid in the little girl's ears.

I found a really interesting article on otitis media with effusion, hearing loss, and auditory processes at school age. The authors of the article wanted to examine the effect of conductive hearing loss secondary to otitis media with effusion in the first 3 years of life on physiologic peripheral, and higher-order behavioral auditory measures examined at school age. The authors found that there was a significant association of peripheral hearing loss at the school age if the children had OME. They also found that hearing loss in early life and OME were significantly associated with the acoustic middle ear muscle reflex. They also found significant correlation between early OME and early HL when examining ABR Wave V latency.

Reference:
Gravel, J.S., Roberts, J.E., Roush, J., Grose, J., Besing, J., Burchinal, M., Neebe, E., Wallace, I.F., and Zeisel, S. (2006). Early otitis media with effusion, hearing loss, and auditory processes at school age. Ear & Hearing (27) 4. 353-368.

If you would like to read this article, please copy the following link and paste it in your browser.
http://ovidsp.tx.ovid.com/spb/ovidweb.cgi?WebLinkFrameset=1&S=GHFAFPBKDGDDLEEENCILKHMJBMPPAA00&returnUrl=http%3a%2f%2fovidsp.tx.ovid.com%2fspb%2fovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.15.16%257c0%257c00003446-200608000-00004%26S%3dGHFAFPBKDGDDLEEENCILKHMJBMPPAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCMJKHEEDG00%2ffs046%2fovft%2flive%2fgv023%2f00003446%2f00003446-200608000-00004.pdf&filename=Early+Otitis+Media+with+Effusion%2c+Hearing+Loss%2c+and+Auditory+Processes+at+School+Age.