A Detour in the Road ..

Missed a blog last night, but never fear I was studying plenty yesterday and last night, I just had a little detour.
So i had class today and I thought I would cover what we talked about in class, getting ready for the dreaded viva exam.

Different Rehabilitation Appointments

• Screening appointments
• Hearing Assessments
• Discussions
• Fitting 
• Follow up & review
• End of warranty appointment

Assessments

• Case History
• Trying to find out about Quality of Life 
• Client Motivation 
• Medical Referrals
• Assistive listening devices
• Lifestyle of client and what sort of listening demands they have
• Give results and link back to difficulties they were having
• Contra indications ie CIC not appropriate for people with problems with wax, sweat
• Discuss COSI goals
• Take impressions if required
• Communication tactics
•  Book client in to come back in 2 weeks time 
• Discuss cost
• Commitment from client need to tell them that there will be several appointments, there is a 30 day trial period, what client is agreeing to
• Terms and conditions 
• It is a partnership, the hearing aids will not just fix their hearing
• They still have options
• They need to be aware of their responsibilities
 

Fitting Appointments

• Put the hearing aids together check they are working 
• Greet clients
• Show them the hearing aids 
• DO OTOSCOPY
• Calibrate the probe tubes
• Perform Real ear unaided gain 
• PErform Real ear Aided gain 
• and the difference in Real Ear Insertion Gain
• Match to target
• Then match to client preference --not on prescription
• Set acclimatisation
• Make sure they are balanced; both ears sound even, check MPO, check if any sounds are too loud or uncomfortable
• comfort
• how doestheir own voice sound ; occlusion
• Set programs ; noise and quiet , tloop 
• Save settings
•  Speech tests SPIN, HINT

• Power more battery more power, shorter battery life

• Book next appointment 2-3 weeks because of the 30 day trial period

 

From Da ear to Da Brain & classifications of hearing loss

I thought I should definitely start at the beginning of how hearing works. I am including a little video, that I didnt make; but sometimes these things are better explained in animation :))

 


XXXXXX There are different types of hearing loss that affect people in different ways. We use our battery of tests to crosscheck and classify the different types of hearing loss. There are also different methods of rehabilitation or treatment for the hearing losses.

They are classified as  Conductive, Sensorineural and Mixed hearing loss.

Conductive Hearing loss is where the lesion is in the middle or outer ear.

• The intensity of the sound has to be increased to reach the cochlea. 

• The inner ear is working normally.

• Conductive hearing losses are not always permanent. 

• They can often be fixed with medical intervention or may clear by itself like a middle ear infection. But sometimes the conductive loss is permanent if the middle ear is permanently damaged from ear infections or there is an atresia.

Sensorineural Hearing loss is when the lesion is in the inner ear and onwards

• This can be caused by damaged cochlear; inner hair cells and/or outer hair cells and along the neural pathway. This damage means that mechanical energy from the middle ear is not converted to neural impulses in the hearing and balance nerve (8th nerve). 

• People with sensorineural hearing loss have many difficulties understanding speech because their frequency resolution and dynamic range is reduced. 

• People often say that they can hear the words but cant quite make out what they are, the words arent clear..or more often "every body mumbles"

• Turning up the volume (intensity) will not take their speech understanding back to normal. 

• Sensorineural hearing losses are permanent; once the hearing organ is damaged it cannot be repaired. So turn your ipod down sonny jim :)

Mixed Hearing Loss is a mix of conductive and sensorineural hearing loss.

• People with mixed losses have a lesion in their outer or middle ear; say an ear infection.

• Meanwhile, they already had a sensorineural hearing loss from listening to loud music all their lives. The conductive component of the hearing loss may be able to be treated.

• However, the sensorineural loss will always remain.

This website was sited in my slides and the bottom of the pages are examples of what different hearing losses might sound like Type of Hearing Loss and how they might sound

Day 5 Just keep swimming :)

XXXXX
Still going, thanks for people visiting my blog. I get stats on the number of people, but no idea who is visiting. So thank you, I dont entirely feel like I am talking to myself :))
I jumped a head a bit today and revised a brainstorm class we had last year, where we covered all the topics we needed to learn for the exams.
Just a little reminder of how much more I need to cover, so that I can pass the exams. SOOO much to revise. :)))


xx

'Say "Otoscopy" :)

XXXX

Otoscopy
Using the otoscope to look in and around the ear canal to see the tympanic membrane.
Look outside and around the ear for anything unusual like skin cancers or deformities refer back to GP for anything that looks unusual.
For Adults pull the ears up and back
For child back and down

Ensure little finger anchors the hand, so that if the head moves the otoscope does not damage their ear.
Looking for

• colour 
• transparency- opaque
• Shape is the TM bulging or retracted
• Integrity- perforations, bubbles, fluid
• Wax occlusion--ear wax is good for your ears ...cotton buds compact the wax ..
• exostosis from cold water (also called surfers ear)
• Foreign bodies 
• Does the ear canal look wet, fungassy 
• Fungus in Da Ear ...  Audiologists do not remove fun guy from your ears ..

Probably Should have Started at the Beginning

XXX So I probably should have started at the beginning...

The first part of an assessment is the Case History:
For Adults it is trying to identify what is their main concern and how their hearing is affecting their life.
The handicap they experience due to their HL.Lack of motivation a big reason hearing aids end up in a draw. Someone can have a big hearing loss, but if it doesnt restrict their activities then they wont wear hearing aids.

 At the same time try to reveal any red flags that require medical referral

Red Flags:

• Acute and rapid hearing loss over 72 hours in one or both ears -> straight to emergency

• Unilateral (one ear) tinnitus= medical referral 

• Vertigo, balance problems =medical referral length, triggers, type

• Fluctuating hearing loss =med referral

• Vertigo, fluctuating HL, roaring tinnitus & blocked ears (suspect Menierre's) = refer

• Pain= med referral

• Conductive (middle ear) problems= medical referral

• Unusual looking skin= refer 

• Any sort of ooze or gross stuff goes without saying =refer
• Noise exposure -=counsel 
• Tinnitus = unilateral refer. May feel suicidal =refer.

XXXX Day 4 So, I really want to know where people are struggling with their hearing and what are their listening demands. How do they feel about hearing aids. Are they in the appointment because their wife dragged them or are they really feeling isolated because they cant follow conversations and want help.
At the same time I am looking for red flags for referrals. An ENT surgeon said that anything unilateral (one sided ) is cancer until proven otherwise. There could be a tumour, it is my job to refer anything that may be cancer. In addition anything that may require medical treatment that could resolve (or not) their hearing problems. 

Paediatrics 

• What is the parents reason for being in the appointment. Frequently it is on the list of things to cross off and there is no concern about hearing 
• Milestones = has the child met milestones will indicate the type of assessment, can indicate syndromes, speech milestones - speech development is frequently dependent on hearing 
• How many words and what are they saying ?Expressive/ Receptive? Do they respond to their name/ instructions; same room?
• Did they pass their birth hearing screening?
•  
• Premature birth?  more risk of HL , Jaundice ? more risk of HL , NICU =risk
• Pregnancy? birth? 
• Family risk factors? 
•  Middle ear infections? refer to Dr ..how many, how often, grommets, antibiotics? what does dr say?
• General health?
• Family history? =siblings HL, genetic testing 
• What does the teacher/ preschool teacher say ?  
• If possible talk to the child see how they react and interact to get a feel for develop and type of assessment would best suit them.
•  
•  
• If they dont speak english = get an INTERPRETOR (In my viva freak out I forgot to ask for an interpretor) 

  

Speech Audiometry

This week on facebook someone asked why when they only say "Morning" people still hear the Good.

It is because of extrinsic and intrinsic redundancy that people still hear the good in your "morning"

Extrinsic redundancy of the speech signal (top down processing). Language is very rich, so people have many cues available to them to receive the same information. So while someone omits the word good. Morning is sufficient to imply the "good". There are also contextual cues that would imply the word "good".

There is also intrinsic redundancy of central nervous system (bottom up).Sensory info is duplicated via rich neural connections at many levels of a normal auditory system.

still unfinished

X Speech audiometry basics
Role ; High face validity, crosscheck principle with other tests, predictor of handicap, assess effectiveness of rehab, function of higher auditory pathways, decide which ear to fit Hearing aid (HA)
Identify ear surgery candidate and assess surgical outcomes.

Relationship with PTA (pure tone audiometry)
Speech recognition scores 90-100% normal , 80-100% Conductive HL; increase level of speech presentations,
big range for sensorineural HL (SNHL) could be outer hair cells (OHC) or inner hair cells(IHC). OHC most common not significant effect, Lesion IHC distortion of speech signal therefore, large effect on speech scores
8th Nerve lesions create a bottle neck limiting speech discrimination and perception (rollover) abnormally low speech recognition scores (retrocochlear).
 Cortical Lesion-signs of central auditory dysfunction are more subtle the further up the auditory pathway the lesion is.



Lots of different types of speech tests most commonly AB word lists - 12 lists each list 10 CVC words, 10 vowels 20 consonants. 30 phoneme score-- larger sample size, less listener fatigue.

Speech masking = filtered white noise correlated to speech spectrum. Masking stops the non test ear hearing and responding. When itmay be cross heard
1 When to mask
Presentation level -40 (interaural attentuation) > or equal to average or Best Bone Conduction of the non test ear? yes then mask
2 How much masking?
If calibrated
Masking Level=  PL -40 (IA) + max air bone gap of the non test ear 
not calibrated
Masking level= PL - 40 = max air bone gap of the non test ear +ESML
3 Could we be overmasking?
Masking level -40 (IA) is greater than or equal to the BEST Bone Conduction of the TEST EAR

Rollover Index
PB max- PB min/ PB max greater than > or equal to 0.45 = Rollover - possible retrocochlear lesion

First Blog on the chain

I am struggling with motivation to study for my final Audiology exam for the third time. There is no resit this time, so this is it. I have tried different methods of getting myself motivated and nothing works. I have a list of anti procrastination methods that have not got me anywhere near being ready for the viva and prac exam.

After reading this article http://www.lifehacker.com.au/2012/05/how-i-tricked-myself-into-being-awesome/ I decided to follow suit and start my own blog. Jerry Seinfeld says that the way he became such an awesome comedian was to practice every day. He got a wall calendar and put a big red cross through every day. After a couple of days there is a chain of red crosses, that will terrible to break. 

I have never blogged before, so it will probably be terrible and very boring for anyone not interested in Audiology. But Im holding myself accountable. Im starting my chain of red crosses today X

My daughter is home sick today. So, I start my chain with a whimper rather than a bang.
I went on placement recently and forgot to write up my reflection. So that is the first thing to be finished off today.
Time to get methodical about my study- Next 802, 803,804