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?
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• 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.
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• If they dont speak english = get an INTERPRETOR (In my viva freak out I forgot to ask for an interpretor)