This week I attended clinic on Tuesday and Thursday. Tuesday, I did not see any patients; however, I observed a hearing aid check. I was also able to review and practice some clinical skills. Practicing tympanometry and acoustic reflexes on myself was a helpful refresher, and manipulating the controls on the audiometer also helped me get re-acclimated to the machinery. Lastly, reviewing the Martin manual and my assessment notebook also better prepared me for seeing clients. The link below for A Week in the Life of a Hearing Professional by D. Van Vliet discusses a typical day for an audiologist. Although this article is older (1996), I enjoyed reading about hearing aid checks for hearing aids that had been “dried” in the microwave and worn in the shower.
http://search.ebscohost.com/login.aspxdirect=true&db=hch&AN=9609151434&site=ehostliveOn Thursday, I saw my first client!!! The client was a retired, older gentleman who came in because his friends prompted him to see a professional about his hearing loss. As I began the case history interview, the client informed me that he was having difficulty hearing, and he reported that he could not read or write. Accordingly, the entire case history was obtained orally, which was difficult without use of a “Pocketalker” or like device.
During the interview, the client also revealed that he had previously experienced intermittent episodes of “dizziness,” and he reported that he was currently experiencing bilateral tinnitus. He stated that, in his former place of work, he was exposed to a great deal of noise, and he reported that he used to hunt frequently before his hearing and vision had deteriorated. However, he reported that he had worn hearing protection at work and during recreation.
Otoscopy was normal, and tympanometry revealed that the client had bilateral A shallow tympanograms. Additionally, ARTs and reflex were not obtainable bilaterally. Following the case history, I did not anticipate that the client would have a conductive component. However, following otoscopy and tympanometry, I estimated that the client would have a moderate or greater mixed loss.
First, I assessed the client’s SRTs using MLV. Testing revealed an SRT of 65 dB HL in the right ear and 70 dB HL in the left ear. Next, I did a tolerance search in order to determine the level that I should present WR stimuli. The client was unable to tolerate stimuli above 90 dB HL, so I presented at 25 and 20 dB SL for the right and left ears respectively. The client responded correctly 74% of the time when stimuli were presented to the right ear and 88% to the left ear.
AC pure tone testing revealed moderate to moderately-severe hearing loss with improved thresholds at 2000 Hz, and the client’s PTA was in good agreement with his SRT. BC pure tone thresholds suggested a mixed loss even following BC MASKING at 500 and 1000 Hz bilaterally and 4000 Hz in the left ear.
Significantly, because I was not an experienced or expedient clinician, testing took a significant amount of time. Consequently, the client became very fatigued toward the end of the test battery. In fact, I had to re-instruct him twice in order to gain his attention. He was incredibly cooperative and patient, and I was so happy that he was my first client.
Discussing the client’s test results and options for amplification were the most difficult and valuable parts of his visit for me. I wanted to be particularly cognizant of the way that I explained things so that he would be able to understand and so that he didn’t feel as though I was the “doctor” telling him what he needed. Mostly, I just wanted to impart that he could potentially benefit from a hearing aid and that we could help him. His need for and potential benefit from amplification were great; however, he was unable to afford hearing aids. He came to the visit with an application for the Starkey “Hear Now” program; however, he did not have enough money yet to pay the application fee. This was disappointing and very sad because he was so eager to receive hearing aids.
At the end of the visit, my supervisor and I discussed possible third-party assistance, and we informed the client that we would do our best and would contact him soon. I planned to contact the local Quota and Lion’s Clubs and to explore other options as well. All and all … it was a great first clinical experience.
The following links pertain to professionals corresponding with and conducting informational counseling with clients who have low or absent literacy skills. The first article (Can Your Patients Understand You by B. Sibbald) explores misunderstandings between clinicians and clients and emphasizes the need for clinicians to provide clear instructions. The second article (The Importance of Adult Literacy Issues in Social Work Practice by Greenberg and Lackey) explains that uncooperative patient behavior sometimes is attributed to poor literacy skills.
http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=3706976&site=ehost-livehttp://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=21516325&site=ehost-live
