Week 5, Fall 2007

During clinic this week, I encountered a recruit who had previously been very dissatisfied with his hearing aid. Prior to his visit, I did not know what type or configuration of hearing loss he had, and I knew very little background information about him.

The case history proved to be greatly important and revealed a significant amount of information about the client. The client noted significant unprotected noise exposure during his service in the military, which he described as the source of his hearing loss and his bilateral tinnitus. He reported that he had experienced difficulty hearing and has had persistent low-frequency tinnitus since that time. He also mentioned that he had chemotherapy treatments two years ago; however, he denied any additional hearing loss, tinnitus, or dizziness subsequent to his treatments. He was unsure of the date of his last hearing evaluation, but he believed that it had been approximately 5 years. At that time, he was fitted with one hearing aid in his left ear, which he described as his worst ear.

Otoscopy and tympanometry were normal bilaterally. Acoustic reflex threshold testing indicated that the client may have possible recruitment because he complained that the input levels were too loud, and at some frequencies, his ARTs were present at low input levels.

Pure tone air conduction and bone conduction testing revealed normal hearing to mild hearing loss in the low-frequencies, and a sharply sloping drop, beginning at 2000Hz, to a severe SNHL Hz. Thresholds and SRTs were substantially worse in the left ear. Significantly, word recognition testing was poor in the left ear and good in the right ear.

Previously, the client had been fit with a BTE in the left ear, and he reported little to no benefit. In fact, he had not worn his hearing aid for over a year because he didn't feel that it was helping him.

My supervisor and I decided to recommend a mini-BTE for his RIGHT ear. During WR testing, he reported that he liked the way the words sounded in his right ear and stated that they sounded "muffled" in his left ear. In my opinion, without viewing his old audiograms, I still feel that it is very likely that this patient was fit inappropriately, which led to his great dissatisfaction. The client was very excited to try something that may give him more benefit. We also talked with him about possibly trying bilaterally amplification on a trial basis, if he was pleased with the benefits from aiding his right ear. Hopefully, we can get him happier with amplification.

The article linked below, Rehabilitation Approaches to Promote Successful Unilateral and Bilateral Fittings and Avoid Inappropriate Prescription by Hickman, (2006), describes factors associated with client dissatisfaction and non-use of hearing aids. It also provides tips about how to promote successful fittings. The article cites a statistic from Dillion, et al. (1999) that indicates that only 10-20% of first-time adult users actually continue wearing their hearing aids for more than 3 months post-fit. That statistic was alarming to me.

The author of the article also completed an independent study that involved 6 males and 15 females with a mean age of 75 years. All 21 participants were contacted by telephone and asked about the amount of time they use their aid(s), their feelings about having one or two aids, their decision-making process for purchasing amplification, and any problems that they have faced. From these questions, participants were classified as successful or unsucessful users. Four unsuccessful users were found, and they reported several reasons for not liking their hearing aids. Overall, the author found that clients with better initial attitudes were more successful. The author also found that individuals reported greater satisfaction when initially fit with one hearing aid and then fit bilaterally IF the client was successful with one hearing aid.

http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2009306852&site=ehost-live

Week 4, Fall 2007

This week I saw several clients enrolled in the hearing conservation program. Otoscopy and tympanometry were normal bilaterally for all clients. Two clients had puretone thresholds within normal limits as well as normal SRTs bilaterally. One client had a mild to moderate high frequency hearing loss beginning at 3000 Hz and normal SRTs bilaterally. All clients had puretone air conduction thresholds that were consistent with last year's findings.

Following explanation of results, I remind clients to continue using hearing protection when they are exposed to noisy environments. For the most part, the clients that I have seen, seem to follow the recommendations given from the clinicians at our clinic. Reviewing clients audiograms and OAE results from previous years and noting minimal changes in my patients leads me to believe that the clients enrolled in the hearing protection program not only understand our recommendations but also follow them. However, these patients are all adults. In contrast, I sometimes wonder ... how would children respond to a hearing protection program?

The following article examined the efficacy of an interactive hearing protection program used with elementary school-aged children (Chermak, Curtis, & Seikel, 1996). The study enrolled 48 fourth-graders in a hearing protection program. The children were given instruction in the normal function of the ear, risks of noise, and prevention of noise-induced hearing loss (NIHL) for one hour each week for a total of two weeks. The investigator in the study showed the children a videotape about the anatomy & physiology of the ear; sources & intensity levels of common noises; causes of hearing loss; hearing conservation methods; and hearing aid use. The video and oral instruction was coupled with interactive activities. For example, the children were asked to act out the physiological process of the transmission of sound through the outer, middle, and inner ear. Children were also permitted to perform hearing screenings on each other using a portable audiometer and were encouraged to ask the investigator questions about hearing and hearing loss. Following the hearing protection sessions, teachers were encouraged to use suggested supplement activities to broaden students' knowlegdge about hearing and hearing protection.

Prior to and following instruction in hearing conservation, the children were given an 8-item questionnaire about hearing & hearing loss and a 10-item questionnaire about noise exposure & hearing conservation. In the 8-item questionnaire, children were given both test question, which assessed children's knowledge about situations that would require hearing protection, and control questions, which assessed children's knowledge about situations that would not necessitate using hearing protection.

The investigators found that, following the hearing protection program, children increased their knowledge in all areas of assessment. Furthermore those students whose teachers provided supplemental activites, improved their post-test scores by even greater margins. The greatest improvement following the hearing protection program was found in the children's intended use of hearing protection secondary to increased knowledge about NIHL. In fact, when children were given supplemental activities, their knowledge of NIHL improved nearly 50% while those who did not receive supplement instruction still improved 35%.

In summary, this program proved to be extremely effective in increasing chilren's knowledge about the dangers of noisy toys and activites. Due to increased use of iPods, video games, and other noisy toys since the completion of this study, it's important for us to remember that hearing conservation is important for children as well as adults.

http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=1996008260&site=ehost-live

Check out the supplemental activities & survey questions ... they're great resources if anyone else is interested in pediatric audiology. :-)

Also, you all might recognize a couple of the authors cited in the article.