Hearing and Speech Evaluation after a Stroke

An elderly man came into the clinic for a speech diagnostic. He has recently had two strokes leaving one vocal fold paralyzed. The patient's vocal fold was left open and caused him to whisper. Automatically, I was thinking about speech testing and if he would be able to be evaluated. However, with just an increase in the talk back, I could hear him perfectly. His hearing was within normal limits and he seemed to do very well with all tasks, even raising his hand. Since the patient was taking many medications, he was dizzy and needed assistance while walking through the clinic.
The biggest concern for this patient was communication. A device was bought to amplify the patient's own voice. However, it was not specific enough to pick up his voice except for at very close proximity. Information was given and he was directed to the augmentative device person in the program. I found a list of tips on choosing augmentative devices here:

http://www.linc.org/ataugcom.html

And # 4 on the list was choosing a device with good speech quality...which is exactly what this patient needs. The list is very informal but gives good general and simple ideas.

Also, I found an article on the information that should be given to family members of a stroke patient. I thought that this article was important since the family is being relied on to take care of the individual and to help with therapy. The patient's daughter came with him to the clinic and showed great concern and attentiveness to all information. Basically, the article found that the patient and family members need three things from their health professionals: information, counseling, and accessibility.

Relatives of hospitalized stroke patients: their needs for information, counselling and accessibility. By: van der Smagt-Duijnstee, Miebet E., Hamers, Jan P.H., Abu-Saad, Huda Huijer, Zuidhof, Arjan, Journal of Advanced Nursing, 03092402, Feb2001, Vol. 33, Issue 3

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/detail?vid=1&hid=107&sid=fff35d66-ce82-4c19-9b67-0cc417fe6594%40sessionmgr107

Adult Student and Auditory Processing

A young adult female came in with complaints of having trouble at work and in classes with understanding speech. She did not believe that she had a hearing loss but was unsure the reason for the difficulties.
Hearing evaluation of tymps, otoscopy, audiometry, speech recognition, and word discrimination was administered. All results were within normal limits and in fact, discrim scores were 100% bilaterally.
For the auditory processing evaluation, the SCAN-A, SSW, and AFT-R were administered. The patient was very attentive and showed great effort to stay on task. The results for the SCAN and SSW were within normal limits. However, a temporal processing disorder was evident after presenting the AFT-R. Her mean ipi was greater than the second standard deviation based on her age.
The good news is that temporal processing disorders can be fixed with programs such as Fast ForWord. The bad news is that the patient has made it through the whole semester without assistance from the school. Hopefully, with correct diagnosis, the patient will get proper management skills to become a successful student.

The article that I found discusses the difference of temporal processing between young (18-40) and old adults (65-76) and also hearing and hearing impaired individuals. The results were consistent with what I expected. The young group had better thresholds and greater percentage correct. Also, the subjects with normal hearing did better than the hearing impaired subjects. These results are an additional piece of evidence for a good prognosis with the present patient. She is considered a young adult with normal hearing. Here is the article:

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/detail?vid=1&hid=101&sid=a0c1956f-addb-4a50-a895-10009397fcef%40sessionmgr106

Profile of auditory temporal processing in older listeners. By: Gordon-Salant S, Fitzgibbons PJ, Journal of Speech, Language & Hearing Research, 10924388, April 1, 1999, Vol. 42, Issue 2

Group Home Patient with Mental Retardation

I had a lady come in with mental retardation, vision problems, and a seizure disorder. She was very sweet but had limited speech and language so evaluation procedures were limited. No responses were observed when presented with pure tones in sound field. However, a speech awareness threshold was found within normal limits with speech stimuli including "hi", "how are you?", "are you ready?", and "come on, let's go". Also, otoacoustic emissions were present in all frequencies except for one that was very low freq. Since we see many patients from the group home with mental retardation, I found an article discussing general information for a physician when dealing with this type of patient. The article includes characteristics, types, diagnoses, and development. I especially found the evaluation and referrals section beneficial to our profession since this is a specialized group to assess. The importance of talking to the parent or caregiver was discussed. In my experience, the caregiver's information and opinions have been essential to testing the individual. Here is the article:

Daily, D., Ardinger, H.H., & Holmes, G.E. (2000). Identification and Evaluation of Mental Retardation. American Family Physician.

http://www.aafp.org/afp/20000215/1059.html

Follow-up to Orientation

The same elderly man from last week came in for a follow-up (this would be the third week in a row). He seemed to be in a better mind-frame in this session and participated without reluctance. I believe that his confidence is getting better which will help him accept his hearing loss. We worked on inserting the hearing aids again and also reprogrammed them because the patient said they were too loud.

Reprogramming included decreasing the gain in the lows and mids for loud sounds. After the change, the patient seemed to be happier. He also seems to need some time to adjust to the new hearing aids. His complaints included rustling of his clothes, an obnoxious laugher, and crowds of people talking too loud. However, these sounds have always been there but were not noticeable to him or they are annoying sounds no matter what level. Aural rehabilitation would be excellent for this patient but he does not seem interested in a weekly plan (even though he has been coming in weekly).

Since this patient has been having some problems, I went to the Widex (his hearing aids are Widex) and found their suggestions for first-time users. So here are some tips...
http://www.widex.com/is-bin/INTERSHOP.enfinity/WFS/Widex-COM-Site/en_GB/-/EUR/SVCPresentationPipeline-Start?Page=issite%3a%2f%2fWidex-COM-Site%2fWidexEnglishDic%2fDic%2f0_0_Index%2f0_0_1_IndexPages%2fAdviseForFirstTimeHearingAidUsers%2epage
The two tips that seemed most important for this patient were adjusting to new sounds and practice makes perfect.

In addition, I also read an article on hearing aid services and satisfaction because I was unsure if the problem was with me or him...which, most likely, it is both. I can not be with him everyday to make sure he is practicing so I'm not doing enough and he started out unmotivated. In this article, hearing aid users were asked to evaluate the service that they received when purchasing a hearing aid. I have seen this article before in class and possibly on someone else's blog. However, I never really noticed that the audiologists and hearing aid dealers were not giving the patient the opportunity for group aural rehabilitation. Also, communication strategies were also not top priority for the professionals to discuss with their patients. I believe that my patient needs both of these pieces of information. In fact, it was more important for me to discuss expectations, communication strategies, and aural rehab than how many programs the hearing aid had or how to change the wax guard. Here's the article:

http://www.hearingresearch.org/Dr.Ross/HAsatisfaction_consumers.htm

Stika, C.J. & Ross, M. (nd) Hearing Aid Services and Satisfaction: The Consumer Viewpoint.

Hearing Aid Orientation for New User

An elderly man came in for a hearing aid orientation and then the next week for a hearing aid check. Many factors effected the way the session went. His general health is not very good and he has been taking chemotherapy over the summer. His wife is the main person in his life and attended the appointment with him. However, she is also the only reason he purchased hearing aids to begin with since she is very opinionated (may be the best way to put it).

After introducing the concept of hearing aids, I showed how to insert the batteries, put on the hearing aids, and change the programs. The patient seemed reluctant to try these things for himself. Instead he would hand the instrument to his wife. Putting the hearing aids on was very difficult for the patient. He got very distraught and anxious to leave. Once he had the hearing aids in, he was out the door. Continuous reinstruction and patience was the key for this patient. The next session went much smoother. He actually put the hearing aids in himself several times. I believe that this patient needed to be seen more than others. He may have had some memory problems due to chemo treatments and because he is elderly. Also, he was not motivated or confident in the beginning. Once he realized that he could not break the hearing aids, he did much better.

The article that I've found is one that I believe someone else used for patient counseling. It is a very good article in this instance because it discusses normal, healthy patients. Just imagine the effects on someone who has other difficulties. Patients were tested to see how much they could remember right after a hearing aid orientation and then a month after. Around 75% was recognized overall after the orientation. I believe that you can't say important information enough. I used repetition to help me. I repeated instructions and I also scheduled for another appointment to reitterate the information. Do you think your patients remember what you say?? What's your method to help a patient insert their hearing aids??

Reese, J.L. & Hnath-Chisolm, T. (2005). Recognition of hearing aid orientation content by first-time users. American Journal of Audiology, 14 (1): 94.

http://aja.asha.org/cgi/reprint/14/1/94

Child with Little Expressive Language

A young boy came to the clinic as part of a speech diagnostic. The child had very little expressive language and was beginning the process of learning some signs. After trying many different stimuli, speech was used to ask where body parts were. The child responded to some by pointing. However, he began to fixate on his nose and started acting like a 'piggy'. Responses were inconsistent but were well within normal limits. Also, OAEs were performed successfully and were normal.

This patient was very energetic and playful. What little vocabulary he had was masked by articulation problems. In the article 'Communicative gestures in children with delayed onset of oral
expressive vocabulary', children with expressive language delays rely heavily on gestures and signs. This was apparent when the child walked in the clinic. He was pointing and handing things to his parents instantly. His nonverbal communication was also very good. He went from being happy to being bored to upset and every emotion was plain as day on his face.

Thai, D.J. & Tobias, S. (1992). Communicative Gestures in Children With Delayed Onset of Oral Expressive Vocabulary. Journal of Speech and Hearing Research, 35, 1281-1289.

http://jslhr.asha.org/cgi/reprint/35/6/1281

Testing Patient with Mental Retardation

I performed a hearing evaluation on an adult male with mental retardation. He also had some vision impairments that will hopefully improve after his cataract surgery within the month. Although very consistent with responses, the patient could not be tested using VRA and would he not allow anything near his ears. Warble tones and speech (patient's name) were used through sound field to elicit a response. The patient would respond by quieting or looking for his caregiver. Chronologically the patient was an adult but his cognitive age required the use of BOA. From the results, his hearing was determined to be normal.

In the article by Karikoski et al., the acuity of BOA in predicting hearing loss in children was evaluated. The results concluded that BOA was good for determining if there was a hearing loss or not. However, the degree of loss was not as easy to pinpoint especially for profound losses. In fact, BOA underestimated the loss when the actual loss was severe or profound.

Karikoski JO, Marttila TI, Jauhiainen T. Behavioural observation audiometry in testing young hearing-impaired children. Scand
Audiol 1998;27:183–7.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=1&hid=107&sid=b37f5c0e-0eb7-4fc7-b0d2-1331a6a0513b%40sessionmgr103

Cookie-bite Audiogram

A previous patient returned to have his hearing aid programmed due to a significant increase in hearing loss from his last evaluation. His audiogram was an obvious cookie bite that reached to ~70 dB at the lowest point. He has one hearing aid, CIC, in his left ear. While programming the hearing aid to fit his audiogram, I had problems getting enough gain without having feedback. The knee-point was increased to allow more soft sounds. This seemed to be the solution.

Since this patient has an unusual progressive hearing loss, I would assume that it is genetic. He was advised to see a physician for further testing. In the article by Steinberg et al., parents are asked their views of genetics and hearing loss after their child was diagnosed with a loss. I thought this was a good article because it covers what our patients or family members of our patients think about audiologists and ways to improve the diagnosis process. For example, the audiologist should treat every patient as an individual. We must understand that everyone will have different emotions to the same news. This article is alot of review from pediatrics but is narrowed down to just genetic hearing loss and genetic testing.

Steinberg et al. (2007). Parental Narratives of Genetic Testing
for Hearing Loss: Audiologic Implications
for Clinical Work With Children and Families. American Journal of Audiology, 16, 57-67.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=1&hid=106&sid=0b9a37fc-d364-4dcd-858c-a3f23c0342e7%40sessionmgr104

Parkinsons and Cognition

The elderly man who came in about two weeks ago to buy a hearing aid was seen this week for the hearing aid orientation. I felt that the hearing aid chosen was going to be satisfactory for the hearing loss and for the individual patient. However, the patient is in the early stages of Parkinson's. Hearing aid care and cleaning procedure was instructed. I had the patient try to put the battery in the aid and after about 1/2 an hour he finally got it somewhat. Then I moved on to putting the aid in his ear. This task was not easy for the patient. He could not see, even with a mirror and it seemed that he was not listening to the instructions that were given. After this struggle, I wanted to see what is the normal cognition of a Parkinson's patient. I'm not sure if he was being stubborn towards help or if he really did not understand what I was saying. Either way, my patience was tested (which is very uncharacteristic for me). Here is an article that I found on the effects of Parkinson's on cognition. It discusses that these patients have subjective problems in daily life activities. The authors suggest a cognitive remediation program. I would also think that my patient may need aural rehabilitation so he will be able to practice with help from a professional.

Here's the article:

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/detail?vid=1&hid=17&sid=0d480066-9228-4e8c-a238-cd4e8b504710%40SRCSM2

Koven, NS, Robert, M., Coffey, DJ, Flashman, LA, & Saykin, AJ. (2007). Cognitive performance and self-reported functioning in daily life among those with Parkinson's Disease: A brief report. Internet Journal of Mental Health, Vol. 3, Issue 2.

Middle Ear Surgery and Infection

A man came into clinic this week to get his hearing aid fixed. After seeing the hearing aid which was a CIC, it was obvious that it needed to be recased. However, the man had recently moved to the area and was new to the Hearing Clinic so a full hearing evaluation was needed. He reported having previous ear surgery on his "bones and trumpets" in the left ear which resulted in a 'dead' ear. Also, he reported having reoccurring infections in the right ear. Otoscopy revealed a red tympanic membrane on the right side and a dark abyss on the left side. Audiometric results were compared with previous tests and a progressive mixed loss was found.

Masking was needed for both bone and air conduction. Unfortunately, his loss was so severe in his left ear that the initial masking level could easily cause overmasking. So, another hearing evaluation is needed with closer attention on masking levels. To avoid this mistake again, I wanted to find an article on the masking dilemma. However, after looking for about two weeks I can not find anything on overmasking or masking dilemma.

Instead I found an article on otitis externa since he has had problems with bleeding and pain. This article has good suggestions for treatment and care. Since he has a CIC, the problem will persist without proper infection control.

http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=4713538&site=ehost-live

Auditory Processing- Adult

This week I saw an adult female experiencing some problems with processing auditory information. To establish normal hearing, otoscopy, tympanometry, acoustic reflexes, reflex decay, puretone audiometry, speech audiometry, and OAEs were performed. All tests in the evaluation revealed normal hearing.
To test for auditory processing disorder, the SCAN-A, AFT-R, and SSW were performed. Once the tests were scored, it was found that the patient did have problems with processing. The most apparent difficulty was in gap detection which makes the patient miss parts or all of fast-paced speech.
Although auditory processing disorders are frustrating, the patient was relieved to receive some kind of help. Temporal processing rehabilitation programs, Earobics and Fast ForWord, were recommended. Also, she was given a list of suggestions on how to make her listening environment better for her problems. Apparently, there are not too many research studies on APD with adults. The article that I found discusses processing problems as people age including gap detection.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=36&hid=9&sid=98e7a827-a2e6-4c46-b52b-d87289609f67%40SRCSM2

Martin, J.S. & Jerger, J.F. (2005). Some effects of aging on central auditory processing. Journal of Rehabilitation Research and Development, 42, 25-44.

Monaural Hearing Aid Fitting

An elderly man came in to the clinic hoping to buy a hearing aid. Otoscopy, tympanometry, puretone audiometry, and speech tests were performed. These tests revealed a high-frequency sloping loss. His results were opposite of what was expected from listening to his speech. He spoke softly and very slowly which led me to believe that there was some conductive component. However, during the case history, he said that he was diagnosed with Parkinson's Disease. Frequency specific loudness levels were also tested.

His speech discrimination scores were both very poor so two hearing aids were recommended. However, the patient did not want to buy two due to cost issues. For a monaural fitting, the ear with the better speech discrimination score was chosen for a hearing aid. The patient expressed hearing problems at church and on the telephone. After discussing with the patient two hearing aid options, we chose the Widex Diva 9 Me since it has a telecoil.

Since two hearing aids were recommended, I wanted to include an article on sound deprivation of an unaided ear. This article suggests that if an ear goes unaided, the patient's speech recognition thresholds will decrease with time. The study included 19 monaurally aided adults, 28 binaurally aided adults, and and 19 control adults. W-22 CID suprathreshold speech-recognition test, nonsense syllable test, and speech-perception-in-noise test were performed.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/detail?vid=1&hid=8&sid=d560badc-20e0-4800-ba60-b0bf9b61064a%40SRCSM2

Silman S; Silverman CA; Emmer MB; Gelfand SA. (1993). Effects of prolonged lack of amplification on speech-recognition performance: preliminary findings. Journal Of Rehabilitation Research And Development, Vol. 30 (3), pp. 326-32.

I love bonding in clinic!!

Since no one came to clinic this week, I used my time wisely by bonding with fellow classmates and supervisors. On Monday, the topic of alternative medicine was discussed and I decided to look up any natural treatments for ear related problems.

I found an article called Alternative Medicine and Hearing which included a survey given to audiologists, otolaryngologists, hearing aid dealers, and family practitioners from Illinois to evaluate their knowledge on natural treatments. Sweet oil, cottonballs, rubbing alcohol, vinegar, olive oil, ear candling/coning, hair dryer, and hot candle wax were some treatments the professionals were familiar with. The professionals reported that patients 61 years and older most frequently used home remedies. One-third of respondents reported seeing damage caused by use of home remedies.

I thought that this article was interesting and much different from the pure medical research. Being from rural WV, I know many people who still rely on the land so it may be necessary to at least be familiar with alternative meds.

Here's the article:
Nungesser, N., & Bierman-Mulvey, N. (2003, Nov. 4) Alternative medicine and hearing: Cultural influences, clinical implications. The ASHA Leader, pp. 6-7.

http://www.asha.org/about/publications/leader-online/archives/2003/q4/f031104b.htm

Here's a site with many different suggestions for alternative treatments (this is not evidence based research, just some neat stuff):

http://earthclinic.com/

Where have all the physical plant people gone?

This week I did not get to see anybody. I observed one lady come in to pick up her hearing aids and one man came in to have his father's hearing aid cleaned. Since the week was uneventful, I decided to find an article that discussed some of the business aspect into hearing aid dispensing. I thought I might find some good advertising tips to incorporate into our clinic. Dugloss (1996) took a survey of audiologists in which number and type of hearing aid sales, price of hearing aids, type of consumers, generation of leads, etc. were included. Dugloss found, "public education/ awareness and trustworthy advertising were the major obstacles to expanding hearing instrument sales." HMOs were also counted as an obstacle to patients seeking help from an audiologist. Audiologists in a clinical setting were referred most of their patients from an ENT. In a private practice, most were repeat or current patients. Somehow, hearing instrument salespeople had the most repeat sales at 38.7 percent, followed by private practice audiologists with 33.2 percent. I could not find a more current article of this survey. However, I hope the numbers have changed since the popularity of the new BTE styles. Even if the article is outdated, it still gives an overview of competition in the dispensing of hearing instruments.

Dugloss, M. L. (1996). Dispensers seek new public image, survey finds. Hearing Instruments.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/detail?vid=1&hid=15&sid=c5134a8f-0eaa-479a-aabc-9015243bd3a2%40sessionmgr7

Asymmetrical Loss

This week I saw a gentleman for a hearing conservation evaluation. He is the second person that I've tested who has had an asymmetrical loss with a slight conductive component. The poorer ear was reduced by at the most 30 dB HL. Most frequencies were within normal range and those that weren't were high frequencies. He has a history of noise exposure from his job and hunting. Since I am cursed with asymmetrical losses, I wanted to find an article on the risk of tumors (acoustic neuroma) in regards to audiometrical findings. Schlauch et al. (1995) discuss the audiometry of tumor and non-tumor groups. They suggested using high frequencies as the basis for referral since a tumor would effect high frequencies first. Although some evidence for a tumor can be seen in an audiogram, false positives may cause over-referral. Schlauch et al. also said if the patients are older or exposed to noise, then differences between ears is not always a red flag for referral.

Schlauch et al. (1995). Evaluating Hearing Threshold Differences Between Ears as a Screen for Acoustic Neuroma. Journal of Speech and Hearing Research, Volume 38, 1168-1175.

http://jslhr.asha.org/cgi/reprint/38/5/1168

NF II and Vestibular Schwannoma

Not too many people were scheduled for clinic this week but I did get to observe an interesting case. A woman who has been diagnosed with neurofibromatosis type II (NF II) came in for a hearing evaluation. There are two types of NF. Type I effects the majority of the body while type II effects mainly the head (which includes the cochleo-vestibular nerve). The patient has already had surgery to remove a tumor in one ear. The surgery resulted in the patient basically having a dead ear. Audiometry revealed that hearing in the opposite ear was not good either (severe-profound loss). The patient wanted to know about cochlear implants, hearing aids, and augmentative communication. Although auditory rehabilitation for her was not likely, Mrs. Haines discussed some computer programs that could possibly help with communication.

Moffat et al. discussed the overall management of patients with NF II. The incidence of NF II is around 1: 40,000. Symptoms tend to become apparent in the second or third decade of life. These include hearing loss, tinnitus, imbalance, and facial paresis. Although hearing loss is usually unilateral, vestibular schwannomas are bilateral. In the study, 23 of the 35 patients underwent surgery. Long-term hearing preservation was not possible in any of these patients. Due to tumor size and poor residual hearing, 11 out of the 15 who were offered surgery as the initial intervention could not have hearing preservation surgery. Although this article does not have many positive outcomes or suggestions, it gives a good overview of the condition and options.

If you haven't seen anything on auditory brainstem implants, I suggest google-ing it. The surgery is geared toward patients with NF II. Crazy new stuff!!!

Moffat, D. et al. (2003). Management strategies in neurofibromatosis type 2. European Archives of Oto-Rhino-Laryngology, 260, 12-18.
http://www.springerlink.com/content/qm8gjt0yw8n2kp2j/fulltext.pdf

Earmolds

I saw a wonderful lady who needed her hearing aids adjusted and, upon inspection, she needed new earmolds. Synth-a-flex II was chosen as the material since it will be soft and comfortable for her. Plus only a small pinhole was suggested to reduce feedback. According to Taylor and Younk, severity of loss is an important factor when choosing an earmold material. In addition, age, ear tissue, and the activity level of the patient should be considered.

See the article by Taylor and Younk here:
http://www.hearingreview.com/issues/articles/2005-11_02.asp

and here is just a good question on audiology online:
http://www.audiologyonline.com/askexpert/display_question.asp?question_id=27

Otitis media and children

Gravel and Wallace (2000). Effects of otitis media with effusion on hearing in the first 3 years of life. Journal of Speech, Language, and Hearing Research, 43, 631-644.

http://jslhr.asha.org/cgi/reprint/43/3/631

This week I saw my first client! He came in for a audiology assessment as apart of a speech diagnostic. He has PE tubes present in both ears due to otitis media problems. He has had the tubes for 6 months and he is now 4 years old. According to Gravel and Wallace, language learning within the first three years is especially important. When a child has OM, testing needs to be often since one test tells little about their whole language development period. Also, the risk for hearing loss is much greater with OM. Another hearing evaluation once the client was older was suggested. This would allow us to test more frequencies and obtain more reliable thresholds.

Just a side note... when working with children, throw everything out the window and pull out the bears. (I couldn't find an reputable article on this topic, sorry)

4/16/07

A lovely day of speech screenings at MountainView Elementary.

4/9/07

An adult male came in for a hearing evaluation and central auditory processing test!! He was once diagnosed with audio-perceptive disorder(?). His mom wanted testing before he entered into college. All of the hearing evaluation was normal so they could proceed to the SCAN. The client had some problems with competing words. He was borderline 2nd and 3rd standard deviation from the norm. AFT-R and SSW were performed and he did very well on both.

4/2/07

A child with William's Syndrome came in to have a hearing evaluation. An auditory processing disorder was suspected. However, she could not have the SCAN administered because she has a high frequency loss. Tymp in her left ear was flat but everything else was normal.

3/19/07

An older female came in to have her hearing aid adjusted. She was having problems with background noise. The clinician increased the high frequencies and the woman was happy with the changes.

3/12/07

I saw a lady from health and safety for a hearing evaluation. She had normal otoscopy, tymps, speech testing, and audiometry. Her audiogram looked close to her past audiograms.

3/5/07

Elderly female came in for a hearing aid check. She was having problems with them not be loud enough. However, before coming in to clinic she changed the batteries and they started to work. Some low frequencies were increased because she had trouble hearing soft voices.

2/26/07

10 year old male came in for APD testing. He had normal otoscopy, tymps, audiometry, and speech. SCAN and auditory fusion test-revised (AFT-R) was used for testing. Since the testing took the entire time, I did not find out the results. The patient was very attentive for being a child.

2/19/07

13 year old female- Came in for speech diagnostic and voice therapy because she is a singer. Otoscopy, Tymp, Audiometry, SRT, and WR were all normal.

Adult male from printing services came in for evaluation. He had normal otoscopy, tymps, and AR. His audiogram showed a loss in high frequencies (notch).

2/12/07

CAPD- A 6 y/o came in because he was having problems with reading. He had normal otoscopy, tymps, and audiometry. His speech testing was normal (used child's list and Hughson-Westlake method). The SCAN was administered and he was within normal range. He was very patient for a 6 y/o and seemed intelligent.

2/5/07

I had a long and wonderful day learning about hearing aids!! Clinic was canceled for the afternoon.

1/29/07

Clinic was canceled.

1/22/07

The son of a 90 y/o man came in to get his father a hearing aid. The father has been wearing a relatives aid but it's not working well. The clinician suggested an Oticon Atlas Plus BTE because it had auto-volume control and did not have many pricey additions.