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