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.