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.