Spring 08 Week 12

An elderly male came in for a hearing aid check. He reported having problems with the dome of his Oticon Delta falling out of his ear when he opens his mouth wide or moved too much.
A retention wire was added to the right hearing aid to keep the receiver and dome in the ear canal. He practiced inserting his hearing aid with success.

He has normal sloping to severe sensorineural hearing loss in the right ear and a normal sloping to profound sensorineural hearing loss in the left ear. Hewas recently fit with an Oticon Delta 4000 in his right ear. Extremely poor speech discrimination in his left ear merited a monaural fitting. He received a10mm Delta dome, (size 3) and has expressed satisfaction with the new fit. He had previously been seen in the clinic for feedback problems; however, feedback has reportedly subsided with the new dome.

This was a perfect patient with little problems and great benefit from his hearing aids. After the session, he talked about how others should come to the clinic for amplification and for aural rehabilitation. I found an article that discussed another option for providing aural rehabilitation which includes peer-mentoring. This would allow the audiologist to provide assistance without being overwhelming and the peer would have some common experiences to share. This is a wonderful idea for those who do not have to meet AR competency requirements.

Shafer, D.N. (2005). Improving access for aural rehabilitation. ASHA Leader.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=1&hid=3&sid=23ebca0f-e4c5-4b29-b448-44c4140450b7%40sessionmgr2

Spring 08 Week 11

A student was recruited to the clinic. He reported having sudden decreased hearing sensitivity in his left ear at the age of 8 years old. Before this time, he recalls having normal hearing (i.e. he could use the telephone on both ears with no hearing difficulties). He noted having recurrent ear infections as a child; however no correlation to his sudden decrease in hearing was noted. He reported excessive noise exposure from rifle shooting for many years. He is also presently a musician who attends concerts on a weekly to monthly basis. He does not wear hearing protection during these activities. Currently, he contributes his hearing loss to noise exposure. Specific information on the type, degree, or configuration of loss was unknown by the patient even after undergoing several previous hearing evaluations as a child. He only knows that a hearing loss is present.

Otoscopy revealed normal ear canals and present, intact tympanic membranes bilaterally.
Normal, type A, tympanograms were measured bilaterally. Acoustic reflex thresholds were normal for the right contralateral and ipsilateral reflex pathways; however, there were no responses for the left contralateral and ipsilateral reflexes. Air conduction thresholds for the right ear were within normal limits using insert headphones. The left ear displayed a severe sloping to profound sensorineural hearing loss. No responses were obtained for 500 Hz, 2000 Hz, and 8000 Hz. The air and bone conduction responses of the left ear for all frequencies tested were described as “felt not heard” from vibrotactile cues due to high intensity stimuli.
Speech recognition threshold (SRT) was 10dBHL and in good agreement with the pure tone average of the right ear. Word recognition for the right ear was 100% presented at 40 dB SL. SRT and word recognition could not be tested for the left ear due to audiometer intensity restrictions.

Distortion product otoacoustic emissions (DPOAEs) yielded passing values bilaterally, at least 3 dB above the noise floor, during a 750 Hz-8000 Hz diagnostic test. No significant response differences were seen between the two ears. These results suggest properly functioning outer hair cells in the cochlea bilaterally. No consistent otoacoustic suppression pattern was measured when testing the left ear. Normal suppression occurs when DPOAEs reduce 1 to 3 dB while presenting broadband noise at 15-30 dB SL to the non-test ear. However, otoacoustic suppression results may vary among normal patients.

The patient was asked to return for auditory evoked potential testing. ABRs and single and alternating polarities electrocochleography should be administered at that time. Noise exposure and hearing protection was also discussed.

Normal DPOAEs usually suggest hearing sensitivity of 40 dB HL or better. Contrarily, behavioral responses for the left ear resulted in a profound loss. A retrocochlear loss is suspected in the left ear due to the abnormal findings of acoustic reflex thresholds and extremely elevated behavioral in the presence of normal DPOAE results. Preliminary results are consistent with unilateral late onset auditory neuropathy; however, further testing, specifically auditory brainstem response (ABR) and electrocochleography (ECochG) are needed for a complete audiologic evaluation with site-of-lesion information and is needed to confirm this suspicion. ECochG results can also give information about the cochlear microphonic when single polarity is used.

I found a study (after much searching) for treatments addressing auditory neuropathy. This study asks two questions: Does noise present a particular problem for people with auditory neuropathy? Can clear speech and cochlear implants alleviate this problem? The results concluded that clear speech improved temporal properties which, in turn, helped improve speech recognition. Comparing acoustic to electrical stimuli merited cochlear implants as a treatment option for those with auditory neuropathy. In addition, the authors suggested the use of high quality hearing aids to help with speech recognition also.


Zeng, F. & Liu, S. (2006) Speech perception in individuals with auditory neuropathy. ASHA, 49.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=1&hid=8&sid=640f8366-e105-4b8a-9cda-4c038216f6aa%40sessionmgr9

Spring 08 Week 10

An elderly male came in for a hearing aid check this week. He reported that his new left Widex Flash FL-X ITE hearing aid was no longer in working condition. He is an experienced hearing aid user, for approximately 15 years, and is currently in his 60 day trial period of bilateral Widex Flash FL-X in-the-ear (ITE) hearing aids. His right aid was recently returned to the manufacturer because it was causing irritation and redness in the helix area. At the current visit, the hearing aid has not been returned from the manufacturer. His previous hearing aids were bilateral analog MicroTech Cabello ITEs.

Upon visual inspection, an excessive amount of cerumen was found blocking the left hearing aid receiver. The wax guard was replaced and the hearing aid was subsequently found to have adequate amplification during the listening check. However, he had other concerns including the battery door configuration, the need for wax guard replacements, and the overall feel and look of the Widex Flash instruments. He then expressed interest in returning the Widex ITEs and purchasing MicroTech hearing aids (with advanced technology) due to his satisfaction with his old hearing aids. When information was elicited from MircoTech via phone call, a gradual merger of Starkey and MicroTech was revealed and some MicroTech instruments were no longer available. Therefore, a comparable Starkey mid-level product, Destiny 800, was recommended by the customer service representative.

He agreed to purchase bilateral Starkey Destiny 800 ITEs. A few special requests were noted on the order form which included no wax guards, a toggle volume control, a touchless t-coil, a 312 battery capability, a 3 year warranty, and a side-open battery door. The Widex instruments will be returned for a refund once the right aid returns from repair.

He seemed to be having difficulty with new technology and the cost of the new hearing aids which seems to be a trend with his purchasing history. So I found an article discussing perspectives on digital hearing aids and the history of hearing aids (which a certain professor would love!). This would be an excellent article to give to a patient who asks why hearing aids are so much more expensive now. Starting from WW II, the author goes through the advancements in amplification leading up to digital hearing aids.

Levitt, H. (2007). A historical perspective on digital hearing aids: How digital technology
has changed modern hearing aids. Trends in Amplication, 11.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=1&hid=5&sid=9fdccebd-c228-4d6e-b399-233f48876fc4%40sessionmgr3

Spring 08 Week 9

An adult male came in to purchase musicians in-ear monitors with custom earmolds. He reported playing the keyboard in a band at his church. No hearing problems were reported. However, the right tympanic membrane has previously been ruptured twice. The last occurrence was approximately ten years ago. No other outstanding case history information was provided. Since he is exposed to noise often, a hearing evaluation was recommended and conducted.

Clear ear canals and visible, intact tympanic membranes were observed bilaterally. Redness was observed in the right ear canal. Normal, Type A tympanograms were measured bilaterally.
Otoacoustic emissions were not attempted due to the conductive component in behavioral testing. Puretone audiometry revealed a normal sloping to mild loss at 2000 Hz rising again to normal in the high frequencies in the right ear. The left ear had normal sloping to moderate loss at 4000 Hz rising to normal in higher frequencies. In both ears, the low frequencies showed a slight conductive component while the high frequencies were sensorineural. Pure tone averages were in good agreement with the speech recognition thresholds (SRT) bilaterally. SRT for the right and left ear was 30 dB HL. Word recognition testing was not completed at this time.

Musician custom earmolds were made. UM 56 ear pieces and UM 2 dual driver universal fit in-ear musicians’ monitors were ordered through Westone. He was recommended to return for annual evaluations or if changes in hearing are noticed. Due to a slight conductive component, an appointment with an otolaryngologist was recommended. The importance of hearing protection was also discussed.

I found a study that examined the impact that changing on-stage music and crowd noise levels during musical performance had on preferred listening levels and minimum acceptable listening levels across both floor and in-ear monitors. Participants for this study were 23- to 48-year-old musicians, with and without hearing loss, who had 10 years of experience. Preferred levels were found to be lower for floor monitors while acceptable levels were lower for in-ear monitors. However, there were no significant difference between the two kinds of monitors and both had acceptable levels according to OSHA. It was suggested by the authors for those patients at risk for noise exposure to use in-ear monitors to reduce other surrounding noises.

Federman, J. & Ricketts, T. (2008). Preferred and minimum acceptable listening levels for musicians while using floor and in-ear monitors. Journal of Speech, Language, and Hearing Research, 51, 147-159.

http://web.ebscohost.com/ehost/pdf?vid=1&hid=117&sid=e7290bc3-1ebb-49b1-96c7-03828271d116%40sessionmgr107

Spring 08 Week 8

A female recruit came in with the problems with hearing in noise, occasional tinnitus, and dizziness due to loud noise. She thinks she has a hearing loss but not a significant one. History consists of working in loud enviroments (i.e. bars, restaurants) and attending concerts frequently.

Otoscopy revealed normal, intact tympanic membranes and clear ear canals. Normal, type A, tympanograms were measured bilaterally. Audiometric findings were within normal limits. Speech audiometry revealed normal speech recognition thresholds and speech discrimination. A vestibular evaluation was not attempted at this time due to time restrictions. She was encouraged to return for further testing.

Since she had normal hearing, I thought that I would find an article that would pertain to the client but not currently. She has been a smoker for several years. This article discusses the increase risk of hearing loss due to smoking. The study showed that long-term smokers have a
higher risk of hearing loss at 3 and 4 kHz after noise exposure. Just one more reason to quit...

Wild, D.C., Brewster, M.J., & Banerjee, A.R. (2005) Noise-induced hearing loss is exacerbated by long-term smoking. Clinical Otolaryngology, 30, 517–520

http://web.ebscohost.com/ehost/pdf?vid=1&hid=104&sid=ce350299-0b60-4375-9fa4-f659dc06f0af%40sessionmgr104

Spring 08 Week 7

An adult female was recruited to the clinic for a hearing evaluation. She reported having problems hearing in noise and she talk excessively loud on the phone. No other problems were reported. Normal tympanic membranes and clear ear canals were observed bilaterally. Normal tympanograms were measured bilaterally. Pure tone audiometry revealed thresholds within normal limits. Distortion product otoacoustic emissions were also administered with normal responses in all frequencies. Overall test results revealed normal hearing :)

After discussing some irrevelant information after the hearing evaluation, it was discovered that the recruit was at risk for breast cancer due to familial issues. This reminded me of an interesting finding of how cerumen characteristics were compared to the risk of breast cancer. Japanese women do not have a high risk of breast cancer genetically. However, in a study conducted in California, Japanese women with breast cancer often had a wet-type cerumen. The authors suggest that the glands controlled by the apocrine system have a genetically determined variation that influences the susceptibility to breast cancer. The article is somewhat old but I did not have access to the newer ones.

Petrakis, N.L. (1971). Cerumen genetics and human breast cancer. Science, New Series, 173, No. 3994, 347-349.

http://www.jstor.org.www.libproxy.wvu.edu/stable/view/1732386