Case Study Questions Flashcards
Options and advice for patients struggling with tinnitus
Referring if necessary Consider hyperacousis Sound enrichment (using aids or environmental sounds)fitting aids Tinnitus retraining therapy CBT Mindfulness
Options and advice for patients struggling with learning difficulties/ dementia/ cognitive issues
Use same staff and clinical environment to comfort familiarity
May be carried out at home
Additional objective tests used if cx can’t comply with PTA
Extra time for appointments
More regular appointments
Good communication with carers and SOP to convey detail cx may be unable to
Dementia friends
Use additional communication tactics write things down for cx.
Options and advice for patients that are profoundly deaf
Frequency + speech discrimination poor
Process of providing appropriate aids is more complex
Additional management strategies usually needed. Assisted listening devices also
Family members usually need support and input to rehab. Family counselling
Usually have psychosocial needs counselling
Extra appointment time
Consider cochlea implant
Extra testing
Skilled audiologist
Realistic expectations
Occupation support and benefits advice
Frequent appointments to adjust aids to suit
EARMOULDS need to be EXCELLENT FIT UPDATED REGULARLY
if testing shows DEAD regions are present consider REDUCING gain in these areas to prevent further damage
Consider using SEVERE and profound questions are for validation
Special alarm system for home that use light or vibrate for fire etc.
Psychological support
Communication tactics
Auditory training
Speech reading training
Peer support
Options and advice for patients struggling with sudden loss
Definition of sudden loss: a loss of 30dB or more at 3 THREE neighbouring frequencies occouring over a period of THREE 3 days
Causes e.g. Infection/surgery/head trauma/ototoxicity/barotrauma but also no know cause.
Referral under BSA
Can be shock emotional counselling support needed
Diagnosis needed by ENT
hearing therapist
Intensive rehabilitation at hearing link
Provide amplification and communication tactics training
Options and advice for patients struggling with single sided hearing loss
Single sided deafness SSD
Often of sudden and unknown origin Can effect Speech in noise Speech localisation Awareness of sounds Can be embarrassing,annoying helplessness
CROS hearing aid
Bone hearing aid BAHA s
Consider cochlea, may be unavailable on NHS
Options and advice for patients struggling with dual sensory loss
Cx with vision difficulties in addition to their hearing loss
Communication during assessment may need to be altered Additional appointment time needed Most questionnaires in appropriate Need to understand if changes in cx vision or health Involve SOP if possible Communication tactics deaf blind U.K. Work and income advice Expectation management Referral to Hearing therapists Psychology
Why do we use compression?
Limit output without distortion Minimise loudness discomfort Prevent further damage to auditory system Optimise residual dynamic range Restore loudness perception Maintain listening comfort Maximise speech recognition Reduce adverse affects of noise
What questions should you ask patients after fitting a hearing aid or changing its settings?
Is it comfortable? What do they think of sound quality of: Own voice Audiologist or SOP voice Other sounds
Check for too loudness
Check for too quiet
Questions to ask patient at review?
Wear time Sound quality Any particular problem situations How their own voice sounds Any problems with loud sounds Any problems with acoustic feedback Can patients fit well Is it comfortable
What are the characteristics of a good earmould?
Comfortable Snug fit Easy insertion/removal Non irritant Cosmetically acceptable Fit for purpose i.e. Degree of loss
When would swim moulds be useful?
Prevents water entering ear Used by children and adults with GROMMETS PERFORATIONS CHRONIC INFECTIONS Tight seal on mould required
Noise protection FILTERED ear moulds when useful?
Musicians
Shooters etc
Filters are interchangeable
Differing degrees of attenuation depending on intended use
Why might you use an open fitting?
Non occluding
Improved comfort
Can fit immediately
Improved cosmetics
Disadvantages: only suitable for mild or ski slope high frequency losses
Different REMs procedure
How to reduce occlusion effect for patient?
Option 1. Modify frequency response
Reflow frequencies gain, however this causes lack of amplification and may reduce cx responsiveness to sound
Option 2
Use an earmould with a long enough tip to reach the bony canal:limits vibration of ear canal, negative-may have difficulties inserting
Option 3
Vent the mould greater than 2mm
Option 4
Open fitting
Only Suitable for mild/moderate losses
