Special cases for hearing aid fitting Flashcards
What are additional complications associated with tinnitus?
-The tinnitus is often perceived as the overwhelming problem rather than the hearing loss
-There is no specific “cure” for tinnitus but there are a variety of treatment options
-The person can be referred to a specialist tinnitus clinic
What are the three types of tinnitus models?
- Physiological models: relate the physiological changes in the auditory system to the perception of tinnitus
- Psychological models: explain the psychological processes that cause some people to find their tinnitus troubling
- Social models: explain the impact of cultural and healthcare attitudes to tinnitus on people’s experience of the condition
Name the four commonly used tinnitus treatments
- Sound enrichment
- Tinnitus retraining therapy
- Cognitive behavioural therapy
- Mindfulness
What is sound enrichment?
-Use of sound to distract the brain from the tinnitus
-Background sounds techniques
-Hearing aids
-Noise generators
What is tinnitus retraining therapy?
-Involves use of sound enrichment together with education about tinnitus and counselling
-Aims to habituate the person’s perception and response to their tinnitus
-Use wearable sound generators, hearing aids or combination devices
-Counselling is directive and concentrates on the cause of the tinnitus and pathways in order to decrease the patient’s fear of the sound
What are the advantages and disadvantages of tinnitus retraining therapy?
Advantages: Some patients report a reduction in awareness of their tinnitus, tinnitus annoyance and negative impact on life, evidence that people show benefit within 3 months and continue to improve
Disadvantage: The treatment does not work for everyone
How is cognitive behavioural therapy used to treat tinnitus?
-Based on cognitive model of tinnitus
-Aims to change the person’s negative thoughts about tinnitus to more realistic, positive ones
-Improves emotional distress, handicap, tinnitus annoyance and quality of life
-Shown to be an effective treatment
How is mindfulness used to treat tinnitus?
-Based on the cognitive model of tinnitus
-Patients care taught to observe an experience that they cannot control rather than reacting to it
-Achieved by focusing awareness on the present while calmly acknowledging feelings and body sensations
Do individuals with tinnitus benefit from hearing aids?
-There is not enough robust research to demonstrate clear benefit
-However some people do report that wearing hearing aids reduces the impact of their tinnitus
At which point would you refer someone with tinnitus to a specialist clinic?
-If they are reporting that their tinnitus is distressing or interrupting their sleep
-If it is causing depression and anxiety
What are some additional considerations associated with profound hearing loss?
-Frequency resolution and speech discrimination may be poor
-The process of providing appropriate hearing aids is more complex
-Hearing aids are unlikely to fully restore hearing and communication function on their own
-Additional management strategies are needed
-Family members more likely to need to support the patient
Why do individuals with severe and profound hearing loss need longer appointment times?
-Communication difficulties
-Additional testing
-Extra counselling and advice
-Consideration of alternative management options
Why is additional testing needed for individuals with severe and profound hearing loss?
- Identification of dead regions: to give realistic expectations of hearing for speech and decide whether hearing aids are appropriate management
- Identification of non-organic hearing loss: requires different management
- Additional needs assessment
What things should be considered when setting up hearing aids for patients with severe and profound hearing loss?
-Choice of prescription fitting rule
-Whether to include bs threshold when entering data into the prescription software
-Compression characteristics
-Omni vs directional mics
-Noise management
-Frequency lowering
-Feedback management
-If testing shows dead regions consider reducing gain in these areas
-Regular review of benefit (REMs, speech testing, special questionnaires)
-Earmoulds need to be an excellent fit
What additional management is considered for individuals with severe and profound hearing loss?
-Advice on technology and communication support
-Counselling on acceptance and understanding their hearing loss
-Assertiveness and communication strategies training
-Family and friends counselling and communication skills training
-Auditory training
-Speech reading training
-Speech and language therapy
-Peer support
-Psychological support
-Occupational and benefits advice
-Referral for cochlear implantation
What are some additional problems associated with sudden hearing loss?
-It may be associated with a specific cause (e.g. infections, surgery, head trauma, ototoxicity)
-Often a shock is the cause is unknown
What is the management for sudden hearing loss? Include audiological management and onward referrals
-Must be diagnosed by ENT
-Audiology: assess the extent of loss, provide amplification and counselling, communication training and hearing therapy
-Other referrals: psychology for management of the emotional consequences of the loss, intensive rehabilitation at Hearing link
What are the difficulties associated with a patient who has hearing loss as well as learning difficulties and other special needs?
-They may be unable to complete audiometry
-They may not understand instructions or be able to concentrate long enough to complete testing
-They may be reluctant to undergo otoscopy or impression taking
-They may be wary of strangers
-They may not be able to report difficulties with hearing or hearing aids
What additional services are available for a patient who has hearing loss as well as learning difficulties and other special needs?
-The same staff and clinic environment are used every time
-Some assessments are carried out in day care centres or at the home of the patient
-Additional forms of testing may be used
-Extra time is allowed for appointments
-Extremely good links are maintained with the client’s carers and social services
What are the difficulties associated with a patient who has hearing loss as well as a cognitive disorder?
-They may be less likely to communicate effectively
-Can lead to social isolation, frustration, depression
-People with hearing loss have a 30-40% greater chance of cognitive decline than people without hearing loss
-They also have an increased rate of developing dementia and more rapid cognitive decline
-Sensory deprivation due to hearing loss causes accelerated brain tissue loss
-The person may not remember that they have a hearing loss, that they have a hearing aid, how to put it in and use it
-The person may continuously adjust the hearing aid controls
-They may refuse to wear the aid
How is an individual with a cognitive disorder and hearing loss supported?
-Additional and regular appointments
-Strong links with carers and/ or family are needed to ensure effective care
What are the difficulties associated with single sided deafness?
-Severe to profound hearing loss in one ear causes significant hearing difficulties in more listening situations
-Causes embarrassment, annoyance, and helplessness
How is single sided deafness managed?
-Using re-routing of signals to the better ear e.g. CROS, BAHA
-Sometimes a cochlear implant can be provided for the worse ear
-Re-routing of speech signals to the better ear improves speech perception in noise but degrades speech understanding
What are the difficulties associated with multi-sensory loss e.g. adults with vision disorders in addition to their hearing loss?
-Inability to use hearing aids, other forms of assistive technology, lipreading, and visual cues
-Likely to increase isolation which may lead to increased incidence of anxiety and depression
-Additional needs during appointment i.e. communication during assessment, questionnaires, need to understand changes in vision
-May need input from hearing therapy
How is multi-sensory loss managed?
-Tactile assistive devices
-Formal needs and lifestyle assessment
-Additional communication techniques
-Support groups and charities e.g. Deafblind UK
-Access to Work for support device funding, benefits advice, managing expectations in the workplace
