Special cases for hearing aid fitting

Question 1

What are additional complications associated with tinnitus?

Answer 1

-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

Question 2

What are the three types of tinnitus models?

Answer 2

1. Physiological models: relate the physiological changes in the auditory system to the perception of tinnitus
2. Psychological models: explain the psychological processes that cause some people to find their tinnitus troubling
3. Social models: explain the impact of cultural and healthcare attitudes to tinnitus on people’s experience of the condition

Question 3

Name the four commonly used tinnitus treatments

Answer 3

1. Sound enrichment
2. Tinnitus retraining therapy
3. Cognitive behavioural therapy
4. Mindfulness

Question 4

What is sound enrichment?

Answer 4

-Use of sound to distract the brain from the tinnitus
-Background sounds techniques
-Hearing aids
-Noise generators

Question 5

What is tinnitus retraining therapy?

Answer 5

-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

Question 6

What are the advantages and disadvantages of tinnitus retraining therapy?

Answer 6

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

Question 7

How is cognitive behavioural therapy used to treat tinnitus?

Answer 7

-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

Question 8

How is mindfulness used to treat tinnitus?

Answer 8

-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

Question 9

Do individuals with tinnitus benefit from hearing aids?

Answer 9

-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

Question 10

At which point would you refer someone with tinnitus to a specialist clinic?

Answer 10

-If they are reporting that their tinnitus is distressing or interrupting their sleep
-If it is causing depression and anxiety

Question 11

What are some additional considerations associated with profound hearing loss?

Answer 11

-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

Question 12

Why do individuals with severe and profound hearing loss need longer appointment times?

Answer 12

-Communication difficulties
-Additional testing
-Extra counselling and advice
-Consideration of alternative management options

Question 13

Why is additional testing needed for individuals with severe and profound hearing loss?

Answer 13

1. Identification of dead regions: to give realistic expectations of hearing for speech and decide whether hearing aids are appropriate management
2. Identification of non-organic hearing loss: requires different management
3. Additional needs assessment

Question 14

What things should be considered when setting up hearing aids for patients with severe and profound hearing loss?

Answer 14

-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

Question 15

What additional management is considered for individuals with severe and profound hearing loss?

Answer 15

-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

Question 16

What are some additional problems associated with sudden hearing loss?

Answer 16

-It may be associated with a specific cause (e.g. infections, surgery, head trauma, ototoxicity)
-Often a shock is the cause is unknown

Question 17

What is the management for sudden hearing loss? Include audiological management and onward referrals

Answer 17

-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

Question 18

What are the difficulties associated with a patient who has hearing loss as well as learning difficulties and other special needs?

Answer 18

-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

Question 19

What additional services are available for a patient who has hearing loss as well as learning difficulties and other special needs?

Answer 19

-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

Question 20

What are the difficulties associated with a patient who has hearing loss as well as a cognitive disorder?

Answer 20

-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

Question 21

How is an individual with a cognitive disorder and hearing loss supported?

Answer 21

-Additional and regular appointments
-Strong links with carers and/ or family are needed to ensure effective care

Question 22

What are the difficulties associated with single sided deafness?

Answer 22

-Severe to profound hearing loss in one ear causes significant hearing difficulties in more listening situations
-Causes embarrassment, annoyance, and helplessness

Question 23

How is single sided deafness managed?

Answer 23

-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

Question 24

What are the difficulties associated with multi-sensory loss e.g. adults with vision disorders in addition to their hearing loss?

Answer 24

-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

Question 25

How is multi-sensory loss managed?

Answer 25

-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