Download Hearing Conservation and Hearing Loss Army Corp of Engineers

Diagnostic and Rehabilitative
Audiology
Danielle Rose, Au.D.
Clinical Audiologist
Vanderbilt Bill Wilkerson Center
What the heck is an Audiologist?
• Minimal credentials: entry level currently the
Au.D.
• Roles:
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Identification and treatment of hearing loss
Assessment of balance disorders
Identification of need for additional medical referral
Rehabilitation: hearing aids, cochlear implants, tinnitus
Intraoperative monitoring, neonatal hearing screening
Diagnostic Audiology
• Diagnosing Hearing Loss
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Managing screening programs
Routine outpatient audiometrics
Otoacoustic Emissions testing
Auditory evoked response testing
Immittance testing
Speech understanding testing
Diagnostic Audiology
• Balance Function Testing
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Vestibular system evaluation (ENG)
Rotary chair testing
Risk of falls evaluations
Vestibular Evoked Myogenic Potential (VEMP)
Hearing Loss in Children
• It is estimated that approximately 30 per 1000
children have some degree of hearing loss (not
including children with fluctuating hearing loss,
high frequency hearing loss, and unilateral hearing
loss) (Wayner, 2005)
• 3 in 1000 infants are born with congenital,
significant, permanent, bilateral hearing loss
• 3 additional children in 1000 will acquire hearing
loss in early childhood
• NICU infants are at a higher risk for hearing loss,
with at least 1 in 50 showing significant hearing
loss (Northern and Downs, 2002)
• 13 in 1000 children have unilateral hearing
loss
• 1/3 of children with a unilateral hearing
loss have failed at least one grade during
their school years and nearly 50% need
special resource assistance (Bess and
Tharpe, 1986)
• 37% of children with minimal hearing loss
have failed at least one grade (Bess et al.,
1998)
Age of Identification
• Until very recently, average age of
identification of severe-to-profound HL has
been 2.5 years…is now closer to 6 months
in areas with newborn hearing screening
• Inverse correlation between degree of HL
and age of identification
Signs of Children With Minimal Hearing
Loss
• Inability to follow directions or answer
simple questions
• Inattentiveness
• Confusion of similar-sounding words
• Frequent requests for repetition
• Fatigue/listening effort
• Academic difficulties
Primary Causes of HL in Children
• Genetics (accounts for > ½ of congenital
HL)
• Infectious disease (pre-, peri-, or post-natal)
• Low birth weight
• Otitis media (middle ear infections)
Genetic Causes of Hearing Loss
• Non-syndromic HL
accounts for 70% of
genetic deafness
– 22% is dominantly
inherited
– 77% is recessively
inherited
Infectious Disease
• Can occur pre-, perior post-natally
• STORCH Complex:
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Syphilis
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes Simplex
Hearing Loss and Otitis Media
• The most common complication of otitis
media (OM) is hearing loss
• The majority of children will have at least
one episode of OM before the age of 2 years
• The average hearing loss resulting from OM
with effusion is 25-26 dB in the speech
frequency range (Gravel, 1999)
Hearing Assessment in Children
• Birth to 6 months
– Auditory Brainstem Response (ABR)
– Otoacoustic Emissions Testing
– Immittance Testing
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6 months to 2 years
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Visual Reinforcement Audiometry (VRA)
Immittance Testing
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Tympanometry
Acoustic reflex testing
Otoacoustic Emissions Testing
• 2 to 4 years
– Conditioned Play Audiometry (CPA)
– Tangible Reinforcement Operant Conditioning
Audiometry (TROCA)
– Immittance Testing
• Tympanometry
• Acoustic reflex testing
– Otoacoustic Emissions Testing
• 5 years and older
– Conventional pure tone audiometry
– Immittance Testing
• Tympanometry
• Acoustic reflex testing
– Otoacoustic Emissions Testing
Types of Hearing Loss
• Conductive: Middle Ear, Otosclerosis,
Tympanic Membrane, Cerumen impaction
• Sensory- Noise-induced, ototoxicity,
genetic, presbycusis
• Neural- Auditory Neuropathy, Tumors of
the 8th cranial nerve, demylinating disorders
• Sensorineural
Rehabilitative Audiology
• Cochlear Implants
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Candidacy evaluations
Initial stimulation
Mapping and remapping
Aural habilitation/rehabilitation
Rehabilitative Audiology
• Hearing aids
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Candidacy evaluation
Fitting
Follow-up
Re-evaluation
Needs of individuals with
sensorineural hearing loss
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Better clarity for speech sounds
Understanding in background noise
Audibility for high-frequency sounds
Better understanding for female and
children’s voices
• Not necessarily volume
Sensorineural hearing loss
Goals in fitting of amplification
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Audibility
Understanding
Comfort for sound- sound quality
Improved intelligibility in noise
Physical comfort
Ease of use
Reduction in handicap
Hearing loss and the Physician
• In-office screening• Welcome to Medicare program (patient
history, physical, hearing, risk of falls,
depression, etc.)
• More than 1/3 of individuals over the age of
65 have appreciable hearing loss
• Referrals for Medicare patients
• Medical clearance for hearing aids