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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: – – – – – 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 – – – – – – Managing screening programs Routine outpatient audiometrics Otoacoustic Emissions testing Auditory evoked response testing Immittance testing Speech understanding testing Diagnostic Audiology • Balance Function Testing – – – – 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: – – – – – – 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 • 6 months to 2 years – – Visual Reinforcement Audiometry (VRA) Immittance Testing • • – 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 – – – – Candidacy evaluations Initial stimulation Mapping and remapping Aural habilitation/rehabilitation Rehabilitative Audiology • Hearing aids – – – – Candidacy evaluation Fitting Follow-up Re-evaluation Needs of individuals with sensorineural hearing loss • • • • 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 1. 2. 3. 4. 5. 6. 7. 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