Diagnostic and Rehabilitative Audiology

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Diagnostic and Rehabilitative Audiology

• Danielle Rose, Au.D.
• Clinical Audiologist
• Vanderbilt Bill Wilkerson Center

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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

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Diagnostic Audiology

• Diagnosing Hearing Loss
• Managing screening programs
• Routine outpatient audiometrics
• Otoacoustic Emissions testing
• Auditory evoked response testing
• Immittance testing
• Speech understanding testing

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Diagnostic Audiology

• Balance Function Testing
• Vestibular system evaluation (ENG)
• Rotary chair testing
• Risk of falls evaluations
• Vestibular Evoked Myogenic Potential (VEMP)

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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)

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• 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)

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Age of Identification

• Until very recently, average age of
  identification of severe-to-profound HL has been
  2.5 yearsis now closer to 6 months in areas with
  newborn hearing screening
• Inverse correlation between degree of HL and age
  of identification

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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

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Primary Causes of HL in Children

• Genetics (accounts for gt ½ of congenital HL)
• Infectious disease (pre-, peri-, or post-natal)
• Low birth weight
• Otitis media (middle ear infections)

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Genetic Causes of Hearing Loss

• Non-syndromic HL accounts for 70 of genetic
  deafness
• 22 is dominantly inherited
• 77 is recessively inherited

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Infectious Disease

• Can occur pre-, peri- or post-natally
• STORCH Complex
• Syphilis
• Toxoplasmosis
• Other
• Rubella
• Cytomegalovirus
• Herpes Simplex

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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)

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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
• Visual Reinforcement Audiometry (VRA)
• Immittance Testing
• Tympanometry
• Acoustic reflex testing
• Otoacoustic Emissions Testing

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• 2 to 4 years
• Conditioned Play Audiometry (CPA)
• Tangible Reinforcement Operant Conditioning
  Audiometry (TROCA)
• Immittance Testing
• Tympanometry
• Acoustic reflex testing
• Otoacoustic Emissions Testing

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• 5 years and older
• Conventional pure tone audiometry
• Immittance Testing
• Tympanometry
• Acoustic reflex testing
• Otoacoustic Emissions Testing

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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

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Rehabilitative Audiology

• Cochlear Implants
• Candidacy evaluations
• Initial stimulation
• Mapping and remapping
• Aural habilitation/rehabilitation

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Rehabilitative Audiology

• Hearing aids
• Candidacy evaluation
• Fitting
• Follow-up
• Re-evaluation

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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 childrens
  voices
• Not necessarily volume

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Sensorineural hearing loss
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Goals in fitting of amplification

1. Audibility
2. Understanding
3. Comfort for sound- sound quality
4. Improved intelligibility in noise
5. Physical comfort
6. Ease of use
7. Reduction in handicap

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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