C D 373 - Ch 1+2

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Audiology

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The study of human hearing, profession has evolved tremendously since its birth after WWII. Combine the medical profession of otolaryngeology with the rehabilitation professions of speech pathology and psychology.

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Audiology Practice

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• Clinical diagnostic and rehabilitative services related to hearing and vestibular problems.
• Dispensing and fitting of hearing aids.
• Providing evaluation and habilitation for hearing impaired children in educational settings.
• Hearing conservation for musicians and others exposed to noise.
• Hearing screening of newborns at risk for hearing loss.
• Evaluation of auditory disorder.
• Industrial evaluations for employers.
• Forensic evaluation in workers compensation and acoustic trauma cases.
• Monitoring neural status during surgical procedures.
• Ototoxic monitoring.

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An audiologist’s goal regardless of where they work their role is:

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• The identification, evaluation, and diagnosis of hearing and balance disorders
• The habilitation or rehabilitation of these disorders

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Where do audiologists work?

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• private practice
• Hospital
• Within an Ear, Nose, and Throat Clinic
• In the Public School System
• University
• In the Military
• Industrial Audiology Units
• Research Facilities
• Hearing Aid Dispensing Franchises

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Explain audiology’s military roots:

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At the end of World War II when veterans were returning home with hearing loss caused by exposure to loud sounds during military service. By 1945 due to the high level of need, otolaryngology physicians, speech pathologists, and psychologists banned together to create hearing rehabilitation centers on select military bases to help these veterans.

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In the 1950s there are ___ audiologists across the US focusing on

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500; auditory training, lip reading, and the use of hearing aids

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Until 1977, ASHA deemed hearing aid dispensing

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dispensing by an audiologist unethical at this time.

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Once the Supreme Court stepped in and reversed this, doors opened for audiologists to enter private practice and renewed the profession’s origins of rehabilitation with a focus on dispensing hearing aids.

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Reversed the ethicalness of hearing aid dispensing

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By 1989, the concept of “Au. D.” clinical doctorate was introduced

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was introduced as a logical direction for the profession to take to continue its advancement in healthcare

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Au. D.

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required by most states in 2011 to practice as a licensed audiologist, a 4 year degree meant to be completed after the undergraduate degree in communicative disorders

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The doctoral degree was a necessary step in the right direction for the profession of audiology, but no one realized that it would

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it would create a shortage of new providers in most states.

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As the baby boomers become seniors, and as audiology services continue to expand

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a new subspecialty has become more popular in the field because of this

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Some audiology practices that have employed audiology assistants report an

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report an increase in efficiency and productivity without compromising patient satisfaction

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What does an audiology assistant do?

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Handling of New and Repaired Hearing Aids
Hearing Aid Troubleshooting
Equipment Maintenance
Restocking Inventory and Supplies
Test Assistants for Infants and Children
Preparing Specialized Equipment for more In-Depth
Audiologic or Vestibular Evaluations

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Hearing impairment is currently estimated to affect

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estimated to affect 31.5 million Americans

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Hearing impairment has more than doubled in the past 30 years, and is projected to

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is projected to reach 50 million over the next 40 years.

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Why is hearing important?

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Hearing allows us to monitor our environment, Provides a connection with others, Facilitates the process of communication

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Hearing Impairment and Hearing Loss

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are general expressions that encompass the varying degrees and types of reduced hearing sensitivity in both children and adults

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Hearing Disability and Hearing Handicap

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describe the functional limitations caused by the hearing loss

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A person who is deaf is one whose

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is one whose hearing is disabled to an extent that it precludes the understanding of speech, through the ear alone with or without the use of a hearing aid

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A person who is hard of hearing is one whose

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is one whose hearing is disabled to an extent that makes difficult, but does not preclude, the understanding of speech with hearing alone, with or without a hearing aid

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Types of Hearing Loss

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Conductive Hearing Loss(often temporary), Sensorineural Hearing Loss(usually permanent), Mixed Hearing Loss

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Common Causes of Temporary Hearing Loss

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•Infection in the middle ear called Otitis Media, which occurs frequently among infants and young children.
• Calcification around the bones in the middle ear called otosclerosis.
• Separation between bones called ossicular disruption or disarticulation.
• Wax buildup or obstruction in the ear canal.

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Common Causes of Permanent Hearing Loss

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• Exposure to loud sounds
• Consequences of the aging process
• Genetic syndrome
• Neural disorder
• Vascular disorder
• Infections or trauma during fetal development, at birth, in childhood, or as an adult.

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Prelingual Hearing Loss

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Occurs PRIOR to normal speech and language development

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Postlingual Hearing Loss

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Occurs AFTER speech and language development

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The disabling consequences of hearing loss on speech and language development in patients with prelingual hearing loss

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can be more severe than in patients with postlingual hearing loss, intervention should occur shortly after onset of the hearing impairment, unfortunately this is not always the case

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Reasons for Delayed Intervention

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•Older adults who have developed hearing loss gradually may deny its existence and resist intervention even after diagnosis
• Denial may also be the reason for delayed intervention with an infant if a parent is unwilling to accept that a hearing impairment exists.
• Ideally onset, identification, and intervention should occur successively and in a timely manner.

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For infants and young children early identification and intervention are

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are critical to maximize speech and language development

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Refer to Figure 1.6 pg 20

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Intervention for Older Adults

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Recent study regarding correlation between hearing loss and Alzheimer’s, Dementia

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Although there are a variety of underlying causes for hearing loss, there are two major pathways for the treatment of hearing loss:

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1. Hearing loss that is medically treatable with medication or surgery. 2. Hearing loss that effects the nerve, is permanent in nature (not treatable with medication or surgery), and reduces the patient’s ability to communicate effectively.

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If the hearing loss is determined to be medically treatable, the patient is

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the patient is referred to their primary care physician or ENT specialist for treatment and retested in order to evaluate the outcome of the medical intervention

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If the hearing loss is not medically treatable

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if this isn’t medically treatable, the audiologist will alleviate the patient’s communication difficulties using aural habilitation or rehabilitation

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Aural Rehabilitation includes

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includes hearing aid fitting, counseling, educating, listening training, speechreading, and referral to speech-language pathology if appropriate

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The ability to hear

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plays a direct role in the ability to perceive and produce speech

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The primary goal in assisting individuals with hearing impairment is to

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is to maximize the ability to hear and understand speech, and in the case of young children, to accurately produce speech with the help of a speech-language pathologist

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Many different kinds of Hearing Rehabilitation for Permanent Hearing Loss

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• Hearing Aids
• Rehabilitation Therapy
• Assistive Listening Devices
• Cochlear Implants
• Surgically Implantable Devices

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Hearing Aids

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the most important tool we have, selecting/fitting/programming hearing aids is a large part of what audiologists do everyday

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Kochkin 2005 revealed a customer satisfaction rating of

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rating of 77.5% which places hearing aids in the top 1/3 of products and services in the United States, this high level of satisfaction has a lot to do with significant advances in technology over the past few years

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Figure 1.8 p 23

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Rehabilitation Therapy

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Can be performed in individual or group settings and generally involves:
• Speechreading training
• Maximize visual cues
• Observe body language
• Develop lipreading skills
• Manipulating listening environments to hear better in background noise

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Cochlear Implants

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For those patients who are unable to benefit from hearing aids because their hearing loss is too profound

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Individuals with Disabilities Education Act (IDEA) also known as Public Law 94-142

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Ensures that all children with disabilities receive a free, appropriate, public education that emphasizes special education and related services designed to meet their unique needs in the least restrictive environment.

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When IDEA was implemented we found that not all

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we found that not all, although the goal of IDEA was to favor integration, the emphasis is now on providing an “appropriate” education, which is sometimes an alternative approach to mainstreaming children with hearing loss could properly function in a regular classroom

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No Child Left Behind Public Law 107-110

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Meant to “ensure that all children have a fair, equal, and significant opportunity to obtain a high quality education and reach, at a minimum, proficiency on challenging state academic achievement standards and state academic assessments.”

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Americans with Disabilities Act (IDEA) also known as Public Law 94-142

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Ensures that a hearing loss cannot be used to rule out an individual to be considered for employment or access to public services as long as the job tasks can be performed with reasonable accommodations.
• Amplifiers for Telephones
• Assistive Listening Devices
• Hearing Aid Compatible Phone Systems
• Amplifiers in Movie Theaters

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Support Groups

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• Hearing Loss Association of America
• Cochlear Implant Club International
• Alexander Graham Bell Association for the Deaf and Hard of Hearing
• Cochlear Implant Association
• National Association of the Deaf

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Acoustics

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Physical science that pertains to sound and vibration, for some species the ability to detect sound in their environment can be critical for survival. for humans, acoustic energy aids us in our most unique and significant ability – SPEECH!

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Characteristics of Sound

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The transmission of sound occurs as the result of the movement of air particles. Sound is a wave that can travel through gases, liquids, and solids. When travelling through air, molecules bounce off one another, causing them to disperse uniformly in space. This is difficult to understand because we can’t SEE them moving through air.