Archive for the ‘Diary of an Audiologist’ Category

Cochlear Implants

Monday, October 5th, 2009

Yesterday I met Mr Hendricks who attended for a reassessment of his hearing. Prior to calling him, I read in his journal that has a severe sensory-neural hearing loss and wears Digital Super Power hearing aids. He is 33 years old.

Interviewing Mr Hendricks, I was surprised at how well he lip-reads, but more so, how well he speaks, enunciating high frequency speech sounds with ease and having near normal intonation. I learnt he is a tax accountant and his idiopathic hearing loss developed from the age of five stabilising at the end of his teens. Even though he functions at such a high level (giving his degree of hearing loss), he currently finds conference calls with foreign clients very difficult and his hearing loss is having an increasing negative impact both professionally and personally.

We discussed cochlear implants and apparently thought the invasive procedure of “destroying the cochlea” sounded too aggressive when he investigated it a good few years ago. He therefore never pursued the idea. My own knowledge of cochlear implants are somewhat rusted but I told him the basics as well as the fact that research indicates the enormous success of it. I stumbled upon this short youtube video which I found quite useful to explain the basics.

I have referred him for a full assessment and only time will tell about his candidacy and whether he indeed will decide to proceed with surgery. Personally I do hope he has the implant as I believe it will prove life changing to him in the end!

Dezi Belle

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How to speak like dolphins and how to see with your hearing

Friday, September 4th, 2009

What if humans can be taught to echolocate (the ability to distinguish objects in the dark), the same process that dolphins and bats use to tell if there are obstacles in their path? This can proof to be very useful.

Ben Underwood lost his eyesight at age three due to cancer but he has learned himself the amazing technique of echolocating. Here is a 3 min video (best with sound) to demonstrate how he did it. Unfortunately Ben died of cancer early this year.

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To read more on echolocation here an article from wired.com

Make Like a Dolphin: Learn Echolocation

Dolphins

With just a few weeks of training, you can learn to “see” objects in the dark using echolocation the same way dolphins and bats do.

Ordinary people with no special skills can use tongue clicks to visualize objects by listening to the way sound echoes off their surroundings, according to acoustic experts at the University of Alcalá de Henares in Spain.

“Two hours per day for a couple of weeks are enough to distinguish whether you have an object in front of you,” Juan Antonio Martinez said in a press release. “Within another couple weeks you can tell the difference between trees and pavement.”

To master the art of echolocation, all you have to do is learn to make special clicks with your tongue and palate, and then learn to recognize slight changes in the way the clicks sound depending on what objects are nearby. Martinez and his colleagues are developing a system to teach people how to use echolocation, a skill that could be particularly useful for the blind and for people who work under dark or smoky conditions, like firefighters — or cat burglars.

Most animals that use echolocation have organs that are specifically adapted to emit and receive sonar signals, but we humans have to rely on our rather clumsy mouth and ears. For instance, while dolphins use a special structure in their nose to generate up to 200 clicks per second, people can make only three or four clicks per second.

echolocate

By studying the physical properties of the many different sounds the human mouth can produce, the Spanish researchers hope to maximize the power of human echolocation. In their latest study, published in a recent issue of the journal Acta Acustica united with Acustica, the group taught 10 of their students and colleagues to use basic echolocation. Then they compared different noises and clicks to determine the best type of sound for “seeing” your surroundings.

“The almost ideal sound is the ‘palate click,’” said Martinez in a press release, “a click made by placing the tip of the tongue on the palate, just behind the teeth, and moving it quickly backwards.” The palate click is better than other sounds, because it can be made in a uniform way, works at a lower intensity, and doesn’t get drowned out by ambient noise.

But there are a few drawbacks to human echolocation – like cotton mouth. “The quality of the sound tends to degrade after a few minutes of constant performance,” the researchers wrote, “due to progressive dryness of the mouth.” Luckily, clicks cause less dryness than other sounds, because you don’t have to exhale to make a click – which also means the sound doesn’t interfere with breathing.

Martinez isn’t the first to recognize the potential for echolocation in humans. At least two examples of blind people who have taught themselves to echolocate (see video above) have made headlines in the past few years, and audiologist Peter Scheifele of the University of Cincinnati has studied these unusual cases.

“Acoustically, according to laws of physics, it’s certainly possible to make a pulse that will tell you something about objects in front of you, such as fences, garbage cans or basketballs,” Scheifele said. How much detail a person can “see” with echolocation depends not only on the speed of their clicks, he said, but also on the frequency. The higher the frequency, the more precise details you can see.

Scheifele has only worked with blind people who can echolocate, but he agrees that others could probably learn the skill. “My gut tells me if you can do it if you’re blind, you can do it if you can see,” he said. “Half the battle is really trying to get yourself in the groove of ‘I can do this if I try.’ We tend to be more visual animals than acoustic, and people don’t usually do it because there’s not a need for it.”

Source: http://www.wired.com/wiredscience/2009/06/echolocation/

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Acceptance

Thursday, July 9th, 2009

This morning I saw Ms Brown on a follow-up appointment. She has a mild to moderate sensory-neural hearing loss and has been fitted with digital aids binaural a year ago. From the notes it appeared that Mr P was not keen to have the hearing aids and the previous appointment was marked with stress and anger between patient and audiologist.
Today Ms Brown was complaining she can’t hear well with the aids and that it doesn’t seem helpful at all. On close examination it appeared that she doesn’t have the ear mould in properly and I instructed her again how to do this correctly.
While I was reprogramming her aids, I broached the subject of realistic expectations and that sparked her underlying emotions. She exploded in anger shouting she is NOT stupid and off course she doesn’t expect it to restore her hearing. Fortunately I have been through such scenarios before and I calmly held my tongue and had her vent her anger. She eventually burst into tears. Initially just sobbing without words and later finally admitting she finds her deafness a tremendous struggle.

This reminded me how important our role as counsellors, are and that we need to equip ourselves in Hearing Loss Counselling that enables patients to identify their difficulties. As in bereavement, a hearing loss may involve the process of grief, denial and anger before final acceptance. It is important for us to give our patients support.

When Ms Brown left unfortunately I could still feel her antagonism but appreciated that for her, it may be a long process of acceptance.

Until next time,

Dezi Belle

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Barotrauma – Never mind the sharks, guard your ears!

Tuesday, June 30th, 2009

This morning I saw a very interesting case of Barotrauma whilst covering an ENT clinic. Mr Naui has been diving in a 10meter pool as part of his SCUBA training five days ago and whilst he was doing bounces (quick up and down movements at three meter depths) he suddenly experienced severe ear ache on the right. He suffered a significant decrease in his hearing, some vertigo and some mild tinnitus on the right.  He has seen his GP the next day that referred to the emergency ENT. His audiogram today looked like this:

 

 audiogram

 

Mr Naui reported that his hearing has subjectively improved since the incident and although the GP noted a tympanic perforation on Sunday, none was visible today. His vertigo also improved.

 

I discussed this patient with the ENT consultant who said Mr Naui clearly had cochlear damage (given the sensory-neural hearing loss,tinnitus and vertigo) likely caused by the a dislocation and rupture of the Reissner’s membrane and/or basilar membrane. He also said it could be inner ear decompression disease which is the result of a gas bubble forming in the inner ear. According to the consultant a fistula is unlikely as all his symptoms are improving and his hearing isn’t fluctuating. He prescribed Mr Naui steroids and antihistamine in an effort to decrease inflammatory changes and increase the delivery of oxygen. He will be reviewed in a few days but the consultant says his hearing loss is likely to remain significant at the high frequencies.

 

I then googled “Barotrauma” and came across this a very interesting summary of Barotrama of the middle and the inner ear http://www.bcm.edu/oto/grand/32395.html

 

According to this article, Mr Naui certainly didn’t have inner ear decompression sickness (IEDS) as:

1)     its commonly seen after dives at extreme depths when divers use helium/oxygen mixture and Mr Naui was diving at only at 3 meter depths

2)     Mr Naui didn’t have any central neurological signs

3)     Inner ear decompression sickness patients needs recompression immediately.  The hearing can return to near normal levels if treated immediately.

 

I wonder if Mr Naui will pursue diving as a hobby after this incident.

 

Until next time,

 

Dezi Belle

 

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Unusual Middle Ear Mischief

Tuesday, June 9th, 2009

This morning I’ve seen an interesting case of a chap with middle-ear trauma. He had a perforated eardrum in December last year and came for a follow-up today. He was somewhat reluctant to tell me what happened (understandably, if it was self-inflicted!) Apparently he was cleaning his left ear with an ear bud when his telephone rung. Oooooops….. He says the person on the other end quite possibly ended up with noise trauma!

Interestingly enough, his audiogram in December indicated a mixed hearing loss and today, with the perforation closed up, the audio indicates a significant sensory-neural dip at 2kHz (down to 50dB!). The conductive component has disappeared altogether. I had a chat with the ENT consultant who says this is quite interesting and is sending the patient for a MRI scan. He wondered if the guy hasn’t had a loss prior to the trauma. In the absence of other symptoms, the ENT doesn’t feel the need to explore the middle ear as such, but the sensory-neural component certainly is interesting (and could benefit from a hearing aid!).

This is just reiterating the golden rule: “nothing smaller that your elbow in your ears please!”

Dezi Belle

P.s. I’ve managed to locate an interesting article of two similar case studies:

Penetrating middle ear trauma: a report of 2 cases

Abstract

Penetrating middle ear injury can result in heaving loss, vertigo, and facial nerve injury. We describe the cases of 2 children with penetrating trauma to the right ear that resulted in ossicular chain disruption; one injury was caused by cotton-tipped swabs and the other by a wooden matchstick. Symptoms in both children included hearing loss and otalgia, in addition, one child experienced ataxia and the other vertigo. Physical examination in both cases revealed a perforation in the posterosuperior quadrant of the tympanic membrane and visible ossicles. Audiometry identified a moderate conductive hearing loss in one child and a mild sensorineural hearing loss in the other. Both children underwent middle ear exploration and reduction of a subluxed stapes. We discuss the diagnosis, causes, and management of penetrating middle ear trauma. To reduce the morbidity, associated with these traumas, otologic surgeons should act promptly and be versatile in choosing methods of repairing ossicular chain injuries.

To Read more, follow:

http://findarticles.com/p/articles/mi_m0BUM/is_1_84/ai_n12417292

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Ear passions

Friday, May 29th, 2009

This article is about a brilliant ENT whose love for his profession, inspires others. It reminded me of a quote of Ralph Waldo Emerson:
Every great and commanding movement in the annals of the world is due to the triumph of enthusiasm. Nothing great was ever achieved without it.

Giving out an earful and loving it

I don’t know much about Dr. Reardon, my ear, nose and throat specialist, except that the man is in love with ears. After all the decades he’s been looking at them, you’d think he’d be done. Seen one, seen ’em all. Bring on some toes and elbows, please.

But every time he walks into the examining room where I sit with my clogged up ear, he is almost whistling, eager to get to his chart and his very realistic “you can take it apart and move it around” facsimile of an ear and explain to me how the middle ear is a hollow chamber in the bone of the skull.

 He is as earnest as a sonnet. And not just to me. Every day his office is packed with people, but no one seems to mind waiting because when he gets to you he is totally tuned into you.

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Chronic otitis media is the result of long-term damage to the middle ear brought about by infection and inflammation, he serenades. Mastoiditis is an infection of the mastoid bone of the skull. See here. This is called cholesteatoma and it usually results from repeated middle-ear infections.

He is like Adam giving a private tour of the Garden of Eden. And he doesn’t just recite the names of things. He explains. And extols.

He makes me think of my friend Antonio, who always beamed when he was sharing the secrets of his perfect marinara sauce. Some cream. Some tomatoes. But not just any tomatoes. “You see this one? Not good enough. You see this? Here, feel it. Smell it. Fresh. Everything has to be fresh. And carrots. Carrots are key.”

And then there’s Paul, a landscaper, who knocked on my door just the other day holding in his hand what appeared to be a dead branch from a dead tree in my yard and declaring the tree alive. “There’s still some green here, see? Give it a chance. Water it. Feed it. Don’t cut it down yet.”

It’s amazing that some people fall in love not just with the obvious beauties, things that everyone loves – other people and babies and dogs and birds and sunsets and lakes and snow-peaked mountains – but with ears and red sauces and even scraggly half-dead trees. And that every day in so many ways, this love changes everything.

You don’t think much about ears and how they work and what life would be like if they didn’t. Or about knees and hearts and lungs and eyes and all the things our bodies do until one day they don’t. You don’t think about a specialist until you need one. Until you have something a pill can’t cure.

We can fix that ear, my specialist told me for the zillionth time three weeks ago. All we have to do is. . . And there he was at the chart again, at his computer pulling up my CAT scan showing me in detail how my ear is supposed to work. And why, exactly, it wasn’t. As confident as Jesus with the fish and the loaves. Fix that ear? Feed the throngs? Not a problem.

Me? I was a disciple still, thinking this is going to take a miracle.

Dr. Reardon wouldn’t call it a miracle. He performed a procedure he’s done a thousand times. But the truth of it is he acts as though it’s all a miracle. The way the ear works. The technology that allows him to see if it’s working. The ear’s structure. The way it heals. And the way he is allowed to participate in the healing.

I have a feeling God is looking down on this man and thinking, “You know, you get it. You appreciate my design. You respect my creation. You’re helping people. And you’re doing a good job.”

Under the radar. Out of the news. Away from the spotlight. Where so much of the good that people do takes place.

Source: http://www.boston.com/news/local/articles/2009/05/17/giving_out_an_earful_and_loving_it/

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The highlight of Audiometry comments

Thursday, May 28th, 2009

Testing peoples’ hearing is never mundane as proved by the following, priceless incidents:

When giving the instructions for masking, I always say to the patient: “You might hear some wind blowing in your other now. Just ignore it completely and only press the button when you hear the beeps” after which this lady quickly responded: “O, much like I have to do with my husband then!”

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Another lady who was visibly stressed by having to concentrate so hard to hear the tones pointed out: “Dear, I’m afraid my teeth clatter too much, I can’t hear those sounds” Thankfully she didn’t remove them to continue the test!

And then there was the lady who asked where she could undress when she entered the booth. Puzzled I asked why she wanted to do that and she replied: “Well the doctor sent me for a urine test” and when I explained he said hearing test, she laughed loudly saying that’s probably why he sent her then!

Dezi Bell

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Having James Bond for a reassessment

Tuesday, May 12th, 2009

One of the delights of an Audiologist is the fact that one meets very interesting characters from time to time.

I had the pleasure of seeing Mr Bond earlier this week for a hearing reassessment. He told me he is a Greek Linguist and works as a translator for the Ministry of Defence. He speaks no less than eight languages and though far past retirement age, still works three days a week and loves his job. Even more remarkable, is the fact that Mr Bond has a severe hearing loss in both ears! His thresholds are on average 70dB and he has air-bone gaps of between 20 and 40dB. Yet he could imitate my accent and intonation absolutely spot-on. When I commented on how amazing this is, he humbly replied: “I love languages dear, it comes easily for me”. Working for MI6 I enquired about interesting cases he might have dealt with but he assured me he is no James Bond and only does office work. I on the other hand, choose to believe he is an under cover agent translating spy documents on the forefront of combating terrorism. You never know!

Dezi Belle

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The “Not-so-pleasant” patients

Wednesday, May 6th, 2009

Fortunately it doesn’t happen regularly but as an audiologist one occasionally sees the “not-so-pleasant” patients as was the case last week whilst I was covering an ENT clinic. When I called Mr R in the waiting room, he was talking with a raised voice on his mobile phone despite a huge sign opposite him requesting no mobile phone usage in that area. As this is always an extremely busy ENT clinic, the waiting room was jammed pack with patients and there was already a pile of files waiting for audio’s to be done. Mr R waved me off with his hand (indicating he has actually heard me) but proceeded to finish his conversation first!When Mr R eventually followed me to the soundproof booth, he didn’t bother to apologise for his rude behaviour but instead pointed out how small the room is (Mr R is extremely over weight). He also chewed incessantly on gum in a very unpleasant manner, appeared bored with the instructions I gave and hardly made eye contact. He then asked whether the test will take long because he is in fact in a hurry!

Goodness me, I thought when he left, hoping he was just having a bad day rather than actually being rude like that every day. If however the latter is true, he is a very sad case indeed!

Dezi Belle

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Should old acquaintance be forgot?

Tuesday, April 7th, 2009

Earlier this week I saw Mr Stephenson who is turning 89 soon. He was seen on a repair clinic a few weeks ago when his right BE36 broke at the elbow. We didn’t have any record of him as he wasn’t seen at the department in ages. Mr Stephenson was advised to obtain a GP referral so we could assess his hearing and upgrade his hearing aids to new all-singing, all-dancing, digital hearing aids.So when I saw Mr Stephenson on a Direct Referral clinic he was pointing out that he loved his old aids and doesn’t want new ones. As he had occluding wax in both ears, I manage to get an ENT consultant to remove this with some difficulty. By then Mr Stephenson already had to “pay a penny” several times and he was clearly fed –up. No matter how I explained it would be useful if we can obtain a quick audiogram whilst he’s in, he insisted that he has lived with his hearing loss for 60 years and has had those hearing aids for 60 years(!) and he doesn’t want anything else.

No amount of explanation that we don’t stock BE 36’s or its elbow’s anymore and that I need some hearing results to program a digital aid, could convince Mr Stephenson to cooperate. In the end I glued the elbow in place. I then also gave him a BE37 as a spare (as the 36 was hanging on for dear life!) but the fact that the switches and batteries were different was a major concern to him. It took careful instruction and reassurance before he was amicable towards my idea.

Unfortunately I have to admit he left looking completely worn out and frazzled. I wonder if we Audiologist realise in our attempt to help some of the elderly people, we sometimes upset their “stable, well-known world”. And I’m holding my heart for the poor 90 plusses that will come around our department in the next few years, when we won’t be stocking any analogues anymore!

Yours sincerely

Dezi Belle

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