Audiology Lecture Notes

Speech Reports and Referrals

• Speech reports use a similar format to other reports.
• Assignment for next week will cover referrals based on test results and age groups.

Subjective Information

• Includes the client's presenting complaints and history (medical, family, etc.).

Assessment

• Details the tests administered, results, and findings.
• For asymmetric hearing, report results for each ear separately (right/left).
• In speech reports, list the tests and break down the assessment results.
• Include recommendations based on the assessment.

Example Scenario: Three-Year-Old with Chronic Ear Infections

• History: Chronic ear infections for a year, using one to two-word phrases, limited vocabulary.
• Tympanograms: Type B bilaterally (indicating fluid in the middle ear).
• Speech Discrimination: Modified speech discrimination due to limited language (picture pointing tasks).
• Audiogram:
  • Bone conduction within normal limits (nerve is fine).
  • 40 dB air-bone gap (issue in outer or middle ear).

Diagnosis

• Bilateral moderate conductive hearing loss.
• Excellent speech discrimination when sounds are louder, indicating the impact of "earplugs".
• Bilateral Type B tympanograms, indicating abnormal middle ear function (though avoid stating "fluid" without direct visual confirmation).
• Reddened ear canals, indicating irritation.

Referrals

• ENT (Ear, Nose, and Throat doctor) for medical management.
• Speech therapy, especially given the language delay, but only after medical management of the fluid.

Plan

• Follow-up testing after medical management.
• ENT may refer back for further audiological assessment.

Insurance Considerations

• Insurance may dictate the course of treatment, requiring a certain number of infections before approving tubes.
• The critical window for speech and language development is 3-5 years old.

Assignment Instructions

• The assignment will present four different scenarios with varying ages and contexts.
• Use notes to determine potential issues and appropriate actions.
• Each scenario requires a diagnosis, referral, and plan.

Recap of Diagnostic and Referral Plan

Diagnosis

• Bilateral moderate conductive hearing loss with Type B tympanograms indicating abnormal middle ear function.

Referral

• ENT for medical management.
• Speech therapy referral should be considered, but implement after medical interventions.

Plan

• Follow up testing after medical management.

Importance of Posting Slides on Blackboard

• Slides should be posted on Blackboard under the "Activity" section.

Case Study: Eight-Year-Old from Mexico with Suspected Hearing Loss

• Background:
  • The student placed in second grade has minimal educational information and does not speak English.
  • Moved from Mexico in the fall.
  • Report from a hospital suggesting bilateral profound sensorineural hearing loss.
• SAT (Speech Awareness Threshold) used because regular speech threshold testing wasn't possible due to language barriers.
• Ling sounds (ah, oo, ee, sh, s, m) used to test hearing across the speech banana
• Family history of deafness on the mother's side. Genetic syndrome looking things. Noted after initial evaluation. The history pieced together afterwards.

Testing and Observations

• Modified pure-tone assessment due to discomfort with headphones.
• Otooscopy revealed excessive cerumen in the right ear, but the tympanic membrane was partially visible.
• Emittance testing (tympanometry) was not available in the testing environment.
• Callie (SLP) introduced signing and the student responded well, indicating potential prior exposure.

Recommendations

• Consultation/evaluation with a Teacher of the Deaf (TOD).
• Speech-language evaluation.
• Further assessment in a more controlled environment.

Further Interventions

• The school psychologist conducted a non-verbal IQ test.
• Speech therapist will soon also evaluate.
• SLPs will provide the auditory training, and it is a positive sign that he is recognizing the auditory information. The more auditory development that occurs, the better! These students may pick up on auditory cues and recognize the auditory vocabulary even if they are in the classroom.

Minimal Pairs

• Minimal pairs such as "ba" and "da" can be contrasted and presented behind the screen to test discriminating the student to test discriminations.

Subject History

• Limited medical and educational history.
• Bilateral profound hearing loss based on a translated report. Some uncertainty in the accuracy of the Google translated report..
• Recommendations include a consolidation or evaluation of the teacher of the deaf, full learning study, and follow up assessment.

Importance of Case History

• Essential for understanding when to refer patients.
• Helps you to save a lot of time and helps guide your approach toward the treatment.
• Case histories also could bring about further questions in which you would further investigate.

Case History Forms

• Use a case history to collect the information needed to get to a valid approach to treat. Use case history questionnaires to generate a general guideline of what to ask.
• Consists of Reason for referral, medical references, and limited education history. Need to understand multicultural aspects and what their history looks like.
• General questions to ask include why the patient is coming in and what is their goal, and what is going on.

Pediatric Specific Questions

• Prenatal and birth history like the mother's health and any complications.
• Developmental history like milestones and speech therapy history provide great insight on the whole view of what is going on.

Referral Red Flags

• Asymmetrical hearing loss.
• Conductive or retrocochlear hearing loss.
• Any congenital hearing loss.
• Medical clearance will also be needed before referring a patient for hearing aids in pediatrics.
• Family history of hearing loss.

HIPAA

• A signed HIIPA is used to share references on records. In order to relay records you you must get a patient or care giver to sign it.

Report Guidelines

• First report patient identification, patient history, reason for referral that they came to you. What you found for a solution, and a treatment plan.
• Utilize the SOAP method.

Specialities to Refer To

• ENT for medical concerns.
• Audiology for issues that can stem to a flat Tympanogram. And it’s asymmetrical. Horrible discriminator. Or potential for a retrococlear issue. And to send to for an MRI.
• Genetic counselors or just based on the parental information they might do testing to further investigate.

Other Specialities to Refer to

• Speech Pathologist due to ENS following hearing issues.
• Peditriciran to monitor any tubes placed for hearing due to surgery.
• Psychologist to deal with elderly patients that exhibit other external issues, or diagnosed issues in kids.

Public Law 94-142

• A precursor to IDEA, which said that all children had a right to a free public education and most appropriate educational development. It has to be in the least restrictive environment (LRE). This all stems from this.
• These all ensure that educational development matches their social development that they are with their peers and siblings close to the children. And allows for the best academic environment for them.
• There are things that need to be looked at in which to challenge the children, place them in the correct classrooms with the right environment to get all the assistance they can get.

Preferential Seating

• Placing the students in the most optimum setting that isn’t necessarily front and center but can be off to the side can allow for optimum hearing of the instructor. For instance, a high school student had two implants and would ask for seating chart so she knows where to look when everyone is contributing.
• Even with deaf implant, they are mild so the teachers always need to be notified to keep an eye on them for awareness of how hard they have to work.

Personal Amplication System

• Worn around the neck that is blue tooth compatible that allows the teacher’s voice to enhance more clearly. Usually the teachers voice will amplify around.

Individualized Education Program

• IEPs also stem from the 94-142 PL. Children in that environment had those children that are handicapped put in the basement. Children who came to school that have disabilities were sent to the lake to county school. There is now a strict guideline of two to three years the age difference. It is building modifications like wheel chair ramps and more.

AuD Rehab

• Involves therapy the patients are going to get and education on the needs communication strategies and education to the patients. The best thing to explain is the Audigram. Explain to them with the hearing means to them.
• Avoid a lot of jargon with and explain what the causes are going to be. More understanding helps them get the information they want. And they should give a strategy to help them out. What is an inventory and is a self guided inventory. A lot of information is provided after those as well. There can be many reasons too why therapy works that is where they are coming from and the way they deal with it.
• Emotional response or handicap, it depends on the psychological interaction if it is going to be positive or negative. Rehab focuses on that concept and deals with more than hearing. People with hearing users may have a misconception. It is basically not going to the doctor and having that “glasses “ treatment. It it more than that and you will have to deal with communication.

Communication Skills for kids

• Start the communication for kid skills to advocate for themselves and not just by adults advocate for them to go see what is what. Reduce the effect of background noise. And it will assist patients to give strategy to assist them overall.
• Adult is strategic placement in restaurants that helps reduce the stress in high frequency levels. Auditory retraining may be helpful where adults may have to refresher how to listen depending the reason that is happening.

Geriatric Issues

• Hearing loss cognitive issues such as thinking that is worsen or loss. Also. Declines in vision and Dexterity has to be considered to get a solution and support to the treatment.

Types of Hearing Loss During Life

• Two important terms are perilingual and post lingual in which the impact on communication matters in the development. These terms are important to ask because they are factors in life. There are considerations that are important because some people can be implanted bilaterally or implanted at certain stages. Some intervention can change all points of what one will learn and when they can learn.

Auditory Processing and Complicating Factors

• Auditory is how one reacts to auditory as well as other neurodivergent people can influence. Auditory neuropathy is when they explain that it does something and one can be interrupted. Developmental issues can also stem from auditory issues. Development is more important that reevaluation. The most that the audiology does impact or manage is listening and helping the environment to improve. The remote preference also can make a huge difference in improving the listening experience.

Diverse Culture

• Respect and understand culture based on beliefs or diversity. Understand the deaf community and ASL community they believe in the code and belief. It is about more than just a genetic component. It is mostly about culture. Capital the code means if they are caught up in their community. Smaller codes mean it’s just the diagnosis that they are in. The diversity of those practices matter how the code operates.

Assignment Expectations

• There will be four assignments next week in which you are meant to diagnose and figure out where you would refer and what your plan would entail. What that means is reevaluation and when they go. To make sure what to do in the moment.

Scenario Expectations

• Next week I the lecture will give you this extra sheet with all this extra information, along with your usual description on your audios. And all these configurations that has been said. Type a b indicates that it’s flat. Has no movement on the eras.

Scenario One: 78 Year Old Female

Background

• Complaint is difficult taking over room young people, Mumbo and no significant history and just that, a loss over certain years. And especially I the social study setting. No significant history and decreased hearing over several years especially I am in the social settings. A type A diagram. In that decent speech discrimination and good ride here borderline for all 78-year-old old. Good in the right ear, borderline excellent in the left ear. And excellent score for a age woman.

Diagnosis

• The code that will be at related for what the patient is saying. Bilateral Sloping mild to severe sensory normal hearing loss. Or high frequency loss. With good with a good speech discrimination.

Referrals

• ENT to see what the issue is. A hearing me out in relation to see what is what she wants for assistance and a primary to get medical clearance.

Plan

• She will need medical clearance if it is due to a hearing issue.

Scenario Two: 40 Year Old Female

Background

• Reports that she is experiencing Tinidis that decreased in hearing in left ear over the last six months. She also says that she is also having recreational noise exposure history. And type at that the patient gram it's normal. And has her and speech discriminations which is just oof.

Diagnosis

• AD and AS code is AD stands for right ear and AS stand for left ear. And Au standards for. Code AD in the right year there's normal reading code left there's a mile to 7 years sensory neural with good speech discriminations.

Referrals

• An ENT referral is needed that needs to check what has happened. She will need to go back there because there is a code what about 4 speech to create about that point. The plan will all be follow with medical management.
• Some people will potentially also experience like mini years depending on how often she also has a fluctuating. And that will also need to discussed and addressed.

Background

There is someone that would tell how the Tele cent neural has operated. There can also me some hearing aid that could also have assisted.

Scenario Three: 42 Year Old Male

Background

• The male can be a candidate to give her something that and it works depending on personal what they want. This person explains they can be can be a candidate dependent and also says that he works and what parts of the code of noise. 42 Year old code and complains with Genesis that decrease and hearing. Also worked to an auto body shop 20 plus years.

Diagnosis

** **Speech History code And the type a code and just type up the grand it's a normal. There is a normal setting. Also the person I has excellent. I mean speech discriminations
Also this person worked for more than 20 20 years in audio body shop which there could be a component to cause their problems. There needs to be investigation what is has happened. The diagnosis the code will be by what and there is no much what it that looks like. The there is no 2000 Hertz there is what would say excellent speech

History

• Excellent street what it should be noted as code and it's it's that. There are two types with the same exact thing. And the ENT can look where the potential hearing. What has happened throughout their ears. Also say will be said medical the air

Plan

• The plan will also be a code in which you get with the. There will be codes for these medical things on the plan