1. Diagnostic and Rehabilitative Audiology Danielle Rose, Au.D. Clinical Audiologist Vanderbilt Bill Wilkerson Center

2. 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

3. Diagnostic Audiology Diagnosing Hearing Loss –Managing screening programs –Routine outpatient audiometrics –Otoacoustic Emissions testing –Auditory evoked response testing –Immittance testing –Speech understanding testing

4. Diagnostic Audiology Balance Function Testing –Vestibular system evaluation (ENG) –Rotary chair testing –Risk of falls evaluations –Vestibular Evoked Myogenic Potential (VEMP)

5. 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)

6. 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)

7. 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

8. 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

9. 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)

10. Genetic Causes of Hearing Loss Non-syndromic HL accounts for 70% of genetic deafness –22% is dominantly inherited –77% is recessively inherited

11. Infectious Disease Can occur pre-, peri- or post-natally STORCH Complex: –Syphilis –Toxoplasmosis –Other –Rubella –Cytomegalovirus –Herpes Simplex

12. 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)

13. Hearing Assessment in Children Birth to 6 months –Auditory Brainstem Response (ABR) –Otoacoustic Emissions Testing –Immittance Testing

14. 6 months to 2 years –Visual Reinforcement Audiometry (VRA) –Immittance Testing Tympanometry Acoustic reflex testing –Otoacoustic Emissions Testing

15. 2 to 4 years –Conditioned Play Audiometry (CPA) –Tangible Reinforcement Operant Conditioning Audiometry (TROCA) –Immittance Testing Tympanometry Acoustic reflex testing –Otoacoustic Emissions Testing

16. 5 years and older –Conventional pure tone audiometry –Immittance Testing Tympanometry Acoustic reflex testing –Otoacoustic Emissions Testing

17. Types of Hearing Loss Conductive: Middle Ear, Otosclerosis, Tympanic Membrane, Cerumen impaction Sensory- Noise-induced, ototoxicity, genetic, presbycusis Neural- Auditory Neuropathy, Tumors of the 8 th cranial nerve, demylinating disorders Sensorineural

18. Rehabilitative Audiology Cochlear Implants –Candidacy evaluations –Initial stimulation –Mapping and remapping –Aural habilitation/rehabilitation

19. Rehabilitative Audiology Hearing aids –Candidacy evaluation –Fitting –Follow-up –Re-evaluation

20. 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

21. Sensorineural hearing loss

22. 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

23. 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