1. BSHAA Professional Development Meeting 13th September 2014 Manchester
Rory Kewney HAD FSHAA PGCert (HE) FHEA

2. Speech in Noise Tests – Why, What and How!
How should you assess whether your client is likely to be able to hear in noise with the hearing aid system you recommend? Why do cancellations happen despite your best efforts with the very latest technology available? What can help you personalise your rehabilitation planning more precisely? Speech in noise tests can help compensate for what the pure tone audiogram cannot tell you. Rory will be explaining why you should be using the Quick SIN and ANL tests as a routine part of your pre-fitting assessment.

3. Patient Centred Approach?
Patient centred care is about much more than simply educating patients about a diagnosis, potential treatment, or behaviour. It does not mean giving patients whatever they want Patients want guidance from their care providers, but they expect that guidance to be provided in the context of full and unbiased information about options, benefits and limitations.

4. Hearing Assessment Patient centred approach
Assess the patients’ willingness to commit to a new auditory care plan
Assess how the patient and the support are affected by the auditory damage
Fully assess the patient for damage to their entire auditory system
Explain the outcome and implications of each assessment
Involve the patient and the support in choosing their care pathway
Empower the patient to take control of their rehabilitation

5. Hearing Assessment
Typical consultations are simply NOT enough to enable us to provide a patient centred approach. We MUST do more if we are to achieve what our patients demand and deserve. If we want to provide that patient centred approach, we need to understand the patient and their specific challenges and capabilities.

6. Hearing Assessment
Assess the patients’ willingness to commit to a new care plan
Tools from IDA Institute such as the line and the box
Assess how the patient and the support are affected
COSI, GHAB, THI, TELEGRAM or any other questionnaire designed to reveal the impact to the patient and support
3. Fully assess the patient for damage to their ENTIRE auditory system

7. Hearing Assessment Entire Auditory System Peripheral sensitivity
Speech recognition
Speech discrimination in noise
Squelch effect (annoyance from background noise)
Non response to amplification

8. Hearing Assessment
We should integrate into our standard practice the following test sequence
PTA
Unaided Word Recognition Scores
Quick SIN
ANL
Aided Word Recognition Scores
Real Ear Measurement
LACE

9. Hearing Assessment Peripheral sensitivity Speech recognition
Carry out PTA
Speech recognition
Unaided Word Recognition Test
Speech discrimination in noise
Quick SIN
Squelch effect (annoyance from background noise)
ANL
Non response to amplification
Aided Word Recognition Test

10. Hearing Assessment
PTA – Threshold definition Unaided WRS – Using AB word lists, presented free field through a loud speaker at approximately 75dBSPL. Score each word correct Quick SIN – Using pre-recorded, calibrated material presented at varying SNR patient repeats sentences, score on key words correct. Presented via headphones at 70dBHL ANL – Using pre-recorded material measure MCL, BNL and calculate ANL Aided WRS – Using AB word lists, presented free field through a loud speaker at the same level used earlier (75dBSPL) score each word correct

11. Hearing Assessment
Quick SIN in more detail Etymotic research have produced a CD containing all the sound tracks required to measure the SNR loss of a patient. You will need an audiometer capable of handling an external input or have something like and OTOSPHERE/Callisto. Simply play the track to the patient and score the words correct Simples!!

12. Hearing Assessment
Lets have a go! Everyone take a pen a piece of paper Write down what you hear Do NOT confer with anyone Quick SIN

13. Hearing Assessment
1. Dots of light betrayed the black cat S/NR 25 _____
2. Put the chart on the mantel and tack it down S/NR 20 _____
3. The steady drip is worse than a drenching rain. S/NR 15 _____
4. A flat pack takes less luggage space. S/NR 10 _____
5. The gloss on top made it unfit to read S/NR 5 _____
6. Seven seals were stamped on great sheets S/NR 0 _____
Total _____
TOTAL = ________ SNR Loss

14. Hearing Assessment

15. Hearing Assessment

16. Hearing Assessment
ANL in more detail A speech passage is played through channel 1 and set in 1dB steps to a level the patient identifies as most comfortable. This is recorded as MCL A competing backround noise is then introduced through channel 2 and adjusted in 1dB steps until the patient identifies as as loud as they would like it whilst listening to the passage for a along duration without it becoming fatiguing. This is recorded as BNL ANL = MCL - BNL

17. Hearing Assessment

18. Hearing Assessment Patient centred approach
Assess the patients’ willingness to commit to a new auditory care plan
Assess how the patient and the support are affected by the auditory damage
Fully assess the patient for damage to their entire auditory system
Explain the outcome and implications of each assessment
Involve the patient and the support in choosing their care pathway
Empower the patient to take control of their rehabilitation

19. Hearing Assessment PTA – You are not deaf
UWRS – you have lost speech discrimination
Quick SIN – You need help separating the sounds you want from the sounds you don’t want
ANL – you find background sounds annoying and distracting from the sounds you want to listen to

20. Hearing Assessment
ANL and Quick SIN are good stablemates and work together to give us a very good indicator of challenges that a patient may present with their care pathway. Quick SIN reveals the SNR required for a patient to hear 50% of the words correct ANL reveals the annoyance that background noises present to a patient.

21. Hearing Assessment
If we plot these two indicators an a graph using Quick SIN as the X-axis and ANL on the Y-axis intersecting at 7dB on both scales. We have a very useful matrix which is easy for patients to understand which guides the care plan and highlights challenges both technically for us and psychologically for the patient. This is what Brian Taylor has described as the RED FLAG MATRIX

22. Hearing Assessment RED FLAG MATRIX Aided target Area Q1 In the Clear20
Q2 RED FLAG for Annoyance Difficulties 15
Q3 RED FLAG for Intelligibility in noise and Annoyance 10 5
Q4 RED FLAG for Intelligibility in noise -5
ANL
Q1 In the Clear
QuickSIN
Aided target
Area

23. Hearing Assessment
By adopting these 5 assessment tools we are able to provide the patient with information to enable them to make an informed decision. We do NOT over promise because we understand the extent of the damage and the limitations this will cause We know what technologies are required and how to manipulate them for best effect for an individual patient We have engaged them in the choice of their care pathway

24. Hearing Assessment Patient centred approach
Assess the patients’ willingness to commit to a new auditory care plan
Assess how the patient and the support are affected by the auditory damage
Fully assess the patient for damage to their entire auditory system
Explain the outcome and implications of each assessment
Involve the patient and the support in choosing their care pathway
Empower the patient to take control of their rehabilitation
We will be looking auditory training programmes next time!!!!

25. Hearing Assessment
How Complicated is it? I am NOT promoting any specific equipment but we have chosen the Otovation Otosphere. It has all these tests imbedded within the software and a very user and patient friendly interface.