audiology should be about meeting patient needs, not selling hearing aids...

 
Audiology and evidence based practice

Audiology is the science of hearing. Clinical audiologists provide diagnostic, and rehabilitative services to patients with hearing and communication problems.

 

Evidence based practice is the idea that to provide the best outcomes for patients, we must use a combination of the most up to date scientific evidence combined with the clinicians experience, mediated by the patients desires and concerns.

 
Hearing assessment

What can you expect at a hearing assessment?

A normal assessment entails a case history, visual inspection of the ear (otoscopic investigation), an assessment of the ear drum and integrity of the ossicular chain (tympanometry and acoustic reflexes), and an assessment of hearing thresholds (audiometry). 

 

None of the assessments are painful. 

 

Active participation is required for the audiometry, adults will be asked to listed for a tone and press a button when they hear a sound (even for the soft ones), children will be asked to play a game instead of pressing a button. 

 

Other assessments can be utilised as needed. 

 

Discussion of the results is an integral part of the assessment, understanding your hearing loss allows you to make informed decisions about your rehabilitation.  

 

 
Hearing aids

Most hard of hearing people will have a real variety of choices which is good, but also makes decision making more difficult.

Styles range from tiny invisible in-the-canal models, to miniature behind-the-ear devices, to the traditional and powerful models 

Most hard of hearing people will have a real variety of choices which is good, but also makes decision making more difficult.

Styles range from tiny invisible in-the-canal models, to miniature behind-the-ear devices, to the traditional and powerful models

 

Hearing aid features are effective but complicated, costs vary significantly by features so it's important to understand them.   

Features
Adjustability:

Refers to how many controls are available for the audiologist to adjust and tweak the hearing aid for your hearing

Automaticity: 

some aids automatically adjust themselves to the environment in a sophisticated way, some in a more basic fashion 

Noise reduction:

Hearing in noise is one of the most difficult situations for a person who is hard of hearing. Some hearing aids have more basic noise reduction features, some very sophisticated.

Connectivity and extras:

Can the aid connect to a mobile phone, a wireless microphone system, a telecoil system? Does the aid allow a clinician to remotely adjust the hearing aid via your phone? Are other health monitoring features included (step counters, patient informatics on aid use, etc).  

Evidence Base 

Modest. 

Sufficient control is available in entry level devices to meet most needs.

Strong. 

Modern hearing aid algorithms can successfully identify many environments that the user is in and adjust themselves accordingly

Strong *

Directional microphones are a key proven technology for improving performance in background noise. 

*Noise reduction algorithms may help with comfort in noise but probably not speech understanding

Mixed

For some people streaming audio from the phone is highly desirable and works very well. For others there is limited need and so limited benefit. Similarly other extra features may suite certain client groups but not all

 
Hearing implants

There are two categories of hearing implants, those which aim to aid those with sensorineural or nerve hearing loss, and those which aim to aid those with conductive or mechanical hearing loss. 

Cochlear implants and brainstem implants are used in those whose inner ear (Cochlea) or hearing nerve are very badly damaged. As hearing loss increases, performance with hearing aids decreases, at a certain point we can identify that a cochlear implant will provide superior performance. The devices consist of two components; an electrode threaded into the inner ear, and an external processor which picks up sound and transmits the signal into the electrode. The electrode creates small pulses of electricity in the inner ear which travel via the hearing nerve to the brain, and are interpreted as sound. 

 

Bone anchored hearing devices are utilised when the Cochlea or hearing nerve is relatively healthy, but the mechanical system (middle ear) is damaged. Bone anchored devices vary, but generally an external processor picks up the sound and sends it via tiny mechanical vibrations to an implanted magnet or abutment (screw). The vibrations then make thier way directly to the inner ear (Cochlea) creating the sensation of sound.     

 
Rehabilitation

A hearing aid or implantable device makes up only a part of the process of hearing rehabilitation.

 

The correct fitting, and adjustment of the device are essential. 

Clients must be also be counselled on how to maintain and utilise the device to obtain the maximal benefit.

 

Auditory training may also be utilised to obtain maximal benefit. This might include  the use of speech/speech in noise training and practice utilising tactics in a simulated listening environment.

 
Tinnitus

Tinnitus is the sensation of sound when no external sound is present. Tinnitus can be generated by a damaged ear, or nerve, or at the level of the brain, and sometimes at mutliple locations. 

For many tinnitus is more of minor annoyance, but for some it can be quite distressing, particularly when trying to sleep, or relax. 

Often tinnitus is coupled with hearing loss, and for many hearing aids or cochlear implants can help control tinnitus. Hearing aids often come with tinnitus distraction features which can aid to reduce the tinnitus sensation. 

For some a specific tinnitus therapy is required. Several therapies with proven benefits exist. Whilst these therapies often to not completely "cure" the tinnitus, for many they can make it very manageable. Two example therapies are Tinnitus Retraining Therapy (TRT) and Neuromonics. 

John Newall, BSc, MClinAud, PhD 

For any questions you have, you can reach me here:

Contact Me

Suite 10 Westmead Private Hospital 

Westmead NSW 2145

Phn: +61296351030

  • Black LinkedIn Icon
  • Black Twitter Icon

© 2019 Evidence Based Audiology. Proudly created with Wix.com