Chapter 3: Setting the Hearing Aid Response and Verifying Signal Processing and Features in the Test Box.

The test box can be used for fitting hearing aids (verifying audibility for the individual), for setting and fine-tuning specific signal processing (e.g., directional microphones, noise reduction, frequency lowering, telecoil responses), and for setting the response for specific accessories (e.g., remote microphones). If you have selected these features for your patient, it is important to make sure they are working properly and turned on. In addition, these tests can help you address specific patient complaints. Let us start by using the test box to pre-set a hearing aid and then we will move on to speech tests of signal processing and features.

Chapter 4: Introduction and Getting Ready for Real-Ear Probe Microphone Measures.

Probe microphone measurements are an essential step in an individualized hearing aid fitting. These measurements allow audiologists to account for the individual's hearing and ear canal acoustics when programming hearing aids. An evidence-based hearing aid fitting includes matching the measured output of the hearing aids to targets for each input level and frequency. This allows the audiologist to confidently counsel the patient that the acoustic fitting is accurate, and the next step is for the individual to use the amplification during all waking hours to adapt to the newly amplified sounds. This also avoids mistakes such as overamplification or insufficient gain, which can endanger the patient and/or lead to a compromised fitting.

Chapter 2: My Hearing Aid Isn't Working Like It Used to .

This chapter will take you through specific patient complaints and the test box measures you can use to address these complaints. These measurements give you data that aid in your decision making about what is wrong, if anything, with the hearing aid and how you might address the problem. Before we discuss specific patient complaints and problems, let us review the American National Standard Institute (ANSI) guidelines for hearing aid testing in a test box.

Chapter 5: Setting the Hearing Aid Response and Verifying Signal Processing and Features with Real-Ear Probe Microphone Measures.

The real-ear probe microphone system provides a powerful tool to individual hearing aid fittings accounting for your patient's hearing and ear canal characteristics. The primary treatment for hearing loss is audibility, returning an audible signal across frequencies and input levels given the constraints of the hearing loss. This chapter will provide detailed information on the measures needed to individualize the hearing aid fitting and will present various clinical scenarios that will allow you to work with this information and see how you apply this knowledge clinically. You will explore the verification of signal processing and features that allow you to support your patients.

Chapter 6: What Else Can I Do with This Equipment?

If there is sound in the ear canal, you can measure it with a probe microphone in the ear. The following are a few examples of how you might use your real-ear probe microphone measures beyond verifying hearing aid fittings, signal processing, and function of features. A process to simulate hearing loss to educate and support family members and patients is described.

Chapter 1: Introduction and Getting Ready for Hearing Aid Test Box Measures.

In this chapter you will be introduced to the hearing aid test box equipment and work through how to prepare the equipment so that it is ready to provide the testing you will use to evaluate, fit, and troubleshoot hearing aids and other amplifiers. At the end of this chapter, you will be familiar with terminology associated with hearing aid test box measures and the leveling required with the reference microphone and coupler microphone to ensure that your measurements are accurate and can be interpreted.

Barriers to Hearing Health Care for Aging Adults: Reframing the Conversation.

Untreated age-related hearing loss (ARHL) is associated with poor health and social outcomes. Treating hearing loss can mitigate these serious issues. Although there are documented barriers to care, we can look at these barriers and potential solutions differently if we view ARHL as a gradual onset, chronic condition. This provides a framework from which to solve problems in line with how other chronic health conditions experienced by aging adults are approached. With this lens, it becomes evident that early identification and treatment of ARHL can be supported by universal senior hearing screening, appropriate Medicare coverage for devices and services, and direct access to audiological care as well as avenues for self-care are necessary ingredients to change the hearing health care landscape.

Hearing screening and amplifier uptake results in a multidisciplinary head and neck cancer survivorship clinic.

PURPOSE: Hearing loss and tinnitus are prevalent among survivors of head and neck cancer (HNC), but auditory issues are under-addressed in the survivorship literature. The purpose of this study was to describe the hearing loss and management experience of a group of survivors provided with a hearing screening and amplifier assistance if needed during their visit. METHODS: A retrospective chart review of 1176 individuals seen in the HNC Survivorship Clinic between December 2016 and October 2020 who interacted with audiology was performed. RESULTS: Of these survivors, 72% failed the 30-dB HL hearing screening at one or more frequencies. Thirty-three percent of the sample reported tinnitus. Consistent with the general population, this group has a low prevalence of hearing aid use. In this clinic, individuals who fail the hearing screening at all frequencies are offered a simple, non-custom amplifier for use during their visit. Thirty-one percent of individuals offered the amplifier used it during their Survivorship Clinic visit to enhance communication and reduce listening effort. Only 54% of individuals who failed the hearing screening self-reported hearing loss. The poor sensitivity and specificity associated with the self-perception of hearing loss data support the need for hearing screening that consists of responding to tones. Of individuals who received a recommendation for a comprehensive hearing test, 21% received a hearing test with 68% of these individuals receiving the hearing test the same day of their Survivorship Clinic visit. CONCLUSIONS: The data from 1176 survivors of HNC seen by audiology over the past few years as part of the UPMC HNC Survivorship Clinic support the need for hearing management in this population to improve communication during and after the Survivorship Clinic visit. IMPLICATIONS FOR CANCER SURVIVORS: Survivors of HNC have a high prevalence of greater than mild hearing loss and tinnitus (both issues known to negatively impact health-related communication and quality of life). This manuscript describes a hearing screening program within a Survivorship Clinic that identifies individuals in need of non-custom amplification during their appointment to support effective communication. Survivors should be referred to audiologists for evaluation and management of treatment-related issues of hearing.

Evaluation and Management of Misophonia Using a Hybrid Telecare Approach: A Case Report.

Decreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, longstanding misophonia. Her evaluation included comprehensive audiometric testing (including uncomfortable loudness levels) and a detailed assessment of the impact of DST on her life. She enrolled in tinnitus retraining therapy and began receiving treatment aiming to facilitate habituation of bothersome environmental sounds. This case was complicated by the advent of the coronavirus disease 2019 (COVID-19) pandemic and a telemedicine hybrid approach was employed to increase access to audiologic care. Using this structure, some appointments occurred in person in the clinic and others occurred via a telemedicine video visit format. Telemedicine video visits facilitated in-depth discussions, afforded the opportunity to answer questions, and provided the option of cloud-based remote programming of on-ear devices. Future care will continue to employ a hybrid approach.

Smartphones and Hearing Loss: There's an App for That!

Smartphone use has become increasingly prevalent and patients are frequently using this technology to engage in health-related activities. There are a variety of smartphone applications that can be used to assist individuals with hearing loss, particularly during extreme situations such as a global pandemic which results in restricted face-to-face interactions. The hearing-related applications can be divided into four categories: (1) screening and assessment, (2) intervention and rehabilitation, (3) education and information, and (4) assistive tools. Several subcategories of applications in the assistive tools category are described that may be of interest to individuals with hearing loss, whether they wear hearing aids or not. Examples of the apps along with links are included for each subcategory.

Towards a Mechanistic-Driven Precision Medicine Approach for Tinnitus.

In this position review, we propose to establish a path for replacing the empirical classification of tinnitus with a taxonomy from precision medicine. The goal of a classification system is to understand the inherent heterogeneity of individuals experiencing and suffering from tinnitus and to identify what differentiates potential subgroups. Identification of different patient subgroups with distinct audiological, psychophysical, and neurophysiological characteristics will facilitate the management of patients with tinnitus as well as the design and execution of drug development and clinical trials, which, for the most part, have not yielded conclusive results. An alternative outcome of a precision medicine approach in tinnitus would be that additional mechanistic phenotyping might not lead to the identification of distinct drivers in each individual, but instead, it might reveal that each individual may display a quantitative blend of causal factors. Therefore, a precision medicine approach towards identifying these causal factors might not lead to subtyping these patients but may instead highlight causal pathways that can be manipulated for therapeutic gain. These two outcomes are not mutually exclusive, and no matter what the final outcome is, a mechanistic-driven precision medicine approach is a win-win approach for advancing tinnitus research and treatment. Although there are several controversies and inconsistencies in the tinnitus field, which will not be discussed here, we will give a few examples, as to how the field can move forward by exploring the major neurophysiological tinnitus models, mostly by taking advantage of the common features supported by all of the models. Our position stems from the central concept that, as a field, we can and must do more to bring studies of mechanisms into the realm of neuroscience.

Recognizing and Reacting to Risk Signs for Patient Suicide.

Evidence-based suggestions for developing an effective clinician-client relationship built upon trust and honesty will be shared, as well as a review of relevant scope of practice issues for audiologists. Audiologists need to be prepared if a patient threatens self-harm. Many patients do not spontaneously report their suicidal thoughts and intentions to their care providers, so we need to be alert to warning signs. Information about the strongest predictors of suicide, how to ask about suicidal intentions, and how to assess the risk of suicide will be presented. Although it is our responsibility to recognize suicidal tendencies and have a plan for preventive intervention, it is not our responsibility to conduct a suicide evaluation. Tips for collecting critical information to be provided to qualified professionals will be shared, as well as additional information about how and to whom to disclose this information. A list of suicide warning signs will be reviewed as well as some additional suggestions for how to react when a patient discloses his or her suicidal intent. A review of available resources (for both the patient and the clinician) will be provided, along with instructions for how and when it is appropriate to access them.

The Effect of Outpatient Interventional Audiology on Inpatient Audiology Services.

Although older adults are likely to experience some degree of hearing loss that if untreated will interfere with treatment for other disorders and result in less-than-optimal health care outcomes, health care providers do not have a reliable and cost-effective way to identify these individuals when admitted to a hospital for inpatient care. This article addresses the impact of untreated hearing loss on health care in a hospital setting and shares how the implementation of interventional audiology in an outpatient clinic has impacted the inpatient audiology services provided at a large tertiary care hospital. A discussion of how these services can be further expanded is provided.

The Role of Audiology in an Outpatient Interdisciplinary Post-Trauma Clinic.

Patients in the process of recovering from severe bodily injury will encounter several barriers to effective treatment. When present, untreated hearing loss can create additional obstacles in a process that is already difficult. This article describes an outpatient post-trauma clinic associated with a tertiary care hospital trauma unit that consolidates rehabilitation resources 2 weeks after inpatient discharge to help these patients on their path to recovery. The role of audiology in the interdisciplinary clinic is described and data related to services are presented. Some practical tips for implementation of audiologic services in this type of environment are provided.