Title: 5.2 Lesson Five Lecture
Course: 14SU-HIS-230-GH101-ADVANCED AUDIOMETRY > Section: Lessons

Lesson Five Lecture

Here are the main topics we will cover this week:

- Tinnitus
- Hyperacusis
- Unilateral Hearing Loss

Tinnitus

You will see quite a few clients that will report ringing or other noises in their ears.  Some will not seem to be too bothered by it but there will be others who are very disturbed by these sounds.  Clients will report it sounding like ringing, buzzing, chirping, whistling, a pulsating sound, clicking, etc.  Most people have experienced tinnitus at one time or another.  While the exact cause isn’t known in a lot of cases, it is very real.  Tinnitus is a symptom that is common to many problems.  Some of the causes include:

- Hearing Loss
- Meniere’s disease
- Noise exposure
- Migraine headaches
- Head injury
- Certain medications
- Hypertension
- Stress
- Certain types of tumors
- Excessive caffeine
- Smoking cigarettes

Many people also report their tinnitus is worse at night because it is quite.  The noise of the day can make the person less aware of their tinnitus.  At night when it is quite they are more bothered.  There are some audiologists and medical clinics that specialize in tinnitus evaluation and therapy.  Many treatments have been tried over the years but there is not one treatment that has been found to be the best or will work for every individual who tries it. There have been many treatments that have come and gone over the years.  You have probably even seen the TV commercials for the “miracle” over the counter drugs you can order to stop tinnitus.  Some of the most common treatments include:

- Biofeedback
- Hypnosis
- Relaxation therapy
- Counseling
- Habituation therapies
- Tinnitus maskers
- Sound machines

When hearing loss is present many people with tinnitus can be helped when hearing instruments are fit.  Of the people with tinnitus who are fit with hearing instruments around 50% will have their tinnitus suppressed by the hearing instruments at least while they are wearing the instruments.  As the bandwidth of hearing instruments has gotten better, hearing instruments seem to be suppressing tinnitus better.

Hyperacusis

The more hearing test you complete the more likely you are to find someone who is very sensitive to sound.  It isn’t something you will see often but it will happen at some point.  You may even wonder if it is real.  It is a real phenomenon and can affect the person’s life greatly.

Some individuals with this condition have been known to use ear plugs to help them deal with the sounds in their environments.  Some causes of hyperacusis include:

- Noise trauma
- Head injuries
- Autism
- Meniere’s Disease

There is a lot more that needs to be learned about this condition.  Some individuals have been helped by desensitization exercises over a period of time.

Unilateral Hearing Loss

If you are testing a lot of people on a regular basis you will see unilateral hearing loss.  It will come in all types: sensorineural HL, mixed HL and conductive HL.  It is also one of the reasons you need to feel very comfortable with masking and learn to do it well.  There are several potential causes for unilateral hearing loss:

- genetic or hereditary
- outer, middle or inner ear conditions
- Meniere’s Disease
- Infections
- Certain illnesses
- head injury
- noise exposure
- acoustic trauma
- potential retrocochlear lesions

If you find a client has unilateral hearing loss in most cases you will want to make a medical referral.  The exception to that would be someone who has had a longstanding unilateral hearing loss and has previously worn a hearing instrument on their better ear.  Some would argue that you don’t need to refer a longstanding unilateral hearing loss if the client has no other symptoms.  I have always been more careful with unilateral hearing loss because of the potential causes.  There are many different environments you may find yourself working in after you obtain your license.  Some people may think that if you are working in a free standing hearing aid office or chain you probably won’t see many people who would need to be referred.  This has not been my experience.  As a young audiologist I first worked in a hospital and then found myself managing a group of retail hearing aid offices.  At that point I only had four years of experience.  I had been fitting hearing instruments all that time but it was still a lot to take on!  In the offices I managed I saw many medical situations I would never had thought about.  Draining infected ears, unilateral hearing loss- potentially acoustic neuromas, otosclerosis and the list goes on!  The point is you need to be prepared and know when to refer.  Establishing a good referral relationship will benefit you, your patients and your reputation.

As you start to be able to put everything together you can see there is a lot to take in and understand!  Making sure you have a good grasp on the various components of the hearing evaluation and masking are the basis for making a good recommendation for amplification, having a successful fitting and a satisfied client.

Let’s go back to the components of the hearing evaluation you have learned:

- Case History
- Otoscopy
- Pure tone air & bone conduction
- Speech Reception Thresholds
- Speech Recognition Testing
- Most Comfortable Loudness Levels
- Uncomfortable Loudness Levels
- QuickSIN
- Acceptable Noise Level

We will add one more test next week- tympanograms and ipsilateral acoustic reflexes.  Most hearing instrument specialists in Missouri and Kansas do not do these tests on a regular basis but you can.  So we want you to know what they are and the potential benefits of these tests.  If any of you decide to go on for a degree in audiology you will need to know more about these tests.  In week seven we will review a few other tests and topics for information purposes.

You have learned a lot in the two audiometry classes!  I know some of it still seems a bit overwhelming but it will get easier with practice.  The best advice I can give you is to keep practicing and learning.  Be willing to take the time to learn to do these tests well and don’t take shortcuts.  We are half way there!  Hang in there!  You are all doing great!

Attached Files: | - HIS Advanced Audiometry Lesson Five Lecture.docx