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Audiology Staff At 3rd Edition contributions from and compilation by the VA Audiology staff at Mountain Home, Tennessee with contributions from the VA Audiology staffs at Long Beach, California and Nashville, Tennessee Department of Veterans Affairs Spring, 2009 TABLE OF CONTENTS Preface ...................................................................................................................... iii INTRODUCTION ..............................................................................................................1 TYPES OF HEARING LOSS ...........................................................................................1 DIAGNOSTIC AUDIOLOGY ............................................................................................3 Case History ...............................................................................................................3 Otoscopic Examination ..............................................................................................3 Pure-Tone Audiometry ...............................................................................................3 Masking ......................................................................................................................6 Audiometric Tuning Fork Tests ..................................................................................6 Examples of Pure-Tone Audiograms ........................................................................7 Speech Audiometry ....................................................................................................8 Site of Lesion Tests ..................................................................................................12 Aural Acoustic-Immittance Measures ......................................................................14 Evoked Otoacoustic Emissions ...............................................................................19 Auditory Evoked Potentials ......................................................................................21 Tests for Pseudohypacusis ......................................................................................24 Vestibular Assessment .............................................................................................25 AMPLIFICATION ............................................................................................................28 Hearing Aids .............................................................................................................28 Cochlear Implants ....................................................................................................32 Assistive Listening Technology ................................................................................33 AUDIOLOGIC REHABILITATION .................................................................................36 Pediatric Habilitation ..................................................................................................37 Adult Rehabilitation ...................................................................................................37 HEARING CONSERVATION .........................................................................................38 ORGANIZATIONS ..........................................................................................................39 EXAMPLE CASES .........................................................................................................42 ABBREVIATIONS ..........................................................................................................66 REFERENCES ...............................................................................................................66 APPENDIX ......................................................................................................................70 ii The Audiology Primer For Students and Health Care Professionals PREFACE This primer is a revision and extension of Audiology: An Introduction and Overview for Residents and Medical Students (1982) developed by Cynthia G. Fowler, Ph.D., Howard C. Jones, M.A., Janet E. Shanks, Ph.D., and Richard H. Wilson, Ph.D. at the VA Medical Center, Long Beach, California. In 1997 the Primer was revised with contributions from Lisa Gibbs, M.S. (Long Beach), Anne Strouse, Ph.D. (Mountain Home), Cheryl Longinotti, Ph.D. and Vallarie Smith Cuttie, M.A. (San Francisco), and Doug Noffsinger, Ph.D. (West Los Angeles). This work represents the 3rd revision of the Primer. As with the previous Primers, the current primer is intended (1) to introduce audiology to clinical and rehabilitative health science students, medical students, interns, residents, medical staff, and allied health professionals, and (2) to serve as a reference for the future audiological needs of these professionals. Contributions to the current primer were made by the following VA Medical Centers: Long Beach, California Janet E. Shanks, Ph.D. (Retired) Mountain Home, Tennessee Faith W. Akin, Ph.D., Earl Johnson, Ph.D., Owen Murnane, Ph.D., Colleen Noe, Ph.D., and Sherri Smith, Ph.D. Nashville, Tennessee Gene Bratt, Ph.D. Richard H. Wilson, Ph.D. Mountain Home, Tennessee February 13, 2009 [email protected] iii SPRING, 2009 1 INTRODUCTION Audiology is the science of hearing that estimates of the incidence of hearing loss conservative, deals with the evaluation of hearing disorders, especially for the older population. Because the VA with the rehabilitation of individuals with hearing patient population is predominantly aging males with a impairment, and with research pertaining to the significant history of noise exposure, a large segment auditory mechanism. The field of audiology started of this population can benefit from the diagnostic and/or in military aural rehabilitation centers during the rehabilitative services of an audiologist. last years of World War II. The term “audiology” Traditionally, in the private sector, the audiologist was applied to the field by Raymond Carhart, a has not functioned as the primary care provider for speech pathologist, and by Norton Canfield, an individuals with ear pathology. Rather, most individuals otologist, who combined their specialized areas with hearing disorders are seen by pediatricians, family to focus on the aural rehabilitation of service practitioners, and internists. These patients frequently men with hearing impairment. Following World are referred in turn to otolaryngologists or neurologists War II, audiology centers were established both for further evaluation. The audiologist then receives in Veterans Administration (Affairs) hospitals referrals from these physicians to perform functional and in the civilian sector. As graduate programs tests of hearing to determine site of lesion and extent were established to educate audiologists, the of hearing loss. Within the VA, the pattern of referral scope of practice of audiology was widened is different. In most VA medical centers, patients to include diagnostic services as well as aural with a primary complaint of hearing loss enter health rehabilitative services. In 1965 the American care through the audiologist. Historical information is Speech-Language-Hearing Association (ASHA), obtained and functional tests of hearing are performed; which certifies audiologists on a national basis, site of lesion and extent of hearing loss is subsequently established the master’s degree as the entry level determined. Patients requiring medical intervention are for audiologists. Slowly during the subsequent referred to the appropriate medical specialties; those 35 years two things happened to audiology. demonstrating hearing loss not medically treatable First, audiology was defined legally by each are referred for audiologic rehabilitation including the state enacting licensure laws that were aimed at provision of hearing aids and other assistive listening ensuring quality professional services. Second, devices, tinnitus maskers, and speech reading/aural the scope of practice increased substantially to rehabilitation classes. include all aspects of auditory and vestibular This primer presents an overview of the diagnostic function. As a result of this expanded scope of and rehabilitative procedures used by audiologists in the practice, the educational institutions determined evaluation and management of patients with impaired that the educational offerings likewise needed hearing. The first section describes the sites of lesions to be enhanced. To meet this need, effective in in the auditory system that produce hearing loss. The 2007 professional education in audiology was second section presents the auditory tests used in increased from a two-year masters program the audiologic test battery for differential diagnosis to a four-year doctoral program. Currently, and outlines the auditory test results associated with audiologists are educated only at the doctoral the various sites of lesions in the auditory system. level with the Doctor of Audiology degree (AuD) The third section describes the aural rehabilitation of focusing on clinical activities and the Doctor of patients with hearing loss. The last section presents Philosophy degree (Ph.D.) focusing on research twelve case studies that exemplify the various sites of and other scholarly activities. lesions and the corresponding auditory test results. According to the American Speech-Language- Finally, a list of professional organizations, a list of Hearing Association, 28 million people in the abbreviations, and a list of references are presented. United
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