CDDS 250
ADVANCED PRACTICUM IN AUDIOLOGY
Spring 2018
California State University, Fresno Speech, Language, and Hearing Clinic
Dr. CynthiaCavazos Dr. Stephen Roberts Dr. Louise Mueller TABLE OF CONTENTS
Clinical Practicum Requirements I
Clinician's Responsibilities...... 2 Instructions on the use of the GSI AudioStar Pro 3-10
Audiolo gic Evaluation Outline 11 Audiologic Evaluation Procedures 12 Air Conduction Testing ...... 13 Bone Conduction Testing T4
Bing Test .. I4
Weber Test . t4
Speech Recognition Test...... , 15
Speech Discrimination Test (AKA WRS) 15
QuickSIN... t6 Recording Test Results and Report Writing t6-17
Instructions to Clients on Various Tests 1 8-19
Immittance Testing. . . . . 20-21
Immittance Interpretation. . . . 22-25 Type, Degree and Configuration of Hearing Loss 26-27 Sharing Audiological Test Results 28-30 Hearing Screening Procedures 31 Hearing Screening Form... 32 Hearing Screening Letters. 33-35 APPENDIX Audiometer Listening Check ... Appendix 1 Clinic Child Case History...... Appendix 2 Clinic Adult Case History... .. Appendix 3 Audiology Child Case History..... Appendix 4 Audiology Adult Case History..... Appendix 5 Audiogram Appendix 6
Sample Audiogram Appendix 7 Immittance Protocols ... Appendix 8 SRT Worksheet Appendix 9
Speech Discrimination Protocol...... Appendix 10
QuickSIN Tracks 3 -7,Large Print. Appendix 11 QuickSINTracks3-12. Appendix 12 Degree of Hearing Loss, SRT and Quick SIN Interpretation Appendix 13 Speech Lists: Spondee List.. Appendix 14
CID-W22 Lists ...... Appendix 15 NU-6 Lists.... Appendix 16 PBK-50 List..... Appendix 17 WIPI List.. Appendix l8 Children's Spondee List... Appendix 19 NU-CHIPS Appendix 20
Sample Audiology Reports. . Appendix 2l - 24 Referral Sources: Audiological Services. Appendix 25 Refenal Sources: Dispensing Audiologists...... ' Appendix 26 Phonetic Audiogram... Appendix 27
Tinnitus Questionnaire Appendix 28 Central Auditory Processing Questionnaire.'...... Appendix 29 Tips for Improving Your Listening Experience. Appendix 30 Improving Understanding with Communication Strategies ..... Appendix 3l CLINICAL PRACTICUM REOUIREMENTS
Where only the minimum 20 clock hours of clinical practicum in Audiology is required for the persons seeking certification in speech language pathology , that practicum may include hours in assessment andlor management of speech and language problems associated with hearing impairment, or in assessment of auditory disorders.
I CLINICIAN' S RESPONSIBILITIES
1. It is imperative that you practice and become familiar with the techniques and procedures that you will be performing during the audiological evaluations. Practice time is available for approximately two weeks prior to the first scheduled evaluation. 2. Please document the days and amount of time that you practice and make available to supervisor upon request. In addition, you may be asked to demonstrate your competency level to your supervisor. 3. In addition to clinical methods, you may also need to spend some additional time reviewing audiometric interpretation. If you need assistance, please don't hesitate to ask your supervisor. 4. At least one week prior to the evaluation, obtain client's name from the master schedule (available from Lynn). Review the case history to determine if you need to consult with your supervisor about the evaluation process. 5. Obtain the client's telephone number from their file and call them at least three days prior to the evaluation to remind them of the day and time of their appointment. Also verify they know the location of the waiting room and clinic and have received a parking code, if pertinent. 6. Record any phone contacts with the client on the contact sheet in their file. 7 . If special tests or materials will be required, be sure they are reviewed and available prior to the time of the evaluation. Do not wait until the day of the evaluation. 8. Record and maintain clinical hours 9. Attend required clinical meetings 10. Dress appropriately and always act professionally. 1 1. Be familiar with and follow clinic policy and procedure 12. See syllabi for additional information
Prior to the Evaluation 1 . Limit number of individuals that accompany client to only a significant other. Ask others to wait in the waiting room. 2. Remind client andlor observers to turn off cell phones and/or pagers.
During the Evaluation 1. Address client formally (e.g, Mr., Ms. Mrs,) unless a different request is made by the client 2. Maintain a professional demeanor throughout the evaluation.
After the Evaluation 1. Shut down all equipment. 2. Return all equipment, forms, etc. to their appropriate location, 3. Leave test area clean and ready for next clinician. 4. Complete the "blue sheet" in client's folder documenting tests administered and findings. 5. Return chart to clinic office
^ GRASON STADLER AUDIOSTAR PRO AUDIOMETER
IMPORTANT GENERAL NOTES: o Anything displayed on the monitor that's underlined can be selected by using the internal or external mouse. The internal mouse are the black buttons in the center of the grey panel. o When a button is selected, it will illuminate veriffing you have selected that option o There are more than one method to perform the tests. This guideline does not list all methods. o "Store" must be selected after each individual threshold is obtained and each individual ear speech test is completed oointernal" o There is an mouse located midline towards bottom of audiometer in grey panel; There is also a wireless "external" mouse next to audiometer
Test Type o Purpose is to determine which type of material is to be utilized (tone, high Hz, speech, more) . Grey buttons on grey panel on left side of audiometer o Note: Speech needs to be selected for SDT/SRT and WRS; More is to be selected for QuickSIN
Attenuator o Purpose is to raise and lower intensity. Defaults to 5 dB steps o The large black round dial at lower corner of blue panel
Interrupter o Purpose is to turn the signal on or off o There is both an "interrupter bar" and atoggle button (for constant ON) o Black buttons on blue panel next to the attenuator dials
Stimulus . Purpose is to select type of stimulus that is to be presented (tone, mic, int/ext A, intlext B) . Black buttons on grey panel near center under stimulus label
Transducer o Purpose is to select the device through which sound/signal is delivered (phones, bone oscillator, speaker, insert earphones, High Frequency phones) o Black buttons on the blue panel under transducer label
Routing o Purpose is to select which ear is to be examined o Black buttons on blue panel near middle of the audiometer under routing label
Frequency Selector o Purpose is to change frequenòy of stimuli o Elongated black buttons with arrow markings located at lower center of grey panel 3 Talk Forward o Purpose is to allow examiner converse with patient o Located in the bottom center of grey panel o To adjust intensity of your voice on this feature, use the "TALK FORWARD" black dial on the far right side of grey panel . IMEqgIAru. Make sure the intensity is turned to a minimum (e.g. 50 dB) prior to using the talk forward feature
Patient Response Button . Purpose to notify examiner of a client's response o Indicated by a thin grey bar in the center of the display screen of the audiometer under the exhibition of the frequency
Monitor o Purpose is to be able to hear the signals being presented to the client and adjust the intensity for the preference of the examiner o Located on top left corner in grey panel o Modifies intensity adjustments to channel 1, channel2, aux.intercom, talkback o To engage, push "select" button until desired channelioption is lit, then adjust black dial next to "select" to desired output level as viewed on display of audiometer
Store o Purpose is to save data as testing is being administered. Must be engaged after each individual threshold and for every individual ear speech test. o Black button on right and left side within blue panel o Either button can be engaged and is not dependent to channel that is being utilized
SET-UP
l. Turn 6(ON" - button is on the right side of audiometer toward the back corner of audiometer
2.If not going to be using, turn off monitor in booth on patient's side
o'data 3. Erase old sessions by (a) pushing erase" grey button in grey panel on left side, (b) use internal or external mouse to navigate to "clear session", (c) click "clear session", (d) click o'conflrm"
4.You can use either Channel 1 or channel 2, whichever is more comfortable for you.
5. Turn "TALK FORWARD" button to 50 dB (black knob on right side of the grey panel)
PURE TO TESTING .'TONE" 1. Under stimulus label select
2. Under transducer label select "PHONE, BONE, SPEAKER, INSERT or HF PHONE"
3. Under stimulus label select "TONE" 4 Under routing select "RIGHT or LEFT"
5 Test hearing using protocol in manual, but must push "Store" button after each threshold is obtained.
6 If you need to mask, determine appropriate level of masking and present by engaging the "INTERRUPT" button on the opposite channel in the 66ON" position.
SPEECH TESTING (SRT, SDT. SDS AKA \ilRS) l. Select appropriate routing for "RIGHT or LEFT".
2. Verify transducer for "PHONE, BONE, SPEAKER. INSERT, HF PHONE' .
3. Stimulus should default to int/ext A for the routinely used word list you want to retrieve. Typically defaults to spondge word list for SRT.
4. To change word list for testing speech discrimination (AKA WRS) use external mouse to click on "TEST TYPE" that is on bottom left corner of display monitor on audiometer. Then click on ,,'wRS"
5. To immediately begin SRT or WRS test, engage "INTERRUPT" button
6. For WRS, may use "CORRECT" and "INCORRECT" grey buttons on left side grey panel to score each response as test is being administered. To clear the displayed score, select the grey ..CLEAR" button located between the correct/incorrect buttons.
7. If pace of SRT or WRS is too fast, disengage and then reengage "INTERRUPT" button to manually control pace that words are administered. This allows you to stop and pause between words.
ooWORD 8. To change word lists, use external mouse and click on LISTS" to view word list options and once option is selected from drop down menu, click "SAVE"
9. If you need to mask, determine appropriate level of masking and present by locking the (6ON" "INTERRUPT" button on the opposite channel in the position once the appropriate routing (right or left) has been selected.
10. NOTE: V/ords typically can be presented manually bu using external mouse and clicking on the displayed word.
QUICKSIN
ooMORE" 1. Under the label "Test Type" on the grey panel on left side of audiometer, push the button
2. A menu will appear on audiometer's display and use mouse and click on "QuickSIN" 5 3. To administer a sentence, use mouse and click on that specific sentence.
4. lJse "incorrect" button on audiometer to record any effor. It will automatically default and ooincolTect" apply a correct score of 5 if the button is not selected for that sentence.
5. Continue test by clicking on each individual sentence and scoring until test is complete
ooword 6. To change word list use the mouse and click on list" to view a drop down menu and select list to be administered next.
TO FINISH
ooOFF" 1. Simply switch toggle on right side of audiometer to position.
2. Return all materials, headset, earphones, bone conduction oscillator, patient response button, etc to their appropriate location.
3. Remove any used insert earphones and dispose of properly.
4. Verify the room is uncluttered and readily available for the next clinician.
(! Navi,gatio,n Menu t4igh tlz Test Type &¡tton This menu is the blue bar located at the bottom of the display. Pressing the High Hz test type button prepares the AudioStar It utilizes the on-board navigation buttons or an external mouse Pro forhigh frequency:ür and bone conduction testingfromthe to access the features. The menu is specific to the test type hlgh range (8,000-20,000 Hz) or the ñrll range (125 - 20,000) selected. Selections on the navigation menu may be changed at Hz. You may select full or high range fronr the blue navigation any time during testing. menr¡. You may utilizæ the HDA 2@,B7L and Sound Ffu:ld speakers from this test type. Pressing this button will set the Tone Test Type Button defaults fto¡n the configur,aûion application to start th€ test q¡Pe. Pressing the Tonê Test Type button prepates the GSI AudioStar Auto Hz may be defined in the Config App and automatically Pro* for pure tone air and bone conduction testing from 125 - ¡noves the next desþated test frequency when "store" is pressed. is 12,000 Hz. Each selection on the blue navigation menu NOTE: If you select ø diferent transducer or stimulus or ear 50, specifrc to Pure Tone Testing. You may utilize TDH ER3A, andteø,i tûe tune test type, when you retum, the Audiostar Pro 871 and Sound Field speakers from this test type. Pressing this will defwtrt to the løst settings that werc selected. button will set the defaults from the confrguration application . Press the High Hz Test Type Button. to start the test t)?e. Auto Hz may be defrned in the Config lntegrated Word Fi¡les .Ensure preferences (High App and automatically moves the next designated test frequency When Speech Test Type is selected, the AudioStar Pro defaults that the Range is set to your or when "store" is pressed. to internal .Wav Files. These may be presentcd for consistent FUU). recorded speech testing. . Veriff that the transdtrcers and signals are correct. , NOTE: If you select a diferent transducer or stimulus or ear and . leave the tone test typa when you return to tone, the AudioStar . Define wordlist favorites in the Config App for fast selection Perform High Frequency Testing. Pro will default to the last settings thøt were selected. of cornrnon lists. . Press the Tone Têst Tlpe Button. . Utilize the navigation ¡nenu or external mous€ to select the . When the high frequency evaluation is complete, move to test tfpe and the wordlist. . Verify that the transducers and signals âre correct. the next test t'?e in your typical testing sequence. . . Perform air conduction threshold testing. Select Wond Nav and use the navigation buttons to highl,ight word stimulus. Press the present bar to present the word. More T,est Type butúon NOTE; Press "store" afier each threshold is obtained. -oR- Pressing the "More" test tfpe br¡tton calls up a rnenu of the . When the pure tone evaluation is complete, rnove to the following special tests: ABLB, BKB-SIN, Qt¡ickSIN, SISI; TEN, . Uti-lize the navigation buttons external mouse to present the next test ty?e in your typical testing sequence. Tone Decay, Use the on boa,rd navigation btrttons or an scternal (single cli,ck to present). words mouse to select the special testr Speech Test Type Button . Wh,en the speech stimulus is being presenúed, the word will Pressing the Speech Test type button prepares the AudioStar be highlighted yeüow. BN(B-Sl{ Pro for Speech testing. The internal .Wav files maybe presented . When the patient responds (and the yellow'highlight Fresemtation Level by either using the present button or by a single click of a disappears), the stimulus wdrd/sentence may be scored For standard SNR Loss testing the BKB-SIN Test should be wireless mouse. The correct/incorrecVclear buttons may be used correct or incorrect. presented at a relatively high level (oud, but below discomfort). to score. It is also possible to automatically play wordlists by . The stimulus word/sentence will turn green for correct or Normative data on normal-hearing adults and normal-hearing preferences are determined presing the inturrupt button. These orange/red for incorrect. The center area ofthe display will children were collected using binaural presentation via insert in the Config App. It is critical that the test type be carefully earphones, at a presentation level of70 dB HL (83 dB SPt). indicate the %io .correctl #words presented. selected as the reporting/storing is dependent upon test type. If 'Nor¡native data on adult cochlear implant users were collected . After the completion of each speech test t)?e, press store to you wish to do a PIPB rollover, you may select the speech using a 65 dB SPL presentation level in sound field (equivalent save the results in the speech resu{ts table. audiogram page. to 50 dB HL at 0 degrees azirnuth). . When your ryeech evahraûion is complefe, rrdov€ to tlq€ rtÊrct test type in your typical test sequence. continued on back... continued from front Ot¡1okSl]ll S¡UR Degree of Expected lsnprcverfl ent Presentation Levd l-oss SIVR l-oss w¡th Directional lvlic pure-tone average (PTA) less than or equal to 45 dB HL, Test Instructions For rMnü.tæ,ar.ùeifier {tiqrt the attenuator (s) in Channel I and Channel 2to70 dB noise "You willhear a man talking to you through the earphones (or set nsnnalshear.in greâter, set attenuators to a "Ready" say a HL. For PTA of50 dB HL or the Ioudspeøker). He is going to say and then he'Il 3-7 d8 Mild SN'R loss May hear almost as well level that is judged to be "loud, but okayi'The sound should sentmce. Repeat the sentence the man says. You will hear other as norrnals hear in noise perceived as loud, but not uncomfortably loud. Tests can talkers in the background. Don't pay any attention to them; be performed in the right, left or binaural conditions. 7-,t5'dB Moderate SINR loss Directional rniclophsnes just says. The background talkers will get be repeat what the rnan heþ; consider a'rray rrnic louder, and then it will be hard for you to hear the møn\ ttoice. Instruotions $f{rR Wen that happens, it is OK ø guess; rePeat anythingyou think Test >1'5 dB S.eve.re Sr[\lR loss N¡13¡i¡urn "Imøgine that you are aÎ a party. There will be a woman talking irnprovernent is needed; you heard the man say! and several otker tølkers in the background. The womanl voice is consider FM system easy to kear at first, because her voice is louder than the others. Test Procedure Table A REeat each sentence the worùan says. The background talkers . Select BKB-SIN from the More Tests Menu. will gradually become loúder, making it dificult to understønd . proper and intensity levels for each Select the transducer the wornøn\ voice, but pleøse guess and repea't as much of each TEN Test channel. sentence as possible!' Presentation Level . Select the appropriate age from the Navigation Menu is 60 dB or less, the TEN noise level at 70 dB. ' Ifthe hearing ioss . Select the appropriate word list pair. Lists 1-8 are appropriate Test Procedu're . If the hearing loss is 70 dB or greatet start the TEN level patients for all patients. List pairs 9-16 are appropriate for CI . Select QuickSIN from the More Tests Menu. 10 dB higher than the threshold. or those with significant hearing loss. . Ensure the proper transducer and intensity levels are selected. . Ifthe TEN is reporfed to be too loud, start the TEN level at and panel navigation buttons or CN Using the Word Nav front . Select the appropriate word list. Lists 1- 12 are standard lists the same level as the threshold. sentence. an external mouse, select the first used to determine SNR loss. Press the present bar or click the first sentence. . Using the Word Nav and front panel navigation buttons or Test l,nstructions instruct the . Score the four/three key words hightighted in each sentence an external mouse, select the first sentence. When the starting level has been determined, pressing or INCORRECT button for each patient in the same manner as when measuring Pure tone by the CORRECT . Press the present bar or click the selected sentence. word repeated by the patient. thresholds with masking. . Score the five key words highlighted in e¿ch sentence by . pair (20 and press "stordl Cornplete the entire list sentences) pressing the INCORR.ECT button for each word repeated Test Proce u,re . To interpret the SNR loss score for Adults, see "Table Ä'. incorrectly by the patient. The procedure for determinirig thresholds in the TEN is identical . test Refer to the BKB-SIN user manual for how to interPret . Press Store to the manual pure tone audiometry except that a 2 dB ñnal results for children. . The SNR Loss score will appear in the SCORE/WORD step size should be used for maximum accuracy. The TEN window. will take approximately 4 minutes per ear (to comPlete â11 test frequencies). NOTE: It is recommended that øt least 2 lists be presented in eøch condition. The averøged score wíll appeør in the Group 1 lnterpretat¡on SNR averages window. The accepted rule is that a dead region is Present when the . To inûerpret the SNR loss score see "Table A'to the right. TEN-masked threshold is at least l0 dB above the absolute threshold and the TEN Threshold is 10 dB above the TEN NOTE: Reþ to tke QuiakSIN user nø'rwøtrf,or advanced testing noise. options. audiostârpro Remote Keyboard Iì(o i.frlìftillt ai ii a/ì1 ,\ L'rllrlìaii:i:
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800-1 00-2282 | www.grason-stadler com I AUDIOLOGIC EVALUATION OUTLINE
The following tests should be administered for an audiologic evaluation. There may be certain situations where it is impossible or undesirable to accomplish all of these tests. Your discretion should be used and if in doubt, contact the Clinic Supervisor. However, each student involved in hearing testing is expected to be able to administer and interpret all of these tests.
I. Preliminarv Preparations A. Review Case History B. Perform listening check on equipment to be used and record on form (Appendix 1) C. Gather and review materials to be used
II. Basic Test Batter)¡ A. Oral Case History B. Otoscopic Inspection C. Immittance Battery 1. T¡rmpanometry 2. Physical Volume Test Measurement (AKA Ear Canal Volume) 3. Acoustic Reflex Thresholds D. Pure Tone Air Conduction Thresholds (Perform masking as necessary) E. Pure Tone Bone Conduction Thresholds (Perform rhasking as necessary) F. Bing Test G. Weber Test H. Speech Testing 1. Speech Recognition Threshold 2. Speech Discrimination (SD) Testing in Quiet 3. Speech Discrimination Testing in Noise, or QuickSIN may be utilized in lieu of SD Testing in Noise I. Review Audiometric Test Results with Supervisor J. Exit lnterview with Client
III. Postliminary Responsibilities A. Shut down equipment B. Put examination area in order. C. Leave exam area clean and ready for the next clinician. D. Gather all test protocols and return chart to office E. V/rite report and submit to supervisor within 24 hours
Note: When utilizing insert earphones for test purposes, the order in which tests are administered may need to be modified. In addition, test order and administration may vary depending upon clientos needs and abilities.
t\ PROCEDURES F'OR INITIAL AUDIOLOGICAL EVALUATION
L Procedures common to both air conduction (A/C) and bone conduction (B/C) A. Operator procedures 1. The audiometer should be turned on and allowed to warm up. 2. The examiner should have performed a listening check and recorded the appropriate data on the form provided in the audiometric suite.
B. Seating 1. Seat the client in a chair at a 45 degree angle to the operator. This allows the operator to view the subject's face and expressions without having the client looking directly at the examiner or equipment. 2. Provide client with the response button, if to be used.
C. Instructions - Give instructions to the client BEFORE placing the earphones on him/her. The following general points should be covered: 1. The client will hear a series of sounds, some high-pitched and others low pitched. 2. The client is to indicate perception of the sound by pushing the response button (or other predetermined manner of responding) whenever he hears a sound and release the button when the sound disappears. 3. Emphasize the importance of listening and responding to the very faint sounds, not merely when he can hear them easily. NOTE: The actual instructions given to the client will have to be adapted to his/her level of understanding.
D. Placement of earphones 1. Earphones should be placed over the ears by the examiner, making certain that the proper earphone is placed on the proper ear. 2. Hair, glasses, earrings, etc. may need to be removed to ensure a good seal. 3. Verify red earphone is over client's right ear; blue earphone is over client's left eat'
E. Placement of insert earphones l. select the appropriate foam tip (adult is yellow; child is beige) based upon otoscopic inspection. 2. If cerumen is visible near the entrance of the ear canal, insert earphones may not be appropriate. 3. Ensure a secure fit of the foam tip by seating it down as far as possible on the connection leading to the audiometer 4. Roll the foam tip while tightly squeezing. 5. Use both hands for inserting. Pull gently up and back on the pinna while inserting the foam tip gently into the proper ear canal with the opposite hand. 6. Relax the pull of the pinna while holding the foam tip in place for a few seconds until it has fully expanded. 7. Yerify the red is fit to the right ear; blue is fit to the left ear.
IL 8. To remove the insert earphone, gently pull it from the ear canal while holding the pinna with the opposite hand. Be sure to hold the tubing that is connected to the foam tip. 9. Remove foam inserts and dispose.
F. Placement of bone conduction oscillator 1. The bone conduction oscillator should be placed on the mastoid process so that it does not come into contact with the other structures, especially the pinna. 2. Be certain to remove the earphones while testing bone conduction.
G. Threshold determination 1. Test the client's better ear first on the basis of previous audiometric data, information provided by the client or client's judgment. If no apparent difference exists, test the right ear first. 2. Allpure-tone threshold testing is done with the interrupter switch in the "normally off'position. 3. Avoid rhythmical sequences and giving of clues when presenting the tonal bursts. 4. Obtain threshold at each test frequency according to the procedure described by Carhart and Jerger in JSHD, Yol.24:330-345,1959, "Preferred Method for Clinical Determination of Pure-Tone Thresholds." Briefly, the procedure is as follows: a. Present the test tone at 30 dB hearing level (if not heard at this level, increase in 20 dB steps until a response is obtained) b. Then decrease in 10 dB steps until the test tone is inaudible (no response is obtained) c. Then increase intensity in 5 dB increments until a response is obtained. d. Then decrease the intensity 10 dB and begin the 5 dB increase again, repeating step "C". Continue this procedure until three responses at a single intensity have been obtained, i.e., lowest intensity at which three responses have been obtained. e. Tones should always be presented as bursts of sound for l-2 seconds in duration. f. Follow this procedure at each test frequency in both ears. This procedure is common to both air and bone conduction threshold testing. il. Procedures Specific to Air-Conduction (A/C): A. Begin in right ear or better ear, if known l. Test frequencies beginning with 1000,2000,3000,4000, 6000, and 8000 Hz;then retest 1000 to test for reliability, and finally proceed with 500 and250Hz. 2. Test opposite ear starting at250 Hz, and then proceeding to 500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz
B. Reliability check 1. Performed in only one ear. 2. If the threshold of the reliability chick is not within a + l0 dB of the original threshold, the client should be reinstructed and testing should begin again at 1000 Hz.
tb C. Interoctave frequencies 1. Evaluate interoctave frequencies if a 20 dB or more difference exists between two adjacent test frequencies of the same ear, 2. Complete bone conduction threshold for the interoctave frequencies, if applicable,
D. Masking 1. Mask the ear opposite the tested ear whenever the A/C presentation level exceeds the B/C threshold of the opposite ear by more than the smallest expected interaural attenuation. 2. lnteraural attenuation is typically 40 dB for standard earphones; 60 dB for insert earphones. 3. This may require a return to A/C testing aftetBlC testing.
III. Procedures Specific to Bone-Conduction (B/C): A. Place bone oscillator on either mastoid bone and initial testing should be by relative (unoccluded) B/C.
B. Test frequencies beginning with 250,500,1000, 2000, 3000 and 4000 Hz.
C. Masking should be applied to the opposite ear when applicable.
IV. Procedures Specific to the Bing Test A. Procedure 1. Bone conduction oscillator should be placed on the mastoid of either ear. 2. Evaluate a low frequency tone, preferably 500 Hz 3. Present a continuous pure tone at a comfortable level (e. 30 dB SL) 4. The examiner or client alternately opens and closes the external canal with light finger pressure on the tragus while the tone is on continuously. 5. Client reports if the intensity of the tone becomes louder or remains the same as the external canal is alternately opened and closed. 6. Repeat the procedure for the opposite ear.
B Interpretation 1. If client reports the tone is louder, no conductive component is suspected 2. If client reports the tone remains at the same intensity level, then a conductive component is suspected
V. Procedures Specific to the V/eber Test A. Procedure 1. Place the bone oscillator on the midline 2. Test a low frequency, preferably 500 Hz' 3. Present a continuous pure tone at a comfortable intensity level (e.g., 30 dB SL) 4. The client is to report if the sound is perceived in the right ear, left ear or midline
r1 B. Interpretation 1. If the tone is heard in the poorer ear, a conductive component is suggested 2. If the tone is heard in the better ear, a sensorineural component is indicated 3. If the tone is heard midline, then there is no significant difference in sensitivity between the ears.
VI. Procedures Specific to the Speech Recognition Threshold A. Procedure 1. Provide your client with specific instructions. 2. Be sure that the client is allowed to review the word list, can auditorily recognize each word, and the vocabulary is familiar. 3. Determine the Starting Level by presenting the initial Spondee words at a comfortable level (e.g. 30 dB HL for normal hearing clients). If the original intensity is too low for the client to repeat the first word, then increase the intensity in 20 dB steps (giving one word per step) to quickly find the threshold level where the client can repeat a word. Then decrease in 10 dB increments, administering one spondee at each 10 dB interval, until two spondees are missed at one level. 4. The Starting Level for the main SRT determination will be 10 dB higher than the level where the two spondee words were missed. 5. Begin the threshold test at the "Starting Level" by presenting 5 words. 6. Decrease in 5 dB increments until 5 words are missed at the same intensity level. 7. Perform the SRT for the opposite ear utilizing the same procedure by re- establishing a starting level for Lhat ear.
B. Calculation - Calculate the SRT for each ear with this formula: starting level - # correct + 2dB: ,SRZ in dB
VII. Procedures Specific to Speech Discrimination (AKA V/ord Recognition Testing) A. Procedure 1. Provide the appropriate forms, writing utensil, and clipboard to client 2, Inform client of the appropriate instrucfions and expected method of response 3. Presentation level will be dictated by audiological findings and goal of the test, but typically the test is performed at conversational level (45 dB HL). If a hearing loss is present, often a 30 to 40 dB sensation level relative to their spondee threshold will be used, but the level depends on the severity of the client's hearing loss. 4. Recorded list of NU-6 is most often used for speech discrimination testing for adults and older children. The V/IPI or NU-CHIPS should be administered to children between 2 and 9 years of age. (See Appendix)
B. Discrimination scores - Aqy deviation from the test word is to be considered an effor. Scores are recorded as percentage correct. Refer to appendix for a listing of Martin's interpretation of speech discrimination scores.
t5 C. Conditions tested - It is recommended that the discrimination test be given for the right ear and left ear in quiet andat¿ +10 dB signal-to-noise ratio presented to the same ear.
Vil. Procedures Specific to QuickSIN A. Calibration - Using the calibration tone on Track 1 (be certain you've selected the appropriate CD), adjust the VU meter of the audiometer to 0 for the channel you are using. Note: Except for tracks 24-35,the target speech and background talkers are recorded together on both channels.
B. Patient Instruction - Instruct the patient to repeat the sentences spoken by the target (female) talker. Encourage them to guess ifthey are not sure ofthe sentence'
C. Testing Method - Present the test with earphones or in a sound field, with the attenuator dial set to 70 dB HL. It is suggested you complete one practice item prior to administering the actual test. For subjects with PTA hearing losses greater than 45 dB HTL, set the attenuator dial to a level that is "loud but OK."
D. Sound Field Testing - When testing in a sound field, have the patient hold the talkback microphone close enough so that responses are clearly audible to the tester
E. Scoring - Score the five key words underlined in each sentence, giving one point for each word repeated correctly. - Add the number of words repeated correctly, totaled across all 6 sentences. Subtract the totarcorrec'u"in:ot;"ï:ii:Tl\Tl,','ä,,,,,,
F. Interpretation - To interpret the SNR loss score, see Appendix 15 within this manual.
IX. Recording Test Results A. Audiogram 1. All initial testing should be recorded on the audiogram. o'Excellent" 2. Anytime you mark other than "Good" or responses in the validity section of the audiogram, give a brief explanation in the "comments" section. Be certain that you have recorded all the identifying information on each audiogram andlor special test forms used. This should be done at the time of the test. 3. The results of any special techniques (i.e., pulse) used to obtain a test result should be indicated in the "comments" section of the audiogram 4. The results of the hearing tests should be connected with neat straight lines and the bone-conduction results with neat dashed lines. 5. Final audiograms must be completed in ink.
þ B. Immittance testing L Complete all identifying information on the immittance sheet 2.Tape immittance findings to immittance sheet 3. Summarizethe findings on the client's audiogram
X. Report Writing A. A complete report should be aocurately written following each evaluation
B. The report is due to your supervisor within 24 hours after the evaluation
C. Format for a report: (See appendix) 1. At the top of the report identifying information is listed. 2. The first paragraph contains a statement of the problem covering an explanation of who was seen and the reason for coming to the clinic, and who referred the client. Any pertinent medical or family history should also be included. 3. The main headings used within the body of the report include: a. Test Results . although audiometric results accompany all reports, it is required that all test data be summarized in the report. The results include results of pure- tone air and bone audiometry, immittance audiometry, speech audiometry u' t-n"" i1T*,Til[ïäffif lïl,iîr,*'ity o r test resurts and ob servarions or significant behavior during testing and interview are recorded here. The clinician should come to some conclusions in regard to potential etiology, type of problem and further needs (tests, referrals, etc.). Recommendations should consist of a brief numerical listing of recommendations. A statement of prognosis should be included if pertinent.
4. Allow space for clinician signature and supervisor signature. Turn the report and all test _ protocols into supervisor for review. Please do not staple. All material should be turned in utilizing a folder.
5. Reports returned to clinicians for modifications should be'turned back to supervisor within a timely manner, preferably within 48 hours.
6. After your supervisor has approved and signed the repoft, it is given to the secretary for photocopying and distribution.
7. Keep a copy of the approved report and all test protocols for your records.
t1 CDDS 250
lnstructions to the client for various audiologic tests
The followinq s ld be oresented at the beqinninq of the Assessment.
Before we get started, I would like to give you a brief overview of what we will be doing today. I would like to begin by taking a brief case history to gather background information on your hearing and any difficulties or situations that you may be having with communication. Next, I will be administering a series of tests and procedures to evaluate your hearing sensitivity and function. This will include a visual inspection of your ear canals and eardrums as well as administering a brief test to evaluate your middle ear function. I will then evaluate how well you can hear and detect the presence of high and low pitched tones as well as understand words and sentences in both quiet and competing background noise. When we complete the testing, we will discuss the findings and any recommendations. The audiologic evaluation should take about an hour õr so. Please feel free to stop me at any time should you have any questions.
The followin q should be presented orior to each individual orocedure.
Otoscopic Exam
I'm going to visually examine both of your ear canals and the eardrum. All you have to do is sit still and not move suddenly. lf you feel any discomfort, please let me know immediately. (Please make sure the client has removed earrings, hair clips, or eyeglasses, etc.)
lmpedance Testing
I'm going to test your outer and middle ears. I'll be placing this probe tip tight against your ear canal. Please do not talk, yawn, or swallow during the test. You may feel some air pressure changes and hear a low-pitched tone. Toward the end of the test, you may hear several loud beeps. Don't be startled. The test will last less than a minute. lf you feel any discomfort at any time during the test, please let me know right away. Do you have any questions?
Pure Tone Testing (Air and Bone Conduction)
You are going to hear a series of tones, first in one ear and then in the other. This test is to find the lowest intensity level at which you can hear and detect the tones presented to you. When you hear a tone, no matter how high or low in pitch and no matter how loud or soft, please signal that you have heard it. Press the push-button switch when you first hear the tone. Remember to signal every time you hear a tone no matter how faint. The tones will be presented to you only in one ear at a time. lt's okay to guess. There are no penalties for guessing. Do you have any questions?
\ß Spondee Threshold Test
I'd like for you to silently read this list of words. lf any of these words are not familiar to you, please point them out to me. This test is to find the lowest level at which you can understand and repeat the words presented to you. So, the words you hear are going to become softer and softer. You need to immediately repeat the word you hear and then wait for the next word. lf you miss a word for any reason, it will not be repeated. Don't worry about missing the word. Only words from the list you looked at will be presented, Even if you can make out only part of the word, please repeat it. lt's okay to guess. There are no penalties for guessing. The words will be presented to you one ear at a time. Do you have anY questions?
Speech Discrimination Test
I'm going to present a series of words through these headphones at a comfortable listening level. After hearing each word, you need to both repeat the word and write the word on this form. This test is to find out how many of these words you can hear correctly. lf you feel that you need to pause or would like me to slow down, please let me know. I'll be testing you one ear at a time. Do not worry about spelling the words correctly. Do you have any questions?
QuickSlN Test
This is the final test that we will be doing today. The purpose of this test is to evaluate your ability to understand sentences in the presence of competing background noise. imagine that you are at a party. There will be a woman talking and several other talkers in thê background. The woman's voice is easy to hear at first, because her voice is louder than the others. Repeat each sentence the woman says. The background talkers will gradually become louder, making it difficult to understand the woman's voice Please repeat as much of each sentence as you can. You will be given credit for each correct word and will not be penalized for guessing. Again, we will test one ear at a time. Do you have anY questions?
Lq GSI 38'" Auto Tymp'" Front Panel Controls and lndicators
PAPER +10d8 PROGRAM DATA POWER FEED INTENSIry INSTRUMENT MEMORY TRANSFER
AUDIOMETRY PRINT SIGNAL FORMAT
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SAVE REFLEX SELECTION INTENSITY PRESENT SELECTON KNOB BAR FREQUENCY REFLEX (R) EAR FREQUENClES SELECTION SELECTION IL) EAR sËlEcroru
Tests in 1. Tymp and Tymp/Reflex test results are automatically stored when the test ends. Memory 2. Audiometric test results are stored in memory once the SAVE M+ button is pressed. 3. A total of eight locations or pages are available. 4. Press the PAGE PAOE button repeatedly to sequence through test results. 5. The memory location number for each page is located in the upper right-hand corner of each screen.
Memory Erase 1. To erase a single test result, PAGE to the test result and press the ERASE i¡- button. 2. 10 erase all tests from memory, press the ERASE ALL M- button
Printing mÉ Test Results 2. 3. q11 they will combine under the lollowing conditions: .There must be one left test and one right test sequentially stored in memory. .A left and right audiometric pair of tests will not be combined if they are separated in the memory by a tymp test. .r,. i, '.;.i' ,. .
Data TfanSfef 1. Press DATATRANSFER @ button to download test results to an attached computer, (optiOnal featUfe) NOTE: . For more information, refer to section 5 in the GSI 38 lnstrúction ":!rt;1' GSI 38 Quick Reference Guide
Tympanometry 1. Press the TYMP lffiãì button. Only 2. Press the button for the ear to be tested, or LEFT L 3. Push the eartip onto the probe, 4. Place the probe against the entrance of the ear canal so that no visible leaks are apparent. 5. When a seal is obtained, the green lamp changes from a blinking to a steady state. Hold the probe securely untilthe solid green lamp turns off and the results are displayed on the LCD. 6. The test results are automatically stored in a page of memory. 7. Press PRINT SCREEN ONLY E button to prinl result immediately, or wait and print at a later time.
Tympanometry 1. Presstne@ button. and Reflex 2. Press the button for the ear to be tested, RIGHT n or 3. Select the Test Type, lpsilateral rPsl or contralateral @Ð or both, and the frequencies (Contrataterat to be tested. Test Capabiltty 4. Push an appropriately-sized white probe tip onto the probe. with lncluded 5. When performing a contralateral test, push an appropriately-sized color coded eartip onto Versions 2 and 3,) the contra insert phone. 6. For an ipsilateral reflex test, place the probe against the entrance of the test ear canal so that no visible leaks are apparênt. 7. When a seal is obtained, the green lamp changes from a blinking state to a steady state. Hold the probe securely until the solid green lamp turns off, and the results are displayed on the LCD, 8. To perform an ipsilateral and conlralateral test, or contralateral test only, place the insert phone into the ear canal of the non-test ear. Place the probe against the entrance of the test ear canal so that no visible leaks are apparent and refer to step 7. L The test results are automatically stored in a page of memory. 10. Press PRINT SCREEN ONLY button fl to print result immediately, or wait and print at a later time. NOTE: . For more complete detail, refer to sections 3.8.2 - 3.8.6 in the GSI 38 lnstruction Manual.
Audiometry 1. Press the AUD AUD button. Test Sequence 2. lf desired, change the signal format from steady tone , to a pulsed tone or frequency-modulated (FM) tone by depressing the button (ncluded wÍth 3. Versions 3 and 4.) 4.
frequency is always displayed on the LCD screen. 5. To change the intensity level, use the dB HL knob. To extend the intensity range by 10 dB, push the +10 dB fl'"¿eì6u¡6¡ when the intensity level is set to the highest value in the normal range. 6. To presenl a test tone, press the present bar. A speaker symbol on the screen. 7. To save the threshold value for each frequency, press the SAVE button. lf no response was detectable over the intensity range available, the appropriate symbol a or {, appears. NOTE: .For instructions on completing a threshold test, see "Threshold Audiometry.' .The screen can display only the results from one ear at a time,
Part No. 1738-0160, Rev.2
^\ CALIFORNIA STATE UNIVERSITY, FRESNO Speech, Language, and Hearing Clinic
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sue¡6ouedurÁ¡ ¡o sadÁ¿ IiITERPRETAIION OF R€SULTS Thc following ¡eric¡ ol 3tylired Tympanogram¡ and Acor¡¡tic Rellex DISARTICUI.AIEO plot¡, with thc hief description which accompanie¡ them, mry prove / \ -ExtrcmC compli¡ncc tt (r ncar zcro pîG¡3urc hclplul in prcliminrry interprctation. Variation¡ ¡nd conrbinrtion¡ of -Complitræc in cxcr¡¡ tht typ€3 prcrcnted of 4.(bc ¡bovc bæc here ¡re common. I \ complirnca -Cord¡ætiv¡ hcrring l9¡3 TYMPANOGRAMS / -O¡¡icul¡r c-trein d i¡continuity _/ \ indic¡trd NORMAL / -Compliancc pcakr rt or nctr l€ro pressurc RE3 RE \ -Pe¡k i¡ well.defined and 0.25 to l.Scc \ .-roo o +roo ¡¡(J z åbove bar€ compliance s -Curve is nerrly tymmetricll tboul peak SCARIFIED G -P¡tient normally has no complaint t -Unusurlly high complirrrc with otherwi¡c o (t I t nclr-norm¡l rymmrtry tnd prcrtura -M¡ximum compli¡næ gnttcr th¡n l.gec ¡bovc b¡¡e complirncr I \ -Ncer no¡m¡l hcering / -Fl¡ccid o¡ ¡carified tymprnic mcmbranc PRESI¡URE \ -Comptiance peaks at grcrt?r than .50mm prtS3Ure -Perk i¡ ururlly wall.defincd ¡nd of no¡m¡l ampliludc -Unururlly lorv complirncc prrk with ncrr. no¡mtl -Curvc ir nrrrly ¡ymmtt¡lc¡|, symmttry ¡nd pn¡$rrt but ¡hifttd -M¡xímum towtrd ncArtlya pr?¡turt cqnplhncr l¡r¡ tñ¡n O.2lcc ¡bovc b¡¡c complirncr -Sruffy ear \ compleint -Moder¡tG conductivr hcÛlr¡ lcr -Tub¡l insuf f iciency indicttcd -Oto¡clersi¡ potriUr v -Po¡¡ible incipient otiri3 mcdit. -lf pcrk ¡hiftcd towrrd ncgrtlvr prc33ura, t\ combincd tubrl ln¡uffichnq¡ or ¡.crltory ot¡ti3 mad¡t FLUIO indiclrd (brokrn curvrl -Not typic¡l of fir¡t four cl¡¡ificrtion¡ -Complirnce m¡ximi¡æ tt rrro or negltive pr!$ura -Poorly-dcfincd or nont¡lrtrnt pr.k, -Vrry low mrxirnum complbnc çncrally lltt lo¡ nca.tiv, prerru¡r with PoorlY-drfïncd pr¡t -Mrxlmum complirncc lcr¡ üin 0.25cc -Prcr¡un ¡bovc ba¡c comptírncc mry br n .r Lror a natü¡yt -M¡ximum -Signíf icrnr hearing lor complirocr h¡r tr¡n 0.lcc ¡bort br¡c complirno -Fluid or tcc¡€tory otitit mcdit índic¡ted -Significrnt conductivc hcrring los -Vi¡cour or flur,ilillcd middb ¡rr lndicræd -Po¡siblc o¡¡icr¡t¡r cfrÍn fix¡tioo -Not typic¡l of fir¡l for¡r clæ¡ificrtion¡ Flgure 3. 1¡ropanograoa (Sheet 1 of 2) Plgure 3. llupanograre (Shee ¿ 2 of 2 )
Ì. AMÍxrcá.N *¡,!f(H.l..1NcuÂ$13 !{rÁ-R.rsG Typ., Degree, and & Érslx-'låTION Al]ilIOIOTÏ Configtration of lnformation Series Hearing Loss
When describing hearing loss, we generally look at three . Head trauma aspects: type ofhearing loss, degree ofhearing loss, and . Malformation of the inner ear conflguration of hearing loss. . Exposure to loud noise
TYPES OF HEARING LOSS O Mixed hearing loss occurs when a conductive hearing loss happens in combination with an SNHL. In other There are three basic types ofhearing loss: conductive, words, there may be damage in the outer or middle ear sensoriàeural, and mixed. and in the inner ear (cochlea) or auditory nerve' O Conductive hearing loss occurs when sound is not sent easily through the outer ear canal to the eardrum and the DEGREE OF HEARING LOSS tiny bones (ossicles) of the middle ear. Conductive hearing Degree of hearing loss refers to the severity of the loss' losi makes sounds softer and less easy to hear' This type of The table below shows one of the more commonly used hearing loss can often be corrected medically or surgically' classification systems. The numbers are representative of Some possible causes of conductive hearing loss are: the patient's hearing loss range in decibels (dB HL). . Fluid in the middle ear from colds or allergies . Ear infection (otitis media) Degree of hearing Hearing loss range loss (dB HL) . Poor eustachian tube function Normal -10 to 15 . Hole in the eardrum Slight 16 to 25 . Too much earwax (cerumen) Mild 26 to 40 . Swimmer's ear (external otitis) Moderate 41 to 55 . Foreignbodyin the ear canal Moderately severe 56 to 70 . Malformation of the outer ear, ear canal, or middle ear Severe 71 to 90 O Sensorineural hearing loss (SNHL) happens when Profound 91+ there is damage to the inner ear (cochlea) or to the nerve Source: Clark, J. G. (1981). Uses and abuses ofhearing loss pathways from the inner ear to the brain. Most of the time, classification. A sha, 23,493-500. SNHL cannot be medically or surgically correóted' This is the most common type of permanent hearing loss. CONFIGURATION OF HEARING LOSS SNHL reduces the ability to hear faint sounds. Even when The configuration, or shape, ofthe hearing loss refers to speech is loud enough to hear, it may still be unclear or the degree and pattern of hearing loss across frequencies sound muffled. (tones) as illustrated in a graph called an audiogram. Some possible causes of SNHL are: For example, a hearing loss that only affects the high . Drugs that are toxic to hearing tones would be described as a high-frequency loss. Its configuration would show good hearing in the low tones . Hearing loss that runs in the family (genetic or and poor hearing in the high tones. hereditary) . Aging On the other hand, if only the low frequencies were affected, the configuration would show poorer hearing for low tones and better hearing for high tones. Some hearing
o ASHA 10802 Audiology Information Series 2015 }la Rubella loss configurations are flat, indicating the same amount of o Illnesses or infections such as CMV hearing loss for low and high tones. o Head injury noise Other descriptors associated w¡th hearing o Exposure to loud loss are: o Traumatic brain injury (TBI) . Bilateral versus unilateral. Bilateral hearing loss means . Symmetrical versus asymmetrical. Symmetrical means hearing loss in both ears' Unilateral hearing loss (UHL) the degree and configuration ofhearing loss are the means that hearing is normal in one ear but there is same in each ear. Asymmetrical means the degree and hearing loss in the other ear. The hearing loss can range configuration are different in each ear. in both adults from mild to very severe. UHL can occur . Progressive versus sudden hearing loss. Progressive and children. means that hearing loss becomes worse over time. Approximately 1 out of every 10,000 children is born Sudden means that the loss happens quickly. Such a *ith UUt, and nearly 3% of school-age children have hearing loss requires immediate medical attention to UHL. Children with UHL are at higher risk for having determine its cause and treatment. academic, speech-language, and social-emotional . Fluctuating versus stable hearing loss. Fluctuating peers. This may difficulties than their normal hearing means hearing loss that changes over time-sometimes be because UHL is often not identifred, and the children getting better, sometimes getting worse. Stable hearing do not receive intervention. loss does not change over time and remains the same. Below are some possible causes of UHL: o Hearing loss that runs in the family (genetic or hereditary) o An outer, middle, or inner ear abnormality o Syndromes such as Down and Usher syndrome
NOTES: For more information about hearing loss' hearing aids, or referral to an ASFIA-certified audiologist, contact:
2200 Research Boulevard Rockville. MD 20850 OD 800-638-8255
SPEBCH-LaNcuAG[- E-mail: actì[email protected] HwNG Asoc¡ÆroN Website: vwwv.asha.org
ComPl¡ments of American Speech-Language'Hearing Association 2200 Research Boulevard, Rockville, MD 20850 ' 800-638-8255
For more information and to view the entire AudiologY Information Series librar¡ scan with your mobile device.
o ASHA 10802 Ancliology Information Series 2015
^1 SHARING AUDIOLOGICAL TEST RESULTS
Procedure DO DON'T Example
Describing DO: lnclude the significant DON'T: Exclude the the other (communication people who may be in audiogram partner) or family member if the waiting room they attend the audiologic unless the patient assessment. Two sets of requests that they may ears are often better than be excluded. one when it comes to listening to test results. Rationale: The family members can provide a wealth of information. lf the client has a hearing loss, it is a "communication loss" that can affect the entire family. DO: Keep it simple. TrY and DON'T: Use jargon. "You have heard lots relate everything to what Even words of ditferent beeps. the client knows and audiologists use daily Some were low relevant to his/her case like frequency and pitched sounds like a history and communication decibel may seem foghorn and some goals. confusing to some were high pitched people, sounds like a bird chirping. This graph tells us how loud we need to turn sounds up for you to just barely hear these sounds that are important for speech." DO: Write information down DON'T: Assume the Make a copy of the so the client can remember client understands audiogram and make what you said later. everything you tell notes on it - or - let him/her. This is a lot of the patient or family information to take in member takes notes and understand, on it as you counsel especially for a new them so they have client. Often, people something to take are coming in for an home with them. audiological evaluation because family members think there is a communication problem and you are the first person to confirm that fact.
Aß SHARING AUDIOLOGICAL TEST RESULTS
DO: Describe what tYPe of DON'T: When "When you heard the hearing loss (e,9., describing the type of different beeps sensorineural, conductive, hearing loss, do not through the headband mixed) the patient has, get too detailed and that we put behind Keep it simple and focus on confuse matters. your ear, we found what this type of hearing the hearing loss is in loss means for him/her the inner ear, so its is rather than the label. what we call a sensorineural hearing loss. This means that we cannot "fix" the hearing loss with surgery or medication." DO: Relate the hearing loss DON'T: Explain the "You told me earlier to the problems theY hearing loss and that you have trouble reported ruing the case audiogram without anY hearing the history. referent that they can microwave beep understand. when you aren't standing right next to Rationale: Telling a it. Because your client that he/she has a hearing loss is 50 dB HL loss at 4000 primarily in the high Hz means very little. pitch range, this is Rather, it is more one ofthe sounds you usefulto provide are missing with your example's of speech hearing loss. The sounds or noises that further away you they may be missing. stand, the less likely A "familiarsounds you are to hear it." audiogram" or an audiogram with the speech sounds may be helpful in illustrating your points.
Describing DO: Be carefulwhen DON'T: Focus too "When lturned up word describing word recognition much on the percent those words you recognition scores. Some clients think if correct of the word heard loud enough so this score is good, theY do recognition test. you could hear them, not have a problem even you understood most though the test stimuliwere Rationale: Often of them. This means presented at a very loud people walk away that if we amplify level. thinking that this is speech for you - make their percent hearing it very loud - you may for hearing loss. Many understand quite well times people come in in quiet. However, we to an office and say, had to turn the words "Mv last hearing test up louder than normal N SHARING AUDIOLOGICAL TEST RESULTS
showed a 20% loss, conversational levels "when what really for you to recognize happened is they words this well." scored 80% words correct on the word recognition test. Degree of hearing loss and percent words correct are NOï svnonvmous. Psychological DO: Pay attention to how DON'T: Assume that if reactions the client is reacting to the clients do not have any description of his/her questions now, they hearing loss. Are they won't have any confused? Do they questions later when understand what you're they get home. saying to them? Are theY Sometimes, they need getting upset? You are to process information often the first one breaking before knowing what the news or telling them they want to ask. Make how significant their sure you give them hearing/communication away to contact you problem may be. Please be should questions come sensitive to that fact when up later. talking to clients. Planning the DO: Give the client and DON'T: Tell the client "You told me when we next steps his/her family all the oPtions what to do. started yesterday that available, including doing you really wanted to nothing. Hearing aids are Rationale: lt is their be able to hear your NOT always the right decision whether to grandchildren on the answer or even the best follow your telephone. One solution. Be sure You have recommendations or suggestion that can taken a thorough enough not. You need to give help you meet that case history to really them a list of options goal is using an understand what the client's and pros and cons for amplified telephone. goals are when the test is these options, but the Another option may finished and you have ultimate decision is the be hearing aids. Here reviewed the results. clients, are some pros and cons to each... "
Adapted from Tye-Murray, Nancy (2015). Foundations of aural rehabilitation (4th ed.). Clifton Park, N.Y.: Delmar.
bo HEARING SCREENING PROCEDURES
1. Be sure to reserve a portable audiometer for the scheduled hearing screening day. 2. Be sure to arrive 15 minutes prior to the scheduled site. 3. It is the student's responsibility to transport the portable audiometer to and from the screening site. 4. All forms for the day of the screen will be provided. You might find a clipboard helpful and a pen or pencil a must. 5. If you are in need of directions to the screening site, consult your supervisor. 6. Please dress appropriately, yet comfortably. 7. Onarotatingbasis, on the day of the hearing screen, the supervisor will assign a student to complete the appropriate paperwork upon the completion of the screening session. This includes a summary letter to the administrator and individualized letters to the parents of those children who did not pass the hearing screen. Samples are provided for your convenience. They are due to the supervisor within 48 hours. 8. It is strongly recommended that you do a brief listening check on the portable audiometer prior to transporting it to the screening site. 9. Please be familiar with play audiometric techniques and the logistics and procedures of a hearing screen
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Passed Hearing Screening at 25 dB
Unable to Screen (See Comments)
Threshold Testing Required
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Dear Parent(s): The California State University, Fresno, Speech and Hearing Clinic will be providing hearing screenings on Mondayo November 612017 beginning at 10:00 a.m. The screenings will be the Department of Communicative Disorders and Deaf -Studi"r,performed by graduate students from underlhe supervision of a licensed Audiologist. The screenings will take approximately 2-3 minutes per child. You will be notified of the results of the screening if your child does not pass. If you do NOT want your child to participate in the screening, please complete and return the section at the bottom of this Page. Sincerely,
Cynthia Cavazos, Au.D., CCC/A (4U1199) Clinical Supervisor of Audiology
I do NOT want my son/daughter, to participate in the (child's name) hearing screenings on Monday, November 612017.
(Date) (Parent's signature)
Please return this section to your child's teacher if you do NOT want your child to participate in the hearing screening.
ZÒ DATE
CONTACT PERSON SCHOOL NAME ADRESS CITY, STATE ZIP CODE
DEAR (Contact Person)
Thank you for allowing us to provide hearing screenings to your students. Below is a Summary of the findings of the hearing screenings that were performed on (Date) The students who did not pass the hearing screening are as follows: Brennen Handler (both ears) Julia Castillo (right ear)
The students who did not participate in the required task and therefore, results were not obtained are as follows: Lori Lyles
Our recommendation for the above listed children is to obtain a complete audiological evaluation. The University's Speech and Hearing Clinic is available to provide these services. For your convenience, we have included a list of other facilities in this area. Furthermore, a letter for the parents of those children noted above is included
Finally, the following students were noted as absent the day of the screenings: Garrett Blake Noelle Cano Ronnie Day
Ifyou, your staff, or your parents have any questions, please do not hesitate to contact us at (sse) 278-2422.
Sincerely
(Student Name)
Cynthia Cavazos, Au.D., CCC/A (AU1199) Lecturer and Clinical Supervisor DATE
Child's Name: School Site: Date of Screening:
Dear Parent:
Your child's hearing was recently screened during our visit to your child's school. The findings suggest that your child may be experiencing diffrculty hearing in the right ear / left ear / both ears. Our recommendation is for your child to have an audiologic evaluation by a licensed Audiologist. We are able to provide these services at our clinic, or you may wish to contact one of the facilities listed on the reverse side of this letter.
If you have any questions, please do not hesitate to contact us at (559) 278-2422.
Sincerely,
Student Clinician, B.A.
Cynthia Cavazos, AuD., CCC/A (4U1199) Audiology Lecturer and Supervisor
b5 APPENDICES LISTENING TEST OF AUDIOMETER FUNCT¡ON
Audio- Audio- Dials & Volume Pitch Pitch Tone Stimulus Date meter # meter Cords Jacks Headband Earphone Sw¡tches tncreases & AC BC on/ûff Switch No No Tester Serial # OK Seated Tension Cushions ,Ticht Decreases OK OK OK lnaudible Static Crosstalk Signature
Comments
Comments
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Comments (Þ + Comments È. x Comments )( l* Ç-c/ Comments
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Comments wdtx L Please check one: Hearing Eval_ hp Diagnostic_ Speech Therapy:_ California State Universify, Fresno Speecþ Language and Hearing Clinic 5310 N. Campus Dr., PH 80 Fresno, CA93740-8019 (5s9) 278-2422 e Fax (ssg) 278-s187
PLEASE ATTACII ANY REPORTS FROM PREVIOUS AGENCY OR SCIIOOLS
Child Case History PLEASE PRINT IN INKOR TYPE ALLINFORMATION General Information
Today's Date
Child's Name Date of Birth: Gender
Address: Phone:
City: zip:
Mother's Name: Age:
Mother's Occupation: Business Phone:
Father's Name: Age:
Father's Occupation Business Phone:
Does the child live with both parents? _
If no, with whom does the child live?
Brothers and Sisters (include nÍrmes and ages):
Referred By: Phone:
Address:
Physician Phone
Address:
Office Use Only: Date Received:
Dates Contacted: Other specialists who have seen the child:
Please attach the most recent report for the Doctor, agency or school lÍsted above. Address Phone:
what were the other specialists' conclusions and/or recommendations?
What language (s) does the child speak?
How does the child usually communicate?
Gestures Sign Language Single Words Short Ph¡ases Sentences
Describe the child's speech-language or hearing problem.
When was the problem first noticed?
IVho first noticed the problem?
What do you think mayhave caused the problem?
Since you first noticed the problem, what changes have you observed in your child,s speech, language, or hearing? Is the child aware of the problem?
What have you done to help your child with the problem?
Describe other speech, language, or hearing problems in the family.
Prenatal and Birth History
Describe mother's general health during pregnancy (illnesses, accidents, prescription and non-prescription
medications, etc.).
Length ofpregnancy: Length of labor:
Child's general condition: Birth weight:
Circle t¡pe of delivery: head first feet first breech Cesarean
Were forceps used?_
Child's length of stay in hospital
Describe any unusual conditions that may have affected the pregnancy or birth. Medical History
Child's general health is: Good Fair Poor
Provide the approximate ages at which the child experienced the following illnesses and conditions.
Adenoidectomy Asthma Allergies
pox Chicken Colds Conwlsions
Draining ear Dizziness
Ear infections Epilepsy Encephalitis
German measles Headaches Hearing loss
Heart problems High fever Influenza
Measles Mastoiditis Meningitis
Mumps Noise Exposure Pneumonia
Seizures Sinusitis Tinnitus Tonsillitis Tonsillectomy Visual Problems
Other Glasses
List child's current medications.
Describe any major accidents, surgeries, or hospitalizations the child has had. Developmental History
write the approximate age when the child began to do the following.
Crawl sir Stand V/alk Feed Self Dress Self Use toilet Use single words Combine words
Name simple objects Use simple questions Engage in a conversation
Does the child have any motor difficulty, such as walking, running, or participating in other activities
which require small or large muscle coordination?
Describe any feeding problems (e.g., problems with sucking, swallowing, drooling, chewing, etc.) your
child has had.
Does the child:
Respond to any sounds?
Respond to the sound ofthe telephone bell?
Respond to the sound of human voices?
Respond to loud sounds only?
Respond to sounds inconsistently? -- Seem to ignore sounds willfully?
Do you suspect any problems with hearing? General Behavior
Does the child eat well? Sleep well?
How does the child interact with other family members?
Is the child: attentive extremely active restless
Does the child bang his/her head, rock, or spin?
Does the child playby himlherself?
How does the child interact with other children?
Does the child lose his/trer temper?
With whom does the child spend most of the day?
Educational History
School or Preschool Grade:
Teacher (s):
Describe any special services your child receives
If enrolled for special education services, list main goals of the Individualized Educational plan (IEp) or
Individual Family Service Plan (IFSP). Please add any additional information you feel might be herpfur in the evaruation or treatment of the child's problem.
Person completing the form:
Relationship to the child:
Signed: Date: PLEASE ATTACH AI{Y REPORT YOU HAVE FROM A¡IOTHER AGENCY, scHOOL OR DOCTOR
**Please Note: You must complete and sign the attached observation consent statement and return it with your case history form' Thank von fo, taking the time io-¡il out ,h; f;;;;lerely and accurately. California State Unive rsity, Fresno Speecþ Language and Hearing Clinic 5048 NorthJackson Ave., tS S0 Fresno, CA93740-8022 (559) 278-2422 o Fax (559) 278_S-LBT
ObservatÍon Consent
Consent is hereby given to faculty, students and other persons approved.by the clinical supervisor at the Language' speech and Hearing clinic at california state university, Fresno to obserye in the clinic or in off campus settings. Client Name
The purpose of these observations is to train university communicative sciences & Disorders students (both diagnostic and treaûnent sessions may be observed). Students from other departments studying children and adults with language, hearinS, and speech disorders may also watch and listen if the supervisor gives permission.
Parent/Guardian/Self ( I 8 or older) Date California State University, F resno Speech, Language and Hearing Clinic 5310 N. Campus Drive pH 80 Fresno CA 93740-8019 (ss9) 278-2422 - Fax (ss9) z7}-stï7
Release of Clinical Information
To: Date
Re: Birthdate:
I, hereby give the Language, Speech and Hearing
Clinic at California State Universit¡ Fresno, permission to release clinical information
regarding any speech, language, or hearing diagnosis or treatment concerning
that occu¡red between the dates of and to the appropriate medical and educational agencies to further his or her care and education.
This release is considered valid for one year from the date it is signed below
ParenlGuardiar/Self (18 or older) Date California State University, Fresno Speech, Language and Hearing Clinic 5310 N. Campus Drive, pH g0 Fresno CA 93740-9019 (559) 278-2422 - Fax (5s9) Z7B-5797
Release of rnformation to Language, speech, and rrearing clinÍc
To: Date:
Re Birthdate:
You have permission from to provide the Language, Speech, a¡rd Hearing Clinic at California State University, Fresno, with copies of all
records pertaining to medical history and diagnostic services rendered or treatment given to from the dates of to
Released information regarding the above named person is for the purpose of determining
the most appropriate treatment for himÆrer.
These records will be released only to authorized persorurel in the clinic, including faculty members, clinic staff,, licensed supervisors, and student clinicians.
This release is considered valid for one year from the date it is signed below
ParenVGuardian/Self (18 or older) Date Please check one: Hearing Eval ---- Diasnostic: Speech Therapy: .-.-.._.- X 3 California State University, Fresno Speech, Language and Hearing Clinic 531.0 N. Campus Drive, PH 80 Fresno, C/^93740-8019 (559) 278-2422 ç Fax (559) 278-s187
PLEASE ATTACH ANIY REPORT FROM PREVIOUS AGENCY OR SCHOOL
Adult Case History PLEASE PRINT IN INK OR TYPE ALL INFORMATION General Information Today's Date:
Name: Date of Birth: Gender
Address: Phone:
City: zip
Occupation Business Phone:
Employer:
Single: _ Widowed:_ Divorced: Spouse's Name
Spouse's Occupation:
Names, ages, and gender of children:
Referred By: Phone
Address:
Have you been tested and/or evaluated at this clinic before?
If yes, how long ago was your last visit?
Office Use Only:
Date Received:
Dates Contacted: Names and relation of other persons living in home:
V/hat languages do you speak?
What is your primary language?
Highest grade completed or degree earned?
Describe your speechJanguage or hearing problem:
V/hat do you think caused the problem?
When did you first notice the problem?
How has the problem changed since you first noticed it?
How has your communication problem affected your life?
List other speech-language specialists or audiologists you have seen and describe their conclusions or recoÍrmendations List any other specialists þhysicians, psychologists, neurologists, etc.) you have seen, and the specialists' conclusions or suggestions:
Describe any other speech, language, learning, or hearing problems in your family:
Medical History
General health is: good fair poor
Provide the approximate ages at which you experienced the following illness and conditions:
Adenoidectomy_ Allergies Asthma Chicken pox Colds Convulsion
croup- Diabetes Draining ear Ear Infections Dizziness
Headaches Encephalitis_ German Measles Influenza Hearing Aids Heart problems Meningitis Hearing Loss High fever Numbness Mastoiditis Measles Otosclerosis Mumps Noise E*posure_ Sinusitis Paralysis Seizures Tonsillitis Pneumonia Tonsillectomy_ Ulcers Visual Problems Glasses
Do you smoke? How much per day? List all prescription and nonprescription medication used during the past year:
Describe any eating or swallowing difficulties you have experience:
List any major accidents, illnesses, surgeries, or hospitalizations (include dates)
Provide any additional information that you might believe to be helpful in the evaluation or remediation process
Person completing the form:
Relationship to client:
Signed: Date
PLEASE ATTACH AI\IY REPORT YOU IIAVI F,ROM ANOTIMR AGDNCY, SCHooL, oR DoCToR. **Please Note: You must complete and sign the attached Observation Consent statement and return it with your case history form. Thank you for taking the time to fill out the forms completely and accurately. California State University, Fresno Speecþ Language and Hearing Clinic 5048 North Jackson Ave., LS 80 Fresno, CA93740-8022 (559) 278-2422 t Fax (559) 278-slBT
Observation Consent
Consent is hereby given to faculty, students and other persons approved by the clinical supervisor at the Language, Speech and Hearing Clinic at California State University, Fresno to observe in the clinic or in off campus settings
The purpose of these observations is to train University Communicative Sciences & Disorders students (both diagnostic and treatment sessions may be observed). Students from other departments studying children and adults with language, hearing, a¡¡d speech disorders may also watch and listen if the supervisor gives permission.
ParenlGuardian/Self (I8 or older) Date California State University, Fresno Speecþ Language and Hearing Clinic 5048 North Jackson Ave., I,S 80 Fresno, C493740-8022 (559) 278-2422 ; Fax (559) 278-S[BT
Release of Diagnostic Information
To: Date:
Re: Birthdate:
The undersigned gives the Language, Speech and Hearing Clinic at Califomia State University, Fresno, permission to release clinical information concerning the above named person to the appropriate medical and educational agencies involved in his or her care and education.
ParenlGuardian/Self (18 or older) Date California State University, Fresno Speecþ Language and Hearing Clinic 5048 North Jackson Ave., l.S 80 Fresno, Cl'93740-8022 (559) 278-2422 : Fax (559) 278-5187
Release of Information to Language, Speech and Hearing Ctinic
To: Date
Re Birthdate:
You have permission to provide the Language, Speech and Hearing Clinic at Califomia State University, Fresno with copies of all records pertaining to medical history, and diagnostic services rendered or treatment given to the above named person. Released information regarding the above named person is for the purpose of determining the most appropriate treatment or services for him or her.
Parent/Guardian/Self ( I 8 or older) Date California State University, Fresno Speecþ Language and Hearing Clinic 5048 North Jackson Ave., LS 80 Fresno, CA93740-8022 (559) 278-2422 : Fax (559) 278-5187
Consent and Release for Photographs or Videotape
Consent is hereby given to the Language, Speech & Hearing Clinic, at California State University, Fresno, with
approval of to takephotographs, or videotape of
'Thesepictureswillbeusedtotrainuniversitystudentsarrddemonstrate department activities to the general public.
I understand that I will be able to view the photographs or videotape if I so request
Parent/Guardian/S elf ( I 8 or older) Date Appendix 4
CALIFORNIA STATE UNIVERSITY, FRESNO Speech, Language, and Hearing Clinic
Audioloev Case Historv - Child
Name DOB Gender Address Phone Parent's Name Referral Source Do you suspect your child has hearing difficulties? Which ear? Explain:
What do you think caused the problem?
AUDIOLOGICAL HISTORY Has your child ever had a hearing evaluation? Where and when? Has your child ever tried hearing aids?- What type? Which ear(s)?- Is your child currently wearing hearing aids? Daily, how many hours does your child wear the hearing aids? Has your child accepted the hearing aids?-
MEDICAL HISTORY Has your child experienced ear infections? V/hich ear(s[_ How Type of treatment? Has your child ever been hit over the head and knocked out? Which side?
What happened ? Did you notice any hearing difficulties after the following illnesses: chicken pox Mumps measles_scarlet fever-meningitis-ototoxic drugs- - FAMILY HISTORY Are there other family members with a history of ear infections? Who? Are there other family members with a hearing loss?- Who? When was the onset of their hearing loss? Additional Comments: A'PPe"Åt" 5 CALIFORNIA STATE UMVERSITY, FRESNO Speech and Hearing Clinic
AUDIOLOGY CASE HISTORY - ADULT
Name DOB Gender Refenal Statement of the What do you think caused the problem? Have you ever had a hearing evaluation? Where and when? Audioloeical Historv
Do you suspect you have a hearing loss? If so, describe How old were you when you first suspected a hearing loss? Hasitchangedsinceitsonset?-Doesyourhearingchangefromdaytoday?- Does yow hearing loss interfere with your work?- Is the speech of your family clear to you?- Isthespeechofotherscleartoyouinanoisyroom?-Explain Have you ever tried a hearing aid?- What type? Which ear? How Are you satisfied with your hearing aid(s)?-
Mediçal Historv What other medical problems do you have? Do you get Describe your dizziness (lightheaded, offbalance, spinning, etc.) How long does it last? Howoftendoesitoccur?-Doyougetnauseatedwiththedizziness?- Do you have some warning before a dizzy spell?- Explain:- Describe any noise (tinnitus) in your ears Which ear? When is it most noticeable? How long have you had it? Do you have any numbness or tingling in your face? Which side? Did you notice any hearing difficulties after having measles? scarlet fever? ,chicken pox? shingles? Have you ever taken any of the following drugs? streptomycin-, vancomycin gentamicin cisplatin carboplatin any diuretic (Lasix) Other Historv Have you ever worked in a noisy place? If so, where? ,l For how -, Hoú-, often did you wear-2 hearing protection What other forms of noise exposure have you had (concerts, firearms, music, construction, carpentry, aircraft, etc.)
Tell me: The types of problems you have experienced because of your hearing loss? How your listening difficulties (hearing loss) affects your everyday life? The kinds of activities that you like to do? The problems you experience in performing these activities that are associated with your listening difficulties (hearing loss)? The activities that you find more difficult to do now than in the past because of your listening difficulties (hearing loss)? The activities that you would like to do that you have stopped doing because of your listening difficulties (hearing loss)? Any new activities that you would like to try? California State IJniwersit¡2, Fresno Speech, Language, & Hearing Clinic (p 53 l0 North Campus Drive lr,VS PH 80 - Fresno, CA 93740-8019 l\çrçz,'tl*
Name: DOB Date
Referred by:- Audiometer n Standard Audiometry tr Play Audiometry ! VRA n BOA n Inserts n Earphones
FREQUENCY IN FIERTZ (HZ)
125 250 500 1000 2000 4000 8000 12000
-10 -10 I þl I 0 I ¡ 0 Modality Rcspixrçc No R@r¡3c I I R L R L É 10 10 Air I I o x I ¡ Unmdcd P \ V) 20 20 Fl I Mdcêd À q ê EL FI I É 30 30 Bo¡rc I I ¡ O I I I Un¡¡u*cd r¡l 40 40 I ¡ I f I r" I I Måstcd :I F 50 z 50 I Sou¡dfdd V) I Ur¡âi&d S F Fl 60 60 r¡ì Áidcd A \ 70 70 FI I I rl I I 80 80 CNT = Could not test I DNT = Did not test z 90 I 90 I Could not establish ú I CNE = 100 rll 100 ¡ rJr 110 I i10
IMMITTANCE AUDIOMETRY Remarks:
Probe Resting Ear Refl ex ThresholdVScreening Pe¡k Ear Pressure Cånal Compliuæ Volume 500 1000 2000 4000
Right lpi. Ea¡ Co¡tra lStin Lt)
Left Imi Ear Codrå (Stim Rl)
E Recorded D Live Voice Speech Materials: tr NU6 tr Quick-SIN tr WIPI D Other:
EAR HL Quick- Discrimination S/N Discrimination HL PTA SIN Quiet Noise Sound Field Quiet Noise SAT Score SAT
l/ Right o/o o/o Unaided /o %
R Left % % Aided o/o a/ L
Recommendations
Student Clinician Supervising Audiologist California. State IJniversity, Fresno lfudwl Speech, Language, & Hearing Clinic 5310 North Campus Drive M/S PH 80 - Fresno, CA 740-80 19 q arl Name: & 7ôout" Address: Referred Audiometer (*t Standard Audiometry tr Play Audiometry ü VRA tr BOA n Earphones K {nserts FREQTiENCY IN FIERTZ (Hz)
r2s 2s0 500 1000 2000 4000 8000 12000
-10 -10 I I I Fl I ãc- -I-'4.\ I 0 t 0 Modaliry Rcspinsc NoRicspor¡3c t Êa It X* ,'\ A¡r R L RL 10 't --+ r l0 v x-) (r t v I I \Ë o x (n I I \/ Unmaskcd P\ 20 ^. 20 Fl I Madcd À o q,. tq I ê Êq 30 30 Boec I I I U I I I Unnu*cd rq 40 40 ì I I f" a I Mâskcd f :l F z 50 50 I I Souadfidd (n I I Unå¡dcd S tS Fl 60 60 r! I Aitcd A A" I 70 70 rÈ I I |-ì I I o 80 80 CNT = Could not test not z 90 90 DNT = Did test CNE = Could nðt establish i00 100 fJì rJ< 110 110
IMMITTANCE AUDIOMETRY Remarks:
Probe Resting Ear Refl ex Thresholds/Screening Pqk ïlL Ear hessure Cånal Compliuce Volume 500 1000 2000 4000
Right lpsi. Ear â 1o ß5 t5 f1Þ 4aL/a DS,; a:l ¿trï rsÒ Ð'-{Ðc[6+{L qo q5 Left lw ß;5 loo fl,1't i rre Ear -fD/üfr, Coúa l.D.f l,5d lStitr Rl)
Live Voice speech Material tt n WIPI t other: ,lkecorded tr /Nuø/Ouick-SIN EAR SR HL SRT Quiok- Discrimination S/N Discrimination HL PTA SIN Quiet Noise Sound Field Quiet Noise SAT Score SAT Right 5 7 *,5 48^ o/o we) Unaided /o /o R Left % Aided % % ID 1 * îlo* MÁ L "l Recommendations i \ of .SÞvØf €'
Student Appendix 8
CALIFORNIA STATE UNIVERSITY, FRESNO Sþeech, Languagen and Hearing Clinic
IMM CE TESTING
NAME DATE DOts GENDER CLINICIAN Appendix 9
spEEcH RECOGNIÏON THRESHOLD (SRT) WORKSHEET l. Be sure that your client is familiar with all of the words that are presented. Provide your client with specific instructions. The instructions should be given in language appropriate to the client and should: explain the nature of the task, specify the client's mode of response, indicate testing material is speech, the words are only from the test list, emphasize the need for the client to listen carefully, guess when necessary and reinforce that the words may become difficult to hear.
2, Be sure that your client is familiar with all the words that are presented. Allow the client to review the word list. Be sure that your client can auditorially recognize each word, and the vocabulary is familiar.
3. Determine the starting level. Present the initial Spondee word at a comfortable level (e.g. 30dB for normal hearing clients), Then decrease in 10dB increments untiltwo spondees are missed at one level, Now calculate your starting level.
RIGHT LEFT lntensitv Level Responses lntensity Level Responses dB HL dB HL dB HL dB HL dB HL dB HL dB HL dB HL dB HL dB HL dB HL dB HL
Two spondee words missed + 1OdB = Starting Level
Right: Left:
4, IMPORTANT! Begin the threshold test at the starting level.
5. Present 5 words at the starting level. Decrease in 5 dB increments and present 5 spondee words at each level Continue decreasing in 5 dB increments until 5 words are missed at the same intensity.
RIGHT LEFT dB HL Responses dB HL Responses
6. Calculate the SRT
Right: + dB HTL starting level # correct correction factor SRT
Left: - + 2 = dB HTL starting level # correct correction factor SRT APPENDIX 10
Name: Name: Examiner: Examiner: Test: Ear:R/L@ dB Test: Ear: R/ L @_dB
26. 1 1. 26. 2. 27. 2. 27. J 28. 28. 4 29. 4. 29. 5 30. 5. 30. 6 31. 6. 31. 7 32. 7,. 32. 8 JJ. 8. JJ. 9 34. 9 34. 10. 35. 10. 35. 11. 36. 11. 36. 37. 12, t2. 37. 38. 13. 13. 38. 39. t4. 14. 39. 15. 40. 15. 40. 16, 4r. 16. 4r. 42. T7, t7. 42. 18. 43. 18. 43. t9. 44. t9. 44. 45. 20. 20. 45. 46. 21. 21. 46. 47. 22. 22. 47. 48. L). 23. 48. 24. 49. 24. 49. 50. 25. 25. 50. AçpenÅix tl QuickSIN - Standard Version Client's Name Date
TRACK3-List1 Rt i Lt Ear dB Score I A white silk iacket goes with anv shoes. sln 25 2 The child crawled into the dense grass. sln 20 3 Foo showed the path he took up the beach. s/n 15 4 A vent near the edge brought in fresh air. s/n 10 5 It is a band of steel three inches wide. sin 5 6 The weieht of the package was seen on the hÍeh scale. s/n 0 zs.s (TOTAL): SNR Loss Total
TRACK 4 -List2 Rt / Lt Ear _dB Score 1. Tear a thin sheet from the yellow pad. sln 25 2. A cruise in warm waters in a sleek vacht is fun. sln 20 3. A streak of color ran down the left edee. s/n 15 4.Itwas done before the bov could see it. s/n 10 5. Crouch before you iump or mÍss the mark. s/n 5 6. The square peg will settle in the round hole. s/n 0 2s,s (TOTAL): SNR Loss Total
TRACK5-List3 Rt / Lt Ear dB Score I . Pitch the straw through the door of the stable. sln 25 2 . The sink is the thine in which we pile dishes. sln 20 3 . Post no bills on this offïce wall. s/n 15 4 Dimes showered down from all sides. s/n 10 5 . Pick a card and slip it under the pack. s/n 5 6 . The store was iammed before the sale could start. s/n 0 25.5 - (rorAl,) - SNR Loss Total
TRACK6-List4 Rt / Lt Ear dB Score 1 . The sense of smell is better than that of touch. sln 25 2.He picked up the dice for a second roll. sln 20 3. Drop the ashes on the worn ld rus s/n 15 4. The couch cover and hall drapes were blue. s/n l0 5. The stems of the tall glasses cracked and broke. s/n 5 6. The cleat sank deenlv into the soft turf. s/n 0 25.5 - (rorAl,): SNR Loss Total ARrudiv E"
ETYM OTI C RESEA acn STANDARÐ Quickslv'" VIRSiON I
TRACK 3 TRÁCK 8 List 1 Score Ust 6 Score 1. A white $lk iacket gæs w¡th a0y shoes. siN 25 1. The þ¿[ dritts along wilh a slow soin. s/N 25 The jOLQ grass. 2. chlld crawled the dense VN 20 2. The penqil was CUI t0 be sharp at both ends. s/N 20
3. Footorlnts showed the 0ath he took up ü¡e beach. s/N 15 3. Down that road is the way to the oraln farmer. S/1,¡ 15 4. A vent near the edoe brought ln fresh A[, S/N 10 4. The best method ¡s to fi¡ it ln olace with cl¡ps. s/¡r 10 lt 5, is a band 0f steel three lnches WiCþ. s/N 5 5. !f you mumble your speech wlll be lQÊl. S/N 5 The weloht package 6. of the was sæn on the hiqh scale. s/N 0 6. A toad and a û@ are hard to lQll aoart. S/N O - 25.5 ToTAL =_ SNR Loss TOTAL 25.5 - ToTAL =_ SNR Loss TOTAT
TRACK 4 TRACK 9 L¡st 2 Score Ust 7 Score 1 . Ieat a lhlt sheet from the vellow pad. s/N 25 1. The k¡te dio0ed and swayed, but stayed aloft. s/It 25 2. A cruise in warm waters in a sleek vacht is fun. sn.l 20 2. The beetle droned in the hot June €![. s/N 20 3. A streak of color ran down the lgft edge. s/N t5 3. ïhe theft of the oearl 0i! was led secrel S/N 15 4. lt was done before the þoy could qee t. s 10 4. His wlde glh eamed many friends. s/¡t 10 you 5. Crouch before ium0 or miss the mark. siN s 5. Hurdle ü¡e p[ witì the ald of a la0S pola. s/t{ 5 The pgg 6. souare will settle ln the round hole. S/N O 6. Peep under the teût and lee lhe clown. S/N O 25.b - ToTAL =_ SNR Loss TOTAI. 25.5 - T0T/\L =-- SNR Loss TOTAI-
TRACK 5 TRACK 10 Ust 3 Score L¡si I Score 1. Pitch the straw ihrouoh the door of the stable. S/N 25 1. The sun came up to light the eastern Sky. s/N 25 2. The sink is the thlno in which we pile d¡shes. s/¡{ 20 2. 1ïe stale smell 0f old beer l¡noers. s/hr 20 3. Post 00 bllls on thls office Wal!. S/l'l 15 3. ïhe desk was firm 9¡ the shaky floor. s/ti 15 4, Dimes showered down from ¿ll sldes. S/N 1O 4. A IS! of names ls carved around the base. s/N 10 5. Pick a card and S!_i! it under the 0ack. siN 5 5. The news struck doubt lnto restless minds. s/N 5 6. The store was þrn¡gd before lhe sale æuld start. S/TI O 6. The sand drifts overlhe lill of the old house. slN 0 _ 2b.5 ToTAL =-- SNR Loss TOTAL 2S.S _ T0ïAL =_ SNR Loss TOTAT
TRACK 6 TRACK 11 Ust 4 ScoÌe L¡st S Score 1 . The sense of smell ls better lhan that of touch. S/N 25 1. Take shelter ln this te0[, but keeo gill. s/N 25 2. He plcked U0 the dlæ lor a second rcll. s/N 20 2. The luls tales lhey þll are false. S/l'l 20 3. Drop he ashes on the wom old ¡Jg. s/N 15 3. Press the 0echl.Wjll your leü fQal. S/N 15 4. The couch cover and hAll drapes wero blue. s/It 10 4. The black ùunk fÊll from the landlng. vN 10 glasses 5. The stems of the þll cracked and broke. s/¡r 5 5, Cheap clothes are flashv but don't lA$1. sn'r 5 6. The cleat sank deeolv lnto the $Otr !ufl. S/TI O 6, At nl0ht the alarm roused hlm ffom a dee0 sleeo. S/l'l 0 25.5 - TOTAL =_ SNR Loss TOTAL 25.5 _ ToTAL =_ SNB Loss TOTAL
ÏRACK 7 ÏRACK 12 Llst 5 Score t¡st 10 Score
1 . To have ls better than t0 wAll and hope. S/N 25 1 . Dots 0f [qh! betrayed the black CA[. s/N 25 2. The screen before the f[q kept ln the soarks. S/l'l 20 2. Pul the chart on the mantel and tack it down. siti 20 3. Thlck olasses helped hlm read the prlnt. S/N 15 3. The steadv dfi0 ls worse than a drenchlng ß10. s/¡r 15 4. The châir looked strong but had ne bottom. s/ilt 10 4. A flal 0ack takes ie$s lu0gage space. s/l'l 10
5. They þ[! wlu tales to friohten hlm. S/l'l 5 5. The oloss on 1Q0 made lt unfit to read. S/l'l 5
6. A foræ eoual to that would move the earth. S/l'l 0 6. Seven seals were stâmped 0n oreat sheets. S/N O 25.5 - T0TAL =_ SNR Loss TOTAT 25.5 - T0TAL =- SNR Loss TOTAI.
PAGE 1 0F2 I Appendix 13
Degree of Hearing Loss Based on the Pure-Tone Threshold Average (PTA) at 500, 1000 and2000Hz
PTA (dB HL) Degree of Communication Impact -10 to 15 None 16 to 25 26-40 Mild 4r-55 Moderate 56-70 Moderate Severe 7r-90 Severe 91 and above Profound
Maftin, F., & Clark , J.F . (2002). Introduction to Audiology. Boston: Allyn and Bacon.
General Guide for the Evaluation of Word-Recognition Tests
Word-Recognition Scores (in General'Word-Recognition Ability Percent 90 to 100 Normal limits
75 to 90 Slight difficulty, comparable to listening over a 60 to 75 Moderate difficulty
50 to 60 Poor recognition; marked difhculty in fol conversation Below 50 Very poor recognition: probably unable to follow running Martin, F., & Clark, J.F . (2002) Introduction to Audiology. Boston: Allyn and Bacon.
QuickSIN In on SNR DEGREEE OF SNR EXPECTED IMPROVEMENT WITH LOSS LOSS DIRECTIONAL MIC 0-3dB Normal/near normal May hear better than normals hear in notse 3-7dB Mild SNR loss May hear almost as well as normals hear in noise 7-15d8 Moderate SNR loss Directional Consider mlc >15d8 Severe SNR loss Maximum SNR improvement is needed Consider FM s Appendix 14 SPONDEE WORD LISTS
Form A Form
1. Playground 19. Airplane 1. Hothouse 19. Hotdog 2. Daybreak 20. Headlight 2. Armchair 20. Farewell 3. Northwest 21. Hothouse 3. Inkwell 2l.Playground 4. Mushroom 22. Stairway 4. Headlight 22. Eardrum
5. Doormat 23. V/oodwork 5. Grandson 23. Sidewalk
6. Eardrum 24. Drawbridge 6. Northwest 24. Woodwork
7. Iceberg 25. Armchair 7. Schoolboy 25. Doormat
8. Padlock 26. Schoolboy 8. Hardware 26. Stairway
9. Sunset 27. Horseshoe 9. Greyhound 27. Workshop l0.Duckpond 28. Railroad 10. Pancake 28. Toothbrush
1 1. Cowboy 29. Workshop 1 1. Daybreak 29. Railroad
12. Inkwell 30. Pancake 12. Mushroom 30. Padlock
13. Baseball 3 1 . Hardware 13. Airplane 3 1. Iceberg
14. Whitewash 32. Toothbrush 14. cowboy 32. Oatmeal
15. Oatmeal 33, Grandson 15. Drawbridge 33. Baseball
16. Greyhound 34. Birthday 16. Duckpond 34. Birthday
17. Hot dog 35. Sidewalk 17 . Sunset 35. Mousetrap
18. Mousetrap 36. Farewell 18. Horseshoe 36. Whitewash A'ppntu t5 m*r CID Auditory Test W-22 LIST 4A LIST 1A LIST 2A LIST 3A
1. yore l. bill l. all Lan 2. wood 2. yard 2. bin 2. add west 3. at 3. carve 3. way 3. 4. cute 4. where 4. us 4. chest 5. then 5. start 5. chin 5. day they 6. ease 6. ears 6. 6. toe 7. dolls 7. felt 7. . smart 7. tan 8. gave 8. nest Lso 8. stove 9. nuts 9. hunt 9. pew 9. say 10. ice 10. if 10. ought 10. ran ll. in knees I l. odd I l. out ll. 12, net 12. not 12. knee 12.lie 13. three 13. my 13. mew 13. move 14. oil 14. leave 14. low 14. now ! 15. king I 15. of 15. owl l5.jaw 16. pie 16. hang 16. it 16. one 17. he 17. save 17. she 17. hit 18. smooth 18. ear 18. high 18. send 19. tea there 19. else 19. farm 19. 20. cook 20.eam 20. tear 20. this 21. does 21. done 21, tin 21. rwins 22.bread 22. could 22. too 22.use 23. cap 23. camp 23.why 23,what 24. arm 24.bathe 24.with 24.wool 25. are 25. yet 25. ace 25, air aim 26. dam 26.you 26, and 26. 27.when 27. art 2'1. as 27. young 28. book 28. will 28. wet 28. cars 29. tie 29. dust 29. chew 29, tree dumb 30. do 30. toy 30. see 30. that 31. hand 31. aid 3 1. deaf 31. 32, end 32,than 32. them 32. die 33. shove 33. eyes 33. give 33. show 34. have 34. shoe 34. true 34. hurt 35. owes 35. his 35. isle 35. own 36, jar 36. our 36, or 36. key 37. oak 37, no 37. men 37.law 38, near 38, new 38. may 38. me few 39. live 39. knit 39. 39. none jump 40. off 40. on 40. 40,jam 41. pail 41. ill 41. is 41. poor 42. go 42. rooms 42.nw 42,him 43. stiff 43. ham 43. glove 43. skin 44. can 44. star 44.ten 44. east through eat 45, dull 45. 45. thing 45, 46. though 46. clothes 46. dad 46. thin 47. chair 47. who 47.up 47. flat 48. we 48. bee 48. bells 48. well 49. ate 49. yes 49, wire 49.by 50. year 50. am 50. ache 50, ail
AUDITEC'Mof St' Louis ûpføv t{p mñ NU Auditory Test #6
LIST 1A LIST 2A LIST 3A LIST 4A
l. laud l. pick l. base L pass 2. boat 2. room 2. mess 2. doll 3. pool 3. nice 3. cause 3. back 4. nag 4. said 4. mop 4. rcd 5. limb 5. fail 5. good 5. wash 6. shout 6. south 6. luck 6. sour 7. sub 7. white 7. walk 7. bone 8. vine 8. keep 8. youth 8. get 9. dime 9. dead 9. pain 9. wheat 10. goose 10. loaf 10. date 10. thumb I l. whip 11. dab I l. pearl I l. sail 12. tough 12. numb 12. search 12. yearn 13. puff 13. juice 13. ditch 13. wife 14. keen 14. chief 14. talk 14. such 15. death 15. merge 15. ring 15. neat 16. sell 16. wag 16. germ 16. peg 17. take 17.r:ain 17. life 17. mob 18. fall 18. witch 18. team 18. gas 19. raise 19. soap r9. lid 19. check 20. third 20. young 20. pole 20. join 21. gap 2l.ton 21. road 21. lease 22. fat 22.keg 22. shall 22.long 23.met 23. calm 23.late 23. chain 24, jar 24.tool 24, cheek 24.kifi 25. door 25. pike 25.beg 25. hole 26,love 26. mill 26. gun 26.lean 27. sure 27. hush 27. jug 27. tape 28. knock 28. shack 28. sheep 28. tfte 29. choice 29. read 29. five 29. dip 30. hash 30. rot 30. rush 30. rose 31. lot 31. hate 31. rat 31. came 32,ruid 32.live 32.void 32. ftt 33. hurl 33. book 33. wire 33, make 34. moon 34. voice 34. half 34. vote 35. page 35. gaze 35. note 35. judge 36. yes 36. pad 36. when 36. food 37.reach 37. thought 37. name 37. ripe 38. king 38. bought 38. thin 38. have 39. home 39. turn 39. tell 39. rough 40. rag 40. chair 40. bar 40. kick 41. which 41. lore 41. mouse 4l . lose 42.week 42.bite 42.hire 42. near 43. size 43.haze 43. cab 43. perch 44. mode 44. match 44.hit 44. shirt 45. bean 45. learn 45. chat 45. bath 46. tip 46. shawl 46. phone 46. time 47. chalk 47. deep 47. soup 47.hall 48. jail 48. gin 48. dodge 48. mood 49. burn 49. goal 49, seize 49. dog 50. kite 50. far 50. cool 50. should
AUD|TECr"of St. Louis nppendix f1 PBK - 50
/ List LA LÍSI 2A Líst 3A 1. please L. laugh l_. tire 2. great 2. falls 2. seed 3. sled 3. paste 3. purse 4. pants 4. plow 4. quick 5. rat 5. page 5. room 6. bad 6. weed 6. bug 7. pinch 7. grey 7. t,hat 8. such 8. park 8. se11 o bus o wait 9. low L0. need 1_0. fat, 10. rích 11. vrays L1. axe LL. those L2. five L2. cage L2. ache 13. mouth l_3. knife 1_3. black L4. ra9 14. turn ¡4. else 15. put L5. grab 15. nest 16. fed l_6. rose 16. jav 17" fold L7. lip 17. rahr L8. hunt L8. bee L8. true L9. had 19. no L9 " bet 20. box 20. his 20. cost 2L. are 2t. sing 2L. vase 22. teach 22. all 22. press 23. slice 23. bless 23. fir 24. is 24. suit, 24. bounce 25. tree 25. splash 25. wide 26. smile 26. path 26. most 27. bath 27. feed 27. thick 28. slip 28. next 28. r-f 29. ride 29. wreck 29. them 30. end 30. waste 30. sheep 3L. pink 31. crab 3L. air 32. thank 32. peg 32. set 33. take 33. freeze 33. dad 34. cart 34. race 34. ship 35. scab 35. bud 35. case 36. ray 36. darn 36. you a., class 37. fair 37. may 38. me 38. sack 38. choose 39. dish 39. got 39. white 40. neck 40. as 40. frog 4t. beet 4L. grevt 4L. bush 42. few 42. knee 42. clown 43. use 43. fresh 43. cab 44. díd 44. tray 44. hurt 45. bir 45. cat 45. pass 46. pond 46. on 46. grade 47. hot 47. camp 47. blind 48. O\^In 48. find 48. drop 49. bead 49. yes 49. Ieave 50. shop 50. loud 50. nuts
rt97 C/FormsAMordlst5.doc Afp{dtt 18 \ryIPI SCORE SHEET /UDITEC 2"o EDITION
NAME DATE OF BIRTH DATE
LIST ONE LIST TV/O LIST THREE LIST FOUR
EAR SRT EAR SRT EAR SRT EAR SRT
UCL SL UCL SL UCL SL UCL SL
Aud. Vis. Comb. Aud. Vis. Comb Aud. Vis. Comb Aud. Vis. Comb school broom moon spoon ball bowl bell bow smoke coat coke goat floor door corn horn fox socks box blocks hat flag bug black
sand fan can man bread red thread bed
egg desk nest dress stair bear chair pear
eye ple fly tie
knee tea key bee
street meat feet teeth wmg swlng king nng mouth clown crown mouse shirt church din skirt gun thumb sun gum
bus rug cup bug train cake snake plane arïn barn car star chick stick dish fish crib ship bib lip wheel seal queen green
straw dog saw ftog tail nail jail pail
SCORE Appendix 19 Children's Spondee Word List
1. sidewalk 27. jacldrrrife 2. birthday 28. ice cream 3, cupcake 29. schoohoom 4. airplane 30. backyard 5. headlight 31. doorbell 6. blackbird 32. drugstore 7. eyebrow 33. hopscotch 8. railroad 34. jump rope 9. baseball 35. shoelace 10. stairway 36. hairbrush 1 1. armchair 37. necktie 12. playground 38. ashtray 13. doorstep 39. bedroom 14. mousetrap 40. toy shop 15. cowboy 41. playpen 16. sunset 42. dollhouse 17. daylight 43. highchair 18. footstool 44. downtown 19. pancake 45. meatball 20. hot dog 46. sunshine 21. outside 47. barnyard 22. scarccrow 48. bus stop 23. playmate 49. football 24. rainbow 50. blue jay 25. toothbrush 51. bird nest 26. bathtub Name hr,n l¡* 7,o NU-CHIPS WORK SHEET
Test Form 1 Test Form 2 Test Form 3 Test Form 4 dB SL dB SL dB SL dB SL o/ o/ o//o /o /o
1. Dog (1) 1. Frog (3) 1. Cake (2) 1. Train (3) 2. Purse (1) 2. Bird (4) 2. Comb (4) 2. Boat (1) 3. Mirk (3) 3. Mirk (3) 3. Man (3) -Yo3.' !-{am (4) 4. Nose (4) 4. Boat (1) 4. Soap (1) 4. Coat (2) 5. Hand (3) 5. Man (4) 5. Tree (4) 5. Teeth (2) 6. Watch (2) 6. Watch (2) 6. Snake (1) 6. Snake (1) 7. Foot (3) 7. Food (4) 7. Bus (2) 7. Dress (3) L Smile (4) 8. Smile (4) 8. Juice (3) 8. Shoe (2) 9. Truck (1) 9. Duck (3) 9. Gun (3) 9. Gum (4) 10. School (1) 10. Spoon (4) 10. Cup (4) 10. Duck (3) 11. Door (1) 11. Door (1) 11. Meat (1) 11 . Tree (4) 12. House (4) 12. Mouth (2) 12. Bear (3) 12. Hair (2) 13. Bike (3) 13. Lisht (4) 13. Girl (1) 13. Girl (1) 14. Train (2) 14. Train (2) 14. Bird (2) 14. Shirt (4) 15. Teeth (4) 15. Tree (2) 15. Ball (1) 15. Dog (4) 16. Snake (4) 16. Cake (3) 16. Food (2) 16. Foot (3) 17. Head (4) 17. Head (4) 17. House (3) ,17. Mouth (1) 18. Bus (3) 18. Dress (1) 18. Spoon (2) 18. School (3) 19. Clock (2) 19. Clock (2) 19. Shirt (4) 19. Purse (2) 20. Shoe (3) 20. Juice (1) 20. Horse (1) 20. Door (3) 21. Hair (2) 21. Bear (3) 21. Light (2) 21. Bike (4) 22. Tongue (3) 22. Gun (41 22. Hand (11 22. Man (21 23. Witch (4) 23. Sink (3) 23. Truck (3) 23. Cup (a) 24. Meat (1) 24. Meat (1) 24. M¡lk (2) 24. Sink (1) 25. Gum (1) 25. Tongue (3) .25. Coat (4) 25. Comb (1) 26. Food (3) 26. Foot (1) '26. Frog (4) 26. Ball (2) 27. Soap (2) 27. Soap (2) 27. Smile (1) 27. Light (4) 28. Bird (1) 28. Girl (2) 28. Mouth (3) 28. House (1) 29. Sink (1) 29. Witch (3) 29. Dress (4) e9. Bus (3) 30. Ball (4) 30. Ball (4) 30. Witch (2) 30. Mirk (4) 31. Tree (1) 31. Teeth (2) 31. Hair (3) 31. Bear (2) 32. Boat (4) 32. Coat (3) 32. Tongue (4) 32. Gun (3) 33. Duck (3) 33. Truck (1) 33. Nose (2) 33. Nose (2) 34. Dress (3) 34. Bus (4) 34. Gum (1) 34. Tongue (2) 35. Ham (1) 35. Hand (3) 35. Ham (2) 35. Hand (1) 36. Horse (4) 36. Horse (4) 36. Shoe (3) 36. Juice (4) 37. Light (2) 37. Bike (1) 37. Train (4) 37. Cake (1) 38. Frog (3) 38. Dog (2) 38. Teeth (1) 38. Meat (3) 39. Shirt (2) 39. Shirt (2) 39. Purse (2) 39. Bird (3) 40. Spoôn (1) 40. Schoot (2) 40. Sink (3) 40. Watch (2) 41. Juice (2) 41. Shoe (3) 41. School (4) 41. Spoon (3) 42. Bear (4) 42. Hair (2) a2. Bike (2\ 42. Smile (4) 43. Girl (2) 43. Purse (1) 43. Head (1) 43. Head (1) 44. Cake (2) 44. Snake (1) 44. Foot (2) 44. Food (1) 45. Comb (1) 45. Comb (1) 45. Duck (1) 45. Truck (4) 46. Coat (2) 46. Nose (3) 46. Door (4) 46. Horse (3) 47. Mouth (2) 47. House (3) 47. Boat (3) 47. Soap (2) 48. Man (4) 48. Ham (1) 48. Watch (1) 48. Witch (3) 49. Cup (a) 49. Cup (a) 49. Clock (4) 49. Clock (4) 50. Bun (3) 50. Gum (2) 50. Dog (3) 50. Frog (1) Appendix 21
CALIFORNIA STATE UNIVERSITY, FRESNO Speecho Language, and Hearing Clinic X'resnoo CA 93740-8019 Phone: (559) 278-2422
Audiologic Evaluation
NAME: Margaret Margaret DOB: 612111992 ADDRESS: 6672 W. Pioneer FILE NUMBER: CITY: Fresno, CA93720 DATE:212612015 TELEPHONE: (805) 55s-s555 CLINICIAN: XXXXXXXXXX, B.A.
Margaret Margaret was seen for an Audiologic Evaluation at the Speech, Language, and Hearing Clinic at California State University, Fresno on February 25,2015. Ms. Margaret reported that she did not suspect a hearing loss in either ear. She also stated that speech of others is typically clear in quiet, and also in background noise. She is in good overall health with no outstanding medical history. She did report occasional noise exposure in the form of musical concerts and through the use of firearms. Ms. Margaret stated that this was her first audiological examination since childhood. The purpose of today's evaluation was to assess her hearing sensitivity.
TEST RESULTS Otoscõpic Inspection: Results of the otoscopic inspection were uffemarkable bilaterally.
Middle Ear Function: Immittance testing revealed a tympanogram with normal shape, amplitude, and peak pressure (normal middle ear pressure-compliance function) bilaterally. Ear canal volume (ECV) measurements were 0.9 cm3 for the right ear and 0.9 cm3 for the left ear. These test results suggest normal middle ear function and ear canal volume measures for both ears. Ipsilateral acoustic reflexes were also found to be within normal limits bilaterally and demonstrated as follows:
500 Hz 1000 Hz 2000 Hz 4000 Hz Right Ear 90 dB HL 85 dB HL 85 dB HL 80 dB HL Left Ear 90 dB HL 95 dB HL 85 dB HL 80 dB HL
Auditory Sensitivity: Pure tone air conduction and bone conduction thresholds were found to be within the normal hearing range in both ears. Pure tone conduction thresholds for the right ear were found to range from -10 dB HTL to 10 dB HTL for frequencies consisting of 250H2 through 8000 Hz. Pure tone conduction thresholds for the left ear were found to range from 0 dB HTL to 10 dB HTL for the same frequencies. Unmasked bone conduction thresholds for the responding (better) ear were found to range from - 10 dB HTL to 1 5 dB HTL for frequencies consisting of 250 Hz through 4000 Hz The Pure Tone Average (PTA) for the right ear was 2 dB HTL and 7 dB HTL in the left ear. Bing and \ileber Tests: Both the Bing and'Weber tests were administered and found to be consistent with audiometric findings. Ms. Margaret reported an increase in loudness in both ears when the Bing test was administered at 30 dB HL for 500 Hz. In addition, at the same test frequency, a sensation in the right side was reported for the Weber test. These results were consistent with the audiometric test findings.
Speech Recognition Threshold Test: Speech recognition thresholds (SRT) were established at Zìg Hff forthe right ear and 0 for the left ear utilizing spondee words. These results indicate good test reliability and validity.
Word Recognition Test: Word recognition testing was administered at 45 dB HL in quiet utilizing theÑU-6 word list. Scores of 92o/o correct for the right ear and960/o correct for the left .u1. *.r. established. These results suggest normal word recognition skills in quiet bilaterally. euickSin Speech Discrimination Test: Speech discrimination testing conducted with the the left euickSlN ui ZO ¿g HL revealed scores of 0.5 dB SNR in the right ear and 0.5 dB SNR in eàr. These results suggest normal ability to hear and understand speech in noise bilaterally.
IMPRESSIONS AND RECOMMENDATIONS irrt.. tl4utgutet was cooperative throughout the evaluation and test reliability was judged to be good. The audiometric test findings reveal normal hearing sensitivity in both ears. Immittance áudiometry suggested no evidence of outer or middle ear pathology bilaterally. These test results also portray excellent word recognition skills in a quiet listening environment for both ears. Moråover,-the test results suggest normal ability to hear and understand speech in the presence of background noise in both ears.
It is recommended that Ms. Margaret have an audiological evaluation as needed to monitor hearing sensitivity and speech discrimination skills both in quiet and in the presence of background noise.
XXXXXXXXXXXXXX, B.A Student Clinician
Stephen D. Roberts, Ph.D., CCCIA Clinic Supervisor/Audiologist Appendix 22
CALIFORNIA STATE UNIVERSITY, FRESNO Speech, Language, and Hearing Clinic Fresno, CA 93740-8019 Phone: (559)278-2422
Audiologic Evaluation
NAME: Leslie Smith DOB: 0912011952 * * ADDRESS: 3715 W. Blackstone FILE NUMBER: 'r. '& 'r. CITY: Fresno, CA 93711 DATE: 212512015 TELEPHONE: (s59) 555-5555 CLINICIAN: XXXXXX, B.A.
Leslie Smith was seen for an Audiologic Evaluation at the Speech, Language and Hearing Clinic at California State University, Fresno on February 25,2015. Ms. Smith is a retired marriage, family and child therapist and currently works as a professional artist in her free time. Ms. Smith was seen due to a sudden decrease of hearing sensitivity in her left ear that occuned on February 20,2015. Ms. Smith was referred to the clinic by Dr. Stephen Roberts. Ms. Smith stated that she had a sudden attack of vertigo and was unable to hear the sounds around her (i.e. music, voices) in her left ear. She was concerned that the sudden episode of vertigo and hearing loss may have been a result of pushing herself too hard in physical therapy, but was unsure as to the cause of the problem. According to Ms. Smith, the vertigo continually worsened, and due to the dizziness, she contacted her primary care physician, Dr' Mary Hill, who recommended that she go to the emergency room (ER). The ER prescribed Ms. Smith with a patch to place on her body for the vertigo, but did not treat her hearing loss. Ms. Smith was able to visit her doctor three days later on the following Monday, and was prescribed with prednisone (600 mg). On the morning of the audiologic assessment, Ms. Smith reported that her hearing in her left ear had improved from the evening before; however, she still has tinnitus in her left ear. She also noted that she has an otologic evaluation scheduled for Friday, February 27Th withDr. George Hsu, Ear, Nose and Throat (ENT) Specialist at Central California Ear, Nose & Throat (CCENT) Medical Group.. Ms. Smith mãst recently had her hearing tested at the California Ear Institute in August 2013. The results of the evaluation indicated a severe to profound bilateral sensorineural hearing loss with poor word recognition skills.
As per report, Ms. Smith stated that her hearing loss was present at birth. She claimed however, that the loss was not identified until the age of 4 % years old. Ms. Smith was sent to a speech language pathologist for further assessment, and was also given a hearing assessment by Dr. Simmons. The initial findings were not sufficient enough, so Ms. Smith was sent to another specialist, Dr. Olson. Dr. Olson removed Ms. Smith' tonsils and adenoids, which she noted improved her hearing at the time. At age 6 years, Ms. Smith was fitted with her first hearing aid x Shurson Hearing Aid Center in Fresno due to her moderate bilateral sensorineural hearing loss. Soon after, Ms. Smith had an accident at school that resulted in a concussion. Ms. Smith thought that the concussion may have led to a decrease in hearing sensitivity which resulted in Ms. Smith needing a hearing aid with greater amplification. She was no longer able to hear without the use of one hearing aid and was eventually fitted binaurally with hearing aids. Around the age of 9 years, Ms. Smith noted that" dizzy spells and tinnitus in hçr ears began; however, the physicians in Fresno stated nothing could be done to address the problem
Ms. Smith was found to have a progressive bilateral sensorineural hearing loss, with her hearing sensitivity continuing to decrease from a moderate to severe bilateral sensorineural hearing loss to a severe to profound bilateral sensorineural hearing loss by the time she reached the age of50 years old. She has used sign language interpreters since the age of35 years old to help with her communication. She currently wears Phonak Naida postauricular hearing aids coupled to canal ear molds in both ears. She further claimed that although the aids help significantly with her hearing ability, they do tend to fall out, which can be frustrating. The purpose of today's audiologic assessment was to evaluate her hearing sensitivity and function bilaterally.
TEST RESULTS Otoscopic inspection: Results of the otoscopic inspection were uffemarkable in both ears.
Middle ear function: Immittance testing revealed tympanograms with normal shape, amplitude, and peak pressure (normal middle ear pressure^-compliance function) bilaterally. Peak compliance *ui 0.3 cm3 for the right ear and 0.8 cm3 for the left ear. Ear canal volume (ECV) -éurur"-"nts were 1.3 cm3 for the right ear and L2 cm3 in the left ear. These results suggest normal middle ear function and canal volume measures for both ears. Ipsilateral acoustic reflexes were measured for 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. When the right ear was assessed, a probe seal could not be maintained for 2000 Hz and 4000 Hz after multiple attempts, and was represented by NT (not tested). The remaining frequencies in both the right and left ears yielded no response Q.JR) as displayed in the following table:
boo nz lrooo n, þooo Hz 4000 Hz Ear Fvn [vn Nr NT eft Ba. Þ.ln [sn Nn NR
Auditory sensitivity: The results of the pure tone air conduction and bone conduction threshold tests revealed a bilateral severe-to-profound sensorineural hearing loss with no measurable responses above 3000 Hz. Air conduction thresholds were found to range from 80 to 115+ dB HTL for the right ear and from 85 to 115+ dB HTL for the left ear for frequencies ranging from 250 through 8000 Hz. Unmasked bone conduction thresholds obtained with the bone vibrator attached to the right mastoid process were found to range from 40 to 85+ dB HTL for frequencies ranging from 250 through 4000 Hz. The frequency threshold levels at250 and 500 Hz were detected tactilely; suggesting Ms. Smith was able to feel the vibration rather than perceive the tone at these two low frequencies. Moreover, there were no measurable responses at 1000, 2000 and 4000 Hz The pure tone threshold average (PTA) for the right ear was 103 dB HTL and 106 dB HTL for the left ear. Bing and'Weber Tests: Due to the severity of her bilateral sensorineural hearing loss, the Bing and V/eber tests were unable to be administered utilizing a 500 Hz tone.
Speech Recognition Threshold Test: Speech recognition thresholds (SRT) were established X tOZ dB HTL for the right ear and at 106 dB HTL for the left ear utilizing spondee words. These results were consistent with the PTA bilaterally, indicating good test reliability and validity.
Word Recognition Test: V/ord recognition administered at 110 dB HL in quiet utilizing the NU-6 word list (phonetically balanced monosyllabic words presented at a confortable listening level). Ms. Smith scored 20o/o conect in the right ear and2Yo corect in the left ear. These results indicate poor word recognition skills bilaterally in quiet.
QuickSin Speech Discrimination Test: The QuickSIN speech discrimination test was unable to be reliably administered during the evaluation due to her poor word recognition skills in quiet.
IMPRESSIONS 1. Ms. Smith was cooperative throughout the evaluation and test reliability was judged to be good to excellent.
2. The audiologic evaluation showed evidence of a bilateral severe-to-profound sensorineural hearing loss with no measurable response above 3000 Hz in both ears.
3. Immittance audiometry suggests no evidence of outer or middle ear pathology bilaterally.
4. Word recognition skills in quiet were poor bilaterally.
5. In comparing the results of today's audiologic evaluation with Ms. Smith' previous audiologic evaluation in August 2013 at California Ear Institute, there appears to be no change in her pure tone threshold levels (i.e., within 10 dB) in either ear except for a 15 dB decrease in the air conduction frequency at 500 Hzinher left ear (i.e., from 85 dB HL to 100 dB HL). The test findings are consistent with Ms. Smith' subjective impressions of improved hearing sensitivity in her left ear since beginning the recently prescribed prednisone medical management.
Moreover, test results further showed an improvement in her right ear with word recognition scores from 8% (re: August2013 at CaliforniaBar Institute) to 20Yo via today's test findings. Conversely, there was a decrease in word recognition skills for her left ear from 20o/o (re: August 2013 at California Ear Institute) to 2o/o via today's test findings.
RECOMMENDATIONS Based on today's findings, the following lecommendations are warranted:
l. ENT consultation to determine the current medical status of the left ear. As noted previously, Ms. Smith is scheduled for an otologic consultation with Dr. Hsu on February 27th aICCENT Medical Group. Of note, I suggested that Ms. Smith continue to document any improvement in her hearing sensitivity and function throughout her course of her medical management.
2 Audiologic evaluation in four weeks at the CSUF Speech and Hearing clinic to monitor hearing sensitivity.
Sally McNeil, B.A. Student Clinician
Stephen D. Roberts, Ph.D., CCC/A Clinic Supervisor/Audiolo gist
CC: Mary M. Hill, MD 7407 N Cedar Ave Ste 102 Fresno, CA93720
George Hsu, MD Central California Ear, Nose & Throat Medical Group 1351 E. Spruce Avenue Fresno, CA93720 Appendix 23
CALIFORNIA STATE UNIVERSITY, FRESNO Speech, Language, and Hearing Clinic Fresno, CA 93740-8019 Phone: (559)278-2422
Audiologic Evaluation
NAME: Peggy Castillo DOB: 0311811970 ADDRESS : 5633 N.'West Ave FILE NUMBER: XXXXXX CITY: Fresno, CA93730 DATE: 314115 TELEPHONE: (559) 5s5-s5s5 CLINICIAN: XXXXXXXXX
Peggy Castillo was seen for an Audiologic Evaluation at the Speech, Language, and Hearing Clinic at California State University, Fresno on March 4,2015. Mrs. Castillo'primary language was Spanish. Mrs. Castillo' daughter, Monica Castillo, accompanied her and translated during the assessment. Mrs. Castillo reported an onset of hearing loss in her right ear when she a child possibly due to a high fever. She further noted that she does have difficulty hearing from her right ear. Mrs. Castillo reported that she worked at a packing company for about four years, and did not wear ear protection while working. She has tinnitus in her right ear described as an intermittent hissing noise. Currently, she uses medication such as Insulin and Acetaminophen. The purpose of today's evaluation was to assess her hearing sensitivity.
TEST RESULTS Auditory sensitivity: Left Ear: The results of the pure tone threshold tests revealed a slight, low-frequency sensorineural hearing loss for the frequencies of 250 Hz through 1000 Hz, with normal hearing threshold levels for the frequencies from 2000 Hzto 8000 Hz. Pure tone air conduction threshold levels ranged from 10 dB HTL to 25 dB HTL for frequencies between 250 and 8000 Hz. Unmasked bone conduction threshold levels ranged from 0 dB HTL to 25 dB HTL for octave frequencies between 250 and 4000 Hz. The pure tone threshold average (PTA) for the left ear was 16 dB HTL.
Right ear: The results of the pure tone threshold tests revealed a severe, relatively flat sensorineural hearing loss across the frequency range from 250 Hzto 8000 Hz. Masked pure tone air conduction threshold levels ranged from 60 dB HTL to 75 dB HTL for frequencies between 250 and 8000 Hz. Masked bone conduction threshold levels ranged from 40 dB HTL to 65 dB HTL for octave frequencies between 250 and 4000 Hz The PTA for the right ear was 63 dB HTL.
Otoscopic inspection: Results of the otoscopic inspection were umemarkable in both ears.
Middle ear function: Results of the immittance testing revealed Type A tympanograms with normal peak, pressure, and shape (normal pressure-compliance function) demonstrated bilaterally. Ear canalvolume (ECV) measurements were 1.0 cm3 for the right ear and .9 cm3 in the left ear. These test results suggest normal middle ear function and canal volume measures in the left ear. Ipsilateral acoustic reflexes in the right ear were absent for all frequencies tested. Ipsilateral acoustic reflexes were within normal limits at 500 Hz,2000Hz and 1000 Hz,butabsent at 4000 Hzinher left ear. The data for the ipsilateral acoustic reflexes are as follows:
500 Hz 1000 Hz 2000 Hz 4000 Hz Rieht Ear NR NR NR NR Left Ear 1OO dB HL 105 dB HL 95 dB HL NR
Bing and Weber Tests: Mrs. Castillo reported that the tone seemed to be louder bilaterally upoã occlusion of the ear canal when the Bing test was administered at 50 dB HL for 500 Hz' Tïe right ear could not be assessed due to the severity of the loss. In addition, a left side sensation was reported for the Weber test at the same frequency and intensity. These findings are consistent with the audiometric test results in the lefl ear.
Speech Recognition Threshold: Left ear: Mrs. Castillo' primary language was Spanish. However, a recorded Spanish version of the Speech Recognition Threshold (SRT) test was not available. Therefore, a live voice versiontf the Spanish Trisyllable Word List was employed to determine her SRT level. With the student clinician's assistance, her daughter, Monica Castillo, presented the words in Spanish and the intensity level of her voice was monitored via the VU meter. The SRT was established at23 dB HTL for the left ear.
Right ear: The speech reception threshold level for the right ear could not be determined due to poor word recognition skills. Therefore, a speech awareness threshold (SAT) was established at 70 dB HTL.
Word Recognition Test: Left ear: Wórd recognition was administered at 70 dB HL utilizing the Spanish version of the NU-6 word list. Mrs. Castillo scored I00% correct in the left ear suggesting excellent word recognition in quiet.
Right ear: Word recognition was administered at 100 dB HL utilizing the Spanish u.Ãion of the NU-6 word list. She scored 0o/o correct in the right ear suggesting poor word recognition skills in quiet.
euickSin Speech Discrimination Test: Unable to assess. The QuickSIN speech discriminatiõn test was not administered since the client's primary language was Spanish and the Spanish version of this test was not available.
IMPRESSIONS M*. C"rtitt" ** delightful and cooperative throughout the evaluation, and the test reliability was judged to be good. The audiologic evaluation showed evidence of a slight, low-frequency sensôriniural hearing loss in the left ear and a severe, relatively flat, sensorineural hearing loss in the right ear. Immittance testing suggested no evidence of outer or middle ear pathology bilaterally. Word recognition in quiet skills were found to be within the normal ia.tg. foi the left ear; whereas, word recognition were poor in her right ear and consistent with her audiometric test findings.
RECO ONS 1. Due to the severity of the hearing loss and poor word recognition skills in her right ear, a hearing aid fitted to her right ear is contraindicated.
2. Based upon today's findings, the following compensation strategies were discussed: a. In noisy social environments, focus on the speaker's lips for lip-reading cues.
b. In noisy social environments, situate herself within close proximity of the speaker to improve the speaker's speech-to-background noise ratio.
c. In social with competing background noise, ensure that the natural and environmental light illuminates the speaker's face for lip reading (e.g., well lit room).
d. Adjust seating anangements so that conversational partners speak towards her better (left) ear.
e. Adjust the rearview mirror to facilitate lip reading in order to communicate in a vehicle.
3. Use of hearing protection when in noisy situations was discussed.
4. It is recommended that Mrs. Castillo have an audiologic re-evaluation in one year to monitor her hearing sensitivity.
XXXXXXXXXX, B.A. Student Clinician
Stephen Roberts, Ph.D., CCC/A Clinic Supervisor/Audiolo gist Appendix 24
CALIFORNIA STATE UNIVERSITY, F'RESNO Speech, Language, and Hearing Clinic Fresno, CA 93740-8019 Phone: (559)278-2422
Audiologic Evaluation
NAME: Morgan Garua DOB: 0511211993 ADDRESS: 5j37 N. MilPitas Ave. FILENUMBER: ****'r.'ß CITY: Fresno, CA93710 DATE: 0310412015 TELEPHONE: (661) 904-s555 CLINICIAN: XXXXXXXXXXX, B.A.
Morgan Garzawas seen for an Audiologic Evaluation at the Speech, Language and Hearing Clinic at California State University, Fresno on March 4,2015. Ms. Garza reported no expected hearing loss. The purpose of today's evaluation was to assess her hearing sensitivity.
TEST RESULTS Otoscopic inspection: Results of the otoscopic inspection were un.remarkable in both ears.
Middte ear function: Immittance testing revealed tympanograms with normal shape, amplitude, and peak pressure (normal middle ear pressure-compliance function) bilaterally. Ear canal volurne éCÐ measurements were 0.8 cm3 for the right ear and 0.9 cm3 in the left ear. These results suggest normal middle ear function and canal volume measures for both ears. Ipsilateral acoustic reflexes were within normal limits bilaterally and found to be the following:
500 Hz L000 Hz 2000 Hz 4000 Hz Rieht Ear 1OO dB HL 105 dB HL 95 dB HL 90 dB HL Left Ear 1OO dB HL 95 dB HL 95 dB HL 90 dB HL
Auditory sensitivity: Pure tone air and bone conduction thresholds were found to be within the normal range in both ears. Air conduction thresholds were found to range from -5 to 10 dB HTL for the right ear and from -10 to 10 dB HTL for the left ear for frequencies ranging from 250 through 8000 Hz. Unmasked bone conduction thresholds obtained with the bone vibrator on the left mastoid were found to range from -5 to 10 dB HTL for frequencies ranging from 250 through 4000H2. The pure tone threshold average (PTA) for the right ear was 7 dB HTL and 0 dB HTL for the left ear.
Bing and \ileber Tests: Both the Bing and'Weber tests were administered and found to be consistent with audiometric findings. Ms. Garza reported an increase in loudness in both ears when Bing test was administered at 40 dB HL for 500 Hz. In addition, atthe same test frequency, Ms. Garza reported the sound to be at the midline between the right and left ears during the Weber test.
Speech Recognition Threshold Test: Speech recognition thresholds (SRT) were established at Zig FlfL foithe right ear and at 6 dB HTL for the left ear utilizing spondee words. These results indicate good test reliability and validity.
\ilord Recognition Test: V/ord recognition administere d at 45 dB HL in quiet utilizing the NU- 6 word list. Ms. Garzascored I00% correct in both the right and left ears. These results indicate excellent word recognition skills in quiet.
QuickSin Speech Discrimination Test: The QuickSIN speech discrimination test was administered at70 dB HL in both the right and left ears. Results of the QuickSIN test revealed a -2.5 dB SNR loss in the right ear and 0.5 dB SNR loss in the left ear. These findings suggest normal ability for Ms. Garzato hear and understand speech in the presence of noise.
IMPRESSIONS AND RECOMMENDATIONS Ms. Garza was cooperative throughout the evaluation and test reliability was judged to be good. The audiologic evaluation showed no evidence of hearing loss in either ear. Immittance audiometry suggests no evidence of outer or middle ear pathology bilaterally' Moreover, word recognition in quiet skills and speech discrimination with competing background noise skills were found to be within the normal range.
It is recommended that Ms. Garzacontinue to have her hearing evaluated as needed.
B.A. Student Clinician
Stephen D. Roberts, Ph.D., CCC/A Clinic Supervisor/Audiolo gist APPENDIX 25
AUDIOLOGICAL SERVICES
Speech, Language and Hearing Clinic Department of Communicative Disorders and Deaf Studies California State University, Fresno 5310 N. Campus Drive, M/S PH80 Fresno, CA 93740-8019 (ss9)278-2422
Heiner Hearing Center 3838 First Street Fresno, CA 93726 (ssg) 227 -t67r
Lowe Audiologist 6101 N. Fresno Street, Suite #102 Fresno, CA 93710 (ss9) 432-26s0
Physician's Hearing Services 1351 East Spruce Fresno, CA 93710 (ssg) 432-se73
Valley Children's Healthcare Department of Speech-Language Pathology and Audiology 9300 Valley Children's Place Madera, CA 93636 (ss9) 3s3-6900
Veteran's Administration Medical Center Audiology and Speech Pathology 2615 E. Clinton Fresno, CA 93703 (sse) 228-s3s2 APPENDIX 26
DISPENSING AUDIOLOGISTS
Lowe Audiologist 6101 N. Fresno Street, Suite #102 Fresno, CA 93710 (ssg) 432-26s0
Fresno Hearing Center (Kaiser Permanente) 1630 E. Shaw Ave.,#124 Fresno, CA 93710 (ss9) 448-s640
Heiner Hearing Center 3838 First Street Fresno, CA 93726 (559) 227-167t
Physician's Hearing Services 1351 East Spruce Fresno, CA 93720 (5se) 432-s973
Valley Children's Healthcare Department of Speech-Language Pathology and Audiology 9300 Valley Children's Place Madera, CA 93636 (ss9) 353-6900
Veteran' s Administration Medical Center Audiology and Speech Pathology 2615 E. Clinton Fresno, CA 93703 (sse) 228-s3s2 Appendix2T
AU'DIOGRAM' OF FAM.llimR SOUNDS
, FREOUENCY lN cYcLES PER SECOND (H4 125 250 500 1000 20oo 4000' 8000
0 \v wM) 10
20 p À tto h zv ì7Or ó30J clr ul g40 t l¡¡gu I o ¡t I lu ng ,:" te I 2so u ((r* I J &ñ .-ç 'i11 860u¡ å brÐ o70 Àtr Þd))) z f äBo -t u¡ r IE æ -Ê 90 €re .tva 1 ^q,¿ f/ 110 ,4. Æ bÞ4' .4.ì..-l 1 û ù v 9 & ñge
AMERICA}¡ ACADEMYOF AUDIOLOGY httpr//wv¡ud¡olo$/.org 820lCFetrsbomDn,Sae.300,MclÆtr VA22¡02'?03'610'9022'800'AAA'233ó'F¡x:703-610'9005 Appendix 28 TINNITUS QUESTIONNAIRE Name DOB Address Phone
1. I have had tinnitus in its present form for : (circle one) a. Less than a year d. Three to five years b. One to two years e. Longer than five years c. Two to three years
2. Prior to my present form of tinnitus I had a mild tinnitus for _ years (number).
3. My tinnitus seems to be primarily located in : (circle one) a. The left ear d' Both ears equallY b. The right ear e' MY head c. Both ears equally
4. The severity of my tinnitus in its worst form, according to the scale below, is represented by the number: 4 89 mild moderate extremely tinnitus severity severe
5. The loudness of my tinnitus is: (circle one) a. Fairly constant from day to daY b. Fluctuates widely, being very loud on some days and very mild on others c. Usually constant, but on rare occasions will decrease markedly d. Usually constant, but will markedly increase
6. If my tinnitus changes from time to time, these changes are caused by
- 7. Onthe scale below indicate the pitch of your tinnitus. It might help to imagine the scale as if it were a piano keyboard. 2 67 low middle high pitch pitch pitch
8. Circle any items below that describe how your tinnitus sounds: (Circle all appropriate) a. Hissing f. Ringing b. Cricket-like g. Steam whistle c. Pounding h. Bells d. Pulsating i. Clanging e. V/histle j. Ocean roaring Appendix 29
Client's Name DOB:_
Central Auditory Processing Checklist
history of ear infections andlot allergies inconsistent responses to sound inability or confusion with carrying out verbal instructions difficulty following long or complicated instructions short attention sPan fatigue with long or complex activity distraction by visual and auditory stimuli poor localizationor identification of sound frequent requests for repetition of verbal information poor long and short term memory skills fear of loud noises delayed responses to auditory information reading problems spelling difficulties poor handwriting strength in math, art, music lack of coordination behavior problems in class poor self-concePt "don't care" attitttde toward leaming poor vocal monitoring word finding problems difficulty relating sequence of events o'out day dreaming or episodes of being in space"
Informant: Today's Date- ÀMñnI{:AN $t,l.r(:H. 1.,\¡ü(tÀ$ ]- llrr\ßjlç Åssfi:¡À'rt(¡N Tips for Improving Your o At]ilIOTOfrÏ Listening Experrence lnformatinn Series
Many people with hearing loss believe their Here are some more specific tips you can use when communication problems are just because of poor particular problems arise: hearing. However, there are other factors that can cause is to a breakdown in communication. Problem:The speaker difficult understand. These factors include: Answer: . Heavy accent or poor pronunciation . Ask the speaker to speak slowly and not to shout dim lighting . Background noise or at you. . Unfamiliar topic . Ask the speaker to look directly at you and not to cover . Fatigue, illness, or difficulties with attention or his or her face or look away. Seeing the speakert lips language and expressions will help your understanding.
Here are some strategies that can be learned and used to Note: Many people think that shouting at someone with help reduce communication breakdowns: a hearing loss will help the person understand better, but in fact this is not so. It can make understanding more Make communication easier from the diffi cult and unpleasant. beginning. Problem: Background noise is loud. Tell others you have a hearing loss and ask the speaker to get your attention before beginning to speak and to Answer: alert you of a change in topic. Find a quiet, well-lit room . Move to a quieter location. for communication and stand or sit 3-6 feet from the . Pick a quiet restaurant and go at an off-hour when it speaker. will be less noisy. Fix communication breakdowns with repair . Turn off or move away from noise sources such as strategies. radios, televisions, or dishwashers. When you realize that communication difficulties Tip: Some restaurant reviews provide information have already occurred, tell the speaker about the on noise levels. Make use of these when choosing a communication issue. Simply saying "huh?" or'þardon?" restaurant. is not going to work well. Instead, offer a suggestion to rephrase or simplify what has been said' Ask that Problem: Room lighting is dim. the speaker repeat the part of the sentence that you Answer: did not get. It is best not to fake it and pretend that . Tiy to improve the lighting in the room, or find a you understand when you do not! Doing this can room with good lighting. Sit with a window at your increase the misunderstandings and result in everyone's back facing the speaker. This makes it easier to see the embarrassment, speaker's face.
Check what you heard by repeating the message back to Tip: Using lipreading and seeing facial expressions can is of the speaker. And if the conversation full important increase understanding ofspeech up to 200lo even for a details, like medical appointments, ask the speaker to person with no formal lipreading training. write down key information such as addresses, phone numbers, and appointment times.
Audiology Information Series o ASHA 2011 7976-Yl9 Problem: Room acoustics are Poor. Problem:You are dealing with fatigue, Answer: stress, and distractions, and ¡t is difficult to . In your home, select floor coverings (such as carpets), pay attent¡on. window coverings (such as cloth draperies), and Answer: furniture (such as upholstered chairs and sofas) that . Set sensible goals foryourself. absorb sounds. When dining out, select restaurants with . Ask to have short breaks in meetings to prevent fatigue. sound-absorbing carpets, curtains, linen tablecloths, and booths. Avoid restaurants that have hard floors and bare Seek out the services of an audiologist certified by walls, the American Speech-Language-Hearing Association (ASHA). Many offer formal communication training/ Problem:The topic of conversation is audiologic rehabilitation. This training is designed to u nexpected or unfamiliar. make you more aware of some of the issues summarized above and help you to improve your listening and Answer: will speechreading skills. This type of training can improve . Ask the speaker or another listener to summarize the communication skills whether or not you wear hearing topic ofconversation for you and to alert you when the aids. topic changes.
. Ask a yes/no question. . If possible, prepare for the conversation/meeting ahead of time by anticipating potential content and vocabulary that will be used.
For more information about hearing loss, hearing aids, NOTES: or referral to an ASHA-certified audiologist, contact the:
2200 Research Boulevard Rockville, MD 20850 800-638-8255 AMBRIcAN SEBCH-LANGUAGE- E-mail: actioncenter@ asha,org HEARING AssocIAToN Website: www.asha.org
Compliments of American Speech-Language-Hearing Association 2200 Research Boulevard, Rockville, MD 20850. 800-638-8255
Audiology Information Series @ ASHA 20ll 7976-Yl9 :- I m proving U nderstanding \M¡th Com m u nicatiön Strategies' (What to do when yo,u.don't u
This material is based upon two HOPE Ontine seminars by the same name Presented by Susan Binzer, M.A. CCC-A
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Itrur now, And, alnw¡s Cochlear* Hearing For adults who receive cochlear implants, hearíng rehabilitation is an important part of auditory Progress with the device. rehabititation programs take on various areas of focus including: communication strategies, famity support and training, environmental sound identification, auditory training, music therapy, tetephone training, advocary, and use of assistive listening devices. Unfortunatety counseling and training in the use of communicatíon strategies is often overlooked' during To understand the importance of communication strateg¡es training, we shoutd first examine the factors that influence understanding conversation. These factors can be assigned to three categories as retated to: the Speaker, the Environment, and the Listener. The fottowing chart lists some common factors that influence understanding related to each category. Reftect on this list to determine which factors in each category are within the controlof the conversation particípants.
SPEAKER ENVIRONMENT LISTENER E EAccent t tlLights too dim E I Not interested in topic I ELooks away E EGtare from lights I EFeelins itl/tired EHand covering mouth 0 El HA/Speech Processor set I E EVisualdistractions or on face incorrectly E EMumbtine E E Auditorv distractions E E Beinp oassive E EI Poor acoustics/high E [Too loud/too soft E ISelf-confidence ceilings/echo E I Facial hair t I Room ventítation E I Distracting thoughts E El Mannerisms/gestures E EAngte of vision EI E Level of hearing loss E EAvailability of Assistive Facialexpressions E E Motivation to hear I t Listening Devices (ALDs) 0 EToo fast/too slow E E Distance E [lEmotional state H E Rooms without furniture, IChewing gum or food D E Speechreading abítity t carpeting, items on watls Exaggerating l¡p E EOutside setting is dark [ [ [ [ Use of strategies movements and noisy with crickets
For examptg, we may be abte to ask a speaker who is speaking too softly to speak louder, we may be able to improve tighting that is affecting communication and we may be able to dismiss distracting thoughts and improve our focus when listening. As listeners, the willingness to use communication strategies is firmty within our grasp in any one situation. Severat of these factors may be "in ptay" at once.
Three Commu,nication Stytes: Know Yours Passive: Most peopte wíth hearíng loss exhibit this communication style. Passive Communicators isotate themselves by avoiding situations in which they fear they wil[ not be abte to communicate well, Often passive communicators withdraw from conversations. When they do participate, they may pretend that they understand by timiting their responses to a nod (because of fear that they may have misheard and a more meaningful response may be inappropriate thus causing them to feetfoolish). They perceive it as "easier" to be passive. Because of passivity, peopte with hearing loss often miss out on socialopportunities and vocational opportunities. Their needs may not be met'
Aggressive: This styte is the opposite of the passive style, Aggressive Communicators may take over conversations in order to avoid having to work to understand their communication partner. They perceive any communication difficutties as being the speaker's fautt rather than noting their own responsibitity in the conversation. A person with an aggressive communication style may ignore a speaker in order to force him/her to repeat. Because they trampte on the needs of others, aggressive communicators are not often well received.
Assertive: Assertive Communicators are not afraid to disclose their hearing loss when necessary. They respect their communication partners by asking for, rather than demanding, hetp in communication. They are not afraid to use communication strategies or to advocate for themselves. Assertive communicators get their needs met.
Why be an Assertive Communicator? . Everyone has times when they don't understand . We are judged by our communication abitities . Those with normal hearing don't know how to help . Being passive results in misunderstandings and missed opportunities . Misunderstanding and missed opportunities result in feetings of isotation, sadness and inadequacy The goatof Communication StrategiesTraining is to devetop skitts that witl hetp us to handle difficutt communication situations assertivety and independentty. Training is necessary because peopte with hearing [oss and their famities rarely devetop effective communication and coping skilts without training and practice. Six Steps to lmproved Understanding with Communication Strategies 1. Answeringthe question: "How do I see mysetf?" 2. Exptainingyourcochlearimplant 3. Stage-managing the environment 4, ldentifyíng current strategies used 5. Experimenting w¡th new strategies 6. Phrasing for optimal results 1. Answering the question "How do I see mysetf?" Consider how you see yourself in terms of your hearing loss. Do you self-identi! with the terms "deaf ", "Deaf", "hard-of-hearing" ,,hearing your needs lmpaired', o, åoyou "have a hearing [oss?" Understanding how you setf identify witt help you to communicate with others.
2, Exptaining your cochlear implant you ask a new script a one to two sentence description of the device that you use to hear. This wording wilt be hetpfut when conversation Partner to use communication strategies,
3. Stage-managing the environment Speid time tfriniing abour the various settings in which you have difficutty communicating. Consider positioning in each at a situation that woutd hetp you to best communicate; seating in a restaurant, positioning in a tecture ha[[, and favorite spot ín your dinner party. Think as wett about what accommodations you are wilting to request in each situation (e.g., a sound system ptace oi worship, prefened seating at performances). Recognize that the choices you make witl effect how wetlyou understand in each environment.
4. ldentifying current strategies used Most often, people with hearing loss rely on asking speakers to repeat as their primary strategy to repair communication breakdown. Howeve¡ most often this request is posed indirectty; for example, by saying "Huh?", "Beg your pardon?" or something because similar. These strategies are non-specific and have been shown to be the least successfulcommunication repair strategies, speakers most often do nothing to change the manner in which they communicated the first time'
5. Experimenting with new strategies More effective than asking someone to repeat would be to use a very specific request that asks the speaker to do something particuiar to change his or her communication' For exampte:
. "Canyou loweryour hand so that I can speechread?" . "Can we move into the tight so that I can see your face?" ' "What is the key word in what you were saying?" Because peopte with normalhearing do not know how to respond when thqse with hearing loss do not understand, these specific requests tettthem how to hetp and take away the awkwardness of this situation.
No one strategy works best for everyone. As a cochlear implant recipient, you are encouraged to try new strategies in different situations and with different peopte. Keep track of those that you have tried. From there, note those that work for you and those that don't and in what situations.
6. Phrasing for optimat result Five ingredients for a successfuI request . Use "1" statements. Do not blame others ' Make a sPecific request . Explain why you are making the request ' Be courteous ' ExPress Your gratitude A simpte request can contain the first two points. Try this carrier phrase initiat[y: "l can (hear, understand, tipread)you better if....," is being From there, begin to use more sophisticated requests incorporating the finalthree points. lt is important to exptain why the request imptant made because those with normal hearing don't know what to do. For exampte, they may not know that a Person with a cochlear phrase to might read tips. Never assume that others understand your hearing toss. This might be the perfect opportunity to use your identity explain (e.g., "l have a cochlear imptant, but I stitt have troubte hearing at distance from a speaker,"), l{wr,m,.Þvrd,alwat6s Cochlear"
a more tikely to compty. Being grateful increases the It,s criticaI to be courteous - the speaker witt feel good about your request and therefore hetp the next time' chances that the speaker will remember how they can hetp and they will be more tikety to
Examptes you woutd please loweryour hand". . lnstead of 'your hand is in the way" try "Excuse me (name), I coutd tipread you better if ,,lt's I trouble in noise . lnstead of too noisy in here" try "My cochtear implant hetps me understand a tot better, but stitlhave - would you mind moving to a table away from the piano?"' ,,you you please wait a moment . lnstead of are atlspeaking too softty" try "l think my implant processor needs adjuslmenu can you have say", while I change the settíng? Thank you for waiting; I reatly want to hear what to
Communication Strategies These strategies appty to famity membãrs. Using them witt hetp both of you to be less frustrated' 1. Ctear Speech ,,clear precise, futty formed manner. Speech" is when the speaker attempts to express every word and sentence in a accurate and ,'Ctear slowly, speech willautomaticatly Use of Speech" witt improve understanding uprol)o/o.When we ask people to speak more so as not become ctearer. ln fact, asking someone to speak more "stowty" is preferabte to asking them to speak more "ctearty" but others witt need to suggest that their speech was previousty stoppy. often this request is enough for some famity members, others what reminders to continue speaking stowly as their tendency witt be to gradualty speed back up. lf needed, model for (pause) speak (pause) you mean by clear speech and be prepared to model how not to speak if necessary. For example: "Ptease toooo io (pause) me (pause) more (pause) tike (pause) this" instead of "Doooo NoooOoT feeet tiiiiiiiiike youuuuuu haaaaave eXXXaaaaaageraaate" phrases witl add to clear speech techniques' Tatk with your famity members and frequent communication partners about some key that For example, suggest using these helpers: . "l think" when stating an opinion or making suggestions . "Now I want to talk about something else" when changing the subject ,,What rePair . can I do to hetp you understand?" to make sure that you are taking responsibitity for communication
2. AnticipatoryStrategies on the situation, try Before entering a communication situation, think about who witt be there and what might be said. Depending the fotlowing: . Read about current events and movies ' Obtain agendas before meetings in advance ' Read the text before a subject is discussed in ctass . Obtain the synopsis of a play or movie before going to see it ' Ask someone the toPic before entering a conversatlon . Review names of dinner and cocktait party guests befo-re arriving those words with Once you have anticipated possibte vocabulary, dialogue and names for a particular situation, practice speechreading your spouse or conversation partner.
3. Repair Strategies Try these once problems occur within a communication situation: a. Change environments it witl be The biggest enemies for those with hearlng toss are poor tighting, background noise and poor acoustics. As a listener, to say, but I'm in your interest to optimize the environment for conversation. For example, say "l'd love to hear what you have having trouble here - would you mind if we moved to the corner of the room?" b. Ask the speaker to get your attention lipread By asking others to iattyour name before speaking, their voice wilt be directed toward you and you wil[ be ready to c. Ask the speaker to face you when speaking and so Even once a speaker has gotten your attention, they may need to be reminded to took at you so that you can lipread that optimal votume is maintained. Try "(Name), I tip read best when I can see your face straight on. Thank you." d. Ask the speaker to speak at a normal loudness [eve[ and The cochtear implant should be abte to provide the appropriate loudness. When others speak loud[y, speech is distorted Thank you for the Cl user gets a confusing experience with loudness. Try saying "My imptant makes speech loud enough for me. trying to help me, but you can speak normatly". e. Guess peopte with hearing loss are often retuctant to guess for fear of getting it wrong and looking silty. However, they are more often correct than ihey woutd think. Don't be afraid to guess but remember that it is criticatto rePeat the guess so that the speaker can confirm it as correct or incorrect. f. Check/Confirm what you have heard you it Check what your have heard by saying: "Díd you say, ...?" Use this strategy even if you got very littte and even if think this seems sitly. Especiatty on the phone, it is essentialthat key details of a message are precisety understood. When you use confirmation strategy, the speaker wítl feel as if you are really trying to understand them and witt be more tikety to continue the conversation. g. Ask the speakerto repeat stower the This is the singte mosf effective strategy. lf a speaker ís asked for a simpte repetition, they witt most tikety repeat exactly way they spoke the first time. lf they do make changes, it witl tikety be to speak louder or to exaggerate their lip movements- neither of which is hetpfut. lnstead, be specific by asking that the speaker repeat more stowty. lf you stitt misunderstand, ask the speaker to say it in a different way. h. AskforthetopicorkeYword Communication is more effective when the topic is known. lt is easíer to predict what witt be said next when a topic or key me word of a conversation has been stated. Say, for exampte, "l am not able to understand what you are saying. Can you tell the subject ptease?" i. Askthe speakerto rePhrase words This is an effective, but underused, strategy. Many times when a speaker is asked to rephrase, she automatically chooses you that are easier to hear and/or speechread. This is a more effective strategy than a repetition. Try "l didn't fotlow what said; coutd you ptease say that a different way?"
j. Ask the speaker to simplify or shorten the sentence jump A simple, short sentence is much easíer to understand than a [ong, detaited one. Shorter sentences atlow the listener to in and confirm information before the speaker moves on to the next sentence. This is especiatly hetpfut on the telePhone'
k, Ask the speaker to spetl a word Be aware when using this strategy that understanding the spelling of a word may invotve difficutt-to-speechread letters or those that sound similar. ln those cases, use the "code word stratery" to clarify. tor example say "Did you say "p" as in "potato"P'This is a familiar strategy to many though it may need to be modeled for some. t. Askthe speakerto use gestures It may ctarify speech if a speaker uses gestures at the same time. Hetpfutgestures inctude nodding, shaking the head, raising the arms to indicate "l don't know", or specific gestures like pointingto a watch to indicate "time".
m. Ask to have it wr¡tten down As a last resort, carry a notepad so that if you do not understand a message you can ask to have it written down.Ihis strategy atways works!
4. Dealingwiththe Expectationsof Others Often famity members and friends have unrealistic expectations of what a cochtear imptant can do for a person with hearing toss. lt wilt be important to dealwith these misunderstandings head on by sharing before and after examples of challenging situations and by sharing examptes of things that are still difficutt for you to hear or do. Discuss with your friends and family the ways that they can assist you when communicating; which strategies work best and which do not work. Reassure them that it is ok to ask you how best to hetp by saying "How can I hetp you to understand?"
Cochlear" .9 Wnnw.Arú,^luajðs ' Tips to Co Specific Strategies for Approaching Common Environments Brenda Battat, MA, MCSP, Hearing Loss Association of America Foltowing are tips for approaching some commonly difficult communication situations. Restaurants many challenges that such an Eating out in a restaurant can be a daunting experience for a person with a cochlear imptant due to the situation with assurance so that you can enjoy environment presents. However, there are many strategies that witt hetp you to approach this time with famity and friends or confidently Partic¡pate in business gatherings. acoustics. consider each: The chattenges that a restaurant presents fatl into four main categories: noise, tighting, seating and music, street noise, heating and cooting . Noise -The sources of noise in a restaurant are many: the kitchen, the bar, peopte tatking, equipment, and decorative elements such as fountains and fish tanks. overhead . Llghtlng - restaurants often attempt a certain ambiance provided by recessed t¡ghting, side tighting, candtes, and lowered tighting. These various sources can create shadows or glare that make lipreading difficult' for creating a good tistening . Sãating -There are a var¡ety of seating choices available in restaurants, some being better than others environment. ceitings which create . Acoustics - Current trends seem to call for restaurants to have bare tabtes, bare windows, bare floors and bare a very reverberant atmosPhere.
Planning Ahead Such a visit will altow you to look at lnvesting the time to visit a restaurant ahead of time can pay off with an improved dining experience. you so you will have strategies in ptace the seating that is availabte and the tighting and acoustic etements that may cause difficutty for that to address these issues. Other tlPs: . cottect menus to prepare yourself for the vocabutary that witl be used in ordering . Avoid ptaces with live music . Choose places with tablectoths, curtains and carpeting. Be aware that these sPots may be among the most expensive . Cet to know the management in your favorite spots to facilitate seating requests or other requested changes . Plan to dine outsíde of peak hours to avoid the noisiest times you have fewer surprises and As you visit a number of places, you witt be able to graduatly buitd a tist of prefened estabtishments so that mor€ enjoyabte eve nings.
At the Restaurant these tips: Once you arrive, be prepared with strategies to assist yoursetf with communication throughout the event. Consider Setect an appropriate table: . lf in a smatler group, ask for a booth as it provides a better listening environment than an open table . For larger groups, a round tabte witt allow you to see the faces of most other diners
Positioning . Position yourself with your back against a wa[[ so as to reduce the noise coming from that direction you wit[ hear the . Seat yoursetf next to the person with whom you witt speak the most or with your "best ear" in the direction that most . Don't be afraid to pick the best seat for yoursetf and to te[[ the other diners why you have done so
Menu you'd . Be prepared for questions about food preparation. For exampte, if you are ordering steak, expect that the server wi[[ ask how like it cooked . Ask for speciåts to be presented in writing . Have a buddy prepared to repeat the speciats or other information from the wait staff as necessary with your Outside of these strategies, realize that an assistive listening device might be very suitabty used in a restaurant situation. Work may be audiologist to determine the best type for your use. lf you use a type that does not plug directty into your processor, the microphone used ptaced in the center of the tabte. The "Lazy-Susan" found on many large tables, particutarty in Chinese restaurants, can be conveniently to turn the microphone toward each speaker as necessary.
t¡r fr.i'g..., "ì. , ln the Car Considering strategies for communicating in the car can be quite tricky because of the number of possible s¡tuations that may be or one of encountered. For example the person with hearing loss may be the driver of one or many peopte, or may be the onty passenger many. Regardtess of the situation at hand, safety of atl persons must be the primary consideration and therefore essential communication must take precedence over socialcommunication. To achieve this, consider the fotlowing: Navigation Tools . CpS systems with spoken instructions may be helpful, but the volume levels are not atways sufficient for some listeners . Having a passenger write directions in large letters on a erasable board can be hetpful The passenger shoutd hotd the sign approximately 12 ínches in front of the driver.
Cood listening environment . Turn off the radio . Keep windows up and heating/cooling fans tow . Have a signat (e,g., a raised hand) to indicate the need for quiet time to avoid distraction . Exptain these necessitíes to passengers before the tr¡P begins
Other considerations be . Before a tong tr¡p, meet with your audiotogist to ensure that you have a noise program that works well for you. This program will idealfor use in the car. . Use an assistive listening devíce. Ctip the microphone to the back of the front seat to altow for listening to rear Passengers . Make sure to select a cett phone that is compatibte wíth hearing aid or cochlear implant use. The labeting shoutd read M3 or M4 to indicate low levels of interference with microphone setting orT3 orT4 for tetecoil use. . A ftashtight could aid in [ipreadíng when traveling at night . A right angle rear view mirror assists with [ipreading those in the rear seats
When ptanning a tr¡p, it is effective to consider communication strategies ahead of time. Set the communication ground rules, including . When it is ok and when it is not ok to talk (e.g., ok during [ong stretches of highway, but not when directions are needed) . Which gestures might be hetpfutto include when giving directions (e.g., hotding up fingers for the number of turns to take) . A system of specific questíons that attow for yes/no answers, lf necessary, also discuss a system of conveying yes/no in a manner that is easy for the person with hearing loss to perceive (e.g., "Yes" versus "No No") . Cuidetines for conversation such as one person tatking at a time, identifying the speake¡ no eating/drinking white speaking etc.
ln short, it is recommended that a driver with hearing toss make sure to bè the person "in the driver's seat" with regard to setting these ground rutes, ptanning the seating arrangements to maximize communication, and determining when communication must be restricted to safety and navigation and when socializing is acceptable. With these strategies in place, every journey can be a pteasant experience. äerciæs use and to let you know then and there what they've not¡ced. Awareness is the 1 , Askyour family to pay attention to what strategies you first step to changing behavior Z. Complete the Challenging Situation Description û Blueprint form for a |istening situation thatyou commonly find difficult. Be as specific as possibte. Take the form to your audiologist on your next appointment. Discuss together how you can make that s¡tuation better next time.
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