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.