What I Learned During My Covid-19 “Lockdown”

I’ve had a little time on my hands lately. Funny, that. I’ve been baking bread (very tasty whole wheat – the kneading process is particularly useful these days), coloring in adult coloring books (not that kind of adult coloring books – though I’ve heard tell that that kind are available), walking the Corgis (it must be that Icelandic royal blood) – being cognizant of social distancing, yadda-yadda-yadda.  A little sick of it already and there’s more to come.  

I realized early on that some CEU opportunities I had expected to take advantage of in the couple of months before my license was to be renewed were not going to happen.  So I have been bettering myself with bite-sized chunks of audiologic expertise on Audiology Online.  

I don’t know about you, but when I attend a conference, I expect that, at the end of the day, I will come away with two or three things that I can make use of the next day.  I am usually not disappointed.  The same has been true in the classes that I have taken in the last several weeks on AO.  They have been uniformly informative and useful (only caveat – the PowerPoints could have been a bit more imaginative), and I have given high marks to all I have viewed.  What follows are a few tidbits that I have gleaned.  

Course 34498: MarkeTrak 10: Survey Results Reveal High Satisfaction with Hearing Aids. Erin Margaret Picou, AuD, PhD

The MarkeTrak surveys conducted over the last 35 years or so have contributed immeasurably to our understanding of our patients, our practices and the hearing aid industry in general.  The most recent is no exception.  

Much of the data here reinforces findings from previous iterations of MarkeTrak.  One of the statements in this discussion was particularly striking –

Patient satisfaction with hearing instruments is not related to the audiogram.   

The factors most closely related to satisfaction were:

  • Hearing aid age 
    • The newer the better 
  • Hearing aid cost 
    • This does not mean the cheaper the better.  On the contrary, patients were happier with higher technology / higher cost hearing aids that provided greater benefit.
  • Style / form factor
    • Patients were happier with hearing aids that they were comfortable wearing. 
  • Features 
    • Specifically, features that addressed problems they had been encountering due to their hearing loss.  

I love it when a study agrees with me, but I have said for a long time that there has been altogether too much emphasis on “the audiogram” in hearing counseling.  It is invaluable in fitting hearing instruments, but much less so in persuading patients to obtain the hearing help they need.  

Course 31755Grand Rounds – Complex Adult Hearing Aid Cases. Brad Stach, PhD, Chelsea Conrad, AuD, and Erica Bennett, AuD, PhD

I really enjoy grand rounds!  This one presents 6 fascinating and sometimes frustrating cases.  All are worthwhile and I particularly enjoyed Dr. Stach’s comments; scholarly and replete with common sense.  

A brief preface:

In early 2009 I had a very interesting conversation with an ENT doc.  He described a patient, referred to him by his staff audiologist, presenting with a conductive hearing loss showing all the hallmarks of otosclerosis.  Subsequent surgical intervention showed no evidence of middle ear disease and the patient was later diagnosed with “third window syndrome”. He was a little outraged that the audiologist had missed the diagnosis.  I smiled and nodded, all the while thinking to myself “What the heck is third-window-syndrome?”  

A little research showed lots of interesting articles in the ENT literature, none of which seemed to have yet trickled down to the audiology side of the street.  So I took it upon myself to write a review article that was subsequently published in Audiology Practices (Summer 2009 1:3, 34-36).   I believe this was the first article in the audiology literature to describe this condition.  Since then, it has become a reasonably common diagnosis, also called Superior Semi-Circular Canal Dehiscence (SSCD).

Among the cases described here are two that include a diagnosis of SSCD.  SSCD is an odd duck, with bizarre bone conduction results and vestibular symptoms.  It may well explain some of the stranger conductive hearing losses you have encountered now and then over the years, just as Auditory Neuropathy / Dyssynchrony Spectrum Disorder (ANSD) explained many strange sensorineural results in the previous decade.  

Course 33975Bone Conduction Audiometry – The Good, the Bad and the Interesting – Sherman Lord, AuD.  

Poor bone-conduction testing.  If it weren’t for SRT, it would be the most maligned component of the audiologic test battery.  It just won’t behave!  

  • Is forehead placement of the oscillator really OK? If so, when and how?   
  • If it is impossible to have bone conduction thresholds that are poorer than air conduction thresholds, why the heck does it always happen?  It makes me look stupid to the ENTs that refer to me, so I just fake it.  
  • What about that pesky air/bone gap that always shows up at 4k Hz?  Those lousy calibration techs screwed up again!   

The cal techs probably did a much better job than you think.  Sherman Lord, a colleague from my days working for an audiologic special instrument dealer, illuminates these matters and much more.  Like the difference between using supra-aural and circum-aural AC transducers when testing bone conduction. Who knew bone conduction testing could be so interesting – to geeks like me, anyway?  A word of warning: The quiz is tricky – be sure to print and complete it as you go along – I wish I had.  

Course 34415Signia Podcast Series: Interpersonal Audiology – Patient Centered Communication and Customizing the Patient Experience with Brian Taylor (Podcast 2 – Understanding Motivations and Behaviors). Brian Taylor, AuD, and Lisa Klop, AuD.

And then there’s Brian Taylor – the guru of all things concerning professional practice.  He can always be counted on for something interesting to say. And none more than in this truly bite-sized (30 minute) podcast with Signia trainer Lisa Klop.  

The focus of this podcast (it’s #2, but I couldn’t find #1) is treating hearing loss as a chronic condition for which the medical model (the model most audiologists have been trained to follow) is ineffective.  He describes several models (the Health/Belief Model and the Transtheoretical Stages of Change Model being two) that provide much more useful frameworks for addressing hearing loss.  

These are only four of the dozen or so AO classes I have taken recently.  Stay tuned for reviews of more as we trudge the road of this damned virus.  In the meantime, stay well, wash your hands and keep your distance.

This too shall pass!  

About Paul Teie

Paul Teie has been an audiologist since 1992, spending 15 years in direct clinical care. For the last 12 years he has found his true calling as a teacher and is currently National Educational Specialist with WSAudiology.

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