Lindsey Jorgensen

The Effect of Decreased Audibility on MMSE Performance: A Measure Commonly Used for Diagnosing Dementia.

BACKGROUND Hearing loss and dementia are both prevalent in late adulthood. The most common test used to determine cognitive status in late adulthood, the Mini-Mental State Examination (MMSE), is presented face to face, usually in the context of the physicians office in the presence of background noise. Despite the problems of hearing loss and cognitive problems in late life, there is an absence of evidence linking hearing-related deficits to performance on the MMSE and dementia diagnoses. PURPOSE This study examined the effect of decreased audibility on performance on the MMSE. RESEARCH DESIGN A between-subjects design was implemented. Participants were randomly assigned to one of five degrees of simulated hearing loss conditions and were blinded to condition assignment. STUDY SAMPLE One hundred and twenty-five young normal-hearing participants were randomized into five conditions of varying degrees of simulated hearing loss. DATA COLLECTION AND ANALYSIS Performance on the MMSE was scored and cognitive status was categorized based on the scores. Analysis of variance with conditions as a between-subjects factor was conducted with post hoc multiple comparisons to determine the effect of audibility on performance. RESULTS Reduced audibility significantly affected performance on the MMSE in a sample of young adults, resulting in greater apparent cognitive deficits as audibility decreased. CONCLUSIONS Apparent cognitive deficits based on MMSE scores obtained in test conditions in which audibility is reduced could result in incorrectly identified cognitive loss if clinicians are not alert to hearing loss when patients are evaluated. Furthermore, health care providers should be cautious when using family report of cognitive impairment to diagnose dementia without accounting for hearing loss because the impression of family members may be based on misinterpretation of the effects of hearing loss.

Legislation Impacting Audiology and the Provision of Audiological Services: A Review of Legislation Across the United States

PURPOSE The purpose of this review was to investigate the legislation about the provision of audiology services. Specifically, the goal of the review was to investigate the similarities and differences in legislation regarding the identification of, and audiology services provided to, children with hearing loss. METHOD A systematic review was conducted to collect state-specific legislation regarding the audiology licensure requirements, requirements about the identification and management of children with hearing loss, and insurance coverage regulations. Compiled data were analyzed for similarities and differences between state regulations and legislature. RESULTS All states require audiologists to hold licensure; however, many differences exist between the requirements of acquiring and maintaining the license. Some states regulate the identification and management of children with hearing loss, whereas others do not. Additionally, states differ in their regulation of services provided to children with hearing loss, who can provide these services, and what is covered by insurance. CONCLUSION It is critical for audiologists to understand the requirements of their state in the provision of audiology services. Specifically, it is important for audiologists to understand how the laws may impact the services they provide to children with hearing loss.

An evidence-based guide to clinical instruction in audiology.

BACKGROUND A significant portion of the AuD curriculum occurs in clinical settings outside the classroom. Expert clinicians, employed within and outside of the university, are called upon to provide this clinical education. Most have had little or no formal training in clinical teaching yet face pedagogical and logistical challenges when simultaneously providing clinical service and teaching. Training to provide optimal methods and approaches to clinical instruction should be based on research evidence; however, there is a paucity of research in this area within the audiology discipline. PURPOSE This article provides a review of literature supplying evidence for important concepts, elements, and approaches to the clinical instruction process. Additionally, we provide readers with some practical tools with which to facilitate application of optimal clinical teaching principles. RESEARCH DESIGN We conducted a systematic review of literature on clinical education in audiology and across a wide array of health professions. Through the use of content analysis we identified four elements of the clinical teaching process most critical in examining optimal practices. RESULTS The elements identified as critical to positive clinical learning outcomes include the establishment of mutual expectations and goals; structured content and delivery of feedback; establishment of a positive instructor/student relationship; and questioning strategies that lead to the development of critical thinking skills. CONCLUSIONS Many disciplines outside of audiology demonstrate robust research activity related to understanding and optimizing the clinical education process. The application of a number of evidence-based clinical teaching principles should allow us to improve student outcomes in audiology. Researchers in our field might consider if and how we should develop our own research literature in clinical education.

Conventional Amplification for Children and Adults with Severe-to-Profound Hearing Loss

The primary goal of amplification is to restore audibility without causing discomfort; for someone with severe-to-profound hearing loss, the reduced dynamic range poses unique challenges in hearing-assistive device fitting. These challenges, including physiological limitation, processing difficulties, technology constraints, and other confounding factors, must be considered when selecting, fitting, and counseling for appropriate amplification. Many of the advanced features in hearing aids do not adequately address the unique characteristics of patients with severe-to-profound hearing loss. This review article will attempt to unravel some of the challenges and associated considerations when fitting adults and children with severe-to-profound hearing loss.

A Review of Craniosynostosis in Communication Disorders Practice and its Effect on my Family

Craniosynostosis is a congenital malformation of the sutures of the scull which fuse too early in childhood which does not allow the scull to expand appropriately. The cognitive and physical consequences of this fusion can last a lifetime. There are several types of craniosynostosis depending on what suture fuses and these have a variety of long-term consequences. The diagnosis is typically made after birth and some of the sequela can be appended if surgery is completed in a quick manner. The children born with craniosynostosis will have long-term complications of which the author, Ms. Peters, is readily aware given her family connection. Working with someone with this disorder can be challenging, but rewarding.

Verification and validation of hearing aids:Opportunity not an obstacle

Verification and validation are objective and subjective measurements of hearing aid function. Many studies have provided rationales for performing these measurements as necessary for hearing aid practitioners to provide the highest level of care. Several researchers have suggested that completing these measurements as part of routine clinical care will reduce the number of return visits, reduce the number of aids returned for credit, and increase patient satisfaction. The purpose of this review article is to provide background, method and rationale for practitioners to use these measurements to improve their practice of hearing healthcare.

Impact of Aging and Cognition on Hearing Assistive Technology Use

Many factors go into appropriate recommendation and use of hearing assistive technology (HAT). The aging auditory system presents with its own complications and intricacies; there are many types of age-related hearing loss, and it is possible that the underlying cause of hearing loss can significantly impact the recommendations and performance with HATs. The audiologist should take into consideration peripheral and central auditory function when selecting HATs for the aging adult population as well as when selecting appropriate types of technology including personal sound amplification products, hearing aids, cochlear implants, and other assistive technology. The cognitive ability of the patient plays a central role in the recommendations of HAT. It is possible that the use of HATs could mitigate some of the effects of cognitive decline and thus should be considered as early as possible. Assessment of ability and appropriate recommendations are crucial to consistent use of HAT devices.

Reduction in High-Frequency Hearing Aid Gain Can Improve Performance in Patients With Contralateral Cochlear Implant: A Pilot Study

PURPOSE The purpose of this study was to determine whether an alternate fitting strategy, specifically adjustment to gains in a hearing aid (HA), would improve performance in patients who experienced poorer performance in the bimodal condition when the HA was fit to traditional targets. METHOD This study was a retrospective chart review from a local clinic population seen during a 6-month period. Participants included 6 users of bimodal stimulation. Two performed poorer in the cochlear implant (CI) + HA condition than in the CI-only condition. One individual performed higher in the bimodal condition, but the overall performance was low. Three age range-matched users whose performance increased when the HA was used in conjunction with a CI were also included. The HA gain was reduced beyond 2000 Hz. Speech perception scores were obtained pre- and postmodification to the HA fitting. RESULTS All listeners whose HA was programmed using the modified approach demonstrated improved speech perception scores with the modified HA fit in the bimodal condition when compared with the traditional HA fit in the bimodal condition. CONCLUSION Modifications to gains above 2000 Hz in the HA may improve performance for bimodal listeners who perform more poorly in the bimodal condition when the HA is fit to traditional targets.