HEALTHCARE

Running head: HEALTHCARE
Healthcare
Student’s Name
Academic Institution
HEALTHCARE 2
Healthcare
Mrs. M has a mild to profound sensor neural hearing loss. Mrs. M was fitted with BTE
hearing aids several weeks ago. She has returned today to tell you about her experiences over the
last few weeks with the hearing aids.
Note: Most of your decisions will have guidelines in the literature, however some of the
decisions you make, may not have clear guidelines in the literature – in this case, ensure you
explain why you are making your adjustments/changes/etc in detail. You will need to try and
find some references as required.
Concern 1:
The first thing you notice is that the hearing aid mould on one side is upside down in the
ear with the hearing aid dangling in the air (i.e. not behind her ear where it should be). The
hearing aid on the other side is in the right way up but appears to not be seated in the ear
completely and is feeding back horrendously. She reports that her ears are sore after wearing the
aids for any length of time. What is the most likely reason her ears are sore? What might be some
strategies to help assist Mrs. M, what modifications might you make?
On examining Mrs. M who attended the clinic for a review/follow-up appointment I found
that she was not inserting the hearing aids correctly. First, I would inspect both hearing aids for
wax and split tubes. I would test the working of the hearing aids for static-like mechanical
distortion. I would then instruct her how to insert them correctly and encourage her to practice
correct insertion at home. The most likely reason for Mrs. M’s ear becoming sore is that the
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hearing aids were not inserted properly. I probably would advise correct insertion and not
perform any modifications at this stage. According to Pascoe (1990), one of the common
problems with insertion is fitting the hearing aid or ear mould into the canal and leaving the helix
lock outside of the pinna, which usually results in discomfort and feedback. Once the hearing
aids are properly inserted in Mrs. M’s ears, I would check for any physical discomfort in the ear.
If there is soreness or any excessive pressure applied to any point in the ear, the area of the ear
mould that is causing discomfort can be ground (Dillon, 2001). Moreover, if the client finds it
too difficult to insert a hearing aid with a helix lock, this part of the ear mould can be ground as
well (Dillon, 2001). Essentially, I would ensure that Mrs. M can properly insert and operate her
hearing aids. I would instruct her and the family member or caretaker, if present, on the
management of her hearing aids and that would include such tasks as changing batteries,
cleaning, and turning the hearing aids on and off. Subsequently, I would ask Mrs. M to come for
her second follow-up appointment, where I would recheck these issues again.
Concern 2
She reports that when she has been able to insert the aids correctly, she has found that
when watching the TV, the voices on the shows are too soft and the commercials hurt her ears.
Also when her little granddaughter “whispers and mumbles” at her, she cannot hear her but when
her “oaf of a father shouts at the football on the television” she has to leave the room due to the
distortion and discomfort it causes. What settings might we alter on the hearing aid and why?
This problem appears to be a compression issue, where the soft sounds are not being
sufficiently amplified and the loud sounds amplified too much. Here it would be appropriate to
fine-tune the hearing aids to ensure comfort and balance in sound quality. The solution to the
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above problems will be to reduce the gain given to loud sounds and increase the gain for soft
sounds (Dillon, 2001). Depending on the flexibility of the hearing aid it would be helpful to
reduce the maximum power output (MPO) in the frequency regions that are responsible for
excessive loudness. I would then perform an MPO check to ensure loud sounds are comfortable
and not harsh or painful. I would also check with Mrs. M how her voice sounds, how my voice
sounds, and if the sound quality is balanced in both ears. I would further counsel her to
acclimatize herself to sounds and explain that some sounds seem to be loud because they are. For
example, TV commercials are certainly louder than actual televised programs. In addition
communication tactics or strategies will need to be addressed. Mrs. M could ask her father not to
yell when she has her hearing aids on and to remind her granddaughter to face her directly and
speak clearly when speaking to her. I would also give her a hearing aid booklet with sections on
communication strategies and hearing loss to pass on to her family and those around her, so that
they too are aware of the effects of hearing loss. I would advise Mrs. M to try the new strategies
at home and find out if she is experiencing similar or even greater difficulties. Any problem will
be addressed in her next follow-up appointment.
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References
Harvey, D. (2001). Hearing aids. Sydney: Boomerang Press.
Pascoe, D. P. (1990). Chapter three: Post-Fitting and rehabilitative management of the adult
hearing aid user. In R. E. Sandlin, (Ed.), Handbook of hearing aid amplification, Volume
II: Clinical considerations and fitting practices (pp. 61-86). Boston: College-Hill Press.