hearing aids for slps

57
DR. REBECCA LOWE AUD, CCC-A UNIVERSITY OF MISSISSIPPI HEARING AIDS: TRAINING FOR SPEECH-LANGUAGE PATHOLOGISTS

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Page 1: Hearing Aids for SLPs

D R . R E B E C C A L O W E A U D , C C C - AU N I V E R S I T Y O F M I S S I S S I P P I

HEARING AIDS: TRAINING FOR

SPEECH-LANGUAGE PATHOLOGISTS

Page 2: Hearing Aids for SLPs

WHY THIS TRAINING?

• Understanding the proper functioning of a hearing aid is key to knowing how to troubleshoot the aid when it is malfunctioning.

• Woodford (1987) proposed that the speech-language pathologist was the key personnel in school systems to check the hearing aids to ensure proper functioning.

• To do so, the SLP must have the knowledge and skills to carry out this task.

• Also, the SLP is often asked to perform teacher in-services on various topics related to speech, language, and hearing.

• The purpose of this power point is to train and equip the SLP with the knowledge needed to troubleshoot hearing aids. It also provides the SLP with a “ready-made” in-service training on troubleshooting hearing aids. The SLP has permission to use this power point and make any changes necessary to assist them in giving in-services on hearing aids.

Page 3: Hearing Aids for SLPs

BASIC FACTS ABOUT HEARING AIDS

• Hearing aids are devices designed to amplify sound from the environment in order to provide the wearer with better access to the world.• Candidacy for hearing aids should not be based

on specific thresholds, but whether the person’s hearing loss that places him/her at a disadvantage during daily life activities (Bentler, 1993). • In other words, children with a minimal loss

may be at an academic disadvantage and therefore be a candidate for a hearing aid or other type of amplification device.

Page 4: Hearing Aids for SLPs

HEARING AIDS CONTINUED

•Hearing aids are specific to the person and his/her hearing loss. •Generally binaural•Behind-the-ear models most often used with children due to need for FM systems, and constantly changing ear canal size.

Page 5: Hearing Aids for SLPs

MYTHS ABOUT HEARING AIDS

Hearing aids are the perfect solutionHearing aids restore perfect hearingOnce the child receives hearing aids, he can hear like his peers

Once the child receives hearing aids, he will start talking immediately

Page 6: Hearing Aids for SLPs

ERADICATING THAT MYTH - CONCEPT OF AUDITORY AGE

•Auditory age/hearing age are terms used to put the language development of a child in perspective• The child’s hearing age begins once he has access to the sounds of his world•Normal infants do not speak the day they are born – normally they say their first words after ~ a year•We cannot expect the hard-of-hearing child to speak “right away”.

Page 7: Hearing Aids for SLPs

HOW TO KNOW WHEN A HEARING AID IS MALFUNCTIONING

• Children may produce symptoms of hearing loss not previously seen in therapy

• The child does not respond to the LING sound check as he/she did previously

• The Listening Check of the Hearing Aid prior to therapy indicates a problem

Page 8: Hearing Aids for SLPs

SYMPTOMS OF HEARING LOSS IN CHILDREN (ASHA, 2011)

• The child is inconsistently responding to sound.• Language and speech development is delayed.• Speech is unclear.• Volume is turned up high on electronic equipment

(radio, TV, CD player, etc.).• Your child does not follow directions.• Your child often says, "Huh?”• Your child does not respond when called.

Page 9: Hearing Aids for SLPs

SYMPTOMS WHEN CHILDREN WHO HAVE HA’S/CI NEED REPROGRAMMING

• Poor/unusual voice quality • Relies on vision for input • Poor speech perception • Inappropriate/unusual consonant development • Consistent omission or substitution of specific

phonemes • Speech production not improving • Speech perception poor in competing noise• The child does not respond as he had previously

to the LING sound check(Hewitt, Madell & Rotfleisch, 2011)

Page 10: Hearing Aids for SLPs

LING SOUNDS• The goal of amplification is to make ALL speech sounds audible to

the child

• The LING sound check is a listening test that is often used with children who wear hearing aids/CI.

• This test is comprised of 6 sounds that represent the entire speech spectrum from low pitch sounds to high pitch sounds. The 7th stimuli in the LING sound test is “silence”.

• If the aids/CI is functioning properly, the child should be able to repeat these sounds

• Have client repeat LING sounds without visual input (stand behind them/use speech hoop)

• Do this with each ear individually and then together BEFORE THERAPY OR A SPEECH EVALUATION

Page 11: Hearing Aids for SLPs

THE LING SOUNDS

• The 7 LING SOUNDS:• AHHHH• OOOO• EEEEEE• SSSSSS• SSHHHHH• MMMM• Silence

Page 12: Hearing Aids for SLPs

IMPORTANCE OF USING LING SOUNDS TO IDENTIFY NEED FOR REPROGRAMMING

• Allows a quick and easy way to check that a person is able to detect and identify sounds within the speech range. • Provides information regarding an individual's

distance of hearing or earshot. • Results ensure that hearing aid and/or CI is

functioning properly and individual is receiving maximum benefit from his/her device • Represents all frequencies across the speech

banana(Archer & Crosby-Quinatoa, 2009)

Page 13: Hearing Aids for SLPs

WHEN TO DO THE LING SOUND CHECK

• The teacher should do the LING sound check at the beginning of class each day to ensure the child has access to all the speech she will use in class.

• The SLP should do the LING sound check at the beginning of therapy each day or the beginning of an evaluation.

• If the child cannot accurately produce the LING sounds as well as he/she was able to before, a listening check and troubleshooting of the hearing aids should occur.

• If the hearing aid sounds fine, then contact the audiologist to see if a referral is warranted.

Page 14: Hearing Aids for SLPs

WHAT SLPS SHOULD KNOW ABOUT HEARING AIDS

• Different types/styles• Basic components• Tools needed for listening checks/troubleshooting

of hearing aids• How to perform a listening check• How to troubleshoot hearing aids

Page 16: Hearing Aids for SLPs

FOUR STYLES OF HA’S

• Behind-the-ear hearing aid (BTE)• In-the-ear hearing aid (ITE), • In-the-canal hearing aid (ITC), • Completely-in-the-canal hearing aid (CIC)

(Mueller, Johnson, & Carter, 2007).

• Each style is a different size and offers different features. The style selected is based upon several client factors which include age, degree of hearing loss, needs of client, and the need for various controls.

Page 17: Hearing Aids for SLPs

BTE-BEHIND THE EAR

• The BTE is worn over the ear and is coupled with tubing to an ear mold that fits inside the ear canal.• BTEs are primarily fit on children with growing ear

canals so that the ear mold can be changed as the ear grows. • BTEs are also fit on individuals with severe-to-

profound losses because they can be powerful and can couple to other assistive devices (Mueller et al, 2007).

Page 18: Hearing Aids for SLPs

ITE-IN THE EAR

• The ITE comes in graded sizes ranging from a full-shell size down to a half-shell size. • Generally, the bigger the ITE, the more gain it

offers (Mueller et al, 2007). • The ITE is easier to insert and remove than the

BTE and may be more appropriate for people with dexterity issues.

Page 19: Hearing Aids for SLPs

ITC-IN THE CANAL

• The ITC takes up approximately one-quarter of the concha bowl, but may not offer as much power and or as many options as the ITE• However, it may be appropriate for those who

desire a smaller aid due to cosmetic concerns, those who have less profound hearing losses, and/or those with dexterity problems (Mueller et al, 2007).

Page 20: Hearing Aids for SLPs

CIC-COMPLETELY IN THE CANAL

• The CIC is the smallest hearing aid and takes up only the canal portion of the ear. • It is popular with those clients who have cosmetic

concerns regarding their hearing aids (Mueller et al, 2007).

Page 21: Hearing Aids for SLPs

COMPONENTS OF A HEARING AIDS

• Components of hearing aids

•How hearing aids function

Page 22: Hearing Aids for SLPs

Microphone (c)The microphone picks up sounds from the air and convert them into electrical signals.

Amplifier (d)The amplifier increases the intensity of the signals from the microphone. Filters modify the sounds so that only sounds which are relevant for the person are amplified.

‘Receiver' (loudspeaker) (g)The third basic component is the receiver (loudspeaker). It converts electrical signals into acoustic signals, which the person then hears.

These three components exist in all hearing aids.

Small computer (Digital)

Furthermore, in digital hearing aids a small computer can be programmed to manipulate the signals to fit the hearing loss of the individual hearing-impaired person.

Battery – power source

Page 23: Hearing Aids for SLPs

• Sound waves enter the hearing aid through the microphone. The microphone picks up sounds from the environment.

• The microphone converts the sound waves into an electrical signal.

• The converted energy is sent to the amplifier.• The amplifier increases the strength of the

electrical signal.• A smaller loudspeaker called a receiver functions to

convert the amplified signals back into sound waves.• The amplified sound is channeled from the receiver

directly to the ear canal.• The battery provides electrical energy to power

the hearing aid and enable the amplification process to occur.

Page 24: Hearing Aids for SLPs

HEARING AIDS

• Though the basic components are the same for the various styles of hearing aids and some of the problems that can occur are also the same; the solutions to these problems may vary depending on the style of hearing aid.

• Some of the more common problems with hearing aids are feedback (whistling), an intermittent signal, no signal, and a distorted signal.

Page 25: Hearing Aids for SLPs

TOOLS SLP’S SHOULD HAVE HANDYFOR CARE OF HEARING AIDS

• Stethoset• Battery tester• Extra batteries• Dri-Aid kit• Brush, wire loop • Ear Mold Blower• Otoferm• An audiologist can help you put a kit together• Some Hearing Aid companies supply kits

Page 26: Hearing Aids for SLPs

STETHOSET

Page 27: Hearing Aids for SLPs

BATTERY TESTER

Page 28: Hearing Aids for SLPs

SAMPLE PICTURE OF DRI-AID KIT

Page 29: Hearing Aids for SLPs

CLEANING TOOLS

Page 30: Hearing Aids for SLPs

TUBING AIR BLOWER

Page 31: Hearing Aids for SLPs

OTOFERM

Page 32: Hearing Aids for SLPs

PERFORMING THE LISTENING CHECK

Page 33: Hearing Aids for SLPs

EASY TIPS IN ORDER TO PERFORM A LISTENING CHECK

• How do you do it?• Before you put the aid on the child, listen to the aid

yourself.• Attach the hearing aid/ear mold to the end of stethoset

open tube• Make sure hearing aid is on• Rotate the volume wheel up and down• Rotate through programs• Talk into hearing aid and listen to the aid• Use the Ling Sounds (ooo, aahh, eee, sss, shhh, mmm)• Count • Use normal speech “test, test”

Page 34: Hearing Aids for SLPs

LISTENING CHECK

• What are you listening for?• Dead hearing aid• Distortion• Crackling• Intermittence/cutting in or out• Weak• Clarity• Feedback• Buzzing

Page 35: Hearing Aids for SLPs

HOW TO TROUBLESHOOT HEARING AIDS

•Troubleshooting ITE/ITC/CICs

•Troubleshooting BTEs

Page 36: Hearing Aids for SLPs

TROUBLESHOOTING

• The SLP faced with a non-functioning hearing aid could consult the chart and start applying the solutions beginning with the most plausible solution first.

• Troubleshooting requires a visual inspection and listening check of the hearing aid. It helps to use an otoscope for the visual inspection.

• One should look at the receiver tubing for wax and should inspect the microphone for dirt.

• If wax or dirt is seen, one should gently brush these parts of the hearing aid using a small brush made for this purpose.

Page 37: Hearing Aids for SLPs

PROCEDURES FOR TROUBLESHOOTING(ITE, ITC, CIC)

• The Following Charts have been slightly modified from that found in Wayner, D.S. (2004). What every SLP needs to know about hearing: Fingertip Facts. Latham, NY: Hearing Again, Inc.

Page 38: Hearing Aids for SLPs

PROCEDURES FOR TROUBLESHOOTING(ITE, ITC, CIC)

Problems Causes Solutions

“Dead” Hearing aid (no sound at all)

Battery is weak

Battery is in hearing aid incorrectly

Wrong type of battery 

Opening in nib is plugged with wax

Put in new battery

Put battery in aid correctly

Replace with right type of battery

Remove wax with a wax brush and clean vent with a pipe cleaner-never use a tooth pick

Page 39: Hearing Aids for SLPs

PROCEDURES FOR TROUBLESHOOTING(ITE, ITC, CIC)

Problem Causes Solutions

Distortion of Sound

Battery is almost dead.

Opening in nib is plugged

Volume control is turned to full-on

Microphone opening is dirty or covered.

Replace battery

Remove wax or dirt with a wax brush

Turn down volume control to correct volume setting

Remove dirt, food etc from mic with care using wax brush and be sure mic is left uncovered. (Sometimes cleaning must be done by the audiologist.)

Page 40: Hearing Aids for SLPs

PROCEDURES FOR TROUBLESHOOTING(ITE, ITC, CIC)

Problems Causes Solutions

Intermittent sound (aid goes on and off)

Battery is almost dead.

Bad volume control.

Moisture in aid

Put in a new battery

Check with audiologist

Use dehumidifier or the dri-aid kit overnight. If

problem persists check with audiologist.

Page 41: Hearing Aids for SLPs

PROCEDURES FOR TROUBLESHOOTING(ITE, ITC, CIC)

Problems Causes Solutions

Feedback (whistling)

Hearing aid is not put into ear correctly

Hearing aid does not fit well

Volume control is turned to high

Internal feedback inside the hearing aid

Put hearing aid carefully into ear so it fits snugly.

Check with audiologist

Turn down volume, but not below its normal setting.

Check with audiologist

Page 42: Hearing Aids for SLPs

THE BTE HEARING AID

• The Following Charts have been slightly modified from that found in Wayner, D.S. (2004). What every SLP needs to know about hearing: Fingertip Facts. Latham, NY: Hearing Again, Inc.

Page 43: Hearing Aids for SLPs

TROUBLESHOOTING FOR BTE

Problems Causes Solutions

“Dead” Hearing aid (no sound at all)

Battery is dead

Battery is in hearing aid incorrectly

Wrong type of battery

 Battery contacts are

corroded

Aid is off

Put in new battery

Put battery in aid correctly

Replace with right type of battery

Check with audiologist

Turn on – often “on” can be the switch in the “M” position or the battery door closed tightly

Page 44: Hearing Aids for SLPs

TROUBLESHOOTING FOR BTE

Problems Causes Solution

“Dead” Hearing aid (no sound at all) continued

Ear mold canal is plugged with wax 

Disconnected 

Tubing is twisted or kinked

Tubing is plugged

Moisture is in tubing

Remove ear mold, remove wax with wax loop; wash w/warm soapy water/ dry mold using forced air blower

Push tubing firmly onto aid

Straighten tubing

Clean tubing with a pipe cleaner, wash and dry with forced air blower

Use forced air blower to dry.

Page 45: Hearing Aids for SLPs

TROUBLESHOOTING FOR BTE

Problems Causes Solutions

Distortion of Sound

Battery is almost dead

Battery contacts are corroded

Ear mold canal is plugged 

Volume control is too high or turned to full-on 

Put in new battery

Gently try to erase using pencil eraser

Remove wax or dirt from ear mold canal with a wax loop and wash ear mold

Turn down volume control from full-on to correct volume setting.

Page 46: Hearing Aids for SLPs

TROUBLESHOOTING FOR BTE

Problems Causes Solutions

Distortion of Sound continued

Microphone opening is dirty or covered

Moisture is in ear mold and/or tubing

Tubing is collapsed or twisted

 

Remove dirt, food, etc. from microphone with care and be sure microphone is left uncovered (sometimes cleaning must be done by the audiologist).

Dry ear mold and tubing well after washing using the forced air blower.

Untwist and open tubing

Page 47: Hearing Aids for SLPs

TROUBLESHOOTING FOR BTE

Problems Causes Solutions

Intermittent sound (aid

goes on and off)

Battery is almost dead

Battery contacts are corroded

Bad volume control switch

 Moisture is in tubing

Moisture is in aid

Put in new battery

Erase contacts gently with pencil eraser

Check with audiologist

Use forced air blower

Use dri-aid kit overnight. If problem persists check with audiologist.

Page 48: Hearing Aids for SLPs

TROUBLESHOOTING FOR BTE

Problems Causes Solutions

Feedback (whistling)

Ear mold is not put into ear correctly

Ear mold does not fit well (too big or too small)

Aid not firmly attached to ear mold

 

Put ear mold carefully into ear so it fits snugly

Check with audiologist

Push ear mold or tubing firmly together

Page 49: Hearing Aids for SLPs

TROUBLESHOOTING FOR BTE

Problems Causes Solutions

Feedback (whistling)

Volume control is turned too high

Internal feedback inside the hearing aid case because of defect in aid

Tubing is stiff, cracked or has hole in it.

Turn down volume (but not below its normal setting)

Check with audiologist

Have tubing replaced

Page 50: Hearing Aids for SLPs

CRITICAL SKILLS FOR SLP’S

• Troubleshooting the hearing aid and performing a listening check are critical skills for the SLP who works with clients who are hard-of-hearing.• It is also important for the SLP to perform a

battery check. Several battery testers for hearing aids are available. • Batteries come in a variety of sizes with the

larger batteries generally powering the larger hearing aids.

Page 51: Hearing Aids for SLPs

PICTURES OF BATTERIES

Page 52: Hearing Aids for SLPs

BATTERY LIFE

• The length of battery life that a given battery has depends on the drain of a specific hearing aid coupled with the number of hours that the client wears the aid each day (Mueller et al, 2007).• The SLP should keep a battery tester with her

when working with hard-of-hearing clients as a dead battery is a frequent culprit for a “dead” hearing aid and the client not being able to respond to sound.

Page 53: Hearing Aids for SLPs

TIPS FOR AMPLIFICATION USAGE

Keep them on during ALL hours• Strings with a clip can attach to the hearing aids and

then you can safety pin or clip the strings to the child’s shirt

• It is critical that hearing aids are used during all waking hours to ensure auditory access to speech and language and environmental sounds.

• During academic classes, an FM system is most often recommended. If the child does not use an FM system, contact the audiologist to see if that person recommended one.

Page 54: Hearing Aids for SLPs

HEARING AID TIPS

• Ensure properly functioning hearing aids• Protect them by: • putting “super seals” on, • using a dry aid kit, • cleaning the wax out on a daily basis

• Perform a listening check before you put them on the child• Ensure the battery is working throughout the

day (To see if the battery is functioning, cup hand over ear and listen for feedback. This only tells status of batteries – not function of aids.)

Page 55: Hearing Aids for SLPs

HEARING AID TIPS

• Keep extra batteries on hand• Troubleshoot feedback• Ensure mold is properly in place • Ensure mold fits• (The volume control cannot be turned up to the correct

level with an ill-fitting mold or it will feedback.) Use otoferm or a similar product on the ear mold and refer for new ear molds if the fit is too loose.

• Ensure that the volume is turned up to a range that provides adequate hearing (Between 2 ½ - 3 on a 1- 4 volume wheel.) Currently, most audiologists will lock a VC for kids so they cannot adjust the volume themselves.

Page 56: Hearing Aids for SLPs

REFERENCES

• American Speech-Language-Hearing Association. (2001b). Knowledge and skills required for the practice of audiologic/aural rehabilitation [Knowledge and Skills], fromwww.asha.org/policy.

• American Speech-Language-Hearing Association. (2007). Scope of practice in speech-language pathology [Scope of Practice]. Available from www.asha.org/policy. 

• American Speech Language Hearing Association. (2011). Self-test for hearing loss.http://www.asha.org/public/hearing/Self-Test-for-Hearing-Loss/

• Archer, J., & Crosby-Quinatoa, G. (2009). Cochlear implant program: Strategies for treating children with hearing impairments in the schools. http://www.asha.org/Events/convention/handouts/2009/1431_Archer_Jamy_Claire/

• Bentler, R.A. (1993). Amplification for the hearing impaired child. J.G. Alpiner & P.A. McCarthy (Eds.). In Rehabilitative audiology: Children and adults,2nd ed. (pp. 115 – 160). Baltimore: Williams and Wilkins.

• Hewitt, J., Madell, J., & Rotfleisch, S. (2011). Listening to kids: Optimizing Technology http://www.asha.org/Events/convention/handouts/2011/Hewitt-Madell-Rotfleisch/

• Mueller H.G., Johnson E.E., & Carter A.S. (2007). Hearing aids and assistive devices. In R. Schow & M. Nerbonne (Eds.). Introduction to audiologic rehabilitation, 5th ed. (pp.31-76). Boston: Allyn and Bacon.

• Wayner, D.S. (2004). What every SLP needs to know about hearing: Fingertip Facts. Latham, NY: Hearing Again, Inc.

• Woodford, C.M. (1987). Speech-language pathologists’ knowledge and skillsRegarding hearing aids. Language, Speech, and Hearing Services in Schools, 18, 312-322.

Page 57: Hearing Aids for SLPs

PICTURE REFERENCES

• http://www.energizerasiapacific.com/products_hearing_aid_faq.aspx• http://broadmeadhearing.com/hearing-aids/hearing-aid-styles • http://www.ecvv.com/product/605085.html• http://memphissoul50.com/hearing-aid-reviews-primary-facts-one-should-know/• http://www.hopkinsmedicine.org/hearing/hearing_aids/size_style.html• http://www.amphl.org/audiology.php• http://hocksproducts.com/product_catalog/accessories__consumer_resale_items• http://www.hear4youtoday.com/comersus/store/comersus_viewItem.asp?

IdProduct=3351• http://www.harriscomm.com/catalog/product_info.php?

products_id=16901&hcCsid=8• http://www.mountainside-medical.com/products/ACU%252dLIFE-Hearing-Aid-Air-

Blower.html• http://www.lloydhearingaid.com/shopping/accessories/multiuse.asp• http://www.aliexpress.com/item/V-168-Sound-Enhancement-BTE-Hearing-Aid/

553190377.html