Audiology ToTT: Sticky Situations with Tubing

Posted on June 12, 2013 by AU Bankaitis

AudiologyCommunityLogo200x83A question was recently posted on the AAA’s Audiology Community by a member seeking advice as to how remove tubing that has become “glued” to the earhook of a BTE without damaging the earhook. Fellow Audiology colleagues (aka #AudPeeps on Twitter) offered very good suggestions, resulting in today’s Audiology Tips of The Trade (ToTT) blog post.  Here is a general recap of what audiologist recommended:

shaper1. If you have access to a hot tubing shaper/blower, hold the tubing/earhook junction in front of the hot blower for a few seconds until you see the tube soften up. It should slip off easily then. (Carol Black, Pittsburgh, PA)

debonder2. Get a debonder called UN-Cure. It has worked for me. (Sandra Rabin, Harrisburg, PA)

3.  I still use Adco Span.  You can dip the hook and tubing in the liquid for a few seconds at a time or use a brush to “paint” it on.  Do not leave the tubing and hook sitting in the mixture for a long time; not only does it expand the plastic but it will also eat away at it. I learned this the hard way when I was first starting out and decided to soak the tubing for an hour! (Esther Coffin Miller, Baltimore, MD)

blade4. We use a straight edge razor blade to slice it open from the top, along the earhook. This opens it up enough that you can then peel it off. (Cynthia Modrosic, Union MO)

5. I know this may sound simple but why not unscrew the earhook and just replace it? (Frank Talerico, Margate, FL)

cement bagThis interaction led another Audiologist to pose a related question: “Is there a tubing that lasts longer that 6 months without hardening into near concrete consistency?”  Hardening of earmold tubing is a by-product of the tubing making contact with the patient’s skin.  Various body oils, skin pH, and/or body temperature will cause tubing to harden.  So, how can Audiologists minimize the need to dritybechange out tubing? According to the majority of Audiologist who responded, there is a specific tubing that will last for about 1 year sold under the trade name DRI-Tube. This tubing has been specifically designed to be resistant to moisture build-up in tubing.  It is harder to cut than traditional vinyl tubing so as mentioned by 30-year veteran James Welsh of Holland, MI, make sure you have access to a pair of really good, tough scissors, a surface wire cutter used in electronics, or a straight-cut toe nail cutter. So, there you go!  A few Audiology ToTTs to make your life a little easier! If you are a member of AAA, be sure to check out their Audiology Community to read and/or post messages in one of the many discussion groups.

Posted in Audiology ToTTs | Tagged , , , , , , , | 4 Comments

Audiology Patients! Eat your Veggies & Go Outside to Play – guest post by Christopher Spankovich

Posted on June 5, 2013 by AU Bankaitis

burger-cool-ear-muffs-fashion-food-funny-Favim_com-95835_largeHow often does a patient come in your door that is in excellent health: eats healthy, exercises, no high blood pressure, no high cholesterol, no medications? Now, how often does a patient come in your door that is 20-30 pound overweight, on high blood pressure medications, on a statin for high cholesterol, pre-diabetic, and leads a fairly sedentary life other than “socializing”?  I first became interested in diet and hearing while completing my Au.D. at Rush University.  Around that time there was a critical mass of literature developing examining the relationship between diet and hearing.  These studies consisted primarily of animal based work exploring influence of micronutrients with antioxidant mechanisms (e.g. vitamin A, C, E, and etc.) and other antioxidant compound pepper-earfound in diet usually in small amounts (e.g. alpha lipoic acid, resveratrol, cysteine (NAC), D-MET, and etc.). You can find a review in the July/Aug 2011 issue of Audiology Today. I found this all very intriguing, but there was very little evidence at this point that dietary intake could influence susceptibility to hearing loss in humans.  Only a few case-control and prospective studies had been performed in humans.  In these cases diet was either supplemented with a specific nutrient, e.g. folic acid (Durga et al., 2007) or a specific dietary component was manipulated, e.g. saturated fat (Rosen et al., 1970).

spoon-pillsWhen I started my Ph.D. at Vanderbilt, my mentor Linda Hood and I began discussing ways to look at diet and its influence on hearing in humans.  My critique of the literature was that it was too focused on trying to find a “magic bullet”, the super-nutrient that would protect us all from age, noise, and ototoxic hearing loss.  The first step was to begin an extensive literature review on anything diet and hearing and increase my personal knowledge through courses in nutrition, biochemistry, and molecular physiology.  This led to epidemiological studies (Spankovich et al., 2011 and Gopinath et al, 2011) in collaboration with the Blue Mountains Hearing Study (a longitudinal study of hearing and contributing cofactors in Australia).   These were some of the first large-scale epidemiological studies to examine the relationship between dietary intake and objective measures of hearing in humans.  Interestingly, our results supported much of the animal-based work.

foodHowever, I recognized several limitations in our analysis (for more information see two-part 20Q series with Gus Mueller at AudiologyOnline entitled Healthy Eating Makes for Healthy Hearing: The Recipe and Today’s Special).  We performed what is referred to as a single-nutrient analysis.  The dietary data was collected by having people fill out a food frequency questionnaire (i.e., subject indicates what their average intake of different foods) then that is entered into a database to derive the estimated intake of every nutrient you can think of.  Now foregoing problems with patient accuracy in self-reporting intake and cross-sectional nature of this design; the single nutrient analysis takes each individual nutrient and puts it into a statistical model (while adjusting for covariates) to determine if there is an association with our outcome measure (e.g. hearing thresholds, OAEs, etc.).  The single-nutrient analysis has several limitations: 1) you end up performing a lot of analyses, which increases the likelihood of finding an association by chance; 2)  nutrients have numerous known and unknown interactions both biochemically and statistically, not addressed with this model; 3) we do not eat single nutrients, we eat a diet.

eatbetter-feelbetterBased on these self-critiques I began to explore other ways of looking at diet and hearing, which led to a recent analysis of dietary quality and hearing using the National Health and Examination Survey (NHANES) database.  Rather than looking at single nutrients, Colleen Le Prell and I focused on a measure of dietary quality called the Healthy Eating Index, a measure of overall dietary quality based on 10 factors of dietary recommendations outlined by the U.S. Department of Agriculture (USDA). To make a long story short, the findings indicated that persons who ate a healthier dietary quality had better high frequency hearing thresholds that those that had poorer dietary quality in all age groups and in both sexes (see Spankovich & Le Prell 2013 for more information). Obviously our dietary quality is critical for our health in general, so it makes sense that hearing health may also be impacted.

Clinical Relevance

relevanceThe research that I briefly discuss above has a variety of goals.  Numerous studies are focused on single or combinations of micronutrients or other antioxidant compounds to prevent acquired hearing loss; the idea of finding a specific nutrient or treatment that will serve as an otoprotecant that can be delivered as a supplement.  question-markSome of these are based on micronutrients we can obtain in our diet, while others are compounds based on chemicals derived through diet in trace levels.  There are remaining questions in regards to the mechanism of these compounds as well as safety of long-term use.  Some agents may be limited to acute application for acute exposures (e.g. while taking ototoxic drug); while others may have better profiles for long-term application (e.g. age).  The other major avenue is not through a specific nutrient, but rather through good old-fashioned healthy living, i.e. eating right and exercise.

recommendI often get asked what supplement or specific nutrients I would recommend for a patient. I first make the obvious statement, I am audiologist, I am not a nutritionist or something to that effect, and you should discuss any changes in your diet or exercise regimen with your physician or a nutrition expert.    With that being said here is a list of some simple changes that will likely improve your and your patients overall health, lose a little weight, and maybe even reduce susceptibility to hearing loss.  Recognize these are only general recommendation and do not apply to everyone; medications, age, pregnancy, disease can all impact what dietary needs are best for an individual.

  1. Eat a balanced diet.  There are a lot of “diets” out there, high-carb, low-carb, low-fat, high-protein, etc.  But when I say balanced diet I am not referring to a weight loss plan, Balancebut a lifestyle plan. You can check out the USDA website for specific information. You need good sources of protein, carbohydrates and yes even fat in your diet.  Overloading or under serving on one is not a good idea.  For example, in longevity studies with animals, caloric intake can be manipulated (reduced by about 20-30%) and increase the lifespan of the animal.  Turns out you can reduce fat = no effect, reduce carbs = no effect, but reducing protein = animals lives longer.  Now it is not that protein is bad for you, protein is actually critical for good health and supply of essential amino acids, but too much may reduce lifespan.
  2. Eat This!  Green leafy vegetables (e.g. kale, spinach, greens), onions, blueberriesmushrooms, berries (e.g. blueberries, raspberries, strawberries), variety of colored vegetables (e.g. carrots, tomatoes (really a fruit), broccoli, artichoke, brussel sprouts, bell peppers, and etc.), nuts and seeds (e.g. almonds, sunflower seeds, not peanuts), other fruits and veggies (e.g. oranges, watermelon, bananas, apples, avocado, and etc.), the brown versions of the white foods to reduce (e.g. sweet potatoes instead of white, brown rice, and etc.) and fish that are lower in mercury.
  3. Not That!  Processed foods (e.g. cold cuts, fast food, fried foods, frozen dinners, high Eat-Real-Food-Cover-383x355fructose corn syrup, and  etc.), these are high in sodium, sugars and processing can remove many important nutrients. Foods high in saturated and trans-fats (e.g. cheese, grain-fed red meat, fried foods, oils and etc.), however not all fat is bad (e.g. seeds, nuts, avocados, fish and etc [these are in the foods to increase above]).  White foods (e.g. white potatoes, white rice, white flour, white bread, white sugar, white pasta); have high glycemic indexes which leads to inflammation, which leads to heart disease, diabetes, cancer, etc.
  4. Other recommendations.  If you like red meat, that is ok, however it is preferable to eggseat grass-fed beef.  Grass-fed beef has a more balanced ratio of omega fatty acids 3 and 6, where grain fed is 15-20 omega-6 to every 1 omega-3.  Eggs are great, recent research really questions if cholesterol intake has any impact on heart disease, if you eat all the food recommended above and reduce the ones not recommended you will likely be getting plenty of good fat in your diet.  Dairy products are a difficult topic.  The hormones are to be avoided, but there are also benefits of vitamin D and calcium, you may be smart to try almond milk.

spinach-dd-02These recommendations are not a diet; eat all the spinach you want! They are a lifestyle change.  Variety is important; you don’t have to eat the same thing every day.  Also, it is ok to have that fast food once in a while, we are only human.  The key really is balance.  If you make the simple changes of reducing processed foods, cutting down on white foods, and eating more fresh vegetables and fruit, it will go a long way.

So what can I tell my patients?  Well, you do not need to give them a specific diet.  Simply recommend that they eat healthy and exercise and it may reduce susceptibility to further hearing loss.  If they are interested in a specific diet then they should follow-up with a nutritionist who can work with them in developing a plan.

Summary

Dr_%20MomWhat we eat influences our health; it makes sense that it may also impact our susceptibility to hearing loss.  No supplement can replace a healthy diet, though they may be beneficial.  The research on benefits of over the counter supplements for prevention of chronic disease is not that great, with some studies even suggesting increases in disease and mortality with use of multivitamin supplements.  When it comes down to it, even with all the advances in technology and science, your mom was right “eat your vegetables and go outside and play”.

christopher-spankovich1 (2)Christopher Spankovich is a Research Assistant Professor in the Department of Speech, Language, and Hearing Sciences at the University of Florida. His academic training includes a master of public health (M.P.H.) from Emory University, a clinical doctorate in audiology (Au.D.) from Rush University, and a research doctorate in hearing sciences (Ph.D.) from Vanderbilt University. His current research includes: dietary health and hearing, DPOAE fine structure and early identification, and novel methods of otoprotection.  He recently was selected as a member of the 2012 AAA Jerger Future Leaders of Audiology Conference (JFLAC) cohort.

References:

Durga J, Verhoef P, Anteunis L, Schouten E, & Lok F. (2007). Effects of folic acid supplementation on hearing in older adults: a randomized, controlled trial. Ann Intern Med 14(6):1-9.

Gopinath B, Flood VM, Teber E, McMahon CM, et al. (2011). Dietary intake of cholesterol is positively associated and use of cholesterol-lowering medication is negatively associated with prevalent age-related hearing loss. Journal of Nutrition 141(7):1355-61

Rosen S, Olin P, & Rosen HV (1970). Dietary prevention of hearing loss. Acta Otolaryngol 70(4):242-247.

Spankovich C. (2011). Bench to Bedside: we “ear” what we eat. Aud Today 23(4):33-41.

Spankovich C, Hood LJ, Silver HJ, Lambert W, Flood VM, & Mithcell P (2011). Associations between diet and both high and low pure tone averages and transient evoked otoacoustic emissions in an older adult population-based study. J Am Acad Audiol 22(1):49-58.

Spankovich C, & Le Prell CG. (2013). Healthy diets, healthy hearing: National health and nutrition examination survey, 1992-2002. Inter J of Aud 52:369-376.

Posted in Audiology, Guest Blog Posts | Tagged , , , | 5 Comments

Audiologists! Avoid This Common Specula Mistake

Posted on May 29, 2013 by AU Bankaitis

confusionA speculum is not that complicated of an accessory although some confusion exists in terms of what brand may be used interchangeably with otoscopes made by different manufacturers.  Obviously, different specula are needed for specific otoscope heads regardless of manufacturer; for example, a speculum designed to fit a diagnostic otoscope head will not fit a pneumatic or operating head. There are instances, however, where one brand of specula will work with diagnostic otoscope heads (including pocket otoscopes) made by different manufacturers and it is important to know which will work with which.

onesizeWelch Allyn and Heine represent two popular brands of otoscopes, each offering its own brand of disposable and reusable specula. Welch Allyn markets its own disposable Kleenspec brand along with their own line of Welch Allyn reusable specula whereas Heine offers both disposable and reusable specula under their All-Spec brand.  The general rule of thumb is as follows:  Welch Allyn specula will only fit Welch Allyn otoscopes whereas Heine specula will fit Heine otoscopes and most diagnostic Welch Allyn otoscopes (NOTE: the operative word being “most”).

Square Peg in a Round Hole_0565For those using the Welch Allyn 3.5V diagnostic otoscope head (item# 25050) or the Welch Allyn 2.5V PocketScope (item# 22820), both the Kleenspec or the All-Spec specula brands will fit.  In other words, you can use either the Welch Allyn disposable Kleenspec (item# 52432U or 52434U), any of the Welch Allyn reusable specula (item# 24302U, 24303U, 24304U, or 24305U), the Heine disposable All-Spec (item# B-00.11.128 or B-00.11.127), or any of the Heine reusable All-Spec (item# B-00.11.107, B-00.11.108, B-00.11.109, B-00.11.110, or B-00.11.111).  In contrast, those using the Heine Mini 3000  otoscope will need to invest in the All-Spec brand of specula as the Welch Allyn brand will NOT fit this Heine otoscope.

exceptionKeep in mind that there are exceptions to every general rule.  While the Welch Allyn 3.5v Macroview Otoscope may be technically categorized as a diagnostic-type otoscope, the only specula that will fit this head is the Welch Allyn brand. Unlike almost every other Welch Allyn diagnostic otoscope head, the Heine All-Spec brand is not compatible with the Welch Allyn Macroview Head. Still confused? No worries! Contact customer service at Oaktree Products at 800.347.1960 or via e-mail at otp@oaktreeproducts.com next time you want to make sure you are ordering specula for your otoscopes!

Posted in Audiology, Otoscopes, Headlamps & Earlights | Tagged , , , , , , | 13 Comments

Free CapTel Phones For Qualified Patients

Posted on May 22, 2013 by AU Bankaitis

755-002503Effective May 1, 2013, there has been a change in the manner captioned telephones from Hamilton CapTel are distributed.  As Captioned Telephone Service (CTS) is regulated and funded by the Federal Communications Commission (FCC), any individual paying less than $75 for CTS equipment (i.e. CapTel Phone) or obtaining CTS equipment from a government program is required to verify that the user has a hearing loss.  An audiologist or hearing healthcare provider must confirm that the individual requires the use of CTS to communicate in a manner functionally equivalent to telephone services experienced by individuals without hearing difficulties.

captel order formFor those of you accustomed to purchasing the Hamilton CapTel Phone for your patients directly from Oaktree Products, your patients are now able to obtain the CapTel Phone at no charge through Hamilton CapTel’s Holistic Hearing Healthcare Program.  The process involves printing off the Certificate of Hearing Loss/Order Form available at www.HolisticHearingHealthCare.org. The audiologist or other hearing health care professional completes the section of the form certifying that the applicant (patient) has a hearing loss justifying the need for CTS.  The applicant fills out the section requesting patient’s name, address, telephone and email address.  Completed forms may be submitted via email to order@HolisticHearingHealthcare.org, fax 877-300-6686, or mailed to Holistic Hearing Healthcare, c/o Hamilton CapTel, 1006 12th Street, Aurora, NE 68818.  Upon receipt, the order will be processed and delivered to the patient within two weeks by Hamilton CapTel. For more details, visit www.HolisticHearingHealthcare.org or contact a Hamilton CapTel representative directly toll-free at 800.826.7111 or via email at info@HolisticHearingHealthcare.org.

CAPTEL-BROCHUREKeep in mind, free promotional and educational materials for demonstration and use within the clinical setting are also available to audiologists and other hearing healthcare providers from Oaktree Products.  Materials include a Hamilton CapTel demo phone with display stand, patient brochure, FAQ sheet, direct mail postcards, large waiting room poster with brochure holder, small desktop poster with brochure holder, and Hamilton CapTel instructional DVD.  To place your order for promotional items, contact Oaktree Products directly at 800.347.1960 and ask for customer service or via web at www.oaktreeproducts.com. Take advantages of these no-cost solutions for your patients and your clinical practice!

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Audiology Infection Control: What Do You Suggest We Do When….

Posted on May 15, 2013 by AU Bankaitis

between_a_rock_and_a_hard_place_w450h450The following question posed by AuD students during an infection control presentation has been popping up, in one form or another, more often: “What do you suggest we do when we, as students, are at a clinical site that doesn’t practice infection control?” Since the question is being asked, AuD students are obviously finding themselves in situations whereby some clinical sites are perceived as not practicing standard infection control procedures. Whether or not that is the case, the suggestion has been made for those students to simply ask for what they need in order to provide patient care in a manner consistent with minimizing the spread of disease.  For example, ask if gloves or disinfectant towelettes are available; these are products that most clinical settings should have available and asking to use something that is readily available is perfectly acceptable.

resourcesBeyond the awkwardness an AuD student may feel in this particular scenario, the practicing audiologist may also feel awkward or perhaps slightly intimidated.  Twenty-five years ago the need for infection control in the audiology clinic was essentially left unaddressed.  Since then, standard infection control precautions have been modified beyond blood borne pathogens to include ubiquitous microorganisms such as Staphylococcus, Audiology scope of practice has evolved, and implementing infection control protocols in the Audiology clinic have become an expected part of routine practice. For more information on this topic, please refer to the following resources addressing infection control in the Audiology Clinic:

Free-to-view Webinars/ at AudiologyOnline:

1. Infection Control Part I: Why Audiologists Need to Do It (Recording of Live Webinar)

2. Infection Control Part II: What Audiologists Need to Do (Recording of Live Webinar)

3. Infection Control Part I: Why Audiologists Need to Do It (Text/Transcript of Course)

4. Infection Control Part II: What Audiologists Need to Do (Text/Transcript of Course)

Practice Guidelines/Policy Documents:

1. Infection Control in Audiological Practice (AAA)

2. Infection Control in Audiology (ASHA)

Articles/Blog Posts of Interest:

1. What’s Growing on Your Patients’ Hearing Aids?

2. Hearing Aids: lick ’em and stick ’em? (page 12-13)

3. FAQs about Infection Control (page 17-19)

4. ABC’s of Infection Control

5. Is a Written Infection Control Plan Necessary (uhm, Yes)

6. Five Key Points of Infection Control

Books:

1. Infection Control in the Hearing Aid Clinic by Bankaitis & Kemp

2. Infection Control in the Audiology Clinic (2nd ed) by Bankaitis & Kemp

3. Infection Control for Speech-Language Pathology by Bankaitis, Kemp, Krival & Bandaranayake

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Crowdtilt Opportunity for Audiology

Posted on May 8, 2013 by AU Bankaitis

crowdtiltDuring the month of May, Alison’s Hope for Hearing is conducting a “Crowdtilt“ fundraiser to enable the organization to continue providing accessible hearing care to underserved populations via partnerships with audiologists nationwide. Crowdtilt is an online service that assists people or organizations to pool money from friends and communities for a specific objective, event, or fundraiser.  What makes a Crowdtilt campaign different from a traditional fundraiser is that each Crowdtilt is associated with a predetermined monetary goal referred to as the “tilt”.  In order for the person or organization to collect any funds, the “tilt” must be reached.  So, unless a campaign raises the minimum amount they establish a priori, nobody ends up getting charged.

alison-berry-41Alison’s Hope for Hearing is trying to minimally raise $1750 to help pay for hearing instruments, follow-up care, and services to individuals with hearing loss that do not qualify for other financial resources such as insurance, state Medicaid, military health, vocational rehab or county services.  This national, non-profit 501c(3) organization was formed by the family and friends of Alison Berry, an audiologist and representative for Unitron killed in a car accident while en route to a morning meeting with a customer. Help alison-berry-36keep Alison’s passion for amplification alive by making a contribution at the Alison’s Hope for Hearing Crowdtilt.  The fundraiser tilts at $1750 with a target goal of $4,000. As part of my personal commitment to Better Hearing & Speech Month, I invite you to join me to make whatever contribution you can for this worthy organization that honors one of our own. For more information on Alison’s Hope for Hearing, go to www.alisonshopeforhearing.org or contact the organization via e-mail at info@alisonshopeforhearing.com. To make a donation to Alison’s Hope for Hearing Crowdtilt, click CROWDTILT for ALISON.

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HEY! WAKE UP, Audiologists! The Future is Here – guest post by Jerry L. Northern

Posted on May 1, 2013 by AU Bankaitis

futureI thoroughly enjoyed the AudiologyNOW! 2013 presentation from futurist, Jack Uldrich. His presentation has given me considerable cause during the past month to think about the future of audiology in light of his intriguing comments. Many of the health specialties that surround audiologists are in the midst of exponential (and exponential is the key word here) change and progress. In contrast, audiology is stuck in our conventional tests and procedures which, frankly, have not changed much over the past two decades. We still test hearing in the same old way and we still manage persons with hearing impairments in the same old antiquated way. I’m thinking that we need to be developing and creating new ways to become more effective and efficient in the delivery of our hearing services.

1-jump the curveI have always been an avid reader, and lately I guess I have almost inadvertently been focused on books dealing with new advanced technologies – but I had honestly not related them to the field of audiology until I heard Jack Uldrich’s speech. Following AudiologyNOW 2013, I purchased Uldrich’s  2008 book, Jump the Curve.  His themes of “…staying ahead of emerging technologies”, and “…keeping up simply isn’t good enough anymore” could certainly be the bell-ringer for audiologists. It seems to me that during the nearly 50 years of my career, audiologists have always followed the lead of technology – rather than being the leaders.  We have simply always been behind the curve – not ahead of it. In most of our specialty areas of hearing, for pediatrics and adults, our diagnostic and rehabilitative 1-lagging curveprocedures have been developed or altered to implement some new technology that suddenly became available (e.g., otoacoustic emissions) – developed by some industry or commercial enterprise – and we found ways to incorporate these new schemes into our daily practice. Sure, we have seen some improvements in our clinical protocols over the years, (e.g., evidence-based practices) but nothing has really changed our approach to testing. And an embarrassingly large percentage of audiologists fail to take advantage of new technology or proven evidence-based practice to change their routine behaviors. Perhaps, the major exception to these remarks has been the exceptional development, acceptance and application of cochlear implants.

1-technologyUldrich identifies the nine technological areas that are undergoing exponential change, and offers a new and intriguing perspective on how the intersection of medicine and technology can transform the future and delivery of healthcare. It is easy to see that audiology is inherent in each of these nine areas which include:

  1. computers/semiconductors;
  2. data storage;
  3. Internet bandwidth;
  4. screening of the human genome;
  5. brain scanning;
  6. artificial intelligence;
  7. nanotechnology;
  8. robotics;
  9. and advancement of knowledge itself.

Woman's Eye and World GlobesAs I wandered through the extensive exhibit area at AudiologyNOW 2013, I saw multiple examples of new technology being applied in various audiology-related enterprises – imploring audiologists to step up and utilize them in their daily practices. And yet, year after year has gone by without much changes in our field in spite of many opportunities. By the way, Jump the Curve is a quick and easy read with numerous fun and fascinating examples of exponential growth that you can toss out as conversation pieces during your next staff meeting, family gathering or cocktail party!

Computer_ChipThis concept of exponential growth is shocking. A common example often cited is known as Moore’s Law, named for Gordon Moore, co-founder and former CEO of Intel Corporation. In 1965, Moore accurately predicted that the number of transistors that could be placed on a computer chip would double every 18 months. By the year 2007, Intel had successfully squeezed more than 500 million (yes, that’s with an M!) transistors on a single chip! The economic impact dropped the cost of 1 megahertz of computer processing power from $7,000 in 1965 to only pennies today. And, of course, our daily lives now have been “exponentially changed” by the ubiquitous utilization of these inexpensive computer chips.

book-2Another fascinating book is The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care, by Eric Topol, M.D. I first saw Dr. Topol interviewed on 60 Minutes a few months ago and then quickly downloaded his book to my iPad. This book offers …“a new and intriguing perspective on how the intersection of medicine and technology will transform the future delivery of healthcare.” Basically, along with other technological developments based on the sequencing of the human genome, he predicts that the future of health sciences will be conducted through a mobile technology platform, remote sensing devices and social networking (ya, like processing everything through your smart phone!).

Topol points out how your cell phone, which he calls the “hub of telecommunication convergence” has become a remarkable collection of devices rolled into one simple, portable gadget that we carry at all times on our person. Although it started as a telephone, it is now our personal assistant that likely includes a camera, a video recorder, a GPS, a calculator, a music player, a voice recorder, a watch, an alarm clock and timer, a what_is_siri_personal_assistant_appspersonal scheduler, a photo album, and a library of books. And, if it is connected to a wireless network, it becomes a ‘smart phone’ which can be used as a web surfer, word processor, video player, translator, dictionary, encyclopedia, and a gateway to the world’s knowledge base with some simple strokes and finger presses. With more than 800,000 apps available now, there seems to be no end to how your cell phone can influence and become an integral part of every activity in your daily life.

Topol offers a plan to use the mobile platform device as our personal and individualized health monitor and data file. He points out that all the applications are now available to put your entire medical history in your hands available to any physician or emergency render of DNAroom, as need be, through your cell phone. Your mobile device can perform routine measures such as blood pressure, weight, body temperature, electrocardiology measures, ultra sound and EKGs as necessary without you ever going into a medical office. By downloading your personal human genome sequencing, disease entities can be identified or predicted and treated with appropriate pharmaceuticals. Although this technology is now available, Dr. Topol points out that medicine in general, and physicians in particular, seem absolutely unable or unwilling to change.

audiometryWe do have a bit of a jump in audiology because apps are available to perform hearing screening and testing, environmental sound level noise measures, and at least one hearing aid company has developed technology to program their hearing instruments via the cell phone. But, I’m thinking there must be myriads of other applications whereby the audiologist armed with a smart phone could provide hearing services? As audiologists, we should right now be asking ourselves how additional audiology services can fit into this mobile platform model? How about educational activities, rehabilitative protocols for use by patients, simulated patient responses for practice by students, etc.? A natural platform for tele-audiology, further development of smart phone apps could do much to extend our hearing services across vast distances to save time and increase our efficiency.

future-al goreTo amaze you with more facts, Time Magazine recently reviewed a new book by Al Gore, titled The Future. I’m probably not going to read this one, but none-the-less Gore states that “The number of mobile-only Internet users is expected to increase 56-fold over the next five years.” Gore also cites the many uses of smart phones including the interesting trivial fact that Swiss dairy farmers are now attaching wireless thermostats to the genitals of their cows so they can track hormone changes to identify the onset of breeding periods. And, the article points out that it should come of no surprise that there are now more mobile phones in the world than toilets!

My final book recommendation (and I give this one my absolute highest recommendation) for your summer reading is The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee, 2011 (Amazon.com, $13.90 paperback, 9.99 Kindle version). The Emperor of All Maladies is a very readable, educational, fascinating and magnificent history about cancer and its treatments. The emperor-of-maladies-210111book begins with the earliest documented appearances of cancer thousands of years ago and continues through the twenty-first century, describing the various attitudes and attempts to cure, control, and conquer cancer right up to our newest understanding of its essence. From the audiologist’s point of view, although we don’t necessarily deal with cancer patients routinely in our work, this book will give you a new understanding of the individualization of cancer treatments, and it might provide you with some new insights to break out of the time-locked hearing service molds that currently curtail us as we seem locked-in to the management of our patients with a one-style-fits-all approach. We recognize that every hearing loss is not exactly the same regardless of similar audiograms? Does every patient with hearing loss benefit from the exactly the counseling story which results in the same hearing aid fitting?

Glass-Surface-Molecuar-ActivatorAnd while we are talking about the future for audiology, let me digress and mention the amazing contributions of Richard J.H. Smith, M.D. and his prolific research team. Dr. Smith is the Founder and Director of the Molecular Otolaryngology and Renal Research Labs (MORE), and the Director of the Iowa Institute of Human Genetics at the University of Iowa. He lists more than 400 peer-reviewed publications in his vitae. I have listened to Dr. Smith’s presentations a couple of times during the past year or two, and most recently when he was featured as the 2013 Carhart Memorial Speaker at the American Auditory Society meeting in Scottsdale during March of this year. His work will have an extraordinary impact on the diagnosis, and ultimately the treatment, of patients with sensorineural hearing loss. An outrageously good speaker, his current body of research, involving the genetic testing of deafness, leaves me in awe. If you ever see his name on a program, or have the chance to hear him speak, run – do not walk – to get a good seat and be ready to be blown away as he discusses his research projects and you can decide for yourself how big an influence his works will have on your practice of audiology.

otoscopeIn brief, they have developed an accurate, comprehensive, and cost-effective genetic testing (OtoSCOPE) to establish “population-level frequencies of reported deafness-causing variants in 1,000 controls from six ethnic populations. These data have been used to determine the cause of deafness in 100 patients with presumed genetic hearing loss.” This approach to determining the etiologies of deafness will facilitate genetic counseling and provide valuable prognostic information for affected individuals.  Dr. Smith’s group has used these data since 2008 to formulate a bioinformatics platform known as AudioGene.  AudioGene is a software system that employs machine-learning techniques utilizing phenotypic information derived from audiograms Medical_05to predict the genetic cause of hearing loss in persons with autosomal dominant non-syndromic hearing loss. These researchers have found that certain easily recognizable audiogram configurations, (termed “audioprofiles’) provide a powerful tool (accuracy is reported at 68% and no doubt will increase as more data is collected) for predicting hearing loss genotypes. Their data set, at this time, is based on 3,312 audiograms from 1,445 patients. Currently, the potential benefits of uncovering the human genome and its relation to deafness and hearing loss are focused more on identifying the causes and less on treatment, although in the future we can anticipate improved diagnostic methods, earlier detection of a predisposing genetic variation, advances in pharmacogenomics and, possible gene therapy to reverse or eliminate deafness disorders. As example, since we know that early intervention is crucial to prevent developmental delays in children with hearing loss, the ability to identify the specific etiology in young children would be beneficial in prognosis and in developing lifelong treatment plans. Now that should get the attention of every audiologist!

innovationIn summary, we continue to see new breakthroughs in technology and social media that I wish we could apply in some form or another to audiology. New innovations will soon change overall healthcare into an individualized approach – where diagnosis and treatment will be customized for each individual based on genomic information and real-time data obtained through embedded nanosensors and wireless technologies. We need to be thinking about how audiology will fit into this futuristic approach to healthcare services. Can some form of social media be used to spread the ‘good word’ about audiology that will result in better student recruitment, more patients looking for better hearing, younger hearing-aid seeking individuals, and improved referrals from our medial Innovation-Blog-Post-Imageand allied health partners? Perhaps one of our “digital natives,” (a term used to describe “under 30 year olds” who have only known the “digital world”), might come up with a new and intriguing perspective on how the intersection of audiology and technology can transform the future and delivery of hearing healthcare. We need something significant to break us out of our complacency and antique clinical protocols; otherwise, these futuristic technologies are going proceed without us and  leave us wondering whatever happened to audiology as a profession.

Photo of Jerry Northern courtesy of EarTunes.com @ http://eartunes.com/if/audiology-inf-109.shtml

Photo of Jerry Northern courtesy of EarTunes.com @
http://eartunes.com/if/audiology-inf-109.shtml

Jerry L. Northern, PhD is Professor Emeritus at the University of Colorado School of Medicine and President of the Colorado Hearing Foundation.  As a native of Denver, Colorado, he received a BA degree in Experimental Psychology from Colorado College in 1962, holds Masters degrees from Gallaudet University and the University of Denver, and earned his PhD in Audiology at the University of Colorado (Boulder). Dr. Northern is amongst the most recognized members of the Audiology profession in the world.  He is a prolific writer including his textbook Hearing in Children (5th Edition, 2003) and also served as editor for Seminars in Hearing and Audiology Today. As a Founder of the American Academy of Audiology, Dr. Northern served as the organization’s third President.

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How Audiologists Promote Better Hearing & Speech Month this May

Posted on April 24, 2013 by AU Bankaitis

better_hearing_speech_month_sticker-ra260c6d952b2429a803884076187f2ff_v9waf_8byvr_216For over 75 years, the month of May has been designated as Better Hearing & Speech Month, a time to increase public awareness on hearing, speech, language and voice disorders. Given that the month of May is right around the corner, here are some ways that your audiology colleagues and AuD Students promote Better Hearing & Speech month followed by some great resources for you to download and either use in your clinic or share with the public:

  • Participate and/or organize local Walk4Hearing fund-raiser
  • The Center for Hearing and Speech in Houston, TX has some of their previous patients present at a local elementary school to inform other children about hearing loss
  • The Children’s Medical Center of Dayton in Dayton, Ohio has the hospital mascot (Wally Bear) walk around with the audiology staff on patient floors wearing ear phones and playing music to educate kids about hearing protection
  • An audiologist from Hawaii makes arrangements to have information on hearing loss inserted in her church bulletin
  • University of Nebraska at Omaha (UNO) chapter of the National Student Speech Language Hearing Association (NSSLHA) participates in hearing screenings at the UNO Child Care Center.
  • The Communication Disorders & Sciences Alumni Association of California State University Northridge presents information to students at a local high school to encourage careers in Audiology
  • One of our Oaktree Products customers always orders several boxes of EAR Classic Foam Earplugs and randomly passes out samples to people with some information on preventing noise-induced hearing loss during the month of May
  • Another handful of Oaktree Products order up Chocolate Ears as a treat to patients and staff

customer-feedbac-surveyHow have you promoted Better Hearing & Speech Month in the past and/or how do you plan on promoting it this year? Share your experiences and plans by leaving a comment at the end of this blog post. In contrast, if you always wanted to do something but didn’t know how, here are some suggestions. For starters, read How to Generate Local Media Coverage offered by the American Speech Language Hearing Association (ASHA).  From there, download a few free press releases to start promoting Better Hearing & Speech month including:

Promotional items are also available to download from the AAA websites including:

Numerous Fact Sheets are offered in PDF format on the AAA website that you can make available in your patient waiting room or to referring physicians including:

Have kids at home? Have friends with kids?  Better yet, have kids who go to school with a lot of other kids? Offer teachers some fun activities for kids to do in school during the month of May that can be downloaded at no charge such as:

  • Customizable activities Just for Kids from the AAA website including crossword puzzles, connect-the-dots, word find, and coloring sheets
  • Fun For Kids activities from the ASHA website

Lots of ideas, lots of resources! Share your ideas and experiences on how you plan on promoting Better Hearing throughout the month of May! Have fun and good luck!

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