Externship Update

I am loving my externship!  I the hospital, I love the Audiologists, I love the work atmosphere, I love the many awesome friends I've made through working ("working") here, and I love this city!!!!!!

The first month and a half of my externship was spent doing hearing evaluations and working with hearing aids for the most part.  The great thing about learning at this clinic is that we see a large variety of patients.  About one half day each week I found myself working with developmentally delayed patients who can be very difficult to test.  We also see a lot of interesting ear disorders that you wouldn't typically see at a smaller clinic as well as asymmetrical hearing losses.  Although I will have rotations in the different specialty areas of audiology throughout the year, I will continue to do hearing tests and hearing aid clinic part time the entire time I'm here in order to keep my foot in the door of some of the basics in audiology. 

About a month ago, I started my first rotation.... the vestibular (balance) rotation!  I was so excited to start this rotation because vestibular is the area of audiology that I think I want to do more with when I graduate.  I was also nervous though because I have not had much experience with vestibular testing before coming here.  Another bonus to this externship placement, is that they know that vestibular is an interest of mine, so they put me in it first and mentioned they will probably keep me doing at least one half day of vestibular testing each week for the rest of my time here so I don't "lose" anything I'm l learn during the rotation.  The last month or two of my externship I may be placed in it again to get me the most of what I want to do in audiology right before leaving.  The best news so far..... I am getting some very positive feedback on my performance so far in this rotation!!!!!  In the first week I was told I exceeded their expectations.  Now they are getting picky with the things they want me to work on and are merely "fine tuning" my testing and interpretation skills for VEMPs (Vestibular Evoked Myogenic Potentials) and VNGs (Videonystagmography).  I have only done the rotary chair test once and posturography once, so those skills still have a ways to go.  I also work in the BPPV (Benign Paroxysmal Positional Vertigo) clinic every Tuesday morning with one of the neurotologists.  I love this clinic.  If we suspect a patient has BPPV we schedule them for BPPV clinic instead of doing the full VNG evaluation.  If they are positive for BPPV then the neurotologist (with my assistance) does the modified Epley maneuver to get rid of the dizziness right away.  It is so much fun to "cure" the dizziness because this is the only type of dizziness we can cure! 

This past weekend I also helped out at the Hearing Health Fair put on by Cochlear.  I helped with the hearing screenings for a few hours, and then joined the UCH booth for a few more hours before going home.  Not the best way to spend my Saturday, but... I guess I'm already volunteering 5 days a week, why not throw in the occasional Saturday too! 

My most interesting/memorable patients so far: 
*A developmentally delayed patient who very much looks and acts like a developmentally delayed version of a guy I know in Wisconsin.  I haven't told this person I met the DD version of himself... he may not like it. 
*A patient without a middle or inner ear!  No eardrum or anything.  It looked like a long curvy tube that never ended. 
*A patient with the outer ear closed off.  Imagine the ear canal pinched off about half way in, before reaching the eardrum. 
*Fitting a "VIP" couple with a set of hearing aids each. 
*Trying to sell a set of hearing aids to a 14 year old girl who has never worn them before.  Once she saw them, she instantly decided she could hear "fine" and doesn't need any help.  Time to bring out the big guns because this girl's education would have suffered had she not gotten hearing aids. 

I'm sure there are some more interesting high points and interesting patients, but I can't think of any more right now. 

Coming up at the end of the month is the Colorado Academy of Audiology in Breckenridge!  Can't wait! 

It's been too long

I have been a very busy girl these days, so I have a lot of catching up to do. First order of business is to answer the question I asked last week. There may only be 2 of you awaiting an answer, but gal darn it you're going to get one!

Truth be told, there are a couple of acceptable ways to clean your ears. Many people have no need to do more than wipe off the outer portion of their ears with a towel or cloth. Wax naturally works its way out of the ear. Some wax is actually a good thing, as it helps protect your ears from bacteria and foreign particles. Many others, though, find it necessary to do more.

One way to clean out your ears is to use a baking soda and water solution. Mix about 1/2 teaspoon of baking soda with 2 ounces of warm water. For convenience, put the solution in a dropper bottle and put several drops into your ear. This will help soften the wax if it is hard in order to help it work it's way out of the ear better.

Another way is to drop hydrogen peroxide in your ears. Only drip a few drops at a time. It will tickle and bubble for a little while, and then tip your head to get the peroxide back out of your ear.

You can also purchase over the counter ear drops used to soften the ear wax to help it move out of the ear canal naturally.

*Warning: Do not use these methods if you suspect you may have a hole in your eardrum. If the drops get behind the eardrum, you would be at risk for infection.

Another option is to see you local ENT or physician for wax removal.

Do NOT use Q-tips people. I know, it is a ridiculously hard habit to crack, but it actually makes the wax situation worse. By using Q-tips, some wax is removed. The wax that touches the Q-tip comes out, but the rest of the wax is actually pushed deeper into the ear canal. This impacts the wax making it more difficult for the wax to work its way out on its own. If you "must" use Q-tips, only use it on the very outer portion of the ear canal to remove what has already working it's way out of the ear. Otherwise, try to steer clear and "don't put anything smaller than your elbow in your ear."

Also, to answer navyguy/navygirl's question: Will wearing ear protection all day do any damage to your ears?

Well, I am going to say, no. Of course I'm sure there are a few random people out there who would love to prove me wrong. At the worst, ear protection worn on a daily basis might stretch your ear out a little. Not a noticeable difference though. It would be no different than wearing hearing aids with a custom earmold for years and years. Occasionally, a new impression may need to be taken to be sure the molds or plugs are fitting well in the ear and are creating a good seal (due to the slight stretching of the ear). Also, you might notice ear wax builds up faster because there is something in your ear blocking the wax from working it's way out. Other than that, there is nothing to worry about. The benefits of custom ear protection is that it will always be inserted correctly in your ear, and therefore will always attenuate sound to the degree that it claims it will (the foam ear plugs actually attenuate sound better when inserted correctly, but when inserted incorrectly do a poorer job of attenuating sound).

Audiology QUIZ

Time to change things up a bit. I am thinking about doing a weekly quiz (and we'll wait and see how long it actually lasts). I like to think of it as Audiology awareness! Once a week I will attempt to post a question related to Audiology in some way. If you want to play along, post your answers in the comments section. A few days later I will post the answer.

• Question #1

What is the best way to clean the wax out of your ears?

COMPASS Clinic

As promised, it is time to talk to you about COMPASS clinic. COMPASS Clinic (or team clinic) is a multi-disciplinary approach to caring for a patient. My placement offers this clinic once a month, every second Friday of the month. COMPASS clinic stands for Colorado Multi-Disciplinary Program for Assessment, Strategies, & Support. K-Mo's and my job is to coordinate the whole day. We arrange the families that are invited to attend the clinic and make sure they are dedicated to showing up for it. There are usually 3 children who attend the COMPASS clinic. We mail them some forms to fill out regarding their history, family history, health, professionals they work with (for example: teachers, family physician, speech pathologist), etc. When they send it back, we contact the other professionals to get any relevant info they have on the child and write up a summary. Then we send the summary out to all professionals the child sees the day of the COMPASS clinic. K-Mo and I schedule the appointments and send the family their schedule for the day, a list of what to bring and some info regarding what to expect the day of. We each stay with one of the families throughout the day and act as their support for the day. We coordinate and assist. The day of, they see some or all of the following: an audiologist, the ENT who is a neurotologist, a developmental pediatrician, a genetics counselor, a psychologist who specializes in Deafness and Autism, and a parent and a patient advocate. We go with them to each appointments and make note of their concerns for their child and their goals for their child's future. Over lunch, we all meet in the conference room to discuss the children seen in the COMPASS clinic and review the findings of the morning appointments. Then, at the end of the day, we all get together again to review the findings of the afternoon appointments. Finally, K-Mo and I write up the recommendations from each professional seen that day and get it to the child's family in the next week. By the time we're done, we get to start preparing for the next one!

So... it's a lot of work, but this clinic is pretty awesome. I learned so much in only a single day, and the families who need it had the opportunity to have their child cared for in a more well-rounded fashion and they get all of their questions answered. The day itself can be overwhelming, but the families leave feeling truly grateful! I still can't believe how much I learned during this clinic. I am thinking about using the little guy I accompanied for my next grand rounds project, so you will probably hear all about him in the near future.