Hello! It’s been a while… I have been adventuring and sleeping and eating, but have also been busy with making sure that University work is up to date (who doesn’t love a really fun assignment, eh?). I’m on the final stretch towards graduation and being fully released into the professional world so it’s quite a crazy time! This is a post I’ve been meaning to do for a while. I aim to enlighten you all, my small handful of readers, with regards to the elusive things that occur on a regular working day as an audiologist! I hope that whether friend, family or somebody I’ve never met (but I’m sure is fabulous), that you enjoy getting to know what I/audiologists get up to on a normal day
First off – what is an audiologist? (don’t worry, I only found out a few months before applying for the degree…).
Here’s what the British Academy of Audiology says: “Audiology is a challenging and expanding field involving the study of hearing and balance. As a healthcare profession, audiology also involves assessment, management and therapeutic rehabilitation of people with hearing and balance problems, and associated disorders. This work involves patients of all ages, from newborn babies and children to working adults and elderly people”.
Things audiologists do: test hearing, test balance, offer counselling, fit hearing aids, offer support with hearing aids, paediatric testing and rehabilitation, tinnitus counselling.
Things audiologists DON’T do: operations to fix stuff, (ENT surgeons), fitting Cochlear Implants (ENT surgeons), removing wax (GPs), speech and language therapy (speech and language therapists).
Things I do: test hearing, offer counselling, fit hearing aids, offer support with hearing aids.
Currently as a student on placement, I help with balance testing and paediatric testing under supervision, but once graduated and working my main focus will be adult hearing rehabilitation. Most clinicians that work with children/balance/tinnitus have undertaken further qualifications and training to do so.
Or in the words that I use when I’m in a rush: “I work with ears!”
Ears are wonderful things. Seriously, how awesome is it that we can hear stuff?…
Each day of work looks slightly different. I’ll go through the different types of things that happen throughout a normal week
Repair clinics run on a drop-in no-appointment basis so can get pretty busy if it’s a cloudy day and patients don’t fancy going to the beach! Patients with hearing aids need to have them serviced approximately every 6 months, so they come to the repair sessions to have this done. This is a nice quick job generally speaking. Other patients come to the clinic if their hearing aid is broken, whistling, or if they’re in a bit of a flap. Repair appointments are an opportunity to test our problem solving skills!
It’s quite illuminating to hear different tales about how a hearing aid has been brutally smashed to smithereens (unfortunately dogs quite like the smell/taste of ear wax…).
Tip: ballpoint pens are not good wax removal tools for your earmould
ENT stands for ‘Ear, Nose and Throat’. ENT is a separate department from audiology, and they deal with all the ‘fixing’ stuff like operations on the eardrum and diagnosing conditions like Meniere’s. Before they see some patients, they need a hearing test and a tympanogram done, so in audiology we do these just before they see the ENT doctor. A tympanogram is basically checking the middle ear function (the bit between the eardrum and the cochlea). It involves changing the pressure inside the ear canal and playing a sound, and it only takes a few seconds so it’s economical on the time! The hearing tests are important, because sometimes an operation can be based off of one. It’s important to get reliable results! I quite like doing hearing tests. To the person having it done, it’s just a bunch of beeps, but there can be a significant amount of scientific thought behind the test which can be challenging sometimes.
Hearing Aid Assessments
Since one of the main things we do as audiologists is fit hearing aids, we therefore have to assess patients for hearing aids. In these appointments we basically do lots of listening and talking, carry out various tests to assess hearing, and discuss management options. The aim of the appointment is just to decide with the patient how to move forwards. It’s not always a case of diagnosing a hearing loss and then fitting hearing aids! There are patients with a very mild hearing loss who are determined to have hearing aids, and there are patients with much worse hearing who really don’t think it’s for them – and that’s okay. Our job is NOT to give hearing aids to every single person with a hearing loss! One of the most important things to learn is how to tailor each appointment to the individual and their own needs and wants – whilst also making sure that we make good professional recommendations.
The hearing aids that are generally fitted across the NHS are ‘behind the ear’ hearing aids. This just means that the actual hearing instrument rests behind the ear. In order to deliver sound into the ear, a tube runs from the aid and into the canal. This tube needs to be held in place in the ear! To do this, either a flexible dome is used, or a custom-made ear mould is used.
The different types of moulds and domes can obviously look quite different. We carefully decide which fitting would work best for each patient. Smaller doesn’t instantly mean “better”! Whether a patient has a flexible dome or an earmould is based on their hearing loss. Generally, a more severe hearing loss means the patient will need a bigger mould.
To make these ear moulds, we have to take impressions of the ears. This just involves putting a little piece of sponge into the ear, and then filling up the canal and outer ear with putty. The putty takes a few minutes to set, and then voila, we have the shape of the ear!
The impressions are sent off to a lab, who scan the impression and produce it using a 3D printer – WOOHOOO 😀
Hearing Aid Fittings
A fitting appointment will consist of programming the hearing aid specifically for the person, and covering the bases on how to use it. Hearing aids are now digital (as opposed to analogue) and have the ability to be uniquely set up for each person. First, the aids are plugged in, and the software uses the patient’s hearing test result to programme them to an initial fitting.
After this, we do something called REMs – Real Ear Measurements. This involves using tiny tubes inside the ear canals, which are basically tiny microphones. We play sounds from a loudspeaker, and with the hearing aid switched on, we can see how close the amplification of the hearing aid is to the desired target (or the ‘prescription’). We adjust the amplification settings for each frequency in order to make the settings in the hearing aid match the target better!
The purpose of having the tube inside the ear canal is so that we can set up the amplification settings taking into account the size and shape of the individual’s ear, since all of our ears are different! For example, a very narrow ear canal will affect sound differently to a very wide ear canal, and therefore the generic initial set up of the hearing aid is often not suitable.
After setting up the aid, we then spend a reasonable amount of time establishing whether the patient finds the sound good and comfortable. It’s all very subjective, and certainly not an instant fix, so it’s normal to spend a while adjusting the settings until the patient likes the sound, or at least finds it tolerable. The beauty of these aids is that we can always plug them in at a later date and adjust many things with just a few clicks!
Pretty much all patients have a follow up appointment around 6 weeks after having a hearing aid fitted. It’s an opportunity to address any problems that have been experienced, or revel in the wonder of how marvellous everything is! Some patients get on perfectly from day 1 and others take a while or never get on with hearing aids. Getting used to them does require perseverance, mainly due to suddenly hearing lots of background sounds at a louder volume. Often, follow up appointments involve counselling in this area since it is common for a patient to be frustrated at hearing so many ‘pointless’ sounds. On the other hand, some people find this wonderful and enjoy hearing the rustling of their hair on their coat again!
My personal favourite is when an avid walker is pleased to be able to hear their favourite birds again!
On the whole…
And thus concludes an overview of the different types of things we do day by day as an Audiologist! We see lots of people, and there are always patients that make you realise that it is a very worthwhile job. Just a few days ago a lovely man had to fight to hold back his tears, saying “I can’t believe how wonderful this is!”… These responses are the ones that make me glad to have done this degree (and make it easier to get through a day of ‘difficult’ patients).
I hope that this hasn’t been too much of a dull read! I’ve enjoyed putting into words what we do The next couple of months involve finalising my portfolio and having my final clinical assessments, but after that I shall be a fully fledged BSc Audiologist, and will be released into the big wide world!
On that note, here is some exciting news!…… I have been offered a full-time audiology job (pending passing the degree), working in the NHS, and it’s near to home!! The whole prospect of being a proper working adult with much more responsibility is slightly scary, but I’m so excited that I have a job for when I graduate, and geographically it couldn’t really be better Praise God!
To finish off, here is a very exciting photo. It is the rather wonderful Jersey Cow sculpture that sits on the lawn at the hospital! Even on murky days, I enjoy seeing it because I think it’s hilarious! Occasionally somebody alters it’s attire (after Christmas it was wearing tinsel)…
Thank you so much for reading!!
** real patient data not used due to the need to maintain patient confidentiality