Case Study – CT

CASE STUDY: CT

A Challenging Case in Educational Audiology

Patient Case History

• Student seen in local school district and by private audiologist
• 8 years old
• Full term with uncomplicated pregnancy and delivery
• Parents speak a language other than English
• Born with bilateral anophthalmia (absence of both eyes), equinovarus (clubbed feet), syndactyly (fusion of 3 toes on each foot)
• Diagnosed with severe to profound hearing loss since birth via ABR
• Behavioral issues that include acting out physically
• Psychological evaluation performed at 5 years old indicated skills ranging in developmental age from 1 month to 1 year
  • It is not meaningful to quantify cognition because of her sensory impairments

Services

• Developmental Instruction, PT, OT, Speech/Language Therapy
• Has been receiving intervention from 25 days old
• EI reports that she only wears her hearing aids for about 10-20 minutes
  • Same reports in primary school
• Deafblind self-contained classroom
  • Teacher is dually certified for special education and teacher of the visually impaired
• Teacher of the deaf and hard of hearing in the classroom on a daily basis
• Full time teacher’s assistant and language facilitator in the classroom (per child)
• Multi-modal approach to communication
  • verbal/tactile, sign, gesture and object schedules

Deafblindness: Deafblindness occurs in about 1.2% of the deaf and hard of hearing population. Along with these patients, about 1.4% are legally blind and 3-4% have low vision. As of 2013 there were 9,452 children with deafblindness in the US (1,2).

 Assessment

• Allow patients to explore the environment with preferred sense
• Allow extra time to get to know and bond with the child
• Pair sounds with vibration to alert the patient that a sound should be attended to
• Use an assistant in the booth to give feedback to the patient
• Use an observational functional evaluation to assess the child’s everyday environment
• Use objective measures as a backup (3)

Case Issues: CT was using outdated technology with old earmolds that she had outgrown.  Because of her cognitive delay, behavioral issues and visual impairments, it was not possible to obtain updated results to fit updated technology in order to comply with her IEP and ensure audibility in the classroom. The only accessible results were outdated ABR testing. The testing did not provide good thresholds for hearing aid fitting purposes as many frequencies indicated that a response could not be obtained at the output limits of the ABR machine.  Therefore, it is difficult to know if the hearing aids were set appropriately to provide good audibility. Complete earmold impressions could also not be obtained as CT is not accepting of people touching her ears.

Hearing aids were set to the best of the educational audiologist’s ability using the ABR reports. Earmold impressions, while not as deep as those obtained previously, were better than those that she had outgrown.

Conclusion

• The deafblind population has unique needs that audiologists and other professionals need to be educated on and aware of.
• Sometimes your patients have more complex audiological and developmental needs that are not the ones that are taught in class and absolute best practice may not be not available to you. In these cases, it is imperative to strive for best practice, but also essential to ensure that the needs of the patient are met to the best of your ability.

References

Bruce, S.M., & Borders, C. (2015). Communication and Language in Learners Who Are Deaf and Hard of Hearing with Disabilities:Theories, Research, and Practice. American Annals of the Deaf, 160 (4), 368-384. doi:10.1016/j.ridd.2010.12.019

Dammeyer, J. (2011). Mental and behavioral disorders among people with congenital deafblindness. Research in Developmental Disabilities, 32(2), 571-575. doi:10.1016/j.ridd.2010.12.019

Palmer, C. (2003). Methods and Strategies for Audiological Assessment of Individuals Who Are Deaf-Blind with Developmental Disabilities. Seminars in Hearing, 24(3), 211-222. doi:10.1055/s-2003-41350

Stephanie Noble is a current third-year audiology student at the University of North Carolina at Chapel Hill. She serves as the SAA State Ambassador to North Carolina, the Liaison from UNC to the North Carolina Audiology Association, and the Vice President of Merchandising for UNC-SAA. Her interests include pediatric audiology, educational audiology as well as legislation and advocacy.