by Col Ben Sierra
Every time I get a phone call from some of you without fail one of the first questions I get asked is what are the folks at WHMC up to. I guess it is part of our nature to be inquisitive otherwise we wouldn’t be audiologists. Maj Pluta and I talked about putting together an update report on “What’s Happening at WHMC” so here it goes. I’d like to start by giving you a brief overview on the new folks assigned to us. Then, I will briefly talk about some of the programs and projects we are working on.
As some of you may be aware we have been very fortunate in getting four CFY Audiologists assigned to us this year. On the other hand, it has been challenging because there are days that we have more audiologists than booths but through creative scheduling we have met the challenge. So you get to know them better their biographies an photographs are posted on our website. Please take time to read them and get acquainted with your new colleagues. We are also very fortunate in that we got a new addition to our Staff, 1Lt David Eisenach. David spent several years in Australia working under the auspices of NAL and has wealth of knowledge on amplification. He’s a fast study and is quickly getting up to speed in all areas. Feel free to call or email our new staff members you’ll find them to be professional, pretty smart and fun to talk to.
As the old saying goes, there is nothing new under the Sun, just simply re-engineered. That is true about many of the things we are doing here at “Big Willy” because for the most part our “new” programs are not really new. They are just new/improved versions (I think) of programs that many of you who worked here had seen before.
First, we have implemented an audiologist-friendly CAPD or APD battery. I know that many of you and I have had discussions about whether there is any value added to performing APD evaluations because there is not much “we can do” about these cases. In fact, there is as lot we can do starting by assuring our patients that “no they are not going nuts” and the fact that we can diagnose (yes we can diagnose within our scope of practice) and document this condition. Once we have concluded that APD is present we can refer these patients to the appropriate providers such as speech therapy, mental health, or physician. Back to our audiologist friendly battery, basically it relies in the following tools:
- case history
- auditory checklists: the C.H.A.P.S and the Fisher
- the SCAN-C and A versions (by the way in case you are wondering the SCAN is not a screening test. It is a well designed and validated APD Diagnostic Battery. Call or e-mail me if you want to discuss.
- the Random Gap Detection Test (takes 10 Min)
- the Auditory Continuous Performance Test (ACPT) to rule out attention deficit; and the QUICK SIN (only used with adult patients and yes I know it has not been advertised as a CAPD test but it is a great tool to determine if the Auditory Figure Ground function is within normal range and it is quick to administer).
We also use the Scanware-C and Scanware-A Version 5.0 software, which are Windows-based computer programs used for complete and accurate analysis and interpretation of SCAN-C and SCAN-A. The programs provide a complete analysis with a printed report of test results and interpretation along with generic recommendations for management. You can get information on both the Scan A/C and the Scanware Software at capdtest.com.
Bottomline: the SCAN battery is well documented and well normed and the subtests meet the current ASHA and AAA guidelines for APD.
Second, we have embarked in a very aggressive equipment purchase and replacement program to build two Balance Centers, one mostly clinical to be located at the old Kelly Audiology Clinic and a research balance facility located at Bldg. 125 on Brooks City Base. To that effect we have been very fortunate in that all our equipment requests submitted have been funded. We already received a new Harmonic Acceleration Chair and in addition, we are waiting for:
- new/improved and much larger test suites
- evoked potential systems
- 3D Eye Tracker by Skalar
- posturography platform
- a 2nd ENG system
- portable audiometers
- a new ENG exam table
We are in the process of procuring: ERO-SCAN OAE screening systems and a second posturography and Harmonic Acceleration Chair both to be located at our Kelly Balance Center. Definitely our clinic is changing its looks and configuration and will continue to change due to new mission requirements.
Next, you all are aware of the great success of our Cochlear Implant Center and the significant number of patients we have seen. Thanks to all of you that have been referring patients to our program, keep them coming. The number of patients has grown exponentially since we re-organized the WHMC Cochlear Implant Program in October 2001. Those of you who attended MASC last year may recall the presentations we did on our program and how we have implemented a Board process to evaluate and identify the right candidates for implantation. To date 14 patients have been implanted and 3 more scheduled for surgery within the next 4 weeks plus several more candidates in the evaluation process. We estimate that our CI cases for 2003 will double compared to 2002.
Finally, we are working on several projects that I will briefly mention. We are in the process of comparing the NU#6 PB Words Lists vs. the A-B Word Lists (A-B Stands for Arthur Boothroyd). Lt Eisenach had significant experience with the A-B Words in Australia and he’ll be doing a small comparative study between A-B Lists and NU#6 by order of difficulty to determine time efficiency of both word lists. He’ll be presenting on this topic at the next MASC. On the vestibular front, Capt Dean Hudson has been experimenting with obtaining Vestibular Evoked Myogenic Potentials (VEMP) which are very useful at assessing acoustic neuromas. Because the VEMP has been thought to originate in the inferior vestibular nerve it is believed it can provide different information from the auditory brainstem response and the caloric test in the diagnosis of ANs. The other project in the works is re-establishing a bonafide audiologic rehabilitation (AR) program. In brief the program will be comprised of 4 phases requiring about the same number of visits we do now. However, we will be re-implementing a mandatory hearing aid orientation class prior to fitting. We will document appropriateness of fit via probe measures and the Quick SIN or SSI. Also we will be using self-assessment questionnaires to assess handicap (HHIE-A and E), expectations (ECHO), benefit (COSI), and satisfaction (SADL). Incidentally in case you are wondering since these inventories are filled by the patient except for the COSI they do not add any more time to your scheduled appointments but they give you a great tool to document and measure outcomes.
In concluding, this are a few of the things “we are up to at WHMC”. One more thing, this piece doesn’t do justice to the outstanding work the folks in speech therapy are involved with; therefore, I’ll ask Dr. Evie Cantu our Chief of Speech Pathology to prepare an update to be submitted in the near future. Please feel free to call or contact us with any questions or concerns you may have…we’d love to hear from you.
Regards,
BEN SIERRA, Colonel, USAF, BSC
Element Leader, Audiology and Speech Pathology
Wilford Hall Medical Center, Lackland AFB, TX