The Final Word: Providing the Opportunity for Patient Follow-up
Final Word | February 2015 Hearing Review
There were several of us trying to troubleshoot a complex wireless and equipment problem. No, it wasn’t a hearing aid problem, it was a cable TV supplier and wireless connectivity issue.
The supervisor was trying to explain the problems sometimes encountered when troubleshooting wireless systems, and I explained that I was familiar with some of the issues because of my experience with wireless hearing aids. To my surprise, the supervisor didn’t react like most people when he found out what I do, and make a corny joke. Instead, he asked me a serious question: “I have a problem with my ear, and the doctor says that nothing can be done. Does that happen often?” Of course, my curiosity was piqued and I asked for more information before answering him.
Trinidad is a 30-year-old man with no significant history of illness, trauma, or other causative factor. He noted a gradual unilateral hearing loss in his left ear over several months. He is experiencing hearing loss and tinnitus, but has no other symptoms. Tinnitus is bothersome most of the time, but he has learned to cope as best he can. The unilateral hearing loss is a problem when trying to localize, and with comfortable volume while watching television. He reports that his daughter and others complain that he likes the volume at a level that is annoying to them.
He had been evaluated by a staff model medical group with ENT and audiology support. Hearing tests showed a moderate sensorineural loss on the left ear with reduced word recognition (52%-60% depending on the presentation level) and normal thresholds on the right ear. He was referred for an MRI, which showed no pathology. He was told that the gradually sloping 45-65 dBHL hearing loss could have been the result of noise exposure, and no treatment would improve his hearing levels. He was advised to return in a year.
“Is there really nothing that can be done?” was the primary question he asked. I explained that he had taken a positive step and ruled out a dangerous medical problem or a hearing loss that would respond to medical treatment. I told him there were a number of treatment options, depending on how much the hearing loss and tinnitus interfered with the quality of his life. I asked him to call me if he wanted to talk about it more.
A few months later, he sent me an e-mail asking for an appointment. I saw him about 7 months after the original evaluation and diagnosis. We discussed his experiences, symptoms, and needs.
Our immediate objective was to see where his hearing levels were after the initial medical evaluation. He felt that his hearing had deteriorated. Fortunately, my assessment showed that the right ear remained normal, and the left ear had improved low frequency thresholds, and better word recognition at a comfortable presentation level.
I explained treatment options, one of which was to experiment with wearing a hearing aid on the left ear. He expressed interest in the hearing aid option and we tried a temporary fit with a receiver-in-canal (RIC) product using a vented silicone dome. His subjective reaction was immediate and surprisingly positive. After discussing his perception of the amplification, I asked him what he was noticing. Unsure of what I meant, he asked, “…other than the sound of hearing from that ear?” “Yes,” I replied, “what else do you notice?”
“It’s gone, the ringing is gone!” he exclaimed with a shocked look on his face. I explained that it probably wasn’t gone, but the additional sound from the hearing aid helped push his awareness of the sound into the background.
We talked a bit about his other needs, and I decided to let him borrow the hearing aid for a couple of weeks to get more information about his response to the amplification in a variety of environments. If the result was encouraging, I’d offer a wireless hearing aid to allow him more help with the television at home using a dedicated transmitter, make a custom mold for the RIC cable, and fit the ear properly with a combination of objective and subjective verification.
We always like a positive outcome. No matter how the outcome turned out, however, how could the patient journey have been smoother for this patient? I cannot fault the medical center for not jumping to a hearing aid immediately, but I would have had that discussion about the possibility with the patient at the time of diagnosis. I think I would have been cautious at the time of the diagnosis, because with a recent loss, we never know where the loss is headed. In this case, it looks like the loss was stable enough for us to continue to monitor, but to proceed with treatment. By the way, hearing aids are a viable treatment!
The Final Word? When patients see us for treatment—whether we are in a medical, rehab, or retail environment—they are looking for answers and for help. Providing information about what we know best might be fine, but we should also be taking a step back to consider all options, including those where we are not experts. The patient may not be ready for all of the options at the time of the diagnosis, but we should include some way to follow up to make sure that the patient is proceeding with appropriate information.
My offhand “elevator speech” about options for hearing loss and tinnitus to this patient turned out to be more helpful than a recommendation for a return appointment in a year. Even if our patient load prevents us from following up with patients personally, part of a treatment plan might be an invitation for the patient to check back with us in a month or two if any questions arise. At that point, the journey might be a little easier.
Citation for this article: Van Vliet D. Providing the Opportunity for Patient Follow-up. Hearing Review. 2015;21(2):50.