In the Purdue University AuD program, students progress through the four-year clinical doctorate program in structured academic and clinical work. This progression includes a weekly seminar for first- and second-year students that is designed as one additional layer of support in guiding students to make the coursework and clinical application connection. This weekly seminar has included guest speakers on a variety of topics as well as roleplay or additional training in different clinic practices. One area of focus that has emerged as a highlight of this course with positive student feedback and clinical application has been hearing aid troubleshooting.
Hearing aid troubleshooting skills are vital to support patient success with amplification. Audiologists must be knowledgeable, active listeners when addressing common complaints expressed by first-time as well as long-term experienced hearing aid users. Assistive listening devices (ALD) technology and wireless streaming communication with multiple devices provides patients with significantly improved communication access.
There are many reasons for poor hearing aid instrument performance, including dirt, moisture, excessive cerumen, battery corrosion, blocked microphones, earmold issues, and broken or bent receiver-in-the-canal (RIC) wire. There is often a vocabulary mismatch leading to miscommunication between AuD students and patients when reporting negative hearing aid experiences. Many common hearing aid complaints expressed by patients include:
- hearing aid is weak/dead
- speech is not clear or sounds muffled
- difficulty understanding speech in noisy environments
- own voice is too loud
- feedback or other noise
- speech sounds harsh or tinny.
Future audiologists need structured learning opportunities over the course of their AuD program to develop their detective listening skills and probing follow-up questions when troubleshooting hearing aid problems to resolve a patient’s complaint effectively.
A four-part series of guided hands-on hearing aid troubleshooting labs were developed to help AuD students increase their confidence and ability to participate in direct patient care in our on-campus Audiology Clinic. Purdue University AuD students are assigned weekly clinic opportunities with clinical faculty beginning Week 1 of their four-year clinical training program. In addition to this weekly clinic assignment, the hearing aid troubleshooting clinical seminar labs provide a partnership with academic faculty to bridge coursework knowledge with direct application to audiologic patient care. AuD clinical faculty teach the skills and knowledge needed to successfully navigate hearing aid issues over several semesters during the graduate students Year I and Year II of their training program. First, we begin identifying the numerous tools necessary to clean and repair broken hearing aid instruments. Next, we focus on the proper application of commonly used tools available in the Audiology Clinic. Then we discuss the connection between the patient complaint and possible hearing aid troubleshooting solutions. Finally, we address verification of hearing aid performance including electroacoustic analysis as well as speech mapping to identify possible resolutions for the patient’s complaint. Ultimately, by creating early hands-on opportunities with various hearing aid manufactures, in-the-ear (ITE) along with behind-the-ear (BTE) or receiver-in-the-canal (RIC) instrument styles we can close the knowledge gap between the classroom and the clinic.
YEAR 1 FALL
Most graduate students have limited working knowledge about hearing aids when they enter the AuD program. To someone unfamiliar with hearing aids, there can be a fear of damaging the device. A variety of hands-on hearing aid orientation activities are introduced during their first six weeks in the program to increase the students’ overall confidence physically handling hearing aid parts as well as take a more active role in direct patient care. An audiology clinic Hearing Aid Orientation I scavenger hunt allows the students to become familiar with workroom layout. Students search for various manufacturer-specific items including wax guards, domes, and basic tools used to clean hearing aids.
Audiologists use many hearing aid terms, which are unfamiliar to beginning graduate students. To create a shared language, a picture identification reference guide was created of 48 commonly used hearing aid tools and parts. The AuD students are provided a fill-in-the blank document to complete during the clinical class lecture creating a vocabulary answer key for this hands-on lab experience.
After the AuD students successfully complete the scavenger hunt and tool identification task, Hearing Aid Orientation Activity II includes a hands-on lab demonstrating how to clean a hearing aid and perform a basic listening check using a variety of hearing aid styles. The students are provided a hearing aid repair quick guide resource in addition to the Ling sounds.
YEAR 1 SPRING
At Purdue University, the AuD students take two 3-credit hearing aid courses early in their graduate education program. To help bridge their knowledge between class and clinic, we introduce a series of guided hearing aid troubleshooting activities. This allows students to begin directly applying what they learn in the hearing aid courses to their clinic experiences.
Over the years, many hearing aids have been generously donated to the clinic for AuD student education. A total of 24 hearing aids were initially collected as part of the hands-on troubleshooting lab. Only 15 of the 24 hearing aids used were defective. Properly functioning hearing aids were intentionally included to allow students to make direct comparisons between functional and non-functional device during a routine listening check. Each hearing aid is identified by manufacturer, model, and numbering system. A troubleshooting worksheet is provided for students as they rotate through six to eight learning stations with listening stethosets to record their findings. The most common hearing aid problems identified include no amplification, weak amplification, internal feedback, white noise, and dead batteries. At the end of class, the identified problem for each device is revealed for students to self-check their answers. As hearing aid technology rapidly evolves, manufacturers update acoustic coupling options, wax protection systems, and receiver styles frequently, which creates challenges for AuD students to select the proper replacement parts.
YEAR 2 FALL
In Year II, clinical teaching focuses on hearing aid verification, in-office repairs and earmold modifications. A variety of functional and non-functional hearing aids are selected for the students to practice performing an electroacoustic check (EAC) analysis in one of 3 hearing aid verification systems used in the Audiology Clinic. This allows students to increase their confidence working with different equipment as well as strengthens clinical decision making and recommendations based on EAC results. Concepts reviewed include proper 2-cc coupler selection for ITE, BTE, and open-fit hearing aids. Electroacoustic acceptable tolerances are reviewed for maximum SPL 90, gain curve, and harmonic distortion. Students review earmold acoustics presented in Hearing Aids II and are provided a supervised hands-on earmold modification lab. Various earmold styles and materials were collected by contacting multiple earmold manufactures requesting any remake or rejected earmolds for AuD clinical education. Earmold modification skills are reviewed and practiced.
YEAR 2 SPRING
The final module develops critical listening and clinical reasoning skills to best resolve hearing aid complaints. A total of six case-based learning activities were created in the audiology clinic NOAH database with various audiogram configurations ranging from a mild hearing loss, sloping high frequency hearing loss, a flat hearing loss, a mid-frequency “cookie bite” hearing loss, and a reverse slope low frequency hearing loss. For each case study, students are provided case history information including demographics, communication difficulties, and any previous experience with amplification. Students select two to three common hearing aid complaints shared by patients which may include excessive feedback, poor audibility in noise, occlusion effect of their own voice, uncomfortably loud sounds, and trouble hearing television or in a car. Following evidence-based practice, students first conduct speech mapping test box measures to verify the demonstration BTE or RIC hearing aid is meeting the prescribed targets for the selected case study. Possible troubleshooting solutions include additional patient counseling, software programming adjustments, acoustic coupling considerations and assistive listening device (ALD) recommendations. Working together, students make real-world clinical decisions applied to the demonstration hearing aid. Synthesizing classroom knowledge, students explore multiple possible solutions to a specific hearing aid complaint. Repeat test box measures allow students to visualize and better understand the impact of their hearing aid programming decisions. Students also compare their proposed hearing aid modifications to the suggested solutions in the manufacturer software fitting assistant tool. This low stakes, practical hands-on hearing aid software experience coupled with test box measures increased the students’ knowledge, clinical decision-making, and confidence providing direct patient care.