MANAGEMENT OF CLINICAL CASES

APPENDIX 1
Valeria Serra
 Management of Clinical Cases

APPENDIX 1

As we studied in the main notes of this unit, in relation to the PLANNING OF THE
AUDIOLOGICAL ASSESSMENT, we highlight the importance of investigating the patient (or
the parents) during the whole diagnostic procedure, with a wide view and/or if ever doubts
would arise us. Likewise, we should previously highlight the importance of data dumped at
the time of the Anamnesis throughout the whole procedure.

We present in the appendixes 2 and 3 some points that guide us in the data collection of the
patient, but they should only be a guide that we direct but not a rigid and uncompromising
scheme.

Anamnesis can be defined as the questioning to the patient prior to their audiological study
and through which we get information on the following topics:

• Personal data.

• Medical history related to hearing.

• Needs or desires on rehabilitation.

• Other information of interest for the prosthetic adaptation.

Anamnesis should always constitute the first step in the audiological study and the prosthetic
adaptation. It can be done in the consultation, talking in front of the patient and with clear
voice. If the person to be studied has an important hearing loss that makes it difficult to
understand our questions, it can be done with the patient in the cabin and wearing
headphones, this way we amplify our voice through the audiometer and we are able to know
the approximate threshold that we have to start our tests with. In cases of children or people

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 Management of Clinical Cases

with a poor level of communication, it will be the family which will provide us the information
that we need.

Performing well an Anamnesis is simple but it requires some training, there are people that
before they are asked: “what is your name?" they are already giving all the information you
need or probably more; in such cases it would be necessary to ask them specific questions,
do the following when we have received the expected answer and take notes; from the
surely wordy descriptions, we will obtain the information that we are interested in. Others, on
the contrary, are expressed monosyllabically, a “yes” or a “no", and sometimes an “I don’t
know” are the most frequent answers, in those cases it would be necessary to extract more
information with short and very specific questions.

A very common example of the first case is when you ask them if they have any other
disease or intake of medication on a regular basis, the first ones even feature details of their
stomach ulcer, including comments because they don't like to go to Dr. “A" or they like a lot
how Dr. “B” attends them. The second ones, it should be necessary to ask them if they take
any medication they say “yes”, we should ask them: “What for?” “Since when?” If he or she
is under medical check-ups, etc. When they don't know it very well because it was
prescribed to them or we do not know the indications, it is useful to write down the name of
the drug and then consult it in a vade-mecum. What is important is that, in all cases we know
about the circumstances of the patient, if there is any condition that might adversely affect
the evolution of the hearing loss or if he or she has been surgically intervened in the ear or
nearby areas that may influence on the decision of the type of rehabilitation to make.

In relation to personal data: Surname, name, address and telephone number. It is important
that we also know the date of birth.

Medical history: First, we will ask about the reason for the consultation, although it seems
obvious, "I don't hear well" or "I don't understand what people say to me" are not the only
responses and we obtain the first information about the wishes or expectations of the hard
hearing user about the rehabilitation. There are people that, the first information that they
provide is "what I want is that it can’t be seen”. Well, it's a great way to start, we do not know
if the patient hears much or little, if the problem is in one or the two ears, etc., but we know
that the patient is prepared to use a hearing aid, that he or she accepts the problem and that
the patient wants a CIC hearing aid or a discreet RITE.

We must also know the time of occurrence of the hearing loss and how it took place, if it was
sudden or progressive, as well as the triggering circumstance if known. We will also ask if it
is progressive and constant and if they suffer or have suffered from earache, otorrhoeas and
tinnitus in one or the two ears.

As we have already indicated, it is important to know if they have been subjected to surgical
operations that can affect the ears or hearing, if they suffer or have suffered from diseases
such as diabetes, dizziness, brain injuries, etc., that affect or may affect the evolution of the
hearing loss, if they take medication on a regular basis, with special attention to ototoxic

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 Management of Clinical Cases

medications, etc. Rhynopharingeal conditions also affect the evolution of the hearing and
may make it fluctuating.

Finally, we will know if the patient uses or not lip-reading and what is the better ear from the
point of view of the patient. Then, we will have a rough idea of the degree of hearing loss
that the patient may have and it will be used, eventually, to mark the level at which the
audiological tests must start.

Needs or desires on rehabilitation: If you are using hearing aids we must know how they are
used, the type of hearing aid, the result that is being obtained with them and even their
characteristics of output volume or with the programming that uses, and which of them can
be accessed through the scanner.

It is also important to meet their expectations; they have already informed us of the
communication problems now we need to know their wishes or expectations from the point
of view of communication and also of the aesthetics, desires or reluctance to use hearing
aids. It is relatively common to have received negative information about hearing aids from
badly adapted people, we need to change that initial negative feeling, sometimes, on the
other hand, we are asked a hearing aid such as the one that a friend of theirs has, which
works very well and it can be barely seen, not realising that his or her friend has 45 dB of
hearing loss and in his or her case there is severe deafness, for example.

In anamnesis, we need to know the patient as a person, in order to carry out properly the
selection and the later advice. We currently have many possibilities of hearing aid choice
and they are going to be expanded in the future; besides, hearing aids programming will also
take into account not only the hearing loss, but also the lifestyle of the user and that
information can be obtained from the anamnesis.

Other issues of interest: There will always be space in the anamnesis sheet to take note of
other information for which there is no specific question that may be of interest as, for
example, if you live or work in a noisy environment or if you have an activity that develops
abnormal noise conditions, etc., as well as notes about the personality of the patient.