The Clinic information below describes in detail the procedures required for completing each clinical task.  Tasks are numbered according to the anticipated sequence which patients will receive them.  Reviewing the protocol will also help you anticipate how a patient is directed through clinic and will detail the steps required.  Before our first patient is seen, we will spend a half-day setting up the clinic, reviewing the protocol, practicing with the equipment, and answering your questions.

Each patient will begin at Registration, where a Patient Management Form (PMF) is created.  The PMF will document the patient’s name, DOB, prior hearing aid use, and pertinent hearing history.  Patients are instructed to take this form with them to each clinic station.

It is imperative that you initial after completing a procedure. These forms MUST be returned to Registration after the patient complete their last procedure.

If the patient’s TM is 50% or more visible, direct them to Screening.  If not, direct the patient to Wax Removal.

Equipment:  Suction, irrigation, loupes, otoscope, cleaning equipment, curette-soaked swaps, forceps, Lucae hook, specula, Debrox, stool softener, hydrogen peroxide, alcohol.

Upon Completion: Perform otoscopic inspection

Analyze the test environment:  Select the quietest environment possible and perform a self-test to confirm that ambient noise levels are not producing false results. Repeat self-test when noise levels change.

Perform OAE test:

• If Pass: Initial the patient’s PMF and return PMF to Registration, thank them for their participation, and inform them that they are free to leave.

• If Fail: Perform tympanometry, record results, initial PMF, and direct the patient to Diagnostic Testing.

If tymps are abnormal consider medical referral.

If using standard audiometer,

Analyze the Test Environment

Select the quietest environment possible and perform a self-test to confirm that ambient noise levels are not producing false results

Repeat self-test when noise levels change.

Devise correction factors if needed, and advise the next clinician, if moving to another task

Note the correction on the patient’s PMF.

If using KuduWave,

Review KuduWave Audiometer Instructional Video

Note: with Kuduwave steps above are not required It is validated for booth-free testing and offers a real solution to mobile audiology services with high-quality testing in almost any environment.

Air and Bone Threshold Testing

• Test frequencies 500-8k Hz

• Test inter-octave if > 20 dB difference between octaves

• Audiologist’s discretion regarding additional test frequencies

Ear impressions become the patient’s earmold after the impression is smoothed, modified, and tubed.

1. Earmolds typically require 45 minutes to complete.

2. RITEs are rarely fit because of receiver failure issues.

NOTE – Patients who will be fit with an open tube should skip Earmolds and proceed directly to Hearing Aid Fitting.

Please limit traffic in the Hearing Aid Fitting area to

• two audiologists (2 working with each patient)
• a translator
• family member

Before directing a patient to Care and Use, ensure that a translator and a family member are available to attend. Consider reviewing the following topics:

• Insertion/Removal: Practice inserting/removing the mold and situating the device behind the ear. This procedure may consume a large percentage of the entire available time.

• Changing Battery: Demonstrate and practice battery insertion and removal. Counsel patient about expected battery life urge then to turn the device off when not using. Inform the patient where they can obtain more batteries, when needed.

• Right Versus Left Hearing Aid: Use red fingernail polish to mark the right battery drawer and review this with the patient.

• Removing Earwax from the Earmold: Demonstrate how to use a wax loop to remove earwax from the earmold. Inform the patient about local resources available if repairs are necessary.

• Volume Adjustment: Demonstrate and practice volume adjustment and discuss how the volume control may help the patient adapt to amplified sound.

• Other Considerations: Discuss avoiding moisture, heat, dust, potential damage from pets or small children, and wear aid all day except during water activities and sleeping.

Hear Aid Follow-Up

Many patients return to our clinic months after initial fitting for follow-up.

1. Listen, clean and check hearing aids. Replace earmolds, tubing, and hooks. Swap hearing device for a new one if the original device is not functioning.

2. If a patient has lost their hearing aid, it is the audiologist’s discretion whether to fit them with a monaural replacement aid.