TJ Audiology Training

Tracy James visits Estonia

Tracy James of TJ Audiology delivered a 3 day BSA certificate training course in Audiometry and Tympanometry at Medivar in Tallin, Estonia. Tallinn was fantastic, with a beautiful old town; cobbled streets, 14th Century buildings and lots of history. Estonians are also very exotic with only 1 million inhabitants. For those of you that don’t know – Estonians speak Estonian which has a lovely sing song lilt to it.

The training course was delivered to 5 employees in English and I was amazed at how those on the course (and Europeans in general) were able to use English in their day to day lives. Everyone took great assurance in having lots of practice time and as the group was small, there was lots of time to make sure that questions could be answered. Some of what we covered included anatomy and physiology, otoscopy images (possible abnormalities we may come across), contraindications, physics of sound as well as the practical procedure.

Feedback included: “Very thorough and in-depth. Informative, professional and gave consistent support and feedback to the practical assessments as well as to how we were progressing in general. Pace was perfect.”

I was pleased to have visited both Estonia and Medivar and to learn more about Estonian culture as well as Audiology Services. Medivar is a European distributor of health equipment, including Audiology equipment and supplies. I found the people I worked with there very professional and I was very well looked after. Thank you very much!

HSE and Hearing Surveillance – Industrial Audiometry UK

The HSE indicates there is variation in practice and standard across practitioners in Hearing Surveillance Programmes. Does your occupational health worker attend a British Society of Audiology accredited course?

Tracy James MSc

The Health and Safety Executive (2013) carried out visits and questionnaires across a range of health surveillance programmes across the UK so that current practices across teams and individuals could be evaluated. Their key findings included that there was variation in practice across practitioners and health surveillance programmes. In particular, they noted that:

‘….some practitioners probably did not adopt sufficient measures to exclude the effects of prior exposure to noise and background noise when the test was being conducted’

…and with regards to training competency they noted:

‘If practitioners had undergone appropriate training there is an assumption that they would be competent to undertake otoscopy, but it was found that otoscopy was not always carried out before testing’

HSE (2013). Current Practice in Health Surveillance for Noise, pp iii

The Health and Safety Executive (HSE) outlines clearly what is required with regards to a health and surveillance programme under the Guidance on Regulations ‘Controlling Noise at Work’ 2005. In Appendix 5 it reports that a training syllabus for industrial audiometricians has been prepared by the British Society of Audiology (BSA) which has accredited a number of courses. The document is available at http://www.thebsa.org.uk/wp-content/uploads/2014/04/industrialaudiometricianstrainingguidelines2008.pdf

Why choose a BSA accredited course? In order to be accredited, the provider has submitted the course content and assessment material to experts in the field to ensure that the training is accurate and according the recommended procedures published by the BSA. It also ensures that the minimum training guidelines are fulfilled and that the trainer has a suitable background knowledge/qualifications for providing the training. A representative of the BSA will also visit the course provider during their training programme. In order to remain accredited, course providers are required to resubmit their training material every 3 years to ensure the course is up to date.

BSA industrial audiometry courses are designed to enable occupational health workers to:

Undertake a brief subject interview and/or administer a questionnaire regarding otological and noise history
Perform otoscopy and pure-tone a-c threshold audiometry without masking, both in accordance with BSA recommended procedures. Audiometry may be manual or automated
Interpret results and classify them in accordance with HSE guidelines
Relay information to subjects and, with consent, to the employer or other person with overall responsibility for that particular hearing test program.
Make appropriate 3^rd party referrals

BSA (2008)

Has your occupational health worker completed a BSA accredited course in industrial audiometry? When you scroll online you can see many courses that quote their course is ‘BSA approved’ or ‘based on’ BSA guidelines or ‘follows’ BSA recommended procedures – but they’re not actually accredited! The BSA lists the accredited courses available nationally on http://www.thebsa.org.uk/wp-content/uploads/2015/03/2015.04.01-Accredited-Course-Providers-List.pdf or you can check your course is accredited by contacting bsa@thebsa.org.uk.

A BSA accredited course may the key to enable consistency in training and competency levels across practitioners within a hearing surveillance programme. Choose your course and make sure it is accredited. The BSA (2008) recommends that the occupational health worker attends a refresher course in industrial audiometry every 3 years.

References

HSE (2013). Current Practice in Health Surveillance in Noise.

HSE (2005). Controlling Noise at Work. Guidance on Regulations

BSA 2008. Guidelines on the Training of Industrial Audiometricians.

Tracy James MSc is a Clinical Scientist and director of TJ Audiology Services, an Audiology Training Service. The next BSA accredited course in Industrial Audiometry is at PC Werth Headquarters, London on 18^TH April 2016 and in-house or tailor-made course are available. See www.tjaudiology.com or email tjaudiology@outlook.com for details and booking.

Are you going around the 2nd bend? How to make a good impression.

The key to good fitting custom earmoulds and hearing protection, ITE and CIC hearing aids are accurate ear impressions. Its important to know when you’ve inserted your otostop deep enough down the canal, and that the otostop is pointed in the direction of the eardrum. A good, deep impression means getting to the 2^nd bend of the ear canal. Some tell-tale signs that you’ve reached the 2^nd bend include a characteristic slip of the otostop into position which often coincides with slight resistance as it enters the bony portion of the canal. When you look on otoscopy, you will see that the otostop is framed by the cartilaginous portion of the canal.

All ear canals are very different from one another and taking good impressions takes practice. Patient/client safety is paramount and the British Society of Audiology has a recommended procedure for impression-taking in adults/children over 5 years of age and for children under 5 years of age.

Tracy James is holding 1-day BSA accredited impression-taking courses at PC Werth on the 8^th of March (Audiology House) and 8^th of May (Venue TBC) 2016 for adults/over 5 years and 9^th March for children/under 5 years. Learn how to take impressions safety and accurately according to the recommended procedure, using the correct brace positions during the procedure. Learn about what to look for on otoscopy and experience how to know when you’ve reached the 2^nd bend.

Find out about Tracy James and take a look at her website: www.tjaudiology.com for more details regarding her courses, or email tjaudiology@outlook.com.

Taking Ear Impressions of babies and children? What’s different?

There are many anatomical differences between the ears of adults and children. For example, children’s ear canals tend to be narrower and straighter. This means you need to consider the equipment you use, for example the size and width of your syringe and the size of your otostop. As babies’ ear canals grow rapidly in the first year of life, you may need to change your equipment as the baby gets older, so you will need to use your judgement on otoscopy. The best view on otoscopy can be obtained by pulling the ear back only in children, since their ear contains more cartilage than adults. You may not recognise a second bend in a child’s ear so you have to learn to ‘feel’ when you have entered the bony portion of the canal.

A neonate ear canal is much shorter than an adult’s therefore the BSA recommended procedure (2013) recommends you use a 10mm marker as a guide on the otolight for babies under the age of 6 months. A cotton otostop is also recommended since sponge may be more abrasive at this age (BSA 2013).

Perhaps the biggest difference in taking impressions in children is the interaction you need with the caregiver as well as the child. There are a range of brace positions that you can try and are documented in the BSA recommended procedure (2013) to ensure that children of different age groups are safe when carrying out the procedure. You also need to make it fun – lots of toys and distractions to keep those little hands busy while the impression material is setting.

So in summary – a range of different sizes of equipment is needed, a good eye on otoscopy to judge the position of the otostop, consider the right brace position, have lots of toys, fun and patience while remaining calm and informing both parent and child as you go along.

It is recommended that anyone carrying out impressions on children under 5 years are competent, and have sufficient training and experience (BSA 2013). Tracy James is holding a 1-day BSA accredited impression-taking course for children under 5 years in Newbury on the 24th of May (Newbury College). Learn how to take impressions in children safely, for different age groups and experience a range of different types of equipment you can use, and learn more about children’s ear moulds.

Find out about Tracy James and take a look at her website: www.tjaudiology.com for more details regarding her courses, or email tjaudiology@outlook.com.

References: British Society of Audiology (2013). Recommended Procedure (Supplement). Taking an impression: children under 5 years of age.

Masking is an ongoing lesson in Audiology.

As audiologists we all learn masking as part of our training. But the truth is, the real learning is in the experience of the various hearing losses we come across. Unfortunately for some, we’re not always in the position to reflect with another practitioner about some of the more complex hearing losses – so how can we really learn?

Masking is carried out as a result of the minimal interaural attenuation of 40dB when using headphones, 55dB when using inserts and 0dB when using a bone conductor. As a result, we follow certain rules to decide when masking should be carried out (BSA recommended procedure 2011) to ensure an accurate hearing test is obtained.

We probably know the rules by heart. But…

Why do we need to do Rule 3 and what is it’s relationship to Rule 1? What about central masking and the effect of conductive losses on masking? When are inserts more appropriate than headphones? When do we choose to mask bone conduction on both ears? What is effective masking? Even the most experienced of audiologists have to reflect on such questions when considering best practice.

A training course in masking in audiometry will enable audiologists to consider and understand why we need to mask, rather than just learning the rules. TJ Audiology Services uses audiometry simulation software to practice different scenarios, alongside interpretation of working audiograms. Audiology Courses are available in 2016 at Audiology House, London. Bring yourself up to speed, or start from scratch and benefit from having the time to ask all those questions and more in a safe learning environment and discussion with other colleagues.

BSA Recommended Procedure (2011): Pure-tone air-conduction and bone-conduction threshold audiometry with and without masking.

Audiometry and tympanometry for professionals who are not qualified audiologists

A hearing test (audiometry) measures the quietest sound and individual can hear, at least 50% of the time – known as hearing threshold level (HTL). An individual’s HTL at different frequencies is recorded in an audiogram for each ear, and this information can be used to categorise hearing as within normal range, or a hearing loss that can range from mild to profound. Otoscopy and tympanometry is used alongside audiometry to identify any abnormalities of the middle ear that may be affecting the hearing, e.g. perforation or glue ear.

In hospitals and hearing aid dispensing practices, audiometry and tympanometry is typically carried out by audiologists who are trained to undertake these procedures during their university course. In the UK, audiometry is carried out according the British Society of Audiology Recommended Procedure.

However, basic hearing tests and tympanometry can also be performed by GPs, occupational health nurses, audiometricians, assistant technical officers, teachers of the deaf and hearing aid assistants. The British Society of Audiology has a Practice Guidance Document for “Hearing assessment in general practice, schools and health clinics: guidelines for professionals who are not qualified audiologists”.

A British Society of Audiology accredited course in basic audiometry and tympanometry trains non-audiologists to undertake hearing tests in the field and interpret the results, according to minimum training criteria.

Are you going around the 2nd bend? How to make a good impression.

Good fitting custom earmoulds and hearing protection, ITE and CIC hearing aids can only be created from accurate impressions. The key is having the confidence to know when you’ve inserted your otostop deep enough down the canal, and to point the otostop in the direction of the eardrum. A good, deep impression means getting to the 2^nd bend of the ear canal. Some tell-tale signs that you’ve reached the 2^nd bend include a characteristic slip of the otostop into position which often coincides with slight resistance as it enters the bony portion of the canal. When you look on otoscopy, you will see that the otostop is framed by the cartilaginous portion of the canal.

Discounts available for booking 2 or more courses

*Courses will be offered with a 10% discount when booking 2 courses, and 15% discount when reserving 3 or more courses. Offer ends August 31st 2015*

New Course Dates for 2015!

TJAudioTraining

Training for Assistant and Associate Audiologists, ATOs, TODs

BSA Accredited Courses Available 2015

Location: London, Berkshire or in-house

22nd – 24th of September:

BSA Certificate Audiometry and Tympanometry

13th of August and 15th October:

BSA Certificate Impression-taking (adults/over 5s)

16th of October:

BSA Certificate Impression-taking (under 5s)

*Discounts available for booking 2 or more courses*

“A well organised and presented day with ample practical training resources. The strengths of the training were level of trainer’s knowledge, opportunities for practical sessions, small group and excellent venue”

BSA Audiometry and Tympanometry Course – June 2015

A new course date is available for the BSA certificate Audiometry and Tympanometry in June 2015. It is a 3-day course at Audiology House in London. Places are limited, so please book now to avoid disappointment.

Delegates include health care professionals, assistant audiologists, nurse practitioners, occupational health workers, nurses, GPs, ENT consultants, hearing aid dispensers, trainee and qualified audiologists.

The courses are mainly practical and focus on being able to carry out the technique according to BSA procedures, thereby maintaining safety at all times.
See the events calendar and training courses for more details or book now.