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Last Updated: Thursday, 14 February 2008, 06:48 GMT
Inside Medicine: The audiologist
Lucy Tinker
Some hearing damage is permanent
In a series focusing on medical specialties, the BBC News website meets audiologist Lucy Tinker.

Audiology is the branch of science that studies hearing, balance and related disorders.

Audiologists treat patients with hearing loss and try to prevent further damage.

WHAT IS YOUR JOB?

I am an audiological scientist working within the audiology department at Cambridge University Hospital NHS Foundation Trust.

My job involves diagnosing and rehabilitating children and adults with hearing impairment and associated symptoms like tinnitus and balance problems.

Tinnitus, which affects 4.7 million in the UK, is the medical term for any noise heard in the ears or in the head.

I work with a team of professionals within the medical, educational, social and volunteer services, working alongside ear, nose and throat specialists (ENT), teachers of the deaf, community paediatricians and the sensory service team.

WHAT IS THE MOST COMMON CONDITION?

Age-related hearing loss (presbyacusis) is the most common hearing complaint affecting the elderly population in the UK.

Presbyascusis is related to sensory damage to the hearing organ, the cochlea, and is usually greater for high pitched sounds. So, it may be more difficult to hear the chirping of bird song which is higher in frequency than a fan whirring, being lower in pitch.

It is often most satisfying to see children who are fitted in their early years after diagnosis who start to give little indications about how they are hearing, like starting to produce single words then link them together
Lucy Tinker

This type of hearing loss is permanent and can range in severity from mild to profound.

In the paediatric population, the most prevalent cause of hearing impairment is middle ear fluid, often referred to as 'glue ear' or 'otitis media with effusion'.

Glue ear tends to affect children more often than adults because within the middle ear, the area behind the eardrum, there is a narrow channel called the Eustachian tube which is smaller and more horizontal, making it easier for the tube to become blocked.

Most often, the result is temporary hearing impairment, referred to as a conductive hearing loss, but some cases can be more longstanding and permanent.

WHAT IS THE MOST COMMON PROCEDURE?

To address the problems relating to glue ear, a small ventilation tube is often inserted into a patient's eardrum, under general anaesthetic, to help drain away the fluid in the middle ear space and to help maintain the air pressure in the middle ear cavity. This procedure often results in an improvement of hearing in the operated ear.

When a patient presents with sensory hearing impairment, where suitable, they are offered a digital hearing aid aimed to amplify the frequencies of sound that they cannot hear.

Digital hearing aid
Hearing aids amplify sounds

The level of hearing can be decided by performing an audiogram - a hearing test performed in a sound proofed room.

This is aimed to record up to the softest sounds they can hear over a range of frequencies.

The extent of benefit from a hearing aid varies according to the cause and degree of hearing loss.

For certain people with moderate to profound hearing impairment, they get associated symptoms of distortion or confusion of sound, therefore a hearing aid is not beneficial.

As a result, they might be referred for a cochlear implant device - surgically implanting a device to directly stimulate the inner ear - and aimed to improve sound generation to the brain via the acoustic nerve.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

The hardest part of my job is breaking bad news, whether it to a parent of a child who has been born with a congenital hearing loss or an adult whose hearing has progressively deteriorated over time to the extent that hearing aids will not restore the reduction in speech discrimination.

It is often more difficult to explain why they are experiencing a confusion of sound in a way that is it easily interpreted and represents the reality of their situation, so you don't raise their expectations about a recovery of hearing, but by highlighting the future management options available to them in a structured and well contained manner.

WHAT IS YOUR MOST SATISFYING CASE?

It is often most satisfying to see children who are fitted in their early years after diagnosis who start to give little indications about how they are hearing, like starting to produce single words then link them together, especially when they meet their communication milestones at a similar stage to youngsters with normal hearing.

Every case is different, and adults are often the most challenging as they will tell you exactly what they want and how they are getting on, so is often very rewarding when they report back that your advice or intervention is helping them function more normally in everyday listening situations.

WHY DID YOU CHOOSE THIS SPECIALITY?

I always wanted to work within a team with the universal aim of helping people to overcome their problems.

I was very interested in music as a youngster and the thought of being able to help people hearing all types of sounds, whether speech or music was very attractive, and the combination of a scientific and musical background meant audiology was a perfect career choice for me.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

No. My career within the field of audiology has continued to be both challenging and full of variety which has kept it enjoyable through the years, and I feel that I have been and continue to be well suited to meeting the needs of hearing impaired individuals.

WHICH SPECIALTY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?

As I like working within a hospital environment, I have often thought that a career in orthotics and prosthetics (both fields to create devices to improve function) would be a similar but equally rewarding profession, as I also had a keen interest in sport, and I would see this type of job as a way of helping get people back "up and running", so to speak!

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

I see the role of the audiologist perhaps being more community based, where an adult or a child may be seen more locally, outside the hospital setting, with close contact with GPs and community paediatricians who will be better equipped to screen and refer patients on in a more 'one stop' clinic

In terms of aiding and rehabilitating hearing loss, digital hearing aid technology has advanced significantly in the 21st century and continues to make great advances, and if this continues, it will allow audiologists give their patients greater clarity and reception of sound, but within the constraints of their hearing loss.

CV - Lucy Tinker
1997: BA (Hons) Human Communication and Communication Disorders, Manchester University
1999: MSc Audiological Science, Southampton University
2001 : Appointed, Audiological Scientist, Addenbrooke's Hospital, Cambridge
2007: Completed Educational Audiology Diploma, Oxford Brookes University




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