ETSU Adult Clinic
Students provide basic audiologic services in a setting that prioritizes clinical instruction. Assessment of hearing including pure-tone, speech, and tests of middle ear function, as well as hearing aid evaluations, are provided for a variety of adult patients from a large regional area. Students are responsible for testing patients, consulting with patients and families, conferring with supervisors regarding recommendations, writing and editing patient reports, and contributing to follow-up testing and treatment plans when appropriate.
Pediatric Diagnostic Audiology Clinic
This clinic provides diagnostic audiologic assessments for the birth to three year age range, for school-age children and adolescents. Referrals for this clinic are from local school systems, parents, early interventionists, family practice physicians, and pediatricians.
Pediatric Audiologic Habilitation Clinic
Children with severe/profound bilateral hearing loss are treated in this clinic. Focus is on the development of spoken language through listening using cochlear implants and/or hearing aids. Emphasis is on an auditory/oral approach using auditory-verbal strategies.
Neonatal Intensive Care Follow-up Clinic
This interdisciplinary clinic is located in the Quillen ETSU Pediatric Clinic. Infants are referred to this clinic from neonatal intensive care nurseries across the East Tennessee region. The interdisciplinary team includes audiology, speech language pathology, nursing, nutrition, child development and neonatology/pediatrician. Families travel to this clinic from southeast Kentucky, southwest Virginia, northwest North Carolina and northeast Tennessee.
Under supervision, AuD students will be involved in performing otoscopy and OAE screenings on infants in the clinic. Students will also be counseling and providing educational information with caregivers on need and nature of the tests performed. Infant’s being seen in the ETSU High Risk Clinic have previously stayed in the NICU greater than 5 days and often present with birth history factors that enhances risk of hearing loss. Infants seen in the clinic will be continued to be monitored till age two years.
Preschool Hearing Screening/Limited Diagnostic Clinics
These clinics in rural and migrant Head Start Centers are conducted to provide hearing detection and intervention services for preschool children. They are part of an interdisciplinary team Child Find initiative.
Central Auditory Processing Evaluation for school-aged children
Listening is a very complex process. The actions of the outer ear, middle ear, and inner ear send sounds via the auditory nerve to the brain. The brain then interprets the auditory information; for example it tells us that a particular sound is a dog barking or a bird singing. Auditory Processing is a medical term for Listening. A child who can hear well, but cannot understand the sounds may have Auditory Processing Disorder (APD).
Some Symptoms of APD
- Difficulty understanding when listening
- Difficulty following auditory directions
- Difficulty remembering multi-step instructions
- Difficulty understanding in noisy situations
- Difficulty following conversations in a group
- Difficulty with note-taking in class
- Difficulty copying from the board
- Reading and spelling difficulties
- Short attention span and fatigues easily
- Verbal IQ lower than performance IQ
Audiology testing may include:
- A complete hearing evaluation
- Screening Questionnaire
- APD test battery evaluation including
- Speech in noise testing
- Speech discrimination testing
- Dichotic listening
- Temporal processing
Speech-Language Evaluation and services may include:
- Speech and Language evaluation
- Speech and Language therapy
- Fast ForWord® and Earobics® computer-assisted treatments
After the evaluation one of the clinicians will discuss the test results with you and make appropriate recommendations. Recommendations may include:
- Speech and Language intervention
- A custom designed hearing training program with listening strategies
- Collaborative management with patients, parents, educators, and speech-language pathologist
- Usage of an assistive listening device to overcome background noise in the classroom
- Collaboration with educators to implement needed classroom modifications
To schedule an appointment, call the ETSU Speech-Language-Hearing Center, Lamb Hall, ETSU Main Campus, (423) 439-4355.
Other off-campus clinic
Audiology students have additional off-campus opportunities for experiences with children in community speech and hearing centers, private practices, schools and otolaryngology offices. Pediatric experiences in these clinics include cochlear implant mapping/troubleshooting, auditory electrophysiologic testing, educational management of children with hearing impairment, and medical management of ear disease and associated hearing loss.
These sites include
- Bristol Regional Speech and Hearing Center, Bristol, Virginia
- Greenville Ear, Nose, and Throat, Greeneville, Tennessee
- Hamblen County Schools, Morristown, Tennessee
- Lakeway Ear, Nose, and Throat, Morristown, Tennessee
- Mountain Region Speech and Hearing Center, Kingsport, Tennessee (cochlear implant mapping/troubleshooting),
- Watauga Hearing Conservation, Johnson City, Tennessee .
During the past two years, four Au.D. students have selected pediatric and educational audiology sites (Sparks Clinic at the University of Alabama-Birmingham, University of North Carolina Hospitals Audiology Clinic-Chapel Hill, and John E. Sexton and Associates in North Carolina) for their fourth year clinical externship.
Cochlear Implant Clinic
East Tennessee State University's cochlear implant clinical services is located at the ETSU Speech-Language-Hearing Center, Lamb Hall, ETSU Main Campus, (423) 439-4355.
Services offered include candidacy evaluation, follow-up implant mapping, aural rehabilitation and speech and language services for patients of all ages. More information about the Cochlear Implant Clinic
Audiology Clinical Rotations at the Mountain Home Veterans Medical Hospital
The Audiologic Rehabilitation (AR) clinic is dedicated to helping patients overcome the deleterious communication and psychosocial consequences of their hearing losses. Significant others are strongly encouraged to participate. Currently, the AR clinic is housed in a patient conference room equipped with a conference table, television, and audio-visual equipment. Three main AR programs are currently conducted, which include following programs: (1) Hearing Loss Patient Education Program, (2) Speechreading, and (3) AR for veterans with dual-sensory impairment (vision and hearing loss).The Hearing Loss Patient Education Program is a group support program that consists of four, one-and-a-half hour group sessions. Examples of some main topics covered over these four sessions include: hearing loss and its consequences, hearing aid use, realistic expectations and adjustment to hearing aid use, communication strategies, optimal communication environment, assertiveness, use of visual cues and gestures, and other assistive listening devices. A workbook was developed to accompany the program that consists of both in-class and homework exercises. Veterans with hearing loss and their significant others are strongly encouraged to attend.
The Speechreading (i.e., lipreading) program also consists of four, one-and-a-half hour group sessions. It was designed to give patients with hearing losses and introduction to speechreading and in-depth practice using speechreading skills. An accompanying workbook was developed for the speechreading program and consists of both in-class and homework exercises. Interested veterans with hearing losses and significant others are welcome to attend.
Audiologic rehabilitation for veterans with dual-sensory impairment is unique. Hearing aid orientation sessions and counseling are usually done on an individual basis. The use of sophisticated magnification systems and special techniques are used in AR for patients with dual-sensory impairment. Significant others are encouraged to attend these special sessions.
The AR program offers an additional service to patients with hearing losses and their families. The goal of the AR clinic is to assist the patient with hearing loss and their loved ones overcome the problems resulting from hearing loss. Dr. Sherri L. Smith is the director of the audiologic rehabilitation program.
The majority of patients in this clinic are referred for otoneurologic auditory brainstem response (ABR) evaluations. Other procedures include extratympanic or tympanic electrocochleography for patients suspicious of endolymphatic hydrops as well as ABR threshold evaluations for patients suspected of pseudohypacusis. An average of thirty patients per month are evaluated and the instrumentation utilized in this clinic includes a Nicolet Spirit 2000. If indicated, then evoked otoacoustic emissions (both TEOAEs and DPOAEs) can be obtained from these patients using the Bio-Logic Scout. Evoked otoacoustic emissions are routinely obtained from patients being seen for compensation and pension examinations. Owen Murnane, Ph.D., is director of the Electrophysiology Clinic.
Compensation and Pension
Veterans are seen for Compensation and Pension evaluations to determine whether their hearing loss and/or tinnitus are related to military service. Veterans who believe their hearing loss and/or tinnitus are related to military service should file a claim for a service-connected disability through their local veteran service officer located in an outside veteran organization (i.e., Veterans of Foreign Wars – VFW, American Legion, etc.). Veteran service officers are also available at the James H. Quillen VA Medical Center.
Hearing Aid Evaluations
The Hearing Aid Evaluation (HAE) Clinic is dedicated to hearing aid fittings, verification, and orientation. Currently the clinic includes four rooms to conduct hearing aid evaluations, each housing probe microphone instruments. Three sound rooms are also equipped for sound-field testing. An hour is allotted for each HAE appointment, thus providing time for verification of the hearing aid and rehabilitation. Hearing aid fittings are verified through either insertion gain or functional gain measures. The patients are counseled on the use and care of the hearing aid(s) in individual sessions; spouses and significant others are involved in the fitting process whenever possible to better facilitate hearing aid use. The veteran is given a copy of a hearing aid manual entitled “ Your VA Hearing Aid” that was developed by VA audiologists. The hearing aid manual provides a written resource reviewing the orientation material. Also included in the manual are communication strategies, troubleshooting guides, and procedures for repairing your hearing aids and reordering hearing aid batteries. New hearing aid users are scheduled for a follow-up appointment to monitor how they are doing with their new hearing aids. This appointment allows the staff to make changes to the hearing aid settings and to verify hearing aid benefit. If veterans are having problems with their new hearing aids, then they should contact the Audiology clinic right away to request an appointment.
Hearing Aid Follow-up
Most veterans who are receiving new hearing aids are scheduled for a hearing aid follow-up (HAF) appointment. The HAF clinic allows for half-hour appointments to monitor the progress the veteran is making adjusting to the new hearing aids. During these appointments, adjustments are made to the hearing aid settings as needed and the veteran is reinstructed on using and caring for their VA hearing aids. Hearing aid benefit specific to the veteran’s listening needs is also assessed in the HAF clinic. If veterans are having trouble with their new hearing aids, then they should call the Audiology clinic right away to make an appointment to be seen at the next available.
Hearing Aid Problem
The Hearing Aid Problem (HAP) clinic allows for half-hour appointments when a veteran is having problems with a hearing aid or needs to pick-up a repaired hearing aid. When veterans are issued hearing aids, they are given a copy of the hearing aid manual Your VA Hearing Aid that includes troubleshooting guides for hearing aids. If the guide does not solve the problem, then the veteran will be scheduled into the HAP clinic. The clinic includes one dedicated repair room equipped with drills, ultra violet lights, shell materials, and a suctioning/vacuum unit that allow for repairs to be completed in-house whenever possible. Currently five half-days are scheduled for HAP appointments, thus allowing for 30-35 appointments weekly. Veterans are also welcome to walk-in to the clinic if they are having problems. In-warranty repairs can typically be returned to the patient within 2-3 weeks if sent to a manufacturer for repair.
Veterans are typically introduced to the Audiology clinic through one of the auditory diagnostic clinics. Consultations for hearing evaluations are primarily received from primary care providers in the Primary Care clinics. Requests for evaluation are also received from ENT, Psychology, Post Traumatic Stress Program (PTSP), Neurology, etc. Once a request has been received, the veteran is scheduled for a Hearing Evaluation (HE).HE evaluations are scheduled for one-hour time slots. There are 5 test booths for evaluations, each equipped with state of the art equipment. During this evaluation otoscopy, case history, pure-tone air- and bone-conduction thresholds, speech recognition ability, and middle ear function (tympanometry and acoustic reflexes) are evaluated. Other tests, such as Otoacoustic Emissions, Stengers, and the audiometric Weber are completed when necessary. The results from this battery of tests allow the clinician to recommend the appropriate course of treatment for the veteran. Follow-up testing may be recommended from the Electrophysiology Clinic, Vestibular and Balance Clinic, Hearing Aid Evaluation Clinic and/or Audiologic Rehabilitation. If the veteran has a mixed or conductive loss, then a consult will be sent to the ENT clinic for medical evaluation. For veterans who are not eligible for further services through the VA Medical Center, referrals are made to professionals in the community.
Nursing Home Care Unit
The Audiology program in the Nursing Home Care Unit (NHCU) is directed by Diana Leonard, M.S. and provides the complete range of Audiology services. Graduate students with traineeships rotate through the NHCU on a monthly basis. Services provided include a screening assessment upon admission, with a comprehensive diagnostic evaluation if needed. Patients found to have significant hearing problems are provided with hearing aids or other assistive devices. Over half of the patients currently residing in the NHCU use some form of amplification. Each patient receives hearing aid follow-up on a monthly basis. In addition, semi-annual inservices are provided to NHCU staff members on care and use of hearing aids and strategies for communicating with patients with hearing impairment.
Primary Care Screening
The purpose of this clinic is to identify veterans who may have communication difficulties due to hearing and/or speech-language problems. We provide this service to benefit the veteran as well as the primary care provider. By screening patients before their appointment, we are able to alert the primary care providers that barriers to effective communication may exist. Another objective of the screening program is to provide comprehensive audiological services to eligible veterans - many of whom are unaware that they can get help from the VA. There are over 200 veterans seen each day in the Primary Care Clinic, located on the second floor of the Domiciliary (Building 169). Although only a small number of patients are screened by Audiology, most patients have the opportunity for screening at a later time because they are seen on a routine basis by Primary Care. Typically, 15-20 patients are screened each day. The screening protocol includes an otoscopic examination, pure-tone hearing screening, and questions assessing communication handicap. Patients who fail the screening are referred to the Audiology or Speech Pathology Service for comprehensive assessment. The clinic typically operates 4 days/week and is staffed by Audiology graduate trainees under the supervision of Dr. Dan Bell.
The James H. Quillen Medical Center is one of the few facilities in the VA system to offer tinnitus management services. Students observe and participate in sessions with patients during which time they assist with case history, tinnitus assessment, and tinnitus counseling. This active clinic provides a unique opportunity for student clinicians to learn first-hand about the disruptions that tinnitus imposes upon individuals. Tinnitus is a common but poorly-understood disorder among veterans and the general public, and this clinical experience exposes graduate clinicians to a variety of treatment and counseling strategies. Students participating in this clinic are encouraged to continue working with these patients, thereby increasing the number of professionals sensitive to the unusual needs of this underserved patient population.
Veterans experiencing dizziness and/or balance problems are assessed in the Vestibular/Balance Laboratory. The Vestibular/Balance Laboratory is located in Rooms L072, L073, and L074 of the Audiology Clinic in the Outpatient Building #204. The Vestibular/Balance laboratory is equipped with the ICS computerized CHARTR video nystagmography/electronystagmograpjy (VNG/ENG) system and a water and an air caloric stimulator. VNG/ ENG is the test of choice for determining site and laterality of vestibular disorders. A System 2000 rotational chair (Micromedical Technologies) is available to determine if dizziness may be due to a disorder of the inner ear or brain and to identify bilateral vestibular loss. The micro-centrifuge and subjective visual vertical options to the rotational chair are available to assess otolithic organ function. Vestibular evoked myogenic potentials are also used to assess otolithic (saccule) function. Other vestibular tests in the Laboratory include the Dynamic Visual Acuity Test and the VORTEQ test (Micromedical Technologies). A computerized dynamic posturography (CDP) system and Long Forceplate attachment (NeuroCom, Smart Equitest) is located in the laboratory and available for balance assessment and balance re-training. The CDP test assesses major sensory and motor components of balance. The laboratory also contains an infra-red video eye movement recorder ( Eye Dynamics ) for use with assessment and treatment of patients with benign paroxysmal positioning vertigo (BPPV. Faith Akin, Ph.D. is director of the Vestibular/Balance Laboratory.
Vestibular rehabilitation therapy may be offered to veterans suffering from dizziness and balance disorders. Vestibular rehabilitation therapy is an exercise-based approach to management of dizziness and balance disorders. The therapy has been advocated as a treatment of choice for many patients suffering from dizziness and balance disorders. Vestibular rehabilitation therapy is provided by Mary Jo Davenport, P.T., M.S., a consultant in Audiology and Speech Pathology Service at Mountain Home and assistant professor in the Department of Physical Therapy at East Tennessee State University. The Vestibular/Balance Laboratory was initiated through VISN (Initiative Pool) funding to document therapeutic outcome of vestibular rehabilitation on a geriatric population.