2015 Audiology Masterclass Series: Complex and Challenging Cases


This series of 6 lectures will feature case studies of complex and challenging audiology cases. 


This course is no longer accredited by Audiology Australia


1) Unexplained Changes in Hearing in a Student with Hearing Loss – A Case Study Recording Available

Paul Peryman

Unexplained changes in hearing in students with hearing loss will occur in clinical practice. Sometimes these changes are accompanied by response behaviour in the clinic and elsewhere that is different to that usually shown by that student, or which is not consistent with the degree of audiometric change. Sometimes there are clues in comments made by the student themselves as to possible explanations for hearing changes.

A case is presented today of a  19 yr old female student enrolled in a school for the deaf who has had a profound SNHL in her left ear and a progressive loss in the right ear since the time of diagnosis by ABR and behavioural audiometry at age 3 years. She has worn a BTE hearing aid in her right ear since the age of 3 years.

 Since late 2013, there have been changes in the pure tone audiometry thresholds not associated with reported changes in hearing and with observed oral language communication ability, except with comments by the student’s mother about some difficulties in communication at home.  Audiometry carried out during 2014 showed inconsistencies between test results within and between test sessions. These hearing threshold changes and test inconsistencies are difficult to explain, and clinical activity is continuing.

2) Implantable hearing technologies for children with single-sided deafness: Candidacy and Management Recording Available

Emma Rushbrooke and Beth Atkinson

Hear and Say provides an Auditory-Verbal Early Intervention Program and a whole of life Implantable Hearing Technologies Program for children with hearing loss. Children with hearing loss in one ear will experience listening difficulties in many situations due to the fact that they do not have the advantages afforded by binaural access to sound. Whilst more research is needed, the current literature suggests that around 35% of these children will experience developmental delays particularly in the areas of speech and language development, educational progress and/or social and emotional development. 

In the past, amplification was not routinely offered to children with a unilateral hearing loss, however increased awareness of the impacts of this type of hearing loss has resulted in amplification being recommended more consistently in Australia and many families have been exploring this option. In addition, implantable solutions, for those children who cannot benefit from conventional hearing aids, are being considered for children with single-sided deafness (i.e. a severe to profound hearing loss). This expanding cochlear implantation candidacy criteria as well as other implantable hearing technology options, has led to an increased number of families with children who have single-sided deafness (SSD) seeking amplification options. A number of children in the Hear and Say program with SSD have received a cochlear implant or bone conduction device.

This presentation will give an overview of clinical observations, case studies, standardised speech and language assessment results, audiological assessment results and anecdotal evidence to share our clinical experiences with this population to date. Candidacy experiences and post implant management and therapy as well as parental insights into children with single-sided deafness who receive an implantable hearing technology will be discussed.

3) Combining parent observations with objective hearing tests in challenging cases - A Case study with Auditory Neuropathy Spectrum disorder. Recording Available

Janet Chapparo

Combining parent observations with objective hearing tests plays a vital role in the management of challenging cases. This case study of a child with Auditory Neuropathy Spectrum Disorder (ANSD) helps illustrate  how the Parents Evaluations of Aural/oral performance of CHildren (PEACH) and Cortical Auditory Evoked Potentials (CAEPs) can be used to guide clinical decisions, provide validation for fitting, and give a medium for parents to structure their observations of children in natural home environments.

4) Minimal device use: The impact of cultural difference and perceptions on cochlear implant outcomes  Recording is available

Colleen Psarros

Candidacy preparation for cochlear implantation requires a comprehensive approach to ensure that families are prepared, and professionals have jointly established a framework  to assist families in managing  the child’s and their families needs. Counselling and exploration of expectations is an essential part of the preoperative procedure. This case is a child who was referred to SCIC at the age of 6 months, and was evaluated over a period of 6 months for cochlear implant candidacy. His family were both severe to profoundly deaf. The mother was a cochlear implant recipient. The baby was identified with a severe to profound hearing loss at birth, and fitted with hearing aids at the age of 6 weeks. Parents both decided they wanted   cochlear implantation for their child. The paternal grandparents were Auslan users, and both parents were bilingual.

Device compliance was discussed when the child attended early intervention sessions without hearing aids, yet lack of device use was attributed to ear infections, and poor fitting moulds. Consistent cochlear implant use was discussed with the parents and mechanisms were put in place to maximise models of speech and language to facilitate bilingualism.

Data logging revealed the child had less than 30 minutes device use on average each day. Retention was an issue, however the family were experiencing pressure from extended family, and had reprioritized the importance of the cochlear implant use. One year post cochlear implantation the child has significant delays in communication.

This case discussion will overview the strategies used to facilitate improvements in device use, and the value of hindsight in identifying the factors that may have identified the issues preventing consistent device use.


5) A case study of the audiological management of a baby with a deteriorating sensorineural hearing loss and a fluctuating conductive overlay. Recording Available

Karen Gillies

This case study will present the results and management pathway for a child born with a mild high frequency sensorineural hearing loss in the left ear and a profound hearing loss in the right ear.  She also had a significant conductive overlay due to middle ear effusion in both ears at the time of diagnosis.  This little girl was referred to Australian Hearing and fitted with hearing aids at 2 months of age.  Over the ensuing 10 months, her audiological management was made challenging by a fluctuating conductive component to the hearing loss due to bouts of middle ear fluid, and a deterioration in the sensorineural hearing loss in the left ear.  She was implanted in the right ear just prior to her first birthday and received a second cochlear implant at almost 2 years of age.  This presentation will discuss the paediatric clinical pathways and protocols followed, including the use of aided cortical evoked potentials.  Outcomes measures used at Australian Hearing, as well as the importance of liaison with other agencies and the parent-professional relationship will also be covered.


6) A case study of unilateral ANSD Recording Available

Genelle Cook and Kim Ter-Horst

This case study will look at cases of unilateral Auditory Neuropathy Spectrum Disorder with varying etiology , both congenital and acquired.  These cases will focus on diagnostic assessments and medical investigation.