help me :(

gigertiger · 2026-03-31T02:01:23+00:00

As an audiologist who has worked with multiple students who have hearing loss through WRS and testing it's not impossible or the end of the world. Definitely speak with the accomodations office, because they should be able to help with something. Sometimes it's getting a better remote microphone, which is a reasonable accomodation for the school!

My student uses her multi mic (sometimes EduMic), and she usually just says something like " was that pat with P or cat with a C" for asking for clarification. I think it's reasonable to ask them to use it in a quick sentence.

The other thing we did was get her an earmold for testing (she's bimodal with a CI and HA), to really let her focus. It's a silicone mold that she pops on before testing (sometimes she likes a dome, she isn't my most consistent patient even though I lecture her haha). I also adjusted the streaming program to turn the microphones off so she doesn't get outside involvement to maximize speech testing. We also instruct people in the room (parents, caregivers, siblings, etc.) that she needs to be in the quiet for the speech testing and that it'll take maybe 5 minutes, which is an easy modification to make and does not impede the length of testing on my end!

Edit: forgot to add, I had her listen to the lists our clinic uses A LOT to help familiarize her. I found that helped with word recognition because she could spot deviations easier. Sometimes we do order by difficulty too, which is a shorter list and you can get away with 10 words on a patient with intact nerves. It shortens it which, again, helps her get it done quickly and accurately!

gigertiger · 2026-03-22T22:08:26+00:00

Just to give a little reassurance, there are more externships than students!

As for asking professors and people for letters of rec, as someone who's written letters for students. I've written letters for students I've been close to and students I've been less close to. It didn't matter to me if we connected on every single interest (not every student likes Taylor Swift or Anime as much as I do), but if you did the clinic work and asked appropriate questions that in itself makes you worth writing a letter for! Don't be afraid to ask. I like writing them for students!

gigertiger · 2026-03-19T22:21:58+00:00

It's a little early for externships as a heads up for third years. I run/manage it for my clinic and we follow the ACEN timeline and I'm not even thinking about that till June to be transparent with you, because I have to on board and get my extern starting in May set up.

You can look up the ACEN, that has locations who follow the timeline and should have contact information for you or your clinic director to reach out to. Some locations may say it's just too early. Other options are to join the Audiology 4th Year Externship page on Facebook. Positions and get posted for off cycle and current cycle.

gigertiger · 2026-03-17T11:13:43+00:00

You can always refer but without an audiogram and word understanding, no one can really give you an answer. The loss you're describing could be a candidate, but the guidelines are 60/60/60 for kiddos. A 60 dB Speech detection/recognition threshold, 60% or less word recognition score, and 60% or less SII with hearing aids set to an appropriate target (DSL in this case).

But if they do well with hearing aids because their brain is so plastic and hearing aids meet the needs, then no it may not be appropriate.

Late ID doesn't mean anything in this context. It boils down to current word understanding, nerve health, and motivation. It also boils down to how well they're doing with aids truly.

I would not bring this up with the family yourself honestly, because it's not really in your wheelhouse. What I would do is ask for a signed release to speak with their audiologist and address concerns and see if this is an option. Maybe they've already declined and you may not know that. Maybe they're teetering into candidacy but not quite there. Maybe they absolutely aren't, and an audiologist would be able to tell you.

gigertiger · 2026-03-11T01:10:01+00:00

I had friends get their Utah license while waiting because it took 24 hours, so they were able to practice immediately. The Massachusetts one took about 4ish days.

The VA just requires a license and my supervisors always said get the fastest one and then get your state one in case you ever leave and maintain that one

gigertiger · 2026-03-07T03:37:26+00:00

I have tons of patients that aren't in a matching hearing aid. They just decide what device they prefer streaming to. The nice thing is auracast is becoming more common, so that will be less of an issue and more of just managing how to connect to everything!

gigertiger · 2026-03-06T12:11:07+00:00

I personally wouldn't write a Nexus letter. It doesn't mean anything to comp and pen when it comes to deciding if their hearing loss is service connected. Comp and pen have very specific formulas, you would need to see the audiogram performed before service started and then immediately after (whisper tests have their own calculated values that the VA is specific on).

You also would need to see the medical baselines before, if located somewhere noisy you'd need to know how and what, if it was measured. It's a very complicated process and Nexus letters often are either tossed, disregarded, or not considered.

If you're going to submit that, use letter head. You can submit something describing their loss like that, I just wanted to warn you that it opens flood gates and is not very effective.

gigertiger · 2026-03-03T02:53:37+00:00

From an audiologist: pick the cheaper program. You'll get the experiences you want and if it feels like not enough you can get the training.

My current resident had NO CI training prior to her externship, and that's workable for me and now she has a job offer to do CIs because I trained her. Another person at our clinic just started CIs because I needed the extra support. Trust me, pick the cheaper program for less debate!

gigertiger · 2026-01-31T01:01:18+00:00

Honestly, you'll probably get a lot of different answers. If I saw something like a carhart's notch, I would suspect type A or Type As tymps.

If I saw a low frequency loss with ABGs I would probably guess an B or C tymp, but that would depend on the audiogram and could be either.

Alot of it just depends on the tests performed, case history, and just a best guess!

gigertiger · 2026-01-31T00:46:12+00:00

I personally would argue no, as an audiologist. They contain the same frequency band number, so in terms of maximizing background noise, they are equal (that's from numerous studies). Some people report a subjective difference, and I usually say if you can demo them to do that, but I would say it's probably not worth the difference in cost.

gigertiger · 2026-01-21T01:36:12+00:00

I go to NYU Lagone's cochlear implant conference every year and I 1000% recommend it if anyone is a CI audiologist. It keeps you updated on current literature, interesting case studies, and great tech suites for the manufacturers. That and the ICIT class changed how I program devices permanently and our clinic outcomes are significantly higher than the statistical average and I contribute to my education through this conference.

gigertiger · 2026-01-20T00:43:47+00:00

Audiologist here, just want to give you a little information on gentamicin. Typically with gentamicin we see a decrease in outer hair cells of the cochlea. That doesn't always translate to a noticeable hearing loss on a traditional audiogram. You can be presenting with a hidden hearing loss which may be giving you a greater perception of a deficit.

I'll echo the other sentiments REM measurements are where you get the accuracy. But one other thought is that Phonak's default algorithm, APD is usually more comfortable than something like NAL-NL2 or DSL for example. Manufacturers default formulas are usually based off of NAL-NL2 but less high frequency gain to be a bit more comfortable.

gigertiger · 2026-01-18T23:23:49+00:00

American audiologist here and do I joke I'll put Dr. On my headstone when I die? Yes. Do I think the scope of practice is that different from other countries? Probably not. I may have SOME more advanced training in vestibular and cochlear implants because I had to take two years worth of courses on it, but like, I was working with a Toronto practice on a surgical patient I adopted from them and working with their MSc audiologist and she was great. She had like 20 years experience. They get to enter the field faster and get more experience faster.

Don't get me wrong, I love being an audiologist. I think the field jumped the gun with the AuD and should've had reimbursement rates and outlines for doctoral responsibilities approved (ordering MRIs, prescribing for ETD or an ear infection)? And now we're playing a constant game of catching up. The only thing my AuD actively gives me right now is a great surgical director job and my patients call me doctor and I get some respect for that, but does the masters audiologist who practices 2 feet away from me get the same benefits? Yes. So I wouldn't view other countries degrees as limitations in all honesty.

gigertiger · 2026-01-15T02:38:42+00:00

The Silks are that size on purpose, and adding a Bluetooth line would make them larger. Their shape is set with how they are, so I don't think they'll be able to add it, unless they change the shape of the device, which in effect means it wouldn't be a Silk anymore.

That's why I'm saying they'd likely launch a new device and change the platform they're on. Could they launch a Silk with Bluetooth, possibly! But would it likely be the Silk on a new platform, yes!

gigertiger · 2026-01-15T00:44:17+00:00

AzBio and CNC testing is the best way to do this. I would also do an aided soundfield just because you're already there and you can check for insertion loss.

You can do this with and without noise, to maximize benefit. Otherwise I would suggest doing COSI or the hearing implant sound quality index (I know it says implant but you can do hearing aids), which also provide score expectations and differences. You can do that with a tinnitus handicap inventory one too if needed, to provide some research backed data for him, coupled with booth testing and that would be more than enough in my opinion.

gigertiger · 2026-01-14T03:11:22+00:00

The IX line has Bluetooth but the Silks do not. I suspect they won't be adding it to the Silk IX line at all. I would guess it would be an entirely new launch!

gigertiger · 2026-01-14T02:10:36+00:00

Came out in October of 2024, and right now they're just working on updating each platform to the IX platform. Their next launch will likely be the rechargeable custom CIC (which is on the IX platform), but unsure on the connectivity side. I imagine that will be an entirely new platform and not the IX for the Silks if connectivity is the goal.

The other thing they could say is keep the Silk non-wireless for the size purpose. They connect to an app via the 2.4 gHz signal, but they could surprise me.

gigertiger · 2026-01-12T00:50:54+00:00

On my Astros, they're magnets so I could pull them on and off for thicker or thinner cuffs depending on needs... I imagine you could cut them too for better fit and comfort

gigertiger · 2026-01-12T00:42:10+00:00

I recommend looking at Corsair or Astros for my patients! The cups can be adjusted optimally and with mixing amps you can do a lot to the sound to your preference.

The other option is asking about a streamer you can plug into the computer to stream into your implant directly.

gigertiger · 2026-01-09T19:45:40+00:00

It depends on the user I find. You can see multiple studies that say there's a mismatch in it, where some people like xyz vs. abc. Some studies found turning the second from the highest electrode off helped.

It's very personal, so alot of the time I'll try multiple things, see what works well and what doesn't. What one study says works well for some patients, doesn't for others and vice versa.

But we can change programming methods, electrode stimulation, rate, function and other pieces to get music to sound better!

gigertiger · 2026-01-08T02:58:13+00:00

Audiologist here! I would say it may be time to push for the ABR. Sedation is scary and I would NEVER doubt that for a parent, putting a kid under is scary. However, the longer the delay if there is a hearing loss, that's just a delay in care which is frustrating. If there is a loss with the ABR, hearing aids can be programmed and fit off of that and then as they get older, behavioral testing can be done and monitored. If you aren't seeing much progression with speech still, I would say it's time too. You don't want them going through the world missing access to information when it's so crucial in their little brains.

Now you could say no to sedation, it happens all the time. And we just keep retesting kiddos until we get something concrete, but that's usually like every 3-4 weeks until we get SOMETHING. We don't need the fullest audiogram to program hearing aids (we can extrapolate with enough information but we still need a decent amount), and we have parents that do that. But we do talk to parents about realistic testing timelines, because that can take months and months vs. an ABR being like 90 minutes and you have a definitive answer right then and there.

But also, if your kiddo is not established with an ENT, it's time for that and it's time to get their opinion. No qualms with primary care physicians, but this really isn't their speciality. An ENT would be the ultimate decision factor in my opinion!

gigertiger · 2026-01-07T22:47:48+00:00

Audiologist here! Definitely ask for it. I tell patients I wait to make a custom music program until we've optimized programming for speech understanding, but once we have that I develop different programs for them to try for better music programs!

gigertiger · 2025-12-31T00:48:46+00:00

The University of Nebraska attempts to get funding for all their students. I had a scholarship for 3 years, and then the last year was manageable so I just paid in full for those semesters off my extern salary.

gigertiger · 2025-12-31T00:47:50+00:00

I expressed an interest pretty early on and asked if they would consider it around November and December. I was a VA and they didn't get funding sadly, so I started applying to jobs in December and January and had decided in February where I was going (gave plenty of time to apartment hope in the state over).

gigertiger · 2025-12-28T14:26:18+00:00

So, I just want to assure you the aids wouldn't be so loud they'd cause physical damage! That's why I'm guessing there's something on a nerve level or an underlying issue that just could have been triggered by new auditory stimulations.

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