Post 3: Mid-week in the clinic

Wednesday, November 19: Another early morning. After spending some fruitless time trying to establish an internet connection (no luck! I don’t think ANY satellites are pointed at Parintins. However, it’s entirely possible that the preceding statement is indicative of just how little I know/understand about how the internet works), we wandered out to the clinic courtyard for breakfast. Our trusty translator, Davison, hadn’t arrived, so we had a comical interaction with Vanessa and Lu as they attempted to explain the local delicacies Lu had included with breakfast. One of these delicacies was fried bananas (which, by the way, are the most delicious things EVER). We were excited because—finally—we found a Portuguese word (“banana”) that was the same as our English word. However, every time we tried to indicate that it was the same word, Vanessa and Lu would painstakingly correct us: “BA-NA-NA” and we’d say “yes! Banana!” and they’d respond “no, BA-NA-NA”. After a few back-and-forths, we gave up and just said, “ooohhhh, BANANA” and nodded. We just had to wait for Davison to arrive and explain the whole thing, which got a good laugh out of everyone when he finally did stroll through the gate.

breakfast on Wednesday
BA-NA-NA!!!

We started seeing patients at 8:30, as usual. Our first patient was quite a character. He was an older gentleman with moderate to profound hearing loss in both ears. It was a bit of a challenge to find the best hearing aid to fit him, but we ended up finding the perfect pair (Oticon Vigo Pro Connect mini-BTE’s) from some of the new hearing aids we had brought with us, courtesy of the Oticon Foundation. The patient really liked his new hearing aids, and said he could understand speech much better with both of them on. My favorite quote from this patient? “The party starts when my hearing aids are on!”

consultation
We discuss options for new hearing aids
new hearing aids
Ellen picks out the perfect pair of new hearing aids
earmold impressions
Ellen also made some earmold impressions so we could order new earmolds.

Our next patient ended up spending nearly two hours in the clinic with us. He had a history of sudden idiopathic sensorineural hearing loss (SISNHL), with onset about eight months prior. In the intervening time, he’d gotten hearing aids from the clinic, and had a laundry list of different tests that had been done (ABR’s, MRI’s, bloodwork, etc.), and all of it came back normal. He’d done a lot of reading about SISNHL, and at some point had read that it was linked to early death. We spent a lot of time discussing his prognosis to the extent that I could, as I’m not a physician, but I’m not sure he was satisfied with my assurances that if all of the specialists he had seen had found normal results, that there was probably little to be worried about. It was pretty frustrating, as it was clear that his anxiety and stress about the hearing loss was causing as many (or more) problems as whatever the underlying etiology was. I hope that my counseling helped, but I’m not entirely sure.
Next we saw an older woman who had a history of profound sensorineural hearing loss (deafness) in both ears. As we did the case history interview, Ellen and I both noticed that she was responding to conversation—even without lipreading/speechreading cues—much better than we would expect with a profound hearing loss, so we went ahead and re-evaluated her hearing. Sure enough, her audiogram was significantly better than previous visits—instead of profoundly deaf, she actually had moderately-severe to severe hearing loss on one side, and severe to profound hearing loss on the other. Rildo said he suspected that the audiometer must have been out of calibration during her previous visit, as the clinic had been burglarized over the summer and the thief had vandalized some of the equipment, including the audiometer. I’m glad we were able to get a better audiogram during this visit, so we could do a more appropriate hearing aid fitting for her.

Ellen otoscopy
Ellen performs an otoscopic evaluation while I make some notes about the patient.

After lunch, it was back into the clinic. We saw a patient who had been wearing hearing aids, but one had gotten lost. His primary complaint was tinnitus in both ears for the past three years. We did a new hearing evaluation and found that his hearing had decreased significantly in one ear. We gave him a new hearing aid to replace the one that had been lost, and reprogrammed the aid in his other ear to account for the decrease in his hearing. We referred him to the otorhinolaryngologist regarding the decrease in hearing and the tinnitus, and we’re hoping that he can get some relief!

happy patient
Another happy patient. We love the people who come to Vivo o Som!

Next was one of our favorite patients of the week. He was such an incredibly nice man, and he was very interested in everything we were doing. He had been wearing some power hearing aids, but wasn’t happy with them because he felt like they were making speech recognition more difficult rather than easier. Ellen and I switched him into a pair of hearing aids more appropriate for his hearing loss (a pair of Epoq XW’s, from the hearing aids sent by the Oticon Foundation), and the patient was THRILLED with the new aids. It felt so good to be able to work with someone who had been ready to completely to give up on hearing aids altogether, and find some technology that really worked for him and met his needs.

couple
We loved this couple so much!

Our next patient was the only baby we saw all week. She was a one-month-old with unilateral microtia (probably grade 2-3, but only an otorhinolaryngologist could make that diagnosis for sure) and atresia. Her mother wanted to know about the baby’s hearing status. I felt so helpless, especially as a pediatric audiologist, because I didn’t have any equipment to help me answer that question. Ellen and I were able to complete a high-frequency tympanogram on the unaffected ear, which was normal, but that was all we could do. I counseled the mother as best I could about the situation, but really, what the baby needs is an ABR, and it’s going to be tough for her to find that anywhere nearby. Maybe on our next visit (!) we can bring some additional testing equipment for cases like this.

baby
Our only infant we saw that week. But look how precious she was! What a well-behaved baby.

Next, we were happy to see the patient from Tuesday, the 80-year-old blind man who had been so difficult to test. We were going to attempt my suggestion to trial a hearing aid on his better ear, even though we didn’t have anything close to a complete audiogram. I programmed the hearing aid and we put it on his ear, and then said his name. His face immediately broke out in a huge grin, and he started turning his head around listening for whoever had said his name. I couldn’t believe the difference from the previous day, when we couldn’t get ANY reliable responses from him. I just broke down weeping from the sheer joy of it. The patient started answering questions from his friend and from the audiologist, and it was just amazing. I couldn’t stop crying. It was such an amazing reminder of why we were all doing this kind of work—to see this man finally reconnected to the world around him, and the joy it brought to him… it was just incredible. By the end we were all in tears because it was just beautiful. What an affirmation.

hearing aid programming
Hearing for the first time in a long time. This was about when I just lost it and started weeping with joy.
happy patient
We wiped our tears away and pulled it together enough to take a happy photo with our patient and his friend.

Our final patient of the day on Wednesday was an 8-year-old boy with profound hearing loss. I was so happy to see a kiddo! He was a new patient to Vivo o Som, but had gotten hearing aids from another clinic. He was a fluent user of sign language, and his mom reported that he was doing quite well in a general education classroom with the support of a sign language interpreter. We wanted to provide some new hearing aids for him, but we couldn’t get the new hearing aids to communicate with the programming box or the programming computer. Ellen, Rildo, and I tried everything we could think of for TWO HOURS, with no success. I don’t know that I’ve felt that frustrated in a very long time. Luckily the patient warmed up quickly to Davison (who, among the eight languages he’s fluent in, is great at Brazilian Sign Language) and also to Ellen, so they had all kinds of fun playing with the different pieces of equipment and “testing” each other’s hearing while Rildo and I wrestled with the finicky computer. Around 7pm we threw in the towel and had to send the patient and his mother home so that we could sort out the computer issues on our own time. I was completely wiped out by that point. What a long day! Thankfully, we had some of the absolute best patients we could have ever hoped for, and despite the long hours, our little team stuck together and had fun with it along the way.

audiogram
Getting a new audiogram
8 year old patient
Our favorite 8-year-old. Once he warmed up to us, he had lots of fun exploring the clinic.
Ellen hearing test
Ellen got her hearing tested by an 8-year-old. She says “I hear it, but just a little bit!”. (Not pictured: me and Rildo troubleshooting every piece of programming equipment, and somehow resisting the urge to throw the darn computer out the window).

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