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ENT and Communicative Sciences Departmental Blog

Hearing Loss and its Effect on Brain Function

oto---blog-2.jpgBy Grace Sturdivant, AuD

Patients most commonly come to me with gradually-acquired sloping hearing loss. What does that mean? Well, most commonly, individuals are able to hear low pitch or bass tones better than they are able to hear high-pitch or treble tones. Functionally, this results in the common complaint of “I can hear but I can't always make out what people are saying.” Or another common statement, “I can hear fine one on one, but when I get into groups or crowds where there is background noise, I have trouble understanding people.” Some patients are resistant to trying hearing technology for a variety of reasons ranging from an outdated negative stigma associated with older hearing aids, to an intimidation of learning how to properly use and take care of new technology.

My job as an audiologist is to make the process simple - to explain the hearing loss diagnosis clearly and to lay out appropriate options for technology. With my adult patients, I consider it part of my job to convey the impact of hearing loss and the advantages of using hearing technology - both for the more obvious quality of life improvement and for the less known physiological cognitive component. Hearing loss truly affects the way our brains operate, and this can be a more compelling reason to make the jump to embrace hearing technology than a more simple annoyance.

There are two primary neurobiological changes that I typically discuss with patients. One is called Cross-modal Plasticity. Don't let that term bog you down - it means that when the area of your brain which is purposed for processing sound (the auditory cortex) is not being stimulated adequately (i.e., when hearing loss is present), a well-functioning system like vision will begin to recruit that area to process its own input. To illustrate this, studies have shown that even in mild sloping hearing losses like the one I described earlier, when visual stimuli are presented to patients, unexpected activity is recorded in the auditory cortex. So the auditory cortex is working to process the visual stimulus. This finding has been correlated with increased difficulty with understanding speech in noisy environments. So the difficulty you are experiencing in noise is not just because you've lost the ability to perceive some of those higher pitches, but also that your brain is re-organizing because of the lack of sound stimulation.

Another fancy term to describe the second brain change I'll discuss is Cortical Resource Reallocation. Even in these mild, sloping hearing loss cases, auditory cortex activity is decreased and frontal lobe activity is increased on listening tasks. Why does this matter? Well, the frontal and pre-frontal areas are critical for working memory and executive function. When hearing loss is present and you are straining to hearing and understand someone in a challenging environment, your frontal lobe is loaded down with trying to understand what someone is saying in that moment. We call this “effortful listening.” This leaves less ability for that frontal lobe to help you remember what someone was saying after you walk away from the conversation.

People have often not considered that hearing loss means that the brain is less stimulated. We do truly hearing with our brains! It could be due to these reasons that people with severe, untreated hearing loss are five times more likely to develop dementia; or that adults with untreated hearing loss develop cognitive decline 3.2 years sooner that people with normal hearing; or that people with dementia and severe untreated hearing loss have rates of cognitive decline 30-40% faster than dementia patients with normal hearing. I don't intend these facts to be scare tactics, but they are evidence-based and are relevant to the conversation. We can all agree that brain stimulation is important from infancy until the end of life.

I'd like to emphasize that we have not proven that hearing aids can prevent, delay, or slow cognitive decline. But we have proven that hearing aids allow for cognitively-engaging behaviors which are known to prevent, delay, and slow cognitive decline. Aside from mitigating the brain changes I discussed, hearing aids facilitate social engagement, interaction, and interpersonal connection. They reduce the depressive symptoms of hearing loss. This improves the quality of life and relationships for both the patient and their friends and loved ones. By decreasing effortful listening, patients are less exhausted after socializing, allowing more energy for further engagement with family and friends.

The bottom line is this, if you are struggling to understand conversations - even if the struggle is only in crowds - go to see an Audiologist. Find out where you stand and be open to exploring the technology available. Hearing aids can be as simple or hands on/techy as you want them to be. Most styles are nearly invisible! They can be fully automatic so that you never have to manipulate them, or they can be synced with apps on your phone for unprecedented controls and wireless streaming. At UMMC, we offer returns and exchanges for the first 60-days aside from the smaller, non-refundable professional services fee. This allows you to try hearing technology at minimal risk. Hearing aids are an adjustment, but the positive outcomes we see with our patients makes the Audiology profession a truly rewarding one.

  • Campbell J, Sharma A. (2014) Cross-modal re-organization in adults with early stage hearing loss. PLos ONE 9, e90594.
  • Campbell J, Sharma A. (2013) Compensatory changes in cortical resource allocation in adults with hearing loss. Front Syst Neurosci 7.
  • Deal JA, Sharrett AR, Albert MS, Coresh J, Mosley TH, Knopman D, Wruck LM, Lin FR. (2015) Hearing impairment and cognitive decline: a pilot study conducted within the atherosclerosis risk in communities neurocognitive study. Am J Epidemiol 181(9): 680.690.
  • Lin FR, Yaffe K, Xia J, Xue Q-L, Harris TB, Purchase-Helzner E, Satterfield S, Ayonayon HN, Ferucci L, Simonsick E. (2013) Hearing loss and cognitive decline in older adults. JAMA Intern Med 173(4): 293-299.
  • Lin FR, Metter EJ, O'Brien RJ, Resnick SM, Zondervan AB, Ferucci L. (2011) Hearing loss and incident dementia. Arch Neurol 68, 214-220.

Global Connection

Members of UMMC's Speech Pathology and Audiology divisions marketing committee consisting of Mary Gunn Spragins (AuD), Hailey Middleton (SLP), and Rachel Tyrone (SLP) met with Nancy Sylvester, director at the Global Connection Learning Center in Jackson. This facility offers child care for ages 2 months to 5 years of age. Global Connection Learning Center also provides care for children with special needs advocating to meet their children's individual, specific needs. Spragins, Middleton and Tyrone met with Sylvester to provide developmental handouts in order to assist staff and caregivers in identifying early speech delays as well as hearing impairments. Contact information was provided to assist caregivers and providers when a speech or hearing evaluation is warranted. The Audiology and Speech Pathology division will partner with the daycare to provide lectures to the parents and staff in the near future. The marketing committee looks forward to all future endeavors with Sylvester and her staff to promote early intervention in order to provide the best outcomes for her students. The marketing committee thanks Mrs. Sylvester and her staff for their willingness to meet with the committee and to establish a partnership between UMMC's Audiology and Speech Pathology division with the Global Connection Learning Center. We look forward to our next meeting. Happy Better Hearing and Speech Month!

Educational handouts regarding suspected hearing and speech problems:

May is Better Hearing and Speech Month

By Christopher Spankovich, AuD, PhD, MPH

It is a common misperception that hearing loss is inevitable. While it is true there are a greater percentage of persons with hearing loss as we age, it is not necessarily “age” causing hearing loss. Rather, so-called age-related hearing loss refers to our lifetime of general health, lifestyle (e.g. smoking, diet, etc.), noise exposure, use of ototoxic medications, and of course, genetics. In reality, there are a number of factors that contribute to hearing loss, some of these you cannot change (e.g. genetics), but others are modifiable. Excessive noise exposure is one of the most common causes of hearing loss and also one that is nearly 100% preventable. Noises that tend to be dangerous to the auditory pathway are not usually natural environmental sounds. Rather most noise that is dangerous is usually made by a machine, including everything from power tools to speakers at a concert.

How do you gauge risk? Risk for noise induced hearing loss is based mostly on the level and the duration of the exposure. In other words, the louder the sound the shorter the duration permissible before risk of hearing loss becomes likely. For example, a popular firearm for target shooting and hunting, the Armalite rifle model 15 (AR-15) can produce levels that peak over 180 dB SPL (Lobarinas, Scott, Spankovich, and Le Prell 2016). The current occupational noise limit set by the Occupational Safety and Health Administration (OSHA) is 140 dB SPL for impulse sounds (an impulse sound is a brief high intensity sound, like a firecracker). Therefore a single noise shot from a firearm can potentially damage hearing. For this reason most shooting ranges require use of hearing protection.

On the other end of the spectrum you have sound exposure that is less impulsive in nature and more steady state. For example, everyday you see people of all ages walking around with an mp3 player, i-something, smartphone, etc. and listening to music or talking on the phone. There is a good deal of concern in the hearing conservation community that this may alter risk for hearing loss. Can listening to music through an i-something increase risk for hearing loss? Yes, but again this is dependent on the level and duration of the exposure, i.e. the louder the music the shorter duration you can be exposed. The maximum output of the iPod with standard earbuds (the most popular music player) is approximately 105 dB SPL (this level can vary by type of earphone). Using the OSHA standards as reference you could listen to that level for approximately 1 hour “safely”. However, music and factory noise for which OSHA standard were created are not exactly same thing. A rule of thumb (with standard earbuds and ipod) is called the “80-90 rule”; do not listen at greater than 80% maximum volume and limit to 90 minutes and then take a break. If you want to use longer reduce the level, 50% of max volume should keep you safe for longer listening. Now you may say I can't hear my music on a plane or bus or in a crowd at only 50%. Another tip is to get sound isolating or noise reducing headphones, people are more likely to increase the level of their music when there is noise around covering up their tunes, isolating/noise reduction headphones can allow a person to achieve the music coma they seek without the need for high levels to battle background noise.

When you go to a concert/live music type venue do wear hearing protection? Unfortunately probably most of us would answer, "No". There are many reasons people do not wear hearing protection: 1. don't think there is any risk of damage, 2. think the amount of damage if even happened would be minimal, 3. think hearing loss is inevitable, so who cares, and 4. feel hearing protection diminishes the experience (i.e. music does not sound as good). There is some truth to these excuses, attending a concert once and while is not going to make you go deaf and many forms of hearing protection make music sound less than great. However, recognize that repeated noise exposure is cumulative and new research suggests that even single noise exposures may have much greater effects than previously thought including acceleration of age related hearing loss. If you are concerned about enjoying the show look into music earplugs, you can find non-custom pairs online for about $10-12 and they are reusable. Musician earplugs provide less attenuation and a flatter filtering (meaning not having greater attenuation of higher frequencies and less in the lows and therefore distorting the sound) which can allow you to protect your ears and still enjoy the show.

Finally, hearing loss is not the only reason to start protecting your hearing now. Tinnitus, the perception of a ringing, buzzing, humming sound without an external source, can develop. Tinnitus can often be experienced after noise exposure and is usually only temporary. Though, with repeated exposure slight damage to the pathway can results in a chronic and permanent tinnitus. There is no cure for tinnitus, but there are effective treatments to help tinnitus suffers cope. For both tinnitus and hearing loss, prevention is key. Use safe listening practices and hearing protection when around loud sounds; your ears will thank you.

Check with you local audiologist about hearing protection options for music, shooting/hunting, work, and etc. Also if you have tinnitus causing distress there is help available, contact your local audiologist.

  • Lobarinas E, Scott R, Spankovich C, Le Prell CG (2016). Differential effects of suppressors on hazardous sound pressure levels generated by AR-15 rifles: Considerations for recreational shooters, law enforcement, and the military, Int J of Audiology, 55, S59-S71.

Alternative Means of Communication

What does alternative means of communication mean?
There are many ways to communicate besides speaking. Alternative means of communication are other ways to communicate that do not involve spoken speech. In this day and age of technology, texting is a common means of communicating that does not involve speaking. Using gestures, writing, body language, sign language and facial expression are also ways we communicate. When someone has difficulty speaking or is unable to speak, they may rely on another way to communicate.

What are communication devices?
Communication devices can be low or high technology. Examples of low technology communication methods include a communication board with words, pictures and/or letters. A person points to these words or pictures to communicate what they want. For example if someone is thirsty they can point to a picture of a glass of water. By pointing to words and pictures someone can convey what they need without speaking. If a person can spell, they can use an alphabet board to spell a message (just like using a keyboard when texting). High technology communication devices are computers that have voice output. When someone selects a word, picture or phrase the computer says it out loud. An advantage of these high technology devices is that they can be connected to the internet so people can communicate in social media like Facebook and through email. If someone has weakness in their hands and they are unable to point to the words or pictures, they can use a communication device with eye gaze or a head mouse. For eye gaze the person looks at the picture or word rather than pointing with their hands. For the head mouse a person has a dot placed on their forehead or glasses and they can pick the word or picture by moving their head. The devices are personalized to include family members' names and even include photographs of family and friends, places they like to visit etc.

Who uses a communication device?
Both children and adults can use a communication device. Adults who have diseases that affect nerves and muscles such as ALS (Amyotrophic Lateral Sclerosis) can develop speech that is not clear. Stroke patients can also have speech and language problems which make it difficult for them to talk. Children who have difficulty developing spoken speech may also benefit from a communication device. By using these devices children can also develop language skills.

What type of communication device does a person need?
A team of individuals is necessary to evaluate an adult or child's ability to use a communication device. A speech language pathologist typically evaluates the speech and language skills to determine the most appropriate device for an individual. An occupational therapist will assess motor skills and hand function to determine the best way an individual will select words and/or pictures on the device. A physical therapist assesses the person's posture and positioning for the most optimal use of the device

How do I communicate with someone who uses a communication device?
Speech language pathologists provide training and support to the individual and their family during the evaluation period and after a person gets their device. It is really important that the environment supports the person who is using a communication device. Allow the person to start a conversation using their device, give them enough time to create their messages and make sure they get a turn in conversations especially in group situations. Being patient and making eye contact with persons using a communication device will help them feel connected to others and greatly improve their quality of life.

Finally Answered: A Patient’s Search to Get Her Voice Back

Kris Williams battled laryngeal cancer - twice. As a 43-year-old, non-drinking, non-smoking patient, Kris came to the Department of Otolar­yngology and Communicative Sciences at UMMC seeking answers for her rapidly worsening voice. Kris scheduled her consultation with Dr. John Schweinfurth, otolaryn­gologist. Schweinfurth and his team at UMMC removed what turned out to be dysplastic cells from the vocal cord.

Unfortunately, Kris developed a new mass on her vocal cord, but this time she knew where to turn. After Schweinfurth removed the sec­ond mass, Kris received a call from him with her results-it was not what they hoped. Kris recalls that Schweinfurth wanted to be the one to tell her that she developed laryngeal cancer; he reassured her that she had a great care team working together on the best treatment for her.

Kris explained, “I'll never forget that. He could have just let the person who called later that day to schedule my CT and MRI tell me the bad news. I'm sure it would have been easier for him.”

At the beginning of her journey, Schweinfurth told Kris he would do everything he could to preserve her voice and rebuild her damaged cord. Through steroid injections, collagen injections, surgery to remove webbing caused by radiation, and voice therapy with Josie Alston, the chief of the Speech Language Pathology division of the Department of Otolaryngology and Communicative Sciences, Dr. Schweinfurth was able to achieve the desired results.

As Schweinfurth treated her cancer, he explained what he was do­ing and why. He reassured her when she was afraid, prescribed medication to help her deal with anxiety, sent her to a neurologist when she started having migraines, and meticulously examined her cords at each post-cancer appointment. Schweinfurth's diligence and hands-on care allowed him to catch the cancer when it returned two years later.

Kris shared, “I am thankful for his expertise. Because of his brains and his skill, I still sing in the choir, teach Sunday school and cheer at my son's ball games after having over ten surgeries on my vocal cords and twenty-eight rounds of radiation. He caught my cancer very early, and I know that makes a huge difference in the outcome. “I know that Dr. Schweinfurth's primary objective was to destroy my cancer, but he went to great lengths to not destroy me in the process.”

Dysphagia (dis-fey-juh) - What Does That Mean?

By Angie Brunson, MS, CCC-SLP
Speech Language Pathologist

Dysphagia is the term used to describe difficulty swallowing that may result from a variety of causes. This is the term used when someone consistently has difficulty with chewing, moving food around in the mouth or keeping food or liquids in the mouth. This involves what we call the oral phase of the swallow; this also includes our sense of taste and production of enough saliva in the mouth to mix with our food which is very important when eating.

Some people may have difficulty getting the swallow started or having food get “stuck” in the throat or airway which can be very frightening for the person as well as those around the dinner table! This results in coughing, throat clearing, or potentially choking in which the airway is completely blocked and the person is unable to breathe, speak, or cough. It is time for the Heimlich maneuver! (which everyone should learn, especially if one has children!) I have had to perform the Heimlich on my son while 5 months pregnant as well as my father. Thankfully I knew what to do!

Everyone “strangles” from time to time especially if engaged in conversation and suddenly something becomes very funny. This is due to the food or liquid entering the airway and into the lungs. However If this is a frequent occurrence there could be a more serious problem. This should be discussed with a physician and referred to a speech language pathologist for a complete evaluation. If dysphagia is not evaluated and left untreated, depending on severity, there is risk of choking, weight loss, dehydration, and/or the development of aspiration pneumonia. There also may be the avoidance of meals due to embarrassment or fear of have a “choking spell” in the midst of people. Eating is a huge part of our lives and part of social gathering with family, friends or co-workers. The person with dysphagia can become very isolated.

Some possible causes of dysphagia:

  • Stroke
  • Traumatic Brain Injury
  • Neuromuscular Illnesses
  • Head and neck cancer as well as radiation and/or surgery to the head/neck area
  • Trauma from intubation
  • Deconditioning/weakness
  • Certain medications

Depending on the cause of the dysphagia, there are treatment modalities very effective for treating and improving the overall quality of life of a patient. If you suspect you have dysphagia, speak with your physician first and then look for a qualified speech language pathologist.

December 2016

Five Facts about Concussions

By Hailey C. Henderson, MS, CCC/SLP
Speech Language Pathologist

oto---blog-3.jpgWith high school football well under way, this particular post will spotlight the topic of sports related concussions specifically looking at how they impact athletes and parents of athletes. Of note, high impact sports is not the only way to obtain a concussion. Anyone can become injured during a fall, car accident or any other daily activity. If your child participates in impact sports such as football or boxing, you have an increased risk of getting a concussion. In 2010, the CDC estimated approximately 2.5 million people in the United States visited the hospital with traumatic brain injuries (TBI).

What is a concussion?
A concussion is a type of traumatic brain injury (TBI). Concussions are caused by a bump or blow to the head. Even a very mild bump or blow to the head could be very serious. You can't see a concussion. But you can look for some signs and symptoms that will likely show up right after the injury. However, some symptoms may not appear or be noticed until days or weeks after the injury. If your child reports any symptoms of concussion, or if you notice the symptoms yourself, seek medical attention right away.

What are some signs and symptoms of concussion?
Athletes say:

  • Headache
  • Nausea/vomiting
  • Balance problems
  • Double or blurry vision
  • Sensitivity to light/noise
  • Feeling sluggish, hazy, foggy, or groggy
  • Difficulty concentrating/remembering
  • Confusion
  • Just not “feeling right” or is “feeling down”

Parents say:

  • Appears dazed or stunned
  • Is confused about where they are
  • Forgets instructions
  • Unsure of details about game, score, opponent
  • Moves clumsily
  • Delayed response to questions or answers questions slowly
  • Loss of Consciousness (even briefly)
  • Shows changes in mood, behavior, or personality

What do you do if you think your child has a concussion?

  • Seek medical attention right away.
    It is important for your child to seek a healthcare professional so that they may be able to assess your child to determine how serious the concussion is and when it is safe for your child to return to regular activities (school, sports, etc.)
  • Keep your child out of play.
    It is so important that once a concussion has been identified that you allow the brain to rest and heal itself. DO NOT let your child return to play the day of the injury and until your child is cleared by a healthcare professional. Children who return to play too soon could be at risk for having a second concussion. Repeat or later concussions can be very serious as they can cause permanent brain damage, affecting your child for a lifetime.
  • Tell your child's coach about any previous concussion.
    Your coaches/PE teachers/school teachers should know if your child has had a previous concussion. Your child's instructors may not know about a concussion your child received in another sport or activity unless you tell them.

What role does the speech language pathologist play if my child has a concussion?
Sometimes after a concussion, people demonstrate cognitive problems as well as communication problems which can impair their ability to live independently. They may not be able to organize their thoughts; they may have a hard time processing new information; or they may have trouble finding the “right” words that they need to express themselves. Early on after a TBI, especially if the injury is more severe, the person may have trouble with swallowing, chewing, or forming basic word sounds.

The speech language pathologist is involved in evaluating and teaching speech, writing, reading, and expression skills aimed at both comprehension and communication. For a person with brain injury, the SLP may work on attention, organization, planning, and sequencing. They also specialize in teaching memory strategies - a classic problem in TBI.

How can you help your child return to school safely after concussion?
Children and teens who return to school after concussion may need to:

  • Take rest breaks as needed
  • Spend fewer hours at school
  • Be given more time to take tests or complete assignments
  • Receive help with schoolwork
  • Reduce time spent reading, writing, or on the computer

Talk with your child's teachers, school nurse, coaches, speech-language pathologist or counselor about your child's concussion and symptoms. As your child's symptoms decrease, the additional support can be removed gradually.

November 2016

Alternative Means of Communication

By Kathleen Wentland, MA, CCC-SLP
Speech Language Pathologist

What does alternative means of communication mean?
There are many ways to communicate besides speaking. Alternative means of communication are other ways to communicate that do not involve spoken speech. In this day and age of technology, texting is a common means of communicating that does not involve speaking. Using gestures, writing, body language, sign language and facial expression are also ways we communicate. When someone has difficulty speaking or is unable to speak, they may rely on another way to communicate.

What are communication devices?
Communication devices can be low or high technology. Examples of low technology communication methods include a communication board with words, pictures and/or letters. A person points to these words or pictures to communicate what they want. For example if someone is thirsty they can point to a picture of a glass of water. By pointing to words and pictures someone can convey what they need without speaking. If a person can spell, they can use an alphabet board to spell a message (just like using a keyboard when texting). High technology communication devices are computers that have voice output. When someone selects a word, picture or phrase the computer says it out loud. An advantage of these high technology devices is that they can be connected to the internet so people can communicate in social media like Facebook and through email. If someone has weakness in their hands and they are unable to point to the words or pictures, they can use a communication device with eye gaze or a head mouse. For eye gaze the person looks at the picture or word rather than pointing with their hands. For the head mouse a person has a dot placed on their forehead or glasses and they can pick the word or picture by moving their head. The devices are personalized to include family members' names and even include photographs of family and friends, places they like to visit etc.

Who uses a communication device?
Both children and adults can use a communication device. Adults who have diseases that affect nerves and muscles such as ALS (Amyotrophic Lateral Sclerosis) can develop speech that is not clear. Stroke patients can also have speech and language problems which make it difficult for them to talk. Children who have difficulty developing spoken speech may also benefit from a communication device. By using these devices children can also develop language skills.

What type of communication device does a person need?
A team of individuals is necessary to evaluate an adult or child's ability to use a communication device. A speech language pathologist typically evaluates the speech and language skills to determine the most appropriate device for an individual. An occupational therapist will assess motor skills and hand function to determine the best way an individual will select words and/or pictures on the device. A physical therapist assesses the person's posture and positioning for the most optimal use of the device.

How do I communicate with someone who uses a communication device?
Speech language pathologists provide training and support to the individual and their family during the evaluation period and after a person gets their device. It is really important that the environment supports the person who is using a communication device. Allow the person to start a conversation using their device, give them enough time to create their messages and make sure they get a turn in conversations especially in group situations. Being patient and making eye contact with persons using a communication device will help them feel connected to others and greatly improve their quality of life.

October 2016

Teaching Toddlers to Talk

By Caroline Hunter, MS
Speech Language Pathologist

oto---blog-4.jpgChildren are watching and learning from their environments and the adults around them all the time. Beginning to talk is an exciting part of development! When children are able to tell adults what they need and want, frustrations are reduced. Language development can also introduce more fun and interaction between parents and toddlers. There are many things that you can do to encourage your toddler's vocabulary to grow.

  • Motivate! Often, as parents, you can anticipate what your toddler needs or want before being told. Break this habit! Give children the opportunity to tell you what they want using words or gestures, such as pointing. If your child points at his or her cup, you can say “You want cup. Tell mommy cup.” If you know what your child wants, but he does not point, gently help him or her to point to the desired item. You may not always get a response, but this gives your child a chance to speak and teaches that words and communication have power!
  • Narrate your life. Talk about everything you are doing. Since children are not born with a vocabulary programed into their brains, they must be exposed and introduced to lots of language in early development. Try talking out things you do in front of your child. If you are in the kitchen, talk to your child about stirring, pouring, even things like hot and cold. If you are in a store, talk about all of the pretty colors of the toys or clothes. When playing, tell your child what you are doing (“Mommy is rolling the ball” or “I am building a tower”). If you are driving, discuss the things that you see around you. There are opportunities for teaching language all around us in ordinary things! Keep sentences short, so your child is more likely to understand. Though you may feel silly at first, this is giving your child exposure to many new words and ideas.
  • Read, read, read! Books are an excellent way to introduce language. They can be used for many different activities. You can read the words on the page, point out pictures, ask your child to name pictures, and ask your child to point things out to you. If your child is using some spoken words, have them “read” to you, making up whatever story they like. Picture walks are another interactive, easy activity. When doing a picture walk, look through the book with your child. Instead of reading the words on the page, make up a new story, or ask your child questions like “what do you think will happen next?” These activities promote practicing language.
  • Give choices. Instead of asking only yes/no questions, give your child two carefully selected options for things like what to wear, eat, play with, or watch (“Do you want ball or car?”). Remember to only offer things to your child that you feel comfortable with them having, for example, don't ask “cereal or cake?” for breakfast options if you do not want them to have cake. Show your child his options; this will give a visual cue that will help your child make a choice. If your child is having trouble pointing to or saying the name of the item that is clearly desired, help them to point. If the child still does not say the name of the desired item, reinforce the name by handing the item to your child and saying “Ball. You want ball! Here is ball,” reinforcing the target word. Giving options gives the toddler opportunities to communicate with you!
  • Talk to your child's pediatrician. If you suspect that your child's language is falling behind, your pediatrician can be your first, easiest to find resource. Make an appointment, and talk to your pediatrician about your concerns. In the days or even weeks leading up to your appointment, try to take note of the following:
    • The number of words that your child says when trying to convey a thought. Do they typically communicate using gestures (pointing, nodding, etc), single word phrases (“juice” or “ball”), or two word phrases (“mama, go” or “want cup”).
    • Does your child talk or babble when playing?
    • How many words does your child use overall? Consider names of family members and toys, action words (want, play, etc.), and expressions (uh oh, oh no, etc.)
    • Will your child imitate things that you ask them to say?

Thinking about these questions ahead of time will prepare you for your appointment and better assist your doctor in assessing your child. If it is determined that your child's language is behind, you may be referred to a speech-language pathologist for further testing.

September 2016

Five Facts about Modified Barium Swallow Studies

By Kimbrell Kimbrell Evans, MS, CCC-SLP
Speech Language Pathologist

oto---blog-5.jpgFirst of all, what is an MBSS?
An MBSS stands for “modified barium swallow study”. This test can also be called a VFSS, which stands for “videoflouroscopic swallow study”. An MBSS is an X-ray procedure performed in the Radiology department that looks at the anatomic structures in your head and neck area to make sure they are working properly while you are chewing, drinking and swallowing. An MBSS also determines whether or not you are aspirating, which is when food or liquid enters into your lungs, or “goes down the wrong way.”

Why do I need an MBSS?
The most common reasons for ordering this test are patient complaints/symptoms of:

  • coughing and/or choking while eating and/or drinking
  • increased time to complete meals
  • unexplained weight loss
  • globus sensation, the sensation that foods or liquids are stuck in your throat
  • uncontrolled reflux
  • known or suspected aspiration pneumonia
  • masses on tongue, pharynx or larynx
  • muscle weakness involving any of the anatomical swallowing structures
  • neurologic disorders likely to affect swallowing (i.e. ALS, Myasthenia Gravis, Cerebral Palsy, Multiple Sclerosis, CVA, TBI)

All of these are signs of dysphagia, the medical term for “trouble swallowing”

How does an MBSS work?
With an MBSS, you will be asked to sit in a standard chair in front of a big fluoroscopy camera that converts X-rays into video images. These images are recorded on a DVD for reviewing after the test is over. Your SLP will guide you through the exam and may ask you to change your body position to aid in swallowing. You will be given various amounts and consistencies of barium, a contrast material, to eat and drink while the SLP watches you in real time while the camera focuses in on your head and neck area. Barium does not taste bad, just a little chalky like liquid medicine. An MBSS does not take long and averages around 15-30 minutes from start to finish.

How can I prepare for an MBSS?
Although most radiology procedures that view the digestive tract at any point in the body restricts you from eating on the day of the procedure, this is not necessary with a MBSS and you may eat, drink, and take medications before your test. However, you may not want to eat too much before the test because you will be consuming barium during the procedure. You should also inform the SLP if you have any allergies, especially to iodinated contrast materials. Allergic reactions to barium are extremely rare. Also, please refrain from wearing jewelry, any metal objects or clothing (ex. a shirt with a large metal zipper or metal buttons) that may interfere with fluoroscopy. Lastly, women should always inform the SLP or X-Ray technologist if there is any possibility that they are pregnant.

How will I know if I “passed” the MBSS?
While this test is not “pass or fail”, you will most likely know how well you did on an MBSS immediately following. When the MBSS is over, the SLP will meet with you to discuss the results of the examination and will also send a finalized report to your referring physician. In some cases, follow up examinations are needed. Additional tests may be ordered if there is a questionable finding that may need clarification with additional views/imaging. Also, if necessary, your SLP will inform you if any follow up treatment is recommended (i.e. dysphagia therapy) or if you need to alter your diet to make it safer for you to swallow.

August 2016

Five Facts about Spoon Feeding

By Rachel Tyrone MS, CFY-SLP
Feeding Specialist

oto---blog-6.jpgIn first few months of life, babies learn all kinds of new and exciting skills. One of the most important skills is learning how to eat from a spoon. This is the beginning stages of moving away from the bottle and becoming an independent feeder. Here are 5 about spoon feeding that parents can use to aid in the transition from bottle feeder to independent feeder.

  • Good head, neck, and trunk alignment are crucial to eating. Always feed babies sitting fully upright in a high chair. You can prevent leaning over by using rolled up wash clothes on either side to help the child not tilt or lean over. This takes the stress off of the baby in trying to keep their body straight and eat at the same time!
  • oto---blog-7.jpgBeginning feeders learn best with flatter spoon. The deeper the spoon, the harder for the baby to pull the food off the spoon with their lips. Cleaning the spoon comes with continued practice! Do not scrape the spoon on your child's gum line. If your child is exposed to this frequent scraping, then he/she may become aversive later on.
  • Start off spoon practice with liquids (formula, etc) that are already familiar to your child. This will help the baby to not become too overwhelmed with a new flavor and new utensil. Move towards baby food as he/she becomes ready.
  • Meal time will be messy for the next few months of life. That is a wonderful thing! Babies learn by exploring their environment. If they are allowed to play with the baby food that is placed on their tray, then they can explore the texture. This will lead to the baby learning how to finger feed which will later lead to independent feeding! Wait until after meal time to clean/wipe your baby's face and use a gently tapping to clean up. Frequent rubbing of the face can lead to some aversive behaviors.
  • Last but not least do not force feed your baby. Force feeding can lead to aversions in the future. If you are having a hard time getting you baby to take baby foods from a spoon, try the following suggestions;
    • Dip your finger in the baby food and place it to the baby's lips. This will give them the flavor without overwhelming them with the spoon.
    • Gently tap the baby's lips and you show them (open your mouth wide and say ahhhh) to have them see what you are wanting them do
    • Don't let your frustrations show. If that feeding is not going well, let someone else try (try siblings if old enough!) or take a break and try again later.

My goal as a feeding therapist is to help all children develop a lifelong positive relationship with food! Whether that be by eating a full meal with a variety of textures or by having a few pleasure feeds a day. If your child is having a hard time with feeding, contact your pediatrician to discuss your concerns. A speech-language pathologist can assist you in helping your child be as successful of a feeder as possible!

July 2016