Case Study: Team Helps Patient Regain Hearing, Balance, and Autonomy After Cochlear Implant
Work Setting: Health Care Work Setting: Private Practice
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Summary
After recovering from meningitis, 72-year-old Jon continued to suffer from hearing loss, severe dizziness, and imbalance. Struggling with daily activities, he sought information from a team of professionals about a cochlear implant (CI) and help improving his daily life. After the implant surgery, the interprofessional practice team helped Jon navigate life with the CI and regain his balance.
Background
Jon, a 72-year-old man, suffered sudden bilateral hearing loss and dizziness after contracting meningitis approximately 6 months ago. His hearing loss has caused him to lose his job as a store clerk, has strained his personal relationships, and has made it difficult to schedule appointments and get medical information over the phone. His dizziness has resulted in multiple falls and makes daily tasks—such as walking, bathing, cooking, and driving—difficult. Jon is single and gets little support at home. His initial post-meningitis audiogram revealed undetectable pure-tone audiometric air conduction thresholds bilaterally across frequencies. He sought information regarding CI candidacy and help improving his daily life.
Meet the Team
The initial IPP team consisted of the following members:
How They Collaborated
The initial team of the neurotologist (team facilitator), audiologist, SLP, and PT met to review Jon’s history and concerns. The team decided to add a social worker to address issues related to loss of income and lack of at-home support. The team members also decided that when unanimous agreement isn’t possible, they would go with the majority opinion.
The team members developed a plan to assess Jon’s needs. They would each evaluate Jon in accordance with their specialties. Also, the social worker would determine Jon’s Medicaid eligibility, provide the necessary paperwork, and review the need for assisted living.
Following the conclusion of their assessments, the entire team met and discussed their findings. The audiologist reported that Jon has profound sensorineural hearing loss. Following an MRI, the neurotologist decided to pursue cochlear implantation in Jon’s left ear but to preserve Jon’s right ear. The neurotologist planned the surgery soon after the assessment. Both the audiologist and the PT found issues with Jon’s balance. The SLP reported normal scores on cognitive linguistic tests and thought that Jon could communicate by writing until his surgery.
After discussing the evaluation results, the team agreed upon a treatment plan. The social worker would help identify an assisted living facility for Jon. Afterward, the neurotologist would perform the CI surgery, and the audiologist would handle the implant’s activation, programming, and testing. The SLP would follow up by setting listening goals and auditory training for Jon. Also following the CI surgery, the PT would reassess Jon’s gait and balance and would start a rehabilitation program
Outcome
Three months after Jon’s CI surgery, sound-field warble-tone thresholds improved from being undetectable to measuring at 30–35 dB HL in the left ear. On his hearing in noise test, Jon recognized 70% of words correctly.
Jon continued to attend weekly auditory training sessions and made improvements on phoneme, word, and sentence recognition. Jon was initially completing daily telephone practice and was experiencing increased success in using the telephone with familiar listeners. However, after a while, he stopped working on his home auditory training program. He also continued to participate in biweekly physical therapy and can now walk with limited assistance. Although improved, his balance and gait remained barriers to independence. In separate conversations with the team members, Jon expressed a desire to move home and out of assisted living.
The team discussed Jon’s lack of follow-through with the home telephone practice. Jon mentioned to the PT that he is more focused on walking and does not see the value of the telephone practice. The team discussed how to reiterate the importance of all facets of his educational program. In particular, the SLP, audiologist, and PT thought of ways to reinforce the other team members and increase Jon’s compliance.
Ongoing Collaboration
The team continued to check in every other week. They monitored Jon’s response to treatment and reviewed his candidacy for CI in the right ear. Jon continued speech-language pathology and physical therapy services to address his listening, balance, and gait goals. Jon’s goal continues to be a return to living independently at home.
