TAP-Clinical-Best-Practice-Guidelines

1. The Audiology Place | Best Practice Guidelines Clinical Best Practice Guidelines The Audiology Place Independent Audiology | Northern Beaches, Sydney The Audiology Place 12/14 Starkey Street, Forestville NSW 2085 Phone: 02 9315 8327 www.theaudiologyplace.com.au Introduction The Audiology Place is an independent audiology clinic on Sydney's Northern Beaches, founded and led by Dr Signe Steers. With nearly 20 years of clinical experience, Dr Steers holds a Bachelor of Speech and Hearing Science, a Masters in Clinical Audiology from Macquarie University, and a Doctor of Audiology from A.T. Still University in Arizona. This document outlines our clinical best practices across five core service areas. As an independent clinic—not owned by any hearing aid manufacturer or retail chain—we are free to recommend solutions based purely on what is right for each patient, not what earns the highest commission. Our philosophy: "From Twinkle to Wrinkle"—comprehensive hearing care for all ages, from infants to older adults, delivered with transparency, clinical rigour, and genuine care. For more about our clinic and approach: About The Audiology Place 1. Hearing Aid Selection Best Practice Principles Hearing aid selection at The Audiology Place is guided by independence, evidence, and individualisation. We fit all major brands and recommend devices based on the patient's hearing profile, lifestyle, dexterity, cosmetic preferences, and budget—not manufacturer incentives. Comprehensive Assessment First Before any hearing aid discussion, every patient receives a complete diagnostic workup: • Detailed case history and lifestyle discussion • Otoscopy (visual ear examination) • Tympanometry and acoustic reflex testing • Pure tone audiometry including extended high-frequency testing • Speech audiometry in quiet and in noise • Otoacoustic emissions (OAE) where indicated Real-Ear Measurement Verification 12/14 Starkey Street, Forestville NSW 2085 | theaudiologyplace.com.au | Page 1

2. The Audiology Place | Best Practice Guidelines All hearing aid fittings are verified using real-ear measurements (REM). This is non- negotiable. REM confirms that the sound reaching the eardrum matches prescription targets—ensuring soft consonants like f, s, t, and k land exactly where the brain expects them. Without REM, fittings are educated guesses that frequently under-amplify critical speech frequencies. Selection Criteria Device recommendations are based on: 1. Hearing loss severity and configuration: Mild losses allow discreet RIC/ITE styles; severe-to-profound losses require power BTE devices with custom earmolds 2. Lifestyle and listening environments: Active social lives warrant premium noise management; quieter lifestyles may be well-served by entry-level technology 3. Connectivity needs: iPhone users benefit from MFi-compatible aids; Android users should consider Phonak's universal Bluetooth or ASHA-compatible devices 4. Dexterity and vision: Rechargeable options eliminate battery handling; larger controls suit those with reduced fine motor skills 5. Budget and funding: HSP eligibility, private health cover, NDIS, or private purchase Follow-Up Protocol New hearing aid fittings include scheduled follow-up appointments for fine-tuning, acclimatisation counselling, and verification that real-world performance meets expectations. We provide coaching on daily use, cleaning, troubleshooting, and connectivity setup. Related Resources • • • • • Hearing Aids – Independent Audiologist Best Hearing Aids for Speech Clarity Which Hearing Aids Use AI in 2025? Best Hearing Aids for Musicians CROS and BiCROS for Single-Sided Deafness 2. Misophonia Assessment and Treatment Understanding Misophonia Misophonia ("hatred of sound") is a neurological and emotional condition in which specific sounds—usually soft, repetitive, and human-generated—trigger intense adverse reactions. Common triggers include chewing, sniffing, pen clicking, throat clearing, and tapping. Research suggests misophonia may affect up to 15% of the population, though severity varies widely. The condition involves hyperconnectivity between the auditory system and emotional processing centres of the brain—particularly the anterior insular cortex. The sound isn't louder, but the nervous system perceives it as threatening. Misophonia is not caused by hearing loss, though it can occur alongside tinnitus or hyperacusis. Best Practice Assessment Our 90-minute initial consultation for suspected misophonia includes: 1. Comprehensive case history: Documenting trigger sounds, onset, progression, and impact on daily life 12/14 Starkey Street, Forestville NSW 2085 | theaudiologyplace.com.au | Page 2

3. The Audiology Place | Best Practice Guidelines 2. Full diagnostic hearing assessment: Ruling out hearing loss, tinnitus, hyperacusis, or auditory processing disorder 3. Loudness discomfort level (LDL) testing: Measuring tolerance thresholds across frequencies 4. Speech-in-noise testing: Evaluating how the brain filters sounds in complex environments 5. Validated questionnaires: Quantifying severity and emotional impact Treatment Approach Treatment is multidisciplinary and tailored to individual needs: • Sound therapy: Using neutral background sounds to reduce the impact of trigger sounds and retrain auditory processing • Education: Understanding the neurological basis helps patients reframe their experience and reduces fear responses • Coping strategies: Practical techniques for managing reactions in triggering environments • Psychology referral: Cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) when appropriate • Avoidance management: While avoiding triggers is tempting, it can worsen sensitivity—we teach balanced approaches Key message for patients: You are not imagining it. You are not "too sensitive." Misophonia is real, and it can get better with the right treatment and support. Related Resources • • Misophonia Treatment: It's Real. It Can Get Better. Hyperacusis and Misophonia 3. Tinnitus Assessment and Treatment Understanding Tinnitus Tinnitus is the perception of sound—ringing, buzzing, humming, hissing—without an external source. It affects 15–25% of adults and is not a disease but a symptom indicating changes in the auditory system. The most common cause is hearing loss: when the brain is starved of external sound input, it "turns up the gain," which can manifest as tinnitus. Best Practice Assessment A comprehensive tinnitus assessment extends beyond standard audiometry: • Standard and extended high-frequency audiometry • Tympanometry and middle-ear assessment • Otoacoustic emissions (outer hair cell function) • Tinnitus pitch and loudness matching • Minimum masking level testing • Residual inhibition measurement • Validated questionnaires (THI, TFI) to assess severity and functional impact 12/14 Starkey Street, Forestville NSW 2085 | theaudiologyplace.com.au | Page 3

4. The Audiology Place | Best Practice Guidelines Treatment Options There is no universal cure for tinnitus, but evidence-based management significantly reduces its impact: 1. Hearing aids: For patients with hearing loss, properly fitted amplification is often the single most effective intervention—restoring ambient sound reduces the brain's need to generate phantom sound 2. Sound therapy: White/pink noise, nature sounds, or fractal tones delivered via hearing aids, apps, or external devices 3. Education and counselling: Understanding tinnitus mechanisms reduces fear and helps the brain habituate 4. CBT/ACT: Cognitive behavioural therapy or acceptance and commitment therapy for emotional and psychological impact 5. Sleep support: Evening sound enrichment and sleep hygiene strategies 6. Medical management: Referral for underlying conditions (ear infection, TMJ, vascular issues) Hearing Aids for Tinnitus Key features when selecting hearing aids for tinnitus patients: • Clean, precise high-frequency amplification • Built-in tinnitus sound therapy programs (adjustable noise generators) • Open-fit RIC style for comfort and natural sound • App control for on-the-fly adjustments • Rechargeable convenience (removes barriers to daily wear) Related Resources • • • • • Tinnitus Treatment Best Hearing Aids for Tinnitus Can Tinnitus Be Cured? What Is Tinnitus? Causes, Symptoms, and Treatment Options Tinnitus Getting Worse? What It Means and How to Get Your Calm Back 4. Paediatric Hearing Services Philosophy Healthy hearing in childhood underpins speech, language, learning, and social development. A child who cannot clearly hear the teacher, friends, or family faces compounding challenges. Early identification and intervention are critical—the brain is still developing, and outcomes are significantly better when issues are addressed early. Assessment Capabilities We test children from 6 months of age using age-appropriate techniques: • Visual Reinforcement Audiometry (VRA): 6 months to ~3 years—child turns toward a visual reward when hearing a sound • Play Audiometry: ~3 years and up—child performs an action (drops a block, moves a peg) when hearing a tone 12/14 Starkey Street, Forestville NSW 2085 | theaudiologyplace.com.au | Page 4

5. The Audiology Place | Best Practice Guidelines • Otoacoustic Emissions (OAE): Quick, non-invasive inner ear function test—ideal for babies and non-verbal children Tympanometry: Middle ear function testing for fluid, glue ear, or eardrum mobility issues Acoustic reflex testing: Brainstem pathway assessment Auditory Processing Disorder (APD) evaluation: For school-aged children (typically 7+) who pass standard tests but struggle to follow instructions in noisy environments • • • Child-Friendly Environment Our sound-treated testing rooms allow children to be tested with a parent present—no isolating booths. We use playful, engaging methods tailored to each child's developmental stage, ensuring they feel safe and curious rather than anxious. When to Refer for Paediatric Assessment • • • • • • • • • Delayed or unclear speech beyond expected age Frequently says "what?" or seems inattentive Difficulty following verbal instructions Teacher or caregiver concerns about listening or learning History of frequent ear infections or glue ear Family history of hearing loss Prematurity or complications at birth Before starting speech therapy (to rule out hearing as a factor) Pre-ENT screening before grommet surgery Auditory Processing Disorder (APD) APD is a breakdown in how the brain processes sound—not a hearing problem. Children with APD pass standard hearing tests but struggle to decode, filter, or interpret what they hear, especially in noisy or fast-paced environments. They may "switch off" in classrooms, mishear instructions, or struggle with oral language while thriving with written/visual information. We offer comprehensive APD testing for school-aged children (typically age 7+), working alongside GPs, speech pathologists, psychologists, and educators to develop individualised care plans. Medicare Rebates for Children Hearing assessments for children may attract Medicare rebates (up to $106 in some circumstances) when referred by a medical practitioner. As a member of Audiology Australia, we can process eligible claims. Related Resources • • • • • Paediatric/Children's Hearing Tests Sydney Children's Hearing Tests When Should You Get a Hearing Test for Your Child? Understanding Auditory Processing Disorder in Children Auditory Processing Disorder 12/14 Starkey Street, Forestville NSW 2085 | theaudiologyplace.com.au | Page 5

6. The Audiology Place | Best Practice Guidelines 5. Ear Wax Removal (Microsuction) Method of Choice: Microsuction Microsuction is the gold standard for ear wax removal. Using a special microscope or loupe for magnified visualisation, and a low-pressure medical suction device, wax is gently removed without inserting anything into the ear. This is safer than syringing (irrigation) because nothing goes in—only out. Advantages of Microsuction • Safe for perforated eardrums: No water introduced, unlike irrigation • Safe for grommets: Can be performed on children with ventilation tubes • Precise and controlled: Direct visualisation throughout the procedure • No moisture: Ideal for those prone to ear infections or with sensitive ear canals • Suitable for hearing aid users: Hearing aids can block natural wax migration; microsuction clears without moisture that could damage devices • Quick: Usually 15–30 minutes for both ears Pre-Appointment Preparation We recommend using wax-softening drops or spray (such as CleanEars olive oil spray) for 3–4 days before the appointment. Softened wax is easier and more comfortable to remove. If wax is not softened and cannot be safely removed, a follow-up appointment may be required—the consultation time is still billable. What to Expect 1. Visual examination with video otoscope (you can see your own ear canal) 2. Assessment of wax type, location, and ear canal/eardrum health 3. Gentle microsuction removal under magnification 4. Post-procedure inspection confirming clear canal and healthy eardrum 5. Advice on preventing future buildup When to Refer for Wax Removal • Muffled or blocked hearing • Sensation of fullness in the ear • Tinnitus or ringing that may be wax-related • Itching or discomfort • Hearing aid feedback or blockage • Before a hearing test (to ensure accurate results) Red Flags – Urgent GP/ENT Referral • Sudden hearing loss in one ear • Severe ear pain, discharge, or bleeding • Dizziness with vomiting, or facial weakness • Foreign object in a child's ear that cannot be safely visualised Related Resources • Ear Wax Removal Microsuction – Sydney Northern Beaches 12/14 Starkey Street, Forestville NSW 2085 | theaudiologyplace.com.au | Page 6

7. The Audiology Place | Best Practice Guidelines • • • • Microsuction Earwax Removal How to Safely Remove Ear Wax Ear Wax Removal Before and After Syringing vs Microsuction: What's Safest? Quick Reference: Service Overview Service Hearing Aids Key Differentiators Independent, all brands; real-ear measurement verification; extended high-frequency testing 90-min assessment; multidisciplinary treatment; sound therapy; psychology referral pathways Holistic approach; hearing aids with masking; pitch/loudness matching; counselling; lifestyle support Testing from 6 months; VRA, play audiometry, OAE; APD assessment; child-friendly rooms Microsuction under magnification; safe for perforations/grommets; video otoscopy Best For Patients wanting unbiased recommendations and precision fitting Patients with intense reactions to specific trigger sounds Misophonia Tinnitus Patients with ringing/buzzing impacting sleep, concentration, or wellbeing Paediatrics Children with speech delays, learning difficulties, or listening concerns Blocked ears, hearing aid users, patients wanting gold-standard gentle removal Wax Removal Contact The Audiology Place Address: 12/14 Starkey Street, Forestville NSW 2085 Phone: 02 9315 8327 Website: www.theaudiologyplace.com.au Book Online: Contact Us Document version: December 2025 | Led by Dr Signe Steers, Doctor of Audiology 12/14 Starkey Street, Forestville NSW 2085 | theaudiologyplace.com.au | Page 7