Tag Archives: speech & hearing sciences

The BiPolar is Catching

30 Jan

I’m excited and happy and stress-free.  Then I’m anxious, stressed-out, and guilty.  That’s my scene as of late, and I’m surprised Cool hasn’t slipped me some of her meds.  Oh that would require her to remember to take them heself. . .  All joking aside, I think I got on some sort of [sleep-disruption–>caffeine–>sleepless] spiral.  You know how those two feed each other.  I have to get it straightened out!

Also, blogging every day during school is too tall of an order for me.  There is just not enough time in a day for all the things I want to accomplish.  I will be relieved when January is over so I can legit break-the-chain and have a few rest days.  Also, it’s been difficult to stick to goals/motivation/trasnsformative/resolution topics only.  I may have stepped a toe on the line a time or two, but I did it for the most part.

Maybe I’ll do another list for time’s sake:

*It has snowed a bunch in the last couple days.

*My 4×4 (the physical shifter) will no longer go into one of the 4×4 settings.  It will now only do the low-speed if I want 4×4 at all.

*This makes driving stressful–it’s either get pushed around by kamikazi-crazies annoyed I’m under the speed limit, or slide around/get stuck.

*I’m nervous about the potential cause–are we talking a few bucks for a shifter-fork-thingy or over a thousand snow(before labor) for a new transmission?!  I cannot be without my car!

*Cool can’t either.  I had to brave the evening commute reckless drivers and take her to work for the last 2 days.  Then pick her up at midnight.  Before getting up in the 4AMs to go to my own job/school.

*Sometimes I feel great about studying.  Sometimes I feel lazy/awful and extremely guilty.  It has been very hard for me to find the motivation to push through with what I feel is the appropriate amount of effort.

Fall finals 123*I’m not sure if I’m just nervous because everything has been school, study, work, sleep, repeat in the past and now I’ve added some fitness and recreation–or if I am in fact.  Slipping.

*I’m trying to study very hard but in short bursts, then be kind to myself afterwards.  Hopefully, things will balance.

*I went to my school’s writing center for help on my CV–and the dude didn’t know the story.  Didn’t know about CVs, had a 2 page personal resume, didn’t understand my program or what the standards for my applications might be–and wasn’t affiliated with my school or our partner school.

*I hate going to things where I feel my time would have been better spent elsewhere–this goes for 5 hours of no appointments at work too.  All I can think is–what a waste.

*Now, I don’t know where to turn for CV guidance.  The professors in my program would be most helpful as a resource, because they’ve written and read CVs, know what schools are looking for, and sort of know me–but I really don’t want to deal with their major meeting-aversion stuff.

*Are these bullet-points or mini-paragraphs?  Am I saving ANY time?

*Let’s see.  I intended on writing a 2013 countdown type post about the top albums put out last year.  But I DMB africawanted to post in New Year’s Eve–as is customary.  I’m not going to be able to finish it in January even–maybe next month?  Maybe why bother?

*We made tacos for lunch today.  I thought they were one of my ultimate favorites.  BUT for whatever reason Grocery Outlet never, never, never has taco seasoning, and it’s not worth going to another store for that item alone.  So we seasoned our own beef.  Who knew?  It’s the taco packet that makes or breaks that meal for me?  I was severely disappointed.

*I’m probably not supposed to say anything about this because of super-scary HIPPA laws, but I transcribe some utterances for my independent study.  And I’m excited I have one with an African-American English Dialect that is already humorous and I’m excited to begin on it.  Secondly, I think my tiny-tron of this morning has a BM at the end of the recording.  I had to transcribe all utterances and noises–I was mortified.

*I’ll write a for-real post tomorrow.  Hopefully something to see where I am on January/2014 goals and set up a plan for February’s focus.

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SLP back-up Goal Essay [+ a little randomness]

13 Dec

My day was OK.  I suppose I’m never happy satisfied at the end because there is always so much I want to accomplish and only so many hours (and energy) in which to do it.  I made it to work by 5:30AM and cheerfully hustled around until 10AM.  Though going in early like that makes me tired, I think of it as relatively easy money.  It’s time that I can clean, restock, care for the clinic cats, participate in patient care–and not have the social aspect that can drag me down.  Today, the social aspect was agreeable, but it’s the thing that has the potential to upset me most.

I don’t don’t where I was going with that.  I was writing to say I wish I outlined more of my Audiometry.  I did pinna 4do a LOT.  I’m not sure how much, because this time I’m taking a more skitzophrenic approach.  I have a hard time getting through an entire textbook in 1 month, and it’s impossible to guess which chapters the syllabus will address first.  So rather then going linear, or trying to guess the most important chapters, I’m writing headings, then defining, then reading and outlining until my brain gets tired.  That way I’m hitting a lot of chapters, at least familiarizing with most of them, and never getting too fatigued over one subject area.  I like it better.  And if I don’t finish–I’ll at least have skimmed most of the things.

I’m not very pleased that this left little time for future grad school application procedures or scholarship essays.  I have the weekend, and maybe I’ll put those up front more.  The scholarship app is due in a mere 2 weeks, so I need to really get a lot more serious about it.  Below, is one of the topics I’m going to work on.  Here’s a very rough outline of what I’m thinking about (in purple):

Oh, and I ran/hiked on the treadmill today, and that feels great.  If I’m not too sore I’ll do some tomorrow too.

-include vet observation & diagnostics

Talk about watching the equine endoscopies and how interesting the diagnostic processes were to me.  Also mention how I have taken, developed, and viewed radiographs for that last 13.5 years in small animal veterinary hospitals.

-why am I interested in this?

I’m interested in dysphhagia because it blends my love of cuisine with my compassion for others.  I love food and can’t imagine the joy that is sheared away if you were not able to enjoy eating or had a fear of choking.  I would enjoy using my creativity to come up with delicious, but practical foods for people who are having difficulty eating.
-who do I want to help?

I want to help any age person that is frustrated with changing their diet, eating a limited vareity of foods, or has a fear of eating things they enjoy because of their health.  Sharing my passion for food and coming up with meals the patient not only can adjust to, but is excited to eat are my career goals.

Key vocab words:

-multifarious-having many different parts, elements, forms; numerous & varied; highly diverse

-abate-reduce in amt degree sevrity

-anodyne-  something that calms/soothes pain

-ardor-intense & passionate feeling

Writing plan options to incorporate the above:

-Tell about the best meal of my life, at Elemental and how everyone should be able to enjoy food.

Everyone knows on your birthday you get a special meal of your choice.  I knew I would only live in a real city for one year of my life, so I chose a restaurant that embodied the Seattle mentality-Elemental.  The location was right off beautiful Lake Union.  Situated in a complex of condos, the restaurant was so nondescript, without even a sign that my dining companion and I had to ask the UPS driver where to go.  We entered the stark white room and lingered by the front door, not sure of the procedure.

After being asked about allergies, our first plate came looking like it had been prepared on The Food Network.  The portions were tiny, yet elegantly garnished.  The smells emanating from the dish ensured freshness of ingredients, the colors vibrant.  The textures were a varied tapestry of deliciousness, with crunchy sweetness, smooth richness, and fluffy tartness.

-Describe a special occasion and show how many holidays and events revolve around food.

What would Independence Day be without a bar-b-que?  The smell of the hotdogs, and bubbles against my tongue from a cold beer help make the occasion special.  

ribs, brats, hot dogs; beer

-Talk about my mom’s Indian fry bread and tacos and explain that food is often foundational to retaining culture.

snake dance 4I have enjoyed fry bread sopping with honey and butter since I can remember.  Unfortunately, because of all the poverty on the Flathead Reservation that contains my people, there is not a lot of Salish pride.  As a result, many of the traditions have been lost to assimilation and survivalist mentalities.  One stronghold on the culture, that remains is our food.  Early settlers may have forced Native Americans to burn their regalia, stop dancing, and neglect their language, but they could not take away our food.  The recipes were memorized, and handed down from tribal elders, to mothers, and now to me.  It is a link to my heritage that I would not want to imagine losing.  Thinking about a life where I could not partake in the sticky, fluffiness that is Indian Fry Bread seems bleak.  That is why I want to work with dysphagia patients–to help them retain and enjoy the foods central to their culture.



11 Dec

While I’m in Stellar-Super-Schooling mode, it’s all about getting $hit done this year, before break is over.  Last year, Spring semester began before I knew it and I did not even come close to getting things finished started.  That’s no way to begin, and I was tired before the real crushing blows of course-work hit me.  So by summer, I was completely burned out.  I will AVOID that this year.  Step 1)  Don’t let work take advantage and sap that extra time.  Step 2)  Start.  That’s all.  Starting early just allows me to break things into smaller, more managable portions.

I typed chapter headings for Audiometry chap 1-6 today.  I’ll define terms tomorrow.  Then, I’ll just fill in the marblehigh points after that–I have to remember the outlining is merely to focus my attention–not enable me to submit a draft to publish my OWN textbook.

Here is info from Pudue on writing a Curriculum Vitae.  I have no idea how to write one, or when I was supposed to have learned this skill.

1)  goal of a CV is quite specifically to construct a scholarly identity

aa)  your CV will need to reflect very specifically your abilities as a teacher, researcher, and publishing scholar within your discipline

bb)  One of the most important things to remember when working on your curriculum vitae is that there is not one standard format.

iii)  instead of writing, “I taught composition for four years, during which time I planned classes and activities, graded papers, and constructed exams. I also met with students regularly for conferences,” you might write, “Composition Instructor (2000-2004). Planned course activities. Graded all assignments. Held regular conferences with students.”

cc)  If, however, you have a lot of very short phrases, breaking them up into bulleted lists can leave a lot of white space that could be used more efficiently. Remember that the principles guiding any decision you make should be conciseness and ease of readability.

2.)  Your CV should include your

aa)  name and contact information,

bb)  an overview of your education,

iii)  Typically, the first item on a CV for a job candidate directly out of grad school will start with the candidate’s education listed in reverse chronological order.

cc)  your academic and related employment (especially teaching,editorial, or administrative experience),

dd)  your research projects (including conference papers and publications), and

ee)  your departmental and community service.

ff)  You should also include a reference list, either as part of your CV, or on a separate page.

Sidenote:  determine both what the jobs that you are interested in require and where your strengths lie. When determining what comes after your educational credentials, remember that the earlier in your document a particular block of information comes, the more emphasis you will be placing on that block of information. Thus, the most important information should come first.

3)  CVs, however, often run to three or more pages.

aa.)  Remember, however, that length is not the determinant of a successful CV. You should try to present all the relevant information that you possibly can, but you should also try to present it in as concise a manner as possible.

-OK, the problems I have with that is A)  I need to look at examples for formatting purposes.  B)  As an undergrad in a new field I have ZERO experience, which will leave my CV pretty short.  C)  The CV seems to be for professors–like people who already HAVE masters and doctorate and are looking for employment.  And I am just trying to enter grad school. . .

Well, That Backfired

5 Dec

I went to bed later then normal, and of course my neighbors blasted music and shoited from 3:30AM to 4:20AM.  Drugs or just inconsiderate?  Hard to tell.  They were louder then the fan we use to mask noise though.  I can’t wait until I can pay more for a place and weed out some of these losers.  Unfortunately, now I can’t actual-sleep, but have no focus due to tiredness.  I thought maybe if I wrote some study things here it would engage my brain and focus more.

flashcards 002

Educational Audiology:

-still ID, dx, help with amplification & ALD, and refers.  (Clin. AuD dx balance issues as well, mng meds, & aud rehab)

—educationally relevant eval

—describe audiogram to school, parents, P

—refer other med conditions, comm issues, & educational concerns to appropriate prof.

—eval classroom/enviro acoustics & makes rec. for improvements

—ensure fit & funct. device & ALDs

—advocates for P; ensure services

—teach about impact HL & HL prevention

—make sure prof. std met & support staff properly trained

—educational accomodatios

—eval comm

—empower P; ensure daily living needs met

->assist is classroom/program placement

->facilitate programs for device & rehab

->calibrate & maint equip.

->assess CAPD

Cocktail Effect

Psycho-Social Considerations:

-early dx allows parents to go through grief stages (shock, denile, negotiation, depression, acceptance) faster

-children w/disabilities tend to be spoiled/indulged (decreased self worth/entitled)

-parental depression–>more stressed household, worse performance; P @ risk for cognitive, emotional, & comm impairments = lang dev promoted w/parental attention/sensitivity & emotional attachments

-good parental coping–>improved cognitive flaxibility, better prob solving skills, better social adjustment, less impulsive behavior, _______)

-kids w/HL tend to be:  more aggressive, complainy, social issues (isolated, depressed, low social acceptance/teasing); less social confidence to express feelings & present arguments

*peer rejection is associated w/worse academic performance & vice versa

Tinnitus Stats:

-30 to 60 million (10-20) US have it

-15 mil have clin. sig. (5%)

-1.5 mil (less than 1%) have debilitating

-75% of AuDs practice might see P w/some degree

-40% of P w/tinnitus also have hyperacusis

-of patients with hyperacusis, 90% have tinnitus

-10-30% kids have tinnitus

-30-60% HL kids have tinnitus

fractal 218

Causes of Tinnitus:

1]  otologic-noise induced, presbycusis, OM

Meiner’s DZ, cerumen impaction, hair against TM

2]  cardiac (pulsitile)-anything that causes tubulent blood flow (hypertention, shunt,________)

3]  somatic-TMJ, whiplash

—-head trauma, MS, migrane , stapedius/tensor tympani muscle/tendons

4]  chronic = central aud. prob

—-neural plasticity (reduced inhibition unmasks hyper-excited resp)

—-infectious (lymes, syphilis, MENNINGITIS)

—-diabetes, allergies, anemia, T4

5]  ototoxic

Mom's camera 083


-BPPV is the #1 cause for vertigo.  BUT w/in 6 wks the calcium carbonate crystals (otoconia) that are causing the disturbance by bumping into cupula w/in the S.C.C. spontaneously resolve.  1]  why do they resolve?  I’m thinking it has everything to do with chemistry here.  2]  do they resolve under specific conditions?  And what are those circumstances.  3]  how do you replicate that condition in people that don’t naturally have it (where labyrinthectomy might be req)?

A]  http://www.library.nhs.uk/booksandjournals/details.aspx?t=Calcium+Carbonate%2Fanalysis&stfo=True&sc=bnj.ovi.amed,bnj.ovi.bnia,bnj.ebs.cinahl,bnj.ovi.emez,bnj.ebs.heh,bnj.ovi.hmic,bnj.pub.MED,bnj.ovi.psyh&p=5&sf=srt.publicationdate&sfld=fld.title&sr=bnj.ebs&did=2002115137&pc=13&id=80

We present a theoretical discussion on the biochemistry of Benign Paroxysmal Positional Vertigo (BPPV) based on the knowledge that the otoconia are calcium carbonate crystals and that their migration into the posterior semicircular canal is responsible for BPPV. Our principal focus has been on the factors that could affect the solubility of the calcium carbonate crystals in endolymphatic fluid and hence their dissolution. We suggest two factors that could affect the dissolution of the otoconia: the concentrations of carbon dioxide and calcium ions in the endolymphatic fluid. Calcium carbonate is insoluble in water or in an aqueous medium at pH 7.4, but it can be solubilized by its conversion to calcium bicarbonate in the presence of an excess of carbon dioxide in the form of carbonic acid. The role of carbon dioxide in body metabolism is discussed, including its function in calcium transport and in the primary buffer system controlling blood pH. The second obvious factor influencing dissolution of the otoconia in the endolymphatic fluid is the concentration of calcium ions in the fluid. The role of calcium in body metabolism is discussed briefly including four factors that affect its concentration in the peripheral circulation. First, the parathyroid glands control the level of calcium ions in the peripheral circulation and respond to low levels by causing release of calcium from the bone structure into the circulation. Other factors are diets high in calcium and vitamin D and soluble calcium supplements such as calcium citrate combined with vitamin D. Finally, the effects of diuretics that cause loss of fluid with consequential loss of calcium from the peripheral circulation are mentioned. In view of these considerations, one can speculate that the dissolution of the otoconia debris in the posterior semicircular canal would be favored by a high concentration of carbon dioxide or carbonic acid and a low concentration of calcium ion in the endolymphatic fluid of the posterior semicircular canal. Hypothetically, one also can speculate that if these conditions could be made to prevail, then the occurrence or reoccurrence of benign paroxysmal positional vertigo or BPPV could be prevented.

B]  http://www.jbc.org/content/285/28/21724.full

Otoconia are subjected to morphological and compositional changes by diverse environmental and genetic factors. Prolonged exposure to medications such as streptomycin results in formation of abnormal giant otoconia (1314). Age-related otoconia degeneration is highly abundant and increases the risk for free floating particles (15). Dislocation of otoconia or their broken particles outside their native position can lead to severe vestibular dysfunction in humans. Benign paroxysmal positional vertigo (BPPV) patients suffer from severe dizziness. This clinical condition affects up to 9% of the population older than 65 years of age (16). The phenotype manifests itself when otoconia migrate to one of the cristae (cupulolithiasis) or the semicircular canals (canalithiasis) and hinders its mechanical sensory properties (17). BPPV is one of the major clinical conditions attributed to dislocated otoconia.

Using Abstracts for Sources

27 Nov

As I explained to Cool, using the interbet to find legit, peer-reviewed journal articles for a school paper–is like trying to write a 10 page research paper using only the outside cover of all the books in our personal library.  You look for certain, specific information, but can only see the back general description of the book’s contents.  That’s what I’m doing now.  But it’s still better then putting on clothes and trying my luck at a physical library.  I’m not sure if my school’s library is open, or what the hours of operation might be.  And I’m fairly certain the city library doesn’t have anything as specific as I require.  So here’s my list (in progress) of the facts I need and their journal sources.

Introduction:  One broad paragraph summarizing your topic (no more than 1/3 of the page) the style is similar to a journal abstract.

-J Ramsay Hunt, who described various clinical presentations of facial paralysis and rash, also recognised other frequent symptoms and signs such as tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus. He explained these eighth nerve features by the close proximity of the geniculate ganglion to the vestibulocochlear nerve within the bony facial canal. Hunt’s analysis of clinical variations of the syndrome now bearing his name led to his recognition of the general somatic sensory function of the facial nerve and his defining of the geniculate zone of the ear. It is now known that varicella zoster virus (VZV) causes Ramsay Hunt syndrome (4).

Ramsay Hunt syndrome (RHS) type 2 also known as herpes zoster oticus (20).

-Herpes zoster oticus (HZO) is a viral infection of the ear and when associated with acute facial paralysis is known as Ramsay Hunt syndrome (?).

-The strict definition of the Ramsay Hunt syndrome is peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) or in the mouth. J Ramsay Hunt, who described various clinical presentations of facial paralysis and rash (14)

Population:  Discuss the population affected by the pathology such as: men, women, race

-children are not usually affected (9)

-The overall annual incidence of zoster was 4.97 cases per 1000 people, with women having a significantly higher incidence than men (5.20 per 1000 vs. 4.72 per 1000, p < 0.001). The incidence increased stepwise with age, with 5.18 cases per 1000 in people 40–50 years old, 8.36 in those 50–60, 11.09 in those 60–70, and 11.77 in those above 70 years old. The estimated lifetime risk of developing herpes zoster was 32.2%. Zoster-related hospitalizations and medical cost per patient increased with age. In conclusion, about two-thirds of Taiwan’s zoster cases occur in adults older than 40 years old and about one-third of the population would develop zoster within their lifetime (2)

-VZV is found in a worldwide geographic distribution but is more prevalent in temperate climates (7).

-Herpes zoster has been described in all age groups, and lifetime risk is estimated to be 10%-20%. The incidence of herpes zoster is about 150-300 cases per 100 000, with the incidence dramatically increased in patients older than 60 years [Ragozzino MW, Melton LJ III, Kurland LT, et al. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore) 1982;61:310-6.].6 Ramsay Hunt syndrome is much less common, approximately 5 cases per 100 000 population; nevertheless, it is the second most common cause of atraumatic facial paralysis [Adour KK. Otological complications of herpes zoster. Ann Neurol 1994;35(suppl):S62-4.].7 The incidence of herpes zoster in patients with peripheral facial palsy is 4.5%-8.9%. Compared with Bell palsy, Ramsay Hunt syndrome generally has more severe paralysis at onset, and patients are less likely to recover completely (18).

-occurred more often in patients older than 50 years. Of the patients with partial facial nerve function at disease onset, 66% recovered completely, whereas only 10% of those who presented with complete loss of function recovered complete (18)

Time of onset:  Discuss whether the pathology is congenital or acquired or delayed in onset

-In the only prospective study of patients with Ramsay Hunt syndrome, 14% developed vesicles after the onset of facial weakness. Thus, Ramsay Hunt syndrome may initially be indistinguishable from Bell’s palsy (4).

-His mother had been infected with chickenpox during the second trimester of pregnancy (9).

-Compared with Bell’s palsy (facial paralysis without rash), patients with Ramsay Hunt syndrome often have more severe paralysis at onset and are less likely to recover completely (14).

Etiology:  Discuss whether the etiology is genetic or environmental or idiopathic

-Varicella-zoster virus (VZV) is a ubiquitous human alphaherpesvirus that causes varicella (chicken pox) and herpes zoster (shingles). Varicella is a common childhood illness, characterized by fever, viremia, and scattered vesicular lesions of the skin. As is characteristic of the alphaherpesviruses, VZV establishes latency in cells of the dorsal root ganglia. Herpes zoster, caused by VZV reactivation, is a localized, painful, vesicular rash involving one or adjacent dermatomes. The incidence of herpes zoster increases with age or immunosuppression. The VZV virion consists of a nucleocapsid surrounding a core that contains the linear, double-stranded DNA genome; a protein tegument separates the capsid from the lipid envelope, which incorporates the major viral glycoproteins (7).

-Varicella, usually a benign manifestation of primary infection, and zoster, a result of reactivation of latent virus, can cause considerable morbidity in patients with immune impairment (6).

-A new case of Ramsay Hunt syndrome will occur every 52 minutes, compared to every 10 minutes for a new case of Bell’s palsy (8).

-Varicella zoster virus (VZV) is an exclusively human neurotropic alphaherpesvirus. Primary infection causes varicella (chickenpox), after which virus becomes latent in cranial nerve ganglia, dorsal root ganglia, and autonomic ganglia along the entire neuraxis. Years later, in association with a decline in cell-mediated immunity in elderly and immunocompromised individuals, VZV reactivates and causes a wide range of neurologic disease (12).

-He explained these eighth nerve features by the close proximity of the geniculate ganglion to the vestibulocochlear nerve within the bony facial canal. Hunt’s analysis of clinical variations of the syndrome now bearing his name led to his recognition of the general somatic sensory function of the facial nerve and his defining of the geniculate zone of the ear. It is now known that varicella zoster virus (VZV) causes Ramsay Hunt syndrome (14).

-Varicella zoster virus (VZV) is an exclusively human neurotropic alphaherpesvirus. Primary infection causes varicella (chickenpox), after which virus becomes latent in cranial nerve ganglia, dorsal root ganglia, and autonomic ganglia along the entire neuraxis. Years later, in association with a decline in cell-mediated immunity in elderly and immunocompromised individuals, VZV reactivates and causes a wide range of neurologic disease (15).

Symptoms:  Describe the symptoms of the pathology

-Otological complications of varicella-zoster virus (Ramsay Hunt syndrome) include facial paralysis, tinnitus, hearing loss, hyperacusis (dysacousis), vertigo, dysgeusia, and decreased tearing. Cranial nerves V, IX, and X are often affected. Gadolinium-enhanced magnetic resonance imaging demonstrates enhancement of the geniculate ganglion and facial nerve. These manifestations are identical to Bell’s palsy but are more severe and carry a graver prognosis (8).

-frequent symptoms and signs such as tinnitus, hearing loss, nausea, vomiting, vertigo, and nystagmus (14)

-Ramsay Hunt syndrome is a disorder characterized by herpetic eruptions on the auricle, facial paralysis, and vestibulocochlear dysfunction, and is attributed to varicella zoster virus infection in the geniculate ganglion. Although it is a common cause of acute peripheral facial paralysis (9)

-Ramsay Hunt syndrome is defined as herpes zoster oticus associated with an acute peripheral facial nerve paresis and quite often with other cranial nerve lesions. The combination of motor, sensory and autonomic involvement leads to a variety of neurological damage patterns, i. e. facial muscle paresis, hearing and balance disorders, sensory problems and disturbances of taste as well as lacrimal and nasal secretion. Additional variability of the clinical picture of Ramsay Hunt syndrome is produced by varying patterns of skin involvement explained by individual anastomoses between cranial and cervical nerves (10).

-severe burning pain referred to the ear and adjacant skin areas characteristically preceeds facial palsy that differentiates it from Bel’s Palsy (19).

-HZO patients with vertigo had facial palsy on the lesioned side and spontaneous nystagmus beating toward the healthy side (11)  he nerve trunks within the internal auditory canal are widely affected in HZO patients with vertigo. Both superior division and inferior division of the vestibular nerve attribute to the vertiginous attack (11).

-14% developed vesicles after the onset of facial weakness. Thus, Ramsay Hunt syndrome may initially be indistinguishable from Bell’s palsy (14).

-Finally, some patients develop peripheral facial paralysis without ear or mouth rash, associated with either a fourfold rise in antibody to VZV or the presence of VZV DNA in auricular skin, blood mononuclear cells, middle ear fluid, or saliva. This indicates that a proportion of patients with “Bell’s palsy” have Ramsay Hunt syndrome zoster sine herpete (14).

-Three major symptoms, auricular vesicles, facial paralysis and vestibulo-cochlear dysfunction, were found in 57.6% of the patients although these symptoms did not always appear simultaneously. Auricular vesicles appeared before (19.3%), during (46.5%), or after (34.2%) the onset of facial paralysis (16).

-causing otalgia, auricular vesicles and peripheral facial paralysis.  Vesicles occurring anywhere along the sensory distribution of the facial nerve, including the anterior two-thirds of the tongue, the pinna or the external auditory canal.  Otalgia.  [Takasu T, Furuta Y, Sato-Matsumura KC, et al. Detection of varicella-zoster virus DNA in human geniculate ganglia by polymerase chain reaction. J Infect Dis 1992;166:1157-9.]  (18)

-3-day history of gradual increasing right-sided head pain overlying her right ear, exacerbated by traction on the pinna. head pain was different from her past migraines, especially in that it radiated to the right mastoid.   (18)

-5 days post:   including right-sided pulsatile tinnitus, right-sided aural fullness, vertigo, reduced ability to close the right eye and decreased taste sensation. She had no hearing loss.  mild right-sided facial weakness with sluggish right eye closure (18).

-syndrome characterized by a painful, unilateral vesicular eruption in a restricted dermatomal distribution.4 Dermatomal pain may precede lesions by 48-72 hours and total disease duration is 7-10 days. Immunocompromised and elderly patients may have a more prolonged and severe course.5 Ramsay Hunt syndrome can be precipitated by reactivation of VZV in the geniculate ganglion, resulting in peripheral facial paralysis, otalgia and auricular vesicles (18).

– In approximately 10% of cases, there is no vesicular rash with the facial paralysis, but there is either a 4-fold rise in antibody to VZV or the detection of VZV DNA in skin, blood mononuclear cells or middle ear fluid. This condition is known as Ramsay Hunt syndrome sine herpete (18)

-Facial palsy is not associated with otitis externa.14 Trigeminal neuralgia is manifest by sudden, usually unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve. Most importantly, trigeminal neuralgia does not cause neurologic deficit, and the pain cannot be attributed to another disorder (18).15

Hearing Loss:  Describe the resultant type (nature) and degree of hearing loss

-variable hearing loss if present from mild to profound, with prognosis worse in more severe (19; 21).

-Diagnosis is based on the sudden onset of unilateral peripheral facial paralysis, usually over hours, but sometimes more gradually. Additional symptoms such as decreased tearing, hyperacusis, loss of taste sensation over the anterior two-thirds of the tongue and ear pain are variable. Bell palsy does not involve the presence of vesicles in the external meatus [Adour KK, Byl FM, Hilsinger RL Jr, et al. The true nature of Bell’s palsy: analysis of 1000 consecutive patients. Laryngoscope 1978;88:787-801.] (18)

-Otoscopy revealed herpetic eruptions in the right ear canal. Otoacoustic emissions were absent in the right ear and auditory brainstem responses confirmed moderate sensorineural hearing loss (9).

-swollen right external auditory canal with a normal tympanic membrane (18).

-right auricular swelling and redness with 3 small vesicles on the concha. The right tympanic membrane was not visualized owing to meatal swelling, but the left tympanic membrane was normal (18).

-The neurotropic herpes virus family may have a special relationship to ISHL, in addition to the Ramsay-Hunt syndrome; Nakajima et al (1976) have detected the herpes virus in the cerebrospinal fluid (CSF) of two of three patients studied with sudden hearing loss. Elevations of antibody titers to the herpes virus usually occur in association with two or more other viral titer elevations (Wilson, 1986), suggesting a possible reactivation of this virus (13).

-Hearing loss was observed subjectively in only 20% but objectively in 48.2% of the patients. Hearing loss appeared before (34.3%), during (34.3%), or after (31.3%) the onset of facial paralysis (16).

-Complete recovery of hearing was also achieved in 45.4% of the patients, and the recovery was better in patients having light hearing loss, less than 35dB (16).

-on the basis of BAEP findings, to suggest that in Ramsay Hunt syndrome both cochlear and retrocochlear involvement may occur (17).

-sudden, unilateral HL, usually sloping (21).

-Otitis externa, inflammation of the external auditory canal or auricle, commonly presents with otalgia, pruritus, discharge and hearing loss. Examination usually reveals pain with tragal pressure and a red edematous ear canal [Agius AM, Pickles JM, Burch KL. A prospective study of otitis externa. Clin Otolaryngol 1992;17:150-4](18).

Treatment options:  Discuss if the condition is permanent or treatable, if treatable, discuss treatment options such as surgical or medical. (No need to describe surgical procedure itself.)

– Prognostic indicators of poor hearing recovery include advanced age, retrocochlear hearing loss, male gender, vertigo, and speech frequency hearing loss (1).

-Antiviral agents are the standard first-line treatment for herpes zoster infections at other body sites and are thought to reduce or minimise nerve damage, thereby improving outcomes. It has been suggested that these agents improve the chance of facial weakness improving or resolving completely in patients with Ramsay Hunt syndrome (3).

– In the light of the known safety and effectiveness of antiviral drugs against VZV or HSV, consideration should be given to early treatment of all patients with Ramsay Hunt syndrome or Bell’s palsy with a 7–10 day course of famciclovir (500 mg, three times daily) or acyclovir (800 mg, five times daily), as well as oral prednisone (60 mg daily for 3–5 days) (4).

-Although the antiviral agent acyclovir is currently used for the treatment of Ramsay Hunt syndrome, its effects on facial nerve and hearing recovery remain controversial. We retrospectively analyzed the effects of acyclovir-prednisone treatment in 80 Ramsay Hunt patients. Of 28 patients for whom treatment was begun within 3 days of the onset of facial paralysis, the recovery from paralysis was complete in 21 (75%). By comparison, of 23 patients for whom treatment was begun more than 7 days after onset, recovery from facial paralysis was complete in only 7 (30%). A significant difference in facial nerve recovery was found between these groups. Early administration of acyclovir-prednisone was proved to reduce nerve degeneration by nerve excitability testing. Hearing recovery also tended to be better in patients with early treatment. There was no significant difference in facial nerve outcome between intravenous and oral acyclovir treatment (5).

-An experimental live vaccine also prevents varicella, but problems regarding its virulence for immunosuppressed patients and the durability of the protective response are still being addressed (6).

-We retrospectively analyzed the effects of acyclovir-prednisone treatment in 80 Ramsay Hunt patients. Of 28 patients for whom treatment was begun within 3 days of the onset of facial paralysis, the recovery from paralysis was complete in 21 (75%). By comparison, of 23 patients for whom treatment was begun more than 7 days after onset, recovery from facial paralysis was complete in only 7 (30%). A significant difference in facial nerve recovery was found between these groups. Early administration of acyclovir-prednisone was proved to reduce nerve degeneration by nerve excitability testing. Hearing recovery also tended to be better in patients with early treatment. There was no significant difference in facial nerve outcome between intravenous and oral acyclovir treatment (5)

-Appropriate treatment resulted in slight improvement after the first week and complete recovery within 4 months (9)

-he patients younger than 16 years old showed better recovery from both facial paralysis and hearing loss than the patients older than 60 years (16).

-another retrospective study of 26 patients treated with acyclovir and steroids, age greater than 60 years, diabetes mellitus, essential hypertension and associated vertigo were identified as prognostic factors for worse outcome and decreased chance of recovery (18)

-recovery of facial, cochlear, and vestibular funct is unpredictable (19).


1)  http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1092464

2)  http://www.sciencedirect.com/science/article/pii/S0264410X09018040

3)  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006851.pub2/abstract

4; 14)  http://jnnp.bmj.com/content/71/2/149.short

5)  http://onlinelibrary.wiley.com/doi/10.1002/ana.410410310/abstract

6)  http://annals.org/article.aspx?articleID=701104

7)  http://cmr.asm.org/content/9/3/361.short

8)  http://onlinelibrary.wiley.com/doi/10.1002/ana.410350718/abstract

9)  http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1470.2007.00329.x/abstract

10)  http://onlinelibrary.wiley.com/doi/10.1111/j.1610-0387.2012.07894.x/abstract

11)  http://onlinelibrary.wiley.com/doi/10.1097/00005537-200302000-00020/abstract

12; 15)  http://www.sciencedirect.com/science/article/pii/S0733861908000406

13)  http://famona.tripod.com/ent/cummings/cumm177.pdf

16)  http://www.ncbi.nlm.nih.gov/pubmed/8997096

17)  http://archotol.jamanetwork.com/article.aspx?articleid=613458

18)  http://www.cjem-online.ca/v10/n3/p247

19)  http://archotol.jamanetwork.com/article.aspx?articleid=600884

20)  Hunt JR (1907). “On herpetic inflammations of the geniculate ganglion: a new syndrome and its complications”. J Nerv Ment Dis 34 (2): 73–96. doi:10.1097/00005053-190702000-00001

21)  http://books.google.com/books?id=yFo8gzZdUwMC&pg=PA27&dq=herpes+zoster+oticus+and+flat+hearing+configuration&hl=en&sa=X&ei=komWUripOOakiQKi5oC4Bg&ved=0CEgQ6AEwAA#v=onepage&q=herpes%20zoster%20oticus%20and%20flat%20hearing%20configuration&f=false


-Don’t copy this or steal my sources, mmkay?  This seriously sucked to compile and I was going to publish it on Monday (after it’s due) but my cut & paste is doing that awful white highlight crap that makes me crazy, so I have to get it on the blog in order to put it on my word document.  Karma will come back to you if you cheat.


When did 10:30 PM become the new 3 AM?

22 Nov

Written yesterday:

I am so non-functional today, and it’s 100% due to the fact that I didn’t go to sleep until 10:30 last night.  But my body still woke up at 3:30 AM as it is accustomed to doing these days.  There were nights in my early-mid 20’s that I was OUT until 3:30AM, then went to work at 7AM!  You know you’re 30 when you can’t stay up past 8PM anymore. . .

The reason I was up late was the Talent Show.  I was very nervous.  I hadn’t performed in 14 years.  I had never THE shirt anteriordanced in those particular shoes.  The tap on my left heel is stiff and I have to stomp really hard to get sound out of it.  My living room carpet muffled my taps, so if I wanted to practice clean-steps I had to do it in my tiny kitchen.  And the stage was in a room used as a classroom so I couldn’t practice there until our actual room reservation–when other people were already there.  So I was never able to practice both full movements, facial expression, AND clean steps simultaneously before I was actually in front of my audience.  And the afore-mentioned music-loudness issues.

rainbow 3 (2)I had started working on this dance, specifically for this occasion in August.  So I wanted to really do the very best version of the dance I knew I was capable of.  And when I got up there–it was magical.  That sounds super-cheesy and overwroght, but I really felt good about everything.  It all came together, and I actually had fun with it–instead of worrying–what move is next, put your arms here, keep smiling, breathe. . .  I just did it.  And truly enjoyed myself.  Which showed, and got the crowd excited.  It was, without exaggeration, the best performance of my life.  Better then team or individual shows or competitions in my prime of dancing.  Better then team or duets with our clogging class.  Better then previous talent shows.  And better then any band, cheerleading, or other performance.

The stars just aligned and instead of worrying about logistics I enjoyed the moment.  And I was proud that the dance was all mine.  My special song, a costume I had spent hours and hours working on (my anatomy muscle shirt, if you recall those struggles), my choreography.  I owned it.  And I love the feeling that I did the best I could.  And of course the surprise, excitement, and praise from the audiance.  I feel like those classmates and teachers see THE shirt posteriorme differently now.  And that feels great.

I had forgotton how much clogging meant to me.  Or maybe at the time, it never felt like the cool thing to do and I sort of took it for granted somewhat.  I feel a renewed excitement, and like this is one of the things that makes me who I am.  And I had forgotten.  Now I’m motivated to choreograph another routine.  I guess for next year’s talent show since I really have no other performance venue/outlet.  Maybe I’ll make my own clogging YouTube page.  Whatever it’s for, I’d like to start writing another routine and making it even more spectacular to top this show.

But today I was too tired to do much of anything.  I couldn’t focus, but I couldn’t nap either.  I tried 3 seperate times to sleep, but couldn’t.  And you know how not studying makes me feel so, so, so guilty and unproductive.  But now I have a week for Thanksgiving break and I promise myself I will really buckle down and do what I need to and work ahead.  So Today will be my break and my reward for doing the very best I could last night.


Talent Show: 11-20-13

21 Nov

Here it is: My clogging dance to “So Much to Say” for my Speech & Hearing Sciences Talent Show.

Sources for Ear Pathologies

13 Nov

I think we have a paper due this next Friday?!  But it hasn’t been mention IN class (annoying) so I haven’t worked on it at all.  But here’s what I did at the beginning of the semester.  I need to pick something and get going!

ear art 3

-acute otitis media *I don’t think I’ll be able to use this–we’ll probably cover it exstensively in class*

is characterized by a short-lived infection (aural hematoma (feline)???


an injury to your ear because of changes in barometric (air) or water pressure. [D]

-bullous myringitis,

-Carhart notch

sensorineural component at 2000 Hz due to stapedial fixation; occurs with otosclerosis [C]


Invasion of Epithelium Cells of the EAM into the middle ear. Causes damage to ossicles, facial nerve, ad can be life threatening; Results from Chronic otitis media, marginal perforation of the TM, long periods of negative pressure with infection or PE tubes insertion [E]

-eosinophilic otitis media

Eosinophilic otitis media is an intractable middle ear disease associated with bronchial asthma and nasal allergy that sometimes induces deterioration of sensorineural hearing loss. How eosinophils accumulate in the middle ear has yet to be determined; active eosinophilic inflammation may occur in the entire respiratory tract, including the middle ear, in patients with this disease. EOM often produces a yellow and highly viscous middle ear effusion and can cause symptoms that range from prolonged hearing loss and otorrhea to sudden deafness. The middle ear symptoms are unresponsive to conventional treatments for otitis media and are instead treated with steroids [A]

***-Glomus Jugulare

Dilation of the internal jugular vein impairing ossicular movement. Can hear heart beat.

-Goldenhar Syndrome

-granular myringitis,

*-Malingering *we talked about this in class a little, plus it’s not really a hearing/anatomical problem*

Individual is actively faking a hearing loss. [E]


Mastoid air cells become infected. Life threatening Meningitis [E]

**-Meniere’s disease., {pics} *I’m sure we’ll cover this in detail*

could be progressive, Sx: fullness,dizziness [B]

Meniere Episodes = Rotary vertigo, tinnitus, ear fullness or pressure, nausea, and hearing loss. Can last minutes to hours. [E]

-meningitis *I wrote my Aural Rehab paper on this, so I have a framework to start.  It’s such a huge cause of hearing loss that we might discuss it in class though*

-mumps *part of meningitis–the agent that gets it started?  Along with chicken pox?*


Fixation of stapes (calcified), so increase in mass of ossicles. Conductive HL, seen in audiogram at 2000 Hz called “Carhart Notch”. Tx: stapedectomy [B]

Fixation of the foot plate of the stapes in the oval window; Autoimmune disease. Higher occuring in caucasians and women.

–>parasites (feline)???

*-Perilymphatic Fistula

Rupture of the oval or round window causing a loss in perilymph. This causes hearing and balance problems. [E]

*-Psychogenic  *Nope, psychological*

Individual does not have a hearing loss but they truely believe they do. Usually result of emotional trauma [E]


acquired– abnormal narrowing of ear canal [C]

**–>Suppurative otitis: (feline)???

The ears of kittens and cats are liable to infection from pus producing organisms

-Swimmer’s Ear {pics}


a roaring in your ears, can be the result of loud noises, medicines or a variety of other causes. [D]


-Usher Syndrome

-vestibular schwannoma

An acoustic neuroma is a slow-growing tumor of the nerve that connects the ear to the brain. This nerve is called the vestibular cochlear nerve. It is behind the ear right under the brain. An acoustic neuroma is not cancerous (benign), which means it does not spread to other parts of the body.

-Waardenburg Syndrome

ear art 2

[A] http://emedicine.medscape.com/article/860227-overview

[B] http://quizlet.com/19275235/middle-ear-pathologies-flash-cards/

[C] http://quizlet.com/8475059/common-ear-pathologies-flash-cards/

[D] http://www.nlm.nih.gov/medlineplus/eardisorders.html

[E] http://quizlet.com/21704867/aural-pathology-flash-cards/


Doors are Opening

10 Nov

This is not my normal life. I can’t figure out if things are just now finally coming together for me, it’s “the finger” pushing me toward my correct path, or just a change in my own mentality.

Green Bluff 2 062

Whatever it is–I like it. I feel happy. And hopeful. And I’m not weighed down by immense stress and worry.

I am a credit short for Spring semester. A credit short of the loan package I need. And that’s a deal-breaker. I must have the loan money to survive. But classes usually come in 3cr packages, which makes juggling work and school all the more difficult. So at first it was awkward, inconvenant–my normal.

But I talked to some faculty and they were actually very supportive. I had many options. And everyone seemed glad to help me persue them too–a very different situation between me and the staff here, indeed.

To make a long story, well, slightly less long. I’m doing an independent study where I will help transcrive child utterances in language samples. But the project can be just that or expand in various directions. I can help with data analysis, and tie it to SLP or audiology topics of interest. I can also extend my work over the summer–maybe even have a long term thing. I might even write a paper about one of the research questions stemming from the language samples and work to get it published!!!

Mom's Camera day 2 147

So I can:
-get the 1 credit I need for my loan
-learn more about computer software
-get more experience transcribing
-delve into all the analysis
-work with children who have cochlear implants
-get face-time with people to work on the letters of reccommendation
-have a school-related project over the summer
-write a paper
-get published
-have something awesome to put on my grad school apps
-have a good scholarship essay
-feel better about Riverpoint’s staff
-network–I know–ME, networking!

Everything is coming up roses. I’m excited.


Bent Out of Shape

8 Nov


Today I (now) get off work at 10 AM. The day is supposed to be for school-related studying, projects, and meetings. So when our student chapter of our professional body put their meetings on Fridays–I was mostly relieved I was able to attend. In the past, I would have been severely annoyed as I would have had to miss every meeting b/c of work. Which is how I played it last year. Paid my dues, never showed up, never participated in anything, because all of it conflicted with work.  And that sucks–because this club is akin to a pre-vet student not being in the pre-vet club. Or a vet student NOT being part of the SAVMA or whatever. It’s not too cool, and it’s a red-flag to any admissions/scholarship committee.  It’s sort of something everyone is expected to do.  And it makes you more of a community with your classmates and puts you more in tune with the career.

Anyway, I want to play a role in the club this year, and because I’m a gung-ho, joiner, kind of gal I would love to take an active role.  Today, I went to school at noon just for the meeting.  And for a second meeting in a row, those-20-somethings chatted/gossiped about boys and television shows, starting late.  You know how I feel about being prompt. . .

ruined hairSidenote:  When did I start feeling so much older than the college-aged kids (did I just type that?) I attend school with???  I never really fit in with the college gals, even when I was in my lower 20s, but wasn’t nearly as annoyed as I am today.  Maybe annoyed is too stong a word–I merely notice that I’m in a completely different place in my life than these younger people.  They are talking about drama, weddings, boyfriends, boys, name-brand shopping, boys, parties, and boys.  Not what I consider substance.  That sounds too harsh as well–it’s not like I feel superior or anything–just worlds apart.  There is suddenly a large gap between me and them.  And it’s been fairly recent.  Maybe when I turned 30?

Back to the topic at hand:  Then, in a disorganized way, the officers at the meeting just said things (sprinkled with many “like” and a “down with that”) that could have been e-mailed or put on Facebook.  And at both meetings when people asked questions, no one really knew the answers.  The meeting (both of them) ended after 20 minutes.

I can’t help but to feel really disgruntled at what a waste of time that is.  Sure, the meeting may be just 20 min of nothing useful, but I have to drive over there. find (far away) parking, walk in, wait for them to start, walk back to my car, drive home–the whole thing sucks an hour out of the middle of my day and breaks it up so I end up being unproductive.

I hate that.  I want to get home from work, get into my jammies, study with my family hanging around me and recouperatingfood at the ready, then get ready for the next day of work, and go to bed.  Here I am.  I have done nothing school-related today.  And now it’s 4:30 PM, 3 hours before bed, when my brain is all lethargic and it’s difficult to find the motivation. . .  Also, when I go an entire day without doing anything “school” I feel really, really guilty and begin to fret.  That ruins sleep.  And I’ll be tired tomorrow too.  I don’t think I’ll go to any more of those meetings unless I’m already at school for some other reason.

In other news, while I was at school I picked up my inner ear/auditory pathway exam.  She keyed in one answer wrong so I get one more point–making my 3rd exam grade a 96.8%.  But I’m not satisfied with that because I don’t think the professor writes her tests (or grades them) very fair.

As an example, she had a fill in the blank portion where you could either write “inner hair cell” (IHC) or “outer hair cell”(OHC)  in response to various items.  One was “motile” which of course is OHC.  Well she wrote “one to many” on one spot and “many to one” on another.  I KNOW that OHC have one efferent nerve fiber that go to many hair cell bodies and that IHC have one cell body with many afferent nerve fibers transmitting info to the brain.  But did she intend “one” to mean a hair cell or the nerve fiber or vice versa???  How am I supposed to know?!  Without being IN her head.  So on the test I wrote “neron” after both questions–to show that I was considering the first item to regard the cell body and the 2nd to be directed at the neron.  And she apparently meant it the other way around, so she marked both of those wrong.  Even though I obviously know the material.

Makes me crazy!  Counting all the unfairly graded questions I’ve missed so far, I’ve missed 8(?) things that it was obvious (from my notes on the exam) I knew, but differed from what she intended to mean when writing the exam/key.  That’s 2 full points of my overall grade. . .  *frown, frown*

Other then those neusances (and feeling extremely tired all week, despite decent sleep) I’m very, very happy that work is going better for me.  I could get used to this.  It really bleeds over into my whole live, emotional state, and attitude–whether negative b/c work is $hitty or awesome b/c work is neutral to good.  Takes tons of stress and worry out of my life-yay!  I hope it lasts.