"Flexibility is the key..."

When I had been in the Air Force, the saying was that "flexibility is the key to airpower". A one-liner lesson learned from the likes of General Billy Mitchell, General Giulio Douhet, General Claire Lee Chennault, etc. Well, I'm sure you are fully aware that flexibility is the key to anything and everything. Seriously! Today was no exception at clinic.

I had a four-year-old patient whose audiological case history I knew nothing of. My clinical preceptor was really busy, and she was comfortable enough in my skills to have me see the patient without 100% supervision. This patient appeared normal so I assumed that this patient was developmentally capable to complete a hearing test using conventional audiometry. I will not bore you with the differences in audiometric testing approaches. But let's just say that this patient was not comprehending that I wanted the patient to raise their hand when they heard the tones. I instructed in English and I also instructed as best as I could in Spanish (the mother accompanying the patient only spoke Spanish). I also found out that the patient communicates sometimes in American Sign Language (ASL), so I had to dig deep to remember a few signs to supplement my verbal instructions. I will admit that I got a little frustrated in the communication breakdown in addition to feeling bad for the patient & mother for taking longer than necessary to complete a hearing test. I went to look for my clinical preceptor for some assistance since she knows Spanish and ASL a heck of a lot better than me. But she was in the middle of an important phone call. So I turned around and went back to the sound booth to try another approach to obtain hearing thresholds. Since I had the patient in soundfield (aka speakers), I could not do conditioned play audiometry, or CPA, without a test assist. I was all by my lonesome. And yes, there was a reason why I was only testing in soundfield and not utilizing insert earphones or supra-aural earphones...twas medically-related. So what other test approach could I take in soundfield that's not conventional? Visual reinforcement audiometry, or VRA. And that is what I did to obtain thresholds at 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. Soundfield testing does not give ear-specific information. I had done tymps on the patient before audiometric testing and knew the ears were A-okay to do otoacoustic emissions testing on to confirm peripheral hearing sensivity with the audiogram & get ear-specific info.

Moral of the story is to "be able to think on your feet and be flexible!". I'm "Hear 4 U Always"...tap-dancing my way through clinic & trying to be like Gumby (yes, the green bendy figure from TV Land back in the day). Speaking of old TV shows, if I could "Dream of Jeannie", I'd wish to be trilingual and be fluent in English (thank you...learned that as a second language back in the day & now fluent ;P), Spanish, and American Sign Language. I'm no genie of any lamp, but I'm going to cross my arms now & blink my eyes...POOF, I'm gone. ;-)