The clinical services of speech pathologists and audiologists commenced at Amrita Hospital in 1999. They functioned as discrete units in Departments of Neurology, Ear, Nose and Throat (ENT) and Head and Neck Surgery until a separate department of Speech Pathology and Audiology was constituted in July 2011. The department is currently full-fledged with state-of- the-art facilities and can be considered as one of the best equipped in the country. The department woks closely with the Departments of ENT, Neurology, Head and Neck Surgery, Neurosurgery, Radiology, Paediatrics, Clinical Psychology, Physical Medicine and Rehabilitation, Paediatric Genetics, and Internal Medicine.
The department offers comprehensive range of services covering all aspects of speech pathology and audiology.
The department has facilities to assess peripheral and central auditory pathways and vestibular system. Infant hearing screening programs have been initiated.
Puretone audiometry is one of the most basic tests to identify hearing threshold levels of an individual enabling determination of degree, type and configuration of hearing loss. It provides basic inputs regarding site of lesion.
Speech audiometry comprises of tests such as Speech Reception Threshold (SRT), Speech Discrimination Score (SDS), Speech Detection Threshold (SDT), Speech Discrimination in Noise (SDIN) and Performance-Intensity for Phonetically Balanced words (PIPB). SRT and SDT are useful indices for estimating reliability of puretone audiometric thresholds. SDS provides information regarding speech discrimination ability. SDIN and PIPB are reliable tools for differentiating cochlear versus retrocochlear pathology and are very sensitive for auditory nerve lesions.
Behavior observation audiometry
The behavior observation audiometry test is particularly useful for estimating degree of hearing sensitivity in infants. Based on behavioral responses, thresholds are assessed.
High frequency audiometry
High frequency audiometry is useful for early detection of hearing loss in pathologic conditions such as presbyacusis, noise induced hearing loss, ototoxicity and tumors affecting auditory pathway.
Central auditory tests
Central auditory tests comprises examinstaions such as dichotic digits test and Gaps-in-Noise test. These tests are effective for unraveling pathologies related to the auditory nerve and central auditory system.
Immittance audiometry is comprised of tests such as tympanometry, acoustic reflexometry, Acoustic Reflex Latency Thresholds (ARLT), Acoustic Reflex Decay (ARD), eustachian tube function tests and middle ear resonant frequency estimation. Tympanometry helps to identify pathologies related to external ear and middle ear. The facility for multiple frequency tympanometry helps in evaluation of neonates and infants. An estimation of acoustic reflex thresholds provides objective means of differentially diagnosing cochlear versus retrocochlear pathology (up to caudal brainstem). ARLT and ARD are additional confirmatory tools for retrocochlear lesion. Eustachian tube function can be assessed in intact and perforated tympanic membrane cases. Resonant frequency estimation provides additional clues to differentially diagnose middle ear disorders.
Otoacoustic Emission (OAE) evaluation
OAE is a useful tool to assess cochlear outer hair cell functioning. Facilities to perform distortion product OAE, transient evoked OAE and contralateral suppression of OAE are available. Contralateral suppression measurements provides inputs regarding efferent auditory pathway functioning. Infant hearing screening program have also been initiated by performing OAE screening.
Auditory Brainstem Response (ABR)
ABR is an electrophysiological tool to assess functions of the auditory nerve and brainstem auditory pathway. To estimate hearing threshold in cases like congenital atresia of ear canal, bone conduction ABR is available.
Auditory Steady State Response (ASSR)
The ASSR electrophysiological tool provides frequency specific information regarding hearing sensitivity. It is also vital for site of lesion estimation of central auditory pathway.
Middle Latency Response (MLR) and Late Latency Response (LLR)
MLR and LLR electrophysiological measures are useful for assessment of subcortical auditory pathway and auditory cortex respectively.
Vestibular Evoked Myogenic Potential (VEMP)
VEMP is an important tool for assessment of symptoms such as dizziness/imbalance. It evaluates arcs comprising of the saccule, inferior vestibular nerve, vestibular nuclei, XIth cranial nerve and sternocleidomastoid muscle.
The department has facilities to do trial and fitting of comprehensive range of digital and programmable hearing aids, cochlear implant mapping and auditory verbal therapy. Clinical services include:
Trial and fitting of hearing aids
Hearing aids of all types with the latest technology from various companies are available. Aids are programmed using a Hearing Instrument Programmer (HIPRO). For properly setting hearing aid gain and measuring the electroacoustic characteristics of hearing aids, an insertion gain optimizer and hearing aid analyzer are available.
Ear mould lab
Hearing aid fitting is only complete if it is coupled with a custom ear mould. The department has a full-fledged, ultra violet ear mould lab with facilities to make both hard and soft ear moulds. Custom made ear protection devices are also available.
A cochlear implant is a very effective management tool for hearing impairment, particularly with bilateral, profound sensorineural hearing loss. The department is involved in cochlear implant preoperative evaluation and counseling, intra-operative neural response telemetry, electrical auditory brainstem response evaluation, cochlear implant mapping and auditory verbal therapy.
Bone-Anchored Hearing Aids (BAHA)
BAHA are primarily suited to people who have conductive hearing loss. The department is involved in determining candidacy, proper fitting and follow up support.
Speech and Language Assessment and Intervention
The department has facilities to treat and determine the pathophysiology associated with speech, language, voice, fluency, articulation and swallowing disorders. Apart from therapy materials and speech and language tests for differential diagnosis, the department has:
Dr. Speech software for diagnostic application and intervention
Dr. Speech evaluates vocal function estimates of hoarseness, harshness, breathiness, regularity of vocal fold vibration and glottal closure time. Dr. Speech includes seventy voice-activated video games to provide real-time reinforcement of a client’s attempts to produce changes in pitch, loudness, voicing, voicing onset, maximum phonation time, sound, vowel tracking and phonetic exercise.
An EEG is used for monitoring of variations of vocal fold contact.
The department has nine acoustically treated, sound proof rooms, eight cubicles for speech language intervention and an ultraviolet ear mould lab.
Acoustically treated sound proof rooms
The rooms are comprised of two audiology suite rooms (double room), one audiology lab, one hearing aid trial room, two electrophysiological rooms and one room for immittance audiometry. In addition, there is one speech lab and one recording room.
Regular Outpatient Clinics function from Monday to Saturday between 8.30 am to 5.30 pm. On Sundays, the clinic function from 9.00 am to 1 pm.
Voice clinic: Fridays-9.00 am to 11.00 am.
The Voice clinic functions in association with the Department of ENT. The clinic evaluates patients with all voice problems. Assessment and intervention is done with the help of equipment such as stroboscope, Dr. Speech software, EGG, Pratt software etc. Management strategies are planned and direct intervention and home training are provided to the needy.
Dysphagia clinic: Second and fourth Thursdays-10.00 am to 5.30 pm.
The Dysphagia clinic functions in association with the Department of Head and Neck surgery. Fiber optic endoscopic evaluation of swallowing and intervention for swallowing disorder patients are planned and provided.