MSN II - 29.6.2020 An-Spl Therapies in Ent

B.
Sc NURSING
MEDGICAL SURGICAL NURSING II
UNIT – I ENT DISORDERS
TOPIC : SPECIAL THERAPIES IN ENT
Mrs. LANCY . J . I , M,Sc (N)

Associate professor
OBJECTIVES
• At the end of the class the students will be able to
• list the types of special therapies in ENT
• describe aural rehabilitation
• explain the goals of aural rehabilitation
• define cognitive behavioural therapy
• describe sound therapy
• list the approaches of auditory training
• describe the roles and responsibilities of audiologists

ANATOMY OF THE EAR
INTRODUCTION
• Speech and language therapy helps the disabled
orimpaired individual b providing maximum
communicative potential, compensatory methods,
rehabilitation and mainstreaming.
• Early diagnosis, treatment and intervening the
communicative problem will reduce the intensity and
severity of the problem which enhances the
effectiveness of language, speech, and complementary
therapies.
COMPLEMENTARY THERAPIES
❖ Complementary treatments may be particularly well
suited for treating the dysfunction associated with
tinnitus, as they specifically target aspects of tinnitus that
are often overlooked in conventional medicine.
❖ Complementary therapies that show promise in a
population of patients with severe dysfunction from
tinnitus and, in particular, for nonauditory aspects of
tinnitus symptoms. In addition, complementary strategies
may be more broadly applied to people from various
cultural backgrounds.
TYPES OF SPECIAL THERAPIES IN ENT
❖ Aural Rehabilitation
❖ Cognitive-Behavioral Therapies.
❖ Mindfulness-Meditation.
❖ Sound Therapy
❖ Environmental Modifications
❖ Auditory Training
❖ Communication Skills Training
❖ Speech reading
❖ Counseling
❖ Person- and Family-Centered Care
AURAL REHABILITATION
❖ Aural rehabilitation is the process of identifying and
diagnosing a hearing loss, providing different types of
therapies to clients who are hearing impaired, and
implementing different amplification devices to aid the
client’s hearing abilities.
❖ Aural rehabilitation includes specific procedures in which
each therapy and amplification device has as its goal the
habilitation or rehabilitation of persons to overcome the
handicap ( disability) caused by a hearing impairment or
deafness .
Cont….
❖ Aural rehabilitation is frequently used as an integral
component in the overall management of individuals with
hearing loss and refers to services and procedures for
facilitating adequate receptive and expressive
communication in individuals with hearing impairments.

AURAL REHABILITATION TEAM
❖ Aural rehabilitation is often an interdisciplinary endeavor

involving :
Physicians
Audiologists
Speech-language Pathologists
GOALS OF AURAL REHABILITATION
❖ Identifying the impact of hearing loss and/or other

auditory complaints (e.g., Tinnitus,)
❖ Communication,
❖ Activities,
❖ Participation,
❖ Interactions with communication partners, and
❖ Quality of life.
STEPS OF AURAL REHABILITATION
Language Intervention Activities
❖ The therapist interact with the patient by talking, using

pictures, books, object , ongoing events to stimulate
language development.
❖ The therapist may also correct the pronunciation and

using the repetition exercise to build speech and
language skills.
Articulation Therapy
❖ Articulation or sound production, exercise involve having
the therapist to correct sound and syllable for a patient,
often during the activities.
❖ The therapy will physically show the patient how to make

certain sounds such as the ‘r’ sound and demonstrate
how to move the tongue to produce specific sounds.
Swallowing Therapy
❖ It will use a variety of oral exercise including facial

message and various tongue, lip and jaw exercise to
strengthen the muscle of the mouth.
❖ The therapist also may work with different food textures

and temperatures to increase a patient oral awareness
during eating and swallowing.
COGNITIVE-BEHAVIORAL THERAPIES
❖ The majority of evidence considers CBT an effective

treatment of the distress associated with tinnitus and
may include :
❖Training In Activity Planning,
❖Relaxation Exercises,
❖Cognitive Restructuring
GOALS OF CBT
❖ Psychotherapists well trained in CBT help patients

recognize and explore the relationship of their thoughts
with other aspects of their experience, including
emotions, physical symptoms, and behaviors.
❖ CBT sessions can also be used to introduce patients to

the behavioral principle of exposure.
GOALS OF
Cont.. CBT
❖ Patients are informed that if a fear response to sounds
occurs, exposure to environmental sounds may be
helpful in reducing emotional reactivity.
❖ Patients with sleep hygiene challenges can be educated
on healthy sleep habits and realistic goals to apply sleep
hygiene practices.
GOALS OF CBT
Finally, CBT can be used to :
❖ Teach the patients relaxation training (e.G., Progressive
muscle relaxation, diaphragmatic breathing, and/or
guided imagery),
❖ With the goal of reducing the negative effects of tinnitus
rather than reducing the tinnitus sound itself.

MINDFULNESS-MEDITATION.
❖ It is a processes that target physiological activity can also
help to address the hyperreactivity that hinders the
habituation process .
❖ Mindfulness-meditation trains participants in attention and

teaches them to observe sensations, thoughts, feelings, and
behavioral urges
❖ This attentional training further teaches participants to

neutrally observe and separate the actual event (e.g., tinnitus
sound) from psychological or cognitive reactions to this event
(e.g., an interpretation of sound or distress about it).
GOALS OF MINDFULNESS-MEDITATION.
• Mindfulness-Based Relaxation Training (MBRT)

❖ MBRT is a method of using meditation and yoga to
cultivate present moment awareness and reduce stress.
It is based on the ancient practice of mindfulness, which
is about waking up and being fully present in the
moment.
❖ From this ,patients are able to learn about how their
minds workthrough directly observing their own
sensations, thoughts, emotions,and urges to behave.
SOUND THERAPY
❖ Sound therapy refers to the use of sound to relieve

bothersome tinnitus. It uses strategies and products to
mask, habituate, or neuromodulate perceived subjective
tinnitus.
❖ Both wearable and nonwearable devices may be

helpful. Tinnitus retraining therapy is an approach to
intervention that includes both sound therapy and
counseling.
ENVIRONMENTAL MODIFICATIONS
❖ Environmental modifications may be helpful for their
specific hearing needs and then to support them in
implementing these changes. Examples of these
modifications include the following:
– Choosing optimal seating arrangements
– Improving room acoustics and minimizing background
noise
– Improving lighting for speechreading
– Installing visual alerting systems
– Using nonwearable masking devices (for tinnitus)
AUDITORY TRAINING
❖ "Auditory training is a process designed to enhance the

ability to interpret auditory experiences by maximally
utilizing residual hearing
❖ The approach to auditory training may be analytic,

synthetic, or a combination of both .
❖ Auditory training may be provided in individual or group

sessions and may involve the use of computer programs
and mobile applications.
AUDITORY TRAINING
❖ In some cases, auditory training may be part of an

intervention plan for persons with normal peripheral
hearing (e.g. tinnitus).
❖ There are two main approaches to auditory training

Analytic Approaches
Synthetic Approaches
ANALYTIC APPROACH
❖Uses the smallest distinguishing linguistic features of

acoustic cues (i.e., bottom-up processing).
❖Uses small segments of speech such as phonemes

or syllables.
❖Focuses on how perception (hearing) influences

communication.
❖ Uses tasks progressing from easy to difficult and/or

from a quiet environment to an environment including
background noise
ANALYTIC APPROACH
Follows the auditory skills hierarchy:
❖Sound awareness (determine if sound is present

or absent)
❖Auditory discrimination (distinguish sounds as

same or different)
❖Auditory identification (label the sound)
❖Auditory comprehension (understand the meaning

of the sound)
SYNTHETIC APPROACH
❖Focuses on the overall meaning of discourse (i.e.,

top-down processing).
❖Uses segments of speech such as words, phrases,

sentences, or conversation.
❖Includes all areas of auditory comprehension.
❖Pulls analytic targets into functional practice to

address the use of strategies in real-world situations.
COMMUNICATION SKILLS TRAINING
Communication skills training may range from
improving articulation to managing conversation. Areas
of focus may include the following:
❖ Articulation
❖ Communication strategies
❖ Conversational repairs
❖ Pragmatics
❖ Self-advocacy
❖ Voice (e.g., resonance, loudness)

SPEECH READING
Speech reading refers to processing speech

using visual information, such as movements of
articulators, facial cues, and gestures. Including
speechreading in an AR plan of care supports the idea
that "cross-modal stimulation from optical and acoustic
events contribute to multisensory enhancement in
speech perception"
SPEECH READING
❖ Training may be provided to both the speech reader
(i.e., listener) and the communication partner (i.e.,
talker). For example, the speech reader may engage in
perceptual practice activities while the talker learns to
modify speech and use proactive behaviors to reduce
miscommunications.
COUNSELING
Effective counseling is paramount and is applicable

not only to hearing loss but also to related disorders.
➢ Types Of Counseling .
❖ Informational counseling
❖ Personal adjustment counseling
❖ Support groups
TYPES OF COUNSELING
Informational Counseling
❖Focuses on providing education to the person with

hearing loss (or related disorders) and their
family/significant others about the disorder,
associated symptoms, prevention and wellness, and
the rationale for specific treatment interventions.
TYPES OF COUNSELING
Personal Adjustment Counseling

Focuses on the person's psychological, social, and
emotional acceptance of the hearing loss and/or related
disorders.
Support Groups
Provides support from a community, practice with
speech in noise, training for conversation partners, work
on auditory comprehension, and discussion of other
concerns that may arise
PERSON- AND FAMILY-CENTERED CARE
Individualized person- and family-centered care is an

approach to the planning, evaluation, and delivery of clinical
services based on collaboration among the person receiving
services, their family/significant others, and the clinical
provider .
Integral Concepts Of Person- And Family- Centered Care
❖ Dignity and respect
❖ Information sharing
❖ Participation
❖ Collaboration
INTEGRAL CONCEPTS OF PERSON-
AND FAMILY-CENTERED CARE
Dignity And Respect
Honoring the priorities and choices of the person
and their family/significant others while incorporating
their values and cultural background.
Information Sharing
Providers communicating with the person and their
family/significant others accurately, completely, and in a
health literate format so that the person and their
family/significant others can fully participate in decision
making.
INTEGRAL CONCEPTS OF PERSON-
AND FAMILY-CENTERED CARE
Participation
Supporting participation by the person in their care
and their family/significant others at the level they
choose.
Collaboration
Enabling the person and their family/significant
others to collaborate with health care professionals in a
variety of ways.
Roles and Responsibilities of
Audiologists
Audiologists play a central role in the screening,
assessment, diagnosis, and treatment of persons with
hearing loss. The professional roles and activities in
audiology include :
❖ Clinical Services (diagnosis, assessment, planning, and
treatment),
❖ Prevention
❖ Advocacy
❖ Education
❖ Administration
❖ Research
APPROPRIATE ROLES FOR AUDIOLOGISTS
INCLUDE THE FOLLOWING
❖ Educating the public and other professionals on the

needs of persons with hearing loss and related disorders
(e.g., tinnitus,)
❖ Advocating for the communication needs of all persons,

including advocating for the rights and funding of
services and devices for those with hearing loss and
related disorders.
❖ Conducting a comprehensive auditory assessment.

❖ Developing and implementing an AR plan of care in
collaboration with the person receiving services as well
as with family/significant others and other professionals
(e.g., physicians, SLPs).
❖ Providing evaluation and fitting services for hearing aids,
cochlear implants, other sensory aids, and hearing
assistive technology
❖ Providing device and technology support, including
programming services.
❖ Educating the person receiving services and the
family/significant others on hearing loss and device use and
care.
❖ Providing information and training in the areas of
➢ Listening Skills And Communication Strategies
➢ Managing The Listening Environment
➢ Communication With Significant Others
➢ Strategies For Addressing Quality Of Life
➢ Hearing Protection/Noise Hazards
➢ Self-advocacy.
CONCLUSION
Hence these special therapies and procedure

needed to facilitate adequate receptive and expressive
communication in individuals with hearing impairments
and it is the integral component used in the overall
management of individuals with hearing loss and is often
an interdisplinary endeavour involving physicians,
audiologists,and speech language pathalogists.
REFERENCE
• http://www.tsbvi.edu/seehear/fall03/training.htm
• http://www.asha.org/Publications/leader/2008/080415/08
0415e.htm
• http://www.heara.ca/content/why-do-i-need-auditory-
training
• http://www.hearingpro.com.au/hearing-
solutions/auditory-training
• http://devdelay.org/newsletter/articles/html/34-auditory-
training.html
• http://www.betterhearing.org/aural_education_and_coun
seling/Hearing_Loss_retraining_brain/

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B.

MEDGICAL SURGICAL NURSING II

UNIT – I ENT DISORDERS

TOPIC : SPECIAL THERAPIES IN ENT

Mrs. LANCY . J . I , M,Sc (N)

• list the types of special therapies in ENT

• describe aural rehabilitation

• explain the goals of aural rehabilitation

• define cognitive behavioural therapy

• describe sound therapy

• list the approaches of auditory training

• describe the roles and responsibilities of audiologists

component in the overall management of individuals with

hearing loss and refers to services and procedures for

facilitating adequate receptive and expressive

communication in individuals with hearing impairments.

❖ Aural rehabilitation is often an interdisciplinary endeavor

❖ Identifying the impact of hearing loss and/or other

❖ Interactions with communication partners, and

Language Intervention Activities

❖ The therapist interact with the patient by talking, using

❖ The therapist may also correct the pronunciation and

❖ The therapy will physically show the patient how to make

❖ It will use a variety of oral exercise including facial

❖ The therapist also may work with different food textures

❖ The majority of evidence considers CBT an effective

❖Training In Activity Planning,

❖ Psychotherapists well trained in CBT help patients

❖ CBT sessions can also be used to introduce patients to

❖ Patients are informed that if a fear response to sounds

occurs, exposure to environmental sounds may be

helpful in reducing emotional reactivity.

❖ Patients with sleep hygiene challenges can be educated

on healthy sleep habits and realistic goals to apply sleep

Finally, CBT can be used to :

❖ Teach the patients relaxation training (e.G., Progressive

muscle relaxation, diaphragmatic breathing, and/or

❖ With the goal of reducing the negative effects of tinnitus

rather than reducing the tinnitus sound itself.

❖ Mindfulness-meditation trains participants in attention and

❖ This attentional training further teaches participants to

• Mindfulness-Based Relaxation Training (MBRT)

❖ Sound therapy refers to the use of sound to relieve

❖ Both wearable and nonwearable devices may be

❖ "Auditory training is a process designed to enhance the

❖ The approach to auditory training may be analytic,

❖ Auditory training may be provided in individual or group

❖ In some cases, auditory training may be part of an

❖ There are two main approaches to auditory training

❖Uses the smallest distinguishing linguistic features of

❖Uses small segments of speech such as phonemes

❖Focuses on how perception (hearing) influences

❖ Uses tasks progressing from easy to difficult and/or

Follows the auditory skills hierarchy:

❖Sound awareness (determine if sound is present

❖Auditory discrimination (distinguish sounds as

❖Auditory identification (label the sound)

❖Auditory comprehension (understand the meaning

❖Focuses on the overall meaning of discourse (i.e.,