Can You Hear Me Now? Stephanie K. Born, AuD

Springfield Clinic Audiology

• Audiologist- can prevent, identify, evaluate, and treat hearing disorders.

• Audiologists also assess balance disorders.

Hearing Loss Statistics

• 36 million people in the United States have hearing loss.

• It is present in all ages.

Hearing Loss is just another chapter

in your life.

• However, do not let it define you.

• You hearing loss is more noticeable than hearing aids.

Your Job

• Now, before we get started….if you have a hearing loss, you MUST have a sense of humor!!

• You miss things and hear strange things that people didn’t really say.

• You have to be able to laugh at it sometimes or it will drive you crazy!

Anatomy of the Ear

• Outer ear- pinna and external auditory meatus (ear canal)

• Middle ear- tympanic membrane (eardrum) and middle ear ossicles (bones)

• Inner ear- cochlea and vestibule (balance system) (Discuss hair cells)

Photo retrieved from: http://www.american-hearing.org/images/ear.jpg

Inner Ear Cochlea

• The inner ear cochlea contains hair cells.

• These hair cells stimulate the acoustic nerve by sending electrical signals to the nerve.

• The sound is then processed in the brain.

Photo retrieved from: http://scienceblogs.com/retrospectacle/upload/2006/06/hair%20cells.bmp

Anatomy of the Ear

• Virtual Tour

Better Hearing Institute

Types of Hearing Loss

Conductive hearing loss- Hearing loss due to a pathology in

the OUTER or MIDDLE EAR.

• Ear infection• Wax accumulation• Otosclerosis• Tympanic membrane (eardrum) perforation• Malformation of the outer or middle ear

• (Note: There is no damage to the inner ear)

Sensorineural Hearing Loss

• Sensorineural Hearing Loss- Hearing loss due to a pathology in the INNER EAR.

Occurs when there is damage to the cochlear hair cells or auditory nerve.

• Noise exposure• Presbycusis (age related)• Medication- chemotherapy, aminoglycoside antibiotics, etc.• Virus• Acoustic trauma (blast)• Genetics• Autoimmune• Meniere’s disease

Cochlear Hair Cell Damage

Sensorineural hearing loss

• Sensorineural hearing loss is the most common hearing loss in adults.

• The damage to the inner ear hair cells can also cause distortion of sound.

• This causes speech to be unclear, even when sound is amplified.

• (That is why hearing aids can increase volume, but cannot make speech clearer.)

Sensorineural hearing loss

•Damaged hair cells become permanently damaged in the inner ear.Damaged hair cells become permanently damaged in the inner ear.

•These hair cells are unable to regain function.These hair cells are unable to regain function.

*There are current studies to regrow hair cells on chinchillas.*There are current studies to regrow hair cells on chinchillas.

Audiogram

Photo retrieved from: http://www.audiology.org/searchcenter/pages/results.aspx?k=audiogram

Word Recognition Score

What can hearing aids do?

• Hearing aids are programmed specifically for your hearing loss.

• Hearing aids do not cure hearing loss.

• Hearing aids are an aid and will HELP improve communication.

• Limitations:• They will make sound louder, but CANNOT make it clearer.• *They can reduce background noise, but CANNOT eliminate it.*

Hearing Aids

Before receiving hearing aids the patient will need:

1) Audiological evaluation to determine

-Is there a hearing loss?

-Type of hearing loss

-Severity of hearing loss

-Word understanding ability (%)

-Is the patient a hearing aid candidate?

2) Medical clearance from physician.

3) Hearing aid consultation to determine best

hearing aids for pt.

Hearing Aid Choices

• Major Things You Have to Decide

1. One hearing aid or two?2. What size or style of hearing aid?3. What features and price level will I need to best address your problem

areas?

Some will affect the cost….

One or Two Hearing Aids?

• Advantages of two hearing aids

1. Ability to hear to the left and right

2. Ability to localize where sound is

3. Sound clarity is better

4. Understand better in noisy environments

5. Most say “it’s easier to hear” with two

hearing aids

One Hearing Aid or Two?

• When Is One Hearing Aid Enough?

1. Hearing loss in one ear

2. When finances are a concern

Style and Size of the Hearing Aids

• Hearing aids come in 4 basic sizes• Which size is best for you depends upon:

1. Size and shape of your ear2. Your hearing test results3. What features you want in the hearing aids to address your problem areas

4. Your ability to put the aid in your ear.

• What are the 4 basic sizes?

Behind-the-Ear Hearing Aid

Photo retrieved from: http://www.phonak.com/us/b2c/en/products/hearing_instruments/styles.html

Open Behind the Ear Hearing Aid

Note: Appropriate for only certain types of hearing lossPhoto retrieved from: http://www.phonak.com/us/b2c/en/products/hearing_instruments/styles.html

In-the-Ear Full Shell Hearing Aid

Photo retrieved from: http://www.phonak.com/us/b2c/en/products/hearing_instruments/styles.html

In-the-Canal Hearing Aid

Photo retrieved from: http://www.phonak.com/us/b2c/en/products/hearing_instruments/styles.html

Completely-in-the-Canal Hearing Aid

Photo retrieved from: http://www.phonak.com/us/b2c/en/products/hearing_instruments/styles.html

What Type of Circuitry?

• Hearing aids can be made with different circuitry.

• Basic circuits to advanced circuits (computer chip inside the aid)

• Prices vary based on what features and options are present in the hearing aid circuit .

• What’s important is to pick the features and options you need in a PRICE RANGE FOR YOU.

What Are the “Special Features” and Options?

• How precisely the hearing aid can be adjusted to your hearing levels

• Automatic regulation of volume levels

• Automatic adjustment for different listening environments

• Noise block processing

• Wind block technology

• Whistle block technology

• Echoblock technology

• Duo-phone (hearing phone signal in both ears)

What Features and Price Range Are Appealing to You?

• Decide this and I will recommend which hearing aids should perform well for you in the size you want in your price range.

• We work with 3 different companies, so I will choose a company and a specific hearing aid model that can best meet your requirements.

Decisions…….

1. One or Two Hearing Aids?

2. Size/Style of Hearing Aid? (Note: there may be compromises on size and features)

3. What Features and Price Range?

Where Do We Go From Here?

• Take impressions of your ears (if needed)

• Audiologist orders the hearing aids

• You will return in 2 weeks for hearing aid fitting.

• Begin 60-day trial period. Aids may be adjusted during office visit during and after trial period.

• Return in 2 weeks for hearing aid follow-up.

• Begin the course “Be the Boss of my Hearing Loss”

Important…

• Wear the hearing aids all day (except during water activities or bedtime)

• The more you wear the hearing aids, the faster you will adjust.

• The brain has to re-adjust to the new sounds.

Helpful Hearing Aid Expectations

1) I have just begun the process of adjusting to my hearing loss and the use of hearing aids.

2) My own voice may sound different when I am wearing my hearing aids.

3) I may have a new awareness of footsteps, door closings, newspaper rustling, and so forth.

4) Listening when background noise is present will still be challenging.

5) My hearing aids are only one part of the services my audiologist supplies.

6) I will benefit most from amplification if I use speech reading and positive listening strategies along with it (e.g., I should not judge the effectiveness of hearing aids by asking people to cover their mouths when they speak).

From Mormer and Palmer in Counseling for Hearing Aid Fittings (edited by Sweetow, Singular Press, 1999).

Bluetooth Technology

• Wireless

• Can listen to cell phone, TV, and MP3 player

• Most companies have Bluetooth technology

Photo retrieved from: http://www.hearingaidresource.com/v/vspfiles/photos/ICOM-2T.jpg

Expectations from Hearing Aids

• Expect improved hearing, Not normal hearing

• Prepare to be patient, it takes time to adjust to hearing aids and hearing sounds again

• Anxiety and nervousness are fine, but be POSITIVE.

Remember…

• We are limited by our own auditory system.

• Damage to inner ear hair cells

• Distortion of sound

Expectations

• Know what hearing aids CAN and CANNOT do.

• They are an aid. They cannot listen for you.

It’s Not All About Hearing!

• Hearing:-the capacity to hear

• Listening:-to make an effort to hear something

-to pay attention

• Hearing aid will help you hear

• You must be the one to listen

(put in effort)

(listening strategies)

Communication

Three Factors influence communication:

• Talker

• Environment

• Listener

The Talker

• Volume of voice

• Dialect

• Speed

• Objects in mouth (food/gum)

• Multiple Talkers

Environmental Factors

• Background noise

• Distance

• Lighting

• Visual distractions

• Good viewing angle of talker

The Listener

• Hearing loss (Severity/ Word Rec. score)

• Vision

• Attention (First name)

Speech Reading

• Must pay attention.

• Get the talker to look at you.

• Use context to help you guess.

• Look at facial expressions.

• Observe body language.

*Make use of all information to make the “best guess”.

Tye-Murray, N. (1998). Foundations of Aural Rehabilitation. San Diego: Singular Publishing Group.

Assertive Behaviors

1. Meet your own needs while respecting the other person.

2. Be willing to admit you have a problem.-Explain it to others.-Suggest ways to improve the communication.

3. Take the initiative to improve the situation by doing something yourself or telling the other person what they can do.

4. Thank them. It will reinforce the helpful behaviors.

Noise Exposure

• Children and ipods

• Noise-Induced Hearing Loss is permanent

and almost ALWAYS preventable!

When is noise/music too loud?

• Must raise voice to talk when person is an arm’s length away.

• Tinnitus (ringing or noise) in ears after leaving the noise.

• Ears feel “blocked” or plugged after leaving the noise.

Rahe and Freeman (Personal Communication, 2008)

Noise-Induced Hearing loss

• iPods/MP3 players

• Children are increasing their risk for Noise-Induced hearing loss.

• Study: iPod/MP3 volume levels of 58 middle school students

were measured.

63% of students set the volume at unsafe volume levels.

Snowden and Zapala (2010)

Tinnitus

• Can be a symptoms of hearing loss

• You are not alone.

• Over 50 million people have some degree of tinnitus.

• 12 million have severe enough tinnitus to seek medical attention.

• Up to 90% of people with tinnitus have hearing loss.

• American Tinnitus Association

Causes of Tinnitus

• Excessive noise exposure (damaged hair cells)

• Hearing loss (damaged hair cells)

• Ototoxic medications (damaged hair cells)

• Aspirin

• Jaw misalignment (contraction of various muscles)

• Cardiovascular disease (hypertension, etc)

• Other

American Tinnitus Association

Tinnitus

• Tinnitus usually does not go away.

• Most cope with it.

• If you stress about it, it can make the tinnitus worse.

• What does it sound like?RingingOceanBuzzingRoaringWhistlingHissing

American Tinnitus Association

Options for Relief

• Hearing aids! If you have hearing loss and tinnitus, hearing aids OFTEN make the tinnitus less noticeable.

• Tinnitus masker- A device that fits in your ear that plays noise to mask the tinnitus.

• Neuromonics Tinnitus Treatment- Expensive device that allows the patient to make tinnitus less noticeable. Option for patients without hearing loss.

For relief at night:• Fan• Radio (music, rain, ocean)• TV• Sound Oasis Pillow- Plays music in your pillow for relief at night.

References

• American Academy of Audiology. (2010). Retrieved on November 14, 2010 from http://www.audiology.org/searchcenter/pages/results.aspx?k=audiogram.

• American Tinnitus Association. (2010). Retrieved on February 8, 2010 from www.ata.org.

• Better Hearing Institute. (2010). Retrieved on July 27, 2010 from Betterhearinginstitute.org.

• Hawkins, David. Electronic Media. Adult Aural Rehabilitation.

• Mormer and Palmer. Counseling for Hearing Aid Fittings (edited by Sweetow, Singular Press, 1999).

• Snowden C. and Zapala D. Do Middle School Students Set Safe Volume Levels for Routine IPod Use? Audiology Today. July/August 2010.

• Photos: • http://www.audiology.org/searchcenter/pages/results.aspx?k=audiogram• http://www.american-hearing.org/images/ear.jpg• http://scienceblogs.com/retrospectacle/upload/2006/06/hair%20cells.bmp• http://www.phonak.com/us/b2c/en/products/hearing_instruments/styles.html