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CSD 2230 HUMAN COMMUNICATION DISORDERS. Audiology The Profession Acoustics Anatomy Hearing Loss and Pathologies Assessment and Treatment. The Profession of Audiology. The discipline involved in: The prevention, identification, and evaluation of hearing disorders

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The Profession



Hearing Loss and Pathologies

Assessment and Treatment

The Profession of Audiology

The discipline involved in:

The prevention, identification, and evaluation of hearing disorders

The selection and evaluation of amplification systems

The habilitation/rehabilitation of individuals with hearing loss

What Kinds of Audiologists are There?

Rehabilitative Audiologists

Educational Audiologists

Medical Audiologists

Industrial Audiologists

Audiologists in Private Practice

University-Based Audiologists

Why Are Audiologists Important??

Hearing loss interferes with communication…






The Hearing System

The Hearing System

Basic schematic diagram of the entire auditory system

The Outer Ear

Major Landmarks:

  • Pinna

  • External Auditory Meatus

  • Tympanic Membrane

Function of the Outer Ear

  • Collect and funnel sound to the eardrum

  • Protection

  • Resonance

The Middle Ear

Major Landmarks:

  • Middle Ear Space

  • Eustachian Tube

  • Oval and Round Windows

  • Ossicles

Function of the Middle Ear

  • Amplifier and Transformer

  • Protection

The Inner Ear

Major Landmarks:

  • Bony Labyrinth

  • Cochlea

  • Auditory and Vestibular Portions

  • Organ of Corti

  • Hair Cells

Central Auditory Pathways

Types of Hearing Impairment

A loss of sensitivity

Auditory nervous system pathology

Important Terms

Time of onset

  • Congenital

  • Acquired

  • Adventitious

Important Terms

Time Course

  • Acute

  • Chronic

  • Sudden

  • Gradual

  • Temporary

  • Permanent

  • Progressive

  • Fluctuating

Important Terms

Number of Ears Involved

  • Unilateral

  • Bilateral

Hearing Sensitivity Loss

  • “The ear is not as sensitive as normal in detecting sound”

  • Types:

    • Conductive

    • Sensorineural

    • Mixed

Conductive Hearing Loss

“Caused by an abnormal reduction or attenuation of sound as it travels from the outer ear to the cochlea”

Sensorineural Hearing Loss

“Caused by a failure in the cochlea to transduce the sound from the middle ear to neural impulses in the VIII Nerve.”

Sensorineural Hearing Loss

  • Implications include:

  • A reduction in the sensitivity of the receptor cells in the cochlea

  • A reduction in the frequency resolving power of the cochlea

  • A reduction in the dynamic range of the system

Mixed Hearing Loss

“A loss with both a conductive and sensorineural component.”

Auditory Nervous System Impairment


  • Disease

  • Disordered auditory nervous system development

Auditory Nervous System Impairment


  • Retrocochlear disorders

  • Central auditory processing disorders

Auditory Nervous System Impairment

  • Auditory Characteristics:

  • Reduced ability to understand speech in a noise background

  • Problems understanding speech with reduced redundancy

  • Problems with localization and lateralization

  • Problems processing normal or altered temporal cues

Auditory Pathologies

Outer and middle ear disorders

  • Conductive pathologies

    Cochlear disorders

  • Sensorineural pathologies

    Central auditory disorders

  • Central auditory pathologies

Outer and Middle Ear Disorders

Structural defects due to embryologic malformations

Structural changes secondary to infection or trauma


“an abnormal smallness of the auricle”


“the absence of an opening of the external canal”

Outer Ear Disorders

Perforation of the tympanic membrane

Otitis Media

Most common cause of transient conductive hearing loss in children

Inflamation of the middle ear

Caused by eustachian tube failure

Middle Ear Disorders

Otitis Media Facts

76-95% of all kids will have one episode of OM by age 6

Prevalence is highest during the first two years of life

50% of all kids with one episode before their first birthday will have 6 or more bouts within two years

Most episodes occur in winter and spring

Risk factors

Cleft palate

Down syndrome

Native Americans

Urban poor

Day care

Secondhand smoke


  • “a bone disorder that affects the stapes and the bony labyrinth of the inner ear. The disease process is characterized by resorption of bone and new spongy formation around the stapes and oval window”


  • Facts:

  • Hereditary

  • Women are more likely to develop the disorder

  • Usually bilateral

  • Progressive

Cochlear Disorders

Syndromes and inherited disorders

Syndromic disorders

Nonsyndromal disorders

Types of Nonsyndromic Disorders


Dominant progressive

Dominant progressive with adult onset

Recessive hereditary SNHL


Noise Induced Hearing Loss

  • The degree of SNHL depends on

  • The intensity of the noise

  • The spectral composition of the noise

  • The duration of exposure

  • Individual susceptibility



  • Cytomegalovirus

  • HIV

  • Rubella

  • Syphilis

  • Toxoplasmosis



  • Herpes Zooster Oticus (Chicken Pox)

  • Mumps

  • Syphilis


Loss of hearing that gradually occurs in most individuals as they grow old.

It is estimated that 40-50 percent of people 75 and older have some degree of hearing loss.

It involves a progressive loss of hearing, beginning with high-frequency sounds such as speech.

Presbycusis most often occurs in both ears, affecting them equally

Central Auditory Disorders

VIII Nerve tumors

Other diseases of the VIII Nerve

Neural disorders

Cochlear neuritis

Diabetes mellitus

Brain Stem disorders



Multiple sclerosis

Temporal Lobe disorders

Hearing Assessment

Main questions

  • Is hearing normal?

  • What is the degree of hearing loss?

  • What type of hearing loss is it?

Hearing Assessment Procedures

Behavioral Measures

Measures of hearing behavior dependent on the perceptions and cooperation of the listener

Nonbehavioral Measures

Acoustic or physiological responses recorded in association with an acoustic event

Pure Tone Audiometry

  • Major behavioral auditory measure

  • Measurement of pure tone thresholds between 250-8000 Hz

  • Air conduction

  • Bone conduction

Pure Tone Audiometry

The results of PTA tell us

  • Air conduction thresholds across frequency tells us if hearing is normal or not

  • If hearing by air conduction is NOT normal, the thresholds tell us the degree of hearing loss

Pure Tone Audiometry

The results of PTA tell us

  • If hearing is normal or not

  • the degree of hearing loss

  • Differences between hearing by air conduction and hearing by bone conduction tell us the type of hearing loss

Air Conduction vs Bone Conduction Testing

Air conduction tests the entire auditory system. Bone conduction bypasses the conductive mechanism, so it tests only the inner ear.

The Audiogram

What the Audiogram Says About the Impairment

Within normal limits

  • Mild




Determining a Conductive Hearing Loss

Determining a Sensorineural Hearing Loss

Determining a Mixed Hearing Loss

Speech Audiometry

Another behavioral measure of auditory ability

Speech thresholds

Speech Reception threshold

Speech Awareness threshold

Word recognition testing

Identifying Hearing Loss Through the First Year

  • Communication checklists

  • Parents’ reports

  • Case history

  • Informal observation

  • Formal testing

    • Visual Reinforcement Audiometry

    • Behavioral Observation Audiometry

Typical Response Levels to Sounds from Birth-2 years

Nonbehavioral Measures of Hearing

Auditory brainstem evoked response (ABER)

Nonbehavioral Measures of Hearing

Otoacoustic Emissions



Most conductive hearing losses, caused by pathologies in the outer and/or middle ear, can be treated successfully by medication and/or surgery



Hearing aids are the most common treatment of sensorineural hearing loss

Hearing aids amplify speech and other sounds

They work best for people with mild through severe degrees of hearing loss


Cochlear Implants

Used for children and adults who are deaf

These devices stimulate the auditory nerve directly

They are best for people who get very little benefit from conventional hearing aids



Auditory Training

Children and adults

Communication Strategies

Speechreading, noise management, assertiveness training

Communication Methods

Sign language, cued speech


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