Modern Hearing Devices and Implants: Enhancing Auditory Experience

1. Chapter 3 Hearing Aids, Hearing Assistance Technologies & Implants

2. Latest Technology • Phonak Roger Pen • GN ReSound LiNX • MED-EL Rondo

3. Question Which of the following is NOT true? • A cochlear implant primarily amplifies sound • A hearing primarily amplifies sound • Hearing aids can be worn by infants from birth • Less than 25% of Americans who could benefit from a hearing aid, wear a hearing aid • Children function better with 2 cochlear implants

4. Purpose of Hearing Devices • Make speech audible • Make non-speech audible • Restore range of loudness • Alerting • Keep in touch with environment

5. Hearing Challenges • Hearing soft speech • Hearing speech clearly • Hearing speech in noisy environment • Hearing speech in reverberant environment

6. Question The Augustana Chapel provides a conducive listening environment for persons with a hearing loss? Yes No

7. Definition of Hearing Aid • Hearing Aids(noun, plural) 1(archaic): electronic devices usually worn by a person for amplifying sound before it reaches the auditory receptor organs. 2(modern): electronic devices worn by a person for processing sound to provide audibility and improve the signal-to-noise ratio before it reaches the auditory receptor organs. A New Definition for Modern Hearing Aids, Victor Bray, Ph.D. & Michael Nilsson, Ph.D., Auditory Research Department, Sonic Innovations, Inc.

8. Types of Listening Devices • Hearing Aids • ALDs/HAT • Alerting Devices • Brainstem Implants • Middle Ear Implant Devices (BAHA & Envoy) • Cochlear Implants (CI) • Smartphone

9. Hearing Aid Styles • Air conduction • Body Aid • Glasses • BTE • RITE • RITA • ITE • ITC • CIC • Bone Conduction • Middle Ear Implant Devices (BAHA)

10. Open Canal • Receiver in the Ear • RITE • Receiver in the Aid • RITA

11. Question A RITA hearing aid has the speaker component in the? • Ear canal • Hearing aid • Middle ear • Both ear canal and hearing aid

12. Bone Conduction HA • When a conventional hearing aid cannot be worn due to microtia, atresia, obstruction in EAM, bone conduction hearing aids may be beneficial

13. BAHA (unisensory conductive loss) Bone Anchored Hearing Aid: • Surgically embedded titanium "post" into skull with a small abutment • A sound processor sits on abutment • The implant vibrates the skull and stimulates the cochlea via bone conduction bypassing outer & middle ear • Treatment for: • Conductive loss • Mixed hearing losses • Unilateral sensorineural hearing loss, • Chronic ear infections • Congenital external auditory canal atresia

14. Alpha 2 (M) Bone Conduction Hearing System • Sophono Inc. • Differding Family Story and Sophono

15. MED-EL BoneBridge • BoneBridge • BoneBridge

16. SoundBite Hearing System • SoundBite Hearing System • Single sided deafness or conductive hearing loss • No surgery required • Removable and totally non-invasive • No dental work or alterations to teeth • BTE (behind-the-ear) microphone unit, housing receiver, wireless transmitter, and attached microphone • Removable ITM (in-the-mouth) hearing device

17. Question The BAHA is? • Air conduction hearing aid • Bone conduction hearing aid • Cochlear implant • Brainstem implant

18. Envoy Implant • Middle Ear Implant • Envoy Medical

19. ESTEEM Implant Criteria • at least 18 years of age • stable, moderate-to-severe, bilateral sensorineural hearing loss (Range = 40 dB to 70 dB, defined as the average of pure tone thresholds at .5, 1, 2 KHz) • speech recognition test score (WRS) greater than, or equal to, 40% in the worst hearing ear • normal tympanic membrane & middle ear anatomy • normally functioning Eustachian tubes • worn properly fit hearing aids for at least one month • no history of immune compromise or chronic staphylococcal skin infections • room in their mastoid cavity to accept the ESTEEM components • able to undergo a 3-4 hours general anesthetic

20. VIBRANT SOUNDBRIDGE Middle Ear Implant System (Medel) Placement Options: Ossicular RoundWindow

21. Hearing Aids • Analog (conventional) • Programmable (analog or digital) • Digital

22. Analog hearing aids pick up the sound and convert it into electronic signals. These hearing aids have trimmers that are manually adjusted by a hearing healthcare professional using a tiny screwdriver. Analog hearing aids are the least flexible, but also the least expensive, level of hearing aid technology. Programmable Programmable hearing aids must be connected to a computer in order for your hearing healthcare professional to make adjustments. These hearing aids offer more flexibility and can provide more features. Digital Digital hearing aids contain computer chips that convert the electronic signal into digital signals. The digital hearing aid can perform complex processing of the sound, such as reducing the intensity of loud background noise. Typically programmed via a computer, offers the greatest flexibility in its ability to match the hearing aid response to the hearing loss. Type of Hearing Aids

23. Question A receiver is another name for: • Microphone • Speaker • Battery • Amplifier

24. HA Components MicrophoneThe microphone picks up sounds from the air and convert them into electrical signals.AmplifierThe amplifier increases the intensity of the signals from the microphone. Filters modify the sounds so that only sounds which are relevant for the person are amplified.'Loudspeaker' (Receiver)The third basic component is the 'loudspeaker' (receiver). It converts electrical signals into acoustic signals, which the person then hears.Small computer (Digital) (How it works)These three components exist in all hearing aids. Furthermore, in digital hearing aids a small computer can be programmed to manipulate the signals to fit the hearing loss of the individual hearing-impaired person.

25. Batteries • Various Sizes • Chemical

26. Question Most hearing aid batteries are? • Mercury • Zinc-air • Hallogen • Sulfer-free

27. Earmolds • Earmolds direct sound into the ear canal • Variety of styles, colors, and other characteristics

28. Ear Impressions

29. Thin Tube (Open Canal)

30. HA Verification • Real Ear (probe microphone) • Speech tests (HINT, QuickSIN, BKB-SIN, SPIN) • Subjective ratings of intelligibility and quality • Loudness verification • Questionnaires • Functional gain • ABR—for infants & young children

31. Probe Microphone • Real Ear measures of sound pressure in the ear canal

32. Speech Tests • HINT • QuickSIN • BKB-SIN • SPIN

33. QuickSIN/BKB-SIN 1.SNR loss of 0-2 dB: Normal to near-normal.These patients will probably do well in noise with any hearing aids that provide undistorted output.  With directional microphones, they may hear better than their normal-hearing peers in noisy situations. 2.  SNR loss of 2-7 dB: Mild SNR loss.Today’s directional microphones provide SNR improvements of 2 to 5 dB; with directional microphones, these patients should be able to hear almost as well as their normal-hearing counterparts in noisy situations. 3.  SNR loss of 7-15 dB: Moderate SNR loss.While directional microphones will provide benefit for these patients, they cannot provide enough SNR improvement to allow the person to hear as well as their normal-hearing counterparts in noisy situations. Microphone arrays, such as the LinkiT, provide a 7 to 13 dB improvement in SNR. 4.  SNR loss greater than 15 dB: Severe SNR loss. These patients need the maximum amount of SNR improvement, and FM systems are the technology of choice for these patients. Today’s ear-level FM systems are cosmetically appealing and are available in a wide range of hearing aids. Contact hearing aid manufacturers for more information.

34. Subjective Ratings • Magnitude Production • Pt is given a number and instructed to adjust a given parameter such as intensity, SNR, until that number is reached • Category Scaling • Pt is given a bounded scale such as 1 to 10 and asked to make a judgment of a speech passage based on intelligibility, quality, etc. • Paired Comparisons • Pt compares 2 different settings or hearing aids • Clarity • Pt asked to judge if sound is clear, distinct, pure…the opposite is diffuse

36. Loudness Restoration • PAL • Soft, comfortable, loud

37. Questionnaires • APHAB • SADL • IOI • SSQ • GHABP • PAL

38. Classroom Function Hearing Evaluation Using Clickers

39. Functional Gain • Compare Aided vs. Unaided results • In the example, the aided (green) thresholds are compared to the unaided thresholds for the right (red) and left (blue) thresholds

40. Ling 6 (HL) CD from Phonak

41. Ling 6 Sound Check • Evaluate student at variety of distances to determine maximum distance Ling sounds heard • Ling 6 Sound Check Chart • Ling 6 Behavioral Daily Checklist • Ling 6 Recording Chart

42. Ling 6 (HL) (free CD from Phonak)

43. UWO Plurals Test (free CD from Phonak)

44. UWO Plurals Test (free CD from Phonak)

45. Phonak Logatom Test • Adaptive, computer controlled test • Developed by Phonak • Female speaker: “My name is…” • Software track level in dB SPL that corresponds to 50% correct performance

46. Functional Listening Evaluation • Determine how listening abilities are affected by noise, distance, and visual input in an individual’s natural listening environment • Designed to simulate listening ability in situations that represent actual listening conditions in student’s classroom– not sound booth • Administration of the evaluation, the student’s teachers, parents, and others gain understanding affects of adverse listening conditions encountered by the student. • The evaluation results are also useful in justifying accommodations, such as assistive listening devices, sign language or oral interpreters, notetakers, captioning, special seating, and room acoustic modifications. • Functional Listening Evaluation (Ying , 1990), (Ross, Bracken & Maxon, 1992)

47. FLE (cont.) • Test administration takes approximately 30 minutes, including set up, with sentences and 20 minutes with words. 1. Auditory-Visual Close Quiet 2. Auditory Close Quiet 3. Auditory-Visual Close Noise 4. Auditory Close Noise 5. Auditory-Visual Distant Noise 6. Auditory Distant Noise 7. Auditory Distant Quiet 8. Auditory-Visual Distant Quiet

48. BKB SIN Test • 10 sentences presented twice • Increasing noise with each sentence • SNR loss is the increased S/N ratio required by a listener to understand speech in noise • BKB-SIN Test scores are reported in SNR • Age normative data • Allows audiologist to recommend appropriate assistive technology (e.g., omni-directional microphones, directional microphones, array microphones, FM systems, etc.) for students with HL to function in noisy situations • Rich in semantic context, thus individuals with HL may be using top-down processing to improve their performance—does not tax bottom-up processing (Niquette et al 2003)

49. AB IT-MAIS (free iPad app)

50. LENA Developmental Snapshots