Basic Audiology: Understanding the Xs and Os Developed by: Sheila Hitchen Tweaked by: Cheryl Davis

1. Basic Audiology: Understanding theXs and OsDeveloped by: Sheila HitchenTweaked by: Cheryl Davis

2. The Issue for VR • 28 million people in US have a hearing loss (10%) • HOH population unemployed due to disability: 22.5% • The rate is essentially constant regardless of whether the loss is in one or both ears • Hearing women stay in labor force 9 years longer than hard of hearing women • 17% more hard of hearing female workers aged 45-54 exit the labor force • People leave jobs because of: • Inability to continue to carry out duties • Social difficulties and isolation Data from U.S. Census Bureau & the Center for Bilingual Education and Research, Arizona State University.

3. Worker #1 Depressed Defensive/Paranoid Poor self image Poor social skills Poor listening skills Feels like they have no control Worker #2 Not depressed Less defensive/ paranoid Normal self image Normal social skills Normal listening skills Feels like they are in control Who Would You Hire or Promote?

4. Myths & Misunderstandings • “What’s the big deal? You hear ‘pretty good.’” • “You speech read, right?” • “Your hearing aids ‘fix’ it.” • “You can hear if you want to.” • “You don’t need accommodations… • Your speech is clear, so you hear well, • You heard me fine in my office, • You talked to me on the phone.”

5. You want me to what??? • Definitely understood • Fairly certain he understood • Certain he did not understand • Certain he understood (but didn’t) • Doesn’t know he didn’t hear

6. “I have an 80% hearing loss.”

7. Individual Experience Includes: • Hearing loss • binaural or monaural • varies in severity (dB) and frequency (Hz) • may fluctuate or be progressive • Age at onset of loss • Acceptance/coping strategies • Support structure • Hearing aid/T-coil use/AT use • Identity • Deaf Hard of Hearing • Late Deafened Cochlear Implant User

8. How Hearing Works

9. Conductive Hearing Loss Sound does not move into inner ear efficiently. Due to a problem in either outer or middle ear. May be medically or surgically treated or cured. Inner ear works fine. Amplification may help to get sound through the auditory system.

10. Sensorineural Hearing Loss Sound is not interpreted efficiently by inner ear. (Louder doesn’t help!) May be due to hair cell/nerve damage. May be due to problem with auditory nerve.

11. Cochlear Structure Low Frequency speech sounds are fewer than high frequency. People have difficulty hearing words in two competing signals (cocktail party effect) High frequency cells take the brunt of the day-to-day damage; most people lose high frequency hearing first. People hear the sounds, but can’t make out the words: "Speak up and quit mumbling!!" Low Frequency High Frequency

12. Normal Hearing Looks Like: Normal Inner & Outer Hair Cells

13. Sensorineural Hearing Loss Going… Going… GONE

14. Causes: • Congenital • Maternal Rubella • Genetic Syndromes • Usher Syndrome • Waardenburg Syndrome • Illness and Infection • Measles, Meningitis • Otitis Media • Ototoxic Medication • Noise Exposure

15. At present exposure limits, one in four people will develop a permanent hearing loss as a result of their occupational exposure to noise hazards. Data courtesy of the National Institute of Occupational Health and Safety

16. Causes: Presbycusis (Age Related) • Progressive sensorineural loss • High frequencies first • 55 to 65: high frequencies in the speech range begin to be affected • Other considerations: • Macular Degeneration • Manual Dexterity Issues

17. Other Issues:Tinnitus • Characterized by ringing, rushing, buzzing sounds in ears • Due to damage to cochlear hair cells • Diet and stress management may help control symptoms • Incurable • Some use maskers to block ringing • www.ata.org

18. Other Issues:Meniere’s Disease • Fluctuating: • Hearing loss • Rotational vertigo • Tinnitus • Sense of Aural Fullness • Balance • Visual • Tactile • Vestibular system • http://www.menieresinfo.com • http://www.menieres.org • http://www.vestibular.org

19. Reading the Audiogram

20. Components of aHearing Test Speech Audiometry Air & Bone Conduction Legend Comments

21. The Audiogram Bass Treble • Frequency is measured in hertz (Hz) • Common range shown is 250 Hz to 8000 Hz • Low numbers = low tones • High numbers = high tones

22. The Audiogram • Volume is measured in decibels (dB) • The higher the line, the better the client’s hearing • 90 dB loss does not indicate the person is 90% Deaf!

23. The Audiogram • X =left O =right ear • Normal: 0-20 dB • Mild: 20-40 dB • Moderate: 40-70 dB • Severe: 70-90 dB • Profound: 90+ dB • ALL levels have vocational impacts!

24. Air Conduction Tests the ability of sound to be processed by the hearing mechanism. Shows severity and frequency of the individual’s loss.

25. Bone Conduction Tests the ability of the middle ear to conduct sound to the inner ear. Used to determine the type of loss.

26. Tympanometry Tests the function of ear drum and air pressure in middle ear A diagnostic tool for middle ear problems.

27. Speech Audiometry How well does person hear speech? • Speech Reception Threshold • Speech Detection Threshold • Discrimination Score • Most Comfortable Level • Uncomfortable Level See “What is a Hearing Aid Evaluation” on WROCC website

28. Options for Amplification

29. Hearing Aids Simplified Microphone—picks up sound Amplifier—makes sound louder Speaker—sends sound down ear canal Bigger = more space for battery! ITE BTE ITC CIC

30. Common Styles • Behind the Ear (BTE) • In the Ear (ITE) • In the Canal (ITC) • Completely in the Canal (CIC) • Body Aids • CROS • Contralateral Routing of Signal

31. Circuit Technology(Analog vs. Digital) • Least Expensive • Conventional • Non-programmable linear (analog) • Programmable • Analog (with screwdriver) • Digital (with computer) • Digital Signal Processing • Most Expensive

32. Hearing Aid Terminology • Programmable means how you set all the options or ‘tune’ the hearing aid • Program means different settings for different listening situations (e.g., music, using the phone/telecoil, in noisy situations) • Channel means how many different ranges of frequencies are amplified

33. Noise Noise Noise Hearing in Noise • Signal to noise ration problem • Directional Microphones • Noise reduction • Assistive Listening Devices • Telecoils • Not as sensitive as hearing aids • Susceptible to electromagnetic interference • Direct Audio Input • FM Boot

34. Better hearing in noise Head Shadow Effect Improved localization Deterioration of unaided ear Improved understanding of speech Save battery power Less tiring Better balance of sound Help mask tinnitus REMEMBER—Unemployment rates are about the same with a loss in one or both ears! Differentiated Right ear: cells respond more to speech Left ear: cells respond more to music Two Hearing Aids Vs. One

35. What About Cochlear Implants?

36. T The microphone sends sounds to the processor, which codes the sounds into useful speech, music, etc. Cochlear implants are designed to by-pass the non-functioning cochlear hair cells and provide direct stimulation to the auditory nerve. Some sounds are easier for the brain to figure out than others. Environmental sounds are less complex that combinations of speech sounds. Sounds are transmitted through the skin to the receiver/stimulator via the magnetic headset. The electrodes then stimulate the auditory nerve which sends the signals to the brain. The brain interprets these electrical signals into sounds. The codes are then converted to electrical signals which activate the coiled electrode arrays in the cochlea.

37. What About Cochlear Implants? • **Destroys existing Cochlear cells • Does not restore normal hearing • Technology constantly improving • Does not change the individual’s identity • Auditory Prosthesis • Surgical procedure • Medical clearance required • Replaces hearing aid • Can restore independence for late-deafened people

38. Environmental sounds Improved speech reading ability Speech of familiar others Speech of strangers Able to enjoy music Able to use phone Personal stories BB & WH KS SR MT How do You Define Success?

39. Cochlear Implants • 1970s: CIs will never work • 1980s: CI users will never understand speech • 1990s: They will never appreciate music • 2000s: They will never hear like normal-hearing people do • Next: Bilateral implantation? • Note: about 45,000 people have CIs to date.

40. Resources • SHHH-Self Help for Hard of Hearing People • www.shhh.org (many materials available) • ALDA-Association of Late Deafened Adults • www.alda.org • CIAI-Cochlear Implant Association International • www.cici.org • NAD-National Association of the Deaf • www.nad.org • WROCC Outreach Site at WOU • www.wou.edu/nwoc/leavitt.htm • www.wou.edu/wrocc and click on Training Materials • Hearing Aid Primer • What is a Hearing Aid Evaluation? • How to Read an Audiogram

41. Resources • “Sound and Fury”, video by Josh Aronson, 2000 • Wired for Sound, by Bev Biderman • Cochlear Implant Forum Listserv – Email: • To: listser@yorku.ca • From: (Your e-mail address) • Subject: (Leave it blank) • Message: Subscribe ci (your name) • Cochlear Corporation – www.cochlear.com • Advanced Bionics (Clarion) –www.advancedbionics.com • Med-El – www.med-el.com • www.hearinglosshelp.com/twohearingaids.htm • www.hearinghealth.org • Consumers Guide to Hearing Aids • www.beyondhearingaids.com: • evaluation of consumer’s environment • Survivor’s Manual: http://shhhor.org/survivor_manual.pdf