Lecture 10 Flashcards
What are the most common reasons for not using a hearing aid?
My hearing loss isn’t bad enough - thinking about just getting by
Hearing aids won’t work for me
Too expensive
Makes me look old
People will notice - embarrassment
Frustration with the process - relative has had one bad experience, and are frightened
When does one decide when to use a hearing aid?
Generally, the more loss the greater the benefit from the hearing aid
Greater degree of loss (severe to profound) reduces benefit
Most often used for sensorineural loss, sometimes for conductive that can’t be repaired medically
Motivation
Lifestyle
How does one decide if one or two hearing aids are needed?
What do bilateral hearing aids provide?
Depends on loss in each ear
Bilateral hearing aids provide - better speech recognition in noise, better localization ability, less power required from each hearing aid.
What is the difference in input with none vs. having hearing aids?
With none, for input the ability to recognize speech will be declining - more for people with hearing loss.
With hearing aids - to nerve and hearing system, you get a slow down in degeneration of the CNS
What are some things that hearing aids can do?
Speech understanding in quiet
Speech understanding in noise
Loud sounds tolerable
Comfortable fit
What are some things hearing aids can’t do?
Perfect hearing
Bionic hearing
Get rid of annoying sounds - will improve
Cure hearing loss
Work instantly (myth) - brain needs to train itself to use the input, can take up to 6 months
How does a hearing aid work?
Microphone changes sound to electricity Amplifier boosts electrical signal Receiver changes electricity back to sound Battery for power Controls to adjust hearing aid response
What are some considerations for the patient when picking a specific hearing aid?
Dexterity and vision problems are a consideration for style for patients.
Not all hearing losses can be fitted with hearing aid types - some cannot fit, need larger amplifiers
What are some benefits and drawbacks for the BTE?
Most powerful aid Durable Lowest repair rate Easiest for caregivers to operate Largest controls but may be difficulty to position behind the ear Most hearing aids are this kind
What are some benefits and drawbacks of the ITE processor?
Largest of the custom-made styles May be easiest for wearers with dexterity problems Suitable for all but severe hearing loss More likely to have wax buildup Benefit: people won't see it
What are some components of the ITC?
Smaller batteries and volume wheel than ITE
May be difficult for wearers with dexterity and/or vision problems
Suitable for mild to moderate hearing loss
What are some components of the CIC?
Smallest aid (and even smaller batteries)
Highest repair rate
Not suitable for wearers with dexterity/vision problems, unusually-shaped or small ear canals, severe loss
What are some benefits and drawbacks for open fit hearing aids?
Has BTE processor, thin tube and open mold
Can be fit same-day in the office
Not suitable tor greater than moderate hearing loss
May be prone to feedback
What is the BAHS system?
Main uses?
Transmits sound the same way as the BC vibrator used for audiometry
Surgically implanted connection
Main uses: for permanent conductive loss, atresia, profound unilateral loss
What is the benefit of having digitally programmable hearing aids?
Can connect to computer and set features to client’s needs
Greater flexibility in fine tuning hearing aid fitting and improving client satisfaction
What are the 3 goals when fitting a hearing aid?
Make soft sounds audible
Make average speech maximally audible
Make sure loud sounds are comfortable
What does gain mean?
How much hearing aid has increased the sound level. To make it audible for the person, get input and put gain on it.
What is frequency response?
Amount of gain as a function of frequency. Can cater to various frequencies for each client’s HL.
What does linear aid gain mean?
Hearing aids provide same gain for every input level until they reach a maximum limit (ex. 110dB SPL)
What does compression in hearing aid gain mean?
Hearing aids automatically adjust volume: more gain for soft input, less gain for loud input - also called automatic volume control.
How does compression work in the hearing aid?
Detectors in hearing aid monitor the sound level? Increase gain for soft sounds
Decrease gain for loud sounds
Different amounts of compression at different frequencies
Can be adaptive - amount used can change with sound input
How does a directional microphone work?
2 microphones, one facing forward, one facing backward
In directional mode, amplifies sound from the front, reduces sound from the rear.
What do “smart” directional microphones work?
Automatic adaptive directional system locates the source of the loudest noice and automatically adjusts hearing aid to reduce sound from that direction.
How can remote controls help with hearing aids? (drawbacks too)
Volume controls Multiple memories Easier to see and operate with reduced mobility or dexterity May not work next to computers Ned to carry remote to operate aid
What is feedback?
Some of the sound produced by aid leaks out of the ear canal, it will be picked up and amplified by the hearing aid microphone and cause a feedback loop. Heard by user as high pitch whistle
How can feedback be improved?
Cancellation - feature that detects feedback and produce signal that is opposite in amplitude and phase and in doing eliminate the signal.
Reduce high frequency gain
Turn volume down
From basic - mid-range - advanced aids, what are the benefits/drawbacks?
Increasing features, increasing costs
advanced noise reduction, bluetooth, feedback management…$4000-5000
For troubleshooting, how do you fix physical damage?
Clean (wax, dirt, water)
Broken (cracks, parts hanging off, parts that don’t move the way they should)
For troubleshooting, how do you fix batteries?
Is is working?
Is it inserted properly?
For troubleshooting, how do you fix sound?
Does it feedback when cupped in your hand?
Talk into aid while listening
Clear? Loud? Intermittent?
Does VCW change loudness?
What are some red flags that prevent you from fitting someone for a hearing aid? (3)
Unilateral or pulsatile tinnitus
Ongoing pain or discomfort in the ear
Facial nerve paralysis
How does a cochlear implant work?
What are the general pieces?
Replacing hair cells - microphone gets sound, processor - transformed into packages of electrical signals, sent into the transmitter/antenna, into receiver, as you put antenna on top (magnet holds it on); packages stimulate electrode in cochlea that stimulate nerve directly where HC give impulse to nerve (electrode array)
Has internal device and outer cochlear sound processor
What are some criteria for adult candidates for a CI?
Moderate to severe/profound hearing loss
Limited benefit from optimally fitted amplification
Cochlear that can accommodate the implant device/integrity of auditory nerve
What are some criteria for child candidates for a CI?
At least 12 months old
Limited benefit from hearing aids - 3-6 months use
No medical contra-indications
What are some criteria for simultaneous bilateral criteria for children for CI?
Bilateral severe-profound SNHL
Post-meningitis
Deaf/blind
Criteria for bimodal - CI and HA?
Asymmetric HL
Better hearing in low frequency
Criteria for sequential bilateral?
HL in HA ear drops
Loss of bimodal benefit
What is included in Audiology 1 year post CI surgery?
After 1 year?
1 year: intra-operative testing, equipment orientation
After 1st year: seen every 6 months, seen annually…assessment and mapping
What is the role of the Audiologist, SLP and combined?
Audiologist: intra-operative monitoring; programming; equipment
SLP: therapy; tracking development
Both: Pre/post assessments; monitoring auditory and speech development; educational support; family support and advocacy
