Hearing, Hearing Loss, Hearing, Hearing Loss, Hearing Help Hearing Help Pamela Fiebig, AuD, Audiologist Northwestern University Dept. of Otolaryngology/Audiology October 14, 2013
Jan 15, 2016
Hearing, Hearing Loss, Hearing, Hearing Loss, Hearing HelpHearing Help
Pamela Fiebig, AuD, Audiologist Northwestern University Dept. of
Otolaryngology/AudiologyOctober 14, 2013
Northwestern Medical Group Dept of Northwestern Medical Group Dept of OtolaryngologyOtolaryngology Galter Pavilion, 15 Galter Pavilion, 15thth Floor; 675 N. St. Clair Floor; 675 N. St. Clair312-695-8182312-695-8182
Audiologists– Pamela Fiebig, AuD– Malini Patel, AuD– Denise Greiner, AuD– Michelle Amosson, AuD– Michelle Burns, AuD– Kelly Waldvogel, AuD
Otologists (physician ear specialists)– Alan Micco, MD– Akihiro Matsuoka, MD
Hearing Loss is CommonHearing Loss is Common
10 Million Americans Report Significant Hearing Loss– 4 Million > 65 y.o.– 5 Million 18-64 y.o.– .5 Million < 18 y.o.
Age of Hearing Loss OnsetAge of Hearing Loss Onset
Source: National Health Interview Survey, 2007.
http://www.nidcd.nih.gov
More More Men Men Than Than Women Women Have Have Hearing Hearing LossLoss
How We Hear
Basic Audiology TestsBasic Audiology Tests
Pure-tone Audiometry– Air-Conduction
»earphones--evaluates from outer to inner ear
– Bone-Conduction»bone vibrator--evaluates inner ear
Word Recognition Testing
AudiogramAudiogram
Normal hearing and Speech Normal hearing and Speech SoundsSounds
Types of Hearing LossTypes of Hearing Loss
Conductive Hearing Loss– Outer or Middle Ear-DEMO
Sensorineural Hearing Loss
– Cochlea or Auditory Nerve– 99% is SENSORY not neural
Mixed Hearing Loss– Both conductive and sensorineural
Conductive Hearing Loss: Conductive Hearing Loss: Causes and TreatmentsCauses and Treatments
Ear Wax (cerumen) or other block Ear Infection/Fluid in Middle Ear Otosclerosis Cholesteotoma Perforated Eardrum
Can often be “fixed”!
Sensory Hearing Loss: Sensory Hearing Loss: CausesCauses Presbycusis (aging) Ototoxic medication Meniere’s Disease Heredity Noise Exposure Unknown
Usually CANNOT be “fixed”
Hearing Loss from Noise Hearing Loss from Noise ExposureExposure
Hearing Loss and AgingHearing Loss and Aging
Acoustic NeuromaAcoustic Neuroma
Benign Tumor in the Internal Auditory Canal
Symptoms Include– Hearing loss– Tinnitus– Dizziness
Treatment is surgical removal– Hearing is often sacrificed in this ear
Hearing Aids for Sensory Hearing Aids for Sensory Hearing LossHearing Loss
Effect of Hearing Loss on Effect of Hearing Loss on Speech UnderstandingSpeech Understanding
Hearing Aids:Hearing Aids:Desirable CharacteristicsDesirable Characteristics
Speech Audibility Physical comfort “Audible” comfort
– Not too much “background” noise– Not too loud
BTE (Behind-the-Ear Style)BTE (Behind-the-Ear Style)
ITE (In-the-Ear Style)ITE (In-the-Ear Style)
ITC (In-the-Canal Style)ITC (In-the-Canal Style)
CIC (Completely in Canal)CIC (Completely in Canal)
Sometimes “extended wear”
““Mini” Behind-the-EarMini” Behind-the-Ear
““BEST” Hearing AidBEST” Hearing Aid
Degree/Configuration of loss Individual Listening Needs Cosmetics/Style Ability to Manipulate Small Objects “Gadget” Tolerance Cost
Today’s Hearing Aids: Special FeaturesToday’s Hearing Aids: Special Features
Directional Microphones Noise Reduction Algorithms Multiple Listening “Programs” Automatic adjustments Feedback controls Bluetooth/wireless compatibility Left-Right Communications
What Patients Say About Today’s What Patients Say About Today’s Hearing Aids...Hearing Aids...
Speech sounds CLEARER– As distortion decreases, performance increases
MORE sounds are HEARD– Automatic loudness scaling allows more sounds
to be audible
Sounds are more COMFORTABLE– Loudness stays within comfort range
I still can’t hear in high levels of background noise– but I do hear better in low to mid-levels of noise
Cochlear Implants–For severe-to-profound hearing
loss
–Where hearing aids are of minimal benefit
When Hearing Aids Are Not Enough…
A A Hearing AidHearing Aid Amplifies Acoustic Amplifies Acoustic Energy and Delivers it to the Energy and Delivers it to the cochleacochlea
A A Cochlear ImplantCochlear Implant Converts Converts Acoustic Energy into Electrical Acoustic Energy into Electrical Impulses and Stimulates the Impulses and Stimulates the Auditory NerveAuditory Nerve Directly, replacing Directly, replacing the function of the sensory cells in the function of the sensory cells in the cochleathe cochlea
Implantable Stimulator
External Speech Processors
How a Cochlear Implant How a Cochlear Implant WorksWorks
Medicare and Hearing Medicare and Hearing CareCare Initial Hearing Evaluation covered
with Physician Referral; with medical condition
Hearing evaluation is part of initial welcome wellness exam
Hearing Aids and related services are NOT a covered benefit
Medicare and Hearing Medicare and Hearing CareCare Some managed plans may have
hearing aid discounting agreements with participating providers
Cochlear Implants ARE a covered benefit for patients who meet criteria set by Medicare
Dispensing Law RequiresDispensing Law Requires
Medical Clearance for Hearing Aid Use by Physician
Waiver of Medical Clearance Allowed for Users Over 18 years old
30-day trial with hearing aid (Mandated in IL, Suggested by FDA)
Do YOU Have a Hearing Do YOU Have a Hearing Problem?Problem? Do people “mumble?” Do you frequently say,
“What?” or “Huh?” Do you misunderstand
numbers and names? Do you like the TV/radio
volume louder? Do you have trouble
hearing in noisy rooms?
What’s should I do if I think I What’s should I do if I think I have an ear or hearing problem?have an ear or hearing problem?
Investigate medical symptoms with an otologist (ear specialist)– Ringing, dizziness, ear pain – Changes in hearing or symptoms
See an audiologist for evaluation– Discuss ear protection for noise– Consider hearing aids, if appropriate
A Parting Thought…A Parting Thought…
Hearing help Hearing help may be less may be less conspicuous conspicuous than your than your hearing losshearing loss