Understanding and Treating Hearing Problems Dr. Diana Barreneche, CCC, FAAA Audiologist/Clinical Educator
Understanding and Treating Hearing Problems
Dr. Diana Barreneche, CCC, FAAAAudiologist/Clinical Educator
Topics To Be Discussed
• Ear Anatomy and Physiology
• Signs of Hearing Loss in Adults
• Causes of Hearing Loss
• Hearing Loss Treatment Options
• Tinnitus
• Signs of Tinnitus
• Tinnitus Treatment Options
Anatomy and Physiology of the Ear
• Outer• Middle• Inner ear
Anatomy and Physiology of the Ear
Outer Ear
Consists of
the auricula or pinna
the external acoustic meatus
Anatomy and Physiology of the Middle Ear
Eardrum Ossicles
Anatomy and Physiology of the Inner Ear
Cochlea/Hearing Organ Vestibular Canals/Balance Organ
Acoustic Nerve (8th)
The vestibular/auditory nerve runs in the internal auditory canal and the peripheral end organs to the central nervous system (CNS) Nerve..
Diagnostic Tools
• Otoscopy• OAEs (Otoacoustic Emissions)• Tympanometry (Middle Ear Test)• Pure tone and Speech Audiometry
(Sound Booth)• Auditory Brainstem Response(8th
Nerve and Hearing Thresholds Estimation)
Common Myths
• Hearing loss affects only "old people" and is merely a sign of aging.
Actually it is the reverse of what most people think. The majority (65%) of people with hearing loss are younger than age 65.
Common Myths
• There are more than six million people in the U.S. between the ages of 18 and 44 with hearing loss, and nearly one and a half million are school age.
• Hearing loss affects all age groups.
Common Myths “If I had a hearing loss, my family doctor would
have told me” • Not true! Only 13% of physicians routinely
screen for hearing loss during a physical. Since most people with hearing impairments hear well in a quiet environment like a doctor's office, it can be virtually impossible for your physician to recognize the extent of your problem. Without special training, and an understanding of the nature of hearing loss, it may be difficult for your doctor to even realize that you have a hearing problem. betterhearing.org
Common Myths
• Hearing might be at the bottom of the medical checklist, but it might be the number one medical cause of your problems.
Why?
Signs of Gradual Hearing Loss in Adults
• The perception that people are speaking too soft or mumbling.
• Frequent misinterpretation of what is being said.
• Difficulty understanding conversations on the phone.
Signs of Gradual Hearing Loss in Adults/ Continuation…
• Difficulty understanding conversations in different environments: restaurants, theater, automobile, family reunions, seminars or places of worship.
• Blocked or stuffy feeling in the ears.
• Ringing in the ears. betterhearing.org
Prevalence of Hearing LossIn US
• 3 in 10 people over age of 60 have hearing loss;• 1 in 6 baby boomers (ages 41-59), or 14.6%, have a
hearing problem• 1 in 14 Generation Xers (ages 29-40), or 7.4%,
already have hearing loss • At least 1.4 million children (18 or younger) have
hearing problems• It is estimated that 3 in 1,000 infants are born with
serious to profound hearing loss. betterhearing.org
Types of Hearing Loss
Hearing loss is categorized by which part of the auditory system is damaged.
1. Conductive hearing loss
2. Sensorineural hearing loss
3. Mixed hearing loss
4. Retro-cochlear hearing loss
Conductive Hearing Loss
Sensorineural hearing loss
Sensori-neural Hearing Loss
SENSORINEURAL HEARING LOSS
(DAMAGE TO THE INNER EAR CELLS
CALLED CILIA)
Healthy Dead and Damage Cilia Cilia
Mixed Hearing Loss Damage to Outer or Middle and Inner ear
Causes of Conductive Hearing Loss• Ear infection (Otitis)• Allergies • Poor Eustachian tube function• Perforated eardrum• Benign tumors (growths along the outer and
middle ear)• Impacted earwax (cerumen)• Presence of a foreign body• Fluid in the middle ear from colds• Atresia (Anotia)
Causes of Conductive Hearing Loss
Microtia and AtresiaEar malformations
PE tube: Surgical tube to drain fluid in middle ear
Causes of Conductive Hearing Loss
Impacted WaxExternal Otitis (Inflammation due to infection of ear canal)
Ear Drum Perforation with a Q-Tip
When cotton tipped applicators are used to clean out ear wax, there is a risk of breaking the ear drum (perforation). Although we realize that this is commonly done, we recommend against using cotton tipped applicators, hair pins, and similar devices to clean the ear.
Causes of Sensorineural Hearing Loss
SNHL reduces the ability to hear faint sounds. Even when speech is loud enough to hear, it may still be unclear or muffled. Some possible causes of SNHL include:
» Illnesses» Drugs that are toxic to hearing» Hereditary » Aging (Presbycusis)» Head trauma» Malformation of the inner ear» Exposure to loud noise» Auditory nerve occupied lesion/ (8th) tumors
Presbycusis (Age Related Hearing Loss)
Presbycusis Hearing Loss due to Aging
• Causes: There is no known single cause for age-
related hearing loss. Most commonly, it is caused by changes in the inner ear that occur as you grow older. However, your genes and exposure to loud noises (such as from rock concerts or loud machinery) may play a large role.
Presbycusis Hearing Loss due to Aging
• The following factors contribute to age-related hearing loss:– Family history (age-related hearing loss tends
to run in families)– Repeated exposure to loud noises– Smoking – Certain medical conditions (Diabetes) and
medications (Ototoxics) also contribute to age-related hearing loss.
PresbycusisHearing loss related to Aging
• Prevalence: About half of all people over the age of 65 have some amount of age-related hearing loss.
• Impact in life style: The loss of hearing occurs slowly over time.
• It is most difficult to hear high-frequency pitch sounds. (ex: speech of women and children)
• As hearing gets worse, it may become difficult to hear sounds at lower pitches. (ex: men’s voices)
Presbycusis (Age Related Hearing Loss)
• It becomes difficult hearing things in noisy areas like restaurants.
• Hard time distinguishing high-pitched sounds such as "s" or "th" from one another.
• Other people's voices sound mumbled or slurred.
• Ringing in the ears and lack of tolerance to loud sounds is reported.
Understanding the Audiogram
Normal Hearing
Presbycusis (Age Related Hearing Loss)
Retro-cochlear Hearing Loss• 8th nerve (Auditory
nerve) tumor• Auditory Neuropathy
(Connection between Cochlea and auditory nerve)
• Problems in the Auditory path from the cochlea to the auditory section in the brain (Auditory Processing Issues)
Hearing Loss Treatment options
• Medication
• Surgery
• Types of Amplification:
- Hearing Aids
-Cochlear Implants (CIs)
-Assisted Listening Devices
Key Factors in Amplification Success
Initial Needs Assessment
Electroacoustic & Physiologic Compatability
Comprehensive Habilitative
Follow-up
Amplification Goalspatient specific
Audibility
Comfort Tolerance
Different Types of Hearing Aids
Hearing Aid Technology- Enhances speech intelligibility
- Sound flows from one environment to
the other
- Wind block & Echo block- Automatic phone program- Feedback (Whistle control)
“Go with your specific needs and do not compare with others”
Assisted Listening Devices
FM systems Bluetooth loops
Amplified Close captioned TV
Phones
Cochlear Implants
Hearing Aids Insurance Coverage
Insurance: • Medicare (Exam)• Some Insurance Coverage e.g., Government, VA, and Medicaid.• UCF LIFE members at UCF Communication
Disorders Clinic (UCF Family Benefits)
Tinnitus
• Definition
• Classification
• Objective Tinnitus
- Pulsatile
• Subjective tinnitus
• Treatment
Introduction
• Tinnitus :“The perception of sound in the absence of external stimuli”
• Tinnere: means “ringing” in Latin
• Includes buzzing, roaring, clicking, pulsatile sounds
Classification
• Objective tinnitus – sound produced by para-auditory structures which may be heard by an examiner
• Subjective tinnitus – sound is only perceived by the patient (most common)
Prevalence
• 40 million affected in the United States
• 10 million severely affected
• Most common in 40-70 year-olds
• More common in men than women
Why?
Tonotopy, columnar organization of cells with similar binaural
interaction
Central Nervous SystemMechanism
• Reorganization of central pathways with hearing loss (similar to phantom limb pain)
Pulsatile Tinnitus
• Arteriovenous malformations
• Vascular tumors• Venous hum• Atherosclerosis• Ectopic carotid artery• Persistent stapedial
artery• Dehiscent jugular bulb• Vascular loops
• Cardiac murmurs• Pregnancy• Anemia• Benign intracranial
hypertension• a
Subjective Tinnitus• Presbycusis• Noise exposure• Meniere’s disease• Otosclerosis• Head trauma• Acoustic neuroma• Drugs• Middle ear effusion• Tempo Mandibular Junction dysfunction• Depression• Meningitis• Syphilis
The cycle of tinnitus
The Impact of Tinnitus
• Thoughts and emotions: annoyed, bothered, depressed, anxious or angry
• Hearing: the sound of the tinnitus competes with or masks speech or environmental sound perception.
The Impact of Tinnitus
• Sleep: tinnitus interferes with the ability to fall asleep. It can also make it more difficult to get back to sleep when awaking up in the middle of the night because of the tinnitus.
• Concentration: difficulty focusing on a task because of the loudness of the tinnitus.
Tinnitus Treatment Options
Multiple Treatments
•Avoidance of dietary stimulants: coffee, tea, cola, etc.
•Smoking cessation
•Avoid medications known to cause tinnitus
Tinnitus Treatment Options
• Amplification (Hearing Aids)
• Sound Generators
• Acupuncture
• Medication (Xanax)
• Counseling Tinnitus retraining therapy
• Neuromonics (customized, music therapy, through a tinnitus evaluation/ tinnitus pitch match/frequency/Hypersensitivity Levels)
Thanks to LIFE’s 2011 Grant to UCF Communication
Disorders ClinicTinnitus Treatment
• Neuromonics, music therapy, was used to treat tinnitus and hyperacusis in an autistic female. It has proven to help reduce her tinnitus, hyperacusis, anxiety levels
and improve her ability to focus
while in speech therapy
and school.
How the Ear Works
http://www.youtube.com/watch?http://www.youtube.com/watch?feature=player_detailpage&v=PeTriGTENocfeature=player_detailpage&v=PeTriGTENoc
QUESTIONS?
THANK YOU!
University of Central Florida
Communication Disorders Clinic
12424 Research Parkway, Suite 155
Orlando, FL 32826
Phone (407) 882-0471 Audiology
(407) 882-0468 Main
Hearing Loss
• http://www.betterhearing.org/hearing_loss/hearing_loss_simulator/index.cfm