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