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Audiology 101

Alice E. Holmes, PhD

Professor

University of Florida

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Normal Hearing

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Conductive Hearing Loss

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Sensorineural Hearing Loss

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Mixed Hearing Loss

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Determine Amount of LossFrom bass to treble, or low to high pitch

From faint

to intense,

or soft

to loud

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Causes of Hearing Loss

Presbyacusis (aging) is #1 cause of hearing loss

Hazardous noise exposure is #2

Just a few other causes include genetics, teratogens, otitis media, idiopathic hearing loss, fistula, congenital anomaly, prenatal or perinatal exposures (syphilis, CMV, rubella), syndromes, head injury, among hundreds of others!

Only one type of hearing loss is preventable

AVOID NOISE Hazardous noise damages hearing

12.5% of children aged 6-19 have some amount of noise induced hearing loss

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US HL Population Projected through 2050

In 2004, this equates to 31.5 million people reporting hearing loss in the US

Kochkin, 2005

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Hearing Loss Population by Age GroupOwners versus Non-owners

0 1 2 3 4 5 6

Millions

<18

18-34

35-44

45-54

55-64

65-74

75-84

85+OwnersNon-owners

Kochkin, 2005

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Hearing Aid Styles

Completely In the Canal CIC

In The Ear ITE

Behind The Ear BTE

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Analog Hearing Aids

Amplifies in a linear fashion, can distort sounds, limited means to filter background noise, least expensive choice

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Digital Hearing Aids: Programmed Via Computer

Has at least 2 channels Analyzes incoming sound and

adjusts the loudness based on preset parameters

Detects softer sounds of speech, raises loudness

Does not amplify background noise to same degree as primary signal

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Optional Features

Directional: Uses dual microphones Available in analog,

compression and digital models

Use of forward facing microphone helps focus on desired sounds

Helps diminish awareness of background noise

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Optional Features Multiple Memory

Increases versatility Memories customized for various situations

Remote Control Change volume,

memory function, directionality of microphone

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FM Communication Systems

Enhanced speech perception in noise, at great distances

Used in classrooms Greatly increases signal

to noise ratio New technology reduces

size, eliminates cords, wiresTransmitter

Receiver/BTE

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Assistive Technology

Pocket Talker One to One

Amplifier Cell Phone with

TDD Telephone

Amplifier Amplified Phone

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Devices for the Home

Strobe Light Doorbell Bed Shake Alarm Clock Flashing Smoke Alarm Vibrating Wrist Watch Television Closed

Caption Decoder TV Infra-Red Listeners

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Cochlear Implant

A device that electrically stimulates the auditory nerve of patients with severe-to-profound hearing loss to provide them with sound and speech information.

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Cochlear Implant

Sound picked up by microphone Speech processor Coded into electrical impulses Transmitter coil Through the skin via FM waves Receiver stimulator Electrodes Nerve Brain

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Cochlear New Freedom

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Advanced Bionics

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Med EL Pulsar

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Worldwide

Over 100,000 multi-channel implants

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University of Florida Cochlear Implant Program

Implanted our first patient in 1985

Currently follow over 450 cochlear patients

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Cochlear Implant Team for Adult Patients

Surgeon Audiologist Speech-Language

Pathologist Psychologist Social Worker VR Counselor

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Formal Evaluation

Medical Audiological

Standard audiometric unaided test battery

Aided speech perception Aided speechreading

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Preimplant Counseling Topics

Candidacy criteria Cochlear implant hardware Realistic expectations Individual and family

commitments Social considerations Communication mode

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Who is a candidate?

Severe-to profound sensorineural hearing loss

Limited benefit from hearing aids

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Who is an adult candidate? < 50% aided speech recognition

on recorded sentence material in the ear to be implanted

< 60% aided speech recognition on recorded sentence material in the un-implanted ear

< 40% for Medicare coverage

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Deaf Culture

Deafness is a culture not a handicap

Characterized by their own language

Resent those trying to ‘fix a deaf child’

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Outcomes for Post-lingual Adults

Wide range of success Most score 90-100% on AV

sentence materials Majority score > 80% on high

context materials Performance more varied on single

word tests but most have some open set recognition

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Impact of CI on Vocational Settings 13 cochlear implant recipients and

their employers completed a modified Profile of Hearing

Aid Benefit Questionnaire Provided employers’ contact

information 9 of the employers returned

completed questionnaire Results indicated the cochlear implant

had a positive impact on the job functioning.

Saxon, J.P., Holmes, & Spitznagel, R.J. (2001) Impact of a cochlear implant on job functioning. Journal of Rehabilitation, 67(3), 49-54.

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Impact of CI on Vocational Settings Both supervisors & clients found

improvements after the CI in. awareness of warning signals understanding conversations in most

environments identifying sounds in their environment

The only negative effect of CI: traffic noises were more bothersome than

before surgery.

Saxon JP, Holmes AE & Spitznagel RJ (2001)

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Outcomes Research

Impact ondaily life

Cost effectiveness

Cost effectiveness

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Health Utility Changes Profound Hearing loss results

in a decrease from 0.36 to 0.63 Cochlear implantation results

in an increase from 0.07 to 0.41

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$1,020,000$919,000

$453,000

$253,000

$43,000

$297,000

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

Lif

eti

me

Co

sts

($

19

98

)

0-2 yrs 3-17 yrs 18-44 yrs 45-64 yrs 65+ Average

Age of Onset

Costs by Age of Onset

Source: Project HOPE calculations from the 1990-91 National Health Interview Survey and U.S. Census, 1991All Costs are inflated to 1998 dollars using the Urban Consumer Price IndexSource: Project HOPE calculations from the 1990-91 National Health Interview Survey and U.S. Census, 1991All Costs are inflated to 1998 dollars using the Urban Consumer Price Index

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Severe to profound hearing loss is expected to cost society an average of $297,000 per individual, over $1 million if the individual is pre-lingually deaf

Costs include both direct medical and nonmedical costs, educational costs as well as indirect productivity losses

Source: Project HOPE, Policy Analysis Brief, April, 2000

Economics of Hearing LossEconomics of Hearing Loss

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500,000 to 750,000 Americans with severe to profound hearing impairment

To function in a hearing society, individuals with this level of loss require specialized education, social services, additional health care services and other resources

Hearing ImpairmentHearing Impairment

Source: Project HOPE, Policy Analysis Brief, April, 2000

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Societal Impact: Societal Impact: AgeAge

The severe to profound

hearing loss population is divided into

four age groups

Source: Project HOPE calculations from the 1990-91 National Health Survey, and U.S. Census, 1991

0-17 yrs9%

45-64 yrs.18%

65+ years57%

18-44 yrs16%

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Societal Impact: Income LevelOver half of the severe to profound hearing loss population have family incomes of less than $25,000

.

15%

10%

38%

26%

33%36%

14%

29%

0%

5%

10%

15%

20%

25%

30%

35%

40%

< $10,000 $10,000 - $24,999 $25,000 - $49,999 $50,000+

Severely to Profoundly Hearing Impaired US Population

Source: Project HOPE calculations from the 1990-91 National Health Survey

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Societal Impact: Societal Impact: Labor ForceLabor Force42% of the population, between the ages of 18-44 years, and 54% between the ages of 45-64 years with severe to profound hearing loss are not working.

Source: Project HOPE calculations from the 1990-91 National Health Survey

58%

82%

46%

73%

11%16%

2% 3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

18-44 yrs 45-64 yrs 65-79 yrs 80+ yrsSeverely to Profoundly Hearing Impaired US Population

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Condition Lifetime Costs

Severe to Profound Hearing Impairment $ 297,000

Schizophrenia $ 295,000

Epilepsy (noninsitutionalized with frequent seizures) $ 172,900

Rheumatoid Arthritis (25-year cost for young women) $ 130,500

Stroke $ 129,200

Near-Drowning $ 98,500

Accidents with Firearms $ 89,100

Lifetime Cost Comparison Lifetime Cost Comparison Of Other ConditionsOf Other Conditions

Magnitude of Difference Between Lifetime Costs of Severe to Profound Hearing Loss and Other Conditions

Source: Project HOPE, Policy Analysis Brief, April, 2000

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Cost-Saving InterventionCost-Saving Intervention

Medical technologies, such as the cochlear implant, have proven to be cost-effective

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Cost of Cochlear Implants Vs Cost of Cochlear Implants Vs Lifetime Costs of DeafnessLifetime Costs of Deafness

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

Total CI Costs Avg. Lifetime Costs ofDeafness

Cost of PrelingualDeafness

Special Ed Lost Productivity Medical Costs Vocational Rehab

$63,000

$297,000

$504,900

$433,400

$70,200

$11,500

Source: Project HOPE, Policy Analysis Brief, April, 2000; and JAMA, Vol. 284, No. 7, August 16, 2000

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NucleusNucleus®® Hybrid Hybrid™™Cochlear Implant Cochlear Implant

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Selection Criteria: Audiometric

Frequency (Hz)125 250 500 750 1000 1500 2000 3000 4000 6000 8000

He

ari

ng

Th

res

ho

ld (

dB

HL

)(A

NS

I -

19

89

)

-10

0

10

20

30

40

50

60

70

80

90

100

110

120

130

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Nucleus® Hybrid™ Cochlear Implant

Based on the Nucleus Freedom cochlear implant

Electrically equivalent Short array (10 mm) composed

of 6 half-band electrodes (to make array as thin as possible)

Designed to allow electric stimulation of high-frequency region of the cochlea while maintaining low-frequency hearing for acoustic stimulation

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Externals Externally, subjects use a Freedom speech processor to deliver electric stimulation via the implant.

Acoustic stimulation is provided via ipsilateral use of an ITE and contralateral use of a BTE.

Freedom™ BTE