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HEARING IMPAIRMENTLiterature Reading

AUDIOLOGY

Achmad S

Dept of OtorhinolaryngologyHNSHasan Sadikin General Hospital

Bandung

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DEFINITION

Hearing impairment any degree and typeof auditory disorder.

Deafness an extreme inability to discriminate

conversation speech through the ear.

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EPIDEMIOLOGY

National Institute on Deafness and Other Communication

Disorders :

28 million Americans deaf or hearing impaired.

1 out of every 10 people.

The most common birth anomaly.

30 million exposed to hazardous noise levels.

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HEARNG LOSS

The timing of the hearing loss :

Congenital present at birth.

Acquired : Later in life.

Sudden or progressive.

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TYPE OF HEARING IMPAIRMENT

HearingImpairment

Conductive Sensorineural Mixed

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CONDUCTIVE IMPAIRMENT

A defect in the auditory system which interferes

with sound waves reaching the cochlea.

The outer or middle ear. Maximum loss 50 - 55 dB.

Loss roughly constant with frequency.

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CAUSE of CONDUCTIVE

HEARING LOSS

The most common in kids and teens otitis media.

A buildup of fluid or pus behind the eardrum block the

transmission of sound.

If fluid goes away hearing returns to normal.

Blockages in the ear a foreign object, impacted earwax or

dirt.

A tear or hole in the eardrum interfere vibrate properly.

Etiology : inserting an object into the ear, a sudden explosion

or other loud noise, a sudden change in air pressure, a headinjury, or repeated ear infections.

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Normal Eardrum

Otitis Media10/26/2013 9


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Sensorineural Hearing Loss

Defect in the inner ear

or connection to brain

Loss can be complete

Loss greater at high

frequencies

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Sensorineural Hearing Loss

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Genetic disorder development of the inner ear and the

auditory nerve.

Injuries to the ear or head.

Complications during pregnancy or birth.

Infections or illnesses development of the inner ear.

Premature babies.

CAUSE of SENSORI NEURAL

HEARING LOSS

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Infections or illnesses.

Repeated ear infections

Brain tumors

Damage the structures of the inner ear.

Medications.

Some antibiotics

Chemotherapy drugs

Loud noise.

A sudden loud noise or exposure to high noise levels over time permanent damage to the tiny hairs in the cochlea

Can't transmit sounds effectively

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CAUSE of SENSORI NEURAL

HEARING LOSS


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RISK FACTORS

Risk factors for congenital loss are:

1. Family history of hereditary loss.

2. Prematurity, with birth weight less than approximately

1.5 kg.3. Maternal rubella during pregnancy.

4. Maxillofacial deformities.

5. Kernicterus, with bilirubin levels greater than 12mg/dl.

6. Neonatal sepsis, especially with meningitis.

7. Forceps delivery, with temporal bone injury.

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Mixed impairments involve both conductive and

sensorineural defects.

Hearing losses occurring from birth to 19 years of age

prevocational deafness or prelingual deafness.

Hearing impairments after 19 years of age do not seem to

severely affect speaking ability and language.

Mixed Hearing Loss

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SPEECH FREQUENCIES

Speech frequencies range from 250 to 8000 hertz.

A pure tone audiogram tests the patients hearing at the

intervals of 250, 500, 1000, 2000, 4000, and 8000 hertz foreach ear.

Normal hearing is defined as hearing the above hertz at or

below 25 decibels.

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Effects on Understanding Speech

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Children with a hearing difficulties may have problems with:

Entering into a group, requesting, responding and taking

turns

Initiating conversations

Understanding subtle social rules Accepting others points of view and others feelings

Monitoring the listener

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Mental Characteristics

They may feel that people who they talk to lose patiencewith them because they have to repeat themselves

Hearing loss can create feelings of emotional isolation

A person may feel that the focus of attention is placed ontheir disability

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How Do Doctors Diagnose It?

History taking

Physical examination

Ancillary test

Hearing test

Radiology Examination

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How Do Doctors Diagnose It?

Difficult to diagnose in infants and babies.

Screened before leave the hospital.

Sometimes parents notice her baby doesn'trespond to loud noises or to the sound of voices.

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According to the American Speech-Language-Hearing Association certain

symptoms in teens should prompt a trip to the doctor :

You feel that people mumble or that their speech is not clear

You hear only parts of conversations when people are talking.

You often ask people to repeat what they said. Friends or family tell you that you don't seem to hear very well.

You don't laugh at jokes because you miss too much of the story.

You need to ask others about the details of a class or meeting you

attended.

People say that you play music or your TV too loudly.

You can't hear the doorbell or telephone.

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HEARING TEST

1. Subjective

2. Objective

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SUBJECTIVE HEARING TEST

1. Whisper test

2. Tuning fork Test

3. Pure tone Audiometry

4. Special audiometry : SISI, ABLB, Tone Decay5. Behavioral Observational Audiometry (BOA)

6. Visual Reinforcement Audiometry (VRA)

7. Play Audiometry

8. Speech Audiometry

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OBJECTIVE HEARING TEST

Ottoacustic Emission (OAE)

Brainstem Evoked Response Audiometry

Auditory Steady State Response (ASSR)

Acoustic Immitance Tests:

Tympanometry

Eustachian tube function

Acoustic reflex thresholds

Acoustic reflex decay

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AUDIOMETRY

Measures hearing threshold

Subject wears headphones

Send pure tone to one ear at

audible level

Decrease level until subject cant

hear it

Repeat at other (standard)frequencies

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AUDIOGRAM

For children, hearing threshold levels exceeding 15 dB should be

considered abnormal.

Hearing Threshold

Levels (dB)Hearing Loss

0202040

4060

> 61

NormalMild

Moderate

Severe

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Mild (2644 dB) Moderate (4559 dB)

Severe (6089 dB)

Profound (> 90 dB)

Understand conversation at 11.5m

May have delayed speech development May miss up to 50% class discussion if

speaker not visible

May need hearing aid

Will need special education attention

May understand speech at


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AUDIOGRAM of NORMAL

HEARING

50

40

30

20

10

0

-10

125 250 500 1k 2k 4k 8k

left ear

right ear

Frequency (Hz)

Hearing

loss

(dB)

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AUDIOGRAM

CONDUCTIVE HEARING LOSS

BC threshold within normal

limits (0-20 Db)

AC Threshold Increased

BC-AC gap > 10 db

Gb. Gangguan dengar

konduktif

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AUDIOGRAM

SENSORI- NEURAL HEARING LOSS

Increased BC thresholds

Increased AC thresholds

BC-AC gap < or = 10 db

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Presbikusis

AUDIOGRAM

SENSORI- NEURAL HEARING LOSS

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AUDIOGRAM

NOISE INDUCED HEARING LOSS

(NIHL)

Decreased hearing (increased

threshold levels) at higher

frequencies (3000- 6000 hz)

Usually starts with a dip at

4000 hz

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TYMPANOMETRY

The dynamic recording of middle-ear

impedance / air pressure in the

ear canal

A sensitive measure of the integrity ofthe tympanic membrane and of middle-

ear function.

Compliance of the middle ear the

vertical dimension of a tympanogram

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Three general types of

tympanogram A, B, and C.

Type A :

The location and peak in

compliance within 0-100 mm

water (dPa) in the ear canal.

TYMPANOMETRY

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Type B:

No peak in compliance (a flat

pattern) Little or even no apparent

change in compliance

Fluid within the middle-ear

space (otitis media)

TYMPANOMETRY

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Type C :

The peak within the negative

pressure region beyond -100 mmwater (dPa)

Eustachian-tube dysfunction and

inadequate ventilation

Often precedes a type B in thedevelopment of otitis media.

TYMPANOMETRY

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A variation of a type A:

Type As.

The s stands for shallow.

Peak compliance is less than the

lower normal limit of compliance.

Middle-ear impedance is abnormally

high.

Fixation of the ossicular chain,

otosclerosis.Tipe As

TYMPANOMETRY

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Type Ad

An unusually steep and high-

compliance tympanogram

Peak can exceed the upper

compliance limits

Disruption of the ossicular chain

Leaves the middle ear extremely

mobile and overly compliant; littleimpedance. Tipe Ad

TYMPANOMETRY

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Up to 30% of a population of outer hair cells can be damaged without

substantially affecting a simple audiogram.

Newborn hearing screening.

Advantage :

The noninvasive . Accuracy and objectivity in assessing cochlear, especially outer

hair cell.

OAEs may be recorded in severely impaired auditory function mass

lesion on the auditory nerve or auditory neuropathy.

OTOACOUSTIC EMISSIONS

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AUDITORY BRAINSTEM RESPONSE

Inexpensive and sensitive initial evaluation.

Electrophysiologic recordings.

Activation of all levels of the auditory system, from

cochlea to cortex.

Estimation of hearing sensitivity in infants and young

children.

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Wave I : cochlea

Wave II : nucleus cochlearis

Wave III : superior olivariWave IV : lateralis lemniscus lateralis

Wave V : inferior colikulus

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WAVES IN BERA

Latency inLatency in msecmsec

Amplitudein

Amplitudein

VV

NormalNormalNormal Latency phaseNormal Latency phaseGood MorphologyGood Morphology

Conductive Hearing LossConductive Hearing LossLate Latency phase Wave ILate Latency phase Wave IInterwafeInterwafe latensilatensi NNGood MorphologyGood Morphology

Sensory Hearing LossSensory Hearing LossLate Latency Wave ILate Latency Wave I sdtsdtterlambatterlambatWave I kecil/Wave I kecil/--InterwaveInterwave latency Nlatency NBad MorphologyBad Morphology

Neural LossNeural LossWave I NWave I NLate Latency Wave ILate Latency Wave I--IIIIIILateLate InterwaveInterwave latencylatencyBad MorphologyBad Morphology

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MRI

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CT-SCAN

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How Is It Treated?

Depending upon etiology.

Treatment :

Removing wax or dirt from the ear.

Treating an underlying infection. Hearing aid or cochlear implant problem in the

cochlea or hearing nerve.

Surgery damage or a structural problem with the

eardrum or ossicles.

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Inflammation of middle ear

1. Medicamentous

2. Surgery

Mastoidectomy

Tympanoplasti

TREATMENT OF HEARING IMPAIRMENT

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Sensorineural hearing loss :

Hearing aids

Cochlear implant Special education SLB B

Speech therapy

Counseling

TREATMENT OF HEARING IMPAIRMENT

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HEARING AIDS

Make sounds louder hear

clearly.

Various forms fit insideor behind the ear.

In profound the hearing loss

a cochlear implant

recommendation.

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COCHLEAR IMPALNT

Surgically implanted devices.

Bypass the damaged inner ear and send signals directly

to the auditory nerve.

These signals perceived as sound and allow the

person to hear.

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Can I Prevent Hearing Impairment?

Many cases of hearing loss or deafness

are not preventable.

Noise-induced hearing loss can be

prevented. Any sounds over 80 decibels

considered hazardous with prolonged

exposure.

Like loud music, sirens and engines.

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Some ways to reduce it.

Turn down the volume on yourstereo, TV, headset on yourWalkman or CD player

Wear earplugs if going to a loudconcert and while working

around loud noise such as powertools, jackhammers.

See your doctor right away ifsuspect any problems with

hearing. Get your hearing tested on a regular

basis

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.Thank You.10/26/2013 53

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