Hearing Aids & Aural Rehab - Aud Final

what happens after diagnosis?

• if the etiology is treatable, it’s treated via surgery, cerumen removal, etc.

  • conductive/mixed hearing loss often has a treatable component

• if the etiology is not, there are options:

  • hearing aids

  • cochlear implants

  • other assistive devices

  • use of sign language

types of hearing aids

• Three primary types:

  • Behind-the-ear (BTE)

  • In-the-ear (ITE)

  • Completely-in-canal (CIC)

common features of hearing aids

• Common features:

  • digital for increased clarity

    • most hearing aids now are digital → clearer than analog hearing aids

  • directional microphones for improved speech understanding in noise

    • face in direction the person is facing, allows for better control of signal-to-noise ratio

  • feedback cancellation to prevent buzzing/whistling

  • streaming via Bluetooth to connect to devices

parts to a hearing aid

• Parts to a hearing aid:

  • microphone(s)

  • speaker

    • for behind the ear hearing aids, the speaker is in the earmold

  • battery

  • amplifier

  • programming button(s)

considerations from audiologists for choosing and programming hearing aids

• severity and type of hearing loss

• most comfortable level (MCL) and uncomfortable level (UCL)

• frequency of the hearing loss

  • need to assess whether the client needs certain frequencies amplified more than others

• desired features and look

  • some people don’t want behind the ear

• audiologists need to consider the person’s ear canal anatomy when programming hearing aids because this will change the acoustic traits

  • two people might have the same exact hearing loss but still hear differently because of their anatomy

    • e.g, longer resonating cavity → likes lower frequencies

  • important to consider this, why it’s recommended to go to an audiologist and not just get OTC hearing aids

    • customize to specific person

common issues for troubleshooting hearing aids

• hearing aids are not working → check battery first

  • most common solution

  • we change a lot of batteries, can teach people how to change their batteries

• there’s a lot of feedback → improve fit in ear canal, check for cerumen, or turn down overall volume

  • feedback occurs when the sound produced by the speaker gets picked back up by the mic

• hearing aids are uncomfortable → check fit in canal and cerumen

• hearing aids sound distorted → check battery contacts and programming settings

• never just assume that someone is “noncompliant” when it comes to their hearing aids → always ask why, it could be a number of things

bone conduction hearing aids

• some conductive etiologies cause a lasting conductive or mixed hearing loss

• in those cases, bone conduction hearing aids might be used

  • bone conduction is intact/better than air conduction

  • less common than air conduction hearing aids

• surgical and nonsurgical options

cochlear implants

• surgically implanted device that can improve hearing for individuals with severe to profound hearing loss and limited benefit from hearing aids

  • once you put something into the cochlea, you can’t go back

    • surgery takes away all residual hearing

    • so, we only do this for people with severe to profound hearing loss

parts of a cochlear implant

• external speech processor

• transmitting coil and wire

  • wire has electrodes like hair cells

• internal receiver/stimulator

  • stimulator stimulates hair cells

why shouldn’t you immediately start using the external component of the CI full-time?

takes time to get used to, electrodes don’t automatically sound like typical speech → robotic at first, but system gets used to it

aural habilitation vs aural rehabilitation

• habilitation = have never had the skill

• rehabilitation =  had the skill, lost it, and are trying to regain it

auditory habilitation framework

• Detection

  • sound or no sound

• Discrimination

  • which sound am I hearing, are these sounds the same or different

• Identification

  • what sound is being produced

• Comprehension understanding

• Sounds → Syllables → Words → Phrases → Sentences → Connected Speech

aural hab - other things to work on aside from framework

• Interpreting prosody

• Listening in background noise

• Using visual cues

• Improving verbal speech

• Understanding and using language

• Managing devices

aural rehab, things to stress in addition to hearing/speech/language goals

• Listening behaviors and strategies

• Modifying the listening environment

• Communication with significant others/family

• Hearing protection

• Self-advocacy

examples of assistive technology for hearing

• induction loop systems

• FM systems

• infrared systems

• personal amplifiers

• TTY machines

• visual alert signalers

induction loop systems

• basically, some spaces have built-in thin loops of wire than encircle whole spaces (rooms)

• amplified sound is picked up by wire and makes electromagnetic field

• some people’s hearing aids have a telecoil in it that can pick up these sounds

• sort of like Bluetooth but just a different way of achieving that

FM systems

• use radio to transmit amplified sounds

• common in classrooms where instructor wears a microphone and the student wears a receiver

• again, many hearing aids can utilize their telecoil to pick up these signals

  • some can directly connect to hearing aids, or student can wear headphones for a receiver if they have CAPD

• for people who have trouble hearing the signal in noise

infrared hearing system

• transmits sound via infrared light

• works a lot like an induction loop, but can’t go through walls

• typically has:

  • audio source

  • infrared radiator (transmitter)

  • listening receivers

• less common these days

personal amplifier

• often used when other types of assistive technology are not available

  • not ideal, but accessible because inexpensive

• increase overall sound level and reduce background noise

• point mic in direction they’re trying to listen, put headphones on

TTY machines

• TTY = teletypewriters

• folks who can’t use a phone because of the severity of their hearing impairment often use these

• converts speech to text that the listener can read

• not as common these days

  • lots of folks prefer texting and emailing

• assumes person who is hard of hearing communicates verbally

visual alert signalers

• lots of devices that traditionally use sound to signal something to us have alternatives that instead use visual or tactile means

• Examples:

  • alarm clocks

  • doorbells

  • telephones

  • baby monitors

• many have a vibrating mechanism

• doorbell could flash all the lights in the house