Aural Rehabilitation Audiology Appointment Notes

Aural Rehabilitation Audiology Appointment

Steps to a Hearing Evaluation

  • Case history
  • Otoscopy
  • Middle ear testing
    • Tympanometry
    • Acoustic reflex
  • Audiometry
    • Pure tone testing
    • Speech testing
  • Otoacoustic Emissions (OAEs)
  • Auditory Brainstem Response (ABR)

Intervention for Hearing Loss

  • If hearing loss is present, intervention is the next step.
  • Audiologic rehabilitation:
    • For adults or those who need to modify communication skills due to acquired hearing impairments.
  • Audiologic habilitation:
    • For children or those learning to use speech and language skills for the first time.
  • Intervention depends on several factors:
    • Social impacts
    • Psychological impacts
    • Communication impacts
    • Degree of hearing loss: Increased hearing loss = increased difficulty understanding speech.
    • Acceptance of hearing loss.
    • Motivation for seeking assistance.
    • Cosmetic concerns.

Amplification

  • Wearable Devices:
    • Hearing Aids
    • FM systems
    • Assistive listening devices
    • Over-the-counter hearing aids
  • Implantable devices
    • Osseointegrated devices (BAHA)
    • Cochlear Implant (CI)

History of Hearing Amplification

  • Ear Trumpet (17th Century) - non-electronic
  • Vactuphone (1920s)
  • Transistors (1950s) - led to concealed body aids and eyeglass-mounted hearing aids
  • Analog hearing aids (1960s)
  • Digital hearing aids (1990s - present)

Hearing Aid Styles

  • Completely-in-canal (CIC)
  • In-the-canal (ITC)
  • In-the-ear (ITE)
  • Behind-the-ear (BTE)
  • Receiver-in-canal (RIC) / Receiver-in-the-ear (RITE)
  • BTE open fit

Hearing Aids

  • Devices that fit on or in the ear, designed to amplify sound reaching the ear drum.
  • Deliver sound through normal air conduction pathway.
  • Increase sound intensity in the frequency region of hearing loss.
  • Functions like an EQ on a car stereo, boosting certain frequencies (called gain).
  • Usually can restore conductive hearing loss to normal range.
  • Usually cannot restore sensorineural hearing loss to normal range.

Hearing Aid Selection

  • Factors to consider:
    • Type & degree of hearing loss (biggest factor)
    • Cosmetic preferences
    • Binaural/monaural fitting
    • Prior use/experience
    • Age
    • Environment of use
    • Controls/compatibility
    • Different levels of technology (Basic, middle, premium)
    • Bluetooth accessibility

Hearing Aid Fitting

  • Audiologist uses expertise and patient's desires to make a selection.
  • Once aid arrives, audiologist performs electroacoustic analysis.
  • At initial fitting, audiologist inputs patient's hearing thresholds.
  • Computer program adjusts the output gain accordingly.
  • Usually set lower than recommended on first fitting.
  • Aids are placed on patient and turned on.
  • Audiologist can (should) perform real-ear measurements.
    • Small microphone (probe-tip) is placed in the ear.
    • Gives reading of what amplification is actually reaching the ear drum.
    • Audiologist makes adjustments according to patient comfort.

Follow-up Appointments

  • Audiologist can see how much patient has used the aids (data logging).
  • Can make adjustments: increase/decrease gain.
  • Design programs for certain listening environments.
  • Standard maintenance & upkeep:
    • Cleaning
    • Replacing worn out parts

Bone-Anchored Hearing Aids (BAHA)

  • For severe conductive loss where the cochlea is functioning normally.
  • Prosthetic device surgically implanted into the skull (abutment).
  • Bone-conduction hearing aid is attached to the abutment.
  • Bypasses the outer & middle ear, stimulates the inner ear via vibrations in the skull.
  • Can also be used for single-sided deafness: transmits sound across the skull to functioning cochlea.
  • Ideal candidates:
    • Microtia
    • Conductive hearing loss
    • Mild or moderate SNHL

Research on Hearing Aid Users

  • Socialize more
  • Perform better in school (younger people)
  • Reduce cognitive decline (older people)
  • Reduce impact of tinnitus

Why Hearing Aids Aren’t More Popular

  • Only about 20% of people who need them seek them out.
  • Usually a period of 7-10 years between needing them and getting them.
  • More than 80% of users are satisfied with them.
  • Fit, comfort, maintenance can be a hassle.
  • Sometimes have unrealistic expectations.
  • Cost: range from 2000 to 5000 for a pair.
  • Psychological factors, social stigma, cosmetic appearance

Over-the-Counter (OTC) Hearing Aids

  • Law passed in October 2022 made OTC hearing aids available to the public.
  • Available at Walgreens, CVS, Best Buy, online.
  • Price range: 200-1000
  • Available for adults 18+ years old.
  • No audiologist involved in purchase.
  • For perceived mild to moderate hearing loss.
  • Users can control and program HAs themselves.
  • Most include a smartphone app.
  • Not included: Audiologist's expertise (programming, maintenance, etc.)

Cochlear Implants (CI)

  • Implantable device that electrically stimulates the auditory nerve.
  • Bypasses the outer, middle, and inner ear and stimulates the nerve directly.
  • Provides sound input for people with moderate to profound sensorineural hearing loss.
  • Doesn't “cure” hearing loss, it works around it.

CI Candidacy Criteria

  • Adults (18+):
    • Moderate to profound sensorineural hearing loss in both ears.
    • Limited benefit from amplification: <50% sentence recognition in the ear to be implanted and <60% in the opposite ear or binaurally.
  • Children (2-7):
    • Severe to profound sensorineural hearing loss in both ears.
    • Limited benefit from binaural amplification.
    • Multisyllabic Lexical Neighborhood Test (MLNT) or Lexical Neighborhood Test (LNT) scores <30%.
  • Children (9-24 months):
    • Profound sensorineural hearing loss in both ears.
    • Limited benefit from binaural amplification.

CI Surgery

  • Hole drilled in the mastoid bone behind the ear.
  • Internal receiver placed under the skin.
  • Electrode inserted through middle ear space into the cochlea, usually through the round window.
  • Electrode threaded upward along the cochlear spiral.

After CI Surgery

  • Sound processor converts external sound into electrical impulses.
  • Transmitted from the external processor to the internal receiver.
  • Receiver transmits them to the electrode array in the cochlea.
  • Electrode array bypasses the hair cells and stimulates the auditory nerve directly.

Benefits of a CI

  • Post-lingual adults (adults that have spoken language):
    • Any age
  • Pre-lingual children:
    • Typically 6 months or older.
    • Younger is better: greater chance for success.
    • Auditory input at a young age is critical for spoken language development.
  • Early implantation can lead to near-normal spoken language skills.
  • Adults deaf most of their life can get a CI but are unlikely to develop speech understanding or production. Can still hear sounds.