Understanding and Treating Hearing Problems Dr. Diana Barreneche, CCC, FAAA Audiologist/Clinical Educator

Topics To Be Discussed Ear Anatomy and Physiology Signs of Hearing Loss in Adults Causes of Hearing Loss Hearing Loss Treatment Options Tinnitus Signs of Tinnitus Tinnitus Treatment Options

Anatomy and Physiology of the Ear Outer Middle Inner ear

Anatomy and Physiology of the Ear Outer Ear Consists of the auricula or pinna the external acoustic meatus

Anatomy and Physiology of the Middle Ear Eardrum Ossicles

Anatomy and Physiology of the Inner Ear Cochlea/Hearing Organ Vestibular Canals/Balance Organ

Acoustic Nerve (8th) The vestibular/auditory nerve runs in the internal auditory canal and the peripheral end organs to the central nervous system (CNS) Nerve..

Diagnostic Tools Otoscopy OAEs (Otoacoustic Emissions) Tympanometry (Middle Ear Test) Pure tone and Speech Audiometry (Sound Booth) Auditory Brainstem Response(8th Nerve and Hearing Thresholds Estimation)

Common Myths Hearing loss affects only "old people" and is merely a sign of aging. Actually it is the reverse of what most people think. The majority (65%) of people with hearing loss are younger than age 65.

Common Myths There are more than six million people in the U.S. between the ages of 18 and 44 with hearing loss, and nearly one and a half million are school age. Hearing loss affects all age groups.

“If I had a hearing loss, my family doctor would have told me” Common Myths “If I had a hearing loss, my family doctor would have told me” Not true! Only 13% of physicians routinely screen for hearing loss during a physical. Since most people with hearing impairments hear well in a quiet environment like a doctor's office, it can be virtually impossible for your physician to recognize the extent of your problem. Without special training, and an understanding of the nature of hearing loss, it may be difficult for your doctor to even realize that you have a hearing problem. betterhearing.org

Common Myths Hearing might be at the bottom of the medical checklist, but it might be the number one medical cause of your problems. Why?

Signs of Gradual Hearing Loss in Adults The perception that people are speaking too soft or mumbling. Frequent misinterpretation of what is being said. Difficulty understanding conversations on the phone.

Signs of Gradual Hearing Loss in Adults/ Continuation… Difficulty understanding conversations in different environments: restaurants, theater, automobile, family reunions, seminars or places of worship. Blocked or stuffy feeling in the ears. Ringing in the ears. betterhearing.org

Prevalence of Hearing Loss In US 3 in 10 people over age of 60 have hearing loss; 1 in 6 baby boomers (ages 41-59), or 14.6%, have a hearing problem 1 in 14 Generation Xers (ages 29-40), or 7.4%, already have hearing loss At least 1.4 million children (18 or younger) have hearing problems It is estimated that 3 in 1,000 infants are born with serious to profound hearing loss. betterhearing.org

Types of Hearing Loss Conductive hearing loss Hearing loss is categorized by which part of the auditory system is damaged. Conductive hearing loss Sensorineural hearing loss Mixed hearing loss Retro-cochlear hearing loss

Conductive Hearing Loss

Sensorineural hearing loss

Sensori-neural Hearing Loss SENSORINEURAL HEARING LOSS (DAMAGE TO THE INNER EAR CELLS CALLED CILIA)

Healthy Dead and Damage Cilia Cilia

Damage to Outer or Middle and Inner ear Mixed Hearing Loss Damage to Outer or Middle and Inner ear

Causes of Conductive Hearing Loss Ear infection (Otitis) Allergies Poor Eustachian tube function Perforated eardrum Benign tumors (growths along the outer and middle ear) Impacted earwax (cerumen) Presence of a foreign body Fluid in the middle ear from colds Atresia (Anotia)

Causes of Conductive Hearing Loss Microtia and Atresia Ear malformations PE tube: Surgical tube to drain fluid in middle ear

Causes of Conductive Hearing Loss External Otitis (Inflammation due to infection of ear canal) Impacted Wax

Ear Drum Perforation with a Q-Tip When cotton tipped applicators are used to clean out ear wax, there is a risk of breaking the ear drum (perforation). Although we realize that this is commonly done, we recommend against using cotton tipped applicators, hair pins, and similar devices to clean the ear.

Causes of Sensorineural Hearing Loss SNHL reduces the ability to hear faint sounds. Even when speech is loud enough to hear, it may still be unclear or muffled. Some possible causes of SNHL include: Illnesses Drugs that are toxic to hearing Hereditary Aging (Presbycusis) Head trauma Malformation of the inner ear Exposure to loud noise Auditory nerve occupied lesion/ (8th) tumors

Presbycusis (Age Related Hearing Loss)

Presbycusis Hearing Loss due to Aging Causes: There is no known single cause for age-related hearing loss. Most commonly, it is caused by changes in the inner ear that occur as you grow older. However, your genes and exposure to loud noises (such as from rock concerts or loud machinery) may play a large role.

Presbycusis Hearing Loss due to Aging The following factors contribute to age-related hearing loss: Family history (age-related hearing loss tends to run in families) Repeated exposure to loud noises Smoking Certain medical conditions (Diabetes) and medications (Ototoxics) also contribute to age-related hearing loss.

Presbycusis Hearing loss related to Aging Prevalence: About half of all people over the age of 65 have some amount of age-related hearing loss. Impact in life style: The loss of hearing occurs slowly over time. It is most difficult to hear high-frequency pitch sounds. (ex: speech of women and children) As hearing gets worse, it may become difficult to hear sounds at lower pitches. (ex: men’s voices)

Presbycusis (Age Related Hearing Loss) It becomes difficult hearing things in noisy areas like restaurants. Hard time distinguishing high-pitched sounds such as "s" or "th" from one another. Other people's voices sound mumbled or slurred. Ringing in the ears and lack of tolerance to loud sounds is reported.

Understanding the Audiogram

Normal Hearing

Presbycusis (Age Related Hearing Loss)

Retro-cochlear Hearing Loss 8th nerve (Auditory nerve) tumor Auditory Neuropathy (Connection between Cochlea and auditory nerve) Problems in the Auditory path from the cochlea to the auditory section in the brain (Auditory Processing Issues)

Hearing Loss Treatment options Medication Surgery Types of Amplification: - Hearing Aids -Cochlear Implants (CIs) -Assisted Listening Devices

Key Factors in Amplification Success Initial Needs Assessment Electroacoustic & Physiologic Compatability Comprehensive Habilitative Follow-up

Amplification Goals patient specific Audibility Comfort Tolerance

Different Types of Hearing Aids

Hearing Aid Technology - Enhances speech intelligibility - Sound flows from one environment to the other - Wind block & Echo block Automatic phone program Feedback (Whistle control) “Go with your specific needs and do not compare with others”

Assisted Listening Devices FM systems Bluetooth loops Amplified Close captioned TV Phones

Cochlear Implants

Hearing Aids Insurance Coverage Medicare (Exam) Some Insurance Coverage e.g., Government, VA, and Medicaid. UCF LIFE members at UCF Communication Disorders Clinic (UCF Family Benefits)

Tinnitus Definition Classification Objective Tinnitus - Pulsatile Subjective tinnitus Treatment

Introduction Tinnitus :“The perception of sound in the absence of external stimuli” Tinnere: means “ringing” in Latin Includes buzzing, roaring, clicking, pulsatile sounds

Classification Objective tinnitus – sound produced by para-auditory structures which may be heard by an examiner Subjective tinnitus – sound is only perceived by the patient (most common)

Prevalence 40 million affected in the United States 10 million severely affected Most common in 40-70 year-olds More common in men than women Why?

Tonotopy, columnar organization of cells with similar binaural interaction

Central Nervous System Mechanism Reorganization of central pathways with hearing loss (similar to phantom limb pain)

Pulsatile Tinnitus Arteriovenous malformations Vascular tumors Venous hum Atherosclerosis Ectopic carotid artery Persistent stapedial artery Dehiscent jugular bulb Vascular loops Cardiac murmurs Pregnancy Anemia Benign intracranial hypertension a

Subjective Tinnitus Presbycusis Noise exposure Meniere’s disease Otosclerosis Head trauma Acoustic neuroma Drugs Middle ear effusion Tempo Mandibular Junction dysfunction Depression Meningitis Syphilis

The cycle of tinnitus Stress Anxiety Level Tinnitus

The Impact of Tinnitus Thoughts and emotions: annoyed, bothered, depressed, anxious or angry Hearing: the sound of the tinnitus competes with or masks speech or environmental sound perception.

The Impact of Tinnitus Sleep: tinnitus interferes with the ability to fall asleep. It can also make it more difficult to get back to sleep when awaking up in the middle of the night because of the tinnitus. Concentration: difficulty focusing on a task because of the loudness of the tinnitus.

Tinnitus Treatment Options Multiple Treatments Avoidance of dietary stimulants: coffee, tea, cola, etc. Smoking cessation Avoid medications known to cause tinnitus

Tinnitus Treatment Options Amplification (Hearing Aids) Sound Generators Acupuncture Medication (Xanax) Counseling Tinnitus retraining therapy Neuromonics (customized, music therapy, through a tinnitus evaluation/ tinnitus pitch match/frequency/Hypersensitivity Levels)

Thanks to LIFE’s 2011 Grant to UCF Communication Disorders Clinic Tinnitus Treatment Neuromonics, music therapy, was used to treat tinnitus and hyperacusis in an autistic female. It has proven to help reduce her tinnitus, hyperacusis, anxiety levels and improve her ability to focus while in speech therapy and school.

How the Ear Works http://www.youtube.com/watch?feature=player_detailpage&v=PeTriGTENoc

QUESTIONS? THANK YOU!

University of Central Florida Communication Disorders Clinic 12424 Research Parkway, Suite 155 Orlando, FL 32826 Phone (407) 882-0471 Audiology (407) 882-0468 Main

Hearing Loss http://www.betterhearing.org/hearing_loss/hearing_loss_simulator/index.cfm