1. Introduction to Audiology Ed Brown Consultant Clinical Scientist (Audiology) South of Tyne NHSP Local Director Royal Hospital Sunderland SR4 7TP 0191 569 9001 ed.brown@nhs.net

2. Audiology  Newborn Hearing Screening  Paediatric Screening  Paediatric Hearing Assessment  Adult Diagnostic Testing  Hearing Aid Provision  Bone Anchored Hearing Aid Provision  Adult Rehabilitation  Hearing Therapy  Tinnitus Rehabilitation  Balance Assessment  Balance Rehabilitation  Auditory Implants (including Cochlea Implants)

3.  School-age children and adults can have their hearing assessed by audiometry  Pure tone sounds are presented through headphones  Frequencies from 250-8000 Hz are typically tested  Threshold is found at each frequency in dB HL  Results (dB HL versus frequency) are plotted on an Audiogram Measurement of Hearing

4. Audiometry

5. Profound Low pitched humming High pitched whistling Very Quiet Very Loud Normal Conversational Voice Severe Moderate Mild

6. Anatomy & Physiology

7. There are two main types of hearing Loss:  Anything which prevents or reduces the vibrations through the external or middle ears will produce a conductive deafness  If the cochlea or nerve is affected it will result in a sensorineural deafness Types of Hearing Loss

8. Conductive Hearing Loss (CHL)

9. Typical CHL Audiogram

10. CHL Summary  Due to an abnormality in middle or outer ear  Ear canal completely blocked with wax  Fluid in the middle ear cavity “glue ear”  Chronic middle ear disease  Abnormality in the middle ear bones (e.g. otosclerosis)  Trauma (things stuck in the ear)  Incidence is high (quite common)  over 4 out of 5 children may have an episode  Management can be conservative or surgical  e.g. grommet insertion

11. Sensorineural Hearing Loss (SNHL)

12. Typical SNHL Audiogram

13.  Sensorineural hearing loss is caused by a problem in the cochlea (because the hair cells of the cochlea are not working properly) or with the hearing nerve.  Sensorineural hearing loss is permanent  Generally a child with sensorineural hearing loss will use amplification (hearing aids and/or a cochlear implant) Sensorineural Hearing Loss

14.  Inherited (genetic) even with no previous family history of deafness  Syndromic  Congenital Infection (eg CMV)  Ototoxic medication  Severe jaundice  Lack of oxygen at birth  Meningitis Causes of SNHL

15. SNHL Summary  Due to an abnormality in cochlea/ auditory nerve  Can be present at (or shortly after) birth  Can be acquired (e.g. meningitis)  Incidence is very low (it is quite rare)  Approximately 1.3 per 1000 live births - 0.1%  Management is early provision of amplification  Early detection is therefore essential  Better outcomes if identified < 6 months  That’s why we’re doing NHSP !

16. Newborn Hearing Screening

18.  First Appointment within 28 days of referral  Up to 120 minute appointment  Tone Pip ABR (e.g. 1 & 4 kHz)  Tells us more about hearing across pitches  Bone Conduction ABR  Can help identify Conductive versus SNHL  Tests for other conditions  Auditory Neuropathy Spectrum Disorder  Tympanometry  Can help identify OME (Glue Ear) NHSP Follow Up Assessment

19.  Diagnostic Assessment by 6 weeks of age  Identify if there is a hearing impairment  Conductive or Sensorineural  Mild, Moderate, Severe or Profound  Results to Parents, GP, Link HV, Child Health, SALT, Paediatrics, (Education/Sensory Support)  Provide appropriate habilitation  Amplification (Hearing Aids)  Family Friendly Approach  Links with Education/Early Support  As soon as appropriate (typically by 6 months of age) NHSP Follow Up Assessment

20. Newborn Hearing Assessment

21. Oto Acoustic Emissions (OAE)  Transient Evoked OAE (TEOAE) most common  Emission elicited by brief acoustic stimuli (click)  Response 4 to 15 ms after the stimulus (“echo”)  Present in almost all normal ears  Response is abolished if hearing loss > 25 dB HL  Quick and non-invasive  Does not provide threshold information  Only indicates healthy hair cell population  Use includes neonatal screening (well babies)

22. Equipment (AOAE/AABR)

23. Auditory Brainstem Response  Objective test of hearing  Assesses function of cochlea and auditory nerve  Does not assess higher auditory function  Use Tone-Pip (Frequency Specific) sounds  1 kHz (low pitch) and 4 kHz (high pitch)  Use Bone Conduction  Identify SNHL versus CHL  Auditory Neuropathy Spectrum Disorder  (OAE/CM present ABR absent/abnormal)

24. Assessing hearing in newborn babies

25. ABR Waveforms

26. Children’s Hearing Assessment

27. Visual Reinforcement Audiometry(VRA)  Children aged 6 to 30 months (or older)  Child sits erect on the parent's knee facing forward  Front distracter engages child in simple play activity  Sounds through loudspeaker system  Warble tone or narrow band noise employed  Frequencies in the range 0.25-4.0 kHz are tested  Child conditioned to respond when sound heard  Visual reward (animated toy)  Once conditioned then test procedure begins  Levels decreased to find "minimum response"  =< 25 dBnHL consistent with (near) normal hearing

28. Visual Reinforcement Audiometry (Age 5 months to 2 Years)

29. Performance/Play Audiometry(age 2 years to 4 years)

30. Tympanometry  Otoscopy  use otoscope to visualise ear drum  Identify contraindications for tympanometry  Tympanometry  probe placed in child’s ear  assesses middle ear function  assesses mobility of ear drum  can help to identify Otitis Media with Effusion

31. Tympanometry Assesses Middle Ear Function

32. ECV= 0.9 ml MEP= -70 DaPa MEC= 1.1 ml = normal Typical Tympanogram Normal Range Shown ECV Baseline Adjusted

33. Glue Ear Normal Glue Thick Glue

34. Other Conditions Normal Otosclerosis Perforation

35. Children’s Hearing Aid Provision

36. Hearing Aids  High Quality Digital Instruments  Wide Dynamic Range Compression  Quiet sounds amplified more  Loud sound amplified less  Speech presented at comfortable level  Reduces need for volume control  Fitted using a prescriptive approach  Desired Sensation Level 5.0  Real Ear Measurement

37. Children’s Hearing Aid Provision

40. Hearing Aids

42. Technology

43. Connectivity

44. Outcomes Hearing vs Hearing Impaired

45. Balance Assessment & Rehabilitation

46. Balance System

47. Balance Assessment

48. Assessment of Visual Pathways

49. Vestibular Myogenic Evoked Potentials

50. Balance Rehabilitation

52. Auditory Implants

53. Cochlear Implant

54. Bone Anchored Hearing Aid