1. HEADS OF SERVICES TRAINING
HAMILTON HOUSE
28th February 2013

2. AUDIOLOGY AND TECHNOLOGY
David Couch

3. Peripheral Auditory System

4. Anatomy of the Ear

5. Cochlea – space in bone

6. Cochlear implant

7. Auditory Pathways

8. Initial (early) Diagnosis:
Methods of diagnosis:
Otoacoustic emissions (OAE)
Auditory brainstem response (ABR)
Clinical
Automated

9. Otoacoustic Emissions (OAE)

10. Otoacoustic Emissions (OAE)

11. OAE

12. Auditory Brainstem Response (ABR)

13. Auditory Pathways

14. Auditory Brainstem Response (ABR)

15. Initial (early) Diagnosis:
Neonatal Hearing Screening Programme (NHSP)
Community (local clinics)
Acute (hospital service)

16. Referral routes (NHSP)
OAE
ABR
Audiological Certainty
Community Clinic OAE
Hospital ABR (earmoulds?)
Referral to SI Services
Hearing Aid Fitting

17. Referral routes late diagnosis – parental concern)
GP Referral
Community Clinic
Hospital Audiology
Hearing Aid Fitting
Referral to SI Services

18. Pure Tone Audiometry (Headphone Test)

19. Referral routes late diagnosis – parental concern) Distraction test

20. Referral routes late diagnosis – parental concern) Co –operative test

21. Referral routes (late diagnosis – school screen)
School Screen (reception)
Community Clinic
Hospital Audiology
Hearing Aid Fitting
Referral to SI Services

22. Play Audiometry

23. Visual Reinforcement Audiometry (VRA)

24. Pure Tone Audiometry

25. Pure Tone Audiometry

26. Pure Tone Audiometry

27. Degree of Hearing Loss
Calculated as the average hearing loss over 5 frequencies (specifically: 250Hz; 500Hz; 1kHz; 2kHz; 4kHz) in the better ear.
There is no such thing as a mild/moderate loss!

28. Type of loss This refers to the location of the hearing problem:
Middle Ear = Conductive Hearing Loss
Inner Ear = Sensori-neural Hearing Loss

29. Intervention – Hearing Aids
The main enemies of hearing aids are
Noise
Distance

30. Intervention – Cochlear Implants
The main enemies of Cochlear Implants are
Noise
Distance

31. Intervention – Radio Aids (FM Systems)

32. Intervention – Radio Aids (FM Systems)

33. Intervention – Radio Aids (FM Systems) MLx

34. Teacher of the Deaf role in Audiology
Testing of hearing aid performance (Test Box)
Radio Aid allocation and ‘balancing’
Hearing Aid maintenance

35. The Educational Audiologist
Testing of hearing aid performance (Test Box)
Radio Aid allocation and ‘balancing’
Hearing Aid maintenance
Hearing Assessment
Training ??

36. Knotty Issues!

37. Auditory Neuropathy Spectrum Disorder (ANSD)
This is a clinical diagnosis and is characterised by the presence of otoacoustic emissions but absence of an auditory brainstem response.
What’s going on?
Should they be included on caseload?
What are the intervention recommendations?

38. Auditory Processing Disorder (Difficulty?) (APD)
This is a diagnosis following the outcome of a series of subjective assessments and observations. Hearing threshold levels are normal.
How is it ‘diagnosed’?
What’s going on?
Should they be included on caseload?
What are the intervention recommendations?

39. Auditory Processing Disorder (Difficulty?) (APD)
What are the intervention recommendations?
Listening Programmes
Good acoustics (?)
iSense

40. Acoustics
The National Deaf Children’s Society (NDCS) has mounted a campaign in this area.
Acoustics describe the sound qualities of a room and there are certain recommendations laid down for those qualities. They are currently described in Building Bulletin 93 (BB93). There is a review pending.
BATOD and NatSIP have published guidelines on this topic (see their websites).

41. Acoustics (continued)
A poor acoustic environment creates more challenge for the listener. A person who has degraded hearing and wears a hearing aid will be more affected than those with normal hearing.
BB93 only applies to new builds (and, by implication, new extensions and refurbishments).
It is the responsibility of the contractor to ensure the build meets the current standards.

42. Acoustics (continued, continued)
Rooms which do not meet the recommendations may not be ‘poor’.
Rooms can be improved (and meet BB93).
The purpose of a Radio Aid is to overcome the detrimental effects of poor acoustics and reduce the acoustic challenge.
Soundfield systems are one way of reducing the acoustic challenge.

43. Soundfield Systems Can be wired in as part of the build
Can be wired in to an existing room.
Can be portable systems.

44. Obligations and Common Practice
Soundfied systems are not usually bought by SI Services but are loaned and then bought by schools.
FM systems are routinely bought and maintained by SI Services.
iSense systems can be loaned or bought by …either!
What is your experience?

45. Questions (there must be some!)