1. Hearing, Hearing Loss, Hearing Help Pamela Fiebig, AuD, Audiologist Northwestern University Dept. of Otolaryngology/Audiology October 14, 2013

2. Northwestern Medical Group Dept of Otolaryngology Galter Pavilion, 15 th Floor; 675 N. St. Clair 312-695-8182 l Audiologists –Pamela Fiebig, AuD –Malini Patel, AuD –Denise Greiner, AuD –Michelle Amosson, AuD –Michelle Burns, AuD –Kelly Waldvogel, AuD l Otologists (physician ear specialists) –Alan Micco, MD –Akihiro Matsuoka, MD

3. Hearing Loss is Common l 10 Million Americans Report Significant Hearing Loss – 4 Million > 65 y.o. – 5 Million 18-64 y.o. –.5 Million < 18 y.o.

4. Age of Hearing Loss Onset Source: National Health Interview Survey, 2007.National Health Interview Survey http://www.nidcd.nih.gov

5. More Men Than Women Have Hearing Loss

6. How We Hear

7. Basic Audiology Tests l Pure-tone Audiometry –Air-Conduction »earphones--evaluates from outer to inner ear –Bone-Conduction »bone vibrator--evaluates inner ear l Word Recognition Testing

8. Audiogram

9. Normal hearing and Speech Sounds

10. Types of Hearing Loss l Conductive Hearing Loss –Outer or Middle Ear-DEMO l Sensorineural Hearing Loss –Cochlea or Auditory Nerve –99% is SENSORY not neural l Mixed Hearing Loss –Both conductive and sensorineural

11. Conductive Hearing Loss: Causes and Treatments l Ear Wax (cerumen) or other block l Ear Infection/Fluid in Middle Ear l Otosclerosis l Cholesteotoma l Perforated Eardrum l Can often be “fixed”!

12. Sensory Hearing Loss: Causes l Presbycusis (aging) l Ototoxic medication l Meniere’s Disease l Heredity l Noise Exposure l Unknown l Usually CANNOT be “fixed”

13. Hearing Loss from Noise Exposure

14. Hearing Loss and Aging

15. Acoustic Neuroma l Benign Tumor in the Internal Auditory Canal l Symptoms Include –Hearing loss –Tinnitus –Dizziness l Treatment is surgical removal –Hearing is often sacrificed in this ear

16. Hearing Aids for Sensory Hearing Loss

17. Effect of Hearing Loss on Speech Understanding

18. Hearing Aids: Desirable Characteristics l Speech Audibility l Physical comfort l “Audible” comfort – Not too much “background” noise – Not too loud

19. BTE (Behind-the-Ear Style)

20. ITE (In-the-Ear Style)

21. ITC (In-the-Canal Style)

22. CIC (Completely in Canal) l Sometimes “extended wear”

23. “Mini” Behind-the-Ear

24. “BEST” Hearing Aid l Degree/Configuration of loss l Individual Listening Needs l Cosmetics/Style l Ability to Manipulate Small Objects l “Gadget” Tolerance l Cost

25. Today’s Hearing Aids: Special Features l Directional Microphones l Noise Reduction Algorithms l Multiple Listening “Programs” l Automatic adjustments l Feedback controls l Bluetooth/wireless compatibility l Left-Right Communications

26. What Patients Say About Today’s Hearing Aids... l Speech sounds CLEARER –As distortion decreases, performance increases l MORE sounds are HEARD –Automatic loudness scaling allows more sounds to be audible l Sounds are more COMFORTABLE –Loudness stays within comfort range l I still can’t hear in high levels of background noise –but I do hear better in low to mid-levels of noise

27. l Cochlear Implants –For severe-to-profound hearing loss –Where hearing aids are of minimal benefit When Hearing Aids Are Not Enough…

28. A Hearing Aid Amplifies Acoustic Energy and Delivers it to the cochlea A Cochlear Implant Converts Acoustic Energy into Electrical Impulses and Stimulates the Auditory Nerve Directly, replacing the function of the sensory cells in the cochlea

29. Implantable Stimulator External Speech Processors

30. How a Cochlear Implant Works

31. Medicare and Hearing Care l Initial Hearing Evaluation covered with Physician Referral; with medical condition l Hearing evaluation is part of initial welcome wellness exam l Hearing Aids and related services are NOT a covered benefit

32. Medicare and Hearing Care l Some managed plans may have hearing aid discounting agreements with participating providers l Cochlear Implants ARE a covered benefit for patients who meet criteria set by Medicare

33. Dispensing Law Requires l Medical Clearance for Hearing Aid Use by Physician l Waiver of Medical Clearance Allowed for Users Over 18 years old l 30-day trial with hearing aid (Mandated in IL, Suggested by FDA)

34. Do YOU Have a Hearing Problem? l Do people “mumble?” l Do you frequently say, “What?” or “Huh?” l Do you misunderstand numbers and names? l Do you like the TV/radio volume louder? l Do you have trouble hearing in noisy rooms?

35. What’s should I do if I think I have an ear or hearing problem? l Investigate medical symptoms with an otologist (ear specialist) –Ringing, dizziness, ear pain –Changes in hearing or symptoms l See an audiologist for evaluation –Discuss ear protection for noise –Consider hearing aids, if appropriate

36. A Parting Thought… l Hearing help may be less conspicuous than your hearing loss