1. 1 Audiology 101 Alice E. Holmes, PhD Professor University of Florida

2. 2 Normal Hearing

3. 3 Conductive Hearing Loss

4. 4 Sensorineural Hearing Loss

5. 5 Mixed Hearing Loss

6. 6 Determine Amount of Loss From bass to treble, or low to high pitch From faint to intense, or soft to loud

7. 7 Causes of Hearing Loss Presbyacusis (aging) is #1 cause of hearing loss Hazardous noise exposure is #2 Just a few other causes include genetics, teratogens, otitis media, idiopathic hearing loss, fistula, congenital anomaly, prenatal or perinatal exposures (syphilis, CMV, rubella), syndromes, head injury, among hundreds of others! Only one type of hearing loss is preventable AVOID NOISE Hazardous noise damages hearing 12.5% of children aged 6- 19 have some amount of noise induced hearing loss

8. 8 US HL Population Projected through 2050 In 2004, this equates to 31.5 million people reporting hearing loss in the US Kochkin, 2005

9. 9 Hearing Loss Population by Age Group Owners versus Non-owners Kochkin, 2005

10. 10 Hearing Aid Styles Completely In the Canal CIC In The Ear ITE Behind The Ear BTE

11. 11 Analog Hearing Aids Amplifies in a linear fashion, can distort sounds, limited means to filter background noise, least expensive choice

12. 12 Digital Hearing Aids : Programmed Via Computer Has at least 2 channels Analyzes incoming sound and adjusts the loudness based on preset parameters Detects softer sounds of speech, raises loudness Does not amplify background noise to same degree as primary signal

13. 13 Optional Features Directional: Uses dual microphones Available in analog, compression and digital models Use of forward facing microphone helps focus on desired sounds Helps diminish awareness of background noise

14. 14 Optional Features Multiple Memory Increases versatility Memories customized for various situations Remote Control Change volume, memory function, directionality of microphone

15. 15 FM Communication Systems Enhanced speech perception in noise, at great distances Used in classrooms Greatly increases signal to noise ratio New technology reduces size, eliminates cords, wires Transmitter Receiver/BTE

16. 16 Assistive Technology Pocket Talker One to One Amplifier Cell Phone with TDD Telephone Amplifier Amplified Phone

17. 17 Devices for the Home Strobe Light Doorbell Bed Shake Alarm Clock Flashing Smoke Alarm Vibrating Wrist Watch Television Closed Caption Decoder TV Infra-Red Listeners

18. 18 Cochlear Implant A device that electrically stimulates the auditory nerve of patients with severe-to- profound hearing loss to provide them with sound and speech information.

19. 19 Cochlear Implant  Sound picked up by microphone  Speech processor  Coded into electrical impulses  Transmitter coil  Through the skin via FM waves  Receiver stimulator  Electrodes  Nerve  Brain

21. 21 Cochlear New Freedom

22. 22 Advanced Bionics

23. 23 Med EL Pulsar

24. 24 Worldwide Over 100,000 multi-channel implants

25. 25 University of Florida Cochlear Implant Program Implanted our first patient in 1985 Currently follow over 450 cochlear patients

26. 26 Cochlear Implant Team for Adult Patients Surgeon Audiologist Speech-Language Pathologist Psychologist Social Worker VR Counselor

27. 27 Formal Evaluation Medical Audiological Standard audiometric unaided test battery Aided speech perception Aided speechreading

28. 28 Preimplant Counseling Topics Candidacy criteria Cochlear implant hardware Realistic expectations Individual and family commitments Social considerations Communication mode

29. 29 Who is a candidate? Severe-to profound sensorineural hearing loss Limited benefit from hearing aids

30. 30 Who is an adult candidate? < 50% aided speech recognition on recorded sentence material in the ear to be implanted < 60% aided speech recognition on recorded sentence material in the un-implanted ear < 40% for Medicare coverage

31. 31 Deaf Culture Deafness is a culture not a handicap Characterized by their own language Resent those trying to ‘fix a deaf child’

32. 32 Outcomes for Post-lingual Adults Wide range of success Most score 90-100% on AV sentence materials Majority score > 80% on high context materials Performance more varied on single word tests but most have some open set recognition

33. 33 Impact of CI on Vocational Settings 13 cochlear implant recipients and their employers completed a modified Profile of Hearing Aid Benefit Questionnaire Provided employers’ contact information 9 of the employers returned completed questionnaire Results indicated the cochlear implant had a positive impact on the job functioning. Saxon, J.P., Holmes, & Spitznagel, R.J. (2001) Impact of a cochlear implant on job functioning. Journal of Rehabilitation, 67(3), 49-54.

34. 34 Impact of CI on Vocational Settings Both supervisors & clients found improvements after the CI in. awareness of warning signals understanding conversations in most environments identifying sounds in their environment The only negative effect of CI: traffic noises were more bothersome than before surgery. Saxon JP, Holmes AE & Spitznagel RJ (2001)

35. 35 Outcomes Research Impact on daily life Cost effectiveness

36. 36 Health Utility Changes Profound Hearing loss results in a decrease from 0.36 to 0.63 Cochlear implantation results in an increase from 0.07 to 0.41

37. 37 Costs by Age of Onset Source: Project HOPE calculations from the 1990-91 National Health Interview Survey and U.S. Census, 1991 All Costs are inflated to 1998 dollars using the Urban Consumer Price Index Source: Project HOPE calculations from the 1990-91 National Health Interview Survey and U.S. Census, 1991 All Costs are inflated to 1998 dollars using the Urban Consumer Price Index

38. 38 Severe to profound hearing loss is expected to cost society an average of $297,000 per individual, over $1 million if the individual is pre-lingually deaf Costs include both direct medical and nonmedical costs, educational costs as well as indirect productivity losses Source: Project HOPE, Policy Analysis Brief, April, 2000 Economics of Hearing Loss

39. 39 500,000 to 750,000 Americans with severe to profound hearing impairment To function in a hearing society, individuals with this level of loss require specialized education, social services, additional health care services and other resources Hearing Impairment Source: Project HOPE, Policy Analysis Brief, April, 2000

40. 40 Societal Impact: Age The severe to profound hearing loss population is divided into four age groups Source: Project HOPE calculations from the 1990-91 National Health Survey, and U.S. Census, 1991

41. 41 Societal Impact: Income Level Over half of the severe to profound hearing loss population have family incomes of less than $25,000. Source: Project HOPE calculations from the 1990-91 National Health Survey

42. 42 Societal Impact: Labor Force Societal Impact: Labor Force 42% of the population, between the ages of 18-44 years, and 54% between the ages of 45-64 years with severe to profound hearing loss are not working. Source: Project HOPE calculations from the 1990-91 National Health Survey

43. 43 Lifetime Cost Comparison Of Other Conditions Magnitude of Difference Between Lifetime Costs of Severe to Profound Hearing Loss and Other Conditions Source: Project HOPE, Policy Analysis Brief, April, 2000

44. 44 Cost-Saving Intervention Medical technologies, such as the cochlear implant, have proven to be cost-effective

45. 45 Cost of Cochlear Implants Vs Lifetime Costs of Deafness Source: Project HOPE, Policy Analysis Brief, April, 2000; and JAMA, Vol. 284, No. 7, August 16, 2000

46. 46 Nucleus ® Hybrid ™ Cochlear Implant

47. 47 Selection Criteria: Audiometric

48. 48 Nucleus ® Hybrid™ Cochlear Implant Based on the Nucleus Freedom cochlear implant Electrically equivalent Short array (10 mm) composed of 6 half-band electrodes (to make array as thin as possible) Designed to allow electric stimulation of high-frequency region of the cochlea while maintaining low-frequency hearing for acoustic stimulation

49. 49 Externals Externally, subjects use a Freedom speech processor to deliver electric stimulation via the implant. Acoustic stimulation is provided via ipsilateral use of an ITE and contralateral use of a BTE. Freedom™ BTE