Types of Hearing Loss

Conductive Hearing Loss

Part of ear affected: outer and/or middle Description: occurs when sound cannot reach inner ear in other words when something prevents sound from getting into ear

Outer Ear - Causes

Blocked ear canal

Wax Infection / swelling

Perforated eardrum Scarred / thickened eardrum

Often caused by glue ear

Middle Ear - Causes

Broken ossicles

Hammer, anvil, stirrup

Glue ear

Infection with build up of sticky fluid which prevents ossicles from vibrating properly

Middle Ear - Causes

Eustachian tube not opening and closing properly

Cold or catarrh Allergic reaction

Middle Ear - Causes

Otosclerosis

Bony growth around base of stirrup which stops it from moving properly Tends to run in families Often triggered by pregnancy in women

Sensori-neural Hearing Loss

Part of ear affected: inner ear and/or auditory nerve

80% of people with a hearing loss have SNHL

Description: occurs when either the hair cells in the cochlea and/or the nerve to the brain are damaged and sound is not been passed onto the auditory centre in the brain Very rare that the exact cause can be identified

The Inner Ear

Auditory nerve

Cochlea

Inner Ear - Causes

Commonest cause old age deafness (presbyacusis) Noise damage Virus or infection High doses of some medications Chemotherapy / radiotherapy sometimes

Inner Ear - Causes

Acoustic neuroma (benign tumour) Accident head injury Autoimmune Inner Ear Disease (AIED) Menieres Disease Congenital

Mixed Hearing Loss

Part of ear affected: Outer/middle and inner Description: combination of both types of hearing loss described previously Causes: generally more than one cause or conductive loss plus age-related hearing loss

Central Auditory Processing Disorder (CAPD)

Part of ear affected: none

Caused by a difficulty in the hearing part of the brain

Description: occurs when sound reaches brain but there is a delay / difficulty in identifying sound patterns
a sort of hearing dyslexia can be helped by lipreading as ability to process words is not affected

Functional Hearing Loss

Persons with functional hearing loss have no physiologic basis for a hearing deficit They are using their 'hearing loss' for secondary gain and are called malingerers This is occasionally seen in adolescents or persons appying for pension benefits as a result of hearing loss

The apparent hearing loss is not due to a physical defect, but rather to a psychological, psychosocial, or emotional disorder or issue. Special testing must be completed to determine if this is definitely the case.

All of the different types of hearing loss

can be present at birth, i.e. congenital or acquired later on in life

Testing the Hearing

There are stages to testing the hearing:1-clinical assessment of the degree of deafness. 2-Tunning fork tests. 3-Audiometry. 4-Otoacoustic emissions . 5-Auditory brainstem response .

1-Clinical assessment of the degree of deafness.

Whispered speech test. -The GP will whisper a combination of numbers and letters behind the patient and check if he can hear anything by asking the patient to repeat the combination. - if unilateral deafness is suspected the good ear should be masked and the deaf ear tested.

2-tunning fork Test.

There are two types of tuning fork: 1-RINNES Test. 2-WEBBERS Test.

1-RINNES Test.

Interpretation of Rinnes test

Air Conduction > Bone Conduction = normal or SNHL Bone Conduction > Air Conduction =

Conductive HL or dead ear

2-WEBBERS Test.

Interpretation of Webbers test

In conductive deafness the sound is heard loudest in the affected ear. In sensorineural deafness the sound is heard louder in the un affected ear.

3-Audiometry.
Pure tone audiometry (PTA). - is the key hearing test used to identify hearing threshold levels of an individual . -the lower the threshold the better hearing. -AC threshold are obtained with headphones and measure outer , middle, inner ear and the auditory nerve function. -BC threshold are obtained with bone conduction oscillators which effectively bypass outer and middle ear function

AUDIOGRAM

Audiogram
0 dB - 20 dB ....... normal hearing 20 dB - 40 dB ..... mild hearing loss 40 dB - 55 dB ..... moderate hearing loss 55 dB - 70 dB ..... moderately severe hearing loss 70 dB - 90 dB ..... severe hearing loss >90 dB................. profound hearing loss

Audiogram Conductive HL
- bone conduction threshold in normal rang . - air conduction threshold outside of normal limits. - gab between AC and BC threshold > 10 db ( air bone gab ).

Audiogram Conductive HL

Audiogram - SNHL
-both air and bone conduction threshold below normal . -gap between AC and BC less 10 db ( no air bone gap).

Audiogram - SNHL

4-Otoacoustic emissions

This is used to measure the cochlear function by recording signals produced by the hair cells.

5-Auditory brainstem response .

This measures the activity of the cochlea, auditory nerve and brain when a sound is heard.

Treatment

Initial treatment Treatment for reversible hearing loss depends on its cause. It is often treated successfully. Hearing loss caused by: Ototoxic medicines (such as aspirin or ibuprofen) often improves after you stop taking the medicine. An ear infection, such as a middle ear infection, often clears up on its own, but you may need antibiotics. An injury to the ear or head you may need surgery. Otosclerosis, acoustic neuroma, or Mnire's disease may require medicine or surgery. An autoimmune problem may be treated with corticosteroid medicines, generally prednisone. Earwax is treated by removing the wax. Do not use a cotton swab or a sharp object to try to remove the wax. This may push the wax even deeper into the ear or may cause injury. If a foreign body is found in the ear canal, the doctor will try to take it out. hearing devices

Hearing Aid Types

Completely In Canal (CIC)
In The Canal (ITC) In The Ear (ITE)

Behind The Ear (BTE)

Disposable

Completely In Canal Hearing Aids (CIC)

This is the smallest type of hearing aid available. All parts, including the battery, are contained in a tiny case that fits deep inside the ear canal. A thin, plastic pull cord sticks out into the bowl-shaped area of the ear to help in removal. The CIC aids are appropriate for Mild to Moderate hearing loss. The CIC aids are NOT appropriate for infants or children. ADVANTAGES: It is the least visible hearing aid. It may help reduce wind noise. DISADVANTAGES: CIC aids have less space for add-ons. Batteries are smaller, so battery life may be shorter. This is the most expensive type of hearing aid. This style may be difficult to handle for those with dexterity problems.

Photo courtesy of www.mayoclinic.com

In The Canal Hearing Aids (ITC)

An ITC hearing aid fits partly in the ear canal but not as deeply as a CIC. The edge of the ITC aid extends into the bowl of the ear. The ITC is appropriate for Mild to Moderate/Severe hearing loss. The ITC is NOT appropriate for infants or children. ADVANTAGES: ITC aids are hardly noticeable, has more opportunities for add-ons than a CIC, and is more powerful than a CIC. DISADVANTAGES: ITC aids can be difficult to Photo courtesy of handle, insert, and change batteries. The ITC www.mayoclinic.com are also rather expensive.

In The Ear Hearing Aids (ITE)

This style of hearing aid fills most of the bowl-shaped portion of the ear. The ITE aids are appropriate for Mild to Severe hearing loss. ADVANTAGES: These aids can be more powerful than those that fin in the canal. The ITE can accommodate more add-ons. Their batteries are larger and more easily changed. DISADVANTAGES: ITE aids may pick up more wind noise.

Photo courtesy of

www.mayoclinic.com

Behind The Ear Hearing Aids (BTE)

BTE Aids have 2 parts. A small plastic case that rests behind the ear contains the hearing aid circuitry: the microphone, amplifier, and loudspeaker. The case is connected by plastic tubing to a custom-made earmold (earpiece) that directs the amplified sound into your ear. BTE aids are appropriate for almost all types of hearing loss and people of all ages. BTE aids are sometimes perceived as being old fashioned or not technologically advanced. But in fact, BTE aids have modern electronic and digital technology like the other styles and in some cases provide the greatest improvement in hearing. ADVANTAGES: These are the most powerful hearing aids, and they can be adjusted for any degree of hearing loss. BTE aids are the best style for infants, children, and people with more severe hearing loss. BTE aids are the easiest to maintain, usually require fewer repairs, and battery replacement is easier. DISADVANTAGES: Some people dont have enough space between their ear and the side of their head to accommodate this style. This style may pick up more wind noise than the smaller aids do.

Photo courtesy of www.mayoclinic.com

Disposable Hearing Aids

Disposable aids are In The Canal (ITC) hearing aids designed to be worn for 40 to 70 days, then discarded. These devices are suitable for Slight/Minimal to Moderate Hearing Loss. Using disposable aids may eliminate maintenance problems due to moisture and wax buildup that occur with ongoing use of standard aids. Disposable aids can be fitted at your hearing evaluation, so you can leave wearing your new hearing aid. However, disposable aids will not fit everyones ears or meet everyones needs. ADVANTAGES: Disposable aids require minimal maintenance. You cn receive them at the time of your hearing evaluation. DISADVANTAGES: These aids are not custom fit, and may not fit everyone comfortably. They have less adjustable circuitry and no special features. Also, there is the ongoing expense of buying a new one every two months.

Photo courtesy of
www.cicoil.com

Implantable Hearing Aid

Implantable hearing aids are an alternative to traditional hearing aids for people with Moderate to Severe Sensorineural Hearing Loss. Implantable hearing aids conduct sound by vibrating the middle ear Photo courtesy of Microtia Australia Vibran bones directly to stimulate the Soundbridge via inner ear. This device is NOT recommended http://microtiaaustralia.org.au for those with Conductive Hearing ADVANTAGES: These devices may Loss. produce a more natural sound and are A wire leads from the receiver to more versatile for sporting activities such the electromagnet attached to one as swimming. of the middle ear bones. Some styles have the receiver surgically DISADVANTAGES: Implantable aids implanted into the skull behind the require surgery, and can cost from $6,000 ear with an external amplifier. to $18,000 depending on which device is Other styles have the receiver and selected and which type of anesthesia is amplifier in an external processor necessary. worn behind the ear.

Cochlear Implant

Cochlear implants are not an alternative to hearing aids. These devices are designed for individuals who receive little to no help from hearing aids. Candidates for cochlear implants typically have severe to profound sensorineural hearing loss in both ears or have great difficulty understanding speech. Children as young as 1 year old can receive the implant, and there is no upper age limit. ADVANTAGES: Many insurance companies cover cochlear implants which greatly reduces the cost to the patient.

DISADVANTAGES:

There is a lot of follow-up and programming that must be done after the surgery. This is a time-commitment that some people do not want. The surgery and all the pre and post operative requirements can cost between $30,000 and $50,000. That can be very costly if your insurance does not cover 100% of the procedure.

A cochlear implant
is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. For children and adults who derive no benefit from the use of properly fitted hearing aids

Cochlear Implants

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