Transcript Hearing_Impairments 06

Audiology 101
Alice E. Holmes, PhD
Professor
University of Florida
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Normal Hearing
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Conductive Hearing Loss
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Sensorineural Hearing Loss
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Mixed Hearing Loss
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Determine Amount of Loss
From bass to treble, or low to high pitch
From
faint
to
intense,
or
soft
to
loud
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Causes of Hearing Loss
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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!
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Only one type
of hearing loss
is preventable
AVOID NOISE
Hazardous
noise damages
hearing
12.5% of children aged 619 have some amount
of noise induced
hearing loss
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US HL Population Projected
through 2050
In 2004, this equates to 31.5 million people reporting hearing loss in the US
Kochkin, 2005
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Hearing Loss Population by Age Group
Owners versus Non-owners
85+
Owners
Non-owners
75-84
65-74
55-64
45-54
35-44
18-34
<18
0
Kochkin, 2005
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Millions
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Hearing Aid Styles
Completely In the Canal CIC
In The Ear ITE
Behind The Ear BTE
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Analog Hearing Aids
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Amplifies in a linear
fashion, can distort
sounds, limited means
to filter background
noise, least expensive
choice
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Digital Hearing Aids:
Programmed Via Computer
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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
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Optional Features
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Directional: Uses dual
microphones
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Available in analog,
compression and digital
models
Use of forward facing
microphone helps focus
on desired sounds
Helps diminish
awareness of
background noise
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Optional Features
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Multiple Memory
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Increases versatility
Memories customized
for various situations
Remote Control
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Change volume,
memory function,
directionality of
microphone
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FM Communication Systems
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Receiver/BTE
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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
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Assistive Technology
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Pocket Talker
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One to One Amplifier
Cell Phone with TDD
Telephone Amplifier
Amplified Phone
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Devices for the Home
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Strobe Light Doorbell
Bed Shake Alarm Clock
Flashing Smoke Alarm
Vibrating Wrist Watch
Television Closed
Caption Decoder
TV Infra-Red Listeners
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Cochlear Implant
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A device that electrically
stimulates the auditory nerve of
patients with severe-toprofound hearing loss to
provide them with sound and
speech information.
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Cochlear Implant
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Sound picked up by microphone
Speech processor
Coded into electrical impulses
Transmitter coil
Through the skin via FM waves
Receiver stimulator
Electrodes
Nerve
Brain
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Cochlear New Freedom
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Advanced Bionics
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Med EL Pulsar
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Worldwide
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Over 100,000 multi-channel
implants
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University of Florida
Cochlear Implant Program
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Implanted our first patient in
1985
Currently follow over 450
cochlear patients
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Cochlear Implant Team for
Adult Patients
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Surgeon
Audiologist
Speech-Language Pathologist
Psychologist
Social Worker
VR Counselor
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Formal Evaluation
Medical
 Audiological
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Standard audiometric unaided
test battery
 Aided speech perception
 Aided speechreading
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Preimplant Counseling
Topics
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Candidacy criteria
Cochlear implant hardware
Realistic expectations
Individual and family commitments
Social considerations
Communication mode
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Who is a candidate?
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Severe-to profound sensorineural
hearing loss
Limited benefit from hearing aids
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Who is an adult candidate?
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< 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
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Deaf Culture
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Deafness is a culture not a
handicap
Characterized by their own
language
Resent those trying to ‘fix a deaf
child’
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Outcomes for Post-lingual Adults
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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
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Impact of CI on Vocational
Settings
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13 cochlear implant recipients and their
employers
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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.
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Impact of CI on Vocational
Settings
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Both supervisors & clients found
improvements after the CI in.
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awareness of warning signals
understanding conversations in most
environments
identifying sounds in their environment
The only negative effect of CI:
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traffic noises were more bothersome than before
surgery.
Saxon JP, Holmes AE & Spitznagel RJ (2001)
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Outcomes Research
Impact on
daily life
Cost
effectiveness
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Health Utility Changes
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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
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Costs by Age of Onset
$1,200,000
Lifetime Costs ($1998)
$1,000,000
$1,020,000
$919,000
$800,000
$600,000
$453,000
$400,000
$297,000
$253,000
$200,000
$43,000
$0
0-2 yrs
3-17 yrs
18-44 yrs
45-64 yrs
65+
Average
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
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Economics of Hearing Loss
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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
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Costs include both direct medical and
nonmedical costs, educational costs as
well as indirect productivity losses
Source: Project HOPE, Policy Analysis Brief, April, 2000
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Hearing Impairment
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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
Source: Project HOPE, Policy Analysis Brief, April, 2000
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Societal Impact: Age
The severe to
profound
hearing loss
population is
divided into
four age groups
0-17 yrs
9%
65+ years
57%
Source: Project HOPE calculations from the 1990-91 National Health Survey, and U.S. Census, 1991
18-44 yrs
16%
45-64 yrs.
18%
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Societal Impact: Income Level
Over half of the severe to profound hearing loss population have family
incomes of less than $25,000
.
38%
40%
33%
36%
35%
29%
26%
30%
25%
20%
15%
15%
14%
10%
10%
5%
0%
< $10,000
$10,000 - $24,999
$25,000 - $49,999
Severely to Profoundly Hearing Impaired
Source: Project HOPE calculations from the 1990-91 National Health Survey
$50,000+
US Population
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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.
82%
90%
73%
80%
70%
58%
60%
46%
50%
40%
30%
16%
20%
11%
2%
10%
3%
0%
18-44 yrs
45-64 yrs
65-79 yrs
80+ yrs
Severely to Profoundly Hearing Impaired US Population
Source: Project HOPE calculations from the 1990-91 National Health Survey
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Lifetime Cost Comparison
Of Other Conditions
Magnitude of Difference Between Lifetime Costs of Severe to
Profound Hearing Loss and Other Conditions
Condition
Severe to Profound Hearing Impairment
Schizophrenia
Epilepsy (noninsitutionalized with frequent seizures)
Rheumatoid Arthritis (25-year cost for young women)
Stroke
Near-Drowning
Accidents with Firearms
Source: Project HOPE, Policy Analysis Brief, April, 2000
Lifetime Costs
$ 297,000
$ 295,000
$ 172,900
$ 130,500
$ 129,200
$ 98,500
$ 89,100
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Cost-Saving Intervention
Medical technologies, such
as the cochlear implant, have
proven to be cost-effective
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Cost of Cochlear Implants Vs
Lifetime Costs of Deafness
$1,200,000
$11,500
$1,000,000
$70,200
$800,000
$433,400
$600,000
$400,000
$297,000
$63,000
$504,900
$200,000
$0
Total CI Costs
Special Ed
Avg. Lifetime Costs of
Deafness
Lost Productivity
Cost of Prelingual
Deafness
Medical Costs
Vocational Rehab
Source: Project HOPE, Policy Analysis Brief, April, 2000; and JAMA, Vol. 284, No. 7, August 16, 2000
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®
Nucleus
Hybrid™
Cochlear Implant
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Selection Criteria:
Audiometric
Frequency (Hz)
-10
125
250
500
750
1000
1500
2000
3000
4000
6000
8000
Hearing Threshold (dB HL)
(ANSI - 1989)
0
10
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40
50
60
70
80
90
100
110
120
130
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Nucleus® Hybrid™ Cochlear
Implant
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Based on the Nucleus Freedom
cochlear implant
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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
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Externals
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Freedom™
BTE
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.
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