Download Audiology - Transcript - New Zealand Federation for Deaf Children Inc

Audiology – Audio Description and Transcript
Parents and Whānau Hui – Growing and Learning Together with your Deaf Child,
brought to you by Ministry of Education, New Zealand Federation for Deaf
Children and Deaf Aotearoa New Zealand.
A presentation by Neil Heslop and Paul Perryman on the Audiogram and cochlear
implants, held in a small seminar room in Living Springs, Christchurch.
Interview with Paul, Audiologist, van Asch Deaf Education Centre giving an
overview of his presentation.
Paul: The presentation was called ‘Audiology’, to do with explaining the audiogram,
recording a child’s hearing thresholds. Parents asked questions around that and I tried
to help their understanding of what that graph means.
PowerPoint presentation on the ‘Audiogram with speech sounds’. The graph
shows at what frequency and intensity we can hear things.
Presentation by Paul, on the Audiogram.
Paul: The graph, along the top, big numbers, 125 to 8000 and down the side, smaller
numbers 0 to 120. Whether children have enough residual hearing sensitivity over a
wide range of frequencies within which all of the sounds of speech fall. So when we
speak, we not only drive the vocal chords into vibrations to produce vowel sounds and
resonance and so on. but we also interrupt that with bursts of noise such as ‘ch ch’ ‘sh’
and ‘c’ and so on within the words and it helps children when they’re learning to hear
oral language to segment syllables and words to meaningful units so they can
understand what’s being said and they have to hear those sounds in order to hear those
words clearly and to learn them, hear others speaking them and to hear themselves
speaking them. So in a hearing test, we’re trying to find out where a child’s hearing
thresholds are and are they sufficiently low, is the sensitivity enough for that child to
hear other people speaking to them and their own voices without the need for any
assistance. We’re trying to measure the threshold for hearing and that’s all that
happens in a hearing test and the threshold is the level where a child just hears a sound
below which they can’t hear it. So when measuring your threshold for hearing, say it’s
there (Paul puts one hand against the edge of the table and his other hand about
30 centimeters above), so it gets quieter and quieter (Paul drops his hand at the
top), you respond and then quieter still (Paul continues to drop his hand) and there’s
no reaction, back up again (Paul moves his hand back up), yes a response. That’s the
threshold for hearing that’s written on the graph with a circle or a cross at each test
frequency depending on what volume was needed for that responding to be present
below which there was no responding. Are those speech sounds arriving at that child’s
ears loud enough for them to hear all of that speech? Or do we need to amplify those
sounds arriving at the ears through an amplifying device? And that’s the decision we’re
making as audiologists as we’re doing audiology testing.
Interview with Neil, General Manager, Southern Cochlear Implant Programme on
cochlear implants.
Neil: Audiology is an allied health profession that is concerned with the identification,
diagnosis and non-medical treatment of hearing loss. My specialist area is cochlear
implants, so it was really the message about what a cochlear implant can provide for
their child and the process involved in being referred, assessed and provided with an
implant.
Presentation by Neil on cochlear implants.
Neil: So we’ll start with some fairly basic things first, so what is a cochlear implant? It’s
a surgically implanted device, so it does involve surgery. It provides auditory sensation
and effectively that’s all it does and it provides that through electrical stimulation so a
hearing aid and normal hearing the mechanism is acoustic, whereas with a cochlear
implant it’s electrical. We provide someone with a cochlear implant to give them a
speech signal that allows them to develop or maintain spoken language and so that
statement’s highlighted in red because it’s essentially the main point of this
presentation.
PowerPoint presentation on ‘Paediatric Referral Criteria, Candidacy Guidelines’.
 What is a cochlear implant?
- A surgically implanted device providing auditory sensation through
electrical stimulation of the auditory nerve,
 Who do we provide cochlear implants for?
- Those with svere-profound hearing loss OR
- Those with ANSD AND
- Who derive no significant benefit from hearing aids
 What do we provide cochlear implants for?
- (This statement is highlighted in red) A cochlear implant provides
access to a speech signal for the development of spoken language
 The provision of an auditory signal may also have benefits for
- Music
- Other environmental sounds
- Safety

… but these are not factors when considering candidacy
Presentation by Neil continued.
Neil: Giving you access to sound gives you access to music, to environmental sounds,
and potentially provides you some safety in a noisy or dangerous environment but we
don’t look at those sorts of things. Those are other things that don’t really feed into the
assessment process when we look at offering someone a cochlear implant.
Clinically why would we recommend an implant for someone versus suggesting to
someone that hearing aids are still appropriate?
PowerPoint slide on ‘Referral Criteria, Candidacy Guidelines’.
 Who can refer?
-ENT
Audiologist
AODC
 We are happy to provide information and advice if you are uncertain about
whether to refer.
www.scip.co.nz/Professionals
www.hearinghouse.co.nz/referral-criteria/
Presentation by Neil continued.
Neil: We offer and provide cochlear implants for people who’s hearing levels fall into
the severe profound range. Below the sever profound range, hearing aids are, well
programmed and fitted hearing aids may provide access to speech for spoken language
development. Above a severe profound hearing loss and they tend to struggle. You can’t
get enough volume and the quality of the signal is distorted so at that point you start to
look at a cochlear implant.
PowerPoint slide on ‘The Audiogram and the Speech Banana’ graph.
Presentation by Neil continued.
Neil: So in the centre of the graph is what we call the speech banana and that’s an
indication of how loud spoken communication is at about a distance of about a metre to
a metre and a half. It just shows the intensity of speech sounds. So if you’re wanting to
develop spoken language, your hearing levels have to be above the speech banana so
that all these sounds become audible and if your hearing levels are below the speech
banana, and if you’re going to access spoken language then you need something in the
way of a hearing aid or a cochlear implant.
Power Point slide on ‘Severe-to-profound hearing loss’ graph.
Presentation by Neil continued.
Neil: So this is an example, this is a sample audiogram. So again the circles and the
crosses indicate which ear, the circles are the right ear the crosses are the left, and
again there are marks by pitch and sound level. So in this case, in the low frequencies
the hearing are in the moderate range and in the high frequencies they’re in the severe
range. So as far as a hearing aid is concerned or as far as that hearing loss in concerned,
anything above the line is inaudible and anything below the line is audible to the person
so without a hearing aid, speech is inaudible at conversational levels at about a metre
or a metre and a half. Well-fitted hearing aids will raise those hearing levels to the point
where speech sounds are audible. If that hearing loss is any worse than it is there then
you start to consider a cochlear implant because a hearing aid will struggle to provide
enough gain.
Interview with Neil.
Neil: What I hope that people take away from this session is a little bit more awareness
of cochlear implants. It’s a specialist area and sometimes it’s a little bit mysterious for
people so it’s demystifying things.
Interview with Paul.
Paul: If we give the time to families, especially when they’re being told their child has
hearing loss not to feel guilty that they’re not doing everything perfectly all the time
because there’s general family life going on at the same time so it’s helping them feel
that there are some things they can do and become more knowledgeable about over
time, all in good time.
PowerPoint on Top Tips for ‘Audiology’.
Top Tips:
 Become familiar with your child’s Audiogram (look again at the one with
all the pictures in the presentation); what it means and how it changes.
 Understand what implications the Audiogram has for your child’s spoken
language development.


Regularly check your child’s technology and equipment, be it hearing aids
or speech processor or DM system (FM system).
Ensure that your child wears their hearing aids or speech processor(s) all
of their waking hours, but remembering that working with them can be
really hard work and that taking a break is okay!
Ministry of Education logo, Deaf Aotearoa New Zealand logo, NZ Federation for
Deaf Children logo.