Download Understanding and Treating Hearing Problems Dr

Understanding and Treating
Hearing Problems
Dr. Diana Barreneche, CCC, FAAA
Audiologist/Clinical Educator
Topics To Be Discussed
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Ear Anatomy and Physiology
Signs of Hearing Loss in Adults
Causes of Hearing Loss
Hearing Loss Treatment Options
Tinnitus
Signs of Tinnitus
Tinnitus Treatment Options
Anatomy and Physiology of the
Ear
• Outer
• Middle
• Inner ear
Anatomy and Physiology of the
Ear
Outer Ear
Consists of
the auricula or
pinna
the external acoustic
meatus
Anatomy and Physiology of the
Middle Ear
Eardrum
Ossicles
Anatomy and Physiology of the
Inner Ear
Cochlea/Hearing Organ
Vestibular Canals/Balance Organ
Acoustic Nerve (8th)
The vestibular/auditory nerve runs in the internal
auditory canal and the peripheral end organs to
the central nervous system (CNS) Nerve..
Diagnostic Tools
• Otoscopy
• OAEs (Otoacoustic Emissions)
• Tympanometry (Middle Ear Test)
• Pure tone and Speech Audiometry
(Sound Booth)
• Auditory Brainstem Response(8th
Nerve and Hearing Thresholds
Estimation)
Common Myths
• Hearing loss affects only "old people" and
is merely a sign of aging.
Actually it is the reverse of what most
people think. The majority (65%) of people
with hearing loss are younger than age 65.
Common Myths
• There are more than six million people in
the U.S. between the ages of 18 and 44
with hearing loss, and nearly one and a
half million are school age.
• Hearing loss affects all age groups.
Common Myths
“If I had a hearing loss, my family doctor would
have told me”
• Not true! Only 13% of physicians routinely
screen for hearing loss during a physical. Since
most people with hearing impairments hear well
in a quiet environment like a doctor's office, it
can be virtually impossible for your physician to
recognize the extent of your problem. Without
special training, and an understanding of the
nature of hearing loss, it may be difficult for your
doctor to even realize that you have a hearing
problem.
betterhearing.org
Common Myths
• Hearing might be at the bottom of the
medical checklist, but it might be the
number one medical cause of your
problems.
Why?
Signs of Gradual Hearing
Loss in Adults
• The perception that people are
speaking too soft or mumbling.
• Frequent misinterpretation of what is
being said.
• Difficulty understanding
conversations on the phone.
Signs of Gradual Hearing
Loss in Adults/ Continuation…
• Difficulty understanding conversations in
different environments: restaurants,
theater, automobile, family reunions,
seminars or places of worship.
• Blocked or stuffy feeling in the ears.
• Ringing in the ears.
betterhearing.org
Prevalence of Hearing Loss
In US
• 3 in 10 people over age of 60 have hearing loss;
• 1 in 6 baby boomers (ages 41-59), or 14.6%,
have a hearing problem
• 1 in 14 Generation Xers (ages 29-40), or 7.4%,
already have hearing loss
• At least 1.4 million children (18 or younger) have
hearing problems
• It is estimated that 3 in 1,000 infants are born
with serious to profound hearing loss.
betterhearing.org
Types of Hearing Loss
Hearing loss is categorized by which part of
the auditory system is damaged.
1. Conductive hearing loss
2. Sensorineural hearing loss
3. Mixed hearing loss
4. Retro-cochlear hearing loss
Conductive Hearing Loss
Sensorineural hearing loss
Sensori-neural Hearing Loss
SENSORINEURAL
HEARING LOSS
(DAMAGE TO THE
INNER EAR CELLS
CALLED CILIA)
Healthy
Cilia
Dead and Damage
Cilia
Mixed Hearing Loss
Damage to Outer or Middle and Inner ear
Causes of Conductive Hearing
Loss
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Ear infection (Otitis)
Allergies
Poor Eustachian tube function
Perforated eardrum
Benign tumors (growths along the outer and
middle ear)
Impacted earwax (cerumen)
Presence of a foreign body
Fluid in the middle ear from colds
Atresia (Anotia)
Causes of Conductive Hearing
Loss
Microtia and Atresia
Ear malformations
PE tube: Surgical tube to
drain fluid in middle ear
Causes of Conductive Hearing
Loss
Impacted Wax
External Otitis (Inflammation
due to infection of ear canal)
Ear Drum Perforation with a Q-Tip
When cotton tipped
applicators are used to clean
out ear wax, there is a risk of
breaking the ear drum
(perforation). Although we
realize that this is commonly
done, we recommend against
using cotton tipped
applicators, hair pins, and
similar devices to clean the
ear.
Causes of Sensorineural Hearing
Loss
SNHL reduces the ability to hear faint sounds. Even
when speech is loud enough to hear, it may still be
unclear or muffled. Some possible causes of SNHL
include:
» Illnesses
» Drugs that are toxic to hearing
» Hereditary
» Aging (Presbycusis)
» Head trauma
» Malformation of the inner ear
» Exposure to loud noise
» Auditory nerve occupied lesion/ (8th) tumors
Presbycusis (Age Related Hearing
Loss)
Presbycusis
Hearing Loss due to Aging
• Causes:
There is no known single cause for agerelated hearing loss. Most commonly, it
is caused by changes in the inner ear
that occur as you grow older. However,
your genes and exposure to loud noises
(such as from rock concerts or loud
machinery) may play a large role.
Presbycusis
Hearing Loss due to Aging
• The following factors contribute to age-related
hearing loss:
– Family history (age-related hearing loss tends
to run in families)
– Repeated exposure to loud noises
– Smoking
– Certain medical conditions (Diabetes) and
medications (Ototoxics) also contribute to
age-related hearing loss.
Presbycusis
Hearing loss related to Aging
• Prevalence: About half of all people over
the age of 65 have some amount of agerelated hearing loss.
• Impact in life style: The loss of hearing
occurs slowly over time.
• It is most difficult to hear high-frequency
pitch sounds. (ex: speech of women and
children)
• As hearing gets worse, it may become
difficult to hear sounds at lower pitches.
(ex: men’s voices)
Presbycusis (Age Related Hearing
Loss)
• It becomes difficult hearing things in noisy
areas like restaurants.
• Hard time distinguishing high-pitched
sounds such as "s" or "th" from one
another.
• Other people's voices sound mumbled or
slurred.
• Ringing in the ears and lack of tolerance to
loud sounds is reported.
Understanding the Audiogram
Normal Hearing
Presbycusis (Age Related Hearing
Loss)
Retro-cochlear Hearing Loss
• 8th nerve (Auditory
nerve) tumor
• Auditory Neuropathy
(Connection between
Cochlea and auditory
nerve)
• Problems in the
Auditory path from the
cochlea to the
auditory section in the
brain (Auditory
Processing Issues)
Hearing Loss Treatment options
• Medication
• Surgery
• Types of Amplification:
- Hearing Aids
-Cochlear Implants (CIs)
-Assisted Listening Devices
Key Factors in Amplification
Success
Initial Needs Assessment
Electroacoustic & Physiologic
Compatability
Comprehensive Habilitative
Follow-up
Amplification Goals
patient specific
Audibility
Comfort
Tolerance
Different Types of Hearing Aids
Hearing Aid Technology
- Enhances speech intelligibility
- Sound flows from one environment to
the other
- Wind block & Echo block
- Automatic phone program
- Feedback (Whistle control)
“Go with your specific needs and do not
compare with others”
Assisted Listening Devices
FM systems
Bluetooth loops
Amplified
Phones
Close captioned TV
Cochlear Implants
Hearing Aids
Insurance Coverage
Insurance:
• Medicare (Exam)
• Some Insurance Coverage e.g., Government,
VA, and Medicaid.
• UCF LIFE members at UCF Communication
Disorders Clinic (UCF Family Benefits)
Tinnitus
• Definition
• Classification
• Objective Tinnitus
- Pulsatile
• Subjective tinnitus
• Treatment
Introduction
• Tinnitus :“The perception of sound in the
absence of external stimuli”
• Tinnere: means “ringing” in Latin
• Includes buzzing, roaring, clicking,
pulsatile sounds
Classification
• Objective tinnitus – sound produced by
para-auditory structures which may be
heard by an examiner
• Subjective tinnitus – sound is only
perceived by the patient (most common)
Prevalence
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40 million affected in the United States
10 million severely affected
Most common in 40-70 year-olds
More common in men than women
Why?
Tonotopy, columnar organization of
cells with similar binaural
interaction
Central Nervous System
Mechanism
• Reorganization of central pathways with
hearing loss (similar to phantom limb
pain)
Pulsatile Tinnitus
• Arteriovenous
malformations
• Vascular tumors
• Venous hum
• Atherosclerosis
• Ectopic carotid artery
• Persistent stapedial
artery
• Dehiscent jugular bulb
• Vascular loops
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Cardiac murmurs
Pregnancy
Anemia
Benign intracranial
hypertension
• a
Subjective Tinnitus
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Presbycusis
Noise exposure
Meniere’s disease
Otosclerosis
Head trauma
Acoustic neuroma
Drugs
Middle ear effusion
Tempo Mandibular Junction dysfunction
Depression
Meningitis
Syphilis
The cycle of tinnitus
Tinnitus
Anxiety
Level
Stress
The Impact of Tinnitus
• Thoughts and emotions: annoyed,
bothered, depressed, anxious or angry
• Hearing: the sound of the tinnitus
competes with or masks speech or
environmental sound perception.
The Impact of Tinnitus
• Sleep: tinnitus interferes with the ability to
fall asleep. It can also make it more
difficult to get back to sleep when awaking
up in the middle of the night because of
the tinnitus.
• Concentration: difficulty focusing on a
task because of the loudness of the
tinnitus.
Tinnitus Treatment Options
Multiple Treatments
•Avoidance of dietary stimulants:
coffee, tea, cola, etc.
•Smoking cessation
•Avoid medications known to cause
tinnitus
Tinnitus Treatment Options
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Amplification (Hearing Aids)
Sound Generators
Acupuncture
Medication (Xanax)
Counseling Tinnitus retraining therapy
Neuromonics (customized, music therapy,
through a tinnitus evaluation/ tinnitus pitch
match/frequency/Hypersensitivity Levels)
Thanks to LIFE’s 2011 Grant
to UCF Communication
Disorders Clinic
Tinnitus Treatment
• Neuromonics, music therapy, was used to
treat tinnitus and hyperacusis in an autistic
female. It has proven to help reduce her
tinnitus, hyperacusis, anxiety levels
and improve her ability to focus
while in speech therapy
and school.
How the Ear Works
http://www.youtube.com/watch?feature=player_detailpage
&v=PeTriGTENoc
QUESTIONS?
THANK YOU!
University of Central Florida
Communication Disorders Clinic
12424 Research Parkway, Suite 155
Orlando, FL 32826
Phone (407) 882-0471 Audiology
(407) 882-0468 Main
Hearing Loss
• http://www.betterhearing.org/hearing_loss/
hearing_loss_simulator/index.cfm