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A society where all people are respected; have full
access to communication; and are able to participate
without social, economic, or emotional barriers.
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The Canadian Hearing Society is the leading provider of
services, products, and information that:
 Remove barriers to communication
 Advance hearing health
 Promote equity for people who are culturally Deaf, oral
deaf, deafened and hard of hearing.
Kim Hennessy, M.Sc.
Hearing Care Counsellor
Overview of Anatomy & Classification of Hearing Loss
 Stigma Related to Hearing Loss
 Hearing Aid Styles/Maintenance/Troubleshooting
 Communication Tips for Caregivers
 Communication Devices
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Ear Anatomy
 Divided
into 3 parts:
◦ Outer Ear
◦ Middle Ear
◦ Inner Ear
Eardrum
 PINNA
◦ collects sound
◦ funnels sound waves into canal
(also holds hearing aids, earrings & glasses )
 EAR
CANAL
◦ directs sound waves inward
◦ produces wax
◦ curved
 TYMPANIC
MEMBRANE
◦ partition between ear canal & middle
ear cavity
◦ sound waves contact and cause vibration
 MIDDLE
EAR
CAVITY
◦ air-filled space behind ear drum
◦ fluid and infections hide here
 EUSTACHIAN
TUBE
◦ passageway from the middle ear cavity
to the throat (infection can travel here)
◦ equalizes air pressure in the middle ear
with atmospheric pressure
 AUDITORY
OSSICLES
◦ Malleus (hammer), Incus (anvil), & Stapes (stirrup)
◦ form a chain from the ear drum to the cochlea
◦ transmits ear drum vibrations to the inner ear
 COCHLEA
◦ organ of hearing
◦ snail-shaped
◦ fluid-filled
◦ stapes moves in and out of oval window like a piston
in an engine, creating waves
◦ Contains thousands of hair cells (organ of corti) that
are displaced in response to waves in the fluid
 hair cells send an electrical impulse to the brain
◦ Depending on the specific location in which this
displacement occurs, we hear low or high pitched
noises
◦ Number of cells activated determines loudness of
the noise
 SEMICIRCULAR
CANALS
◦ organ of balance
◦ oriented in different planes and
work together to keep us balanced
◦ fluid-filled
◦ this system responds to movement
in any direction
Hearing Loss
 Conductive
 Sensorineural

Result of any pathology within the outer ear or
middle ear:
- pinna and ear canal
- middle ear cavity
- tympanic membrane
- ossicles
- eustachian tube

Originates from pathology of the inner ear:
◦ the sensory cells in the cochlea
◦ the auditory nerve fibers of the VIII cranial nerve
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When these structures are damaged their ability to
transmit mechanical energy (vibrations) into
electrical energy (nerve impulse) is reduced
◦ the signal does not reach the brain
VS
Conductive
Sensorineural
- Abnormality of outer ear
- Narrowing of canal (stenosis)
- Osscular discontinuity
(bones do not form chain)
- Middle ear infection (OM)
- Otosclerosis
(bony chain cannot move)
- Perforated ear drum
- **Build up of ear wax**
- Head trauma
- Noise exposure
- Age-induced/presbycusis
- Acoustic Neuroma (tumor)
- Congenital
- Hereditary/Genetic
- Meniere`s Disease
- Consequences of other
illness ex. Meningitis
- Ototoxic Medications
(Dr. Timothy Hain’s website)
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Only old people have hearing loss
Hearing Aids
1. Behind-the-ear (BTE)
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Most seniors wear
For severe losses
Good for dexterity problems
Usually have volume control and program button
Custom ear mold – must be cleaned regularly!!
Large tubing – must be cleaned and should
always be flexible (pinch to test)
Battery located in bottom
BTE; Open-fit:
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First time wearers
Mild-moderate loss
Cosmetic appeal
No occlusion
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Eliminates hollow sound
Voice sounds more natural
Air ventilation
BTE; Open-fit:
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Battery still in bottom
Thin tubing
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Cleaning not as important (occasionally needs attention)
Flexibility not an issue – no pinch test required
Soft silicone dome
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Fits mid-way down the ear canal
Domes (umbrella-looking piece) need to be cleaned
Domes need to be changed by audiologist every 6-12
months, depending on wax accumulation
Tail is to keep dome in place – rest in concha
RITE – receiver in the ear
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Open-fit aids can also be designed with a receiver
(the speaker) placed at the end of the tube or in the
ear…this delivers the sounds directly to the
eardrum
Tubing has thin wire inside
CANNOT clean tubing!!!
Often have custom tip
◦ If not, will have domes
2. In-the-ear (ITE)
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Many seniors wear
Custom made to fill concha
Moderate to severe losses
Large volume wheel and program button
Good for dexterity problems
Must be cleaned regularly
Battery door located near volume wheel
3. In-the-canal (ITC)
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Mild to moderate losses
Less visible
Custom made to fill acoustic
meatus
Must be cleaned regularly
Insertion and volume controls require good dexterity
Smaller volume wheel and sometimes program button
Battery still near volume wheel
Newest Style
4. Completely-in-the
canal (CIC)
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Mild to moderate losses
Low power & barely visible
Fits just inside the proximal canal
Good dexterity is needed for insertion
No volume control or program buttons
Must be cleaned regularly
Batter often very small but placed in similar location

Hearing aids are uncomfortable

Hearing aids cost way too much & don’t work
◦ “My sister has them and she never wears them.”
◦ “Mine have been in my drawer for months.”
◦ “There is so much noise when I wear them, I don’t bother.”
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If someone sees that I wear a hearing aid, they
look at me as incapable
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If someone sees that I wear a hearing aid, they
seem to think its ok to leave me out
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If someone sees that I wear a hearing aid, they
assume I can hear as if I have perfect hearing
…..and hearing aid manufactures are contributing to it
Red = Right
 Blue = Left
 Usually some sort of writing or coloured
section on HA
 Sometimes located inside battery door
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◦
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Any pain occurs
Hearing loss has worsened/communication breaking down
Ear mold is not fitting properly
Constant whistling occurring
After new battery installed, HA still not working
For thorough cleaning once every year
You can call and request:
◦ Cleaning tools
◦ New tubing & new domes
◦ Wax guards

Fills the hole in HA that delivers amplified sound to the
ear drum
◦ If plugged with wax, sound waves can’t be easily transmitted
i.e. is distorted and decreased!
◦ Common cause of complaining!
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Usually small white circle in hole (or Red/Blue)
Must be changed every few months
Almost never fully explained to the client
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Hearing Aid Cleaning:
◦ Wipe hearing aid/ear mold with tissue – do not use water
 Good to do more often when sick
◦ Wax removal is crucial to the function of aid(s)
◦ Use tools provided by audiologist
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Brush dead skin cells and wax off aid/ear mold
Pick wax from holes
Use vent cleaner for hole that goes all the way through aid/ear mold
Change wax guards when plugged
Battery Details

# 1 problem in long term care facilities is:
◦ Wearing aids with dead batteries…basically wearing an ear plug!
◦ Quick test: cup hand over ear or enclose hearing aid in your cupped
hands – should hear whistling sound
 Yes = battery still has life
 No = dead battery = needs to be changed
TIPS:
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When inserting battery – flat side faces up
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Open battery door to prolong the life of the battery when not
using ex. every night
For reminders to change batteries, place sticky tab on calendar
or charts when you replace them - Last 7-10 days
When sticky tab is removed, battery begins to drain!
Have a battery tester on hand
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Feedback – sound waves are being amplified over
and over again (like a microphone held near speaker)
◦ Common causes:
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Ear molds (BTE) or HA not inserted properly – air escapes
Ear mold has shrunk and person needs new one (about $80/ear)
Volume turned up too high
Tubing is clogged

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Occasionally, a person with hearing loss is wrongfully
diagnosed with a degenerative condition due to poor
communication, giving wrong answers or being nonresponsive
Sometimes a person who always seems to be foul or
who does not respond to you or whose
communication has changed…could be living with:
◦ An undiagnosed/untreated hearing loss
◦ Their hearing loss might have gotten worse
◦ Their HAs are not working properly
**Their ear canals are impacted with wax!!!
Fatigue
Isolation
Irritability
Rejection
Stress
Loneliness
Avoidance
Anger
Fear
Guilt
Withdrawal
Frustration
Negativism
Embarrassment Bluffing
Headaches
Muscle tension
Lowered Self-esteem
Feel less independent and more limited
These psycho-social difficulties lead to
reduction in quality of life and physical
health status

Can lead to higher incidence of:
deterioration, sensory deprivation, arrhythmias,
heart disease, hypertension, osteoarthritis, etc.
Communication
Tips

Don’t shout – volume is not as important as you think
◦ Shouting further distorts speech sounds
Speak clearly and at a moderate pace
 Put space between words not within them
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◦ Do not exaggerate your mouth movements
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Get the person’s attention before speaking
◦ Tap on shoulder/flick lights/state their name
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Face the person when you speak to them
◦ Stop speaking if you need to turn around, then continue
once you are facing them again
Don’t cover your mouth or chew gum
 Use facial expressions and gestures
 Gives clues when the subject changes
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◦ State topic of conversation
Be patient
 Avoid noisy background situations
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◦ More to a quieter place if communication is difficult
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Some background noises, such as loud stereos,
machinery and traffic are obvious to everyone and
people generally avoid trying to talk in these situations
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For hard of hearing people, subtle sounds such as the
hum of air conditioning, running water or wind can cause
difficulties
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In all these situations, hearing aids become a challenge
to wear & this requires adjustment
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With new technology we are better able to control
background noises
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Visual smoke/CO detectors
Visual/tactile alarm clock and TTY in room
Have at least one staff learn ASL
LTC: Post activities in their room
If 2 Deaf people in facility, seat them together
Hospital: write down all important information,
especially upon discharge
White board with markers available
Always have CHS’s contact info. on hand
Communication
Devices
Program
Communication Devices
Program at CHS
CHS offers a full range
of assistive devices for:
• Home
• The workplace
• Schools
• Community facilities
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Amplified Telephones & TTY’s
Alerting Systems
Personal Amplification Systems
T.V. Listening Devices
FM Systems
Super Ringers/Visual Ringers
Visual Alarm Clocks - with bed shaker
Visual Smoke/Carbon Monoxide Detectors
Sound Conditioners
And more…
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Amplify voices to 30, 40, 50, & 60 dB
Provide increased clarity
Tone and volume controls
Bright visual ringer
Memory storage
Headset jack
Hearing aid compatible
Read and Talk phone
For deafened individuals
TTY for Deaf individuals
These easy-to-use, portable amplifiers can improve your
communication one-on-one, in small groups, in the car,
or when at important meetings etc.
Serene Innovations
Sennheiser
Audioport - $305
DT - $169.95
Williams Sound
PocketTalker Pro
$250.00
5 year warranty
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Notifies you when the phone rings, when
someone is at your door, when the alarm clock
goes off or if there are loud noises in the room
◦ Other audio alarms can be added to the system and setup
beside your smoke detector etc.
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Signals person using a flashing lamp and/or
vibrating bed shaker
◦ Tactile portable pager can be added
to the system
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Infrared technology delivers sound from the
television to headphones, within 100 ft. range
The headsets are wireless and have adjustable volume control
$385
$99.95
Questions??
For further information please contact;
The Canadian Hearing Society
1300 Bath Road, Kingston
(Frontenac Mall)
T: 1 877 347 3427
TTY: 1 877 216 7310
F: 416 928 2506
chs.ca