Aural Rehab: Chapter 2 Hearing Aids + Chapter 3 Cochlear Implants Part 1

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The basic components of a hearing aid

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The microphone, amplifier, and speaker (receiver).

Using algorithms designed to improve speech perception, modern digital instruments are programmed to individualize the fitting.

Front 2

Hearing aid styles

Back 2

In-the-Ear (ITE)
In-the-Canal (ITC)
Completely-in-Canal (CIC)
Receiver-in-the Canal (RIC)
Behind-the-Ear (BTE)
Bone Conduction Aids
CROS and BICROS
BAHA (Bone Anchored Hearing Aid)
Bone Conduction Implant
BAHA

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In-the-Ear (ITE)

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-Mild to moderately-severe hearing loss.
-built into a custom-made shell obtained from an impression of the patient’s ear
-must be replaced as the ear grows and, as a result, often are not selected for pediatric use
-Hard outer shell, is not flexible and can injure the child’s ear if he or she is hit during sports or rough play

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In-the-Canal (ITC)

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-Mild to moderately-severe hearing loss
-Fits into the ear canal and are custom fit
-must be replaced as the ear grows and, as a result, are not often selected for pediatric use
-must be replaced as the ear grows and, as a result, are not often selected for pediatric use

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Completely-in-Canal (CIC)

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Mild to moderate hearing loss

Built into a custom-made shell obtained from an impression

Fits a bit farther into the canal and extends deeper toward the eardrum than the in-the-canal hearing aid

Although generally not "invisible," this hearing aid style is often the least conspicuous or noticeable

MAY be appropriate for older children (ear wax production, severity of loss, and child’s dedication to maintenance must be considered)

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Receiver-in-the Canal (RIC)

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Mild to moderately-severe hearing loss.

Perfect for older children with high frequency loss.

Discrete receiver wire coupled with CIC mold makes the aid more cosmetically appealing than a traditional BTE.

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Behind-the-Ear (BTE)

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-Aid is behind the ear. Customized earmold anchors the hearing aid to the ear and sends sound into the canal. 
-Suitable for almost all types and degrees of hearing loss (from mild to profound) and for persons of all ages.
-Most appropriate style for infants and young children due to rapid growth. They will inevitably grow out of their earmolds every 3 to 6 months.
-It’s expensive to remake in-the-ear hearing aids. BTEs, which can easily be attached to a new earmold, are therefore the most appropriate style for young children.

Front 8

Bone Conduction Aids

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-Usually used because of a congenitally absent or incomplete ear

-Patient must have normal
or near normal bone conduction
scores on the audiogram

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Individuals with unilateral hearing loss can benefit from

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can benefit from CROS hearing aids or implantable bone-anchored hearing aids

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CROS and BICROS

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Used for unilateral or asymmetrical hearing losses when the poorer ear cannot benefit from traditional amplification

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BAHA (Bone Anchored Hearing Aid)

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Vibratory portion is implanted in the bone

Microphone and amplifier are in the external aid

Requires relatively good cochlear hearing

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Bone Conduction Implant (picture)

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BAHA (picture)

Back 13

Front 14

Custom Molded Instruments

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-Earmolds and all in-the-ear hearing aid shells are often molded to fit the cli- ent’s ear and couple the hearing aid to the ear.

-The audiologist can use the earmold’s style, tubing, venting, and damping to change the sound going into the ear.

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Hearing aids are appropriate for individuals with hearing loss that cannot

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-are appropriate for individuals with hearing loss that cannot surgically remediated
-fitting process must include a full hearing evaluation and an evaluation of the client’s communication difficulties and motivation

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Most individuals with hearing loss benefit from wearing two hearing aids, a binaural fitting.

A hearing aid in both ears improves

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improves listening in background noise and helps in sound localization

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Hearing aid fitting protocols must include

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-must include selection of the device, quality control, orientation/fitting, and validation with outcome measures.
-All aspects of the protocol are vital to a successful hearing aid fitting.

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Successful pediatric fittings require

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require a team approach with members including the audiologist, speech pathologist, teachers of the hearing impaired, and the parents

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The audiologist must ensure the wearer, or in the case of the pediatric fitting, the caregivers, know how to

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know how to remove and work the controls, troubleshoot the instrument, do a listening check, care for, and clean the instruments

Front 20

Special Hearing Aid Features

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Telecoils
Directional Microphones
Noise Reduction
Data Logging
Multiple Programs

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Telecoils

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-Enables telephone use directly through the hearing aid without environmental sound interference.
-Picks up electromagnetic signal from the telephone, and converts that signal back to amplified sound.

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telecoils are valuable for

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are valuable for direct communication with other sources containing electromagnetic energy, such as audio induction loop systems for groups

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Directional Microphones

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-By “focusing” towards a signal they enhance the ability to hear speech in the presence of background noise
-are clinically proven to help the patient gain speech understanding in difficult listening environments

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Noise Reduction

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-Minimizes the annoyance of low and high level sounds from the patient’s environment.
-Can reduce environmental sounds like their refrigerator running, an air conditioner, engine noise, restaurant noise, etc

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Data Logging

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-Provides an electronic record of how and when the patient uses the hearing aids.
-Can give information on how loud the noise is during their average day.
-All of this information helps us to fine tune their instruments.

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Multiple Programs

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-Allow the hearing aids to be programmed with special settings for a variety of listening situations.
-Patient controls two or three of these settings, some have up to 6.

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Assistive listening devices (ALD)

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are designed for specific listening situations like television, telephone, or auditorium listening

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Assistive listening devices can be helpful for people with hearing loss and also helpful to all us when

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helpful when in difficult listening environments, e.g., watching the television in the airport and using the captions

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Cochlear Implants offer an alternative for

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sound stimulation to individuals who receive limited benefits from traditional amplification

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Careful evaluation by a team of professionals is needed to determine

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is needed to determine candidacy for cochlear implantation and to develop the appropriate treatment plans for these individuals

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Audiologic re/habilitation is an integral part of the cochlear implant process, including speech processor programming and training. With training, the cochlear implant can

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can improve the quality of life for persons with severe-to-profound hearing loss

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Patients with balance problems or complaining of tinnitus no longer must be told

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must be told there are no successful treatment plans available when this happens

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Research in vestibular and tinnitus rehabilitation

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promises hope to the many individuals suffering from vertigo and tinnitus. New advances in these areas have helped many patients resume active and productive lives

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Cochlear Implants

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A device made for patients with profound (sometimes only severe) sensorineural hearing loss

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Cochlear Implants must prove

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Must prove little or no benefit from traditional hearing aids before being considered for candidacy

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After surgery (cochlear implants) the patient

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the patient heals for 4-6 weeks, and then undergoes rigorous rehabilitation to program and adjust the device called mapping

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How Do Cochlear Implants Work?

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Newest implants are very small

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Best CI Results

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-Late deafened adults with oral communication skills
and a recent memory for sound
AND
-young children whose brains are very malleable are the best candidates and derive the greatest benefit from cochlear implantation