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Author: admin | 08.12.2014 | Category: Ringing In The Ears Causes

CSD 2230 HUMAN COMMUNICATION DISORDERS Topic 5 Hearing Disorders and Hearing Loss Introduction to Sound Types of Hearing Loss. Audiology Resource Notebook This presentation is intended as a resource for professionals in Deaf Education, Audiology, and Speech Pathology.
Hearing Disorders The most common hearing disorders are those that affect hearing sensitivity.
Generally speaking, early treatment and training can help to minimize the developmental problems caused by hearing impairment. If the impairment is incurable, the child may need to use a hearing aid or receive a cochlear implant, depending on the nature of the lesion. Nokia E7 will be one of the first Nokia smartphones to run on the new Symbian^3 operating system.
Teens and kids are losing their hearing ability at much younger age due to various reasons including loud noise and too much exposure to personal music players and mobile phones. Inner ear structure may be damaged due to repeated ear infections, measles, brain tumors and mumps. Throughout the literature, one finds almost unanimous consensus over the major psychological and psychosocial deterrents for hearing impaired consumers’ failure to seek help for their hearing and communication breakdowns. Regarding social stigma and vanity, the hearing aid industry has gone to great lengths to overcome reasons why reluctant consumers have not been seeking help with hearing loss. Indeed, it has been reported that a sizable segment of would-be hearing aid users have been discouraged precisely because of others’ negative experiences (Chartrand, 1999). Everybody, it seems, has a friend or a relative who has had an unsuccessful experience with hearing aids, and is quite vocal about it. While some negative consumer attitudes appear to be changing (Bentler, 2000), others linger on, as the industry comes to grips over physiological and fit factors.
Furthermore, studies published to-date show that some newer technologies and smaller-size instrumentation are burdened with a much higher RFC rate than the older, less costly technology.
Consequently, the higher the cost, the greater the expectation of benefits and an increased propensity to return instruments for a refund. In recent years, numerous self-assessment scales have been devised to gauge levels of consumer satisfaction with hearing aids.
A more recent scale of consumer perceptions is the Satisfaction with Amplification in Daily Life (SADL) scale. On the other hand, an analysis of the International Outcome Inventory for Hearing Aids (IOI-HA), a seven-item survey comparing outcome data from various research settings, reveals some inclusion of physical acclimatization issues (Cox, Alexander, & Beyer, 2003). Jenstad, Van Tassell, and Ewert (2003) conducted a hearing aid-user study with a post-fitting questionnaire covering five areas of complaints (gain, output, physical fit, compression characteristics, and unwanted sounds), and found that patients were very lucid in describing complaints relating to physical fit. It is entirely probable that some variations between user reports of discomfort, occlusion, and own-voice problems are mostly physiological.
When one considers that the majority of ear impressions are taken in fixed mandible position, it is no wonder that problems of discomfort arise in so many hearing aid fitting cases.
Natural, dynamic processes of the human ear canal tend to respond negatively to the fixed, inert materials of hearing aids and earmold, and tend to treat hearing aids and earmolds as invading foreign objects (Chartrand, 2003a). In dispensing and audiological practice, perhaps the least known or appreciated anatomical feature of the EAC is the stratum corneum or keratin layer of tissue.
Undisturbed, keratin is what shields the ear canal from bacteria, fungus, yeast, amoeba, and potentially septic debris.
The natural desquamation of tissue in the ear canal is such that tissue grows outward from near the umbo (or center point of the eardrum) to the aperture of the ear canal (Robert, Funnell, & Laszlo, 2005). So, if one were to place a piece of sand on the tympanic eardrum today, about three months from now that person could remove the same piece of sand from the bowl or concha of the ear by fingertip (Chartrand, 2004). In addition, frequent use of ear preparations containing boric acid or hydrogen peroxide solutions not only destroy keratin and layers of epithelium, they also eliminate the water repellent ability of same and leave the external ear canal at risk for chronic otitis externa. Table 1 lists medication classifications that have been found to adversely affect human epithelium and keratin, both directly and indirectly (Facts & Comparisons, 2006). It is likely that the vast majority of consumer complaints relative to acceptance or rejection of hearing aids pertain to discomfort and own voice problems.
In the meantime, the hearing aid industry continues to be plagued with consumer, medicolegal and regulatory agency misperceptions about the benefits and crucial need for hearing instrumentation. More importantly, however, it is time for more research to engage in a frank discussion regarding the emerging data showing a link between hearing aid discomfort and own-voice issues and entrenched cases of failure to fit. Outer and Middle Ear Disorders Structural defects due to embryologic malformations Structural changes secondary. How the Ear Hears Structure Outer ear ? The pinna is a collector of sound wave vibrations that are sent through. A person suffering from hearing impairment has difficulty in perceiving or identifying sound clearly due to auditory problems.
With the help of appropriate auditory and speech training, even children with severe hearing impairment could gradually show improvement in response to sound.
Movie theaters, appliances and machines, television sets and video games are also creating noisy environment.
Some people may have partial hearing problems whereas others can’t hear completely and considered as deaf. The baby may be born with hearing impairment if the mother suffered from illness during pregnancy. Intake of certain medicines including chemotherapy drugs and antibiotics could cause hearing loss. Avoid talking to friends and relatives in trains and buses, as the background noise would create hearing problems.
Teens, kids and adults are advised to consult their physician for immediate treatment if they suffer from any hearing related issues. These show promise for those with mild losses, or normal hearing in the low frequencies to moderately severe loss in high frequencies (Schweitzer & Jessee, 2006). The most commonly accepted scale has been the Abbreviated Profile of Hearing Aid Benefit (APHAB), which is a shortened version of the much lengthier Profile of Hearing Aid Benefit (PHAB).


SADL is designed especially to measure quality-of-life perceptions for experienced consumers who have purchased new hearing aids (Cox & Alexander, 1999).
Its co-authors note that aided outcomes negatively correlate closely to mean average and standard deviations of patient subjective perceptions in unaided state. Their scales of measure were particularly instructive in drawing out these kinds of concerns.
Food and Drug Administration (FDA) Hearings Panel, in response to the Etymotic and Gudhear Petitions seeking approval of over-the-counter sales of hearing aids, Magelin (2004) provides an excellent review of the many physical complexities and variations that require keen professional skills to help patients accommodate to amplification.
In other words, barring idiosyncrasies resulting from chronic illness, pharmacology, personal ear care habits, and levels of professional care, there are likely more similarities than differences between user experiences. Pirzanski and Berge (2002) present data gathered from a survey conducted by 56 international doctoral audiology students participating in a distance learning course on earmold technology. This dynamicism excites the mechanoreceptors imbedded within the tissues of the human epithelium each and every time movement occurs. Yet the health of the keratin layer determines the health of the human ear canal, which status can negatively or positively affect the success in hearing aid adaptation (Chartrand, 2004).
In turn, minute accumulations of dead skin cells, debris, and earwax are steadily deposited into the concha of the ear for easy removal (Jahne & Cook, 1997).
This natural process generally requires about three months to migrate the full length of the canal at the rate of about 1mm per day. Left undisturbed, healthy ear canals are self-cleaning and wax impaction is rare (Jahne & Cook, 1997).
Furthermore, these acids can inhibit cerumen formation, as well as interrupt natural desquamation of tissue and the regrowth of the badly needed keratin. However, once the offending practices cease, later video otoscopy should reveal an ear returning to normal homeostasis and health. Indeed, these suspect medications garner the lion’s share of research attention, while medications affecting the human EAC are only peripherally explored (Kavanaugh, 2007) compared to research with veterinary external ear issues (Haar, 2003).
Although most of these medications are generally not prescribed for ear-related conditions, they exhibit varying levels of effects upon hydration, immunological, and dermatitis issues.
At the same time, hearing aid self-assessment questionnaires tend to side-step these troublesome issues in favor of auditory and psychosocial perceptions. These chronic misunderstandings create an overly cautious and distrusting market, and contribute mightily to chronically suppressed sales of hearing aids. Such considerations as the dynamicism the external ear, the need to recognize and counsel regarding the importance of keratin, and the neuroreflexes of the external ear, and the effects of underlying disease and medication side-effects must be explored and acted upon as an industry. We might even remove cost pressures on the manufacture and sales of hearing instrumentation.
Chartrand serves as Director of Research at DigiCare Hearing Research & Rehabilitation in Colorado City, Colorado, and is an adjunct assistant professor at Northcentral University.
Keratin polypeptide composition as a biochemical tool for the discrimination of benign and malignant epithelial lesions in man. Indeed, Ramsdell (1978) suggested some years ago that the most significant problems presented by unmitigated hearing loss were psychological, including depression and anxiety, defensiveness, distrust, and social paranoia. It is beyond the scope of this review to provide an in depth exposition of these and other psychosocial barriers to hearing care. This irrational ambivalence can only contribute to the psychosocial deterrents already keeping many individuals with hearing impairment from seeking help.
That translates into meaning that 18 to 21 of every 100 hearing aids manufactured are returned and scrapped or refurbished for sale. However, it is also arguable that a large part of the problem is that smaller instrumentation encroaches upon physiological dynamics located deeper into the external auditory canal (EAC) than do larger instruments. APHAB is a 24-item self-assessment inventory on the functional before and after aspects of hearing aid adaptation and benefits (Cox & Rivera, 1992). In other words, the more difficulty consumers encounter in the unaided state, the less objection they exhibit toward artifacts of acclimatization. Thus, physical acclimatization success may be intricately intertwined with the skills and attention of a dispensing professional working personally with each new hearing aid user- something that cannot be afforded in a so-called over-the-counter practice setting. These similarities are founded in the predictable, yet variable elasticity and dynamic nature of the ear canal itself. They estimated from that survey that more than 50% of impressions result in poor earmold fittings from professionals’ failure to recognize the dynamic aspects of the human ear canal. The keratin layer is the outermost portion of the external ear canal (Johnson & Hawke, 1988). In the EAC it completely covers ultra-sensitive epithelial tissue, starting at a point near the umbo of the tympanic membrane and traveling the entire length of the canal lumen to the aperture or opening of the ear canal (Naiberg, Berger, & Hawke, 1984). Abnormally low pH (below 6.5) often leaves the ear canal dry with a host of extant skin problems, such as psoriasis, eczema, chronic external otitis, contact dermatitis, allergy and abnormal cell growth such as basal and squamous cell carcinomas. Unfortunately, such harsh solutions are the mainstay of today’s over-the-counter otopharmacopia.
Likewise, unless there is underlying pathology, patient complaints usually resolve on their own. It is not our purpose to include a review of vestibular or cochlear ototoxicity, but instead to focus upon the less-explored external ear effects. The effects of these otherwise helpful medications on the human EAC need to be considered when they appear to be causing cases of failure to fit. This is likely due to the paucity in the literature of definitive, explanatory information showing a strong link between hearing aid comfort and consumer perceptions. In addition, there is the historically chronic problem of excessive RFCs, factory remakes, and in-office modifications.
His areas of research interest are psychosocial effects of hearing impairment, neurophysiology of the ear, and auditory rehabilitation.
Utilization of Neurophysiology of the External Auditory Canal in Resolving Problem Hearing Aid Fittings.
Hearing Instrument Counseling: Practical Applications in Counseling the Hearing Impaired, 2nd edition.


An examination of changes in hearing-aid performance and benefit in the elderly over a 3-year period of hearing-aid use. The pathologic features of keratosis obturans and cholesteatoma of the external auditory canal. The dynamic ear canal and its implications: The problem may be the ear, and not the impression. Keratosis obturans and external ear canal cholesteatoma: How and why we should distinguish between these conditions. We would suffer from Sensorineural hearing loss if the auditory nerve or inner ear were damaged.
Van Hecke (1994) noted the need for development of better counseling methodologies to help hearing impaired individuals overcome negative emotional responses to hearing loss, while Herbst and Humphrey (1980) long ago noted the deleterious impact that hearing loss can have on quality of life for older adults who forego obtaining appropriate help.
However, these considerations are important for one to have a perspective of the factors for which consensus may not have yet developed, such as the negative impact on prospective consumers with hearing impairment who put off purchasing hearing aids because of someone else’s hearing aid experience (Kochkin, 1999). Of course, some of this may begin to change with the recent push with more non-occluding devices. Of its four subscales, ease of communication, reverberation, background noise, and aversiveness, none deal directly with physical discomfort complaints, sensations of occlusion, or own-voice problems. It was further noted that only 43% of survey respondents utilized dynamic impression techniques.
Passage of time and relative cessation of movement can cause neural firing to cease, in which case neural adaptation occurs (Nafe & Wagoner, 1941).
Its physiological role is critical in maintaining homeostasis and adapting comfortably to hearing aids. Not unlike the proverbial elephant in the living room, keratin protein is arguably the most ignored part of the outer ear by hearing health professionals in general, and by hearing aid manufacturers specifically. After removal via cotton swab trauma or scratching with any foreign object, it requires about 10 to14 days for a good, strong layer of keratin to re-form.
Moreover, perhaps the most universal effect is that the medications cause or contribute to dehydration. However, on an empirical level, working professionals see evidence of such a link in everyday practice. These add cost pressures on the industry, while discouraging the next hearing impaired prospect from seeking hearing help. Effect of earmold fit on predicted real ear SPL using a real ear coupler difference procedure. Comments Opposing the Etymotic and Gudhear Petitions Docket Numbers 2003P-0362 and 2003P-0363.
We may not be able to hear clearly or understand the speech due to improper functioning of outer hair cells.
You may suffer from hearing problems for weeks or months even after the treatment, as the fluid may reside in the middle ear. The trends are now rapidly steering away from custom instruments and more toward OTE and BTE instruments, which show promise in removing some of the invasiveness of hearing instrumentation (Nemes, 2007). 1) instead of testing out the validity and relevance of current consumer satisfaction measures. In other research, failure to take dynamic ear impressions is a major contributor to failure to fit (Boys Town, 2006; Stakeholder Forum, 2001). Yet, though easily viewed through video otoscopy, its status often goes unnoted during the normal course of dispensing activity (Chartrand, 2004).
So important is its role in maintenance of the human ear canal, that, as shown in Figure 1, a good, healthy layer of keratin in the human EAC and also an example of peeled keratin arising from systemic disease. As recent as 2001, Bray, Johns, and Ghent (2001) reported that return for credits (RFCs) account for nearly 30% of manufacturers’ initial cost of producing the next new hearing instruments.
Indeed, Robert, Funnell, and Laszlo (2005) identify a host of dynamic changes that occur on a perpetual continuum from the aperture of the EAC all the way to the manubrium of the tympanic membrane.
To subordinate and minimize the effects that movement causes in the dynamic ear canal, therefore, requires dynamic ear impressions that split the difference between dimensional extremes of change (anterior to posterior and superior to inferior) so that the adaptation process can be shortened for the hearing aid user (Chartrand, 2006). Others interrupt homeostasis, delay healing, and interact adversely with other substances, including food and other drugs. These costs go far beyond the cost of wasted parts and labor, but also in expenditures in customer service, billing, shipping, and costs associated with losing future business. These living changes conflict daily against inert earmold and hearing aid shell materials.
Hence, dynamic impression-taking alone can help minimize adaptation barriers to hearing aids. Any medication that exacerbates chronic semi-dehydration causes a loss of keratin formation and sets the stage for chronic otitis externa problems (Chartrand, 2003b).
We may suffer from mixed hearing loss due to a combination of sensorineural and conductive hearing problems. Hence, those who keep their custom hearing aids are absorbing the cost of those that do not (Barber, 2005). But there are other considerations for adaptation, most importantly the status and health of the layer of keratin that lines the external ear canal. These facts point to a need to keep in mind that pharmaceutical solutions were meant to be temporary, rarely permanent, solutions to healthcare issues until underlying causes can be addressed. In the case of over-the-ear (OTE), mini-behind-the-ear (mBTE), or behind-the-ear (BTE) instruments, the cost of returns is estimated at a loss of about 15% of the manufacturing cost, because most of these may be refurbished, restocked, and resold back to the market, provided the actual time period of trials is short, and wear and tear minimized (DigiCare, 2006). To not follow that paradigm of healthcare risks setting up far too many individuals with hearing impairment with limited auditory rehabilitative options, namely hearing aids and cochlear implants.



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