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Author: admin | 10.08.2014 | Category: Ringing Of The Ears Treatment

The BTE is a popular style worn behind the ear that connects to an ear mold that rests inside the outer ear.
A new and smaller type of BTE hearing aid, the open fit style fits snugly behind the ear and includes a narrow tube that is inserted into the ear canal to remove occlusion or what’s called the “head in a barrel” effect. The newest in custom hearing aid styles is a micro device that fits deep into the ear canal completely hidden from view. Remote Mic Hearing Aids are designed so that the microphone is contained outside of the hearing aid. Behind-the-ear (BTE) – The BTE is a popular style worn behind the ear that connects to an ear mold that rests inside the outer ear. Open Fit (BTE) – A new and smaller type of BTE hearing aid, the open fit style fits snugly behind the ear and includes a narrow tube that is inserted into the ear canal to remove occlusion or what’s called the “head in a barrel” effect. In-the-ear (ITE) – This type of hearing aid fits snugly inside the bowl-shaped area of the outer ear and can be used to fit mild to severe hearing loss. Completely in-the-canal (CIC) – This customer hearing aid model is molded to fit completely inside your ear canal. Invisible in-the-canal (IIC) – The newest in custom hearing aid styles is a micro device that fits deep into the ear canal completely hidden from view. Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. Key words: adult, audiology, auditory dysfunction, blast injuries, brain injuries, hearing, hearing loss, mTBI, tinnitus, Veterans, wounds and injuries. A dramatic increase in the use of explosive devices in Operation Enduring Freedom and Operation Iraqi Freedom is responsible for a significant shift in the types of injuries experienced among soldiers.
In conjunction with the increase in mild TBI, blast-related injuries also result in auditory and vestibular issues.
Ear and hearing injuries may significantly affect the daily lives of soldiers, both in and out of combat. A retrospective chart review of 250 Veterans with mild TBI was performed at a single, midwestern Department of Veterans Affairs (VA) medical center. Veterans with mild TBI and hearing problems were identified using the VA’s comprehensive second-level TBI evaluation. Detailed data were collected from electronic medical records by using a data collection tool developed for this study.
At the time of the comprehensive second-level evaluation, the average age of the 240 Veterans was 27.9, with 73 percent of the population under the age of 30. Table 1.Demographics for patients overall (N = 240) and for those receiving hearing examination (n = 37).
More than half the cohort, or 64.2 percent (n = 154), reported at least one blast exposure, 106 of whom were injured solely from blast injuries. CAPD = central auditory processing disorder, DPOAE = distortion product otoacoustic emissions. Of the 37 Veterans who had audiology clinic visits, hearing loss occurred in varying degrees (Table 4). Of particular interest, 50.7 percent (n = 38) of Veterans who were referred did not attend their audiology clinic appointment. Unexpectedly, Veterans who did attend their audiology appointment received about 25 percent more referrals at the comprehensive second-level examination than those who did not attend.
To better assist patients, physicians need to be aware of the services that are provided by audiologists; otherwise, referrals will not be made. The use of additional testing, such as CAPD testing that helps to identify CAP deficits, allows for patient-specific management [22]. When hearing loss occurs, the VA offers premium amplification choices and has many assistive listening devices available to suit nearly all hearing impaired Veterans. During your appointment, Audiologist Michael Michelli will explain the advantages and benefits associated with each hearing aid style suitable for your particular hearing loss and lifestyle. More discrete than a traditional BTE hearing aid, this device leaves the ear canal more open, making it ideal for those with mild to moderate high-frequency hearing loss.
Although ITE hearing aids are more visible, they are generally easier to insert and adjust and have a longer battery life than other, smaller hearing aids. Because the human ear is designed to be sensitive to changes in pressure, it is the most susceptible organ to damage from the pressure created by a blast wave [6]. Permanent hearing loss has been reported to contribute to psychosocial and physical health problems, such as depression, decreased social and emotional function, personal relationships, and decreased cognitive function [9-11].
Individuals with a confirmed diagnosis of mild TBI between June 15, 2007, and July 15, 2009, were identified by local physicians based on TBI reports to the Veterans Health Administration (VHA) Support Service Center and considered for inclusion. Veterans are referred for a comprehensive second-level evaluation after receiving an initial positive mild TBI screening. Information was extracted from the comprehensive second-level TBI evaluation and from subsequent referrals to audiology (including all audiology follow-up appointments). However, the average NSI hearing difficulty score did not differ statistically among these groups. In our study, 87 percent of Veterans with mild TBI reported some level of hearing difficulty while more than 64 percent of Veterans reported at least a moderate level of hearing difficulty. In support of this, our study found that a significantly greater percentage of men were involved in blast-related mild TBI.

One possibility for low attendance at audiology appointments is the stigma attached to both hearing loss and hearing aids. This result was not consistent with our hypothesis that patients with many health concerns may prioritize their visits. We were unable to find any previous studies that examined the mild TBI population; however, our results are similar to previous studies that found TBI patients (TBI injury severity unreported) to have decreased hearing sensitivity on audiograms [7,20]. Blast-related auditory deficits can occur throughout the auditory system, from the outer ear to the cortex, which can result in a variety of complex symptoms [23]. Once the nature and severity of specific deficits are identified, appropriate guidance for management can be offered.
In the current study, 20 percent of the Veterans with hearing loss exhibited a mild sensorineural hearing loss. Many options for tinnitus management are currently available, including counseling, sound generators, hearing aids, and other devices. Michael will help you determine what style makes the most sense with your loss, listening environments and budget. Although this can be the largest type of hearing aid, it is also the most powerful and often the easiest to adjust. Results of a comprehensive second-level mild TBI evaluation and subsequent visits to audiology were evaluated. Head and neck injuries have increased in proportion relative to previous conflicts, and 78 percent of these injuries were consequential to explosions caused by devices such as improvised explosive devices (IEDs), land mines, mortars, bombs, or grenades [2].
Previous studies have found that 62 percent of blast-related TBI patients admitted after the onset of Operation Iraqi Freedom complained of hearing loss and 38 percent reported tinnitus [7]. While studies have examined the link between TBI and hearing loss, the mild TBI population specifically has not been widely studied.
The initial screening is administered by a healthcare provider and consists of four questions regarding exposure to a mild TBI event(s), immediate symptoms, and current symptoms. Data elements collected from the medical record of audiology encounters included family history, demographics, hearing complaints, number of visits, noise exposure, examinations received, diagnoses, and treatment. A total of 75 Veterans received an audiology referral, with 37 presenting for an examination (Figure).
The average reported NSI hearing difficulty and percentage reporting hearing difficulty did not differ by degree of blast exposure (primary, secondary, tertiary) among patients incurring a blast-only mild TBI (n = 106) or by number of visits to audiology (Table 2). White Veterans were also found to report significantly greater hearing difficulty and increased percentages of hearing complaints than non-white Veterans for unknown reasons.
Previous studies have found that perceived stigma has an influence on decision-making processes that occur during initial acceptance of hearing loss, testing, and use of hearing aids [18].
Instead, some of these patients may be more likely to visit all their appointments because they are already spending a greater amount of time at the healthcare facility. Pure sensorineural hearing loss was found to be the most common type of hearing loss among Veterans, as in previous studies [7].
Yet, the high prevalence of testing beyond the audiogram in our cohort found abnormalities in a significant number of these Veterans. Audiologists can offer a variety of treatment and management options for audiological and vestibular dysfunction. Education and counseling on deficit-specific compensatory and communication strategies should also be offered.
Open-fit devices are ideal for mild to moderate high frequency hearing losses and are appealing to a younger population because of cosmetics and Bluetooth compatibility. The method currently endorsed by the VA is progressive tinnitus management, developed at the National Center for Rehabilitative Auditory Research, which is located at the Portland VA Medical Center in Portland, Oregon [25-26]. We found the vast majority (87%) of Veterans reported some level of hearing disturbance and those involved in blast injuries reported a higher incidence of hearing disturbance than those with other injury etiologies.
Mild traumatic brain injury (TBI) can result from these types of blast-related injuries [3], and their prevalence in modern combat has increased dramatically. Hearing problems were also found to be present in TBI patients who had not experienced a blast, with 44 percent complaining of hearing loss and 18 percent reporting tinnitus [7]. A previous study of 36 American adults with a history of mild TBI found that when compared with the normative values, these individuals performed significantly worse on the Dichotic Word Listening Task [12]. Further information regarding the VHA’s mild TBI screening process is described by Donnelly et al.
Degree of hearing loss was measured as decibels hearing loss (dBHL) on an audiogram, where any threshold above 25 dBHL at any frequency was considered a hearing loss.
No significant associations were found between age, marital status, education, or employment and reported hearing difficulty disturbance.
Additionally, this stigma is not exclusive to men and is perceived by younger women as well [19].
While previous studies have found that tympanic membrane perforation is the most common ear-related blast injury, we found no tympanic membrane perforations in this mild TBI population [6,21]. DPOAE testing within our sample also produced a large group diagnosed with subclinical hearing loss.
Additionally, audiologists must be aware that although a patient who complains of hearing loss in this population may present a normal audiogram, further testing may result in identifying auditory dysfunction. Unfortunately, the results of a 2007 questionnaire given to randomly selected members of the American Academy of Audiology found that audiologists have very limited knowledge of this additional testing [24].

For those with more severe atypical losses, many VA centers offer cochlear implants and bone-anchored hearing devices. This is a hierarchal program designed to be maximally efficient and address the needs of all tinnitus patients [27].
An estimated 20 percent, or 300,000 of the 1.6 million soldiers deployed to Iraq and Afghanistan, have mild TBI [4]. Additionally, more than one-third of individuals with a mild TBI were found to fail at least one condition of a dichotic word recall task [13].
Because of the complicated medical needs of those with mild TBI, the significant percentage of Veterans experiencing hearing difficulties may not have received a referral because more pressing issues presented at the time of their comprehensive second-level examination.
Efforts to reduce the stigma surrounding hearing loss may increase the number of Veterans who return for follow-up visits after the comprehensive evaluation. This finding suggests that blasts and other mild TBI etiologies may cause damage that is not detected by an audiogram and strongly indicates that audiological testing should not stop after the audiogram. Hence, it is not surprising that many VA audiology clinics are not providing these services [22]. Counseling on hearing conservation and preservation as well as various auditory training exercises may be offered.
Individuals with mild TBI can present clinically with cognitive, physical, or behavioral problems [5].
Of these, Veterans who experienced blast-related injuries were found to have the highest rate of self-reporting both auditory and visual impairment [8]. The comprehensive TBI evaluation [14-15] is designed to identify the presence or absence of mild TBI and examines items such as demographics, injury etiology, number and degree of blasts exposed to, distance from blasts, and the Neurobehavioral Symptom Inventory (NSI) [16]. Previous studies have found that in such patients, ear and balance deficits are commonly overlooked [1].
Although the effect of hearing loss on the Veteran population is lesser known, its effects in the general population and the elderly are well documented.
More training is needed for audiologists with regards to this type of testing, and more research is needed on CAP and management in the adult TBI population [22].
Auditory training may take several forms, including clinician-directed (Auditory Process Training), self-directed (Auditory Process Training 3), and computer-based (Listening and Communication Enhancement).
Nearly half (48.6%) of Veterans were diagnosed with conductive hearing loss, sensorineural hearing loss, or central auditory dysfunction. Individuals also often present with complaints of anxiety, depression, apathy, and mood swings [5]. The NSI consists of 22 TBI symptoms, including hearing difficulty, and asks patients to rate the degree to which the symptom disturbs them.
In instances where otoacoustic emissions (OAEs) were performed, one of two methods was used. An additional nine Veterans (23.7%) did not schedule or attend an appointment for unknown reasons.
Because hearing loss increases with aging, these Veterans may also experience symptomatic hearing loss at younger ages than expected. Diagnostic testing was performed with the Bio-logic Scout OAE device (Natus Medical Inc; San Carlos, California) from 750 to 8,000 Hz using Boys Town criteria (65 and 55 dB for level 1 and level 2, respectively). These findings highlight the need for clinicians to pay particular attention to hearing complaints among mild TBI patients and for more comprehensive screening methods and proper referral methods to be developed. Conceivably, the Veteran population, with an active role both in the workplace and home life, may also experience a significant loss of quality of life because of unmanaged hearing loss. A screening test was performed with the Bio-logic AuDX Pro (Natus Medical Inc), from 1,500 to 6,000 Hz. Strategies to address perceived stigma associated with hearing loss may increase attendance at follow-up visits.
For diagnostic testing, results were deemed to be abnormal if an emission was absent at any or all frequencies.
Furthermore, the effects of hearing loss are only further compounded by the effect of mild TBI on an individual’s health overall. Additionally, while only a third of audiograms were found to be abnormal, advanced testing resulted in a significant percentage of our population being diagnosed with auditory dysfunction.
An absent response was defined as less than 6 dB emission to noise-floor ratio, as well as an emission amplitude greater than −10 dB, replicated. Tertiary blast injuries are the result of people being thrown into the ground or a fixed object. For acoustic reflex thresholds, findings were abnormal if they were unexpectedly absent or elevated based on pure tone findings.
Speech recognition tests were most often CID-W22 recorded word lists, but sometimes may have been performed with a monitored live voice. Descriptive statistics used include chi-square for dichotomous variables and analysis of variance for continuous variables.

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