Asymmetric hearing loss guidelines 1999,tinnitus hearing device xp,reasons for sudden hearing loss in dogs gratis - Test Out

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The prevalence of this hearing loss configuration in adults is difficult to estimate partly from its varied etiologies and partly from the differences in the criteria used to estimate this condition. In this paper, we briefly summarize the current audiological thinking in the treatment of this patient group. It is generally accepted that bilateral fitting is the norm in managing someone with a symmetrical hearing loss.
Although a mild-to-moderate degree of hearing loss is typically aidable, the audiogram is not a good predictor of aidability. The impaired ear can be unaidable for two reasons: either the degree of hearing loss is so severe that conventional amplification is insufficient to bring about adequate audibility, or hearing is so distorted the wearer cannot accept the sound quality provided by the hearing aid on the impaired ear. In the case of a profound loss, use of a Contralateral Routing of Signal (CROS) hearing aid to route sounds to the normal ear provides a good solution.
The impaired ear is also unaidable when sounds (amplified or unamplified) result in significant distortion. The choice is less certain when one of the ears is aidable and the other one is unaidable because of the severity of the loss. When the reason for the unaidable ear is due to perceived distortion in the unaidable ear, a BiCROS solution is the most appropriate.
Because a CROS system transmits sounds from the unaidable ear to the aidable ear, the goodness of the transmitter, the technology used in the transmission, and the quality of the receiver are important determinants of sound quality, efficacy, and usability of the CROS system.
Despite this advantage, the quality of the wireless transmission affects the integrity of the transmitted signals. Because the receiver of the Widex CROS can be any model and style of the DREAM hearing aids, all the features available in the series are available to the wearer, including multichannel processing, slow-acting compression, noise reduction and speech enhancer, fully adaptive multichannel directional microphone, active feedback cancellation algorithm, frequency transposition, and Zen (for tinnitus management).
A study at Widex ORCA-USA was conducted in order to document the improvement in speech understanding and SNRs offered by the Widex CROS device. On the other hand, the DREAM Fashion hearing aid in the “aided better ear alone” condition yielded a consonant score that is 30% higher (53% – 23%) than the subjects’ own hearing aids. The use of the Widex CROS further improved the SNR even with the use of the omnidirectional microphone in both the DREAM Fashion and the CROS transmitter. Second, the use of a BiCROS system can further improve the SNR of the aforementioned condition over the “hearing aid on better ear only” condition, even when both the microphones on the BiCROS system are omnidirectional and the “hearing aid in the better ear” has a directional microphone.
Fourth, the Widex CROS (when both transmitter and HA are in directional mode) improved the SNR by almost 8 dB over the unaided condition and 6 dB over the subjects’ own aid condition.
People with an asymmetric hearing loss (including those with a unilateral hearing loss) are not restricted to unilateral hearing aid fitting. The current study demonstrated that, when speech is presented to the unaidable ear of a hearing-impaired person, the Widex CROS hearing aid system improved speech understanding in quiet by >10% and SNR by almost 5 dB over the DREAM hearing-aid-alone condition. In selecting a CROS system, it is important to understand how the CROS system is designed to ensure the highest sound quality and SNR for as many situations as possible. Classic stigmata of congenital syphilis SNHL, interstitial keratitis, Hutchinson teeth (notched incisors), mulberry molars, Clutton joints (bilateral painless knee effusions), nasal septal perforation & saddle deformity& frontal bossing. See related patient information handout on preventing noise-induced hearing loss, written by the author of this article. Epidemiological evaluation of hearing damage related to strongly amplified music (personal cassette players, discotheques, rock concerts): high definition audiometric survey on 1,364 subjects. Noise-induced hearing loss in young adults: the role of personal listening devices and other sources of leisure noise.
NYOG physicians have consistently been recognized among the city's foremost doctors within their areas of specialization. The rationale and evidence to support the use of the Widex CROS system to manage this patient group is also provided.
The goal is to preserve as much of the binaural benefits as possible.2 To a large extent, the same philosophy is applicable for people with an asymmetric hearing loss unless evidence suggests otherwise.
An asymmetric hearing loss may include one normal-hearing ear (thresholds <20 dB HL across frequencies) and one impaired ear. Knowing if the speech understanding score is commensurate with the degree of hearing loss may be a better predictor of aidability. Alternatively, the use of a unilateral, super-power hearing aid fitting with a deep, tightly occluding earmold may provide some benefits.
Typically, it is accompanied by a speech identification score that is significantly poorer than what the audiogram suggests. Six asymmetric hearing loss conditions and their management options.Figure 1 summarizes the six scenarios of asymmetry and the treatment options for each combination. On the other hand, if noise (or an undesirable sound) is presented to the unaidable ear, the noise that was once inaudible would become audible to the better ear in a CROS arrangement. From the product perspective, it requires device manufacturers to have features within the CROS system to circumvent the potential degradation introduced by the CROS system in non-ideal listening situations. However, the two microphone inputs in a BiCROS system would result in a louder input (3-6 dB) than a hearing-aid-alone condition. The transmitter in a CROS system picks up the input signals and transmits them to the receiving hearing aid. Microphones used in analog hearing aids (including CROS) typically saturate below an input level of 115 dB SPL. It was indicated earlier that a CROS system is optimal when speech is presented to the side of the unaidable ear. Similarly, a VC on the side of the transmitter allows the wearer to adjust how much sound is transmitted to the hearing aid receiver for a better balance of transmitted and direct sounds, and thus a better SNR. In cases where noise is presented to the side of the unaidable ear, or when speech and noise are presented to the side of the unaidable ear (but spatially separated), a directional microphone on that side may further improve the overall SNR for the aidable ear.
The first CROS devices used a wired connection between the transmitter and the receiver to ensure the consistency of the transmitted signals. The sampling frequency that is used could affect the bandwidth of the transmitted signals, and the nature of the coding could also affect the stability of the transmission. This includes all DREAM hearing aid styles at all price points (440, 330, 220, and 110, as shown in Figure 2). It is equipped with user-friendly features that improve the usability and satisfaction with the device. Like all DREAM hearing aids, the input stage of the Widex CROS only saturates above an input of 113 dB SPL to ensure an almost distortion-free transmitted signal. Thus the wearer does not have to sacrifice any features to receive the benefits of a CROS system.
A secondary objective was to estimate the additional SNR improvement offered by the fully adaptive directional microphone on the Widex CROS transmitter. The DREAM Fashion hearing aid was fit to the subjects’ aidable ear using the default Widex gain target.
All speech testing was conducted with the speech materials presented to the unaidable or poorer ear. The speech sentence materials were presented to the side of the unaidable ear, while the continuous noise was presented to the front (0°), back (180°), and the side of the aidable (or better) ear (either 90° or 270°) at an overall level of 68 dB SPL. In addition, for the hearing aid (HA) and BiCROS conditions, the microphones on the hearing aid and CROS transmitter were systematically changed between omnidirectional and directional modes in order to examine the contribution of a directional microphone in a BiCROS system.


Figure 3 compares subjects’ performance across the 4 hearing aid conditions, separating the consonant and vowel scores. Reception thresholds for speech on the HINT for four hearing aid (unaided, own aid, aided, BiCROS) and two microphone (omnidirectional, directional or locator) conditions. Figure 4 summarizes the SNR required for 50% correct identification on the HINT at a 68 dB SPL noise level across the various hearing aid conditions. In the BiCROS mode, a SNR of 6.5 dB was obtained when both the aid and the CROS transmitter were in the omnidirectional mode.
First, the use of a hearing aid with or without a directional microphone on the aidable ear can improve the SNR of the listening environment by 2-3 dB over the unaided condition when speech is presented to the unaidable ear.
However, the benefit can be as much as 40% improvement in speech understanding in quiet and 8 dB improvement in SNR over the unaided condition!
In that regard, the details of the wireless platform that is used for the transmission, ergonomic factors such as user controls, cosmesis, current drain, cost, and the quality of the receiving hearing aid are all important factors to evaluate. Kuk F, Korhonen P, Crose B, Kyhn T, Morkebjerg M, Rank M, Kidmose P, Jensen M, Larsen S, Ungstrup M.
Skeletal findings osteochondritis& periostitis of long bones SNHL, interstitial keratitis, Hutchinson teeth (notched incisors), mulberry molars, Clutton joints (bilateral painless knee effusions), nasal septal perforation & saddle deformity& frontal bossing.
Noise-induced hearing loss is the second most common form of sensorineural hearing deficit, after presbycusis (age-related hearing loss). As many as 30 million Americans are exposed to potentially harmful sound levels in their workplaces.3 Outside of work, many persons pursue recreational activities that can produce harmful noise.
When excessive, this force can lead to cellular metabolic overload, cell damage and cell death. Screening audiometry performed in the office revealed a 30-dB (mild) elevation of hearing thresholds at 4,000 Hz.
An occupational hearing conservation program includes engineering and administrative controls to reduce noise exposures, employee training in the use of hearing protection and annual audiometry for all workers who are exposed to noise.Physicians providing occupational health services to a company may supervise the hearing conservation program, review abnormal audiograms and advise the program administrator.
Audiologists can test a greater number of frequencies and can measure air and bone conduction to confirm whether the loss is sensorineural, conductive or mixed. By preventing noise-induced hearing loss, patients can reduce the impact of age-related changes on their hearing. Staffed by an exceptional team of board-certified physicians and specialists, the NYOG adheres to a comprehensive disease management approach to ensure its patients receive the best possible care of their sinus, head and neck, hearing and balance, speech and swallowing, and sleep apnea conditions. Amplifying an aidable ear with conventional amplification devices typically leads to improved audibility and speech understanding. In that case, amplification provided at the impaired ear creates a vibration so the cochlea of the opposite (normal) ear is stimulated through bone conduction. The unaidable ear may be fit with a BiCROS, where the signal from the profound ear is routed to the aidable ear for processing.
In a CROS system, the hearing aid on the unaidable side picks up the signal through the microphone on that side and routes it (through either a wire or wireless connection) to the receiving hearing aid on the normal ear. It has a microphone on the hearing aid for the unaidable ear (transmitter side) and another one on the receiving hearing aid for the aidable ear. It may interfere with the speech sounds that are received on the side of the aidable (or normal) ear and reduce the signal-to-noise ratio (SNR).
From the users’ perspective, the listener needs to understand the conditions where the use of the CROS may be counterproductive so they may develop coping strategies.
Thus, any components that affect the pickup and transmission affect the overall sound quality.
In a digital hearing aid (and CROS system), the use of a 16-bit analog-to-digital converter (ADC) at the input stage means that many digital hearing aids saturate or start compressing at an input level lower than 115 dB SPL—sometimes as low as 96 dB SPL.
On the other hand, when speech is presented to the aidable (or normal-hearing) ear and noise to the unaidable ear, the once inaudible noise may become audible and the SNR decreases. These two critical features allow the wearers better control of their listening environments. In addition, how the signal is coded and transmitted will affect the current drain on the transmission. Widex CROS integrates the WidexLink wireless platform6 and the DREAM True Input Technology platform. The option of a fully adaptive broadband directional microphone on the CROS transmitter adds to improve the SNR of the listening environment. A thin-tube with appropriate instant ear inserts (open and tulip inserts) were used to couple the aids to the subject’s ears. For speech-in-quiet testing, the ORCA-NST speech test8 was presented at 50 dB SPL to the poorer ear. The level of the speech was adaptively varied to estimate the speech level for 50% correct identification of the test sentences. It is clearly seen that performance with subjects’ own aids was not much better than the unaided condition. The use of the BiCROS further improved the speech score by 10% over the DREAM Fashion HA alone condition. A SNR of 6.2 dB was obtained when the aid was in the omnidirectional mode and the CROS transmitter was in the directional mode. Greater improvement can be expected when the hearing aid has a directional microphone than an omnidirectional microphone. Considering that many people with an asymmetric hearing loss do not wear or only wear one hearing aid on the aidable ear, the Widex CROS, which can be configured as a CROS or a BiCROS hearing aid, could provide substantial improvement in the wearers’ speech understanding ability under some listening conditions. Transformation of sound pressure level from the free field to the eardrum in the horizontal plane.
Shearing forces caused by any sound have an impact on the stereocilia of the hair cells of the basilar membrane of the cochlea; when excessive, these forces can cause cell death. Sixty million Americans own firearms, and many use them without adequate hearing protection.4 Other nonoccupational sources of noise include chain saws and other power tools, amplified music,5 and recreational vehicles such as snowmobiles and motorcycles. They can also perform tests for speech discrimination and speech reception threshold.If a unilateral or asymmetric sensorineural loss, tinnitus, vertigo or other significant ear pathology is found, referral to an otolaryngologist is warranted.
Hearing aids can amplify sounds but, despite technologic advances, often cannot fully correct problems of speech discrimination. Family physicians should educate and motivate patients of all ages to avoid potentially damaging noise, use hearing protection when necessary and seek treatment for an existing hearing deficit. As well, its facial plastics practice offers a broad array of facial reconstructive surgeries and cosmetic procedures. An alternative is a trans-cranial CROS for the ear with the profound loss, making this essentially a bilateral fitting.
There is not a microphone on the hearing aid for the normal ear; thus, the routed signals from the unaidable ear are processed alone and transduced through the receiver. The same sound could reach the aidable ear, but it would be attenuated by the amount of the head shadow effect.4 By routing sounds directly from the side of the unaidable ear to the aidable ear, a CROS system or microphone eliminates the head shadow effect. When the CROS transmitter uses the same ADC, it will have the same problems as hearing aids with a low input stage. Kuk et al6 provided a summary of the considerations affecting the quality of wireless transmission, and they are as relevant for hearing aids as they are for wireless CROS devices.
All the factors that affect the performance and quality of a hearing aid would affect the performance of the CROS receiver.
WidexLink uses bit-true transmission with a sampling frequency of 25 KHz so that input frequencies up to 12 KHz can be sampled and transmitted accurately.


In addition, a volume control that has a range of over 35 dB allows wearers to control sounds that are transmitted to the receiving ear. All were BiCROS candidates with a mild-to-moderately severe degree of hearing loss in the aidable ear and a severe-to-profound hearing loss in the unaidable ear. Subjects were tested in the unaided, own aids, DREAM Fashion only (HA on aidable ear), and BiCROS with DREAM Fashion (BiCROS). An average of 3% improvement (23% – 20%) was seen in the consonant scores (although almost 20% improvement was seen in the vowel scores). This shows that the use of the BiCROS can improve consonant identification over the unaided and own aid conditions by over 40% in an ideal or intended condition! A SNR of 5.2 dB was obtained when the aid was in the directional mode and the CROS transmitter was in the omnidirectional mode.
Some types of toys for children can produce sounds capable of causing permanent hearing damage.6Noise can be described in terms of intensity (perceived as loudness) and frequency (perceived as pitch).
Concurrent exposure to ototoxic substances, such as solvents and heavy metals, may increase the damage potential of noise.7 Once exposure to damaging noise levels is discontinued, further significant progression of hearing loss stops.
In response to questioning, the girl reported spending several hours a day listening to music through head-phones. An aid should be carefully matched to the person's hearing deficit and lifestyle by a trained audiologist.
Rabinowitz received his medical degree from the University of Washington, Seattle, and completed a residency in family medicine at Natividad Medical Center, Salinas, Calif. They will be summed, processed, amplified, and transduced through the receiver on the aidable ear. This includes sophisticated signal processing features to process the transmitted sound, and a broad receiver to output the sounds (see Kuk et al7 for a summary about factors related to sound quality). In addition, many features to maintain the security and stability of the transmission are implemented in the Widex CROS for stable and consistent sound transmission.
These two features are critical in situations where undesirable sounds are presented to the unaidable ear. An exception was one subject who had severe distortion and poor speech recognition in the unaidable ear, albeit a moderate hearing loss. This may be related to the limited high frequency output provided by subjects’ own hearing aids. A SNR of 3.2 dB was obtained when both the aid and the CROS transmitter were in the directional mode.
Noise-induced hearing loss can be prevented by avoiding excessive noise and using hearing protection such as earplugs and earmuffs.
Both the intensity and the duration of noise exposure determine the potential for damage to the hair cells of the inner ear. The previous night, she had spent several hours at a rock concert without wearing hearing protection. Widex CROS uses near-field magnetic induction (NFMI) with a carrier frequency of 10.6 MHz for safe and stable wireless connection. Properly adjusting the level of transmitted sounds can improve listening comfort and enhance the SNR of the listening environments. Kuk et al5 reported on the impact of a high input range on speech intelligibility in noise. PowerSave technology also is utilized in the Widex CROS such that the typical current drain of the transmitter is only 0.89 mA. When hearing loss is suspected, a thorough history, physical examination and audiometry should be performed. Noise exposure measurements are often expressed as dB(A), a scale weighted toward sounds at higher frequencies, to which the human ear is more sensitive. If these examinations disclose evidence of hearing loss, referral for full audiologic evaluation is recommended. Noise can cause permanent hearing loss at chronic exposures equal to an average SPL of 85 dB(A) or higher for an eight-hour period.7 Based on the logarithmic scale, a 3-dB increase in SPL represents a doubling of the sound intensity. Noise-induced hearing loss is a sensorineural hearing deficit that begins at the higher frequencies (3,000 to 6,000 Hz) and develops gradually as a result of chronic exposure to excessive sound levels.1 Although the loss is typically symmetric, noise from such sources as firearms or sirens may produce an asymmetric loss. The physical examination of the ears should assess presence of cerumen impaction or evidence of middle ear disease.
Although complete recovery from a given episode can occur, repeated episodes of such shifts occurring after noise exposures give way to permanent threshold shifts because hair cells in the cochlea are progressively lost.CASE 2A 55-year-old factory worker consulted his family physician because of ringing in his ears and depression that began soon after the onset of the tinnitus. The Weber and Rinne tests, performed with a 512-Hz or 1,024-Hz tuning fork can provide clues to whether the loss is conductive or sensorineural. He had seldom worn hearing protection at work, where he had to shout to communicate with co-workers.
In the Weber test (Figure 4), sound will lateralize to the side away from a sensorineural loss and toward a conductive deficit. Away from work, he had difficulty understanding conversations in crowded rooms, and he said he often argued with his wife about the volume of the television set.
The Rinne test (Figure 5) will demonstrate air conduction better than bone conduction if the loss is sensorineural. The clinician can motivate patients to maintain their hearing health and thereby reduce the risk of hearing disability as they grow older (Tables 2 and 3).
Key factors in this effort are learning to avoid excessive noise when possible and correctly using hearing protection when necessary.
The patient was referred to an audiologist, who confirmed a sensorineural hearing loss that was probably caused by excessive noise exposure, with superimposed age-related changes.
Hearing protectors, including earmuffs, disposable earplugs and custom-fitted earplugs, can provide 20 to 40 dB of attenuation when used correctly. Physicians can obtain samples from manufacturers and keep them in the office for distribution and demonstration of techniques for proper use. The physician can clarify this test by performing the test on himself or herself, plugging one ear with a finger to simulate a conductive loss.
If hearing is symmetric, the patient perceives the sound in the middle of the forehead.FIGURE 4.
Tinnitus is a common symptom of noise overexposure, and it further interferes with hearing acuity, sleep and concentration. Holding a 512-Hz or 1,024-Hz vibrating tuning fork against the mastoid process, the physician asks the patient to indicate when the sound can no longer be heard. At this point, the physician places the tuning fork in front of the auditory meatus to determine whether the sound can be heard again.
Normal hearing patients and patients with sensorineural hearing loss hear the sound longer through air than bone. In a conductive hearing loss, bone conduction becomes equal to or greater than air conduction. An audiogram hearing threshold level above 20 dB is considered abnormal.If the loss appears to be sensorineural, etiologies other than noise should be excluded. While this type of loss in early childhood is often caused by congenital factors,22A  presbycusis becomes the most common sensorineural condition after midlife.



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22.04.2016 admin



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