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Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. The resource may also contain words and descriptions that could be culturally sensitive and which might not normally be used in public or community contexts. Sensorineural hearing loss relates to damage to the hair cells in the inner ear, auditory nerve or brain. Conductive hearing loss relates to a problem in the transmission of sound through the outer and middle ear.
Children with recurrent, persistent and chronic OM conditions for more than 3 months should be seen by an audiologist.
In a hearing test sounds are played at a particular frequency (pitch) at different intensities (volume) usually increasing from soft to loud.
Across the top of the audiogram are numbers representing the frequencies of sounds that are to be tested. Air and bone conduction tests are used to work out what type of hearing loss a person might have. Sensorineural hearing loss is defined as a difference of 15dB or less between the air conduction thresholds and the bone conduction thresholds of a given ear, and the air and bone conduction thresholds are worse (higher) than 15dB.
Conductive hearing loss is when bone conductor thresholds are 15dB better (lower) than air conduction thresholds and the bone conduction thresholds are 15dB or less.
There are certain symbols to indicate if test results are from the right or left ear, and whether tests have been masked or not. Any of the above symbols with an arrow pointing downwards means that there was no response at that frequency. There is some uncertainty about the degree of hearing loss associated with different forms of OM, but it is generally agreed that children with persistent OME, recurrent AOM or a perforation (wet or dry) for more than three months are likely to suffer from significant effects of hearing loss and should be referred to an audiologist and an ear, nose and throat (ENT) specialist.
Do sudden loud noises wake the baby?Does the baby cry at very loud noises?Does the baby jump at sudden loud noises like the door slamming or dog barking nearby? Does the baby sometimes turns its eyes and start to turn its head to see where a noise comes from? Does the baby turn to find things heard but not seen?Does the baby gurgle, coo or babble to unseen sources of voices or other sounds?
Does the child talk in 3 word sentences?Are you able to have a conversation with the child?
Does the child sit too close to the television?Does the child respond to you when you call them from a distance or when they have their back to you?Does your child have trouble listening in noisy places i.e. Parents need to be aware of ways to communicate more effectively with children with hearing loss i.e.
Darwin Otitis Guidelines Group (2010) Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Strait Islander populations. Conventional hearing aids, the most common solution, aim to overcome the degree of conductive or sensorineural hearing loss by amplifying the incoming signal and sending the amplified sound via air conduction through to the cochlea. Cochlear implants are suitable for individuals with a severe or profound hearing loss, where the extent of destruction to the cochlea’s hair cells is so great that hearing aids are unable to provide benefit.
Baha provides an optimal amplification choice for those with conductive, mixed, or single-sided sensorineural deafness through the use of direct bone conduction. Importantly, while there are a number of implantable technologies for hearing loss (eg, middle-ear implants), Baha remains the only technology that the patient can thoroughly evaluate before surgery.
Figure 1 gives an indication of the sound a patient with this type of hearing loss is missing.
Even without medical indications, the Baha provides significant benefits over conventional hearing aids due to large gain requirements.
Baha provides an optimum solution for patients with conductive hearing loss because the treatment avoids difficulties associated with middle-ear pathology and the limitations of hearing aids. When deciding on treatment options, it is important to remember that the overall amplification required for people with a mixed loss is less with a Baha than that required for a hearing aid.
Conversely, the air conduction hearing aid must address both the conductive and sensorineural elements.
Therefore, for patients with air-bone gaps greater than 30 dB, Baha should be evaluated as a potential amplification option due to numerous reports indicating significant benefit when compared to traditional air-conduction amplification.
Single-sided sensorineural deafness (SSD™) poses significant communication difficulties for the patient.
For patients with SSD, the Baha is worn on the deaf side, and it transfers the signal directly across the skull via bone conduction, thus eliminating the head shadow effect described above.
For many patients, the sound will seamlessly transfer from one side to the other via bone conduction.
A recent study15 examined the efficacy of Baha Intenso for patients with a mild hearing loss in the hearing ear (Figure 6). A number of studies have also compared the performance of Baha versus the more traditional solution of Contralateral Routing of Signal (CROS) hearing aids11,13 (ie, one hearing aid with two microphone attachments). Baha provides an additional treatment of choice that complements conventional hearing aids and cochlear implants. Due to the properties of bone conduction, Baha bypasses the conductive element of conductive and mixed hearing losses, resulting in a reduction in the amount of amplification required when compared to traditional air-conduction aids—devices that must overcome the conductive component. The recent addition of the Baha Intenso, which compensates for up to 55 dBHL of sensorineural hearing loss (current CE indication; expanded indication awaiting approval from FDA), means that a larger population of individuals can benefit from Baha. The white area represents the sounds that the person would not hear (softer then their thresholds) and the tan area indicates all of the sounds that the person would be able to hear (louder then their thresholds).
They can occur when a person has a permanent sensorineural hearing loss and then also develops a temporary conductive hearing loss. For example, some information may be considered appropriate for viewing only by men or only by women.

Sensorineural hearing loss can be caused by: exposure to loud noises, ageing, meningitis, viruses, genetic factors, certain drugs, certain pre-natal conditions.
Conductive hearing loss can be caused by: wax blockage, perforated eardrum, various forms of otitis media (OM), otosclerosis (abnormal growth of bone in the ear), or a break in one of the middle ear bones. A person may have normal hearing or slight, mild, moderate, moderately severe or profound hearing loss. When the person hears the sound they raise their hand or press a button to let the audiologist know they have heard the sound.
Sometimes the symbols will be colour coded with red representing the right ear and blue representing the left ear.
A hearing loss of 35dB or more in the better ear is considered disabling, but even a loss of 20dB occurring during speech development and early schooling may have negative social and educational consequences. Does the baby make a variety of babbling sounds?Does the baby enjoy playing with noisy toys or objects?Can you soothe the baby with your voice?
Teachers should try to reduce background noises such as: people talking and moving, outside traffic, air conditioners and building site operations. Excluded material owned by third parties may include, for example, design and layout, images obtained under licence from third parties and signatures. Depending on the degree and nature of their hearing loss, one of three treatments may be suitable: conventional air-conduction hearing aids, cochlear and middle-ear implants, and bone-conduction hearing devices, including Baha® (an osseointegrated hearing device). In cochlear implants, sound is picked up and processed by the sound processor and the cochlea is electrically stimulated, thus restoring the sensation of hearing. The Baha consists of three parts, the ossiointegrated implant, the sound processor, and the abutment that connects the two.
Through the use of a softband or test rod, the patient is able to evaluate in advance the potential benefits of Baha. This is, in part, because conductive hearing loss is often concomitant with various outer- and middle-ear abnormalities (eg, atresia) or middle-ear pathologies (eg, continuously draining ear) that preclude hearing aid use.
Because of the abnormal growth of loudness caused by sensorineural hearing loss, most hearing aid rationales prescribe approximately 50% gain of the degree of hearing loss. Therefore, one would consider providing 100% compensation for the degree of conductive hearing impairment. A new device, the Baha Intenso™, compensates for up to 55 dBHL of sensorineural hearing loss (current CE indication; expanded indication awaiting approval from FDA). Put simply, the device bypasses the conductive element of the hearing loss and addresses the sensorineural component directly. Example of the aided sound-field thresholds following the fitting of a Baha for a patient with mixed hearing loss. While hearing aids are good at compensating for sensorineural hearing loss, compensation for the conductive element rapidly increases the required gain and maximum power output. Approximately 18% of patients with a severe or profound hearing loss have a significant mixed component to their loss. Increase in available gain with Baha Intenso that is available with the implementation of an active feedback cancellation system. Primarily, this difficulty is due to the inability to accurately localize where sound is coming from. In this way, sounds are efficiently transferred across the skull from the deaf side to the good ear via bone conduction. For a small number of patients, additional amplification force may be required to overcome an increased interaural attenuation to provide sufficient loudness in the good ear. An expanding area of research for Baha is for patients who have a single-sided sensorineural deafness and some degree of hearing loss in the good ear. Improved aided thresholds in patients with a profound loss in one ear and a mild hearing loss in the contralateral ear. The authors found that the additional amplification provided by the device effectively normalized performance. These studies reported that speech understanding and subjective reports were significantly better with the Baha than with CROS-based solutions. Osseointegration provides options for patients with conductive, mixed, or single sided sensorineural hearing losses. Miller, PhD, addressed the topic of sudden hearing loss and single-sided deafness in the special December 2003 edition of HR available in the online archives. Similarly, due to the ease with which bone-conducted sounds transfer across the skull, the device offers a relatively simple solution for people with single-sided sensorineural deafness. Together with the advanced signal processing of Divino and the superpower performance of Cordelle, Intenso complements the portfolio of these devices by offering a discreet yet powerful head-worn solution. Flynn, PhD, is director of research and applications in the Cochlear Bone Anchored Solutions Group of Cochlear Corporation, Gothenburg, Sweden. Long-term results of bone-anchored hearing aid recipients who had previously used air-conduction hearing aids. An intra-individual comparison of the previous conventional hearing aid with the bone-anchored hearing aid: the Nijmegen group questionnaire. Intraindividual comparison of the bone-anchored hearing aid and air-conduction hearing aids.
Bone-anchored hearing aids in unilateral inner ear deafness: an evaluation of audiometric and patient outcome measurements. Amplification in the rehabilitation of unilateral deafness: speech in noise and directional hearing effects with bone-anchored hearing and contralateral routing of signal amplification.
The HealthInfoNet respects such culturally sensitive issues, but, for technical reasons, it has not been possible to provide materials in a way that prevents access by a person of the other gender. If the patient can hear the sound 2 times out of 3, the audiologist plots the intensity and the frequency of the sound on an audiogram.

Children with hearing loss should sit at the front of the classroom and the teacher should try to use as much face to face communication as possible.
Although each of these treatments seeks to overcome the difficulties caused by hearing loss, the differences among these approaches provide specific advantages for different populations.
This process compensates for the destruction of the hair cells by routing the signal directly to the auditory nerve. The sound processor is connected directly to the skull through an osseointegrated titanium implant in the temporal bone.
With Baha, the conductive element of the hearing loss is bypassed by sending sound vibrations directly from the sound processor, through the skull, and to the cochlea. For example, for a sensorineural hearing loss of 60 dBHL, the hearing aid would prescribe approximately 30 dB of gain. Counterintuitively, most published prescriptive formulae recommend only 75% compensation for the conductive element.2,3 Interestingly, this decision has been based on the technical limitations of the hearing aid rather than the needs of the patient.
Circles represent air-conduction thresholds and arrows represent bone-conduction thresholds. As observed in Figure 5, Intenso produces 10-15 dB more gain for the patient through the use of a more powerful transducer and an active feedback cancellation system. This provides a more efficient and comfortable method of sound transmission to the cochlea. These requirements indicate that conventional air conduction hearing aids may have insufficient overall power and that saturation from loud inputs will occur more readily.
Given the limitations of conventional hearing aids, and the capability of Baha, numerous studies4-9 recommend that, when the conductive component of the mixed hearing loss becomes greater than 30 dB, Baha should be the amplification method of choice. In addition, speech-understanding difficulties arise in situations where the noise is directed toward the good ear and the talker is near the deaf ear. For these patients with an increased head transfer function, a more powerful device, such as the Intenso, is recommended. It may be for these patients that the unilateral total hearing loss increases the difficulties experienced from a mild hearing loss, and that a Baha becomes even more relevant. For all conditions, speech comes from the front and noise comes from the good side (red), deaf side (blue), or front (black). Before bone-anchored devices, the patient was at a significant disadvantage when speech was spoken from the deaf side. Therefore, for patients with single-sided deafness, the bone-anchored device should be considered the treatment of choice.
While there are a number of implantable technologies available (eg, middle-ear implants), Baha remains the only one that the patient can thoroughly evaluate, via softband or test rod, before surgery. In a bone conduction test a small bone vibrator is placed on the mastoid prominence behind the auricle (raised area behind the external ear). Sound vibrations are thereby passed through the titanium implant and vibrate the temporal bone that houses the cochlea, thereby providing the sensation of hearing. A number of technical limitations arise when attempting to fit hearing aids to larger conductive loss. To achieve this, an additional amplification force is required to compensate for the degree of sensorineural deafness.
For patients in these studies, Baha performed significantly better than conventional air-conduction hearing aids in terms of aided thresholds, speech perception measurements, and subjective reports. In many situations (eg, driving a car), the patient is unable to compensate for this difficulty by changing head position. For this population, the Baha improves performance so that the patient experiences a more natural overall sound picture.
The range of frequencies on this audiogram match the range of frequencies for general speech. The bone vibrator transmits sounds to the bones of the skull which stimulates the inner ear directly. Bone conduction thereby overcomes conductive hearing loss by innervating the cochlea directly.
These include insufficient gain, saturation, feedback, and also the necessity of a tight-fitting earmold. As shown in Figure 4, the resultant aided free-field thresholds are extremely good with the device, providing excellent compensation for the sensorineural element of the mixed hearing loss. Teachers should be aware of using new words and ideas in English that may be unfamiliar to Indigenous children. It can also compensate for a degree of sensorineural hearing loss in a mixed hearing loss with increased amplification. The insufficient power of most hearing aids compromises the hearing performance of the patient with conductive hearing loss.
Comparisons of air and bone conduction thresholds are used to determine the type of hearing loss. Parents can also help by participating in their child’s learning at child care and preschool. Writing key vocabulary on the board and using pictures or objects are useful ways to communicate new ideas. Additionally, Baha provides a solution for individuals with single-sided sensorineural deafness, as the skull can efficiently conduct the sound from one side of the head to the opposite cochlea.

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