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Author: admin, 19.09.2015. Category: Cure Ringing Ears

This presentation will focus on cochlear implant candidacy criteria and how it has changed over the years to current standards. In this webinar, several unusual causes of conductive hearing loss will be examined including enlarged vestibular aqueduct, superior semicircular canal dehiscence, malleus fixation and cerebrospinal fluid leak.
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Hear in Maine is an Alpha One program addressing hearing aid need and acquisition within Maine. Audiologist is a person who holds a mater’s or doctorate degree in the field of Audiology. Hearing Aid Specialists are people who have been sponsored and trained by someone in the field of hearing aid distribution. The purpose of a hearing exam is to quantify and qualify hearing in terms of the degree of hearing loss, the type of hearing loss and the configuration of the hearing loss. The type of hearing loss is information that suggests the point in the auditory system where the loss is occurring. An Audiogram is a report that is generated by hearing tests which graph out a chart of your hearing loss. Hearing exams are generally covered by insurances, but you should always check before making an appointment to be sure. More than 75 percent of all hearing aid repairs are due to moisture and earwax accumulating in the hearing aid. Hearing aid batteries normally last 7-14 days when the hearing aid is used 16 hours per day. The sizes of hearing aid batteries are listed below along with their standard number and color codes.
For equipment needs such as amplified phones, large button phones, door bell alert system, alarm clock alert, flashing fire alarms, etc. One in 20 school age children suffer from unilateral hearing loss or hearing loss in one ear. Children with hearing loss have difficulty writing, are less socially active, and are more likely to be bullied. Hearing loss in one ear, unilateral hearing loss, has been shown to affect a child’s performance in school and with communication.
Research has not been conducted on the benefit of unilateral hearing loss being treated with hearing aids, but the research has been done for students with varying degrees of hearing loss in both ears. A child will have more problems in school and with self-esteem and social settings if no intervention occurs to help with their hearing loss.
It makes sense to take action when it comes to unilateral hearing loss, since doing nothing is how these children ended up falling between the cracks to begin with. Unilateral hearing loss (UHL) is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties. This indicates that the majority of people today who are fit monaurally with hearing aids are those with unilateral hearing loss (UHL).  UHL is defined as a loss in one ear of any degree (mild to profound) regardless of the type of hearing loss.
Recent research indicates school-aged children with UHL demonstrate worse oral language scores (worse language comprehension, oral expression, and oral composite) compared with siblings and normal-hearing age peers.5 Academically, children with UHL have been found to perform more poorly than their normal-hearing counterparts. Although the choice to fit infants with moderate or greater degrees of bilateral hearing loss has become standard practice, the decision of whether to fit amplification to children with UHL is less clear. With the introduction of universal newborn hearing screening, UHL can be diagnosed within the first 3 months of life.
The treatment of UHL can include sound field systems, FM systems, traditional hearing aids, CROS hearing aids, bone-anchored hearing aids (BAHA), and even a cochlear implant depending on the type, configuration, and degree of hearing loss. The benefits of hearing aids include increased audibility, minimizing of auditory deprivation, as well as ease of listening in both quiet and noisy listening conditions. Johnstone and her colleagues10 investigated the sound localization acuity of children with mild-to-severe UHL ages 6 to 14 years who wore a hearing aid in the impaired ear.
Fitting of hearing aid amplification is indicated for some people with unilateral hearing losses. Regarding timing, older children and adults with UHL who are identified as candidates should be fit with amplification as soon as possible.
Should hearing aids be fit differently for patients with UHL than for those with bilateral hearing losses? It should be noted that current prescriptive methods are specifically studied and designed for people with bilateral hearing loss. When doing the initial fitting, be aware that some software will default to a monaural fitting prescription when only one hearing aid is connected if the fitting rule incorporates a binaural correction.
As mentioned, the literature on fitting of asymmetric hearing loss can inform how to fit UHL. One technique12 to achieve the goal of binaural fusion or balance for fitting an asymmetric hearing loss can easily be applied to fitting UHL. Whether hearing aids should be fit differently for those with UHL also extends beyond the gain-frequency response prescription to features of the hearing aids. Children’s limited experience with receptive speech and the importance of overhearing will limit the use of directional microphones. One important consideration when using wireless accessories is that the fitting should be considered open regardless of how the impaired ear is fit. Frequency lowering (frequency compression, frequency translation, or frequency transposition) algorithms are another common feature in hearing aids today.
UHL is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties. This type of loss is due to the inability of sound to pass through the outer and middle ear.
This type of hearing loss occurs when there is damage to the cochlea (inner ear) or to the auditory nerve that goes to the brain. Without amplification, the child can hear most conversations up close and in quiet environments, but is likely to miss parts of words.
Until recently, children with unilateral hearing loss did not have their hearing loss detected until they were in school. The audiogram is a graph that represents how loud a sound at a specific pitch has to be for the child to hear the sound. Configuration of hearing loss - is the shape of the hearing loss due to the amount of hearing loss at each frequency. A 5-year-old boy was referred to me for a hearing test because he did not pass a kindergarten screening test in his right ear.
Otoscopic examination showed a clear ear canal and a normal-appearing tympanic membrane on the right side.
The child’s parents were informed of these results, and we scheduled him to return for a retest in order to confirm these findings.
I repeated the behavioral tests with the same results that I obtained the first time (Figure 2). After completing the tests, I explained auditory dyssynchrony to the parents, and told them that this is what their son appeared to have. The left inner ear structures, cranial nerves VII and VIII complex, and internal auditory canal are normal. Key finding: The results were consistent with atresia versus severe stenosis of the right cochlear nerve canal and cochlear nerve and deficiency described above. According to the MRI, the cochlea on the right side is normal—which would explain the present DPOAE results. This case has certainly caused me to re-evaluate what I think and say about my test findings.
Finally, this case only reinforces my trust in “mother’s intuition” and the value of deferring to the sensible requests of parents. And although it may not make a large difference in the boy’s current treatment plan, I do know that the boy’s mother is grateful for understanding the reason for her son’s hearing loss and that it’s at least possible the boy may benefit from this knowledge in the future. Jill Messina has experience with audiological and vestibular diagnostic assessment, electrophysiological testing, hearing aids, aural rehabilitation, and supervision of audiology Doctoral students.


The presentation will include brief videos of the mechanics of ossicular reconstruction and surgical reconstruction of the ossicles including stapedectomy.
The differentiating features of these unusual causes of conductive hearing loss will be discussed relative to more common causes of conductive hearing loss.
Topics to be discussed include the symptoms and signs, audiologic profile and the latest treatments for these two conditions. When going to places like restaurants, theaters, or traveling in a car, is it difficult to hear speech? The training for an Audiologist consists of not only hearing aid selection and fitting, but also detailed study of the ear and its function.
In Maine, a Hearing Aid Specialist is required to pass a written and oral exam in order to receive their dispensing license. The loss may be conductive (a temporary or permanent hearing loss typically due to abnormal conditions), sensorineural (typically a permanent hearing loss due to disease, trauma, or inherited conditions), mixed (a combination of conductive and sensorineural components), or a central auditory processing disorder (a condition where the brain has difficulty processing auditory signals that are heard).
Performance will vary depending on the style and type of hearing aid technology you are using.
In the past, it has been common practice not to treat hearing loss that occurred only in one ear. Those with hearing loss in one ear have these issues in addition to being less likely to get treatment for their condition. That research clearly shows an advantage to children with hearing loss who wear hearing aids.
Make sure to have your child's hearing tested regularly and see your hearing health provider immediately if you suspect hearing loss. Research shows sound localization test scores were significantly poorer for the children with UHL than for the children with normal hearing. In a study of 60 children with UHL, Bess and Tharpe6 found that 35% of the children had repeated at least one grade in school, and an additional 13.3% required resource assistance, such as academic tutoring. It has been shown that fitting of aids soon after identification can minimize language delay; however, there can be a delay of up to 7 months in provision of amplification for children with mild and UHL. In this article, we will only discuss the fitting of conventional hearing aid amplification. Their results showed that a hearing aid can provide bilateral localization benefit to some children with UHL. The decision to fit a patient with unilateral hearing loss should be made on an individual basis, taking into consideration the person’s or family’s preferences, as well as audiologic, developmental, educational, and communication needs.
Those with moderately severe or better UHL are likely to accept the use of a hearing aid, whereas those with a severe or profound UHL may not comply with hearing aid usage at all.
For infants, there is still debate whether they should be fit before or after 18 months of age. Although the prescription may provide targets for a monaural versus binaural fitting, it might not specifically address the needs of people with UHL.
NAL-NL2 is an example of a prescription that provides binaural correction for both pediatric and adult patients, while DSL 5.0 only has a binaural correction for adults.
Directional microphones can be fitted according to the patient’s communication needs for adults with UHL. When a directional microphone is used, it is recommended to keep it in the automatic mode.  There is some evidence that directional microphones in the automatic mode will switch appropriately between a directional and omnidirectional response for the given environment approximately 90% of the time.
But there is only limited literature about hearing aid fitting for patients with UHL; some of the ideas have to borrow from asymmetry hearing loss fitting. Fitting of a hearing aid should be individually based and using your own expertise, taking consideration of patient age, degree of hearing loss, speech development, communication needs, and other morbidities, etc. Monaural hearing aid fitting considerations for Patients with unilateral hearing loss: Who should receive unilateral fittings, and how should you fit them? Hearing Review. The sound is prevented from passing through the middle ear due to a blockage such as wax, a foreign object in the ear canal, infection in the middle ear or malformation of the pinna, ear canal or middle ear bones.
Sensorineural hearing loss cannot be medically or surgically corrected therefore this damage is permanent.
There is a problem with the outer and middle ear and damage to the cochlea or auditory nerve. The possible effects of a hearing loss depends on degree of loss, early identification services, amplification, and parent involvement. If loss is from birth, spoken language and speech may not develop spontaneously, or could be severely delayed unless modifications and interventions are taken.
The child may rely on vision rather than hearing as the primary means for communication and learning. Now, with newborn hearing screening, unilateral hearing loss is detected during the first months of life. Usually frequencies of 250-8000 Hz are used in testing because this range represents where normal conversation speech occures, although the human ear can detect pitches from 20-20,000 Hz. How many times have I thought to myself that, just because a child passes their newborn hearing screening test, it does not mean they have normal hearing? His parents reported that he said “Huh?” frequently, and more recently they noticed him turning his head when spoken to.
Unfortunately, otoacoustic emissions (OAE) testing could not be completed because of an equipment malfunction. This prompted me to walk into the test booth and check the equipment and wires; everything was plugged in and looked normal.
I added acoustic reflexes, which were normal in his left ear (80-90 dB), and questionable in his right ear (105-115 dB). The right ear was reduced in amplitude compared with the left, but not what I would expect to see with a profound hearing loss (Figure 1). Bone conduction scores were not obtained at this time because I felt I was reaching the limits of a 5-year-old, and the tympanograms were normal on two occasions. Since they were people with resources, I advised them to make an appointment at Johns Hopkins to have this diagnosis confirmed by ABR. According to the report from the parents, the physician reviewed my test results and said it was unlikely that they were valid.
After she arrived home and mulled things over, she called Johns Hopkins and asked if they could do an MRI.
Evaluation of the right inner ear structures demonstrated absence of the right cochlear nerve. The cochlear branch of the VIIIth Cranial Nerve is completely absent, which would explain the absent ABR result and the profound hearing loss by behavioral testing. If she had not felt uneasy about what she had been told at one of the most prestigious clinics in the country, the actual source of this problem would not have been discovered. He is in private practice at the Ear Institute of Illinois (formerly called the Ear Institute of Chicago) in Hinsdale, Illinois. It is recommended to get a copy of your Audiogram so that you can bring this with you to compare other brands, vendors, and services.
Most insurances will not help with the cost of hearing aids, but there are a few exceptions, so again it is always better to check to be sure.
It is extremely important to clean the entire hearing aid every time it is removed from your ear by wiping and brushing it. You can buy them at most general retail stores (drug stores, grocery stores) and also via the internet. If your audiologist started you off with hearing aid batteries color coded orange, you can buy any brand of battery with the same color coding. Having hearing loss in one ear also means the limits of a child's ability to understand are often misunderstood or underestimated. As educators at MSU, point out, “numerous studies have shown improvement in attention, understanding directions, classroom participation and school behavior” when fitted with a hearing device.
Lieu supports this point, saying, "Parents, educators and pediatricians shouldn't assume that having hearing in one ear means children won't need additional assistance." Perhaps the best practice in the case of hearing loss in one ear is for a parent to take their child to an audiologist and ask them about getting a hearing aid for their child.
If you need help finding a hearing health provider click HERE to be connected with the largest network of trusted hearing health professionals in the nation!


In the ensuing years, as the benefits of binaural hearing aid fittings became apparent, the proportion of monaural-to-binaural fittings did a dramatic flip-flop. Localization acuity in younger children with UHL was significantly improved, but not in the group of older children; time of intervention is also a main factor affecting the localization benefit. On the one hand, it is unknown what degree of UHL may result in auditory deprivation and what is the critical time to provide amplification thereby avoiding these effects. That is, we do not yet know if people with UHL prefer the gain generated by a prescriptive method designed for monaural fitting of a bilateral hearing loss.7 But we can get some inspiration from fitting experiences with asymmetrical hearing loss. While a program button to access multiple listening programs may be of little relevance for patients with UHL, a volume control is a must. WDRC will automatically adjust the gain of the hearing aid based on the input sound level to ensure natural perception of loudness. For children, the use of directional microphone may be beneficial in some listening situations, such as when the target signal is located in front of the listener; however, decreased performance with directional response has been noted when the target signal was located to the side or behind the listener. Such hearing aids can receive an audio signal from a remote location to improve signal-to-noise ratio (SNR) and can be of particular benefit when listening in noisy environments.
The time of arrival of the streamed wireless signal to the impaired ear should not be delayed too much relative to the good ear receiving the signal acoustically to avoid disturbing perceptual effects.
Noise reduction has not been found to improve or degrade speech understanding in adults or school-aged children, but it can improve comfort and ease-of-listening in realistic listening situations.
Since the good ear will receive undistorted normal sound, the frequency lowered sound may interfere with binaural processing.
The role of aided ear is to provide more useful information to help understand speech and for binaural processing. The relevance of other treatment options than conventional hearing aids, such as FM, CROS, BAHA, and a cochlear implant, also should be considered and communicated to the patient. Amplification considerations for children with minimal or mild bilateral hearing loss and unilateral hearing loss.
Sound localization acuity in children with unilateral hearing loss who wear a hearing aid in the impaired ear. An evidence-based systematic review of amplitude compression in hearing aids for school-age children with hearing loss. Fewer wires, less complexity, and more connections: The new challenge for wireless hearing instruments. A conductive hearing loss is usually correctable through medical management such as surgery, medication, or removal of the obstruction.
Proper amplification and intervention should enable the child to hear and recognize most sounds. With early and consistent use of hearing aids, many children will be able to detect sounds such as speech.
Speech and oral language will not develop spontaneously without modifications and intervention.
He had passed his newborn hearing screening, and he had experienced a few ear infections that responded well to antibiotics. The ENT assured her that it probably would not show anything, but if it would allay her concerns (and since they had good insurance coverage), they would schedule the MRI.
How many times have I thought to myself that, just because a child passes their newborn hear- ing screening test, it does not mean that they have normal hearing? She is working in conjunction with the physicians of the Ear Institute of Chicago, LLC on a research study examining the Vibrant Soundbridge as a method for treating conductive and mixed hearing losses. They also have desiccants to absorb moisture and fans to circulate air around the internal components of the hearing aid. Batteries cost about one dollar each so on average, if you wear 2 hearing aids, expect to spend about $4 per month.
A new study at Washington University School of Medicine has proven that long established myths claiming unilateral hearing loss does not hinder a child’s performance in school are false. It's easier to determine the benefit of hearing aids for a child after consulting a professional.
The children with UHL also had significantly poorer speech-recognition scores than their normal-hearing peers. Children who were fit earlier showed bilateral benefit, whereas children who were fit later showed bilateral interference. Thus, any binaural correction should be used even though only one hearing aid is being fit to compensate for binaural summation effects. Then, ask the patient about where they perceive your voice to be coming from when you are sitting in front of him or her. This is because it won’t be known how the poor ear with amplification will interact with the good ear in real-world situations. An example of a wireless accessory that could be used for this purpose is a companion microphone that can be held or worn by a conversational partner or speaker-of-interest. When the poor ear has a severe hearing loss, the aided sound can reach the brain, but it may not be helpful. Unilateral hearing loss is associated with worse speech-language scores in children: a case-control study.
The child is at risk for significant delays in spoken language speech understanding, language comprehension and voice quality. Spoken language is significantly delayed, abnormal speech patterns may develop and voice quality is usually diminished. The parents mentioned a maternal aunt who is “nearly totally deaf” and wears binaural hearing aids. Naturally, I was somewhat skeptical about this disorder: Is it real, or does it reside in the realm of the Yeti. View PDFSigns and SymptomsUnilateral sensorineural hearing loss is most common presenting symptom of a patient with an acoustic neuroma. Get in the habit of cleaning the hearing aid after each use and keeping the hearing aid in the dry-aid kit at night.
And, without hearing aid amplification, localization performance in children with UHL rarely equals that of peers. Increase or decrease gain accordingly until the patient reports hearing your voice at the front and center of the head. The patient should have the opportunity to make volume adjustments to match the good ear.11 For young children, the volume control may need to be deactivated for safety concerns. The speaker’s voice will be picked up by the microphone and transmitted wirelessly to the hearing aid.
An evidence-based systematic review of directional microphones and digital noise reduction hearing aids in school-age children with hearing loss. When the behavioral tests were completed, the results indicated normal hearing in his left ear and a profound hearing loss in his right ear. From a purely clinical standpoint, I think that it is poignant because it brings home the importance of understanding what our tests really say about the hearing mechanism and auditory system (ie, is working or not working?). If you answered yes to any of these questions, maybe it is time to get your hearing tested. May have difficulty understanding spoken conversations coming from the side of the head that has the hearing loss. The cochlea has the normal amount of turns, and the vestibule semicircular canals appear normal.
The sensitivity of auditory brainstem response testing for the diagnosis of acoustic neuromas.



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