Chapter 3 Hearing Aids, Hearing Assistance Technologies - PowerPoint Presentation

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Chapter 3

Hearing Aids,Hearing Assistance Technologies& Implants

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Latest Technology

Phonak Roger PenGN ReSound LiNX2

Oticon Opn (IoT)MED-EL RondoJacoti Hearing Suite

AudioeverywhereRechargeable BatteriesPSAPs

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Phonak Roger Pen

Wireless microphone that enables people with hearing loss to hear and understand speech in loud noise and over distance

Compatible Roger receiver for most hearing aids & CisWideband audio Bluetooth (HD voice) for cell phone use, TV connectivity and an audio input for listening to multimedia

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MFi

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LiNX2 & Halo

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Hearing Aid Sales in U.S.

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Trends in HA Sales

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HA Styles Dispensed in

2016¾ of hearing aids were BTE

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Question

Which of the following is NOT true?A cochlear implant primarily amplifies soundA hearing primarily amplifies sound

Hearing aids can be worn by infants from birthLess than 25% of Americans who could benefit from a hearing aid, wear a hearing aidChildren function better with 2 cochlear implants

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Purpose of Hearing Devices

Make speech audibleMake non-speech audibleRestore range of loudnessAlerting

Keep in touch with environment

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Hearing Challenges

Hearing soft speechHearing speech clearlyHearing speech in noisy environmentHearing speech in reverberant environment

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Question

The Augustana Chapel provides a conducive listening environment for persons with a hearing loss?YesNo

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FDA Definition of Hearing Aid

Sec. 874.3300 Hearing Aid.TITLE 21--FOOD AND DRUGSCHAPTER I--FOOD AND DRUG ADMINISTRATION

DEPARTMENT OF HEALTH AND HUMAN SERVICESSUBCHAPTER H--MEDICAL DEVICES(a) Identification. A hearing aid is wearable sound-amplifying device that is intended to compensate for impaired hearing. This generic type of device includes the air-conduction hearing aid and the bone-conduction hearing aid, but excludes the group hearing aid or group auditory trainer (874.3320), master hearing aid (874.3330), and tinnitus masker (874.3400).(b) Classification. (1) Class I (general controls) for the air-conduction hearing aid. The air-conduction hearing aid is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to 874.9.

(2) Class II for the bone-conduction hearing aid.[51 FR 40389, Nov. 6, 1986, as amended at 65 FR 2316, Jan. 14, 2000]

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Types of Listening Devices

Hearing AidsALDs/HATAlerting DevicesBrainstem Implants

Middle Ear Implant Devices (BAHA & Envoy)Cochlear Implants (CI)Smartphone

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Hearing Aid Styles

Air conductionBody Aid

GlassesBTERICRITAITEITC

CICBone ConductionMiddle Ear Implant Devices (BAHA)

 

             

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Question

A RIC hearing aid has the speaker component in the?Ear canalHearing aidMiddle ear

Both ear canal and hearing aid

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Bone Conduction HA

When a conventional hearing aid cannot be worn due to microtia, atresia, obstruction in EAM, bone conduction hearing aids may be beneficial

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BAHA/BAHS (

unisensory conductive loss)Bone Anchored Hearing Aid

: Surgically embedded titanium "post" into skull with a small abutmentA sound processor sits on abutment The implant vibrates the skull and stimulates the cochlea via bone conduction bypassing outer & middle ear

Treatment for:Conductive lossMixed hearing lossesUnilateral sensorineural hearing loss, Chronic ear infectionsCongenital external auditory canal atresia

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Alpha 2 (M) Bone Conduction Hearing System

Sophono Inc.Differding Family Story and Sophono

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MED-EL BoneBridge

BoneBridge

BoneBridge

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SoundBite Hearing System

 SoundBite Hearing SystemSingle sided deafness or conductive hearing loss

No surgery requiredRemovable and totally non-invasive No dental work or alterations to teethBTE (behind-the-ear) microphone unit, housing receiver, wireless transmitter, and attached microphoneRemovable ITM (in-the-mouth) hearing device

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Question

The BAHA is?Air conduction hearing aidBone conduction hearing aidCochlear implant

Brainstem implant

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MED-EL ADHEAR

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Envoy Implant

Middle Ear ImplantEnvoy Medical

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ESTEEM Implant Criteria

at least 18 years of agestable, moderate-to-severe, bilateral sensorineural hearing loss (Range = 40 dB to 70 dB, defined as the average of pure tone thresholds at .5, 1, 2 KHz)

speech recognition test score (WRS) greater than, or equal to, 40% in the worst hearing earnormal tympanic membrane & middle ear anatomynormally functioning Eustachian tubesworn properly fit hearing aids for at least one monthno history of immune compromise or chronic staphylococcal skin infectionsroom in their mastoid cavity to accept the ESTEEM components

able to undergo a 3-4 hours general anesthetic

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VIBRANT SOUNDBRIDGE Middle Ear Implant System (Medel)

Placement Options:Ossicular RoundWindow

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Hearing Aids

Analog (conventional)Programmable (analog or digital)Digital

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Type of Hearing Aids

Analog

hearing aids pick up the sound and convert it into electronic signals. These hearing aids have trimmers that are manually adjusted by a hearing healthcare professional using a tiny screwdriver. Analog hearing aids are the least flexible, but also the least expensive, level of hearing aid technology.

Programmable

Programmable hearing aids must be connected to a computer in order for your hearing healthcare professional to make adjustments. These hearing aids offer more flexibility and can provide more features.

Digital

Digital hearing aids contain computer chips that convert the electronic signal into digital signals. The digital hearing aid can perform complex processing of the sound, such as reducing the intensity of loud background noise. Typically programmed via a computer, offers the greatest flexibility in its ability to match the hearing aid response to the hearing loss.

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Question

A receiver is another name for:MicrophoneSpeakerBattery

Amplifier

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HA Components

Microphone The microphone picks up sounds from the air and convert them into electrical signals.

Amplifier The amplifier increases the intensity of the signals from the microphone. Filters modify the sounds so that only sounds which are relevant for the person are amplified.'Loudspeaker' (Receiver)

The third basic component is the 'loudspeaker' (receiver). It converts electrical signals into acoustic signals, which the person then hears.Small computer (Digital) (How it works)These three components exist in all hearing aids. Furthermore, in digital hearing aids a small computer can be programmed to manipulate the signals to fit the hearing loss of the individual hearing-impaired person.

 

             

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Batteries

Various SizesChemical

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Question

Most hearing aid batteries are?MercuryZinc-airHallogen

Sulfer-free

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Earmolds

Earmolds direct sound into the ear canalVariety of styles, colors, and other characteristics

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Ear Impressions

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Open Canal

Receiver in the EarRIC

Receiver in the Aid RITA

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Thin Tube (Open Canal)

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Hearing Aid Features

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HA Directional Microphones

Most HA have directional microphonesProven beneficial technologyData support use of directional hearing aids in some noisy school environmentsSuggest use of directional mode should be limited to situations in which all talkers of interest are located in front of the student

. (Ricketts & Galster 2007)

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HA Digital Feedback Reduction

Technology has dramatically improved the reduction of acoustic feedbackHelps increase HA gain without “whistle”

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Telecoil—Orientation

Telecoil situated perpendicular to installed loop wire or telephoneIncorrect orientation of telecoil results in attenuated signal

Head orientation and tilting head may result in poor signal receptionPlacement not ideal for landline phone

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Frequency Lowering Hearing Aids

Used to improve high-frequency sound audibilityHigh-frequency sounds are shifted to a lower frequency rangeMay be more beneficial for children than adults (due to adults’ greater linguistic experience)Should be used selectively (more studies are in progress)

Souza et al. 2013; McCreery et al., 2014; Bentler et al., 2014

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Directional Microphones

Most digital hearing aids are equippedApply less gain to noise from different location than talkerImprove relative levels of the talker (“signal”) and background noiseCan improve speech audibility (and understanding) if signal and noise are spatially separated

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Digital N

oise ReductionAttempts to determine what is “noise” and what is “speech” based on their sound patternsMathematically removes the pattern of the noise

May not improve speech understanding, but can reduce listening effort and improve listening comfort

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Hearing Loss in Children: Fatigue and Stress

Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS)Children with HL report greater fatigue of all types compared to children with normal hearing

Reduce the amount of listening effort in difficult listening situations, thereby decreasing stress and fatigueHearing aids and cochlear implantsDigital noise reduction (DNR)Direction microphonesHearing assistive technologiesFM/2.4 GHzClassroom soundfield amplification

(Hornsby et al 2014)

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HA Verification

Real Ear (probe microphone)ABR—for infants & young children

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Probe Microphone

Real Ear measures of sound pressure in the ear canal

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HA Validation

Speech tests (HINT, QuickSIN, BKB-SIN

, SPIN)Subjective ratings of intelligibility and qualityLoudness verificationQuestionnairesFunctional gain

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Data Logging

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Speech Tests

HINTQuickSINBKB-SIN

SPIN

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QuickSIN/BKB-SIN

1.   

SNR loss of 0-2 dB: Normal to near-normal. These patients will probably do well in noise with any hearing aids that provide undistorted output.  With directional microphones, they may hear better than their normal-hearing peers in noisy situations. 2. 

SNR loss of 2-7 dB: Mild SNR loss. Today’s directional microphones provide SNR improvements of 2 to 5 dB; with directional microphones, these patients should be able to hear almost as well as their normal-hearing counterparts in noisy situations. 3. 

SNR loss of 7-15 dB: Moderate SNR loss. While directional microphones will provide benefit for these patients, they cannot provide enough SNR improvement to allow the person to hear as well as their normal-hearing counterparts in noisy situations. Microphone arrays, such as the LinkiT, provide a 7 to 13 dB improvement in SNR.

4.  SNR loss greater than 15 dB: Severe SNR loss. These patients need the maximum amount of SNR improvement, and FM systems are the technology of choice for these patients. Today’s ear-level FM systems are cosmetically appealing and are available in a wide range of hearing aids. Contact hearing aid manufacturers for more information.

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BKB SIN Test

10

sentences presented twiceIncreasing noise with each sentenceSNR loss is the increased S/N ratio required by a listener to understand speech in noise

BKB-SIN Test scores are reported in SNRAge normative dataAllows audiologist to recommend appropriate assistive technology (e.g., omni-directional microphones, directional microphones, array microphones, FM systems, etc.) for students with HL to function in noisy situationsRich in semantic context, thus individuals with HL may be using

top-down processing to improve their performance—does not tax bottom-up processing (Niquette et al 2003)

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Subjective Ratings

Magnitude Production

Pt is given a number and instructed to adjust a given parameter such as intensity, SNR, until that number is reached

Category ScalingPt is given a bounded scale such as 1 to 10 and asked to make a judgment of a speech passage based on intelligibility, quality, etc.

Paired ComparisonsPt compares 2 different settings or hearing aidsClarityPt asked to judge if sound is clear, distinct, pure…the opposite is diffuse

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Loudness Restoration

PAL

Soft, comfortable, loud

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Questionnaires

APHABSADL

IOISSQGHABPPAL

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Classroom Function Hearing Evaluation Using Clickers

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Functional Gain

Compare Aided vs. Unaided results

In the example, the aided (green) thresholds are compared to the unaided thresholds for the right (red) and left (blue) thresholds

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Ling 6 (HL) CD from Phonak

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Ling 6 Sound Check

Evaluate student at variety of distances to determine maximum distance Ling sounds heard

Ling 6 Sound Check ChartLing 6 Behavioral Daily Checklist

Ling 6 Recording Chart

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Ling 6 (HL) (free CD from Phonak)

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UWO Plurals Test (free CD from

Phonak)

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UWO Plurals Test (free CD from Phonak

)

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Phonak Logatom Test

Adaptive, computer controlled testDeveloped by PhonakFemale speaker: “My name is…”Software track level in dB SPL that corresponds to 50% correct performance

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Functional Listening Evaluation

Determine how listening abilities are affected by noise, distance, and visual input in an individual’s natural listening environmentDesigned to simulate listening ability in situations that represent actual listening conditions in student’s classroom– not sound booth Administration of the evaluation, the student’s teachers, parents, and others gain understanding affects of adverse listening conditions encountered by the student.

The evaluation results are also useful in justifying accommodations, such as assistive listening devices, sign language or oral interpreters, notetakers, captioning, special seating, and room acoustic modifications. Functional Listening Evaluation(Ying , 1990), (Ross, Bracken & Maxon, 1992)

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FLE (cont.)

Test administration takes approximately 30 minutes, including set up, with sentences and 20 minutes with words. 1. Auditory-Visual Close Quiet 2. Auditory Close Quiet

3. Auditory-Visual Close Noise 4. Auditory Close Noise 5. Auditory-Visual Distant Noise 6. Auditory Distant Noise 7. Auditory Distant Quiet 8. Auditory-Visual Distant Quiet

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AB IT-MAIS (free iPad app)

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LENA Chart Example

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LENA Developmental Snapshots

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Hart & Risely

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C.H.A.T.

Phonak launched the Child Hearing Assessment Toolkit (C.H.A.T.) at the EAA Summer Conference 2013. New web-based tool allows hearing care professionals working in education to go digital - selecting, filling out and managing their patient assessments on any laptop, desktop PC or tablet device

.Try C.H.A.T. at www.chatbyphonak.comMore info found at http://ow.ly/mpf9t

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Oticon Hearing Diary App (iOS)

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Oticon

Functional Auditory Measures

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Binaural vs. Monaural Advantage

head shadowloudness summationlocalizingsignal to noise ratio

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Marvel Superhero HL

A 4-year-old boy in Salem, MA who decided he did not want to wear his blue hearing aid to school anymore received some new inspiration after Marvel Comics designed a superhero after him.

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Hearing Assistive Technology (HAT)

Refers to devices and services that help deaf and hard of hearing people compensate for hearing lossFour primary categories of HAT:

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Phone communicationLandline, mobile phone, etc.Alerts

Doorbell, alarms, telephone ring, environmental sounds, etc.Listening to talkersOne on one, group, place of worship, meeting, classroom, lecture, conferences, presentation, theater, etc.Media Radio, TV, mp3, YouTube, etc.

It’s in the PALM: HAT Types

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HAT includes listening, alerting, and/or signaling devices that use auditory, visual, and/or tactile modalities to facilitate communication and/or awareness of environmental sounds.

What is HAT?

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No single HAT suites every listening/alerting situation 

Each HAT interfaces differently with hearing aids or implants  Each HAT generally operates differentlyLaszio, (2012) Canadian Hearing Report, Vol.7  No.6.

The HAT Challenge

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DAILY EVENT

HEARING

ASSISTIVE DEVICESWake-up

Alarm clock with vibrator and/or flashing light

Land lines: home and work

HAC phone, texting, built in amplification, ringer

connected to visual or vibrator signal, speech recognition

1:1 conversationsPersonal communication device (FM or infrared)

Small group meetings

Portable FM or infrared device, loop, real-time captioning, 1:1

personal communicator

Noisy restaurant

Personal

communication device

with directional

mike

Large group meetings

Large-area

infrared

, FM or loop

system

Cell

phone

HAC

p

hone, vibrate option,

t

exting,

h

igh volume output

 

Vehicle

1:1 device

with directional

mike, emergency siren recognizer

Family

meals

Portable infrared or FM device

in middle

of

table

TV

Captioning, Infrared

, FM or loop

connected

to

TV

Door

bell

Vibrator worn on body and flashing

lights

Child care

Baby monitoring device with vibrating annunciator

Fire/Carbon

Monoxide

alarm

Flashing lights and/or vibrating

annunciator

Weather alert

Weather

radio

with vibrator and/or

flashing light

Theater

Infrared, loop or FM

Laszio

,

(2012)

Canadian Hearing Report, Vol.7  No.6.

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How ALDs/HAT Help

Bypassing or minimizing background noise Overcoming the weakening effect of sound traveling through air Reducing the effect of poor room acoustics

Signal to noise ratio (SNR) – background noiseDistance from the speaker/talkerReverberation

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Title II of the ADAEffective Communication

A November 2014 policy guidance from the US Department of Education and US Department of Justice clarified that, under Title II of the ADA, schools are required to ensure that

 communication for students who are deaf and hard of hearing “are as effective as communication for others” [ADA Title II 28 C.F.R. 35.160(a)(1)] through the provision of appropriate aids and services “affording an equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others” [ADA Title II 28 C.F.R. 35.130 (b)(1)(iii)] and “to participate in and enjoy the benefits of the district’s services, programs, and activitie

s” (DOJ-DOE p14). These requirements apply to all school-related communications for children ages 3 through high school in public schools, including charter and magnet schools.

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ALDS/HAT

Loop Induction (Loop)(Electromagnetic)Radio FrequencyAMFM (most used system in educational settings)

FM plus Video900 MHz (Starkey)2.4 GHz (ReSound)BluetoothLight (Infrared)Hardwire

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ALDs/HAT

Loop Induction Systems

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Loop Induction Components

MicrophoneLoop amplifierLoop wireTelecoil

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Loop Inducton

Large areaHome area (cushion loop pad)

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Loop Options

Silhouette:

Near telecoil and signal relatively low therefore less susceptible to) most EMI (ElectroMagnetic Interference). Stay aligned relative to the hearing aid, they are less sensitive to head position.

Neckloop:Drive both hearing aids (not with true stereo, but with a mono signal into both aids). Does not require wires running up the neck to the hearing aid(s), and can be worn under a shirt or jacket.

Portable Loop

Portable and able to carry

Communicate one on one or in small groups, cars, etc.

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Loop Induction

LI transmits via an electromagnetic field and require no receiver if the hearing aid wearer has a

telecoilOval Window

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Loop Induction: Telecoils

Inductive/audio loop systems transmit an electro- magnetic field Receivers are not necessary for hearing aid wearers with a telecoil (the telecoil itself is the receiver)

Loop receivers can be provided for people who do not have telecoils. Loops are often permanently installed

Neckloop

Direct audio input

Silhouette inductor

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ClearSounds

Quattro 4.0

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ALDs/Hat

Radio Frequency Systems

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Question

Radio Frequency can include:AMFMBluetooth

All the aboveA and B

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Question

Which is a digital signal for HAT technology?AMFMBluetooth

All the aboveA and B

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Radio Frequency

FM (radio frequency) systems

transmit radio waves to receivers

Used in classrooms and where mobility is requiredNot affected by light, able to cover 100+ feet, and are portableSystems can be set to different frequencies to allow several uses in same place Miniaturized FM receivers using the 216-217 mhz range are available as an attachment for some BTEs and CI processorsSome FM transmitters have built-in microphones that can switch from an omnidirectional, directional and/or super directional setting

Susceptible to some radio interference

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Radio Frequency Systems

PhonakMulti-frequency receivers (MLxS, ML8S and ML9S)

synchronized automatically using the WallPilot or directly with Campus S. The MLxS also has a standardized connector that makes it compatible with both Phonak hearing instruments and BTEs from other manufacturersSingle-frequency receivers (MLx, ML8, ML3-7)single-frequency receiver which clips to BTE hearing aidMicroLink CI Sminiaturized FM receiver for cochlear implant users that attaches directly to the bodyworn speech processor

WallPilot hangs at the entrance to a room and performs an Automatic Frequency Synchronization (AFS) and ensures that the multi-frequency receivers of wearers entering the room are automatically set to the correct frequency

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Phonak Dynamic FM Inspiro

Phonak Dynamic Inspiro Studies show students with Dynamic FM on average improve 50% in loud noisy situations

Recommended for students wearing hearing aids or cochlear implants

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2.4 GHz

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Phonak Roger

RogerPhonak Roger Pen2.4 GHz bandwidth

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Jace Wolfe 2013

CIs with Roger

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Thibodeau L 2013

HA with Roger in Classroom

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FM Radio Frequency Systems

Phonic EarSprite BTE FMused by people of all ages who have hearing abilities ranging from normal to profound loss used in the car, at restaurants and parties, watching TV, on tours, and talking with others across a distance.

students with ADD or CAPD benefitToteable

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Oticon (FM)

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AVR (FM)

AVR Sonovation was one of the first companies to develop FM receivers inside the BTE hearing aid.

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Bluetooth 4.0 LE

Bluetooth is a short-range, wireless, digital communication standard. Bluetooth devices send data and voice in a clean, clear, digital format

audio signal is not subject to the same sources of signal degradation that sometimes compromise the quality of analog (FM, AM or inductive) transmissions. Radio frequency transmission in the 2.4-gigaHertz range

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BlueTooth Advantages

Bluetooth signal is extracted from the noise; it alone is transmitted and amplified, while noise is rejected. Minimizes battery consumption for portable devices

Also, it places an intentional limit on the range of transmission — the most common version has a range of 10 meters which helps to avoid interference among nearby devicesWalls and other obstacles have a negligible effect on Bluetooth transmission

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BlueTooth Interference Advantage

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Bluetooth (RF)

Open standard for wireless communicationsNearly 12,000 products using Bluetooth

Uses more computational and power resources to operate than a designed for hearing aidsBluetooth Version 4.0 (2.4 GHz)Remains under development…receiver may eventually be housed in hearing aidNo hearing aid/CI/BAHAHoused in streamerCouples phone or mp3 players wirelessly to streamer

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ALDs/HAT

Infrared Systems

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Infrared

Infrared systems transmit sound via infrared light waves to receivers worn by users

IR commonly used in courtrooms, movies, and live performance theaters, conventions and with TVs (signal contained in room)Infrared systems may be susceptible to interference from bright sunlight or fluorescent lightsRequires line-of-sight between the IR transmitter and the receiver, IR waves can effectively reflect off some surfaces, depending upon the power of the transmitter

 

                     

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WiFi System

A recent development may add a new option to providing access to speakers/talkers in schools and public meeting placesWiFi may be implemented in more locations than other HAT systems and install are increasingWiFi access may become ubiquitous

Uses existing technologies

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Jacoti ListenApp

(free) iOSFDA approved, optimized for use with Apple EarPods

and personal audiogram

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Classroom Soundfield Amplification

BenefitsChildren with temporary HLImprove S/N ratio

Reduce teacher vocal fatigueChildren with APD and ADHD (hearing in noise)Improves academic achievement and behaviorIncreased word and sentence recognitionImproves literacy growthDisadvantagesWill not compensate for poor classroom acousticsPoor installation/systems may not be helpfulPoor microphone management by teacher not helpful

Unclear speech by teacher not helpful

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Sound Field Systems

Portable or permanently installed speakers placed close to listeners at a distance from the speakerThey are most often used in classrooms and are helpful for people with mild to moderate loss

They offer a secondary benefit to those who are not HOHWireless speakers perform the same function. Audio Enhancement Video 1LightSpeed

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Phonak Dynamic Soundfield

Phonak Dynamic Soundfield with Inspiro

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Classroom Amplification Systems

Self install systems:LightSpeed REDCAT

Phonak Dynamic SoundField

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Phonak Dynamic Soundfield

Inspiro Dynamic microphoneCompatible with Dynamic FM receivers, BAHA, other HASoftware updatable

Remote computer accessMonitors classroom environment and adjusts volume and frequencyProvides optima S/N ratioConnects to Smartboard

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Children with HL Require +15 dB SNR

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Classroom Signal to Noise Ratio (SNR)

17 kindergarten classrooms: -1 dB SNR12 elementary classrooms: +5 dB SNR12 high school classrooms: +5 dB SNR

(Sanders, 1965)

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Phonak 5000 DigiMaster

Classroom System

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Personal FM with Roger Best OptionChildren with Hearing Loss

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Phonak Classroom Dynamic Soundfield

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Phonak Roger Studies

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Vibrotactile Devices

Tactaid - small, battery-powered instruments that can help a deaf person understand sounds by allowing the user to feel the unique pattern of vibrations present in every sound

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Why HAT?

NoiseRecommended quiet room conditions are 35 dBAMost classroom above 35 dBA

Signal to Noise Ratio (SNR)Younger children (6 years) with normal hearing require significantly higher signal-to-noise values (>+15dB) for speech recognitionReverberationNeed reduced reverberation times for speech recognitionReverberation AND noise have far greater impact on hearing aid users compared to normal hearing individualsDistance Hearing aids and implant devices function best 3-8 feetClassroom teacher-student distance can vary

Bradley & Sato, 2008; Neuman et al, 2010, Nishi et al, 2010; Valente et al, 2012; Yang and Bradley, 2008

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ALDs (HAT)

Assistive listening devices and systems (including couplers and accessories for hearing aids and cochlear implants)Alerting devices and systems (weather, doorbell, phone, fire/smoke alerting devices)

Amplified telephones (some of which have tone controls and/or audio output jacks) and telephone accessoriesTTYs (teletypewriters), VCO (Voice Carry Over) phones, CapTel, and telecommunications-related software and services Speech-to-text services and technology, such as CART (Computer Assisted Realtime Transcription), C-Print and CAN; closed caption decodersVideophones and other visual technology to facilitate speechreading and/or the use of sign language or cued speech

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Question

POTSPerry on teaching sciencePlain old telephone systemPeaches on tea and sun

Popular only TV showsNone of the above

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TELECOMMUNICATIONS

TelevisionTelephonesPOTS (plain old telephone system)Cell Phones

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TELECOMMUNICATIONS: TV

Television There are two ways to understand communication on TV: hear it or read it: closed captions, a menu option ability built into most TVs (TVs over 13 inches in diameter sold after 1993).

HAT Increase volume on a personal receiver, not TV sound across the roomMost are cordless and utilize different types of technologiesSome devices marketed specifically for TV useHearing aid users and non hearing aid users can use technologies

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TELECOMMUNICATIONS: PHONES

Two needs with phones:

understanding conversation on the phoneknowing phone is ringingThere are two ways to understand the conversation on the phone: hear it or read it. There are four basic types of telephone amplifiers: portable, handset, inline and phone set.

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TELECOMMUNICATIONS: PHONES

Types of telephone amplifiers: PortableHandsetInlinephone set

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TELECOMMUNICATIONS: PHONES

Portable amplifiers Not recommended for regular useInconvenient--strapped onto a phone handset turned off after use or battery runs deadOccasionally helpful with wireless phones that do not have amplification

May make a phone hearing aid compatiblePeace of mind for use while traveling

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TELECOMMUNICATIONS: PHONES

In-line amplifiersdevices that connect to the jack in the phone where the curly handset cord plugs inmay be a good value, as some go as high as 40 dBCompatible with most phones, home and business.

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TELECOMMUNICATIONS: PHONES

Amplification handsetsReplace original phone receiverLess popularAdjustment controls in the handle In some cases, not electrically compatible

universal amplifier (battery or A/C powered) used for compatibility

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TELECOMMUNICATIONS: PHONES

Amplified phonesMany features

Some provide 50 dB gain. Louder not always helpful for claritySome provide tone controlAdditional features (optional)variable ringer soundsbuilt-in ringer light flash

big buttons for dialingaudio jack HATmay require electrical outlet connectioncordless amplified phones

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TELECOMMUNICATIONS: PHONES

Other telecommunications devicespagers cell phones

faxemailtexting Phone company custom calling helpful featurescaller ID (for calling back the person through relaydistinctive ringing (for differentiating voice and TTY calls)

voice mail (to listen to voice messages with amplified phones or via the relay service)

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Internet

EmailSocial networks (FaceBook, Twitter, etc.)FaceTime, Google Hangouts and IP RelayIP VRS

CapTelWeb CapTel/mobile CapTel

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Access Glasses

Sony’s Entertainment Access Glasses are closed-caption glasses for moviesDirect line of sight to movie screen with captioned text right on the lenses 

Regal Theaters availableCurrent locations

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Hearing Aids and You!

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CI Manufacturers

MED-ELAdvanced BionicsCochlear

Neurelec

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Video Resources

How a cochlear implant works8 Month Old Deaf Baby's Reaction To Cochlear Implant Being ActivatedThe RONDO cochlear implant from MED-EL | 2D | I

GBMC Cochlear Implant Center - MappingCochlear Implant Mapping Part 3

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How does an implant work?

Sound picked up by microphone

Electrical pulses of sound signals sent to speech processorSpeech processor codes sound signalsCode is sent to transmitter

Transmitter sends coded sound across skin to internal receiver (via FM transmission)Receiver converts code to electrical signalsElectrical signals sent to electrode array

Signals recognized as sound by the brain

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Why are the outcomes different for each child

?

Age at time of implantPre-implant duration of deafness Etiology of hearing lossResidual hearing prior to implant

Family supportImplant technology/channelsConsistency of usage

Appropriate programming of deviceAdditional special needsQuality of educational and habilitative environment

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CI Parts

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Criteria for Cochlear Implantation in Children

In general, it is recommended child wear HAs 3-6 months before determining implant candidacyMeningitis,

shorter HA trial may be recommended or trial waived as bony growth in the cochlea following meningitis may create problems for implantation Implantation prior to 12 months of age to insure adequate insertion of electrodes into cochlea before

bony growth fills cochleaDegree of hearing loss Between 12 months and 18 months of age: Profound SNHL of 90 dB or greater in both ears

18 months of age and older: Severe-to-profound sensorineural hearing loss of 70 decibels or greater in both ears

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Criteria for Cochlear Implantation in Children

Lack of benefit from hearing aidsInconsistent response to his/her name in quietFailure

to alert to environmental sounds while wearing amplificationNo medical contraindicationsContraindications include absence of the auditory nerve; medical conditions or developmental delays that would severely limit participation in aural habilitation; and active middle ear infections.Children should be in rehabilitative or educational setting where

development of auditory (listening and speaking) skills emphasized High motivation, positive family environment, and realistic expectations in a child's performance of CI

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Deciding which ear to implant-some issues to consider

Anatomy (lack of calcification, is there an auditory nerve,

malformed/no cochlea)

Perhaps one ear accepts electrical stimulation better than otherLeave ear with better hearing, implant worse ear, then if not successful can revert back to aiding that earImplant better ear (opposite argument) - It has already benefited from hearing aid, will more readily acclimate to implant

Facial nerve too close to cochlea-may pick other earIf no difference may want it on right- as speech and hearing centers of brain on left

Want on right- later for later when driving. Can hear people in the car

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Surgical Considerations

General

·   

Usually outpatient, 1-2 hours 

·   Two parts of implant are inserted during surgery- electrode array in cochlea and the implant body placed in mastoid bone. Body holds a magnet that attaches to external components of the implant.

 

After

·

Usually up and

around in 1-2 days

·May be some

swelling externally

·

Warned of some

possible nausea

from anesthesia

·

  W

ait 4-5 weeks for all swelling/healing to take place before activation

 

During

·

       

Shave area

·

       

Mastoid bone uncovered (skin flap)

·

       

Carve space for body of implant

·

       

Drill hole to cochlea

·

       

Small opening in cochlea to insert

electrode array

·

       

Incision closed

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What about insurance

Cost of cochlear implant is $40,000-50,000

Most private insurance companies are paying for surgery

Most of the time Medicaid pays 90-100%May be problems with insurance related to child being too young based on FDA guidelines

Implant manufacturers have special departments to handle insurance related problems and secure payment.Some insurance companies pay for post implant training/mapping Only a few insurance companies pay for upgrades (ear level) ( may get coupon for upgrade from the manufacturer)

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Not CI Candidates

a child that does not have the eighth nerve (auditory nerve) which carries sound from the cochlea to the brain as determined by a CAT scan (x-ray) and/or Magnetic Resonance Imaging (MRI) during the candidacy process. a child who has significant residual hearing levels and receives good benefit from traditional hearing aid devices.

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Mapping Cochlear Implants

Threshold (T) awarness/detectionComfort (C or M) Levels

Loudness Balancing (judge relative loudness of signals presented to different electrodes)Pitch Ranking (ability to discriminate pitch from one electrode to the next, basal to apical end)During mapping process, "T" and "C" levels of each individual electrode on CI internal electrode array (the spiral located inside the inner ear or "cochlea") are adjusted for the user to hear wide range of sounds that one is typically exposed (soft to loud).

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Mapping

YouTube CI MappingYouTube CI Mapping IIYouTube CI Map of 8 mo oldYouTube Ling 6 with CI