amp Implants Latest Technology Phonak Roger Pen GN ReSound LiNX2 Oticon Opn IoT MEDEL Rondo Jacoti Hearing Suite Audioeverywhere Rechargeable Batteries PSAPs Phonak Roger Pen ID: 920755
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Slide1
Chapter 3
Hearing Aids,Hearing Assistance Technologies& Implants
Slide2Latest Technology
Phonak Roger PenGN ReSound LiNX2
Oticon Opn (IoT)MED-EL RondoJacoti Hearing Suite
AudioeverywhereRechargeable BatteriesPSAPs
Slide3Phonak 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
Slide4MFi
Slide5LiNX2 & Halo
Slide6Hearing Aid Sales in U.S.
Slide7Trends in HA Sales
Slide8HA Styles Dispensed in
2016¾ of hearing aids were BTE
Slide9Question
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
Slide10Purpose of Hearing Devices
Make speech audibleMake non-speech audibleRestore range of loudnessAlerting
Keep in touch with environment
Slide11Hearing Challenges
Hearing soft speechHearing speech clearlyHearing speech in noisy environmentHearing speech in reverberant environment
Slide12Question
The Augustana Chapel provides a conducive listening environment for persons with a hearing loss?YesNo
Slide13FDA 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]
Slide14Types of Listening Devices
Hearing AidsALDs/HATAlerting DevicesBrainstem Implants
Middle Ear Implant Devices (BAHA & Envoy)Cochlear Implants (CI)Smartphone
Slide15Hearing Aid Styles
Air conductionBody Aid
GlassesBTERICRITAITEITC
CICBone ConductionMiddle Ear Implant Devices (BAHA)
Question
A RIC hearing aid has the speaker component in the?Ear canalHearing aidMiddle ear
Both ear canal and hearing aid
Slide17Bone Conduction HA
When a conventional hearing aid cannot be worn due to microtia, atresia, obstruction in EAM, bone conduction hearing aids may be beneficial
Slide18BAHA/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
Slide19Alpha 2 (M) Bone Conduction Hearing System
Sophono Inc.Differding Family Story and Sophono
Slide20MED-EL BoneBridge
BoneBridge
BoneBridge
Slide21SoundBite 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
Slide22Question
The BAHA is?Air conduction hearing aidBone conduction hearing aidCochlear implant
Brainstem implant
Slide23MED-EL ADHEAR
Slide24Envoy Implant
Middle Ear ImplantEnvoy Medical
Slide25ESTEEM 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
Slide26VIBRANT SOUNDBRIDGE Middle Ear Implant System (Medel)
Placement Options:Ossicular RoundWindow
Slide27Hearing Aids
Analog (conventional)Programmable (analog or digital)Digital
Slide28Type 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.
Slide29Question
A receiver is another name for:MicrophoneSpeakerBattery
Amplifier
Slide30HA 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.
Batteries
Various SizesChemical
Slide32Question
Most hearing aid batteries are?MercuryZinc-airHallogen
Sulfer-free
Slide33Earmolds
Earmolds direct sound into the ear canalVariety of styles, colors, and other characteristics
Slide34Ear Impressions
Slide35Open Canal
Receiver in the EarRIC
Receiver in the Aid RITA
Slide36Thin Tube (Open Canal)
Slide37Hearing Aid Features
Slide38HA 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)
Slide39HA Digital Feedback Reduction
Technology has dramatically improved the reduction of acoustic feedbackHelps increase HA gain without “whistle”
Slide40Telecoil—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
Slide41Frequency 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
Slide42Directional 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
Slide43Digital 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
Slide44Hearing 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)
Slide45HA Verification
Real Ear (probe microphone)ABR—for infants & young children
Slide46Probe Microphone
Real Ear measures of sound pressure in the ear canal
Slide47HA Validation
Speech tests (HINT, QuickSIN, BKB-SIN
, SPIN)Subjective ratings of intelligibility and qualityLoudness verificationQuestionnairesFunctional gain
Slide48Data Logging
Slide49Speech Tests
HINTQuickSINBKB-SIN
SPIN
Slide50QuickSIN/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.
Slide51BKB 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)
Slide52Subjective 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
Slide53Slide54Loudness Restoration
PAL
Soft, comfortable, loud
Slide55Questionnaires
APHABSADL
IOISSQGHABPPAL
Slide56Classroom Function Hearing Evaluation Using Clickers
Slide57Functional 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
Slide58Ling 6 (HL) CD from Phonak
Slide59Ling 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
Slide60Ling 6 (HL) (free CD from Phonak)
Slide61UWO Plurals Test (free CD from
Phonak)
Slide62UWO Plurals Test (free CD from Phonak
)
Slide63Phonak Logatom Test
Adaptive, computer controlled testDeveloped by PhonakFemale speaker: “My name is…”Software track level in dB SPL that corresponds to 50% correct performance
Slide64Functional 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)
Slide65FLE (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
Slide66Slide67AB IT-MAIS (free iPad app)
Slide68LENA Chart Example
Slide69LENA Developmental Snapshots
Slide70Hart & Risely
Slide71C.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
Slide72Oticon Hearing Diary App (iOS)
Slide73Oticon
Functional Auditory Measures
Slide74Binaural vs. Monaural Advantage
head shadowloudness summationlocalizingsignal to noise ratio
Slide75Marvel 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.
Slide76Hearing Assistive Technology (HAT)
Refers to devices and services that help deaf and hard of hearing people compensate for hearing lossFour primary categories of HAT:
Slide77Phone 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
Slide78HAT 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?
Slide79No 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
Slide80DAILY 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.
Slide81How 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
Slide82Title 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.
Slide83ALDS/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
Slide84ALDs/HAT
Loop Induction Systems
Slide85Loop Induction Components
MicrophoneLoop amplifierLoop wireTelecoil
Slide86Loop Inducton
Large areaHome area (cushion loop pad)
Slide87Loop 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.
Slide88Loop Induction
LI transmits via an electromagnetic field and require no receiver if the hearing aid wearer has a
telecoilOval Window
Slide89Loop 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
ClearSounds
Quattro 4.0
Slide91ALDs/Hat
Radio Frequency Systems
Slide92Question
Radio Frequency can include:AMFMBluetooth
All the aboveA and B
Slide93Question
Which is a digital signal for HAT technology?AMFMBluetooth
All the aboveA and B
Slide94Radio 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
Slide95Radio 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
Slide96Phonak 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
Slide972.4 GHz
Slide98Phonak Roger
RogerPhonak Roger Pen2.4 GHz bandwidth
Slide99Jace Wolfe 2013
CIs with Roger
Slide100Thibodeau L 2013
HA with Roger in Classroom
Slide101FM 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
Slide102Oticon (FM)
Slide103AVR (FM)
AVR Sonovation was one of the first companies to develop FM receivers inside the BTE hearing aid.
Slide104Bluetooth 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
Slide105BlueTooth 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
Slide106BlueTooth Interference Advantage
Slide107Bluetooth (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
Slide108ALDs/HAT
Infrared Systems
Slide109Infrared
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
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
Slide111Jacoti ListenApp
(free) iOSFDA approved, optimized for use with Apple EarPods
and personal audiogram
Slide112Classroom 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
Slide113Sound 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
Slide114Phonak Dynamic Soundfield
Phonak Dynamic Soundfield with Inspiro
Slide115Classroom Amplification Systems
Self install systems:LightSpeed REDCAT
Phonak Dynamic SoundField
Slide116Phonak 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
Slide117Children with HL Require +15 dB SNR
Slide118Classroom Signal to Noise Ratio (SNR)
17 kindergarten classrooms: -1 dB SNR12 elementary classrooms: +5 dB SNR12 high school classrooms: +5 dB SNR
(Sanders, 1965)
Slide119Phonak 5000 DigiMaster
Classroom System
Slide120Personal FM with Roger Best OptionChildren with Hearing Loss
Slide121Phonak Classroom Dynamic Soundfield
Slide122Phonak Roger Studies
Slide123Vibrotactile 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
Slide124Why 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
Slide125ALDs (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
Slide126Question
POTSPerry on teaching sciencePlain old telephone systemPeaches on tea and sun
Popular only TV showsNone of the above
Slide127TELECOMMUNICATIONS
TelevisionTelephonesPOTS (plain old telephone system)Cell Phones
Slide128TELECOMMUNICATIONS: 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
Slide129TELECOMMUNICATIONS: 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.
Slide130TELECOMMUNICATIONS: PHONES
Types of telephone amplifiers: PortableHandsetInlinephone set
Slide131TELECOMMUNICATIONS: 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
Slide132TELECOMMUNICATIONS: 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.
Slide133TELECOMMUNICATIONS: 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
Slide134TELECOMMUNICATIONS: 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
Slide135TELECOMMUNICATIONS: 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)
Slide136Internet
EmailSocial networks (FaceBook, Twitter, etc.)FaceTime, Google Hangouts and IP RelayIP VRS
CapTelWeb CapTel/mobile CapTel
Slide137Access 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
Slide138Slide139Slide140Hearing Aids and You!
Slide141Slide142CI Manufacturers
MED-ELAdvanced BionicsCochlear
Neurelec
Slide143Video 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
Slide144How 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
Slide145Why 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
Slide146CI Parts
Slide147Criteria 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
Slide148Criteria 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
Slide149Deciding 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
Slide150Surgical 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
Slide151What 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)
Slide152Not 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.
Slide153Mapping 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).
Slide154Mapping
YouTube CI MappingYouTube CI Mapping IIYouTube CI Map of 8 mo oldYouTube Ling 6 with CI