Hearing is important because it connects us with people and our surroundings: Our Family and Friends – whether they live cross town or next door, you depend on your hearing to interact with them in person or on the phone. The Sounds In Our Environment – (put in a personal story about sound that you love and why it is important for you to hear) Music – Music is a complex signal made up of many different sounds. When parts of music are missing, it can sound very different or distorted and may no longer be enjoyable. This is what occurs with hearing loss. A person may hear parts of the music but is not perceiving the entire complex signal. (Personal story about how music is important to you… radio, grandchildrens’ concert, etc..) The “Sounds of Life” do not sustain life, but they do impact a person’s quality of life – isolation from the ones you love; inability to enjoy the sounds that you love.
Many of the activities that we enjoy and are involved with in life use the ability to hear, like: Listening to your favorite radio station or TV shows Talking on the telephone – You depend on the telephone to keep in touch with friends and family and to make appointments, and get information Meetings – at work or with groups that you are involved with Religious Services – where both speech and music typically are present, and are often at a distance from you Theater – similar listening situation to religious services Traveling – communicating with those you are traveling with—be it in a car or airplane—and with persons you encounter during your travel
When it comes to general safety for ourselves and others, we all rely on our hearing. We must be aware of our environmental surroundings to know what is occurring around us so that we prepare for and prevent danger from occurring. Driving, walking, and public places all require us to constantly be monitoring sounds around us. Our hearing is often the first sense to detect any kind of movement. Environmental sounds are often not in our direct line of sight, and we depend on our hearing to detect them – phone calls, door bells, alarms and smoke detectors.
The ear is an amazing structure in the human body. There are three different parts to our ear structure that each play a different and important role in hearing. Let’s take a look at each of these three different parts….
First, the outer ear is made up of the pinna. The pinna gathers sound and sends it down the ear canal, which then channels the sound to the eardrum. If you use your hand cupped behind your ear, you are gathering more sound to send down the ear canal. This can enhance sound by 6-8 dB.
Second is the middle ear – the sound channeled down the ear canal hits the eardrum and causes the eardrum to vibrate. These vibrations are sent via the eardrum to the three tiny bones in the middle ear – the bones are the malleus, incus and stapes. (For trivia buffs – these are the three smallest bones in the human body.) So the eardrum and middle ear bones vibrate and send the vibrations (sound) to the inner ear.
And now, third – the inner ear. There are thousands of tiny hair cells within the inner ear surrounded by fluid. When the inner ear is vibrated, the fluid begins to vibrate and subsequently moves the hair cells. When the hair cells move (vibrate), they send a signal to the hearing nerve and the hearing nerve sends the information to our brain. Our brain then perceives these signals as sound. In summary: The outer and middle ear transmit sound mechanically through vibration; and the inner ear sends the sound through nerve signals to the brain. That is how we hear.
There are two main types of hearing loss, the first is a conductive loss. Conductive losses are caused by problems in the outer or middle ear – something is causing the sound not to be “conducted” properly through the outer or middle ear. The most common cause in the outer ear is excessive earwax. For some people, earwax has a tendency of building up and completely blocking the ear canal causing a hearing loss. However, this is not the problem in the majority of people. In the middle ear, the eardrum can be damaged due to excessive infections or trauma (ie. Injury by a Q-tip). If the eardrum does not heal properly or is scarred, hearing loss can result. Children that have chronic fluid in their middle ear space often have a temporary conductive hearing loss. Also, if the middle ear bones do not vibrate properly due to stiffness and/or due to injury (ie. Acute head trauma), hearing loss can result. Conductive hearing loss is often treated by medical treatment. Medical treatment may include surgery to correct the problem.
The second type of hearing loss is Sensorineural Hearing Loss. These types of hearing losses are caused by problems in the inner ear – those tiny hair cells that transmit sound to the nerve are not working correctly. The most common cause of sensorineural hearing loss is due to aging. All the hearing that we do over the years causes “wear and tear” on the hair cells. Throughout our life, we are exposed to intense sounds that may damage our hearing. Hunting, factory work, and even listening to loud music can contribute to the hearing loss. Over time, these damaging sounds can result in permanent damage to the inner ear hair cells or hearing nerve. You have a greater chance of hearing loss if your mother or father, grandpa or grandma had a hearing loss. Sensorineural loss can be treated/corrected very successfully by hearing aids. It is possible for someone to have both a conductive and sensorineural hearing loss, and it is referred to as a mixed hearing loss.
Your hearing professional has been trained to identify hearing loss and to assess how the hearing loss may be affecting your life. Based on this knowledge, they are educated to provide a recommendation on how to resolve hearing problems.
(Read the points on the slide)
This is a chart or audiogram that is used to plot your hearing. When conducting an audiogram you are asked to raise your hand or push a button every time you hear a beep. The red, round symbols represent the right ear. And the blue X represents the left ear. There are two scales. The first going across the top represents the frequency or pitch of the beep. It is arranged just like a piano keyboard -- low pitch sounds to the left and high pitch sound to the right. The second scale is the intensity or loudness of the beep. The lower on the chart the worse your hearing is. You can see we classify sounds -- normal hearing 0 – 20 db, mild loss 20-45 db, moderate loss 45 – 70 db, severe loss 70 – 90 db, and profound loss below 90 db. Typically hearing loss is not represented in percentage, but rather a degree of hearing loss. Each degree represents a range, so it is hard to give an exact percentage to loss.
Here is an example of how normal hearing compares with normal hearing in the lows dropping down to a moderate high frequency hearing loss. This hearing loss is called “Presbycusis” and refers to the gradual loss of hearing due to age and results in the loss of hearing in the higher pitches first. So what can this individual hear or not hear?
This screen displays where familiar sounds occur in regards to frequency (pitch) and intensity (loudness). Remember the previous hearing loss – hearing dropped to 60 dB in the high frequencies. So everything above the plotted line on the previous slide, they can’t hear – so they can’t hear a fan or leaves rustling. For speech, they cannot hear high frequencies like f, sh, th and s. In order to hear these sounds, the sounds would have to be amplified above the level that they can hear. The speech sounds displayed on this audiogram represent the “speech banana” which shows how some speech sounds are low in pitch and others are very high in pitch. This explains why different types and shapes of hearing loss can affect people differently when it comes to listening to speech. For example, some persons have problems hearing female voices, while others have problems hearing male voices.
People may have hearing loss in an area only certain speech sounds are present; thus they can hear some of the speech sounds but not all of them, so speech is unclear. For example, the consonants listed here are located in the higher pitch region where many people have hearing loss (as seen in the speech banana). This results in the popular “I can hear but I can’t understand” – one can hear someone is talking but because they don’t have normal hearing in both the low and high frequency region--usually high frequency information is missing--it is impossible to understand everything that is said. Sometimes, even if you talk louder they can’t understand.
(This is an opportunity for interaction especially if spouse is present. Ask the audience for signs of hearing loss) (Review slide) Often times, people are unaware of the amount of hearing loss they have due to the gradual onset of the hearing loss. Persons with hearing loss often do not realize how much they have been missing until they get some help. Often times family and friends notice the problem before the person with hearing loss does.
Regaining the ability to fully communicate with those around you can bring new light to many lives. Human relationships and interactions drive our emotions and overall being. (Read last paragraph)
Hearing loss affects more than your quality of life. It can also affect your income. (Read the slide)
(Go over points in slide) Examples of good communication strategies: Utilize eye contact when speaking to someone While speaking to someone, ensure you are in the same room as them If in a group situation, face the person you are listening to Correctly fitted hearing aids are those that are appropriate for your lifestyle and your hearing loss. Each person is very unique in terms of their hearing needs.
(Review slide) Let’s take a look at these four items that make hearing aids different.
The size of hearing aid is determined by the amount of hearing loss, the size of the patient’s ear, and the patient’s preference in size. The greater the hearing loss, the larger the hearing aid needs to be. Also, the smaller the hearing aid, the higher the price.
Digital hearing aids can offer the best in flexibility and sound quality. The actual chip or integrated circuit in the hearing aid can perform millions of calculations to provide the best hearing – in quiet and in noise. 95% of the hearing aids sold today are digital. Conventional hearing aids have been around for a long time. These hearing aids use amplifiers and resistors to provide the proper amplification for each individual. Few adjustments can be made with this instruments. Sound quality is usually limited. Today only 5% of hearing aids sold are conventional.
As mentioned before, everyone’s hearing needs are unique. And hearing needs can change over time. Flexibility in hearing aids are very important so that your hearing aid can change as you change. Digital hearing aids that can be customized using a computer can provide the optimum in flexibility (depending on the manufacturer).
Difficulty hearing in background noise is one of the most common complaints of persons with hearing loss. Difficulty in background noise is typically the first sign of hearing loss since persons were used to their normal auditory system filtering out unwanted distracting sounds. When hearing loss is present it is much more difficult for a person to filter out unwanted noise. The background noise may begin to overpower the hearing sensitivity that remains and the brain is unable to hear the wanted speech clearly.
What are directional microphones and how do they work? Typically hearing aids have one microphone, which picks up sound all around you – in front of and behind you. Most commonly, the sound you want to hear is in front of you (someone talking to you) and the sounds that are disrupting your ability to hear the sounds you want to hear are coming from behind you. CLICK MOUSE: With Directional Microphones ,two microphones in the hearing aid work together. These two microphones working together allow sounds from behind to be reduced and the sounds in front of you can be amplified – allowing you to hear them better than those from behind. With Directional Microphones, you want to position yourself so that the noise is behind you because it will reduce sounds behind you. Some times in a restaurant people want to sit with their back against the wall to reduce the amount of noise, with directional microphones just the opposite should occur - sit with your back towards the noise.
It is difficult not to compare hearing with eyesight – you wouldn’t just put an eyeglass on one eye if you have vision loss in both. Your ears are similar – you use them together to hear all around you, thus you would want to have both ears hearing equally. If your goal is to hear the very best then two hearing aids are always recommended (if hearing loss in both ears).
There have been many studies conducted to test if digital hearing aids really are better than other hearing aids. These studies tested actual patients with digital hearing aids with both subjective - how did you like your hearing aids - and objective - actual word or sentence test to measure hearing improvement – tests. Here is what the studies reported: (see above)
Our main goal is to help you hear better – at home, at meetings, at theater – in your everyday environments. Your hearing expert has the expertise to determine the best solution for your hearing loss, your hearing needs and your budget. Unitron digital hearing aids offer the flexibility needed for your hearing loss, your listening environments and your activities. Sometimes, sophisticated noise reduction processing allows flexibility – sometimes it is multiple memories – different programs that you use in different situations that helps improve your hearing in various listening environments.
Today, digital hearing aids are usually classified in one of three categories. You can consider this first class, business class and coach. Premium – is the top of the line, the most features and benefits and is offered at a premium price. This level of technology provides more automatic features. Advanced – is the middle tier, with many features and benefits for meeting everyday hearing needs. Essential – is your basic model with essential features at an affordable price
Regardless of which model of Unitron hearing instrument we are talking about, there are several features which are found in all categories (or classes) of products. These features all help to contribute to more comfortable listening and good sound quality. (see slide to discuss features) Now let’s take a look at the specific features of each model that might best suit your individual lifestyle and needs…
Consider your long term needs – you hearing may change. These days, we are around more and more noise; we have many environments that we need to hear in. Your hearing professional is you best source of information about hearing better and hearing instruments. If your hearing professional recommends hearing instruments, it to help you hear the very best. There are many options to help you hear better. Discuss your needs with your hearing professional and together you’ll find the best option. Finally, your involvement and attitude are the most important factors to becoming a successful hearing aid user. Some people report that even with hearing aids they can’t hear like they used to. Here is the best analogy – when I purchase a great pair of running shoes, I don’t expect that I can run like I would when I was 20 – I have changed and my running shoes will help me enjoy what I still like to do – running. Hearing aids will help you stay connected to your world by helping you hear better.
Educational Seminar By: Dr. Tony Evans, Au.D. Audiologist