Children & Hearing Loss, Semarang 2015 -09-27

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• Born, raised and educated in Vienna, Austria
• Married with 2 Boys
• Hearing Aid Acoustician AAHA, Honors
• Business Administration Retail, Honors
• Hearing Health Care Industry since 1976
• Living and working in Asia since
1986
• Established THSG in 2003
• Living in Singapore since 2005
• Coordinator for right-to-hear foundation since 2003
• Coordinator for since 2014.
About the Presenter

Children & Hearing Loss
Manfred Stoifl, Hearing Aid
Acoustician, AAHA Vienna,
Austria

Hearing Loss
WHO, 2012

Indonesia
250
million
population
25
million
have a
disabling
hearing loss
1.5 million
children have a
disabling hearing
loss
WHO, 2012

Pinna
Ear Canal
Brain
Liquid
Hearing
Nerve
Electric
Stimuli
Cochlea
Eardrum
Sound
Physiology of Hearing
Hammer
Stirrup
Comprehension
Electrical Patterns
Anvil

Development of the
Auditory System
.
Progressive maturation of the thalamic projections to the cortex
and of the longer latency Pa and P(1) evoked potentials.
BeforeBirthAfterBirth
3–1314–2627–40
WeekYear
0-56-12
Formation of basic structure at all levels of the system, i.e. the inner
ear, the brainstem pathway, and the cortex.
Rapid growth and development, and by the end of this period, the
cochlea has acquired a very adult-like configuration
Brainstem reaches a mature state and peak development of
brainstem input to the cortex
Maturation of the superficial cortical layers and their intercortical
connections and improved linguistic discriminative abilities.

Development of the
Auditory System

10
left
middl
e
ear
right
middl
e
ear
left
cochlea
right
cochlea
left
Monaural
processing
right
Monaural
processing
arrival
time
difference
evaluation
binaural
activity
imaging
aural
activity
image
memory
auditory processes
comparison evaluation
aural
scene
memor
y
smell
activity
images
Other
sensory
activity
images
vision
activity
images
other
high level
processes
Ears Brainstem Auditory cortex Other
brain
areas
left
outer
ear
right
outer
ear
time
domain
frequen
cy
domain
aural
activity
image
aural
scene
meaning
enjoyment
action
level
difference
evaluation
Physiology of hearing

Hearing/Language
Development
Silver Years
0 – 6 years
6 – 12 years

Hill, N.M. & Schneider, W. (2006) Brain Changes in the Development of Expertise: Neurolical Evidence on Skill-Based
Adaptations in Cambridge Handbook of Ex-pertise and Expert Performance. New York: Cambridge University pp. 653-
683
Brain activity (shown by means of fMRI) is strongly decreased
throughout a given automation task over a duration of 3x 20
minutes. Cortical activities reduced by 85%.
Automatic hearing is
more efficient

Sensory Hearing loss

Peripheral Hearing Loss –
incorrect conversion of sounds to Electrical
Impulses
Central Hearing Loss –
Problems assigning meaning
to electrical impulses
Hearing Loss is a complex
Problem

How can you help your Child?
Don’t loose time
Intervene
Provide Auditory Input
Hearing Aids
Test, Fine Tune or Change
Cochlear Implants
Test and Fine Tune
Habilitation with
Central
AuditoryTraining
Test

Every day without(binaural) auditory
input is a day missed for auditory
development
Your childs time is limited

as soonas possible …
…… as oftenas necessary
All test must correlate with each other to form
one coherent picture
Your childs auditory system develops
Regularre-testing is necessary.

Pediatric Hearing Test Battery
Tympanometry
Oto Acoustic
Emission
ABR / ASSR
Otoscopy
Audiometry
Checking the status
and the function of
middle ear
Verifying
functionality of
outer haircell in the
cochlea
Promontory
Stimulation / eABR
Verifying overall
function of the
peripheral auditory
system
Ensuring the ear canal is
normal & free from
obstruction / wax
Free Field
Visual Reinforced &
Play Audiometry
Stapedius Reflex
Electrophysiological
measurement Electrically
verifying the
conduction pathway
before CI
Objective testing of the middle
ear muscle and bilateral
connection of ear
Check the condition of
pathways from ear to the brain

19
left
middl
e
ear
right
middl
e
ear
left
cochlea
right
cochlea
left
Monaural
processing
right
Monaural
processing
arrival
time
difference
evaluation
binaural
activity
imaging
aural
activity
image
memory
auditory processes
aural
scene
memor
y
smell
activity
images
Other
sensory
activity
images
vision
activity
images
other
high level
processes
brain
areas
left
outer
ear
right
outer
ear
time
domain
frequen
cy
domain
aural
activity
image
aural
scene
meaning
enjoyment
action
level
difference
evaluation
Intervention

Hearing
Aid
Range
Hearing Loss

Hearing with hearing aids

Paediatric Hearing Aid Selection
Audibility
Power
Sound Quality
Wide Frequency Range
High Frequency Content
Feedback control
Comfort.
Kids tough durability and water & sweat resistant
FM or
Bluetooth
ability for hearing in
educational settings
Good fitting fun earmolds
Exchange warranty &
affordable price.

Sometimes
hearing aids are
not enough

Hearing Loss
Cochlear
Implant
Range

Hearing loss & Hearing Aid
profound hearing loss

Hearing with a
Cochlear Implant
System

The more electrical
Information an implant system
provides to Central Auditory
Centres the better and
easier the child will hear

Quality of a C.I.
It’s not about if you hear or not
It’s about how easy you
hear!

Normal Hearing
Up to 18 million
impulses per second
resolution per ear
Advanced
Bionics
Cochlear MedEl
83,000 32,000 50,000

Why do you need TWO?
2 Hearing Aids
Or
2 Cochlear implant systems

31
left
middl
e
ear
right
middl
e
ear
left
cochlea
right
cochlea
left
Monaural
processing
right
Monaural
processing
arrival
time
difference
evaluation
binaural
activity
imaging
aural
activity
image
memory
auditory processes
aural
scene
memor
y
smell
activity
images
Other
sensory
activity
images
vision
activity
images
other
high level
processes
brain
areas
left
outer
ear
right
outer
ear
time
domain
frequen
cy
domain
aural
activity
image
aural
scene
meaning
enjoyment
action
level
difference
evaluation
Physiology of hearing
Binaural
activity
imaging

Quality of hearing
It’s not about if you hear or not
It’s about how easy you
hear!

Q & A

Children & Hearing Loss, Semarang 2015 -09-27

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