Sensory Neural Hearing Loss

SolutionforSensoryNeural
HearingLoss
2/20/2013

HearingLoss
Solution for Sensory Neural
Hearing Loss
Manfred Stoifl
Hearing Aid Acoustician (Honors), AAHA, Vienna, Austria
2/20/2013

HearingLoss
Overview
• Principals of Sensory Neural Hearing
Loss
• Neural (Central) Hearing Assessment
• Indication for AudioFitness Training
• Measuring Benefits
• Clinical Data.
2/20/2013

HearingLoss
2/20/2013
Peripheral
Hearing
CentralAuditory
Functions
Sensory Neural Hearing Loss

HearingLoss
2/20/2013
Sensory
Hearing
Loss
NeuralHearingLoss
Sensory Neural Hearing Loss

HearingLoss
6
left
middle
ear
right
middle
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
memory
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
frequency
domain
aural activity
image
aural
scene
meaning
enjoyment
action
level
difference
evaluation
How We Hear

HearingLoss
7
Sensory Neural Hearing
Loss
Where
Functional
problem
Cause
Cochlear Brain
Physical Hair Cell damage
Loudness
Frequency Discrimination
Language Discrimination
Hearing in Noise
Directional Hearing
Genetics
Age / Wear and Tear
Trauma
Diseases
Under utilisation
Treatment Hearing Aids / C.I. Low Level Function
Training
Test Audiometry
EFI-EFK test
Low Level Function Test
Sensory
Hearing Loss
Neural (Central)
Hearing Loss
?
?
-
Ability never (fully)
acquired

HearingLoss
8
10 20 30 40 50 60 70 80
Age
Slow / Bad
Fast / Good
Time
Normal Aging
Accellerated degeneration due
to peripheral Hearing Loss
Central Auditory Processing
Lifecycle
ProcessingSpeed

HearingLoss
9
10 20 30 40 50 60 70 80
Age
Sever Hearing
Loss
Normal Hearing
Time
Central Auditory Processing
Lifecycle
ProcessingSpeed
0

HearingLoss
10
Nach: Ptok-M: „Auditive Verarbeitungs- und Wahrnehmungsstörungen
und Legasthenie“, Hessisches Ärzteblatt 2/2000, S. 52-54
Low-level
Automatic extraction of basic acousitc features like
time and frequency resolution
Automatic exraction of phonetic cues for phonem
differenciation
Automatic identification and discrimination of
syllables in a language
Automatic recognicion of words and their
meanings 1. Order – without context
Metalanguage awareness to decode both the
syntax and prosody
Sounds
Syllables
Words
Sentences
i / e / a / o / u
train (Transport) / train (practice)
I train my hearing with AudioFitness.
d/t g/k b/p
Auditory processing and
perception of speech

HearingLoss
11
Automatic exraction of phonetic cues for
phonem differenciation
Automatic identification and discrimination of
syllables in a language
Automatic recognicion of words and their
meanings 1. Order – without context
Metalanguage awareness to decode both the
syntax and prosody
Sounds
Syllables
Words
Sentences
i / e / a / o / u
train (Transport) / train (practice)
I train my hearing with AudioFitness.
d/t g/k b/p
Auditory processing and
perception of speech
Time

HearingLoss
Common Signs of Central Hearing
problems
Talks or likes TV louder than normal
Unusually sensitive to sounds
Asks many extra informational questions
Confuses similar sounding words
Hears better when watching the speaker
Problems with rapid speech
Frequently misunderstanding instructions or questions
Porblems understanding in background noise
Problems with phonics or discriminating speech sounds
Frequently requests repetition.

HearingLoss
Common Signs of CAP problems
Can not multi-task
while listening.

HearingLoss
Neural / Central Hearing
Assessment
&
Training
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HearingLoss
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Wahrnehmungs -Trennschärfe -Test
Teil 1 O n.a.* Teil 2 O n.a.*
Links Rechts Links Rechts
EFI O
EWI O
EDI O
EPI O
EWI O
ETI O
EPI O
EFI O
EBI O
EDI O
EGI O
EKI O
ETI O
EBI O
EKI O
EGI O
OEBI O
EPI O
EGI O
EKI O
ETI O
EFI O
OEWI O
EGI O
EPI O
EDI O
EKI O
EFI O
EDI O
EWI O
EBI O
ETI O
EKI O EFI O
EBI O ETI O
EPI O EWI O
EFI O EGI O
EWI O EBI O
EDI O EPI O
OETI O EKI O
EGI O EDI O
ETI O
O
EPI O
EDI O EKI O
EPI O ETI O
EBI O EDI O
EFI O
O
EGI O
EWI O
EGI O
EKI O
EBI O
EFI O
EWI O
C C C
% % %
Richtige Silben: /32 Richtige Paare: /16
PRS: PRS:
Perception-Separation
Accuracy Test by Warnke (EFI-EKI)

HearingLoss
Abbreviated Profile of Hearing Aid
Benefit
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Ease of Communication (EC scale)
I have difficulty hearing a conversation when I’m with one of my family
at home.
Background Noise (BN scale)
When I am in a crowded grocery store, talking with the cashier, I can
follow the conversation easily.
Reverberation (RV scale)
I miss a lot of information when I’m listening to a lecture.
Aversiveness (AV scale)
Unexpected sounds, like a smoke detector or alarm bell are
uncomfortable.

HearingLoss
Assessment & Test
• Patient hears acoustic stimuli over
headphone (except 1st test –sees flashes).
• Has to react by pressing buttons.
• If pressed correct, speed/difficulty increases
• Through training/repetition patient will be
able to perform tasks faster and faster.
2/20/2013

HearingLoss
1. Visual Order Threshold..
– is the minimum time at which you can separate 2 visual
stimuli
• This ability is very important for digesting written information
• Increase the speed with which the brain is able to digest and
process information.
2. Auditory Order Threshold..
– is the minimum time at which you can separate 2 auditory
stimuli
• If it takes you too long, you may have difficulty differentiating
critical plosives b-d, g-k, or p-t from each other. Which results in
difficulty understanding
We assess, and customer
trains 8 CAP task (1-2)

HearingLoss
3. Spatial (Directional) Hearing
– Is the minimum time difference at which you can localize a
sound
• Allows correct training of spatial (directional) hearing.
– Very important to be able to perceive sounds and especially
language selectively
» from different directions,
» to be able to assign them
» to ignore them as well.
4. Pitch Discrimination
– is the minimum difference between two tones
• vital ability for differentiating vowels and decoding of voice
melody.
• extremely important for speaking as well as for understanding

HearingLoss
5. Rhythm
– fastest rhythm you can follow
• Ability to convert perceived auditory stimuli as fast as possible
into movements.
• very important for thinking, speaking and writing
• To train hemispheric coordination.
6. Auditory Choice Reaction
– separating two different tones and reacting as fast as possible
• Decisive for identifying time of Phonemes (spoken) and
graphemes (reading).
• To react fast and focused to auditory stimuli without visual aid

HearingLoss
7. Frequency Pattern Recognition..
– quickly and accurately resolve auditory patterns
• An important pre-requisite for the segmentation of the
continuous stream of auditory stimuli during speech
identification and processing.
8. Duration Pattern Recognition..
– quickly and accurately resolve auditory patterns
• An important pre-requisite for the segmentation of the
continuous stream of auditory stimuli during speech
identification and processing.

HearingLoss
28
Function
Target Values (Training)
Ideal
Results
*
20
years
old
30
years
old
40
years
old
50
years
old
60
years
old
70
years
old
80
years
old
90
years
old
100
years
old
Order-v 12 ms 18 ms 24 ms 30 ms 36 ms 42 ms 48 ms 54 ms 60 ms 12 ms
Order-a 23 ms 30 ms 36 ms 43 ms 49 ms 56 ms 62 ms 69 ms 75 ms 23 ms
Bearing 10 µs 16 µs 22 µs 28 µs 33 µs 39 µs 45 µs 51 µs 57 µs 10 µs
Pitching 4 % 5 % 7 % 8 % 9 % 11 % 12 % 13 % 15 % 4 %
Rhythm 128 ms 139 ms 150 ms 161 ms 173 ms 184 ms 195 ms 206 ms
218
ms
128 ms
Reaction 305 ms 335 ms 366 ms 396 ms 427 ms 457 ms 488 ms 518 ms
549
ms
305 ms
Sequenc
e
10 ms 29 ms 48 ms 67 ms 86 ms 105 ms 124 ms 143 ms
162
ms
10 ms
Duration 20 ms 28 ms 36 ms 44 ms 52 ms 60 ms 68 ms 76 ms 84 ms 20 ms
Age specific long-term Adult Target Values
Valuating results

HearingLoss
29
Valuating results
Age specific Pediatric Target Values

HearingLoss
• Practice all 8
functions at home
for 15-20 min a day
• The Home Trainer
will store data in a data log
• Follow up assessment and
advice in weekly
• consultations.

HearingLoss
Unique 2 Step Training Approach
• Practice
• Consolidation.
2/20/2013

HearingLoss
32
t
Access Information
Task Latency Reply Confirmation
Great!
Quelle: Skinner-BF & Correll-W in „Denken und Lernen“, 1976
Confirmation
German Patent # 196 03 001
„System for supported training and learning“
Explanation: Mirror-Neurons
How practice works

HearingLoss
• 6 -8 weeks
• Final low level assessment function
• Final discrimination
• assessment
• Continue training alone to reach ideal values.
• Maintain reached goals by training
once weekly
• Move on to second stage training.

HearingLoss
Measuring benefits of AudioFitness
• Improvement in Processing Speed
– Each task can be done faster
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HearingLoss
2/20/2013
• Improvement in Speech
Perception Separation
Accuracy Test
– Reduction of mistakes

HearingLoss
2/20/2013
• Improvement in
APHAB
Questionnaire
– Reduction of
situations with
Hearing/Compreh
ension problems.

HearingLoss
Validation
• 30 years on the Market
• Widely used in Germany and
Switzerland
• Numerous Publications

HearingLoss
Clinical trials proof benefits of
Low Level Training
• Learning Disabilities
– Dyslexia
– ADD / ADHD etc…..
• Hearing “Problems”
– Normal Hearing
• Central Auditory Problems
• Hearing in Noise
– Hearing Impaired
• Hearing in Noise
• Adaptation to Hearing Aids.2/20/2013

HearingLoss
Low level functions and education
.
100 adults 20-70 years of age
Quelle: Katerji-D „Veränderungen der Low-Level-Funktionen im Erwachsenen-
alter“, Dissertation (2006), Medizinische Hochschule Hannover, U. Tewes
Grade High Colle. Univ
0
6
12
18
24
30
Pitch Discrimination
0
150
300
450
600
750
900
ChoiceReaction
Time
0
30
60
90
120
Duration Pattern
0
15
30
45
60
75
V. Processing Speed 0
20
40
60
80
100
Aud. Proc. Speed
0
40
80
120
160
200
Frequency
Pattern

HearingLoss
Clinical Trail
Speech discrimination in Noise (144 adults)
Hearing Impaired with
Hearing Aids
Normal Hearing without
Hearing Aids
with Training without Training

HearingLoss
38 adults before and after LLF training (average age 43.7
years)

HearingLoss
Trail Making Test 60+ age group
Before Training
After Training
Besides Improvement in central auditory processing it also
resulted in improvement general cognitive abilities.
We therefore recommend the training
for this age group.
TimeinSeconds

HearingLoss
42 dyslexic children
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Group A Group B Group C
Error rate reduction in %Error rate reduction in %
Group A was given lessons specially designed for dyslexics
Group B did Low-Level Training with the Brain-Boy
Group C did Low-Level-Training and Lateral-Training together
6.3 %
18.9 %
42.6 %

HearingLoss
45
Hearing Treatment
Functional
problem
Cause
Cochlear Brain
Physical Hair Cell damage
Loudness
Frequency
Discrimination
Language Discrimination
Hearing in Noise
Directional Hearing
Genetics
Age / Wear and Tear
Trauma
Diseases
Under utilisation
Treatment Hearing Aids / C.I. Low Level Training
Test Audiometry EFI-EFK test
APHAB
Low Level Function Test
Hearing Understanding
-
Main Location

HearingLoss
Thank YOU
Any Questions?
2/20/2013

Sensory Neural Hearing Loss

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