This document discusses hearing aids and aural rehabilitation. It describes different types of hearing aids including conventional air conduction hearing aids, bone-anchored hearing aids, and cochlear implants. Bone-anchored hearing aids use a surgically implanted fixture to transmit sound through bone conduction. Factors considered during hearing aid fitting include the type and degree of hearing loss. Aural rehabilitation includes speech reading, auditory training, and speech conservation. Tinnitus is the perception of sound within the head with no external source; it is commonly bilateral, subjective, and non-pulsatile.

1. Hearing Aids

2. Aural Rehabilitation
1. Instrumental devices
2. Training

3. Indications for Hearing Aid
1. Sensorineural hearing loss - which interferes with day-
to-day activities of a person.
2. Deaf children - should be fitted with hearing aid as
early as possible for development of speech and
learning. In severely deaf children, binaural aids (one
for each ear and individually fitted) are more useful.
Training in lip reading is given simultaneously.
3. Conductive deafness.

4. Instrumental devices
a) Hearing aids
i. Conventional hearing aids
ii.Bone-anchored hearing aids
iii.Implantable hearing aids (vibrant sound bridge)
b)Implants
i. Cochlear implants
ii.Auditory brainstem implants
c) Assistive devices for the deaf

5. Hearing Aids
1. Microphone
2. Amplifier
3. Receiver

6. Conventional Hearing Aids
• Air Conduction Hearing Aids
1. Body-worn type
2. Behind-the-Ear type
3. Spectacle type
4. In-the-Ear type
5. Canal type (ITC/CTC)

8. Fitting
1. Degree of hearing loss.
2. Configuration of hearing loss (type of frequencies
affected).
3. Type of hearing loss (conductive or sensorineural).
4. Presence of recruitment.
5. Uncomfortable loudness level.
6. Age and dexterity of patient.
7. Condition of the outer and middle ear.
8. Cosmetic acceptance of the aid.
9. Type of ear mould.

9. 10. The type of fitting, whether it is
• Monoaural (one aid only)
• Binaural (one aid for each ear)
• Binaural with y-connection (one aid but two receivers,
one for each ear)
• The contralateral routing of signals type.

10. Bone Anchored Hearing Aid
• Bone-anchored hearing aid is a type of hearing aid which is based
on the principle of bone conduction.
• Bone-anchored hearing aids use a surgically implanted abutment
to transmit sound by direct conduction through bone to the
cochlea, bypassing the external auditory canal and middle ear
• BAHA has three components:
• titanium fixture
• titanium abutment
• sound processor

11. • The titanium fixture is surgically
embedded in the skull bone with
abutment exposed outside the
skin. The titanium fixture bonds
with the surrounding tissue in a
process called osseointegration.
• Sound processor is attached 2–6
months after implantation.

13. Indications for BAHA
1. When air-conduction (AC) hearing aid cannot be used:
i. Canal atresia, congenital or acquired, not amenable to
treatment.
ii. Chronic ear discharge, not amenable to treatment.
iii. Excessive feedback and discomfort from air-conduction
hearing aid.
2. Conductive or mixed hearing loss, e.g. otosclerosis
and tympanosclerosis where surgery is
contraindicated.
3. Single-sided hearing loss.

14. Surgery for BAHA
• The surgery is typically performed in a sin- gle stage in adults. About 3 months
are allowed for osse- ointegration before the sound processor can be attached. A
two-stage procedure is recommended in children in whom the fixture is placed
into the bone in the first stage. After about 6 months to allow for
osseointegration, a second-stage operation is done to connect the abutment
through the skin to the fixture.

15. Training
a) Speech (lip) reading
b) Auditory training
c) Speech conservation

16. Tinnitis

17. • Tinnire : To ring (latin)
• The conscious expression of a sound that
originates in an involuntary manner in the head of
its owner, or may appear to him to do so. - Dennis
McFadden
• In reality, the sound perceived by the patient does
not have to be ringing, does not have to be a
continuous sound, and in some cases can even
represent complex sounds such as musical tunes.

18. Classification
• Pulsatile (Synchronous / Non Synchronous) / Non-Pulsatile
• Subjective / Objective
• Unilateral / Bilateral
• Commonest – Bilateral Subjective Non-Pulsatile with no
specific associated pathological process

19. Epidemiology
• The prevalence of persistent spontaneous tinnitus in the adult
population ranges from 10 to 15%
• The prevalence in much higher in patients over 60 years of age
and in patients with high noise exposure.