Aural Rehab Final

• Counseling session that we do after HA fitting.
• Encourage family members to attend
• Provide written information.

• 1. Components
• 2. Check fit
• 3. Telephone use
• 4. Inserting the earmold or tie (canal in first, then concha rim, then helox 
• 5. Basic care and maintenance
• 6. Return visit during 30 day trial period

• 1. too loud?
• 2. whistling (feedback)?
• 3. comfortable?
• 4. is the HA helpful?
• 5. Problem inserting?
• 6. Any other problems

Abbreviated proflie of hearing aid benefit.

• 1. Damage is water or mosture (even persperation)
• 2. Problem is excessive heat (no hairdryer or sound)
• 3. Dust (not usually a problem)
• 4. Don't take it apart
• 5. Don't drop it
• 6. Extreme cold will not dame it but may cause temporary quit 
• 7. Battery may leak or have corosion
• 8. Carry batteries with you
• 9. Don't eat a battery
• 10. Don't spray hairspray or insecticide
• 11. don't expose to xrays or radiation
• 12. Don't clean with alcohol or cleaning solution
• 13. Don't turn volume down to save battery
• 14. Don't keep batteries near metal
• 15. Don't put batteries in fire (they explode)
• 16. Take of every night.

electromagnetic

• older phones naturally leaked electromagnetic energy
• new phones are designed to produce an electromagnetic signal = hearing aid compatable
• But digital cell phones often produce electromagnetic noise.
• HI consumers should try before buying a cell phone.

Hearing Aid Compatable

• 1. Reduces background noise
• 2. Eliminates feedback

• T-on
• M off

• Don't turn volume down
• Check ear mold fitting
• Tubing is old or cracked
• Impacted wax
• Internal feedback (squealing inside case)-send to factory.

• Check battery first
• cord on body aid is broken
• could be progressive HL

• dirty volume wheel
• cord on body aid broken
• internal problem that is factory problem
• weak sound

likely internal in causing

Broken HA case and internal noise

Daily

30

• Same basic components as a HA (Microphone-amplifier, receiver, power source.
• Key component is a remote microphone
• Remote microphone provides non- transmission of speech from the speaker to the hearing impaired listener
• Teacher wears remote mic and non acoustic transmission

• 1. Distance (reduces to 3 inches and provides consistent signal level)
• 2. Noise: improves signal to noise ratio
• 3. Reverberation: virtually eliminates it.

• Hardwire
• Induction 
• FM
• Infrared

Wire from mic to child. True wire connects it, Inexpensive, no interference. 40 years ago more common, used now in theaters or churches.

electromagnetic energy, wire loop around room. Microphone changes to electromagnetic signal. signal is different around room (non-uniform distribution of signal) Can get spill over through walls- noisy not as clear

Non-acoustic transmission = radio waves

body type but now they are ear level

• Complete mobility, good range
• No spill over if working right
• High quality (fidelity) signal.

• Mor advantages or as many as other systems but less disadvantages 
• No significant disadvantages.

hearing oneself or hearing others around.

• Non-acoustic transmission: light waves
• Newer but not better

• High quality signal
• no spill over
• complete mobility in classroom but not outside(light admitters in walls and ceiling)

• Non even (uniform)distribution
• can pick up environment noise (windows)

• remote mic and casing mic
• mic comfortably worn
• amp/receiver unit can be fit individually to student
• electronically flexible
• the binaural (seperate circuit for two ears)
• uniform signal throughout room
• high fidelity
• complete mobility
• durable 
• no spillover
• cost effective
• simple to use and care for
• trouble lights
• adaptable to use outside classroom

• teacher wears microphone but signal goes to loud speakers not personal receiver
• Does not overcome distance, noise, and reverberation like personal ATs but does reduce distance, and improves SNR.

• Especially useful when student HLL is slight/ mild
• Student may wear ha in addition
• appears to benefit normal hearing students also
• teachers like them (students attend better and saves teacher voice.)

• 1. Classrooms are notoriously noisy
• 2. Noise disproportionately reduces the skills of HI individuals
• *external noise (traffic on busy street)
• * Internal noise (ventilator in school) -greatest noise source and some teachers turn it off during teaching.

• 1. Classrooms are reverberant
• 2. Reverberation disproportionately reduces the skills of HI individuals.

The time it takes for sound level to decrease by 60 dB

• 1. legislation- laws concerning construction of school buildings
• 2. Standards = asha and other professional organization developing standards for the classroom listening environment.
• 3. Building codes.

• Telephone amplifiers
• Pocket talker
• Personal amplifiers
• Specialty Amplifiers
• Personal amplifyin systems for rooms

• Built into telephones (cellphones& others)
• Land-line phones without amplifiers (pocket size unit fits on handset receiver $25)
• In line amplifier ~50
• Commonly 30 dB gain

Symbol = telephone with volume control

• similar to HA
• Microphone, receiver, amplifier
• 150 
• Useful in Dr. Office to help patient hear dr.

• Could be used to watch tv
• radio frequency or infrared unit 
• ~170-350

Amplifier in stethoscope for nurse/md

Theater, church, lecture hall, concert hall, courtroom, training areas (operating room in med school)

Distance, Noise, Reverberation

• A HA feature to provide a remote mic - hardwire or FM (boot)
• Recommended for children's HA

• For severe HI Persons
• To signal presence of doorbell, telephone, smoke detector, wake up alarm, waking child, police siren, automobile directional signals. 
• Signaling stimuli: flashing lamp, strobe light, tactile stiuli (wrist band bed shaker-fan) louder sound (or modify to frequency they can hear).

• Can be very expensive
• EX: icommunicator
• Converts speech to text or to video sign language
• Converts text to computer generated voice
• requires speaker training and personal microphone (for consistency)
• Used in the classroom
• ~6500.00

• Replaces cochlea and is as small as a penny
• An electronic device to replace to organ of hearing (needs battery)

50000

• highly successful (but not with everyone)
• early in life and who receive proper management often develop age appropriate speech and language
• after language acquisition display improved speech understanding

Kids.

• Bipases organ (cochlea that doesn't work.
• Hearing aid: amplifies filters and otherwise manipulates sound and sends it through to damaged organ.
• Cochlear Implant: Bypasses damaged organ and sends the signal directly to the 8th nerve 
• The cI is a tiny computer and used to be pocket but are now ear level.

• Microphone
• Processor (computer)
• Transmitter (side of head)

• Receiver and electrode wire 
• *these are simple and not usually replaced

• goes through the round window
• wind the electrodes in cochlea to get all frequencies ~ 1 full turn out of the 2.5 in cochlea
• Cortex is layed out like cochlea of one side has high frequency and one has low frequency.

• The candidates must qualify for CI (insurance pays for cochlear implants).
• Primary qualifications: 1- severe or profound hearing loss in both ears (permanent, cochlear, some auditory neuropathy patients) 2-Little or no benefit from a hearing aid.
• Other qualifications: 1- x-rays;mri 2-physical exam 3- psychological exam (family as well) 4- interview (commitment and appropriate expectations

• It is not predictable.
• It has been on the increase but not predictable.
• In use ~30 years.

• adults
• children at age 12 months (and younger)

Because they aid in learning language.

first 3-5 years of life

reading, academic performance, social emotioanl adjustment and career.

In the Deaf community but things are changing

• Survey of the Deaf community members in colorado. 
• -47% of respondents indicated no desire to hear or hear better.
• -Although most felt that a cochlear implant should be an option for Deaf people, 82% said that they would not get or probably would not consider a CI

has sparked particularly fierce controversies.

• typically the view of parents with normal hearing ~ 90% of deaf children are born to hearing parents. 
• Children should be given every opportunity to succeed in the world
• Children should receive a CI at as young an age as possible for maximal language learning.

• typically from some members of deaf community
• Deafness is not a disability. it does not need to be fixed. Deaf people are different, not impaired or inferior relative to hearing people.
• Children fit at an early age have no choice in deciding if they want to be deaf or hearing

deaf culture and the deaf community may eventually disappear.

wide range of success: sound awateness only to relatively good speech understanding.

best for individuals with previously good speech and language skills.

120,000

5,000 and increasing in most recent years.

• FDA
• Performed by otologist (ear or ear-nose-throat physician) with special training.

• otologist
• other medical personnel (nurse etc)
• psychologist
• counselors
• audiologist
• Speech language pathologist

• determine candidacy
• pre-surgical counseling
• surgery (1 night stay)
• Fit the processor (4-6 weeks after surgery)
• Ongoing processor adjustments
• long term rehabilitation program

resetting electrical signals of the CI to produce stimulation at soft to comfortable loud levels

• ~50,000
• Private insurance pays for most CIs. 
• Also medicare, medicaid, VA, Vocational rehab services.

• General risks associated with surgery and anesthesia (infection)
• Slightly higher risk of meningitis
• Risk that cochlea will not be available for more advanced treatments in the future years (one or both ear)
• risk that the CI will not be effective and may delay other habilitation strategies
• Defective CI and more surgery 
• related expenses.

Child will not achieve his/her potential with regard to language, speech, communication, reading, academic performance, social-emotional adjustment, and career.

• Telecoils are also available in the CI
• Avoids background noise

• Electronic device to replace cochlea and 8th nerve 
• Used when can't use cochlea or 8th nerve 
• Electrode pad inserted adjacent to the cochlear nucleus

• 500
• Neurofibromatosis Type II (bilateral tumors)
• Usually placed during removal of NF2 tumors

• WIde range of success- some success equivalent to that of CI, others detect sound but cannot recognize words. 
• Importance of "auditory contact" with the world.

• Brand new and currently in experimental stage (one human fit as of march 2012)
• desgn and some of instrument are based on CI
• Three tiny gyroscopes in external processor
• Each of the three lines stimulates one semicircular canal
• designed especially for meniers's patients

• provides tactile sensation to sound (feel sound)
• tactile = vibratory or electrical (tickle on skin)
• cost $1000
• trial period
• no risk
• effectiveness: Awareness of sound only

• tty or tdd
• typed message is coded into electronic pulses, sent through telephone lines, and decoded and displayed for the person receiving the message.

• used by deaf persons to communicate by phone (now texting is possible)
• Both parties need to have ttyp or use relay system

• portable
• cell phone connector
• memory
• pocket sized also available
• full size keyboard
• 80 character display
• printer

• a revolution in communication alternatives
• relay service
• telephone text message
• web cam
• email
• telephone captioning
• video relay

• Wyoming Relay System
• Communication between a HI person (using a TTY) & a hearing person (no tty) through a relay operator
• HI person can 
• A) receive text and 
• B) send text or use VCO

• Voice Carry Over 
• Means HI persons speech is intelligible.

A video relay system for computer or handheld device.

• CapTel (captioned telephone)
• HI person has telephone with text capability
• go through relay person
• Call HI person & captel the captel person types to the HI person and speaks to the normal hearing person.
• The text display of telephone conversation on a special telephone
• Real-time captioning via captioning secive.

• Less time delay and more personal than relay 
• special telephone with display ~495 (may be available free through wyo relay program) now available on the iphon
• Captioning service, like relay service is not charged to individual user
• English or spanish Captions.

Text display of telephone conversation on a computer screen

2009- Waterloo, IA

the process by which the audio protion of TV programs is translated with a decoder into captions.

• Closed  means that decoder is required (not there unless you select captioning)
• Open means that caption always visable

• authorized by federal communication (FCC) in 1976
• 16 hrs/week available in 1980
• Beginning in Jan 2006 all new english programs must be captioned.
• Some expections (commercials)

• Around for 30 years
• real time captioning
• did all captioning and is still involved
• Live events, news/sports
• Most comedy and drama tv programs are prepared ahead of time not captioned real time

Accurate simultaneous with speaker

• person typing captioning
• Special keyboard, special training
• well paid

• regular tv programming
• commercials
• movies on DVD
• how to videos
• college courses
• *expensive to caption but sponsers pay for it.

• used by deaf and other hearing impaired individuals and requires at least english literacy (but also being used to learn english and assist in learning reading)
• May not be useful if only know asl

• Federal law 1990
• 13 inches

retianed

American Disabilities Act (ADA) and netflix has agreed to close caption all streaming by 2014

• Alerts HI person to important sounds
• Has privliges under ADA law

• 400 years ago no education for HI 
• Classified as mentally ill persons
• Got rid of and kept at home so not involved - no rights
• 400 years ago in Europe (wealthy) started hiring people to come in and teach their HI children (sign language, fingerspelling, other means created)

• 3 schools for Deaf (presidential)
• England - Braidwood
• Germany - Heincke
• Paris, France -eppe
• North america being sttled at this time
• Thomas Gallaudet sent over to europe to learn HI teach strategy
• England oral, france manuel, brought back manuel strategy

• New england teach manuel from gallaudet
• sign was prominent way of teaching HI
• Some education available for deaf kids starting 200 years ago if lived in right place
• one in every state
• choose normal school or school for the deaf.

• helped mild to moderate kids get in appropriate spot (didnt qualify for deaf school, had hard time in normal school)
• Least restrictive environment
• IEPs

• 1986
• Included younger kids from birth
• SLP auds start seeing a lot of younger clients
• must use childs normal mode of communication in regular communication and in evaluations
• School is responsivle for proper function of hearing aids worn in school
• to the maximum extent appropriate children with disabilities should be educated with children without disabilities.

• 90% never went beyond high school
• 1850 Gallaudet University (WASH DC)

• National Technical Institute for the Deaf
• (alternative) Rochester NY

There are other colleges and universitities and are accesible now and have class amp and interpreters.

• Alternatives and issues 
• Many placement alternatives
• oral vs manual methods of education

• Oral: Preparing child to live in the hearing world with the English language and the children focused to learn and communicate through disordered system
• Manual: Easy language learning and communication that is not english and may result in reading and writing deficiencies in english. May have limited function in the hearing world
• Last 30 years: goes back and forth but manual has upper hand.

• Family educational rights and privacy act 1976
• Data transport
• data storage
• data destruction
• client access to information
• client right to challenge information

• Screening and diagnostic test results for each student
• Management program activities (AR, HA, use, etc.)
• Evidence for program modification
• Activities as evidence in disputes regarding services

ESSENTIAL (anything after initial screening)

follow up is often not accomplished

• diagnostic testing following screening failure
• audiometric re-evaluation/ monitoring follwing medical referral to ensure that the HL is resolved
• appropriate classroom management (eg teacher notification, preferential seating, student support services, amplification for chronic HL
• some children with otitis media may experience HL for weeks or months
• Hearing aid evaluation
• ongoing hearing aid function and care

others need our help

habilitation

• 1-3-6
• 1 month of age screening
• 3 Diagnosed by 3 months
• 6 intervention by 6 months
• 98%

• Diagnositc testing is completed as soon as possible, no later than at 3 months of age
• If child has hearing loss, management is initiated immediately

• very poor (~50)
• Excellent

Immediate consideration for HAs (funding?)

• Early intervention program
• Research suggest that if HI infants are in intervention by 6 months of age, language will develop at a pace consistent with cognitive abilities, for most HI children this means a normal rate of language development.

• Parent education and counseling 
• HA and other amplification
• Acceptance of HAs (both parent and adult)
• Care and maintenance of HAs.
• Device for monitoring daily provided to parent
• Parent support contacts
• Funding options

• Referrrals
• Additional referrals in conjunction with referring physician (vision, ENT, possible genetic counseling, audiologic evaluation of siblings if genetic casue suspected)

ongoing audiologic and hearing aid evaluation as needed.

• Identification of HI patients
• At admitting or sticker on file

• Amplification and assistive devices
• portable amplifier (pockettalker)
• telephone amplifier
• TTY
• Sign language interpreter
• TV captioning
• Nurses have knowledge regarding services and devices.

• Education
• In-service training of nurses and other hospital personel
• Information for patients (brochures, posters,direct counseling)
• Public service announcements or advertisements include notification that the hospital provides services for HI patient

• support group
• volunteers sharing inforamtion with patients and their families

• live interpreter
• super imposed interpreter
• captions
• scripts

• Wyoming
• new in 2013
• Founded by FCC
• Provides communication technology to low income persons with combined hearing and vision loss to allow them to make a phone call, send an email,and access the internet 
• must qualify by impairment and financially.