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- WNL – within normal limits
- AU – both ears
- AD – right ear
- AS – left ear
- DNT – Did Not Test
- DNE – Did Not Evaluate
- CNE / CNT – Could Not Evaluate/Test
Audiologic rehabilitation (AR)
- those professional efforts designed to help someone with hearing loss achieve better communication and minimize associated problems.
- does not include closely related medical intervention or academic teaching to the deaf
trying to rehabilitate hearing to what they have had before
trying to habilitate their hearing to better than what they haveever had
Restore or enhance auditory/receptive auditory function with individuals with hearing loss.
Remedial auditory efforts for individuals with hearing loss since birth.
Other Audiological Rehabilitation
- Vestibular Rehabilitation
- Tinnitus Treatment/Rehabilitation
- Vestibular system gives us our balance
- treatment techniques to aid in the recovery from a vestibular insult with accompanied dizziness and/or disequilibrium
- Physical therapists with specialties in equilibrium can also work with these patients
- Tinnitus – ringing in your ears that has no outside source (can be experienced as music, humming, ringing, etc) most common reason for it being hearing loss
- treatment techniques to promote “habituation”to tinnitus
- AuD - chief provider
- Teachers of the deaf and hard-of-hearing
- Social workers and other counselors
- Rehabilitation counselors
AR providers need some background in...
diagnostic audiology and they need to understand hearing loss and its effects both on children and adults
National Institute on Deafness and other Communication Disorders
What % of American adults report some degree of hearing loss
Approximately 17 percent (36 million)
How many children in the United States are born deaf of hard-of-hearing.
About 2 to 3 out of ever 1,000
How many children who are born deaf are born to parents who can hear.
Nine out of every 10
What % of Americans between the ages of 20 and69 have high frequency hearing loss due to exposure to loud sounds or noise at work or in leisure activities.
Approximately 15 percent (26 million)
How many Americans have experienced tinnitus
Roughly 25 million
Reason that Only 1 out of 4 people who could benefit from a hearing aid actually wears one
The number one reason that people who could benefit from hearing aids does not get them is because they are afraid of how that will make them look
How many people worldwide have received cochlear implants
In the United States how many people have received cochlear implants
roughly 42,600adults and 28,400 children have received them. –Statistics from the FDA
Hearing Loss (AKA Impairment) can be defined in terms of
- Degreeo Configuration
- Type of loss
- Time since onset – pre-lingual or post-lingual
- Word recognition ability
Hearing Loss Degree
- Normal -10 to 15 dB
- Slight (Children) 16 to 25 dB
- Mild 26 to 40 dB
- Moderate 41 to 55 dB
- Moderately Severe 56 to 70 dB
- Severe 71 to 90 dB
- Profound 91+
Mild hearing loss
Thresholds are between 25-40 dB HL. With a mild hearing loss difficulty will occur for soft speech and listening in background noise; however in quiet a mild hearing loss is manageable.
Moderate hearing loss
Thresholds are between 41-55 dB HL. With a moderate hearing loss you will experience difficulty hearing conversations, especially while in background noise. The TV or radio may be turned to higher levels also in order to be heard clearly.
Moderately-severe hearing loss
Thresholds are between 56-70 dB HL. For a person with a moderately-severe hearing loss clarity of speech is significantly reduced and the most difficulty will occur in groups
Severe hearing loss:
Thresholds are between 71-90 dB. At this degree of hearing loss, normal conversation will not be audible. Loud speech is also difficult to hear or understand. At this point people with severe hearing loss will only hear if speech is shouted or amplified for them.
Profound Hearing loss
- Thresholds are 91 dB and higher. At this level, people with profound hearing loss may have difficulty understanding even amplified speech.
- Deaf vs. deaf
The configuration, or shape, of the hearing loss refers to...
the degree and pattern of hearing loss across frequencies, as illustrated on the audiogram
Conductive hearing loss
Most common sensorineural hearing loss, most common with age
If the difference between two adjacent primary frequencies is 25 dB or more
- Worse in low frequencies, better in the high frequencies
- Conductive and there are two sensorineural disorders that can create this audiogram
The age of onset for hearing loss has the potential to impact:
- Amplification options
- Cochlear Implant candidacy
- Use of verbal speech
- Use of language
- Educational needs
- Social/emotional well being
Hard of hearing:
Congenital or acquired, typically less severe HL and have normal speech and language.
The deaf may be divided into three groups:
- Pre-lingually deaf: Born deaf or acquire it in the first five years of life (prior to language).
- Post-lingually deaf: Acquire hearing loss after age 5 through the school years.
- Deafened (late onset deafness): Acquire hearing loss after their education is completed.
Hearing Loss Types
- Conductive – medical based, medical Tx or amplification
- Sensorineural – no medical Tx, sensory, amplification/CI
- Mixed hearing loss – combination of above
- Non-organic – no physical abnormality – people who function with a hearing loss but do not actually have a hearing loss
- Central – Disorder in the auditory processing centers of the brain
Normal Hearing Audiogram
20 dB or higher at all frequencies
Conductive Hearing Loss Audiogram
Air bone gap of 20 dB or higher
Mixed Hearing Loss Audiogram
Sensorineural Hearing Loss Audiogram
bone and air conduction are relatively the same
When is masking needed?
- Masking is needed anytime that there is an air bone gap of more than 25dB.
- And anytime that there is a conductive loss and you want ear specific information then you must mask.
Hearing Loss – Word Recognition
Degree of hearing loss does not indicate the auditory function of the individual
- Reception or detection: typically noted by dB
- Identification or recognition: typically noted by % and intensity level
Other Important Characteristics
- Bilateral versus unilateral
- Symmetrical versus asymmetrical
- Progressive versus sudden hearing loss
- Fluctuating versus stable hearing loss
Consequences of Hearing Loss
- The most serious and primary consequence of hearing loss is the effect on verbal receptive communication and this is often referred to as a disability.
- The secondary consequences of hearing impairment may be referred to as a handicap and includes social, emotional, educational, and vocational issues.
World Health Organization (WHO) suggests..
- that communication activity limitation be used instead of disability and that we speak of participation restriction instead of handicap.
- In connection with these new terms, WHO also suggests that personal factors and environmental factors are key issues in the provision of AR hearing services.
- These terms and factors help us properly understand the consequences of hearing impairment and provide the basis for a model of AR.
- Disability= “communication activity limitation”
- Handicap=“participation restriction”
- The early history of AR is essentially the history of efforts to help the deaf, beginning in the 1500s.
- Audiology came into being as a profession in the mid- 1940s during World War II and both diagnostic audiology and audiologic rehabilitation (AR) are key elements within this profession
- In recent years, audiologists have become more involved in hearing aid fitting, and new developments such as cochlear implants, assistive listening devices (aka. HATs), wider support for disabilities.
- The emerging use of outcome measures have helped revitalize AR.
AR Model Assessment
includes assessment and management; rehabilitation assessment includes four elements defined by the acronym CORE.
- Communication and impairment through audiometry and self-report
- Overall participation variables, including psychological, social, educational, andvocational factors
- Related personal factors
- Environmental factors
AR Modal: Management
includes assessment and management; rehabilitation management includes four elements defined by the acronym CARE.
- Counseling, which includes an effort to help clients accept the hearing loss and set reasonable goals.
- Audibility improvement by using hearing aids and assistive devices.
- Remediation of communication.
- Environmental coordination and participation goals.
AR Settings based on age
- adults and elderly adults: typically served in settings that dispense hearing aids; these include private practice, medical offices, hearing aid specialists, military or VA service centers and community Audiology clinics
- Children: Early intervention, school programs and through their diagnostic audiologist