Audiology 101Normal HearingConductive Hearing LossSensorineural Hearing LossMixed Hearing LossDetermine Amount of LossCauses of Hearing LossUS HL Population Projected through 2050Hearing Loss Population by Age Group Owners versus Non-ownersHearing Aid StylesAnalog Hearing AidsDigital Hearing Aids: Programmed Via ComputerOptional FeaturesSlide 14FM Communication SystemsAssistive TechnologyDevices for the HomeCochlear ImplantCochlear ImplantPowerPoint PresentationCochlear New FreedomAdvanced BionicsMed EL PulsarWorldwideUniversity of Florida Cochlear Implant ProgramCochlear Implant Team for Adult PatientsFormal EvaluationPreimplant Counseling TopicsWho is a candidate?Who is an adult candidate?Deaf CultureOutcomes for Post-lingual AdultsImpact of CI on Vocational SettingsSlide 34Outcomes ResearchHealth Utility ChangesCosts by Age of OnsetSlide 38Hearing ImpairmentSocietal Impact: AgeSocietal Impact: Income Level Over half of the severe to profound hearing loss population have family incomes of less than $25,000Societal Impact: Labor Force 42% of the population, between the ages of 18-44 years, and 54% between the ages of 45-64 years with severe to profound hearing loss are not working.Lifetime Cost Comparison Of Other ConditionsCost-Saving InterventionCost of Cochlear Implants Vs Lifetime Costs of DeafnessNucleus® Hybrid™ Cochlear ImplantSelection Criteria: AudiometricNucleus® Hybrid™ Cochlear ImplantExternals1Audiology 101Alice E. Holmes, PhDProfessorUniversity of Florida2Normal Hearing3Conductive Hearing Loss4Sensorineural Hearing Loss5Mixed Hearing Loss6Determine Amount of LossFrom bass to treble, or low to high pitchFrom faintto intense, or softto loud7Causes of Hearing LossPresbyacusis (aging) is #1 cause of hearing lossHazardous noise exposure is #2Just a few other causes include genetics, teratogens, otitis media, idiopathic hearing loss, fistula, congenital anomaly, prenatal or perinatal exposures (syphilis, CMV, rubella), syndromes, head injury, among hundreds of others!Only one type of hearing loss is preventableAVOID NOISE Hazardous noise damages hearing12.5% of children aged 6-19 have some amount of noise induced hearing loss8US HL Population Projected through 2050 In 2004, this equates to 31.5 million people reporting hearing loss in the USKochkin, 20059Hearing Loss Population by Age GroupOwners versus Non-owners0 1 2 3 4 5 6Millions<1818-3435-4445-5455-6465-7475-8485+OwnersNon-ownersKochkin, 200510Hearing Aid StylesCompletely In the Canal CICIn The Ear ITEBehind The Ear BTE11Analog Hearing AidsAmplifies in a linear fashion, can distort sounds, limited means to filter background noise, least expensive choice12Digital Hearing Aids: Programmed Via ComputerHas at least 2 channelsAnalyzes incoming sound and adjusts the loudness based on preset parametersDetects softer sounds of speech, raises loudnessDoes not amplify background noise to same degree as primary signal13Optional FeaturesDirectional: Uses dual microphonesAvailable in analog, compression and digital modelsUse of forward facing microphone helps focus on desired soundsHelps diminish awareness of background noise14Optional FeaturesMultiple MemoryIncreases versatilityMemories customized for various situationsRemote ControlChange volume, memory function, directionality of microphone15FM Communication SystemsEnhanced speech perception in noise, at great distancesUsed in classroomsGreatly increases signal to noise ratioNew technology reduces size, eliminates cords, wiresTransmitterReceiver/BTE16Assistive TechnologyPocket TalkerOne to One AmplifierCell Phone with TDDTelephone AmplifierAmplified Phone17Devices for the HomeStrobe Light DoorbellBed Shake Alarm ClockFlashing Smoke AlarmVibrating Wrist WatchTelevision Closed Caption DecoderTV Infra-Red Listeners18Cochlear Implant A device that electrically stimulates the auditory nerve of patients with severe-to-profound hearing loss to provide them with sound and speech information.19Cochlear ImplantSound picked up by microphoneSpeech processorCoded into electrical impulses Transmitter coilThrough the skin via FM waves Receiver stimulatorElectrodesNerveBrain21Cochlear New Freedom22Advanced Bionics23Med EL Pulsar24Worldwide Over 100,000 multi-channel implants25University of Florida Cochlear Implant ProgramImplanted our first patient in 1985Currently follow over 450 cochlear patients26Cochlear Implant Team for Adult PatientsSurgeonAudiologistSpeech-Language PathologistPsychologistSocial WorkerVR Counselor27Formal EvaluationMedicalAudiologicalStandard audiometric unaided test batteryAided speech perceptionAided speechreading28Preimplant Counseling TopicsCandidacy criteriaCochlear implant hardwareRealistic expectationsIndividual and family commitmentsSocial considerationsCommunication mode29Who is a candidate? Severe-to profound sensorineural hearing lossLimited benefit from hearing aids30Who is an adult candidate?< 50% aided speech recognition on recorded sentence material in the ear to be implanted < 60% aided speech recognition on recorded sentence material in the un-implanted ear < 40% for Medicare coverage31Deaf CultureDeafness is a culture not a handicapCharacterized by their own languageResent those trying to ‘fix a deaf child’32Outcomes for Post-lingual AdultsWide range of success Most score 90-100% on AV sentence materialsMajority score > 80% on high context materials Performance more varied on single word tests but most have some open set recognition33Impact of CI on Vocational Settings13 cochlear implant recipients and their employers completed a modified Profile of Hearing Aid Benefit Questionnaire Provided employers’ contact information9 of the employers returned completed questionnaire Results indicated the cochlear implant had a positive impact on the job functioning. Saxon, J.P., Holmes, & Spitznagel, R.J. (2001) Impact of a cochlear implant on job functioning. Journal of Rehabilitation, 67(3), 49-54.34Impact of CI on Vocational SettingsBoth supervisors & clients found improvements after the CI in. awareness of warning signals understanding conversations in most environmentsidentifying sounds in their environment The only negative effect of CI: traffic noises were more bothersome