1. Hearing loss and audiograms

2. City Lit Objectives To understand how hearing loss is measured To recognise the degree and type of deafness from an audiogram To relate a person’s audiogram to how they might understand speech Relevant for: Assignment 1 b Audiology and aural rehabilitation

3. City Lit Referral pathways in NHS Over 55 G.P examines outer ear with otoscope If nothing abnormal detected (NAD), G.P refers direct to audiology department for hearing test (if only age- related) or to ‘Any Qualified Provider’ (AQP) Hearing aids if appropriate Under 55 - or over 55 and needs further examination G.P examines outer ear with otoscope and refers to hospital ENT (ear, nose and throat) Consultant ENT Consultant examines outer ear, takes a history, sends patient to audiology Audiology department does hearing test and further diagnostic tests if required. Hearing aids if appropriate

4. City Lit What is Any Qualified Provider - AQP? Patients can choose from a range of providers to get NHS hearing aids e.g. local hospital or Specsavers, Boots etc. Prices paid to providers are determined by the NHS.. Patients choose based on individual preferences and money will follow patients’ choices. Providers must pass a standard qualification process to ensure they meet the appropriate quality standards However, about 20%* of the patients meeting AQP criteria will have complex needs and so require referral back *Source: Reading Health Forum

5. City Lit Pure tone audiometry (PTA) Uses ‘pure tones’ = tones of a single frequency Measures the ‘hearing threshold‘ = the quietist sounds the person can hear Results are used to help diagnose the type and degree of hearing loss Results can be used to prescribe hearing aid(s)

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7. Ways of classifying the degree of hearing loss Hearing loss is classified as: Normal Mild hearing loss Moderate hearing loss Severe hearing loss Profound hearing loss

8. City Lit Degrees of hearing loss

9. City LitDocument Title

10. City Lit The ‘speech banana’

11. City Lit normal mildmoderate severeprofound The higher the line = the better the hearing

12. City Lit Remember how we hear?

13. City Lit Pure tone audiometry (PTA) Measuring the ‘hearing threshold‘ using pure tones at different frequencies - air conduction - bone conduction

14. City Lit PTA air conduction test Pure tones presented through headphones Measures the hearing from the outer ear, through the middle ear to the cochlea i.e. tests the whole hearing mechanism

15. City Lit PTA bone conduction test Pure tones presented through a receiver placed behind the ear on the mastoid process (bone) Bypasses the outer ear and the middle ear; sound goes to the cochlea through the skull

16. City Lit Why consonants matter… A _ _ _ _ u _ e _ _ _ _ i _ e _ _ o _ o _ a _ e _ i _ _ u i _ _ (vowels only)

17. City Lit Why consonants matter… _ ll st_ d_ nts l_k_ ch_c_l_t_ b_sc__ts (consonants only)

18. City Lit The ‘speech banana’

19. City Lit Presbyacusis ( Age-related hearing loss)

20. City Lit Noise-induced hearing loss

21. City Lit The cochlea Different frequencies detected in different parts High frequencies detected nearest to the end where the stapes joins Excessive noise damages this part

22. City Lit Descriptors of hearing loss Sensori-neural Conductive Mixed Congenital Acquired Progressive Fluctuating Bilateral Unilateral Symmetrical Asymmetrical High frequency Low frequency