2. Vision
A society where all people are respected; have full access to communication; and are able to participate without social, economic, or emotional barriers.
Mission
The Canadian Hearing Society is the leading provider of services, products, and information that:
Remove barriers to communication
Advance hearing health
Promote equity for people who are culturally Deaf, oral deaf, deafened and hard of hearing.

3. Hearing Care Counsellor
Kim Hennessy, M.Sc.
Hearing Care Counsellor
OUTLINE
Overview of Anatomy & Classification of Hearing Loss
Stigma Related to Hearing Loss
Hearing Aid Styles/Maintenance/Troubleshooting
Communication Tips for Caregivers
Communication Devices

4. Ear Anatomy Eardrum Divided into 3 parts: Outer Ear Middle Ear
Inner Ear
Eardrum
The ear is the organ that allows us to hear sound and also keeps us balanced. Equilibrium = a sense of being balanced.
It can be divided into 3 functional parts. The external, middle, and internal ear.
External = part you can see attached to the lateral side of head and also the canal leading inwards (yellow) **Tympanic Membrane = Eardrum = separates external & middle ear**
Middle = a cavity within the petrous temporal bone that the canal leads too. It contains tiny bones, muscles, nerves, and a canal connecting it too the pharynx (blue)
Internal = a series of cavities deep within the petrous temporal bone. Inside these cavities are a series of continuous ducts/sacs, in which the organs/sensory receptors for hearing and balance are found. (purple)
*The external and middle ear are mainly concerned with transference of sound to the internal ear
*Internal ear send signals to the CNS in order to produce the perception of sound and a sense of balance
Details of each section will be discussed in the following slides…..

5. Outer Ear PINNA collects sound funnels sound waves into canal
(also holds hearing aids, earrings & glasses )
EAR CANAL
directs sound waves inward
produces wax
curved
The part you can see
The part of the ear you hand your earrings and glasses on
Wax helps protect the ear from infections and removes dirt
If the wax builds up, never try to remove it yourself

6. Middle Ear TYMPANIC MEMBRANE
partition between ear canal & middle ear cavity
sound waves contact and cause vibration

7. Middle Ear MIDDLE EAR CAVITY air-filled space behind ear drum
fluid and infections hide here
If the Eustachian Tube is not working, your ears may feel plugged and could fill with fluid.
one end of the chain is attached to the eardrum & the other to the Inner Ear

8. Parts of the Middle Ear EUSTACHIAN TUBE
passageway from the middle ear cavity to the throat (infection can travel here)
equalizes air pressure in the middle ear with atmospheric pressure

9. Parts of the Middle Ear AUDITORY OSSICLES
Malleus (hammer), Incus (anvil), & Stapes (stirrup)
form a chain from the ear drum to the cochlea
transmits ear drum vibrations to the inner ear

10. Parts of the Inner Ear COCHLEA organ of hearing snail-shaped
fluid-filled
stapes moves in and out of oval window like a piston in an engine, creating waves
The hair cells bend when the fluid in the IE moves & send a message to the brain
The bending of the hair cells sends an electrical impulse or message to the brain, travelling along the auditory nerve.
Some hair cells respond to low pitched sounds and others respond to high pitched sounds

11. More on the Cochlea
Contains thousands of hair cells (organ of corti) that are displaced in response to waves in the fluid
hair cells send an electrical impulse to the brain
Depending on the specific location in which this displacement occurs, we hear low or high pitched noises
Number of cells activated determines loudness of the noise

12. Parts of the Inner Ear SEMICIRCULAR CANALS organ of balance
oriented in different planes and work together to keep us balanced
fluid-filled
this system responds to movement in any direction

13. Hearing Loss

14. 2 Types of Hearing Loss
Conductive
Sensorineural

15. Conductive Hearing Loss
Result of any pathology within the outer ear or middle ear:
- pinna and ear canal
- middle ear cavity
- tympanic membrane
- ossicles
- eustachian tube

16. Sensorineural Hearing Loss
Originates from pathology of the inner ear:
the sensory cells in the cochlea
the auditory nerve fibers of the VIII cranial nerve
When these structures are damaged their ability to transmit mechanical energy (vibrations) into electrical energy (nerve impulse) is reduced
the signal does not reach the brain VS

17. Causes of Hearing Loss Conductive Sensorineural
- Abnormality of outer ear - Head trauma
- Narrowing of canal (stenosis) - Noise exposure
- Osscular discontinuity - Age-induced/presbycusis
(bones do not form chain) Acoustic Neuroma (tumor)
- Middle ear infection (OM) - Congenital
- Otosclerosis - Hereditary/Genetic
(bony chain cannot move) Meniere`s Disease
- Perforated ear drum - Consequences of other
- **Build up of ear wax** illness ex. Meningitis
- Ototoxic Medications
(Dr. Timothy Hain’s website)
Shape of a Q-tip
Analogy = carpet fibers

18. Stigma
Only old people have hearing loss

19. Hearing Aids

20. 1. Behind-the-ear (BTE) Most seniors wear For severe losses
Good for dexterity problems
Usually have volume control and program button
Custom ear mold – must be cleaned regularly!!
Large tubing – must be cleaned and should always be flexible (pinch to test)
Battery located in bottom

21. BTE; Open-fit: First time wearers Mild-moderate loss Cosmetic appeal
No occlusion
Eliminates hollow sound
Voice sounds more natural
Air ventilation
Open Fit hearing aids were developed to meet the specific needs of the early stage, first time user’s group
First time users – basically younger people with a high frequency hearing loss – are active, discerning and committed to a high quality of life
the ear mold is made of soft silicone and shaped like a dome which makes it feel like almost nothing is in the ear
The unique vent structure allows sound to escape, eliminating the occlusion effect i.e. the "my voice sounds like I'm talking in a barrel" complaint
Outside air freely enters the canal reducing moisture and enhances the natural sound
Open Fit HAs are also less visible
Although CIC's are considered to be the least visible, occlusion can be a problem and gain may be insufficient.  BTE's can solve these problems but are less cosmetically appealing.  So, Open Fit HA's combines the best of each to provide a better solution - useful high frequency amplification, cosmetic appeal and no occlusion
"Slim Tube" and is much less visible than standard tubing

22. BTE; Open-fit: Battery still in bottom Thin tubing Soft silicone dome
Cleaning not as important (occasionally needs attention)
Flexibility not an issue – no pinch test required
Soft silicone dome
Fits mid-way down the ear canal
Domes (umbrella-looking piece) need to be cleaned
Domes need to be changed by audiologist every months, depending on wax accumulation
Tail is to keep dome in place – rest in concha
Open Fit hearing aids were developed to meet the specific needs of the early stage, first time user’s group
First time users – basically younger people with a high frequency hearing loss – are active, discerning and committed to a high quality of life
the ear mold is made of soft silicone and shaped like a dome which makes it feel like almost nothing is in the ear
The unique vent structure allows sound to escape, eliminating the occlusion effect i.e. the "my voice sounds like I'm talking in a barrel" complaint
Outside air freely enters the canal reducing moisture and enhances the natural sound
Open Fit HAs are also less visible
Although CIC's are considered to be the least visible, occlusion can be a problem and gain may be insufficient.  BTE's can solve these problems but are less cosmetically appealing.  So, Open Fit HA's combines the best of each to provide a better solution - useful high frequency amplification, cosmetic appeal and no occlusion
"Slim Tube" and is much less visible than standard tubing

23. RITE – receiver in the ear
Open-fit aids can also be designed with a receiver (the speaker) placed at the end of the tube or in the ear…this delivers the sounds directly to the eardrum
Tubing has thin wire inside
CANNOT clean tubing!!!
Often have custom tip
If not, will have domes
Open Fit hearing aids were developed to meet the specific needs of the early stage, first time user’s group
First time users – basically younger people with a high frequency hearing loss – are active, discerning and committed to a high quality of life
the ear mold is made of soft silicone and shaped like a dome which makes it feel like almost nothing is in the ear
The unique vent structure allows sound to escape, eliminating the occlusion effect i.e. the "my voice sounds like I'm talking in a barrel" complaint
Outside air freely enters the canal reducing moisture and enhances the natural sound
Open Fit HAs are also less visible
Although CIC's are considered to be the least visible, occlusion can be a problem and gain may be insufficient.  BTE's can solve these problems but are less cosmetically appealing.  So, Open Fit HA's combines the best of each to provide a better solution - useful high frequency amplification, cosmetic appeal and no occlusion
"Slim Tube" and is much less visible than standard tubing

24. 2. In-the-ear (ITE) Many seniors wear Custom made to fill concha
Moderate to severe losses
Large volume wheel and program button
Good for dexterity problems
Must be cleaned regularly
Battery door located near volume wheel

25. 3. In-the-canal (ITC) Mild to moderate losses Less visible
Custom made to fill acoustic
meatus
Must be cleaned regularly
Insertion and volume controls require good dexterity
Smaller volume wheel and sometimes program button
Battery still near volume wheel
Newest Style

26. 4. Completely-in-the canal (CIC) Mild to moderate losses
Low power & barely visible
Fits just inside the proximal canal
Good dexterity is needed for insertion
No volume control or program buttons
Must be cleaned regularly
Batter often very small but placed in similar location

27. Stigma Hearing aids are uncomfortable
Hearing aids cost way too much & don’t work
“My sister has them and she never wears them.”
“Mine have been in my drawer for months.”
“There is so much noise when I wear them, I don’t bother.”

28. Stigma
If someone sees that I wear a hearing aid, they look at me as incapable
If someone sees that I wear a hearing aid, they seem to think its ok to leave me out
If someone sees that I wear a hearing aid, they assume I can hear as if I have perfect hearing
…..and hearing aid manufactures are contributing to it

29. Which HA is for which ear?
Red = Right
Blue = Left
Usually some sort of writing or coloured section on HA
Sometimes located inside battery door

30. Refer to an Audiologist:
Any pain occurs
Hearing loss has worsened/communication breaking down
Ear mold is not fitting properly
Constant whistling occurring
After new battery installed, HA still not working
For thorough cleaning once every year
You can call and request:
Cleaning tools
New tubing & new domes
Wax guards

31. Wax Guards…
Fills the hole in HA that delivers amplified sound to the ear drum
If plugged with wax, sound waves can’t be easily transmitted i.e. is distorted and decreased!
Common cause of complaining!
Usually small white circle in hole (or Red/Blue)
Must be changed every few months
Almost never fully explained to the client

32. Maintenance of Hearing Aids
Hearing Aid Cleaning:
Wipe hearing aid/ear mold with tissue – do not use water
Good to do more often when sick
Wax removal is crucial to the function of aid(s)
Use tools provided by audiologist
Brush dead skin cells and wax off aid/ear mold
Pick wax from holes
Use vent cleaner for hole that goes all the way through aid/ear mold
Change wax guards when plugged

33. Battery Details TIPS: # 1 problem in long term care facilities is:
Wearing aids with dead batteries…basically wearing an ear plug!
Quick test: cup hand over ear or enclose hearing aid in your cupped hands – should hear whistling sound
Yes = battery still has life
No = dead battery = needs to be changed
TIPS:
When inserting battery – flat side faces up
Open battery door to prolong the life of the battery when not using ex. every night
For reminders to change batteries, place sticky tab on calendar or charts when you replace them - Last 7-10 days
When sticky tab is removed, battery begins to drain!
Have a battery tester on hand

35. What is that annoying whistle?
Feedback – sound waves are being amplified over and over again (like a microphone held near speaker)
Common causes:
Ear molds (BTE) or HA not inserted properly – air escapes
Ear mold has shrunk and person needs new one (about $80/ear)
Volume turned up too high
Tubing is clogged

36. Stigma
Occasionally, a person with hearing loss is wrongfully diagnosed with a degenerative condition due to poor communication, giving wrong answers or being non- responsive
Sometimes a person who always seems to be foul or who does not respond to you or whose communication has changed…could be living with:
An undiagnosed/untreated hearing loss
Their hearing loss might have gotten worse
Their HAs are not working properly
**Their ear canals are impacted with wax!!!

37. Implication of Hearing Loss
Fatigue Isolation Irritability
Rejection Stress Loneliness
Avoidance Anger Fear
Guilt Withdrawal Frustration
Negativism Embarrassment Bluffing
Headaches Muscle tension
Lowered Self-esteem
Feel less independent and more limited

38. Implication of Hearing Loss
These psycho-social difficulties lead to reduction in quality of life and physical health status
Can lead to higher incidence of: deterioration, sensory deprivation, arrhythmias, heart disease, hypertension, osteoarthritis, etc.

39. Communication Tips

40. Communicating with Hard of Hearing Persons
Don’t shout – volume is not as important as you think
Shouting further distorts speech sounds
Speak clearly and at a moderate pace
Put space between words not within them
Do not exaggerate your mouth movements
Get the person’s attention before speaking
Tap on shoulder/flick lights/state their name
Face the person when you speak to them
Stop speaking if you need to turn around, then continue once you are facing them again

41. Communicating with Hard of Hearing Persons
Don’t cover your mouth or chew gum
Use facial expressions and gestures
Gives clues when the subject changes
State topic of conversation
Be patient
Avoid noisy background situations
More to a quieter place if communication is difficult

42. Background Noise
Some background noises, such as loud stereos, machinery and traffic are obvious to everyone and people generally avoid trying to talk in these situations
For hard of hearing people, subtle sounds such as the hum of air conditioning, running water or wind can cause difficulties
In all these situations, hearing aids become a challenge to wear & this requires adjustment
With new technology we are better able to control background noises

43. Deaf Adults in Hospital or Long Term Care
Visual smoke/CO detectors
Visual/tactile alarm clock and TTY in room
Have at least one staff learn ASL
LTC: Post activities in their room
If 2 Deaf people in facility, seat them together
Hospital: write down all important information, especially upon discharge
White board with markers available
Always have CHS’s contact info. on hand

44. Communication Devices
Program

45. Communication Devices Program at CHS
CHS offers a full range of assistive devices for:
Home
The workplace
Schools
Community facilities

46. Communication Devices
Amplified Telephones & TTY’s
Alerting Systems
Personal Amplification Systems
T.V. Listening Devices
FM Systems
Super Ringers/Visual Ringers
Visual Alarm Clocks - with bed shaker
Visual Smoke/Carbon Monoxide Detectors
Sound Conditioners
And more…

47. Amplified Phones Amplify voices to 30, 40, 50, & 60 dB
Provide increased clarity
Tone and volume controls
Bright visual ringer
Memory storage
Headset jack
Hearing aid compatible

48. VCO, TTY, Cordless Read and Talk phone For deafened individuals
TTY for Deaf individuals

49. Personal Amplification
These easy-to-use, portable amplifiers can improve your communication one-on-one, in small groups, in the car, or when at important meetings etc.
Serene Innovations
DT - $169.95
Williams Sound PocketTalker Pro
$250.00
5 year warranty
Sennheiser
Audioport - $305

50. Alerting Systems
Notifies you when the phone rings, when someone is at your door, when the alarm clock goes off or if there are loud noises in the room
Other audio alarms can be added to the system and setup beside your smoke detector etc.
Signals person using a flashing lamp and/or vibrating bed shaker
Tactile portable pager can be added
to the system

51. T.V. Listening Systems
Infrared technology delivers sound from the television to headphones, within 100 ft. range
The headsets are wireless and have adjustable volume control
$385
$99.95

52. Questions??

53. THANK YOU The Canadian Hearing Society 1300 Bath Road, Kingston
For further information please contact;
The Canadian Hearing Society Bath Road, Kingston
(Frontenac Mall) T:
TTY: F:
chs.ca