1. Understanding and Treating Hearing Problems
Dr. Diana Barreneche, CCC, FAAA Audiologist/Clinical Educator

2. Topics To Be Discussed Ear Anatomy and Physiology
Signs of Hearing Loss in Adults
Causes of Hearing Loss
Hearing Loss Treatment Options
Tinnitus
Signs of Tinnitus
Tinnitus Treatment Options

3. Anatomy and Physiology of the Ear
Outer
Middle
Inner ear

4. Anatomy and Physiology of the Ear
Outer Ear
Consists of
the auricula or pinna
the external acoustic
meatus

5. Anatomy and Physiology of the Middle Ear
Eardrum
Ossicles

6. Anatomy and Physiology of the Inner Ear
Cochlea/Hearing Organ
Vestibular Canals/Balance Organ

7. Acoustic Nerve (8th)
The vestibular/auditory nerve runs in the internal auditory canal and the peripheral end organs to the central nervous system (CNS) Nerve..

8. Diagnostic Tools Otoscopy OAEs (Otoacoustic Emissions)
Tympanometry (Middle Ear Test)
Pure tone and Speech Audiometry (Sound Booth)
Auditory Brainstem Response(8th Nerve and Hearing Thresholds Estimation)

9. Common Myths
Hearing loss affects only "old people" and is merely a sign of aging.
Actually it is the reverse of what most people think. The majority (65%) of people with hearing loss are younger than age 65.

10. Common Myths
There are more than six million people in the U.S. between the ages of 18 and 44 with hearing loss, and nearly one and a half million are school age.
Hearing loss affects all age groups.

11. “If I had a hearing loss, my family doctor would have told me”
Common Myths
“If I had a hearing loss, my family doctor would have told me”
Not true! Only 13% of physicians routinely screen for hearing loss during a physical. Since most people with hearing impairments hear well in a quiet environment like a doctor's office, it can be virtually impossible for your physician to recognize the extent of your problem. Without special training, and an understanding of the nature of hearing loss, it may be difficult for your doctor to even realize that you have a hearing problem betterhearing.org

12. Common Myths
Hearing might be at the bottom of the medical checklist, but it might be the number one medical cause of your problems.
Why?

13. Signs of Gradual Hearing Loss in Adults
The perception that people are speaking too soft or mumbling.
Frequent misinterpretation of what is being said.
Difficulty understanding conversations on the phone.

14. Signs of Gradual Hearing Loss in Adults/ Continuation…
Difficulty understanding conversations in different environments: restaurants, theater, automobile, family reunions, seminars or places of worship.
Blocked or stuffy feeling in the ears.
Ringing in the ears.
betterhearing.org

15. Prevalence of Hearing Loss In US
3 in 10 people over age of 60 have hearing loss;
1 in 6 baby boomers (ages 41-59), or 14.6%, have a hearing problem
1 in 14 Generation Xers (ages 29-40), or 7.4%, already have hearing loss
At least 1.4 million children (18 or younger) have hearing problems
It is estimated that 3 in 1,000 infants are born with serious to profound hearing loss.
betterhearing.org

16. Types of Hearing Loss Conductive hearing loss
Hearing loss is categorized by which part of the auditory system is damaged.
Conductive hearing loss
Sensorineural hearing loss
Mixed hearing loss
Retro-cochlear hearing loss

17. Conductive Hearing Loss

18. Sensorineural hearing loss

19. Sensori-neural Hearing Loss
SENSORINEURAL HEARING LOSS (DAMAGE TO THE INNER EAR CELLS CALLED CILIA)

20. Healthy Dead and Damage Cilia Cilia

21. Damage to Outer or Middle and Inner ear
Mixed Hearing Loss
Damage to Outer or Middle and Inner ear

22. Causes of Conductive Hearing Loss
Ear infection (Otitis)
Allergies
Poor Eustachian tube function
Perforated eardrum
Benign tumors (growths along the outer and middle ear)
Impacted earwax (cerumen)
Presence of a foreign body
Fluid in the middle ear from colds
Atresia (Anotia)

23. Causes of Conductive Hearing Loss
Microtia and Atresia
Ear malformations
PE tube: Surgical tube to drain fluid in middle ear

24. Causes of Conductive Hearing Loss
External Otitis (Inflammation due to infection of ear canal)
Impacted Wax

25. Ear Drum Perforation with a Q-Tip
When cotton tipped applicators are used to clean out ear wax, there is a risk of breaking the ear drum (perforation). Although we realize that this is commonly done, we recommend against using cotton tipped applicators, hair pins, and similar devices to clean the ear.

26. Causes of Sensorineural Hearing Loss
SNHL reduces the ability to hear faint sounds. Even when speech is loud enough to hear, it may still be unclear or muffled. Some possible causes of SNHL include:
Illnesses
Drugs that are toxic to hearing
Hereditary
Aging (Presbycusis)
Head trauma
Malformation of the inner ear
Exposure to loud noise
Auditory nerve occupied lesion/ (8th) tumors

27. Presbycusis (Age Related Hearing Loss)

28. Presbycusis Hearing Loss due to Aging
Causes:
There is no known single cause for age-related hearing loss. Most commonly, it is caused by changes in the inner ear that occur as you grow older. However, your genes and exposure to loud noises (such as from rock concerts or loud machinery) may play a large role.

29. Presbycusis Hearing Loss due to Aging
The following factors contribute to age-related hearing loss:
Family history (age-related hearing loss tends to run in families)
Repeated exposure to loud noises
Smoking
Certain medical conditions (Diabetes) and medications (Ototoxics) also contribute to age-related hearing loss.

30. Presbycusis Hearing loss related to Aging
Prevalence: About half of all people over the age of 65 have some amount of age-related hearing loss.
Impact in life style: The loss of hearing occurs slowly over time.
It is most difficult to hear high-frequency pitch sounds. (ex: speech of women and children)
As hearing gets worse, it may become difficult to hear sounds at lower pitches. (ex: men’s voices)

31. Presbycusis (Age Related Hearing Loss)
It becomes difficult hearing things in noisy areas like restaurants.
Hard time distinguishing high-pitched sounds such as "s" or "th" from one another.
Other people's voices sound mumbled or slurred.
Ringing in the ears and lack of tolerance to loud sounds is reported.

32. Understanding the Audiogram

33. Normal Hearing

34. Presbycusis (Age Related Hearing Loss)

35. Retro-cochlear Hearing Loss
8th nerve (Auditory nerve) tumor
Auditory Neuropathy (Connection between Cochlea and auditory nerve)
Problems in the Auditory path from the cochlea to the auditory section in the brain (Auditory Processing Issues)

36. Hearing Loss Treatment options
Medication
Surgery
Types of Amplification:
- Hearing Aids
-Cochlear Implants (CIs)
-Assisted Listening Devices

37. Key Factors in Amplification Success
Initial Needs Assessment
Electroacoustic & Physiologic Compatability
Comprehensive Habilitative
Follow-up

38. Amplification Goals patient specific
Audibility
Comfort
Tolerance

39. Different Types of Hearing Aids

40. Hearing Aid Technology
- Enhances speech intelligibility
- Sound flows from one environment to
the other
- Wind block & Echo block
Automatic phone program
Feedback (Whistle control)
“Go with your specific needs and do not compare with others”

41. Assisted Listening Devices
FM systems Bluetooth loops
Amplified Close captioned TV
Phones

42. Cochlear Implants

43. Hearing Aids Insurance Coverage
Medicare (Exam)
Some Insurance Coverage e.g., Government,
VA, and Medicaid.
UCF LIFE members at UCF Communication Disorders Clinic (UCF Family Benefits)

44. Tinnitus Definition Classification Objective Tinnitus - Pulsatile
Subjective tinnitus
Treatment

45. Introduction
Tinnitus :“The perception of sound in the absence of external stimuli”
Tinnere: means “ringing” in Latin
Includes buzzing, roaring, clicking, pulsatile sounds

46. Classification
Objective tinnitus – sound produced by para-auditory structures which may be heard by an examiner
Subjective tinnitus – sound is only perceived by the patient (most common)

47. Prevalence 40 million affected in the United States
10 million severely affected
Most common in year-olds
More common in men than women
Why?

48. Tonotopy, columnar organization of cells with similar binaural interaction

49. Central Nervous System Mechanism
Reorganization of central pathways with hearing loss (similar to phantom limb pain)

50. Pulsatile Tinnitus Arteriovenous malformations Vascular tumors
Venous hum
Atherosclerosis
Ectopic carotid artery
Persistent stapedial artery
Dehiscent jugular bulb
Vascular loops
Cardiac murmurs
Pregnancy
Anemia
Benign intracranial hypertension a

51. Subjective Tinnitus Presbycusis Noise exposure Meniere’s disease
Otosclerosis
Head trauma
Acoustic neuroma
Drugs
Middle ear effusion
Tempo Mandibular Junction dysfunction
Depression
Meningitis
Syphilis

52. The cycle of tinnitus
Stress
Anxiety Level
Tinnitus

53. The Impact of Tinnitus
Thoughts and emotions: annoyed, bothered, depressed, anxious or angry
Hearing: the sound of the tinnitus competes with or masks speech or environmental sound perception.

54. The Impact of Tinnitus
Sleep: tinnitus interferes with the ability to fall asleep. It can also make it more difficult to get back to sleep when awaking up in the middle of the night because of the tinnitus.
Concentration: difficulty focusing on a task because of the loudness of the tinnitus.

55. Tinnitus Treatment Options
Multiple Treatments
Avoidance of dietary stimulants:
coffee, tea, cola, etc.
Smoking cessation
Avoid medications known to cause
tinnitus

56. Tinnitus Treatment Options
Amplification (Hearing Aids)
Sound Generators
Acupuncture
Medication (Xanax)
Counseling Tinnitus retraining therapy
Neuromonics (customized, music therapy, through a tinnitus evaluation/ tinnitus pitch match/frequency/Hypersensitivity Levels)

57. Thanks to LIFE’s 2011 Grant to UCF Communication Disorders Clinic
Tinnitus Treatment
Neuromonics, music therapy, was used to treat tinnitus and hyperacusis in an autistic female. It has proven to help reduce her tinnitus, hyperacusis, anxiety levels
and improve her ability to focus
while in speech therapy
and school.

58. How the Ear Works

59. QUESTIONS?
THANK YOU!

60. University of Central Florida
Communication Disorders Clinic
12424 Research Parkway, Suite 155
Orlando, FL 32826
Phone (407) Audiology
(407) Main

61. Hearing Loss