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HEARING IMPAIRMENTLiterature Reading
AUDIOLOGY
Achmad S
Dept of OtorhinolaryngologyHNSHasan Sadikin General Hospital
Bandung
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DEFINITION
Hearing impairment any degree and typeof auditory disorder.
Deafness an extreme inability to discriminate
conversation speech through the ear.
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EPIDEMIOLOGY
National Institute on Deafness and Other Communication
Disorders :
28 million Americans deaf or hearing impaired.
1 out of every 10 people.
The most common birth anomaly.
30 million exposed to hazardous noise levels.
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HEARNG LOSS
The timing of the hearing loss :
Congenital present at birth.
Acquired : Later in life.
Sudden or progressive.
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TYPE OF HEARING IMPAIRMENT
HearingImpairment
Conductive Sensorineural Mixed
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CONDUCTIVE IMPAIRMENT
A defect in the auditory system which interferes
with sound waves reaching the cochlea.
The outer or middle ear. Maximum loss 50 - 55 dB.
Loss roughly constant with frequency.
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CAUSE of CONDUCTIVE
HEARING LOSS
The most common in kids and teens otitis media.
A buildup of fluid or pus behind the eardrum block the
transmission of sound.
If fluid goes away hearing returns to normal.
Blockages in the ear a foreign object, impacted earwax or
dirt.
A tear or hole in the eardrum interfere vibrate properly.
Etiology : inserting an object into the ear, a sudden explosion
or other loud noise, a sudden change in air pressure, a headinjury, or repeated ear infections.
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Normal Eardrum
Otitis Media10/26/2013 9
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Sensorineural Hearing Loss
Defect in the inner ear
or connection to brain
Loss can be complete
Loss greater at high
frequencies
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Sensorineural Hearing Loss
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Genetic disorder development of the inner ear and the
auditory nerve.
Injuries to the ear or head.
Complications during pregnancy or birth.
Infections or illnesses development of the inner ear.
Premature babies.
CAUSE of SENSORI NEURAL
HEARING LOSS
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Infections or illnesses.
Repeated ear infections
Brain tumors
Damage the structures of the inner ear.
Medications.
Some antibiotics
Chemotherapy drugs
Loud noise.
A sudden loud noise or exposure to high noise levels over time permanent damage to the tiny hairs in the cochlea
Can't transmit sounds effectively
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CAUSE of SENSORI NEURAL
HEARING LOSS
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RISK FACTORS
Risk factors for congenital loss are:
1. Family history of hereditary loss.
2. Prematurity, with birth weight less than approximately
1.5 kg.3. Maternal rubella during pregnancy.
4. Maxillofacial deformities.
5. Kernicterus, with bilirubin levels greater than 12mg/dl.
6. Neonatal sepsis, especially with meningitis.
7. Forceps delivery, with temporal bone injury.
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Mixed impairments involve both conductive and
sensorineural defects.
Hearing losses occurring from birth to 19 years of age
prevocational deafness or prelingual deafness.
Hearing impairments after 19 years of age do not seem to
severely affect speaking ability and language.
Mixed Hearing Loss
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SPEECH FREQUENCIES
Speech frequencies range from 250 to 8000 hertz.
A pure tone audiogram tests the patients hearing at the
intervals of 250, 500, 1000, 2000, 4000, and 8000 hertz foreach ear.
Normal hearing is defined as hearing the above hertz at or
below 25 decibels.
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Effects on Understanding Speech
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Children with a hearing difficulties may have problems with:
Entering into a group, requesting, responding and taking
turns
Initiating conversations
Understanding subtle social rules Accepting others points of view and others feelings
Monitoring the listener
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Mental Characteristics
They may feel that people who they talk to lose patiencewith them because they have to repeat themselves
Hearing loss can create feelings of emotional isolation
A person may feel that the focus of attention is placed ontheir disability
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How Do Doctors Diagnose It?
History taking
Physical examination
Ancillary test
Hearing test
Radiology Examination
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How Do Doctors Diagnose It?
Difficult to diagnose in infants and babies.
Screened before leave the hospital.
Sometimes parents notice her baby doesn'trespond to loud noises or to the sound of voices.
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According to the American Speech-Language-Hearing Association certain
symptoms in teens should prompt a trip to the doctor :
You feel that people mumble or that their speech is not clear
You hear only parts of conversations when people are talking.
You often ask people to repeat what they said. Friends or family tell you that you don't seem to hear very well.
You don't laugh at jokes because you miss too much of the story.
You need to ask others about the details of a class or meeting you
attended.
People say that you play music or your TV too loudly.
You can't hear the doorbell or telephone.
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HEARING TEST
1. Subjective
2. Objective
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SUBJECTIVE HEARING TEST
1. Whisper test
2. Tuning fork Test
3. Pure tone Audiometry
4. Special audiometry : SISI, ABLB, Tone Decay5. Behavioral Observational Audiometry (BOA)
6. Visual Reinforcement Audiometry (VRA)
7. Play Audiometry
8. Speech Audiometry
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OBJECTIVE HEARING TEST
Ottoacustic Emission (OAE)
Brainstem Evoked Response Audiometry
Auditory Steady State Response (ASSR)
Acoustic Immitance Tests:
Tympanometry
Eustachian tube function
Acoustic reflex thresholds
Acoustic reflex decay
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AUDIOMETRY
Measures hearing threshold
Subject wears headphones
Send pure tone to one ear at
audible level
Decrease level until subject cant
hear it
Repeat at other (standard)frequencies
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AUDIOGRAM
For children, hearing threshold levels exceeding 15 dB should be
considered abnormal.
Hearing Threshold
Levels (dB)Hearing Loss
0202040
4060
> 61
NormalMild
Moderate
Severe
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Mild (2644 dB) Moderate (4559 dB)
Severe (6089 dB)
Profound (> 90 dB)
Understand conversation at 11.5m
May have delayed speech development May miss up to 50% class discussion if
speaker not visible
May need hearing aid
Will need special education attention
May understand speech at
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AUDIOGRAM of NORMAL
HEARING
50
40
30
20
10
0
-10
125 250 500 1k 2k 4k 8k
left ear
right ear
Frequency (Hz)
Hearing
loss
(dB)
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AUDIOGRAM
CONDUCTIVE HEARING LOSS
BC threshold within normal
limits (0-20 Db)
AC Threshold Increased
BC-AC gap > 10 db
Gb. Gangguan dengar
konduktif
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AUDIOGRAM
SENSORI- NEURAL HEARING LOSS
Increased BC thresholds
Increased AC thresholds
BC-AC gap < or = 10 db
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Presbikusis
AUDIOGRAM
SENSORI- NEURAL HEARING LOSS
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AUDIOGRAM
NOISE INDUCED HEARING LOSS
(NIHL)
Decreased hearing (increased
threshold levels) at higher
frequencies (3000- 6000 hz)
Usually starts with a dip at
4000 hz
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TYMPANOMETRY
The dynamic recording of middle-ear
impedance / air pressure in the
ear canal
A sensitive measure of the integrity ofthe tympanic membrane and of middle-
ear function.
Compliance of the middle ear the
vertical dimension of a tympanogram
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Three general types of
tympanogram A, B, and C.
Type A :
The location and peak in
compliance within 0-100 mm
water (dPa) in the ear canal.
TYMPANOMETRY
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Type B:
No peak in compliance (a flat
pattern) Little or even no apparent
change in compliance
Fluid within the middle-ear
space (otitis media)
TYMPANOMETRY
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Type C :
The peak within the negative
pressure region beyond -100 mmwater (dPa)
Eustachian-tube dysfunction and
inadequate ventilation
Often precedes a type B in thedevelopment of otitis media.
TYMPANOMETRY
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A variation of a type A:
Type As.
The s stands for shallow.
Peak compliance is less than the
lower normal limit of compliance.
Middle-ear impedance is abnormally
high.
Fixation of the ossicular chain,
otosclerosis.Tipe As
TYMPANOMETRY
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Type Ad
An unusually steep and high-
compliance tympanogram
Peak can exceed the upper
compliance limits
Disruption of the ossicular chain
Leaves the middle ear extremely
mobile and overly compliant; littleimpedance. Tipe Ad
TYMPANOMETRY
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Up to 30% of a population of outer hair cells can be damaged without
substantially affecting a simple audiogram.
Newborn hearing screening.
Advantage :
The noninvasive . Accuracy and objectivity in assessing cochlear, especially outer
hair cell.
OAEs may be recorded in severely impaired auditory function mass
lesion on the auditory nerve or auditory neuropathy.
OTOACOUSTIC EMISSIONS
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AUDITORY BRAINSTEM RESPONSE
Inexpensive and sensitive initial evaluation.
Electrophysiologic recordings.
Activation of all levels of the auditory system, from
cochlea to cortex.
Estimation of hearing sensitivity in infants and young
children.
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Wave I : cochlea
Wave II : nucleus cochlearis
Wave III : superior olivariWave IV : lateralis lemniscus lateralis
Wave V : inferior colikulus
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WAVES IN BERA
Latency inLatency in msecmsec
Amplitudein
Amplitudein
VV
NormalNormalNormal Latency phaseNormal Latency phaseGood MorphologyGood Morphology
Conductive Hearing LossConductive Hearing LossLate Latency phase Wave ILate Latency phase Wave IInterwafeInterwafe latensilatensi NNGood MorphologyGood Morphology
Sensory Hearing LossSensory Hearing LossLate Latency Wave ILate Latency Wave I sdtsdtterlambatterlambatWave I kecil/Wave I kecil/--InterwaveInterwave latency Nlatency NBad MorphologyBad Morphology
Neural LossNeural LossWave I NWave I NLate Latency Wave ILate Latency Wave I--IIIIIILateLate InterwaveInterwave latencylatencyBad MorphologyBad Morphology
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MRI
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CT-SCAN
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How Is It Treated?
Depending upon etiology.
Treatment :
Removing wax or dirt from the ear.
Treating an underlying infection. Hearing aid or cochlear implant problem in the
cochlea or hearing nerve.
Surgery damage or a structural problem with the
eardrum or ossicles.
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Inflammation of middle ear
1. Medicamentous
2. Surgery
Mastoidectomy
Tympanoplasti
TREATMENT OF HEARING IMPAIRMENT
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Sensorineural hearing loss :
Hearing aids
Cochlear implant Special education SLB B
Speech therapy
Counseling
TREATMENT OF HEARING IMPAIRMENT
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HEARING AIDS
Make sounds louder hear
clearly.
Various forms fit insideor behind the ear.
In profound the hearing loss
a cochlear implant
recommendation.
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COCHLEAR IMPALNT
Surgically implanted devices.
Bypass the damaged inner ear and send signals directly
to the auditory nerve.
These signals perceived as sound and allow the
person to hear.
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Can I Prevent Hearing Impairment?
Many cases of hearing loss or deafness
are not preventable.
Noise-induced hearing loss can be
prevented. Any sounds over 80 decibels
considered hazardous with prolonged
exposure.
Like loud music, sirens and engines.
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Some ways to reduce it.
Turn down the volume on yourstereo, TV, headset on yourWalkman or CD player
Wear earplugs if going to a loudconcert and while working
around loud noise such as powertools, jackhammers.
See your doctor right away ifsuspect any problems with
hearing. Get your hearing tested on a regular
basis
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.Thank You.10/26/2013 53
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