anaging people with normal...

Dr. Douglas L. Beck Au.D.Executive Director of Academic SciencesOticon Inc.Somerset, NJ

MANAGING PEOPLE WITH NORMAL THRESHOLDS

Hearing is

perceiving sound

Listening is

comprehending sound

The first 75 years of audiology were all about

hearing, the next 75 years will be

all about listening.

It ain’t all about hearing!

It is all about the brain…

we can make anyone hear,

we cannot make anyone listen.

People live in a world where

cognition, attention, memory,

and hearing interact

and each plays a critical role

in listening.

“Listening is where

hearing meets brain”

To be at the top of the

food chain depends

more on LISTENING

than HEARING!

Fluffy & Sparky

The REAL challenge…

Beyond hearing.

Improve the opportunity

For listening success!

An established goal of modern hearing aids is

to improve speech understanding for the wearer.

This goal is best achieved by improving SNR.

Goyette, Crukley & Galster. AJA March 2018

The Effects of Varying Directional Bandwidth in

HA Users’ Performance and Speech in Noise Performance

Speech in quiet does not predict speech in noise.

JAAA, 2011 R. Wilson: Clinical experience with the Words-In-Noise Test on 3,430 veterans: Comparisons with PT Thresholds and WRS in Quiet.

PREDICTING SIN DEFICITS FROM AUDIOGRAMS E&H MAY

2019 SHUB, MAKASHAY & BRUNGART

In occupations with hearing critical tasks, SIN may be more

important than thresholds (n=5487 people)

RESULTS SUGGEST

details of the audiogram are a

RELATIVELY INSENSITIVE PREDICTOR of

PERFORMANCE during SIN TASKS.

As hearing loss increases,

the required SNR

increases.

Harvey Dillon, in HEARING AIDS 2012See page 7, Boomerang Press

MRS. SMITH, A 35-YEAR-OLD CEO OF

A SMALL BUSINESS REVEALS

Difficulty hearing her husband and children at home

Difficulty hearing employees at weekly staff meetings

Difficulty hearing in noisy restaurants

The Happy Talk

37 million people

26million people

POSSIBLE ETIOLOGIES?

Auditory Neuropathy Spectrum Disorder

Cochlear Synaptopathy

Hidden Hearing Loss

Auditory Processing Disorders

Neurocognitive Disorders

Attention Deficit Disorder

Attention Deficit Hyperactivity Disorder

ADDITIONAL POSSIBLE ETIOLOGIES

Alzheimer’s Disease

Traumatic Brain Injury

Dementia

Extended High Frequency Hearing Loss

Dyslexia

Specific Language Disorders

Blast Exposure

KILLION, SEMINARS IN HEARING, 2002.

SPEECH IN NOISE TEST TIMES

HINT Sentence test Approx 2 mins

QuickSIN Sentence test Approx 2 mins

BKB-SIN* Sentence test Approx 2 mins

WIN Monosyllable test Approx 3 mins

*(Pediatric application per Andrea Hillock-Dunn AO Sept 7, 2015)

Other Pediatric Speech in Noise Tests: SPIN, HINT-C

MAY/JUN 2019 WWW.AUDIOLOGY.ORG

BENEFITS OF AN IMPROVED SNR

Thibodeau and Schaper (2014) suggested wireless technology

tools may allow users to approach SIN results that were

obtained by people with relatively normal-hearing ability.


Thibodeau and DeConde Johnson (2014) reported that increased

use of wireless technology by people with hearing challenges

outside of educational settings were apparent and not limited

to those with hearing loss, and evidence shows that adults

with TBIs, particularly veterans, benefit from improved SNRs

while using RMs.


Gallun, Papesh, and Lewis (2017) and

Beck, Larsen, and Bush (2018)

described successful use of FM systems by veterans.

In particular, they reported when audiologists worked

with patients having experienced blast exposure

and normal or near-normal audiograms, hearing aid

fittings were also successful.


Saunders, Frederick, Arnold, Silberman, Chisholm,

and Myers (2018)…

CONCLUSION:

FM and RM systems using Bluetooth are effective

interventions for blast-exposed veterans with

normal or near-normal hearing sensitivity, these

tools should routinely be considered as an

intervention approach.

The benefits of mild amplification and use of RMs is

not limited to veterans.

NOTHING NEW UNDER THE SUN…1989

92%purchased

the aids

85%worthwhile investment

Bennett (1989) evaluated hearing aid use by patients with hearing threshold levels of

20 dB or better at 500 and 1000 Hz, and 35 dB or better at 2000 Hz.

Of 98 patients who completed a 30-day trial with hearing aids, 92% elected to

purchase the aids and 85% considered their hearing aids to be a worthwhile

investment after 6 months of use.

WELL-FITTED HEARING AIDS, SIN, AND HD

Roup, Post, and Lewis (2018):

GROUP ONE:

20 normal-hearing adults

(19-27 years of age) with no self-reported HDs,

GROUP TWO:

19 normal-hearing adults

(18-58 years of age) with self-reported HDs.

WELL-FITTED HEARING AIDS, SIN, AND HD

GROUP TWO fitted binaurally with mild-gain,

receiver-in-the-canal (RIC) hearing aids for a four-

week trial with directional and noise reduction

algorithms engaged.

GROUP TWO HEARING AID FITTINGS…

provided 5-10 dB of insertion gain between 1000 and 4000 Hz.

Assessment tools included:

HHIA, Auditory Processing Questionnaire (APQ), SCAN-3:A,

Dichotic Digits Test (DDT), Gaps-in-Noise (GIN) test and

500 Hz Masking Level Difference (MLD) task.

67% stated hearing aids helped a little or a lot in quiet.

71% stated hearing aids helped a little or a lot in noise.

Results indicated that mild gain amplification is a viable

treatment option for some individuals who present with HD,

but whose hearing thresholds are WNL.

REMOTE MICROPHONE SYSTEMS

RM systems are radio devices

RM systems improve SIN

1- by improving the SNR,

2- reducing reverberation, and

3- minimizing the deleterious effects of distance

Mroz, 2018;

Beck, Tomasula, and Sexton, 2006


Today, most RM systems deliver the audio signal

from the microphone to radio receivers via

digital RF transmission.

ADDRESSING THE NEEDS OF PEDIATRIC PATIENTS AND

THEIR PARENTS: AN INTERVIEW WITH JANE MADELL,

PHD INSIDE THE RESEARCH | JULY 2019 HEARING

REVIEW

Absolutely. There is no doubt.

Children and adults with hearing loss and/or

listening difficulty absolutely need,

and would benefit from, remote microphones.

DIGITAL REMOTE MICROPHONE SYSTEMS

Superior speech recognition in noise is possible

with the use of digital RM systems relative to

FM systems.

(Thibodeau, 2014; Wolfe et al, 2013b)


Keith and Purdy (2014)…

FM systems are being replaced by RM systems

and that the latter have performed very well for

people with APD, dyslexia, autism spectrum

disorder, and attention and other learning

disorders.


Superior speech recognition in noise…with the

use of digital RM systems relative to FM

systems.

(Thibodeau, 2014; Wolfe et al, 2013b)


Salehi, Parsa, and Folkeard (2018)…

hearing aids with directional mics are the most common solution to

SNR problems and that they offer 2-3 dB of SNR benefit in typical

fittings.

RMs enhance listening by increasing SNR up to 20 dB.

Are we offering information, hearing aid trials,

SNR-enhancing technologies, and services that

may enhance the QoL of patients…including those

with slight or mild hearing losses and/or complaints

of HDs and trouble understanding SIN?

Or, as questioned by Roup (2016)…

Are we doing a dis-service to patients who seek their care, when they

label their hearing as normal or mild, despite complaints and supra-

threshold auditory deficits in the presence of hearing WNL as

determined by traditional audiometric tests?

People live in a world where cognition,

attention, memory, and hearing interact and

each plays a critical role in listening.

OUR CHALLENGE

Beyond hearing.

Improve the opportunity

For listening success!

37 million people

26million people

Beck, DL, Danhauer JL, Abrams HB, et al. Audiologic considerations for people with normal hearing sensitivity yet hearing difficulty and/or speech-in-noise problems. Hearing Review. 2018;25(10) [Oct]:28-38.

Salehi, Parsa, and Folkeard (2018) reported

RMs can significantly enhance listening by

offering an increase in the SNR of up to 20 dB.

…performance with technology is what will determine

functional outcome.

Pediatrics and Hearing and Change . Flexer C, Madell J. (2014) Why Hearing is Important in Children. Chapter 1, in Pediatric Audiology Diagnosis, Technology and Management. Second Edition. Editors: Jane Madell and Carol Flexer. Published by Thieme. http://www.audiology.org/news/pediatrics-and-hearing-and-change

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