children & hearing loss
TRANSCRIPT
9/6/2015 Manfred Stoifl 1
About the Presenter • Born, raised and educated in Vienna, Austria
• Married with 2 Boys
• Hearing Aid Acoustician AAHA, Honors
• Business Administration Retail, Honors
• Hearing Health Care Industry since 1976
• Living and working in Asia since
1986
• Established THSG in 2003
• Living in Singapore since 2005
• Coordinator for right-to-hear foundation since 2003
• Coordinator for since 2014.
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Children & Hearing Loss
Manfred Stoifl, Hearing Aid
Acoustician, AAHA Vienna, Austria
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Hearing Loss
WHO, 2012 9/6/2015 Manfred Stoifl
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Hearing Loss
WHO, 2012 9/6/2015 Manfred Stoifl
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Hearing Loss
WHO, 2012 9/6/2015 Manfred Stoifl
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Hearing Loss
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Indonesia
Population 2015 ~ 250 million
~ 30 % between 0-14 years of age =
~75 million
2 % have a disabling hearing loss
1.5 million Indonesian children have a
disabling hearing loss.
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Peripheral Hearing
Central Auditory Processing
Physiology of Hearing
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Sound
1 Sec 2 Sec 3 Sec
Frequency
Inte
nsi
ty
Duration
4 Sec
Place in Time Tone
Rythm
The 5
Attribute
s o
f S
ound
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Converting Sounds to Electrical Impulses
Pinna
Ear Canal
Brain
Liquid
Hearing
Nerve
Electric
Stimuli
Cochlea
Eardrum
Sound
Physiology of Peripheral Hearing
Hammer
Stirrup Anvil
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Unique patterns of electrical
impulses
Up to 18 million
impulses per second
resolution per ear
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Physiology of Central Hearing
Hearing is
electrical
patterns in
the Brain.
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-20
0
20
60
60
80
80
100
120
40
140
100
Frequency Hz
1k 2k
3k 4k
10k 20 20k 5k 8k
Human Range of Hearing
Human Auditory Range
Orchestral Range
Vocal Range
6k
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Directional H
earing
You will hear the sound first and louder on your right ear and
second and softer on your left ear
If someone calls you from your right side, ….
THE CALLER IS ON MY
LEFT!
THE CALLER IS ON MY RIGHT!
If Someone calls you from your left side …
You will hear the sound first and
louder on your left ear and second
and softer on your right ear.
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We are born with
hearing but have to learn
how to hear
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We are born with the ability to do this ……
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but…..have to learn to do this ….
Hearing is
electrical
patterns in
the Brain.
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……..and this……
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Automatic hearing recduces cortical activities by 85%.
and ……this!
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?
Learning to hear
meaning
saving in long-term memory 9/6/2015 Manfred Stoifl
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We need to hear as much as
possible to learn ….
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Hill, N.M. & Schneider, W. (2006) Brain Changes in the Development of Expertise: Neurolical Evidence on Skill-Based Adaptations in Cambridge Handbook of Ex-pertise and Expert Performance. New York: Cambridge University pp. 653-683
Brain activity (shown by means of fMRI) is strongly decreased throughout a given automation task over a duration of 3x 20 minutes. Cortical activities reduced by 85%.
Automatic Hearing is More Efficient
……to do this!
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Hearing
Automatic retrieval of meaning from long-term memory
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Hearing loss
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z v p h g ch sh
l r o a
s f th
j mdb n
ng e i
u
AUDIOGRAM OF FAMILIAR SOUNDS FREQUENCY IN CYCLES PER SECOND (HZ)
10
0
30
40
50
60
70
80
90
100
110
120
125 250 500 1000 2000 4000 8000
HEA
RIN
G L
EVEL
(dB
HL)
20
NORMAL HEARING
MILD HEARING LOSS
MODERATE
SEVERE
PROFOUND
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Hearing Loss
10 0
20
30
40
50
60
70
80
90
100
110
120
125 250 500 1000 2000 4000 8000
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Hearing Loss
10 0
20
30
40
50
60
70
80
90
100
110
120
125 250 500 1000 2000 4000 8000
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Peripheral Hearing Loss – incorrect conversion of sounds to Electrical
Impulses
Central Hearing Loss – Problems assigning meaning
to electrical impulses
Hearing Loss – a complex Problem
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?
SNHL Hearing Loss
meaning
saving in long-term memory 9/6/2015 Manfred Stoifl
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Instant recall from memory
Cortical activities increases by 85%.
No
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Pediatric Hearing Test Battery
Tympanometry
Oto Acoustic Emission
ABR / ASSR
Otoscopy
Audiometry
Ensuring the middle ear is functional and
free of fluids
Verifying functionality of outer haircell in the
cochlea
Promontory Stimulation
Verifying overall function of the
auditory system
Ensuring the ear canal is normal &
free from obstruction
Free Field Visual Reinforced &
Play Audiometry
Stapedius Reflex
Latency measurement Electrically verifying
function of retro cochlear structures in
case of C.I.
Objective confirmation of UCL.
Measures retro cochlear structure
development 9/6/2015 Manfred Stoifl
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Hearing
Aid Range
Hearing Loss
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Hearing with hearing aids
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Paediatric Hearing Aid Selection
• Audibility
– Power
– Sound Quality
– Wide Frequency Range
• High Frequency Content
• Durability
• FM or Bluetooth ability
• Good fitting fun earmolds
• Warranty & Cost.
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Sometimes hearing
aids are not enough
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Hearing Loss
Cochlear
Implant
Range 9/6/2015 Manfred Stoifl 40
Hearing loss & Hearing Aid profound hearing loss
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Hearing with a Cochlear
Implant System
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We need to hear as much as possible !
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Advanced Bionics provides
more electrical Information
to Central Auditory Centres
than any other Implant
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Quality of a C.I.
It’s not about if you hear or not
It’s about how easy you
hear!
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Normal Hearing
Up to 18 million
impulses per second
resolution per ear Advanced
Bionics
Cochlear MedEl
83,000 32,000 50,000
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We need to hear as much as possible !
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We need to hear as much as possible !
Cochlear 22 Sounds
MedEl 16 Sounds
Advanced Bionics 120 Sounds
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Impact resistance in Joules
Is the force an implant can survive before it
breaks
Cochlear Freedom
1 joule
MedEl
2.5 joule Advanced Bionics
HiRes 90K Advantage
6 joules
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Sometimes Hearing Aids or
Cochlear Implants alone are
not enough!
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Reverberation
Classrooms are noisy places
Background noise Distance
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Distance between the listener and
the sound source
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Adapted from Johnson 1996
The effect of distance and noise on
word recognition in Children
Age Group Word recognition in quiet Word recognition in noise
close (1.8 m) far (7 m)
4 years 88.3 % 67.0 %
5 years 94.3 % 84.0 %
6 years 98.0 % 86.7 %
Adults 99.3 % 97.0 %
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Washington University
Rec
epti
on
Th
resh
old
for
Sen
ten
ces
(RT
S)
Listening Condition
Clinical Study result on FM
-20
-15
-10
-5
0
5
10
Unaided Omni Dir FM(Mon) FM(Bi)
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FM is absolutely necessary for
your child to succeed in school !
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Our Vision for our Children
Economic
Independence
Social
Independence
Hearing
Language
Education Social
Competence
Mental
Development
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Q & A
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