Vision

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. 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. Divided into 3 parts: Outer Ear Middle Ear Inner Ear Ear Anatomy Eardrum

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

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

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

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 ConductiveSensorineural - 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)

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

22. BTE; Open-fit: • Battery still in bottom • Thin tubing • 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 6-12 months, depending on wax accumulation • Tail is to keep dome in place – rest in concha

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

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 • # 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 lifeand 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