Hearing, Hearing Loss,
Hearing Help
Pamela Fiebig, AuD, Audiologist
Northwestern University Dept. of
Otolaryngology/Audiology
October 14, 2013
Northwestern Medical Group Dept of Otolaryngology
Galter Pavilion, 15th Floor; 675 N. St. Clair
312-695-8182

Audiologists
– Pamela Fiebig, AuD
– Malini Patel, AuD
– Denise Greiner, AuD
– Michelle Amosson, AuD
– Michelle Burns, AuD
– Kelly Waldvogel, AuD

Otologists (physician ear specialists)
– Alan Micco, MD
– Akihiro Matsuoka, MD
Hearing Loss is Common
 10
Million Americans
Report Significant Hearing
Loss
– 4 Million > 65 y.o.
– 5 Million 18-64 y.o.
– .5 Million < 18 y.o.
Age of Hearing Loss Onset
Source: National Health Interview Survey, 2007.
http://www.nidcd.nih.gov
More
Men
Than
Women
Have
Hearing
Loss
How We Hear
Basic Audiology Tests

Pure-tone Audiometry
– Air-Conduction
» earphones--evaluates from outer to inner
ear
– Bone-Conduction
» bone vibrator--evaluates inner ear

Word Recognition Testing
Audiogram
Normal hearing and Speech
Sounds
Types of Hearing Loss
Conductive Hearing Loss
– Outer or Middle Ear-DEMO
 Sensorineural Hearing Loss
– Cochlea or Auditory Nerve
– 99% is SENSORY not neural
 Mixed Hearing Loss
– Both conductive and
sensorineural

Conductive Hearing Loss:
Causes and Treatments

Ear Wax (cerumen) or other block
Ear Infection/Fluid in Middle Ear
Otosclerosis
Cholesteotoma
Perforated Eardrum

Can often be “fixed”!




Sensory Hearing Loss: Causes
Presbycusis (aging)
 Ototoxic medication
 Meniere’s Disease
 Heredity
 Noise Exposure
 Unknown


Usually CANNOT be “fixed”
Hearing Loss from Noise
Exposure
Hearing Loss and Aging
Acoustic Neuroma
Benign Tumor in the Internal
Auditory Canal
 Symptoms Include

– Hearing loss
– Tinnitus
– Dizziness

Treatment is surgical removal
– Hearing is often sacrificed in this ear
Hearing Aids for Sensory
Hearing Loss
Effect of Hearing Loss on
Speech Understanding
Hearing Aids:
Desirable Characteristics
 Speech
Audibility
 Physical comfort
 “Audible” comfort
– Not too much “background” noise
– Not too loud
BTE (Behind-the-Ear Style)
ITE (In-the-Ear Style)
ITC (In-the-Canal Style)
CIC (Completely in Canal)

Sometimes “extended wear”
“Mini” Behind-the-Ear
“BEST” Hearing Aid
 Degree/Configuration of
loss
 Individual Listening Needs
 Cosmetics/Style
 Ability to Manipulate Small Objects
 “Gadget” Tolerance
 Cost
Today’s Hearing Aids: Special Features
 Directional
Microphones
 Noise Reduction Algorithms
 Multiple Listening “Programs”
 Automatic adjustments
 Feedback controls
 Bluetooth/wireless compatibility
 Left-Right Communications
What Patients Say About Today’s
Hearing Aids...

Speech sounds CLEARER
– As distortion decreases, performance increases

MORE sounds are HEARD
– Automatic loudness scaling allows more sounds to
be audible

Sounds are more COMFORTABLE
– Loudness stays within comfort range

I still can’t hear in high levels of
background noise
– but I do hear better in low to mid-levels of noise
When Hearing Aids Are Not
Enough…
 Cochlear
Implants
–For severe-to-profound hearing
loss
–Where hearing aids are of
minimal benefit
A Hearing Aid Amplifies Acoustic
Energy and Delivers it to the cochlea
A Cochlear Implant Converts Acoustic
Energy into Electrical Impulses and
Stimulates the Auditory Nerve
Directly, replacing the function of the
sensory cells in the cochlea
External Speech
Processors
Implantable
Stimulator
How a Cochlear Implant Works
Medicare and Hearing Care
Initial Hearing Evaluation covered
with Physician Referral; with
medical condition
 Hearing evaluation is part of initial
welcome wellness exam


Hearing Aids and related services
are NOT a covered benefit
Medicare and Hearing Care

Some managed plans may have
hearing aid discounting agreements
with participating providers

Cochlear Implants ARE a covered
benefit for patients who meet
criteria set by Medicare
Dispensing Law Requires

Medical Clearance for Hearing Aid Use by
Physician

Waiver of Medical Clearance Allowed for
Users Over 18 years old

30-day trial with hearing aid
(Mandated in IL, Suggested by FDA)
Do YOU Have a Hearing
Problem?





Do people “mumble?”
Do you frequently say,
“What?” or “Huh?”
Do you misunderstand
numbers and names?
Do you like the TV/radio
volume louder?
Do you have trouble
hearing in noisy rooms?
What’s should I do if I think I
have an ear or hearing problem?

Investigate medical symptoms
with an otologist (ear specialist)
– Ringing, dizziness, ear pain
– Changes in hearing or symptoms

See an audiologist for evaluation
– Discuss ear protection for noise
– Consider hearing aids, if appropriate
A Parting Thought…
Hearing
help
may be less
conspicuous
than your
hearing loss