Rehabilitation of hearing impaired.pptx

Thia presentation is about how to assess hearing loss, how to categorise it, how to investigate it, and finally how to rehabilitate the deaf people of different ages

1. Rehabilitation of Impaired Hearing Dr Rehman sher tmo ent mmc

2. Rehabilitation Of Hearing Impaired All hearing-impaired individuals need some sort of aural rehabilitation for communication. The various means available to them are: Instrumental devices Hearing aids Implants Assistive devices for the deaf Training Speech (lip) reading Auditory training Speech conservation

3. 1. Instrumental Devices HEARING AIDS: A device which amplify sound reaching the ear Conventional hearing aids Bone anchored hearing aids Implantable hearing aids Conventional Hearing aids: these are air conduction type hearing aids consist of three parts; Microphone, Amplifier, Receiver Bone conduction Type: fit on mastoid bone Instead of Receiver it has vibrator which directly stimulate cochlea Most of the hearing aids are air conduction type, they can be;

4. Types Of Conventional Hearing Aids Body worn types; most common type Microphone and amplifier in one case worn at chest level Receiver is situated at ear level Useful for severely deaf person or children with congenital deafness Behind the ear type; All three components are in one unit Worn behind the ear Useful in slight to moderate hearing loss at highr frequencies

5. Types Of Conventional Hearing Aids In The Ear Type; Entire hearing aid is housed in an earmould which can be worn in te ear Useful for mild to moderate hearing loss with flat cofiguration Very popular beacausenof its cosmetic appeal Spectacle Type; Its modification of behind the ear type HA HA is fitted in the Frame of the spectacles Useful for candidates who use spectacles

6. 5. Canal Type; Entire Hearing aid can be worn in ear canal For this type of HA ear canal should be large and wide Useful in mild to moderate type of hearing loss of high frequencies

7. Indications For Hearing Aid SNHL; Which interfer with day to day activity HA may not suit all such patients because of intolerabe distortion in some and particularly in those with recruitement Deaf Child; Should be fitted with HA as soon as possible for development of speech and language In severely deaf child binaural hearing aid are useful Lip reading should be practiced simultaneousely Conductive Deafness; When surgery is either refused, not feasable or failed

8. Fitting of Hearing Aid While fitting a hearing aid,
consideration is given to:
1. Degree of hearing loss.
2. Configuration of hearing loss (type of frequencies affected).
3. Type of hearing loss (conductive or sensorineural ).
4. Presence of recruitment.
5. Uncomfortable loudness level. 6. Age and dexterity of patient.

9. Fitting of Hearing Aid 7. Condition of the outer and middle ear. 8. Cosmetic acceptance of the aid. 9. Type of earmould .
10. The type of fitting, whether it is monoaural (one aid
only), binaural (one aid for each ear), binaural with
y-connection (one aid but two receivers, one for each
ear) or the contralateral routing of signals type.

10. Contra lateral routing of signal (CROS) In this type of Hearing aid microphone is on side of deaf ear and receiver on better Ear Nowadays it is replaced by bone anchord hearing aids bone anchord hearing aids; It has three components Titanium fixture; it is surgically embedded in skull bone Titanium abutment; it is exposed outside on the skin Sound processor; it received sound

11. Fixture bond with surrounding tissue in a process called osseointegration It takes 2-6 months The processor is attached to abutment Candidancy profile; Patient who has chronic inflamation or infection of auditory canal Children with malformed or absent external auditory canal as on microtia or canal atresia Single sided deafness

12. Surgery; Single stage procedure in adults Two stage procedure in children Complications; Occaisional failure of osseointegration Local infections And inflamation

13. Implantable middle ear hearing aids It works on direct drive principle It uses mechanical vibrations delivered to ossicular chain Available in two types Piezoelectric Devices Passes electric current to piezoelectric crystals which changes its volume and thereby produces a vibrating signal Its coupled with ossicles and drive ossicular chain Electromagnetic Hearing aids Electric current in coil produces magnetic flux that drives the adjacent magnet The small magnet is attached to one of the ossicles to convey vibrations to cochlea

14. C ANDIDANCY Adults 18 or older Moderate to severe sensory neural hearing loss Should have experience of using traditional hearing aids Candidates who desire for this type of hearing aids are usually complaining of dissatisfaction of quality of sound of the current hearing aids Other reasons are akluj ine aapke naal impacted wax inability to wear the conventional hearing aids due to sensitive ear canal

15. Advantages Eliminate inherent issues of conventional hearing aids such as occlusion, feedback, discomfort and wax related problems One major advantage is the ability to provide improved sound quality particularly in noisy environment

16. IMPLANTS Cochlear implants These are electronic devices that provide useful hearing and improved communication abilities for persons who have severe to profound sensory neural hearing loss and who cannot benefit from hearing aids It works on the electrical stimulation of the auditory nerve Components of cachlear implants External component It has speech processor and transmitter Speech processor maybe body worn ir behind the ear type Internal component It is surgically implanted and has receiver or stimulator package with an electrode array

17. Candidency profile It can be done in both children and adults Bilateral severe to profound SNHL Little or no benefits from hearing aids No medical contraindications for the surgery Realistic expectations Good family and social support towards rehabilitation

18. Outcome Outcome of cochclear implants different on several factors Previous auditory experience that is pre-lingual or post-lingual Age Short duration of deafness Neural plasticity without auditory system

19. Auditory brainstem implants (ABI) This implant is designed to stimulate the cochlear nucleus complex in the brain stem directly by placing the implant in the lateral recess of the fourth ventricle Such an implant is needed when cranial nerve 8 has been severed in surgery of vestibular schwannoma

20. Assistive devices Different devices are needed for the hearing impaired person to coup with the special situations These device can be divided into three groups assitive listening devices and systems This device is help the hearing impaired person to listen a patiently in the presence of background nice poor the telephone in auditorium or theatres It include hardware system induction loops, amplitude modulation, frequency modulation, or infrared signals

21. Allertive Devices Hearing impaired person may not here a telephone or a doorbell, a baby crying in another room an alarm clock or the noise of a smoke detector allertive devices are useful in such situations 3. Telecommunication devices Telephone amplifier is the best example of this type of assistive devices

22. Training Speech reading Called lip reading It is a process to understand speech by studying moment of lips facial expression gestures and the probable context of conversation Auditory training It is useful for those using hearing AIDS and cochlear implants Speech conservation Speech conservation aims to teach the patient how to control his own voice

23. Thanks