HEADS OF SERVICES TRAINING HAMILTON HOUSE 28 th

HEADS OF SERVICES TRAINING HAMILTON HOUSE 28 th February 2013

AUDIOLOGY AND TECHNOLOGY David Couch

Peripheral Auditory System

Anatomy of the Ear

Cochlea – space in bone

Cochlear implant

Auditory Pathways

Initial (early) Diagnosis: Methods of diagnosis: • Otoacoustic emissions (OAE) • Auditory brainstem response (ABR) – Clinical – Automated

Otoacoustic Emissions (OAE)

Otoacoustic Emissions (OAE)

OAE

Auditory Brainstem Response (ABR)

Auditory Pathways

Auditory Brainstem Response (ABR)

Initial (early) Diagnosis: Neonatal Hearing Screening Programme (NHSP) • Community (local clinics) • Acute (hospital service)

Referral routes (NHSP) OAE Community Clinic OAE ABR Hospital ABR (earmoulds? ) Audiological Certainty Referral to SI Services Hearing Aid Fitting

Referral routes late diagnosis – parental concern) GP Referral Community Clinic Hospital Audiology Hearing Aid Fitting Referral to SI Services

Pure Tone Audiometry (Headphone Test)

Referral routes late diagnosis – parental concern) Distraction test

Referral routes late diagnosis – parental concern) Co –operative test

Referral routes (late diagnosis – school screen) School Screen (reception) Community Clinic Hospital Audiology Hearing Aid Fitting Referral to SI Services

Play Audiometry

Visual Reinforcement Audiometry (VRA)

Pure Tone Audiometry

Pure Tone Audiometry

Pure Tone Audiometry

Degree of Hearing Loss Calculated as the average hearing loss over 5 frequencies (specifically: 250 Hz; 500 Hz; 1 k. Hz; 2 k. Hz; 4 k. Hz) in the better ear. There is no such thing as a mild/moderate loss!

Type of loss This refers to the location of the hearing problem: • Middle Ear = Conductive Hearing Loss • Inner Ear = Sensori-neural Hearing Loss

Intervention – Hearing Aids The main enemies of hearing aids are • Noise • Distance

Intervention – Cochlear Implants The main enemies of Cochlear Implants are • Noise • Distance

Intervention – Radio Aids (FM Systems)

Intervention – Radio Aids (FM Systems)

Intervention – Radio Aids (FM Systems) MLx

Teacher of the Deaf role in Audiology • Testing of hearing aid performance (Test Box) • Radio Aid allocation and ‘balancing’ • Hearing Aid maintenance

The Educational Audiologist • • Testing of hearing aid performance (Test Box) Radio Aid allocation and ‘balancing’ Hearing Aid maintenance Hearing Assessment • Training • Hearing Assessment • ? ?

Knotty Issues!

Auditory Neuropathy Spectrum Disorder (ANSD) This is a clinical diagnosis and is characterised by the presence of otoacoustic emissions but absence of an auditory brainstem response. • What’s going on? • Should they be included on caseload? • What are the intervention recommendations?

Auditory Processing Disorder (Difficulty? ) (APD) This is a diagnosis following the outcome of a series of subjective assessments and observations. Hearing threshold levels are normal. • • How is it ‘diagnosed’? What’s going on? Should they be included on caseload? What are the intervention recommendations?

Auditory Processing Disorder (Difficulty? ) (APD) What are the intervention recommendations? • Listening Programmes • Good acoustics (? ) • i. Sense

Acoustics • The National Deaf Children’s Society (NDCS) has mounted a campaign in this area. • Acoustics describe the sound qualities of a room and there are certain recommendations laid down for those qualities. They are currently described in Building Bulletin 93 (BB 93). There is a review pending. • BATOD and Nat. SIP have published guidelines on this topic (see their websites).

Acoustics (continued) • A poor acoustic environment creates more challenge for the listener. A person who has degraded hearing and wears a hearing aid will be more affected than those with normal hearing. • BB 93 only applies to new builds (and, by implication, new extensions and refurbishments). • It is the responsibility of the contractor to ensure the build meets the current standards.

Acoustics (continued, continued) • Rooms which do not meet the recommendations may not be ‘poor’. • Rooms can be improved (and meet BB 93). • The purpose of a Radio Aid is to overcome the detrimental effects of poor acoustics and reduce the acoustic challenge. • Soundfield systems are one way of reducing the acoustic challenge.

Soundfield Systems • Can be wired in as part of the build • Can be wired in to an existing room. • Can be portable systems.

Obligations and Common Practice • Soundfied systems are not usually bought by SI Services but are loaned and then bought by schools. • FM systems are routinely bought and maintained by SI Services. • i. Sense systems can be loaned or bought by …either! • What is your experience?

Questions (there must be some!)