Re: HLAA Convention 2011 Special: Workshops - Auditory Rehabilitation

[Guest guest]

Is this what he's referring to when he mentioned " Q: What resources are there to

help learn speech understanding with a cochlear implant? " ?:

http://www.neurotone.com/

Thanks Bob as usual for posting helpful information in the group!

Dan

A: All of the cochlear implant companies have online resources, and there

is a web product called LACE.

>

> NVRC News - June 27, 2011

>

> ---------------

>

> New Options in Auditory Rehabilitation

>

>

>

> By Cheryl Heppner 6/27/11

>

>

>

> Dr. Niparko wears many hats at s Hopkins Medical - or should that

> we say he wears many surgical masks or coats? He is the Interim Director of

> the Department of Otolaryngology-Head and Neck Surgery and T. Nager

> Professor, as well as Director of the Division of Otology, Audiology,

> Neurotology, and Skull Base Surgery, and Director of the Listening Center.

> Long-time attendees of NVRC's educational programs will remember his

> highly-acclaimed workshops at NVRC in past years.

>

>

>

> Every new presentation by Dr. Niparko brings exciting information, and his

> workshop " New Options in Auditory Rehabilition " on Friday, June 17, 2011 at

> the convention was no exception.

>

>

>

> Setting the backdrop for his program, Dr. Niparko emphasized the importance

> of the spoken word, which connects us to one another and maximizes our

> communication. He called the importance of the cochlea to our hearing akin

> to flipping a switch to turn on a light fixture. The hair cells in the

> cochlea are some of the body's smartest cells, and they have a very complex

> structure. Atop them are tufts of cilia; if they fail to beat, or fall off,

> or die, we get hearing loss.

>

>

>

> The importance of speech sounds

>

> There are 45 different sounds in English spoken by a native speaker. Each

> has its own sound signature. That sound signature is very different in a

> non-native speaker. The brain learns these sounds from the time you are

> born. The sounds have three dimension - intensity which comes from loudness

> of the speech, frequency which comes from pitch, and timing which is

> determined by the onset and duration of the speech. There are regional

> differences and dialects. As an example, people from the Midwest hold their

> vowels longer.

>

>

>

> Dr. Niparko quipped that the 45 speech sounds for male listeners have a hole

> for the spouse's voice, and this is a problem he can't solve.

>

>

>

> We tend to tail off frequency at the end of a word. A change in frequency

> information aids in localization, which is the ability of our ears to zone

> in and choose the voice of the person we want to listen to. When there are

> multiple speakers, we zone in with their specific pitch cues.

>

>

>

> The effect of hearing loss

>

>

>

> The effect of aging on hearing is one of the things we can do the least

> about. Hair cells are fragile, particularly for men. A 60 year old male

> will typically have much higher hearing loss than a female of the same age.

> Trauma is another cause of hearing loss. It could come from damage due to

> noise. We now start to see signs of hearing loss in young adults. An

> estimated 8.5% of those aged 20-29 have a hearing loss. In the future there

> is hope we can see continued steps to avoid the onset of hearing loss.

>

>

>

> Sensorineural hearing loss is almost completely absent on Easter Island.

> Here in the U.S., something genetic may be the cause of the higher rate. We

> now also know that medications can cause hearing loss and that some people

> are more sensitive to the effects of noise than others.

>

>

>

> The impact of hearing loss

>

> The symptoms of hearing loss are not just reduced ability to hear. There is

> reduced sensitivity to sound and impaired pitch resolution. There can be

> loudness recruitment, which causes painful or almost painful surges of

> loudness. Tinnitus continues to be an issue, although advances which can

> mask or suppress it have helped. Some individuals were helped by putting

> sound that is just below the level of the tinnitus in the ear, such as

> music.

>

>

>

> Understanding speech in noise is a great problem in sensorineural hearing

> loss. With this form of hearing loss, the ear is being swamped by noise and

> recruitment. Speech is remarkably resistant to corruption. We are born

> with the ability to use it well, but it can be difficult or impossible to

> understand speech when there are multiple speakers, especially in a large

> room where sound is being reflected from hard surfaces. These are factors

> that modify the pitch and timing structure of the speech signals and create

> a masking effect.

>

>

>

> Perceptions about hearing rehabilitation have been varied. A recent

> MarkeTrak survey found that seniors with hearing loss often reported " I hear

> well enough and don't mind it, " thus marginalizing themselves. As a result,

> they often tend to adopt a less communication-filled lifestyle and reduce

> their social connections. Sensorineural hearing loss has long been

> associated with social withdrawal, which frequently brings consequences such

> as decreased general health and impaired immunity.

>

>

>

> Recent research has also shown that hearing loss could be associated with

> increased risk of dementia. With severe hearing loss, an individual's

> chance of getting clinically significant dementia is 70% if left untreated.

> Getting a cochlear implant can significantly mitigate the effect, and use of

> hearing aids on a consistent basis also helps. It is essential that we

> bring hearing aids and cochlear implants into the treatment picture.

>

>

>

> Current predictions show that the percent of people with dementia will

> double in 20 years, and by 2050 it could affect 1 in 30 Americans.

>

>

>

> New advances

>

>

>

> Newer hearing aids are a step in the right direction. They look better, are

> more comfortable, and more of them are able to provide directionality

> (ability to identify direction of sound) and provide noise reduction. They

> also increase the naturalness of speech and its fidelity. But they still

> are not the same as normal hearing and require adjustment.

>

>

>

> Cochlear implant electrodes in the inner ear stimulate the auditory nerve

> through responsiveness to electrical signals. Modern digital technology has

> helped us to increase the speed of sound processing; in the early years

> cochlear implant users said sound had a robotic or cartoonish quality.

>

>

>

> We have now been able to achieve preservation of healthy hair cells in the

> ear and stimulate the rest of the cochlea with a cochlear implant. It is

> possible to wear a hearing aid in the same ear and preserve hearing while

> getting a more natural sound. This has worked very well for selective

> patients.

>

>

>

> Questions and answers

>

>

>

> Q: Which comes first, the hearing loss or dementia?

>

> Dr. Niparko: Someone could have reduced speech understanding due to

> dementia, but data in many cases showed that hearing loss preceded the

> dementia. Data is also beginning to show us the importance of social

> connections.

>

>

>

> Q: If someone is already exhibiting symptoms of dementia, is it too late

> for a cochlear implant?

>

> A: Based on data we have now, a hearing aid is probably much more helpful.

>

>

>

> Q: What are the experiences of cochlear implant users who have had

> chemotherapy?

>

> A: Several patients went through chemotherapy with a cochlear implant in

> place. The implant may not be stable in many cases due to the neurotoxic

> effect chemotherapy can have on nerves, but it hasn't seemed to have a

> permanent effect.

>

>

>

> Q: How good are the results with partial insertion implants?

>

> A: A lot of music comes into the ear through the low tones, which helps

> pick up the beat/rhythm and bass. Research is still open on this. Some

> people with the partial implants were not happy and came back to get

> implants with full insertion. One individual has done well. This person

> had hearing loss that started in high school and got an implant 30 years

> later. Hear hearing aids in both ears are supplemented with a cochlear

> implant. She calls it " trimodal hearing " .

>

>

>

> Q: What about auditory neuropathy?

>

> A: We are seeing this more frequently. It is a result of the brain

> mechanisms not putting information together well.

>

>

>

> Q: What are the primary predictors of a cochlear implant?

>

> A: An auditory foundation.

>

>

>

> Q: What resources are there to help learn speech understanding with a

> cochlear implant?

>

> A: All of the cochlear implant companies have online resources, and there

> is a web product called LACE.

>

>

>

> Q: What will be the impact on bilateral cochlear implants if I have carotid

> surgery?

>

> A: Today the only concern about surgery is if it involves the head, not the

> neck or anything below it.

>

> Q: What cochlear implants make it possible to have MRIs?

>

> A: We now have a way to perform MRIs on patients who have cochlear implants

> without having to remove the magnet. A binding procedure is used. The

> important thing to know Is that we can do the scan but we can't keep you

> comfortable. It will hurt for about 10 minutes afterward because the

> magnets are moving around. We couldn't find an MRI with a Tesla

> (measurement of strength) of less than 1.0, so the research has used one

> with a Tesla of 1.5.

>

>

>

> Dr. Niparko showed a short video from his famous 2005 study with Ryugo

> where deaf cats were implanted for three months with a 6-channel cochlear

> implant that used human speech processing programs. The cats responded to

> environmental sounds and their auditory nerve fibers showed some recovery.

> Food conditioning was used, and the cats could differentiate the sound of

> music by Bach from the sound of music by Beethoven.

>

>

>

> _____

>

> C Copyright 2011 by Northern Virginia Resource Center for Deaf and Hard of

> Hearing Persons (NVRC), 3951 Pender Drive, Suite 130, Fairfax, VA 22030;

> <blocked::blocked::blocked::blocked::blocked::http://www.nvrc.org/>

> www.nvrc.org; 703-352-9055 V, 703-352-9056 TTY, 703-352-9058 Fax. Items in

> this newsletter are provided for information purposes only; NVRC does not

> endorse products or services. You do not need permission to share this

> information, but please be sure to credit NVRC.

>

>

>

>