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Consists of outer, inner and middle ear

Located in temporal bone section of the skull

Outer ear is made up of pinna and external auditory canal - pinna gathers sound waves and transports into the ear canal/

Middle ear consists of ear drum, malleus, incus, stapes and eustachean tube. The ear drum converts the sound energy to sound waves

Inner ear consists of the cochlear, eighth nerve, semicircular canals, facial nerves. Cochlea converts sound waves/vibrations to electrical signals, sending nerve impulses.

When nerve impulses arrive at the brain stem, it is received by the auditory cortex

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Role of the Pinna:

Cartilage covered with skin

Unique configuration of ridges and grooves

Gathers sound waves from the environment, into the ear canal

Assists in sound localization – where is the sound coming from?

Role of Ear Canal:

Opening at the pinna

25mm in adults

Direct the sound energy to the eardrum

Outer – cartilaginous portion

Inner – bony portion

Hair follicles and glands – produces ear wax/sporinum

Sticky and smelly, prevents flys, dust, protects ear drum

Skin of ear canal grows outward

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Ear drum (tympanic membrane), malleus, incus, stapes

Thin membrane made up off several layers of skin

Ear drum is fairly taught, concave, turning toward ear drum

Ear drum should be greyish in color, converts acoustic energy to magnetic energy

Malleus – long arm is behind the ear drum

Stapes reflex – activated with loud sounds, tightening the bones which lessens the sounds that travel

Ossicles link the tympanic membrane to the oval window

Middle ear improves the sound energy from the air to the fluid cochlea

Ossicles add as a lever, increasing amplitude at the stapes

3 smallest bones in the human body

Eustachean tube – links to the nasal pharynx

Responsible to equalize air pressure from the middle ear and environment

Yawn/Swallow to open eustachean tube

Provides exit for mucus of fluids that may collect in this area

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Consists of the cochlea – snail shaped bone, inner part of the ear with 2 and half turns in its axis

Base and bottom, top and apex of the cochlea

Footplate is embedded in the oval window near the base of the cochlea

Exiting out from the cochlea is the cochlear nerve

Partitioned into 3 fluid filled chambers

Scala media, scala vestibuli, scala timpani – filled with endolymph, perilymph, and perilymph

Sound from the air vibrates the ear drum, sound energy increases the ossicles, then transferred to the fluid filled cochlea

Scala media

Basilar membrane runs along the cochlea and divides the three chambers

Organ of corti lies on the basilar membrane – very important as it contains the sensory cells of hearing, inner and outer ear cells

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Organ of corti – inner hair cells sit on the basilar membrane and send nerve impulses

Basilar membrane is arranged according to frequency

Each specific frequency stimulates a different place along the basilar membrane

Lower frequency – further along the basilar membrane where it is wide and floppy

Higher frequency – closer to the basal end

Eighth nerve – beginning of this deeper system

Modiolus – essential bone of the cochlear, which it surrounds

Nerve fibers exit the organ of corti where the cell bodies form the spiral ganglion, forming the modiolus

Exits and maintains tonotopic (spiral) organization with nerve fibers from the basal end where the high frequency and low frequency nerve fibers are on the inside

30,000 nerve fibers in the cochlear which carry information to the brain stem

As the eighth nerve exits the cochleas through the internal auditory canal of the temporal bone, it joins to the vestibulocochlear nerve

Together they travel to the central auditory system

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The symptoms of hearing loss consist of:

Otalgia - ear pain

Tinnitus - ringing/buzzing sounds

Vertigo - spinning

Aural Fullness - plugged ear feeling

Hyperacusis - abnormal sensitivity to loud sounds

Hearing disorders can be broken down into

1. Conductive hearing loss -- abnormality in outer and middle ear. Causing a loss of loudness, not clarity

2. Sensorineural Hearing Loss -- abnormality in the inner ear. Both loudness and clarity from the cochlear.

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Infection of the meninges -- can be bacterial or viral

Sensorineural hearing loss occurs in 30% of cases of bacterial meningitis

Leads to inflammation and damage to inner ear/cochlea → sensorineural hearing loss

Ossification of cochlea – hardening into bone, growth with less permeable cochlea, challenging the placements of the ossicles

Bilateral, permanent, severe sensorineural hearing loss

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Medications caused damage to hearing, specifically the cochlea or auditory nerve and sometimes the vestibular system

Bilateral hearing loss, ringing in the ear (tinnitus), or balance disorders.

More than 200 medications and chemicals are known to cause hearing and balance problems

Aminoglycoside antibiotics – end in “mycin”

Antineoplastic drugs – used in cancer treatment

Can cause permanent hearing loss

Salicylate pain relievers

Quinine

Loop diuretics

Noise and Ototoxicity

Hearing loss from medication

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Eustachian tube dysfunction (CHL, middle ear)

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Eustachian tube dysfunction (CHL, middle ear)

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Inadequate opening of the tube – usually when we yawn or swallow it opens/closes, normal reaction

Lets air into the nuclear space, equalizes pressure

Dysfunctions will not let pressure be equalized, negative pressure will build up and cause the ear drum to be retracted inward, toward the middle ear space and will interfere with normal vibration

Prolonged eustachian tube dysfunction can lead to fluid build up

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Build up of fluid in the middle ear space

Eustachian tube cannot open and close

So the middle space sucks the fluid from surrounding tissue, builds up in middle ear space and impede movement of ossicles and ear drum

Common in children – shorter and more horizontal tube

More susceptible to otitis media as fluid isn't being drained

More floppy eustachian tube

Worse during winter months

Cleft palate and down syndrome – more risk

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Temporary Threshold Shift (TTS) - Reversible

Permanent Threshold Shift (PTS) - Irreversible

Can be unilateral or bilateral depending on noise source

Important Factors

Length of Exposure

Intensity and frequency of sound

Certain audiometric configuration

Can be caused by extremely loud bursts of sound, such as gunshots or explosions, which can rupture the eardrum

Can cause Tinnitus

SPL is greater in smaller spaces

Noise destroys the hair cells of our ears → broken and bent hair cells

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The Speech Banana and Audiogram of Familiar Sounds

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The Speech Banana and Audiogram of Familiar Sounds

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The audiogram of familiar sounds is a great visual tool to help explain what regular sounds are being heard. The familiar sounds model is great to plot a person's threshold against the sounds that are audible (or not), indicating the type and degree of hearing loss.

The speech banana is the yellow shaded area that explains the speech sounds in that given range. On the lower frequencies, more of the vowels can be heard, and the higher frequencies are fricatives, and whispers that can be heard.

This is helpful in plotting a person's results against the sounds to understand what they can hear.

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Possible reasons for the types of hearing loss

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Conductive Hearing Loss

If the difference between Air Conduction and Bone Conduction is greater than 10dB, there is a significant air-bone gap (ABG) at that frequency and the hearing loss is conductive

Air Conduction channel thresholds are poorer due to a blockage of the sound when listening through the headphone or insert

Suggests it is blocked by outer or middle ear

Presence of air bone gap, greater the gap, greater the hearing loss

Abnormality in outer or middle ear that prevents sound from being conducted properly

Usually abnormal tympanogram with absent reflexes

Sensorineural Hearing Loss

Air Conduction and Bone Conduction thresholds are abnormal with no significant air bone gaps

Due to damage of the sensorineural mechanism

Missing or damaged hair cells in the cochlea

Abnormality of the auditory nerve

Likely impaired speech recognition discrimination score

Even when speech is loud enough to hear, it may still be unclear or sound muffled

Can have loss of both clarity and loudness

Damaged inner ear result in distortion of the signals

Mixed Hearing Loss

Sound is being delivered to an impaired cochlea that is attenuated by a disordered middle or outer ear

Both air conduction and bone conduction thresholds are abnormal

Air bone gaps present

Combination both conductive and sensorineural components

Speech recognition score could be depressed

Tympanogram usually abnormal – due to outer or middle ear

Bone conduction thresholds should NEVER be worse than air conduction thresholds

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Determined by air conduction threshold

Considers the entire auditory system

Lower the threshold, the more severe hearing loss is

Adults have higher thresholds

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Red "o" marks the air conduction results for the right ear

Blue "x" marks the air conduction results for the left ear

If the two lines are essentially overlapping, your hearing loss is considered symmetrical

Bone conduction -- marked with a “[“ or a “<” symbol and vibrations occur on the mastoid bone

Configuration:

Configuration

Determined by the shape of air conduction threshold on audiogram

Flat

Sloping – high frequencies affected e.g in old age

Noise-notched

May be related to etiology of hearing loss

Rule of Thumb:

Air conduction thresholds always tell you the degree of the hearing loss

Bone thresholds tell you the type of hearing loss

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Both ears are symmetrical

The mid-range frequencies are hard to hear

No significant airborne gaps between bone and air conduction - SNHL

Even when speech is loud enough to hear, it may still be unclear or sound muffled

Can have loss of both clarity and loudness

Damaged inner ear result in distortion of the signals

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Airborne gaps more than 10dB

Symmetrical

Bone conduction - slightly abnormal

Air conduction - moderately severe

Configuration is sloping

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Pretty symmetrical

Airborne gaps suggest it is CHL

Air Conduction channel thresholds are poorer due to a blockage of the sound when listening through the headphone or insert

Blocked by inner or middle ear

Clarity of speech is maintained

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The Ling 6 sounds represent different speech sounds from low to high pitch frequency.

It helps to test hearing and to check that individuals can hear speech sounds necessary for learning language.

Ling 6 text

/a/

/u/

/i/

/sh/

/m/

/s/

They need to repeat the sounds they hear

Each ear should be tested individually

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Parts of a Hearing Aid

Microphone – Converts sound into electrical signals

Amplifier – Boosts signal and adjusts output

Receiver (Speaker) – Delivers sound to the ear

Battery – Powers the device; can be disposable or rechargeable.

Other Features – Volume control, tone hook, tamper-resistant doors, gold contacts for external connectivity

Hearing Aid Styles

CIC, ITC, ITE, BTE (with mold/slim tube), RIC

BTE is most common for children due to growth

Factors to consider: age, canal shape, hearing profile, lifestyle, and assistive tech compatibility

Troubleshooting Tips and Techniques

Daily Visual & Listening Checks – Use stethoset, Ling 6 sounds, check for static/feedback

Common Issues:

Dead sound: Battery/contact issues.

Feedback: Poor earmold fit, wax blockage.

Intermittent sound: Circuit or receiver damage

Cleaning Tips:

Wipe daily with a dry cloth.

Brush earmolds and microphone ports

Procedures for Listening Check

Tools: Stethoset, listening hoop, Ling 6 card

Daily checks are key for detecting changes in hearing

Test each ear separately

Major Companies

Widex, Oticon, Phonak, ReSound, Signia, Starkey

Vary in processor design, feedback control, and connectivity features.

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Cochlear Implant Overview

Used for severe to profound SNHL when hearing aids aren’t effective

Implanted: Electrode array, receiver

External: Microphone, processor, battery, transmitting coil

Parts of a Cochlear Implant

External: Sound processor, microphone, battery, coil

Internal: Electrode array (inside cochlea), receiver/stimulator under the skin

Candidacy Guidelines (FDA)

Age- and severity-based guidelines.

Trial period with hearing aids required.

Requires long-term commitment to rehab and follow-up.

Troubleshooting CIs

Confirm battery charge, check indicator lights, test cables

Use monitor earphones to test mic

Swap parts between bilateral processors

Major Companies

Cochlear Americas: Nucleus 7, Nucleus 8

Advanced Bionics: Naída CI M

MED-EL: Rondo 3, SONNET 2

New tech: Indicator lights, waterproofing, MAP programming, wireless streaming.

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Used for:

Conductive and mixed hearing loss.

Single-sided deafness (SSD).

Bypass outer and middle ear by sending vibration directly to cochlea.

Procedure for BAHD

Simple outpatient procedure

Bone healing period required before fitting processor

FDA age limit: 5+ for surgical candidacy

BAHD Troubleshooting

Use a test rod to check function.

Ensure device is clean and battery is functional.

Feedback and mic checks are similar to HAs and CIs

Current Companies:

Cochlear Baha

Oticon Ponto

MED-EL ADHEAR

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FM/Roger Hearing Assistive Technology (HAT) Overview

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FM/Roger Hearing Assistive Technology (HAT) Overview

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FM (Frequency modulator)

Improves signal to noise ratio by using remote microphone that is placed close to sound source (e.g teacher)

Wireless

Speech signal is changed into electrical signal

Transmitter → receiver

Channel specific → 1-80 channels are set aside for children

Set to same frequency

Dynamic benefit

Data logging in transmitter

Connection of transmitter to computer

Roger

The first to use adaptive digital wireless transmission

Bridges the gap of noise and distance

Intelligent and adaptive algorithms that avoid interference and optimize range

Flexible and easy creation of networks without worrying about frequency planning

Low acoustic delay

Cleaner signal

Compatible with cochlear and hearing aids

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Phonak and Oticon are the most notable companies

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1 transmitter can send to unlimited receivers

Dynamic FM receiver

Clipped within 6 inches of teachers mouth

Can no longer shut the FM from receiver end

Placing a wireless microphone like Roger in close proximity to the speaker has several key benefits:

Improves speech recognition in noise and at a distance

Reduces the distance between speaker and listener

Compensates for the effects of background noise and reverberation

Roger touch screen

Roger touch is a wireless teacher microphone

Roger touch is the core component of any Rogersystem

Three modes

Lanyard

Small group

Pointing

On / Off Button

Press and hold

Mute Button

Connect Button

Battery Life

Networks with multiple Roger Touchscreens or Pass Around Microphone

If you have multiple teachers

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Universal Roger X:

Looks like a small t plug

Roger X is the world’s smallest universal receiver at 0.83 cm3

Compatible with most manufacturers on the market

Fully automatic, no buttons, no programmer

Operating Range 65ft

Power consumption – more battery drain with receiver attached

Roger MyLink:

Used with T-coil for hearing aids or cochlear implant

Unilateral Hearing Loss (UHL)

Minimal Hearing Loss

Attention Disorders

Auditory Processing Disorder

Learning Disabilities

Volume control and on/off button

Quick charging 80% in 1 hour, 100% in 2 hours

Operating time: 10 hours

Operating range: 20m / 66 ft

Can also be used with headphones

Roger Focus

Unilateral hearing loss / Single Sided Deafness

Minimal hearing loss

Learning Disabilities

Auditory processing disorder

ADHD

Autism

Dyslexia

Roger DigiMaster 5000

Adaptive behavior

One DigiMaster 5000 per classroom

Microphones: Roger Touchscreen

For normal-sized classrooms:

100 m2 / 1076 ft² and more

Floor stand or wall mounted

12-loudspeaker array

Benefits to teachers

Roger X with mini mic 2+ streamer with a Baha 5

Need the Cochlear Mini mic 2+

Student must press streaming button for 3 second every morning

Mini mic must stay within 30 feet of student (cochlear up to 83ft)

Shutting down mini mic 2+ breaks stream

To disconnect turn mini mic 2+ off

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Daily hearing aid and FM/Roger Check

Daily listening check

Look at the hearing aids, earmolds and FM/Roger

Broken or cracked casing

Blockage of openings

Build-up of moisture in tubing

Corrosion in battery compartment

Carefully inspect Direct Audio Input (DAI)

Check the battery

FM/Roger will drain battery faster than hearing aid alone

Hearing aid may work, but FM may not – not enough battery to drive FM

Check the audio shoe and DAI contacts

Inspect the casing of the audio shoe

Inspect the gold contacts of the audio shoe

Gently clean the contacts with an alcohol pad

Listening Checks:

1. Hearing Aid

1. Firmly attach student's hearing aid to listening stethoset

2. Monitor the sound produced by the hearing aid by speaking into the microphone

3. Ling Sounds, Spondee Words

4. Turn the aid up to the volume that the child wears it and listen for distorted, intermittent or weak sound (must know child’s hearing loss)

5. Check to see if the aid gets louder as the volume control indicates

6. Squeeze aid for intermittency or static

7. Ensure zero distortion

8. Listen for “noise” in the aid (circuit noise ok)  buzzing

9. Should listen to student’s hearing aid every session or each morning

2. Roger/FM and Hearing Aid

1. Attach audio shoe and receiver to hearing aid or the receiver to the cochlear implant

2. Speak into the Roger/FM microphone (Ling sounds, spondee words)

1. Be sure the microphone is far enough away from environmental microphone of hearing aid to

2. Cover environmental mic ports of hearing aid

3. Listen for distortion or buzzing

4. Ensure that the signal is loud enough

5. Listen for absence of speech signal

6. Squeeze receiver – is it intermittent?

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Troubleshooting the Receiver

Visual Inspection of Receiver

Are prongs straight and clean?

Is casing cracked?

Visual Inspection of AudioShoe

Are DAI contact prongs straight and clean

Is casing cracked?

Is the battery in the hearing aid / cochlear implant fresh and charged?

If other bilateral devices.. Use one device to troubleshoot the other

Have the student turn their hearing aid / cochlear implant on and off Connection

If you are still having troubles, get extra support

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The National Association of the Deaf (NAD) is the leading civil rights organization in the United States run by and for deaf and hard of hearing individuals. Founded in 1880, it is a nonprofit that advocates at a national and international level for the deaf and hard of hearing community. They do this by organizing, preserving, and promoting linguistic rights of deaf and hard of hearing people across the U.S.

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Hands & Voices is a nonprofit, parent-led organization that supports families of children who are deaf or hard of hearing, regardless of the communication method they use - sign language, spoken language, cochlear implants ETC.

They aim to:

Support parents of deaf and hard of hearing children by providing guidance.

Empower families to make informed choices through access to information workshops and connections.

Advocate for the well-being of children at every stage without promoting one communication method over another.

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ESAD is dedicated to promoting the welfare of Deaf and hard-of-hearing individuals in New York.

ESAD promotes educational measures that support the Deaf community, including access to educational programs and resources.

ESAD works to improve employment opportunities and economic security for Deaf individuals.

They have ASL classes, legal aid, social services, mental health services.

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National Association of the Deaf (NAD) – Civil rights organization advocating for the rights of deaf and hard of hearing individuals in the U.S.

Hearing Loss Association of America (HLAA) – Focuses on education, advocacy, and support for people with hearing loss.

American Society for Deaf Children (ASDC) – Advocates for early language access and family support.

Deaf CAN! – Promotes empowerment and advocacy through education and awareness.

Deaf Youth USA (DYUSA) – Youth-led organization advocating for equity and justice for deaf youth.

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Described and Captioned Media Program (DCMP): Free accessible educational media for deaf, hard of hearing, blind, and visually impaired students.

National Deaf Center on Postsecondary Outcomes (NDC): Offers tools and research to improve accessibility in education and employment.

Gallaudet University Accessibility Resources: accessibility for deaf students in higher education.

Apple Accessibility Features: Built-in iPhone and iPad features like Live Captions, Sound Recognition, and Visual Alerts.

Google Accessibility Tools: Live Transcribe, Sound Amplifier, and Android captioning settings.

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Hands and Hearts - children's picture book about a mother and daughter who spend a day at the beach communicating through ASL, the story incorporates teaching 15 basic ASL words in the side bars

You're Welcome, Universe - teenage girl gets expelled from her school. Now, in a mainstream school, she’s treated like an outcast as the only deaf student.

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https://www.dailymoth.com/blog

News delivered in ASL

https://www.nyfoundling.org/what-we-do/our-programs/child-welfare/family-services-for-deaf-children-and-adults/

Many resources and forums individuals can join

https://support.apple.com/en-by/guide/iphone/iphe0990f7bb/ios

Speech to text app

https://childrenshearing.org/children-and-families/programs-for-parents/

Children's Hearing Institute (CHI) is a non profit that brings together the pediatric hearing loss community in New York, New Jersey, and Connecticut.

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Hearing in a Deaf World

https://www.thehummingbirdpost.com/life/hearing-in-a-deaf-world-part-four

Deaf YouTuber and activist sharing life experiences and accessibility topics

https://www.youtube.com/user/rikkipoynter

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Marlee Matlin - Academy Award-winning American actress and activist who was the first deaf performer to win an Oscar, for her role in Children of a Lesser God

Dr. Glenn Anderson - famous for achieving his doctoral despite discrimination as a Black deaf man

Claudia Gordon – First Deaf Black female attorney in the U.S., advocate for disability rights