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04/18/2023 Manfred Stoifl 2
Overview of hearing, hearing loss & hearing treatment
Manfred Stoifl, Hearing Aid Acoustician, AAHA Vienna,
Austria
04/18/2023 Manfred Stoifl!! 3
About the Presenter• Born, raised and educated in Vienna, Austria• Married with 2 Boys• Hearing Aid Acoustician AAHA, Honors• Business Administration Retail, Honors• Hearing Health Care Industry since 1976• Living and working in Asia since
1986• Established THSG in 2003• Living in Singapore since 2005• Coordinator for right-to-hear foundation since 2003• Coordinator for since 2014.
Sound and what we hearAnatomy & Physiology of Hearing
Learning to hearHearing Loss
Hearing treatmentHearing aids
Cochlear implants.
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04/18/2023
Our Vision for Adults
Treating hearing loss to alleviate it’s effect on quality of life.
Our Vision for Adults
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EconomicIndependenc
e
SocialIndependenc
e
Hearing
Language
OverallHealth
AvoidIsolation
Mental Preservation
Quality of Life
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Our Vision for Children
Provide hearing, to enable speech development and mainstream education.
Our Vision for Children
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EconomicIndependenc
e
SocialIndependenc
e
Hearing
Language
EducationSocial
Competence
Mental Development
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Sound & what we hear
The 4 Attributes of SoundW
hat
do w
e h
ear?
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1 Sec 2 Sec 3 Sec
Frequency
Inte
nsit
y
Duration
4 Sec
Place in TimeTone
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-20
0
20
60
60
80
80
100
120
40
140100
Frequency Hz1k
2k3k
4k10k20 20k5k
8k
Human Range of Hearing
Pengalaman Auditori
Kemampuan Orkestral
Kemampuan Vokal
6k
Dari(sebelum) Lahir hingga lanjut usai
Siklus Mendengar & PemahananG
ood
Ab
ility
10 20 30 40 50 60 70 80Age
0
Bad
Anatomi PendengaranTinjauan Dasar
Telinga Luar
TelingaTengah
Telinga Dalam
Pusat Auditori Otak
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Pendengaran Peripheral
Pendengaran Pusat
Bagaimana Kita Mendengar
Hearing – Converting sounds to Electrical Impulses
Hearing - Assigning Meaning to electrical Impulses
Two meanings of the word “Hearing”
Hearing – Converting sounds to Electrical Impulses
Pendengaran Peripheral
Automatic – starting from 7th month of gestation
Physiology of Peripheral Hearing
Pinna
liang telinga
palu
sanggurdi
landasanotak
Liquid
syaraf pedengaran
simulus elektrik
koklea
gendang telinga
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Peripheral Hearing
Faithfully converting sounds to electrical
impulses and conduct to Central Auditory System
The 4 Attributes of SoundW
hat
do w
e h
ear?
04/18/2023 Manfred Stoifl
1 Sec 2 Sec 3 Sec
Frequency
Inte
nsit
y
Duration
4 Sec
Place in TimeTone
Hearing - Assigning Meaning to electrical Impulses
Learned – with help of other senses and experiences
Pendengaran Pusat
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The 4 Attributes of Electrical PatternsHearing is electrical patterns in the Brain
FrequencyIntensityDurationPlace in
Time
Learning to Hear
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We are born with hearing but have to learn how to hear
Learning to hear
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meaning
saving in long-term memory
? ??
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24
Dir
ect
ion
al H
eari
ng
You will hear the sound first and louder on your right ear and second and softer on your left ear
If someone calls you from your right side, ….
THE CALLER IS ON MY
LEFT!
THE CALLER IS ON MY RIGHT!
If Someone calls you from your left side …
You will hear the sound first and louder on your left ear and second and softer on your right ear.
? ??
Learning to hear
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meaning
saving in long-term memory
26
Hill, N.M. & Schneider, W. (2006) Brain Changes in the Development of Expertise: Neurolical Evidence on Skill-Based Adaptations in Cambridge Handbook of Ex-pertise and Expert Performance. New York: Cambridge University pp. 653-683
Brain activity (shown by means of fMRI) is strongly decreased throughout a given automation task over a duration of 3x 20 minutes. Cortical activities reduced by 85%.
Automatic Hearing is More Efficient
Learning to hear
27
10 20 30 40 50 60 70 80Age
Slow / Bad
Fast / Good
Time
Normal Aging
Central Auditory Processing Speed Lifecycle
Pro
cess
ing
Sp
eed
Learning to hear
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meaning
saving in long-term memory
Hearing
Automatic retrieval of meaning from long-term memory
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Hearing Assessment
10
0
20
30
40
50
60
70
80
90
100
110
120
TIN
GK
AT P
EN
DEN
GA
RA
N (
dB
HL)
KERAS
LEMBUT
Apa yang kita dengar?Intensitas / Kekerasan/ Dynamic-range/Kompresi
Dynam
ic
Range
Ambang Dengar
Ambang Ketidaknyamanan (UCL)
125 250 500 1000 2000 4000 8000
FREKUENSI DALAM SIKLUS PER DETIK (Hz)
NA
DA
RE
ND
AH
NA
DA
TIN
GG
I
Apa yang kita dengar?
Frekuensi / Bunyi / Nada
20
Hz
20
,00
0 H
z
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Hearing Loss
Hearing loss
Hearing Loss
It typically takes 7 – 10 years from the onset of hearing loss until a
patient seeks treatment!
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-20
0
20
60
60
80
80
100
120
40
140100
Frequency Hz1k
2k3k
4k10k20 20k5k
8k
Pengalaman Auditori
Kemampuan Orkestral
Kemampuan Vokal
6k
Hearing Loss
100
203040
5060
708090
100110120
125 250 500 1000 2000 4000 8000
Peripheral Hearing Loss – incorrect conversion of sounds to Electrical
Impulses
Central Hearing Loss – Problems assigning meaning
to electrical impulses
Hearing Loss – a complex Problem
Connected Aggravate
d over time
? ??
SNHL Hearing Loss
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meaning
saving in long-term memory
Hearing
Automatic retrieval of meaning from long-term memory
39
Cortical activities reduced by 85%.
Instant recall from memoryCortical activities increases by 85%.
No
Sequence of SNHL Hearing Loss
Can’t understand automatically and easy, use context extensively..
Sig
nal
further degraded - too little input further degrades ability
- distorted and weak signal is being processed slowly & inaccurately
Sig
nal
distorted and weak Haircell damage in Cochlea
Peri
ph
era
l
Audit
ory
Cort
ex
Hig
her
Bra
in
Fun
ctio
ns
Leads to Mental, Physical and Emotional problems
Cen
tral Pro
cess
ing
Learning to Hear
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Everything we learn we will forget if not using it
to it’s full extend!
SNHL Hearing Loss
Hearing Treatment
Central Hearing Loss – Clearer, less complex input, time
and training
Hearing treatment is a complex undertaking
Peripheral Hearing Loss – Correcting the Input signal to provide the best audibility
and clearest output from the cochlear
Hearing loss Hearing with hearing aids
Hearing with Hearing Aids
Only with hearing from both ears can good
hearing be expected!
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Hearing with Hearing Aids
Always choose the style/design/visibility
customer is comfortable with!
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Hearing with Hearing Aids
• Binaural functions• Sound quality• Noise suppression• Speech enhancement• Convenience features.
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Cost
Heari
ng
in
Nois
e
Con
ven
ien
ce
Tech
nolo
gy
Cost – Benefit Chart
Hearing with Hearing Aids
Treatment with Hearing Aids is a life-long process!
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Hearing Aids need to be adapted and re-adjusted
regularly!
Quality of Hearing Aids
It’s not about if you hear or not
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It’s about how easy & comfortable you hear!
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Hearing with cochlear implants
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Why hearing aids are sometimes no
enough
Hearing loss & Hearing Aidsever hearing lossprofound hearing loss
Hearing with a Cochlear Implant System
Hearing with a Cochlear Implant
Stimulation rateFrequencies
Dynamic Range
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Primary quality criteria for Cochlear Implants
— Faster is better— More is better— Wider is better.
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Advanced Bionics provides more electrical Information to Central Auditory Centres
than any other Implant
Other Systems 120 Channels
Speech
Music
Hearing with 120 channel real pitch perception
56
Quality of Cochlear Implants
It’s not about if you hear or not
04/18/2023 Manfred Stoifl 57
It’s about how easy you hear!
Thank YOUQ&A
04/18/2023
