An innovative and innovative attempt to explain the complexities of hearing and hearing loss

2. Overview of hearing, hearing
loss & hearing treatment
Manfred Stoifl, Hearing Aid
Acoustician, AAHA Vienna, Austria
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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.
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4. Sound and what we hear
Anatomy & Physiology of Hearing
Learning to hear
Hearing Loss
Hearing treatment
Hearing aids
Cochlear implants.
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5. 8/9/2015
Our Vision for Adults
Treating hearing loss to alleviate
it’s effect on quality of life.

6. Our Vision for Adults
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Economic
Independenc
e
Social
Independenc
e
Hearing
Language
Overall
Health
Avoid
Isolation
Mental
Preservation
Quality of
Life

7. 8/9/2015
Our Vision for Children
Provide hearing, to enable
speech development and
mainstream education.

8. Our Vision for Children
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Economic
Independenc
e
Social
Independenc
e
Hearing
Language
Education
Social
Competence
Mental
Development

9. 8/9/2015 Manfred Stoifl 9
Sound & what we hear

10. The 4 Attributes of Sound
Whatdowehear?
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1 Sec 2 Sec 3 Sec
Frequency
Intensity
Duration
4 Sec
Place in Time
Tone

11. 9/8/2015
-20
0
20
60
60
80
80
100
120
40
140
100
Frequency Hz
1k
2k
3k
4k
10k20 20k5k
8k
Human Range of Hearing
Manfred Stoifl 11
Pengalaman Auditori
Kemampuan
Orkestral
Kemampuan Vokal
6k

12. Dari(sebelum) Lahir hingga lanjut usai
Siklus Mendengar & Pemahanan
GoodAbility
10 20 30 40 50 60 70 80
Age
0
Bad

13. Anatomi Pendengaran
Tinjauan Dasar
Telinga Luar
Telinga
Tengah
Telinga Dalam
Pusat Auditori Otak
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14. Pendengaran Peripheral
Pendengaran Pusat
Bagaimana Kita
Mendengar

15. Hearing – Converting sounds to
Electrical Impulses
Hearing - Assigning Meaning
to electrical Impulses
Two meanings of the
word “Hearing”

16. Hearing – Converting sounds
to Electrical Impulses
Pendengaran Peripheral
Automatic – starting from 7th
month of gestation

17. Physiology of Peripheral
Hearing
Pinna
liang
telinga
palu
sanggurdi
landasan
otak
Liquid
syaraf
pedengaran
simulus
elektrik
koklea
gendang
telinga

18. Peripheral Hearing
Faithfully converting
sounds to electrical
impulses and conduct to
Central Auditory System
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19. The 4 Attributes of Sound
Whatdowehear?
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1 Sec 2 Sec 3 Sec
Frequency
Intensity
Duration
4 Sec
Place in Time
Tone

20. Hearing - Assigning Meaning
to electrical Impulses
Learned – with help of other senses
and experiences
Pendengaran Pusat

21. 8/9/2015 Manfred Stoifl 21
The 4 Attributes of Electrical Patterns
Hearing is electrical patterns in the
Brain
Frequency
Intensity
Duration
Place in
Time

22. Learning to Hear
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We are born with
hearing but have to
learn how to hear

23. Learning to hear
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meaning
saving in long-term memory
?

24. 9/8/2015
Manfred Stoifl
24
DirectionalHearing 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.

25. ?
Learning to hear
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meaning
saving in long-term memory

26. 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. 27
10 20 30 40 50 60 70 80
Age
Slow / Bad
Fast /
Good
Time
Normal Aging
Central Auditory Processing
Speed Lifecycle
ProcessingSpeed

28. Learning to hear
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meaning
saving in long-term memory
Hearing
Automatic retrieval of meaning
from long-term memory

29. Hearing
Assessment
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30. 10
0
20
30
40
50
60
70
80
90
100
110
120
TINGKATPENDENGARAN(dBHL)
KERAS
LEMBUT
Apa yang kita dengar?
Intensitas / Kekerasan/ Dynamic-range/Kompresi
Dynamic
Range
Ambang Dengar
Ambang Ketidaknyamanan (UCL)

31. 125 250 500 1000 2000 4000 8000
FREKUENSI DALAM SIKLUS PER DETIK (Hz)
NADATINGGI
Apa yang kita dengar?
Frekuensi / Bunyi / Nada
20Hz
20,000Hz

32. Hearing
Loss
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33. Hearing loss

34. Hearing Loss
It typically takes 7 – 10 years from
the onset of hearing loss until a
patient seeks treatment!
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35. 9/8/2015 Manfred Stoifl 36
-
20
0
20
60
60
80
80
100
120
40
140
100
Frequency Hz
1k
2k
3k
4k
10k20 20k5k
8k
Pengalaman Auditori
Kemampuan Orkestral
Kemampuan Vokal
6k
Hearing Loss
10
0
20
30
40
50
60
70
80
90
100
110
120
125 250 500 1000 2000 4000 8000

36. 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
 Aggravated
over time

37. ?
SNHL Hearing Loss
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meaning
saving in long-term memory
Hearing
Automatic retrieval of meaning
from long-term memory

38. 39
Cortical activities reduced by 85%.
Instant recall from memory
Cortical activities increases by 85%.
No

39. Sequence of SNHL Hearing Loss
Can’t understand automatically and easy, use
context extensively..
Signal
further degraded
- too little input further degrades ability
-distorted and weak signal is being processed slowly &
inaccuratelySignal
distorted and weak
Haircell damage in Cochlea
Peripheral
AuditoryCortex
HigherBrain
Functions
Leads to Mental, Physical and Emotional problems
CentralProcessing

40. 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

41. Hearing Treatment

42. 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

43. Hearing lossHearing with hearing aids

44. Hearing with Hearing Aids
Only with hearing from
both ears can good
hearing be expected!
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45. Hearing with Hearing Aids
Always choose the
style/design/visibility
customer is comfortable
with!
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46. Hearing with Hearing Aids
• Binaural functions
• Sound quality
• Noise suppression
• Speech enhancement
• Convenience features.
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Cost
HearinginNoise
Convenience
Technology
Cost – Benefit Chart

47. 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!

48. 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!

49. Hearing with cochlear
implants
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50. Why hearing aids are
sometimes no
enough
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51. Hearing loss & Hearing Aid
sever hearing lossprofound hearing loss

52. Hearing with a Cochlear
Implant System

53. Hearing with a Cochlear Implant
Stimulation rate
Frequencies
Dynamic Range
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Primary quality criteria for Cochlear
Implants
— Faster is better
— More is better
— Wider is better.

54. 8/9/2015 Manfred Stoifl 55
Advanced Bionics provides
more electrical Information
to Central Auditory Centres
than any other Implant

55. Other Systems 120 Channels
Speech
Music
Hearing with 120 channel real
pitch perception
56

56. Quality of Cochlear Implants
It’s not about if you hear or not
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It’s about how easy you hear!

57. Thank YOU
Q&A
8/9/2015