Contents Foreword Introduction Contributors Acknowledgments vii ix xi xiii 1. Why Should I Use Hearing Aids? Talking to the 1 Patient about Hearing Loss William Luxford and Sergei Kochkin 2. Review of Audiometry 11 Michael J. Nilsson and Michelle L. Hicks 3. Hearing Aid Types 27 David M. Barrs 4. Subjective and Objective Measures of Hearing Aid 39 Performance Stephen J. Sanders and John R. Coleman 5. Hearing Aid Candidacy in Adults 51 Marcia Raggio 6. Verification of Hearing Aid Fitting 67 David Fabry 7. Hearing Aid Amplification in Pediatric Patients 83 Margaret E. Winter 8. Medical Reasons for Hearing Aid Failure 95 M. Jennifer Derebery 9. The Management of Tinnitus in the Hearing-Impaired Patient 113 John W. House 10. The Role of Hearing Aids in the Management of Tinnitus 119 Pawel J. Jastreboff and Margaret M. Jastreboff v
vi HEARING LOSS: THE OTOLARYNGOLOGIST S GUIDE TO AMPLIFICATION 11. Nutritional Supplements for the Hearing-Impaired Patient 133 Michael J. A. Robb and Michael D. Seidman 12. Implantable Hearing Devices 173 William H. Slattery, III 13. Assistive Listening Devices 193 Randy Drullinger 14. Hearing Aid Dispensing for the Otolaryngologist 201 Neil Giddings 15. Economics of Hearing Aid Dispensing 217 Brad Volkmer 16. Lessons from the Real World 231 Michael Valente 17. The Future of Hearing Aid Research 243 Brent Edwards Index 265
Foreword Dr. Derebery and Dr. Luxford have assembled a list of Who s Who to write this important text highlighting the importance of treating the hearing impaired through amplification. As surgeons, otolaryngologists sometimes forget that surgery has risks and complications, hence surgery should be the last resort. There are times when medications and surgery will not alleviate the hearing loss. The 21st century generation of hearing aids can do wonders for our hearing-impaired patients. As an otologist for four decades, I am a successful hearing aid user in each ear. People saw better with a monocle; however, that was in the 18th century we now wear a pair of glasses. Hence, binaural hearing is crucial to enjoying life in this fast-paced technologic age. Yet many of us still prescribe only one hearing aid for a patient with bilateral hearing loss. The editors and the authors of the chapters in this book have contributed greatly in helping us to help our hearingimpaired patients. They are to be congratulated. Our heartfelt thanks. K. J. Lee, MD, FACS Past President, American Academy of Otolaryngology- Head and Neck Surgery vii
Introduction Hearing loss is the third most common health problem in the United States, and affects more than 31 million Americans. Most hearing loss is sensorineural, which, at the time of this writing, is not curable with medical or surgical means. For most patients with clinically significant hearing loss, hearing aids are the best treatment option available. No patient is happy with the recommendation that they should seek amplification for hearing loss. We are all familiar with the denial that commonly accompanies the recommendation that hearing aids would be of benefit. Yet, most patients will obtain a hearing aid only after a physician, rather than a family member, both confirms that a hearing loss exists, and recommends that amplification is the best treatment available to treat it. The otolaryngologist is uniquely trained in the ability to diagnose, as well as treat, hearing loss by medical or surgical means. With the aging of the baby boomer population, the significant noise exposure in modern life, as well as the greater comfort the population at large is getting in wearing ear level devices for communication, we can expect that the need for professional recommendation for the treatment of hearing loss with hearing aids will continue to increase in the future. Diagnostic tests for hearing loss and hearing aid dispensing are taught as a core component of otolaryngology residency programs. Questions regarding the treatment of hearing loss with hearing aids are mandated by the American Board of Otolaryngology in both the oral and written examinations taken upon matriculation. The authors intend this book to enhance the training that is already being given in residency programs. The chapters discuss in detail not only technical aspects of hearing aid fitting useful to the physician, but also address specific areas of challenge, such as fitting the pediatric patient with hearing loss, or the patient with hydropic hearing loss with a changing baseline audiogram. We have included research trends in hearing aids, as well as potential nutriceutical interventions to protect hearing health. The related problem of tinnitus management in this population is also of great concern to our patients. Practical solutions for the hearing impaired are at times best addressed by the use of assistive listening devices; to read about them is to begin to think about coping in everyday life from the perspective of the hearing impaired. Bone-anchored hearing aids and other surgically implantable devices are growing in both sophistication and popularity, and also are discussed. In addition to clinical issues, the welltrained graduating resident or practitioner is faced with the very unfamiliar task of trying to establish both a financial model of how to develop hearing aid dispensing within his or her practice, as well as what they should be looking for in hiring nonphysician professional personnel to join them in practice. Marketing and advertising, foreign concepts to most physicians, can be done both professionally and tastefully to enhance both the hearing aid dispensing as well ix
x HEARING LOSS: THE OTOLARYNGOLOGIST S GUIDE TO AMPLIFICATION as the medical and surgical components of practice. This book would not have been possible without the collegiality and professionalism shown by the many contributors. No one profession or group has a monopoly on providing patient care to the hearing impaired. The knowledge shared here is given by top professionals in the audiology, hearing instrument, business, and medical professions, and we editors genuinely have learned by working with them in preparation for this book. It is our hope that in the future, we professionals in varied fields can put aside turf battles to work more closely together to better serve the needs of the growing population of the hearing impaired. William M. Luxford M. Jennifer Derebery
Contributors David M. Barrs, MD Department of Audiology Mayo Clinic Arizona Phoenix, Arizona Chapter 3 John R. Coleman, AuD, FAAA Orange County Physician s Hearing Services Mission Viejo, California Chapter 4 M. Jennifer Derebery, MD Associate, House Clinic and Ear Institute Clinical Professor of Otolaryngology USC Keck School of Medicine Chapter 8 Randall R. Drullinger President of the Aegis Group Portland, Oregon Chapter 13 Brent Edwards, PhD Vice President of Research Starkey Laboratories Berkeley, California Chapter 17 David Fabry, PhD Chief of Audiology Miller School of Medicine University of Miami Miami, Florida Chapter 6 Neil A. Giddings, MD Spokane Ear Nose and Throat Spokane, Washington Chapter 14 Michelle L. Hicks, PhD Senior Research Audiologist Center for Amplification and Hearing Research Sonic Innovations Salt Lake City, Utah Chapter 2 John W. House, MD House Clinic Clinical Professor, Department of ORL-HNS Keck School of Medicine University of Southern California President, House Ear Institute Chapter 9 Margaret M. Jastreboff, PhD Jastreboff Hearing Disorders Foundation, Inc. Adjunct Professor School of Audiology Salus University Philadelphia, Pennsylvania Chapter 10 Pawel J. Jastreboff, PhD, ScD, MBA Professor Department of Otolaryngology Emory University School of Medicine Atlanta, Georgia Chapter 10 xi
xii HEARING LOSS: THE OTOLARYNGOLOGIST S GUIDE TO AMPLIFICATION Sergei Kochkin, PhD Executive Director Better Hearing Institute Washington, DC Chapter 1 William M. Luxford, MD Associate, House Clinic and Ear Institute Clinical Professor of Otolaryngology USC Keck School of Medicine Chapter 1 Michael J. Nilsson, PhD Director, Center for Amplification and Hearing Research Sonic Innovations Salt Lake City, Utah Chapter 2 Marcia Raggio, PhD Professor San Francisco State University San Francisco, California Chapter 5 Michael J. A. Robb, MD Private Practice Neurology, Oto-Neurology and Medical Neurotology Robb Oto-Neurology Clinic Phoenix, Arizona Chapter 11 Stephen J. Sanders, AuD, FAAA Orange County Physician s Hearing Services Mission Viejo, California Chapter 4 Michael D. Seidman, MD, FACS Medical Director, Division of Otologic/Neurotologic Surgery Department of Otolaryngology-Head and Neck Surgery Medical Director, Center for Integrative Medicine Program Henry Ford Health System Clinical Associate Professor Department of Otolaryngology Wayne State University Detroit, Michigan Chapter 11 William H. Slattery, III, MD Director, Clinical Studies; House Ear Institute Associate, House Ear Clinic Clinical Professor, University of Southern California Chapter 12 Michael Valente, PhD Director of Adult Audiology Professor of Clinical Otolaryngology Washington University School of Medicine St. Louis, Missouri Chapter 16 Brad Volkmer, MBA President/CEO Ear Professionals International Corporation City of Industry, California Chapter 15 Margaret E. Winter, MS, CCC-A Board Certified in Audiology Coordinator of Clinical Services House Ear Institute Children s Auditory Research and Evaluation (CARE) Center Chapter 7