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Speech Discrimination Score
The speech discrimination score is a very important factor in determining a patient's projected communication success with amplification. The function of a hearing aid is to make sounds louder. In some instances, increased loudness of sound may not improve the clarity of words at the listener's ear. If an individual exhibits very poor speech discrimination under ideal listening conditions, then it is likely that the hearing aid will benefit the patient in awareness of sound but not in intelligibility of speech. This information is thoroughly explained at the time of the hearing aid selection so that accurate expectations of the hearing aid can be established by the patient.

Speech Discrimination Performance at a Comfortable Listening Level

90 - 100%

Excellent

80 - 90 %

Good

70 - 80%

Fair

60 - 70%

Poor; marked difficulty in following conversation

50 - Below

Limited; probably unable to follow running speech

Facts About Hearing Loss in Adults:

General Facts

• Nearly 40% of adults seek medical treatment for dizziness.†
  
  
• Most forms of dizziness are treatable, often without medicine or surgery.
  
  
• Approximately 28 million Americans have a hearing impairment.†
  
  
• Only 1 out of 5 people who could benefit from a hearing aid actually wears one.†
  
  
• About 250,000 people would be good candidates for a cochlear implant.†
  
  
• At least 12 million Americans have tinnitus (ear noises). Of these, at least 1 million experience it so severely that it interferes with their daily activities.†
  
  
• Three out of 4 children experience ear infections (otitis media) by the time they are 3 years old.†
  
  
• Allergies can cause many ear related symptoms and disorders, including eustachian tube dysfunction, recurrent or chronic ear infections, ear pressure, ear itching, Meniere’s disease, and other causes of dizziness. Allergy testing and treatment can assist in control of these symptoms.
  

†Source: National Institute on Deafness and Other Communication Disorders
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Statistics Related to Hearing Loss in Adults

• About 28 million people in the U.S. have hearing loss.
  
  
• Of these, 80% have irreversible hearing loss.
  
  
• 10 million Americans have suffered irreversible noise induced hearing loss, and 30 million more are exposed to dangerous noise levels every day.
  
  
• Hearing loss is present in 4.6% of individuals between the ages of 18 and 44 years.
  
  
• Hearing Loss is present in 14% of individuals between the ages of 45 and 64 years.
  
  
• Hearing loss is present in 32% of people over 65.
  
  
• Hearing loss is present in 40-50% of people 75 and older.
  
  
• Hearing loss is the 3rd most prevalent chronic condition in the older population.
  
  
• At least 12 million Americans have tinnitus (ringing in ears).  Of these 1 million experience it so severely that it interferes with their daily activities.
  
  
• Almost 12% of men who are 65-74 years of age are affected by tinnitus.  Tinnitus is identified more frequently in white individuals and the prevalence of tinnitus is almost twice as frequent in the south as in the northeast.
  
  
• Approximately 4,000 new cases of sudden deafness occur each year in the United States.  Hearing loss affects only 1 side in 9 out of 10 people who experience sudden deafness.  Only 10-15% of patients with sudden deafness know what caused their hearing loss.
  
  
• Approximately 615,000 individuals have been diagnosed with Meniere’s disease  (which can cause hearing loss, tinnitus, fullness in the ears, and vertigo) in the United States.  Another 45,500 are newly diagnosed each year.
  
  
• One out of every 100,000 individuals per year develops an acoustic neuroma (vestibular schwannoma), which is a tumor near the brainstem that can cause hearing loss, tinnitus, and dizziness.

National Center for Health Statistics (1995) Vital Health Stat 10, US Dept of Health and Human Services (1991) Healthy People 2000,  National Institute on Deafness and Other Communication Disorders.(2007).
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Categorizing Hearing Loss

• Variables:
• Type of hearing loss (conductive, mixed, sensory,  neural, or central)
• Frequency characteristics of the loss
• Slope of the audiogram
• Age of onset of the hearing loss
• Differences in hearing between the ears
• Speech and language skills
• Presence of other physical, intellectual, or emotional handicaps
• Types of listening environments

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Types of Hearing Loss

• Can be transient or permanent, but usually can be improved.
• Causes include: ear wax, malformation of auditory structures, ear infection, eardrum perforation, eustachian tube dysfunction, ossicular (ear bone) erosion
• Treatment: medication, surgery, amplification

• Usually permanent
• Sensory: typically due to damage or death of outer hair cells/inner hair cells of the cochlea
• Neural: caused by nerve damage, such as by a tumor
• Central: any damage or disuse involving the brain
• Sensory hearing loss is the most common type of HL in adult/geriatric populations
• Treatment: Amplification (hearing aids and/or assistive listening devices), cochlear implantation for severe profound sensory hearing loss

Mixed:

• Combination of conductive and sensorineural hearing losses

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National Council on Aging Study (May 1999) http://www.ncoa.org/attachments/UntreatedHearingLossReport.pdf

Social Implications of Hearing Loss

• Feelings of sadness and depression
• Feelings of worry and anxiety
• Paranoia (“people get angry at me for no reason”)
• Social isolation: withdrawal from social circles and activities
• Emotional turmoil (irritable, fearful, and tense) and insecurity

Majority of HA wearers report improved quality of life

• Improved personal relationships (74%)
• Improved self esteem (67%)
• Improved overall health (71%)
• Family members reported average 15% greater benefit than the wearer

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Facts About Hearing Loss in Children

General Facts:

• Hearing loss affects 12,000 children born in the United States each year – 33 babies a day – making it the most common birth defect.
  
  
• According to the National Institute on Deafness and Other Communication Disorders, an estimated 28 million people in the United States have some degree of hearing loss.
  
  
• In the 2002–2003 school year, nearly 72,000 children ages 6 to 21 years got special education services under the “hearing impairment” category in the United States. Another 1,600 children received services under the “deaf blind" category. The total number of children with hearing loss is likely higher, since some of them may have other disabilities and be served under other special education categories. Still others may not be counted because they receive only regular education services. (Centers for Disease Control, http://www.cdc.gov/ncbddd/dd/hi3.htm)
  
  
• In addition to these statistics on permanent hearing loss, children are often afflicted by transient and potentially correctable conductive hearing losses due to ear infections.  Ear infections (otitis media, or OM) constitute the most frequent medical diagnosis for children. The National Center for Health Care Statistics estimates that annually there are 70 ear infection cases for every 100 children under the age of 5 years. The peak of ear infections is between 2-5 years of age.  However, even older children still experience bouts of OM; there are 14 cases annually for every 100 children ages 5 - 17. Ear infections result in hearing loss that ranges from very slight to moderate, and averages approximately 20 dB. (Peggy Nelson, http://www.acoustics.org/press/133rd/2paaa2.html)
  
  
• Only 69% of babies are now screened for hearing loss before 1 month of age (up from only 22% in 1998).  Of the babies screened, only 56% who needed diagnostic evaluations actually received them by 3 months of age.   Moreover, only 53% of those diagnosed with hearing loss were enrolled in early intervention programs by 6 months of age.  As a result, these children tend to later re-emerge in our schools’ special education (Individual Disability Education Act (IDEA), Part B) programs. (Hearing Loss Association of America, http://www.hearingloss.org/learn/factsheets.asp)

When children are not identified and do not receive early intervention, special education for a child with hearing loss costs schools an additional $420,000, and has a lifetime cost of approximately $1 million per individual. (Hearing Loss Association of America)
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What Causes Hearing Loss in Children?

Normal hearing requires that all parts of the auditory pathway are working correctly. This pathway includes the external ear, middle ear, inner ear, auditory nerve, and the connection between the auditory nerve and the brain. The exact location and nature of the problem in the auditory pathway determines the type and severity of a person’s hearing loss.

Some causes of hearing loss occur before a baby is born. These include genetic disorders and infections.  About half of all cases of hearing loss among children are thought to result from genetic factors. Sometimes a child has a syndrome of which hearing loss is only one feature. However, in most children with hearing loss that is due to a genetic cause, the hearing loss is not part of a syndrome. A variant of the connexin 26 gene is responsible for much of the hearing loss in this latter group of children.

Problems before, during, or soon after birth can also be risk factors for developing hearing loss. These include infections during pregnancy, hypoxia (where the baby does get not enough oxygen), bleeding in the brain, and hyperbilirubinemia (severe jaundice). Children who are born prematurely or at low birth weight are more likely to have problems that may lead to hearing loss. However, children of normal birth weight can have hearing loss.

Hearing loss can also occur and progress later in a child’s or adult’s life. Causes during this time include infection (such as meningitis, chronic middle ear infections, or measles), injuries (such as head injury), or certain drugs (such as the antibiotic gentamicin or chemotherapy drugs). High noise levels (such as from firecrackers or loud rock concerts) can also damage a person’s hearing. About 30 million workers are exposed to dangerous noise levels on their jobs. Another 9 million are at risk of hearing loss as a result of working with certain metals or solvents.

Catching Childhood Hearing Loss Early Can Lead to New Opportunities

Because most babies learn language by hearing speech long before he or she can talk, a baby’s first months and years are critical for learning language and communication skills. Any degree of hearing loss has the potential to interrupt speech and language development, and interfere with a child’s overall educational progress.  For children with hearing loss, early screening, diagnosis and intervention can make a considerable difference.
Because of this, the state of Texas has instituted a law requiring hospitals to take part in a Newborn Hearing Screening program in an effort to identify hearing loss as early as possible.
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Interventions

The sooner a child is diagnosed with hearing loss, the better. Experts recommend beginning family-centered early intervention programs (including listening and speech training) before a baby is 6 months old to take advantage of the critical time window for learning language.

Historically, the majority of children with hearing loss communicated through sign language, either alone or in combination with the spoken word. Now, advances in technologies are providing a greater range of communication options – even for young children. Babies can be fitted with hearing aids before they are 3 months old, and cochlear implants can help children as young as 1 year old.

The primary goal for children with severe hearing loss is to help them develop language at the same rate as children with typical hearing.  There are various communication options to help children attain this goal. 

Second, the United States and a number of other countries offer specialized programs, called early intervention, to support children with hearing loss and other disabilities and give them an early start to their education.

Third, advances in hearing technology have improved dramatically in the past 10 years. Early intervention combined with the use of hearing aids or cochlear implants and other assistive listening devices enable a child with hearing loss to develop language skills comparable to their hearing peers by the time they enter first grade.

Parents who want their children to communicate using spoken language also need to find an appropriate educational environment for their child. This may be a private school or the local public school system. If the child is entering a regular or “mainstream” classroom, teachers will want to know about effective teaching techniques to assist children with hearing loss.  (Alexander Graham Bell Association)
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How Much Loss is there?

Hearing loss severity is based on how well a person can hear the frequencies or intensities most often associated with speech. Severity can be described as mild, moderate, severe, or profound. The term “deaf” is sometimes used to describe someone who has an approximately 90 dB or greater hearing loss or who cannot use hearing to process speech and language information effectively, even with the use of hearing aids. The term “hard of hearing” is sometimes used to describe people who have a less severe hearing loss than deafness.
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