4) HEARING AID PARTS Hearing aids are fairly simple devices, consisting of four basic parts:

A microphone picks up sound from the environment and converts it into an electrical signal, which it sends to the amplifier. An amplifier increases the volume of the sound and sends it to the receiver. A receiver/speaker changes the electrical signal back into sound and sends it into the ear. Then those impulses are sent to the brain. A battery provides power to the hearing aid.

Hearing aids aren't effective for everyone. Hair cells in the inner ear must pick up the vibrations that the hearing aid sends and convert those vibrations into nerve signals. So, you need to have at least some hair cells in the inner ear for it to work. And, even if some hair cells remain, a hearing aid won't completely restore normal hearing. TYPES OF HEARING AIDS

Photo courtesy National Institutes of Health

People with hearing loss have several hearing aid styles from which to choose. Generally, the smaller the hearing aid, the more it costs and the shorter its battery life. In the ear (ITE): This large hearing aid works well for people with mild to severe hearing loss. It fits completely in the bowl of the ear. Because it is so large, the ITE hearing aid is among the most visible of styles, but the battery lasts longer than in smaller aids, and it can accommodate directional microphones (more on that later) and other added features. In the canal (ITC): The ITC hearing aid works only for mild to moderate hearing loss. It is customized to fit the size and shape of the person's ear canal. Although this hearing aid is inconspicuous, its small size makes it difficult to adjust and change the battery. Some ITC hearing aids come with a remote control to make changing the settings easier. Also, users sometimes experience feedback noise with this type of hearing aid because the microphone and receiver sit close together. Completely in the canal (CIC): This hearing aid is also appropriate for mild to moderate hearing loss, and it's even smaller than the ITC hearing aid. In fact, it's so small that a user must pull on a small wire to remove it from his ear. Because it fits completely in the ear canal, the CIC hearing aid is barely visible. Again, though, its small size makes it difficult to adjust and use added features. It's also more expensive than larger hearing aids. Behind the ear (BTE): The BTE hearing aid can help with all types of hearing loss, from mild to profound. The electronics are in a case that sits just behind the ear. The case connects by a piece of clear tubing to a plastic piece called an earmold, which sits inside the ear. Sound travels from the earmold into the ear. This powerful and adjustable hearing aid can accommodate progressive hearing loss, as well as growth, which makes it ideal for children. However, its size and the tubing attaching the electronics to the earmold make it very visible. Also, the BTE hearing aid can cause feedback if it's not fitted correctly.

Cochlear Implants What is a cochlear implant?

Ear with cochlear implant. Credit: NIH Medical Arts A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin (see figure). An implant has the following parts:

A microphone, which picks up sound from the environment. A speech processor, which selects and arranges sounds picked up by the microphone. A transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses. An electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve.

An implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech. How does a cochlear implant work?

A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognize warning signals, understand other sounds in the environment, and enjoy a conversation in person or by telephone. Who gets cochlear implants? Children and adults who are deaf or severely hard-of-hearing can be fitted for cochlear implants. According to the Food and Drug Administration (FDA), as of December 2012, approximately 324,200 people worldwide have received implants. In the United States, roughly 58,000 adults and 38,000 children have received them. Adults who have lost all or most of their hearing later in life often can benefit from cochlear implants. They learn to associate the signal provided by an implant with sounds they remember. This often provides recipients with the ability to understand speech solely by listening through the implant, without requiring any visual cues such as those provided by lipreading or sign language. Cochlear implants, coupled with intensive postimplantation therapy, can help young children to acquire speech, language, and social skills. Most children who receive implants are between two and six years old. Early implantation provides exposure to sounds that can be helpful during the critical period when children learn speech and language skills. In 2000, the FDA lowered the age of eligibility to 12 months for one type of cochlear implant. How does someone receive a cochlear implant? Use of a cochlear implant requires both a surgical procedure and significant therapy to learn or relearn the sense of hearing. Not everyone performs at the same level with this device. The decision to receive an implant should involve discussions with medical specialists, including an experienced cochlearimplant surgeon. The process can be expensive. For example, a persons health insurance may cover the expense, but not always. Some individuals may choose not to have a cochlear implant for a variety of personal reasons. Surgical implantations are almost always safe, although complications are a risk factor, just as with any kind of surgery. An additional consideration is learning to interpret the sounds created by an implant. This process takes time and practice. Speech-language pathologists and audiologists are frequently involved in this learning process. Prior to implantation, all of these factors need to be considered.

5) PET scan

A positron emission tomography (PET) scan is an imaging test that uses a radioactive substance called a tracer to look for disease in the body. A PET scan shows how organs and tissues are working. This is different than magnetic resonance imaging(MRI) and computed tomography (CT), which show the structure of and blood flow to and from organs, Related tests include:

Brain PET scan Breast PET scan Heart PET scan Lung PET scan

How the Test is Performed A PET scan uses a small amount of radioactive material (tracer). The tracer is given through a vein (IV), most often on the inside of your elbow. The tracer travels through your blood and collects in organs and tissues. This helps the radiologist see certain areas of concern more clearly. You will need to wait nearby as the tracer is absorbed by your body. This takes about 1 hour. Then, you will lie on a narrow table that slides into a large tunnel-shaped scanner. The PET picks up detects signals from the tracer. A computer changes the signals into 3-D pictures. The images are displayed on a monitor for your doctor to read. You must lie still during test. Too much movement can blur images and cause errors. How long the test takes depends on what part of the body is being scanned.

8) Three Types of Hearing Loss

Conductive hearing loss - when hearing loss is due to problems with the ear canal, ear drum, or middle ear and its little bones (the malleus, incus, and stapes). Sensorineural hearing loss (SNHL) - when hearing loss is due to problems of the inner ear, also known as nerve-related hearing loss.

Mixed hearing loss - refers to a combination of conductive and sensorineural hearing loss. This means that there may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve.

Conductive Hearing Loss Causes:

Malformation of outer ear, ear canal, or middle ear structures Fluid in the middle ear from colds Ear infection (otitis media - an infection of the middle ear in which an accumulation of fluid may interfere with the movement of the eardrum and ossicles Allergies Poor Eustachian tube function Perforated eardrum Benign tumors Impacted earwax Infection in the ear canal Foreign body in the ear Otosclerosis

Treatments of Conductive Hearing Loss: Types of conductive hearing loss include congenital absence of ear canal or failure of the ear canal to be open at birth, congenital absence, malformation, or dysfunction of the middle ear structures, all of which may possibly be surgically corrected. If these are not amenable to successful surgical correction, then the hearing alternatively may be improved with amplification with a bone conduction hearing aid, or a surgically implanted, osseointegrated device (for example, the Baha or Ponto System), or a conventional hearing aid, depending on the status of the hearing nerve. Other causes of conductive hearing loss are: infection; tumors; middle ear fluid from infection or Eustachian tube dysfunction; foreign body; and trauma (as in a skull fracture). Acute infections are usually treated with antibiotic or antifungal medications. Chronic ear infections, chronic middle fluid, and tumors usually require surgery. If there is no response to initial medical therapy, infectious middle ear fluid is usually treated with antibiotics -- while chronic non-infectious middle ear fluid is treated with surgery (or pressure equalizing tubes).

Conductive hearing loss from head trauma is frequently amenable to surgical repair of the damaged middle ear structures, performed after the patients general medical status is stabilized following acute traumatic injuries. A genetic form of conductive hearing loss is otosclerosis, in which there is bony fixation of the stapes (the third little bone of hearing in the middle ear), where sound cant get to the middle ear. Otosclerosis usually presents with hearing loss in early adulthood. Otosclerosis can successfully be managed with surgery to replace the immobile stapes with a mobile stapes prosthesis or with a hearing aid. Research suggests that the measles virus may contribute to stapes fixation in those with a genetic predisposition to otosclerosis. The incidence of otosclerosis may be decreasing in some communities due to measles vaccination. Otosclerosis (a hereditary disorder in which a bony growth forms around a small bone in the middle ear, preventing it from vibrating when stimulated by sound) usually causes a conductive hearing loss, a hearing loss caused by a problem in the outer or middle ear. Less frequently, otosclerosis may cause a sensorineural hearing loss (damaged sensory cells and/or nerve fibers of the inner ear), as well as a conductive hearing loss. Sensorineural Hearing Loss Causes:

Exposure to loud noise Head trauma Virus or disease Autoimmune inner ear disease Hearing loss that runs in the family Aging (presbycusis) Malformation of the inner ear Menieres Disease Otosclerosis - a hereditary disorder in which a bony growth forms around a small bone in the middle ear, preventing it from vibrating when stimulated by sound. Tumors

Treatment of Sensorineural Hearing Loss:

Sensorineural hearing loss can result from acoustic trauma (or exposure to excessively loud noise), which may respond to medical therapy with corticosteroids to reduce cochlea hair cell swelling and inflammation to improve healing of these injured inner ear structures.

Sensorineural hearing loss can occur from head trauma or abrupt changes in air pressure such as in airplane descent, which can cause inner ear fluid compartment rupture or leakage, which can be toxic to the inner ear. There has been variable success with emergency surgery when this happens. Sudden sensorineural hearing loss, presumed to be of viral origin, is an otologic emergency that is medically treated with corticosteroids. Bilateral progressive hearing loss over several months, also diagnosed as autoimmune inner ear disease, is managed medically with long-term corticosteroids and sometimes with drug therapy. Autoimmune inner ear disease is when the bodys immune system misdirects its defenses against the inner ear structures to cause damage in this part of the body. Fluctuating sensorineural hearing loss may be from unknown cause or associated withMenieres Disease. Symptoms of Menieres disease are hearing loss, tinnitus (or ringing in the ears), and vertigo. Menieres disease may be treated medically with a low-sodium diet, diuretics, and corticosteroids. If the vertigo is not medically controlled, then various surgical procedures are used to eliminate the vertigo. Sensorineural hearing loss from tumors of the balance nerve adjacent to the hearing nerve, generally are not reversed with surgical removal or irradiation of these benign tumors. If the hearing loss is mild and the tumors are very small, hearing may be saved in 50 percent of those undergoing hearing preservation surgery for tumor removal. Sensorineural hearing loss from disease in the central nervous system may respond to medical management for the specific disease affecting the nervous system. For example, hearing loss secondary to multiple sclerosis may be reversed with treatment for multiple sclerosis. Irreversible sensorineural hearing loss, the most common form of hearing loss, may be managed with hearing aids. When hearing aids are not enough, this type of hearing loss can be surgically treated with cochlear implants.

Mixed Hearing Loss Treatments for Mixed Hearing Loss Audiologist Mark Ross, Ph.D., recommends taking care of the conductive component first. There have been times when the addition of the conductive component made the person a better hearing aid candidate, by flattening out the audiogram for example, while the underlying sensorineural component presented a high-frequency loss. However, still the emphasis would be on treating medically what can be treated. He says that, generally, you would expect positive results.