Sensory Neural Hearing Loss

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

2/20/2013

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Solution for Sensory Neural Hearing Loss

Manfred Stoifl

Hearing Aid Acoustician (Honors), AAHA, Vienna, Austria

2/20/2013

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Overview

• Principals of Sensory Neural Hearing Loss

• Neural (Central) Hearing Assessment

• Indication for AudioFitness Training

• Measuring Benefits

• Clinical Data.

2/20/2013

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

2/20/2013

Peri

ph

eral

H

eari

ng

C

entr

al A

ud

ito

ry

Fun

ctio

ns

Sensory Neural Hearing Loss

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

2/20/2013

Sen

sory

H

eari

ng

Loss

N

eura

l Hea

rin

g Lo

ss

Sensory Neural Hearing Loss

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

6

left middle

ear

right middle

ear

left cochlea

right cochlea

left Monaural processing

right Monaural processing

arrival time difference evaluation

binaural activity imaging

aural activity image

memory

auditory processes

comparison evaluation

aural scene

memory

smell activity images

Other sensory activity images

vision activity images

other high

level processes

Ears Brainstem Auditory cortex Other brain areas

left outer

ear

right outer

ear

time domain

frequency domain

aural activity image

aural scene

meaning enjoyment

action

level difference evaluation

How We Hear

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

7

Sensory Neural Hearing

Loss

Where

Functional problem

Cause

Cochlear Brain

Physical Hair Cell damage

Loudness Frequency Discrimination

Language Discrimination Hearing in Noise Directional Hearing

Genetics Age / Wear and Tear Trauma Diseases

Under utilisation

Treatment Hearing Aids / C.I. Low Level Function Training

Test Audiometry EFI-EFK test Low Level Function Test

Sensory

Hearing Loss

Neural (Central)

Hearing Loss

?

?

-

Ability never (fully) acquired

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

8

10 20 30 40 50 60 70 80 Age

Slow / Bad

Fast / Good

Time

Normal Aging

Accellerated degeneration due

to peripheral Hearing Loss

Central Auditory Processing

Lifecycle

Pro

cessin

g S

peed

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

9

10 20 30 40 50 60 70 80 Age

Sever Hearing

Loss

Normal Hearing

Time

Central Auditory Processing

Lifecycle

Pro

cessin

g S

peed

0

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

10

Nach: Ptok-M: „Auditive Verarbeitungs- und Wahrnehmungsstörungen

und Legasthenie“, Hessisches Ärzteblatt 2/2000, S. 52-54

Low-level Automatic extraction of basic acousitc features like

time and frequency resolution

Automatic exraction of phonetic cues for phonem

differenciation

Automatic identification and discrimination of

syllables in a language

Automatic recognicion of words and their

meanings 1. Order – without context

Metalanguage awareness to decode both the

syntax and prosody

Sounds

Syllables

Words

Sentences

i / e / a / o / u

train (Transport) / train (practice)

I train my hearing with AudioFitness.

d/t g/k b/p

Auditory processing and perception of speech

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

11

Automatic exraction of phonetic cues for

phonem differenciation

Automatic identification and discrimination of

syllables in a language

Automatic recognicion of words and their

meanings 1. Order – without context

Metalanguage awareness to decode both the

syntax and prosody

Sounds

Syllables

Words

Sentences

i / e / a / o / u

train (Transport) / train (practice)

I train my hearing with AudioFitness.

d/t g/k b/p

Auditory processing and perception of speech

Time

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Common Signs of Central Hearing problems

Talks or likes TV louder than normal Unusually sensitive to sounds Asks many extra informational questions Confuses similar sounding words Hears better when watching the speaker Problems with rapid speech Frequently misunderstanding instructions or questions Porblems understanding in background noise Problems with phonics or discriminating speech sounds Frequently requests repetition.

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss Common Signs of CAP problems

Can not multi-task while listening.

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Neural / Central Hearing Assessment

& Training

2/20/2013

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

2/20/2013

Wahrnehmungs -Trennschärfe -Test

Teil 1 O n.a.* Teil 2 O n.a.*

Links Rechts Links Rechts

EFI O EWI O

EDI O EPI O

EWI O ETI O

EPI O EFI O

EBI O EDI O

EGI O EKI O

ETI O EBI O

EKI O EGI O O

EBI O EPI O

EGI O EKI O

ETI O EFI O O

EWI O EGI O

EPI O EDI O

EKI O

EFI O

EDI O EWI O

EBI O

ETI O

EKI O EFI O

EBI O ETI O

EPI O EWI O

EFI O EGI O

EWI O EBI O

EDI O EPI O O ETI O EKI O

EGI O EDI O

ETI O O

EPI O

EDI O EKI O

EPI O ETI O

EBI O EDI O

EFI O O

EGI O

EWI O

EGI O

EKI O

EBI O

EFI O EWI O

C C C

% % %

Richtige Silben: /32 Richtige Paare: /16

PRS: PRS:

Perception-Separation Accuracy Test by Warnke (EFI-EKI)

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Abbreviated Profile of Hearing Aid Benefit

2/20/2013

Ease of Communication (EC scale) I have difficulty hearing a conversation when I’m with one of my family at home.

Background Noise (BN scale) When I am in a crowded grocery store, talking with the cashier, I can follow the conversation easily.

Reverberation (RV scale) I miss a lot of information when I’m listening to a lecture.

Aversiveness (AV scale) Unexpected sounds, like a smoke detector or alarm bell are uncomfortable.

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss Assessment & Test

• Patient hears acoustic stimuli over headphone (except 1st test –sees flashes).

• Has to react by pressing buttons.

• If pressed correct, speed/difficulty increases

• Through training/repetition patient will be able to perform tasks faster and faster.

2/20/2013

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

1. Visual Order Threshold.. – is the minimum time at which you can separate 2 visual

stimuli

• This ability is very important for digesting written information

• Increase the speed with which the brain is able to digest and process information.

2. Auditory Order Threshold.. – is the minimum time at which you can separate 2 auditory

stimuli

• If it takes you too long, you may have difficulty differentiating critical plosives b-d, g-k, or p-t from each other. Which results in difficulty understanding

We assess, and customer trains 8 CAP task (1-2)

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

3. Spatial (Directional) Hearing – Is the minimum time difference at which you can localize a

sound

• Allows correct training of spatial (directional) hearing.

– Very important to be able to perceive sounds and especially language selectively

» from different directions,

» to be able to assign them

» to ignore them as well.

4. Pitch Discrimination – is the minimum difference between two tones

• vital ability for differentiating vowels and decoding of voice melody.

• extremely important for speaking as well as for understanding language.


Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

5. Rhythm – fastest rhythm you can follow

• Ability to convert perceived auditory stimuli as fast as possible into movements.

• very important for thinking, speaking and writing

• To train hemispheric coordination.

6. Auditory Choice Reaction – separating two different tones and reacting as fast as possible

• Decisive for identifying time of Phonemes (spoken) and graphemes (reading).

• To react fast and focused to auditory stimuli without visual aid


Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

7. Frequency Pattern Recognition..

– quickly and accurately resolve auditory patterns • An important pre-requisite for the segmentation of the

continuous stream of auditory stimuli during speech identification and processing.

8. Duration Pattern Recognition..

– quickly and accurately resolve auditory patterns • An important pre-requisite for the segmentation of the

continuous stream of auditory stimuli during speech identification and processing.


Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

28

Function

Target Values (Training) Ideal

Results

*

20

years

old

30

years

old

40

years

old

50

years

old

60

years

old

70

years

old

80

years

old

90

years

old

100

years

old

Order-v 12 ms 18 ms 24 ms 30 ms 36 ms 42 ms 48 ms 54 ms 60 ms 12 ms

Order-a 23 ms 30 ms 36 ms 43 ms 49 ms 56 ms 62 ms 69 ms 75 ms 23 ms

Bearing 10 µs 16 µs 22 µs 28 µs 33 µs 39 µs 45 µs 51 µs 57 µs 10 µs

Pitching 4 % 5 % 7 % 8 % 9 % 11 % 12 % 13 % 15 % 4 %

Rhythm 128 ms 139 ms 150 ms 161 ms 173 ms 184 ms 195 ms 206 ms 218

ms 128 ms

Reaction 305 ms 335 ms 366 ms 396 ms 427 ms 457 ms 488 ms 518 ms 549

ms 305 ms

Sequenc

e 10 ms 29 ms 48 ms 67 ms 86 ms 105 ms 124 ms 143 ms

162

ms 10 ms

Duration 20 ms 28 ms 36 ms 44 ms 52 ms 60 ms 68 ms 76 ms 84 ms 20 ms

Age specific long-term Adult Target Values Valuating results

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

29

Valuating results

Age specific Pediatric Target Values

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss • Practice all 8

functions at home for 15-20 min a day

• The Home Trainer will store data in a data log

• Follow up assessment and advice in weekly

• consultations.

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss Unique 2 Step Training Approach

• Practice

• Consolidation.

2/20/2013

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

32

t

Access Information

Task Latency Reply Confirmation

Great !

Quelle: Skinner-BF & Correll-W in „Denken und Lernen“, 1976

Confirmation

German Patent # 196 03 001

„System for supported training and learning“

Explanation: Mirror-Neurons

How practice works

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss • 6 -8 weeks

• Final low level assessment function

• Final discrimination

• assessment

• Continue training alone to reach ideal values.

• Maintain reached goals by training once weekly

• Move on to second stage training.

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss Measuring benefits of AudioFitness

• Improvement in Processing Speed

– Each task can be done faster

2/20/2013

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo


• Improvement in Processing Speed

– Each task can be done faster

2/20/2013

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo


2/20/2013

• Improvement in Speech Perception Separation Accuracy Test

– Reduction of mistakes

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo


2/20/2013

• Improvement in APHAB Questionnaire

– Reduction of situations with Hearing/Comprehension problems.

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Validation • 30 years on the Market

• Widely used in Germany and Switzerland

• Numerous Publications

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Clinical trials proof benefits of Low Level Training

• Learning Disabilities – Dyslexia

– ADD / ADHD etc…..

• Hearing “Problems” – Normal Hearing

• Central Auditory Problems

• Hearing in Noise

– Hearing Impaired • Hearing in Noise

• Adaptation to Hearing Aids. 2/20/2013

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

40

Low level functions and education

.

100 adults 20-70 years of age

Quelle: Katerji-D „Veränderungen der Low-Level-Funktionen im Erwachsenen-alter“, Dissertation (2006), Medizinische Hochschule Hannover, U. Tewes

Grade High Colle. Univ

0

6

12

18

24

30

Pitch Discrimination

0

150

300

450

600

750

900

ChoiceReaction

Time

0

30

60

90

120

Duration Pattern

0

15

30

45

60

75

V. Processing Speed 0

20

40

60

80

100

Aud. Proc. Speed

0

40

80

120

160

200

Frequency

Pattern

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Clinical Trail Speech discrimination in Noise (144 adults)

6/21/2013 Manfred Stoifl 41

Hearing Impaired with

Hearing Aids

Normal Hearing without

Hearing Aids

with Training without Training

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

38 adults before and after LLF training (average age 43.7 years)

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Trail Making Test 60+ age group


Before Training

After Training

Besides Improvement in central auditory processing it also resulted in improvement general cognitive abilities.

We therefore recommend the training for this age group.

Tim

e in

Sec

on

ds

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

42 dyslexic children


0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

Group A Group B Group C

Error rate reduction in % Error rate reduction in %

Group A was given lessons specially designed for dyslexics

Group B did Low-Level Training with the Brain-Boy

Group C did Low-Level-Training and Lateral-Training together

6.3 % 18.9 %

42.6 %

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

45

Hearing Treatment

Functional problem

Cause

Cochlear Brain

Physical Hair Cell damage

Loudness Frequency Discrimination

Language Discrimination Hearing in Noise Directional Hearing

Genetics Age / Wear and Tear Trauma Diseases

Under utilisation

Treatment Hearing Aids / C.I. Low Level Training

Test Audiometry EFI-EFK test APHAB Low Level Function Test

Hearing Understanding

-

Main Location

Solu

tio

n f

or

Sen

sory

Neu

ral

Hea

rin

g Lo

ss

Thank YOU

Any Questions?

2/20/2013

Health & Medicine

Sensory Neural Hearing Loss