Getting some facts straight regarding audiograms, hearing loss, HAs and CI.

Someone said to me: I learned something at JTC I thought I would share with you.

(you showed me the image)

Do you see that triangle at the top of the audiogram? You hearing aids should be programmed inside that triangle for speech perception. If they aren't able to reach that high, they need to be, at least, shaped like the triangle. Low frequency sounds like "ahh" and "b" are much louder when produced than sounds like "th" and "f", so they need to be amplifed LESS than the high frequency sounds. If they are louder, they will overpower even more. Your audiogram should ALWAYS slope UP, even if that means that you need to amplify the lows less.

Also, the line at the bottom represents the WORST your hearing can be and still be aided into the speech banana.

Caution: This is only true if you are seeking the ability to understand speech through audition.




It's impossible to get to the triangle(25db HL) in the high frequencies. For that ill need the transposition cutoff to be closer to 500Hz than 1500Hz. Maybe Phonak will design a new HA where the transposition has more programmable options. With a 1500Hz cutoff, I pretty much don't benefit from transposition since I have 120db loss at that frequency.

When my HAs were reprogrammed, different aided results were tried and with the gain on the lows reduced, I heard less. My parents said I begin to talk too loud and they had to shout at me so I could hear them. My ability to understand speech dropped as well. I also was missing out on some environmental sounds with less gains. So yea it's always good to give as much gain as possible, why hear less?

As for the bottom line(black dots) that's not true! Look at the 750Hz, 1000Hz and 1500Hz results. It's a matter of getting the most powerful HA and correctly programming it for the best possible aided hearing. I am sad when I see people with better unaided hearing than me hear worse than me aided. They need better HAs and more amplification!

------------------------------------------------------

Levels of Hearing Loss. What's the difference?

(note: I had to correct some of the grammar. Whoever wrote the guide below needs to go back to school)

Mild Hearing Loss(25-40db unaided, 0-10db aided)- a child with mild hearing loss usually has normal speech, but will have trouble in the school setting because it will be difficult to hear speech from more than 12ft away or when there is background noise. This is because much of the meaning in English is contained in the voiceless consonants which are high-pitched and soft. They are s, sh, t, p, k ,f, ch, and th.
A child with a mild loss in both ears will need some amplification in each ear to hear clearly at school , in groups, or at a distance.

My comments:  Makes sense. People who get a CI on average end up hearing 25-40db aided. So I want to make it clear that a CI does not cure your deafness nor does it give you normal hearing in the large majority of cases. You will hear equal in quantity to someone with a mild hearing loss after CI. Someone with a mild unaided loss should be aided to 0-10db with HAs. Low power, open fit HAs can do the job in this case and will give you normal aided hearing.

Moderate Hearing Loss(40-70db unaided, 0-10db aided)- a child with a moderate hearing loss can clearly hear speech only when the speaker is very close-less than two feet away. They need hearing aids to hear the softest sounds and to acquire understandable speech. If they receive hearing aids before four years of age, they usually progress rapidly in learning to talk.

My comments: Powerful HAs can aid a moderate hearing loss to 0db and no worse than 10db. I have a 55db loss at 125Hz and am aided to 0db. At 250Hz, my loss is 70db and im aided to 5db. There's still enough residual hearing to hear normally and even get to 0db.

Severe Hearing Loss(70-90db unaided, 10-30db aided)- Children with a severe hearing loss do not perceive speech no matter how close they are to the speaker. They will not learn to talk clearly and be understood without hearing aids or cochlear implants (70db or worse across the audiogram should consider a cochlear implant). All children with a severe hearing losses require special help because they receive only a portion of the clues usually available in speech sounds. With hearing aids they can detect vowel sounds,pitch,some consonants, and stress clues from speech. With their eyes they can learn to detect about 25 consonants sounds. With lipreading and listening together, they may receive about half of the clues that normal hearing people use to understand speech.

My comments: While severely deaf people experience a silent world unaided, they can be aided to normal or near normal with powerful HAs. A CI is not a wise option when powerful HAs can aid a severe loss similar to what a CI can aid. I have friends with a severe hearing loss and with the right HAs, they hear/understand speech(including S and F) as good as a CI. 

Profound Hearing Loss(90db+ unaided, 30db+ aided)-

Children with a profound hearing loss receive even less auditory information. If the child is under one year of age, they are too young to get a cochlear implant. In most states, the child needs to be at 9-12 months old. Hearing aids are not going to give much to a child with a profound hearing loss. Example: A child wearing hearing aids with a profound hearing loss will hear the sentence "Go get your shoes" as "oh eh yoo ooh" If you have dreams of your child talking and speech sounding very clear, then hearing aids are not an option for a child with a profound hearing loss. Remember 70 db or worse across the audiogram. Match the technology with the hearing loss. No Hearing aid in the world will help a profound individual like a Cochlear Implant will. 

My comments: This is only half true. I was born profoundly deaf for the most part and my old audiograms show a 100db HL at 1000Hz and higher frequencies. I was still severely deaf in the low frequencies with a 70db HL at 250Hz. I had to make do with analog HAs as well. Someone today would hear much better with powerful digital HAs.

They can still get decent benefit depending how profound their loss is. I was able to talk/speak clearly and hear/understand some speech as a child. I had much worse than 70db in the mid/high frequencies, try 100db! Not only that, I did great with old analog HA technology. Today's HAs can give good aided results for hearing loss as profound as 110db and have fitting ranges as high as 120db HL!

There's no guarantee if you have residual hearing that youll hear better with a CI, especially if you have plenty of residual hearing. CIs are great technology but should be considered a last resort after you have tried all the best HAs programmed with maximum gains. As for understanding speech, most deaf people are great lip readers and combined with sound awareness, they can score around 90%. Many of them also use sign language as a means of communication. There is a $50,000 cost(sometimes paid for by insurance) for CI as well as many risks including surgery itself.

I am not against CI but realise there is way too much hype surrounding this technology. Ive read many CI blogs and alot of people have unrealistic expectations. They claim that they will(as in 100% chance) that they will hear perfect or at least much better than with HAs. I hate to say this but there are no guarantees with CI or any other technology. The more residual hearing you have, the more you will benefit from HAs. I get great benefits from HAs(at least in the low frequencies) and if you have equal or greater residual hearing than me, you will hear more/better/louder with the right HAs than I can. Go visit your audiologist and get your HAs reprogrammed like I did, you will thank him and hear much better.

Move over cyborg queen! The Ambling Rambler sets new CI record at -5db!

Move over Deanna Bono the Cyborg Queen with her record 10db! Robyn Carter, the Ambling Rambler sets new CI record at -5db! I nearly fell out of my chair when I saw her audiogram! Thanks DeafLissa90 for the link to her audiogram and blog!

Check with Guinness world records, you could be famous! 

Her amazing CI score! Great blog, thanks for sharing your story! She lost all her hearing years ago so no residual hearing was sacrified.

She included her audiogram. I extrapolated/estimated additional frequencies to show the full range of 11 audiometric frequencies.



I have devised a foruma to calculate hearing. Ill explain it fully in another post. 

125Hz=0db HL
250Hz=5db HL
500Hz=0db HL
750Hz=5db HL
1000Hz=10db HL
1500Hz=0db HL
2000Hz=-5db HL
3000Hz=5db HL
4000Hz=10db HL
6000Hz=10db HL
8000Hz=0db HL

LFA=5/3=2(2x0.6=1) *normal*
MFA=10/5=2(2x0.3=1) *normal*
HFA=20/5=4(4x0.1=0) *normal*
OFA=40/11=4 *normal*
WFA=1+1+0=2 *normal*

Her current aided audiogram with CI. I rounded the db numbers to the nearest whole number. According to my math, she hears normally across the board! In fact she hears better than most hearing people, at least as far as quantity and thresholds goes! That is one amazing CI result you got there. Nothing worse than 10db and several with scores of at least 0db! Your record will probably last a very, very long time!

Furthermore, I was told that 10db was the best possible CI score and that 0db was impossible with CI and for the matter, with HA. I will need an official HA test to confirm the 0db aided score at 125Hz. However at that frequency, I hear better than hearing people. I don't have enough residual hearing to achieve 0db at above 250Hz. However I am interested in those with only a mild/moderate HL getting their HAs programmed for gains equal to their HL and ending up with 0db aided.  Don't you want to hear great at 0db?

I would be very interested to see how it was possible for her to achieve this record breaking CI results. Her audiologists and surgeon(s) should investigate and discover the factors contributing to such a steller result. They then can learn and share the knowlege with others and help improve CI technology. This will allow more people to end up hearing better with CI over what the best HAs with maximum gains could offer. It would also decrease the number of people who hear worse after CI, especially the borderline candidates with plenty of residual hearing and who should benefit great from HAs.

More information on stem cells to treat/cure deafness and diseases.

source1

The difference between he and I is that a symptom of his MS involved the loss of hearing. His hearing improved dramatically after the first treatment. Richard returned because scientists there believed they discovered the stem cell responsible for inner ear hair growth. His return involved the hope that his hearing would be improved even more.

source2

This was repeated again intrathecally and then an extra 3 million CD 34+ & CD133+ concentrate for inner ear nerve hair growth.

7. Risks are very minimal. The very small percentage of patients that have issues are nerve bruising at the spinal cord site but goes away in about 24 hours. Preston had this but I did not that. There are no side effects, how can there be? We as humans are composed of stem cells and if they body rejects it, it is simply eliminated out of the body. PERIOD! It is not a drug. Some have side effects from every single medicine but not with stem cells.

On Feb. 15-28th I return to Costa Rica for another treatment. ICM will be trying two new experimental treatments. One includes using the stem cell CD 133+ that was proven in Israel last Dec. to improve inner ear nerve hair growth. Since MS robbed my hearing we will now try a concentration of this stem cell to see what it can do. It was included in our original stem cell treatment and I have had to have my hearing aids turned down 4x.

source3

recently ive been reading so much about the future and the future of technology.....man, as someone once said before on this board, there really hasnt ever been such a good time to have tinnitus! all the research and funding going into tinnitus and deafness is higher than ever before, and we're constantly getting news of stem cell/gene therapy research into these areas - the scientists are ON it!!

I know how awful tinnitus etc is, but guys, we're making so much progress at such an increasing rate...there WILL be a cure for all these aural conditions soon enough! im no futurologist or anything but from what ive read about the exponential progress of technology in the futur...man, its SURELY relasitically just a matter of years away!!

I mentioned stem cells/gene therapy as personally i'm concerned mostly by hearing loss, which either stem cells or gene therapy will cure, within a decade (i base this on the research i've done thus far). i agree that the cure for tinnitus may not be based in one of these approaches, but that doesn't mean it won't be cured very soon. Diseases are most definitely on their way out...

source4

Dennis finally got time to post the answers regarding treatment for the deaf. Id be interested in seeing what the doctors and experts say about anecdotal reports of people who are having their deafness(sometimes in conjuction with other conditions/diseases) treated/cured now!

Ive seen anecdotal reports of deafness being treated/cured several times since 2007. If this is really true then we can expect human clinical trials by 2015-2020. Perhaps it's too risky and expermental to be done on healthy humans today but it may still be done on humans that have serious diseases such as MS. They can treat both the MS and deafness together with taking the risk only once. When they establish more safety, that's when we will see deaf clinical trials.

We will probably see such clinical trials in other countries first then later on in America. I will keep searching the net and get more news. Some experts are now forecasting 2015-2020 for human clinical trials to restore some hearing loss. If the anecdotes are any indication, we won't have to wait as long as feared. There still is no date yet on when human clinical trials will begin but once we have a date, itll be around the corner.

I applaud the brave souls who will risk their hearing, health and even lives being the first clinical trial subjects. Ive read that demand will be fierce with thousands applying to get into the first trials. I am not a risk taker so ill bow out and eagerly await the results of pioneers. When a high degree of safety is proven, ill try to join the later trials(phase II or III)

Update: I read more and found out that having *too* many hair cells actually results in a hearing loss as bad as having too few! Too many also increases the risk that some hair cells could become cancer! So yes just like CI, those with too much residual hearing may in fact hear worse after stem cell treatments!

However I also read that methods for halting the growth of hair cells is being developed to minimize this problem of ending up with excess hair cells. Even if you do end up with a few too many, it should be possible to kill off the extras with loud noise. It remains to be seen how much of a hearing loss is required to be a candidate, however I see no reason the severely and profoundly deaf won't make good candidates.

Good Wikipedia on Cochlear implants

People were getting CI before FDA approval and even before clinical trials. Even if it takes around 30 years to see clinical trials for stem cells to treat/improve deafness, there will be thousands of people who seek that treatment well before the first clinical trials. We are already seeing a few dozen people getting stem cells for their deafness, expect that number to rocket in the next few years. I will be following closely to evaluate results and safety.

Update! Another anecdote!

Stem cells!

My son has CP and severe to profound hearing loss. We went in 2007 and 2008 in
China for umbilical stem cells treatment. One of teh outcomes and they have been
many was the improvement in hearing loss. Each time I decreased teh power of teh
hearing aids. From their case studies they say in 6-7 treatments you recover
your hearing loss.
 
I also know they had several patients with no vision that after one treatment (
6 injections) started to see with glases. This is something you may want to look
into. There is a group BIA4kids on which lots of parents went to China for
treatment of neurological and degenerative diseases including hearing loss and
lack of vision.

My HAs have been reprogrammed. 5db aided at 125Hz, 98% speech score!

I have talked for a few months about getting my HAs reprogrammed and finally I got them reprogrammed! One of my HAs suddenly died, but the other is going strong. The dead one will be sent in for repair/replacement. Many others have experienced this bug with their Naidias dying on them. I learned alot more about hearing loss and hearing aids when I can see all the reprogramming going on.



I posted about this in a previous post. My speech comphrension has increased and my best score is a whopping 98%, higher than many with CI who took this test. I constantly score around 85% which is a 15% improvement just from boosting the lows! More gains has brought out extra loudness and makes it easier to hear!

The funny thing is "John" and "Joan" both sounded identical before my HA was reprogrammed for more gain and before I kept training my brain. Now I can differnate the two most of the time.

Im still stuck unable to distinguish between "has" and "had" although I hear both words. My dad says I need to listen closely for the hissing "s" sound. Can you hear that sound with either HA or CI? How do you score on the above speech test, see my earlier post for a link.

My dad said a bunch of numbers such as "four hundred sixty six" or "six hundred fifty two" and I got it right most of the time. Fifty and sixty still give me trouble for now, gotta keep training my brain to tell the subtle differences!



Red dots: My unaided hearing for both ears.
Blue dots: My aided hearing for both ears.

The difference is amazing! Reprogramming my HAs for more gains has gotten my low frequency aided thresholds down to normal hearing, quantity(but not quality) wise. I hear (low frequency) sounds that my mom, dad and brother don't hear! When there was a thunderstorm, I could hear the pattering of every drop of rain on the roof! I heard thunder before my mom and dad did! It was a loud, rumbling sound!

I am still learning what makes some people with similar audiograms get more benefit from HAs than others. My audiologist says it has to do with training your brain and he says I need to keep training my brain or I won't properly understand speech.

If everyone is different, why can't others train their brain to understand speech(provided they still have a measurable amount of residual hearing, such as similar to mine) I do know you still need to train the brain with CI to improve speech. Hopefully you can train your brain in your HA ear to hear lots of environmental sounds and a good deal of speech. Can your HA be reprogrammed for more gains? It's made a big difference for me in my experience. Ill be sharing it in my blog.

Right now, it's mostly the S and F that I can't differnate although I hear both of them, they sound the same! However if someone says "snake" and "snakes" I can tell there's an extra S. But between "fun" and "sun" they are so similar. So yea even with me hearing mostly low frequencies(nothing much above 1000Hz) I still am able to convey a high percentage of speech information. I read that frequencies of 2000Hz and up only account for 10% of speech.

I will post more as I learn and get fine tuned programming on my HAs