CAN YOU HEAR ME NOW? SADDLEBROOKE HEALTH NIGHT OUT Sonoran Ear Nose and Throat

August 24, 2015

AGENDA

ACT 1: HEARING LOSS with Dr. Thomas Kang

ACT 2: HEARING AIDS with Dr. Amanda Kester

ACT 3: DIZZINESS AND VERTIGO with Dr. Jonathan Lara

(520)775-3333

6340 N Campbell Ave Ste 256

Tucson, AZ 85718

www.sonoranent.com

(520)775-3333

1521 E Tangerine Rd Ste 331

Oro Valley, AZ

www.sonoranent.com

EAR NOSE AND THROAT

Ears (Otology)

Nose (Rhinology, allergy)

Throat (Laryngology)

Head and neck cancer

Sleep medicine

Facial Plastic and Reconstructive surgery

HEARING LOSS

Thomas Kang, MD Sonoran Ear Nose and Throat, PLLC

Saddlebrook Health Night Out

August 24, 2015

QUESTION #1

What is the name of the smallest

bone in the human body?

A: The stapes

HEARING ANATOMY

CERUMEN (ear wax)

Insect Perforation (hole in eardrum)

COCHLEA Converts mechanical energy to electric signal

QUESTION #2

Inner ear hair cells have a natural

ability to regrow and repair

themselves. True or False?

A: False

HEARING TESTING (AUDIOGRAM)

AUDIOGRAM

Normal hearing

AUDIOGRAM

High-frequency sensorineural hearing loss

COMMON SYMPTOMS OF HEARING LOSS

Family members complain that I have hearing loss

Television volumes are getting higher

Difficulty hearing on telephone or women’s voices

Difficulty hearing when there is background noise

Ringing in the ears (tinnitus)

Can’t understand foreign accents

Age Percent with disabling

hearing loss

45 – 54 2%

55 – 64 8.5%

65 – 74 25%

75 and greater 50%

Causes of

hearing loss

Loud noise exposure

Age-related

Genetic predisposition

HEARING AIDS

Age 20 - 69: Only 16% who could benefit from hearing aids use them

Age 70 and up: Less than 30% who could benefit use hearing aids

HEARING AIDS

Amanda Kester, AuD Sonoran Ear Nose and Throat, PLLC

Saddlebrook Health Night Out

August 24, 2015

YOU HAVE HEARING LOSS… NOW

WHAT?

HEARING AID TECHNOLOGY

Hearing instruments cannot cure hearing loss;

however, the technology in these devices can compensate for the different types of hearing loss and contribute to quality of life

COMMON QUESTIONS ABOUT

HEARING AIDS

• How much do they

cost?

• Are they digital?

• Do they take

batteries?

COST OF HEARING AIDS

Personal Sound Amplifier (PSAP)

Per the FDA: A PSAP is a wearable electronic product that is not intended to compensate for impaired hearing, but rather is intended for non-hearing impaired consumers to amplify sounds in certain environments, such as for hunting or other recreational activities.

PSAPs typically are simpler sound amplification devices with fewer features and less functionality than hearing aids.

An Electronic Product

Price Range from $8.00 - $450.00 per device

Hearing Aid

Per the FDA: A hearing aid is a wearable sound-amplifying device that is intended to compensate for impaired hearing.

A hearing health professional (such as an audiologist or a hearing aid dispenser) is usually required to program and optimize the performance of hearing aids with these more complex features.

A Medical Device

Price Range from $700.00 - $3,000.00 per device

COST OF HEARING AIDS

Personal Sound Amplifier (PSAP)

$150.00

$450.00

$19.95 $74.99

$35.74

COST OF HEARING AIDS

Hearing Aids

Pricing from $700-$3,000 for ANY STYLE

Programmed to precisely accommodate your individual hearing loss

Sophisticated sound processing, microphone response, wireless communication and connectivity

Fitted by a professional, includes service and manufacturer warranty

DOES MY INSURANCE COVER

HEARING AIDS?

Medicare does not cover the cost of hearing aids

The majority of private insurance plans exclude hearing aids as a covered benefit

Some insurance plans are working with third-party hearing aid discount programs

Call your insurance company to determine your benefits. Sonoran ENT will bill for, and work with most insurance plans for hearing aid coverage.

DIGITAL HEARING AIDS

• Digital hearing aids have

been the standard since the 1990s

• The first digital hearing aid

was designed in 1995, and

have been continuously

improving ever since

DIGITAL HEARING AIDS

Are programmed and fine-tuned using

computer software in order to precisely

meet your individual hearing loss

Analyze the sound environment and make

automatic adjustments

Process sound so that speech is enhanced

Eliminate feedback (no more whistling)

DIGITAL HEARING AIDS

Adjust the microphone response to provide optimum

hearing in the direction of speech (adaptive directional

microphones)

Allow for wireless communication between ears so that

hearing aids are synched together and function as a pair

(binaural hearing, binaural synchronization, etc.)

Allow for wireless communication other devices (TV,

phones, tablets, etc.)

WHAT’S NEW IN DIGITAL HEARING AIDS

Better, clearer sound quality

More efficient at processing

speech in noisy environments

Binaural Processing (2 hearing aids work together as a pair)

Smaller devices with more

power (and no whistling)

Sophisticated, automatic,

adaptive directional

microphones

WHAT’S NEW IN DIGITAL HEARING AIDS

Is there an app for that?

NEW hearing aids are wirelessly able to communicate with your smartphone and/or tablet

Change programs, adjust volume, adjust bass/treble, locate your hearing aid, create customizable programs, narrow microphone response, reduce wind noise, stream phone calls and music…

EASYTEK / EASYTEK APP

Control the direction of microphone

focus using the app

WIRELESS STREAMING

Wirelessly “stream” phone calls, music,

or TV directly to your hearing aids!

Sound is sent wirelessly to your hearing

aids, essentially turning your hearing

aids into a sophisticated (fine-tuned)

headset

Allows other people in the room to

listen to TV at a volume they prefer

Reduces the influence of ambient

noise

BATTERIES

Hearing aids use Zinc-Air Batteries

Batteries last 3 days – 2 weeks depending on the size of battery

Batteries generally cost less than $1.00/cell

Rechargeable batteries are an option

We sell a typical year supply of batteries for $60 + tax

WHAT TO EXPECT WITH HEARING AIDS

You will hear some sounds that you previously had trouble hearing

Your own voice may seem louder

It is normal for it to take a few weeks to adjust to listening and hearing with hearing aids

You will not have “normal hearing,” but you should have better clarity

Properly-fit hearing aids should be comfortable

Overall, understanding speech in conversations should become less difficult

We should be able to decrease the strain and struggle that often accompanies hearing loss

WHAT TO ASK WHEN BUYING A

HEARING AID

What is the warranty?

What is the trial period?

Arizona State Law mandates that all hearing aid sales must come with a 30 day trial period

Non-refundable fitting fee is standard with returns

Are return visits for adjustments, programming, and cleaning of the hearing aids included?

What are the credentials of the person you are working with?

Masters or Doctoral level Audiologist is recommended

Do I need medical clearance from my Doctor?

How will I know the hearing aid is set correctly for my hearing loss?

HOW TO CHOOSE A HEARING AID

Choose a size and style that appeals to you and that can be fit for your degree of hearing loss

A hearing aid should be easy for you to use

Select the features that you are interested in and fit your lifestyle

Considering a hearing aid that can fit within your budget

Work with an audiologist to help determine a solution that meets your needs, and that will be programmed and fit appropriately

Make sure that the fitting is verified using Real Ear Measurement verification method

There are prescriptive targets for amplification, and Real Ear Measurement verifies that the hearing aid it matching your prescription

DIZZINESS AND BALANCE

R. Jonathan Lara, DO, FACOO Sonoran Ear Nose and Throat, PLLC

Saddlebrook Health Night Out

August 24, 2015

DESCRIBE THE SYMPTOMS

Dizziness – Imprecise term commonly used by

patients in an attempt to describe various

symptoms such as faintness, vertigo, disequilibrium,

or unsteadiness

Stedman’s Medical Dictionary

for the Health Professions and

Nursing, Fifth Edition, 2005

DESCRIBE THE SYMPTOMS

Vertigo – 1. A sensation of spinning or whirling

motion; implies a definite sensation of rotation of

the subject in any plane. 2. Imprecisely used as a

general term to describe dizziness

Stedman’s Medical Dictionary

for the Health Professions and

Nursing, Fifth Edition, 2005

DESCRIBE THE SYMPTOMS

Could mean:

- Vertigo - Syncope - Presyncope

- Weak - Giddiness - Anxiety

- Anemia - Depression - Unsteady

INNER EAR ANATOMY

3 Semicircular Canals (horizontal, superior, posterior) respond to rotational movement and are filled with fluid (endolymph)

Saccule responds to vertical movement

Utricle response to horizontal movement

VESTIBULAR SYSTEM

1. Ears = Inner Ear

2. Brain = cerebellum

3. Eyes = movement and vision

4. Joints = Proprioception

Maintaining balance depends on information from all 4 systems and their communications.

DIAGNOSING – TESTING IN AN ENT

OFFICE

Videonystagmography (VNG) and Audiology -

Balance and Hearing systems are related.

Hearing test

Goggles are used to measure eye movements (nystagmus)

Positional movements of head/body

Cold and warm air

Measure weakness of 4 balance systems.

DIAGNOSES – INNER EAR DYSFUNCTION

Four common entities:

1. Benign paroxysmal positional vertigo

(BPPV)

2. Labyrinthitis (Viral)

3. Ménière disease

4. Acoustic Neuroma

BENIGN PAROXYSMAL POSITIONAL

VERTIGO

Very Common

Otoconia (“ear stones”) displacement

Short-lived episodes brought on by rapid changes in head position

Nystagmus inducing

DIX-HALLPIKE MANEUVER

EPLEY MANEUVER

VESTIBULAR NEURONITIS

Suspected viral etiology

Sudden onset vertigo that increases in intensity over several hours and gradually subsides over several days

Mild vertigo may last for several weeks

May have auditory symptoms

Highest incidence in 3rd and 5th decades

MÉNIÈRE DISEASE

French physician Dr. Prosper Ménière in1861

Pressure buildup in the microscopic fluid of the

inner ear

Triad of vertigo, tinnitus and hearing loss (+/- ear

pressure)

Often patients have eaten a salty meal prior to

attacks

Treatment may include short term steroids/long

term diuretic and diet modifications

Rarely surgical

ACOUSTIC NEUROMA

RARE - incidence of 1 per 100,000 persons per

year.

Benign tumor of the balance nerve (8th CN)

Vertigo with hearing loss and tinnitus

Treatment –

Stereotactic Radiosurgery

Surgical resection

Fine

结束

結束

終わり

Το τέλος

Finem

Конец

Sfârșitul

النهاية

La Fin

El Fin

Das Ende

THE END

6340 N. Campbell Ave, #256 Tucson, AZ 85718

1551 E. Tangerine Rd. #331 Oro Valley, AZ 85737

Thomas S. Kang, MD

R. Jonathan Lara, DO, FAOCO

(520) 775-3333 www.sonoranent.co

m

Amanda Kester, AuD