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Hearing Problems

It is estimated that in Europe, one in seven people suffer some degree of impaired hearing and is therefore more or less hard of hearing. In many cases, the hearing so deteriorated that problems arise in following conversations.

Poor hearing can have different causes. Excessive noise such as whether certain drugs can damage our hearing. For most people, hearing ability with age in any case gradually decline. Hearing impairment can also occur at younger ages, even in very young children or neonates. Heredity can also sometimes play a role.

Hearing usually occurs gradually, allowing the person in question himself at first but little notice. Because the sounds in the environment gradually softer and softer, it is hardly to fade it. Until the soft consonants such as m, b, n, f, s, v, w are no longer audible. Often family members or colleagues marks the first time that someone is hearing impaired. They must constantly repeat what they just said if they are disturbed by TV or radio louder each time a level is put.

At the time the hearing itself realizes that he does not hear so well, the process of hearing loss usually in a while underway (research showed that such a process can take up to 7 years). Telephoning is less smooth and soft passages in music seem more quiet moments. Especially in companies such as receptions and parties takes an awkward conversation. Outside on the street and in situations with background noise is difficult to communicate.

The first step for that hearing problems are often long delayed. This while an untreated hearing difficulties have significant negative social and emotional consequences. This is apparent from a U.S. survey conducted by "The National Council on the Aging" (NCOA) in 2300 adults with hearing problems. The untreated elderly hearing impaired are more likely to suffer from depression and depression, are more often concerned, anxious and sometimes show more paranoia and less socially active. In addition, untreated hearing emotionally unstable and insecure. This study helps finally the myth from the world of show that untreated hearing loss is not so much harm. Seniors who wear hearing aids or otherwise indicate that they feel better and better relationships with their families. In addition, they experience improved mental health and they go back independently, and certainly by the life and cognitive functions remain intact for longer.

Hearing aids therefore have a positive effect on quality of life and welfare of the hearing impaired.

Hearing loss can occur suddenly from one day to another. More than once hearing is also accompanied by ringing in the ears (tinnitus) as an additional burden.

The operation of a normal ear

Sound, a wave phenomenon, causes the eardrum starts to move (oscillate). This causes the bones in the middle ear (hammer, anvil and stirrup) in turn driven. The stirrup brings this vibration on the cochlea (cochlea). The middle ear, the hammer, anvil and stirrup, makes sure that actually sounds without too much loss of energy, converted into a vibration of the fluid in the cochlea (the cochlea).

 

The various bones in the middle:

 

2 = anvil 1 = hammer 3 = stirrup

 

One problem is that the incoming sound to go on an air medium to a liquid medium. Exists a large degree of impedance or resistance, a loss of energy, here a loss of intensity.

To address this issue now as much as possible to face the middle ear acts as a impedantieaanpasser.
This is because the middle ear is structured as follows:

• the surface of the footplate of the stapes is much smaller than the eardrum, the pressure on the fluid in the inner ear is thus 30 times as large as the sound pressure on the eardrum.
• exists a tonic effect on the leverage of the ossicles, the movement of the oval window is smaller, but the force exerted is greater.

The mechanical vibrations of the middle ear are transmitted to very fine hair cells in the inner ear. Because these hair cells move creates voltage differences, which in turn lead to discharge volleys in many nerve fibers. The collective signal is ultimately via the auditory nerve to the brains forwarded.

The inner - Our Hearing

The inner ear is a very complex working whole, which still investigating the exact mechanism is done to understand. The inner ear is a fluid-filled space located in the petrous bone.

The inner ear is anatomically divided into three parts:

• the vestibule
• the semicircular canals
• the cochlea (cochlear)

In the oval window, one of two openings in the vestibule, is the footplate of the stapes. The second opening is the round window.

The semicircular canals, together with two cavities in the vestibular organ of balance. The semicircular canals are capable of rotations of the body to register. The two cavities, the sacculus and utriculus have a small organ. These organs provide the common perception of speed. The cochlea (the cochlea) is the body responsible for sound perception.

The middle - Our Hearing

At the end of the ear is the eardrum which the outer ends and the middle ear begins.
 
The eardrum is the handle of the hammer (malleus) fused. The hammer head attached in turn to the anvil (incus), which in turn is connected to the bottom of the stirrup (stapes). These three smallest bones in the human body, the ossicles or ear bone called chain. They are connected by a small joint articulate and ensure the transfer of sound vibrations to the inner ear. The footplate of the stapes is a valve of the oval window, the door of the inner ear.
 

Normal eardrum	Hole in the eardrum	Otitis

 
The cavity in which the ossicles hang with ligaments and muscles, also called the tympanic cavity is filled with air. This cavity is through the Eustachian tube connected to the nasopharynx and thus with the air. The Eustachian tube ensures that the air pressure in the middle of the atmosphere remains constant. To loud sounds and noises that man produces himself to be dampened by this principle.

The external ear

The outer ear and ear canal are part of the external ear. The ear cartilage is actually a wayward drive-coated skin. Earcups are very personal and can often vary considerably in their shape and size. Because our ears are not separately move, they play only a minor role in directional hearing: only the front-back sound different, they can help to determine.

 

An overview of the external ear, middle ear and inner ear:

 

 

The outer part of the ear also consists of cartilage, while the inner portion is bony. Both with skin. The ear canal is about 2.5 cm long and has an S-shape, slightly upwards. In the outer part of the ear canal are a number of hairs and glands that earwax (cerumen) separate. In the wax remains dust and dirt adhere to the hairs gradually being brought out.

The structure of the ear

When we talk about our ears, many think as immediately visible to the ears. The whole process of hearing is an extremely complex and amazingly complex and ingenious that we have done a lot of knowledge, but still under investigation.

We love this idea of ​​how deliberately very general.

 

Our hearing, we share most in two parts: one part conductive and sensorineural part. In the perceptive part of the mechanical energy of sound into an electrochemical signal via the auditory nerve to the cerebral cortex is headed. Brains in the process of perception place: that we become aware of the presence of noise and finds the eventual perception of it instead.

 

An overview of the various components in our ears:

 

The external ear Skull (bony structure) Ear Auricle The inner Eardrum Oval window Hammer Anvil Stirrup Semicircular canals Cochlea Auditory Nerve Eustachian tube

The above picture shows that the conduction of sound into the external ear and middle ear and the inner place of the perceptual function of the ear condition.

Better understanding of PCAs

Return to participate in group discussions and conversations during meetings with PCA's technically possible with the specific target microphone technology. A PCA is in fact equipped with two microphones. That in itself is not new. The front micro focuses on the speech before the person speaks while the rear microphone reduces annoying background noise.

There are currently three different double Directional Microphone Systems. The difference in the three systems is in the selectivity of the voice recording. The more selective the system, the better the intelligibility in noise. This selectivity in recent years experienced a true advancement.

The following figures show the selectivity of the various dual microphones schematically.

 

FIXED
Background sounds and voices are less observed.

Adaptive
Suppression loudest sounds and voices of whether side or behind you.

ADAPTIVE MULTI

Multiple sounds and voices from different directions simultaneously suppressed.

The aesthetic value of PCAs

A common argument against the wearing of hearing aids is the classic aesthetics, people do not want their environment is that there are hearing problems. Here too, in PCA, with a very modern, but discrete design.
 
The new PCA's simply no longer see how well you hear!

 

PCAs are available in a variety of hip, cool and sexy colors and shapes.

 

What are PCAs?

PCA stands for P ersonal A ssistant C ommunication.

They are specifically designed to understand in noise complaints effectively solve. PCAs have at least this for the classic hearing aids so that they are aesthetically designed to be invisible, or at least very inconspicuous.
 

Indeed, with PCAs bystanders see, literally and figuratively, not how well you hear.

 

Fig: The various components of a PCA

Interpretation of Test Understand

Understand the test measures in a specific way of understanding the presence of noise or noise. The test is based on the fact that normal hearing is able to have almost 100% of the words to understand, even if the background noise as loud as the voice level. Hence, people talking loudly at a party or a meeting. In fact, the speaker's voice intensity change (even making loud) to the overall loudness level of the environment to his hearers to enable him to understand.

Understand who at a test-not all words can be understood as the ambient noise as loud as the voice, intelligibility suffers loss. This intelligibility loss is relevant if more than 50%.

 

(I) PCA - TESTED AND APPROVED Results of Hearing Study Lapperre 2010

Last year Lapperre undertook a study of people who have good hearing but not hearing "were invited to try out the PCA. 1351 people participated and tested the PCAs for several weeks.

After confirming 70% of the PCA hearing system better hearing and decree annoying noise. 77% of people who already wore a hearing system, found the new PCAs even perform better than their own hearing.

 

We go over the findings with Ivan Dierickx, head of the audiology team Lapperre and closely involved in the study.

"Why study the idea of a Hearing to take?"

 

Dierickx ivan: "The approach of the study was to hear people with hearing loss to become acquainted with the possibilities of our PCA and PCA to make them aware that a solution to their problem. From experience we know that many people have been aware of their hearing loss, but doubt a first step. This is also confirmed by the investigation: more than 40% of the subjects experienced four years been affected by their hearing loss, 1 in 5 ran for over 10 years consciously around without anything to do.

The Hearing Study, we have these people can drive action. Their participation in the study shows that they realize that their hearing could use a hearing aid and now they have put themselves first step to better hearing, that a hearing aid testing. "

 

"What were the reactions?"

 

Dierickx ivan: "We can still say that these were positive. Most participants were aimed particularly better hearing and understanding in a noisy environment and when watching TV. After the test period less than 70% confirmed that they have achieved this goal PCAs, so I think we succeeded in our mission. Now they know what real difference PCAs are in daily communication and that they can improve their quality of life with it. "

"Some participants wore hearing aids already a classic. What they found in the modern PCAs? "

Ivan Dierickx: "This 'experienced' people have to some extent been enhanced hearing with their current hearing aid, but would still consider the comparison with the PCAs. No less than 77% of them experienced the new PCAs perform better than their own hearing aid, which still a remarkable result. The big difference is situated mostly in terms of speech intelligibility and hearing comfort. The PCAs were initially designed to understand in noisy situations.

They usually have a more modern technology than most conventional hearing aids and scoring so often a lot better in terms of hearing comfort. The IPCA's add to that the extra dimension. 78% of the participants think that calling with Bluetooth mobile phone via a significant improvement. Even watching TV is easier thanks to the Bluetooth connection of their IPCA's. "

"You have different people with tinnitus also tested."

 

Dierickx ivan: "What was remarkable was that one in three participants indicated to have tinnitus. In practice, it is also confirmed in the study, we see that tinnitus patients during the trial period, a specific guidance. Given the complexity of the problem has a specialized Tinnitus Lapperre home team, which has ten years experience in guiding tinnitus patients. With the foundation of our Lapperre Medical Center, the first beginning in May Godtschalckstraat two in Ostend (059/51 69 05) opens, we will be better able to meet the needs of the group. "

 

"Do PCAs an impact on how they experience their tinnitus?"

 

Dierickx ivan: "We saw that. But the results show that many of them PCAs were an important support for tinnitus suppression. In 75% of people with tinnitus, the degree of satisfaction in quiet situations even more positively than in the population without tinnitus. Their tinnitus often causes so many problems that the concentration necessary attention needed to comfortably speech difficult. Many people took the test tinnitus less true with the wearing of PCAs. "

"Good points so the PCAs. Conclusion: in the future continue to focus on speech understanding and optimizing the communication between? "

 

Dierickx ivan: "Yes. Good hearing, but also well understood and easily communicate the core message, around which we continue to work. The new product, which will soon be launched, was a response to the results from the Horn Study and provide an adequate response to the desires of many active hearing. "

• In 88% of the testers was a relevant audience fall down, half of them have already experienced four years of discomfort. 20% has more than 10 years know their hearing problem, but wearing a set of PCA because of the aversion to wearing a hearing aid or because they feel too young.
  
• Over 70% of participants confirm that they used the PCA hearing system have achieved their main goal, namely to better hear and understand conversations with annoying noise and TV programs.

• 77% of participants who already wore a hearing, found the new PCAs perform better than their own hearing. The vast majority (78%) found the phone to phone via Bluetooth, a significant improvement content.

• One of the three participants have tinnitus. For many of them will lower the perceived tinnitus by wearing PCAs and improves speech understanding in quiet situations.
  

Understand consequences of complaints

Wrong or inability to understand a conversation cause numerous irritations both the hearing and its immediate surroundings:

• TV and radio are put louder, something that usually do not appreciate other family enjoyed
• Fatigue occurs due to excessive effort to listen
• Misunderstandings arise because things be misinterpreted.

In short, the social life of the hearing impaired suffer from the symptoms-wise!

Rust Rust

We hear only one side, then get the brains gradually lose some of their ability to sound information from the bad ear use.

This phenomenon, also called auditory deprivation, occurs mainly when a hearing impaired ear correction mate long time no answer or if wait too long to wear hearing aids or PCAs.

Understanding speech in noisy environments

In a quiet environment you can use an ear sufficiently understood. But life takes place largely outside the living room. Problems occur especially if a lot of mean people - for example, roommates, friends, acquaintances or colleagues - in a noisy environment by talking. In such situations you have two similar and equal working ears needed.

Why? If the brains of both ears receive sound signals, your hearing is capable of amazing things: they suppress the background noise and filtering the speech from the hubbub.

Localize sounds with both ears

How do we know, without looking, that a car comes from the left?

The left ear receives the sound slightly faster and a little louder than the right. Faster and more reliable than modern computer brains calculate this difference, and thus determine the direction of the sound. Binaural hearing is therefore an important safety factor.
 

Two are better than one

Several scientific studies have proven the only effective option to speech in noisy conditions, properly understood, the use of two identical working ears.

The following graphic table shows undeniably that the results of speech in both ears much better than with only one ear, and especially in noisy environments.

 

Description lines in figure:

The red curve shows an ideal audience that gives 100% intelligibility in all listening conditions.

The green curve (normal hearing) shows the percentage of intelligibility that normal hearing in different circumstances. We find that, even with normal hearing, speech intelligibility decreases in noisy conditions.

The blue curve (a hearing) shows the percentage of intelligibility that reached by only one hearing-impaired. As soon as noise is very poor intelligibility.
The orange curve (two-part set) shows the percentage of intelligibility that reached by the hearing wearing a binaural fitting. In a noisy environment, the intelligibility much better than with just one device.

Localize sounds with both ears

How do we know, without looking, that a car comes from the left?

The left ear receives the sound slightly faster and a little louder than the right. Faster and more reliable than modern computer brains calculate this difference, and thus determine the direction of the sound. Binaural hearing is therefore an important safety factor.

 

Understanding speech in noisy environments:

In a quiet environment you can use an ear sufficiently understood. But life takes place largely outside the living room. Problems occur especially if a lot of mean people - for example, roommates, friends, acquaintances or colleagues - in a noisy environment by talking. In such situations you have two similar and equal working ears needed.

Why? If the brains of both ears receive sound signals, your hearing is capable of amazing things: they suppress the background noise and filtering the speech from the hubbub.

 

Rust Rust

We hear only one side, then get the brains gradually lose some of their ability to sound information from the bad ear use.

This phenomenon, also called auditory deprivation, occurs mainly when a hearing impaired ear correction mate long time no answer or if wait too long to wear hearing aids or PCAs.

Hear and understand: two different worlds

From our twentieth year, some hair cells in the inner ear, responsible for the perception of high tones that die.

This high tone hearing loss leads initially difficult to distinguish the consonants, which in turn leads to less well understood and wrong interpretation of certain statements or sayings.
 

Intelligibility problems caused by the first high-frequency hearing decrease will mainly be observed in the presence of background noise. Later, the person in question is also difficult conversations remotely, and even in a quiet area to follow. There is thus an important difference between 'hear' and 'understand'.

  

Hearing

'Hearing' is simply the perception of sound. Even with a significant hearing loss, we can still perceive sounds or hear.
A listening device lets you certainly hear better in the sense that you hear sounds a lot more help than without. A classic instrument will indeed be back for sure that everything is audible.

Mean
By "understand" it is not only to observe but also to distinguish different words and sounds (eg the distinction between 'container' or 'roof').

As consonants (b, d, k) are located in the treble region. As vowels a, o, oe earlier in the bass region. With age we lose little by little the ability to perceive the treble and as such the perception of consonants.
Furthermore, there situations with background noise especially in low tones. That bass create a disturbing (masking) effect on the high-frequency consonants. Hence the first characteristics of a hearing to identify himself in communication with background noise conditions.

You hear what is said but everything is properly understood as there is no more.

In a first phase we can describe as an impairment loss of selectivity which means less well understood.
In subsequent phases will total audience (including middle and low tones) step by step backwards so there is actually louder voice you want something clearly understood.

Speech audiogram in noise (noise) - intelligibility test

The same test as above, this time performed in the presence of noise or noise.

Of understanding silence is often fairly well but is often problematic in the presence of background noise. Very often the intelligibility test in noise to the real indication of hearing problems and defining element of the social disability.

Speech Audiogram in silence

In a speech audiogram is recorded graphically how well you can distinguish different sounds. Example, the different sounds in "box-top-pick-pocket-mak-lacquer-branch '. Actually here is the difference between "hearing" and "means" test.

The test person receives through a headset to hear simple words on a different volume. These words, scientifically selected for this test should be echoed. The result is compared to a norm group of young persons of 18 years without hearing complaints.

Concretely this means that a 100% normal hearing have trouble understanding takes on a soft voice level of 40 dB.

Speech Audiogram - Our Hearing

Now to see how well the ear and the brains are able to analyze and sounds into meaningful parts, the speech audiogram taken.

 

It looks at how well the ear can distinguish between different sounds, ie how well the speech intelligibility or discriminatory.

To conduct the speech audiogram, we first look at the performance of the ear under the most favorable conditions, namely in a quiet environment. A common complaint of hearing is the poor ability to understand speech in noise. It is therefore necessary to repeat this test in noise.

 

Speech Audiogram

Determination of uncomfortable loudness level

When the show in a tone audiometry every extra mile to be made, at some point will be reached with an intensity the listener the sound is uncomfortably loud. The intensity in which this occurs determines the uncomfortable loudness thresholds. In the figure below the hearing threshold (red) and uncomfortable loudness (black) indicated a good hearing.

The area between the threshold for a tone is heard and it just where it is perceived as uncomfortably loud, it's dynamic range. Another word for hear dynamic range span. In the figure above is shown with vertical blue arrows.

Some hearing impaired is also the uncomfortable loudness threshold shift. At a much lower level of intensity they find unpleasant noises. This hearing as it were, two sides of a disadvantage: on the one hand by the hearing threshold and on the other hand, reduced by unpleasant, loudness threshold. Both provide for reducing the dynamic range of the horn span. In the picture below clearly shows that the arrows have become a lot shorter by shifting both thresholds.

 

The reduction of the dynamic range by shifting
the thresholds is also described as recruitment.

Tone Audiogram - Our Hearing

An audiogram defines how well a person showing different strength and height can hear. Several beeps offered, sometimes hard, sometimes soft, sometimes high, sometimes low.
 

An audiogram gives a graphical representation of the absolute threshold of hearing person in a function of frequency.

 

The lowest intensity barely be heard, taken as a hearing threshold. This threshold is determined at different frequencies (125, 250, 500, 1000, 2000, 4000 and 8000 Hz).

In an audiogram does the 0 dB line is the threshold of normal hearing.

 

The straight (red) line in the figure below shows the audiogram of hearing a good show (air conduction).

Audiogram of a good hearing

 

The above person has tested so at all tested frequencies (on the horizontal axis and expressed in kHz = kilohertz) 0 dB (vertical axis) hearing loss. This test is performed in a quiet room using an audiometer and headphones, so that each ear can be tested separately. A tonal hearing test is done systematically in the medical school.

 

The hearing loss is expressed as the number of dB's (decibels) difference compared to the 0 dB line of normal hearing. The result in the figure below tells us that this person is 20 dB hearing loss at 125 Hz (low tone), 10 dB hearing loss at 500 Hz (Mid tone) and 70 dB hearing loss at 4000 Hz (high tone).

Audiogram of a person with hearing problems

 

A loss in the treble leads to no more (good) observation of the (speech) is so important consonants (m, n, b, s, t, etc.). A loss in the bass leads to no more pronounced the vowels. A speaker with a normal speaking volume speaks to an average intensity of about 65 dB. Part of the voice will sound louder, some softer.

The above audiogram is a blue "speech banana" is displayed at which frequencies and with what intensity normal speech occurs. The portion of the speech banana above the red line is for the hearing impaired person is no longer audible. He will most consonants no longer perceive. Because the consonants mainly determine the distinguishing sounds, and therefore for understanding speech, will be with this person following a conversation problematic. This means that this hearing the TV and radio will be a lot harder to turn the conversation or the course of the broadcast to follow.

The curve in an audiogram can take many forms. Typically, the first hearing is in the treble, even when the person in question by low-frequency noise has become hard of hearing. When the hearing gets worse, the line further down shift. The lower line is therefore the worse ear.

The bone conduction threshold (black line) in the right audiogram is normal, while the air conduction threshold (red line) about 30 dB. The difference between these two thresholds, the "air-bone gap mentioned.

The bone conduction threshold shows that the perceptual part of the ear (the inner ear so) normal. The vibration from a vibrator on the skull block is transmitted is immediately transported to the inner ear. For example: the tones are presented through headphones, in their way hampered by the moisture that is located behind the eardrum.
The audiogram is to make the middle ear malfunction. There is talk of a conductive hearing loss .

If the air conduction threshold and support threshold are equal, then we speak of a perceived loss .

Hearing loss?

If there is now a normal hearing and a (very) light, moderate, severe or profound hearing loss? The following classification may include some insight:

• 0 to 15 dB:
  Normal hearing. No adverse effects are expected
• 15 to 25 dB:
  Very mild hearing loss. Sometimes difficulty understanding soft speech and some difficulty following a conversation in a rumoeirge environments (bar, reception, meeting, presentation, restaurant).
• 25 to 40 dB
  Mild hearing loss. Difficulty in understanding someone at a distance (soft voice), the TV must often be a little harder and put in noisy environments should have a nice effort to follow the conversation.
• 40 to 70 dB
  Moderate hearing loss. Others can only be understood if it is to talk louder and a short distance. The TV must be hard to put others who are in the same compartment, and this noise will experience. Understanding in noisy environments is problematic.
• 70 to 90 dB
  Severe hearing loss. Someone who is a short distance, to shout to make himself heard. The TV must be hard to put that potential neighbors are affected by this. The doorbell ringer and are no longer noticed when distant sounds. Conversations in noisy environments will be virtually impossible.
• 90 dB and more
  Profound hearing loss. Only very loud sounds are still visible. A conversation is no longer to follow, since (normal) speech even in silence no longer heard.

The above classification is comprehensive and based on the audiogram. At one and the same audiogram can be found considerable variation in the ability to follow a conversation in the din. To better understand the extent to which someone is able to understand speech is often a speech audiogram examination and in some cases, a test that gives insight how well someone is able to understand speech in background noise.

Most frequent hearing tests

The exact measurement of the hearing is called audiometry. You can not do this himself, these measurements are performed by a hearing, an ENT physician, audiologist.

There are different types of hearing tests. The hearing test is the most performed reduction of the audiogram. This hearing test the sensitivity of the ear tested for pure tones. The details of this hearing test is important for adjusting hearing aids or PCAs.

In addition, often a speech audiogram tests to see what the ear can perform up to the understanding of words.

Noise as a source of pleasure - Our Hearing

Sounds can also be very relaxing.

Think of the tranquility of a babbling brook in the background the sound of crickets or a quiet piece of classical or modern music.
 
Music can also compelling and very strong emotions bring about. Such emotions can also bring about physiological responses to the same as stress.
 

Sound as a warning and alert - Our Hearing

Sound makes us feel connected with the world around us. This connection can also have negative effects entail as sound as a stressor can serve.

 

Besides the aforementioned "connection function has also sounds a warning and alarm function.

Man is capable of monitoring the acoustic field around him to limit or constrict. Such sensory constriction can be arbitrarily and held involuntarily.

If you are in a noisy environment can be away from the environment so as to understand the caller.

This "focus" of attention is random. For the hearing will "focus" much more complicated because understanding speech in noisy environments is a major problem for them.

A similar sensory filtering may also involuntarily expire when a specific signal occurs. Example, the ringer, the beeping of the microwave and the buzz of our alarm clock, are signals that their specific characteristics and intensity an alarm function. The response of man to such signals is due to learned patterns. For the hearing impaired is undetectable such signals a problem. One more reason to do anything.

The innate reflex goes well involuntarily. Because some hearing by recruiting more sensitive to loud noises, they quickly scared of loud noises. They also hear soft sounds worse, making them an approaching object or person late and heard just scare them. Many signals have an alarm message is also a warning. A car horns in traffic alerts us to danger, the "new siren" warns us of impending danger, and also tells us that we should go inside and have to close doors and windows. Our alarm clock has an alarm function and tells us otherwise we will have to get up too late.

Sound as a source of contact - Our Hearing

We hear all day and night, whether we like it or not. Only hearing, we can partially avoid the sound world around us.

Through our senses, we know that a world exists around us. With our ears we have a permanent connection to this world. A compound that hinders us sometimes terrible and sometimes extremely pleases.

 

Even noises bother us but we will often feel very strange if these sounds are no longer present. For example, when we are in a so-called silent or anechoic chamber are often assails us an unpleasant feeling: the feeling of contact with the outside world to have lost.

 

The sounds that the body produces also a function, also known as the internal body perception function is called.

It is to think of their own breathing, the beating of our heart, the sound of our stomach when we are hungry and intestinal gas bubbling. By hearing these noises coming from the body, we know that we exist and we also experience the condition and needs part of our body.

 

The above described function, body dysmorphic externally oriented and has a guiding and controlling action. For example, a flight of stairs when we heard our footsteps on the stairs by which heard or our feet well and have put down or take it strong enough.

 

Another example: according to the sound of the ice under our feet, we hear if our bodies do not charge too much. We also hear that the sounds we produce are not easily noticed by others or disruptive to them. By the sounds that we produce through our actions, we hear that our bodies a place in the space around us, and we also hear how strongly we are present.

The frequency - Our Hearing

When we talk about sound is usually the concept of frequency around the corner. Frequency below the mean number of vibrations per second. Frequency is a physical term. What we ultimately perceive when we hear sound with a certain frequency, is expressed by the term "pitch". The wavelength determines the oscillation frequency: the higher the vibration frequency (ie the more waves per unit length and the shorter the wavelength), the higher the perceived pitch.

 

frequency = pitch = Hertz (Hz)

 

The tone of a sound is determined by the pitch or number of vibrations per second (frequency). The frequency is measured in Hertz (Hz).

 

Whether we sound a tone or sound like high or low is of course subjective. However, the following relationship is certain: as the frequency increases tone sounds higher. A high tone has more waves per second than a low tone. Thus, a high-sounding piccolo also a very high frequency with thousands of vibrations per second. The sound of a tuba sounds very low, however (subjective) and has a very low frequency (objective). A healthy ear will show that between about 20 and 20,000 Hz. That does not mean that sounds above 20,000 Hz can not be important in the perception of complex signals such as music. They also influence certain aspects of the soundstage. The sensitivity of our ears is higher for the midrange. With age comes the hearing back for treble, with many adults, the upper limit for sensing sound dropped to about 15,000 Hz.

 

Fig.: The red tone has a higher frequency as the blue.
Both tones are equally loud

The sound intensity

We know that air particles vibrate by a sound source to be charged. From experience we know that close to the source (eg a loudspeaker) the sound louder than further away from the source. This is because the vibration circles get bigger as the sound source moves away. Thus becoming more and more air particles in the collision process. The energy must always be dealt with more air molecules, as shown in the figure.

 

 

Sound Intensity is a measure of the energy consumed by the sound per second on a surface of 1 m² can be received. Sound intensity refers to the amplitude of the sound and is expressed in decibels (dB SPL - Sound Pressure Level).

When the noise increases with a call, it means 10 times the intensity is made. The human ear is capable of much smaller differences can be observed (between 0.2 and 0.3 Bel). Therefore, the decibel introduced. The decibel scale is the horn divided into 120 steps.

The figure below shows some noise of some everyday sounds appear.

 

 

Our ear is most sensitive to sounds in the frequency range between 500 and 8000 Hz. Tones below and above are required to have a greater amplitude observed to be equally loud.

 

The red and blue tone have the same frequency.
The red tone is louder than the blue.

 

The maximum deflection known as the amplitude is larger than the red tone in the blue tone. The frequency is the same. The surrounding air particles get through the red show more energy than the blue tone. The red tone will be perceived as louder than the blue tone. Hard, soft, loud, weak are all subjective descriptions of the physical understanding, volume.

What is sound?

Sound is very important for hearing people.
It is mainly used:

• For communication
  (Speech and Hearing)
• Entertainment and leisure
  (Music, radio, TV and film, ...)
• A warning signal
  (Car horn, overwegbel, fire alarm, ...)
• Noise as a nuisance
  (Explosions, traffic, crowds, ...)
• And soothing background
  (Music, rolling sea, babbling brook, ...)

Sounds are vibrations of air. By definition, a variable sound pressure in air, which propagates as a wave. We talk about noise, then we usually mean "hear" sound. However, there are many "inaudible" sounds impossible to perceive the normal limits of human hearing capacity or hearing.

Sound is the experience that informs our ears, very small and rapid changes in air pressure, arising from a sound source, and further propagated. Examples are the shaky legs of a tuning fork, the strings of a piano or guitar, the vibrating vocal cords in singing or speaking, ...

If these pressure variations reach the ear of man, they are through the ear canal to the eardrum. The eardrum starts to vibrate and sends the generated vibrations through the middle and inner ear to the brains, where the sound can be perceived and interpreted.

Sound waves have two main characteristics: height, length and amplitude, wavelength

Examples of acquired conductive hearing loss

Closed ear

The ear canal may be fully or partially closed by a clot, earwax (cerumen), a pimple, by eczema, inflammation or a tumor.
 

Damaged eardrum

A very loud bang, or a hearty slap could damage the eardrum. You can also damage the eardrum by placing an object by pushing or by stabbing. If the eardrum is not agile enough or too mobile, also a problem arises. By example, scarring of the eardrum, the eardrum stiffer and less flexible. Also, a hole in the eardrum to ensure that we hear less.

Mechanical trauma

A traffic accident or a fall where the head has received a sharp blow can also cause hearing loss. Sometimes over the middle ear bones (hammer, anvil and stirrup) is damaged.

Middle ear infection (otitis media)

Middle Ear infections are very common in children. Even in adults with solid oral and nasal airways inflammation can occur. Medication, more synthesis or placing a tube than to offer solace. When a middle ear infection can cause chronic damage to the ossicles in the middle.

Dysfunction of the Eustachian tube

When the Eustachian tube is blocked, the pressure control before and behind the eardrum does not work optimally. This leads to reduced mobility of the eardrum and temporary hearing loss.

Otosclerosis

In a normally functioning ear, the stapes moves back and Fri. This movement moves the fluid in the cochlea. Growing stirrup this is called otosclerosis. This will lead to a diminished sense of hearing. In this condition, bone forms abnormally on the walls and bones of the middle ear.

 

The footplate of the stapes can not move freely and is stuck in the oval window. When the calcification spreading further to the round window, is called total calcification.

 

Because noise in total calcification hardly transported, there is a big loss. Because both windows (the oval and round) are closed, the pressure of the fluid in the cochlea difficult road and there is no transport of fluid impossible. This is precisely a condition for achieving any hearing experiences.

 

Congenital sensorineural hearing loss

Congenital deafness can be hereditary, but can also arise from complications during pregnancy. It is estimated that about 1 in 1,000 babies severely hearing impaired or deaf.

 

When hearing loss is hereditary, then this is recorded in the genes. It may indeed be that a genetic form of hearing impairment later in life are revealed.

 

Likewise, in addition to hearing impairment are also other bodily functions are disturbed. The GP may refer to an institution that provides information on heredity.

Examples of acquired sensorineural hearing loss

By noise damage

Our ear is like a unique balance that is capable of both the weight of a stamp to weigh, but also that of a large, heavy army tank. Because of this enormous sensitivity is also a very fragile organ.

 

When our ears regularly exposed to noise, we can be of hearing impairment (hearing impairment). In addition, both the intensity of the noise and the duration of exposure assessment in the noise determines the onset of sensorineural hearing loss. Thus it is possible that after a visit to a rock concert temporarily impair our ear hears, but is still recovering.

 

Join the ear, however, before it has fully recovered, back to too much noise exposure can cause permanent hearing damage. Hearing damage from noise is barely noticeable when we have such a constant daily noise exposure level of 85 dB, as we know in the industry. Near term there is not much to notice.

But long term it will lead to hearing loss. With a noise damage the hair cells in the cochlea at the time, as it were completely exhausted and broken, and thus irreparably damaged.

Age hearing loss (presbycusis)

Age hearing loss occurs gradually and in most cases invisible, so the person in question himself at first but little notice, and so there is so little talked about. Also show a lot of older people tend to view their "aging ear" to hide. This form of hearing loss is called presbycusis mentioned. Everyone gets here, if he lives long enough, to do with it. Yet it is clear that performance of hearing start to diminish from the 25th year of life. It is possible that age-related hearing is not caused by the increase of the year, but for example by surrounding noise, drug use, impaired blood flow or a combination of such factors.

Meniere's disease

In Meniere's disease, there is not a functioning inner ear, causing symptoms of hearing impairment, dizziness and tinnitus occur. Usually proceeds by Meniere's disease attacks. Such an attack is accompanied by dizziness, nausea, vomiting, and hearing sounds that do not come from the environment, namely tinnitus . An attack may be caused by increased fluid pressure in the cochlea and the vestibular system. The increased pressure on the membranes of the labyrinth may cause the deformation and sometimes even tears.

The symptoms of Meniere's disease, about a century ago, described by French physician Prosper Ménière.
Meniere's disease usually affects one ear first and in about a quarter to half of the cases, eventually the second ear done.

Lack of oxygen
Our inner ear is very sensitive to oxygen deficiency. This is done through the blood that reaches the inner ear along very fine capillaries. These thin channels clog, but the thick wall. Stress, poisoning, narcosis or severe lung disease may cause inadequate blood touches the inner ear.

Sudden deafness (sudden deafness)

Some people hear of the sudden one day to nothing or get a sudden decrease in ear camps. This is called 'sudden deafness' and can be an ear if both occur. There are several possibilities: a malfunctioning auditory nerve, infection or poor circulation of the inner ear including

Affected (defective) nerve function

A hearing loss can be caused by the auditory nerve signals not properly forwarded to the brains. This can occur when a tumor on the auditory nerve is pressed. Sounds that only a short duration are usually observed, but the sounds persist longer be gradually softened.

Mechanical trauma (acoustic trauma)

 

By a blow on the head or a very loud noise (explosion) can also cause hearing damage. Not only the eardrum and the ossicles can be damaged, but the inner ear. Often this is accompanied by tinnitus.

Damage by ototoxic substances

Ototoxic substances harmful to the body and so can also damage hearing. Some drugs have such a harmful side effect. These include the so-called mycineverbindingen and some resources that are part of chemotherapy.

Quinine and chlorokine, both anti-malarial drugs include damaging to hearing. However, aspirin (salicylates) can be harmful in large quantities for the hearing. The harmful effects of these substances occurs primarily in the high frequencies. In patients receiving ototoxic drugs administered to the hearing then frequently checked. So to see if the hearing loss increases or is progressive. If this proves to be timely medication can be discontinued or modified put.

Partnering with other diseases

It is also possible that hearing was not isolated, but the result of other diseases. Impaired renal function, diabetes and multiple sclerosis can cause hearing impairment. Mumps, measles, rubella, scarlet fever and even the flu can lead to hearing loss.

Causes and types of hearing

Many hearing impaired people want to know the cause of their problem. Hearing impairment can have different causes and not always with certainty to determine the cause of poor hearing is. The most common audiological terminology based on a determination of the place or places in the auditory chain, which is the weak link. We are talking about sensorineural, conductive and mixed hearing losses.

Perceptive loss occurs when the problem occurs in the cochlea (cochlear hearing loss), for example damage to the (outer and / or inner) hair cells. The problem may also do so in the auditory nervous system. Sensorineural losses are permanent. Only offer hearing aids in most cases outcome.

Conduction loss is something wrong with the mechanical transmission of the sound enters the ear. This allows the sound to the cochlea or only partially achieved. At each place where the sound is converted into a mechanical movement can go wrong. Currently most conduction losses by the ENT doctor almost perfectly resolved through surgery or medication. Also hearing - if there is no contraindication is - do always excellent.

In a mixed hearing loss, there are problems in both the cochlea and in the transfer of sounds.
Hearing Losses occur both in one ear and two ears. Unilateral hearing loss is called a monaural loss. In hearing loss in both ears, we speak of double sided or bilateral hearing loss. In almost 80% of the tests in people with hearing impairments found bilateral hearing loss back. That is why ear correction in most cases, fitted with two hearing aids or PCAs.
When there is a bilateral loss, so in both ears, this loss in both ears equal or even different for each ear. If the loss in one ear equal to that of the other ear, called a symmetric loss. Hearing loss is different between the two ears, we call this an asymmetrical loss.

Hearing Loss, we can categorize the severity of hearing loss with a tonal or a speech audiogram (see figure).

Hearing Problems

It is estimated that in Europe, one in seven people suffer some degree of impaired hearing and is therefore more or less hard of hearing. In many cases, the hearing so deteriorated that problems arise in following conversations.

Poor hearing can have different causes. Excessive noise such as whether certain drugs can damage our hearing. For most people, hearing ability with age in any case gradually decline. Hearing impairment can also occur at younger ages, even in very young children or neonates. Heredity can also sometimes play a role.

Hearing usually occurs gradually, allowing the person in question himself at first but little notice. Because the sounds in the environment gradually softer and softer, it is hardly to fade it. Until the soft consonants such as m, b, n, f, s, v, w are no longer audible. Often family members or colleagues marks the first time that someone is hearing impaired. They must constantly repeat what they just said if they are disturbed by TV or radio louder each time a level is put.

At the time the hearing itself realizes that he does not hear so well, the process of hearing loss usually in a while underway (research showed that such a process can take up to 7 years). Telephoning is less smooth and soft passages in music seem more quiet moments. Especially in companies such as receptions and parties takes an awkward conversation. Outside on the street and in situations with background noise is difficult to communicate.

The first step for that hearing problems are often long delayed. This while an untreated hearing difficulties have significant negative social and emotional consequences. This is apparent from a U.S. survey conducted by "The National Council on the Aging" (NCOA) in 2300 adults with hearing problems. The untreated elderly hearing impaired are more likely to suffer from depression and depression, are more often concerned, anxious and sometimes show more paranoia and less socially active. In addition, untreated hearing emotionally unstable and insecure. This study helps finally the myth from the world of show that untreated hearing loss is not so much harm. Seniors who wear hearing aids or otherwise indicate that they feel better and better relationships with their families. In addition, they experience improved mental health and they go back independently, and certainly by the life and cognitive functions remain intact for longer.
Hearing aids therefore have a positive effect on quality of life and welfare of the hearing impaired.

Hearing loss can occur suddenly from one day to another. More than once hearing is also accompanied by ringing in the ears (tinnitus) as an additional burden.

Lysosomal diseases: the impact of the diagnosis

"Your child has a lysosomal disease." Such a statement refers to most parents, like a bomb. It's usually at that time that a psychologist of the hospital will notify the parents. Of course you are free to refuse his or her help, but it would be a shame to make this option not to use. Especially if you take into account the different steps you have to come.

Of the shock to the acceptance of the diagnosis of lysosomal diseases

• Phase 1: the shock

The shock caused by the diagnosis is similar to what one feels at the loss of a loved one. The parents hear medical decisions, but skip the details and explanations do not. Overwhelmed by emotion, they are as it were surrounded by a dense fog.

• Phase 2: denial, resistance

The parents accept the diagnosis. They often consult another doctor, because they are convinced that the first was mistaken. Sometimes they are even angry with the doctors.

• Phase 3: the depression

The parents were desolate and even desperate. During this time they are withdrawn, they mourn the child whom she had dreamed of (a 'normal' child of course) and the future plans for him they had anticipated.

• Phase 4: the return to equilibrium

The above-described intense feelings gradually fade. The parents are again more confident and above all confidence in their ability to raise the child.

• Stage 5: the reorganization of daily life

In this phase, the parents come to terms with the news, even news that they have often not accepted. Life resumes its normal course and parents adjust their lives to meet the needs of the child. The parents perspective what hit them and begin to think back to the future.

The importance of psychological support

The duration of the phases varies from person to person. Psychological support helps to have these successive periods easier and sometimes faster to get through. A psychologist can help you include your feelings to express. Perhaps you experience a love-hate feelings toward your child. The therapist will then try to get you from your guilt to help. Such a feeling is very common among parents with these problems. The psychologist will also demonstrate a positive future is possible, despite the lysosomal disease that affects the child.