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About the Presenter
• Born, raised and educated in Vienna, Austria
• Married with 2 Boys
• Hearing Aid Acoustician AAHA, Honors
• Business Administration Retail, Honors
• Hearing Health Care Industry since 1976
• Living and working in Asia since
1986
• Established THSG in 2003
• Living in Singapore since 2005
• Coordinator for right-to-hear foundation since 2003
• Coordinator for since 2014.
9/6/2015 Manfred Stoifl
2

Children & Hearing Loss
Manfred Stoifl, Hearing Aid
Acoustician, AAHA Vienna, Austria
3

Hearing Loss
WHO, 2012
4

Hearing Loss
WHO, 2012
5

Hearing Loss
WHO, 2012
6

Hearing Loss
WHO, 2012
7

Indonesia
Population 2015 ~ 250 million
~ 30 % between 0-14 years of age =
~75 million
2 % have a disabling hearing loss
1.5 million Indonesian children have a
disabling hearing loss.
8

Peripheral Hearing
Central Auditory Processing
Physiology of Hearing
9

Sound
1 Sec 2 Sec 3 Sec
Frequency
Intensity
Duration
4 Sec
Place in Time
Tone
Rythm
The5AttributesofSound
10

Converting Sounds to Electrical Impulses
Pinna
Ear Canal
Brain
Liquid
Hearing
Nerve
Electric
Stimuli
Cochlea
Eardrum
Sound
Physiology of Peripheral Hearing
Hammer
Stirrup
Anvil
12

Unique patterns of electrical
impulses
Up to 18 million
impulses per second
resolution per ear
14

Physiology of Central Hearing
Hearing is
electrical
patterns in
the Brain.
15

-20
0
20
60
60
80
80
100
120
40
140
100
Frequency Hz
1k
2k
3k
4k
10k20 20k5k
8k
Human Range of Hearing
Human Auditory Range
Orchestral Range
Vocal Range
6k
16

DirectionalHearing
You will hear the
sound first and
louder on your
right ear and
second and softer
on your left ear
If someone calls you from your right side,
….
THE CALLER
IS ON MY
LEFT!
THE CALLER
IS ON MY
RIGHT!
If Someone calls you from your left side
…
You will hear the
sound first and
louder on your left
ear and second
and softer on your
right ear.
17

We are born with
hearing but have to learn
how to hear
18

We are born with the ability to do this ……
19

but…..have to learn to do this ….
Hearing is
electrical
patterns in
the Brain.
20

……..and this……
21

Automatic hearing recduces cortical activities by 85%.
and ……this!
22

?
Learning to hear
meaning
saving in long-term memory9/6/2015 Manfred Stoifl
23

We need to hear as much as
possible to learn ….
24

Hill, N.M. & Schneider, W. (2006) Brain Changes in the Development of Expertise: Neurolical Evidence on Skill-Based
Adaptations in Cambridge Handbook of Ex-pertise and Expert Performance. New York: Cambridge University pp. 653-
683
Brain activity (shown by means of fMRI) is strongly decreased
throughout a given automation task over a duration of 3x 20
minutes. Cortical activities reduced by 85%.
Automatic Hearing is More Efficient
……to do this!
25

Hearing
Automatic retrieval of meaning
from long-term memory
27

Hearing loss
28

z v
p
h
g
ch
shl
roa
sf th
j mdb
n
nge i
u
AUDIOGRAMOF FAMILIARSOUNDS
FREQUENCY IN CYCLES PERSECOND(HZ)
10
0
30
40
50
60
70
80
90
100
110
120
125 250 500 1000 2000 4000 8000
HEARINGLEVEL(dBHL)
20
NORMALHEARING
MILD HEARINGLOSS
MODERATE
SEVERE
PROFOUND
29

Hearing Loss
10
0
20
30
40
50
60
70
80
90
100
110
120
125 250 500 1000 2000 4000 8000
30

Hearing Loss
10
0
20
30
40
50
60
70
80
90
100
110
120
125 250 500 1000 2000 4000 8000
31

Peripheral Hearing Loss –
incorrect conversion of sounds to Electrical
Impulses
Central Hearing Loss –
Problems assigning meaning
to electrical impulses
Hearing Loss –
a complex Problem
32

?
SNHL Hearing Loss
meaning
saving in long-term memory9/6/2015 Manfred Stoifl
33

Instant recall from memory
Cortical activities increases by 85%.
No
34

Pediatric Hearing Test Battery
Tympanometry
Oto Acoustic
Emission
ABR / ASSR
Otoscopy
Audiometry
Ensuring the middle
ear is functional and
free of fluids
Verifying functionality
of outer haircell in the
cochlea
Promontory
Stimulation
Verifying overall
function of the
auditory system
Ensuring the ear
canal is normal &
free from
obstruction
Free Field
Visual Reinforced &
Play Audiometry
Stapedius Reflex
Latency measurement
Electrically verifying
function of retro
cochlear structures in
case of C.I.
Objective
confirmation of UCL.
Measures retro
cochlear structure
development
35

Hearing
Aid Range
Hearing Loss
36

Hearing with hearing aids
37

Paediatric Hearing Aid Selection
• Audibility
– Power
– Sound Quality
– Wide Frequency Range
• High Frequency Content
• Durability
• FM or Bluetooth ability
• Good fitting fun earmolds
• Warranty & Cost.
38

Sometimes hearing
aids are not enough
39

Hearing Loss
Cochlear
Implant
Range9/6/2015 Manfred Stoifl
40

Hearing loss & Hearing Aid
profound hearing loss
41

Hearing with a Cochlear
Implant System
42

We need to hear as much as possible !
43

Advanced Bionics provides
more electrical Information
to Central Auditory Centres
than any other
Implant
44

Quality of a C.I.
It’s not about if you hear or not
It’s about how easy you
hear!
45

Normal Hearing
Up to 18 million
impulses per second
resolution per ear
Advanced
Bionics
Cochlear MedEl
83,000 32,000 50,000
46

47

Cochlear 22 Sounds
MedEl 16 Sounds
Advanced Bionics 120 Sounds
48

Impact resistance in Joules
Is the force an implant can survive before it
breaks
Cochlear Freedom
1 joule
MedEl
2.5 joule
Advanced Bionics
HiRes 90K Advantage
6 joules
49

Sometimes Hearing Aids or
Cochlear Implants alone are
not enough!
50

Reverberation
Classrooms are noisy places
Background noise
Distance
51

Distance between the listener and
the sound source
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Adapted from Johnson 1996
The effect of distance and noise on
word recognition in Children
Age Group Word recognition in quiet Word recognition in noise
close (1.8 m) far (7 m)
4 years 88.3 % 67.0 %
5 years 94.3 % 84.0 %
6 years 98.0 % 86.7 %
Adults 99.3 % 97.0 %
53

Washington University
ReceptionThresholdfor
Sentences(RTS)
Listening Condition
Clinical Study result on FM
-20
-15
-10
-5
0
5
10
Unaided Omni Dir FM(Mon) FM(Bi)
54

FM is absolutely necessary for
your child to succeed in school !
55

Our Vision for our Children
Economic
Independence
Social
Independence
Hearing
Language
Education
Social
Competence
Mental
Development
56

Q & A
57

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