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CAN YOU HEAR ME NOW?

SADDLEBROOKE HEALTH NIGHT OUTSonoran 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 256Tucson, AZ 85718

www.sonoranent.com

(520)775-3333

1521 E Tangerine Rd Ste 331Oro Valley, AZ

www.sonoranent.com

(520)775-3333

1521 E Tangerine Rd Ste 331Oro Valley, AZ

www.sonoranent.com

La Encantada

SONORAN ENT

EAR NOSE AND THROAT

Ears (Otology)

Nose (Rhinology, allergy)

Throat (Laryngology)

Head and neck cancer

Sleep medicine

Facial Plastic and Reconstructive surgery

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HEARING LOSS

Thomas Kang, MDSonoran Ear Nose and Throat, PLLC

Saddlebrook Health Night Out

August 24, 2015

E A R S

QUESTION #1

�What is the name of the smallest bone in the human body?

�A: The stapes

HEARING ANATOMY

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CERUMEN (ear wax)InsectPerforation (hole in eardrum)

COCHLEAConverts 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)

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

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HEARING AIDS

Amanda Kester, AuDSonoran 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 productthat 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 devicethat 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

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� Personal Sound Amplifier (PSAP)

$150.00

$450.00

$19.95$74.99

$35.74

� 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 proper programming, 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

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

� Wireless Streaming of audio signals

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…

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�Control the direction of microphone focus using the app � Adjust Bass/Treble � Locate missing hearing aids

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 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?

� Real Ear Verification is now the law in AZ

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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, FACOOSonoran 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

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VESTIBULAR SYSTEM

1. Ears = Inner Ear2. Brain = cerebellum

3. Eyes = movement and vision4. 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

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JASON DAY – US OPEN 2015 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

النھاية

La Fin

El FinDas Ende

THE END

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QUESTIONS?

Email for a copy of the presentation:

info@SonoranENT.com

� 6340 N. Campbell Ave, #256Tucson, 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.com

Amanda

Kester, AuD