| 1) Hearing Aids |
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A comprehensive range of services includes:
• Complete audiological evaluation and counselling services
• Professional hearing aid selection and fitting by experienced hearing aid audiologists
• Provision of full spectrum of custom-made hearing aids such as the Completely-In-The-Ear (CIC), In-The-Canal (ITC), In-The-Ear (ITE) and Behind-The-Ear (BTE) models.
• Comprehensive after-fitting services such as hearing aid repair and fine-tuning
• Sale of related-accessories such as hearing aid batteries, dehumidifier, custom-made swim plugs, custom-made earplugs, etc.
In order for patients to reap maximum benefits from hearing aids, the patient and/or family members should be informed about the type of technologies available and their limitations. This critical, value-adding step can only be performed by a professional clinician who possesses a sound knowledge of the advantages and disadvantages of different technologies and their application in terms of performance, features and fit in accordance to the hearing needs of each patient. The other key challenge is to present this information to patients in a simple, easy-to-understand format. |
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Completely-In-Canal (CIC)
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In-The-Canal (ITC)
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In-The-Ear (ITE)
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Behind-The-Ear (BTE)
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Counselling for New Hearing Aid Users
Audiologists can help patients to understand:
• their hearing capabilities and hearing loss type. This will help patients to correlate their hearing configuration and the influence on speech discrimination in various situations. The advantages and limitations of various hearing aid styles such as size, power, ease of insertion and removal, technology limitation, avoidance of occlusion, feedback issue as well as financial cost will be explained.
• various digital technologies such as - noise reduction which helps to reduce stationary noise and upward spread masking effect.
- feedback suppression which allow the possibility of implementing a higher gain setting with a bigger venting
- adaptive directional microphone which improve signal to-noise ratio and result in better speech discrimination in noisy environment.
Digital technology with multi-channels signal processing, noise reduction and directional have been proven to improve speech discrimination in noisy environment. However, many patients will be balancing cost against the advantages of the complex technologies. Thus, it is important to help patients manage and adjust their expectations accordingly.
Occlusion and Own-Voice Issues – new solutions for an age-old problem
Changes in the user’s perception of his/her own voice is one of the most common complaints of hearing aid users. First-time users often comment that their voices sound unnatural and sound as if they were in a "barrel". It is also not uncommon for users to comment that their chewing sound is so loud that they were unable to follow the conversation around the dining table. This problem is the result of occlusion and effect of amplification of one’s own voice.
Occlusion is the main cause of this "unnatural own voice" problem especially for those patients with high frequency hearing loss and good low frequency hearing. It is caused by the resonance of sound when the ear canal is blocked by either the hearing aid itself e.g. CIC or the custom made ear-mould. The resonance increases the sound pressure level at the eardrum by as much as 20 to 30 dB. This occlusion problem has become more common among users of smaller hearing aids such as the CIC.
Mild-to-moderate high frequency sensorineural hearing loss patients often reject hearing aids because of this occlusion problem. A direct way to solve or minimise this occlusion problem is to reduce the blocking of the ear canal when the patients are using hearing aids. To address this issue, CGH’s hearing aid clinic started offering the following solutions:
• Open Fitting Hearing Aids
These are Behind-The-Ear (BTE) digital hearing aids connected to a highly ventilated off-the-shelf ear-tip. The relatively large ventilation will greatly reduce the occlusion effect. Together with advanced digital signal processing capabilities such as noise reduction, feedback suppression and directional microphone, speech intelligibility is significantly improved in noisy environment such as restaurants.
This group of hearing aids usually have smaller housings as compared to conventional BTE and are usually operated with smaller-sized battery. However, as the aids are worn behind the ears, this group of aids are not popular among younger patients due to aesthetic reasons.
• Retro-X Semi-Implant Hearing Aids
This semi-implant hearing aid was designed for patients with mild-tomoderate high frequency sensorineural hearing loss. It consists of a titanium tube and a hearing processor. The titanium tube is implanted in the soft tissue of the outer ear.
It is not in direct contact with the cartilaginous skeleton of the ear or with the bone of the mastoid. Once the wound has fully healed which usually takes about a month, the hearing processor is inserted into the retroauricul ar end of titanium tube and worn behind the pinna and the mastoid. The hearing device is a multichannels digital processor that can be programmed to individual hearing loss pattern like any other conventional digital hearing aids. With a truly open-ear device, patients not only avoid occlusion problem but also preserve the natural ear effect such as outer ear resonance and directional hearing. |
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A First in Singapore & Asia
The first Retro-X implantation in Singapore, as well as Asia, was performed in Changi General Hospital in November 2006 by Dr Eng Soh Ping. As the total cost of the implant procedure and the hearing processor is very close to the high-end digital hearing aids in the private market, more patients will be expected to receive this implant and reap its benefits in the near future. |
| 2) Other types of instrumentation available |
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Tinnitus
Part of the treatment would often involve sound therapy and instrumentation including sound generators. Various types of digital sound generators can be programmed to match the tinnitus pitches as follows:
• 4-channel behind-the-ear digital noise generator that can be configured according to the pure-tone audiometry data in order to realise an audible masking noise.
• 2-channel behind-the-ear digital hearing aid with masking noise feature designed especially for those who require hearing amplification and tinnitus masking.
• 4-channel modular CIC digital noise generator that can be fitted deep in the canal. |
| The Tinnitus Evaluation & Rehabilitation Programme (TERP) at CGH was introduced in CGH in June 2006 to manage tinnitus sufferers. It involves a 6-month treatment protocol that allows the patient to receive a holistic therapy from multi-disciplinary sources which includes a tinnitus counsellor, ENT doctor and a psychologist. |
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Vertigo
Meniere’s disease, a common cause of vertigo, is caused by endolyphatic swelling or hydrop of the inner ear. The Meniett Device is a recent development in the management of Meniere’s disease. The ENT surgeon performs a simple procedure to place a ventilation tube in the ear drum and through a tube connected to an ear piece placed in the outer ear, the Meniett device delivers controlled, low-pressure air pulses. The energy of the low-pressure pulses displaces the excess inner ear fluid, which normalises the symptoms of the disease. | |
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