TINNITUS

TINNITUS

INTRODUCTION:-  Tinnitus and Hyperacusis  are two challenging in audiology as patients can be desperate and t`here are no cures. Tinnitus can been defined as a perception of sound (it must be heard, Involuntary (not produced internationally) and originating in the head (rather it is not an externally produced sound) , whereas Hyperacusis does not  have a widely accepted definition. Hyperacusis can involve loudness, annoyance, fear and pain. We have noted that tinnitus is often accompanied by hyperacusis and many current sound therapy protocol that tinnitus and hyperacusis in parallel.

NEUROPHYSIOLOGICAL CAUSES MECHANISM AND MODELS:-

Hearing loss can also produce tinnitus. The most common causes are noise exposure, aging, head injury, and medication. Sometimes the causes are unknown. The prevalence of tinnitus increase with

Age and hearing loss, but in particular is influenced by noisy situations report that the onset of tinnitus is gradual. Initially tinnitus is heard only occasionally during the day or for brief periods after work. The onset of tinnitus occurs after the onset of hearing loss. Tinnitus is classified as either Sensory/neural or middle ear .Middle ear tinnitus is typically related to middle ear vascular or muscular dysfunction. Sensory neural tinnitus originated in the cochlea and neural auditory pathway.

AUDITORY HALLUCINATION AS TINNITUS:-

When someone reports hearing sounds that are like music or voice, it is important to considered mental illness. Reports of imagined voices or music can occur as part of psychotic illness such as Schizophrenia. If there is no record of such illness, but there is evidence of depression, anxiety, or unrealistic thoughts or actions, then these should be addressed with the client and a referral provided to a mental health professional. In the absence of indications of mental illness, one could treat this as with other type of tinnitus. Certainly tinnitus has a central origin. Patients who present no sign of mental illness and who hear music and voices could benefit from programs described later. It is important not to overact to the patients reports.

MEDICAL EVALUATION:-

Often a focus of the evaluation will be on the cardiovascular system and on metabolic disturbance such as diabetes and hypercholesterolemia. Laboratory examination (e.g. cholesterol levels, glucose, zinc, and screen for ototoxic drugs) and imaging tests (e.g. ultrasound, computed tomography scan magnetic resonance angiography) might be utilized.

Middle ear tinnitus is associated with either abnormal middle ear blood flow or middle ear muscle ear muscle contraction. Some call this “objective” tinnitus” because it can be amplified and heard by the examiner. Some spontaneous otoacoustic emissions, which are produced in the cochlea can also be heard. Therefore we prefer the term middle ear tinnitus. Otologists may determine whether the tinnitus sensation changes with manipulation of blood flow. These manipulations can change the pulsing sensation. A proportion of these can be eardrum and can sometimes be observed . Movement of the eardrum can sometimes be observed visually or with the help of measurement of air pressure in the external canal with tympanometery. Oral cavity examination may demonstrate myoclonic activity.

Tinnitus can sometimes be influenced by movements of the head and neck. Some ototlogists search for sign of temporomandibular dysfunction which can involve jaw or facial pain or tenderness and difficulty or discomfort in chewing. Another focus is a search for treatable sensory neural tinnitus .

Another focus is a search for treatable sensory/neural tinnitus. This includes some forms of sudden hearing loss, Méniére’s disease, or a tumor of the auditory nerve. It could be that some forms of tinnitus might be caused by metabolic diseases and deficiencies (e.g., anemia, diabetes, hypercholesterolemia, zinc and vitamin deficiency). Evaluations for these conditions would involve studies of the blood and urine.

Measuring the Tinnitus

The pitch, loudness, and amount of noise necessary to mask tinnitus can be measured to quantify tinnitus, provide assistance for fitting maskers, and monitor changes in tinnitus perception. Patients can usually compare the pitch produced by a puretone to the “most prominent pitch” of their tinnitus. Pitch matching can be highly variable, and an indication of the variability should be reported in the patient chart. Patients can also adjust the intensity of a tone so that it has the same loudness as their tinnitus. Sensation level is not a measure of loudness.

The results of a tinnitus loudness match can be reported in dB sensation level (SL), but this level can only be interpreted over time for a particular patient if the hearing threshold at that frequency does not change. An alternative approach is to convert the physical intensity of the sound into the subjective loudness scale based on sones. Sones represent an international standard; 1 sone equals the loudness of a 40-dB sound pressure level (SPL) 1,000 Hz tone (about 49 dB HL) in a normal listener. A sound that has a loudness of 4 sones is four times as loud. Another measure of the magnitude of tinnitus is the amount of noise required to mask the tinnitus, sometimes referred to as the minimum masking level. The noise level (specify the frequency characteristics of the noise, e.g., broadband 250 to 8,000 Hz) is increased until it just masks the tinnitus. Several things can contribute to the variability of tinnitus measurements. First, one should be aware that the test stimuli can change the tinnitus. This is probably more likely to happen for intense stimuli and when stimuli are presented ipsilaterally to the tinnitus. The ear receiving the stimuli should be reported. Second, in many patients the perception of tinnitus is not constant but varies throughout the day or from day to day. A reasonable approach to this is to make multiple measurements and report each value. The variability of the measurements can be documented by replicating the measures and recording the results of each trial in the patient’s chart. For example, we often use the average of three loudness matches, three minimum masking levels, and six pitch matches (because pitch tends to be more variable). In patients with highly variable tinnitus, additional measurements can be made, and the measurements can be repeated at subsequent visits. Measuring the Reaction to the Tinnitus People’s reaction to their tinnitus covers a broad range. Some appear not to be particularly bothered by it, whereas for others, the tinnitus can have a dramatic effect on their lifestyle. The primary impairments can result in difficulties with thoughts and emotions, hearing, sleep, and concentration Sleep disturbance is one of the most common of these impairments causing some to have difficulty falling asleep, whereas others have difficulty falling back asleep if they wake up in the night. The impact tinnitus is having on an individual’s life, an easy first step is to ask the person to “list all the problems you have that you associate with your tinnitus, starting with the problem that bothers you the most”. This can be done before the first appointment and can lead to an open discussion of the important problems as perceived by the patient. Several questionnaires designed to quantify the problems caused by tinnitus are available. These differ based on the scale used. Our experience is a 0 to 100 scale is easy for patients (a familiar decimal scale like dollars), in which a patient will respond 0, 5, 10, 15, . . . 100, which enables a 21-point scale. This provides greater resolution than a 0 to 10 scale. Questionnaires also differ on the scope of questions asked. Tinnitus Handicap Questionnaire has been widely used to assess the influence of drugs, cochlear implants, and sound therapy approaches. Others also include general questions on the quality of life. We believe this can make the questionnaire less sensitive to treatment effects, as the quality of life can be influenced by many factors not directly captured by treating tinnitus. The Tinnitus Primary Function Questionnaire which focuses on emotional, hearing, sleep, and concentration difficulties and is sensitive for clinical trials and assists in determining treatment needs. All appendices can be found at the end of the book.

TREATMENTS

There are two basic types of tinnitus treatment strategies: Those designed to reduce or eliminate the physical perception and those designed to change the patient’s reaction. Counseling

There are various counseling approaches: They range from providing information to more engaged collaborative counselling.  Many of these are based on the work known as tinnitus habituation Special Populations therapy. Others include strategies for improved coping, management, and behavioral change. Among these are tinnitus activities treatment, tinnitus retraining therapy, and tinnitus cognitive behavior therapy . The aim of these procedures is to provide ways for the person suffering with tinnitus to adjust his or her reactions to the experience.

The goals of these psychologically based therapies often overlap. For example, patients can

be helped to habituate to their tinnitus by de-emphasizing the fear associated with it. Another approach is to decrease the attention given to the tinnitus, often with the help of background sound. The way a patient thinks about the tinnitus can influence his or her reactions to it. Therefore, some clinicians will help patients consider how they think about their tinnitus. These thoughts can be challenged and revised. Another approach is to assist patients to change their focus away from their tinnitus.  It is our general view that many patients concerned about tinnitus can adapt to it after the explanation of its origin and its nonthreatening nature. A substantial number of patients such reassurance is less effective, and a more elaborate intervention is needed. The descriptions in the following sections provide guidance on the sorts of appropriate counseling within the context of general audiologic practice. When more elaborate counseling is required, reference to the clinical psychologist is appropriate. Important attributes of the clinician include

• Ability to listen

• Patience

• Ability to be encouraging to the patient

• Emotional insightfulness

• Self-awareness

• Ability to laugh at the bittersweet aspects of life

• Positive self-esteem

• Ability to talk candidly about depression, anxiety, and other psychologic stressors At the initial interview, it is helpful to determine if patients are curious, concerned, or distressed about their

tinnitus. Much of the anxiety associated with tinnitus stems from uncertainty regarding its source and consequences. Curious patients typically require only basic information regarding possible causes, mechanisms, prevalence, consequences, and likely outcomes. These patients find that once the mystery of tinnitus is explained to them, their reaction is largely resolved.

Concerned patients require more detail and benefit from information regarding things they can do on their own or other treatment options. Depending on the level of concern, these patients can require a more formal evaluation that includes the questionnaires and psychoacoustical measurements discussed earlier. Distressed patients require specific tinnitus treatment. Patients with severe anxiety and depression should obtain help from psychologists or psychiatrists. Patients who report suicidal thoughts or self-harm need to be further questioned regarding their intentions, and a referral to clinical psychology or psychiatric services should be made immediately if any concern exists.

PROVIDING INFORMATION

Most approaches provide information about hearing, hearing loss, and tinnitus. They usually include the causes, prevalence, and common consequences of tinnitus. For many people, the unknown aspects of tinnitus are the most alarming. They often find this basic information about tinnitus reassuring and may require no further assistance.

THOUGHTS AND EMOTIONS

It is helpful to distinguish the tinnitus itself from the person’s reaction to the tinnitus. The way people think and feel about their tinnitus can have a major influence on their reactions. One focus of cognitive behavior therapy, and other counselling strategies, is on challenging a person’s thoughts about tinnitus and thereby facilitating changes to the reactions to the tinnitus.

MEETING THE PERSON’S NEEDS

Some counseling procedures go beyond providing information and attempt to understand and influence the overall emotional well-being of the patient.  Several approaches are available to help individuals understand and change the emotional consequences of their experience with

their tinnitus.  

COPING/MANAGEMENT STRATEGIES

Some counseling approaches include coping/management strategies to help patients understand and change their perceptions about tinnitus and to modify their reactions and behaviors. Activities are planned to determine situations in which tinnitus might be a problem and then to modify their specific situation to reduce these occurrences. For example, patients might report that their tinnitus is worse when they first get home from work. This might be a result of sitting in a quiet room reflecting on the day’s activities. An alternative activity might be to go for a walk while listening to music, or physical exercise, such as Tai Chi or yoga, to limber up. Just about any activity that reduces stress can be helpful.

RELAXATION AND IMAGERY PROCEDURES

Some patients benefit from learning specific relaxation or imagery procedures. These can be used when people experience stress, and it can be helpful for them to learn relaxation strategies or to focus attention to other thoughts. Exercises to learn how to redirect attention away from the tinnitus are also employed. For example, in a quiet room, patients can imagine the sound of waves on a deserted beach. Then, they can redirect their attention to their tinnitus—then back

to the waves.  

Sound Therapies

Sound therapies include strategies that use background sounds to reduce the prominence of tinnitus or decrease its loudness or level of annoyance.

THE USE OF HEARING AIDS

Most patients with tinnitus also have hearing loss. Properly fitted hearing aids should help with communication and often also help with tinnitus by reducing the stress involved with intensive listening and by amplifying low-level background sounds. Hearing aids are often the first component of sound therapy for patients with tinnitus.

Tinnitus Activities Treatment

Our counseling approach has evolved over the years. We continue to prefer the partial masking strategy we recommended in the 1980s, although some patients benefit from total masking.

THOUGHTS AND EMOTIONS

The way patients understand and think about their tinnitus influences their reactions to it. Providing information in a collaborative fashion to ensure understanding is essential. Key aspects of this area include

•              Listening to the patient and addressing issues that are important to him or her

•              Providing information about hearing, hearing loss, tinnitus, and role of conscious and subconscious attention

•              Understanding the patient’s reactions to unexpected, uncontrollable events

•              Suggesting changes in behavior and lifestyle that can facilitate acceptance and habituation

It is important to help patients recognize the difference between the tinnitus itself and their reaction to it. Cognitive therapy separates the tinnitus from the patients’ reactions to it and may provide a sense of control over the impact tinnitus has on their lives.

HEARING AND COMMUNICATION

Tinnitus and hearing loss often occur together, but the patients cannot “hear” their hearing loss, so they project their communication problems on the tinnitus. Reviewing the patient’s hearing loss and its impact on communication may redirect some of the anxiety to an area where treatment is more obvious. In addition to hearing aid information, a review of assertive communication versus passive or aggressive communication styles is useful.

SLEEP

Understanding normal sleep patterns is the first step in gaining control over the problem. Other strategies include

•              Exploring factors that can affect sleep (e.g., stress, environmental noise, room temperature)

•              Arranging the bedroom to promote sleep (e.g., comfortable bedding, remove distracting items from room)

•              Avoiding alcohol, smoking, and eating before bedtime

•              Using sound to mask tinnitus (e.g., noise generators or soft radio)

•              Learning relaxation exercises (e.g., imagery, progressive relaxation)

CONCENTRATION

In our therapy, we discuss the importance of concentration and things that affect our concentration. We review factors in the environment (e.g., lighting, background noise, distractions, and temperature) and personal factors (e.g., being tired, current health status, and other stressors in our lives) that impact our ability to focus our attention for a sustained period of time. Activities in “attention diversion” give patients practice switching attention from one engaging task or stimulus to another. This type of exercise shows people that they can control what sounds, images, or other stimuli they consciously focus their attention on. Repeated practice with this type of activity can help give patients a sense of control over their attention as well as their tinnitus.

CLASSROOM AMPLIFICATION DEVICES FOR CHILDREN

CLASSROOM ACCOMMODATIONS AND HEARING ASSISTANCE

The classroom environment

Classrooms are a critical auditory environment for children yet many do not provide favorable conditions for hearing. The classroom environment is one that must be controlled to provide favorable conditions for hearing. There are three important variables to be noted: Noise, reverberation, and distance from the teacher. Sources of classroom noise may include the children themselves, furniture noise, ventilation systems, and external ambient noise. Ambient noise levels often exceed an optimum 35 dBA (unoccupied), and hard surfaces can reduce hearing effectiveness by increasing reverberation time beyond an optimum maximum of 0.3 to 0.6 seconds (American Academy of Audiology; AAA, 2011a). Signal level and SNR decrease with distance from the signal source.  

Children require a greater SNR than adults for speech recognition. Young children require speech levels that are at least 20 dB above those of interfering noise and reverberation (AAA, 2011b). In practice, this is difficult to achieve without amplification. Consequently, even children with normal hearing may experience difficulty hearing in class. Many children with CAPD particularly have difficulty hearing in background noise. The noise level does not need to be loud to disrupt auditory input. Adults with CAPD describe how noise from a fan or  refrigerator can interfere in properly decoding speech. Some children with CAPD are overwhelmed by all classroom noise levels, becoming distressed and unable to function. Such children are sometimes withdrawn from school.

Sometimes, minor modifications to a classroom, for example, sealing obvious entry points of external noise and introduction of absorbent materials, may improve the acoustic classroom environment, but are unlikely to sufficiently improve the audibility for a child with CAPD. This

is because some children with CAPD may need amplification of the primary signal, not just an improved SNR, to hear well (see Section “Amplification”). Hearing assistive technologies (HATs) and in particular remote microphone systems can alleviate or overcome all three sources of signal degradation in the classroom: Noise, reverberation, and distance from the talker.

Other Environments

Children with CAPD have difficulty when speech is rapid or degraded by distance, acoustic conditions, or accent, when information streams are complex or lengthy, and when competing sounds are present. It follows that HAT can be helpful to them in many aspects of their lives besides the school environment. Moreover, given the positive neuroplastic changes that occur over time from wearing amplification (Friederichs and Friederichs, 2005; Hornickel et al.,

2012), children with CAPD should be encouraged to use their HAT as much as possible.

Amplification

Terminology

The majority of recent studies of amplification for children with CAPD have used remote microphone hearing aids, with body- or head-worn receivers, which receive a signal from a microphone worn by the speaker. The transmission medium has typically been frequency modulation (FM). Hearing systems of this type are usually referred to as “personal FM systems.” This term is ambiguous, because it refers to accessory FM systems used by wearers of conventional hearing aids or cochlear implants. Furthermore, FM is increasingly being replaced by digital modulation (DM) technology. From the point of view of advocacy as well as accuracy, use of the term “remote microphone hearing aids” reinforces the point that children with “central deafness” require amplifying hearing aids in much the same way as do children with peripheral hearing loss. Until remote microphone hearing aids become recognized as simply another type of hearing aid they remain classified as assistive listening devices (ALDs) or, in more current terminology, a type of hearing assistive technology (HAT).

CLASSROOM AMPLIFICATION SYSTEMS

Classroom amplification systems, also referred to as sound distribution or sound field systems, provide amplification of the teacher’s voice through loudspeakers. Their efficacy is variable, depending in particular on the room acoustics. Classroom amplification systems typically improve SNR by 3 to 5 dB, but may worsen SNR in classrooms with very poor acoustics. Adaptive systems which increase the amplification as the noise level increases can achieve better than 5 dB. Portable desktop systems in which a small loudspeaker is placed on the desk of an individual child provide a slightly better SNR, perhaps 10 dB, for that child. Remote microphone hearing aids can provide at least 20 dB improvement in SNR. A meta-analysis by Schafer and Kleineck (2009) comparing speech discrimination in noise with various FM systems in trials involving cochlear implant users showed no significant improvement with sound field systems but 17% improvement with desktop systems and 38% improvement with personal direct auditory input FM systems.

CANDIDACY FOR AMPLIFICATION

It is sometimes mistakenly assumed that only children with CAPD who complain of difficulty hearing in noise, or who score poorly on a speech-in-noise test, will benefit from remote microphone hearing aids. In fact, research results and clinical experience indicate that nearly all children with CAPD show classroom benefit from personal amplification as long as the classroom teacher is cooperative. Results range from children whose hearing ability in class is instantly transformed through to those in whom benefits are more subtle and slower to manifest. There is no known predictive test of degree of benefit to be derived from amplification

(though the Hornickel et al. study reported above shows an interesting correlation between initial inconsistency of the brainstem response and subsequent benefit). However, recommendation of amplification only for children with abnormal scores on tests of hearing in noise undoubtedly denies potential benefit to many children.

Electroacoustic verification of remote microphone hearing aid. Upper curve(vertical hatches) represents audibility of the amplified pathway. Lower curve (horizontal hatches) represents audibility of the unamplified pathway through the open ear canal.

EUSTACHIAN TUBE DYSFUNCTION

EUSTACHIAN TUBE DYSFUNCTION

Normal Eustachian tube function is essential for the well being of the middle ear cleft as it maintains the equilibrium between middle era pressure and the atmosphere. Any obstruction of air from the middle ear with consequent retraction of the drum as a result of a higher atmosphere pressure. Eustachian tube function is characterized by a middle ear pressure of less than 100 m HZ0. Patient with mild hearing loss and feeling of pressure in the ear. If the process continue and the tube does not reopen then a serous exudates occurs which is associated with a more severe hearing loss, discomfort in the ear, occasionally tinnitus and in some patient dizziness. Throat infection may be transmitted by the tube to the middle ear causing otitis media. This is more common in children because their tube is shorter and straighter and has an exuberance of lymphoid tissues in throat. 

TYPES OF HEARING LOSS

TYPES OF HEARING LOSS

Slight hearing loss (16 to 25dB): Difficulty in understanding very soft speech from a distance. E.g. falling or rustling leaves and whisper. Children can experience difficulty in classroom when more than 3 feet away from a teacher.

Mild hearing loss (26 to 40dB): People having mild hearing loss may struggle with having conversation especially if the environment is loud and noisy. E.g. birds chirping, the sound of stream. Children can experience in difficulty in classroom and comprehending some vocabulary.

Moderate hearing loss (41 to 55dB): One a person has moderate hearing loss they will find keeping up with conversation difficulty when they are not in using of hearing aid. Difficulty understanding normal speech especially in a noisy environment. E.g. conversation at home, light traffic and distant large transformers. Children have trouble with normal speech and difficulties with learning.

Moderately severe loss (56 to 70dB): Individuals with moderately severe loss need speech to be loud and difficulty hearing with background noise and in groups. E.g. vacuum cleaner and conversation in restaurant and offices. Children experience difficulties with language and skill development.

Severe hearing loss (71 to 90dB): Persons with severe hearing loss will benefit from hearing aids. They may also need to reply on lip reading and the use of sign language. They cannot hear normal speech and sometimes difficulty with loud speech. E.g. train at 50 feet, food processor, alarm clock, passing trucks. Children require hearing loss habilitation and assistance of a speech therapist.

Profound hearing loss (above 90dB): People who have profound hearing loss will find listening incredibly difficult and are most likely to reply on lip reading or sign language. Difficulty with very loud speech and sometimes cannot hear loud speech. E.g. air craft landing, noise in a train, rock music live, running wipes. Children require hearing habilitation and speech therapy.

MOTOR DEVELOPMENT IN EARLY CHILDHOOD

MOTOR DEVELOPMENT IN EARLY CHILDHOOD

(6-11) YEARS OF AGE

6-11 years old coming out of their classes after school is over? Yes you are Right! Some of them would be running, others would be skipping and still others leaping on to narrow edges and balancing themselves. The children are learning to coordinator their muscle for different types of movements. The body had two types of muscles, namely the large muscles such as those of legs, arms, back etc. and the small muscles or fine muscles such as those in the fingers, toes etc.

Muscle coordination is of two types: (Fine or Gross)

The movements of fine (small) muscles is called fine motor muscular coordinator while the movement of large muscle is called gross motor muscular coordinator. Activities such as running, balancing, skipping, climbing etc.

Gross muscular coordination

Motor skill are action that involves that the movement of muscles in the body. They are divided into two groups. Gross motor skills develop over a relatively short period of time. Most development occurs during childhood. E.g. crawling, running, jumping.

Fine motor skills

AS the child grow older greater proficiency over fine movement is gained. This is the period which involves fine motor coordination can be taught to the child such as writing, needle work, painting etc. It is known from experience that children learn to walk run, jump, kick etc. before they learn to feed themselves or write.

It means that gross motor muscular coordination is learnt before fine muscle coordination. From 6-11 years, the handwriting gradually improves i.e. it becomes better and faster. Children in the age group between 6-11 years learn maximum number of different activities. They play different types of games.

Activities and skills from 6-11 years

·         Throw a ball at an estimated distance.

·         Catch the ball

·         Balance on one feet

·         Jump at a good height

·         Skip with two legs

DISORDER OF PHYSICAL DEVELOPMENT DURING

(6-11) YEARS OF AGE

Some of the disorders that arise in children could be due to physical illness, fall, injuries and accidents etc. Some of the disorders are Genetic, while some are acquired. Did this order that are obtained during this period are given below: (ADD) Attention Deficit Disorder.

·         Hyperactive

o   Children with this disorder are distractible, impulsive, irritable, moody, slow in learning and in attentive, physically such as children tend to move from one side to another and are constantly diverted by sounds and objects. They are chaotic in their behaviour and tends to forget what they are told to do, cannot do sequentially ordered tasks.

·         Hypoactive

o   Children with disorder show less than normal activity levels and excessive day learning. They may be quite and understanding in their behaviour but may not be able to attend to specific tasks.

·         Execution of motor skills

o   Children at this age show wide range of individual differences in the execution of motor skills and in their ability to masters, complex motor tasks. They show improvement in gross motor skills reflected in increased speed, power, coordination, agility and balance. These children appear to be always in a hurry. They also show intense interest in acquiring and improving these skills.

o   As for disorder in regards to these aspects they may have certain congenital or acquired deficits in motor skills and activities. Many may not be able to show coordination or fine motor skills due to deficiency or abnormality in their physique. Sometimes high fever and many physical illness may keep the children of from many of these activities and when they do recover, they may not be able to equal their peers and thus feel unhappy.

·         Fail to close attention to details leading to careless mistakes

·         Avoiding task that require strenuous activity

·         Having difficulty in organizing task

·         Easily destructed by extraneous activity

·         Fidgets and squirms in seat

·         Forgetting schedule for daily activities

·         Loosing material that is necessary for the task they need to complete

·         Having difficulty in listening and what is being said

·         Having difficulty sustaining attention to task or to play activities

·         Leave desk or seat in the classroom inappropriate time

·         Talk excessively

·         Run or climb in situation when it is inappropriate

·         Avoid engaging in quite leisure activities

·         Displays difficulty waiting in lines and taking turn

Interrupting into conversation or other peoples gain and intruding on others 

Hearing Aid

Ayush Speech and Hearing Clinic provides above facilities in different cities- Ludhiana, Jalandhar, Jagraon, Punjab are committed to provide world class hearing care and speech therapy to our valued customers life is miserable and impaired without the power to experience sounds and calls so we of her all types of hearing aids with a wide range of product. you can also aspect the best from our special speech therapist that will heal you with the best treatment.We have  made a name in the industry as one of the most patient-centric services.

Different types of hearing aid

Hearing Aid: A Hearing Aid is a electronic device that you wear In or Behind your ear. Hearing Aids are sound amplification device for those who have hearing impairment. It helps to make sound louder so that a person with hearing loss can listen, communicate and share knowledge or information between each other.

BTE (Behind the Ear) Hearing Aid: There is a small piece that sits behind your ear with a slim tube that goes into your ear.

Advantages:

·         Versatile (Suitable to all types of hearing loss)

·         Easier to clean

·         Affordable to price

·         Long term battery life

·         Easy to wear

RIC (Receiver in the Canal): RIC is a type of open fit hearing aid that use a thin plastic tube that extends from the body of the hearing aid over the outer ear and into the ear canal.

Advantages:

·         No plugged up feelings

·         Small in size

·         Minimize sounds of your own voice

·         Invisible tubing

·         Large batteries for longer batter life

CIC (Complete in the Canal): CIC is a type of hearing aid that is so small that is fits into the ear canal. It has the advantage that is usually less visible as compared to BTE and RIC.

Advantages:

·         Invisible (less visible)

·         Custom made shell

·         Receiver and wax protection system

·         Vent

·         Right and left indicator

·         Protected Microphone

IIC (Invisible in the Canal): IIC are very smallest custom hearing 

aids. IIC is a hearing aid that fit the portion of your ear canal, within a 

few millimetre of your ear drum.

Advantages:

·         Invisible appearance

·         Help with using telephone

·         Vent

·         Right and left indicator

·         Protected Microphone

·         Receiver and wax protection system