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This is a presentation
from LiveTextAccess:

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Training for real-time
intralingual subtitlers.

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This presentation is from the Unit 1:
Understanding accessibility.

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The target users and their needs is
the topic for this presentation

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under Element 2.

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The overall topic of this presentation
is hearing and hearing loss.

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This material has been created by EFHOH,
SDI München and SUBTI-Access.

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My name is Aïda Regel Poulsen.

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I represent European Federation
of Hard of Hearing – EFHOH.

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I am the secretary of EFHOH,
and I have a hearing loss.

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I use hearing aids.

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I am also an educated teacher,
a teacher of the deaf,

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and a trained educational audiologist.

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I have worked as a hearing consultant
for school children with hearing loss

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included in local school settings
nationwide in Denmark

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for a great number of years.

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I retired since March 1st 2020.

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The learning outcomes
of this video lecture are:

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explain how hearing works,

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describe how hearing loss may occur,

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and to illustrate how hearing loss
relates to the needs of users

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of real-time intralingual subtitles.

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Firstly, we will look into
how hearing works.

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Then we will discuss
what hearing loss is.

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After that, we will discuss
some terminology issues

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before concluding the video lecture.

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Let´s take a look at the human ear
and how it functions.

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Sounds move around in the air
like waves.

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Sound waves.

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They hit the outer ear (the pinna),

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and if you look at each others’ ears,

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you will notice, your ears are similar
and still different.

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They shape differently.

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This means, that outer ear
and its curves lead the sound waves

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into the ear but the curves differ
between you

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and somehow we hear differently.

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Also related acoustics
in the room of course,

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but that is a different matter just now.

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The sound waves are led
into the ear canal.

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Children’s ear canals are smaller,
more narrow than adults’ are.

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But also ear canals between adults vary.

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The sound needs a certain space to let
the sound waves move smoothly

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in through the ear canal.

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This matters to how the sound sounds.

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If there is wax in the ear canal,
this will block for the sound

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and the sound waves will not have
the room and space they need.

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Also if there is an infection in the ear
and the ear canal is swollen,

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this will change the route
of the sound waves.

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In through the ear canal,
the sound waves travel

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and hit the ear drum.

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The sound waves literally hit
the ear drum as we tap or hit a drum.

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The ear drum as the skin
on the drum will move

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and activate three little bones

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(malleus, incus and stapes)

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in the middle ear.

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If there is a cold with infection
and/or fluid in the middle ear

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where the three little bones are situated,

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this will limit the movements
of these little bones

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and this will change
and lower the hearing.

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All this is in the conductive part
of the ear.

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The conductive part of the hearing.

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The stapes, one of the little bones,
is attached to a small oval window

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which links middle ear to the cochlear,
and we are now in the inner ear.

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In cochlear there are two canals
filled with fluid.

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And the sound waves are
now transmitted to waves in fluid,

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like in the water,

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by the stapes moving rapidly.

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In each of these two canals
there are hair cells.

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When the fluid is being put into motion,

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it makes the hair cells move
just like sea grass in a stream.

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The hair cells grow on the inner side
of these two canals

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and when they are being moved,
waved,

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they send electric impulses
to the auditory nerve

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and the brain receives
the sounds and the messages.

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Notice the movements in the cochlea,

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where high frequency hair cells are
in the opening of the cochlea

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and low frequency up
in the top of the cochlea.

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This is just like an organ:

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short pipes,
high frequencies (the treble),

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long organ pipes,
low frequencies (the bass).

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This is basically how we hear.

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The hair cells can be broken,
damaged, or gradually degenerating

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and it is not yet possible
to restore them.

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But cochlear implants,
where an electrode is implanted in cochlea,

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can to some extend replace
the hair cells

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and send the electric impulses
to the auditory nerve

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and the person can learn to hear.

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And now to what hearing loss may occur as.

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Hearing loss differ.

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Persons with hearing loss are affected
in different ways by their hearing loss.

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Hearing loss is often measured
in an audiogram.

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In the audiogram, it will show how much
of the hearing has been lost

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in the different frequency areas.

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Also, hearing loss can be caused
by different things.

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It can be genetic inherited.

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It may be caused by
and damaged in an accident.

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It can be caused by some illness,
or the medication needed in treatment,

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known in meningitis and cancer,
for instance.

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It can be caused by repeatedly colds
and middle ear infections.

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It can also be caused by noise,
of course.

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Hearing difficulties can also be caused
by difficulties in the auditory pathways

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in the brain.

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This may show an audiogram
with no measureable hearing loss

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but the person can still have problems
with directional hearing

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and to discriminate sounds and speech.

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Tinitus is also a well known diagnosis,
which can be caused from different things

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and also sound different according
to what has caused it.

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Hearing loss are different

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and they are defined from the audiogram
into 4 major categories.

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One is mild.

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The second is moderate.

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Then there is severe,
and then profound hearing loss.

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Hearing aids can be prescribed
according to what the need is.

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And this is what we use
the audiograms for.

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But it is also possible to have,
for instance, a mild hearing loss

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in the low frequency area,

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and a severe hearing loss
in the high frequencies.

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Furthermore,
the audiogram is seldom enough.

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Tests need to be done as to find out

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how the auditory pathways
in the brain work.

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It is also important to know
if the person suffers

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from other illnesses.

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Some can be directly linked
to developing hearing loss.

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This is technically
how an audiogram looks

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and we should also look here
to the dynamic range in hearing.

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On the top, the horizontal line,
we have the Hertz,

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the frequencies.

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And the lower frequencies go down
to 250 Hz.

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Via the middle frequencies
around 1000 Hz.

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And the higher frequencies
at 8000 Hz.

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This is where speech sounds are.

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Human ear hear further up
than 8000 Hz,

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but in the audiogram
we do not measure that.

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However, that is surrounding sounds
and they matter, of course.

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We use sounds for more than to talk
and to communicate.

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We navigate using sounds.

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This is the directional hearing.

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The Decibels are shown
on the vertical line.

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That is the volume of the sound.

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Any newborn with no hearing loss
will hear at 0 dB at all frequencies.

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Not just hear at 0 dB,

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but in the range between 0
to 120 dB.

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This is the dynamic range.

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Within the range of the 120 dB is
the total dynamic range

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for a typical hearing

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and we hear from near and far away.

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We also sense the mood of others
when they talk.

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This is how we sense our intonation.

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Any hearing loss will limit
the dynamic range.

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For adults we consider an audiogram
between 0 and 20 dB

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to be a typical threshold.

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This is because hearing aids
make a noise when they work

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and you cannot treat a hearing loss
of less than 20 dB.

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But it may affect the individual, though.

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The UCL means uncomfortable level.

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Even with hearing loss,

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the uncomfortable level may be
less than the 120 dB.

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Some people suffer hyperacousis.

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This speech banana is what
we rather use in educational audiology.

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It is easier to understand
for everybody else.

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Note also, that speech bananas vary.

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They vary from one country
and language to another.

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I am only showing you one
of the most used pictures

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of a speech banana.

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When you google “speech banana”,
you find many different versions.

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Notice in particular,
also the surrounding sounds

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from everyday life.

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Not just the speech sounds
that are in the banana.

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Everyday sounds give us
directional hearing,

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for instance in traffic.

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It reminds us on sounds
that are close to us and far from us,

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and come from left or the right side.

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This audiogram with the speech banana
goes down to 125 Hz.

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The audiograms showing people’s
hearing loss in this presentation

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only go down to 250 Hz.

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And I will explain to you how to read
the audiogram.

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The red line is the right ear,
and the blue line is the left ear.

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But often to save colour print
when we work,

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we get the audiograms
in black and white.

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So round dots mean right ear,
and the crosses mean the left ear.

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It is very important to differ
between the two ears.

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They don’t necessarily come out
with the same hearing, or audiogram.

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And also the two ears have different jobs
in hearing to do,

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related the hemispheres in the brain.

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None of the above audiograms
are age-related hearing loss.

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Most typical is high frequency loss.

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In the cochlea, high frequency hair cells
are right at the entrance of the cochlea,

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and all sounds pass through there.

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This is like the door mat
in your corridor.

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It gets worn out.

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Age-related hearing loss is also
typically high frequency loss.

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The typical audiogram used goes
from 250 Hz to 8000 Hz,

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which is the area where we also find
the speech sounds.

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But there are sounds below 250 Hz
as well as beyond 8000 Hz too.

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But audiological treatment
for people with hearing loss is a matter

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of enabling the person to pick up
speech sounds and understand speech.

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Note also that,
the hearing test is a screening.

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We do not test all the sounds,
individual Hz,

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or frequencies in the audiogram,
because it would take far too long

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for both the Hard of Hearing person,
as well as the audiologist.

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So we test typically from 250 Hz,
you can see the figures,

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up to 8000 Hz.

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Notice, please, on figure 1 and 2,
where there is a steep fall in the curve,

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for instance, from 2000 to 3000 Hz,

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that frequencies between 2 and 3 KHz
are being tested

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to find where exactly the difference occurs
and the curve gets a steeper fall.

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Figure 1 could indicate that the person
has been working with shooting.

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Military, or hunting.

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This damage to the ear is typical
to this population.

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Figure 2 could indicate lack
of oxygen during birth,

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where figure 3 and 4 could indicate
a genetic hearing loss.

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Figure 4, with the very flat curve,

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seems somehow easier
to treat audiologically,

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because it seems to be just a matter
of turning up the volume.

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But it is at the same time a moderate
to severe hearing loss.

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The steep curves in figure 1, 2 and 3
can cause some distortion.

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But there are other measures
to be taken as well,

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for instance, discrimination score,
DS, in short,

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and how well the person with hearing loss
discriminates words.

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The hearing can also be damaged
in the auditory pathways

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in the brain or the auditory nerve
that processes the sounds to the brain.

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To roughly decide
whether a person could be a candidate

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for cochlear implant (CI),
the audiogram must show

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a severe hearing loss,
as well as the discrimination score

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must show a score no better than 60%.

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But again there are more tests
to be done than just these two.

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The audiogram indicates
how the hearing aids should be tuned in,

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but the audiogram is, as described,
not at all enough.

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Different hearing aid brands give
the person with hearing loss

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different experience with sounds.

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In this way, it is just like buying shoes.

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You know which size you need,

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but the brands will fit you
in different ways.

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It can be necessary to try out
different types of hearing aids,

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as well as have them re-tuned
to make them fit better.

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Also the moulds,
or the domes in the ear canal

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play a very important role
in passing the sounds

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from the environment
through the auditory system

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up to the brain.

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Hearing aids use
different sizes of batteries

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depending on the size
of the hearing aid.

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This means that we cannot all just have
the smallest ones.

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We need to have the hearing aids
that support us best with the type

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and degree of hearing loss
each person has.

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And now to the terminology
in this presentation.

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There is “Hearing Loss”,
“to have a hearing loss”.

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And there are those who like
to identify themselves

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as “Hard of Hearing”.

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We are different: some like to be
a person with a hearing loss

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and others call themselves
Hard of Hearing.

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We have been through the audiogram.

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We have been through
Conductive Heaing Loss, shortly,

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and Sensorineural Heaing Loss,
which is in the inner ear.

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The decibel, and in short this is dB.

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And the Hertz, the frequencies,
and in short Hz.

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And we came around Discrimination Score,
which is shortened DS.

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Dynamic Range was mentioned,

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which helps understanding intonation,
for instance.

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Auditory pathways was mentioned.

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Auditory pathways are in the brain
processing the sounds.

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Then the speech banana
and the frequency of speech sounds.

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Then audiological treatment
like Hearing Aids, in short HA.

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Together with hearing aids,
we use moulds, that are in our ears,

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or domes,
for other types of hearing aids.

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And Cochlear Implant,
in short CI, was mentioned.

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CIs are for hearing loss that cannot be
sufficiently treated with hearing aids.

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And the summary of this presentation.

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This presentation has been about
how hearing works

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and what can harm a person’s hearing,

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this be in the ear or
in the auditory pathways in the brain.

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How to understand audiograms
and diagnoses in hearing loss,

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and briefly how a hearing loss
can be treated.

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And in order to learn more.

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There are no  exercises
with this presentation,

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but I like to draw your attention
to some more literature on this topic.

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Thank you for your attention.

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LTA - LiveTextAccess.

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00:17:19,202 --> 00:17:21,792
Universitat Autònoma de Barcelona.

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00:17:22,839 --> 00:17:26,157
SDI - Internationale Hochshule.

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00:17:27,005 --> 00:17:30,826
Scuola Superiore
per Mediatori Linguistici.

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00:17:31,799 --> 00:17:33,444
2DFDigital.

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00:17:34,509 --> 00:17:37,977
The European Federation
of Hard of Hearing People - EFHOH.

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VELOTYPE.

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SUB-TI ACCESS.

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00:17:43,265 --> 00:17:48,533
European Certification
and Qualification Association - ECQA.

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Co-funded by the Erasmus+ Programme
of the European Union.

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00:17:57,579 --> 00:18:11,593
Erasmus+ Project:
2018-1-DE01-KA203-004218.

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The information and views
set on this presentation

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are those of the authors
and do not necessarily reflect

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00:18:20,800 --> 00:18:24,142
the official opinion
of the European Union.

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00:18:24,890 --> 00:18:28,905
Neither the European Union institutions
and bodies

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00:18:28,905 --> 00:18:34,020
nor any person acting on their behalf
may be held responsible

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00:18:34,020 --> 00:18:38,650
for the use which may be made
of the information contained here.