Hearing Loss and Deafness 179Constant noise is a by- product of its power. Balers, which turn rows of alfalfa into neat bales, are
loud compressing and knot- tying contraptions. Hay choppers that pulverize the bales of hay into
powder for cattle consumption nearly deafen anyone within earshot. Many factors may be respon-
sible for Ivan’s significant hearing loss, but de cades of noise exposure are the prime culprit.
Like many persons suffering from gradual- onset hearing loss, Ivan denied it and engaged in
projection. In his early 60s, he started having difficulty understanding the speech of family and
friends. Because the higher frequencies in the speech range were most impaired early on, he had
par tic u lar difficulty understanding the speech of women and children and often complained that
they mumbled. As his hearing loss worsened progressively, he fi nally agreed to be tested for a
hearing aid.
During the test, Ivan observed the examination of his external ear canal and ear drum on
a video monitor. The audiologist performed a series of tests involving pure tones and pressure
changes in his ear. A tape recording of spondees, words with two syllables produced with equal
stress, was given to him, as were phonetically balanced words, to test his ability to receive and
discriminate speech. The evaluation was conducted in a soundproof booth, and toward the end of
testing, several aids were tried to determine which ones provided the best results.
The new digital hearing aids convert speech and environmental sounds into numbers and
modify them. The amplified sound is then fed into the person’s ears. Using them, Ivan was
impressed by his improved ability to understand speech. It took several months before he became
accustomed to them, and he was disappointed at their per for mance in environments with com-
peting noise. However, they gradually became a part of his life and improved his ability to com-
municate with his loved ones.
Case Study 9-4: Idiopathic Progressive Hearing Loss and
Cochlear Implant
“Toast,” as Ryan was nicknamed by his friends, started coming to the university speech and
hearing clinic in his early teens. The audiologists could not determine the cause of his rapidly
deteriorating hearing. Toast and his family took several trips to the Mayo Clinic in Rochester,
Minnesota, to be evaluated and diagnosed, but the specialists all described the origin of his hear-
ing loss the same way: idiopathic. There were many theories about why he was losing his hearing,
but no one knew for certain. In the end, the diagnosticians suspected that his inner ear was injured
due to his own body’s misguided immune reaction. For some reason, his body had attacked his
inner ear as foreign and in need of destruction. At the university speech and hearing clinic, in
addition to audiological diagnostic ser vices, Toast received aural rehabilitation, including speech
reading, in anticipation of deafness. He was also given behind- the- ear hearing aids.
Eventually Toast lost functional hearing, and his hearing aids were essentially useless. He was
diagnosed with bilateral profound sensorineural hearing loss, and when he turned 17, he met all of
the requirements for a cochlear implant. Fortunately, he was healthy, with no medical conditions
that would prohibit the surgery. Most impor tant, Toast and his family had realistic expectations