Re: Inexpensive hearing aids (Barbara Reynolds )


Subject: Re: Inexpensive hearing aids
From:    Barbara Reynolds  <br_auditory(at)HOTMAIL.COM>
Date:    Sun, 28 Mar 2004 19:01:34 -0600

<html><div style='background-color:'><DIV class=RTE> <P>True, I have that abstract as well.&nbsp; But according to Sinha, U.; Hollen, K.M.; Rodriguez, R. &amp; Miller, C.A.: Auditory system degeneration in Alzheimer's disease.&nbsp; Neurology 1993;43: 779-785<BR></P> <P>1)&nbsp; Senile plaques and NFTs were distrubuted throughtout the ventral nucleus of the medial geniculate body and central nucleus of the inferior colliculus in 9 of 9 AD patients.&nbsp; 2)&nbsp; Adjacent nuclei within the MGB and IC were consistently spared.&nbsp; 3)&nbsp; NFT and SP were also present in the primary auditory and auditory association cortices.&nbsp; 3)&nbsp; IN all control tissues, there were neither SP nor NFTs in any of the above sites.&nbsp; 4)&nbsp; The cochlear nuclei were normal in tissues from both AD and controls.&nbsp; 5)&nbsp; The MGBv is the majro thalamic relay for the AI function and receives fibers from neurons of the central nucleus of the IC, with projections arranged tonotopically in a lamianar pattern corresponding to a dradient of high-to-low frequency ranges.&nbsp; 6)&nbsp; IN contrast, the clnical features of presbycusis in ellderly include only high-frequency loss due to lesion peripherally.&nbsp; 7)&nbsp; These changes in the brain! s of AD patients may provide an additional basis for altered cognitive function due ot primary sensory deafferentation<BR></P> <P>This may or may not affect peripheral hearing loss.&nbsp; Since the inferior colliculus is a major relay station both afferently and efferently auditory perception can be affected at the central level.</P> <P>In addition, to support my stance of increased ability through stimulation, see:&nbsp; Inglis, F.M. &amp; Fibiger, H.C.: Increases in hippocampal and frontal cortical acetylcholine release associated with presentation of sensory stimuli, Neurosci 1995;66: 81-86</P> <P>1)&nbsp; Rats: hippocampal probes: auditory, visual, olfactory and tactile stimuli.&nbsp; 2)&nbsp; All stimuli increased acetylcholine release in hippocampus and cortex.&nbsp; 3) Reached significance:&nbsp; hippo: all except olfactory stimulation.&nbsp; \&nbsp; Frontal:&nbsp; all except visual.&nbsp; 4)&nbsp; NO differences in amount of release in hippocampus between 3 stimuli.&nbsp; 5)&nbsp; Tactile responses resulted in the highes ACh release in the frontal.&nbsp; 7)&nbsp; Affects attentional systems mediated by frontal cortex or memory encoding by hippocampus.\</P> <P>These are my notes on the articles,&nbsp; Please excuse spelling errors or short hand.&nbsp; There are numerous other articles that deal specifically with hearing loss, but more on the central auditory system and neurotransmission</P> <P>see also&nbsp; Thiel, C.M. Friston, K.J. &amp; Dolan, R.J.:&nbsp; Cholinergic Modulation of Experience-Dependent Plasticity in Human Auditory Cortex&nbsp; Neuron 2002;35: 567-574<BR></P> <P>There's also the Uhlmann article in JAMA of 1989.</P> <P>I'll work on your specific questions when I can print them out.&nbsp; My printer is screwed up right now.&nbsp; Sorry<BR><BR><BR></P></DIV> <DIV></DIV>&gt;From: "Ward Drennan" &lt;wdrennan(at)umich.edu&gt; <DIV></DIV>&gt;Reply-To: wdrennan(at)umich.edu <DIV></DIV>&gt;To: "Barbara Reynolds" &lt;br_auditory(at)hotmail.com&gt; <DIV></DIV>&gt;Subject: Re: Inexpensive hearing aids <DIV></DIV>&gt;Date: Sun, 28 Mar 2004 00:19:20 -0500 (EST) <DIV></DIV>&gt; <DIV></DIV>&gt;I just found somethings relevant to your comments on medline. It's going <DIV></DIV>&gt;to be hard to take a close look at this first one seeing as the text is in <DIV></DIV>&gt;Chinese. I think you've already referred to the 2nd. <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;Zhonghua Er Bi Yan Hou Ke Za Zhi. 2003 Jun;38(3):198-201.&nbsp;&nbsp;Related <DIV></DIV>&gt;Articles, Links <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;[Hearing impairment in senile dementia of Alzheimer's type] <DIV></DIV>&gt; <DIV></DIV>&gt;[Article in Chinese] <DIV></DIV>&gt; <DIV></DIV>&gt;Wang NY, Yang HJ, Su JF, Kong F, Zhang MX, Yan B, Dong HQ, Zhang XQ, Jia <DIV></DIV>&gt;JP, Han DM. <DIV></DIV>&gt; <DIV></DIV>&gt;Department of Otorhinolaryngology, Capital University of Medical Sciences, <DIV></DIV>&gt;Beijing 100053, China. wny(at)sohu.com <DIV></DIV>&gt; <DIV></DIV>&gt;OBJECTIVE: To evaluate the pure tone hearing threshold and word <DIV></DIV>&gt;recognition score of senile dementia of the Alzheimer's disease (AD) <DIV></DIV>&gt;patients, and to analyze the relationship between hearing loss and the <DIV></DIV>&gt;cognition impairment. METHODS: Pure tone audiometry, word recognition <DIV></DIV>&gt;score (WRS), acoustic immittance and auditory brainstem response (ABR) are <DIV></DIV>&gt;used to evaluate the auditory function of 43 patients with AD and 50 <DIV></DIV>&gt;subjects of the control group. The confounding factors are controlled. <DIV></DIV>&gt;RESULTS: The average age of 43 dementia patients was 72.7 +/- 6.4, and <DIV></DIV>&gt;69.7% was female. Bilateral hearing thresholds are similar in all <DIV></DIV>&gt;subjects. All indices but Mini-mental scale of equastionnaire (MMSE) of <DIV></DIV>&gt;patients and control group were not statistically different. There was no <DIV></DIV>&gt;significant difference in pure tone audiometry (PTA), PTA2 (dB HL, mean <DIV></DIV>&gt;+/- s) and WRS (%, mean +/- s) between the two groups (P &gt; 0.05), <DIV></DIV>&gt;therefore the hearing threshold of AD group (PTA = 26.3 +/- 8.5, PTA2 = <DIV></DIV>&gt;29.1 +/- 8.7, WRS = 85.5 +/- 15.5) is lower than that of control group <DIV></DIV>&gt;(PTA = 23.2 +/- 10.6, PTA2 = 26.2 +/- 11.8, WRS = 87.6 +/- 16.8). No <DIV></DIV>&gt;significant difference was found between the two groups in audiometry <DIV></DIV>&gt;reliability, acoustic immittance and ABR (P &lt; 0.05). CONCLUSION: No <DIV></DIV>&gt;significant difference was found between the peripheral hearing <DIV></DIV>&gt;dysfunction of AD patients and that normal elderly people, i.e., PTA, PTA2 <DIV></DIV>&gt;and WRS were not related to MMSE. <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;&nbsp;&nbsp;Age Ageing. 2003 Mar;32(2):189-93.&nbsp;&nbsp;Related Articles, Links <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;The effects of improving hearing in dementia. <DIV></DIV>&gt; <DIV></DIV>&gt;Allen NH, Burns A, Newton V, Hickson F, Ramsden R, Rogers J, Butler S, <DIV></DIV>&gt;Thistlewaite G, Morris J. <DIV></DIV>&gt; <DIV></DIV>&gt;York House, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, <DIV></DIV>&gt;UK. hallen(at)psy.cmht.nwest.nhs.uk <DIV></DIV>&gt; <DIV></DIV>&gt;BACKGROUND: audiological function is impaired in people with dementia and <DIV></DIV>&gt;poor hearing is known to exaggerate the effects of cognitive deficits. <DIV></DIV>&gt;OBJECTIVE: the objective of this study was to assess the effects of <DIV></DIV>&gt;increasing auditory acuity by providing hearing aids to subjects with <DIV></DIV>&gt;dementia who have mild hearing loss. METHOD: subjects were screened for <DIV></DIV>&gt;hearing impairment and fitted with a hearing aid according to standard <DIV></DIV>&gt;clinical practice. Measures of cognition and psychiatric symptoms, <DIV></DIV>&gt;activities of daily living, and burden on carers were made over 6 months. <DIV></DIV>&gt;Hearing aid diaries were kept to record the acceptability of the hearing <DIV></DIV>&gt;aids to the subjects. RESULTS: more than 10% of eligible subjects were <DIV></DIV>&gt;excluded as removal of wax restored hearing. Subjects showed a decline in <DIV></DIV>&gt;cognitive function, no change in behavioural or psychiatric symptoms over <DIV></DIV>&gt;the study period. Forty-two percent of subjects showed an improvement on <DIV></DIV>&gt;an independently rated measure of change. The hearing aids were well <DIV></DIV>&gt;accepted. Both carers and subjects reported overall reduction in <DIV></DIV>&gt;disability from hearing impairment. CONCLUSIONS: all patients with hearing <DIV></DIV>&gt;impairment require thorough examination. The presence of dementia should <DIV></DIV>&gt;not preclude assessment for a hearing aid as they are well tolerated and <DIV></DIV>&gt;reduce disability caused by hearing impairment. Hearing aids do not <DIV></DIV>&gt;improve cognitive function or reduce behavioural or psychiatric symptoms. <DIV></DIV>&gt;There is evidence that patients improved on global measures of change. <DIV></DIV>&gt; <DIV></DIV>&gt;PMID: 12615563 [PubMed - indexed for MEDLINE] <DIV></DIV>&gt; <DIV></DIV>&gt;-------------------------------------------------------------------------------- <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;2: Lakartidningen. 2001 Jun 6;98(23):2802-6.&nbsp;&nbsp;Related Articles, Links <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;[Presbyacusis--hearing loss in old age] <DIV></DIV>&gt; <DIV></DIV>&gt;[Article in Swedish] <DIV></DIV>&gt; <DIV></DIV>&gt;Rosenhall U. <DIV></DIV>&gt; <DIV></DIV>&gt;Horselkliniken, Karolinska sjukhuset/institutionen for klinisk <DIV></DIV>&gt;neurovetenskap, Karolinska institutet, Stockholm. ulf.rosenhall(at)ks.se <DIV></DIV>&gt; <DIV></DIV>&gt;Presbyacusis is a very common type of hearing loss, often having profound <DIV></DIV>&gt;effects on the quality of life in old age. Since the number of elderly <DIV></DIV>&gt;persons is increasing, the incidence of presbyacusis is also expected to <DIV></DIV>&gt;increase in the future. Presbyacusis is caused by cochlear degeneration, <DIV></DIV>&gt;most pronounced in the basal cochlear coil. The most common audiometric <DIV></DIV>&gt;configuration is a gently sloping audiogram, above all affecting the high <DIV></DIV>&gt;frequencies. Efforts to improve auditory communication in old age are <DIV></DIV>&gt;important, and can be expected to result in improved quality of life for <DIV></DIV>&gt;elderly persons and in more efficient use of public resources. The <DIV></DIV>&gt;alleviation of age-related hearing handicap includes aural rehabilitation <DIV></DIV>&gt;with hearing aid fitting and training programs, specially designed for <DIV></DIV>&gt;elderly people. Hearing loss is often combined with other handicaps, such <DIV></DIV>&gt;as dementia, immobility and poor vision. The synergistic effects of <DIV></DIV>&gt;multiple handicaps can be extensive. Prevention is an issue which is both <DIV></DIV>&gt;challenging and problematic. The most important preventive measure is <DIV></DIV>&gt;noise reduction, which must start early in life and not shortly before <DIV></DIV>&gt;retirement. Inner ear treatment programs, currently under development, <DIV></DIV>&gt;might possibly be suitable for treatment of inner ear disorders in the <DIV></DIV>&gt;future. Considerable gains can be achieved with respect to resources both <DIV></DIV>&gt;human and economical through rehabilitation and suitable preventive <DIV></DIV>&gt;measures. <DIV></DIV>&gt; <DIV></DIV>&gt;Publication Types: <DIV></DIV>&gt;Review <DIV></DIV>&gt;Review, Tutorial <DIV></DIV>&gt; <DIV></DIV>&gt;PMID: 11462274 [PubMed - indexed for MEDLINE] <DIV></DIV>&gt; <DIV></DIV>&gt;-------------------------------------------------------------------------------- <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;3: Can J Psychiatry. 1999 May;44(4):393-4.&nbsp;&nbsp;Related Articles, Links <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;Deafness mistaken for dementia. <DIV></DIV>&gt; <DIV></DIV>&gt;Jalbert M, Primeau F. <DIV></DIV>&gt; <DIV></DIV>&gt;Publication Types: <DIV></DIV>&gt;Case Reports <DIV></DIV>&gt;Letter <DIV></DIV>&gt; <DIV></DIV>&gt;PMID: 10332584 [PubMed - indexed for MEDLINE] <DIV></DIV>&gt; <DIV></DIV>&gt;-------------------------------------------------------------------------------- <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;4: West J Med. 1997 Oct;167(4):247-52.&nbsp;&nbsp;Related Articles, Links <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;Hear ye? Hear ye! Successful auditory aging. <DIV></DIV>&gt; <DIV></DIV>&gt;Gates GA, Rees TS. <DIV></DIV>&gt; <DIV></DIV>&gt;Department of Otolaryngology-Head and Neck Surgery, University of <DIV></DIV>&gt;Washington School of Medicine, Seattle 98195-7923, USA. <DIV></DIV>&gt; <DIV></DIV>&gt;Age-related hearing loss (presbycusis) is a multifactorial process that <DIV></DIV>&gt;affects nearly all people in their senior years. Most cases are due to a <DIV></DIV>&gt;loss of cochlear hair cell function and are well mediated by communication <DIV></DIV>&gt;courtesy and modern amplification technology. Severe hearing loss is <DIV></DIV>&gt;generally due to cochlear problems or age-related diseases and may require <DIV></DIV>&gt;speech reading, assistive listening devices, and cochlear implants, <DIV></DIV>&gt;depending on the degree of loss. Presbycusis may seriously impair <DIV></DIV>&gt;communication and contribute to isolation, depression, and possibly <DIV></DIV>&gt;dementia. Accurate diagnosis and prompt remediation are widely available <DIV></DIV>&gt;but are frequently underused. Geriatric health care and well-being is <DIV></DIV>&gt;enhanced by the detection and remediation of communication disorders. <DIV></DIV>&gt; <DIV></DIV>&gt;Publication Types: <DIV></DIV>&gt;Review <DIV></DIV>&gt;Review Literature <DIV></DIV>&gt; <DIV></DIV>&gt;PMID: 9348755 [PubMed - indexed for MEDLINE] <DIV></DIV>&gt; <DIV></DIV>&gt;-------------------------------------------------------------------------------- <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;5: Biol Psychiatry. 1995 Nov 15;38(10):649-58.&nbsp;&nbsp;Related Articles, Links <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;Age at onset of geriatric depression and sensorineural hearing deficits. <DIV></DIV>&gt; <DIV></DIV>&gt;Kalayam B, Meyers BS, Kakuma T, Alexopoulos GS, Young RC, Solomon S, <DIV></DIV>&gt;Shotland R, Nambudiri D, Goldsmith D. <DIV></DIV>&gt; <DIV></DIV>&gt;Department of Psychiatry, Cornell University Medical College, New York, NY. <DIV></DIV>&gt; <DIV></DIV>&gt;Comorbidity of sensorineural hearing deficits and both depressive states <DIV></DIV>&gt;and dementia in late life provided the rationale for this investigation. <DIV></DIV>&gt;Cognitively intact geriatric major depressives (n = 43) were assessed for <DIV></DIV>&gt;depressive symptoms, cognitive performance, and delusions while <DIV></DIV>&gt;symptomatic, and following treatment, when audiometry was performed. <DIV></DIV>&gt;Late-onset depressed patients (LOD) had more hearing deficits compared to <DIV></DIV>&gt;early-onset depressives (EOD). Age at onset of depression was found to <DIV></DIV>&gt;have a significant effect on Pure-Tone Thresholds for 0.5-4.0 kHz and on <DIV></DIV>&gt;Word Recognition in Noise in the better ear (0.001 &lt; p &lt; 0.031; ANCOVA). <DIV></DIV>&gt;Criteria for neural deficit were met more frequently in LODs compared to <DIV></DIV>&gt;EODs, although this was attributable to the older age of LOD. Additional <DIV></DIV>&gt;investigations can contribute to our understanding of the relationship <DIV></DIV>&gt;between forms of hearing loss and both the course of geriatric depression <DIV></DIV>&gt;and its relationship to dementia. <DIV></DIV>&gt; <DIV></DIV>&gt;PMID: 8555376 [PubMed - indexed for MEDLINE] <DIV></DIV>&gt; <DIV></DIV>&gt;-------------------------------------------------------------------------------- <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;6: Arch Neurol. 1995 Jun;52(6):626-34.&nbsp;&nbsp;Related Articles, Links <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;Auditory dysfunction in aging and senile dementia of the Alzheimer's type. <DIV></DIV>&gt; <DIV></DIV>&gt;Gates GA, Karzon RK, Garcia P, Peterein J, Storandt M, Morris JC, Miller JP. <DIV></DIV>&gt; <DIV></DIV>&gt;Virginia Merrill Bloedel Hearing Research Center, Department of <DIV></DIV>&gt;Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, <DIV></DIV>&gt;USA. <DIV></DIV>&gt; <DIV></DIV>&gt;OBJECTIVE: To determine the prevalence and type of auditory dysfunction in <DIV></DIV>&gt;older volunteer subjects with mild probable Alzheimer's disease (pAD). <DIV></DIV>&gt;METHODS: Pure-tone thresholds, word recognition in quiet, Synthetic <DIV></DIV>&gt;Sentence Identification with Ipsilateral Competing Message or <DIV></DIV>&gt;Contralateral Competing Message, distortion-product otoacoustic emissions, <DIV></DIV>&gt;and auditory brain-stem responses were done in 82 elderly volunteer <DIV></DIV>&gt;subjects whose cognitive, psychologic, and neurologic status had been <DIV></DIV>&gt;determined through annual testing in a research center. Based on clinical <DIV></DIV>&gt;criteria and the Clinical Dementia Rating (CDR) scale, 40 subjects had <DIV></DIV>&gt;been judged to be nondemented (CDR score, 0), and 42 had a clinical <DIV></DIV>&gt;diagnosis of pAD, with 22 in the questionable (CDR score, 0.5) and 20 in <DIV></DIV>&gt;the mild (CDR score, 1) categories. RESULTS: The mean age-adjusted <DIV></DIV>&gt;pure-tone average thresholds (0.5, 1.0, and 2.0 kHz) were poorer in the <DIV></DIV>&gt;subjects with pAD by 5.1 dB in the right ears and 6.1 dB in the left ears; <DIV></DIV>&gt;these differences were not statistically significant. Word recognition in <DIV></DIV>&gt;quiet did not differ by CDR category. The age-adjusted scores on the <DIV></DIV>&gt;Synthetic Sentence Identification with Ipsilateral Competing Message or <DIV></DIV>&gt;Contralateral Competing Message were significantly reduced in the subjects <DIV></DIV>&gt;with mild pAD. Distortion-product otoacoustic emission amplitudes and <DIV></DIV>&gt;auditory brain-stem response thresholds and latencies paralleled the <DIV></DIV>&gt;pure-tone threshold results and did not differ across the CDR groups. <DIV></DIV>&gt;CONCLUSIONS: Central auditory dysfunction was evident in subjects with <DIV></DIV>&gt;even mild cases of pAD, whereas peripheral auditory function was not <DIV></DIV>&gt;different from that in age-matched control subjects. Additional research <DIV></DIV>&gt;is needed to delineate the mechanisms of central auditory dysfunction and <DIV></DIV>&gt;to establish the sensitivity and specificity of auditory testing in <DIV></DIV>&gt;subjects with Alzheimer's disease. We recommend auditory assessment, <DIV></DIV>&gt;including Synthetic Sentence Identification with Ipsilateral Competing <DIV></DIV>&gt;Message or Contralateral Competing Message, for older patients in general <DIV></DIV>&gt;and in particular for those in whom dementia is suspected. <DIV></DIV>&gt; <DIV></DIV>&gt;PMID: 7763213 [PubMed - indexed for MEDLINE] <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt; &gt; I just read the piece on Mead Killion's idea of inexpensive hearing aids. <DIV></DIV>&gt; &gt; Hearing aids are not just something to slap in your ears and off you go. <DIV></DIV>&gt; &gt; There are a myriad of considerations to take into account when not only <DIV></DIV>&gt; &gt; choosing the setting during the first fitting, but the follow up care. <DIV></DIV>&gt; &gt; This is largely due to the plasticity of the auditory system and the <DIV></DIV>&gt; &gt; absolute need for the Audiology, Dispensing, Manufacturing and other <DIV></DIV>&gt; &gt; related medical fields to go beyond hearing aids as a simple correction. <DIV></DIV>&gt; &gt; <DIV></DIV>&gt; &gt; Auditory neuroscience has been my specialty for the last 6 1/2 years. <DIV></DIV>&gt; &gt; It's taken me a long time to amass the amount of journal articles (3400) <DIV></DIV>&gt; &gt; among multidisciplinary fields of medical science to be able to fit <DIV></DIV>&gt; &gt; successfully those patients that range from mild to severe hearing losses. <DIV></DIV>&gt; &gt;&nbsp;&nbsp;Considerations such as their current and past medical or developmental <DIV></DIV>&gt; &gt; history is of utmost importance if I am to be successful at fitting the <DIV></DIV>&gt; &gt; hearing aids during the first 6 months that match the initial auditory <DIV></DIV>&gt; &gt; system capability and to keep pace with the neurophysiological changes <DIV></DIV>&gt; &gt; that occur through stimulation and rehabilitation <DIV></DIV>&gt; &gt; <DIV></DIV>&gt; &gt; For example, if I have a patient with panic and anxiety disorders and a <DIV></DIV>&gt; &gt; patient who is a professional musician, even though they may have the <DIV></DIV>&gt; &gt; exact same audiogram, their settings on the hearing aids will be <DIV></DIV>&gt; &gt; completely different including the type of hearing aid.&nbsp;&nbsp;The P and A will <DIV></DIV>&gt; &gt; be drastically below the expected settings and the PM will be above.&nbsp;&nbsp;This <DIV></DIV>&gt; &gt; is due to their specific neurophsyiology makeup that give substantial <DIV></DIV>&gt; &gt; control over his system in the musician and the lack of control in the <DIV></DIV>&gt; &gt; P&amp;A.&nbsp;&nbsp;The neuroanatomical differences in musicians vs. non-musicians <DIV></DIV>&gt; &gt; have been established numerous times.&nbsp;&nbsp;With a 25% greater response to <DIV></DIV>&gt; &gt; piano harmonics than pure tones, I need to try to match the hearing aids <DIV></DIV>&gt; &gt; to musical harmonics instead of the pure tones we use during testing. <DIV></DIV>&gt; &gt; Additionally, the counselling that would go into encouraging and <DIV></DIV>&gt; &gt; maintaining use of the hearing aid is also going to markedly different. <DIV></DIV>&gt; &gt; <DIV></DIV>&gt; &gt; An Alzheimer's patient and a Parkinson's patient's rehabilitation time is <DIV></DIV>&gt; &gt; going to be significantly longer than a normal healthy control due to the <DIV></DIV>&gt; &gt; depletion of Acetylcholine through the degenerative process of AD and the <DIV></DIV>&gt; &gt; anticholinergic medication of the PD patient.&nbsp;&nbsp;Acetylcholine is largely <DIV></DIV>&gt; &gt; responsible for auditory system plasticity during rehabilitation.&nbsp;&nbsp;A <DIV></DIV>&gt; &gt; decreased availability will extend the rehabilitation time and potentially <DIV></DIV>&gt; &gt; reduce the final recovery of function. <DIV></DIV>&gt; &gt; <DIV></DIV>&gt; &gt; I could go on and on about the different parameters that make hearing aid <DIV></DIV>&gt; &gt; fittings difficult for so called "easy" mild hearing losses.&nbsp;&nbsp;But I won't. <DIV></DIV>&gt; &gt;&nbsp;&nbsp;Suffice it to say, if more University programs would concentrate on the <DIV></DIV>&gt; &gt; neuroscience end of central auditory processing and the degenerative <DIV></DIV>&gt; &gt; processes as a result of a hearing loss (which can begin at 20dBHL with <DIV></DIV>&gt; &gt; the loss of GABA receptors creating more spontaneous activity, less <DIV></DIV>&gt; &gt; temporal resolution, less frequency resolution, less spatial acoustics, <DIV></DIV>&gt; &gt; etc.) Mr. Killion, with all due respect to his position in Audiology would <DIV></DIV>&gt; &gt; not be so quick to relegate hearing aids to the "over the counter reading <DIV></DIV>&gt; &gt; glasses" genre. <DIV></DIV>&gt; &gt; <DIV></DIV>&gt; &gt; Barbara Reynolds, M.S. <DIV></DIV>&gt; &gt; Clinical Audiologist FREE pop-up blocking with the new MSN Toolbar – get <DIV></DIV>&gt; &gt; it now! <DIV></DIV>&gt; &gt; <DIV></DIV>&gt; <DIV></DIV>&gt; <DIV></DIV>&gt;Ward R. Drennan, Ph. D. <DIV></DIV>&gt;Kresge Hearing Research Institute <DIV></DIV>&gt;Ann Arbor, MI 48109 <DIV></DIV>&gt;Phone: (734)763-5159 <DIV></DIV>&gt;Fax: (734)764-0014 <DIV></DIV></div><br clear=all><hr> <a href="http://g.msn.com/8HMBENUS/2737??PS=">Free up your inbox with MSN Hotmail Extra Storage. Multiple plans available.</a> </html>


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