Binaural considerations for HA

Question 1

Shift from monaural fittings to bilateral around

Answer 1

1980-1990 due to more research evidence and technological advancements

Question 2

Binaural benefits

Answer 2

improve speech recognition, sound localization, and overall satisfaction, loudness summation, better SNR, enhanced spatial awareness, and redundancy in input

Question 3

brain processes input from both ears together to help detect sound location and clarity

Answer 3

At the superior olive

Question 4

Specialized brain cells respond to

Answer 4

timing and loudness differnce between the ear

Question 5

What two differences allow spatial hearing and are crucial for localizing sound sources and separating speech from background noise

Answer 5

interaural time differnces and interaural level differences

Question 6

Refers to the increased perceived loudness when a sound is presented to both ears simultaneously, compared to one ear alone. Supports improved detection of low-level sounds in binaural fittings.

Answer 6

binaural loudness summation

Question 7

The effect of binaural loudness summation is measurable at both threshold and suprathreshold levels—around

Answer 7

3 dB near threshold and 6 dB or more at higher levels.

Question 8

Binaural Loudness Summation-Benefits

Answer 8

reduce feedback, saturation distortions, allow larger venting, better freq and intensity discrimmination. Recommended for severe to profound HL

Question 9

refers to improved detection of a signal in noise when the phase or level of the signal and noise differs between ears

Answer 9

masking level difference (MLD)

Question 10

For speech, MLD can improve detection of monosyllabic words by as much

Answer 10

as 13 dB

Question 11

MLD magnitude depends on frequency and stimulus type—up to

Answer 11

15 dB at 250 Hz and about 3 dB above 2000 Hz

Question 12

True or false. MLD results the binaural system’s ability to use interaural time and level differences to separate the target signal from background noise.

Answer 12

true

Question 13

True or false. Clinically, MLD does not support advantage of binaural over monaural hearing aids in noisy environments, supporting better speech intelligibility.

Answer 13

false it does support

Question 14

The ability to determine where a sound is coming from in space, based on interaural intensity and phase differences.
These auditory cues allow normal-hearing individuals to detect azimuth differences as small as 1°and judge both distance and elevation of sound sources

Answer 14

localization

Question 15

true or false Individuals with HL may struggle with localization due to elevated thresholds, asymmetric hearing loss, or possible neural degeneration affecting binaural processing

Answer 15

true

Question 16

true or false Binaural hearing aids, especially custom styles with microphones near the concha-canal opening (ITE, ITC, CIC), can significantly reduce localization

Answer 16

false it reduces localization

Question 17

The reduction in sound intensity as it travels around the head, particularly affecting high-frequency sounds due to their shorter wavelengths.
The attenuation can be up to 15 dB at 4000 Hz, affecting perception of consonants, since they primarily occupy the high-frequency range.

Answer 17

head shadow

Question 18

what eliminates the head shadow effect

Answer 18

binaural amplification

Question 19

In humans, particularly children, studies confirm that adequate auditory stimulation between_____ is critical for the proper development of speech, language, and cognitive abilities

Answer 19

0 to 2 years

Question 20

who can benefit from binaural amp

Answer 20

all ages

Question 21

Failing to provide or recommend binaural amplification may be considered

Answer 21

malpractice

Question 22

involved an audiologist and otologist being sued by a patient who was not informed about the benefits of binaural amplification.

Answer 22

A notable case (Lowe, 1988)

Question 23

Over ___ of users report reduced tinnitus when a hearing aid is worn on the affected ear.

Answer 23

50%

Question 24

Patients with asymmetric hearing loss often report positive outcomes with binaural amplification, such as:

Answer 24

• Clearer and louder speech
• Comfortable, relaxed listening
• Better sound localization and spatial awareness

Question 25

The decision for binaural amplification should consider the individual’s

Answer 25

central auditory processing ability and their capacity for binaural fusion.

Question 26

If one ear is truly “dead” or fusion is not achieved, consider:

Answer 26

CROS, BiCROS, or Power-CROSsystems. Monaural aid on the ear with better speech recognition or sound quality.

Question 27

Candidacy criteria for other HA options

Answer 27

Patients with Profound Unilateral SNHL, other ear has normal to mild hearing loss through 4000 Hz

Question 28

is used for patients with unaidable hearing loss in one ear and normal hearing in the contralateral ear. The microphone on the unaidable ear transmits sound wirelessly to a receiver in the normal-hearing ear, improving access to sounds from the poorer side.

Answer 28

CROS (Contralateral Routing of Signal)

Question 29

appropriate for patients with unaidable hearing in one ear and a hearing loss in the better ear. The better ear’s device functions as both a receiver and an amplifier, providing amplification for both sides.

Answer 29

BiCROS systems

Question 30

These systems typically use wireless digital transmission and are most commonly fit using RIC or BTE instruments.

Answer 30

CROS/BiCROS

Question 31

Amplified sound delivered to bone vibrator worn on mastoid, bypassing middle ear. Stimulates cochlea directly through mechanical vibration rather than air conduction. An option for patients with medical conditions that preclude occluding the ear (e.g., atresia). Can achieve similar cochlear stimulation as air conduction HA even with significant CHL.

Answer 31

bone conduction HA

Question 32

Surgically implanted titanium screw transmits vibrations directly to skull. External processor is detachable. Provides stronger mechanical coupling than conventional bone conductionHA. Bilateral BAHAs may enhance localization and speech understanding via dichotic input.

Answer 32

bone anchored HA (BAHA)

Question 33

Transmits acoustic signal from profound SNHL side to normal hearing ear via vibrations picked up by the better cochlea. CROS strategy for unilateral hearing loss using bone conduction. High-gain ITE or CIC HA fitted on non-functional ear to transmit sound to good cochlea via bone vibrations. Pt wears one device

Answer 33

transcranial cros

Question 34

Implanted electronic devices placed in mastoid or middle ear space. Deliver vibratory energy directly to ossicles for amplification. Various experimental designs exist:stimulation of TM, ossicles, or round window. ` Designed for patients who can't tolerate traditional HAs or need advanced solutions.

Answer 34

middle ear implants

Question 35

Shift high-frequency sounds into lower, more audible regions for the listener. Useful for corner audiograms where high-frequency residual hearing is absent. Provides audibility of speech cues but may not always improve intelligibility. Best suited for children or adults with limited high-frequency hearing.

Answer 35

freq transposition HA