The symptoms experienced by Anna are caused by the build up of fluid in the different components of the inner ear; the semicircular canals, utricle, saccule, and cochlea.The labyrinth contains the organs of balance which is the vestibular system and the cochlea. It comprises of two sections: the bony labyrinth and the membranous labyrinth. The membranous labyrinth is filled with endolymph, a fluid that stimulates receptors such as body movements. The receptors then transmits signals to the brain about the body’s position and movement. In the cochlea, the endolymph is compressed in reciprocation to sound vibrations which the stimulate sensory cells that are in charge of sending signals to the brain.With respect to Anna’s hearing condition, her common vertigo episodes, tinnitus and the feeling of blocked ears may be caused by the dysfunction of the balance organs in the inner ear which is the vestibular system in the inner ear. The most common cause of tinnitus is damage and loss of the tiny sensory hair cells in the cochlea of the inner ear. This tends to happen due to prolonged exposure to excessively loud noises and aging could be one of the causes.Therefore, she may have the Ménière’s disease which is one type of vestibular disorder that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. The vestibular membrane separates the endolymphatic chamber from the perilymphatic chamber. The fluid within the chambers are different and are kept at a stable equilibrium. However for unclear reasons patients with Ménière’s disease will start to suffer from excessive fluid buildup within the endolymphatic chamber causing the vestibular membrane to start stretching. When this happens symptoms of ear fullness and tinnitus occur. If enough fluid fills the endolymphatic chamber, the vestibular membrane will eventually rupture causing the fluids to mix resulting in the symptom ofspinning/dizziness which can be said as Vertigo.Over days the vestibular membrane will slowly heal back together and the fluid in the endolymphatic chambers and perilymphatic chambers will convert back to normal. Which results in normal hearing and balance.Speech Perception & UnderstandingBased on the audiograms that we have completed, we can conclude that Anna has a mild to severe sensorineural hearing loss in her left ear (better ear) and a moderately-severe to profound mixed hearing loss in her right ear (worse ear). The sensorineural hearing loss indicates damage in the cochlea and the balance organs in the inner ear. The mixed hearing loss includes both sensorineural hearing loss and conductive hearing loss which indicates the dysfunction of outer and middle ear. Speech perception will be affected mostly in crowded places. May not be able to hear high pitched sounds for example women and children voices which usually has a high pitch/frequency. Patients with this condition are also unable to differentiate between rising and falling pitches, due to reduced frequency selectivity. Apart from that, Anna’s perception of dynamic cues will also be affected. Due to her poor frequency selectivity, her gap detection threshold is worse, as compared to a person with normal hearing impairment. Hence, gaps as wide as typical stop occlusions in continuous speech may be obscured, resulting in Anna being unable to correctly identify word pairs such as “speed” and “seed”.The tinnitus direct effect on Anna’s thoughts and emotions, hearing, sleep and concentration could lead to secondary problems in her daily activities, mainly problems in any of these areas can lead to obstacles at her workplace, socialization with her family or friends and enjoying leisure activities.Only a few consonants and vowels sounds e.g. ‘n’, ‘e’, ‘j’, ‘m’ are audible in Anna’s left ear, hence she would not be able to hear most of the distinguishing speech features as a result of her mild to severe hearing loss in the left ear.Since she suffers from a moderately severe to profound hearing loss in her right ear, Anna is unable to hear any conversation.After analysing Anna’s audiogram we searched for a suitable hearing aid for her type of hearing loss. Since she has a mild to severe hearing loss in her left ear and moderately-severe to profound in her right ear, Anna’s audiogram falls within the range in the audiogram of the hearing aid shown above. Therefore, this hearing aid is recommended for Anna. The hearing aid has two directional microphones for detecBased on Anna’s hearing test results and the explanation of the causes of her hearing loss, we recommend the cochlear implant for both ears. The cochlear implant aims to help people who have moderate to profound hearing loss, by directly stimulating the hair cells in the cochlea and transmitting the electrical signals of sound to brain without affecting the possible damaged part of inner ear. It consists of external parts (a microphone, a speech processor an a transmitter) and internal parts (a receiver and electrodes).Firstly, the microphone picks up the sounds and sends them to the speech processor. Secondly, the speech processor converts the mechanical movement to the electrical / nerve impulses. The transmitter will send the signals to the receiver implanted under the skin behind the ear and the receiver then passes the signals to the electrodes. The electrodes will stimulate the fibre of auditory nerves and hence, the sounds can be ‘heard’ by the patient.The cochlear implant will improve her hearing back to normal condition, where she can hear different sounds better in social places such as lectures, cinema or theatre and she can interact with friends without difficulties. Besides, it also reduces or even eliminates the tinnitus which hence improves her sleeping quality.Since it is suspected that Anna may have Ménière’s disease, it is recommended to avoid salts, caffeine and alcohol which will prevent fluid build up in the endolymphatic chamber.