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By Linda M Luxon; et al

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24. Suga F, Lindsay JR. Histopathological observations of presbycusis. Ann Otol Rhinol Laryngol 1976; 85: 169-84. 25. Willott JF. Aging and the Auditory System. Anatomy, Physiology, and Psychophysics. San Diego: Singular Publishing Group, 1991. 26. Robinson D. Threshold of hearing as a function of age and sex for the typical unscreened population. B rJ Audiol 1988; 22: 5-20. 27. International Standards Organisation. Acoustics - Determination of Occupational Noise Exposure and Estimation of Noise-induced Hear­ ing Impairment 2nd edition, Geneva, ISO, 1990.

Signal amplifiers are examples of other unso­ phisticated but valuable devices. Hearing aid fitting includes counselling in order to ensure that the device is handled properly. People with hearing impair­ ment can be offered more extensive training programmes. g. as individual counselling or group training courses. The goals are to provide information about hearing impairment and the impact on activities and participation in society, to teach about hearing aids and their management, and to provide com­ munication abilities.

4 Cholesteatoma of middle ear, composed of benign stratified squamous epithelium with keratin (stained red in the original) on the surface. Microscopic appearances Under the microscope, the pearly material of the cholesteatoma consists of dead, fully differentiated anucleate keratin squames. This is the comeal layer of the squamous cell epithelium. Some­ times, biopsy material shows only squames when the so-called capsule has not been excised. This capsule, often called the matrix, is composed of fully differentiated squamous epithelium similar to the epidermis of skin, and resting on connective tis­ sue.

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