By Gael Hannan, Editor, Hearing Better Consumer, March 27, 2012

Three simple house rules – is that too much to ask of my teenage son? I’m not reaching for the moon, or a spotless room or a 95% average. The first two are meant to train him for life on his own, and the third is to make life easy for me.  If I really wanted to be mean mom, I would go even further – move those lips when speaking, slow down your train wreck-pace of speech, and apply some volume to that mumble, kid!

Oh, where did my little boy go? Where is the toddler whose smile-lit gibberish was somehow understandable, who turned my face towards his if he wanted something? The four-year-old who called my hearing aids “mommy’s hearings”? The five-year-old who, in the early morning gloom, would paddle up to my pillow and speak into my sleeping ear (because he knew I couldn’t hear him otherwise), “Mommy, can I get up now?”

In the boy’s place now stands a tall, handsome young man, almost 17. Once Joel hit the teen years, everything changed. This energetic guy doesn’t always have time for quality interaction, and he often “forgets” the communication fundamentals that he has lived and breathed since he could identify me as his mother in a lineup.

Other parents complain about their eye-rolling teenagers not speaking to them, period. I have an additional problem when he does speak to me.  Joel starts talking, usually only in response to a question, but then quickly loses interest. He turns away mid-sentence, even mid-word, forcing me to follow him in a moving arc, trying to read his lips. This is not easy. My son is a full foot taller than me.

“Face me, please! And what did you say?!”

Major eye-rolling, but he shuffles back into view and repeats himself. To his credit, Joel never replies to this question with a “oh, it was nothing”, because he knows this is the rudest response one can give to person with hearing loss.

Lately, though, if he’s watching TV and I join him, sometimes he turns on the captioning without prompting. The other day while we were chatting, I looked away briefly and he waited for me to look back at him before continuing to speak. I thought my heart would jump out of my chest with pride.

In fact, as my son is pondering university and career directions, I had the brilliant idea of his becoming an audiologist! It’s a growing profession and an audiologist son could keep me in hearing aids for the rest of my natural life. He’s always been kind of interested in my hearing loss. He likes science. And he has already attended a university Audiology class.

One spring, when I was presenting to Audiology students at the University of Western Ontario, I took Joel, then 7, with me. He sat at the back of the classroom, supposedly drawing. I asked the students, “What do you think is the biggest challenge facing people with hearing loss?” Like a shot came the childish voice from the back, “Uh…um…I think it’s not being able to hear?”

As I started to write this, I asked Joel how my hearing loss has affected him through the years.  He replied, “Well, always having to repeat myself is kind of irritating sometimes. And then when you yell at me because of something you thought I said, but you actually mis-heard. Oh yeah, and when I’m sitting in the back seat and I almost put my neck out, so you see my lips in the rear view mirror.  Stuff like that.”

But he went on, “If my friends laughed because you misheard me or said something goofy, I told them to shut up, that you were a famous person with hearing loss who has her own DVD.  I’m really proud of you, Mom.  Your hearing loss is dad’s and mine, too.  It’s ok.”

What a kid. Give me a hug, then go mess up your room and forget about homework for the night. But, face me when you’re talking to me!

There are three main types of hearing loss:

Sensorineural Hearing Loss
Permanent hearing loss occurs when inner ear nerves become damaged and do not properly transmit their signals to the brain. Those who suffer from this condition may complain that people seem to mumble or that they hear, but do not understand, what is being said. The aging process is a very common cause of sensorineural hearing loss. As we get older, the inner ear nerves and sensory cells gradually die. The condition is not often medically or surgically treatable. In most cases, the symptoms can be significantly minimized with hearing aids.

In addition to aging, sensorineural hearing loss may be caused by:

•Injury
•Excessive noise exposure
•Viral infections, such as measles or mumps
•Ototoxic drugs, which are medications that damage hearing
•Meningitis
•Diabetes
•Stroke
•High fever
•Meniere's disease
•Acoustic tumors
•Heredity

Conductive Hearing Loss
These disorders can be either temporary or permanent. They are caused by problems in either the outer or middle ear, which prevent sound from reaching the inner ear. People who experience this condition may find that voices and sounds appear faint. Many forms of conductive hearing loss can be helped medically or surgically. Some common causes of this condition include:

•Infection of the ear canal or middle ear
•Fluid in the middle ear
•Perforation or scarring of the eardrum
•Wax build-up
•Unusual growths or tumors in the ear
•Otosclerosis, a condition in which there is an abnormal growth of bone of the middle ear. This bone prevents structures within the ear from working properly and causes hearing loss. For some people with otosclerosis, the hearing loss may become severe.

Mixed Hearing Loss
Some people have a combination of both sensorineural and conductive hearing loss.

Hearing loss is often gradual and not immediately noticed by the person affected. Sometimes friends or family will notice a person's hearing problems before the person with the hearing loss recognizes it. For instance, family members may complain that the person with hearing loss listens to the television or radio too loud and often ask them to repeat what they've just said. Or, that the person with hearing loss doesn't answer the telephone or doorbell because they didn't hear it ringing.

Although each person may experience symptoms of hearing loss differently, some of the most common symptoms may include:

•Inability to hear people clearly and fully. People may seem to mumble and those experiencing hearing loss may not hear all parts of a conversation. For instance, someone with hearing loss may miss the essence of a story or punch line of a joke that someone just told.
•Frequent requests for repetition or clarification.
•Tendency to need to stare at people when they are talking in order to make it easier to understand what they are saying.
•Fatigue at the end of the day from straining to hear.
•Avoidance of social situations because of difficulty following conversations in noisy environments.
•Tendency to bluff when not hearing someone because of the fear of asking them to repeat themselves.

Reviewed by health care specialists at UCSF Medical Center.
Last updated April 26, 2012

Better Hearing Institute Warns on Do-it-yourself Hearing Care

Washington, DC.: The Better Hearing Institute (BHI) is warning consumers of the inherent risks associated with purchasing over-the-counter, one-size-fits-all hearing aids instead of consulting a hearing healthcare professional. Hearing loss is sometimes the symptom of a serious underlying medical problem. All 50 states require that consumers use a credentialed hearing care professional to purchase hearing aids.

BHI also points out that hearing devices that are purchased over-the-counter or Internet without the consultation of a hearing healthcare professional may result in the devices not being accurately customized to the specific hearing needs of the individual.

"Today’s state-of-the-art hearing aids should be programmed to the individual’s specific hearing loss requirements in order to provide good levels of benefit and customer satisfaction,” says Sergei Kochkin, BHI’s Executive Director. “The process requires a complete in-person hearing assessment in a sound booth; the training and skills of a credentialed hearing healthcare professional in order to prescriptively fit the hearing aids using sophisticated computer programs; and appropriate in-person follow-up and counseling. This is not possible when consumers purchase one-size-fits-all hearing aids over the Internet or elsewhere.”

The truth is, hearing loss happens gradually and the signs are subtle at first. Our own built-in defenses and ability to adapt make it difficult to self-diagnose. Extensive research shows that individualized hearing health assessments and fittings programmed specific to the needs of the hearing aid user provide the best chance for optimal hearing enhancement and customer satisfaction.

“The best advice BHI can give anyone purchasing a hearing aid is to find a state credentialed hearing healthcare professional and to communicate openly during the evaluation, fitting and trial period to increase the likelihood that you are receiving the best possible benefit from your hearing aids,” says Kochkin. “It will make a tremendous difference in your ability to hear and in your quality of life.”

BHI has published a comprehensive consumer guide entitled, “Your Guide to Buying Hearing Aids.” (See www.betterhearing.org under hearing loss treatment). The guidelines give confidence to first-time hearing aid buyers by providing a detailed, step-by-step explanation of what to expect, ask, and look for when selecting and visiting a hearing healthcare professional and purchasing a hearing aid.

The following questions will help you determine if you need to have your hearing evaluated by a medical professional: Do you have a problem hearing over the telephone? Do you have trouble following the conversation when two or more people are talking at the same time? Do people complain that you turn the TV volume up too high?

Do you have to strain to understand conversation? Do you have trouble hearing in a noisy background? Do you find yourself asking people to repeat themselves? Do many people you talk to seem to mumble (or not speak clearly)? Do you misunderstand what others are saying and respond inappropriately? Do you have trouble understanding the speech of women and children?

Do people get annoyed because you misunderstand what they say? If you answered “yes” to three or more of these questions, you may want to see a hearing instrument specialist for a hearing evaluation. The material on this page is for general information only and is not intended for diagnostic or treatment purposes. A hearing health care professional must be consulted for diagnostic information and advice regarding treatment.

Hearing Journal: January 2012, Chung, King PhD

Thoughts exist on the effects of hearing loss on cognitive function. Studies report the flow of information to the brain cause declines in cognitive abilities.

The National Health and Nutritional Examination Survey was created to quantify the relationship between hearing loss and cognitive ability in 605 participants 60 to 69. Participants' hearing thresholds were measured using supra-aural headphones or insert earphones in an environment that met the American National Standards Institute guidelines for maximum permissible ambient noise levels. The degree of hearing loss was calculated from the four-frequency pure tone average in the better ear. Cognitive skills were assessed using the nonverbal Digit Symbol Substitution Test, which examined participants' executive function and psychomotor processing ability. Only 7.3 percent of participants had moderate or severe hearing loss, so analysis was carried out using data from participants with normal to mild hearing loss only.

The results indicated that increases in age and degree of hearing loss are related to lower Digital Symbol Substituting Test scores (lower cognitive function). After accounting for age, gender, race, education, income, smoking, diabetes, hypertension, and stroke, the authors estimated that a 25dB increase in hearing thresholds is equivalent to an increase in seven years of age in this group of participants with normal and mild hearing loss. Further studies are needed to examine if this relationship holds true for people with a higher degree of hearing loss. Results also suggested a positive change in cognitive function for 13 hearing aid users.

These findings imply that it is essential for studies to examine cognitive function before and after hearing aid adoption to include a control group tested at the same interval and for studies to include hearing aid users and non-users with similar demographic data and account for other characteristics that might affect cognitive function. The control group is also especially important when the study involves participants with progressive diseases such as dementia to account for the natural progression of the hearing loss.

Some 50 million people in the United States have tinnitus. Ten to twenty percent of tinnitus patients manifest a “clinically significant condition,” and the average tinnitus patient waits more than six years between tinnitus onset and seeking relief. The majority of tinnitus patients have sensorineural hearing loss.

The vast majority of all tinnitus patients have subjective tinnitus. Subjective tinnitus typically accompanies sensorineural hearing loss, secondary to presbycusis, noise-induced hearing loss, and acoustic trauma, etc. Subjective tinnitus is generally defined as the perception of sound in the absence of an external sound source.

There are many options for management of subjective tinnitus. The condition is generally managed by hearing aid amplification, cognitive behavioral therapy, electrical stimulation, tinnitus maskers, combined tinnitus masker and hearing aids.

Hearing aid amplification is useful for managing tinnitus in two ways. First, hearing aids amplify ambient background noise which may simply cover up or mask the patient's perception of tinnitus. Second, while wearing hearing aids, the patient improves their communication ability, likely leading to a reduction of stress. Hearing aid amplification has served as the audiologic mainstay of tinnitus treatment for more than half a century. They note that even for marginal hearing aid candidates, high frequency amplification may be “accepted and beneficial.” Over 90% of tinnitus patients may benefit from hearing aid amplification.

Tinnitus patients receive two major benefits from hearing aids: the patient becomes less aware of their tinnitus and the patient improves their communication ability. They report tinnitus is often a result of neural plasticity, evoked via deprivation of auditory input (i.e., hearing loss), and as hearing aid amplification activates the auditory nervous system, the perception of tinnitus is reduced. For the best results, binaural amplification with open fittings and the widest possible bandwidth are recommended and interestingly, they suggest noise reduction should be disabled, so as to allow background and inconsequential noise to enter the auditory system. Open-canal fittings were also useful for tinnitus patients with mild hearing loss.

Tinnitus may impact a person's emotional well-being and may negatively impact socialization, relaxation, and job performance, and may contribute to psychological problems such as depression, stress, anxiety and anger.

Hearing aids can be enormously effective in assisting tinnitus patients based on the five factors listed here:

* Hearing aid amplification serves to increase neural activity. Presuming tinnitus is exacerbated by silence, the brain may seek neural stimulation which is otherwise attenuated secondary to hearing loss.

* Tinnitus may be related to a lack of neural inhibition and hearing aid amplification may help the brain's inhibitory function correct itself.

* Because tinnitus is not subject to in-depth analysis (as is speech), the brain may not be able to determine its meaning. In this regard, hearing aid amplification may supply a truer auditory signal to attend to, thus helping the brain recognize true sound versus pseudo-sound.

* Hearing aids amplify background noise such that they may provide partial masking while reducing the difference between amplified sound and tinnitus.

* As hearing aids reduce listening fatigue and stress, the ability to cope with tinnitus is improved.

Hearing Journal:

June 2011 - Volume 64  

 Photo by: Bloomberg

By JUDY SIEGEL-ITZKOVICH
01/04/2012 05:46

TAU researchers: One in four teens is in danger due to personal listening devices

MP3 players and other electronic devices that funnel noise directly into the ears are a serious health hazard – especially to teenagers, according to a new study at Tel Aviv University’s Sackler Medical Faculty.

Users listen to crystal-clear tunes at high volume for hours at a time, a significant rise in sound quality compared to the days of the Walkman. But, says Prof. Chava Muchnik of TAU’s department of communication disorders and colleagues, these advances have also resulted in personal listening devices causing harm to hearing, just as former US president Bill Clinton lost some of his hearing in middle age by playing a saxophone as a young man.

But today’s exposure is almost incessant.

One in four teens is in danger of early hearing loss as a direct result of these listening habits, says Muchnik and her team, who studied teens and music listening habits, and took acoustic measurements of their preferred listening levels.

The results, recently published in the International Journal of Audiology, demonstrate clearly that teens have harmful music-listening habits.

“In 10 or 20 years, it will be too late for a generation of young people suffering from hearing problems much earlier than expected from natural aging,” says Muchnik.

Noise causes damage to the tiny hairs in the inner ear that enables it to hear, and continuous exposure to loud noise is a slow and progressive process that many people don’t notice, Muchnik says. Young people’s hearing can thus deteriorate as early as their 30s – much earlier than past generations.

The first stage of the study included 289 participants aged 13 to 17, who were asked questions about their habits on personal listening devices (PLDs) – specifically, their preferred listening levels and the duration of their listening. In the second stage, measurements of these listening levels were performed on 74 teens in both quiet and noisy environments.

The measured volume levels were used to calculate the potential risk to hearing according to damage risk criteria laid out by industrial health and safety regulations.

The study’s findings are worrisome, says Muchnik.

Eighty percent of teens use their PLDs regularly, with 21% listening from one to four hours daily and 8% listening more than four hours consecutively.

Taken together with the acoustic measurement results, the data indicate that a quarter of the participants are at severe risk for hearing loss.

Industry-related health and safety regulations are the only benchmark for measuring the harm caused by continuous exposure to high volume noise. Yet there is a real need for additional music-risk criteria to prevent music-induced hearing loss, Muchnik says. In the meantime, she recommends that manufacturers adopt the European standards that limit the output of PLDs to 100 decibels. Currently, maximum decibel levels can differ from model to model, but some can go up to 129 decibels.

Steps can also be taken by schools and parents, she says. Some school boards are developing programs to increase awareness of hearing health, such as the “Dangerous Decibels” program in Oregon schools, which provides early education on the subject. Teens could also choose over-the-ear headphones instead of the ear buds that commonly come with an iPod.

The researchers will soon focus on the music listening habits of younger children, including preteens, and the development of advanced technological solutions to enable the safe use of PLDs.