April 30th, 2012 - Categories: Advice, Common Hearing Loss Myths - Tags: advice audigy, communication issues, community awareness, hearing loss, hearing loss and cognitive function, hearing treatment, patient care, sound void - No Comments
SoundVoids™ can cause unnecessary frustration in visiting with your loved ones.
Here at Advanced Hearing Care, I spend a lot of time counseling patients and their families and friends on realistic expectations for hearing treatment and rehabilitation. Some of the conversations can be quite passionate, especially when the family can’t understand why their loved one cannot seem to hear them, even though they’re wearing their hearing aids. After all, hearing aids are supposed to fix the problem, right?
Well, no, not really. Hearing aids are wonderful devices that supplement bad hearing. They help a person make the most of the hearing that they may have left. But they are not a substitute for good hearing. Nothing, no magic pill or surgery, can restore a person’s hearing to the way it was before the hearing loss occurred.
How Hearing Works
One of the biggest reasons why people have this misconception of hearing aids and hearing treatment is that they don’t really understand how hearing works or what is happening when someone has a hearing loss. After all, your ears just work, right? And you don’t have to think about it to make them work. So, most people just don’t have reason to think about it.
Like most of your senses, hearing requires a means of collecting stimuli and a method of delivering the data from those stimuli to the brain for processing. Your ears act as a funnel to collect sound waves in your environment and then both amplify and transform those sound waves into an electrical signal that can be processed by your brain. This process involves the outer ear, called the pinna; the ear canal; the middle ear, which is made of the ear drum and the ossicular bones; the inner ear, or cochlea; and the auditory nerve and brain. Along the way, the ear drum converts sound waves into mechanical energy, the stapes and cochlea convert the mechanical energy into hydraulic energy, and the cilia in the cochlea converts the hydraulic energy into electrical energy, which is finally processed by the auditory cortex in the brain.
A Matter of Physics
Sounds are formed anytime an object creates a vibration. These vibrations are called sound waves and they happen at a molecular level in every substance that has matter and mass. A good way to visualize this is to drop a pebble in a pond and watch the waves it creates. As mentioned above, the ear collects these sound waves in order to amplify and transform them into signals in the brain.
Generally speaking, the less complicated the sound environment, the easier it will be for the brain to sort through the sound waves available. In a small quiet room, there is very little interference from other sources of sound waves, there are fewer barriers to sound wave transmission, and the sound waves don’t have to travel very far to the ear. This is an ideal situation for hearing. The larger the space, the more sources of interfering background noise, the farther away you are from a reflective surface, the harder it will be to hear, even with normal hearing. Imagine again the pond and the pebble. The sound waves are a lot easier to “see” in a small pond with just a few pebbles than they are in an ocean during a rain storm.
Hearing aids cannot change the physics of environmental sound. There are certain properties to background noise, such as frequency ranges and harmonic patterns, that a hearing aid processor can be programmed to reduce, but it doesn’t work like a pair of noise-cancelling headphones. Those headphones have a distinct signal input from an audio device and a distinct sound pattern for the noise collected through a microphone. The headphones produce an inverse sound wave that cancels the noise. With hearing aids, the signal is mixed in with the noise and there’s no way to produce that inverse sound wave.
Mucking Up the Works
When hearing loss occurs, something happens to the anatomy of the ears and brain that causes the sound wave conversion and amplification process to not work the way it’s supposed to work. One of the most common problems is that the cilia in the cochlea, the part of the hearing that sends those electrical signals to your brain, begin to die. This is called sensorineural hearing loss. It is nerve damage and it is permanent.
This kind of hearing loss also often involves an issue with sound clarity in addition to the inability to detect certain sounds. In the case of someone who has those sound clarity issues, something is happening in the brain that causes the electrical signals that the brain receives to become garbled and distorted. When a person is experiencing this distortion, simple amplification of sound doesn’t help as much as you might think. After all, making a garbled sound louder does not improve its clarity. Since the distortion is actually happening in the brain, it is different for each person who experiences it and it cannot be easily measured or quantified, making compensation practically impossible.
So What Can I Do?
There are small things that you can do while you are speaking to make it easier for your loved one to understand you. Slow down and speak clearly; don’t shout! Shouting only distorts your speech. Rather than repeating a misunderstood word or phrase to the point of frustration, use different phrasing to avoid that misunderstanding. Make sure that you’re not speaking with your mouth full or obstructing your mouth with your hand or another object.
The best thing that can be done to help someone who has sound clarity and processing issues is to make the listening environment as simple as possible. First, turn off all potential sources of interfering noise. If it can’t be turned off, then turn it down or adjust its position to minimize the interference. Get on the same level as the person with the hearing loss and face them so you can speak directly to them. Move closer to them and stay within 4 to 6 feet. Never walk away from them while you’re talking or try to talk to them from another room in the house. Small environmental changes can do a lot to assist someone who is having trouble understanding speech.
In Closing
It’s very important to remember that hearing loss is a permanent impairment and the goal of any hearing loss treatment process is to make the most of an individual’s remaining hearing. In even a best-case scenario, there are limitations to what hearing technology can do as far as speech enhancement and background noise reduction in very complex listening situations. No matter how much the technology advances, no matter how far it develops or how sophisticated it gets, it will never be a replacement for the hearing that you or your loved one enjoyed had before the hearing loss. For more tips and tricks, feel free to visit our Communication Tips page, or Contact Us with any questions you may have.
April 19th, 2012 - Categories: Advice, News - Tags: advice audigy, community awareness, hearing conservation, patient care - No Comments
By: Bettie Borton, Au.D., FAAA
Doctor of Audiology
Doctors Hearing Clinic
7025 Halcyon Park, Suite A
Montgomery, AL 36117
(334) 396-1635
“Like” Doctors Hearing Clinic | Facebook
www.doctorshearingclinic.com
Have you ever wondered if your children or grandchildren are damaging their hearing by using personal listening devices, cell phones, or by listening to loud music that’s too loud? Most of us look at the noisy environment that envelopes young people today, and can’t help but worry about this as potentially hazardous to their hearing.
We often think of hearing loss as a problem affecting only older Americans. However, a stunning one in five teens has lost a little bit of hearing, and the problem has increased substantially in recent years, a new national study has found. Audiologists and hearing healthcare researchers are urging teenagers to turn down the volume on their digital music players, suggesting loud music delivered through earbuds may be to blame. Although definitive evidence is lacking about the cause, experts warn that slight hearing loss can cause problems in school and set the stage for increased hearing loss in later life.
Our hope is we can encourage people to be careful,” said the study’s senior author, Dr. Gary Curhan of Harvard-affiliated Brigham and Women’s Hospital in Boston. Researchers here analyzed data on 12 to 19 year-olds from a nationwide health survey. They compared hearing loss in nearly 3,000 kids tested from 1988-94 to nearly 1,800 kids tested over 2005-06.
The prevalence of hearing loss increased from about 15 percent to 19.5 percent. Most of the hearing loss was “slight,” defined as inability to hear at 16 to 24 decibels – or sounds such as a whisper or rustling leaves. A teenager with slight hearing loss might not be able to hear water dripping or his mother whispering “good night.”
Extrapolating this data to the nation’s teen population, that would mean about 6.5 million young people with at least slight hearing loss. Those with slight hearing loss “will hear all of the vowel sounds clearly, but might miss some of the consonant sounds” such as t, k and s, Curhan said. “Although speech will be detectable, it might not be fully intelligible,” he said. While the researchers didn’t single out iPods or any other device for blame, they found a significant increase in high-frequency hearing loss, which they said may indicate that noise caused the problems. And they cited a 2010 Australian study that linked use of personal listening devices with a 70 percent increased risk of hearing loss in children. Theses findings recently appeared in the Journal of the American Medical Association.
Loud music isn’t new, of course. Each new generation of teenagers has found a new technology to blast music – from the bulky headphones of the 1960s to the handheld Sony Walkmans of the 1980s. But according to Dr. Brian Fligor, an audiologist at Harvard Medical School, today’s young people are listening longer, more than twice as long as previous generations; older technologies had limited battery life and limited music storage, he points out. And with the Apple iPod, users can set their own volume limits, but parents can use the feature to set a maximum volume on their child’s iPod and lock it with a code.
One of Fligor’s patients, 17-year-old Matthew Brady of Foxborough, Mass., recently was diagnosed with mild hearing loss. He has trouble hearing his friends in the school cafeteria. He ends up faking comprehension. “I laugh when they laugh,” he said.
Fligor believes Brady’s muffled hearing was caused by listening to an iPod turned up too loud and for too long. After his mother had a heart attack, Brady’s pediatrician had advised him to exercise for his own health. So he cranked up the volume on his music while walking on a treadmill at least four days a week for 30-minute stretches. One day last summer, he got off the treadmill and found he couldn’t hear anything with his left ear. His hearing gradually returned, but was never the same.
Often, young people turn their digital players up to levels that would exceed federal workplace exposure limits. In Fligor’s own study of about 200 New York college students, more than half listened to music at 85 decibels or louder. That’s about as loud as a hair dryer or a vacuum cleaner. Habitual listening at those levels can turn microscopic hair cells in the inner ear into scar tissue, and for reasons that we don’t fully understand, some people may be more predisposed to damage than others; Fligor believes Brady is one of them. And remember, once damage is inflicted, it cannot be undone.
These days, Brady still listens to his digital player, but at lower volumes. His sage advice…”Do not blare your iPod,” he said. “It’s only going to hurt your hearing. I learned this the hard way.”
If you or a loved ones are concerned with a teen’s hearing or listening habits, contact Advanced Hearing Care for ideas or a complete audiological evaluation.
March 1st, 2012 - Categories: Advice, News - Tags: advice audigy, patient care, personalized solutions, tinnitus - No Comments
By: Bettie Borton, Au.D., FAAA
Doctor of Audiology
Doctors Hearing Clinic
7025 Halcyon Park, Suite A
Montgomery, AL 36117
(334) 396-1635
“Like” Doctors Hearing Clinic | Facebook
www.doctorshearingclinic.com
If it seems like your ears ring constantly, it’s probably not crickets, your imagination or the economy . . . and you’re not alone. You may have tinnitus, an inner ear ailment that affects between 25 million to 50 million Americans — with about 12 million people experiencing such severe symptoms it affects their daily lives. The good news is treatment, including hearing aids, can offer relief to some from the persistent ringing, buzzing or humming associated with tinnitus, according to the Better Hearing Institute.
Tinnitus can be intermittent or constant. Causes range from ear infections and exposure to extremely loud noises, to underlying health problems like allergies or heart and blood pressure problems. Often, sufferers are unable to pinpoint the cause of their tinnitus. “Tinnitus can have a direct impact on a person’s emotional well being,” says Dr. Sergei Kochkin, BHI’s executive director. “Not only can their hearing be affected but also their ability to sleep or concentrate.”
Kochkin and Dr. Richard Tyler, professor and editor of The Consumer Handbook on Tinnitus (Auricle Ink, 2008), published a survey of 230 hearing health professionals in the United States and Canada. Their survey found that six out of 10 patients reported some tinnitus relief when using hearing aids and two out of 10 reported major relief. The symptoms of tinnitus “influence basic life functions such as socialization and relaxation,” the duo wrote. “In severe cases it can interfere with the individual’s ability to perform adequately on the job, or contribute to psychological disorders such as depression, suicide ideation, posttraumatic stress disorder, anxiety and anger.”
Although tinnitus is actually common and can cause major life disruptions, the number of sufferers who seek treatment for tinnitus is relatively small. One reason may be that they mistakenly believe their condition is untreatable. Unfortunately, many doctors are also unaware of the latest treatment options, and as a result patients may think they simply have to learn to live with the noise.
“No one should ever ignore persistent tinnitus,” Kochkin says. “Not only is every individual entitled to a chance to regain his or her quality of life, but in rare cases tinnitus also can be a symptom of a more serious health issue that could demand medical intervention. What’s more, nearly everyone with tinnitus has hearing loss as well.”
In a recent large-scale survey of the American hearing impaired population, 39 percent (more than 9 million adult Americans) indicated they had not sought help for their hearing loss specifically because they also had tinnitus. “Research shows that untreated hearing loss has its own negative social, psychological, cognitive and health effects on the individual suffering from it,” Kochkin adds. “So those with both untreated tinnitus and untreated hearing loss suffers an even more diminished quality of life than individuals with just tinnitus or just hearing loss alone.”
While hearing aids are not a cure for tinnitus, they may be able to help tinnitus patients by:
- Improving communication and reducing stress, which makes it easier to cope with the condition.
- Amplifying background sounds, which can make tinnitus seem less prominent.
A new type of hearing aid, called the open fit hearing aid, may be particularly useful in alleviating tinnitus. The open fit hearing aid can reduce the effects of the tinnitus ringing sensation while still allowing sounds from the outside to pass into the ear. If you think you have tinnitus have your hearing evaluated by an audiologist and to explore the use of hearing aids to alleviate tinnitus. The American Academy of Otolaryngology (AAO-HNS) and the American Tinnitus Association recommends these additional tips for minimizing the effects of tinnitus on your health:
- Avoid exposure to loud sounds and noises.
- Get your blood pressure checked. If it is high, get your doctor’s help to control it.
- Decrease your intake of salt. Salt impairs blood circulation.
- Avoid stimulants such as coffee, tea, cola, and tobacco.
- Exercise daily to improve your circulation.
- Get adequate rest and avoid fatigue.
- Eliminate or reduce some stress in different parts of your life; stress often makes tinnitus worse.
- Experiment by eliminating other possible sources of tinnitus aggravation, e.g. artificial sweeteners, sugar, alcohol, prescription or over-the-counter medications. (Do not stop taking medications without consulting with your health care professional about the possible ototoxic impact of your medications.)
Dr. Bettie B. Borton is a licensed audiologist in Alabama, and was the first audiologist in Montgomery to hold certification by the American Board of Audiology, and is the only audiologist with such certification in private practice in this area. Dr. Borton holds a BS degree with CED Certification in Education of the Deaf from the University of Texas, a Masters degree in audiology from the Louisiana State University Medical Center, and a Doctor of Audiology degree from the the University of Florida. She has served as a Visiting Professor, teaching associate and Supervising Clinical Audiologist at Auburn University, as well as a Supervising Clinical Audiologist at Auburn Montgomery. Dr. Borton was a charter member of the Alabama Academy of Audiology (ALAA), and served as President of this organization. She has also served on the Board of Governors for the American Board of Audiology (ABA), and is the former National Chair of the ABA. Dr. Borton is currently the CEO and Director of Doctors Hearing Clinic, a full service private practice in Audiology. In April of 2010 Dr. Borton was elected to the Board of Directors of the American Academy of Audiology, and will serve a three year term in that capacity. She is the first (and to date, only) audiologist from Alabama to have been elected to the Academy Board. Dr. Borton was honored as a 2010 recipient of the prestigious Oticon “Focus on People” award, which annually recognizes 12 individuals across the nation for their dedication to helping those with hearing impairment.
January 5th, 2012 - Categories: Advice - Tags: advice audigy, communication issues, hearing loss, hearing treatment, patient care, personalized solutions, technology - No Comments
Originally posted on the Hearing Care Blog
By: Amit Gosalia, Au.D., FAAA
Board Certified Doctor of Audiology
Audiology Clinic, Inc.
505 NE 87th Ave., #150
Vancouver, WA 98664
(360) 892-9367
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www.audiologyclinic.com
“Dr. Gosalia, I just bought a pair of $8500 hearing aids from XYZ in Portland. I was told that I would hear normally in all environments, including restaurants and ball-games. I am less than pleased because I still can’t hear or understand in noise. Did I waste my money?”
This was a case I dealt with a few months ago. This patient went to a business to purchase hearing aids, and this franchise/chain location set some lofty expectations for the patient. As hearing instrument technology improves, so do patient expectations. Terms such as noise reduction, noise management & directional hearing (along with many other proprietary terms) give the perception that the end-user will not hear background noise, and only hear the person in front of them. Unfortunately and fortunately, this is not true. Below I’ve touched the surface of noise, noise reduction and directivity.
Let’s start with noise. Noise is any disrupting event (in this case, sound) that impedes one’s ability to sense (in this case, hear) a signal (in this case, speech). For the purpose of this post, we’ll concentrate on hearing speech within a noisy environment. A general term and formula that is used in hearing healthcare is Speech-to-Noise Ratio (SNR) which tells us how loud speech is in relation to noise. For example, average speech is 45-55 decibels (dB) hearing speech in a basketball stadium where the crowd is cheering over 90 dB is difficult because the speech is 35-45 dB lower than the noise. This is considered a very low SNR; now compare this to speaking at a normal volume in a quiet library, the SNR will be high making speech much easier to understand. When someone has a hearing loss things change. Without amplification important parts of speech are not heard well, making understanding the person next to you difficult, if not impossible. The natural ability of any person to hear through noise decreases as hearing loss increases. This is a fact that has been well established in research on the human auditory system. Thus, a hearing aid can help make missing pieces of speech more easily heard but it cannot repair one’s ability to hear through noise and find valuable pieces of speech. For this reason, modern hearing aids focus on managing noise and amplifying clean speech.
Hearing instruments can come with or without venting. Vents are holes that are drilled through either the hearing instrument or the earmold for the purpose of letting air and sound travel in and out of the ear canal. The larger the vent, the closer you get to a more natural, open ear. Newer technology has allowed us to keep the ear open with small hearing instruments that rest behind the ear and even some custom molded devices (please see other postings for detailed descriptions of hearing technology). As cute as they may be, if your hearing is not within or near normal limits in the lower frequencies, an open ear device may not be for you.
One advantage of an open ear hearing aid is to allow low frequency sound to escape the ear canal, keeping the user’s voice more natural. When the user complains of hearing their own voice in their head or sounding as if they are speaking in a barrel, it’s usually a phenomenon called occlusion (or ampclusion). Keeping an ear canal open minimizes this effect but also introduces two detrimental issues. First, low frequency environmental sounds will bypass the hearing aid and travel into the ear naturally through the vent. These sounds that bypass the hearing aid are often heard naturally because most hearing losses are minimal in the low-frequencies and greater in the high-frequencies. This also means that the hearing aid is not able to process the sound before it’s heard, so technologies such as noise reduction do not affect low-frequency sounds in the open ear hearing aid.
Secondly, directional microphones will prove less beneficial in the open-ear fitting.2 What this means is that the more open the ear canal, the harder it becomes to hear what’s in front of you. So, theoretically, if our goal is to have the instruments focus more front-facing, the ear canal should not be very open. Note that normal low frequency hearing will be affected by closing the ear canal, and opening the canal with moderate to profound low frequency hearing will result in less hearing in those frequencies.1,2
So, what does this tell us about hearing in noise with amplification? You will hear background noise in noisy environments. You will most likely hear the kids screaming four tables away. You may still have difficulties hearing the person across the table from you. The good news is that with proper hearing aid selection and the correct technology that meets your lifestyle and budget, you’ll hear much better. Only a well trained hearing care professional can make these choices and help you to establish reasonable expectations for better hearing.
“Ms. XX, although the level of technology you purchased is consistent with an Active Lifestyle (in our clinic approx $7500 – $1000 less than the chain!!), you should know that hearing aids only supplement your hearing in those difficult environments. In fact, with normal hearing, I have difficulty hearing at basketball games and certain restaurants as well. Although we can not restore normal hearing, we can help you hear much better in more environments. You will still have some difficulty hearing and understanding in certain environments, but, with some realistic expectations, expert advice, and some auditory retraining, you will find greater success.”
Footnotes:
1 What is the Effect of Venting on Directivity? Audiology Online 10/2009; Todd A. Ricketts, Ph.D., CCC-A, FAAA
2 Efficacy of an Open-Fitting Hearing Aid; Hearing Review February 2005; Francis Kuk, Phd, et al
December 28th, 2011 - Categories: Advice, Events, Greetings, News, Research - Tags: advice audigy, communication issues, hearing conservation, hearing loss, hearing loss and cognitive function, hearing treatment, patient care, personalized solutions, sound void, technology - No Comments
SoundVoids™ can cause unnecessary frustration in visiting with your loved ones.
It’s coming. 2011 is almost over and 2012 is on its way. As the new year approaches, it’s a great time to begin the journey toward better hearing. Here are four great reasons to start today:
- If you don’t use it, you’ll lose it. A common phenomenon, especially among those who let their hearing loss go untreated, is called phonemic regression. Simply put, phonemic regression is when we find a loss of speech discrimination that isn’t proportional to the person’s pure tone thresholds. The most common symptom of this is being able to hear that someone is speaking but simply not being able to understand what is being said, something we call a Sound Void. This is a very frustrating situation, as the problem is not a simple matter of volume. In some cases, phonemic regression could have been prevented simply by wearing hearing aids earlier.
- Keep your brain sharp! In February, John’s Hopkins University released a startling study that linked untreated hearing loss to the development of dementia in elderly populations. While the exact nature of this link remains a bit of a mystery, it is well known that social isolation contributes to dementia. One of the biggest contributing factors to this kind of isolation is the inability to hear well enough to enjoy getting out and being active.
- New technology provides superior sound quality and satisfaction. The king of hearing aids is no longer that big ear plug that your father or grandfather wore (or refused to wear, as the case may have been). There are many styles available for nearly every budget that are designed to treat nearly every type of hearing loss. The possibilities are all but endless, and so is our ability to help people with many different kinds of hearing loss.
- Better hearing has never been easier! Our ultimate goal as hearing professionals is to reintroduce you to a world of sounds that you haven’t been hearing. Our Service Excellence Guarantee provides you with peace of mind knowing that we’ll have your back and make sure that you get the full value of your investment in better hearing. We offer a 75-day trial period, well beyond the 30 days required by state law, with a 100% refund if you’re not completely satisfied. We also offer extended warranties, in-office repairs and service, manufacturer repair if needed, and a wealth of knowledge to customize hearing solutions for every patient, all as part of our Service Excellence Guarantee. We will support you every step along your journey to better hearing.
To start your journey toward better hearing, call us to schedule an appointment for a hearing test. Through our 4-step process, we’ll learn about you and your better hearing goals, examine your ears for any defects or blockages, diagnose your hearing loss, and show you what we can do to help you hear better. Don’t wait to hear what you’ve been missing! Early treatment can make all the difference!
In observance of New Year’s Day, Advanced Hearing Care will be closed on Friday, December 31. We will return for normal office hours on Monday, January 2. Have a safe and happy New Year!
December 15th, 2011 - Categories: Advice, Technology - Tags: advice audigy, hearing treatment, patient care, technology - No Comments
Regular hearing aid checks can extend the life of your technology.
One of the most-asked questions we encounter here at Advanced Hearing is, “What can I do to keep my hearing aids working well?” Given the investment involved in purchasing hearing aids, it’s perfectly reasonable to want to extend the value of that investment by extending the life of the technology. Today, we’d like to share with you five suggestions that we normally give in answer to this question.
- Clean your instruments daily — At the end of every day, use a dry soft cloth to wipe off any visible debris and ear wax. Check the wax guards and domes (if applicable) to see if they need to be changed. Make sure that there aren’t any cracks or holes in the shell or case. Gently brush the microphone covers with your cleaning tool.
- Keep your instruments in a safe place when you’re not wearing them — Treat your hearing aids like you would your watch, glasses, or fine jewelry. In fact, it’s a good idea to put your case in the same spot where you store these other things. Keeping it in the same spot and closing them up tight in their case when you’re not wearing them ensures that you always know where they are and that they’re safe from any indoor pets that might decide they want an extra crunchy snack.
- Always carry a travel case in your pocket or purse — When you’re out and about, you may want to take your instruments off for some reason or another. We see a lot of people who put their instruments in a wad of tissue or just leave them loose in a pocket or purse. Before you do that next time, stop and think about what you do with that wad of tissue when you get home. Most people just throw the tissues out, and some chuck their hearing aids in the bin along with the tissue! Leaving them loose in a pocket exposes them vulnerable to being crushed. Travel cases are the best way to protect the instruments from damage and from an accidental trip to the dump.
- Schedule regular cleanings with your hearing professional — At Advanced Hearing, we ask most of our patients to come in every six months so that we can do a thorough cleaning and can make any adjustments that may be required at that time. Some patients come in more regularly because they have more ear wax and body oil issues and their instruments need the TLC a little more frequently.
- Have your hearing tested yearly — Hearing instruments don’t do a whole lot of good if they aren’t programmed appropriately for your hearing loss. And, sometimes despite our best efforts, hearing loss has a nasty tendency to progress. Yearly exams keep you aware of what is happening with your hearing as well as allow your hearing professionals to set your technology appropriately. It will also help you be better prepared to upgrade when you’ve reached the end of your technology’s capabilities.
