Tag: advice

What Is Reverse-Slope Hearing Loss and How Can It Be Treated?

Reverse-Slope Hearing Loss

Your Refrigerator Is Running – Can You Hear It?

You’re probably familiar with the many telltale, well-known signs of hearing loss ó asking people to repeat themselves frequently, turning up the TV to uncomfortable levels for others in the room, or leaning into a conversation on one side to use your ìgood ear.î

But what if speech is clear to you and you never turn up the TV ó but you can’t hear whether the car you’re standing next to is running? This is an actual type of hearing loss, called reverse-slope hearing loss (RSHL), and people with this type often don’t realize they have a hearing impairment.

What Is Reverse-Slope Hearing Loss?

Hearing Loss Basics

The most common type of hearing loss ó the kind most people think of when they think of hearing loss ó is characterized by loss of sounds at higher frequencies and is sometimes called high-frequency hearing loss. These frequencies correspond to what we think of as high notes or high-pitched voices. As such, when someone first notices this type of hearing loss, it’s usually because they’re having trouble hearing women’s voices or those of the children in their life, and having difficulty hearing conversation in a restaurant.

Because this particular kind of hearing loss doesn’t affect lower frequencies but does affect mid-level and high frequencies, it has a distinct appearance on what’s called an audiogram ó the graphical representation of the results of a hearing test. On an audiogram, the graph starts in the upper-left-hand corner and may slope downward steeply, like a ski slope or more subtly as a gradual decrease across this frequency range. This is where this type of hearing loss gets its most common name: ski-slope hearing loss, sometimes shortened to simply sloping loss.

Reverse-Slope Hearing Loss

RSHL is so named because its shape on an audiogram is the reverse of ski-slope hearing loss. In this type of hearing loss, the low frequencies are affected far more than the higher ones. This gives the audiogram the opposite shape ó the graph starts in the lower-left-hand corner and slopes upward steeply. Because it affects mainly the lower frequencies, it is also known as low-frequency hearing loss.

RSHL is rare: It affects only 3,000 people in the U.S. and Canada. Put differently, for every 12,000 cases of hearing loss, only one person has RSHL. Like ski-slope hearing loss, there are different degrees of RSHL.

Causes of Reverse-Slope Hearing Loss

Many people don’t suspect they have RSHL unless someone in their family already has it, which underscores one of the main sources of RSHL: genetics. Wolfram syndrome, Mondini dysplasia, and inheritance through a dominant gene have all been identified as sources of RSHL.

Certain diseases have been implicated as well, mainly those affecting the hair cells, which are responsible for sending sound information from the inner ear to the brain. Examples include sudden hearing loss, MÈniËre’s disease, and viral infection.

The third most common source of RSHL is anything that causes a change in the pressure of the endolymph, a fluid in the inner ear. This includes things such as spinal or general anesthesia, intracranial hypertension, and a perilymphatic fistula.

How Is Reverse-Slope Hearing Loss Diagnosed and Treated?

From symptoms to industry norms, hearing care is focused chiefly on ski-slope hearing loss, so RSHL can be difficult to recognize, diagnose, and treat. Because it is often hereditary or genetic ó that is, because they were born with it ó many who have RSHL don’t realize that the way they hear is different, so they may never seek out a hearing appointment.

Symptoms of RSHL
  • Difficulty understanding speech on the phone. The aspects of speech that give it clarity (the consonants) are in the higher frequencies, the treble side of sound, but the aspects of speech that give it volume (the vowels) are in the lower frequencies, the bass side. Because RSHL involves the lower frequencies, speech loses its volume but retains its clarity. Face-to-face conversation, therefore, is not usually a problem. But the phone mainly delivers the low and middle frequencies, so it can pose a problem for RSHL.
  • Ease understanding women and children but not men. Again, because RSHL affects the lower frequencies, those with RSHL more clearly understand higher-frequency speech ó that of women and children ó than lower-frequency speech, such as that of men.
  • Inability to hear low-frequency environmental sounds. Thunder and a refrigerator humming are examples of low-frequency environmental sounds. Because the click of a refrigerator is a high-frequency sound, someone with RSHL might hear their fridge click, but they wouldn’t know if the hum was the fridge turning on or off, even if they were standing right next to it.
Diagnosing RSHL

Because of the prevalence of ski-slope or other high-frequency hearing loss, diagnostic tools focus on that type. Therefore, many with RSHL may ìpassî a hearing screening or are treated as though they have other issues. Naturally, this leads to frustration for all involved.

Key to diagnosis is a well-educated patient. Because this condition is rare, many in the hearing care field simply haven’t encountered it. RSHL has a distinct set of characteristics that an audiologist will look for but is not limited to:

  • Unusually good speech
  • Sensitivity to high-frequency environmental sounds
  • Poor speech perception in the absence of visual cues
  • High speech-detection thresholds
  • Pure-tone hearing losses
  • Inability to adjust to standard ski-slope hearing technology settings

A simple test any hearing care provider can use as an initial screening for RSHL is the Ling sound test performed while standing behind the patient. RSHL is most likely present if the ìsî and ìshî sounds are heard at a much softer sound level than the other sounds.

Treating RSHL

Those with RSHL tend to have high expectations of hearing aids, which can lead to frustration. An audiologist who hopes to successfully fit an aid for RSHL has to build the settings from the ground up, for several reasons.

  • Manufacturer-recommended hearing aid settings are meant for high-frequency hearing loss. As previously mentioned, only 3,000 people in the U.S. and Canada have RSHL; many millions have high-frequency hearing loss. It makes sense that the industry would weigh toward the type of hearing loss with the highest incidence but still allow audiologists to customize individual aids for rare types of hearing loss.
  • Hearing aids may be programmed based on computer settings that are based on the audiogram. These computer settings assume the most typical situation: ski-slope hearing loss. These settings rarely work for RSHL.
  • Hearing aids are built with the expectation of a high-frequency hearing loss. Often high-frequency losses need amplification in the high frequencies. The shape of the aid complements the shape of the typical ear canal, and this combination dependably treats high-frequency loss very well. But RSHLs require different amounts of amplification across a different range of frequencies.
  • People with RSHL have already successfully adapted to their speech needs. Having been born with this condition, many with RSHL develop the ability to navigate speech easily.

Treating RSHL means parking industry standards and theoretical fitting curves. It requires taking time to really listen to the patient, and then build the settings channel by channel, frequency by frequency, to what they find comfortable, audible, and helpful.

But there are certain starting points that may help in the treating of an RSHL. A study by Kuk et al. determined that

  • A digital, multichannel, nonlinear hearing aid is optimal
  • Wide dynamic range compression, a low compression threshold, and high-level compression might more effectively preserve hearing and comfort
  • Amplification in the lower frequencies is preferred, but gain may vary depending on input levels
  • A broad bandwidth with individualized amplification customization is desirable
  • The paired comparison technique may help customize individual settings
Why Is It Important to Treat Reverse-Slope Hearing Loss?

You may well be thinking, ìThose symptoms don’t sound so bad ó why bother putting myself through all the frustration of getting diagnosed and fitted?î

The key reason is safety. Much of what you lose with RSHL is environmental sound. If you can’t hear a car coming, you can’t avoid it. If someone some distance from you is trying to warn you away from something, you might not hear it, because volume is a product of the lower frequencies.

Another reason is enjoyment. There are many aspects and nuances in music that you might be missing out on if you have RSHL, because you’re missing the low-frequency sounds ó for example, much of what is below middle C.

Contact us today if you think you or someone you love might have reverse-slope hearing loss.

Sources:
Kuk F, et al. Changing with the Times: Managing Low-Frequency Hearing Loss. Hearing Review. November 2003. http://www.hearingreview.com/2003/11/changing-with-the-times-managing-low-frequency-hearing-loss/. Accessed Feb 2, 2018.
Bauman N. The Bizarre World of Extreme Reverse-Slope Hearing Loss (or Low-Frequency) Hearing Loss. http://hearinglosshelp.com/blog/the-bizarre-world-of-extreme-reverse-slope-hearing-loss/#characteristics. Accessed Feb 2, 2018.

Earwax Dos & Don’ts. Hint: Hold the Cotton Swabs!

Earwax, that yellowish-brown goo, might inspire an ìIck!î or two, but managing it the right way can make a difference in your hearing health.

Here’s a primer on why you have earwax and what to do about it.

Why is earwax in your ear?

Earwax, or ìcerumen,î results from secretions by the ceruminous glands in the outer ear canal. The secretions help lubricate the ear canal and help maintain an acidic environment that curbs harmful bacteria and fungi.

Life without earwax would be a lot less comfortable: It not only helps keep the ear canal clean but prevents dirt and other debris from reaching and potentially damaging the eardrum. In addition, earwax can help keep ears from feeling itchy and dry.

When should earwax be removed?

Normally you needn’t remove earwax; your ears will naturally handle that function by pushing out the excess.

Sometimes the glands may produce more wax than the ear can eliminate, and blockage can occur. People who use hearing aids, wear earplugs, or push objects such as cotton swabs into their ears can be more prone to these problems.

When excess buildup gets to the point of causing pain or symptoms such as hearing loss, ringing in the ear, or dizziness, it’s time to clean it out.

What are the dos and don’ts of ear cleaning?
  • DO use a warm, soft cloth ó after washing or showering ó to remove normal amounts of earwax at the outer ear, if needed.
  • DO gently soften the earwax with drops of warmed olive oil, almond oil, water, or a commercial solution to remove larger amounts of earwax or an earwax plug.
  • DO try irrigating the ear by gently rinsing it out with water.
  • DON’T use ear candles, which may cause serious injury and have not been proven effective in scientific studies.
  • DON’T stick cotton swabs or other objects in the ear; they can cause injury and push wax farther into the ear canal.

Sometimes earwax buildup requires the attention of a professional who can examine your ears, determine the nature of the problem, and customize a treatment, which may include prescribing eardrops, irrigating the ear, using a suction technique, or providing another appropriate solution.
 

Why do people still clean their ears with cotton swabs?

Despite the unequivocal warnings from the medical community and the warning on each box, people still clean their ear canals with cotton swabs. Why is that? To put it bluntly, it feels good, because of the numerous sensitive nerve endings in the ear canal. Compounding the problem is the itch-scratch cycle: You use a swab to calm an ear itch, but the more you use cotton swabs, the more your ear itches.


If you’re experiencing problems such as persistent ear pain, hearing loss, blockage of the ear canal, or potential perforation of the eardrum, contact us for an evaluation.

Better Hearing and Speech Month: 5 Tips to Step Up Your Hearing Game

Did you know? About 360 million children and adults — more than ve percent of the global population — have disabling hearing loss, according to the World Health Organization.

The good news? Not only can most hearing loss be helped with state-of-the-art hearing technology or other options, but simple steps can help you prevent some types of hearing impairment altogether. With the 90th celebration of Better Hearing Month just around the corner in May, here are ve tips to help you and your loved ones take charge for better hearing every day.

Know the Signs
Frequently asking people to repeat themselves, turning up the TV, having di culty understanding phone conversations, complaining about noise or earaches — these
and other signs point to potential hearing loss. Detecting it early can reduce the risk of academic, social, physical, and other problems.

Curb Noise Exposure
More than 31 million Americans ages 6 to 69 have permanent hearing damage due to noise, per the Centers for Disease Control and Prevention. Reducing exposure to sounds above 85 decibels, curbing use of MP3 players, and wearing earplugs even when mowing or using leaf blowers, snowblowers, and weed wackers can go a long way.

Partner With Your School
Teachers and administrators are critical to helping kids hear their best during the school day, with classroom seating arrangements, loop and FM systems, closed captioning, and other supportive options. They can also identify possible signs of hearing loss, such as decreased engagement and changes in grades or behaviors.

Keep Hearing Aids in Top Shape
If you or your loved ones are already hearing better through today’s advanced hearing technology, help keep the devices in their best shape with a professional clean and check. Also, keep extra batteries on hand at home and on the go.

Get a Hearing Checkup
Take the whole family for professional hearing evaluations at least once a year, just as you would for their eyes or teeth. Timing the visits before summer camp or the new school year, for example, can help you catch any hearing di culties before they a ect your child’s learning and development.

Our audiology experts are here to help you and your loved ones hear your best. For more tips on taking charge of your hearing health or to schedule a hearing evaluation, call our o ce today.

8 Tips That Preserve Your Technology and Protect Your Hearing

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Thanks to hearing aids, people are able to engage in more activities each holiday season. Protect your technology with these eight tips and tricks specifically created for a winter full of festivities and fun.

1. TEMPERATURE CHANGE.
Moisture from a drastic change in temperature (like walking into your cozy home from a chilly outdoor adventure) can damage hearing aids and shorten battery life. Earmuffs, a hat, or an umbrella will help prevent unwanted moisture from getting in.

2. WATER-RESISTANT TECHNOLOGY.
If you lead an active lifestyle through the seasons, consider choosing water-resistant (note that these are not waterproof) hearing aids. These devices have a coating that protects them from perspiration and water drops.

3. MAKE SURE YOU’RE COVERED.
Behind-the ear hearing aids are at risk for damage due to the humidity from sweat. Ask us about hearing aid protection to reduce exposure to moisture, dirt, and dust.

4. HIGH AND DRY.
Hearing aid dehumidifiers rid your technology of moisture overnight so they’re ready to go in the morning. Use this handy tool all year round to help extend the life of your technology.

5. DON’T BLOW IT.
Snowblowers are estimated to range from 90 to 106 decibels (hearing damage starts at 85 decibels, or the sound level of a bulldozer). The longer you’re exposed to this noise, the greater your risk for hearing damage. Make sure you adjust the volume settings on your devices, or pick up a pair of decibel-reducing earmuffs.

6. SOAKED, NOT SUNK.
If your hearing aid has gotten wet, remove the batteries immediately, store the hearing aid in a dry-aid kit or dehumidifier, and contact us to find out if other steps should be taken.

7. CAN’T STOP, WON’T STOP.
Keep your batteries (and hearing aids) in tip-top shape by keeping them away from excessive temperatures. To help ensure your batteries perform efficiently, leave the battery door open at night or whenever you’re not using them.

8. SAFETY FIRST.
When snow hits the ground, the fun outdoor activities begin. Risking damage to or loss of your hearing aids in the snow is not so entertaining. To keep the fun and your technology going, ask about adjustable retention products for hearing devices.
Have questions about any of the tips or devices mentioned? Well, we’ve got answers! Give us a call at 918.333.9992 so we can help you have the happiest, healthiest hearing this winter! You can also call us to schedule a free clean and check, and receive $500 off AGX5, 7, or 9 technology!

It’s Summer Time And The Best Time To Protect Your Hearing

Actually we need to be protecting our hearing year round, but summer comes to mind most commonly as more people are mowing, using weed eaters and leaf blowers. Typically all of that equipment has potentially damaging decibel levels to our hearing. And once you damage or lose your hearing, we cannot grow it back. It’s just gone. So take some steps to protect your hearing this summer and the rest of the year. Hearing protection comes in a variety of styles and strengths. That is one of our specialties and please contact us if you need guidance.

  1. Wear hearing protection devices while mowing and using loud equipment. Keep in mind 4th of July fireworks are loud as well as winter time chainsaws.
  2. Concerts both indoors and outdoors can be loud and damaging.
  3. Hunting and shooting are hazardous.
  4. If you have to be in a noise environment, such as a sporting event and you cannot or do not have hearing protection then limit your exposure time.
  5. Some motorcycles and tractors (especially those without cabs) can be dangerous to your hearing.
  6. Music headphones can get really loud being so close to your eardrums, so turn them down or limit your time. Also invest in decibel limiting headphones.

Hopefully those are some helpful ideas to protect your hearing. Please contact us if you have any questions as we are happy to help.

Sincerely,

Dr. Stephanie R. Moore
Audiologist

6 Ways You Can Damage Your Hearing Without Knowing It

Noise-induced hearing loss (NIHL) is the most common type of hearing loss, but folks aren’t always sure where their hearing loss comes from. There are some fairly obvious ways to damage your hearing, such as listening to music at excessive volumes, or firing weapons without hearing protection. Then there are situations where protecting your hearing doesn’t seem very important, but doing so might actually prevent further damage. Consider the following sneaky causes of hearing loss.

1) WORKPLACE NOISE

Although many construction and manufacturing jobs state that hearing protection should be worn at all times on the job, these warnings are not always adhered to. Those who wear hearing protection may not be wearing it at all times — it may be removed to talk with co-workers or supervisors despite close proximity to high-noise-producing machines, and depending upon how loud those machines are, damage can be caused fairly quickly. Even with hearing protection, noise damage can slowly accumulate and wear on the delicate hair cells in the inner ear.

2) OTOTOXIC MEDICATION

Ototoxic medications are drugs such as painkillers that have chemical properties that make them toxic to the sensory cells in the ear. Painkillers taken in high quantities create not only a risk for dependency but for losing hearing as well; strong pain medications first cause a ringing in the ears before beginning to have adverse effects on hearing, but the impairment often goes away after discontinued use.

3) SMOKING

Because of the impact and high profile of major diseases caused by smoking, potential hearing damage as a side effect of smoking often flies under the radar. But nicotine is a vasoconstrictor that causes blood vessels to shrink slightly, restricting blood flow to the inner ear and preventing oxygen from reaching it. Over a lifetime, this “suffocates” the ear.

4) DRIVING A CONVERTIBLE

Driving more often creates potential for developing or worsening hearing loss, thanks mostly to the sounds of the road and other passing vehicles. Some cars dampen sound, but convertibles lose that extra layer of “quiet ride” protection, leaving ears exposed to potentially dangerous noise levels around them. An October 2009 study found that driving some convertibles at speeds between 50 and 70 miles per hour exposed drivers to noise levels of 88 to 90 dB — beyond the level where damage begins to occur (85 dB).

5) PUBLIC TRANSPORTATION

The squeal and grind of light rails, trains, and even buses coming to a stop have the potential to cause hearing damage to daily riders of public transportation because they’re constantly exposed to noise. Rough or curved tracks prevent smooth rides, leading to more noise. And those who are waiting for their bus or train are exposed to potential traffic on a busy street, which can sometimes reach levels of 100 dB or more.

6) ATTENDING SPORTING EVENTS

Due in part to the nature of sporting events — watching athletes perform — the danger of noise is often forgotten. Many stadiums still manifest crowd noise dangerous enough to damage hearing. Seattle’s CenturyLink Field last year posted a decibel record of 137.6, enough to cause permanent damage in 30 seconds. Noise levels of 115 dBs or more — about the equivalent of a concert — are not uncommon but are safe to experience for only 15 minutes.

Call today for your custom-fit hearing protection! 918.213.4405