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Hyperacusis: Hearing That is Too Good

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Most of us are aware of hearing loss and the difficulty associated with not being able to hear conversation or other important sounds. What about the people who suffer (suffer is the correct word to use here) with hyperacusis? One in 50,000 people reportedly suffer from hyperacusis.

What is Hyperacusis?

The definition of hyperacusis varies and may even seem unclear. Most audiologists define hyperacusis as a condition in which a person has intolerance to a level of sound. It can be defined as a condition that is a disorder of the perception of loudness of sound. This may also occur with what you might consider a soft sound.

The physical characteristic of the sound need not be loud to have the sensation of pain or discomfort. Another way to describe hyperacusis is a decrease in sound tolerance. There are other definitions for sound intolerance, such as phonophobia: the fear of a sound; and misophonia: a negative reaction to a sound. The term hyperacusis is usually reserved for individuals who feel that particular pitches or sounds cause physical discomfort. Individuals may describe discomfort, pain, tingling or pinging.

What Causes Hyperacusis?

A hypothesis about the cause of hyperacusis is that the individual has a reduced nerve input in response to sound. This causes the brain to attempt to compensate and increase the gain of the sound, which causes the over-amplification. This means that the issue is in two areas: the hearing organ and the auditory path in the brain.

There are people who have increased activity of a muscle that tenses the eardrum called the tensor tympani. This muscle is designed to contract in response to loud sound but in some individuals the muscle moves too much and causes discomfort. Hyperacusis is more prevalent in people with a history of noise exposure, ringing in the ears, physical trauma to the head or viral infection of the inner ear. There are conditions associated with hyperacusis, including Bell’s palsy, Lyme disease, depression and autism. Actual hearing ability does not seem to predispose someone to this condition. People with hearing loss or normal hearing may experience the discomfort.

How is Hyperacusis Tested?

All forms of hearing sensitivity are tested by having a person sit in a very quiet room and listen through earphones for pure tones or speech signals. The unique nature of hyperacusis shows as a reduction in loudness growth from the pure tones or standardized environmental sounds. The individual will say that sound which is slightly louder than what they can just hear is uncomfortable. A normal response to stepping the sound up louder and louder while staying comfortable is about 100dB! A person with hyperacusis may only tolerate an increase of 10dB.

Hyperacusis Treatment

The two most common management techniques for hyperacusis are counseling and sound therapy. Counseling for hyperacusis includes activities that are focused on cognitive behavior therapy, helping the individual to adjust his or her perceptions of sound. The individual is exposed to the noise in a controlled environment and the noise is increased in volume and the length of time of the session is increased. Some of these therapies focus the sound to be similar to the difficult sounds; other therapies focus on general environmental sounds. The therapy is a slow process but people with significant hyperacusis are thankful that they can try this technique rather than withdraw from the sounds of society.

Wearing Musicians’ Earplugs

Another treatment is noise reduction by wearing musicians’ earplugs. These are custom-fit earplugs that are comfortable enough to wear day and night. This type of noise reduction does not completely block your hearing but reduces the extreme edges of sound. The plugs come in 9dB, 15dB and 25dB sound-reduction options.

The plugs have a diaphragm that functions as an acoustic filter to give various amounts of reduction to sound. The 9dB reduces the sounds through the middle frequencies, the 15dB uniformly reduces sound across all frequencies and the 25dB gives a relatively flat sound reduction across all frequencies. The sound of your own voice sounds the most natural using these filters (not muffled). The goal is to wear the least amount of noise reduction so that your natural auditory filter is given the chance to work as much as possible. Many people find that they only need to wear the plugs in certain situations and they are comfortable enough not to wear them in other situations.

It is important to discuss your hearing issues with an audiologist. A professional will be able to point you in the right direction. QCBN

By Karon Lynn, Au.D.

Trinity Hearing Center is located at 1330 N. Rim Dr., Suite B in Flagstaff. For more information, visit the website at TrinityHearing.net. Karon Lynn is a doctor of audiology with 30 years of experience working with hearing impaired individuals. Dr. Lynn may be reached at 928-522-0500 or at audio@trinityhearing.net.

Understanding the Connection Between Sleep Apnea and Hearing Loss

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Sleep apnea is a common disorder and, according to the National Sleep Foundation, it affects about 18 million Americans. Most of us think of sleep apnea as snoring with periodic gasping or “snorting” noises. This seemingly innocent annoyance interrupts sleep and can cause excessive daytime fatigue and other symptoms such as generalized inflammation, cardiovascular and endocrine problems. It can also affect the way a person thinks and even hears.

More than half of individuals with sleep apnea are overweight and most snore heavily. Untreated sleep apnea can lead to a variety of other health issues, including high blood pressure, heart attack, stroke, diabetes and obesity. In addition to snoring and daytime sleepiness, symptoms of sleep apnea may include morning headaches, irritability, learning or memory problems, mood swings, dry throat upon waking in the morning and frequent urination at night.

Types of Apnea

There are two types of sleep apnea; obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea occurs when the airway collapses or becomes obstructed. This is the most common type of apnea. Central sleep apnea occurs when your brain doesn’t send the right signals to your breathing muscles. Central sleep apnea is more common in individuals with certain medical conditions, such as congestive heart failure and stroke or sleeping at high altitude.

How Does Sleep Apnea Affect the Hearing Organ?

The organs in the inner ear are dependent on a healthy supply of blood flow. Good circulation nourishes delicate hair cells in the hearing organ or cochlea. These hair cells do not regenerate or re-grow so any damage to this part of the inner ear results in sensorineural hearing loss, the most common type of permanent hearing loss.

Hearing health professionals know that circulatory issues can cause hearing loss. Research indicates that people with heart disease are 50% more likely to have hearing impairment. According to the American Diabetes Association, patients with diabetes are twice as likely to have hearing loss as those individuals who do not. Smokers are more likely to develop hearing loss because of the depleted oxygen levels in the inner ear. Untreated high blood pressure can also contribute to hearing loss and tinnitus, also known as ringing in the ears.

Why the connection with sleep apnea? Researchers think inflammation in blood vessels could be to blame, since the ear would be prone to that kind of damage. Sleep apnea causes major inflammation in the bloodstream and brain, which promotes vascular complications. People with sleep apnea have thicker blood and their blood clots more readily.

Sleep Apnea and Sudden Hearing Loss

The results published in Archives of Otolaryngology-Head & Neck Surgery showed that men who experienced sudden deafness were 48% more likely to have previously been diagnosed with sleep apnea. According to the researchers, this shows a clear link between the two disorders. The sudden hearing loss or deafness is typically in one ear and, if treated promptly, is regained in a period of two to three weeks.

Scientists do not yet understand the link between hearing loss and sleep problems. They have discovered that sleeping less – just over two nights – can harm blood vessel function. Your ears depend upon the blood that circulates in your body. The slowing of blood flow means fewer nutrients to the ear and this can lead to atrophy and destruction of the auditory hair cells. But this is a theory that has yet to be proven conclusively.

Treating Sleep Apnea

If you suspect you have sleep apnea, schedule an appointment with your physician. Before you go to the appointment, write down notes to help you remember when you think the sleeping issues started and how often you have difficulty sleeping. Mention any over-the-counter or prescription medications you may have tried to help your sleep quality. Discuss any lifestyle changes you may have already implemented that do not appear to help with sleep.

Your physician may recommend changes such as weight loss, smoking cessation, use of a continuous positive airway pressure (CPAP) machine or oral breathing devices to wear at night, medicine to help you stay awake during the day, and/or surgery to correct a blockage. This treatment will become a partnership of management between you and your physician. Ask to have your hearing tested even if you are not currently experiencing hearing difficulty. A baseline audiogram is important to help your physician monitor any changes in your hearing sensitivity over time. QCBN

By Karon Lynn

Trinity Hearing Center is located at 1330 N. Rim Dr., Suite B in Flagstaff. For more information, visit the website at TrinityHearing.net. Karon Lynn is a doctor of audiology with 30 years of experience working with hearing impaired individuals. Dr. Lynn may be reached at 928-522-0500 or at audio@trinityhearing.net.

Changes in Hearing After Head Injury

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Approximately 1.4 million individuals suffer from traumatic brain injury (TBI) each year in the United States. The most common causes of injury are automobile accidents, falls, assaults/blows, sports-related injuries and explosive blasts. Internal causes of brain injury are strokes, edema, meningitis, tumors and even certain medications. The resulting hearing loss symptoms a person suffers are varied depending on the damage.

 

Injury from Automobile Accidents

The brain may be shaken within the skull, causing bruises or contusions to form at the sites of impact. Like bruises elsewhere on the body, these will heal with time. Brain injury can occur even when there is no direct blow to the head, such as when a person suffers whiplash. The force may stretch and sever fibers in the brain. Damage to these fibers disrupts the communication between nerve cells, and reduces the efficiency of the brains ability to function. The established pathways may be damaged enough that they do not send the necessary nerve signal properly anymore.

 

Injury from Bleeding

Damage to blood vessels surrounding the brain is another common source of injury, causing bleeding between the brain and skull. When this type of bleeding stops and the blood vessels heal like any other cut. Bleeding may permanently damage the surrounding brain tissue even after the blood vessels have healed.

 

What Does the Injury Do?

Minor head injuries cause a wide range of cognitive deficits such as impaired attention, slowed information processing, memory difficulty, difficult word retrieval, deficits in understanding speech and problem-solving. There can be personality changes including increased irritability, anxiety, depression and social inappropriateness. Depression is one of the most commonly reported problems after head injury. Hyper-sensitive vision and hearing are also common side effects of head trauma.

 

Hypersensitivity to Sound

Hypersensitivity to sound is called hyperacusis. After an individual has suffered a head injury, he or she may become nervous or anxious when they go to stores, movies or restaurants. These individuals may feel that they hear as well as they did prior to the injury, but now they have difficulty focusing on only one sound. It is as if all the sound in the room rushes into the brain without any type of governor or filtering system. People report they hear a solid wall of noise that is constantly closing in on them.

Individuals with hyperacusis have difficulty tolerating sounds that do not seem loud to others, such as the noise from running faucet water, riding in a car, walking on leaves, a running dishwasher, the fan on the refrigerator, shuffling papers and the sound of their own breathing. Although all sounds may be perceived as too loud, high frequency sounds may be particularly troublesome. The quality of life for individuals with hyperacusis can be greatly compromised. For those with a severe intolerance to sound, it is difficult and sometimes impossible to function in an everyday environment with all the ambient noise.

 

Treatment for Hyperacusis

Hyperacusis may occur without damage to the hearing organ (cochlea). On other occasions, it occurs in conjunction with damage to the cochlea. After head injury or brain injury, it is recommended that you have a hearing evaluation. During the visit, you and your audiologist will discuss any symptoms you are experiencing. You will learn if your hearing symptoms are isolated to the cochlea or throughout the auditory pathways in your brain.

Your audiologist may recommend that you use musician’s earplugs. This special custom fit ear plug filters out sounds of specific frequencies and intensities depending on the severity of your situation. Because they are custom fit to your ears, they are comfortable enough to wear all day. As time progresses, you will be able to wear the earplugs less and less. Some individuals wear the plugs only in the noisy situations that bother them.

 

Find a Support Group

One of the primary difficulties of living with this disorder is other people’s reactions to what you are experiencing. Those who do not have hypersensitivity to sound simply cannot imagine how their chewing and swallowing noises can be so distracting to another person. Often, protests from the sufferer are misinterpreted as passive-aggressive personal attacks or that the head injured person is faking the problem.

Remember that you are not alone. If you feel that you are having significant difficulty coping with your symptoms, speak to a professional. There are support groups that focus on head injury suffers, which offer information and the opportunity to establish camaraderie with other people who are experiencing similar difficulty. QCBN

 

 

By Karon Lynn, Au.D.

 

Understanding Hearing Loss and Associated Comorbidities

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I found this article from the CapTel phone organization and liked it so much that I am sharing it with you.

In only the last dozen years, many important studies have surfaced linking hearing loss to disabling conditions such as cognitive decline and Alzheimer’s disease, clinical depression, diabetes, falls among the elderly, heart disease and many more. These linkages are often referred to as “comorbidities,” which is defined as the simultaneous presence of two or more chronic conditions or diseases in a person. A “chronic condition” is defined as a health condition or disease that is persistent or otherwise long-lasting in its effects. The term chronic is applied when the course of the disease lasts for more than three months. Using this definition, hearing loss clearly qualifies as a chronic condition.

Seven Comorbidities Linked to Hearing Loss

 

  1. Social isolation and loneliness. Although social isolation and loneliness are usually looked at as different constructs, for the purpose of this general discussion the two are combined here. The researchers measured loneliness using the UCLA Loneliness Scale, and found that younger-age hearing loss was significantly correlated with greater loneliness. Other depressive symptoms and hearing-related quality of life, communication difficulties, emotional well-being, mental health on the 36-item Medical Outcomes Study Short-Form (SF-36) were also negatively correlated with loneliness.
  2. Depression. Recent research shows that there appears to be a direct relationship with the prevalence of moderate-to-severe depression being 4.9 percent for people reporting excellent hearing, 7.1 percent for those with good hearing, and 11.4 percent for those reporting a little trouble or greater hearing loss. This study also contains some interesting data that shows how, as the hearing loss increases, the incidence of depression also increases. The trend appears to be more obvious for women, and the exceptions to this were people who reported themselves to be “deaf.”
  3. Falls. Falls are the leading cause of fatal and non-fatal injuries among the elderly leading to significant health, social, economic and emotional consequences. Falls often lead to fatal outcomes within the first 12 months of a fall with injury in the senior population. Research has shown an increase in falls by 1.4 percent increasing to a much larger percentage the more hearing loss a person has.
  4. Cardiovascular disease. An interesting 2009 study by Friedland and colleagues published in Laryngoscope showed that the audiometric patterns – particularly low-frequency (sloping) and flat (strial) losses – were strongly correlated with cardiovascular disease. In fact, the researchers reported that patients with low-frequency hearing loss should be regarded as “at risk” for cardiovascular events, and appropriate medical referrals should be considered. One chart in the study suggests that about 85 percent of diagnosed strokes were associated with individuals who had flat or low-frequency sloping losses, causing the authors to suggest that the vascular pathology extended throughout the body, including the ears.
  5. Diabetes. A study looking at the association between hearing loss and diabetes was conducted by Kathleen Bainbridge and colleagues, published in the July 2008 edition of the Annals of Internal Medicine. They found that people with diabetes had significantly increased odds of hearing impairment in worse and better ears at all severity levels and frequencies. It appears that prevalence of hearing loss among those people with diabetes was more than twice that than those without diabetes. The association between hearing loss and diabetes was actually stronger among those people younger than age 60, and was independent of gender or chronic exposure to noise.
  6. Cognitive impairment and dementia. Perhaps the landmark study that elevated the interest of healthcare professionals and the public about this topic was the paper by Dr. Frank Lin and colleagues published in 2011. The results showed that, compared with normal hearing, the hazard ratio for incident all-cause dementia was 1.89 for mild hearing loss, 3.0 for moderate hearing loss, and 4.94 for severe hearing loss.
  7. Mortality. As if all these comorbidities are not enough, it turns out that there may even be a relationship between hearing loss and mortality. The Reykjavik study by Fisher, et al, examined the vision and hearing of 4,926 Icelandic individuals ages 67 years or older between 2002-2006 who were prospectively followed for mortality through 2009. In the study, individuals with hearing loss had a higher risk of death from all-cause cardiovascular disease than those without hearing loss. QCBN

 

 

By Karon Lynn, Au.D.

Understanding Brain Controlled Hearing Aids

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One of the most difficult situations in which to hear well is to hear one person in a group of loud-spoken people. Not hearing well in the company of friends and family is a quality of life issue. Without the ability to hear what is going on, you tend to withdraw and become isolated. Rather than giving up on social interaction, I recommend that you try a pair of hearing aids. Hearing aids are outfitted with directional microphones to help you focus in a direction you choose. For instance, if you are driving a car and want to hear the passenger more clearly, you can push a button to stream the sound from the passenger side into the opposite ear hearing aid. The aids are able to turn down the noise from the window and receive the speech from the passenger so that you hear them in both ears equally. It really helps increase the clarity of the speech. Some of the hearing aids are able to do this without pushing a button. The aids have sensors (a computer program) that know when you are in a car environment and automatically make the adjustment for you!

What happens when you are in a restaurant? The hearing aids are able to reduce distant sound from a nearby table so that you are better able to focus on the person sitting across the table from you. To do this, the hearing aids turn down the input from the back facing microphone. This will provide a better signal-to-noise ratio. In this case, the signal is the person across the table and the noise is the group of people behind you. Research has shown us that people with hearing loss need more of a reduction in noise compared to speech (signal to noise ratio) than people with normal hearing. That is why normal hearing people are able to understand speech in moderate noise. The brain and auditory pathways are able to separate the two signals better if you have normal hearing and processing. The problem arises if you have compromised hearing organs (cochlea) or compromised pathways into the area of the brain that understands speech. The current hearing aids are not able to eliminate the unwanted noise, but they are able to reduce the noise.

Researchers at Columbia University are focusing on this issue by combining traditional hearing aid technology with brain scanning and artificial intelligence. It is called auditory attention decoding (ADD), or a cognitively controlled hearing aid. In the research stage, they use externally worn sensors that monitor brain activity to determine what the hearing target is, and then it isolates the targeted speech and makes it louder while suppressing all the background noise. (That is a lot to put into one sentence, much less into one hearing aid!) To collect the massive amount of data coming from the brain, the person wears a cap with electrodes in it so that the electrodes touch the scalp. The information is fed to a computer that is able to learn what you prefer to hear and what you want to ignore. This system can take a single audio channel from a group of speakers (talking people) and combine it with the listener’s neural signals (from the brain) and in less than 10 seconds it determines which speaker is being listened to and amplifies it to the required loudness for clarity. One day you will be able to have cognitively controlled hearing aids!

Until the time that these hearing aids are available to the public, we need to continue to use the following tips to get the most out of what we can hear.

  1. Ask people to face you when they speak.
  2. Reduce background noise when possible.
  3. Select off times to go out to restaurants so they are not so noisy.
  4. Ask people to get your attention before they start speaking.
  5. Ask people to speak slower, not louder.
  6. Keep the hearing aids and ear canals clean.
  7. Have the hearing aids checked once a year for proper function.

By following these guidelines, you will have more success understanding speech in a competitive environment. If you are not happy with the sound of your hearing aids even when you are at home, then maybe it is time to investigate the newer technology that is available. A one month trial of the newer technology while you own your older hearing aids is a great way to make an apples-to-apples comparison. QCBN

By Karon Lynn, Au.D.

 

 

 

What is it Like to Have a Hearing Loss?

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As an audiologist, I see hearing impaired individuals every day. One of the most rewarding activities of my job is to teach the family members what it is like to have a hearing loss and how to better communicate with hearing impaired people.

 

What can the hearing impaired person hear?

I think that understanding what a person really can and can’t hear is the key to successfully living with or working with a hearing impaired person. It is crucial to understand what can change the clarity of your voice for a person attempting to comprehend what you are saying.

For the sake of argument, let’s select the most common hearing loss to use in our discussion. That would be a high frequency hearing loss. Now, we will put lovely hearing aids on them that have been programmed by your favorite audiologist! That individual is now being given sound to augment what they hear without amplification. Can they hear the same as you? I am sorry to say they do not. They are able to hear more sounds that are used for speech and they also hear room noise that is sharing the same pitches as speech. They can hear water running, cinders crunching under their feet, paper rustling and other high pitch sounds. They hear your voice much easier (note the word easier) but not perfectly. They can now hear the competitive speech sounds in the same room. The damage in the hearing organ is still there. In essence, even as a person wears hearing aids they are still hearing impaired. Their hearing is aided.

 

Filtered speech that you can hear online

There are some amazing websites that play a variety of sound samples for the normal hearing person to hear speech through a damaged hearing organ. One website is called The Hearing Loss Sampler by Scott Bradley Ph.D. from the University of Wisconsin-Whitewater. The web address is: facstaff.uww.edu/bradleys/radio/hlsimulation/. This website demonstrates a variety of hearing losses by using a filter to modify the sound to match the audiogram shown.

It is a remarkable learning experience to listen to the samples and step into the shoes of an individual who lives in a world with this type of hearing. After listening to the samples, imagine going to church service or a meeting with the “sample ears.” How loud would you need to turn the TV? Now imagine sitting in your favorite chair reading a book and suddenly hearing the demonstration sentence start up. Would you be able to understand it? If you turn the “sample ears” louder, does it eliminate all the difficulty or do you still need to concentrate on what is being said? Do you think that you could relax and listen as people were talking in a group setting?

You will notice at this website that speech in noise is separate from the speech in quiet. Listen to the difference. Notice how noise is a significant distraction to the desired sentence you are concentrating on.

Another website called The Real Sounds of Hearing provides sentences with filtered sound giving you a unique insight into the life of a hearing-impaired person. Go to: npr.org/blogs/health/2013/04/06/175945670/the-real-sounds-of-hearing-loss. This website is provided by Audrey Carlsen. She demonstrates to the listener how it is to hear with the high frequencies missing or damaged. In another sample, she demonstrates what it sounds like with a flat hearing loss. A flat hearing loss causes you to miss all the soft sounds of speech.

 

Another source of information about hearing is at YouTube. Go to YouTube and type in the words “simulated hearing loss.” You will find many samples of what hearing loss sounds like and how the hearing system works.

I hope those of you who do not own a computer will go use a family member or friend’s computer to listen to these samples. You could go to your audiologists office and ask to hear the samples. Another suggestion is to go the public library. The librarian will be happy to help you find the web sites and help you use the computer.

If you live with or work with people who are experiencing hearing loss, you will find this knowledge profound. Please take a few minutes to put yourself in their shoes. My experience is that the normal hearing family members are moved to tears as they finally understand what their loved one is experiencing. QCBN

By Karon Lynn, Au.D.

Trinity Hearing Center is located at 1330 N. Rim Dr., Suite B in Flagstaff. For more information, visit the website at TrinityHearing.net. Karon Lynn is a doctor of audiology with 30 years of experience working with hearing impaired individuals. Dr. Lynn may be reached at 928-522-0500 or at audio@trinityhearing.net.

 

 

 

Research Linking Exercise to Reduced Hearing Loss

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Researchers have shown us that exercise is good for your hearing! We all know that regular exercise helps reduce weight gain, improves bone density, increases cardiovascular fitness and even helps to support your immune system. Now, the results are showing that lack of aerobic exercise in mice caused the structures inside the hearing organ (cochlea) to collapse or deteriorate. The hair cells or nerves that pick up sound and change it to electrical signal and the strial capillaries, which provide the blood flow to the cochlea were not as productive in the sedentary mice. The strial capillaries take the necessary oxygen to the auditory system, which is essential for the function of the hearing organs.

The mice that exercised showed a five percent hearing loss in their lifetime, while the mice that were not allowed to exercise experienced a 20 percent hearing loss. Now, researchers believe that 70 percent of hearing loss in people over 70 years is related to the loss of these important structures. The researchers also noted that age related inflammation in the less active mice was more significant than in the active mice.

 

Cardiovascular Health

 

Cardiovascular health seems to be one of the secrets to keeping the body and all of its intricate organs happy. The body needs oxygen to maintain a state of functional health. The body at rest does not challenge the heart enough to keep the oxygen rich blood flowing to all the distant tiny areas (like the hearing organs) that are dependent on a continual supply of fresh oxygen. The aging process promotes saggy skin, right? So, think about your insides; they are probably saggy, too. If the outside of our body teaches us anything, it is that “things are a’changing.”

How does blood full of life-giving oxygen easily travel down the arteries that branch out into smaller and smaller areas to tissue changing into tiny capillaries when the resistance of the artery walls is no longer there? The heart must maintain strength to pump the blood all over the body. As we age, there is a reduction in total body water; thus, less fluid in the bloodstream, causing a reduction in the amount of blood we have. The reproduction of the blood cells is reduced as we age, which is problematic if there is blood loss or anemia. If we simply let things go as they go, we fall into poor cardiovascular health.

 

 

 

Brain Energy

It is important to remember that the brain is dependent on oxygen delivered from blood. The brain is responsible for taking all the sound you hear and converting it into signals that make sense. It has to work hard to decipher the speech sound and separate it from background noise. This requires a healthy brain that is able to transfer information from one area to the other in a timely manner. It needs to race the information to the necessary area of the brain so you will be able to understand the current sentence and not need to stop to figure out the previous sentence that was said. As we age, speed of processing is compromised naturally but with consistent fresh supply of oxygen this is less noticeable. When an area of the brain is not consistently provided oxygen, the nerves degenerate and are never able to be used again.

 

What Type of Exercise Helps Hearing?

The important part of exercise is not what you do but that you do something on a regular basis. You can walk, bike, run or go to a class at the gym. It does not really matter what you do, so pick something that you like and create the habit to do it. The important thing is that you make it part of your normal routine. Think of it as the daily norm similar to taking a shower, brushing your teeth, eating, drinking and, of course, exercising. Make exercise one of your normal daily activities.

During your exercise, it is important to use large muscle movements for at least 20-30 minutes five days a week. Walk for 10 minutes, turn around and go back – and magically, you have your 20 minutes of exercise! Stretching helps blood flow to your muscles and other structures, which are necessary to have a full and happy life. Simple, gentle stretches help wake the muscles and increase blood flow at the same time! You are the only person who can change your blood flow, so make it your choice today! QCBN

 

By Karon Lynn, Au.D.

How to Buy Hearing Aids Online

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This is a new topic in the world of hearing aids. There is a whole new world out there offering you hearing aids at a price “too good to be true.” You will now see hearing aids sold online and even offered through your insurance company. This new process for obtaining hearing aids is not without a significant set of issues. First, you need to make certain you do not have a hearing loss that needs medical attention. It is important to understand that online aids are not able to be fine-tuned to meet your specific environmental needs. Do you sing in a choir, go hiking in the wind or are you a birder? All of the “special” activities you engage in will require sound modification in the hearing aids.

When you purchase hearing aids online or from other sources outside of your living area, you must be careful about the level of technology you are actually getting. Do they advertise features that are not really in the device? Some companies are offering hearing aids with entry level circuitry with no ability to upgrade. An entry level circuit may be adequate for that individual who lives alone, does not leave the house very often and is rarely in a noisy environment. The average individual needing hearing aids has a full array of listening environments such as at the grocery store, church, meetings, restaurants and family gatherings.

 

Online Hearing Aid Purchases

Online hearing aids may sport a great price, but remember that price is typically for a device only. The programming, repairs, upkeep and cleaning may not be included when the price is too good to be real. Hearing aids can be high maintenance and will need to have someone check to keep the sound quality good by cleaning them and making sure the ear canals are clear. The hearing aid sound needs to be changed as your hearing changes. Be prepared to purchase service and upkeep from a local audiologist if you choose an internet hearing aid. There may not be an audiologist who has the software to make the modifications you need as your hearing changes or to make the sound more comfortable for you. Another option is to ask your audiologist if he or she can offer a total package for a similar model hearing aid with the service and adjustments at a comparable price.

 

Hearing Aids Through Insurance Companies

Before you select a particular insurance supplement based on the fact that it offers a hearing aid benefit, research the actual benefit, the hearing aid make and model and ask how the hearing aid will be maintained for any damage and all the necessary adjustments to the sound. Realize that if the sound quality does not meet your needs, you are limited to the skills of the technician to whom you mail the aid. That individual has not established a personal relationship with you and will change the settings based on a flow sheet that the industry has provided. If you don’t like the new settings or the hearing aids hurt your ears, you have to mail the aids back again and again.

Some insurance companies offer hearing aids to the consumer with various levels of technology. The consumer sees an audiologist to complete an evaluation and assist the consumer in selecting a certain level of technology. The consumer pays the insurance company for the hearing aids. The audiologist is paid a flat rate by the insurance company for the fitting and initial adjustment of the hearing aids. The subsequent adjustments could take three to five visits, are to be paid by the person wearing the aids. There are also insurance plans that offer a flat rate toward the purchase of hearing aids. The difference in actual price of the hearing aids is paid to the audiologist by the consumer.

 

Ask Your Local Audiologist

Another option is to make an appointment with a local audiologist and ask for advice on hearing aids offered through the plan on which you are focusing. The audiologist may be able to offer suggestions to reduce your risk of being saddled with hearing aids with which you may not be happy. You may be able to see if that audiologist carries a hearing aid with similar technology at a competitive price. If so, you will get hearing aids and the ongoing service that you will need with a person you can see and talk to! Remember, hearing changes. You wear the hearing aids every day and expose them to moisture, heat, wax and the potential of physical damage; you need an ongoing professional team to help you with your hearing health! QCBN

By Dr. Karon Lynn, Au.D.

Speech Understanding in Wind

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Wind noise has been an ongoing issue since the beginning of hearing aid use. I remember 30 years ago talking to people about managing wind noise when they were wearing a body-worn hearing aid. I asked people to change the direction they were facing so their back was to the wind or stand sideways to the wind. I helped parents design headbands to be worn over the ear level hearing aids to protect the hearing aid on their child from wind exposure. I recommend that people wear baseball caps with material hanging down on the sides to reduce wind hitting a microphone. (Now we wear them to keep the sun off our face, reducing the risk of premature skin aging.)

For the industry as a whole, the focus has been on comfort and clarity of speech inside a house or gathering in a social setting. People wearing hearing aids can hear “indoors quiet” well but are struggling to hear speech during outdoor activities. The non-hearing aid wearer rarely complains of not hearing speech because the wind noise is too loud. Playing golf or watching an outdoor sports event can be frustrating while wearing hearing aids. Try playing outfield wearing hearing aids and your coach is yelling instructions to you. Why do hearing aids pick up so much wind noise?

First, we need to understand what happens to the microphones of a hearing aid when wind blows across it. The microphones are designed to pick up sound pressure changes but the poor things think that the phantom noise caused by vibrations of the microphone membrane is from sound pressure changes like speech. And more importantly, it does not need to be a significant wind to be picked up by the hearing aid. The microphone is picking up fluctuations in the air, meaning the wind distraction is neither a sound nor a noise. We know people will not wear hearing aids with big fluffy windscreens on them like TV crews use to protect their microphones! How does the industry create a hearing aid that reduces the air fluctuations while letting the desired sound in?

What has been used is a two-step process; detection of the low frequency interference that wind causes and suppression of this unwanted sound. To help suppress the sound, omnidirectional microphones are used. Some hearing aids automatically switch to omnidirectional when wind is detected by noticing the difference in input between the two microphones on each aid. But if you are outside with someone and having a conversation, this adjustment may make it difficult to focus on what is being said. If the hearing aid has enough frequency channels to detect wind as opposed to speech, it is able to attenuate those channels.

However, any time we take sound away, speech clarity is compromised. You don’t hear the distraction, but you can’t understand the words, either!

Comfort in wind is enhanced by the above scenario with the assistance of a new technology called binaural voice stream to help with clarity. This technology uses four microphones on two hearing aids to regulate the wind noise, operating under the assumption that wind is often picked up by a single microphone or both microphones on the same hearing aid. Another way to say this is that wind usually comes from one side of your body more than the other. The desired speech sound is picked up by all the microphones. This technology takes the speech signal from the hearing aid with the least amount of wind distraction and streams it to the opposite hearing aid. This hearing aid then exchanges its low frequencies with the other hearing aid because the low frequency sounds are most likely to be contaminated by the wind. The high frequencies are not exchanged to help maintain the ability to localize the sound source. You as the user do not have to do anything; the computers inside the aids are doing all the work at lightning speeds.

All technology is available for you to try at little or no cost. A previous negative experience with hearing aids is no longer a reason to put off experimenting again. Your quality of life in and out of the house is what we as audiologists are attempting to enhance. Grow your life into what you want; don’t let your life compress because of hearing issues. The most common comment I hear from my patients is that I changed their life! I truly believe I have the best job in the world! QCBN

By Dr. Karon Lynn, Au.D

Trinity Hearing Center is located at 1330 N. Rim Dr., Suite B in Flagstaff. For more information, visit the website at TrinityHearing.net. Karon Lynn is a doctor of audiology with 30 years of experience working with hearing impaired individuals. Dr. Lynn may be reached at 928-522-0500 or at audio@trinityhearing.net.

Hearing in a Noisy Place

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Many people say to their audiologist that they are able to hear fine in a quiet room but the minute there is background noise they are not able to hear well. Sometimes it happens while watching a TV program and the background music suddenly gets louder. Difficulty may arise if a conversation is being held in a large room with echo or reverberation. This comment is true for people who hear normally or people with a hearing loss.

The Physiology of Hearing

All hearing situations are not created equal. There are numerous variables, from the shape of the room to the number of people in the room. The distance you are from the speech you are trying to hear will affect how your brain understands. The pathway of sound from the outside of your head through the canal and into the middle ear space can be altered by earwax, a hole in the eardrum or fluid behind the eardrum. The pathway of sound from the middle ear to the inner ear then through the nerves in the brain to the area of the brain that understands speech may be altered by damage to the inner ear from noise, genetics, medications or trauma. The area of the brain that understands speech may be compromised by blood flow and the speed the nerves can send the signals. It is a complicated system, to say the least.

 

Why is Background Speech Noise So Frustrating?

In a group of people there is speech sound that you are attempting to ignore and other speech that you want to hear. With a normally functioning auditory system, you can simply “tell” the brain to focus. It is almost an automatic occurrence that you do not need to even think about. However, many people with normal hearing and with a hearing loss struggle to pull the desired sound out of the background. Both the desired sound of the person talking has the same frequencies, timing and modulation as the speech of the people behind you. The two “noises” are very similar. The plethora of filters that control how you process the various sounds may not work well.

The Filters in the Brain

The brain and the ears work together to provide a seamless signal to us. Each side of the brain has its own job depending on the location of the noise versus the desired signal you want to hear. Some brains process the various noises very quickly and other brains like to take their time. Some brains do a great job on one side but for one reason or another have difficulty on the other side. The speed of how you take a sound and send it up the various brain pathways will help determine how well you understand. The pathways in the ear and brain modify some pitches and sound, which help understanding. Researchers are still discovering new “automation” in healthy functioning hearing system pathways. We know that people with two equally hearing ears understand speech better in noise than a person with one good ear and one impaired ear. The brain itself does much of the work but it needs the sound to be clear from both sides without distortion.

 

How to Improve your Odds to Understand Speech in Noise

There is not a single method of repairing the hearing pathways to function better in noise. We know that people who are exposed to competitive situations often do better than people who avoid noise continually. Practice listening to something enjoyable in a noisy room to help the areas of your brain “remember” what they are supposed to do. Help your brain stay active in how it functions in a variety of situations. When you are stressed your brain does not function with the same fluidity as on days that you are relaxed. Play games with your brain to help it function well so that when your day is not flowing and you become tense you will have enough brain power to work through your situation. Control the noise in the environment for important conversations. Sit near the person you have the most difficulty understanding. Try a pair of hearing aids with noise reduction circuitry and directional microphones. Just because you have to work at understanding speech does not mean you are a failure. It is a sign that you need to expend more energy for some activities than others. Speech understanding in noise is one of them, for all of us. QCBN

By Dr. Karon Lynn, Au.D

Trinity Hearing Center is located at 1330 N. Rim Dr., Suite B in Flagstaff. For more information, visit the website at TrinityHearing.net. Karon Lynn is a doctor of audiology with 30 years of experience working with hearing impaired individuals. Dr. Lynn may be reached at 928-522-0500 or at audio@trinityhearing.net.