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Understanding Your Audiology Results

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The first step on any hearing health journey is undergoing an examination. This exam provides you and the audiologist an understanding of your current state of hearing and allows for proper recommendations to be made. The findings are presented in a report called an audiogram. An audiogram contains both a written section and a graph. While the audiologist does review the audiogram during the appointment, it can sometimes be difficult to remember or fully grasp how to interpret your results. Proper interpretation is imperative, as it empowers you to be an equal part in treatment.

Hearing Thresholds

Hearing thresholds are presented graphically on the audiogram. The x-axis of the graph (left to right) represents frequency. Frequency is interpreted by humans as pitch, with increasing frequency corresponding with increasing pitch. Pitch increases from left to right along the x-axis. Thus, the left half of the audiogram would represent bass, while the right half would be treble. An average exam will test frequencies between 250 and 8,000 Hz. While human hearing can detect frequencies above and below this range, these are the most important for daily communication.

The y-axis (top to bottom) represents intensity as measured in decibels hearing level (dB HL). On this scale, 0 dB HL does not represent the absence of sound, but rather the quietest sound that the average adult can hear. Intensity is interpreted by humans as loudness. A higher decibel level corresponds to a louder sound. Quiet sounds are at the top of the graph, while very loud sounds are at the bottom of the graph.

Your ears function both as combined and independent systems. As such, the audiologist will want to test the respective performance of each ear. The hearing thresholds for the right ear are represented by circles or triangles, while the left ear thresholds are Xs or squares. Hearing thresholds are the quietest sound you can hear at a given frequency. For example, the right ear threshold at 1k Hz may be 20 dB HL. This would mean that at that specific frequency, the right ear can hear the sound when it is 20 dB HL or louder, but not below that level. This will hold true for the threshold of each respective frequency. For normal hearing, 20 dB HL is considered to be the cut-off, with 21 dB HL and higher representing increasing degrees of hearing loss.

Speech Understanding

Another main component of a hearing exam is speech testing. Speech test results may be found in numerical form in a box typically located at the bottom of the page. Two main speech tests are typically performed. The first is the speech recognition threshold (SRT). It represents the quietest level at which you can understand speech 50% of the time. The SRT mainly functions as a way to verify accuracy within the test battery. A measurement which is more relevant to daily communication performance is the word recognition score (WRS). Your WRS represents how well your brain can interpret speech sounds and is reported as the percentage of words repeated correctly. When measuring the WRS, the words are presented at a loudness level that is easy for the patient to hear. A high WRS means you can understand words well, while a lower WRS means that the brain has difficulty interpreting the speech sound because of distortion in the auditory system.

Relationship Between Thresholds and Speech Understanding

One important concept to understand is that your hearing thresholds and ability to understand speech are not necessarily correlated. Better hearing thresholds do not always mean a better WRS, nor do worse thresholds always mean a worse WRS. Indeed, two individuals may have the exact same hearing thresholds, yet drastically different abilities to understand what is being said. What then, influences your WRS? It all has to do with the frequency filters in your ears. Each speech sound has a different fundamental frequency. Sounds like “shh” have a higher frequency than “oo” would. When sound is picked up by your ears, it is sent through specially designed filters to help separate out all the speech sounds. As more damage occurs to the auditory system, those filters become less precise and overlap with each other. Thus, “shh” and “oo” may appear to your brain to be coming from the same filter and it has difficulty distinguishing them.

While many factors are taken into account when deciding treatment, test results are a main one. By possessing a greater understanding of your results, you can feel confident in the decisions being made. QCBN

By Jeff Lane, Au. D.

Dr. Jeff Lane is an audiologist at Trinity Hearing Center, located at 1330 N. Rim Dr., Suite B in Flagstaff. For more information, visit the website at TrinityHearing.net. Jeff Lane is a doctor of audiology with a passion for improving the lives of others. Dr. Lane may be reached at 928-522-0500 or at audio@trinityhearing.net.

Strategies to Improve Communication

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One inevitable side effect of hearing loss is increased difficulty communicating with others. Specifically, the person with hearing loss will often not hear, or will misunderstand, what someone has said. Sometimes, the misunderstanding can be humorous. More often, though, it is frustrating and embarrassing. Some people with hearing loss will eventually began to retreat from social interactions, reducing quality of life. Hearing aids can be of great benefit in restoring these communication abilities. However, hearing aids alone are not a total solution. While astounding advancements have been made in the world of hearing aids in the past few years, they still have their limits, as with any technology. Use of effective communication strategies can greatly improve the benefit received from hearing aids. All of these strategies are simple to implement in daily life (although adjusting habits make take time).

Assertive vs. Passive or Aggressive

People with hearing loss often change their communication style over time. It is not done purposefully, but as a subconscious adjustment to the progressing loss. Many will become passive, allowing others to do the majority of the talking. On the other side of the coin, a smaller group will become aggressive, dominating the conversation (talking more means they have to rely less on their ears to lis-ten). Again, no blame should be dealt or guilt felt for adopting either of these styles, but neither is effective or sustainable. The goal should be an assertive approach to communication. Allow for a natural flow to occur, but do not be afraid to stick up for yourself. Ask someone to speak louder or slower if not understood, or to repeat if necessary. Choose the seat in a restaurant that will be most conducive to listening (more on this later). Although people with hearing loss often fear that they will annoy or inconvenience others, the literature states that others are very receptive when those with a hearing loss own it and are upfront about the topic.

Effective Communication Strategies

Distance: One of the best ways to improve understanding is simply to get closer. The Inverse Square Law states that for each doubling of distance the auditory signal is reduced by six decibels (dB). Thus, if a person’s voice is at 60 dB when standing three feet away, it will decrease to 53 dB at six feet and so on. The take away here is that talking to a person with hearing loss from across the room is ineffective as the signal will be much quieter by the time it actually reaches their ears (or hearing aids). This also means that there is more interference (other noise) between the listener and the talker, and that the interference may be louder to the person with hearing loss than the speech signal. If you want to talk, get close.

Vision: A person with hearing loss will often say that they are expert lip readers. While they may not be able to spy on your conversation from across the room, it is true that people with hearing loss rely heavily on visual cues. It allows their brain to expend less energy trying to understand. The talker should be in the same room and facing the listener, with good lighting and nothing obstructing their mouths (e.g. a hand or hands).

Noise: Understanding speech in noise is a difficult task for anybody. As noise cannot be erased from the world, minimizing its impact is the best outcome. At a party or restaurant, try to sit as far away from the source of the noise as possible. Do not choose a table at a restaurant that is in a corner or in the middle of the room, as these locations increase the echo. The person with hearing difficulty should choose a seat that places the majority of the noise behind them. This is especially important for those with hearing aids, as the aids will detect the extraneous noise and turnoff the rear microphone, only amplifying signals coming from the front.

Rephrasing: Everyone’s natural response to missed speech is to say, “What?” However, a more effective response would be to ask the person to rephrase or fill in missing information, like asking, “What time are we going to dinner on Tuesday?” This allows the listener to receive the needed information and acknowledges to the talker that they were heard.

While communication may never be perfect, implementing these strategies, along with hearing aid use, will greatly improve understanding and enjoyment. QCBN

By Jeff Lane, 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. Jeff Lane is a doctor of audiology with a passion for improving the lives of others. Dr. Lane may be reached at 928-522-0500 or at audio@trinityhearing.net.

Becoming Hearing Aid Savvy

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Hearing is something we often take for granted, until we have concerns. The following are some of the commonly asked questions that come up when individuals are considering hearing aids.
I think I need hearing aids, but how do I know what I should buy?
Your lifestyle determines the technology that would be the best for you. Those who are in group settings for church, meetings or family gatherings will need to purchase aids with more advanced technology than someone who is usually in quiet environments and only occasionally attends small meetings or gatherings. The ability of the hearing aid to switch from surround sound to directional sound is what helps you understand better in the presence of noise.
What technology is available?
There are a variety of bells and whistles available inside hearing aids: omni-directional microphones, directional microphones, automated feedback squelch, multiple tuning channels, sound recover of high frequencies, controls that allow the sound from one ear to transfer to the other, to name a few. You may want wireless connectivity for your cell phone, PDA or wireless laptop and the TV. There are even waterproof and water-resistant hearing aids for the active individual.
What features should I look for in a hearing aid?
Directional microphones will greatly reduce (not eliminate) background noise. Car noise, fan noise and other steady state noises are reduced. Unwanted speech noise from other people in the room is more difficult to eliminate because that sound is the same pitch you are trying to hear. Because of size restraints, you can’t zoom into speech like the huge directional microphones used to eavesdrop on the pro golfers talking to their caddies!
Wind block technology focuses on the sound wind makes flowing over a microphone and suppresses it.
Automatic feedback squelch is one of the most wonderful technologies. It is now uncommon to have hearing aids that whistle!
Multiple tuning channels will help the audiologist fine tune the aids to sound more comfortable.
Sound recover is a feature designed to take the energy from the high frequencies that you cannot hear and push them to frequencies you do hear. This helps with clarity of speech. There are microphones that will transfer wanted sound on one side to both ears so that you can hear better while walking with your friends or driving a car.
Bluetooth connection allows you to hear speech on the telephone in both ears while the phone is in the room rather than holding it up to your ear! This helps with clarity on the phone.
How are hearing aids priced?
Hearing aid features require enormous engineering to create a technology that is small, physically stable/dependable and able to reduce noise and expand and compress the desired sound before it enters the ear canal. The base price of the hearing aid is increased to cover the audiologist’s time for fitting and adjusting the device five or six times, educating the patient on the use and the ongoing care of the hearing aid. The audiologist can teach you how to pair the hearing aids to a phone and TV and help with troubleshooting if a problem arises. Fitting and caring for the hearing aid wearer is labor intensive. The price includes years of care of the devices. The warranty covers loss and damage, so the price of replacement and repair shipping fees are a factor. Appointments are made to keep the hearing aids clean and functioning, despite being housed in a warm, moist and wax-producing ear canal. Additional office visits may focus on counseling the family on the emotional and stress-related issues that arise when living with a hearing-impaired individual. The hearing aid is just part of the package that comes with the purchase price. The audiologist becomes part of your family’s hearing team.
What do I take with me to the appointment with my audiologist?
Write a list of the situations in which you have difficulty hearing. Ask the people you are most often around to do the same. When you compare the lists, you may see a significant difference in perception. The audiologist will be able to point out more situations to you so that you will have a good picture of when you have difficulty hearing. Many times, the family and friends of the hearing-impaired person will have as much relief from a hearing aid being used as the person wearing the hearing aid! Take a copy of any previous hearing tests with you to the appointment. Ask to have a trial with the hearing aids. As you use the devices and go back for adjustments, you will be able to make an educated decision about how much hearing aids are able to improve the quality of your life. QCBN

By Karon Lynn, Au.D.

Trinity Hearing Center is located at 1330 N. Rim Dr., Suite B in Flagstaff. For more information, visit 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.

Exploring New Hearing Aid Technology

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A new technology in the hearing aid industry is remote adjustment to the hearing aid. This reduces the number of trips back to the office to have fine tuning completed. An appointment is made with your audiologist to be seen remotely at your house or office. It has been an interesting option to implement during the last few months. Most of the people I have contacted remotely are happy about the process, as they can stay in the comfort of their home or go to the environment causing difficulty and have the hearing aids adjusted by their audiologist while they listen.

Technologies Inside a Hearing Aid

We now have reliable rechargeable hearing aids. The battery life is designed to last a full day, between 18 and 30 hours. The difference in the length of battery life is based on the type of technology used in that hearing aid. A person using the Bluetooth circuit while streaming the phone or other Bluetooth enabled devices will drain the battery more quickly than someone who rarely talks on the phone. The battery is charged every night and is designed to last about six years.

Hearing aids are doing a better job of adjusting sound to make it more natural and realistic. The ability to change the way the hearing aid automatically modifies and enhances the sound in a place that has significant noise competition is now more successful. The two hearing aids are able to communicate with each other to focus on what you are looking at and diminish the input from other places in the room. This uses near-field magnetic induction (NFMI) and requires little power drain. Battery life is an important consideration for anyone wearing hearing aids. The two aids will change volume and programs together automatically or with the touch of a button. This near-field signal is a safe and effective means of changing the settings and using the specialized features that require two hearing aids.

Another circuit available in hearing aids is Bluetooth, which uses a band of radio frequencies around 2.4 GHz. Bluetooth technology works well to reduce the distance restriction of near-field technology but classic Bluetooth requires more energy than the NFMI. There are a few types of Bluetooth technologies on the market with different abilities. The type of Bluetooth in your car that streams your phone to the speakers requires significant power, which hearing aids are not able to accommodate (at this time). The Bluetooth circuit in a hearing aid is called Bluetooth low energy (BLE). The earlier versions of Bluetooth used in hearing aids needed a gateway device worn near or around the neck to send the signal to the hearing aids. Today, the gateway device is not needed!

After pairing the hearing aids to the device that you want to hear, e.g. phone, computer, car phone system or TV, you are able to hear the sound in both ears. As you listen to the signal through the hearing aids, you hear the sound with the proper frequency enhancement for your particular hearing loss. To talk on a Bluetooth phone, you do not need to hold the phone in your hand, you simply touch a button on the hearing aid and magically, you hear the voice in both ears! The other person hears your voice through a microphone inside your hearing aid. The phone can be sitting up to 30 feet away from you before the signal becomes weak.

The TV will need a transmitter to send the sound to your hearing aids. The device can be programmed to automatically connect to the TV sound when you walk into the room or you push a button on the hearing aid to hear the sound. This technology is nice because the other people in the room are able to set the volume where they want and the hearing aid user can listen at the volume he or she prefers.

Remote Microphone Use

Some environments are so noisy that even normal hearing people have difficulty understanding speech. If a hearing aid wearer is in this type of environment, often a remote microphone helps increase understanding of speech. The tiny hearing aid with its two microphone openings is just not able to make a voice louder that is six or more feet away from you. The remote microphone can be placed near the person you want to hear and it streams the sound back to the hearing aids.

As with any electronic device, change/improvement is a given. Don’t give up on hearing better, try out the new technology and decide if it improves your quality of life. 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.

Environmental Noise May Cause Health Issues

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Most people are not aware of the excessive noise in their daily lives. Noise comes from traffic sounds, trains, airplanes, roadwork, construction sites, even noise from people near you talking and listening to music, etc. Your brain is constantly processing all the sound, deciding what it wants to focus on and what is to be ignored. Even when you sleep, your ears are working, picking up and filtering the sound to different parts of the brain. This constant stimulus causes mental fatigue and eventually can become physical stress. According to the World Health Organization (WHO), noise pollution is on the increase, while other forms of pollution are decreasing.

Work Related Noise Exposure

Noise may be in your work environment. It can be in the form of equipment running near you, people talking on the phone, music overhead, traffic sounds outside your window. If you work outside you may be exposed to power tools, pneumatic tools, engine noise and specific noise to your job description. The loudness of the noise you hear being discussed in this article is not loud enough to cause hearing loss but rather it causes a form of stress build-up in your body.

Noise Off the Job

Our environment is constantly filled with noise. It is a chore to find a space that is truly quiet. Our electrical appliances at home have a constant hum or beep to get your attention. The sound of someone in another room in the house may intrude with the activity in which you are engaged. Most social events have background music, which causes people to talk over it to be heard. When everyone is talking louder over each other, the intensity of the sound grows.

Health Conditions Related to Environmental Noise

The WHO data was collected over a 10-year time span. The report, titled “Burden of disease from environmental noise,” was released in 2011. Findings included an increase in cardiovascular disease, sleep disturbance, tinnitus and cognitive impairment in children, communication difficulty and basic annoyance from environmental noise. This data did not even take into consideration work-related noise, just noise found in most basic living environments for large numbers of people.

The first ranked adverse effect on health comes from air pollution; the second is noise pollution. While most of us understand how air pollution affects quality of life for the public, most of us do not think of noise pollution as a health threat.

Continual noise sets off the body’s acute stress response, which may raise blood pressure and heart rate and can potentially create a state of hyperarousal. Another study measured the brain activity of people as they slept while in a hospital. The sounds heard were people talking, phones ringing, doors closing, machinery, toilets flushing, outside traffic and other intermittent sounds. Researchers found the brain constantly monitoring the environmental sounds, forcing relentless activity instead of the brain shifting into a state of rest. There is evidence that unwanted noise provokes endocrine and metabolic dysfunction, which may initiate a large number of physical issues.

During sleep, a noise that is constant and soft is less disturbing than a noise that is impulsive or a sound that is intermittent. The change in sound activates the brain to take note and see if there is danger nearby.

Noise and Mental Heath

Noise that is not considered a physical threat or hazardous to our hearing ability can make us tense or even angry. Consider how irritating the simple dripping of a faucet can be in the middle of the night. How about the dog next door who engages in recreational barking? Many studies around the world are pointing to an increase in violent behavior because of noise disputes.

How to Reduce Noise Pollution

There are many ways to reduce exposure to unwanted sound. Close windows in the room in which you are sitting. You can wear earplugs or noise-canceling headphones, improve the insulation in your home and install wall-to-wall carpeting to reduce reverberation of sound. Purchase furniture that is made of cloth rather than leather, which bounces sound around. A slatted fence will bounce sound away from your home. Create a dedicated quiet space in your home to use when overwhelmed with sound. In the office, you can place insulated wall partitions around noisy equipment or around your desk area. Bring up the noise topic during a meeting and see if others are bothered. Then, work as a team to reduce exposure to unwanted noise. FBN

By Karon Lynn, Au.D.

Treating Hearing Loss in Babies

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Hearing loss in children is more common than you may realize. Hearing loss occurs in two to three per 100 babies born in the United States, prompting hospitals to offer hearing screening as part of the newborn package or charge a small fee for the test. I strongly recommend all parents have their baby’s hearing checked prior to discharge.

Hearing Test for Newborns

The hearing test is quick and painless for the baby. It is administered by either a nurse or other hospital employee trained in the procedure. The test will be explained and results will be available as soon as the test is completed. The test will be an automated auditory brainstem response (AABR) or otoacoustic emissions (OAE). I have completed thousands of these tests and can assure the parents there is absolutely no discomfort from the test. If you have a home birth, you can call an audiologist, ask if he or she has the newborn hearing screening equipment and schedule the test at the doctor’s office. It is important to complete the test during the first month so the baby will sleep through the test. Much later than one month of age, the baby will wake up and see the stranger touching them and become agitated.

When Babies Don’t Pass the Screening

If the baby does not pass the hearing screening at the first attempt, the baby is scheduled for a follow-up screening. Many times when a baby is born, there is debris in the ear canals, causing a mild hearing loss. I ask the parents to massage the baby’s ears gently as they are feeding the baby to encourage the debris to migrate out. Do not stick anything in the ear canal, just massage the ears.

When Babies Don’t Pass the Follow-Up Test

A diagnostic test is completed if the follow-up test shows possible hearing loss. The test is an auditory brainstem response test (ABR) and will show the audiologist how well the hearing organ picks up sound and sends it into the brain. Each ear is tested independently. There are small electrodes taped to the baby’s head and earphones in the ear canals to send a sound to be measured. This, too, is a painless procedure. The baby must be asleep for this test to work so again, the younger the baby, the more likely he/she will sleep during the procedure. If the child is much more than four months old, the audiologist may recommend a light sedation to ensure the baby stays asleep during the entire test.

What If My Baby has a Hearing Loss?

If the audiologist says there is hearing loss in one or both ears, the next topic will be the cause. A referral to an ear, nose and throat doctor will be made. Is the hearing loss conductive or sensorineural? With a conductive hearing loss, there is a chance the hearing loss is because of continued debris in the canal or middle ear fluid. This would be temporary hearing loss. If the hearing loss is because of abnormal middle ear bones or a growth in the middle ear cavity, an ear surgeon would discuss surgical options with you. A sensorineural hearing loss is caused by damage to the hearing organ of the ear or the sound pathways in the brain. This type of loss is treated with hearing aids or a cochlear implant, depending on the degree of hearing loss.

Choosing Hearing Aids or Cochlear Implant

Babies with hearing loss are fit with hearing aids around two months of age. When hearing aids are fit, speech therapy is recommended to help teach the family how to speak to the baby and how to monitor speech and language development.

If the child has a profound hearing loss with no improvement in awareness of sound while wearing hearing aids, a cochlear implant is recommended. I like to schedule the cochlear implant surgery at 12 month of age. I ask parents to schedule a consultation with the surgeon for cochlear implant at 10 months so all involved are ready to go by 12 months of age. The FDA requires a trial with hearing aids prior to the cochlear implant. The earlier a baby is fit with a cochlear implant, the better the outcome.

I have seen amazing speech and language development in children who are amplified and receive consistent speech therapy. The new technology is remarkable! 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.

The Trinity of Hearing: Part One, The Family

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LYnnThis is part one of a three-part series on hearing loss and the relationship of the three primary elements or the Trinity of players involved in facilitating hearing as efficiently as possible. This Trinity includes the family, the hearing-impaired person and the hearing health-care provider. I was asked to repeat this series by some of my QCBN readers.

“I have watched the relationship of my family shift from loving and charismatic to cordial and formal. Every interaction has to be directed and preplanned. The spontaneity is almost totally gone.”

 

The Family

Family support plays a crucial role in maintaining successful relationships, as the emotional strain of hearing loss on the entire family must be treated as aggressively as the hearing loss itself. Hearing loss can cause isolation and depression. It can hurt the emotional and physical health of the spouse. In some cases, it may lead to divorce.

 

“It happened slowly over time. We seemed to have stopped talking. I feel ignored.”

Couples with long-term relationships are affected heavily by the onset of hearing loss. The roles or responsibilities may change because of the “side effect” of hearing loss. The normal-hearing spouse can begin making assumptions about the person with hearing loss, assigning them characteristics that seem purposefully angry and judgmental or uncooperative. Likewise, the person with hearing loss can feel bullied and defensive about their condition, retreating even more into themselves and the silent barrier hearing loss creates. TIP: When you have an important topic to talk about, turn off the TV and sit across from the hearing impaired individual. Tell them you want to have a discussion so they will focus only on you.

“I start to say something to you and then I think: ‘Is it worth the effort?’”

Repeating what you say takes out the feeling part of what you said. When you repeat yourself, you instinctively raise the volume of your voice and sometimes that is heard as frustration and anger. The person with the hearing loss wonders why every time you speak to them you are angry. Can’t people just talk to me and not get all worked up? TIP: Say their name and wait for a head turn before you talk.

“I feel frustrated that our activities have changed so much because of the hearing difficulty. We just can’t enjoy the same functions that we used to.”

Hearing loss may create a psychological solitary confinement. Going out with friends or even family members becomes stressful because of the noise in the room while people are talking. The joy of listening to music or going to a play or movie is gone. TIP: Go to the restaurant at off times; sit across from the hearing impaired person so they can see your face. Review the plot of the play prior to going to the theater. Invite only one other couple or a small part of the family at one time to visit.

“If I tell you that you missed something that was said, or ask if you understood what I just said, you seem to get angry.”

It is embarrassing to misunderstand or completely miss a conversation or comment. Though the partner of a hard of hearing person wishes to accept and support them, the continued stress of miscommunications can cause a rift to develop. TIP: Ask the hearing impaired person if they want you to trigger them if you feel they missed something. Discuss how you want to be helpful but don’t really know how to do it.

“I feel that I am walking on eggshells. Do I repeat myself or do I just let it go?”

You are not alone! What you are feeling is real and surprisingly common. It is important to talk to someone about your feelings, which in turn may help find strategies to facilitate your relationship. Talk to the hearing-impaired person in a quiet room and discuss what you are experiencing. Do not get emotional; just state facts. Do not place blame on the other person. TIP: Speak to an Audiologist or other professional, so that you have the opportunity to view your situation from a new vantage point and possibly help you shift some of your negative feelings towards feelings which are more positive and productive.

Hearing loss is detrimental in relating to the world in general. It affects the relationship to people, hobbies and entertainment. 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 Loss in Children

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LYnnThe incidence of hearing loss in children is higher than you might expect. Studies have shown that newborn hearing screenings identify from one to four out of 1,000 babies tested, depending on the research cited. Most hospitals offer newborn hearing screening and many audiologists offer the test in their office for the babies missed at birth. The babies may have hearing loss because of genetic causes, birth trauma, middle ear fluid, debris in the ear canals or even the side effect of medications given to the newborn. The reported incidence of hearing loss varies from hospital to hospital.

 

Causes of Hearing Loss

There are genetic and non-genetic types of hearing loss. There are two types of genetic hearing loss, syndromic and non-syndromic; and of these, 50 percent are recessive and 15 percent are dominant. The hearing loss is considered non-syndromic if it is the only issue the baby has. The term syndromic is used if there is hearing loss and other findings. Some genetic hearing loss will not show up until later in life. Twenty-five percent of babies with hearing loss are from non-genetic causes. The hearing loss might be from trauma before or during the birth process or a virus that can cause hearing loss. A baby with low birth weight is at risk for hearing impairment. If there is a history of hearing loss in the family that occurs at a young age then that baby has a higher risk for hearing loss. Hyperbilirubinemia (jaundice) that requires blood transfusion may cause hearing impairment. Older children get temporary hearing loss from ear infections, or permanent hearing loss from trauma to the head or from bacterial or viral infections.

 

Testing for Hearing Loss

Hearing screening is usually completed while the newborn is in the hospital. A test called an OAE (otoacoustic emission) is completed while they sleep. A small tip attached to a wire is placed in the ear canal. The tip houses a device that produces a sound that travels to the hearing organ or cochlea. If the cochlea is able to detect that sound, a tiny movement occurs which the tip records. If the baby does not pass, the screening is repeated at the age of two weeks. If the second screening is not passed, a diagnostic test is ordered. This test is called an ABR (auditory brainstem response) and provides information about the amount of hearing loss and the type of hearing loss. Again, the baby sleeps as tones go into the ear and a recording is generated. These tests are accurate enough that the initial hearing aids are programmed using this information.

 

Treatment for Hearing Loss

The treatment for hearing loss in children is similar to adults in that hearing aids are used. Because children learn so much about the world though language, it is important that the hearing aids are programmed well and are comfortable enough to wear all day. The parents play a significant role in the success of the child learning language and coping with the stigma of being hearing impaired. The parent’s attitude influences how the child views himself as he grows older. A positive self-image is important in learning how to deal with peer pressure.

 

Speech Therapy

Hearing impaired babies and children hear sound differently, making it important that they are exposed to speech and taught how to speak at a very early age. A speech pathologist will evaluate the baby’s speech development and design a plan for the parents to follow at home. Children spend the most time with their parents and learn the majority of their pre-school skills from them. If formal speech therapy is available that will start very early; the earlier, the better. Many insurance companies will help with the cost of this service.

 

Assistive Technology

Children use assistive technology to help focus on speech in a noisy room. In a classroom, the teacher wears a transmitting microphone which sends an FM signal directly back to the child’s hearing aids. These remote microphones provide a wonderful signal that has very little background noise embedded in it. If a child is able to use a remote microphone at home and in family social activities, or even TV viewing, the child has more opportunity to be successful learning language. Remember that hearing aids are not hearing cures, they simply aid (help) hearing. Deaf babies and children usually have a trial with hearing aids but if they do not benefit from the aids a cochlear implant (CI) is considered. We will discuss CIs for deafness in another article. QCBN

By Dr. Karon Lynn, Au.D