Archive for November, 2011

Make the Most of Your Hearing – (re) Train Your Brain!

November 23rd, 2011

By: Bettie Borton, Au.D., FAAA
Doctor of Audiology
Doctors Hearing Clinic
7025 Halcyon Park, Suite A
Montgomery, AL 36117
(334) 396-1635
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www.doctorshearingclinic.com

We hear in our ears, but we process and understand sound in our brain. Hearing aids can help a person detect that are no longer in their range of audibility, but they don’t necessarily provide good listening skills. There is a fundamental difference between hearing and listening, and hearing devices alone do not assure good listening. We all know people who have normal hearing but are poor listeners (ok, ok, don’t reference your spouse’s selective hearing!). Hearing requires a functional auditory system that allows sound to be heard, listening requires specific effort and skill, and that can become more difficult when a hearing loss is present.

As technically advanced as modern hearing aids might be, these devices alone cannot ensure listening skills needed for communication. Listening integrates a number of skills including attending, understanding, and remembering. Unfortunately, many of these cognitive skills deteriorate as we age. This may show up as a worsening of short-term memory, or increasing difficulty understanding rapid speech. Modern hearing aids have certainly improved the quality of sound in noisy environments, but they do not eliminate background sounds. People with sensorineural hearing loss have disproportionately difficult time understanding speech in noise. In addition, research shows that a loss of hearing produces physical changes in the auditory pathways of the brain. We now know that when hearing loss deprives parts of the brain of auditory stimulation, neural pathways actually degrade. The old adage of “use it or lose it” is very true with regard to hearing loss- waiting to get hearing aids when you know you have hearing loss is problematic because your brain may not be receiving the kind of stimulation it needs to maintain speech understanding.

Bettie Borton, Au.D. Doctor of Audiology AudiologistWhen people lose confidence in their ability to communicate in noisy social situations, they simply drop out and avoid those environments. While this may save them effort and embarrassment, it ultimately costs them important personal and social contact. Some individuals utilize compensatory strategies that may result in successful hearing aid use. Others, however, are not so fortunate. The need for additional therapy beyond that provided by devices alone is becoming increasingly evident, and is underscored by the fact that individuals with similar hearing loss frequently report a wide range in satisfaction and benefit from their hearing aids.

The good news is a Board Certified Audiologist can optimize your hearing aid hearing experience using a number of methods, strategies and techniques. The hearing healthcare professionals at Doctors Hearing Clinic specialize in developing individualized treatment plans for those struggling with hearing impairment, and can offer the very latest in technologies, as well as the time required to successfully implement them! Have realistic expectations for hearing aids – they’re wonderful devices, but not new ears. Join a self help group to share methods and techniques that are successful for you and others (Montgomery has a Hearing Loss Support Group that meets the second Thursday of each month at the First Methodist Church, 4 PM, free of charge!). And consider new computer software to “train your brain” to listen more effectively!

The great news is that with the help of a skilled Audiologist who routinely offers programs in aural rehabilitation, you or your loved ones can keep listening skills from deteriorating and improve ability to function in noisy situations. When a person injures an arm or leg, everyone recognizes the importance of physical therapy to strengthen adjacent muscles and instruction to optimize function. Similarly, it is likely that hearing devices alone will not produce optimal communication skills unless accompanied by counseling and training.

There are many exercises you can try on your own. Here are three examples:

• Use closed- captioned TV, or record programs using a DVR or TIVO. Watch the show live. Then replay it with closed captioning or by slowing it down.

• Listen to, while reading, audio books.

• Buy two copies of the newspaper. Have your spouse or colleague read the newspaper aloud while you are listening only, and then go ahead and read it yourself. Try this in quiet at first, and then proceed to noisier listening environments.

• Try self-help computer assisted training programs

One such auditory training therapy program designed to help the brain listen, Listening and Communication Enhancement (LACE) uses a computer or DVD. LACE is designed to enhance listening and communication skills, improve confidence levels, and provide communication strategies. The program consists of a variety of interactive and adaptive training tasks for listening to speech in noise, rapid speech, and auditory memory. Besides the immediate feedback given for each task, LACE provides you with a graph depicting daily improvement from the start of the training.

LACE training is conducted in the privacy of your own home at a pace comfortable to you; Doctors Hearing Clinic also offers a computer lab where you can take all or part of the training in their office. Research on thousands of people with hearing loss demonstrates that you can expect on average a 40% improvement of speech comprehension in noisy situations, if you complete the training program.

So if you or someone you love uses hearing devices, take the important step of seeking help from a Board Certified Audiologist to help you develop a comprehensive strategy for hearing and communication skills – train your brain for listening!

References: Robert W. Sweetow, Ph.D., Professor of Otolaryngology, University of California, San Francisco and the Better Hearing Institute

Can I Prevent My Hearing Loss From Getting Worse?

November 10th, 2011

By: Bettie Borton, Au.D., FAAA
Doctor of Audiology
Doctors Hearing Clinic
7025 Halcyon Park, Suite A
Montgomery, AL 36117
(334) 396-1635
“Like” Doctors Hearing Clinic | Facebook
www.doctorshearingclinic.com

Bettie Borton, Au.D. Doctor of Audiology AudiologistWhen I diagnose patients with a loss of hearing, they usually want to know if there is any way they can stop the progression of the loss. Common sense (and a large body of research) tells us that hearing loss tends to get worse as we get older, but each case is unique. In many cases, hearing is stable for many years. In others, the hearing loss progresses relatively rapidly.

One of the most important things that all adults over the age of 50 need to do is to have an audiological evaluation that will establish their baseline hearing, and keep that on file with their primary care physician and with their health records kept at home. Getting a comprehensive audiometric  by a Board Certified Audiologist ensures that you have been evaluated by a professional who has the most training for this purpose, and ascribes to the highest ethical, practice,  and continuing education requirements available. Why is it so important to have this baseline? Well, if your hearing changes, it will be much easier to gauge the rate of progression of the loss if you have clearly established a “starting point”, and have annual re-evaluations to document any shift in thresholds. And remember, documenting that starting point could be very important –No one wants to borrow trouble, but  don’t forget that  17% of all of those involved in motor vehicle accidents with air bag deployment have permanent sensorineural hearing loss as a result! That could be difficult to prove in a court of law if you haven’t had a recent hearing test.

Noise is a leading cause of hearing loss, and hearing loss from noise exposure is usually preventable. Both the level of the noise and the length of time you’re exposed to it determine if a noise will cause damage to your hearing. A good rule of thumb is: if you have to raise your voice to be heard by someone standing three feet away, the noise around you could be damaging.  Everyday sounds, such as music, power tools, or a lawn mower, have been shown to cause hearing damage.

Visit a local hearing center for advice regarding the best options for ear plugs or other noise protection to wear during these activities and get your hearing checked on a a regular basis.  Your hearing professional can compare your exams over time to determine if your hearing loss is worsening. If a significant change is noted, your hearing professional may refer to you to an ear doctor for further evaluation.

 

You bought new hearing technology, but, you still have difficulty hearing in noise. What’s going on??

November 3rd, 2011

By: Amit Gosalia, Au.D., FAAA
Board Certified Doctor of Audiology

Audiology Clinic, Inc.
505 NE 87th Ave., #150
Vancouver, WA 98664

(360) 892-9367
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www.audiologyclinic.com 

Dr. Gosalia, I just bought a pair of $8500 hearing aids from XYZ in Portland. I was told that I would hear normally in all environments, including restaurants and ball-games. I am less than pleased because I still can’t hear or understand in noise. Did I waste my money?”

Amit Gosalia, Au.D. - Doctor of Audiology, Vancouver, WAThis was a case I dealt with a few months ago. This patient went to a business to purchase hearing aids, and this franchise/chain location set some lofty expectations for the patient. As hearing instrument technology improves, so do patient expectations. Terms such as noise reduction, noise management & directional hearing (along with many other proprietary terms) give the perception that the end-user will not hear background noise, and only hear the person in front of them. Unfortunately and fortunately, this is not true. Below I’ve touched the surface of noise, noise reduction and directivity.

Let’s start with noise. Noise is any disrupting event (in this case, sound) that impedes one’s ability to sense (in this case, hear) a signal (in this case, speech). For the purpose of this post, we’ll concentrate on hearing speech within a noisy environment. A general term and formula that is used in hearing healthcare is Speech-to-Noise Ratio (SNR) which tells us how loud speech is in relation to noise. For example, average speech is 45-55 decibels (dB) hearing speech in a basketball stadium where the crowd is cheering over 90 dB is difficult because the speech is 35-45 dB lower than the noise. This is considered a very low SNR; now compare this to speaking at a normal volume in a quiet library, the SNR will be high making speech much easier to understand. When someone has a hearing loss things change. Without amplification important parts of speech are not heard well, making understanding the person next to you difficult, if not impossible. The natural ability of any person to hear through noise decreases as hearing loss increases. This is a fact that has been well established in research on the human auditory system. Thus, a hearing aid can help make missing pieces of speech more easily heard but it cannot repair one’s ability to hear through noise and find valuable pieces of speech. For this reason, modern hearing aids focus on managing noise and amplifying clean speech.

Hearing instruments can come with or without venting. Vents are holes that are drilled through either the hearing instrument or the earmold for the purpose of letting air and sound travel in and out of the ear canal. The larger the vent, the closer you get to a more natural, open ear. Newer technology has allowed us to keep the ear open with small hearing instruments that rest behind the ear and even some custom molded devices (please see other postings for detailed descriptions of hearing technology). As cute as they may be, if your hearing is not within or near normal limits in the lower frequencies, an open ear device may not be for you.

One advantage of an open ear hearing aid is to allow low frequency sound to escape the ear canal, keeping the user’s voice more natural. When the user complains of hearing their own voice in their head or sounding as if they are speaking in a barrel, it’s usually a phenomenon called occlusion (or ampclusion). Keeping an ear canal open minimizes this effect but also introduces two detrimental issues. First, low frequency environmental sounds will bypass the hearing aid and travel into the ear naturally through the vent. These sounds that bypass the hearing aid are often heard naturally because most hearing losses are minimal in the low-frequencies and greater in the high-frequencies. This also means that the hearing aid is not able to process the sound before it’s heard, so technologies such as noise reduction do not affect low-frequency sounds in the open ear hearing aid.

Secondly, directional microphones will prove less beneficial in the open-ear fitting.2 What this means is that the more open the ear canal, the harder it becomes to hear what’s in front of you. So, theoretically, if our goal is to have the instruments focus more front-facing, the ear canal should not be very open. Note that normal low frequency hearing will be affected by closing the ear canal, and opening the canal with moderate to profound low frequency hearing will result in less hearing in those frequencies.1,2

So, what does this tell us about hearing in noise with amplification? You will hear background noise in noisy environments. You will most likely hear the kids screaming four tables away. You may still have difficulties hearing the person across the table from you. The good news is that with proper hearing aid selection and the correct technology that meets your lifestyle and budget, you’ll hear much better. Only a well trained hearing care professional can make these choices and help you to establish reasonable expectations for better hearing.

“Ms. XX, although the level of technology you purchased is consistent with an Active Lifestyle (in our clinic approx $7500 – $1000 less than the chain!!), you should know that hearing aids only supplement your hearing in those difficult environments. In fact, with normal hearing, I have difficulty hearing at basketball games and certain restaurants as well. Although we can not restore normal hearing, we can help you hear much better in more environments. You will still have some difficulty hearing and understanding in certain environments, but, with some realistic expectations, expert advice, and some auditory retraining, you will find greater success.”

 

1 What is the Effect of Venting on Directivity? Audiology Online 10/2009; Todd A. Ricketts, Ph.D., CCC-A, FAAA

2 Efficacy of an Open-Fitting Hearing Aid; Hearing Review February 2005; Francis Kuk, Phd, et al