Archive for the ‘Treatable Hearing Loss’ category

Invisible Pervasive Handicap in the Classroom

April 12th, 2010

Invisible Pervasive Handicap in the Classroom

By Linda S. Remensnyder, Au.D.
Doctor of Audiology
      
Hearing Associates, P.C. . . . Eliminating the Sound of Silence
755 S. Milwaukee Avenue, Suite 189
Libertyville, IL 60048
www.hearingdoc.com

One-Third of Young Children Affected:  Recent research confirms that, on any given day, one third of all children, kindergarten through third grade, have impaired hearing/listening. 

The vast majority of these statistics reflect children missed in hearing screenings.  Their ranks are comprised of so-called “normal hearing children” who experience greater speech-recognition difficulties in classroom noise and reverberation than previously suspected. These subtle hearing deficits cause the affected child to experience an invisible handicap—a handicap comprised of not being able to hear well consistently.

These kindergarten and primary grade children have slight or “minimal” hearing loss for a variety of reasons. Causes can be as innocuous as occluding ear canal wax or as serious as otitis media (fluid accumulation behind the eardrums). Otitis media (middle ear fluid) ranks second to the common cold as the most common health problem in young children.  Ear infections, which have increased by 224% since 1975, cause five million school days to be missed annually and half of all episodes are undetected by parents or teachers. Even the ventilating tubes resorted to in serious cases can become plugged by infection or debris and cause hearing deficits.

These “minimal” hearing loss statistics also reflect youngsters who have allergies causing them to be chronically “stuffed up”, bilateral high frequency hearing loss in ranges not screened in hearing screenings, or unilateral hearing losses in which excellent hearing is limited to one ear.  They reflect youngsters with developmental delays, articulation disorders, or dyslexia.  Students who have central auditory processing disorders (CAPD), attention deficit disorders (ADD), and behavioral problems also fall into this category.  In addition, the slight hearing impairment statistics include children for whom English is not their primary language because language comprehension requires sustained effort.

A “Minimal” Condition with Maximal Consequences: A “minimal” hearing loss, which requires neither medical intervention nor hearing aids, does not constitute a minimal handicapping condition with minimal consequences, especially during the younger elementary school years when the child’s brain is assimilating and developing language.  Hearing is the acknowledged bridge to reading and to future academic performance and this critical period to learn language is time-locked (generally considered age 0 through 7).

Children with minimal hearing loss experience problems hearing faint or distant speech and the esteemed educational audiologist, Carol Flexer, calculates that these children are missing more than 25% of classroom instruction. What 25% of the speech signal do these children miss?  They miss the soft intensity sounds — the endings of speech, the sibilants (s, sh, ch) and the fricatives (f, th).  They miss the subtleties of speech — the plurals, the tenses, and the possessives/auxiliaries.  They miss the innuendoes and the asides, the responses from fellow classmates in the back of the classroom, and they miss the whispers.  And they definitely miss what the teacher is saying when the room is noisy, when other classmates are conversing, or when the teacher’s back is facing them.

It is believed that 90% of a young child’s knowledge is attributed to incidental reception of conversations around them.  Thus, learning and understanding are hindered even with the slightest hearing difficulty.

How, then, are these children with “minimal” hearing loss able to learn language when language is learned by hearing it in full context? They’re not — they’re handicapped by their inability to hear consistently well.

It is important to keep in mind that the classroom is a difficult listening environment. Chatting students, humming air conditioners, squeaking desks, and outside traffic contribute to a level of background noise that distracts from the teacher’s voice.  The problem becomes even more significant when the noise echoes off uncarpeted floors in rooms with high ceilings and hard desks and windows.

In addition, Dr. Flexer also believes that “children are not short adults; they bring a different ‘listening’ to a learning situation.”  Research has documented that children do not develop an adult-like capacity to recognize speech in noise until approximately 13 to 15 years of age.  The central auditory system of children is not neurologically mature until a child is about 15 years old.  Thus levels of classroom noise and reverberation can deleteriously affect the speech perception of those younger than 15 even if the children do possess normal hearing sensitivity.

IMPACT of an Enhanced Signal and Improved Acoustics:  Research has confirmed that if the teacher wears a lapel microphone and if her or his voice is amplified via suspended speakers placed in each of four corners of the classroom, all children are able to hear better and all children benefit (even those who already wear hearing aids).  These sound field systems simply make it easier to understand or focus on the teacher’s voice. 

Teachers who use these systems have less vocal strain, are less fatigued at the end of the school day, and require fewer sick days off.  More importantly, the ability of all children to hear an enhanced speech signal has resulted in improvements in reading (comprehension and test scores), fewer discipline and behavioral problems, and increased classroom participation.

The trend is to place these sound field systems in all kindergarten and primary grade classrooms.  Strides are also being made in terms of classroom acoustics insuring that new construction and planned renovations take into account the need to limit ambient noise levels.  PTA’s and school fund-raisers are providing funding for the technology to promote optimum hearing. Parents can make it happen and make the future brighter (and more audible) for all.

DIABETES LINKED TO HEARING LOSS

March 26th, 2010

Diabetes Linked to Hearing Loss

By Amit K. Gosalia, Au.D., FAAA
Doctor of Audiology
      
Audiology Clinic
505 NE 87th Ave., #150
Vancouver, WA 98664
www.audiologyclinic.com

As of late, many studies have been published regarding a variety of factors, causing hearing loss.  The most recent study concluded that diabetics’ auditory (hearing) system may age faster, although past a certain age (~60 years old), the hearing loss may be obscured by presbycusis (age-related hearing loss).

Initial findings of this new study have determined that diabetes mellitus (DM), which is approaching epidemic proportions, may lead to premature aging of the body’s auditory system. The findings, which come from the Department of Veterans Affairs National Center for Rehabilitative Auditory Research (NCRAR) in Portland, OR, add to the literature that has chronicled diabetes’ damaging impact on various organs of the body such as the kidneys, eyes, heart and nervous system.  NCRAR is currently conducting a five-year epidemiological study to assess the prevalence and severity of auditory dysfunction in veterans with diabetes.

The study included 694 veterans age 25 to 85. Of this group, 342 had diabetes, and 352 did not. By the completion of the study, 800 participants in all will have been evaluated. Participants were divided into two groups: those 60 years old and under, and those older than 60. Diabetic patients included only those who had been diagnosed at least five years ago.

All participants underwent audiometric (hearing) testing and were given a questionnaire. Glucose levels and HbA1c (glycosylated hemoglobin, a measure of overall diabetes control) were tested to indicate metabolic control over the past three months. A variety of tests were used to evaluate auditory function. Further investigation is planned to determine the cause and effect of the central auditory processing delays seen in diabetic patients.

Diabetic patients under 60 years old exhibited greater hearing loss than non-diabetic study participants of the same age. However, in those over 60, hearing loss was similar between diabetic and non-diabetics. It is theorized that in older diabetic patients, presbycusis may obscure any changes in hearing loss due to diabetes. Central auditory processing functions are affected by diabetes to a greater extent than peripheral functions, indicating that ABR and pure tone testing may be appropriate to reveal changes early in diabetic care. Since hearing takes place not only in the ear, but in higher auditory and cognitive centers (i.e. auditory cortex in the brain) responsible for processing the sounds received in the inner ear (cochlea), early identification of processing changes could be important to verbal communication.  The finding that hearing loss is exacerbated in diabetics under 60 years of age is consistent with the theory that diabetes is associated with accelerated aging of the auditory system. 

Hearing loss due to premature aging of the cochlea is a permanent sensorineural hearing loss, which can not be treated medically or surgically.  Sensorineural hearing loss is commonly mistaken as “nerve-deafness.”  The nerves can degrade over time, however, initially, the hair cells in the inner ear are damaged.  Proper amplification can improve a person’s hearing abilities in quiet and in situations with loud background noise. 

Hearing testing is recommended on an annual basis after the age of 60.  With this new research, hearing testing may be used as a screening tool.   If you would like more information on this research, or if you know someone who is diabetic or has a hearing problem, please do not hesitate to call our office at (360) 892-9367, or visit our website at www.audiologyclinic.com to schedule a complete hearing test.

Why YOUR Lifestyle – Regardless of Age – Needs to be Considered When Selecting Hearing Aids

March 19th, 2010

Why YOUR Lifestyle - Regardless of Age – Needs to be Considered When Selecting Hearing Technology

By Crystal L. Chalmers, Au.D.
Doctor of Audiology
      
North State Audiological Services
15 Jan Court
Chico, CA 95928
www.nsaudiology.com

Ah, high-technology consumer-oriented electronic devices.  They’re everywhere we look in our daily lives.  From the L.E.D. read-out timer-controlled automatic coffee maker to the hands-free cellular phone to digitally enhanced music and television systems, high-tech products are all the rage, enhancing our lives in ways that couldn’t have been imagined less than a generation ago.

And judging from some of the advertisements that are out there one might get the impression that high-tech hearing aids are the end-all answer to communication difficulties for someone with hearing loss.  People are bombarded with ads on hearing aids telling them that by purchasing the “latest and greatest” from Brand ABC that they’ll immediately hear like they did when they were a teenager.  Being good consumers, they research for hours on end, and then decide on a product with high expectations.      

But for someone with hearing loss, taking that path is like trying to follow a map without directions nor a compass. 

That’s because the first step towards better hearing lies not in selecting a hearing aid, but rather in examining one’s lifestyle and listening needs. 

Regardless of age, people have different lifestyles.  While one person might lead a very active life, another seemingly similar individual might lead a more quiet life.  If both have similar levels of hearing loss, should they both select the “latest and greatest” from Brand ABC?  Of course not!

Instead of focusing on the hearing aid one of the first things I like my patients to do is talk with me about their lifestyles and how that lifestyle is affected by their hearing and communication difficulties.   Whenever possible, I also like to involve a spouse or significant life partner; oftentimes those close to the patient can offer helpful insight about their loved one’s difficulties as well as positive support.

Only after this communication process — coupled with a thorough audiological assessment – is complete is it time to start discussing the appropriate level of hearing technology. 

That is the path that will lead to successful use of today’s hearing aids  …. because hearing is a wonderful gift!

SIDEBAR –  A Slice of Life (Well, 4 of Them, Actually)

Following are four different lifestyle categories.  Where do you fit in? 

Active lifestyles: Characterized by a variety of video and audio entertainment, diverse restaurant dining, sporting events, outdoor activities, demanding careers, group participation, family gathering, movies, driving, mall shopping, and church activities.  Frequent background noise.

Casual Lifestyles:  Typically include activities such as regular conversation, frequent television, quiet restaurant dining, small meetings, family gatherings, driving, shopping trips, movies, and weekly church services.  Occasional background noise

Quiet Lifestyles:  Often feature one-to-one conversations, some television and radio, quiet shopping, trips, and weekly church services.  Limited background noise.

Very Quiet Lifestyle:  Comprised of activities in and around the home, such as limited television, radio, or recorded books, and small church services. Rarely includes background noise.

About the writer:  Crystal Chalmers, Au.D., is an AudigyCertified™ Doctor of Audiology, the owner of North State Audiological Services in Chico, and a member/owner of AudigyGroup, the nation’s largest member-owned association of independent hearing care professionals.

Noise-Induced Hearing Loss: an Epidemic that is Preventable

March 12th, 2010

Noise-Induced Hearing Loss – an Epidemic that is Preventable

By Linda S. Remensnyder, Au.D.
Doctor of Audiology
      
Hearing Associates, P.C. . . . Eliminating the Sound of Silence
35 Tower Court, Suite A
Gurnee, IL 60031
www.hearingdoc.com

In the United States, hearing loss is the third most common condition in those over 45 preceded only by high blood pressure and arthritis. A large factor contributing to this statistic is the high noise levels in the United States. From the subway to the airport, to the power tools on the weekends to the motorcycles we drive during the summer, to the music levels we listen to while exercising, to the loud movies our children attend; our citizens are becoming hearing impaired.

Prolonged exposure to potentially damaging noise levels in the workplace has been the subject of much litigation. Certainly, manufacturing environments such as steel mills, foundries, and welding plants are places people typically think of when they think of noise-induced hearing loss. The Occupational, Safety, and Health Administration (OSHA) has made great strides in terms of resolving the issue. Workers such as carpenters, electricians, and construction workers who are not employed in the manufacturing industry are not so lucky. OSHA is unable to exert pressure on their employers because those workers frequently work at different workstations and often work for different employers depending upon the season. Tinnitus (ringing of the ears) and eventual hearing loss is shrugged off as an occupational side effect because everyone has it. Our military has aggressively tried to prevent noise-induced hearing loss by mandating ear protection during target practice and other noisy maneuvers. Research conducted by the U.S. Navy has resulted in the formulation of special antioxidants (one such product is called The Hearing Pill) that can be taken prior to and after exposure to help prevent noise-induced hearing loss. Other preventative substances are in various stages of research and production. Even the sound levels of air-powered instruments that orthopedic surgeons use during surgery exceed those sound levels of manufacturing plants that are being monitored by OSHA.

Many TV and radio professionals have noise-induced hearing loss secondary to the use of earphones for monitoring equipment. And certainly, noise-induced hearing loss is an occupational hazard with musicians. Incidences of noise-induced hearing loss occurring among musicians range up to 52% in classical musicians and up to 30% in rock/pop musicians. Over the past ten years, functionally superior hearing protection products have become widely available for performing artists. Musicians have learned that if they lose their hearing, they’ve lost their livelihood. Unfortunately, they are not making the same diligent effort to preserve the hearing of their audiences. The amplifiers which face out during concerts often cause tinnitus, ear fullness, hearing loss, and sometimes hyperacusis (intolerance to loud sounds) in their attendees. Motorcycle drivers, especially those with Harley Davidsons whose mufflers have been tampered with, generally have a noise-induced hearing loss that’s worse in the right ear. Right-handed use of guns (even when restricted to the hunting season) causes noise-induced hearing loss more pronounced in the left ear. That’s because the right ear is sheltered by the right shoulder as the rifle/shotgun is positioned. Airbags and some leaf blowers have been measured to have the same noise levels as aircrafts. Aerobic instructors can have noise-induced hearing loss because they play the music so loud in the attempt to motivate their students.

IN CHILDREN: Research has confirmed that children are being exposed to excessive and potentially damaging levels of noise. A 7-year nationwide survey indicated that approximately 5.2 million Americans ages 6 to 19 have a noise-induced hearing loss in at least one ear (July 2001, Pediatrics). This is approximately one child in eight having a noise-induced hearing loss. The low-level chronic noise of everyday local traffic has also been shown to cause stress in children and raise blood pressure, heart rates, and levels of stress hormones. In addition, traffic noise has been found to adversely effect children’s motivation. Children’s toys need to be tested before purchase. If the noise levels hurt the parent’s ears, then it will definitely hurt the child’s. According to a recent newsletter from the Sight & Hearing Association, Baby’s First Cell Phone, for example, generates 90dB of noise.

Two things are certain, noise-induced hearing loss is preventable and everyone has unknown and different susceptibility to noise exposure. My own son developed bilateral tinnitus after dropping a few cherry bombs in our driveway before leaving for college. He’s now thirty-five and still has to sleep with a fan running to relieve his tinnitus. He will suffer a lifetime because of that isolated exposure. Be vigilant with your children. If you have to raise your voice to be heard while they are listening to music under earphones, then the sound levels are too high. Original earphone CD players that did not have a maximum loudness level should be replaced with newer ones which have limiting devices in place to preserve the user’s hearing.

WHAT YOU CAN DO: Purchase multiple packets of those squishy spongy yellow earplugs available at sporting good stores or the pharmacy. Also purchase a good pair of headset noise protection earphones. Keep the earplugs in your purse or briefcase and keep a pair of earplugs and earphones in the garage/basement where your power tools are stored. The combination of both earplugs and earphones provides the best hearing protection. If your ears ring or you suspect hearing loss, call for an appointment so the nature of the hearing loss can be documented and you can learn further techniques to prevent further self-inflicted hearing loss. If you are taking ototoxic (hearing toxic) medications (and there are MANY of them—ask your pharmacist), be especially vigilant about not being exposed to noise because your chance of developing a hearing problem is higher than those who are not taking the medications. Your susceptibility is also significantly enhanced if you smoke or if you are a blue-eyed blond. PLEASE, don’t take your hearing for granted. You and your children need good hearing for a lifetime.

Psychosocial Implications of Hearing Loss

February 26th, 2010

Psychosocial Implications of Hearing Loss

By Crystal L. Chalmers, Au.D.
Doctor of Audiology
      
North State Audiological Services
15 Jan Court
Chico, CA 95928
www.nsaudiology.com

When someone discovers that he, she, or a loved one has a hearing loss there is a tendency to experience a feeling of distress.  Oftentimes this emotion coincides with concerns about aging and self-perceived negative social stigmas associated with aging.

These emotions, if turned inward, can cause the person with hearing difficulties to become alienated from family and friends.  Here is what generally occurs.  (Note that this is for individuals who have chosen not to receive professional hearing healthcare.)

1.)  Family members and friends, no matter how well intentioned, become frustrated trying to communicate with the hearing impaired person.

2.)  The person with the hearing loss becomes even more frustrated with the family member(s) and friends who do try to communicate, but lack the learned skills, such as those taught in “Clear Speech”, to do so effectively. 

3.)  The person with the hearing loss sometimes places the blame for miscommunications on the family members or friends because “they speak too fast” or “mumble their words”.  The person with the hearing loss begins to withdraw.

4.)  Family members and friends sometimes confuse the miscommunications with memory loss and erroneously conclude that the person is experiencing diminishing memory capabilities.

5.)  The person with the hearing loss and the family members and friends drift apart in a sort of vicious cycle in which no one involved can help or reach out to the other. 

Left unaddressed, hearing loss can lead to depression, sadness, paranoia, anxiety, insecurity, and a measurable decrease in an individual’s social activity, further enlarging the gap between family and friends. 

 What a sad situation!  And what makes this scenario all the more sad is that it actually occurs quite frequently – and in most cases it doesn’t have to. 

That’s because studies have shown that most people diagnosed with hearing loss can benefit from appropriately chosen and properly fit hearing aids designed for their unique audiological profile. 

One study, conducted in 1999 by the Seniors Research Group for the National Council on Aging (NCOA) found that people within its sample (2,304 hearing impaired people aged 45 and older, with both treated and untreated hearing loss) who had been properly fit with correct hearing aids experienced these benefits:

  • Better relationships with family members and friends
  • Better feelings about themselves
  • Improved mental health
  • Greater independence and security

 Many of the participants also reported improvements in their confidence, relations with children and grandchildren, and a better view of life overall.

The NCOA study confirmed what many audiologists already believed – hearing loss is closely linked to emotional well-being and quality of life.

And yet, many – too many – Americans keep themselves from seeking treatment for a variety of reasons.  In fact, only about 22% of people who could benefit from hearing aids actually do use these products.  If you or a family member are among the 78% who are not using hearing technology, my advice is to seek professional advice from an AudigyCertified professional who has the education, training, and experience for successful hearing technology fitting and counseling. 

Hearing is, after all, one of our five senses and a cornerstone in our ability to communicate with others. 

About the writer:  Crystal Chalmers, Au.D., is an AudigyCertified™ Doctor of Audiology, the owner of North State Audiological Services in Chico, and a member/owner of AudigyGroup, the nation’s largest member-owned association of independent hearing care professionals.