If it seems like your ears ring constantly, it’s probably not crickets, your imagination or the economy . . . and you’re not alone. You may have tinnitus, an inner ear ailment that affects between 25 million to 50 million Americans — with about 12 million people experiencing such severe symptoms it affects their daily lives. The good news is treatment, including hearing aids, can offer relief to some from the persistent ringing, buzzing or humming associated with tinnitus, according to the Better Hearing Institute.

Tinnitus can be intermittent or constant. Causes range from ear infections and exposure to extremely loud noises, to underlying health problems like allergies or heart and blood pressure problems. Often, sufferers are unable to pinpoint the cause of their tinnitus. “Tinnitus can have a direct impact on a person’s emotional well being,” says Dr. Sergei Kochkin, BHI’s executive director. “Not only can their hearing be affected but also their ability to sleep or concentrate.”

Kochkin and Dr. Richard Tyler, professor and editor of The Consumer Handbook on Tinnitus (Auricle Ink, 2008), published a survey of 230 hearing health professionals in the United States and Canada. Their survey found that six out of 10 patients reported some tinnitus relief when using hearing aids and two out of 10 reported major relief. The symptoms of tinnitus “influence basic life functions such as socialization and relaxation,” the duo wrote. “In severe cases it can interfere with the individual’s ability to perform adequately on the job, or contribute to psychological disorders such as depression, suicide ideation, posttraumatic stress disorder, anxiety and anger.”

Although tinnitus is actually common and can cause major life disruptions, the number of sufferers who seek treatment for tinnitus is relatively small. One reason may be that they mistakenly believe their condition is untreatable. Unfortunately, many doctors are also unaware of the latest treatment options, and as a result patients may think they simply have to learn to live with the noise.

“No one should ever ignore persistent tinnitus,” Kochkin says. “Not only is every individual entitled to a chance to regain his or her quality of life, but in rare cases tinnitus also can be a symptom of a more serious health issue that could demand medical intervention. What’s more, nearly everyone with tinnitus has hearing loss as well.”

In a recent large-scale survey of the American hearing impaired population, 39 percent (more than 9 million adult Americans) indicated they had not sought help for their hearing loss specifically because they also had tinnitus. “Research shows that untreated hearing loss has its own negative social, psychological, cognitive and health effects on the individual suffering from it,” Kochkin adds. “So those with both untreated tinnitus and untreated hearing loss suffers an even more diminished quality of life than individuals with just tinnitus or just hearing loss alone.”

While hearing aids are not a cure for tinnitus, they may be able to help tinnitus patients by:

1. Improving communication and reducing stress, which makes it easier to cope with the condition.

2. Amplifying background sounds, which can make tinnitus seem less prominent.

A new type of hearing aid, called the open fit hearing aid, may be particularly useful in alleviating tinnitus. The open fit hearing aid can reduce the effects of the tinnitus ringing sensation while still allowing sounds from the outside to pass into the ear. If you think you have tinnitus have your hearing evaluated by an audiologist and to explore the use of hearing aids to alleviate tinnitus. The American Academy of Otolaryngology (AAO-HNS) and the American Tinnitus Association recommends these additional tips for minimizing the effects of tinnitus on your health:

1. Avoid exposure to loud sounds and noises.

2. Get your blood pressure checked. If it is high, get your doctor’s help to control it.

3. Decrease your intake of salt. Salt impairs blood circulation.

4. Avoid stimulants such as coffee, tea, cola, and tobacco.

5. Exercise daily to improve your circulation.

6. Get adequate rest and avoid fatigue.

7. Eliminate or reduce some stress in different parts of your life; stress often makes tinnitus worse.

8. Experiment by eliminating other possible sources of tinnitus aggravation, e.g. artificial sweeteners, sugar, alcohol, prescription or over-the-counter medications. (Do not stop taking medications without consulting with your health care professional about the possible ototoxic impact of your medications.)

Are you Assisting Employees with Hearing Loss? If not, listen up.

In a 2009 survey of 46,000 U.S. households, the Better Hearing Institute (BHI) determined that over the past generation hearing loss grew at an alarming 160 percent of the U.S. population growth— largely attributable to the aging of the American population. Yet the study found that 60 percent of people with hearing loss are below retirement age, indicating that 16.3 million people with hearing loss were in the U.S. workforce in 2010. In other words, untreated hearing loss has serious consequences for both employers and employees. Untreated hearing loss is costing society and those with the loss millions of dollars annually in lost revenue, productivity, and manpower.

Good hearing is good business.  Given the incidence and prevalence of hearing loss, most businesses will confront this challenge in the context of management’s responsibility and oversight of human resources. So, what can companies do to plan for and address the impact of employee hearing loss?  There are a number of simple steps employers can take to educate employees about hearing loss and to facilitate the use of hearing aids, where needed, that are simple to implement and very cost effective.

Previous research at BHI has shown that 50 percent of people with untreated hearing loss have never had their hearing checked by an audiologist and lack sufficient information to know whether they need to take action to correct it. Company owners and human resource professionals can help employees understand if they need treatment by:

• Educating employees regarding the impact of untreated hearing loss on quality of life.
• Encouraging employees to have their hearing screened on an annual basis, and providing opportunities for them to do so.

Employers can create a corporate climate where hearing loss is recognized so those with hidden hearing loss feel more comfortable. Here are some suggestions:

• Avoid noisy restaurants as meeting locations.
• Summarize meeting minutes in writing to be sure that those with hearing issues are clear on the outcome of the meeting.
• Provide easy accommodations, such as moving an employee’s desk away from noisy hallways, machines, or air conditioning and heating vents, or installing a phone that amplifies high frequencies.
• Build work environments that facilitate better hearing by choosing cubicles with noise-absorbent materials and equipping meeting rooms with an inductive loop that creates a wireless zone for hearing aids with telecoils, headsets or microphones.

In many cases, hearing aids can help protect employees from being at a competitive disadvantage with peers. Organizations can encourage the use of hearing devices, when needed, by participating with a private practice in Audiology to contract for the provision of services, group discounts, hearing devices, and more! Audiologists can design and implement screening programs (on and off site), as well as effective follow up scenarios to assist employees with managing hearing loss if it is identified.

Companies can also encourage employees to purchase hearing aids using pretax medical flexible spending account funds. In Montgomery, Doctors Hearing Clinic offers just such an option through their BHP program , and the good news is that it is FREE to employers, as well as employees and their families. This Better Hearing Program (BHP) offers free screenings, group discounts on hearing devices, in-service educational presentations, and a host of other hearing related employment benefits.

If you’re currently employed, encourage your employer to seek offerings for the provision of hearing healthcare services, and remember, these services can often be contracted with local audiology practices. If you’re an employer in the Tri County region and don’t currently offer a hearing healthcare package, the program at Doctors Hearing Clinic is an example of what is available to your company. This FREE array of benefits for your staff and their families, offers great value in hearing healthcare at no cost to you or your employees!

So start the 2012  business year out right. By encouraging employees to treat hidden hearing loss rather than hide it, an employer creates a win-win situation by ensuring that the loss of hearing does not interfere with job performance, productivity, safety, or the employee’s career or quality of life on or off the job.

References:

Sergei Kochkin, Ph.D., executive director of the Better Hearing Institute, a not-for-profit that educates the public about hearing loss, prevention and treatment.

Better Hearing Institute (BHI)

The Society for Human Resource Management

A recently completed study by Johns Hopkins University – published on November 14, 2011 in the Archives of Internal Medicine – now confirms that 1 in 5 Americans have hearing loss in at least one ear.  This is well over 50 million people and far exceeds previous hearing care industry estimates of approximately 25 million.

The Johns Hopkins study is unique in that the data used statistically corresponded with the entire US population by including both men and women of all races, aged 12 and older, living in cities throughout the country.

Using the World Health Organization’s definition of hearing loss – not being able to hear sounds of 25 decibels or less in the speech frequencies – the Johns Hopkins researchers found that over 30 million Americans have hearing loss in both ears and that over 20% of the population – in excess of 50 million people – have hearing loss in at least one ear.

Despite there being so many of us with hearing difficulties, too many people are still unaware of how or where to obtain professional help as the misconceptions about hearing loss and hearing aids are commonplace in our society.   The fact that you are reading this article is an excellent first step towards empowering yourself (or a family member) and taking control of your hearing health.

Common Hearing Loss and Hearing Aid Myths

Myth: Buying hearing aids online, by mail, or at a big box store saves time, money, and gets the same results as professionally fit devices.

Fact: The proper diagnosis and selection of hearing technology as a solution for hearing difficulties is not the same thing as purchasing common consumer goods.  Rather, it should be a process built upon a relationship of respect and trust between the patient and a highly trained, competent, and ethical professional whose services and products provide long-term value.

Myth: Anyone licensed to sell hearing aids is qualified to test a person’s hearing.

Fact: By law in the state of California, only audiologists are licensed to perform diagnostic hearing evaluations.  The “free” tests that hearing aid dispensers frequently advertise are not comprehensive exams and are merely designed to determine if a person could be helped by a hearing aid.

Myth: Hearing loss affects only “elderly” people and is merely a sign of aging.

Fact: Hearing loss can affect people of all ages.  As mentioned in the Johns Hopkins study, 20% of the US population aged 12 years and older have hearing difficulties severe enough to impact communication.

Myth: Hearing aids don’t really do anything but amplify sound.  Besides they’re unsightly and uncomfortable.

Fact: While the hearing aids from 20 years ago left a lot to be desired from both technology and cosmetic standpoints, today’s hearing devices are exceptional technological performers and are so small as to be very discreet.  However, the most important consideration for you, the consumer, is not what the product is, but rather how it is fit to your hearing lifestyle, and to what extent you are provided with expert follow-up in the fitting of that device.   That is what makes my patients so successful in being able to enjoy better hearing.

Would you like to learn more about solutions to hearing difficulties and  hearing aid technology?  Here are two great places to start:

#1.) My Internet website at www.nsaudiology.com. This educational website offers a world of information, including highly informative videos, a free guide to better hearing, online specials, current “News & Events”, and the “Ask Dr. Chalmers” section where I have posted previously published original articles such as the one you are reading now.

#2.) Attend my upcoming Free Educational Luncheon Seminar which will be held Wednesday, January 25, 2012, starting at 11:30 AM at the Chico Women’s Club.  I’ll be providing an in-depth discussion covering everything from how your hearing works, to what are the different types of hearing care professionals, to insights about technology solutions for hearing difficulties.  A delicious catered lunch will be served.  There is no cost or obligation to attend, but due to limited seating, reservations are required.  Simply call my office today at 1 (888) 893-1352 …. Because hearing is wonderful gift.

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 of Audigy Group, the nation’s largest member-owned association of independent hearing care professionals.

Since 2006, Audigy Group has interviewed over 5,000 of the 18,000 audiologists in the United States, yet has selected only 230 to be members in this elite association. AudigyCertified™ is a trade-mark of Audigy Group, LLC.

To learn more about Dr. Chalmers, her practice, and Audigy Group visit online at www.nsaudiology.com.

More than 32 million Americans have significant hearing loss, yet only a fraction of that number have ever had their hearing tested by a Board Certified Audiologist. Everyone over 25 should have a baseline audiogram! Consider this fact- 17% of all those involved in motor vehicle accidents will have resultant permanent sensorineural hearing loss. However, if you’ve never had a valid hearing evaluation, you’d be hard pressed to show that your hearing was normal prior to such an accident.

A thorough hearing test is the first step in determining if you do, in fact, have hearing loss. The hearing test results also allow your audiologist to recommend the best treatment options if you do in fact have hearing loss. A hearing test is a quick, painless and non-invasive test, and should always be performed by a licensed, Board Certified audiologist. Ask to see the credentials of those who will be doing your testing! As with most health care  professionals, credentialed individuals have the greatest amount of educational training in diagnosis and treatment of hearing impairment, and will offer you or your loved ones solutions that reflect their knowledge base.

The test begins with a thorough case history, which reviews specific health information that may provide insight into hearing loss causes and will assist in determining which tests should be performed. Following the case history, the audiologist will examine your ear canals and eardrums with a special light called an otoscope. Your middle ear function will also be assessed by a test called tympanometry, which offers insight regarding the status of the area behind your eardrum. This area cannot be easily seen, and so the tympangram offers valuable information to the examiner. The test involves a pressure change, and may replicate the feeling you experience while going up in an elevator, but is not painful in any way.

Next, the levels of hearing in each of your ears should be measured in a sound-treated test booth. Some hearing aid technicians don’t use this type of equipment~ but be wary of any hearing test that is not conducted in such a booth, as reliability may be seriously compromised. During this test, a series of tones of different pitches, as well as speech signals, are presented to each ear through headphones. You will be asked to respond to the signals by either pushing a button, raising your hand or in the case of speech signals, repeating what you heard. You will be asked to respond to the lowest level that you can hear which determines your hearing thresholds. Thresholds for each pitch and ear are plotted on a graph called an audiogram. These thresholds indicate the level at which you are just barely able to detect sound. The speech testing yields a word recognition score, which is important in determining in part how well you will perform with hearing aids, which listening situations will be most challenging, etc.

Further tests may be conducted during the hearing test. Your ability to understand words or sentences at different volume levels or in the presence of noise may be assessed to determine how clearly you hear speech in various conditions. Following the tests, the hearing professional will discuss the results with you and may provide further recommendations, including treatment options, like hearing aids.

If you suspect you have hearing loss it is important to have your hearing tested as soon as possible. The use-it or lose-it principle does apply to our hearing; the sooner you treat hearing loss, the better the outcome of treatment. Most people wait an average of seven years from the time they suspect they have hearing loss until they purchase hearing devices. During that time period, the auditory system is at extreme risk for auditory deprivation, or lack of stimulation due to insufficient volume. This can make a difficult situation worse than it really needs to be. So why wait? Have a Board Certified Audiologist evaluate your hearing as soon as you (or others!) suspect there might be a hearing loss.

“What’s the best hearing aid?” As an Audiologist, I’ve heard that question so many times. To successfully answer that question, perhaps the very first thing I need to do is modify it slightly ~ “What’s the best hearing aid for you?” An important concept to keep in mind when exploring today’s vast array of options for hearing devices is that what’s right for you may not be right for someone else, and vice reverse. The decision regarding which type of hearing instrument technology will sound and perform the very best will be largely dependent on you, your lifestyle, budget, and listening needs. These parameters tend to be highly variable from person to person, so let’s take a closer look.

Not all hearing losses can be correctly fit with the same style or type of device. This is very evident when fitting those with precipitous loss in the high frequencies.  High frequency deficits are the most common configuration of hearing loss, and respond best to open fit technology. This type of device leaves your ear canal open, ensuring that the sound of your own voice is normal and pleasant. Conversely, fitting those with high frequency loss with conventional “in the ear” devices can have catastrophic results in terms of patient satisfaction. Have hearing instruments that you or your loved one are not using? It may be resultant from the units being the wrong style for the loss! High quality open fit technology has been available for a relatively short period of time, and many of those whose instruments were purchased more than 5 years ago may not have had access to those devices.

What about some of the new “fancy stuff”, like Blue Tooth technology? Is that for you? Many of my patients are not familiar with Blue Tooth, but it can open up a world of ancillary devices and couplings for your hearing devices. For example, if you use Blue Tooth enabled hearing aids, you can wear a “streamer” around your neck, and answer your cell phone hands free through your hearing aids! With the new cell phone use restrictions now in place in Montgomery, that can be a really handy feature. It’s also possible to listen to your TV or IPod directly through your hearing instruments with this technology, or use a special microphone to make conversations with your significant other in a noisy car or restaurant much easier. Other technologies to consider are remote controls, assistive listening devices like amplified phones or doorbell alerts, or FM devices to help with performance in a classroom or job environment. However, if you don’t want or need such technologies, don’t pay for them!

What kind of lifestyle do you have? If you are still working, it’s likely that you are in highly variable listening environments, or your profession demands auditory accuracy (and most jobs do!). Those who lead very active lifestyles need to consider today’s high end technology, with plenty of noise reduction capability. On the other hand, if you’re retired, living alone, and seldom go to restaurants or parties,  simpler, more basic noise reduction features will suffice – and cost less! If you are the type of person who “wants the best of everything” then there are plenty of high end technologies to wow you (and your friends and family). Don’t overbuy, but do be honest with your Audiologist about your listening needs. If you aren’t you may be disappointed with your hearing devices.

Finally, as self-serving as this might sound, perhaps the only honest and comprehensive answer to the question above is “a hearing device recommended and provided by an exceptionally skilled and dedicated Audiologist.” Sometimes that’s not the answer folks are looking for. I have patients tell me “it’s all about price” or request a specific brand because a friend or relative was successful with a particular device. Hearing aids are a big investment with the potential for providing a big improvement in the quality of your life. People with hearing impairment need a competent and caring Board Certified Audiologist who will go the extra mile to provide them with solutions custom-tailored to their own unique hearing loss and listening situations. As critical as the various aspects of technology may be to the hearing aid industry, it is ultimately the professional who is the decisive factor in guiding patients to satisfaction and benefit with hearing devices.

Note: Doctors Hearing Clinic was recently named Best of 2011 Hearing Healthcare Professionals by The Hearing Review, and was Dr. Borton and her staff were the only clinic in Central Alabama to receive this award. This recognition was provided to only 165 hearing healthcare clinics across the United States.

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.

When 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

When 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.

“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?”

This 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

WRONG! According to ScienceDaily (Sep. 20, 2011), mild hearing loss has now been linked to brain atrophy in older adults. Anecdotally, over the course of my 30+ years in private practice as a Board Certified Audiologist, I’ve observed this to be true. But now, more and more research is indicating strong correlation between failure to obtain or use hearing devices and increased problems with understanding speech and cognition.

We have all heard (or perhaps experienced) the complaint that despite the fact that speech is audible, it’s not understandable. “I hear but I can’t understand” is probably the most commonly voiced concern in my office. So, if someone has hearing loss, if your hearing aids make sounds louder, why doesn’t that solve all hearing related issues? Well, like lots of things in life, it’s just not that simple.

A person’s audiogram (or those little blue X’s and red O’s on the graph of your responses to the “beeps”) tells us a lot, but it does not yield the whole story. Hearing thresholds (or the point at which someone is just barely able to detect sound across the frequency range) are certainly important, but don’t give much information regarding how well someone will understand when speech sounds are made sufficiently loud. Word recognition testing, with and without noise, provides additional information regarding this capability, and as a by-product, an indirect measure of the distortional component inherent to sensorineural hearing loss.

We now have mounting evidence that those who have hearing loss, but fail to get and/or use hearing devices run the risk of depriving their auditory system of sufficient loudness, which in turn results in degradation of the mechanisms responsible for understanding speech. A new study by researchers from the Perelman School of Medicine at the University of Pennsylvania shows that declines in hearing ability may accelerate gray mater atrophy in auditory areas of the brain and increase the listening effort necessary for older adults to successfully comprehend speech. When any one of our senses (smell, taste, sight, hearing, or touch) is changed in some way, the brain reorganizes and adjusts. In the case of those with hearing loss, researchers found that the gray matter density of brain in areas specific to hearing was lower in people with decreased hearing ability, suggesting a link between hearing ability and brain volume.

So, use it or lose it may be the prevailing philosophy. Take heart (and USE those instruments that you have!) According to this study,  early intervention for hearing loss with the consistent use of amplification can slow the progression of speech comprehension difficulty. “As hearing ability declines with age, interventions such as hearing aids should be considered not only to improve hearing but to preserve the brain,” said lead author Jonathan Peelle, PhD, research associate in the Department of Neurology. “People hear differently, and those with even moderate hearing loss may have to work harder to understand complex sentences.”

In two recent research studies, researchers measured the relationship of hearing acuity to the brain, first measuring the brain’s response to increasingly complex sentences and then measuring cortical brain volume in auditory cortex.  Results indicate that older adults (60-77 years of age) with normal hearing for their age were evaluated to determine whether normal variations in hearing ability impacted the structure or function of the network of areas in the brain supporting speech comprehension.

The studies found that people with hearing loss showed less brain activity on functional MRI scans when listening to complex sentences. Poorer hearers also had less gray matter in the auditory cortex, suggesting that areas of the brain related to auditory processing may show accelerated atrophy when hearing ability declines.

In general, research suggests that hearing sensitivity has important consequences for neural processes supporting both speech perception and cognition. Although most the research has been conducted in older adults, the findings also have implications for younger adults, including those concerned about listening to music at loud volumes. “Your hearing ability directly affects how the brain processes sounds, including speech,” says Dr. Peelle. “Preserving your hearing doesn’t only protect your ears, but also helps your brain perform at its best.”

Physicians should monitor hearing in patients as they age, and everyone should have a baseline audiogram performed by a Board Certified Audiologist, looking specifically at speech recognition abilities even in the presence of normal hearing. Patients should talk to their physician or audiologist if they are experiencing any difficulty hearing or understanding speech. If your physician has not referred you for hearing evaluation, take action!

The research cited above in this article appears in the latest edition of The Journal of Neuroscience and was funded by the National Institutes of Health.

Here in California – as in many states – purchasers of hearing aids are afforded protections under state laws and regulations administered by the Department of Consumer Affairs (DCA) through the Speech-Language and Audiology and Hearing Aid Dispenser Board (SLPAHADB).

The SLPAHADB was formed on January 1, 2010 by combining the Speech Language Pathology and Audiology Board with the Hearing Aid Dispensers Board.  Previous laws and regulations remain virtually unchanged except that audiologists are no longer required to hold dual licensure for practicing audiology and dispensing hearing aids.

This board’s mission is ensuring the competency and fair practices of hearing aid dispensers.  It does so by providing licensure through testing, ethical guidelines, boundaries for advertising practices, and acts as a vehicle for consumer complaints, ultimately providing enforcement and disciplinary functions.

While political discussion in the media about government intrusion in our lives is a hotbed topic, consumer protection laws are generally an accepted interaction between the citizenry and government.  Who wants to buy poisonous food, cars that don’t run, or housing that collapses in the slightest breeze, to name just a few examples?

Why should it be any different with hearing aids?   Purchasers have a right to expect fair and honest treatment as well as professional expertise from those they seek help.  It could be argued that hearing aid purchasers – many of whom are our senior citizens – should receive an added degree of protection as many of our laws are designed to protect us as we age beyond our more active years, and thereby tend to rely on the care and guidance of those who are younger.

While all the laws and regulations are too lengthy to list here, these are several of the most important.  For the full listings, visit the SLPAHADB website at www.speechandhearing.ca.gov

• 30 Day Warranty  – The “Song-Beverly Consumer Warranty Act” provides a 30 day warranty on all new and used hearing aids.  If the hearing aid is not specifically fit for the buyer’s particular needs, the device may be returned to the dispenser within 30 days of the of the date of the actual receipt by the buyer or completion of fitting by the seller, whichever occurs later.  If the buyer returns the device the seller must either adjust or replace the device or promptly refund the total amount paid.

It should be noted that while many dispensers advertise things like “30 day risk-free guarantee” they are merely staying within the state mandated minimum trial period of 30 days.  My professional opinion is that for many purchasers, 30 days is too short as it does not allow enough time for the brain to get used to hearing again.  In my practice, I offer a 75 day trial period in order to make certain my patients have all the time they need to be successful.

• Mail Order & Internet Sales  – California law provides that mail order/Internet hearing aids may only be purchased through a dispenser licensed in California.  The law also states that that when hearing aids are purchased by mail order/Internet, there must be no fitting, selection, or adaptation of the instrument and that the seller must not give any advice with respect to the taking of an ear impression(s). Anyone contemplating this avenue should be aware of potential risks as to work effectively, hearing aids must fit correctly.  If a sale doesn’t involve personal contact between the dispenser and buyer, it is difficult to assume that proper fitting and follow-up care could occur.

• In-Home Contracts & Cancellation Rights – If you sign a hearing aid purchase contract in your home, federal and state laws allow you to cancel it for any reason by midnight of the third business day after you signed the contract.

• Advertising Guidelines –  Did you know that in California, hearing aid dispensers are not licensed to perform diagnostic hearing evaluations (only audiologists are licensed to do so) and are therefore not allowed to charge a fee for “testing”?  That is why they advertise “free” tests, BUT they must state that the “test” is “to determine if you could be helped by a hearing aid.”

No one selling hearing aids in California can refer to themselves as a “specialist” without including the title “hearing aid dispenser”, nor can anyone refer to certification by putting a bunch of letters after their name.  For example, this listing: “John Doe, NB-HIS” is unlawful.  The correct listing should be:  “John Doe, Hearing Aid Dispenser, Lic. No. XXXX, NB-HIS, Certified by the National Board of Certification in Hearing Instrument Sciences”

Have you ever received one of those “rebate coupons” that resemble checks as part of a direct mail solicitation?  It is a violation to send those to anyone living in California.

And finally, no California licensed hearing aid dispenser can use the terms “doctor” or “physician” or “clinic” or “audiologist” or any derivation thereof, except as authorized by law.

These are just a few of the consumer protections for purchasing hearing aids.   I urge you to be good consumers by getting the facts and educating yourself about where you stand and whom it is that you are considering doing business with.  You’ve worked hard all your life and deserve to be treated fairly, professionally, and with what is in your best interest  …. Because hearing is a wonderful gift!

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 of AudigyGroup, the nation’s largest member-owned association of independent hearing care professionals.

Since 2006, AudigyGroup has interviewed over 5,000 of the 18,000 audiologists in the United States, yet has selected only 200 to be members in this elite association. AudigyCertified™ is a trade-mark of AudigyGroup, LLC.

To learn more about Dr. Chalmers, her practice, and AudigyGroup visit online at www.nsaudiology.com