Posts Tagged ‘Audiologist’

What’s the Best Hearing Aid?

December 8th, 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

“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!

AGX Hearing Lifestyle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

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
“Like” Doctors Hearing Clinic | Facebook
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

It Doesn’t Really Matter If I Wear My Hearing Aids, RIGHT?

October 28th, 2011

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

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.

Bettie Borton, Au.D. Doctor of Audiology AudiologistWe 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.

 

Consumer Protection Laws & Regulations for Hearing Aid Purchases

October 12th, 2011

By Crystal L. Chalmers, Au.D.
Doctor of Audiology

North State Audiological Services
15 Jan Court
Chico, CA 95928

(888) 844-7024
Follow North State Audiological Services | Facebook | Twitter | Youtube
www.nsaudiology.com

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.

Audiologist & Ear Doctor, Dr. Crystal Chalmers, Chico, CaliforniaThis 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

Sound Advice

October 6th, 2011

By: Dr. Amin Musani
Doctor of Audiology
The Hearing Clinic
119 W. Main Street
Denison, TX 75021
(903) 462-4022
www.thehearingclinic.org

I watched as the next IDPA shooter stepped up to the firing line. You could tell he had done this before. He carefully but purposefully loaded a magazine into his handgun and chambered a round. On cue, he drew and shot a perfect score in amazing time. His handgun seemed like an extension of his arm. The bullets landed exactly where he willed them to on the cardboard target. After safely holstering he stepped back, turned around and flashed a smile, which told you he was pleased with his results and all that training and endless hours of practice had finally paid off. As he made it back to the observer area I walked over and congratulated him for a job well done. Curious as to what type of handgun he was using I asked him, “What kind is it?” He replied, “It’s 2:30pm.”

It never ceases to amaze me the high number of shooters that I come in contact with that do not wear any type of hearing protection while shooting. Granted, some things in our lives we cannot control. However, noise induced hearing loss (NIHL) and Acoustic Trauma are phenomenon that we most certainly do have control over and yet many shooters ignore the very basic principle of wearing hearing protection.

When is firearm noise is too much? When do we cross that line between loud and damagingly loud? Table 1 [1] displays some of the decibel (dB) levels of various sounds found in our daily lives. A decibel is a unit of measurement and for our purposes here it is measured on a logarithmic scale and there is a 10-fold increase in noise energy for each 10 dB increase. Said another way, an increase of 10 dB doubles the loudness level.

Sounds over 140dB can cause pain, and prolonged exposure to noise over 85-90dB can result in permanent hearing loss. Gunfire may be categorized as an impulse noise, which has the characteristic of an explosive burst. Impulse noise of sufficient intensity and pressure is often a cause of acoustic trauma. Generally, studies have shown that such impulse sounds may result in the shifting, skewing, bending, swelling, bursting, tearing, fusing &/or severe mechanical damage to the inner ear cells, structures, and auditory pathways. That is, short-duration sounds of sufficient intensity (e.g., a gunshot or explosion) may result in an immediate, severe, and permanent hearing loss, which is termed acoustic trauma. The degree of hearing impairment seen after acoustic trauma varies and may range from a mild to profound hearing loss.

Figure 1 (Pickles & Heumen; 2001) compares electron microscopy of normal, healthy outer hair cells (specialized hearing cells in our inner ear) to damaged ones. Once such damage occurs, it is permanent. There is no method of regenerating these cells or “curing the damage.” Bear in mind that this is only one site where such damage can occur from noise exposure along our auditory pathway.

There is evidence to suggest that once deterioration of certain specialized hearing cells (spiral ganglion cells) has begun, there is a corresponding deterioration within the central nervous system at areas higher up in the auditory system (Kim et al., 1997; Morest et al., 1998). Thus, once damage has occurred at lower levels it is not isolated there but rather may progress upwards through the auditory pathway. This is very characteristic of impulse noise such as gunfire that causes acoustic trauma. The inner ear, then, is not the only structure at risk from such exposure.

Figure 1. Normal, healthy outer hair cells (L) vs. damaged outer hair cells (R).

Virtually all of the structures of the ear and hearing system can be damaged from gunfire noise (NIH Consensus Statement; 1990). Generally, for sound levels below 140 dB, different types of sounds produce the same hearing loss. This does not appear to be the case at levels above 140 dB, where impulse noise creates more damage than would be predicted. This may imply that impulse noise above a certain critical level results in acoustic trauma from which the ear cannot recover (NIH Consensus Statement; 1990).

Exposure to noise between 90 and 140 dBA (dBA denotes a decibel measure made with a filter that adjusts for human auditory sensitivity) damages the inner ear metabolically rather than mechanically and causes injury depending on the level and duration of exposure. Noise-induced hearing loss, in contrast to acoustic trauma, develops slowly over years, and is caused by any regular and consistent exposure exceeding a daily average of 85-90 dBA (Clark & Bohne; 1999). Acoustic trauma may occur from just one unprotected exposure to gunfire noise.

For sounds between 75 – 90 dBA, the ear has a natural protective mechanism to reduce its sensitivity to low frequency impact sounds through what is termed the middle ear reflex. Generally speaking, muscles in our middle ear contract and stiffen three tiny bones (the smallest bones in the human body called ossicles; see Figure 2) that relay sound to the inner ear. However, a delay of 300 to 500 milliseconds is required to set this protection fully in operation. Most naturally occurring impact sounds can easily be dealt with by the middle ear, but many man-made sounds, such as explosions from guns, as well as certain industrial noises, occur so quickly that our middle ear protective mechanism cannot respond quickly enough. The hearing loss caused by such sounds is permanent acoustic trauma (Truax; 1999).

Peak sound levels from rifles and shotguns can range from 132 dB SPL (sound pressure level is another unit of measurement) for small-caliber rifles to more than 172 dB SPL for high-powered firearms. Americans collectively own more than 230 million guns, and more than half of men in the American industrial workforce occasionally use guns. The National Rifle Association estimates that 60 to 65 million Americans collectively own more than 230 million guns. Because guns are so prevalent in our culture, shooting firearms is the most important source of excessive noise outside the workplace. The severity of injury produced by impulsive noise exposure and the prevalence of shooting by Americans makes gun noise America’s most serious non-occupational noise hazard. The acoustic energy in a single report from a high-powered rifle or shotgun is equivalent to almost 40 hours of continuous exposure at 90 dBA. In other words, 1 bullet equals 1 week of hazardous occupational noise exposure. An avid target shooter can be exposed to an entire year’s worth of hazardous occupational noise in just a few minutes (Clark & Bohne, 1999; NRA, 1999).

What about firearms themselves? Is a .22LR any better on your ears than a .45ACP? Table 2 [2] compares the dB levels of various cartridges.

Recall that sounds over 85-90 dB can lead to permanent hearing damage without hearing protection. As can be seen from Table 2, even firing a .22LR (134 dB) has the potential of causing permanent, irreversible, inner ear damage.

There are various kind of hearing loss. Conductive hearing loss refers to physical damage, infection or fluid build up in the middle ear cavity (Figure 2). If the gunblast is of sufficient intensity a conductive loss may be seen and accompanied by such symptoms as eardrum rupture or middle ear bone damage.

Conductive losses are typically open to medical treatment from a physician who specializes in diseases of the ear (Otologist or Otolaryngologist). Sensorineural hearing loss refers to damage within the inner ear. This is usually, incorrectly, referred to as “nerve type deafness” which really only occurs in about 1% of the American population (Mueller and Hall, 1998). Sensorineural hearing loss is the most common type of hearing loss in America, and noise induced hearing loss or acoustic trauma from firearms is typically sensorineural. It is permanent, irreversible and with proper hearing protection, can be avoided or minimized.

Probably the most common excuse I have heard from shooters is that “my ears have toughened up from shooting and I don’t have to wear hearing protection.” Well, I’m sorry to say that this is not possible. What is more likely is that you have sustained sensorineural hearing loss and some sounds just don’t seem as loud any longer (along with speech). However, it is still critical to wear hearing protection as the hearing you do have left can still be harmed from unprotected firearm exposure. As researchers and educators have noted, “Ears don’t get tough, they get deaf.” (Mueller & Hall, 1998).

Typically, noise induced hearing loss and acoustic trauma affect the high frequencies first. Our ears respond to sounds across a wide range of frequencies, from about 20 to 20 000 Hertz (Hz). Speech frequencies are roughly located between 250-8000 Hz. Low frequencies are used to “hear people” while the highs are what we use to understand what they say. To put it another way, the power of speech (vowels) is located in the low frequency range while the clarity of speech (consonants such as s, k, th, sh, f, th) is located in the highs. High frequency consonants are necessary to maximize speech intelligibility. Noise damage from firearms affects these high frequencies first due to, some believe, anatomical reasons (Mueller & Hall, 1999). Figure 3 [4] depicts an audiogram (record of one’s hearing) of a sensorineural hearing loss typical of shooters.

As such, many people complain that “I hear people, but sometimes I don’t understand what they said.” Women’s and children’s voices, typically in the high frequency range, are usually the most difficult to understand when one has such a high frequency hearing loss. Add to all this that our hearing gets worse just from the normal aging process and you quickly realize just how important hearing protection really is.

Other factors also determine how susceptible one is to firearm noise exposure. For examples, blue-eyed individuals may be more susceptible than people with greater melanin content in their eyes. Some studies have shown that males are more susceptible to noise induced hearing loss (NIHL) than females. Newborns and older individuals also seem to be more likely to develop hearing loss from NIHL. Finally, some studies have also shown that smoking increases one’s chances of acquiring hearing loss from noise. This may be due to the carbon monoxide in the smoke (Henderson, Subromaniam, & Boettcher; 1993).

I’ve also noticed that some shooters will wear their hearing protection, but only while shooting. When observing from just a few yards away, they do not wear their hearing protection. This is simply not good hearing conservation practice and is against competition rule #7 of your IDPA manual. In fact, if one was to comply with this rule, anyone within 50 yards of the firing line must wear not only hearing protection, but eye protection also. Some handguns at IDPA produce a very discernible boom that can still damage your ears (see Table 2), even if you are not shooting and are only a few feet to yards away. Of course, this will vary with the type of firearm, cartridge, and distance from the shooter, but Table 2 clearly shows that even a report from a .22 can damage your ears. Though not relevant to IDPA purposes, the use of muzzle brakes and ports dramatically increases the level of noise exposure from firearms.

In the consideration of sounds that can damage hearing, one point is clear: it is the acoustic energy of the sound reaching the ear, not its source, which is important. That is, it does not matter if the hazardous sound is generated by a machine in the workplace, by a loudspeaker at a rock concert, by a lawnmower or a firearm during an IDPA event. Significant amounts of acoustic energy reaching the ear may create damage–at work, at school, at home, or during leisure activities. Although there has been a tendency to concentrate on the more significant occupational and transportation noise, the same rules apply to all potential noise hazards, including and especially firearms (Clark and Bohne; 1999).

Sound advice dictates that when at the gun range, by all possible means, take appropriate measures to practice safe gun handling. Wearing hearing protection (along with eye protection) falls into this category, whether you are the shooter or an observer. Think of it this way: hearing aids could cost you anywhere from $600 to $8000 per pair! Protect your hearing and you could spend that on more important things…like firearms, ammunition, training & IDPA.

References
  • American Academy of Audiology. http://www.audiology.org/consumer/guides/aural.php
  • Clark, W.W. & B.A. Bohne (1999). Effects of noise on hearing. Medical Student Journal of American Medical Association. May 5th, Vol. 281: 17.
  • E.A.R., Inc. (2001). http://www.earinc.com/howhearingworks.html
  • Henderson, D., Subromaniam, M., & Boettcher, F. (1993). Individual susceptibility to noise-induced hearing loss. Ear and Hearing, 14(3): 152-156.
  • Kim, J., Morest, D.K., and Bohne, B.A. (1997). Degeneration of axons in the brain stem of the chinchilla after auditory overstimulation Hear Res, 103:169-191.
  • Kramer, W. Gunfire and Hearing Protection. Ball State University, Muncie, Indiana.
  • Mestel, R. (2000). Los Angeles Times. Original print date February 28, 2000. http://www.audiology.org/consumer/guides/aural.php
  • Morest, D.K., Kim, J., Potashner, S.J., and Bohne, B.A. (1998). Long-term degeneration in the cochlear nerve and cochlear nucleus of the adult chinchilla following acoustic overstimulation. Micro Res Tech 41:205-216.
  • Mueller, H.G. & Hall, J.W. (1998). Audiologists’ Desk Reference. Vol. I Singular Publishing: San Diego
  • Mueller, H.G. & Hall, J.W. (1998). Audiologists’ Desk Reference. Vol. II. Singular Publishing: San Diego.
  • National Rifle Association (1999). Fact Card. http://www.nraila.org/research/99fctcrd.htm.
  • NIH: National Institute of Health Consensus Statement Noise and Hearing Loss. Online 1990 Jan 22-24;8(1): 1-24. http://text.nlm.nih.gov/nih/cdc/www/76txt.html
  • Pickles, J., & Heumen, W. (2001). Hearing Unit. Vision Touch and Hearing Research Centre, University of Queensland. http://www.vthrc.uq.edu.au/hearing/hearing_home.html
  • Truax, B. (1999). Handbook of Acoustic Ecology (2nd Edition). Cambridge Street Publishing.

Dr. Amin Musani is a Clinical Audiologist practicing in Denison, TX. Any comments or questions may be directed to DrAminMusani@cableone.net or The Hearing Clinic 119 W. Main St. Denison, Texas, USA 75021, Phone: (903) 463-9900, FAX: (903) 463-9911.

[1] Mueller and Hall (1998).

[2] William Kramer, Ph.D.

[3] Mestel, 2000.

[4] E.A.R. Inc.

Stop Transactional Hearing Care!

September 21st, 2011

By: Dr. Helen Hallenbeck
Board Certfied Audiologist
Vibrant Hearing
601 South Orange Street
Missoula, MT 59801
(406) 549-1951 
www.myvibrantsound.com

A gentleman called yesterday and wondered if one of our audiologists would please make an impression of his ear. He found a hearing aid and wanted to “whittle on it” to make it fit his ear better. My first reaction (after “YUCK!”) was Why in the world would anyone want to wear a hearing aid that was customized for another person’s ear and hearing loss?!?!

Helen Hallenbeck, Audiologist Missoula, MTWas it a fundamental lack of understanding of the complexities of hearing loss and the insidious impact that loss has on relationships, communication patterns and lifestyle? Was it financial limitations? It takes an average of 7 years from the moment a person realizes they have a hearing loss until that person decides to get help. Throughout that period of emerging awareness, the person with a hearing loss is bombarded with mixed marketing messages. “Our Amazing Hearing Aids get rid of ALL unwanted background noise!” “Our Amazing Hearing Aids are INVISIBLE!” Our Amazing Hearing Aids will let you hear ONLY what you want to hear!”. In addition to the inexcusable exaggeration of the capabilities of any hearing technology, the hearing aid companies lure people in with FREE! everything.

Is it any wonder, when a person is finally ready to make the deeply personal and incredibly important  investment, that they fundamentally misunderstand what it is they are investing in and who it is they are investing with? The gentleman’s request for an ear impression so he could make his own hearing aid should not come as a surprise. The  hearing industry has painted themselves into a corner with salesmanship and bottom-dollar marketing. As a result the industry has devalued it’s very existence.

The truth is, hearing loss is complicated, frustrating and has a profound negative impact on the lives of the people that are affected. It is time the industry began to address the PERSON with the hearing loss. Today’s hearing technology is truly amazing and an appropriate solution can be found to fit within virtually any budget. But unless that technology has been chosen specifically for the individual, with all of his needs, desires, concerns, question and fears having been accounted for and carefully considered, then the technology has been wasted.

Let us each  work to make rigorous diagnostics, counseling, education, prevention and rehabilitation the expectation of the consumer.  Let’s stop the transactional process of hearing care that so dominates this industry and start humanizing what is truly a disability.

Medicare and Hearing Health Care

July 6th, 2011

By Crystal L. Chalmers, Au.D.
Doctor of Audiology

North State Audiological Services
15 Jan Court
Chico, CA 95928

(888) 844-7024
Follow North State Audiological Services | Facebook | Twitter | Youtube
www.nsaudiology.com

Two questions my staff and I get on a regular basis are: #1.)“Does Medicare pay for hearing tests?  Also: #2.) “If the tests show that I need hearing aids, will Medicare pay for the devices?”

The answer to question #1 is that Medicare does not cover routine hearing exams.  When I say “routine” I am referring to regular hearing testing done at the request of the patient for the purpose of determining the extent of hearing difficulties, much the same as any other health care check up.

Diagnostic audiological services are paid for, by Medicare, when a physician orders testing to obtain information to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem.

Audiologist & Ear Doctor, Dr. Crystal Chalmers, Chico, CaliforniaHowever, services are excluded when the diagnostic information required to determine the appropriate medical or surgical treatment is already known to the physician or the diagnostic services are performed only to determine the need for hearing aids or hearing aid reprogramming.

If the need for testing and hearing technology does not come under the specific guidelines outlined above, then the patient is responsible for 100% of the professional fees.

As for question #2.), the same is true for hearing aids, which under Federal law are considered “cosmetic” items.  Whether or not you agree with this, the law has stood this way for decades and it would take an act of Congress to change the national coverage policy.

That said, as a consumer you should be aware of any audiologist or hearing aid dispenser who tells you “yes” they will bill Medicare for your non-referred hearing tests and/or hearing aids.  This practice is illegal and as a consultant and special witness for the FBI, I can tell you that the Federal Government is not taking these fraudulent acts lightly.  In fact, they are cracking down on this activity and have recently prosecuted cases here in California.

To find out more about Medicare coverage for hearing care services and technology, visit the official U.S. Government site at www.medicare.gov.

If you have more questions about hearing care such as diagnostic testing and hearing technology, you can visit my website, or call my office toll free at 1 (888) 893-1352 …. 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 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 190 to be members in this elite association. AudigyCertified™ is a trade-mark of AudigyGroup, LLC.

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

The Hearing Aid Tax Credit – Not Moving at the Speed of Sound

June 16th, 2011

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

As a member of the American Academy of Audiology Board of Directors, the “big picture” with regard to hearing healthcare is one of my primary focus areas. With all the talk about the new healthcare plan currently being debated in the Senate, you may be wondering what is the status of the Hearing Aid Tax Credit Act? Unfortunately, it is not part of the current healthcare reform legislation and it has been moving through the House and the Senate at a snail’s pace.

Bettie Borton, Au.D. Doctor of Audiology AudiologistThere are some differences between the House of Representatives and the Senate bills: the House one (H.R. 1646) calls for provision of a tax credit towards the purchase of each hearing aid of up to $500 per device, available once every five years. It would be available to people age 55 and over, or those purchasing a hearing aid for a dependent. This bill excludes coverage for people earning over $200,000 a year. The Senate bill (S. 1019) would provide the same $500 credit but cover all age groups.

Although similar bills are introduced on the Hill every year, they never get very far. However, since August 2009, the bill has reached the threshold of 100 bipartisan co-sponsors (66 Democrats and 34 Republicans), so there is every reason to be optimistic that it will finally be passed. This hope is shared by leading healthcare and advocacy organizations, including Better Hearing Institute (BHI), the Hearing Loss Association of America, the American Academy of Audiology, the American Speech-Language Hearing Association and the AARP, among others.

Why should you care about the passage of the Hearing Tax Credit legislation? Well, for one thing, hearing loss is one of the most common conditions affecting older Americans. As Better Hearing Institute, points out that:

  • 3 in 10 people over age 60 have hearing loss
  • 1 in 6 baby boomers (ages 41-59) have a hearing problem
  • 1 in 14 Generation Xers (ages 29-40) already have hearing loss
  • At least 1.4 million children (18 or younger) have hearing problems; it is estimated that 3 in 1,000 infants are born with severe to profound hearing loss.  In fact, hearing loss is the most common of birth defects, occurring more frequently than, for example, Down Syndrome.

While sensorineural hearing loss can’t be “cured”, studies have conclusively shown that hearing technology, such as hearing aids, not only helps users hear better, but, at the same time, it vastly improves the overall quality of their lives by allowing them to participate in conversations and social activities, as well as reducing isolation, getting better compliance with medical concerns, and a host of other advantages.

By the same token, those who do not wear hearing aids are at an increased risk of loneliness, isolation and depression. For children, untreated hearing loss means that their language and social skills development will be delayed and / or diminished. Any way you look at it, hearing aids are necessary for quality of life, safety, and skill development for many Americans, young and old.

Unfortunately, for far too many people with hearing loss they remain out of reach.

Millions of people need hearing devices, but don’t get them, and a large part of the problem is the cost. There are currently an estimated 36 million Americans with some degree of hearing loss. Yet, according to BHI, only nine million actually wear hearing aids. Of those who do not, many cite the high cost of assistive technology for not getting treatment; in fact, two out of three adults with hearing loss say financial constraints are the main reason they do not use hearing aids.

The cost of hearing aids – ranging from $1,000 to 4,000 per hearing aid – is not covered by either Medicare or most private insurers, making it too expensive for many people. But a survey carried out by BHI demonstrates that 10 million of the 27 million Americans with untreated hearing loss would likely buy hearing aids if tax credits were available.

That’s why it is crucial that the Hearing Aid Tax Credit Act does not languish on the Hill much longer.

Make your voice heard! Congressmen do listen to their constituents, so it is critical that you write your representatives urging them to support this legislation.

For optimum effect, Doctors Hearing Clinic and BHI recommend that you personalize your letter, sharing the story of why the hearing aid tax credit is important to you and your family. For example, you may mention that your elderly parents are on fixed income and can’t afford the full price of hearing aids. Or, you are struggling financially and can’t pay for your child’s devices.

Alternatively, BHI offers online forms so you can type your message to your Congressperson directly, and Doctors Hearing Clinic provides copies of written directives to take further action.

Hearing Aid Tax CreditAdditionally, three states – New York, North Dakota and Montana – are currently debating hearing aid tax laws similar to the federal ones. Consider asking our state representatives to entertain such legislation. The more feedback and comments your representative receives, the better a chance of him or her sitting up and listening. For more information about this very important legislation, visit www.hearingaidtaxcredit.org, or call the professionals at Doctors Hearing Clinic. If we work together on this issue, we will all benefit.

Connectline: Creating Success & Satisfaction with Hearing Aids

June 8th, 2011

By: Dana Luzon, Au.D., CCC-A, FAAA
Doctor of Audiology

Audiology & Hearing Aids of the Palm Beaches, Inc.
4266 Northlake Blvd.
Palm Beach Gardens, FL 33410

(561) 627-3552
Facebook | Twitter | Youtube
www.hearingcarefl.com

Hearing aids are designed for enhancing speech communication from person to person, however there are some environments and situations even with good hearing devices patients may continue to struggle based on their hearing loss. These situations can include non-face-to-face communication like in a car, communication at a long distance or in a large group, as well as, while watching television or talking on the telephone. These patients need to use other assistive listening devices in conjunction with hearing aids to enhance communication in these areas.

The development of using Bluetooth technology to wirelessly connect the patient to their TV, cell phone, land line phone, and long distance microphones has increased the patients’ ability to hear and understand clearly in difficult listening situations.  The Bluetooth device, the Streamer, allows the patient secure connections with up to eight devices.

Dana Luzon, Au.D. - Doctor of Audiology in FloridaAs patients age, keeping in contact with their loved ones who may live far from them becomes increasingly important.  These relationships can depend solely on telephone communication.  Sometimes with physical limitations and mobility difficulties patients have a hard time getting to their telephone in a timely manner to answer the call. With the inclusion of the Connectline, the individual can answer their landline or cellular phone wirelessly by a simple click of a button without the need to pick up the handset! This allows the patient hands free communication of their telephone that sends the signal into both of their hearing aids at the same time. We know that hearing equally well through both ears helps enhance the overall quality of speech and the Connectline allows us that capability.

If watching television is of great importance to a patient, the Connectline allows the patient to hear television in both hearing instruments simultaneously and allows their friends and family to listen to their television at a normal listening level. While listening to TV, the patient can also communicate with everyone else in the room while feeling engaged in conversation.  This increases the patients’ ease of understanding of their television programs.

With the newest addition to the Connectline family, the Connectline Microphone, users can improve their understanding of speech at a distance.  Likely uses include communication in a meeting or a religious service, or when a companion is not facing them like in the car. This discreet microphone aids the patient in difficult or noisy listening environments by simply pushing a button.

Training the patient and their loved ones on how to utilize the new accessories is essential to its success. It is imperative that that patient be comfortable using the assistive listening devices in their everyday lives and training with a Doctor of Audiology will increase comfort and success with these devices.  As an AudigyCertified professional, providing unsurpassed patient care is always my standard.  These user friendly devices allow the Audiologist to address patients’ concerns in all aspects of their everyday life and aid in overall success and satisfaction with their hearing instruments.  As part of my consultation process, I demonstrate better listening through the Connectline family of products in the office so patients experience the positive impact it may have firsthand before making the decision to purchase.

Improving the Lives of Orphans

March 4th, 2011

Treasure Valley Hearing & Balance
By: Jacquie Elcox, BC-HIS

Boise, ID 83704

(208) 377-0019
www.treasurevalleyhearing.com

In July we had two different groups of children hosted by Summer of Hope in our clinic for free hearing screenings.  One group was from Columbia, the other from the Philippines.  These children are orphans in their home countries.  They were brought to the United States this the summer to be introduced to potential adopting families.  While they are here, the opportunity is taken to get them different medical exams which they have not been able to get in their home countries.  Enter Treasure Valley Hearing & Balance.  We offered the free hearing screens, while other local clinics donated eye, dental and physical exams.  Our Audiologist, Dr. Mel Miller, who is a pediatric specialist, performed the screening work.

The Summer of Hope is a faith-based Christian organization that brings school aged orphans from other countries to the United States for a 4-week vacation.  The children get exposed to potential adopting families before returning to their home countries to await a possible legal adoption.  While here, they receive medical attention, mentoring, and often stay connected with the people they meet for life.

For more information about the program visit SummerofHope.org.