Transcripts 2016 Healthy Hearing Expo

Healthy Hearing Expo 2016

Talk 1
Dr. Erin Wright

Dr. Erin Wright:  Alright, welcome! Thank you for coming to our 7th annual hearing expo!
My name is Erin Wright. This year is my 20th year being an audiologist. I'm very proud and excited to share some of the information that I've learned over the past 20 years.

Today I'll be talking about what's new in the hearing aid industry in 2016. At the beginning I'm going to talk about what manufacturers are making, what features exist, and what is being released in 2016.

I was just at the Triple A Conference in Arizona.  This is our biggest conference, and a lot of manufacturers released a lot of technology in the last week. You'll learn a lot today, it's a lot of brand new information.

There are 6 or 7 main hearing aid manufacturers out there. Sonova owns Phonak. There's Oticon, which is based in Denmark. Widex and Resound are based in Denmark. Siemens is based in Germany, and is now called Sivantos.

They have had their hearing aid division for sale for the past 3 years. A private equity group purchased them about a year ago. They're using two names until they fully change over.

I'll go over a few of the features that are currently available. A lot of the features you'll know about, but I'm going to go over some that I think are important. I want you to think about what resonates for you.

Made-for-iPhone hearing aids have been around since 2012. Resound and Starkey both have hearing aids that don't require a device in the middle.

Through a phone app, you have control over the environment. If there is a noisy environment, you can open up your phone and inch that back a bit. There are taps where you can change the directivity of your microphone. Same thing with wind. If it's a windy day, you can make the wind noise higher or lower.

There are many things you can use through that connection. You can also use your GPS on your iPhone if you lose your hearing aids! They have a warmer/colder tool, so if they're under your cushions the app will help you.  [Audience laughing.]

There are different ways that we can connect hearing aids to phones. You don't even need to hold your phone up to your ear. In the absence of the iPhone, Widex and Phonak use landline hearing aids.

If you have hearing aids on, the signal from the phone will stream into the hearing aids. It just streams in quite naturally. The benefit of this is that you can process that signal through both ears.

Phonak purchased Lyric. The story is that one of the main CEO of Phonak was wearing a Lyric hearing aid. It is the only option for an extended wear hearing aid. That means that it's placed by the audiologist and then it stays there between 6 weeks and 3 months. There are a few factors that make them last longer. The more hearing loss somebody has, the more battery life it takes.

It's got good applications for some people. I have GP's using this. I have quite a few people who for dexterity reasons, it becomes easier it come in and have this done. If it's important for people not to know you're wearing it, this one is good.

You have to have a certain degree of hearing loss, and a certain slope, as well as a healthy hearing canal. People with a lot of wax production get can have plugged up hearing aids.

We provide a free 30 day trial. We can then see if this is going to work, or if the ear canal health makes it not a viable option. It's fairly expensive because it's a subscription-based product. For a year, it's about three thousand dollars.

We've had tinnitus maskers out on the market for a while. It's up to the audiologist to decide whether to turn that on. There's a tinnitus talk this afternoon, but it's when there is ringing in the ear. It's mostly for the people with tinnitus that we apply maskers or sound therapy.

This is a picture of what hair cells look like. These become damaged when we have hearing loss. There's one row of inner hair cells. The most common reason for tinnitus is the loss of these hair cells. We have sound that we put into the ear. If the hair cells are functioning, we can measure an echo. It’s pretty amazing.

There have been direct to TV options. Some people come in to talk about buying the ear phones for their TV. That can work great, but you don't have to do that if you have hearing aids already.

If you have gotten a hearing aid in the last 4 years, it can probably connect to the TV. It won't cut you off from the room around you. When you have earphones on, that's it, you only hear the TV. If you have your hearing aid on while you're watching television and your wife asks if you want popcorn, you can answer!

If you're interested in hearing aids, all of the reps are here today. You can ask about connecting to the TV, and they'll have those products.

There are rechargeable options. There are different philosophies. All of the manufacturers haven't adopted a wireless function. It's a really great option for people who don't want to deal with batteries. It's not necessarily less expensive, because of the rechargeable battery.

Frequency transposition is a feature that was first released by Phonak, but now the rest of the companies have it as well. It's for people who have hearing loss in the high frequencies. Putting high volume in those frequencies doesn't help. This means that all of those hair cells in the high frequency areas have been damaged.

What the companies came up with is that they transpose them to a lower frequency. This is something that has changed.

What’s new in 2016?  Widex's newest product was released in October. Their second version was released in March. In April, they released a microphone. Phonak has had Venture for a while, but what's new is their "power" version. Starkey has their Muse hearing aid. Oticon, it has "Opn."

Let's start with Widex. They have a platform called "Unique." It's a bit like cars. You might have the Ford "Explorer." So there are different models. Widex has "Unique." Before that they had "Dream."

It comes in 4 different price points. Physically, it's the smallest ear shell. This is the hearing aid that Steven is going to be talking about in the next session. The company has worked hard with musicians and with music. These hearing aids, I have found, work really well for people who are musicians.

I have a client from Broadmead who is a cellist. I fit him with these hearing aids and he's blown away! He just wrote a testimonial about how much he loves them.

So the next one I want to talk about is Resound. This hearing aid works really well with the iPhone. The people who I have fit with it have been happy with it and so have I.

What I like about the microphone is that Resound has released an affordable microphone. Historically, we used microphones in school.  The teacher wears a microphone that the student can pick up. That's an FM system. It's a great system. I have nothing bad to say about it other than the fact that it costs a lot.

It's about $1500 for that microphone. All of the manufacturers have created a less expensive microphone, just $150. They don't work as well but it has to go from the speaker to the device and then into the hearing aids. It's an option but not as good.

Resound, just last week - I only fit two people because it was just last week - has created a multi-microphone. It's a bridge between an FM system and a hearing aid. It has multiple microphones like the Roger FM system. It has a distance of 80 feet, a longer battery life and an accelerator. This means that the microphone knows where it is in space.

If it's being worn around someone's neck, it changes how it picks up sound versus being on a dinner table. How you hold it will change how it picks up sound. That was not available with expensive FM systems. It's a good middleman at a reasonable price.

Signia is the hearing aid company of Sivantos. They bought Siemens’ hearing aid technology. This was April 25th. They call this new hearing aid "Primax." It's a more sophisticated directional microphone that can detect where the speech is coming from. That has always been available, but Primax is saying they're going to be able to measure the distance between the hearing aid and the main speaker.  If you're the main speaker, it's going to amplify your voice without the voices behind you.

That's always been the problem with directional microphones.  If everyone is looking behind you, it gets noisier.  Phonak has the venture product from October 2014.   

Audiosense means that the hearing aid will differentiate between 7 different environments. Generally hearing aid companies release something new every few years.

They stagger that release a little bit. The question with Phonak is, why did it take so long between 2014 and 2016 - a year and a half - to release the power version of this venture platform hearing aid? What was the delay? They were trying to make sure that the second feature of the frequency transposition actually worked. This is hard, because it takes the high pitches and switches them to a lower range.

What they were really studying was severe hearing loss. Sometimes shifting that information to a lower frequency range distorted the sound. It didn't make things clearer. The sounds were detected but there was no clarity. They were working on changing how they shift the frequency. Instead of one cut-off frequency, now there are two.

Prior to this, we might decide as audiologists that the sound higher would be transposed. Now, the higher the hearing loss, the more helpful the feature will be. The area of the cochlea is now more adaptive. It's going to transpose it down, but not without evaluation of the signal. I think it was smart of Phonak to hold back on that.

Speaker: What is the cochlea?

Erin: That's the part of the ear that houses those hair cells. That's where the hearing loss usually is, in the cochlea.

This new product is 25% smaller than the Quest hearing aid. They also had a power version. In the new version, it's smaller and thinner than the Quest product.

Speaker: I'm not familiar with the power version. What does that mean?

Erin: There are hearing aids and then power hearing aids. If you have hearing loss more than 70 decibels, you need a power hearing aid. It gives more value and features to deal with the small range of features. There's hearing aids for people with mild to severe loss, and then severe to profound. That's what we call power. Thank you.

Speaker: As you get smaller ones, isn't it more difficult to change the batteries, and the issues with wax catchers?

Erin: The wax catcher is the same size no matter what. They all have the same receiver design. It is true that the batteries get smaller. The Widex has a smaller battery and it's hard to change. You have to consider that based on your needs. Is it more important to have a smaller hearing aid knowing that it's harder to change the battery?

Many hearing aids have to use a 675 battery, which means a bigger shell. The Naida is working on a smaller battery. It makes it more durable. It's made with glass fibre technology. It's 60% more resistant to dust and moisture than any other Phonak hearing aid to date. The waterproof is the IP 68 rating. This is IP 67. You can't dunk it under water, but it's water resistant to our general rain, sweat, etc.

This is important because people who have severe hearing loss are pretty reliant on a hearing aid. They wear them 15 hours a day so we need it to be durable.

Speaker: The last picture showed it had a receiver in the canal. Will the next option have the mold or both options?

Erin: There's a receiver, and you can put a mold on there or a dome, which is a flexible rubber piece. We can also make something in your ear that the receiver fits into. The Naida is a receiver in the hearing aid. You can have the tubing in the other version, the Bolero.

Starkey has a new platform called "Sinergy" coming out on June 2nd. It's a good year because we're in this three year cycle. We had some products in 2015 but most of the new products are being released April 2016. Starkey has a new app for the iPhone called Halo.

Don't worry about remembering the names. It's about remembering the feature that might be right for you. Sinergy is the main platform, with different sizes of hearing aids. What I like about Starkey is their ability to make the smallest hearing aid that fits down the ear canal. You take it out at night and put it in in the morning. They've done the best job of making the shells small.

If you have a small shell - I'm not sure if the component pieces are smaller or fitted differently - but we can fit hearing aids that fit down the ear canal that are nearly invisible. I chose Starkey because no other manufacturer has been able to make them so small. It's the first hearing aid of this size that is wireless. That means you can stream information from the TV directly to your hearing aid.

If you have a device plugged into your TV device, we can hook it up two ways. If the TV is on and you move within a certain distance, you can hear it. Sometimes people will have the distance be as far as the main spot they sit in when they watch TV. When they sit there, the hearing aids pull in the sound without doing anything.

The other thing is a remote control that you push a button on, which allows you to hear the TV. Starkey created the first product in that size.

Speaker: If someone wanted to buy this and had hearing aids already, could you trade it in?

Erin: You'd have to talk to me one on one to see what could happen there.

The next product is from Oticon. They're a really good manufacturer. I've used them for many years. A lot of you in here are using them. My own mom uses Oticon hearing aids. They had a huge leap up in 2008 when they introduced a hearing aid they called Epoch. It was the first hearing aid with ear to ear communication. It has binaural reception in the ears. It was a big step up.

I just heard about this new hearing aid at the Triple A Convention in April. They call it Opn because they're shifting away from the typical way hearing aids process speech and noise. We've focussed on directional microphones to pick up what you're looking at. This platform, Vilox, has a philosophy of being a more open sound processing strategy.

They're not planning on using directional microphone technology from hearing aids. They want to identify the noise around you in all directions and attenuate that noise without attenuating the speech.

The focus is to allow the brain to determine where the brain wants to focus, as opposed to the hearing aid. It's a new paradigm. They say the processing strategy is 5000x faster than the existing hearing aid. The speed of processing is what allows it to do a better job of attenuating the noise without reducing the primary signal.

They're also working connecting it to the iPhone. It'll be on a size 312 battery. It's not in the ear yet, probably not until the fall. It's only in the premium version of the hearing aid. I don't know how much it will cost but probably on par with other manufacturers.

They're also developing an app called "If this, then that." It allows two different technologies to connect together. In this example, it's about photos. With hearing aids, you might be able to have a phone alert your hearing aid when it goes off. As technology evolves, more things that people have in their homes - like thermostats that nest and allow you to make changes, or if there's a smoke detector going off when you're outside the house, it will alert the hearing aid. This is trying to loop hearing aids into this technology.

The next few slides talk about what's coming up in the fall of 2016. There are two things in this category. One is a technology from Resound. Resound is saying that in the fall, they're going to release a cloud based program for audiologists to update the frequencies remotely. I could send the change to the cloud, and then it sends it to your hearing aid!

There's lots of potential for people who live in remote areas. I had someone come from Alert Bay! When people are less mobile, there are applications for this technology.

Another final thing is that Starkey has partnered with wireless earphone technology. Right now, it has wireless ear phones that have an in the ear thing that looks like that. In the headphone, it has its own MP3 player. It can track your heart rate and steps.

Starkey is coupling with this technology to get this amplification in the ear phones, or just to embrace the concept of "hearables." There's a movement to get rid of the words “hearing aid.” There's more technology coming in, and more people using them to bring technology together.

I'm going to show a video. This isn't for everyone but it's a funny little video.

[Transcriber's Summary: [Music playing.]

Man’s voice: "Go faster! Go go go!"

[Computer Voice tracking work out.] ]

Erin:  I'm just super excited to be part of this industry. Even when I graduated from school in 1996, I graduated with a screwdriver and there were trim pods! We would screw down and ask if it was better! I remember crying on my way home from work thinking I couldn't help anyone. It's so much different now! The evolution and technology! I have so much job satisfaction because of all of the positive things I hear about how this technology is changing how people hear.

I wish I could video what some people say. There is somebody here - who I won't point out - but she is one of those moments. She got hearing aids and is also visually impaired. She came in with a pad of paper with her notes on it. She was looking at them carefully and I was thinking "Oh, she's going to say something bad," but she looked up and she said "I can see better!"

Opening up her hearing allowed her to open up her environment and actually see better. As younger people are noticing hearing loss at younger ages, we have these options.

Speaker: With all this new technology, how would it affect somebody who's wearing a pace maker?

Erin:  That's only been an issue with somebody who has worn a receiver around their neck.  When people wear pacemakers, it's important that you choose a hearing aid that doesn't have that.

Speaker: You keep referring to the iPhone connection; are there other formats?

Erin:  It's the only one that can be used to stream audio. They're working with android platforms too. There are apps you can get on Android, but you can't stream anything unless it's an iPhone or iPad.

Speaker: You were pointing out the various manufacturers.  Could you predict that they all get together?

Erin:  That's a great idea, for one big brain to figure it out! The prices would triple. It keeps people honest. These manufacturers will take this product from Oticon and then they'll come up with something similar, just like phones and everything else.

Speaker: What happens to the old hearing aids?

Erin:  That's a good question. So many people use hearing aids that can be used by other people. If you have hearing aids that you don't need anymore, you can donate them to Lend an Ear, which is a program we have. If they don't have disability insurance or anything, we can figure out charges.

They can be free or very discounted. I don't get people to give me their T-4's or anything. I'm hoping people use the honour system. There are people who are very much in a system where they can't afford it.

Thank you guys so much for coming! The next talk is by Steven Pugsley.


[End of presentation]


Talk 2
Dr. Steven Pugsley

Erin: Hello, you guys. Welcome to our Healthy Hearing Expo. I am proud to introduce Dr. Steven Pugsley. He came from Burlington, Ontario. He's a respected audiologist in our field. It's a small community. He's done a lot of work with musicians and hearing loss. He's a chief person at Widex Canada. He's going to talk about the challenges for music, hearing loss and hearing aids.

Dr. Steven Pugsley: I'm just going to do a sound check for those in the back. I tend to be a bit of a wanderer. What I'm going to talk about is hearing aids and music, and hearing loss and music.

A disclaimer: I work for Widex, which is a Danish hearing manufacturer. We are known for technological innovations and for having the most natural sound possible coming out of the hearing aid.

The whole goal of the talk today is to give some education to you, in terms of what does an impact of a hearing loss have on a musician, and what can we do in terms of today's technology to help a music lover and musicians.

Hearing has three functions. There's the safety functions. We need to know when to get out of the way. There's the communication aspect. We are a social species so we want to communicate with others. Third, we have to enjoy life. One of the ways we do that is through music.

Music brings beauty and richness to life. When it comes to hearing aids, the focus is on speech. That makes sense. Most people think of hearing as happening in the ears. Hearing actually happens in the brain. We need to realize that when we test a person's hearing we're testing the ear function. We have a few tests that tell us what's happening upstairs, but not many.

Hearing is extremely complex. You can have two hearing losses in two people that looks very much the same, but what happens in the brain is very different.

This is a hearing aid. We all know what that is - it's a small battery device to help people hear. There is a computer inside that hearing aid. There's a battery, speaker, and microphone, but also a computer.

The sound quality that comes out of the hearing aid is only as good as the computer. It's what drives everything. Widex was the first company to come out with the digital hearing aid in 1996.

Like I said, it's the computer chip that does the sound processing. When the sound comes into the microphone, they become an analog signal. But now, we have to change it into a digital sound. We do that with an analog to digital converter. At the other end, we have to take that digital signal and turn it back into an analog signal. We have an analog to digital converter at one end and a digital to analog converter at the other.

We have some steps that I've mapped out here. We're trying to approximate the analog signal. We don't have enough steps to do prefect mapping from analog to digital. Widex is doing a little better job than other companies at these steps, but ideally we would have an infinite number of steps.

What we have to deal with is the front end of the hearing aid. I'll come back to that in a second. Music has been a tricky subject for hearing aids. This is what drives the development of hearing aids. Music and speech are very different. Music is a different signal.

The 3 big differences are that music is louder than speech. I can yell at the top of my lungs and it won't be as loud as music. Music has a wider range. We have handled that dynamic range of music differently than that of speech.

Music has a wider frequency range than speech. The signal is different. We've spent a lot of time with digital hearing aids, focusing on speech. We spend a lot of time and development about what is speech and what is noise. All of that processing we do for speech can have a negative effect on music.

This gives you an idea of the absolute loudness. We have speech on the left hand side and music on the right hand side. Soft speech comes at about 55 dB. Soft music, 65 dB. I'm talking about conversational speech, about 70 dB. That would be medium speech. Medium music is 80. If I yell as loud as possible, I might hit 85 dB. At a nightclub, three feet from the speaker is about 100. Then it goes up to 110 and higher.

Speaker: What about the orchestra? What's the decibel level?

Steven: It depends on what is around you. It could be way up there. We'll talk about noise and hearing loss in a moment. The question is: where am I as musician in an orchestra?  Let's look at the range of musical instruments. A cymbal is 45-110. That's a 60 db range. How is a hearing aid designed to handle 30 going to handle that?

When my daughter picked a flute as her musical instrument in grade 8, we thought it would be quiet. It is not quiet! We could hear her on the deck when she was in the basement. Flute is easy to carry but not quiet. It goes up to 111! We have a wide range of sounds for music that are different from speech.

This shows frequency on the x axis. 20 dB on the x axis goes up to 20,000. On the y axis, we have the intensity level, from soft all the way up. The black area is hearing for a human being. The bottom is the softest sound. The top is the loudest sound. Above that is painful for us. We don't want to hit that threshold of pain.

We plotted this area in yellow, which is important for language. This is the speech area. Look how small it is! No wonder hearing aids designed for speech don't do so well! Look at the frequency range. Language may be 100 hertz up to 5000. Music goes from 70 hertz all the way up to 15,000. That's a wide range of frequencies and pitch.

These are the issues - intensity and frequency range - that lead to poor sound quality. Most hearing aid companies can turn off advanced features. This way we know they're not going to affect music in the hearing aid.

There are a couple of things that you can't turn off that could have an effect. When it comes to speech, we want to enhance speech, and turn down noise - like a steady hum or a crinkly plastic bag - and some hearing aids can be adjusted to focus better on speech in front of us, behind, to the right or left.

All of these features can have a negative effect. Let's shift gears and talk about the hearing loss most musicians have. Most have a noise-induced hearing loss, because they've been around loud noise for a long time.

Somebody who has been working in a factory without noise protection has a noise induced hearing loss. You don't hear the high frequencies as loud as you used to. Low frequencies can be good at the start, but if you don't use protection and if age kicks in, you get a mix of age and noise induced hearing loss. That affects low and high frequencies.

From a musician's perspective, the loudness, pitch and timber are part of the problem. The loudness problem is something any other person runs into. It's trouble hearing the "t's" and "sh"'s. These give meaning. From a musician's perspective, it's a judgment of balance.

You have a signal that is a low and high frequency. If your hearing is affected, you're not getting as much of the range. It's hard for you to judge how loud you're playing. If you're playing as part of a group, it's hard to judge how loud you're playing and how loud the group plays in comparison to each other. Those are important to a musician.

Pitch changes are important for understanding melody. This gets distorted with hearing loss. You need larger and larger differences in pitch to tell that there's actually a difference there. The best example I've come across is Pete Townshend of The Who. When he plays a C compared to a C sharp, he sometimes hears them as the same. His pitch perception is distorted. No wonder he pulled back for years and stopped doing live shows! As a musician, it's devastating to not know if you're playing the right note or not.

Timber. Timber is the color of sound. It gives each musical instrument its unique sound. Timber tells us a guitar is a guitar and violin is a violin. Imagine that if you had a timber problem, a guitar and violin sounded exactly the same. If you look at the spectrum of the sound, this is the same note on a guitar and violin. Visually, it looks different. Auditorily, some people will hear this as the same note, the same instrument. The processing in the brain causes the problems.

Hearing aids and music. I talked about the speech understanding being a key thing without respect to the design of hearing aids. If we go back to the early 1990s, when some hearing aid companies were trying to come up with the first digital hearing aid on the market. We based the first digital hearing aid with a 90 dB hearing range, which we took from compact disks.

A musician will know that a compact disk and live music sound different. For lay people, we might not notice. This problem with music goes back a long time, to the early 1990s. We said, 96 dB, where do we put the ceiling of the hearing aid? We want it to handle speech and didn't care about anything above. We put a ceiling of 92 dB, which the hearing aid couldn't handle. It doesn't matter for speech, but does for everything else.

Up until 2015, every hearing aid on the market handled a 96 dB range. We moved that range up and down, depending on the company. We handled sounds close to the top of the range differently depending on the company. Hearing aids were unable to handle the loudness, high frequency range and different signal of music. The advanced features couldn't handle music.

In 2002, Widex launched the first digital hearing aid with a music program. We realized musicians didn't like our hearing aids because of the advanced features. It's like a separate channel with everything turned off. You had to manually change the hearing aid to a music setting, but it was the same. It was better than nothing, but nowhere near where we are now.

In the early 2000s, Widex wanted to know why people who are hearing impaired aren’t doing as well as we'd like in noisy situations. Can we do something for these people that is going to be of benefit to musicians as well?

I'm going back in my presentation for a second. I didn't talk too much about the pictures on the side of our little intensity meter. Soft sounds at the bottom, loud sounds at the top. We looked at where people wear hearing aids. What we found was that people wear hearing aids in a lot of noisy places. They want to wear their hearing aids in a lot of noisy places, or they have difficulty hearing in noisy places. Restaurants, live events, music, etc.

We wanted to see what the hearing aid was doing in these loud places. Yesterday, when I landed, construction at the Empress was tapering off but I heard a lot of sounds. If I was talking with somebody, some of the sounds were louder than conversational speech. If I had difficulty hearing, so would someone with hearing aids or hearing loss. We wanted to figure out how to handle these loud sounds and still allow people to hear speech and give music its due.

If you can handle music, you can handle speech. If we design a hearing aid that can handle music, we can handle speech without a problem. We talked about the hearing aid having a limit of the loudest sound. The limit of the hearing aids on the market now is between 90-160 dsbl. The loudest sound they can handle - before distortion, compression, etc. - is 106-92 dsbl. Think about the musical instruments. They're above 92, 100, 106.

Widex had 103 until recently. What we did was re-design our analog to digital converter to handle 113 dsbl. The first was the Widex Dream in 2013, 96 dB dynamic range. It can handle 113 in its ceiling. The softest sound is 76 dB. Still a 96 dynamic range. We re-designed it. Our new design, Unique, pushes the floor down to hear the soft sounds. The range is 108 dB, which is the widest on the market.

This is still a challenge we have: if a sound exceeds the ceiling of a hearing aid, the hearing aid has to handle it someway. It's either going to clip the sound or compress it, and you're going to lose information.

There's a ceiling and a floor to every sound. This is an idealized sound wave of conversational speech. The hearing aid has a ceiling and floor. This signal is far away from the ceiling and the floor. This hearing aid can handle the signal without a problem. What if I put music through? The hearing aid is going to clip the signal. You get distortion in the hearing aid.

When you put distortion into a hearing aid, the hearing aid can't get rid of the distortion. Garbage in, garbage out. I heard this in grade 8 about computers. If you distort the signal coming in, the computer can't fix it. This is what we mean by compression.

With compression, it looks like what was going in but it's not the same. To a musician, they can tell that the sounds are different. You're handling the fact that the hearing aid is not handling loud sounds well, but it's unnatural. It's better than clipping but still not good.

Both of these solutions to dealing with a poorly designed analog to digital converter aren't good. Widex re-designed the analog to digital converter to prevent clipping from occurring. We never use compression to handle input ranges. We push the ceiling up.

This is a nice sound sample that gives you a visual and auditory analogy of what we're trying to do. This is a video we released in 2013 with the Dream hearing aids. It's cool. I'll play it twice: once with voice over from me and once so you can hear it.

[Video.] [Music playing.]

What we have in this video is a demonstration of input hearing. What we have is a tube. This little ball represents the world of sound. We're going to put a compression hearing aid in this tube. The ball is going to go up until it hits the ceiling. When it does that, it doesn't sound very good.

Let's look at clipping. Same tube, same intensity, and same ball. Those blades represent clipping. Here comes our sound! Clipping. We're cutting the sound off. Still poor sound quality. With Widex, we don't have that clipping problem. Same ball, but we go way beyond our competitors, up to 113.

We can handle louder sounds, that's not the problem. The problem is the clipping issue. So we are the best on the market for loud sounds. Let's look at this without me talking over it so you can appreciate the sound.

Steven:  There's our compression ceiling. Doesn't sound good. Doesn't look good! Our clipping.

[Music playing.]

Steven:  Then Widex. If I designed this, I would've put the fan up to 113, just so you could see it, but –

Then they catch it. I actually got to see that tube and equipment!

Let's go back to the slide about loud music verses loud speech. If you're between 92 - 106, it's these sounds here that you won't hear well. You can hear speech well but not music well.

What about using that range of the musical instruments? You're really only catching one third of a flute. Saxophone? You're missing some. With Widex, you're going to catch all of them. It's the best ceiling out there.

Let's look at the frequency range. This is an interesting area to handle. We've talked about the frequency range of music and language being different. Hearing aids typically start at 300 hertz and go up to 60 000.

This is pretty good for speech and language but not good for music. With Widex - and you're using the hearing aid in its fully automatic setting - you're actually going to 125 hertz up to 11 000 hertz.

We still have that music program that we talked about from 2002. We only use it for one thing. We use it now for those people who really need to hear the low frequencies. It's for the musicians or the physicians who need to hear a heartbeat or breathing. They need to hear much lower than language.

In our music program, we turned everything lower but put things down to 70 hertz. So, for the advanced processing features, the issue is that music can be mistaken for noise or feedback.

If you have a music program that can turn off those features, the issue is that it’s manually used. When you go to the music program you may have feedback occurring. What we do with our latest hearing aids is created an automatic music detection program. You don't have to touch the hearing aid anymore if you're just listening or playing music.

We have a feedback cancelling setting. Basically what it tells the hearing aid is that if what is coming into the hearing aid could be music, it won't cancel it.

Musicians and music lovers: you have unique needs. You have needs that the hearing aid industry has not been paying a lot of attention to. When I graduated from university, they didn't touch music. It was all about speech.

I joined Widex in 2000. There's a clinic in Toronto called the Musician's Clinic. I was a sales rep at the time, and someone was always asking me questions about how the hearing aids could handle music. I didn't know what to tell him but I wanted to find out.

If you Google hearing aids and music you will find a study that we did. If you give a musician a Widex and a non-Widex hearing aid, that will pick a Widex one. We have a ways to go, but we're doing well. We still have a speech focus, but we're trying to move away from it. The speech-focused research is more funded.

Both have a 113 ceiling. The Unique hearing aids are actually smarter. They can turn things off automatically. We still have a music program there, because when pushing that lower level of the hearing aid; we keep that there.

The best in understanding in quiet, noise, and music listening. It's the closest you'll come to natural sound hearing. When I first become an audiologist and I listened to hearing aids, it didn't want to do it. I can actually put on a Unique hearing aid and totally forget about it.

That brings me to the end of my talk, and I want to thank you all for listening to me talk for the last half hour. Widex is a manufacturer of hearing aids. If you have questions about music and how we handle it, you can certainly ask them. If you have questions about what is the right hearing aid for you, and what style, you should really visit the staff from Oak Bay and Broadmead. They are one of Widex's recommended clinics. The recommended ones - Broadmead and Oak Bay - are great.

Speaker: You mentioned about us exceeding the ceiling - wouldn't that be dangerous?

Steven:  You asked, “If the ceiling has been raised - if the ceiling is too high - isn't there a danger to our hearing loss?”

What I've talked about is where sounds come in. It's in the back - where we handle the output - is where we handle what you're talking about. I talk with my hands - I have some French in me!

We have the front end and the back end of the hearing aid. The output of the hearing aid isn't the problem with music, it's the input. But the output: when a hearing aid is prescribed for a person we take into account what the person needs. The output shouldn't be more than the input.  We don’t want to make the hearing loss worse.

This is one of the factors that we use in selecting a hearing aid. It's a concern but it's one we know a lot about and one we take into account.

The question is whether or not there's is downside to having the frequency widened. We want to make sure we don't widen the frequency when it's too low. That's a judgement call we made. We can move the low and high frequency range. We try to be as broad as we can, but we can narrow it from a speech perspective. There's a potential for one affecting the other.

Widex actually amplified soft sounds more than any other manufacturer. We believe that soft speech and distant speech is important. We don't just concentrate on conversational and above. We concentrate on whispers. It's a downside, but we could roll that back and be like everybody else.

Speaker: For people who can detect music, how quick can they switch and detect music?

Steven:  1.5 milliseconds.

Speaker: You mentioned somebody from The Who whose C would become a C sharp.  Is it possible with the computer program to analyze if the person's hearing is that distorted so they can fix it?

Steven:  Can we test for it? That would be a hard one. Even if we could, there's nothing we can do to bring it back yet. That's a hallmark for those with a pitch perception problem. Good question!

Speaker:  There is work around that using a digital tuner. For example, on my harp, my digital tuner will tell me where I should be.

Speaker:  With relation to sensitivity, is there a feature to dampen the sound?

Steven: I would say we should deal with hyperacusis, then tinnitus, and then deal with frequency later. Finally, we move onto appropriate amplification.

Speaker: I noticed while listening to music in my home, at one point I get like a squeal. It seems like a high note above where it should be. I noticed just this weekend that the in live music situation the same thing happened. So it's not a digital problem. Is this feedback?

Steven: Do you wear hearing aids?

Erin: What you have is entrainment. We can work together to make that better. I'm going to thank Steven for coming all the way from Ontario. It's such an honour to have you here.


We have a new receptionist at the clinic who uses these hearing aids and was talking about how nice it was to hear the rain and all the soft sounds.

The next talk is by Lia, who's talking about communication strategies for people with hearing loss.

[End presentation.]

Talk 3

Lia Best

Erin:   Hi, welcome to our next talk.  It's called, "what does it mean to have hearing loss?"  I'm introducing our speaker, Lia Best.  She is an audiologist in our Broadmead clinic.  This is a good talk for people who have spouses here to learn about hearing loss and to live with someone with hearing loss.  Let's welcome Lia. 


Lia:   Before I talk, I'm using a lapel microphone.  Can everyone hear me at a comfortable volume?  We also have captioning going on if this is your first talk.  I also wanted to mention that if you miss anything, the talks will be posted on our website in a couple of days.  You don't have to take notes. 

I'm talking about what it means to have hearing loss.  Many of you are dealing with hearing loss or you're the significant other or friend of somebody with hearing loss.  This talk is geared towards both of you.  Really, it's about understanding what it's like for somebody with hearing loss when they're communicating.  It's not just about hearing.  There are a lot of processes happening that we're going to cover. 

We're going to zoom into these topics.  This is the outline of the talk.  We're going talk about hearing loss and what it is.  We'll talk about the implications it has for communication, strategies that enhance communication, and the effects hearing loss can have on your body.  We'll have time for questions, and you can always email me after. 

Before we talk about what it means to lose hearing, I wanted to show you two really short videos.  They are two situations where somebody is hearing something for the first time.  Many of us were born being able to hear, and we don't remember what it's like to have sound for the first time.  It can mean something different for everyone. 

The first video is of a four year old girl named Kai.  She is hearing her own voice for the first time. 

[On screen.]  [Video.] 

Lia: Sorry, hold on a second!  That audio should be louder.  Can anyone hear that?  That's not good!  I tested it earlier. 

Speaker:   It looks like it's off on the screen down there. 

Lia:   No, it's on.  I will get someone to fix that.  I want to show you these videos because they're very cute.  We'll look at them after. 

[On screen.]  Types of hearing loss. 

We're going to talk about hearing loss.  There are three main types.  The first, the most common, is sensorineural hearing loss.  This is a problem in your inner ear, auditory nerve or the brain.  This is a permanent type of hearing loss.  There is no medication or surgery to improve this.  The best treatment for these patients is a hearing aid. 

Conductive hearing loss is pathology of the outer or middle ear.  This can be temporary or fluctuating.  It could be treated with medication or surgery.  If permanent, we go ahead with a hearing aid.

There's also mixed hearing loss, which can be a combination of these two. 

When you come in for a test, we're like detectives trying to figure out where the problem is and what the best course of action is. 

[On screen.]  Diagram. 

This is where we record your hearing levels.  Some of you have had tests in the past.  On the graph, you see x's and o's.  You see frequencies from low to high pitch.  We need to plot where you hear on this chart so we can get idea of what speech sounds you are and are not hearing. 

The bottom is from quiet to loud.  The line on the page is the cut off for normal hearing.  There isn't such a thing as normal for any age.  There's normal or not normal hearing, from mild, moderate, severe to profound.  Anything below the thick line is what a normal person can hear.  They can hear anything in the green area and louder. 

With mild hearing loss, we lose some speech sounds we should hear.  There's still a lot of speech, but we're missing "k" "f" and "s."  That can be challenging.  You're going to have to wait until you've heard a whole sentence or word to fill in the missing sound.  This is where things become problematic. 

At a moderate hearing loss, you've cut off all speech sounds.  To hear speech at an average level, it has to be louder.  Not everyone has hearing loss across the graph.  Sometimes it's sloping, upward sloping, or looks like it has a bite taken out of it.

Not all loss is the same.  It is unique to everyone.  There are similarities in the problems you have, but you can't look at someone and know what problems they're having.  There are different situations. 

As you go down to moderately severe to profound, in the moderately severe category, most of these patients are going to be wearing hearing aids.  At a profound level, sometimes a hearing aid isn't an option and you look at a cochlea implant. 

We'll move on to talking about hearing aids.  They're part of the reason you're here.  Either you have hearing aids, you want to, or you have a partner who wants to hear.  Hearing aids are essentially computers programmed for hearing loss by your audiologist. 

Going back to the graph, we take the plot of the hearing loss graph, put it into a program and calculate how much sound we should send in to a person's ear to get it as close to normal as possible.  They're designed to make speech as clear as possible.  It's not as simple as turning things up.

As many of you know, with hearing aids, they can make a big improvement to hearing and communication, but there are still things you can't do, or that you're not hearing with your hearing aids. 

The reason for that is that we don't hear with our ears.  We hear with our brains.  You might have learned about that today from earlier talks.  That's the focus of a lot of new technology.  It's not what the device can do, but how well it can complement what your brain is already doing.  We use brains to integrate information from what we're seeing. 

We might not realize we're doing speech reading, but we're doing that without knowing it.  We use our brains to separate noise from background noise.  If we hear a sound in our right ear, that tells our brain the sound is on the right side.

If we have asymmetrical hearing loss, you might not know where the sound is coming from.  We use memory and other senses to make sense of what we're hearing.   

What does this mean for communication?  There's going to be several things that will either help or hinder the hearing aid.  Even if you're not wearing hearing aids but dealing with hearing loss, these are going to make a big difference. 

[On screen.]  Quote. 

I hear this quote very often.  If my husband speaks to me from another room in the house, I don't understand what he's saying even if I'm in the house.  Why is that?  The higher frequencies in speech are the most crucial for us as English speakers.  These high frequencies are the consonant sounds and they don't travel well.  They get absorbed by carpet and bounce off of things.  They can't travel around walls. 

If you're out walking and you hear the bass of a car stereo, all you hear is the pounding bass and not the lyrics.  The reason for that is that the person the car is hearing all the components of the sound, but all the high frequencies are staying in the car.  The bass can travel wherever it wants.  These are long wave lengths.  We care more about the high frequency sounds. 

If you're listening to someone talking from a different part of the room, there are many obstacles the sounds have to pass to get to the hearing aid.  The hearing aid can't do anything with a sound it can't pick up.

If you're in the same room and face to face, it's a lot easier.  Being close together means the sounds go right into the hearing aid microphone.  This has to do with the physics of sound.  There's no technology to make that better. 

When you're close to your partner, you have visual cues and they can't ignore you.  The optimal distance is about 1-2 metres.  You've probably noticed that if you have hearing aids or if you're dealing with hearing loss.  If someone you're listening to is facing another way, you don't hear the actual clarity.  You have to ask them to repeat. 

Distance is important.  When people think about communicating with someone with hearing loss, you think that if you yell, they'll hear you.  That doesn't help at all.  Volume isn't as important as you think.

Proximity is more important.  Clear speech that is precise and accurate gives the reader time to catch up and understand what you're saying. 

Because of the distance factor, if you are close together you won't have to raise your voice.  I work with people who have hearing loss, and I rarely have to yell.   If I'm face to face, they can hear me. 

When you raise your voice, we feel angry even when we're not. 

Even if we're not angry, when we yell our blood pressure rises and it send messages to your body telling it that you're upset.  It makes us unhappy or frustrated, even when we don't think we are.  That will cause tension in a relationship. 

When you're raising your voice you also look mad.  It's not as effective as you think it is.  It's better to be close together. 

The other important thing is making sure you maintain a steady volume.  Somebody might trail off, which is very frustrating for somebody with hearing loss because they often hold the whole sentence in memory.  If you trail off, they may get lost. 

I'm going to come out of here for just a sec, because the cool thing about this presentation is being able to come in and out when you want. 

Just as a refresher, this is Kai who hasn't heard her voice before. 

[Transcriber's Summary:

Speaker: can you hear me talking?  You can hear me clearly?  You can hear what I'm saying? 

Kai: It's so funny!  I can hear my voice! 

Father: so you can hear your voice?  You can hear me real well? 

Kai: yeah!  ]

Lia:  That's pretty cute.  This video is a bit more emotional.  This is a 29 year old girl who was born deaf and was fitted with the cochlear implant.  She can speak English but this is the first time she's heard what that sounds like. 

[Transcriber's Summary:  [Sniffing.] 

Woman: Now technically your device is on.  Can you tell?  It's exciting!  You can put it down for a second and get used to the sound.  What does it sound like? 


Woman: can you hear me?  Does your voice sound loud? 

Woman: Not really [laughs.]  ]

Lia: So these are two different perspectives.  We often hear about hearing as something you lose, but for some people it's something they gain over time. 

Where was I?  Let's go here.  We talked about distance and volume.  I want to talk about context.  Let's zoom in. 

I made this slide to show what's happening in the brain for somebody with hearing loss. 

You can't always provide context, so it's not always a communication strategy, but it's still important to know about. 

So the person with hearing loss may hear "at" instead of "hat."  So the person with hearing loss has a lot of context to use.  So it sounds like hat, and it goes on your head.  These are all things the person is thinking about whether or not they realize it or not.  That's why it might take a bit longer for them to respond. 

The sad little guy over there [on screen] is somebody who doesn't really have anything to work with.  All they heard was "can you hand me my ___?" 

They don't have much to work off of so they'll ask.  That person is trying, but they don't have enough to work with to figure it out. 

We're going to talk about signal to noise ratio.  Background noise is a challenge for people with and even without hearing loss. 

Hearing aids can help a little bit with signal to noise ratio.  They have directional microphones, but as some of you know, it's not always as clear cut as that.  It's not about isolating one thing and blocking out everything else.  Some sounds will still come through. 

The best way to help with this is to use a microphone of some kind to enhance the ratio.  The signal would be my voice but if we were to put on music or something my voice would be louder because of the microphone I'm wearing. 

So every hearing aid has some ability to do this.  Sometimes I explain this to people and they say that they don't want to make people wear a microphone.  I can tell you that it makes such a big difference.  If you are a partner of somebody with hearing loss and you think of all of the effort it is to repeat yourself, or that you go to events as your partner's extra set of ears. A remote microphone takes some of that effort off of you and it also helps your partner.  It's also pretty small and many people wouldn't notice that I'm wearing it. 

Attention is probably the most important thing.  When you have normal hearing, hearing is passive; you can watch a show and somebody can ask you what you want for dinner and then you can answer.  When you have hearing loss, you're expending way more energy listening.  You have to listen to the whole sentence, you have to filter out the noise, you have to deal with the fact that people aren't interacting face to face.  This will impact something called "cognitive load." 

Our brain can do a lot but hearing loss takes a lot of those resources away.  We have to concentrate and be focused 100% of the time, and it's exhausting.  If you feel tired after an event like this, it makes sense.  You are working way harder than somebody with normal hearing. 

When somebody with hearing loss is reading a book or something, they're essentially resting.  If you come in the room and ask them something, they may ask what you said.  It's not that they're not listening; it's the fact that they're resting.

It would be great if you first got their attention and then let them know what you need.  This can relieve a lot of frustration.  If you think about how much work somebody with hearing loss is doing with listening, they're going to need a break and they may not be ready for what you want to say.  So what happens - this is probably familiar to a lot of people - is a communication break down.  You say something and the person with hearing loss says "what?" and you say "never mind." 

The first problem is that the person with hearing loss just said "what?"  The person speaking doesn't know what they didn't catch.  There sometimes isn't enough information to say just "what". The person speaking then thinks that what they said isn't that important. Then the person with a hearing loss wants to know what was said.  It's frustrating for both people.  When you are communicating with somebody with hearing loss you have to think about that.  Ask yourself if you want to say it more than once. 

The other thing that's useful is repair strategies.  Instead of saying "what?" you could say "I heard you when you said this, but I missed this part."  This saves people a bit of energy.  Those are called repair strategies.  They either prevent it or help you get out of it. 

There are three main types of communication styles.  People with hearing loss can fall into these quite easily.  The passive communication style is the person that feels like they don't want people to know they're struggling and they'll pretend they heard.  They don't want to make people feel bad for missing out on communication.

Sometimes if you ask somebody to repeat and you miss it a second time, you might just decide to let it go and miss what they said.  Instead of saying what, you could say, "I didn't catch that.  Could you say that a different way?" It's not great because you might socially withdraw.  You may not want extra help, or to ask for it.  So you may stay home from social events.  We don't want that.  We want people to be able to to socialize. 

The aggressive communication style is when somebody is afraid of not hearing something so they dominate the conversation.  They always have a story and are always talking.  If they don't know where the conversation is going, they might not hear something.  If they're in control, then that's their comfort zone. 

That's not great because people who want to talk to you might not feel like they can get a word in.  They might not get to say anything.  The assertive communication style is a good mix of both.  You advocate for what you need. 

If you miss something someone says or you know it will be challenging, feel confident to say, "I can't hear you, can we talk outside?"  I do that with people sometimes.  We could go around the corner and be away from the noise.  That can make a big difference.

You want to make sure you know what's going to make things harder for you.  If it's a dimly lit room or you know someone who covers their mouth, you might want to explain why that's a challenge.  People will forget but they won't be offended by you explaining what you need.  They're your friend for a reason and won't be offended if you tell them what you need. 

It's good to have that power and say “I have a hearing loss but I can still participate if you do this”.  It's a teamwork thing. 

We're coming to the end here.  This is the effects of hearing loss on the body.  Hearing loss can have a number of different side effects.  The biggest is fatigue, from the extra work for trying to hear.  The other is muscle strength.  If you talk with someone with hearing loss, they often lean in.  Getting closer means they will see or hear better, but that's not a natural way to sit.  You put a lot of strain on your back or neck.  If you have one ear better than the other, you might say, "talk into my good ear" but if you're doing that all the time, it could cause problems for your neck. 

You might have seen our blog post about the increased risk of falls for people with hearing loss.  They're doing research on this because falls can be so detrimental.  It could be a benign fall but someone could break their hip, and then have other issues.

When you can't hear well, you have to try harder to hear.  You're using some of the resources you would normally use for balance and spatial awareness.  If you're straining to hear someone, all your resources are on that.  You might not be fully aware of what is around you.  If you can't hear your footsteps, you lose a sense to tell if your feet are on solid ground.  Even if we're not aware of it, our bodies are using that information.  Hearing aids can help with that. 

This gets into the social aspect.  If you have to repeat yourself, as the partner, or ask someone to repeat as the person with hearing loss, that puts a strain on relationships.  It might make you frustrated and irritable.

The other component tied into that is anxiety and depression.  If you don't feel confident being out because you might miss something, you might not want to go out and do those things we get enjoyment from.  That can be linked to depression. 

The final comment is about memory.  There's a link between hearing loss and memory.  Because of that extra load on our cognition, all the extra stuff we do to hear leaves extra resources for memory.

If you think about the person with hearing loss holding the information in their working memory, they're always going to be one step behind the conversation because they're waiting to hear the whole sentence. Some points might be left out so they can catch up.  You might feel like, "I told you this, so why don't you remember it?" but it might be because their memory is working overload on something else. 

These are some tips that summarize what we're talking about.  As the person with hearing loss, you need to understand what you need to hear better and advocate for that so the people around you know what to do.

If you are hearing, you want to let people know you've picked up some things.  If they look confused, repeat the last part.  You could say, "I missed that part" and it saves some time and effort. Communication goes both ways.  If you're speaking to someone with hearing loss, there are things you can do.

Having attention of the person before you talk is number one.  Number 2 is making sure you have good visual contact with each other.  Try not to trail off and to pause between sentences.  Don't slow your speech down but leave time for the person to catch up. 

Try to avoid communication breakdowns.  Instead of saying, "never mind," try to rephrase so you can have a good conversation.  That was it! 


Any questions? 

Speaker:   I'm frequently in a situation where there's a presentation to a large group, and then we go into small groups for discussion.  The challenge is to try to get people to understand that they need to keep their voices quiet.  When I was a primary teacher, I used to tell my students they needed a 30 centimetre voice when they speak with someone.  It works for a while, but then people forget.  I'm wondering if you have other tactful phrases. 

Lia:   She's asking if when you're in a presentation with a small break out and everyone is talking, sometimes you can tell people to keep their voices down but it will come back up. 

I think it would come down to the person organizing it.  If they have the authority of the room and they notice the volume getting high, they can bring it back down.  If someone with hearing loss feels comfortable saying, "it would help me if we could speak one at a time or go to a different room" if that's an option. 

Speaker:   You said this would be on the website? 


Erin:   Shout out to the captionists, you're doing a really good job! 


We're going to get transcripts from all four talks and they'll be online. 

Speaker:   Will the PowerPoint be online? 

Erin:   The transcripts but not the PowerPoint. 

Speaker:   The PowerPoints are great! 

Speaker:   Did you have another video? 

Lia:   I did.  Do you want to watch it?  It's short. 

Speaker:   Would you consider making a video about this talk so we could take it to the husbands who refuse to come? 

[Audience laughing.]

Lia:   Yes, that's a great idea.  We had a question about the video I didn't play.  This is the video - this is the Flintstones.  You see the audiogram getting worse.  You're listening to it through the feeling of somebody with hearing loss.  If you don't have hearing loss, this will give you a sense of what that's like. 

[Transcriber's Summary: 

Fred counting.  "You owe me 300 bucks!  Wilma, I'm a tycoon, I play to win." 

[Sound decreasing, getting fuzzy.  Words are indistinct.] 

Speaker:   Please put that on your website! 

Speaker:   I want to say that I think the biggest part that develops between two people with hearing loss and without is the frustration.  Frustration for the person speaking, because the person has to repeat all the time, and it's just as frustrating for the person who can't hear.  I think that's the biggest frustration for both parties. 

Lia:   That was why I created the talk.  Often significant others come in, which is great, but often we just work with the person with hearing loss.  They say that people don't understand it's frustrating for them.  Hearing aids are helpful but there are some communication strategies that can make a huge difference. 

Erin:   Thanks for coming out.  The next talk is about tinnitus.  It'll start in five or ten minutes. 


[End of presentation.] 


Talk 4

Aisling Smyth, Presented by Erin Wright and Lia Best.

Erin:   Thank you for coming to our talk.  I'm Dr. Erin Wright.  The outline said this talk would be done by Aisling Smyth, an audiologist at Broadmead, but Lia and I are going to give this talk today.  We're going to do a teamwork form to talk about mindfulness-based tinnitus reduction

Lia: I just want to make sure you can hear me.  We'll be talking about what is tinnitus, strategies to manage it, and how to use mindfulness to manage our tinnitus.  We will have time for questions at the end. 

So, what is tinnitus?  Many of you are here because you experience it or know somebody who does.  It's a sound that can't be attributed to the environment.  Sometimes it's humming, crackling, or motor running sounds. 

1% of people will report that tinnitus is bothersome and .5% will report that it will significantly affect their quality of life.  So some people may be on this end of the spectrum where they notice it but it's not impacting their life too much. 

On the other end of the spectrum it could really affect your life, and create a lot of anxiety and frustration.  We're going to be talking about that difference. 

We know that tinnitus increases with age.  Hearing loss also does, and these two things can go hand in hand.  A small percentage of people actually go to see a doctor about tinnitus.  A doctor may have told them that they just need to deal with it.  So we're going to talk about how to deal with it today. 

We know that it's associated with noise exposure.  It can also be related to drugs and medication.  It can also be related to head or back injury, muscle issues, dental issues, and diet.  So where do we start? 

If you have tinnitus, and you haven't seen an audiologist it's a good idea to see one.  The audiologist will try to uncover what the cause is, and how much it's impacting you.  Through assessment we can get a clear picture of what's going on.  We can then come up with an individualized plan.  It plan may involve treatment and/or counseling. 

Treatment is often in the form of hearing aids along with sound therapy.  It involves making sure that you're hearing what you want and need to hear, but also other sounds to help you from being distracted by the tinnitus. 

One of the things that I've found to be helpful is informational counseling.  In the first appointment you uncover a lot of the unknowns about why this might be happening.  This can alleviate a lot of stress and anxiety. 

Mindfulness, which is what we'll talk about today, is a new way to look at tinnitus management. 

Erin: Oh this is my slide!  So what does this mean?  Mindfulness - there was a program developed by Jon Kabat-Zinn.  What it means is that trying to bring your thoughts to what you're doing. 

So I may be brushing my teeth but thinking about what I need to do that day.  Mindfulness is about making sure I'm thinking about brushing my teeth and being aware of what's happening in the moment.  So Jon Kabat-Zinn talks about how things originate in thought, and then behaviour follows. 

So we might come up in our mind something that is very anxiety provoking.  We may think that if we walk across a bridge the bridge will collapse.  So now I'm thinking about that and having anxiety even though I'm not even walking on the bridge. 

So in relation to tinnitus, the point is to come up with some thoughts and judgments about our own tinnitus.  One thing we talk about is curiosity.  What we mean by this, is looking at your tinnitus from an outside perspective.  Thinking about it instead of judging it; having one step removed from the tinnitus.

A client I saw a few years ago said that he felt that the tinnitus was coming from the fluorescent lights.  I look at him like I knew that wasn't true, but he was able to detach from the tinnitus in a way that helped him with his response. 

The curiosity part of it comes into play when the tinnitus is in a spike.  Some days people can manage it, but then there are moments where it's unbearable.  It's in those moments, when you can imagine you are a  beautiful dessert island - the tinnitus might be the storm.  You just have to endure the tinnitus and try to understand the concept of impermanence. 

It involves treating the tinnitus or your body in that moment with some kindness.  That comes to centering yourself with the tinnitus.

If you go to the massage therapist and they push on an area that really hurts, it's an active release.  Awareness is a little bit like that.  You can be in your mind and have the tinnitus storm and be thinking that you can't bear it.  You can do that.  Or, you can try to detach from it and realize it's not permanent. 

It's as though you have a baby who is crying.  You wouldn't go into the crib and shake or hit the baby.  You would hold the child and bring your awareness to the child and do what you can to settle it. 

You become aware of that spot in your body that has the most anxiety or contraction with the tinnitus.  I can feel it right now because I'm public speaking. 

The awareness is the focused energy on that contracted spot.  You may take a few minutes to do some deep breathing exercises. 

Just imagine like you're listening to it; trying to not think about other things, but just having your awareness.  That's what I'm talking about, imagining you are the massage therapist who is going to actively release this knot.  Then you do what you can to bring the storm down to the beautiful island that will always exist there. 

The openness part of it is trying to remove your judgment from your tinnitus.  Meaning "Why do I have this?  No body else does."  And being open to the idea that there may be other ways, outside of medication, that can actually work to bring your tinnitus down. 

I'm talking about the people who rate their tinnitus 7/10 or higher.  When people say they have it they say it's intermittent or 2/10, they're doing a great job of handling it.  It's people who have 7/10 that show lasting results with this method. 

So Jon Kabat-Zinn is who created that whole program.  The idea is that we can't resist reality.  We suffer when we try to resist reality, and sometimes reality doesn't go with our preferences.  The only person who suffers when you resist reality is you.

The concept is of accepting it and having a sense that it is happening, and it's not your preference. The more you fight against it, the worse it becomes.  As audiologists, we try to figure out where people are in the cycle and break it up. 

It's different for everybody.  People have different thoughts about their tinnitus.  We have to figure out, as audiologists, where you are with your tinnitus and help you move into accepting the reality that it's there.  Some people take it from a 7 out of 10 or to a 5 out of 10.  You can do your daily things at 5 out of 10, but not when it gets higher. 

If we can take little steps with all these things, we can diffuse it and make it not so stuck.  Lia will talk about the stuckness.  That's part of the acceptance of it. 

Lia:   I'm going to talk about the tinnitus brain.  What happens when Erin mentioned the four categories is that there are things going on in the brain to make us feel anxiety, fear and frustration about tinnitus. 

There are three main parts to our brain: 

The reptilian part that is the autonomic functions like breathing.

The limbic system is developed after.  That's our fight or flight response.  It's a reflex, the part of our brain that makes a quick decision and reacts.  It labels something as safe or not.  If it detects a threat, it sends information up to the neocortex, which is the later developed part. 

The neocortex is where we do planning and higher cognitive processes, where we think and think about thinking.  It's what separates us from other animals.  We thought that the limbic system sent signals for fight or flight and that the neocortex just listened and did what it needed to.  In the context of the bridge, the limbic system says something is a threat and the neocortex says, we're going to stay here. 

Tinnitus sometimes means the limbic system is stuck in flight or fight.  We need to train the neocortex to say “this isn't something we need to be fearful of”.  It's stopping the negative firings from happening.  The limbic system is important because it keeps us alive.  When it deals with our tinnitus in a situation where it's spiking, it's stuck on.  We need to get it un-stuck. 

Erin:   I like the stuck-on thought because for people who manage their tinnitus, this is the difference compared to people who have difficulty managing it.  The limbic system is stuck on, in tension. 

We need to let the limbic system become adaptive to figure out what is or is not a threat.  The tinnitus is not our preference, but it's not a threat to our health.  I shouldn't say that, there are negative things associated with it.  Some people think there's something wrong, like a brain tumor.  It's not ideal, but you can help the limbic system to become adaptive. 

Lia:   With the limbic system in a state of fight or flight, you're not able to do the things we would do when relaxed.  It can affect digestion, sleep, focus etc. because your brain is concentrated on something it doesn't need to focus on. 

Erin:   I wanted to talk about creating new neural networks.  The analogy I have here is like you have a stimulus and a response.  The stimulus is the tinnitus and the response is how you always respond to it, however that may be.  Because it's been like that for a long time, it develops a strong pathway, like the autobahn.  The signal goes as fast as it can. 

We want to create a new neural network so the stimulus response happens a different way.  It's like a work out, an effort to go from here to here.  The more it travels, the easier it will be to take that direction.

You could say the same thing about weight loss or anger management.  Tinnitus is one example of how the trigger or stimulus and response are connected.  Can I imagine taking a different road, which involves a mindfulness approach? 

This is a slide about coming back to your breath in those moments where it feels like the tinnitus is peaking.  You can realize we have all we need to manage this.  We can do it.  There's proof in this audience that we can do that.

I see a few people I have worked with and who they were the first time I met them is much different from where they are now.  I know this works because I have seen it work hundreds of times. 

If we can figure out how it's different with each person and how to unravel the patterns they're in, we can use other techniques to manage that. 

Lia:   Lastly, I wanted to talk about Dr. Jennifer Gans.  She's a psychologist.  She developed an eight week program involved mindfulness tinnitus stress relief.  A lot of you are thinking, does this work and would it work for me?

Dr. Jennifer Gans studied this and had participants do her course.  They did pre-tests and post-tests.  After, everyone scored lower on stress and anxiety and reported that tinnitus was less bothersome. 

Does it last longer than the eight week course?  Dr. Jennifer Gans touched base with them a year later.  She had them do the same test.  Some of the scores were lower or the same.  A lot of them were still doing the mindfulness practices without the coaching.  They could apply it to other aspects of their life, not just tinnitus. 

Erin:   We have been saying that anxiety is the food for tinnitus.  When you are mindful, you're in the present moment.  When you're in the present moment, there's no room for anxiety, because anxiety is about predicting or worrying about the future.  Guilt is about the past.  If you're in the present moment, there's no anxiety. 

Public speaking is something people are fearful of.  If I'm in the present moment, there's nothing wrong.  Nobody is going to shoot me or throw a rock at me.  That's why mindfulness stress reduction works.  We know that being present in each moment leads less room for anxiety to have life.  I think that's part of the reason it works. 

If you're interested in this, Dr. Jennifer Gans has this eight week program.  You check in online.  There are classes you go to.  It's about a $450 program.  It's a resource available if you're interested in it. 

That's the conclusion of our presentation.  I'm glad you're all here.  Sometimes I see people individually and they feel alone, but I know from certain people that you're not alone.  You've got other people suffering with the same thing as well.  Any questions?  

Speaker:   Does the noise ever go away? 

Erin:   Has someone had tinnitus and had the noise go away?  No.  For some people, the shorter amount of time you have it, the more likely it is to go away.  If it's been a week, it'll probably go away.

Most people here have had it long-term.  We use the term "habituate."  Our brain habituates signals.  You might hear a train and think you're going to die the first time, but then your brain decides you can sleep through it the next night. 

With tinnitus, there's a fan going on with this monitor, but it hasn't interfered with my talk.  If I listen to it, I hear it.  That would be the goal with any successful program to habituate the tinnitus.  It's still present but has no trigger of anxiety. 

Speaker:   My second question - this happened to me 15 or 20 years ago.  I went to an audiologist.  He said to me, "I don't hear anything, you must be imagining it."  My question, as audiologists, are you able to hear that? 

Erin:   We're not able to hear it.  I think about it like pain.  If you tell me you have a headache, I can't prove it.  I trust that it's happening and I'm going to try to help.  We used to try to match the frequency of tinnitus but it wasn't giving us any information.  It gave information that was fun to know but didn't help to manage it. 

Speaker:   On one of the slides, you said that medication may be a cause?  If one stopped taking the medication, could it go away? 

Erin:   Yes, but with medications you have to weigh the risk.  Someone may offer one medication, but there's another medication that could be chosen for blood pressure lowering, for example, that doesn't have the side effect of tinnitus. 

Speaker:   Is there anywhere we can get more information about medication that causes tinnitus? 

Erin:   That's part of having an audiological assessment.  What is going on with you, what your hearing is like, what it could be, etc.  When there's normal hearing and tinnitus, it can be puzzling.  That's a place where we could figure out what's going on.  Maybe it's related to stress and anxiety.

I find that people will come in with normal hearing and tinnitus, and six months prior they had a seriously stressful event in their life.  It's that six month delay that makes it hard to put the things together.  That delay on-set tinnitus can be related a stressful event. 

Speaker:   I'm wondering about the 12 month follow up to the study.  Did the author comment on the importance of continuing the mindfulness practice? 

Lia:   He asked if she told them that they should be continuing to practice. 

Speaker:   Did those who practiced score higher on the follow up than those who didn't? 

Lia:   Good question.  I don't know.  I'm sure it's in there but I can't tell you. 

Erin:   I think that once people start practicing mindfulness, you start doing it in different situations.  It has a positive domino effect in your life.  People who start doing it continue doing it. 

Speaker:   I think it would be valuable to continue if it's working for someone. 

Speaker:   I had an experience with putting myself in relaxation to lower tinnitus and it did.  I find one thing that isn't addressed is a grief response to never having silence again.  That's the same with hearing loss.  There's grieving that goes on. 

Erin:   That comes into the acceptance part.  Maybe it's not dead silence but sound in your environment that's soothing.  You could put on ocean waves.  You could be in silence but have nature sounds.  It can still be there, with those quiet sounds.

That makes me think of something.  People think, I have tinnitus in my head, why would I add more sound?  That's a valid thought, but it's about habituation.  You might never have dead sound, but you could have a sound you don't notice so you can habituate.  It's not like a TV on all the time. 

Those are maskers, sound therapy, etc.  They're very quiet.  They're so quiet people can barely hear them.  You try to train the brain to habituate the sound and take the tinnitus down with it. 

Speaker:   I've been experiencing tinnitus for a couple of years off and on.  I remember that it started up last spring.  This spring, it started up again.  Often I'll be asleep - I could be dead to the world - but the tinnitus wakes me up and I can't get back to sleep. 

Erin:   That's pretty common.  In that moment, it's important to have something at your bedside table, or in your pillow, with some ambient noise.  It could be rain or anything you find pleasant.

When you're laying in bed, try to do some visualizations.  Where is the noise in your body?  Focus that breathing - perfect opportunity if you're in bed - and have some different visualizations that you're actively releasing the tinnitus.  That can lull you back to sleep, as opposed to getting up and fighting it. 

Speaker: I keep telling myself to go to sleep and it doesn't work.

Erin: Try not to do that.  Focus on where you feel it most outside of your body.  Do a whole body scan and if there's a place where it seems to be louder than others, all of the sudden focus all of your attention on that spot.  Instead of being in your mind telling yourself to go to sleep, you're now using awareness to release that pressure point. 

There are different visualizations you can do that. 

Speaker:  I don't feel it anywhere but my head. 

Erin:  Try it tonight.  Just like when we're nervous.  If I pulled a gun out and pointed it at you, there would be a physical sensation in you.  It's your fight or flight.  That's the place you're trying to get to; to locate that energetic spot and focus there. 

Speaker:  Is multi-tasking the opposite?  Because it's anxiety in your body somewhere? 

Erin: Often with multi-tasking you're doing one thing and your brain is doing something else.  You can't be mindful and multi-task at the same time.  In relation to tinnitus, it's about recognizing what's going on in your thoughts and realizing where you are in your mind.

I may be having negative self talk because our minds are our inner critic.  But where am I in my mind and what is my body doing?  Mindfulness means they're both doing the same thing. 

Speaker:  I'm part of the Buddhist community, and I recommend it.  Any Buddhist community will help with mindfulness practises.

Erin: I've tried to leave that component out of this talk a bit because people will say that they're not religious or that they're Christian, etc.  It really has nothing to do with religion. 

Speaker:  All I'm saying  is that people can go to your office for support or even other places in Victoria. 

Erin:  There's a doctor that works with Island Health who does a mindfulness program.  The guy who teaches it is um, I'm blanking on his name. 

Thich Nhat Hanh is the Buddhist guy who has written a hundred books. 

Speaker:  When you're in a quiet room with the lights off, there's some high pitch?  Is that normal? 

Erin: That's tinnitus. 

Speaker:  But most people say that. 

Erin:  Lots of people have tinnitus.  

Speaker:  Is says 28.5 million people in Canada have it.  That's about 75%. 

Erin: I'm not sure how much the numbers are, but a lot of people have it. 

Speaker:  It says 75%. 

Erin:  That might be a U.S. number. 

Speaker:  It's related to neck and muscle tensions. 

Erin:  Yes, acupuncture can help with that.  They can help with tinnitus if it's related to muscle injury.  Often after car accidents people get it.  It's also related to stress. 

Speaker:  Would you be able to assess that? 

Erin:  It would depend on your case history.  Thank you guys for coming! 


[End of lecture.]






Healthy Hearing Expo 2015

Erin:   Good morning.  Thank you for coming to the 6th annual Healthy Hearing Expo.  We have some good speakers today and some new information to share with you. 

Don't be afraid to ask the people behind the booths anything about hearing. 

I am Dr. Erin Wright.  I am the owner of the two hearing clinics and an audiologist. 

Here we have Ted who owns ALDS.  They have a selection of assisted living and technology products for different needs. 

Talk 1

Ted Clegg – ALDS

Ted:   Good morning. 

The suggestion was made:  If you can hear me, raise your hand.  Great. 

I'll start with the bad news.  You have to listen to me first.  I'm softening you up for everyone else.  My kids say I tell bad jokes, and talk loud and fast.  I will try to solve that.  These ladies to my left, if I talk too fast, they'll tell me to slow down. 

As Dr. Erin mentioned, I am with ALDS.  We specialize on products for the hearing and voice impaired. 

ALDS was founded by Charles Lazlo.  It's been under family ownership since 2008.  We do amplification products.  Our office is in Langley. 

We'll start at the beginning.  My father had undiagnosed hearing loss almost his whole life.  None of us knew.  As a child I learned to talk loud.  My family still complains that I do this! 

We didn't realize the reason was my father's undiagnosed hearing loss.  Research says 60% of people in the workforce and school have undiagnosed hearing loss.  One thing I'd like everyone to do is get their hearing checked. 

One day my father's friend said he should get his hearing checked.  He would say, "Yes," in situations when he should be saying, "No." 

He didn't do anything until he retired.  My father has failed at retirement 4 times!  He thought ALDS would be a nice retirement hobby.  My father said to me, "Ted, I need you to take over ALDS."  That's what we did. 

Male Speaker:   Could you repeat what ALDS stands for? 

Ted:   Assisted Listening Device Systems. 

ALDS are the terminology for our products.  ALDS are the hearing aids. 

Assisted is defined in the dictionary as helping.  Our products bridge the gap between hearing aids and other needs. 

ALDS are not a replacement for hearing aids.  They get you into hearing aids or assist when a small hearing aid is beyond us. 

There's a lot of reading here I won't do.  [On screen] This is from audiologist Mark Ross.  He basically says hearing aids are wonderful.  Who agrees?  10% of you? 

Assistive technologies come in when we're not wearing our hearing aids. 

As a kid, the dentist would ask if I'm brushing every day.  I'd say yes, and he'd know I wasn't.  The audiologist is the same.  "How are your hearing aids?"  "Good..."  We innately don't want to disappoint anyone.  We spend a lot of money so the hearing aids should work!

But when I get home, I take my hearing aids out.  I don't wear them in the shower, so I won't hear the smoke alarm. 

Or I could be away from home with my "hearing ears", my spouse or partner.  How do I hear the alarm clock or smoke alarm? 

Even at home, maybe you can't hear over the neighbors having a party or the stereo.  So we crank the volume on the TV and it drives our spouse crazy. 

Volume is not the problem.  Who thinks volume is just the problem?  It's not.  It doesn't necessarily help us hear better.  We need tone adjustment.  This is where a TV listening system comes in.  It helps us without driving others away. 

When we need hearing help or a notification for something important, we really need these things.  That's what I'm helping with. 

ALDS send signals or communications to people.  They do basic sound amplification, they can be a loop system, FM signals… [reading slide]  Let's cover each. 

Basic sound amplification takes the sounds around you, amplifies them, and puts them in your ears. 

A Pocketalker goes beyond hearing aids for sound amplification. 

Who knows what a loop system is?  Who has used one?  Half a dozen? 

I have a question.  Who has a T-coil activated in their hearing aid?  7 people. 

Male Speaker:   Can you tell by looking at them? 

Ted:   No.  To know if I can have a T-coil, I need to ask my audiologist. 

A T-coil is a tiny wire that assists you to listen on a hearing-compatible telephone.  It mutes external microphones. 

If this room had a loop in it, it is a wire that encircles the room.  Instead of listening me through the amplification system, the loop mutes external microphones and you hear the feed through the T-coil.  The advantage is that you don't hear the person next to you eating their popcorn. 

Male Speaker:   Is it automatic? 

Ted:   No, it has to be manual.  A loop system can be personal around your neck or around a room.  You have to manually turn it on.  Then it sounds like I'm talking right beside your head. 

VanCity banks now have a personal loop kiosk at almost every bank.  Tell them that when you go in and you can use the personal loop.  Now the teller doesn't have to raise their voice to tell you that you have no money!

You can set up a home theatre with a loop.  Some churches or houses of worship also have loop systems. 

Next are FM systems.  These are common for one-on-one communication. 

With RF systems you need two parts, a receiver and transmitter. 

FM systems are great for schools.  They help children hear the teacher. 

For FMs there is no limit to number of listeners.  They are common in public venues.  If you have a hearing aid, they help you receive more sound. 

Infrared is like a light beam that goes out.  They help for TV listening.  They're also used in court rooms.  The sound is secure in infrared.  It doesn't travel through walls. 

Bluetooth communication.  Many hearing aids now have this.  Many people have streamers that hang from the neck.  It picks up Bluetooth signals.  We can amplify telephones to send signals to the streamers. 

We can also have TV systems that go to the Bluetooth streamer so you can hear clearer.  Loudness isn't always the big problem, it's clarity. 

Another way we're notified is flashing lights, vibration, and extra loud alarms. 

[On screen.]  These are pictures of sensory notification.  This is a telephone rig signaller.  It makes your phone ring louder and can add a strobe light.  We need something to notify us of the phone at home. 

Next is a smoke alarm with a strobe light. 

[On screen.]  That disc is a bed shaker.  You put it under your mattress and if your phone rings or smoke alarm goes off, it shakes the bed. 

On my table I have a portable alarm that vibrates.  You can clip it to your pillow.  It's great for traveling. 

We also have extra loud alarm clocks.  They sound like a race car! 

So we have many products in the ALD family.  Answering machines are another one.  When people leave a message, they talk so quickly!  You play it 10 times and don't understand.  We all do that.  Since I entered this business, I've tried repeating my phone number and name when I leave a message.  I run out of tape because I'm so slow!

We have phones with built-in answering machines.  They are amplified.  I have one with 30 decibels of amplification and slow speech playback.  You can slow the message down. 

So we have amplified clocks, bed shakers, neck loops, voice amplifiers, etc. 

Pocketalkers.  My wife says I don't listen to her -- at least that's what I think she said!  We never hear the ones most important to us.  My kids say I never hear them.  When I answer, I call them by the wrong name anyway! 

Though I'm not a full-time hearing aid wearer yet, I think I have a few years to go, but my kids say I need it now. 

A Pocketalker is a unit by the ear.  We often use them in care homes.  It helps people hear when their family visits.  They're a great pre-hearing aid bridge product.  Once you re-experience sounds you've been missing such as birds, you'll know it's great. 

All of our phones are hearing aid compatible.  We have a lot of different models and there's definitely one to meet your needs.  There's tone and volume control, call display, amplified ringers, multiple handset options.  One of the big features is the tone control. 

All I need to know is what kind of telephone you need.  You can even get multiple handsets and have handsets all over your house.  Some have extra bright lights. 

VCO and TTY telephones.  CapTel service is not available in Canada.  It's a direct voice to text service.  When someone phones you, you answer and say, "Hello," and your screen will read, "Hello, it's Ted calling."  We need to call on our government to get that in place in Canada. 

What we've got here is either VCO or TTY service.  VCO is voice carry over.  If I'm profoundly deaf and I have family and friends calling me, they go through a VCO operator.  They connect the call and when I answer, the operator, probably overseas, will say, "Hello, it's Lia from Broadmead calling, would you like to take the call?" I say, "Can we make it Wednesday at 1?" 

A lot of people say that they don't like the operator hearing your call, but I say to them, "Okay, but this morning you posted on Facebook what you had for breakfast!" 

VCO phones are still available.  The other one is TTY.  It's for people who are profoundly deaf and who struggle to communicate.  Nowadays, we use a lot of text messaging. 

Male Speaker:   What does TTY stand for? 

Ted:   Teletype. 

Even when my wife and I go traveling, we take a television listening system with us.  We put the kids to bed and we don't want to wake them up so her and I just plug this device into the TV and we're good to go. 

You can get an infrared or FM or Bluetooth style.  You hear it in a volume that's nice for you.  The volume can stay at a good level for everyone else in the room. 

Alerting systems.  Whether it's a smoke alarm, telephone, doorbell, alarm clock ringing, they're all critical sounds, right? 

I was talking to a family that was thinking of starting a family, but they were scared they wouldn't hear the baby crying.  We have alert systems to hear all those critical sounds. 

We always leave our hearing aids in, right?  No.  Whether we need to hear the telephone or the oven timer or the baby crying, I can design an alerting system to help. 

We even have systems that go from person to person as a form of notification.  If you have two people living in a house and one or both has hearing loss, we can create an alerting system using strobe or a light or a vibrating pager.  We can even use a lamp in your house. 

I carry a brand of systems called "Silent Call" to notify you of these critical things. 

Maybe you're the grandparents looking after your grandkids.  You're worried about not waking up when the baby wakes up in the night.  Our systems our portable so you can take them wherever.  The adapters are flexible. 

Alarm clocks.  If you don't hear your alarm clocks, we have a solution.  Our models go up to 130 decibels.  You can have ones that hook into your telephone.  We have vibrating travel alarms.  You don't have to have multiple boxes all over your house to receive signals. 

Hearing aid conditioners.  I think most of us in this room have hearing aids.  How many have conditioners?  Not a lot. 

A hearing aid conditioner is like oil for your car.  Oil is essential for your car, or gas.  A hearing aid conditioner is essential for anyone with hearing aids.  It's going to keep them running, maintained.  It deodorizes, sanitizes and dries.  It also means you know where they are every morning.  You put them in the same place every night.  Often, people put them somewhere where kids grab them or the cat knocks them on the floor. 

Hearing aid conditioners are a little box that protects and cleans.  You can leave your batteries in.  If you're traveling and you don't know if you're going to have the right level of power, I have models for traveling. 

Erin is telling me to speed it up because we want time for questions. 

We mentioned Bluetooth before. 

Male Speaker:   Why would I come to you for a Bluetooth aid or TV and not my hearing aid manufacturer? 

Ted:   Ours are kind of like the generic, they'll go with any hearing aid.  We're not manufacturer-specific.  It may come down to cost.  What happens is that a lot of hearing aid companies make their devices closed. 

In summary, this is a quick overview.  [On screen.] 

Male Speaker:   We've talked about receiving the signal. Is there anything that can be done with getting the person to talk clearly? 

Ted:   We'll just wrap this up and I'll get to that. 

You're the best advocate for hearing.  You need to tell people when you're not hearing things.  Don't worry about offending your audiologist.  Tell them. 

One thing some hearing aids have is remote microphones.  These help in situations like you're talking about.  You can put it in the center of the room and it will wirelessly transmit the sound to your hearing aid. 

Unfortunately, I have no way to fix people's mumbling.  We tend to mumble and talk softly. 

Male Speaker:   I said mumble, but that's just one.  Speaking softly or not enunciating properly.  I have a hearing problem and I recognize that, but the people I'm talking to don't speak properly and enunciate.  It's difficult to tell them to shut up or speak properly. 

Ted:   It's difficult but we can be the ones to change that.  We need to get past the point of worrying about hurting their feelings.  What if we've got the winning lottery ticket in our hand?  Wouldn't you like to know that? 

So hearing aids are great, but they're not going to solve everything. 

Let's take one more question. 

Male Speaker:   If you have a Bluetooth connection and someone else has a phone, will you hear that? 

Ted:   No, you won't pick up their signal.  The only problem might be if their signal is more powerful than yours, it might infringe on your signal.  Bluetooth is secure communication.  It's a pin frequency.  It's a single point connection. 

Thanks very much everyone, I really appreciate it. 


Talk 2

Dr. Erin Wright – Brain Hearing and Cognition

Erin:   Good morning.  Thanks for coming.  We've had wonderful feedback so far.  My name is Dr. Erin Wright.  I am the audiologist and owner of both clinics, along with Lia.  We've been operating for almost 10 years. 

The focus of my talk is brain hearing.  Recent research looks at how hearing loss affects the part of our brain responsible for hearing. 

I will talk about latest research about hearing loss and auditory processing, as well as the auditory pathway. 

Hearing loss is the 3rd most common chronic medical condition in adults.  You're not alone.  40-50% of adults over 65 have hearing loss, and 80% of people over 70. 

Researchers wondered how this was affecting our brains.  This research started around 2010.  In 2011, new research started to emerge on how hearing loss impacts cognitive ability. 

One topic is Dr. Arthur Wingfield's.  He looked at memory and hearing acuity. 

He found that with a mild degree of hearing loss, memory is affected.  That's because there is an increase of cognitive load on the brain when hearing. 

The brain has a limited amount of energy to expend on a task.  If part of the brain's energy is used to hear a message, less energy can be used to remember it. 

Dr. Franklin is a professor at John Hopkins University in head and neck surgery and geriatric medicine.  He published a study with 639 people over 12 years.  It was a controversial study because he correlated hearing loss and an increased risk for dementia. 

He found that if people had a mild hearing loss, they were 2x as likely to develop dementia.  Moderate hearing loss had 3x more likely incidence of dementia.  Severe hearing loss had a 5x greater risk of developing dementia.  Dr. Franklin found that these results applied to people who didn't use hearing aids. 

So there were benefits outside of just hearing someone better.  It increases overall brainpower.  Hearing aid manufacturers had a heyday with this study! 

Another study is by Dr. Susan Resnick.  She works for the National Institute on Aging.  She found that hearing loss was linked to accelerated brain tissue loss.  MRI testing was done over a 10 year period.  People with unaided hearing loss (no hearing aids) showed accelerated brain atrophy.  The brain atrophy happened in the auditory cortex, the part of the brain that processes sound. 

[On screen.]  This is a review.  Many people consider hearing as only happening at the ears.  The ear is just the vehicle for sound to the brain. 

Much amplification focuses on brain hearing rather than the ear.  It's about making the brain interpret the message. 

Sound goes through the outer ear, then inner, then the cochlea.  90% of people have hearing loss due to damage to the cochlea.  We have fragile hair cells there that take mechanical waves and change them to electrical impulses.  These impulses are transmitted to the brain.  It's so incredible that this happens. 

In the cochlea, the hair cells can be damaged by noise, disease, genetic factors, etc.

[On screen.]  The purple area highlights the auditory cortex.  That's where we hear.  The auditory cortex receives sounds at different frequencies, just like the cochlea.  Certain hair cells respond to bass or treble tones. 

The treble part of the cochlea is in the front line.  The outer part of the "snail structure" is where the high frequencies are.  It's the battlezone of loudness.  This means high frequencies are affected first. 

The auditory cortex is assembled in a similar manner.  When you have high frequency hearing loss, which is the most common, the sound wave diminishes. The auditory cortex isn't receiving the high frequency signals.  It's in this part of the auditory cortex where there is atrophy.  If you don't use it, you lose it. 

[On screen.]  This is a synapse.  It's where the hearing nerve leaves the cochlea and travels to the brain.  Millions of nerve fibres send electrical impulses across.  This is very important to the auditory system.  When you have unaided hearing loss, those impulses weaken. 

When you need your hearing aids, you put them on.  Some people say they only wear their hearing aids when they need them.  But when you wear your hearing aids, you're making this auditory pathway a superhighway.  Without them, it's like a gravel road. 

Now you're in a situation where you need to hear.  If you wear your hearing aids consistently, it will be like a superhighway.  When you need to hear, you'll have a much better job with understanding the message if you have consistent use. 

[On screen.]  This is a diagram that I often have conversations about.  It's the pathway to get sound to the brain.  On the left hemisphere is the auditory cortex.  Sound that goes into the right ear goes to the left side and vice versa.  It crosses the corpus callosum to get to the auditory cortex. 

There is the "right ear advantage."  This comes up especially for people with hearing loss in 1 ear only.  Here's an example.

At my first job I was an educational audiologist.  Kids who were Deaf in their right ear were on an education plan.  They always came up with some sort of learning disability because it is a heavy load.  Kids with hearing loss in their left ear had hearing losses that weren't even noticeable in school. 

So you can understand the binaural benefits of having them in both sides, but the right ear is especially important. 

Strengthening the auditory pathway is why we use hearing aids.  Hearing aids could be used to hear better.  Or they can be used to understand more. 

Someone pulled me aside once and said their wife was complaining that they could hear them fine, just not understand what they were saying!  We want better understanding more than hearing.  We use hearing aids to strengthen those auditory pathways. 

There's a lot of information about brain plasticity.  People may use puzzles to strengthen their brain. 

If you have hearing loss, there's nothing better you can do than amplify your hearing to get those signals to your brain.  It's about rewiring nerve fibres. 

Male Speaker:   When you talked about strengthening the auditory pathway, were you saying that if we're doing this, it will help our understanding ability as well? 

Erin:   Yes.  Strengthening the auditory pathway will help you understand better. 

There's the issue of hearing, listening, and processing.  We often get caught up in the hearing -- damage to the cochlea, etc.  But all 3 of those things have equal importance in understanding a message. 

Processing is harder to test for.  The tests aren't very sensitive. 

Sometimes I'll use the analogy of visual processing.  You rely on your brain to fill in the blanks like this.  [On screen.]  "Where are the bathrooms."  You can use visual processing to fill in what your eyes aren't getting to your brain.  Same with the ears. 

But when you have a word without context it is harder to fill in the blanks. 

[On screen.]  Hearing.  You guys are good!

People can have auditory processing loss in the presence of normal hearing.  One example is my dad.  He is 75.  He asks me to test his hearing every 6 months because he is sure he has hearing loss. 

We go to restaurants and he breaks down from the noise.  Even though his hearing is normal, he avoids going for dinner or social situations because he can't hear.  He's looking at me for help.  There is a whole area of auditory processing that is separate from your system. 

When people have difficulty with auditory processing, there are some hallmarks. 

For example, "Young people speak so quickly these days."  This happens because it takes longer for the signal to get from the ear to the brain. 

It's like people with hearing loss in their right ear.  They will almost always have auditory processing delays because it has to travel farther. 

Keeping up with quick speech is difficult, accents can be difficult, and hearing in noise.  Those are 3 symptoms of difficulty with auditory processing. 

What makes some people successful with hearing aids and others not?  I've been fitting hearing aids for a long time.  I give people the same hearing aids and one comes back, they're working great, no problems, and the other comes back struggling.  There's a lot of variables. 

One is in their inherent ability to process auditory information.  The time of the onset and the period of time that passes between using hearing aids is big. 

The longer you have unaided hearing, the more of a gravel road begins to develop.  It takes longer, more consistent use to build up the neural pathway. 

Someone's residual hearing is a big one.  The more severe hearing loss you have, the more difficult it is to benefit from hearing aids.  Residual hearing loss means how much hearing you have left. 

Consistent of use of hearing aids.  Anyone who's seen me in my clinic will have heard this: the best thing you can do once you get hearing aids is use them.  It's going to give you the best chance of hearing what you want to hear and understanding the message.  

Female Speaker:   If you don't hear anything all day like if there's no one there, do the batteries last longer? 

Erin:   No, it's going to last the same amount of time.  But I get that a lot.  People will say that there's no one around a lot of the time, so why should they have their hearing aids on?  It doesn't matter to the auditory cortex what sounds are going on, whether it's a voice or the sound of your newspaper rustling.  It's a sound wave that's coming into that part of the brain. 

Male Speaker:   If you lose it because you haven't used it, can you repair that interpretation of what the sound is? 

Erin:   Yes, like in the study on brain atrophy, can you regain that brain tissue?  From my understanding, the answer is yes.  There's such plasticity to the brain that it can be reawoken.  You can regenerate the neural pathways in the auditory cortex. 

Male Speaker:   Are there any empirical studies? 

Erin:   I can give you the longitudinal study on aging.  Talk to me after.  I'll take more questions at the end. 

These are all statements that I commonly hear in the clinic.  [On screen.]  I think you know what I think about these. 

I also wanted to touch on the difference between active and passive listening.  This comes up primarily in your relationship at home.  When you have hearing loss, even to a mild degree, you have a different level of listening.  It becomes an active job.  Right now, you're all making an effort to understand what's going on. 

When your hearing is normal, the same effort is not necessary to understand the message.  Even I've come up against this in my 40s.  I was recently on a bus tour and I found I wasn't even looking out the window to see what the guide was talking about because I was efforting so hard to hear what he was saying.  I never used to have to work that hard to pick something up. 

When you have hearing loss, most of your listening activities require a degree of active listening.  This is important if you live with someone with hearing loss.  Active listening is exhausting.  There's something called auditory fatigue.  People with hearing loss come home from work and just can't deal with anything else, they're done. 

When you live with someone with hearing loss, imagine them being "on" all day.  If you walk in and they're reading a book and you ask them if they want soup for lunch, by the time they've turned on their active listening, they have to ask for repetition. 

It's a worthwhile habit to get into is saying, "Honey, it's lunch time, would you like some soup?"  That prompts them and they might not have to ask for repetition.  They don't want to ask for repetition.  Sometimes when people are asked to repeat, they'll speak louder and just the increase in volume makes the listener feel like you're mad.  It becomes this dynamic that gets a bit more hostile. 

So if you can keep that dynamic to patience, it would be so kind of you as the partner.  It's very difficult to understand how difficult it is to live with hearing loss if you don't have hearing loss.  You simplify it to, "Well, you're wearing your hearing aid, you should be able to hear me."  But hearing aids aren't magic.  They don't restore hearing to normal.  I use the analogy of broken legs and crutches.  It's a similar concept.  There's still damage to the ear, but you have an aid. 

If you're the one living with someone with hearing loss, be kind, be patient.  It'll make your interactions more pleasant on both sides. 

Female Speaker:   I really appreciate these examples you've given because they're so much a part of everyday life.  I have an interesting form of hearing loss that's made me consider what's really going on here.  For years, I felt on the back door because of my hearing loss, but recently, I've been getting fed up.  The example you gave about the tour guide on the bus, and here you are a normal speaker and a normal hearing person.  You're still efforting to hear him. 

Why do we as listeners presume that there's something wrong with us?  Maybe it's the speaker.  The other thing about relationships at home, it would seem to me that if there's two people with different hearing, the person with their nose in a book, even a person with normal hearing, would have to be repeated to if they're engrossed in a book. 

Erin:   Yes, and different personality types respond differently.  All of this stuff relates to auditory processing. 

When you're actively listening, you're always in the ready position.  It's very tiring.  It's almost impossible to maintain.  Getting the person's attention jars them into the ready position and prepares them for your message. 

Whenever I listen to someone with a thick accent, it's a level of concentration that's a little bit like it is for people with hearing loss.  There's more efforting required. 

If you have hearing loss, it's best to use your hearing aids consistently.  This is especially important at home.  If you wear them at home, you'll have a happy marriage.  It's a nice thing to do for your spouse.  If your spouse is going to get into the habit of getting your attention, you can also get into the habit of wearing your hearing aids. 

If you wear them consistently and your spouse says something and you miss a word, you'll have a higher chance of filling in the blank than if you don't wear them consistently. 

A lot of manufacturers' literature is about brain listening.  [On screen.]  Consistent use of hearing aids is the best way to facilitate brain processing. 

Male Speaker:   Going back to auditory fatigue, a lot of us complain about hearing people in social situations.  My sense is that it's really hard work.  I never had this problem before.  This external sound overwhelms the person you're talking to.   It's almost directional. 

Erin:   It affects different structures.  It's true that noisy situations are the hardest for everyone, including manufacturers and researchers because often the noise is also speech.  You have to differentiate certain speech from others.  We're trying to make this better.  Assistive devices like the directional mics, some people need more of these than others. 

Janet from Island Deaf & Hard of Hearing Centre is an audiologist who teaches lip reading classes.  In social situations, you want to use all of your resources.  If your ears are picking up 30% and your eyes 40%, maybe your brain can piece together the rest. 

Male Speaker:   Is there any dietary supplement that can help with this? 

Erin:   I haven't read any research about that, but if you find something let me know. 

Female Speaker:   What about programs like LACE? 

Erin:   Yes, and that stands for Listening and Auditory Communication Enhancement.  We have it in our clinic.  Have you done it? 

Female Speaker:   Yes, it's helpful. 

Erin:   It helps to retrain your brain to increase your auditory processing.  It's called auditory training and there's evidence that people who use it do better than those with hearing aids alone. 

Male Speaker:   I know people in my family that refuse hearing aids and they're getting worse and worse and could benefit from them.  Is there a way of sharing this information with them? 

Erin:   These ladies are typing this all out and we can print it out or share it with you.  If you want the transcripts of this talk, I'm happy to give them to you. 

Thanks for coming out.  Our next talk is from Lia at 12:30. 


Talk 3

Dr. Lia Best – Tinnitus

Erin:   Good afternoon, thanks for coming.  I'd like to introduce Lia Best.  She is an audiologist in our Broadmead clinic 5 days a week.  Lia is giving a talk on tinnitus and strategies for managing it. 

Lia:   Before we start, I want everyone to recognize how many people are here. 

There's a chance that everyone here knows someone who is experiencing tinnitus. 

If you suffer from tinnitus, recognize two things.  One, you're not alone.  Two, there is something you can do. 

I have 3 main objectives.  First, that you understand better what tinnitus is.  Second, I want to equip you with how to take action.  I'll also go through some strategies you can implement at home. 

What is tinnitus?  There are many forms.  I'll talk about the most common, subjective tinnitus.  This is the perception of sound that cannot be attributed to an environmental source.  It's not a disease itself; it is a symptom from an underlying cause.  The most common cause is hearing loss. 

Tinnitus can be constant or intermittent and can be from one or both ears.  It can be soft or loud and vary in volume, pitch, and quality. 

[On screen.]  These are examples of common forms of tinnitus: ringing, buzzing, etc. 

I'll go through some stats.  These come from the Tinnitus Association of Canada.  10-20% of adults report long-term tinnitus.  1% report that it's annoying.  0.5% report that it significantly impairs their quality of life.  Tinnitus does become more common with age and hearing loss.  Only 2-4% of people with tinnitus have been referred to healthcare professionals for it. 

Tinnitus is a symptom, not a disease.  There are many possible causes. 

The two most common causes are noise exposure and hearing loss.  Some medications list tinnitus as a side effect.  It's also related to head/jaw injuries, stress, cardiovascular disease, muscle tension in the back or neck, or a combination of things. 

Many of you may be here to learn about tinnitus.  Some may have looked online for the cure.  At this point there is no cure, pill, or surgery for it.  Some experimental methods may help. 

We need to move away from finding the cure and move toward managing it.  We need to think about it in a different way.  I'll talk about that today. 

The first step in managing tinnitus is talking to a medical professional.  Audiologists are highly trained to assess, train, and educate on hearing imbalance disorders.  Once hearing problems are known, audiologists can help determine the best course of action. 

It's important to recognize that not every professional in a hearing clinic is an audiologist.  Audiologists are highly educated to treat tinnitus.  They can create individualized programs tailored to you. 

The first step is a tinnitus assessment.  It judges whether the tinnitus is in one or both ears and its impact on your quality of life.  We'll ask if the tinnitus affects your concentration or sleep, or if it causes anxiety or depression. 

Then we do a diagnostic hearing evaluation since hearing loss is a main cause of tinnitus.   This will also tell us if there is a medical red flag to investigate further.  We send a report to your family doctor and they will refer you to further investigation if needed. 

Then we decide on specific treatment or counselling to make things better, as well as follow-up services. 

Everybody is different.  I might see two people with the same audiogram but the way they experience sound is different.  Some people love jazz.  Some love rap.  We can't say everyone here will love one or the other.  That's why a magic pill for tinnitus won't work.  We experience sound differently.  We need to consider your case history in order to manage it. 

The bulk of this presentation will be about tinnitus associated with hearing loss.  If you don't have hearing loss, it doesn't mean an audiologist can't help you. 

75-80% of people with hearing loss will report tinnitus.  The odds of tinnitus increase with hearing loss. 

We need to understand how we hear first.  A common misconception is that we hear with our ears.  We really hear with our brains.  Sound waves travel through the ear to the brain.  The cochlea transmits the mechanical signals into electrical signals. 

The brain is the part of our body that makes sense of the sound.  It uses information from other parts of the brain to interpret the sounds.  Is it a familiar sound?  Is a loved one speaking or a stranger?  The brain uses other information to make sense of it. 

If you have hearing loss due to damage in the inner ear, the brain won't receive accurate signals.  Experts believe tinnitus is caused by the brain trying to adapt to this loss of information.  The brain is misinterpreting this reduced auditory input and perceives sound that isn't there. 

There is a lot of research looking into this.  We know this is the underlying mechanism for most tinnitus. 

Sometimes exposure to a loud sound is enough to trigger tinnitus. 

Tinnitus severity isn't fully explained by the degree of ear damage because there isn't a correlation between degree of hearing loss and severity of tinnitus. 

How do we know this?  Some research found that when the auditory nerve is severed and people are completely Deaf, they will still hear their tinnitus. 

To summarize, tinnitus is caused by damage to the peripheral auditory system.  This results in less input to the brain's auditory pathways.  The brain tries to make up for the loss of auditory activity.  It perceives sound that can't be attributed to an environmental source. 

But tinnitus doesn't bother everyone.  Only 10% of people will say they have it.  Only 0.5% of people say it impacts their quality of life.  Many people tune it out.  I'll talk about why people might experience it differently. 

It comes down to the tinnitus cycle.  It starts with the onset of tinnitus.  This may be gradual or sudden, maybe after a loud noise exposure. 

A lot is unknown about tinnitus at that point.  You may wonder if something's seriously wrong. 

When you have an emotional association with your tinnitus, the amygdala in your brain reacts.  The amygdala codes memories with emotional attachment. 

The amygdala is why we feel scared if we hear a noise in the middle of the night.  It's why we're happy when we hear children play. 

For people whose tinnitus bothers them, the amygdala has coded the sound as bothersome.  They may feel worried or frustrated or confused.  When this happens, your brain focuses on it.  The brain's job is to keep us alive and it sees tinnitus as a threat.  If the threat changes, your brain is ready to take action. 

The part of your brain that interprets sound has decided that your brain should pay attention to the tinnitus. 

Some people say they hear their tinnitus the most in a quiet environment: before bed, in a doctor's office, etc.  The reason for this is because your auditory cortex doesn't have much else to listen to at this time.  It can be more difficult to relax in a quiet environment. 

This can affect your life.  It might affect your sleep or your relationships with other people.  This affects your quality of life. 

Another part of the body is the autonomic nervous system.  This prepares us to take action.  Our body is quick to respond to threats. 

If someone pulls in front of you in their car, you have an immediate reaction.  You need a moment to calm from the stress.  Your heart rate increases.  This is the autonomic nervous system. 

With tinnitus, your body has decided that it's a threat to you.  Your body might be in a constant state of fight or flight.  You will have higher stress levels which makes it difficult to sleep.  You may have more anxiety.  Your blood pressure and heart rate will be raised.  You may have muscle tension. 

Because of this, you might get even more upset about your tinnitus.  Now your brain is focusing on it negatively.  Your body is prepared to fight it but doesn't know how to. 

The amygdala and the autonomic nervous system play off each other too.  It's a cycle.  There may be more structures involved. 

How do we manage this?  There are 4 approaches your audiologist will do.  Some are things you can do at home.  Some may need people's help. 

First, education and counselling.  I'm doing this now.  It will help recode the tinnitus as non-threatening.  With more information there is more power.  Once you know there's nothing wrong you may feel better. 

Second is sound enrichment.  You might notice tinnitus more in a quiet environment, so there are strategies you can do to avoid silence. 

Third, we can also give advice on managing stress. 

Last is the use of hearing aids and sound therapy. 

Education and counselling, we're doing that now.  Understanding what causes tinnitus can relieve anxiety.  Getting it checked by medical professionals can rule out underlying medical issues. 

The goal at this stage is to re-code tinnitus as less negative.  Your body will know it will be okay. 

Here is an example of how we re-code the tinnitus as less negative.  If you're trying to have a conversation with someone and see a large snake in the room, you'll wonder if the snake is alive, poisonous, mobile, etc.  It will be hard to concentrate on anything else. 

Some people have said they don't feel they have hearing loss but their tinnitus is affecting their ability to hear other people.  This is because the brain is focusing on the tinnitus rather than people.  Your brain doesn't have the resources to focus on the message if you're focusing on the tinnitus.  It's the fight or flight response.  Your blood pressure will go up and your palms may sweat. 

But then your friend tells you it's just a stuffed snake.  The fear is removed but the snake is still there.  Now your autonomic nervous system will release hormones to reduce heart rate and increase relaxation. 

This is why it's helpful to talk to somebody.  Audiologists are well-equipped but it can be anyone.  Investigating the tinnitus will help alleviate fear.  Removing the threat of the unknown will have a positive response. 

The second approach is sound enrichment.  This is avoiding silence.  It's creating something else for the auditory cortex to listen to. 

You can do this at home when you leave today.  Pick something you enjoy listening to with a more positive sound to it.  It could be nature sounds, the ocean, music, etc. 

You can have it playing on the radio or CD player.  You can get apps now too.  You can also get speakers that go into your pillow so that you don't have to have your significant other listening to the ocean at 3 a.m. You can also get headbands to plug something into. 

The important thing is to seamlessly transition from quiet environments to noisier ones.  If bed time is the most annoying part, you can have your sound generator on before you even get into the room.  Every time you go and turn it on, you'll have a bit of a negative response.  But if you can go in and have the sound already on, you're breaking that cycle. 

This is a graph explaining why sound enrichment is helpful.  [On screen.]  There's a squiggly line at the bottom which is background noise.  Your tinnitus is the spike you see.  It's evident on that screen. 

If you can raise the background noise with any other sound that's better to listen to, the signal to noise ratio drops quite a bit.  The tinnitus doesn't stick out as much. 

This is an analogy I like.  [On screen.]  It's very noticeable all of a sudden.  You might ask your neighbour, "Do you hear those trains?" and they might say to you, "I don't really notice them as much anymore."  That's the goal for tinnitus.  It might take a really long time or it might happen pretty quickly.  It's worth experimenting with and trying it out. 

Stress management is the third piece of the puzzle.  If you're in a constant state of fight or flight, it'll be affecting other aspects of your life.  Some people might say to avoid stress, but we know that's not possible.  We need to know how to manage it. 

There are lots of relaxation techniques like meditation and deep breathing.  You may realize that you're taking on too much.  Sleep has a huge correlation with stress.  You can talk to your doctor and see if there are ways that can be improved.  Having a healthy diet can make a big improvement.  If you're dealing with muscle or body tension, massage can help with that. 

There's a stress reduction technique for tinnitus that can be accessed online. 

Some people have also accessed counselling and psychologists for tinnitus relief. 

I'm going to talk about sound therapy, which is the incorporation of certain sounds to help you adjust to your tinnitus.  These are ear-level devices that aren't amplifying sound, but sending specific sounds into your ear at all times. 

People may just wear these at home or if they know they're going to be in a place like a waiting room for a long time. 

You might be saying right now, "If I hear a sound in my head all the time, why would I want to hear more sounds?"  I'll tell you. 

One reason is that when we're choosing the sound, we're able to find a more positive sound.  If you hear something pleasing, it tricks your brain.  Not every sound you hear is annoying.  It has a positive impact right away.  We can choose all sorts of sounds.  There are so many options. 

The other reason we'd want to do this is that environment sound is not always enough to mask your tinnitus.  You can get hearing aids that have sound generators built into them.  You can turn the sounds on and off. 

Ultimately, we're trying to reduce the tinnitus to positive noise that we talked about. 

Sound generators give you control over your hearing.  You choose the sound, you choose the volume.  Research has shown that when people have this control, they also feel like they're in control of their tinnitus. 

There are a lot of manufacturers out there today, and you can talk about the different sound generators they offer with their hearing aids. 

Most audiologists would agree that it's not enough to turn on the masking noise and, "See you later."  You should also have counselling and support. 

Currently, hearing aids are the most effective method for people with tinnitus.  Even if you have a mild hearing loss, tinnitus is going to be noticeable. 

Hearing aids are non-invasive, have no side effects, and have a purpose: they're going to help you hear better.  Speech will be more clear. 

They're also going to provide natural masking of tinnitus with environment sounds.  For people with hearing loss even at a low level, you might not be hearing sounds in this room right now.  With hearing aids, it gives your auditory cortex something to do.  It distracts you from your tinnitus. 

It also increases the activity in the neural pathways.  If you can stimulate those and keep them active, you can keep the auditory system intact. 

This is an analogy of how hearing aids help.  [On screen.]  If you have hearing loss and tinnitus, there's nothing to help you see anything besides this candle.  But if you turn on the light, you'll see a lot more. 

The same can be said for hearing aids, it's like turning the lights on.  You might not even have realized the sounds you were missing. 

To wrap up, this is an overview of the advantages of hearing aids and sound therapy.  Some people find immediate relief.  You regain control over your tinnitus.  It's portable, small and inconspicuous now.  It's going to increase the neural activity in your auditory cortex. 

We know that there's this tinnitus cycle that's affecting more than your ear.  Everyone is different.  No two people are hearing their tinnitus the same.  Some people are already using some of these strategies. 

The first step is talking to someone about it.  Also, ruling out the medical things we'd want to find out. 

At this point, there's no cure.  They're working on it, but right now, the most effective approach is managing it.  A lot of these things you can do at home, but the first step is talking to an audiologist.  They'll customize an approach to you. 

Thanks for listening.  If you have any questions, you can ask them now.  If you don't get to today, you can talk to myself or Dr. Erin Wright after. 

Male Speaker:   Is it possible to be experiencing tinnitus and not realize that you are? 

Lia:   Yes, it's possible. I think everybody will have tinnitus at certain times.  If I go into a really quiet room, sometimes I feel that I can hear a sound.  So I think everybody has it a little bit but it doesn't bother everyone. 

Male Speaker:   If you don't know you have it, how do you know to get rid of it? 

Lia:   Maybe it's about defining what it is.  If you hear a sound and it feels like it's coming from inside your head, that's tinnitus. 

Male Speaker:   With my tinnitus, it changes from day to day.  Sometimes it's a 1, other times it's a 10 and I can't make out what people are saying.  Why is there such variance?

Lia:   For a lot of people, it doesn't really change.  You might have a bad day where it feels like it's louder, but I think it's more complicated than that.  Your hearing loss may be fluctuating.  We should maybe talk about why that's happening.  It primarily has to do with the ears' function and your hearing may be fluctuating. 

Male Speaker:  So when it's a 10, that's when I need to learn to manage it more effectively? 

Lia:   And the stress and anxiety may have already been going on.  It's hard to say which is happening first, or what's causing what. 

It's common to think that you should wear ear plugs, but don't.  Give your brain something else to pay attention to.  If you can do that, that's going to help manage it. 

Female Speaker:   Further to things like fluctuations, I've had tinnitus for years, and when I went to Ireland, I had Irish music in my head all the time, but not in tune.  It was irritating.  I didn't know if it was tinnitus or a hallucination. 

The other thing is that I thought I heard planes going over and it went on and on and on.  I went online to find out what was causing it.  Another time, it woke me up at 3 a.m.  It was like a loud vacuum cleaner. 

Lia:   To repeat, she's saying she's had her tinnitus a long time but there are also sounds that come on randomly.  It can be related to hearing loss but not always.  It's hard to answer without knowing the whole picture.  The first step would be a diagnostic hearing test. 

Female Speaker:   I've had it for years. 

Lia:   Did they talk to you about tinnitus being associated with hearing loss? 

Female Speaker:   No. 

Lia:   There are many forms of hearing loss.  Some people have high frequency hearing loss and a ringing in their ears.  Or some people have tinnitus that is random, what you described. 

Female Speaker:   It's genetic hearing loss and I lose the low sounds. 

Lia:   They don't know why a particular hearing loss causes a particular sound of tinnitus.  Sometimes sound in the environment can trigger it, for example, loud sounds can cause tinnitus during the day. 

It can also be related to muscle tension or vascular issues.  The ear is a complex structure with lots of muscles nearby.  There is no clear answer but it's worth looking into. 

Female Speaker:   Thank you. 

Female Speaker:   Is there any objective way of measuring tinnitus?  Because I've heard that it's buzzing, ringing, or many other things.

Lia:   Great question.  The tricky thing is that tinnitus is a subjective experience.  Only you hear it.  But we can try to objectively measure it in the clinic by doing frequency matching and volume matching.  We play certain sounds with our equipment and we get you to tell us whether your tinnitus sounds like this or that sound.  We also judge how loud it is. 

Sometimes we do masking where we play a noise and see how responsive the ear is.  We'll see if the noise gets louder temporarily or not.  This is to see if you will benefit from sound generators. 

However, research now shows that this isn't that effective in getting this information.  Generally in the clinic we do frequency matching and volume matching. 

Male Speaker:   Is there a relationship between tinnitus and sensitivity to loud sounds? 

Lia:   There is a huge relationship.  I wanted to talk about that but we didn't have time.  Sensitivity to loud sounds is called hyperacusis.  It's almost always correlated with tinnitus. 

Tinnitus could be the loud sound.  Maybe someone is doing dishes beside you and the sounds make you jump more than they do for anyone else.  There's no clear answer why that happens.  They think it has to do with the hearing loss piece. 

All the nerve fibres that go from your ear to the brain are usually intact with hearing loss.  It's the hair cells in the cochlea that are malfunctioning.  The nerve fibres may be contributing to the tinnitus.  Some may be intact and some may not.  It can contribute to an over-stimulation to your brain. 

All the things I mentioned before that will help tinnitus will help hyperacusis too. 

Male Speaker:   I participated in a tinnitus study that seemed to be promising.  Then I lost contact with the company.  Is that still happening?  Is there anything similar?

Lia:   We did a tinnitus study a year and a half ago as part of a larger research group.  We did tinnitus masking that was effective.  But they had problems getting FDA funding. 

The study had to do with selecting certain sounds for your brain to listen to.  The answer is no, the technology looked at is not widely available quite yet. 

Male Speaker:   What's happening on a good day when I can make out your voice compared to a bad day when things are distorted?  What's the difference internally? 

Lia:   I don't know the exact cause of your hearing loss.  Some people have hearing loss that fluctuates.  An example is Meniere's disease.  A main symptom is hearing loss and tinnitus. 

It comes and goes.  It's a swelling of the fluid in the cochlea which can cause dizziness.  Sometimes the tinnitus subsides and the symptoms come down.  It's something we can work with you and treat. 

I'll be out there if you have questions.  Thanks. 


Talk 4

Dr. Erin Wright – What's New in 2015

Erin:   Okay, good afternoon everyone.  Thanks for coming.  My name is Dr. Erin Wright and I'm going to be talking about what's new in 2015. 

I'm going to do an overall summary of what we've seen from the manufacturers and how we might benefit from the new features. 

So there are six major manufacturers in the industry.  [On screen.]  Phonak is in Sweden and is owned by Sonova.  They have retail outlets which were purchased about four years ago. 

Oticon is in Denmark and there are two subsidiaries.  Widex is also in Denmark.  There's also Resound and Siemens.  About a year ago, Siemens wanted to rid themselves of the hearing aid division.  They put it up for sale but no one wanted to buy it. 

This past November, a group of investors purchased the hearing aid division of Siemens.  They're allowed to use the name for two years, and then it will change. 

The final one here is Starkey. It is the only North American company, based in Minneapolis. 

Each spring we go to a conference at the American Academy of Audiology.  At the last conference at the end of March, we got the most recent platforms from each manufacturer. 

Platform is a word for operating system.  The underlying chip in the hearing aid is the operating system, much like with our computers and phones. 

I'm going to talk about some of the new features you can potentially take advantage of. 

The thing about hearing aids is that they're all good, but they all do things slightly differently.  Learning about what you need might be different from what someone else needs.  Everyone's needs are unique and it's good to know what features are available.  That drives your decision about what manufacturer to use. 

Phonak released their latest line in November.  Their main feature is something they call "autosense."  That means that the hearing aid is trying to figure out where you are, be it in a quiet room, a car or whatever.  It switches the setting based on your environment. 

They now have a way for the entire audio bandwidth to stream from one ear to the other.  For most of the manufacturers, they're all trying to incorporate this technology. 

They try to exploit the position of the better positioned ear.  If this young woman to my left were to start to talk, the hearing aid on my left would be better positioned to hear her than on the right.  The hearing aid picks up on that.  It'll amplify this side and decrease over here.  It takes the bandwidth and streams it to both ears. 

You may have read some brochures about brain hearing.  That's what this is: getting the signal to the other ear so that it comes in both ears and then to the auditory cortex.  This feature is the most significant feature to help you in noisy environments. 

There are made-for-iPhone hearing aids.  They were released last year but they've got new models available now.  Certain people love these.  It's wonderful to use your phone as your remote control and to stream phone calls to your hearing aid.  When someone calls you on your phone, you can stream it to both hearing aids. 

Some people have gone away from using their home phone and gone to their cell phone because it allows them to hear a lot better.  The connectivity is nice. 

With the made-for-iPhone hearing aids, Resound just released a new app.  It works with iPhones, iPads and the iTouch.  It allows you to have more control over your hearing aids in different environments. 

We've always been able to control our volume, but people want more control.  So manufacturers have released apps.  This one goes straight to your hearing aid and is very simple.  There's this cool ability for people to increase and decrease the level of the noise manager.  They try to detect and reduce noise.  If you reduce it too much, it can affect the person you're hearing. 

It gives people a little more control if they want control.  Some people don't want to touch it and that's fine.  Other people really want to fine tune on their own in different environments. 

I haven't seen anyone who has the Apple Watch, but as soon as people start wearing that, it's going to get even easier to make all the controls right on your wrist. 

These take advantage of GPS on your iPhone or iPad because if you lose them, they can track them.  It's like searching for hot/cold.  You can even find your spouse using this! 

Easy call.  Two manufacturers have made their own telephones.  Phones and hearing aids have not always been the greatest pairing, but these new phones work for anyone in your home.  If you're wearing your hearing aids, you only have to put the phone this close to your ear to get the audio pulled into your ear. 

It's a quick and seamless connection between the phone and your hearing aids.  It's a cordless phone and they work really well. 

Duophone.  This has been around a while but many people don't know about it.  You may have hearing aids that have this feature but it's not turned on.  This will stream the audio from one hearing aid to another using a regular phone.  You get binaural input to get more signal to your brain. 

Oticon released a new platform last Friday.  Their new aid is called the Alta 2. It has a Soft Speech booster that detects soft speech and strives to increase it.  This technology has been available for a while, but so far it's been a general increase to all soft sound, including your fridge and other things you might not want to hear. 

Oticon has this way of amplifying only soft speech and not everything else in the world that's soft.  This will help a lot with high frequency consonant sounds.  All of the consonant sounds that are unvoiced, vowel sounds, like "aaah."  A sound like "f" is going to be helped the most by something like this. 

Lyric 3 is the third version of Lyric and it's been out for about 6 months.  They're continuously improving this device.  Phonak purchased this because the president wasn't even using his own company's hearing aids.  He was using Lyric.  So they purchased it and it became Phonak's. 

For certain people, this is a wonderful product.  I have 7-8 physicians who are using this because it works perfectly with a stethoscope. 

I have quite a few patients with tremors or Parkinson's.  They can't manage inserting hearing aids or changing batteries.  This hearing aid is inserted into the ear and stays there for about 2.5 months.  Then the battery dies and you can remove it, but to get a new one, you have to come to the clinic to get it reinserted. 

On a day-to-day basis, you don't have to worry about it.  It stays in.  There's a magnet that comes with it that allows you to turn it on and off. 

Female Speaker:   Does that save the battery? 

Erin:   Yes.  If you turned it off every night, you might get more time out of it. 

It's on a subscription basis.  You're getting a new hearing aid every 2.5 months.  The subscription costs $1500 per hearing aid.  That becomes quite expensive over a period of time. 

I have a woman who's 94 and she told me she wanted hearing aids on a monthly basis, so this works for her.  Fair enough. 

Maybe some of you have gone to the Phonak table and seen the Roger system.  This is an FM system that primarily gets used in classrooms where the teacher wears a mic and the child wears a listening device.  This technology has been made available to the school district.  It was expensive, but this new Roger pen is excellent. 

I have quite a few people using it and the more severe the hearing loss is, the better the Roger pen.  If we were at dinner in a noisy environment, I'd wear the mic and it would take my voice into your hearing aid. 

You can turn your hearing aids to a setting that only picks up the mic, or the mic as well as the surrounding environment.  You could just tune into what's coming in through the mic.  However, a lot of people want to hear more than just one speaker.  You can do that with this. 

A study was done in Europe because the government pays for hearing aids there and there is more government support.  They gave a group of veterans FMs for free.  Quite a few FMs were actually returned because of people's hesitation to use it.  They just wanted to use the hearing aids and not deal with anything else. 

So this technology works if you are motivated to use it.  You must remember to charge it.  You give the person who is speaking the unit and give a brief explanation.  Some people are hesitant to put themselves out there like that. 

So the more hearing loss you have, the more beneficial this unit is.  You can also stream it to your TV, internet, or mobile phone. 

The technology is about $1200 for the pen.  The pen has an accelerometer in it.  This lets the unit know where the pen is in space.  If I'm pointing the pen at people, it will have a wider band.  If I put it on the table, it will use an omni-directional pickup.  It has multiple microphones as it tries to figure out its position in space. 

There are new options with tinnitus masking.  Widex was the first company to come up with sound therapy.  They're moving away from the term "masker" because it assumes you're trying to make it louder than your tinnitus.  It's not about that. 

Every manufacturer now has some form of sound therapy that you can turn on or off.  This sound support can help people manage their tinnitus. 

[On screen.]  This is a picture of the cochlea.  There's a normal cochlea and one with damaged hair cells.  If you have hearing loss, this is what your cochlea looks like.  The hair cells aren't receiving the mechanical sound waves. 

There are more direct-to-TV options now.  Resound and Starkey have these options.  [On screen.]  They use a 2.4ghz band plus a Bluetooth signal to go right to the hearing aids. 

You can put a box on the TV and get the audio signal right to your hearing aids.  You can turn the volume of your TV down or off.  If someone in the room doesn't want to hear the TV, you can turn that volume off and listen alone. 

Waterproof hearing aids have been around for a while.  I wanted to put them here in case you didn't know.  It might be helpful if you do something like water aerobics. 

Siemens is the only company that makes these rechargeables.  They have a new version that has significant improvements.  The battery is rechargeable. 

Why don't they all use rechargeable batteries?  It's because you can't find a good wireless hearing aid with binaural streaming that can work off a lithium battery with a drain over time.  They can't get all the processing power needed for hearing using a rechargeable battery. 

I've heard there is a new battery manufacturer in Nevada that is putting a lot of energy and money into battery research for cars.  I think some of this research can trickle into the battery industry and the hearing aid industry. 

The hearing aid industry is limited by the battery industry.  They've been able to create better hearing aids but the battery will only last a day.  No one wants to change their batteries every day.  They have to power-manage in terms of what the hearing aids can do. 

Frequency transposition has been around for a while too.  It's available in almost all hearing aids.  It's useful if you have a type of hearing loss where you have normal hearing in low pitches and you have a steep drop-off for hearing ability in high pitches.  This is common in people who've been exposed to high levels of industrial noise. 

Remember the hair cells and cochlea?  When there are no hair cells left, making it louder doesn't help because nothing can change it to an electrical impulse. 

Instead of trying to amplify the high pitches, we can transpose them to a lower frequency region of the cochlea where there are more viable hair cells to process the sound.  Examples are "s" and "f" sounds. 

When I was an educational audiologist, one company that created this technology around 1997 had a girl with the typical Deaf speech.  She'd never heard a consonant in her life and her speech reflected this.  She was about 10 years old.  I put this FM on her and within three weeks her speech became much more intelligible.  She was really excited.  I was so excited because it was the first time I'd experienced seeing someone be able to experience these high voiced frequencies on their own.  I really like this feature. 

With so many options, how do you know what's good for you? 

In the first talk, being an advocate for yourself was mentioned.  Know what your lifestyle and needs are like and mention that to your audiologist.  Say if you have problems with TV or noise.  Then we can figure out which manufacturer can produce the right product to suit your needs. 

Using a clinic that's independent (i.e. not affiliated or owned by a manufacturer) can help.  That's something I'm proud of in terms of the Canadian market. 

In many industries there is vertical integration.  Big companies buy other big companies and it streams as such.  You get a biased opinion about what's right for you. 

Choosing the clinic is critical in what options you're given.  This is something I'm proud of as an owner; I don't have an affiliation with a particular manufacturer. 

I use them all for each different niche.  That's why they're all here today. 

You also want to go to someone like Lia or I who stays up to date with the various technology. 

Be as clear as possible about your needs and your budget.  We can work within your budget. 

Thank you!  That's all. 

Male Speaker:   They seem to be going back to the over-the-ear ones rather than inserts.  Is that right? 

Erin:   Oh sorry!  I have one more thing before I answer the question. 

I have a great client named Tom.  I fitted him with hearing aids months ago.  He almost brings me to tears every time with his results.  Here is some firsthand experience of someone who had hearing loss for a few years and resisted getting hearing aids. 

Tom:  It took me a while to come to the conclusion.  My hearing had been going for some time.  My wife let me know!  That's where it comes in, the relationships. 

I decided I was tired of not being part of the conversation.  It's funny and tragic, but I had most hearing loss in this ear from a childhood incident.  Then my left ear degraded with time. 

I'm a musician which makes it tricky.  I want to be able to hear quiet and soft sounds.  I've been fitted with hearing aids for 8 months.  What worked for me was keeping them on.  I wear them all day and let my brain do the work. 

I'm very pleased.  It solved most of my problems.  I see most people here are wearing a hearing instrument of some kind.  You had previously the experience of not being able to hear sounds.  You couldn't tell if someone said book, took, or look.  So I may be having a conversation all on my own when all they asked me was what was for dinner!

My wife brought me to the decision to come in.  I was thinking about getting hearing aids before.  I was at the stove and she wasn't 8 feet away.  I heard her say "If you take your pencil, I can finish what I'm doing." 

I said, "What do you want me to do with my pencil?"  I thought I heard her say that clearly.  She said "No, if you take your pants off, I can finish what I'm doing!"  She was doing the laundry!  You can draw your own conclusion on that! 

Humour aside, it's been wonderful.  We've done about 3 adjustments.  The main benefit is now I'm part of the conversation.  I'm not embarrassed to ask for someone to repeat.  It can be frustrating for the speaker too.  So I recommend Oak Bay Hearing Clinic! 

Erin:   Thank you Tom.  Sometimes people come in and there's such job satisfaction.  Fitting Tom was a highlight for me because of the degree of loss since he was a musician, and because of the huge improvement made.  I think it had an emotional effect on us both to see how things changed. 

The question you asked is about how there are more people going back to behind-the-ear as opposed to in-the-ear. 

The reason is that it's a more flexible device.  We can change the power better.  It's more comfortable because we can use a soft dome in the ear.  It also fits common hearing loss which is loss in the high frequencies.  It doesn't block the ear canal and lets you take advantage of the frequencies. 

Male Speaker:   I'm curious about the binaural in terms of localization.  If it's flipping to the loudest sound, what about a car coming?  That would be loud on both sides so how do you localize where the car is? 

Erin:   The stream is mostly related to speech.  A car noise won't do that as well.  It will apply more noise management.  With the phone app for example, it will recognize there's no speech.  It flips into a car program.  If someone is talking it flips into a speech-and-car setting. 

Male Speaker:   To expand that, most of us have problems with noises we don't want to hear when we set up the hearing aids.  We play tennis early in the morning and we'll hear construction noises, people on the Seawall, etc.  Do all these companies have something to block background noises?  Even the 4-5 channels don't do that. 

Erin:   Different technologies do it better than others.  That's where the price points change.  If you had a premium hearing aid, it will do a better job at that.  If not, you can change your hearing aid settings manually so you can reduce the sounds of the leaf blower.  Some are more automatic and some require manual adjustments. 

Female Speaker:   I have 2 questions about the hair cells.  Why would the higher frequencies go before the lower?  Secondly, if it's about hairs causing the problem, when are we going to know how to replace the hairs?

Erin:   The reason the high frequencies go first is because of the shaping and organization of the cochlea.  It's a snail-shaped structure.  One side is for the high and one for the low frequencies. 

High frequencies are on the outside.  The amplitude of the wave hits the high frequency region first because of the location. 

The second question is, why can't researchers figure out how to regenerate hair cells?  There is a whole centre working on this in Seattle.  Rotary is a big sponsor of this.  They've found that in some birds with hair cell damage, they regenerate. 

Why can birds do it and humans can't?  They've figured out it is a gene that is suppressed in mammals.  They're looking to find something to not suppress the gene so the hair cells can regenerate.  If that happened, it would be a miracle.  It's a focus of many researchers.  I hope one day it will come up. 

Male Speaker:   Considering everyone is different, how well does the software work? 

Erin:   The software works as well as the person working it. 

Male Speaker:   What if it's automatic? 

Erin:   Same thing.  We can change so much in the software and make it more or less sensitive.  We can manipulate the programs.  If it switches too soon to a different program, we can make it less sensitive. 

The manufacturers have given audiologists a lot of control.  You might want to prioritize comfort in noise whereas others might prioritize audibility.  It's about having the audiologist make proper adjustments. 

Female Speaker:   If you have hearing aids that work with the iPhone, what happens if the battery dies? 

Erin:   The hearing aid will still work but you can't access the remote control or other features.  You'll still have buttons to change the volume.  It's just another remote control. 

Female Speaker:   If a phone call comes in, can you receive it in your hearing aid? 

Erin:   Yes but not if your cell phone is dead. 

Male Speaker:   Does that work with Android devices? 

Erin:   Starkey the manufacturer is working with Android.  With Resound you still have to send it through a lapel clip.  You have to wear a little clip for it to happen. 

Female Speaker:   For someone who hasn't worn hearing aids yet, can you give a range of prices from most exotic to whatever? 

Erin:   It will be about $1200-$2900 each for the most premium. 

Lower than $1200 is available if we go with older technology. 

In my clinic is a program called Lend An Ear.  If someone donates an unneeded hearing aid, that will go toward people who can't afford them.  It's a used hearing aid that is sent to the manufacturer and sanitized. 

If anyone wants to donate, I have a list of people waiting for them. 

Male Speaker:   Some of you may be listening to CBC FM which changes around 2:00 to another type of music.  When they do that, they have a short program which represents a type of music between the two types.  It's called "Shift."  But guess what I heard instead by accident?  I'll let you figure it out!  It makes me smile. 

People are concerned about not being able to hear me coming in a car.  There's no reason not to put a device in a car…

Erin:   I think the same thing could be said for bikes. 

Thanks for attending our sessions today and if you have any other questions please let me know. 


[End of Expo Talks]