Dr. Wright's Blog

Arthritis and Hearing Loss

Person with arthritis rubbing a sore hand.

 

If you’re living with arthritis, you may be at risk of developing hearing loss. And while the disease may affect the systems needed for hearing, often it’s the drugs used for arthritis treatment that is the culprit behind hearing loss.

Arthritis and hearing loss

Arthritis is a common condition. According to the Arthritis Foundation, 1 in 5 Canadians live with arthritis; more than half are under 65.

This 2018 study in Clinical Rheumatology showed that rheumatoid arthritis and systemic autoimmune disorders are associated with hearing loss. Previous thinking was that the inner ear was an “immune-privileged” site, unaffected by autoimmune diseases.

Sensorineural hearing loss is most commonly associated with autoimmune disorders. This type of hearing loss can make it hard for the brain to interpret sound.

Conductive hearing loss (when sounds can’t get through the outer or middle ear) may also occur.

Or a person may have mixed hearing loss in which both types of hearing loss are present.

Can arthritis cause hearing loss?

People with arthritis may experience hearing loss from the disease or from the drugs used for treatment. Causes may include:

  • High doses of aspirin (e.g. Bayer), ibuprofen (e.g. Advil or Motrin), or acetaminophen (e.g. Tylenol).
  • Prolonged use of medications used to treat arthritis.
  • Arthritis may attack the cochlea and small bones, joints and cartilage of the inner ear.
  • Rheumatoid arthritis (RA) can increase the chance of autoimmune inner ear disease (AIED) and hearing loss.

What symptoms of hearing loss are caused by arthritis?

Pinpointing arthritis or arthritis medications as the root cause of hearing loss can be difficult. People often report:

  • Speech may seem muffled.
  • Trouble hearing with competing background noise.
  • A feeling of fullness in the ear.
  • A ringing or other sound in the ear.
  • Dizziness, issues with balance, or vertigo.

Symptoms of hearing loss should be treated as early as possible. An Audiologist can conduct a complete Hearing Evaluation.  With your permission, the results of the Hearing Evaluation will be shared with your doctor or rheumatologist.

How do you treat arthritis-related hearing loss?

The main focus for treating hearing loss due to an autoimmune disorder like arthritis is preserving hearing. Your doctor may consider alternative medications or options such as steroids, vasodilators that improve blood flow to the ear or anti-inflammatory drugs.

Hearing aids can’t restore hearing, but they will help you hear and communicate better.

Tinnitus can be managed using Tinnitus Retaining Therapy. Learn more about this gold standard in tinnitus treatment here.

How is rheumatoid arthritis linked to hearing loss?

RA can damage the nerves or tissue in the ears that allows us to hear. This puts people with RA at risk for hearing loss, autoimmune inner ear disease, and damage to the bones and cartilage in the ear.

Up to 75% of people with rheumatoid arthritis may experience sensorineural hearing loss. However, people with RA may also have conductive hearing loss if the outer and middle portions of the ear are damaged.

Risk factors include:

Exposure to noise, smoking, alcohol

RA medications

RA-related ear damage

If you have rheumatoid arthritis, make sure you pay attention to your hearing and discuss any changes you notice with your doctor. You should also have a Hearing Evaluation baseline on file and get your hearing retested every 1 – 2 years.

Does osteoarthritis cause hearing loss?

Yes, osteoarthritis can result in hearing loss. This is because osteoarthritis breaks down joint cartilage. The body responds to the damage with an abnormal repair mechanism that changes bone structure.

Studies have shown a higher occurrence of abnormalities in the middle ear in people with osteoarthritis. Cartilage degenerates in the middle ear ossicles or cochlear capsule.

People with osteoarthritis also report more complaints of tinnitus.

What is Autoimmune Inner Ear Disease?

Though rare, Autoimmune inner ear disease (AIED) occurs in just under 30% of people who have another autoimmune disease such as rheumatoid arthritis.

With AIED, the immune system attacks the inner ear. Hearing loss can often start in one ear then move to the other ear over time.

AIED can be treated, and as with other autoimmune disorders, preservation of hearing should be a priority as early as possible.

 

If you have arthritis, let your Audiologist know. If a friend or loved one with arthritis is experiencing tinnitus or difficulty hearing, encourage them to book an appointment.

Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921.

 

Hearing Aids: Choosing The Right Ones

An Audiologist helps a customer choose hearing aids at Broadmead Hearing

This post has been updated from the original 04/19/2013. Lots of hearing aid features added since then!

How do you find the right hearing aids?

I had a client who was ready to start the process of getting hearing aids. He’s planning to retire in June and wanted to use his current benefits to pay for the hearing aids. After completing a Hearing Evaluation and giving him my recommendations, he left to consider his options. A few days later, he walked into the office to show me a spreadsheet that he created. I love this type of person - someone who is an information-gatherer and an analyst of information.

What you should consider when comparing hearing aids

Hearing aid technology is continually advancing. When I first wrote this post, features that are standard today, such as Bluetooth® wireless connection, tinnitus relief, and rechargeable batteries weren’t even available. A recent example is the Mask Mode feature introduced after the pandemic required us to wear face masks.

Your Audiologist will recommend hearing aids that are best suited to you after a Hearing Evaluation based on your case history, test results, and personal preferences. If you want to do your own research, here’s what you should look for:

#1. Hearing Aid Style

There are 6 main hearing aid styles named for where the hearing aid is positioned in or on the ear. Each style is best suited for specific factors such as the degree of hearing loss, the size and shape of the inner and outer ear, ease of handling and personal preferences for technology, shape and colour. You may often see each hearing aid style called by its short form (e.g. BTE).

Completely-in-the-canal (CIC)

Invisible-in-the-canal (IIC)

In-the-canal (ITC)

In-the-ear (ITE)

Behind-the-ear (BTE)

Receiver-in-the-ear (RIC)

Read more about each hearing aid style here.

#2. What is the best hearing aid brand?

It really depends on what you need and what a manufacturer offers. Some brands focus on a particular range of hearing loss, while others offer rich features. Dr. Erin Wright talks about new hearing aid features for 2021 from the big brands in this video. Because we are independently owned (not owned by a manufacturer), we can choose hearing aids from all manufacturers.

#3. What colour are hearing aids?

When you wear hearing aids every day colour preference is important! Colour options range from blending with hair and skin tones to fun shades that make your hearing aids a fashion accessory.

A row of hearing aids in various colours

#4. Hearing aid batteries

Cost, power, how well fingers and hands can manage small items, and environmental concerns may factor into battery choice. Disposable and rechargeable hearing aid batteries are now both options.

Rechargeable hearing aid batteries in a charger

#5. Connectivity

New hearing aids can transmit sound from Bluetooth devices, such as cell phones, tablets, or audio players. Smart phone apps (short for “application”), such as the Livio Edge Thrive app, connect to your hearing aids and allow you to adjust the volume, switch programs, track your health, alert an emergency contact if you fall, and more.

Smartphone app that connects to a hearing aid

#6. Warranty

Almost all hearing aids come with some type of warranty that covers loss and damage. Warranty duration may vary based on cost and technology level.

#7. Tinnitus relief

Some hearing aids offer tinnitus apps that help manage symptoms. An app can be part of a tinnitus therapy program.

#8. Accessories

Often hearing aids come with accessories such as:

  •  Remote microphones that help with group situations or in background noise
  • TV connection that plays your TV audio into your hearing aids.
  • Remote controls that allow you to adjust the volume.

Ask about which accessories come with the hearing aids and options for purchase.

Hearing aid accessories - TV Connection, Microphone, Remote

 

#9. Aftercare program

Hearing aid aftercare ensures that your hearing aids work their best for you. Aftercare often covers cleaning, adjustments, and visits to the hearing clinic. Aftercare with our Audiologists includes the lifetime of the hearing aids.

#10. Professional qualifications

There are different levels of qualifications to work in hearing health. An Audiologist has an advanced degree in the detection, diagnosis and management of hearing and balance disorders. An Audiologist has a master’s degree in Audiology, while a Doctor of Audiology has a doctorate.

So, what happened to that client?

In the end, different clinics recommended different hearing aid makes and models and only one of them was a lower price than the price I had quoted. To be fair, the competing clinic quoted a more basic and less reliable product. After comparing all of his categories, he proudly walked back into the clinic and announced, “You won!” He told me that the tipping point for him was professionalism in our office and our qualifications and experience.

The place to start is a Hearing Evaluation. If you have questions about hearing aids you can speak to an Audiologist about the options for your hearing needs and lifestyle.

To schedule a Hearing Evaluation with an Audiologist, please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921. Or request an appointment online.

What is a Baseline Hearing Test?

Baseline hearing test by an Audiologist at Broadmead Hearing

 

This is an update to Dr. Erin Wright's original post from 05/14/2014.

I had an interesting conversation the other day with a patient of mine who is a radiologist. We were talking about the importance of ‘base lining’. In his field, he is aware of the effects of unnecessary radiation exposure inherent in many important radiology tests. On the other hand, we agreed that a baseline hearing assessment is an easy and painless process with absolutely no downside. 

What does “baseline” hearing test mean?

A baseline simply means it’s your first hearing test. The baseline provides a starting point for comparison in the future. Because hearing loss usually occurs over time, an Audiologist will refer to the baseline to see how your hearing has changed. At a minimum, a client will have results within the normal range on file. 

I have also experienced many cases where a baseline “proof of normal” hearing helped my patient when they suffered hearing loss from an accident or work-related injury.

What does a hearing test measure?

We call a “hearing test” a Hearing Evaluation. That’s because in addition to the test measurements, we also ask you about health and lifestyle factors that may impact your hearing.

There is no pass or fail for the testing portion of the Hearing Evaluation. We test how you hear the sound that reaches your inner ear through the ear canal (air conduction) and sounds that are transmitted through the skull (bone conduction).

The value of a baseline

If you have an issue with your hearing health at any time, the baseline provides your Audiologist or physician with a valuable reference point to compare how you’re hearing today.

There are many reasons that your hearing can change such as:

  • Aging
  • Exposure to a loud noise
  • Heredity (hearing loss in your family)
  • Noise at work (Noise-induced Hearing Loss)
  • Ototoxic medications (harmful to the ear)
  • Illnesses (such as Meniere’s disease, meningitis, mumps, chickenpox)

What happens at a Hearing Evaluation?

Audiologist explaining the results of a hearing test

We begin by taking your case history in which we ask you about your hearing, your general health, whether you have a history of noise exposure or any family history that may affect your hearing.

Then you proceed to the soundproof booth for the familiar ‘press the button when you hear the tone’ exercise as well as more in-depth tests which measure:

  • Speech discrimination
  • Hearing speech-in-noise
  • Acoustic reflexes
  • Eardrum health
  • Eustachian tube function  

Once a full assessment is done, your Audiologist will clearly explain the results. If hearing loss is present, you’ll be shown where it’s occurring in the ear.

With your permission, we will send the results to your physician and provide you with a copy.

What if the Hearing Evaluation indicates hearing loss?

If your Hearing Evaluation indicates that you can benefit from amplification your Audiologist will make recommendations for the most appropriate hearing aids for you. There are many models, styles and colours available so your Audiologist will help you navigate the options.

How often should you have your hearing evaluated?

A Hearing Evaluation should be part of your regular health check-up routine. If you’re over the age of 50 and have never had your hearing tested, or it has been 2 years since your last hearing test, then it’s time to see an Audiologist.

Many doctors don’t include a hearing in an annual physical, so it may be up to you to ask. A hearing test is an easy process that everyone should consider as part of a regular health check.

 

If you want to schedule a Hearing Evaluation with an Audiologist, please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921. Or request an appointment online.

Is Your Hearing Making it Harder To be Social Again?

Broadmead-Hearing-People-Socializing-At-A-Long-Table

 

You’ve waited so long to be with people. But if you are exhausted at the end of the day, it may be that your hearing needs to adjust to being social again.

Why is hearing in social situations tiring?

Visiting with friends, returning to your favourite coffee shop, and group conversation in background noise all make your ears and brain work harder to process sound.

Because you've become used to one-on-one conversation, it can be harder to hear people who interrupt or speaking over each other in a larger group. Add a mask on top of those communication dynamics and it’s no wonder hearing can be more tiring now!

Being social again will take extra energy so give yourself some time to adapt.

Hearing loss takes extra energy

If you or a loved one has untreated hearing loss, your brain is already working harder than someone without hearing loss.

Here are 5 reasons untreated hearing loss takes more energy:

  • It’s harder for the brain to interpret the signals from the inner ear.
  • Your brain is constructing meaning from missed sounds.
  • Energy spent guessing at what’s been said.
  • Figuring out context for missed words.
  • Reading lips and concentrating on facial gestures and body language.

All that extra effort can leave you feeling drained by the end of the day. And because the energy spent offsetting hearing loss is diverted from other parts of the brain, cognitive functions like problem-solving and memory can also suffer.

Wait, did you know you hear with your brain?

Broadmead Hearing - You Hear With Your Brain

Your ears deliver sound signals to the parts of the brain that process auditory (relating to the sense of hearing) signals. The brain makes sense of incoming signals by turning noise into speech or sounds. This is called auditory processing.

3 parts of the brain work together to enable hearing:

  1. Broca’s Area: speech production (ideas & thoughts become words)
  2. Temporal Lobe: auditory processing
  3. Wernicke’s Area: understanding speech

Hearing loss is the reduced ability to hear sounds. It’s like an incomplete delivery of information to the brain. The parts of the brain involved in hearing have to work harder and that is why overcoming hearing loss when you’re being social is tiring.

How can an Audiologist make your hearing "social-ready" again?

An Audiologist can ensure your hearing is ready for social situations. The first step is a Hearing Evaluation so the Audiologist can make an appropriate recommendation for your hearing.

Take our Online Hearing Check to find out how well you’re hearing.

Hearing aids can reduce social fatigue

If hearing aids are recommended, they will ease listening effort in social situations.

Hearing aids isolate the sounds you want to hear and put the sounds you don’t want to hear in the background. While it’s not possible to restore lost hearing completely, hearing aids help fill in the gaps for your brain that hearing loss creates.

Hearing aids assist by:

  • Making it easier to hear sounds and speech in different listening environments.
  • Amplifying sounds you want to hear.
  • Reducing background noise.
  • Mask Mode apps boost sound in the frequencies that a mask muffles.

*To find out more about communicating with masks and Mask Mode on hearing aids watch Audiologist Nina Perisic’s Communicating with Masks video.

If you already have hearing aids

It’s important that you don’t “make do” with your current hearing aid settings if they’re not working optimally in this listening environment. Simple actions can be taken that will help you hear better.

An Audiologist will:

  • Adjust hearing aid settings for an increase in background noise.
  • Set your hearing aids to Mask Mode, if available.
  • Change the volume setting – for a temporary volume boost.
  • Show you accessories such as remote microphones that pair to your hearing aids and help you hear a single speaker in a noisy environment like a coffee shop.
  • Set up Bluetooth™-enabled hearing aids to stream calls, TV, and music.

These are still unusual times

You are still working harder communicating with masks on top of hearing loss and that takes extra energy whether you have hearing loss or not. If you need help during this transition time, please do reach out to our Audiologists.

Call us or request an appointment online to schedule an appointment: Broadmead Hearing Clinic: 250-470-2926 or Oak Bay Hearing Clinic: 250-479-2921.

 

Photo by Kevin Curtis, Unsplash

Noise Exposure In The Workplace: Is Your Work Too Loud?

Noise exposure in the workplace, including at the gym

 

I joined a new gym this month which is great for my health and fitness. But as I sat listening to the music increase in volume for the 60-second sprint on the stationary bike, it got me thinking about noise exposure.

Is your workplace too loud?

The leading cause of hearing loss is noise exposure, which ironically is also the most preventable form of hearing loss. For many people, the gradual decrease of hearing over time is not enough of a “cause and effect” to take more care in a noisy environment. This new gym I joined is fantastic, but I wondered about the trainer’s hearing health working in this loud environment for 4 hours a day.  

The impact of noise at work

More than 11 million Canadians have worked in a noisy environment. Of course, almost every workplace will have some level of noise. Whether the sound level is excessive depends on the risks associated with mental and physical health.

Excessive noise in the workplace can lead to:

  • High blood pressure
  • Sleep disturbance or insomnia
  • Noise-induced hearing loss (NIHL)
  • Tinnitus
  • Difficulty concentrating
  • Work-related stress

Occupational health and safety legislation helps protect workers from excessive noise. Remember – it’s not just obviously loud noise like a siren or saw that can cause hearing loss. For example, we have clients who worked below deck in a ship who have hearing loss after years of exposure to the low thrum of the engines. Less-obvious workplace noise – such as workout music – can be just as harmful to hearing health.

Allowable noise limits

So how much workplace noise is too much? This table from Statistics Canada shows how much noise is allowed in a workplace.

Stats Can Workplace Noise Limits

A sound’s loudness is measured in decibels (dB). For context, a conversation is about 60 dB, regular office noise is 70 dB, a chainsaw 106-115 dB and a gunshot or siren at 30 metres (100 feet) is 140 dB.

How can you tell if a workplace sound is too loud?

A loud workplace can cause occupational hearing loss with sudden, damaging noise or exposure to harmful noise levels over time.

Signs your workplace may be too loud

As a rule of thumb, if you’re a metre away and have to use your voice to be heard, the noise level may be around 85 dB.

Other indicators that it’s too loud may be:

  • Trouble hearing another person talk over the sound
  • Raising your voice to be heard
  • Ringing in your ears at the end of your workday
  • Other sounds seeming muffled or unclear after your workday

While apps on a smartphone or tablet can measure noise levels, they’re not sensitive enough to offer valid data. For assessing workplace noise levels, the accuracy provided by a calibrated external microphone is required.

Workplace hearing conservation programs

Broadmead Hearing - Noisy Construction Site

In workplaces in BC, the allowable noise limit is 85 dB over 8 hours. Impact noises, such as hammering or pile driving, must not exceed 140 dB.

According to WorkSafe BC, to reduce worker exposure to noise, a company will have a hearing conservation program in place that includes:

  • Noise measurement
  • Education and training
  • Hearing protection
  • Engineering controls
  • Identifying areas with hazardous noise levels
  • Hearing testing
  • Program review annually

If you’re concerned about noise levels at work, speak with your employer. Measuring the noise is the starting point.

How can you protect your hearing?

First, be aware of how loud a noisy sound is and how long you’re exposed to that sound. We think of it like this:

Loud enough x long enough = hearing loss.

It is hard to understand what is really happening in the ear during exposure. The most proactive step you can take is consistently using hearing protection. We offer various models of custom earplugs, including noise breakers for work, motorcycle ear molds that help eliminate wind noise, and custom earbuds for iPods. If your hearing has already been damaged, hearing aids will help preserve the hearing ability you have left.

As for me, I think I will try to be a role model for those around me and put in my custom hearing protection when I clip on my heart rate monitor. 

If you want to speak with an Audiologist about noise-induced hearing loss or custom ear plugs please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921. Or request an appointment online.

 

This post has been updated from the original which was published 02/13/2015. We're happy to report that Erin is still going to the gym.