Submitted by Erin Wright on Thu, 08/05/2021 - 12:26
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)
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.
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.
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
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
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:
Education and training
Identifying areas with hazardous noise levels
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.
Submitted by Erin Wright on Thu, 06/17/2021 - 07:56
Dr. Erin Wright shares what’s new in hearing aids for 2021 for each of the major hearing aid manufacturers and covers the highlights of their latest technology releases.
You will learn about:
The hearing aid features that are considered standard now
Research in the field of hearing restoration
The newest products from: Signia, ReSound, Phonak, Starkey, and Oticon
What's new in Apps & Accessories
This talk was originally presented as part of the Healthy Hearing Online Expo.
Read the video transcript:
What is hearing restoration?
Okay, so let's start with the technology side of things. So, I'd like to start off with a little bit of research that's being done around the field of hearing restoration. So there's a company called Frequency Therapeutics, and Frequency Therapeutics is a pharmaceutical company that's looking at innovative ways to regenerate cochlear hair cells. So in this image, you can see this beautiful black and white picture of a healthy cochlea. So the cochlea, one of the main structures in the cochlea are these hair cells. And you can see there's four rows of the hair cells. And in 90% of people, it's those hair cells that become damaged and they don't regenerate. So we don't hear at the level of our cochlea. But the cochlea is very important because it's the organ that changes a sound from a physical sound wave into an electrical impulse. And then that electrical impulse travels up the auditory nerve to the auditory cortex, which is where we perceive the sound. But if the hair cells are damaged, that signal doesn't get translated, and the sound doesn't get to the brain, and you don't hear it.
So, Frequency Therapeutics has promising phase one clinical trials that have been shown to help with word recognition. And they are releasing their phase two results in early 2021. So currently, we are not in a stage of generally having this hearing loss be medically correctable. So the current practice for managing hearing loss right now is managing a hearing loss through amplification. So, that's where we're going to go next is what features are available in the market currently to manage people's hearing loss. So, a lot of times people come into the clinic, when we're trying to pick out a hearing aid they say, "You know what, I'm a Luddite. I don't need a hearing aid that's going to connect to my phone. I don't use any of that technology. I don't want to pay for it." And I can understand that. It seems as though it would cost more money to have a hearing aid that had that connectivity than one that doesn't. But now, a lot of these features are standard in every hearing aid by every manufacturer at every price point.
Standard hearing aid features
So, these features like connectivity and rechargeability have been around for a number of years now, and it isn't something that makes a hearing aid more expensive. It's just standard in technology. What makes a hearing aid more expensive, one than the other isn't necessarily features like this, it's the chip, the actual computer chip inside the hearing aid that does a better job or a less a better job of analyzing the sound scene and making decisions about how best to process that signal. So let's talk about each manufacturer specifically or some of the manufacturers that have released something new in the last year. And we can see what their new features look like.
Signia hearing aids
Signia which used to be a company called Siemens launched this particular form factor of hearing aids just recently, just March of 2021. So interesting we've got 55% of the people that are voted. I'll just give people 10 more seconds to give me their opinion about this form factor. This is quite interesting. It's not actually what I thought people would say. I like it. Okay, I'm going to end the polling here. Now, check it out, 50/50 pretty much. Wow, I'm surprised. When I saw this hearing aid I thought people wouldn't like it. That people would maybe think, "Why would I want to be looking like I'm wearing headphones all the time? Doesn't that seem like I'm distracted or maybe not in the moment with somebody because I've got headphones in?" But it looks like 49% of you love them. They look cool like headphones not hearing aids, and 51% of you don't like them.
This is Signia's idea as well is that there is a portion of the population that avoids or delays treating their hearing because of the stigma around being seen as wearing hearing aids and the things that are around that. So Signia launched this hearing aid called The Active Pro, it's what they call it. So there's two levels of this hearing aid. It's a hearing aid primarily that looks like a headphone. Now, Signia has their full line of technology, so all of their hearing aids in all of their different form factors.
So they have all of these different styles of a hearing aid. So the way the hearing aid looks or fits in your ear, whether it's in your ear or behind your ear doesn't really affect the price too much. It's just physically what somebody feels comfortable wearing cosmetically, as well as what's going to be the best acoustical solution for their hearing loss. So, Signia has launched this product, The Active Pro, for people who may feel more comfortable with that particular form factor of a hearing aid. Also, you can see this image here of that, a hearing aid which is called the Styletto, which is another innovative form factor that Signia has launched.
Signia has a new chip that they call Xperience, or X, the X chip and The Active Pro has been launched in this X chip. And one of the things that the X chip is doing is it includes motion sensors. So hearing aids, obviously have microphones and have acoustic sensors where the sound comes into those microphones and the acoustic sensors of the two microphones on the hearing aid are constantly making decisions about what to do with that information. So, an example of that would be that you're at a restaurant. And the acoustic sensors realize that this is a noisy place, and that you want to hear the person that presumably you're looking at. So the hearing aids put the microphones in a directive sort of narrow beam bandwidth, so that it's focusing more on what you're looking at.
The addition of motion sensors just adds to the functionality of these hearing aids because let's say you leave that table. You get up and walk out of the restaurant. Now, the hearing aids if they only have acoustic sensors are going to still be in that narrow band of directionality. But presumably you want to hear the person that's walking next to you. So after six steps, the motion sensors realize that you're no longer sitting but now you're moving. And the movement makes the motion sensors and the acoustic sensors work together to relax that directionality so that you can hear the person that is walking next to you. So, that is a great new feature that Signia has launched in their X platform.
The other thing that they have unique to their manufacturer is called their Own Voice Processor. So, the Own Voice Processor is a technology from Signia that tries to recognize the person's voice. And we train it to learn that voice in the clinic when they first get fit with their hearing aids. And then it doesn't amplify their voice in the same way that it amplifies speech around them. So historically, with hearing aids, there's always been complaints about people hearing their own voice too loud or feeling like their own voice is echoing. There's a number of factors that are involved in that, but this particular proprietary way of managing that by Signia has definitely been helpful.
ReSound hearing aids
Okay, so let's move to ReSound. ReSound is another of the manufacturers and ReSound has always been an innovative technological company. They were the first company to introduce Bluetooth into a hearing aid in 2012. They were also the first company to launch a receiver in the ear hearing aid, which is now about 80% of hearing aids that are out there. So, ReSound is always coming up with ways to innovate. Sometimes they're good, and sometimes they don't work. But they're courageous at introducing new technology into the market. So what they've done with their new hearing aid, called ONE is introduced a microphone into the receiver. So, can you see on this picture, there's a little hole, and the little hole is right here next to the... Whoops, that didn't work. Wow. The little hole is right by that wire that's feeding into the hearing aid. And that's an actual microphone.
So now this hearing aid has two microphones that are on the back of the ear, which is what every hearing aid has, an additional third microphone in the ear canal that is communicating with the three microphones on the other ear through a near field magnetic transmission. So, you've got a six microphone system that is working to enhance the natural sound quality of the room around you. So when you have normal hearing and you're not wearing a hearing aid, we rely on what's called the pinna effect. So the pinna is the technical name for your outer ear, all these folds that collect sound and direct it into the ear canal. So the pinna effect is important. It enhances sound at the very frequency where most of the speech sounds occur.
When you have hearing aids with microphones behind the ear, you lose that pinna effect. So the manufacturers employ correction factors to account for this, but the correction factors are never good as the real thing. So ReSound is trying to fix that problem by adding this third microphone. Now, this has never really been able to be done before because when you have a microphone that's that close to the speaker at the end of the hearing aid where the amplified sound is coming out. It's a recipe for feedback. So feedback is when a hearing squeals. And that happens because amplified sound leaks out of the hearing aid and leaks back into the microphone and gets re-amplified. So when amplified sound is re-amplified, we get feedback. When you have a microphone and a speaker that close to each other, you can see how that would be possible.
ReSound has launched a pretty sophisticated feedback cancellation algorithm into their hearing aid so that they can accommodate this microphone in the ear. One of the benefits of this is wind. It really does a much better job at being able to hear outside on a windy day, if you're going for a walk with a friend and it's particularly windy, this third microphone can reduce wind by up to 19 decibels. So, it's pretty effective. So this receiver they call it a Murray receiver, mic and receiver in the ear, and it's brand new as of November 2020.
Phonak hearing aids
Our next manufacturer that I'm going to talk about is Phonak. So Phonak launched their new product called Paradise in August of 2020. So it's been launched with a new and faster chip that is called Prism. So this chip, the faster they can process the signal, the better the hearing aid does it correctly analyzing that sound signal. So one of the best features about this is they've added the motion sensors just like the Signia product. So, the Signia product and the Paradise product both have those acoustic sensors and the motion sensors working together. In addition, this Phonak Paradise product is one of the best hearing aids for connectivity. So they can connect to eight different Bluetooth devices and two devices at the same time.
Hearing aids have always been able to pair to Apple iPhones or iPads for quite a long time. Phonak was holding out to launch a product that could be connected to any Bluetooth device which they have done with this Paradise product. So we can connect it to any Android, any technology that has Bluetooth can be effectively paired to a hearing aid. So even things like an amplify stethoscope or a Bluetooth stethoscope can be paired to a hearing aid. So, things that have Bluetooth can be paired to these hearing aids so it opens up a few more options for people who have difficulty with certain types of sounds.
The other thing that this hearing aid in addition to its faster chip and better sound quality. It's a truly hands-free phone call. So, with other hearing aids that connect to phones, you have to answer that call on the phone and speak into the phone for the other person to hear you. What Phonak has done is made the microphones on the hearing aid pick up the speaker's voice. So when you get a call, you can answer the call by double tapping the hearing aid, that answers the call, and then the microphone on the hearing aid picks up your voice, sends it back to the phone for the other caller. So you can effectively leave your phone in your purse, and you would get a call and say call from Broadmead Hearing Clinic, and then I would tap my hearing aids, answer the call, take that call and then tap it to hang up. So, it's truly hands free, which is fantastic.
In addition to phone calls, you can stream any audio, so music or audio books, and you can do the same thing. You can tap to stop the streaming and tap to start the streaming. I'm just making a little bit easier for people with dexterity issues where it's hard to find a physical button to push the button to answer the call. They're just slowly introducing features that make things easier for people.
The other thing Phonak has is a prescriptive algorithm that they use in calculating their sound for people who have more severe hearing losses. So, people with more severe hearing losses have different challenges with amplification than people who have mild hearing losses. With severe hearing losses, sometimes, one time I heard somebody describe it where it's not just a matter of making things louder because louder can be too loud. So imagine that with normal hearing, imagine you have a volume dial. And you can hear when the volume dial is at one, and it's painful when the volume dial is at 10. When you have severe hearing loss, what happens is maybe you can hear when the volume dial is at seven, and that at eight and a half, it's too painful.
So, your dynamic range of hearing shrinks on both sides where instead of having this range where we can fit all of the sound into, now the range shrinks not only on the soft sounds, but also the loud sounds. So, Phonak has come up with a way to compress sound without affecting the overall clarity. So, it's genuinely a really good product for people who are in that category of hearing loss that's considered more severe. For that particular population as well, Phonak has developed an app called myCall-to-Text, which I really love because historically, phones have understandably been challenging for people with hearing loss. When they put a phone to one ear, they don't have any of their speech reading capability. They just have to rely on the hearing in that one ear on top of a hearing aid.
Now with Bluetooth connectivity, you can stream that phone call into both hearing aids. And simultaneously, you can look at your phone and read real time captions. Just like you're looking at these real time captions right now. That's what it would be like when you're on a phone call. So if you're on a phone call to something important where you need to get information of phone numbers or different things where you feel maybe less confident with your hearing. A lot of times people will say, "I'll just pass the phone to my partner and they'll take that call." Well, hopefully people can become independent with taking those calls. Look at that transcript on the real time caption which can be saved on your phone for reference later. So you can go back to the conversation and reread the conversation using those real time captions.
This is a subscription service. So there's an annual cost to having it. If you call somebody else who has the app. So, if you're frequently talking to your sister... It's a free app to download if you talk to somebody else who's downloaded that app that call is free. But maybe your doctor's office is calling you and they won't have the app and then that would be more of when you would want to have the subscription service. So Phonak has come up with that app as well called myCall-to-Text.
Starkey hearing aids
The next hearing aid manufacturer we're going to look at is Starkey. So, Starkey is an American company and what they have new in 2021, they have a full line of products as well. But what's new in their particular product line is a rechargeable in the ear hearing aid. So rechargeable hearing aids have been fantastic, game changing for a lot of people to not have to deal with batteries anymore, but you have to have had it sit behind your ear in order to take advantage of the rechargeable feature. Starkey is the first and only manufacturer that creates a product that fits in your ear, and is also rechargeable.
So, in this past year of mask wearing, people have... I mean six or seven people a day say, "I've got so much going on behind my ears. I've got the masks, my glasses, my sunglasses, my hearing aids, it's too much." So it's understandable, it is too much. It's valuable real estate behind the ear. And sometimes people say, "Well, if I'm going out, I'm not going to wear my hearing aids because I'm going to have to wear my mask," and they feel like they need to choose between those things. Starkey has this technology in the ear rechargeable where it's just fitting in the ear canal leaving the space behind your ear free for those other things like masks and glasses.
Starkey has some pretty innovative artificial intelligence that they're using. They have a feature called Edge Mode. And what Edge Mode is Starkey is utilizing artificial intelligence. And Edge Mode is a feature in the hearing you that you have to activate. So when you would do that is if you were in a restaurant and it was quite noisy, you would double tap the hearing aid signaling to the hearing aid that you want it to go into Edge Mode. And what Edge Mode does is it takes a momentary scan of the environment to determine... It's basically you're telling the hearing aid, "I'm struggling in this environment, help." Double tap the hearing aid, it scans the environment and tries to apply noise management to help pull that signal out of the background noise. So, that's Starkey.
Oticon hearing aids
The next manufacturer that I want to talk about is Oticon. So, Oticon released their new chip called More in January of 2021. Now, every once in a while we encountered technology that moves the hearing aid industry forward in a big way. So in 1996, Widex came out with the first digital hearing aid. Now there's nothing other than digital hearing aids. In 2012, ReSound came out with Bluetooth hearing aids. Now every hearing aid has Bluetooth. And now Oticon has come up with a hearing aid that employs a different type of artificial intelligence than we've seen in the past. So for the last few years hearing aids have employed artificial intelligence in their hearing aid technology.
What that means is that the engineers feed hearing aids millions of sound samples and by millions in this specific case, specifically 12 million sound samples. So when we're relying on engineers to do this, we're relying on their ability to describe the sound. So Oticon is taking this a little bit further, one step further with a product, with a process called deep learning. Deep learning is sort of a next level of artificial intelligence. And it's the process that is used in computer chess games, that's used in Apple's face ID, facial recognition, as well as Tesla's self-driving cars. So, the chess game for example. People have fed or engineers have fed computers specific chess moves, but it's impossible to feed a computer every infinite possible chess move. So what happens is that the computer uses this deep neural deep learning to execute moves that it hasn't specifically been taught. So it allows the computer to make its own decisions in any given moment.
So, if we're asked to describe the difference between a cat and a dog, for example, we obviously intuitively know the difference. But when we're describing them, we might say that they're both animals, they both have four legs, they both have fur, they both have tails. And we might know what the difference is, but it might be a little bit hard to describe to a computer chip what these differences are. So when we rely on human engineers, we rely on their limited experiences and their descriptions of sounds. And when we can rely on a computer's ability to learn, we just get more specific, more sensitive classification of sound, which results in an overall better clearer sound quality.
My experience, I've been an audiologist for 25 years this year. And in my experience, so far, I've had a similar reaction when I'm fitting people with this hearing aid for the first time, which is this sounds clear. So, if you were listening to Christine's talk this morning, she was talking about a feature in hearing aids called, where we can gradually increase the sound over time. So rather than giving people all of the sound that they need on the first day, which can be overwhelming and harsh, what we've done is gradually up that sound over time. What I'm finding with this particular product is that at the full prescription, people's perception is that it sounds clear, including my own parents, who I've been fitting hearing aids with several number of years. Their impression right off the bat was clarity. And I had them write to the prescription right off the bat.
Often, I hear just words like this sounds tinny, or this is echoing. And that's understandable when the brain hasn't heard those high frequency sounds in a long time. But this is a new description for me in clinic. So each one of these iterations of technology, each time the computer chip gets a little bit faster, we're only improving the experience of the person who's wearing the hearing aids. So this is an exciting new technology for us to try in the clinic.
And finally, I just want to review apps and accessories. So, apps are actually a big thing now with hearing aids. We always have had the remote control, which has been very basic volume up and down or change your programs type of thing. Remote controls often come along with hearing aids, and they've been around forever. Now, with apps, the person using the app has so much more control over their overall sound quality than ever before. So in previous sessions, today, we talked a little bit about Mask Mode. But these apps allow people to change bass and treble. They allow them to lock in the directionality of their microphones. They allow them to prioritize different signals in the environment. Sometimes I find people can be nervous about, well, I don't really need that. I don't want to fuss with them. And that's fine, 90% of the time hopefully the hearing aids will be automatic. But it's nice to have that control on your phone with you where if you are struggling, you have an avenue that you can deal with that.
The apps are only getting better. And as well with the apps, they have functions like find my hearing aids. So if you lose your hearing aids, you can go to the app and find them. You can also look at other data about your hearing aid like what your battery life is or what your average wearing time is. Some of those types of things. Some of them like Starkey, are even trying to combine things like fitness trackers with hearing aids, so it will actually track your steps. So you don't need an additional fitness tracker. So they're moving into a technology of hearables as opposed to just hearing aids.
And finally, with accessories, every manufacturer has their array of accessories that are devices separate from the hearing aids that connect to the hearing aids. So the best of those devices are going to be the TV adapter, which for many people is fantastic. One of the things about these new TV adapters is that it's better able to separate the background music from the actual speech. And oftentimes, people will come into the clinic and complain that the mixing of this signal is not good. And they can't hear the person talking, the actor talking because all they can hear is the background noise. These TV adapters do a good job at separating out that signal from the noise.
The other great accessory is a remote microphone. So a remote microphone is almost like a third hearing aid and fantastic for when you're with somebody who's at a distance from you. When you're in a car where there's other road noise, or especially if you're one on one in a restaurant. The partner could wear the microphone, it picks up their voice, and wirelessly sends their voice to your hearing aids so you could be in another room. For example, I was with my mom and we were at a museum that had a ton of people in the museum. And I lost her in the moment and I was wearing a microphone and I said, "Mom, I lost you. Put up your hand." And I could see her, in the sea of people I could all of a sudden I saw her hand come up because she could hear me from that distance. It's a fantastic technology.
What’s best for me?
Finally, I just want to conclude by just wrapping up and addressing the question of okay, there's all these new things and all these new features and all these new hearing aids, which one is the best one for me? The best one for you is, you can't say. It's such a unique individual decision, but the best thing for you is to see an independent audiologist and describe to them as best you can your environments, and your needs, and your budget, and your lifestyle. And that audiologist will listen to those things and go through their bank of information and try to match you with the technology that's going to best suit your particular needs.
Using caution when researching online
I would just caution you, and just be aware of what you're looking online, what you see online, because online can be confusing. Particularly, Signia has a branch of their business called hear.com. And hear.com is a marketing machine that if you ever type the word hearing into your computer, you're going to get advertisements from hear.com saying that there's some sort of German engineering hearing aid that's better than anything else. It makes it seem like it's something incredible and new. So just be aware of the advertising that you're seeing online. Also, be aware that some of these websites that seem neutral or consumer report types are actually owned by manufacturers. So they will do a consumer report type review on the hearing aids, but it's owned by that manufacturer. So, it's obviously going to make that hearing aid seem better than the rest.
The best thing you can do for your hearing loss is to trust that the audiologist that you're with is independent and that they are going to provide you with all of the options and narrowing those options down to figuring out what is the best thing for your particular lifestyle. Okay, thank you so much for attending. I'm impressed with how many people showed up today. I'm honored that you'd spend your afternoon listening to me talk. So, I'm opening the floor to any questions.
Questions & Answers
Doran: That's great. As usual, Erin, that's fascinating. And you can see there is a lot of information packed into just what's new this year. So, Erin's advice of see an independent audiologist is a good one. It's different than consumer electronics, or a car like I keep saying where you can just go online and figure out which Honda Civic is the best for you. It's frustrating for us to see how much misinformation is there, how much people with alternative motives are reviewing hearing aids and putting those reviews out there. So, you're best to see your independent audiologist. Erin, just a couple of questions for you coming through. First one is a popular one. Why are hearing aids so expensive? And people are always comparing them to consumer electronics again, to IMAX or TVs? Why are hearing it so expensive?
Dr. Erin Wright: That's a good question, and it's a popular question. And there's a lot that goes into them. I mean, namely the research and development. So you've got teams of PhD level people and engineers trying to create these tiny little chips to fit into hearing aids that can process sound. So you've got these big manufacturers with a lot of research and development costs. And the problem as compared to companies like Apple where everybody buys an iPhone, there's less people out there to recuperate the cost of their research and development. That's one of the factors.
The other factor is that you are paying for the professional services for the life of your hearing aid from an audiologist. So if you were to add up how much you pay your accountant, imagine over five years, what are you paying that professional person to manage your finances, your financial planner, or your accountant. You have a professional service on top of an electronic device. So it's not like Best Buy where you can just walk in and buy a TV and you never have to go back there. It's a combination. And currently, it's a bundled combination where you're not really seeing what you're paying for the hearing aid versus the professional services. So, that in combination with the research and development is what goes into the cost of them.
Doran: Yeah, for sure. And if I could just add, you talked a lot about the chip. A lot of that is the programming. Those are proprietary programs that are running and it's very complex, like you mentioned. It's sound compression. It's its connectivity. These are supercomputers that fit behind your ears. Let's not talk about the battery technology involved. So, I would say, yeah, there's a lot that goes into putting these things behind your ears for sure. Erin, can you just talk about Signia for a second? A couple questions about that. That's a newer name in the market. What's their history?
Dr. Erin Wright: Signia is a private equity firm that purchased the hearing aid division from Siemens about four years ago. And Siemens agreed to let this private equity firm use their name for about three years. And then they had to switch to Signia. So, it's just been basically a Siemens hearing aid that's been purchased by a different company.
Doran: Okay, a couple questions about what hearing aid is good for music or what hearing aid is good for tinnitus. That's where your audiologist is going to come in where they know the entire range, what your specific listening situation is. So they're going to do a good job of picking that make and model out for you. But maybe just speak to who does a good job often is for music lovers.
Dr. Erin Wright: Well, for me, I want to answer the tinnitus one. We use Widex a lot for tinnitus because they have those fractal tones like Martina was talking about. And that has been shown to be less cognitive load than some of the white noise maskers out there on the market. For music, there was a time about four years ago where certain manufacturers had better microphone technology that was really making a difference for music processing. Now it's leveled out a little bit. There isn't, I don't think, I wouldn't necessarily rule out a certain manufacturer with music anymore. That used to definitely, definitely be the case. But now with a lot of their new chips, they're all employing some of these microphones with better ways to tolerate loud sounds.
Doran: For sure. Now, what about refreshing your hearing aids? Linda's asking her hearing aids are five years old? Should she look at new ones? Or what do you usually recommend for the age of what you're wearing?
Dr. Erin Wright: Well, that's a good question. I mean, the average age of people replacing their hearing aids would be five years old. But that would be an average. So I would say to anybody in that situation to look at how they're doing with their hearing aids. If their hearing aids are five years old, and they're not feeling like they're having any trouble. They've seen their audiologist. They've had those hearing aids checked and programmed to make sure that they're fitting their hearing loss. And if they're doing well with their hearing aids, that's great, then their problems are solved. If they're struggling with their hearing aids and finding they're asking for repetition, or finding the sound quality is tinny or harsh or annoying in any way, then there's definitely room for improvement and they could try different technology.
Doran: Yeah, so again, people are curious about the price. Can you give us a quick range about what hearing aids cost for a very entry level to the latest technology of bells and whistles?
Dr. Erin Wright: Sure, that's a good question. The very basic entry level technology is going to cost around $1,750 per hearing aid. And most people need them in both ears. So you're looking at $3,500. There's no tax on hearing aids. But that would be generally the price, and there's a lot that goes into those hearing aids. Those hearing aids are connected to Bluetooth, they're rechargeable, they're excellent. They've got excellent quality hearing aids with some features like impulse noise management. So, at $3,500 you're still getting a good product. The very premium, the most expensive hearing that we have is going to be about $2,850 each. Those would be some of the newer technology like that Oticon More hearing aid with that deep learning deep neural network that is employing some new features to help the hearing aid better analyze the environment around them, and make decisions about how to process a signal in noise.
So, the difference between any level of hearing aid really boils down to one feature, which is how does the hearing aid deal with a complex environment. And I hate using the word noise because a lot of people interpret that word to mean something annoying like traffic or a blender or a vacuum or people say to me concerts, that kind of thing. It's not noise as much as competing signals. So you might be in an environment where you're talking on the phone and you've got a TV, you've got a competing signal here. How does the hearing aid know you want to hear this and not that. And especially when that competing signal is also speech. So a classic environment would be like a cocktail party where there's a lot of noise, but that noise is people talking speech. So there's this speech that you want to hear and that speech that you don't want to hear. And that's a complex task that our brain does. And so some of the hearing aid technology is better than others at helping somebody focus in that particular environment.
Doran: Yeah, for sure. Now, that's a good time to set people's expectations, right? People want to put hearing aids in and have the hearing of an 18 year old normal hearing. We both know that shouldn't be the expectation. So, you're dealing with auditory processing, as much as what's going on just right inside the ear. It's the whole systems.
Dr. Erin Wright: Yeah, that's right. So, I mean, hearing aids are addressing one third of the problem. And that third is damage to those cochlear hair cells. And so, hearing aids are addressing one third of the problem. The other third is listening, and the other third is processing. So all of those things have to be firing in order for somebody to understand a message. So, a lot of people have the most difficulty hearing their primary communication partner because they might be at home reading the newspaper, and their spouse walks in and says, "Do you want to go for a walk?" And then the person with hearing loss will turn on, realize they're talking, know there's something about going for a walk, but maybe just missed out one word. And say, "Are you asking me to go with you? Or are you just telling me that you're going for a walk?" And then it just turns into a what?
So, the listening aspect of that is that the partner says, "Honey, yes." Allows that person to focus their attention, and get that listening aspect of the piece in order, then they say, "Do you want to go for a walk?" Now we're dealing with the hearing aids and the actual amplification of that person's voice, and getting that full signal to the brain. Maximizing your hearing is what we're dealing with as audiology with hearing aids. We're maximizing that third of the issue. The other third is about processing. So, processing is how well does your brain fill in the blanks.
So my best analogy around processing is looking at the TV show Wheel of Fortune, where sometimes you can see people who get the word when they only have two letters. And you think, "How on Earth did that person know that that word was banana when there was only one and in there?" And it wasn't that they saw it any better. It's that their visual cortex can fill in the blanks. And the auditory cortex is the same structure. So when you're not hearing the whole signal as you don't when you have hearing loss, we rely on the brain or the auditory cortex's ability to fill in the blanks. And so, for people who've had untreated hearing loss for a long time or degenerative auditory processing issues, there is more issues around filling in the blanks, so they might need 90% of that signal in order to understand the message.
If you have questions about this presentation, or want to speak with an Audiologist about about tinnitus treatment programs, please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921. Or request an appointment online.
Submitted by Erin Wright on Wed, 06/09/2021 - 11:42
Audiologist Martine Schlagintweit shares an in-depth view of tinnitus, its causes, and components of a successful tinnitus management program.
You will learn:
The definition of tinnitus
How often tinnitus occurs
Causes of tinnitus
Neurophysiological model of tinnitus
Can tinnitus be cured?
The components of an effective tinnitus management program
This talk was originally presented as part of the Healthy Hearing Online Expo.
Read the video transcript:
Martine: Hello, everybody.
Doran: Nice to see you. So yeah. So, I just want to say a couple words about your presentation. I mean, it's often misunderstood, so that's one of the reasons why we chose this as a topic. A lot of questions around what it is, the cause, the cure, so I'll turn it over to you for our Tinnitus presentation.
Martine: Thank you so much, Doran. Thank you for that introduction. Good afternoon, everyone. And thank you so much for joining us today at the Healthy Hearing Expo, our first virtual Healthy Hearing Expo, no less. I'm excited and so honored to present to you today, because tinnitus is one of the main reasons that people interface or seek audiological care. And it's a symptom that can have such a huge impact on people's quality of life. So, it's a great topic for us to discuss today.
What you’ll learn about tinnitus today
A couple housekeeping things here first: Through this presentation, we're going to define what is tinnitus. And we'll also look at how common tinnitus is, and identify the known causes for this symptom. Next, we'll unpack the neurophysiological model of tinnitus, which is the way that tinnitus is best explained by science today. And in the latter half of the presentation, we're going to talk about whether tinnitus is curable, and outline the journey of effective and successful tinnitus management.
It's my hope that, by the end of this talk, our audience will be able to define tinnitus, and explain it using basic physiology and the neurophysiological model, will be able to identify the common causes of tinnitus, and understand effective management strategies for tinnitus. But also, it's important that you walk away today with the knowledge of when it's important to consult your physician if you have tinnitus.
What is tinnitus?
So, what is tinnitus? Simply put, tinnitus is an involuntary perception of sound that comes from inside your head or ears, and which lacks an external source. Now, as a point of interest, the Latin root of the word tinnitus means to tinkle, which sounds kind of pleasant. But it's most often described as a ringing, buzzing, roaring, hissing, or even whooshing sound that comes from inside your head. Tinnitus is also typically associated with really negative emotions and reactions like you see in this Edvard Munch painting, titled The Scream, here, which actually many people believe to make reference to the experience of tinnitus. So, that's kind of interesting.
Now, tinnitus is a symptom. It is not a disease in and of itself. And it's incredibly common, especially among individuals with hearing loss. In fact, about 10 to 20 percent of North Americans, and about 85% of people who also have hearing loss, report chronic tinnitus. The prevalence increases with age and severity of hearing loss. And more men report tinnitus than women. And this actually relates to the leading known causes of tinnitus being noise exposure and hearing loss, both of which are more common among the male population.
Now, that being said, only about one in five people that have tinnitus are bothered by their tinnitus. And that 20% reports negative comorbidities that present with or as a result of their tinnitus. And these can be things like sleep disturbances, difficulty concentrating, social withdrawal, and in the more severe cases, emotional disturbances like anxiety and depression. I'm going to go back here. I'm interested to note, just because tinnitus is so common and we do have quite a few people in the audience today, who of our audience has tinnitus? So, I'm going to launch a poll here. And you're welcome to respond with the box that jumps up on screen. So, let's give that a couple minutes. Whoo, we're almost at 100%. Climbing...
Okay. So, let's give this another 10 seconds here. We've got about half of our audience responding. Okay. Five, four, three, two, one. Okay. I'm going to end polling there. And I'm going to share those results with you. So, we can see that about 80% of our audience today, of those that responded, actually experience some tinnitus. So, that gives you an indication that it is such a common, common symptom that many of us do experience at times. I'm just going to stop that there, and I'm going to close out that poll. And now, the problems in our audience may actually exceed that of the regular population.
What causes tinnitus?
And that may be because most of the clients that seek our services have hearing loss. And many of those clients have also been exposed to noise, which is the root cause of their hearing loss. Now, we know that noise exposure and hearing loss are the top known causes of tinnitus. But we should clarify that noise exposure alone, even if it doesn't cause a permanent hearing loss, can still cause tinnitus. And it often does. I don't know if anybody here has ever been to a concert, and afterwards, when they get home, their ears are just ringing as a result of having that noise exposure.
Other common causes of tinnitus include degenerative changes associated with aging; head, neck, or back injury; and medication side effects. And things like excessive ear wax, middle ear pathology, ear infections, temporal mandibular joint issues, and stress have also been demonstrated to cause tinnitus. So, we can see here that tinnitus has so, so many causes. And part of that likely relates to the fact that the auditory system only has so many symptoms available to it that it can present with, when things are changing or going wrong with it.
So, you can get tinnitus, dizziness or vertigo, hearing loss, pain in the ears, a sense of coldness or pressure, but that's about it. And so, that tinnitus is your auditory system communicating with the rest of the brain and body that things are going a little differently. Now, we've defined tinnitus as a symptom, and the experience of tinnitus as a symptom. But what actually is the tinnitus? What is responsible for our experience of that tinnitus? And essentially, tinnitus is the auditory nerves coding for sounds that are not present in our environment. So, in that sense, we can think of tinnitus as this extra neural activity that's present in our auditory pathway, which the auditory cortex, or the part of the brain that deals with sound, is correctly analyzing as a ringing, buzzing, or hissing noise.
Is tinnitus real?
Now, I'm interested to know, more as a point of interest, because I don't think there's great consensus on this in the field... But I'd like to know, from all of you, whether you think that the sound that people hear when they experience tinnitus is real, based off of this description we've just given. So, I'm going to add that as a poll. And feel free to vote, okay? And we'll let that go for about 20 seconds. Ooh, we're divided. I love it, contention in the audience. Okay. All right, 10 more seconds here. Let's see if we can get most of our audience voting. We're up to 70%. Let's see. All right. So, I'm going to end polling here. And I'm going to share those results with you.
And I'm delighted to know that most of our audience agrees with me that the sound that people hear when they have tinnitus is real. And the reason that I think that is because our auditory nerve is sending signals, up to the auditory cortex in the brain, that mimic that of sound. And that is very similar to the way it does so when there is an external sound. So to me, that is a real sound that people are hearing, whether or not other people can hear it too. So, I'd like to introduce you to the neurophysiological model of tinnitus in just a moment here. But in the meantime, I want to talk about the two different types of tinnitus.
Types of tinnitus
There's subjective tinnitus, or sensory neural tinnitus, which is thought to originate in the inner ear and central auditory pathways. So, those are the auditory nerves. And this is the most common type of chronic tinnitus. And subjective tinnitus is going to be the main focus of our presentation going forward. But we need to give objective tinnitus its moment as well, okay? Objective tinnitus is a sound that originates inside the body. It can be amplified, heard, or recorded by an observer. So, it is a real sound that we can even record and play for others.
Everyone should have some degree of objective tinnitus, because our physiological processes, like swallowing, digesting, popping our ears, etc. actually make sound. And that is sound that is generated inside the body. But in problematic cases, this type of tinnitus can be associated with injury, infection, or abnormalities to the anatomy of the middle and inner ear like, for example, twitching of our middle ear muscles, which we can then hear as a ticking sound. In these cases, treatment with medical or surgical intervention is often indicated. And most of the time, it will actually cure the tinnitus.
And so, that's why it's a really good idea to have your tinnitus observed and evaluated by an audiologist when you first notice it, because that may be you.
The neurophysiological model of tinnitus
You may be experiencing objective tinnitus that would benefit from medical intervention. Next, we're going to come back to our subjective tinnitus. And I'd like to introduce you to this neurophysiological model. It's the most established scientific description of how tinnitus is generated and perceived by the auditory system. So, Figure A here reveals the entire auditory network involved in the perception of tinnitus. Whereas, Figure B and C separate that out into what's called the Upper and Lower loops.
So, let's go in reverse here. I'm going to focus on Figure C first. This is the lower loop. And this demonstrates the subconscious pathway for tinnitus. And this involves the auditory periphery, so that's the ear, the nerve running from the ear, and the nerve fibers in the brain stem where they connect with what's called the limbic system. And the limbic system is the emotional center of our brain. It regulates the autonomic nervous system. And the autonomic nervous system is responsible for the body's state of fight or flight, or rest and digest. Okay?
And so, this subconscious pathway is the tinnitus being generated along the auditory nerve or in the ear, and communicating with that subconscious limbic system in the mid brain. In Figure B, we see our upper loop. And this is responsible for our cognitive processing and perception of the tinnitus. This loop also starts at the ear. But instead of stopping at the limbic system, it goes right up to the auditory cortex, which is the part of the brain that analyzes sound and assigns meaning to the sound. And then, the auditory cortex sends nerve projections down to the limbic system. And in this way, it further modulates our emotional and autonomic response to the tinnitus. Okay?
Now, the upper loop is most active during the initial stages of bothersome tinnitus, whereas the lower loop is most active during chronic tinnitus. So essentially, what's happening there is, as the person becomes aware of their tinnitus, cognitively aware of their tinnitus, they make decisions about whether this is a good sound or a bad sound, and may experience some confusion about where is this sound coming from. And that sends projections to the limbic system, or the emotional center, which starts to generate a reflexive response to the tinnitus, which impacts our whole body because it releases those autonomic nervous responses of fight or flight, and rest and digest.
Now, the block diagram can be a bit abstract. But I do like to include this figure here, because it shows you whereabouts these things are happening in the brain. Mind you, this figure in particular, is borrowed from research that actually looks at the brains positive response and reactions to music and pleasant sounds. Because incredibly, that process is very similar to the process involved in our reflexive responses to tinnitus. It's just that our emotional brain, the limbic system, has attached a label of threat to the tinnitus, whereas it has attached a label of friend, or pleasant stimulus, to the music.
Is there a cure for tinnitus?
So, here is the million-dollar question that I'm sure everyone would like an answer to today. Is there a cure for tinnitus? And the short answer is no. There have not been any safe or consistent treatments for tinnitus that can act to silence the noise or sound that people perceive when they have tinnitus. We cannot actually change the tinnitus, but we can manage our reactions to it. And by changing our reactions to the tinnitus, we can make it less of a problem for us, and we can avoid the adverse psychological effects of tinnitus. So, the key there is to learn to manage your reactions to the tinnitus. And the goal is to live well and feel better, whether or not that tinnitus persists.
Paths to successful tinnitus management
So, the first step in successful tinnitus management is to have your hearing evaluated by an audiologist to determine an appropriate treatment plan. The audiologist will determine whether the tinnitus is suspicious for an underlying condition that could benefit from medical or surgical intervention. And in this case, they will provide a referral to your primary care physician to get that under way. Provided there are no treatable underlying conditions, they will work with you to develop a personalized tinnitus treatment plan. And depending on the audiologist, this may follow a more structured intervention strategy, or a blend of several. And we'll take a look at those interventions shortly.
But first, I'd like to talk about when it's appropriate to see your physician if you have tinnitus. Now, in most cases, having tinnitus does not mean you have to see your physician. But in the odd time, such as in the case of objective tinnitus, you can benefit from seeing a primary care physician, or ear nose throat specialist. And indications that this would be necessary include: sudden hearing loss and tinnitus presenting together; injury to the ear, causing tinnitus; weakness or paralysis of the face that accompanies tinnitus; vertigo or extreme dizziness; ear pain with the tinnitus; blood or drainage from your ear. That's never good; single sided tinnitus; and pulsatile tinnitus.
Your physician or ENT specialist may order medical imaging and other test to further investigate that tinnitus. And the objective of those tests is to identify any causes of tinnitus that may benefit from that medical or surgical intervention. And if nothing is found, that tinnitus is considered idiopathic, or without cause... or without identifiable cause is a better way to put that. And in that case, medical clearance is given for that tinnitus. Now, people are often very, very disappointed with the outcome of medical clearance for their tinnitus, because they perceive that news as being the practitioner telling them to learn to live with it, or just get over it. And that couldn't be farther from the truth, because what that medical practitioner is telling you is that their portion of the diagnostic process is compete, and your tinnitus is in a management stage.
So, how do we manage tinnitus? There is two main approaches for tinnitus management strategies. And the first is to eliminate or reduce the perception of the tinnitus. And the second is to modify the individual's reaction to the tinnitus. And most clinical interventions that are being used today actually use a bit of both of these approaches. Starting with tinnitus retraining therapy, this is one of the more structured methods of tinnitus management, and has been available since 1990. So, it's been around for 31 years now. And this method is based off of the neurophysiological model of tinnitus, which was actually developed by Jastreboff, and later Jastreboff and Hazel, which are the developers of this tinnitus retraining therapy.
The goal of this treatment is to promote perceptual habituation of the tinnitus, as well as emotional habituation of the tinnitus. Habituation refers to the brain's ability to filter out repetitive sensory information. An example of auditory habituation that you might experience in your day to day lives, or might have come across at some point, is if you live in a quiet rural area, or visit a quiet rural area, and then move to a home next to, say, a train station or some source of noise. You may initially be bothered by that source of noise, as the trains are passing by your residence. It might even wake you up at night or prevent you from concentrating on the quiet activities.
But as your brain habituates to that irrelevant and unimportant signal, what you find is that you barely notice the trains going by. So, the attention is not being given to that signal anymore. And you can return to your quiet activities without too much annoyance, and sleep right through the night. So, the theory here, with tinnitus retraining therapy, is that about 80% of people with tinnitus, so those 80% that are not bothered by their tinnitus, have successfully habituated to the signal of their tinnitus, and no longer experience a limbic and autonomic response when they become aware of that tinnitus.
But the other 20% that are bothered by it need a little bit of support and guidance in figuring out how to decrease those responses. And they do that, through directive counseling, to habituate that emotional response, so learning how to recognize when one is experiencing an emotional response to tinnitus, and also learning to recognize when one is experiencing an autonomic response to the tinnitus, so going into a state of fight or flight, and using strategies to calm the autonomic nervous system, and allow us to disconnect those two events in the auditory limbic system.
Mindfulness based tinnitus stress reduction
Once the emotional response to tinnitus has been habituated, we can start to look at habituating the perception of tinnitus. And masking devices or hearing aids are heavily relied upon for the perceptual component of habituating tinnitus. Now, moving on to mindfulness based tinnitus stress reduction, I think that this is a really cool tinnitus management method. And it's adapted from from mindfulness based stress reduction, which developed by Jon Kabat-Zinn in the '70s. Now, this program was originally used to manage chronic pain and illness, and the adverse effects that go along with that. But Dr. Jennifer Gans is a psychologist down in California who best applied the concepts of mindfulness based stress reduction to the management of tinnitus in 2009.
And she had incredibly positive results. And it's unique from other tinnitus treatments because the point of entry does not actually have to be through audiology. And it's not actually necessarily delivered by these professions. Now, that's not to say that having your hearing tested, if you're going through mindfulness based tinnitus stress reduction, is not important. It's still going to be your first step. But engaging with this management program can be delivered by other professions like psychologists, counselors. And it's even offered as an eight-week online course now. The premise of mindfulness based tinnitus stress reduction is to reframe the individual's experience with bothersome tinnitus symptoms, using elements of yoga, relaxation exercises, and meditation.
And the purpose is to bring space between the perception of the tinnitus and our reaction to the tinnitus. So, it's not unlike TRT in that sense. It also encourages us to bring our reactions, judgments, thoughts, and feelings, and stories that our brain creates about our tinnitus to our awareness and evaluate them. So, instead of habituating the tinnitus, this method actually promotes taking an attitude of acceptance, and embracing the tinnitus. Finally, we have Widex Zen tinnitus therapy. And this is another form of tinnitus treatment or management that is based on a neurophysiological model of tinnitus, much like TRT.
Widex Zen tinnitus therapy
It was developed by a researcher named Robert Sweetow, in partnership with a team of scientists and audiologists at the Widex Audiological research department. This method is very similar to TRT in that it involves elements of counseling, habituation, and sound therapy for perceptual habituation. But it integrates a lot more cognitive behavioral intervention strategies into the counseling. And it operates under the assumption that attention is also a key component of tinnitus perception. So, I'm showing in our image here, there's four key areas of Widex Zen therapy that can be combined in varying degrees, depending on the case, to improve the quality of life for the individual experiencing tinnitus.
So first, it starts with a hearing test and initial intake interview, where counseling is provided. That can be information counseling about what tinnitus is, how it's generated in the auditory system. We can also start to integrate some cognitive behavioral intervention strategies here to minimize the distress, or challenge our perceptions and beliefs about the tinnitus because, when the brain is in distress, it is very difficult to think clearly. Next, we have amplification. And amplification is used to correct any concurrent hearing loss. And the basis for this is that research has demonstrated that the auditory nerve fibers that are not being stimulated reliably by sound receptors, due to hearing loss, increase their base rate of firing to compensate. And this is something called bursting.
And this leads to increased tinnitus perception, because what it's effectively doing is creating extraneural activity in the auditory pathway, which is basically our definition of tinnitus. Now, using hearing aids meets the threshold of the sound receptor, causing the corresponding nerve fiber to behave in a more normal way. And this also minimizes the contrast between the sound of the tinnitus, which comes from inside our head and in our body, and the ambient sound around us. So, that can provide a little bit of masking there. Fractal tones are a proprietary form of sound therapy developed by Widex. And there are six pleasant tone profiles that can be programmed into a Widex hearing aid.
And they tend to be more musical in nature, compared to other sound therapies. And they're effective in a few different domains. So number one, they're pleasant. And pleasant soothing sounds have a positive and calming effect on our autonomic nervous system. So, we're managing the autonomic response to the tinnitus right off the hop. Also, these tones were developed to address some of the drawbacks of the other existing sound therapies. So, when you use masking or sound therapy for tinnitus, we don't want to be swapping one annoying sound source for another. Right? So, using really loud static to cover up our tinnitus can be just as annoying, and can interfere with habituation of tinnitus just as much as leaving our tinnitus alone.
So, using that kind of Fractal Tone therapy, what we're doing is we're using a soothing sound, and we're not trying to cover up that tinnitus entirely. Finally here, we have scheduled relaxation exercises, which are integrated into the Widex Zen therapy program to address the contribution of stress, limbic, and autonomic activities' involvement in our perception of tinnitus, and our sense of intrusion based on that tinnitus.
Is one therapy more effective than another?
So, with all of these different intervention strategies, it makes us wonder which one is the most effective?And I know that's always been my question as a clinician, because I always want to make sure I'm giving my clients the best that is available. But the quick answer to that question is, none, or all of them, because 80% of people that engage with tinnitus management programs report significant reductions to the awareness or perception of their tinnitus. So, it actually gets quieter for them. And they report significant improvements to their quality of life. So, they're overall quality of life improves when they're engaging with those programs. Now, recent data reveals that none of the tinnitus management programs are more or less effective than the other. But they all provide that 80% kind of improvement that we see, where 80% of the population is improving significantly. So, the way I take this data is that it suggests that it's useful to participate in tinnitus management programs. But the specific program may not be so important. And that likely comes down to the fact that a lot of them share the same key elements or components.
And those are being that enriched sound environment, so minimizing the contrast between either tinnitus and the ambient sound, and also using hearing aids to treat any sort of underlying hearing loss. They all contribute a sense of habituation or awareness, so taking one of those approaches to live with the tinnitus, and not experience those reflective negative emotions and fight or flight response to the tinnitus. They all integrate an element of cognitive behavioral intervention. Whether they're outright in saying so or not, they do integrate those strategies. And all of them are non-curative. So, they're not looking to influence the tinnitus itself, but rather look at our reaction to the tinnitus.
Complimentary tinnitus management
On a final note here, almost everybody that comes into the office with tinnitus, and that's being evaluated for their tinnitus, asks about medical or pharmacological treatments out on the market that are designed to treat tinnitus. And there has been a ton of research in this area over the last few years, unfortunately with very little success. Most pharmacological interventions aim to treat the negative adverse psychological effects that are secondary to the tinnitus. And so, in that sense, anti-depressants have been investigated, with little success.
Most interventions aim to treat concurrent illness, such as PTSD, anxiety, and depression. And those treatments that have been developed, most of them are in the category of anti-depressant. And they've shown clinically significant effect. However, that's believed to be because they actually modulate that limbic response, as well as the underlying condition, so the individual's health benefits as a whole, their mental health improves, and then they're better able to deal with that clinical signal, that clinical presentation of tinnitus.
What about natural remedies?
Now, there are infinite recommendations available, regarding the use of homeopathic remedies and vitamins, or supplements, or oils, or CBD, or what have you, for use of treating tinnitus, although there's an absolute dearth of evidence to support their effectiveness. And part of the reason for that is because natural treatments for tinnitus do not have to register with the FDA as a drug. They're actually registered as a food product, and they do not have to supply any evidence of efficacy, or really just even safety, for the treatment of tinnitus. So, be careful about what you read on the internet, especially if it is a supplement, a vitamin, essential oil, or any of that. And make sure that whatever evidence is provided is valid and not just marketing.
What about diet changes?
Now, diet changes are another thing that people often ask. A lot of people that experience tinnitus, that come into the clinic to be evaluated, are sitting down in my chair, and telling me, "I've cut out caffeine. I've cut out alcohol. I've cut out this. I've cut out that." And they're eating these really really restrictive diets that prevent them from enjoying a lot of their kind of meal times. And I want to encourage people to know that there actually hasn't been any evidence to suggest that changing the diet actually impacts the perception of tinnitus. In fact, a study published in 2010, focusing on the effects of abstaining, or skipping caffeine, on tinnitus, actually found that foregoing your regular caffeine intake made people suffer their tinnitus more, and their quality of life went down.
So, the message there is maybe don't skip your cup of joe if you're experiencing tinnitus. Now, all of that being said, most clinicians will take a perspective of, "If it helps and it doesn't hurt, then why not?" I myself have engaged with some of these complementary treatments. And while I didn't find great or vast improvement in my tinnitus, I also found that it wasn't harmful to my overall health. So, do check in with your physician to make sure that is the case, and if you want an engagement that you can go right ahead. All right. So, thank you so much for participating today. I'd now like to open up the floor for questions and discussion.
Questions & Answers
Doran: Martine, thanks so much. So, of course, we just had the power turned off to our entire building during Martine's presentation. So, that was fun. But I think we're back now. Martine, some people are just asking about the closed captioning, if we can re enable that. I think we can.
Doran: So, let me just talk about the presentation. You can tell that it is a complex issue. When we see what's happening when you Google this, there's all kinds of cures out there, and it will stop it immediately. As Martine outlined, and I like the way she said it... Is there a cure for tinnitus? No. There is no cure. And what is my best course of treatment? Also, unknown. Your best course is to try to all of these different techniques that have been shown, to mitigate your tinnitus.
And just like we talked about in Christine's presentation, it's not in the ear, right? It's the entire auditory pathway, the entire auditory processing, that's involved here. So, it's complex. There's no simple answers. There's no one pill you can take, Martine, to solve this. So, what can we do for people? You laid it out as kind of try these things and one of them may work for you. But no, there's no cure. I did get one question through. What is the pulsating tinnitus, pulsatile?
Martine: That's a great question. So, pulsatile tinnitus is a specific type of tinnitus where the person does not hear a constant tone or a modulated tone, but actually hears the tinnitus fluctuating in time with their heartbeat. That's an example of cardiac synchronous tinnitus. So, as your heart beats, you can hear a whooshing or a beating in the ears. And that is what pulsatile tinnitus is.
Doran: And the person asked... Because you mentioned it's in rhythm with your heart, is it caused by high blood pressure? Is there any correlation there?
Martine: No. Pulsatile tinnitus can present with high blood pressure. Now, I will say that high blood pressure always puts you at higher risk of hearing loss. And it also puts you at higher risk of experiencing both subjective and objective tinnitus. And in the case of high blood pressure, you are a little bit more prone to experience that pulsatile tinnitus. But it's certainly not the only cause.
Doran: Sure. And now, another person says, "Is it dangerous? Is pulsatile more dangerous than another type?"
Martine: No. I wouldn't... I really don't like to classify tinnitus as dangerous. Right? Because today, in our presentation, we've talked about what tinnitus is. Right? It's our auditory cortex coding for sound that does not originate outside the body. Right? It's just a symptom. In many cases, it's a benign symptom. And in other cases, it's the auditory system telling the rest of the brain and body that something is changing there. Now, pulsatile is not a dangerous form of tinnitus, but it is a form of tinnitus that can be objective. So, that's that type of tinnitus that can benefit from medical or surgical intervention.
So, that's why you want to catch that tinnitus with an audiological intervention, and have it diagnostically investigated through the medical health system.
Doran: Exactly. And you talked about stress as well. We have another question about stress in tinnitus. And I was struck by the fact that you said that stress can be a contributing factor in tinnitus. And tinnitus also causes stress. So, it seems to me like a pretty hard loop for some people to get out of.
Martine: Yeah. That is a nasty little cycle, Doran. So, what's going on there is that, when we are stressed, when we experience stress, our limbic system and our autonomous nervous system work together to put us into that state of fight or flight. So, our body becomes primed to deal with that treat. So, our heart rate can go up. We secrete a bunch of cortisol, which is a hormone, a stress hormone, that cycles through the entire body, and basically tells your muscles, your visceral organs, everything, to get ready to fight/flight, or do something to get out of dodge there. Right?
And so, that is where stress kind of creates this problem that is very similar to the problem that tinnitus, or bothersome tinnitus, creates. So, when we're stressed, when we're in that fight or flight, our brain actually has a compensatory mechanism that makes us more tuned to signals that might be a threat, or maybe have a negative impact on our whole body's well-being. So, stress puts us into fight or flight. The fight or flight says we need to look out for more threats. And the limbic system goes, "Hey, I found a threat. It's the tinnitus." And all of a sudden, that tinnitus can get louder. And we can become more anxious. And we experience more of those systemic issues relating to that initial stress response.
Doran: For sure. Yeah. So interesting to me, and so cutting edge as far as the science around mindfulness, mindfulness meditation, neuro plasticity. That all speaks to this kind of cutting edge stuff that a lot of really smart people are researching. So, we'll hopefully get some advancements, but no cure right now. Right?
Martine: Yeah. We certainly can't impact the perception of the tinnitus itself, but we can dissociate from that perception. We can manage our autonomic responses. And we can really learn to live well and live better with tinnitus.
Doran: Sure. I mean, I wanted to also say easier said than done, right? We can do that in a lot of areas in our lives. It's easy to say, more difficult to do. We see some people with... They're really debilitated... and it's not over exaggerating there... debilitated by this condition.
Martine: For sure. For sure. And that's why it can be so helpful to make that first point of contact, meet with an audiologist, have them provide you with some specific recommendations just to get you started on that path, whether or not you continue with them, or administer that yourself through the remainder there.
Doran: For sure. Now, can you go over the sound therapy treatment again? I think we lost each other kind of in the middle of that. So, just briefly go on to sound therapy and what that does.
Martine: Yeah. So, using sound to manage the tinnitus perception is something that's been kind of present in our management of tinnitus since the very beginning of when people started looking at possible management strategies. And there's a couple of different ways we can do that. And number one is that we know that hearing loss is one of the leading causes of tinnitus. Okay? We know that when the sound receptors in the inner ear have hearing loss, become they've become damn... are causing hearing loss because they've become damaged, they don't communicate as effectively with the nerve fibers underneath.
And the nerve fibers underneath have a compensatory mechanism that increases their resting rate. So, all of a sudden, a nerve factor that had a base line going "boop, boop, boop" starts bursting. And it goes, "boopboopboopboopboop" to self-stimulate, or compensate for the lack of sensitivity of the sound receptor. And that contributes to our sense of tinnitus. So, using sound on a basic case of tinnitus is going to mean treating your hearing loss, so using a hearing aid to treat that hearing loss, and to meet the sound receptor's threshold so that the nerve fibers start to respond a little bit more in a normal way. Okay?
So, that's one component of sound therapy, so treating hearing loss if it's present. Two is to use pleasant or soothing sounds that act to calm the autonomic nervous system. So, just as we have reflexive responses in the limbic or emotional brain, to the tinnitus, that are negative, we have reflexive responses in our limbic system and emotional brain that are positive. And those respond to things like soothing and environmental sounds, music, sounds with tonal qualities. So, we can introduce a little bit of that into our environment, whether it's played through a hearing aid or masking device, or whether you're just using speakers to play those signals off of an app or what have you.
Then, we can use a background sound. Background sound is just any sound that minimizes the contrast between the perceived tinnitus, which is the ringing or buzzing or noise that you hear as your tinnitus, and the environmental sounds in your ambient space. So, you want to use a little bit of ambient sound to kind of mask and minimize that contrast. Okay?
Doran: Yeah. That's interesting. Again, we're going to go back to all treatments don't work for everyone. So, you're describing a lot of different things there. And we do offer TRT and other different mitigation techniques. But we really don't know, until a person starts to receive those treatments, what's going to work for that person, because it is so shockingly an individual thing.
Martine: Yes, for sure.
Doran: Is there always hearing loss present when tinnitus is present? Always?
Martine: No, actually. There's not. So, what I was talking about earlier in the slides was that, even just with noise exposure, for example, that doesn't cause a permanent hearing loss, we can experience tinnitus. Right? Because tinnitus is a symptom of the auditory system. It's extraneural activity in the auditory system. And that can originate from a lot of different things. Hearing loss is one of those things. Injury to the neck or back is another. You can have loud noise exposure, which then results in some residual tinnitus. That can either be chronic, or it can be temporary, such as after a rock concert or any concert that you go to where you've been exposed to loud noise.
Even things like lack of sleep and things like that can make us more aware of tinnitus in our body. And none of those things mean you have an underlying hearing loss.
Martine: Thank you.
If you have questions about this presentation, or want to speak with an Audiologist about about tinnitus treatment programs, please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921. Or request an appointment online.
Submitted by Erin Wright on Tue, 06/01/2021 - 08:55
The tips that Audiologist Nina Perisic shares in this video will make communicating through masks easier for everyone!
You will learn:
Why masks make listening so difficult
How masks impact speech signals
How you can take control of your listening environment
How to adjust your hearing aids for masked communication
How to keep hearing aids from flying off your ears
This talk was originally presented as part of the Healthy Hearing Online Expo.
Read the video transcript:
So good afternoon, everyone. Thank you for joining me. My name is Nina. I'm one of the audiologists here at Broadmead Hearing Clinic and today I'm going to be talking about some tips and tricks for communicating while wearing a mask. And I know that this has definitely been a huge challenge for many of us during the pandemic. So I'm hoping that after today's session, you'll walk away with some new tools under your belt that can help keep those conversations flowing a little bit easier. Okay. So let's get started. So let's just go over what we'll be talking about today. So we'll go over why it's harder to hear with a mask, what we can do about it and, lastly, how do we keep those hearing aids from coming off when we take off our masks? And I know that this last one is of particular concern and we have patients ask us this almost every day.
Why do masks make listening so difficult?
And for anybody who has the most popular behind-the-ear style hearing aids, every time that mask comes off, those hearing aids tend to want to go flying off the ear. So I'm going to try to address that towards the end of the presentation and, hopefully, give you some ideas on how to prevent that from happening. So let's talk about why masks make communication so difficult in the first place. So, firstly, they lower the volume of the speakers voice and they garble that voice slightly. If a person is speaking at their normal volume, it can be almost impossible to hear them clearly, as well lip cues and facial expressions are no longer visible. And this one is particularly important, because we rely heavily on facial expressions and cues to help us deliver our intended messages, and even if we're not consciously aware that we're doing so.
We rely on emotions and facial cues
For example, the letters S and F look very different on my face, but as soon as my lips are covered, it can be much harder to tell what the difference between those sounds is, especially for anyone who has a hearing loss. Background noise will interfere with hearing even more. And we know that background noise is already bothersome for anyone who has a hearing loss and who is trying to participate in a conversation. So that already challenging situation now becomes even more challenging and more effort has to be given to that conversation. And with the masks already lowering the volume of speech, garbling it, and the lack of facial cues, conversations can become really difficult in background noise. Additionally, anyone who is speaking with a mask and has an existing communication problem, like a voice problem or aphasia, this will add to that complexity. And, finally, due to social distancing, we can no longer just walk closer or lean in to hear someone better.
So we're going to talk a little bit about how a lack of access to emotions and facial cues makes communication more difficult. And to do this, I'm going to use some examples from this article, which is entitled Effect of Face Masks on Interpersonal Communication during the COVID Pandemic. So, first of all, I'm just going to ask you what emotion do you think this person is showing? And I'm going to put up a poll right here. (silence) Okay. I'll give you all some time to think about this and answer. (silence) Excellent. I see so many results coming in. I'll give it a couple more seconds. (silence) Okay. I will count down. So five, four, three, two, one, ending polling. Good. Okay. So as you can all see, it's actually about 30% think he's showing happiness, 33% think it's sadness and 35% think it's frustration. So it's actually very, very close. So we'll go over what he's actually trying to express.
So for everyone who gets happiness, congratulations, that's the actual emotion. But for anyone who found this really difficult, the reason it's so challenging is because the eyebrows and the eyes are the upper part of that face are not the most important part of his expression, but rather we look at the mouth, the cheeks and the teeth. And we know that emotions are so important during an interaction, because it lets the person who is speaking know whether their message is being received in a positive way, or, at least. In the way that it was intended. And in this article, the authors talk about a study done by Kestenbaum and they found that, of course, for happiness, the mouth is the most important part of the face that lets us recognize a smile or a happy expression. And we find that with facial masks covering up expressions, especially during medical appointments, it will reduce the ability of the medical professional to determine what their patient is feeling and their emotions, and it can affect their response to the situation.
And as well, the patient will have increased anxiety while their medical professional is wearing a face mask, because they can't feel that they're being understood. Or if what they're saying is actually being interpreted. Going onto this slide here, and it's the summary slide from this article actually. So one of the things that they show here is that not all emotions will be affected by face mask use completely, but some important ones will. So as an example, anger, we can usually tell much more easily, because the furrowed brow is so pronounced and it's much easier to tell that, whereas something like disgust, which is down here in the E section, it involves the nose wrinkling and the raising of that upper lip and both of these things are covered by face masks.
How do masks impact speech signals?
So we'll talk about how face masks actually impact speech signals. So each mask is actually reducing the high frequencies in this picture here. And this is a study based out of Israel and they were comparing N95 masks, simple masks and no masks to the speech signal. So the green line, which is right here, actually shows no face mask use. We can already see where this purple line is that any simple mask use is decreasing the high frequencies, especially, by three to four decibels. And when somebody puts on an N95 mask, it's going to reduce that signal even further up to about 12 decibels, which is quite significant. So you can see both types of N95 down here in the corner.
So masks are significantly reducing the quality of the speech signal. And this effect gets compounded or gets worse when the listener cannot see the speaker's face and lips, which we just discussed, is in the presence of background noise or has hearing loss. So now that we've talked about some causes of what's going on with face masks and our ability to hear, what can we do about it? So we'll talk about taking control of your listening environment, changing some settings on your hearing aids and, as well, using other tools to aid in communication.
Take control of your listening environment
So for taking control of your listening environment, what you want to make sure is that, first of all, you're facing your communication partner and that you have their attention before you speak. We really tend to look away or bend down while we're speaking to each other, and that can make our voices softer and make things more difficult to hear.
Secondly, for the speaker, we want you to speak a tad louder and slower than you normally would. And I want to emphasize here that when I say speak louder and slower, I don't mean yell. Please do not yell at your communication partner or slow down your speech so much that it becomes distorted. What you want to do is just make sure that you're speaking a little bit louder and really enunciating your words. And if a sentence isn't being understood, do not repeat yourself numerous times. A good rule of thumb is that if you said something twice and you can see that the person hasn't registered what you said or looking at you blankly, you just know that they're maybe even nodding, but you know that they haven't actually understood what you've said, say that phrase or word that they're missing in a different way. And also try to shorten the sentences just while wearing face masks, especially, to make that message a little bit simpler.
You can also move to a quieter place to have a conversation. And I know that we've been spending a lot of time outdoors lately, not so much indoors, and this makes that not so easy, because there's traffic, there's wind, there's all kinds of environmental sounds. But if you can, find a spot in a quiet park or a bench at least away from any main roads, and that can really help everybody be heard a bit easier. Using hand gestures and body language to your advantage. And as you've probably noticed, maybe you can't see my hands during this, but I have been using my hands through this entire presentation to get my point across. And if you're a patient of mine, you've probably seen me do this regularly. But don't be afraid to do it. Most of what we say to each other is actually translated through body language and not so much the words that we say.
And finally, don't be afraid to ask your conversation, partner if there's anything you can do to make things easier for them. We all learn and receive information in different ways and I don't think there's anything wrong in asking the person that you're talking to to try to make things a little bit more comfortable for both of you. We can now talk about how we can change some settings on your hearing aids. So as we've said, masks reduce some speech frequencies more than others. And the strongest reduction is actually at 4,000 hertz and 4,000 Hertz includes all of these speech sounds. So the F, the S, the “tha” sound, and those are particularly hard for anybody with a hearing loss to catch. So to get around that, two manufacturers have actually created something called a mask mode, and I'm going to what that is.
Mask mode on hearing aids
So let's talk about turning on mask mode. So for Starkey, there's both something called an edge mode and mask mode that they have made available. So for edge mode, which is only for the Livio Edge AI hearing aids, you'll turn it on by double tapping the hearing aid. If it's behind, you'll tap here. If you have an in the ear style, you can tap here. And edge mobile will scan the environment that you're currently in and try to make adjustments to the sound accordingly. For mask mode. It's only available for their Livio AI hearing aids and it's available through the Thrive app. And since it's a little bit hard to find in that app, I'm just going to go over how you can locate it. So when you open up the app at the bottom of the screen in the lower right-hand corner, there's something called a hamburger menu. And if you click on that, it will lead to this new page. And the second from the top is device settings. And you'll want to click on that.
And once you've done that, it will give you mass mode at the very bottom. So once you see that you can toggle that little switch until it's blue, and that will turn on mask mode for those hearing aids for you. Signia, as well, has a mask mode and it's available in all of their Bluetooth-equipped Xperience hearing aids. So it is located as soon as you open the app and at the very top, so in the upper right hand corner, there is a man wearing a little face mask. As soon as you tap on that, mask mode is activated, and you can tap it again to turn it off. There are some minimum phone operating system requirements, such as Android 6.0 or iOS 11 or higher, so make sure that your operating system can actually help you get this going.
And, of course, not all of us have Signia or Starkey hearing aids, so what happens if you don't have a mask mode? So another thing you can do is you can adjust the treble in your hearing aids. So you'll open up the application and Unitron, Phonak, Resound and Widex all have an option to change the volume of the bass, the treble and middle sounds. And you'll want to change the treble in this case. So in Resound, it's at the bottom in their sound enhancer menu, and you'll click on that. And for Phonak, it's also in the bottom right hand corner in their hamburger menu that will allow access to that. Widex in their Moment app also has it. Again, it's a little bit hidden, so you'll have to click in the lower right-hand menu and then go to equalizer and that will give you this little shape here. And for most manufacturers, it's a similar sort of graph, and you'll be able to increase or decrease the trouble as much as you need.
And for Unitron, as well, it's in that lower, bottom, right-hand corner. So if you're ever confused, just check that place first, you'll most likely run into the menu that you're looking for. And if you're not feeling tech savvy or if you don't want to connect your hearing aids to your phone, there are other things you can do. So you can increase the volume of your hearing needs temporarily. And sometimes that's all you really need to do. And to do that, it'll be about one or two presses of the up volume button on your hearing aid. And the pros of this, of course, is that volume control is available in most hearing aid styles and manufacturers, and it's pretty easy to change. And the cons of this are that it can make everything louder, not just the sounds that you're missing. So we aren't able to do a frequency-specific change like we are in an app, for example. So you have to remember to change the settings back to a lower volume.
And this is a question we also get, "How do I get back to my normal settings?" So you can decrease the volume by pressing the button down on your hearing aids. And if you have a certain behind-the-ear style, usually the left will lower and the right will raise, unless you have a toggle switch, in which case you can use either ear. For in-the-ear hearing aids, they generally have a little button that you can press and change the volume that way. Opening and closing the battery doors, as well, will always set everything back to normal or putting the hearing needs in the charger and taking them out will also reset them. And sometimes the volume button on the hearing aids is actually not enabled. So if you're trying to change the volume and nothing's happening, give us a call. We can try to add it in for your specific hearing needs.
And we'll talk about using some accessories, because sometimes hearing these themselves won't be enough. So for remote microphones, they are available across all manufacturers and for many different hearing aid models. They're very easy to use and we can show you how to do that in clinic. And they work well for both tech-savvy people or people who consider themselves to be very tech savvy, and also not so tech savvy users. So what they do is that they reduce the distance between the speaker and the listener and it allows for easier listening to a single speaker in very noisy environments, restaurants, lectures, or outside, as I was saying, with a lot of background noise, and it will take that information and send it straight to your hearing aids. And we compare this, like I said, in the clinic. The cost varies between manufacturer going from about $175 to about $300 per remote microphone.
There's also something called a speech-to-text application and these are available for iPhone or Android phones, they're available online to use with tablets or computers, and they're great because they transcribe speech into text in real time. And there's so many options. They can be free. They can have monthly fees. Today, I'm going to focus on Otter.ai and the reason being is that there's a really great article in the Canadian Audiologist that goes through the pros of using this tool actually in clinic. Although I think that given all the things that Otter.ai Allows you to do, I believe it can be used just fine outside of the clinic as well. So their transcriptions have really good accuracy and they automatically insert punctuation and breaks between phrases and different speakers. And once you've created an account, you can record 600 minutes of transcriptions per month for free, all of which are stored separately on your account and you can actually access afterwards. I will note however that it will only record 40 minutes per conversation.
Though I think that's a good amount of time, but you can always stop the recording and start another one if your conversation is going to be longer. And it's super simple to do. You can open up and create an account with Otter.ai with their app. You put in your email address or your Apple ID, and you can automatically use their system. The only thing is, is just to make sure that you point the microphone of your phone towards the person who is speaking so that you can best record them. It can sometimes, if the microphone isn't super close, it can miss some words. And, finally, for programming changes, we can always make a custom-mask program for you and they can be created for any difficult listening situation. So definitely call and make an appointment with one of us. We'd be happy to help.
And just to recap here, so how do you hear better with a mask? One, you take control of your listing environment and you take advantage of your hearing aid settings. So there's mask modes, there's adjusting treble with the phone app, or just turning your volume up temporarily. Also using available accessories, like remote microphones or speech-to-text application. And, finally, you can come in and see your audiologist for a custom program. I should note that it might take a combination of everything that I've talked about. You might need a few or even all of the above options to get you curing better with a face mask. And I don't think there's any shame in trying a couple and you need more help, definitely call us. We're happy to walk you through anything that you need.
Keep the hearing aids from flying off your ears
And now let's talk about how we keep those hearing aids from coming off when the mask comes off. And this is something that we get asked about almost on a daily basis, and it's super frustrating. And it is usually happening to the most popular style of hearing aid, which is the behind-the-ear style. So let's talk about some things we can do. First, I know we all have a tendency to rip the mask off our face as fast as possible, as soon as we step into our house or into our cars, but for any hearing-aid wearers, we really do need to take an extra second to get those masks off of our ears. So to do that safely, make sure that you can actually pull the mask up and over your ear. So I'm going to use my mask here. What you'll want to do is to take that top piece and pull it up and over gently and slowly, and then take the mask off.
And also make sure that you're standing in one place as you do this, because if the hearing aids do come off, you can be conscious of that and you can look around and they can't have gotten far, because there's only finite space where they can go in that moment. And, definitely, the other thing to do is as you're getting ready for appointments or if you're stepping out of your car, just have a good look in the mirror, make sure that the hearing aids are there and that the mask is sitting right next to them and then you should be fine. As well, there are things called mask strap enhancers, mask retainers or your savers, and these all work by keeping the mask strap away from your ears, so that it can't tangle up with the hearing aid receiver wires. There's so many different choices for something like this. Right here, I've just posted a picture off of Amazon and they have this example of an ear saver and it allows for the ponytail to come through.
I've also seen people use the monkeys from Barrel of Monkeys, and then just put that behind and keep those mask straps away from their ears. And you can, definitely, make some at home. It's 100% something that you can do. If you you sew two buttons on a strip of fabric, you can have your very own ear saver. I've seen people put buttons on a cap as well, and also on their glasses, which was an interesting solution, having buttons right here, but all to say that it will keep those hearing aids safe and those masks straps away from your ears. And a simple hair clip or two can also be used just to clip it up. Finally, there's something called ear gear. And these are, basically, little boots here and they come with a little cord. And the cord can clip onto your jacket or onto a pocket or onto your shirt. And these little boots is where you put the hearing aids and they come a variety of colors here. And what happens is with the boots going over the hearing aids, they will keep them safe as well for moisture.
But if they do fall off, when the mask is removed, they'll hang from the cord and they won't get lost. And if anybody's interested in this, you can let us know. We can always order one into the clinic for you. And also if the hearing aids do fall out, what do we do? So, firstly, take a breath, look around, don't panic. They might've fallen into a really strange place. We always hear they go under the couch or in a shoe, sometimes in a sock. So just have a look around and don't worry. I'm sure you will find it. Some hearing aids also have a find my hearing aid feature and you can use your phone app to actually locate the hearing aids using geolocation. And these will show if you're close or far from the hearing aids. So as you get closer to them, it will actually give you a signal that says, "Yeah, we're pretty close." And they will also show the last-known location before the battery died. So even if the battery goes out, don't worry, you at least know where the last time they were on was.
Perfect. So thank you everybody for listening. I've put my email and my phone number up here as well. And if you have any further questions, you can definitely call. And also a big thank you to Aisling, who really helped with this presentation. So I'll turn it over to Doran, because I'm sure he has questions for me.
Questions & Answers
Doran: Nina, naturally, that was great. Thank you for that. Very timely and who knew you think of all of the unintended consequences of a pandemic, you wouldn't have called that lost hearing aids would be one of them. And believe me, we see this literally every day. People are losing their hearing aids because of the behind-the-ear on masks for sure. And from what I've heard, they do actually go flying. They're hooked on that elastic and they fly. It's not like they just drop right next to you. So it is a problem for sure. Nina couple of questions. First one is about plexiglass. Another barrier there. Can you speak to communication strategies with a plexiglass in between?
Nina Perisic: So I know that absolutely. This has been another huge barrier for people. And I think that if we just ask the person behind the plexiglass, just to speak a little bit slower and a little bit louder and also using any of the tools, so the remote microphones or turning up your hearing aids and asking for them to reword the sentence, maybe in a different way, I think is really, really helpful.
Doran: Yeah, for sure. And I want to stress, too, that you talked about some mask mode, but custom programming is something that we'd love to do to people's hearing aids. And it's a really great feature, these new, advanced hearing aids that we can program to do almost anything. There's car mode, there's mask mode. So even if it's not on your app, give us a call, we can set that up for you. One question, does Oticon have a mask mode or mask program?
Nina Perisic: So they do not, unfortunately. So one thing they do have on their app, though, is the ability to change volume. So that is something that you can use their app for.
Doran: Again, I'll say it one more time. We can do that for you. That's what we do.
Nina Perisic: We can.
Doran: Bring your hearing aids in. We don't want you struggling through apps if you can't figure it out. Give us a call. We can customize your hearing aids quite easily.
Nina Perisic: Absolutely. We can definitely make custom programs for anybody with Oticon hearing needs. That's no problem.
Doran: And I'm loving some of the strategies as well. The monkeys from a Barrel Full of Monkeys is being used. That's awesome. And who knew that that would be a clinic recommendation? And also Doug is saying that he's fashioned himself a baseball cap and the mask attaches here. And then in behind your neck. It's a problem. And people are, like you said, "I'm out of the store. I'm ripping this thing off my face, because I want it off of there," and, yeah, it goes flying. It's a big problem.
Nina Perisic: Definitely.
Doran: Okay. Brian's just asking about the find-your-hearing aid modes. "Does the hearing aid need to send a message to the other hearing aid if you have a pair?" Work in the smartphone, just find that hearing aid if they're far away. How does that actually work?
Nina Perisic: The app should be able to find the hearing aids. So I'm happy to go over everybody's apps, because everybody has a little bit of a different one. So if anybody wants that, you can always call in and I'm happy to walk you through that. But the app itself should be able to find a hearing aid, no matter if it's separated from its brother, I guess, it should still be able to find the other one.
Doran: And I guess what I'm thinking is patients is your best asset here, because talk about the cards being stacked against you. You have a hearing loss that's taking out those high-frequency noises, then we're putting a mask on a person, which reduces those high-frequency noises. And then putting a piece of plexiglass in between those two people. And that mask also masks the lip reading that we've all done throughout our whole lives, so it's just plain old difficult. There's no way around that or a silver bullet there.
Nina Perisic: Yes, exactly.
Doran: So talk more a little bit about the Otter.ai. How would a person download that and then get that to installed onto their phone?
Nina Perisic: So I do have also, for anyone who's interested, step-by-step instructions for how to do that, but if you have an Apple phone or if you have an Android phone, if you go into the play store for an Android phone or the Apple store for an iPhone, you can just type in Otter.ai and download the application and then just follow the steps. It's very straightforward, but if you run into any problems, let me know.
Doran: That's great. And that voice-to-speech has just come leaps and bounds, even in the past year or so you can see it along the bottom of our screen here. And that simply wasn't possible even six or eight months ago, I don't believe. So it's really something to consider a tool that you may not have used in the past. Okay. Nina, thanks so much for the presentation. Very informative and timely, of course.
Nina Perisic: Thank you to everybody and thank you, Doran.
If you have questions about this presentation, or want to speak with an Audiologist about custom programming for masks for your hearing aids, please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921. Or request an appointment online.
Submitted by Erin Wright on Tue, 05/25/2021 - 10:26
Is hearing loss affecting daily life for you or somone you know?
Audiologist Christine Stangeland talks about what causes hearing loss, how it can affect daily life, the mental and physical consequences of leaving hearing loss untreated, and the benefits of better hearing.
This talk was originally presented as part of the Healthy Hearing Online Expo.
Read the video transcript:
Christine: So as you guys heard, my name is Christine. I'm an audiologist here at Broadmead and Oak Bay Hearing Clinic. I work out of our Oak Bay Clinic five days a week right now. So if you're ever looking for me, that's where you'll find me. So let's jump right into it. Today I'm going to be talking to you about, is hearing less affecting daily life for you or someone that you know? So we're going to start things off with a little bit of a poll just to gauge how you guys are feeling about this topic. So I'm just curious to see how many of you think, what percentage of adults between the ages of 40 and 79 have hearing loss? So I'm just going to get a poll going and you guys can actually vote on this.
So you should be able to see that poll right now. So I'll give you guys a couple of seconds just to get your answers in. It's awesome. I see lots of you guys responding already. This is really exciting. It's my first time doing an interactive webinar like this and having a poll feature where I can actually see you guys interacting given you're not here in the clinic with me. So this is really awesome. I do see the numbers changing a little bit more. So I'll give you guys a couple more seconds just to get those answers in. Right, I think things have stopped. So let's have a look at what you guys thought. So you guys should be able to see the results of the poll. The majority of you guys felt that the percent of adults with hearing loss of between the ages of 40 and 79 was in between 40 and 60%. And the awesome thing about that is that most of you guys were correct. Really well done you guys.
Hearing loss is common
So we know about 54% of Canadians age four to 79 have at least mild hearing loss in the high frequency range. That's a huge number. So the amount of people who have hearing loss within that age range, that can vary. It can vary a bit just based on your age itself and it can vary actually just based on your sex too. So let's dive into that a little bit more. So this really interesting figure comes to us from Stats Canada and basically what they had done was they pulled a bunch of people about if they thought they had hearing loss and then they measured if they actually had hearing loss. And we're going to dive a bit more into that discrepancy a little bit later, but first let's just have a look at the amount of people who do have hearing loss.
So we see that in general, 54% of people have hearing loss within that age group of 40 to 79. If we break it down by the person's sex, men are more likely than women to have hearing loss. 63% of men within that category versus 46% of women in that category. If we break things down by age and generally the younger people within that category, less hearing loss. So with people 40 to 59 years old, 38% of them had hearing loss. If we jump up to ages 60 to 69, 75% of people had hearing loss. You can see that prevalence of hearing loss is increasing with age. And if we move into that 70 to 79 years old category, a whopping 93% of people have hearing loss in the ages of 70 to 79. And that's just cutting off at 79. That's not extending into those later years in life.
Onset of hearing loss
So you can see that in general, men are more likely to have hearing loss than women. And just as you continue to age, that hearing loss is more and more likely to be more prevalent. So let's talk a little bit about hearing loss onset. How does this happen? So even though in rare cases, people can develop a sudden hearing loss. You might just wake up one day and have a hearing loss. That is not common. Most commonly hearing loss develops just really gradually and very slowly over time. Because this hearing loss is developing so slowly and so gradually over years, this becomes really hard to detect for the person who's developing hearing loss. Something that's quite common is often friends or family will actually notice the person is developing hearing loss first.
So it's quite common for me to ask somebody in the clinic, oh, what brought you in today? And a lot of them will be like, my wife, my husband, my kids, they think I have hearing loss. So very, very common for people's communication partners to notice the hearing loss before the person with hearing loss themselves. Interestingly enough, it actually takes on average seven years before a hearing loss makes communication difficult enough for somebody to feel motivated to do something about it. But there are some reasons that we don't actually want to delay things seven years. We want to treat hearing loss sooner rather than later. So first, what causes hearing loss? As you guys probably figured based on that graph we were looking at earlier, the prevalence of hearing loss with age, age is a huge contributing factor to hearing loss.
What causes hearing loss?
So our fancy term for age-related hearing loss is presbycusis. We see tons of people with presbycusis in the clinic. That's super common. Another really common factor that could cause hearing loss is significant loud noise exposure. So if you're somebody who works in the trades or you have really noisy hobbies like using firearms for example. You like to go to the shooting range and practice your target shooting a lot. If you're not protecting your hearing, you're at risk for noise related hearing loss. Some people genetically are just more susceptible to hearing loss than others. There are certain medications though quite rare are known to cause hearing loss as well or be associated with an increased risk of hearing loss.
Head injuries or skull fractures. Those are known to cause hearing loss as well or they can and it's not a guarantee, but it's something that could contribute to a hearing loss. Serious infections, especially in childhood can cause hearing loss and certain chronic health conditions, but you at a higher risk of hearing loss. So things like high blood pressure, diabetes, those are some health conditions we know do make it more likely for you to develop a hearing loss. So how can hearing loss affect daily life for you or for somebody you know who's experiencing hearing loss? So often what happens is... I told you that sometimes these patients come in and they say, "I'm only here because my partner thinks I need to be here. I think I'm fine." So what's that partner noticing that that person's not noticing?
How does hearing loss affect daily life?
So the person with the untreated hearing loss, typically their one-on-one communication skills are great. And there's a few reasons for that. But things that they may start noticing as their hearing loss develops is that they're having difficulty hearing in background noise. I have a lot of my patients say to me, "You know what? Sitting here talking to you, I have no problem, Christine. I hear you just fine. But if I go to the pub, forget it. Can't do it. I don't even like going to the pub anymore." So background noise more commonly becomes a problem sooner than listening in quiet environments. Some people, if they're not hearing well, that hearing loss is developing, they're going to start turning the volume up on listening devices. So the TV or the radio, that volume is going to start increasing and it's going to be louder than it needs to be for people with normal hearing.
Another thing that might happen is people will start missing sounds that are occurring say behind them. They don't have a visual cue and somebody starts talking to them. Maybe they're just not going to get the clarity that they need. They're going to hear that somebody is talking, but they're not going to know what they're saying or they might miss what somebody is saying from the other room. If somebody is in the living room and somebody else's in the kitchen, that cross room communication gets lost quite easily with hearing loss. In conversation, typically people who are developing hearing loss, they're just going to have to ask people to repeat more. There's just going to be more that's being said that they're missing. So they're going to ask, I'm sorry, what did you say? Can you repeat that? Or just another common thing is just mishearing or needing repeats on the telephone.
How we compensate for hearing loss
We know that the telephone already, the audio signal, the quality of that audio is certainly not comparable to hearing somebody in real life. So it's already degraded. And then if you're out of hearing loss on top of that, that can sometimes become unmanageable or people are going to need to turn the phone up to maximum or put it on speaker phone just to have it be usable for them. So what are some ways that people with this untreated hearing loss that they're not really aware of? How are they compensating for it? So people, as I touched on before, they'll start to withdraw. So maybe they won't go to a noisy restaurant if... I mean, it's COVID now, so we're not going. But if we pretend it's not COVID times, people will stop going to those noisy places. If their friends invite them to the pub, they might say, you know what, what if we do this at my house instead or I'll give it a miss because they know they just can't participate in the conversations the way that they would like to.
Another very common thing I hear from a lot of patients who come in is they're like, I can hear you just fine, Christine because you speak clearly. My son, my daughter, my wife, my whoever, they mumble. And if they didn't mumble, I would hear them just fine. But unfortunately the reality is it's sometimes there's mumblers. Don't get me wrong. There are. But once everybody in your life starts becoming a mumbler, that's usually a sign that it's not the other people in your life who are mumbler, it's you developing hearing loss and that's why it sounds like people are mumbling. Typically, that high frequency hearing loss we see with age or noise exposure affects the high tones first. You're going to lose the clarity first before you lose volumes. That's why it's easy to blame that lack of clarity on other people.
Another common thing is people with this high frequency hearing loss that's untreated are going to feel that people speak too fast. So what happens is because you have all this extra work to do because you're not hearing as well, you can't keep up with the conversation the same way. So if things are slower, it gives your brain more time to fill in the blanks. So another thing people are going to do is really rely on the context of the situation to fill in the blanks and try and piece together what they're missing. Something people will do, but you shouldn't do. You should advocate for yourself if you're not hearing well, but it's easy to fall into this pattern. I'm still guilty of this myself. It's not that you just pretend and you smile and nod and you're like, Mm-hmm (affirmative) And you have no idea what the other person said. Maybe you already asked them to repeat two times and you're embarrassed to ask them a third time. That's something that's still on very rare occasions happens to me.
So I completely understand that sometimes you're just like, you know what? We're just going to move on. And at the end of the day, that's not a great way to facilitate communication. And you do need to advocate for yourself if you're not hearing well. Another way that people with untreated hearing loss really compensate for this hearing loss is using visual cues. So even normal hearing people rely a lot on facial expression and lip reading. But if you have a hearing loss, you're relying on that that much more to get information from the person that you're speaking to. This is something that we've really seen an increase in difficulty for our hard hearing patients because of mask wearing because of COVID.
Another way, I already touched on this, compensating for that untreated hearing loss is just turning up the volume on things. So you're going to turn that TV volume up. People are going to say to me, "Christine, I hear the TV volume just fine if I put it at 25." And maybe their partner is going to say, "Yeah, but we only needed, I only need at 15." So there becomes that discrepancy in the volume that people require.
Some consequences of hearing loss
So some consequences of hearing loss. We know that there's actually a lot of negative consequences of untreated hearing loss. We want to treat this hearing loss not seven years later when you really feel that communication is becoming unmanageable even in easy listening environments, we want to treat hearing loss as soon as possible. And the science backs that up. So what are some reasons that we want to treat this hearing loss and what could happen if we don't? So we know that untreated hearing loss is correlated with cognitive decline. So if you have mild hearing loss, you already have double the risk of developing cognitive decline. Another thing we could refer to that is dementia. If you have moderate hearing loss, your risk increases to triple the risk. And if you have severe hearing loss, you have five times the risk of cognitive decline, of developing dementia than somebody with a lesser amount of hearing loss. And that's huge.
When we have a look at reducing the risk of cognitive decline, of dementia, there's a lot of things. If we have a look here, a lot of things in your life that are risk factors. So early in life, less education, that's a risk factor for developing dementia. If we have a doubt, a look down here in the mid-life, things that can occur that are risk factors, hearing loss is our largest known potentially modifiable risk factor for dementia. So this is something you can manage in mid-life that may affect your cognitive wellbeing later in life. So not only is that huge, but it's awesome that we know that it's something that's potentially modifiable. We know that we can, almost always, treat this hearing loss. Some other consequences of hearing loss. Another one is fatigue.
So like I was saying earlier about when people feel that other people are speaking too fast for them, I mentioned that your brain has a lot more work to do because it's having to fill in the blanks. Because your brain is having to fill in those blanks, that takes a lot more energy. And because that takes a lot more energy, people with untreated hearing loss, we know, studies have shown this, their mental energy is going to fatigue way sooner in the day compared to somebody without hearing loss because they just are having to put so much effort into every single communication that they have throughout the day. There's also a lot of psychosocial and emotional effects of untreated hearing loss.
So we know that you're more likely to suffer from depression if you have untreated hearing loss, your stress levels increase, you're more likely to be frustrated in your everyday interactions because maybe communication is just not happening as easily as it could be. You're also more likely to be lonely, you're more likely to withdraw and you're more likely to suffer from social rejection as well. So there's a lot of negative things with this untreated hearing loss. Another thing, this one actually surprises a lot of my patients when I talked to them about this is you're actually at a higher risk of falls if you have untreated hearing loss. So we know that even just a mild degree of hearing loss, triples your risk of having an accidental fall. And as that hearing loss increases by 10 decibels, each 10 decibels your hearing loss increases, your fall risk increases 140%, huge.
Awareness of your environment
So this is often a big shock for people. And why is this the case? We don't 100% fully understand why this is the case, but what people realize is that when you have this untreated hearing loss in general, you just have less awareness from the environment. You're just not hearing if somebody is coming up behind you, maybe you're not overhearing somebody walking on the other side of the sidewalk or what have you. You're not hearing as well as you could be. Just not as aware. Another thing is we theorize that this affects down your spatial awareness. So that's just how your body perceives itself in space.
You can perceive if you hold your hand up. I know my hand is going higher. And we also know, again, touching on that fatigue aspect, because you're using so much more of your energy resources for hearing, less of those energy resources are getting devoted to other things including balance. So that's kind of what we theorize is going on and why you're at a higher risk of falls when you have untreated hearing loss. This is probably arguably one of the biggest consequences of untreated hearing loss or at least I feel so is that hearing loss doesn't just affect the person with hearing loss, it affects their significant others. So our fancy-dancy scientific term for this is third party disability.
So a third party disability is a disability of a family member due to the health condition of their significant other. So we know that there are negative consequences of untreated hearing loss for those significant others, for those communication partners. And a whopping 98% of people spouses reported some degree of third party hearing disability. So that's massive. That's not just a few people feeling negatively affected from their spouse or partner having a hearing loss that's untreated, it's almost all of them. There are some risk factors that make that more likely to occur. So lower relationship satisfaction overall is a risk factor for proceeding a third party disability, spousal age difference is also a risk factor for proceeding that third party disability as well as the spouse perception of their partners hearing disability.
The benefits of better hearing
So that all sounded kind of doom and gloom. But the good news is this is treatable. Hearing loss is manageable. Audiologists are here. Our whole profession is designed to help people manage their hearing loss. So what are the benefits of better hearing? At this point, I feel like it's pretty self-explanatory. You're going to improve your communication with other people. Well, communications become easier because you're not having to ask for less repeats. Both people involved in communication are not going to be as frustrated. It's not going to be as tiring. You're going to get more enjoyment out of watching TV or watching movies. Maybe now you're going to understand those British shows that are so hard to understand.
Maybe you're going to catch what they're saying now or you're going to get way more brilliance out of live music. Again, once COVID is over and we're allowed to go to concerts. That's something I personally am really looking forward to is just being able to attend live music again. You're going to get more out of it or catch more of the dialogue when you go to see a play or a musical. We know that it's going to improve your safety because we're reducing that fall risk. We're potentially reducing that risk for dementia, for cognitive decline. And we're going to just overall maintain our auditory processing skills.
So when I talk about auditory processing skills, your ears pick up sound, but your brain is actually responsible for hearing. Ears are just the pathway of getting sound to your brain. So it's your brain's job to decide what speech, what's music, what's noise, what should I focus on and what should I ignore. And we know that if you have untreated hearing loss because just in general, you're overhearing less, you're not overhearing background noises, basically your brain becomes weaker at filtering out background noise for you.
So another big reason we recommend treating hearing loss right away is to maintain those auditory processing skills. Keep your brain good at hearing this background noise so it knows to ignore it so that way you're not going 10 years without hearing your own footsteps and then when you get hearing aids, you're like, uh, I can hear my footsteps again. I can hear the paper... When I turn the newspaper, I can hear that again. And the longer you go without hearing those things, kind of the more overwhelming it is. Initially when you get hearing aids, we need to readapt to that and kind of undo all those years of not hearing basically.
So another great benefit of having better hearing is we're going to maintain those brain processing skills. So what should you do if you think you have a hearing loss, you're having some difficulty, you think somebody else in your life has a hearing loss, generally, when should you get it checked? Even if you don't perceive any hearing difficulties. And again, we know that in that age group of 40 to 79, 54% of people had hearing loss, only 6% thought they did. So if you're at age 50 and you have not had a hearing test, get it tested. The next thing is we do know that still when you're aged 50, the majority of people are still going to have normal hearing.
But the great thing is we're establishing a nice normal baseline for the future because we know that as you continue to age, that likelihood of hearing loss developing increases. So if you've never had a hearing assessment, just here's a little bit of what to expect. If you're coming in to talk to an audiologist, we're going to have a conversation with you about your health, your general health. We're going to ask you if you do have any specific concerns about your hearing loss. These are really great appointments to bring your spouse or your kids or whoever your significant communication partners, bring them with you because we know that 98% of those people also feel this hearing loss is affecting them.
Addressing hearing loss
So sometimes they'll come and they'll say, "You know what? I've noticed that you don't hear me if I'm not facing you." And sometimes that's something the person with hearing loss may not have noticed yet. Again, because it sneaks up so gradually, your brain just becomes really used to hearing with a hearing loss. So bring that family member with you so that we can have a discussion, not only with you, but with your communication partner about any specific concerns you have because at the end of the day, we want to help you. We want to know if TV hearing your British shows is your number one goal for hearing better. We want to know that so we can help you.
Once we talked about your concerns, we're going to do some listening tests. We're going to do some listening to beeps, but we're also going to do listening to speech tests so that we know how much clarity is in the hearing system. Once we've done all of our speech tests and our beep tests, we're going to have our results and we're going to review them with you. So we want to explain them to you in a way that makes sense and in a way that can clearly explain to you like if you do have a hearing loss kind of what kind of things that it would be impacting.
And then we're going to make a recommendation based on those hearing test results kind of the icing is if things are normal, we're probably going to say, "You know what? Things look awesome today. We've got a great baseline. Let's retest in a couple of years or sooner if you notice any changes." If there is a hearing loss, we're going to identify if that's a hearing loss that maybe does need medical or surgical attention or if it's a kind of hearing loss that needs treatment with hearing aids. And then we can walk you through that.
So definitely don't be afraid to come in and get a hearing testing if you've never had one. It's definitely a great thing to do even if you don't think you're having any problems. It's just so smart to have a baseline for the future because we know that or just about everybody, things are eventually going to change. And that's all I have for you guys today. So thank you so much for attending. I believe Doran's going to jump back on and we're just going to answer some questions if anybody has questions now.
Questions & answers
Doran: Christine, that was great. So being in this industry for 20 years, there's a lot of themes in there that we hear in clinic every day. For the first one, what I like to think what we do is solve problems. And the biggest problem we solve I believe is hearing in noise. That's something you hear over and over again in the clinic. So for those people out there, it's not uncommon. It's very common. A lot of those themes that you had are common themes. So you get the same, I can hear you now, like what you said in clinic. We get that a lot from clients.
So there's a lot of recurring themes there, but also I want to say it's also an individual journey. And a lot of people, and you can attest to this, they may have the same exact hearing loss percentage-wise as someone else, but they are dealing with it or managing it in a totally different ways. So a person might have a very slight loss. They want aids, they really find them helpful and they changed their lives. Whereas someone with maybe more significant loss, they're not ready, it's not for them and they end up not purchasing hearing aids. So can you talk to them maybe a little bit?
Christine: Yeah, so just to reiterate for anybody, it sounds like basically the question is how come some people have more degree of hearing loss and they just don't feel like they're ready for hearing aids. Is that correct?
Doran: That's right.
Christine: Yes, that is a good question. I don't know if I have any science based answer for you just off the top of my head, but speaking from personal experience, definitely there's still a lot of stigma attached to having hearing loss. So there's a lot of people who are still worried that if they start wearing hearing aids, it means they're old or they're going to look old and people are going to think they're dumb. It's unfortunate and that's the reality of it.
And even for myself when I decided I needed to get hearing aids because I wasn't hearing people well, there was still a little bit of a medium like, oh, just... I don't know because people do have this negative reaction to it. But the really nice thing is once you do treat the hearing loss, then you see the benefit, it's like, oh, why was I so silly about this? Why did I have these hesitations? My life is so much easier now that I can hear and I don't have to put all this energy in. And it is very true what you said that some people can present on paper as having the same hearing loss, but have very different experiences.
And a large reason for that is not the amount of damage to their ears, it's their brain's ability to help filter out background noise and process speech for them. So we know that as you age, already you're... Even if you don't have a hearing loss just as you age, your brain's ability to process sound becomes less and less accurate. It's just not as precise as it used to be. So it could be these brain differences that are not measurable on the hearing test itself that account for these differences in how well or how slowly people adapt to hearing aids.
Doran: Yes, for sure. People think that hearing loss is just your ears and it's auditory processing. I know I'm old now and I'm not as smart as I used to be. I'm sure if I tried to take grade 12 chemistry, it wouldn't go that well for me. So some of it's ears, some of it's auditory processing, it's a whole system that your brain is trying to process these sounds that it can't quite hear well. So to you guys out there, I just want to say, if you have questions, I didn't mention this before, you can type them into either the chat or the question and answer that's at the bottom of those Zooms. Just go ahead and type those questions in and I'll pass them on to our panelist. We do have one coming through. It says, why is hearing loss more prevailing in men than women?
Christine: Oh, that's a great question. So why hearing loss is prevalent more so in men than in women, it's not a biological reason, it's a lifestyle reason. So we just like gender stereotypically, the men are the guys who go to work in the ship yards or go work on construction sites. And just generally, men are putting themselves more into those environments where there is a lot of background noise compared to women. So it'll be interesting to see if that does change in the future as those kind of stereotypical gender roles maybe change as time goes on. But it's certainly not a biological factor, it's just an environmental and lifestyle factor.
Doran: For sure. Another question is, what about telecoil hearing aids? So he's asking, do audiologists advocate for these telecoil hearing aids in places like the Royal theater and movie theaters? We're not aware of anywhere in Victoria that has that option. So can you speak to telecoil first of all, what that is and how it's used?
Christine: Yeah, so a telecoil is a specific type of technology that is present in some hearing aids. So basically, this telecoil, what it allows us to do is via magnetic induction basically placed down directly through hearing aids. So because that sound is going directly into your hearing aids, it's kind of like old-school Bluetooth streaming. You get this direct input, you're going to get better clarity and better signal resolution. So a telecoil can be used often for landline telephone use or as this person alluded to some theaters or banks or other businesses, they might have something called a hearing loop.
So you have to activate your telecoil to get the sound from the hearing loop into your hearing aids. It's definitely something that audiologists are aware of. I think some people used to think of that kind of as old school technology. There was kind of a phase where I feel like telecoils, at least in my opinion, they just weren't getting advocated for and they were getting put in less hearing aids. But I think people are starting to see the value in them again. I definitely know that there are some theaters that do have loop systems. Off the top of my head, I don't recall which ones, but I have had patients tell me they've gone to them and use their loop system.
Another awesome thing is I do know that some of our independent living places like the Cedars over on Cedar Hill Road, I know they had talked to me about getting a loop installed and just trying to find ways to help facilitate better hearing for their residents. So general in Canada, they're kind of under utilized. I think they do get utilized a lot more in Australia and Europe. But definitely not only audiologists were advocating, but you as the patient, you should definitely advocate for it where you go as well and help bring awareness that there are these easy technologies to use.
Doran: For sure. That's a good one. Another question from Ron and he's talking about he had a hearing test. Many clinics send those results through to their doctor. And then he was referred to as ENT, ear, nose and throat doctor, which as we know in Canada takes weeks and maybe months to see that guy. So I know this is a source of frustration for us. Can you just speak to the role of your primary care physician and your ENT in diagnosing hearing loss or what they might be looking for?
Christine: Yes, so as an Audiologist, it's our scope of practice to diagnose hearing loss and the non-medical management of hearing loss. Certainly then your primary care physician gets looped in more so if there's any, we call them red flags that come up when we're doing that, either that questioning of your ear health. In general health, there are some things that we know we want medically investigated or if something shows up on the hearing test that again, we believe should be medically investigated. It's not typical for age or noise related hearing loss.
So just one example of those things would be having a significant difference between your ears, their ability to hear. With age or noise related hearing loss, we expect both your ears to be pretty well the same. So just as an example, if somebody had come in and we saw a significant difference between their hearing, we would want to loop in their primary care physician. We want it investigated because we're wondering why, why is one ear worse than the other? Is something medically going on that could be treated or stopped to prevent this difference from occurring or getting worse?
Typically at that point, the primary care physician usually will refer on to the ear, nose and throat specialist. Certainly they're the experts in the medical management of ear, nose and throat diseases and disorders. So that's kind of where the ENT comes in and you're so right. The waitlist are unfortunately in Victoria very long. A lot of my patients have been telling me, it's going to take about a year for them to get it and see the ear, nose and throat doctor. But the ear, nose and throat doctor is going to be the one who can evaluate the health of the hearing or not the hearing system, but the structures of the ear and determine if there is anything that does need medical or surgical attention.
Doran: Yes. I mean, that's a tough one for us because sometimes we see there's often valid reasons for you to go see your ENT and some pretty scary medical reasons, but often a doctor will just refer through just because that's what they do. So if you've been referred, you want to definitely go to that. But if it is just hearing loss, can we say you don't need to see an ENT for that or-
Christine: Absolutely, if there's no red flags on the case history and there's no red flag conditions apparent on the hearing test, absolutely you do not need to see an ear, nose and throat specialist and you don't need necessarily to consult with your primary care physician. You can just proceed directly with hearing aids. And something that sometimes people don't realize is even if we do find those red flag conditions like the difference between the ears, often we will send a medical clearance forum to the family doctor anyways and say, hey, in the meantime, this hearing loss needs addressing, can we proceed with hearing aids while we wait? And often they'll come back with a yes. Sometimes they'll come back with a no. But we try to work together with them so that we're not delaying that treatment if we know that that hearing loss is most likely to be permanent and not medically correctable.
Doran: That's great. Okay, I've got another question from Lynn. She's asking, what effects do cell phones have? And what strikes me is people's interpretation of how they get hearing loss. It's a duration as of a low noise. A lot of times people have the misperception like, oh, I went to one rock concert and now I have hearing loss. It was one big blast and that's not always the case. Is it?
Christine: No, that's certainly not always the case. I don't... Off the top of my head, I haven't encountered any stays that say, cell phone use significantly impacts your hearing thresholds. That's just not something that would raise my alarm bells if you were telling me that you had been exposed to loud noise. I just don't think your cell phone is... You're going to be using it that long enough or that loud enough for it to make a difference.
Doran: One last question, a good one from Barry is that the tax implications, the CRA implications, people are trying a lot of times for us to get us to fill out the disability tax credit form to get that tax deduction. How does that typically work, Christine?
Christine: Yes, so I guess, there's two things. One is that hearing aids in general, they are considered a medical expense. So you can claim the most as a medical expense when you're doing your income taxes. With regards to income tax, I am no expert. That's kind of where my knowledge ends. Definitely consult with an accountant or somebody who specializes in that if you're not sure of how that process works. Secondly, there is a disability tax credit for hearing loss if you have a disabling hearing loss. The tricky thing with that is that their criteria is quite strict. Ultimately, the judgment is up to them, not up to us as the audiologist. But they will ask questions like can this person understand you at least like, I can't remember what it was, like for example, 50% of the time, even with hearing aids.
Christine: .. in the ideal listening situation?
Doran: That's right.
Doran: And that's key there.
Doran: ... That it is aided as well. It's not without hearing aids, I can't hear. We can aid that person. That's important, right?
Christine: It's your aided performance. So the majority of patients who we see on a daily basis, I would be saying, yes, I can communicate with them more than whatever percent of the time. If they're aided, no problem. They don't have that disabling level of hearing loss. We can still fill out that form, you can still submit it for judgment, but just be aware that their criteria is you basically have to be unable to communicate even with hearing aids even face-to-face one-on-one. So it is quite a strict criteria.
Doran: That's great. One more question because it's also a good one is that does it take a certain amount of time for your brain to adapt to your new hearing aids? That's a great one.
Christine: That's a great question. And the answer is yes, it absolutely takes some time and that can vary for people. So for myself, personally when I started wearing hearing aids, I felt like I adapted fairly quickly. I have a younger brain. So that kind of works in my favor. I was all about getting hearing aids once I decided I needed them. So for myself, personally I felt like I was adopted within the first week. I felt it was pretty easy. The majority of patients I would say are pretty adapted within the first two weeks. When we fit you with hearing aids, we typically like to see you two weeks out for a follow-up to see how that adaptation process is going. So it's even majority of people are adopted by two weeks, but there are some people where we know it's going to take four, six, maybe even eight weeks, maybe longer. That's not the majority of people that just individual brain differences, differences in the amount of hearing loss, differences in the amount of time that hearing loss has been untreated can all factor into that acclimatization period.
Doran: For sure. I mean, that's a great point in that a lot of people think they'll put these things in their ears and bang, normal hearing. That's not what happens. It's not normal hearing, it's aided hearing with the hearing aid. So we want to make sure we set those expectations, which you do quite well in the clinic. I don't know what their expectations are. Another technique that we use is to step people up. So when we first program your hearing aids, we may not step it down a notch. You haven't been exposed to all of these environmental sounds for a number of years. So to hear the toilet flush or the car go by or the garbage disposal. Those are jarring sounds. And again, we're talking about auditory processing here. A lot of what your auditory processing does is filter noise and speech in a noisy. You don't need to hear, you don't even realize you don't hear the car go by, right?
Doran: Guess what? All of a sudden, we amplify everything and that's going to be overwhelming to a lot of people. So we do have the ability and do quite frequently step up. And that's why we want to follow-up shortly thereafter and able to step up that volume because yeah, your brain has to get used to that. Again, it hasn't heard those sounds in years.
Christine: Totally, and something that's so cool about hearing aids these days, a lot of people don't know we have this technology. But for example, say instead of starting you at 100% of the prescription, we started at 80%. If you're doing well at that follow-up, we can just set the hearing aids to automatically slowly over time increase you to 100%. And we as the audiologist, we get to set that. So maybe I'm going to give it two more months to get you from 80% to 100% every single day just a fraction of a percent louder. The hearing aids are just going to automatically increase that volume. So the great thing about it being gradual is you're not going to perceive that change, but we're going to get you to the spot to optimize your hearing. Just the same way your hearing loss gradually deteriorates and you don't notice it changing. The same thing occurs when we then introduce the hearing aids and we can start-
Christine: ... automatically increase.
Doran: Sure, and another big part to that is you got to wear your hearing aids. If you're going to lecture people, it's going to be, but these things in your ears when you wake up and take them out right before you go to bed because even though you may perceive, oh, I don't need to hear anything for the next hour or so or I'm just hanging out at home alone, it's your auditory processing system. Your whole brain is getting used to those noise, ignoring some, amplifying others. Your brain is going to do that. So I know Christine agrees, where your hearing aids all the time, 100% of the time, your brain will eventually compensate for those loud sounds.
Christine: Yeah, something our patients don't always know as well is that our hearing aids actually do tell us when we see you for a follow-up how much you've been wearing them. So don't lie. We're going to see on average, we don't get a day by day breakdown, we don't get geo tracking, nothing fancy like that, but just on average, how much you're wearing the hearing aids. So we want to see that typically be 12 plus hours a day to consider that full-time wear.
Doran: For sure. And another kind of unrelated question, but good is, what are we doing for COVID safety around here?
Christine: Oh geez, COVID.
Doran: Who knows? It's been extensive. It's been a year long for us. We have an extensive protocol of all the things you'd want to see. It's weird to see Christine without a mask right now. I haven't seen her face in like a year. I am not in clinic. I'm working from home. So we're doing all of these things that we need to be doing in order to keep our customers safe. So rest assured. All those protocols that you'd like to see in any healthcare setting, we are adhering to those.
Christine: And something in hearing aid technology that's quite new as well as you've got new hearing aids is the ability for remote programming. So that's a great thing that we can offer to our patients who want to be able to... They just need a quick adjustment and they don't want to come to the clinic. They can do that from the safety of their home. So if that's the case and you do have hearing aids and you're wondering if that's an option, reach out to your audiologist and we'll be able to let you know, yes, is that an option or no? Are the hearing aids new enough to have that feature? And if so, we can guide you through getting that set up if we ever need it in the future.
Doran: For sure. And another thing I want to mention is our delivery service. If you need batteries or domes or anything for our customers, it is free delivery right now. So we're happy to drop those off at your front door. Okay, Christine, I think that's it. Thanks so much for that presentation. It was well laid out.
Christine: Thanks for having me. Then thank you guys for attending. It's been so great to be able to engage, even if it's not in-person. We'll get one day. We'll be there one day - eventually.
If you have questions about this presentation, and need to speak with an Audiologist, please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921. Or request an appointment online.