Submitted by Erin Wright on Wed, 06/15/2022 - 19:02
June is Men’s Health Month, so we’re diving in to explore the topic of men and hearing loss.
You may be surprised to discover that hearing loss is different for men and women.
Read on to learn more and find out why.
So first things first: Are men really more affected by hearing loss than women? YES!
Men do experience hearing loss more often than women. And on top of that, hearing loss in men tends to appear earlier, and the loss is more profound than in women.
This is partly because men are still less likely than women to address health issues when they first arise. But like many ailments, catching a hearing problem early often allows us to stay in front of the issue, and retain a fuller range of sounds.
So, men - I’m talking to you directly here! - if you notice yourself missing parts of conversation, or the volume on the TV is slowly inching upwards, this is not the time to grin and bear it. Let’s schedule a hearing test and make sure we can nip any early hearing problems in the bud.
Your quality of life relies on it.
But is this true in Canada too? ABSOLUTELY
We may wear a toque, when everyone else in the world calls it a wool cap, and we may love complaining about the weather over a warm cup of Tim Horton’s, but unfortunately these national idiosyncrasies won’t help close the hearing disparity between men and women.
Even in Canada, 63% of men are likely to experience hearing loss, compared with 46% of women.
Still, women aren’t off the hook. As we age, everyone’s risk of hearing loss increases.
Overall, 93% of Canadian adults aged 70-79 will experience hearing loss, compared with 38% of adults aged 40-59.
For this reason, we recommend everyone get a baseline hearing test around age 50 - man or woman, whether you notice any hearing issues or not - simply to set a standard against which we can compare future hearing tests.
Men report higher levels of tinnitus too
Often described as a ringing or buzzing in the ears, tinnitus is the term used to describe any sound that cannot be attributed to an external source.
While 37% of Canadians experience tinnitus in any given year, that figure is higher for men (39%) than for women (34%).
This is likely due to their role in the workforce, and their traditionally louder choice of hobbies.
Why are more men affected by hearing loss and tinnitus than women?
Photo credit: Paul Trienekens, Unsplash
There are many physiological, social and occupational reasons hearing loss is more prevalent in men. For example:
Submitted by Erin Wright on Tue, 05/17/2022 - 13:06
Hearing loss doesn’t just impact one individual. Because listening is such an important part of communication (as well as human connection), when the message can’t get through, all parties are affected - including the speaker and other participants in the conversation.
When communication is hampered by hearing loss, it can easily lead to misunderstandings, delays, frustration - and if it’s not dealt with appropriately - social isolation.
Here are a few strategies to help improve your conversations. Regardless of who is experiencing hearing loss, both the speaker and the hearer have a role to play.
There are three different types of communication strategies:
Verbal communication strategies: just as it sounds, this is where we use words to convey our meaning, using either speech or writing.
Non-verbal communication strategies: this is where tone and body language - including eye contact and hand gestures - come in. For example, consider how a simple phrase like Yes please takes on a totally different meaning if said with an eye roll versus a shrug, versus with clasped hands!
Visual communication strategies: this is where we use photographs, charts and graphics to help illustrate our point. Visual communication strategies are especially useful in simplifying complex information and data.
Using a combination of all three strategies will help you communicate most successfully.
The benefits of good communication strategies
Whether we have hearing loss or not, we can all strive to be better communicators.
By controlling habits such as interrupting or talking over others, we not only demonstrate respect for the speaker, but we make it easier for everyone to hear.
Here are some examples of the benefits of using good communication strategies and the consequences of choosing poor communication strategies:
Recognizing hearing loss in your conversation partner
Because hearing loss occurs so gradually over time, it’s often the people around the person who notice their hearing loss first.
And while we all want to be gracious conversationalists, we never want our communication support to be the only assistance our hearing impaired loved ones receive.
If you notice ongoing patterns in your conversation partner, it may be time to recommend to check in with an Audiologist.
Here are common signs your conversation partner may be experiencing hearing loss:
Asking you to repeat what you’ve said
Complaining that you’re mumbling or not speaking clearly
Missing words or guessing at what others are saying
Speaking too loudly or talking over others
Responding incorrectly or jumping into conversation at the wrong moment
Our Audiologists use a variety of tests to pinpoint any hearing issues and their cause, as well as recommend the best treatment and support, like hearing aids.
Strategies for speaking to someone with hearing aids
While hearing aids bring sounds back into range, they do not restore hearing loss. That means factors like distance, ambient noise and other considerations can still get in the way of clear communication.
Here are some best practices when speaking with someone who wears hearing aids to help ensure a successful conversation:
Face the person you’re speaking with, in good light.
Speak slowly, clearly and distinctly – don’t shout or exaggerate mouth movements, as this makes reading lips harder.
Don’t talk from another room - speak where you can see each other.
Keep your hands from covering your face, as many non-verbal signals come from facial expressions.
Reduce background noise and other distractions (such as turning off the radio or TV, even if it’s in the background).
Best practices for conveying important information to someone with hearing loss
In a perfect world, everyone would hear everything we have to say. But some messages are more important than others.
Here are some tips to ensure our important message gets through, regardless of any hearing loss our listener may be experiencing:
Get the person’s attention before speaking to them.
Make sure you are close enough to hear - face-to-face is best if possible.
Whenever possible, provide relevant details - like directions, schedules and assignments - in writing.
Pay attention – if your listener looks confused, they likely are. Ask questions to make sure your message has been understood.
How has technology changed communication?
You may remember a time when each household had one television for the entire home. Your telephone was attached to the wall (or sat on a desk), and was used solely for voice calls. Remember that?!
Today, our technology is almost omni-present and far more powerful, and we need to remember to practise good communication strategies with our devices too.
For better understanding and comprehension, consider:
Turning off the television or music in the room where you’re talking.
Setting down your phone or computer to help you focus on face-to-face conversation.
Communicating by text or email may help those with hearing loss understand the message more clearly in writing.
In certain situations, it may also be helpful to use voice-to-text functions on your phone or computer…but be careful - this technology is not perfect yet, and may lead to crossed wires! Make sure to double check the written output to ensure it matches what you intended to say.
Three final tips to effective communication
Remember, when it comes to good communication it takes two to tango: a speaker and a listener.
To ensure you both have a positive experience and achieve your communication goals, remember to:
Be aware of the person you’re speaking with.
Know how (and when) to speak, ensuring you’re speaking clearly and articulating well, without shouting or interrupting.
Check in often – ask good questions to make sure your listener understands you, and to make sure you understand them as well.
And finally, if you’ve noticed you or your favourite conversation partner are struggling to communicate, it's time to speak to an Audiologist. Our Audiologists will assess your hearing and recommend a variety of supports and treatments - like hearing aids - to help you back to communicating effectively again.
Call us or request an appointment online to schedule an appointment: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921.
Submitted by Christine Stangeland on Tue, 04/26/2022 - 19:35
All about hearing aid apps
We get a LOT of questions about hearing aid apps. And we love that! If you are curious about the benefit of apps and how they can benefit your lifestyle, Audiologist Christine Stangeland explains how it all works!
In this presentation, Christine talks about:
Streaming audio to your hearing aids
How to connect your hearing aids to your cell phone/tablet
Using hearing aid apps
Benefits of using Bluetooth apps with your hearing aids
Troubleshooting Bluetooth connections
We're going to walk through some of the most common hearing aids and phones and just kind of review how those can get connected together. So, I've got some really great screenshots to share with you guys. So, this will be a good reference for the future if you get a new phone and you're not sure how to set it up. And then we'll talk a little bit more about why, why do we even want our hearing aids connected to our cell phones? And then just some basic troubleshooting tips, because we do a lot of that with Bluetooth these days as well.
So, what is Bluetooth? Bluetooth is just a type of wireless communication from one device to another device. So, in this instance, we could think of it as just a wireless communication between our hearing aids and our cell phone. When we're talking about Bluetooth and connecting devices together, that process is called pairing.
If you ever hear somebody talk about, "Oh, you need to pair your hearing aids to your phone or put them in pairing mode," that's talking about Bluetooth and just allowing those devices to then find each other and join together wirelessly. We're not going to dive too much into the nitty-gritty technical stuff of Bluetooth today, but there are different types of Bluetooth and this is going to be relevant later on. So, we have Bluetooth Classic, there's also Bluetooth Low Energy. Some of our hearing aids are using Made for iPhone Bluetooth. And we also have the ASHA protocol, Audio Streaming for Hearing Aids. So, all of these are Bluetooth, but they have subtle differences. The great thing about Bluetooth and utilizing a Bluetooth connection with your cell phone or with your tablet, you don't need internet. A lot of my patients come in saying, "Oh, but I don't have a data plan." Or, "I don't have my phone connected to the internet." This is internet-free for the most part and we'll touch on that. Generally speaking, you do not need the internet to connect these devices together. So, that's really awesome.
The benefits of pairing hearing aids to your cell phone or tablet
So, what are some of the benefits of pairing our hearing aids to our cell phone or to our tablet? One of the biggest and best thing is that you can stream. And so, streaming is I guess, the technical language for sending an audio signal from one device into another listening device. You can stream audio from your cell phone right into your hearing aids. So, if you're somebody who really struggles hearing on a cell phone, trying to hold it up and find the right position with your hearing aids, having this streaming allows the audio signal to go directly into both hearing aids. So, we know we're going to get improved word understanding if we're utilizing two ears versus one ear. But the great thing about the audio being streamed through your hearing aids as well is that the sound quality of the audio signal is then being corrected.
Your hearing loss is being corrected and accounted for by the hearing aids. So, you're going to hear things better than you would just trying to hold the phone up to your hearing aid and then allowing your hearing aid microphone to pick up that sound and then amplify it for you. So, we can stream all kinds of audio. Basically, anything you can play from your phone, you can play through your hearing aids, whether it's music, podcasts, audio books, FaceTiming with your fans or family, watching YouTube videos, phone call audio. Basically, any sounds that you want to hear from your phone or your tablet, you can hear through your hearing aids.
How to pair your hearing aids
So, how to pair your hearing aids and your cell phone. This is where things get a little complicated, so bear with me. This is going to depend, number one on the kind of hearing aids you have and what kind of Bluetooth you're using, and also the kind of cell phone or tablet that you're using. If you are ever unsure, the best thing you can do is just consult with a hearing aid user manual. Another really great resource is just checking the hearing aid manufacturer's website, they should have written instructions on their website. Many hearing aid manufacturers actually also have YouTube channels as well, walking you through all sorts of things that you can troubleshoot. This instance, we're discussing Bluetooth, but lots of our manufacturers have great troubleshooting videos for changing wax filters and all that great stuff as well. They're a really good resource.
I did compile a list of links to some of these websites as well - just as a quick and easy guide for you to find some of these things and maybe then bookmark them.
So, ultimately different hearing aids are going to pair differently. Apple devices are going to pair differently to Android devices, because they are using different Bluetooth protocols. So, our first step is to check that your hearing aids and your phone or tablet are compatible. So, if you don't already know, if you haven't talked to your audiologist about whether your hearing aids are compatible with your cell phone, you can always go on to the hearing aid manufacturer's website, and they'll have a list where you can see which phones or tablets are compatible with the hearing aids that you have.
Before investing in a new smartphone...
So, let's say you're thinking of upgrading and if you're like me and your cellphone's getting on the older side and you're thinking of upgrading, maybe you want to go and make sure like, "Oh, is that iPhone 13 compatible with my hearing aids?" Or, "Is that latest Samsung Galaxy phone compatible with my hearing aids?" So, they should have a drop down list and it should let you know if things are compatible. So, that's a great thing to check before you do invest in new technology if you're hoping to utilize that Bluetooth connection with your hearing aids.
Pairing Phonak / Unitron hearing aids with Apple products
So, first, we're just going to talk about pairing Phonak and Unitron hearing aids with Apple products. So, a lot of what I'm going to say is going to be repeated with other manufacturers, other hearing aid manufacturers and other cell phone or tablet manufacturers. There's ultimately just very basic steps we want to take with all of these devices. The first thing is we want all of our devices to be fully charged or have a good charge. If you're on 2%... Bluetooth does take a lot of energy. It takes about three times the energy and just compared to regular hearing aids if you're streaming. So, we do want to have a good battery charge. What we're going to do then is we need to put the hearing aids into pairing mode. So, these days, our new hearing aids, all of them automatically will be in Bluetooth pairing mode for the first two to three minutes that they're turned on.
So, all we have to do is restart the hearing aids. So, that means if you have a hearing aid that has a battery compartment, open and close your battery compartment to restart the hearing aids, or if you have rechargeable hearing aids, you can put them into the charger and then give them a couple of seconds and take them out of the charger to turn the hearing aids on again. If for some reason you're trying to pairing your charger is not handy and you do have rechargeable hearing aids, almost all rechargeable hearing aids, you're going to push and hold on either the lower rocker button or the button that's on the hearing aid, and you're going to push for around four seconds, and the hearing aid will turn off. If the hearing aid has a light, often it'll flash yellow or red letting you know it turned off, wait a few seconds, push and hold the button again. And if the hearing aid is the kind that does have a light built into it, you'll see a green light and it's turned back on.
So, once our hearing aids are turned on freshly and they're in pairing mode, where do we need to go in our phone? So, I'm showing you just some examples here from an iPhone. So, what you're first going to do is you're going to go into settings and then we're going to go into the Bluetooth menu. We do need Bluetooth to be toggled on because we need to use that Bluetooth to talk between the phone and the hearing aids. For a Phonak or a Unitron hearing aid, it should pop up here under other devices. In this instance, I was pairing my own hearing aids to make these example screenshots, so I have labeled it Christine.
However, for the large majority of you, if you have a Phonak or Unitron hearing aid, it's not going to say R-Christine, it's going to say R-Phonak hearing aid or R-Unitron hearing aid. So, once that shows up, you're just going to go ahead and tap on that and a couple of seconds later, it should say connected and you are good to go for audio streaming. It's that simple. If for some reason that fails, we'll talk more about troubleshooting later, but ultimately that's all you need to do. Just a few easy steps, navigate yourself to settings, Bluetooth, restart the hearing aid, it should show up and then just tap on it.
Something that is important to know about Phonak and Unitron hearing aids is they are using Bluetooth Classic. To my knowledge, they're the only manufacturer utilizing Bluetooth Classic technology. So, on this previous slide where you saw that my hearing aid showed up and it had an R in front of it, that R was indicating it's the right hearing aid. So, you might be thinking, "Christine, why only the right hearing aid? There's two hearing aids. You have two hearing aids. Where's the left hearing aid? Phonak and Unitron are doing something quite unique. So, they are having a connection from the cell phone into the right hearing aid or the Bluetooth hearing aid. And then that hearing aid kind of gets looped in through proprietary magic basically. So, it's kind of the phone to the one ear and the one ear in the other ear. So, it's correct that we are only connecting one hearing aid in this instance. So, I know that often gets asked a lot. They're like, "Where is my other hearing aid?" It will work, just trust the technology.
So, here's just another example of seeing some of those connections. And we're going to talk a little bit later too about why we might use some apps. With Phonak and Unitron, if we are going to utilize their apps with the hearing aids, the apps are using Low Energy Bluetooth. So, we're using different Bluetooth for the app than we are for audio streaming. So, if you have connected your hearing aids to your cell phone for audio streaming as well as for app use, when you head into that Bluetooth menu, it's actually going to look like you have three hearing aids now. So, we have our right hearing aid for audio streaming, but then we have two hearing aids, our Low Energy, LE, Low Energy left hearing aid and our Low Energy right hearing aid connection for using the app. Almost always, if you go into this screen, you're going to see that they say not connected, and that is okay.
The only time those Low Energy connections between the app and the hearing aids are going to activate is when you're actively using the app. And as you know, on your cell phone, you can't see multiple things at a time like you can on the computer. You're really only looking at the app or you're looking at your Bluetooth screen. So, if those say not connected, that is okay. For the most part, just ignore them. Just know that it is okay that it looks like we have three hearing aids. The one that does not have the LE for Low Energy is our audio signal, and that's the one you're going to want to pay attention to if we need to do any troubleshooting.
Pairing Phonak or Unitron hearing aids with Android products
If say we were pairing our Phonak or our Unitron hearing aids to an Android product, very similar process, the screens just look different. So, again, we're going to go into our settings menu and then we're going to go into connections. And again, we're going to want to make sure that Bluetooth is turned on. And if you click on Bluetooth, that's again going to bring us into a menu where you are going to have to hit scan. I'm assuming we've rebooted our hearing aids already, that they're already in pairing mode by the time we've gone into settings, connections, Bluetooth, hit scan and again, your hearing aid should just pop up. You're going to click on it. The phone is going to pop up a little request asking, do you want to connect to this hearing aid? Do you want to pair to the hearing aid? Yes, we're going to hit pair and away we go, you should be connected and that's your audio connection.
So, pairing, pretty well all other hearing aid manufacturers, they're using mostly Made for iPhone or that ASHA protocol. So, these are going to be a little bit different and actually less intuitive to connect if you're not super familiar with them. So, if you've got Oticon hearing aids or Widex hearing aids, Starkey hearing aids, Signia hearing aids and we're pairing to an Apple product, that's what we're covering next. So, again, kind of the same basic setup, ensure your hearing aids are turned on and well charged, ensure your phone is turned on or your tablets turned on and well charged. Same thing, restart the hearing aids to put them in Bluetooth pairing mode. On an iPhone, where we're going to head is into settings, but this time we're heading into accessibility. This is probably a place where a lot of you haven't spent a lot of time on your phone, but we're heading into accessibility.
And you will likely have to scroll down a bit, but then we're going to look for hearing devices. Once we've gone into hearing devices, it should show up. If your name's William, it's going to say William's hearing aids. And then it's actually going to display which hearing aids they are too. So, in this instance, it's found William's open, Oticon hearing aids. You're going to click on them and once you click on them, again, we're going to just receive this pairing request, do you want to pair? The answer is yes, hit pair. If you have two hearing aids, it'll probably ask you to pair again right after you've hit pair and that's okay. And then everything should be nice and connected. So, now we're connected for audio streaming.
Pairing Apple products to MFI hearing aids (Oticon, Widex, Starkey, and Signia)
If we're pairing to an Android product that's using that ASHA protocol with basically any of our other manufacturers, Oticon, Widex, Starkey or Signia, there can be a little bit of variability here. Sometimes they're going to want you to pair directly through the hearing aid apps. You'll already have to have the hearing aid app installed, but some you can just pair directly through the Bluetooth menu. So, this is just an example to show you using Widex hearing aids. In this instance, they did want us to have the app installed already and you just follow the prompts, basically get started. It's asking you, "Do you have batteries in your hearing aids or are they rechargeable?" If they're rechargeable, take them out of the charger and put them in pairing mode. Again, it should just automatically find them after a couple of seconds. It's going to pop up that Bluetooth pairing request, you're going to hit pair and success.
So, in almost all instances, the real take-home message with all of these connections is generally just follow the prompts, turn things off and on, and just find out where in the phone you need to look to establish this connection. It can be really intimidating at first when everybody's phones are different, things are hidden in different places, but it really is easy. And there's really not a whole lot you can do to... You can't mess up your hearing aids if you somehow mess up, for lack of a better term, the pairing to the phone. So, just feel really empowered to try it yourself and build that confidence. And if not, you can always again, watch this video for help, call the clinic for help, drop in for help or check out manufacturer website, manufacturing YouTube videos. There's so many great resources on the internet we have these days to help with these things.
If we were pairing, again using those ASHA hearing aids, so Oticon, Widex, Starkeys, Signia but pairing to an Android product, similar to what we saw before. Just as an example, heading into settings, heading into that connections, we're going into Bluetooth, the hearing aids should show up. In this instance, we did need to find two hearing aids. Again, you're going to click on them and it's going to pop up that request to pair, you're going to hit pair. And things should say connected and everything should be good.
So, now that the hearing aids are paired, I did talk about this at the beginning, you can listen to all audio from your phone or tablet through your hearing aids, phone calls, music, podcasts, videos, you name it, it'll play through your hearing aids. In an ideal world, this will just happen automatically all the time. Anytime you go to play your favorite song, it should just start playing directly into your hearing aids. If you're calling your mom to say hi, it should just automatically start playing into your hearing aids. If that's something you don't want, you can always delete your hearing aids from your phone so that you no longer have that connection, or you can temporarily disconnect them as well.
Disconnecting audio streaming Apple products
So, as an example, being a hearing aid wearer myself and I do have my hearing aids connected to my cell phone. When I come into work, I do disconnect my hearing aids from my cell phone, because I don't want to accidentally hear a phone call going into my hearing aids or a text message going into my hearing aids when I'm in the middle of helping one of our patients. So, this is again, an easy thing to do and once you understand that you can do that, I think you'll get along just fine with the hearing aids and using them with your phone. So, this is an example of disconnecting hearing aids in an Apple product. Again, I was using my hearing aids for this example. I do have Phonak hearing aids, so we're using that Phonak or Unitron protocol. So, we've gone into settings and you we've gone into Bluetooth.
Disconnecting Android products
If my hearing aids said connected, what I want to do is tap on that little eye, hit disconnect, and then it should say not connected. I put those on the wrong order, I'm so sorry. Same thing works in the reverse order. If it was the end of the day and my hearing aids were disconnected from my phone and I wanted to reconnect, come back in and just click on the hearing aid. You don't even have to hit that little eye, just tap on it and it should reconnect for us. Very similar process for disconnecting from an Android product. We've gone into Bluetooth, in this instance, we've hit that little settings cog for the hearing aid connection, and you can see there's just nice little button down here called disconnect.
Changing Audio Routing during a phone call
You're going to click on that and it's going to stop sending sound into your hearing aids. The cool thing here too is in the Android product, it does allow you to decide if you want that separate control over phone call audio versus all other audio. So, maybe you did only want your hearing aids to play phone calls, but if you didn't want, for whatever reason, mute like a music or a YouTube video is playing out loud, you can disable other audio. So, you do have some choices. And again, there's a lot of variability with what you can control in the phone, but don't be afraid to have a look in your phone and see what you can do in there. Something a lot of my patients do worry about, or they ask about during an appointment is they're like, "Okay, well, I'm making a phone call and now I'm on the phone with my son or daughter, but I want my partner to hear it as well. How do I put it on speaker mode? How do I disconnect from my hearing aid so that somebody else can hear too?"
So, when you are actively making a phone call, and this is again, just a screenshot from my iPhone, there's this audio button. So, this is already giving me a clue. I can see this little Bluetooth logo, that funny, looks like a B, I'm not sure where they were going with... What their inspiration for that was, but to me it kind of looks like a capital B, so I know that's Bluetooth. So, I can see that the audio is already routing through my hearing aids, but if I wanted to change it, I can just click on that. And now, it's going to give me the option of either selecting to play it through my iPhone speaker like normal so that I would just have to hold the phone up like normal to hear and to talk.
I then also have the option of speaker phone if I wanted somebody who was also with me to hear, and we could both hear at the same time, or I could keep in my hearing aids. So, that's a nice, easy way to change that. And you can do that mid-phone call, like whenever you need. There's also the flexibility with the hearing aids to have the hearing aids always route phone call audio through your hearing aids or never route it through your hearing aids or the phone, I guess, to try to be smart and pick and choose. So, again, some people, they want to hear music, but they don't want to hear phone calls. So, if we had a Phonak or Unitron hearing aids and we wanted to change something like that, we're going to go into accessibility.
This is a funny one. I forget where this is every single time and it's hidden in touch. Once we're in touch, if you go to call audio routing, here's where we see the option for automatic routing, Bluetooth headset or speaker. So, the funny thing is by default, with iPhone, with Phonak or Unitron products, if we leave it on automatic, if you are the one receiving a phone call, if you answer the phone, just touching the answer button on your phone, the signal is just going to play through your phone. It's not actually going to default to your hearing aids. Phonak and Unitron are manufacturers that allow you to either do a double tap function on your hearing aid or push a button on your hearing aid to answer a phone call. So, if you had done that double tap or that push of that button, then it's going to default to playing it through your hearing aids.
Changing the audio setting:
But let's say for example, you're just not a fan of the double tap or the buttoning, you just want to touch on your phone and have it go into your hearing aids. We want to change this call audio setting. So, in that instance, we don't want automatic, we don't want the phone to pick based on how we answer the phone, we want it to default to a Bluetooth headset. And in this instance, our Bluetooth headset is our hearing aid, so that's what we're going to choose. There is the option, if for some reason you always wanted your phone to default, to being on speakerphone, that lives in here too. But for the majority of my patients, we will come into this setting and change it to default to Bluetooth headset. Streaming audio, you can change audio streaming settings in your phone settings as well. So, something we get asked a lot about as well is people will hear maybe notification sounds through their hearing aids or the volume of their notification sounds is too high.
The volume of their ringtone playing into their hearing aids is too loud. Those things are actually not controlled by your Audiologist. So, it's nothing that we can program for you. That's all actually set by your phone. So, then it sometimes does take some exploring of your phone to find where these settings might be and which ones are going to manipulate what you are hoping to manipulate. So, just as an example in here, if you felt like the ringer... Because sometimes when your phone receives a phone call, it sometimes will play the ringtone through your hearing aids, depending on the manufacturer, and again, what you set up. But let's say the ringtone was going into your hearing aids and you were finding it too loud, in this instance, we went into settings and we went into sounds and haptics, and then here's where we can change our ringer volume. There's a lot of other things we can change here too, like what the ringtone is and how loud these things are.
Because the phone now will want to play a lot of these system sounds to you and some people don't like that, you'll want to turn some of these sounds off, so again, go into sounds and haptics. Another thing we often want to disable is keyboard clicks, so that way when you're texting on your phone, you're not just hearing click, click, click, click as you type out to everybody and turn off lock sounds as well. Some of these sounds, these keyboard clicks and these lock screen sounds can actually interfere with app use. So, once we have an app installed, we definitely want these disabled, just so we don't accidentally disrupt what the app is doing to our hearing aids.
Again, just another example of where you can try to customize some of those sounds going into your phone. This is an example with an iPhone. In this instance, we've gone into notifications. Let's say we have this fitness app installed, but we didn't want those notifications to play through our hearing aids, then we can go in here and we can either just turn off notifications in general if we don't care about having them, but there's also this option to turn off sound notifications for that app specifically. So, those aren't going to play through your hearing aids if you don't want to. This is again, just a general example. This could definitely apply to really any app you have installed on your phone. So, the possibilities are endless.
Same thing if we were trying to look at more of an Android platform, same thing, we're heading into notifications. In this instance, we're looking at a Google app and you can go ahead here and just hit see all, and then you've got the option to either allow all those notifications, or you can see each one has its own little toggle, we can turn those off or on individually. Just another example of turning off those keyboard sounds and Android. Again, I mentioned keyboard sounds in particular can interfere with hearing aid app functionality. So, we're going into settings, we're going into sounds and vibration, systems sound and vibration control. And here's where we can toggle off things like touch interactions, screen lock sounds, the sound that happens when you plug in your charging cord, dialling keyboard sounds, all that good stuff. So, if in doubt, a lot of these system sounds, it's better to have them disabled, turned off just to help reduce the chance of them interfering with our app functionality.
Just an example, again, with some of those hearing aids using the Made for iPhone protocol, so Oticon, Widex, Signia, Starkey. If we've gone into settings, we've gone into accessibility and now we're in hearing devices, and you can see we've got our hearing aids connected. But here's where you can also choose to either do you want the phone ringtone to play through your hearing aids or not? Toggle it on or toggle it off. Do you want to hear things like text message notifications coming into the hearing aids? Yes or no? You can toggle that on or toggle that off. We do have the audio routing option, so you can always go into that menu further to decide how sounds are going to get played, or if they're going to get routed to your hearing aids.
This is my favourite tip of all time
I use this all the time. If you can't find something or you're not quite sure where within all of these menus things are hidden, you can just search. So, it's kind of funny because when you normally... I know on my iPhone, when I go into settings, this search is kind of hidden. It doesn't actually show up at first, you have to pull down on the screen to see that little search menu and have it pop up, but the great thing is you can search for whatever in there. So, in this instance, I've just done the example of searching for hearing, thinking I was searching for my hearing aids, and then it's giving us a list of possible locations that we could be looking for. So, the great thing is if I was trying to connect some Made for iPhone hearing devices, now I already know this is where I want to go. I didn't have to go the complicated way. I can just click on here and it's going to automatically take me there then. So, this is a really helpful tool. I do believe Android has this search setting as well. I use it all the time when I'm setting up phones and tablets in the office with my patients.
Hearing aid Apps
So, switching gears a little bit and just talking about hearing aid apps and why we want them and how they work. So, the hearing aid apps are something that we download and install onto the phone, and they are, again using that Bluetooth connection between the phone and the hearing aids to allow us to make adjustments to the hearing aids. The apps are manufacturer-specific, so you do have to have your hearing aid manufacturers app installed on your phone. So, if you've got Phonak, you're going to download the Phonak app. If you've got Unitron, you're going to download the Unitron app and so on.
The great thing about these apps is they're free to download. They only take a couple of maybe 20 seconds to install on the phone at most. It's nice and easy. So, essentially what you're going to do is head into the, whether it's the App Store on an iPhone or Google Play Store or whatever kind of app downloading system your phone or tablet has, head in there and just search for your hearing aid manufacturer. And it should be one of the top, if not the top results that pops up when you search for your hearing aid manufacturer. And then it should just allow you to install. Like I said, it's free, you don't have to pay. Sometimes where I do get stuck with my patients who are using iPhones or iPads is that Apple will want you to enter your Apple ID password to allow the installation of the app. So, do make sure that you know your Apple ID password.
Pair your hearing aids to your App
The benefits of hearing aid Apps
Some, not all, but some hearing aid manufacturer apps do have the ability to pseudo-track your hearing aid location. So, if that's something that you want to have, so just in case you ever did lose your hearing aids, you want to allow location services. I do encourage a lot of my patients to allow that, just so that if you did ever accidentally lose a hearing aid while you were out and about shopping, running errands throughout the day, you can go into the hearing aid app and then see where your hearing aid was last connected to your phone.
Pair your hearing aids to your App
Once you've done all this, if we need to put the hearing aids into pairing mode again to successfully connect, you're just going to need to restart the hearing aids. So, again, open and close the batteries or put them in the charger, take them out of the charger, they should be in Bluetooth pairing mode and the app should just do the rest of the work. So, what are some reasons that we actually might want to have the apps installed on our phone? They make it really easy these days just to get more functionality, more customization out of your hearing aids. So, probably the biggest and most common reason is it allows for you to adjust the volume of your hearing aids. So, once we have the app installed, I'm just going to click ahead for just a second, you can see most apps are... This is an example of Phonak's app, but they're going to have some sort of volume slider, whether it's up and down to indicate volume or going left or right. You're going to have a really easy way to adjust your volume.
The benefits of hearing aid Apps
And the great thing is the apps will typically show you your default volume as well, so you know exactly how much louder or how much softer you've adjusted your hearing aids compared to what your audiologist has programmed them to be at. So, this is nice because some of my patients previously, maybe they adjusted their hearing aids using the button on the hearing aids and then two hours later, they're like, "Oh, I don't remember, am I too loud or am I normal? Or am I too soft?" And they just don't remember, but they wanted typically try to be at the prescribed programmed volume from their audiologist. Having this app and having this visual can make it really straightforwards to see exactly where you are. Most apps allow you to mute to your hearing aids. Not that as your Audiologist, "I want you wearing your hearing aids muted most of the time."
Putting hearing aids on mute temporarily:
But the example I give to my patients is the only time I mute my hearing aids is if I'm at home and I'm making a smoothie and just using the blender for a minute or two. I'll quickly just mute my hearing aids, either using the button or the app, because in this instance, it's only a minute or two, it's not going to be such a long hazardous noise exposure that I need earplugs, but it's more comfortable have the hearing aids muted while the blender's going. So, that's an example of when you might want to mute your hearing aids. We can change programs using the app as well. So, some manufacture apps are going to come with some default programs in there. They might have a default program you could try for listening to music or listening to television, or perhaps during our appointment together, we've built a program specifically for you for something you told me about.
So, for example, if you were one of my patients and you said, "You know what Christine, I'm doing well with the hearing aids except when I'm at choir practice, it's quite echoey." Then I might actually go into your hearing aids and build you a program specifically for your choir practice environment, so then you could change your hearing aid into choir program as needed. Most apps also allow you as the patient to make your own program now. So, that's kind of a really cool function that we have. So, again, all of these apps are slightly different in their function, but lots of them will allow you to adjust. They'll give you a little bit of an equalizer, you could adjust the bass tones, the mid-tones and the treble tones. Some of them are going to also allow you to adjust the amount of noise suppression going on or the microphone direction or the microphone focus.
So, then the cool thing is you can make those live changes. So, for example, if you're at a pub with your friends and you're having a hard time hearing, open up the app and start making some of those quick changes and just see if that is giving you what you want, whether it's more clarity or more noise suppression. You can do that while you're in that environment and make some changes to help yourself further.
I do tend to say to my patients personally, "At the end of the day, if you're doing a lot of fiddling with the app, that's often a sign to come into me so that I can make some more precise or maybe more specific adjustments for you so that you don't have to do so much work." But if it's just kind of a one-off, you're at a restaurant while visiting a family member in a totally different city and you just need this quick and easy help, it's absolutely a great tool to use. Some of our apps do also allow for remote programming of hearing aids. This is something that's been really helpful during the pandemic when some people don't feel comfortable coming into appointments or just don't have that ability to come in. So, we are able to now make some adjustments to your hearing aids through the use of these apps, which is really great.
Your Audiologist can use an app to adjust your hearing aids:
So, if you're traveling or you're just not able to come into the clinic or not comfortable with it, but you just want an adjustment made to your hearing aid settings, we can do that as well through the use of these apps. So, these are really, really great tools to have. If this is something that does overwhelm you or just doesn't seem like something you're going to use, you don't have to. Your hearing aids are going to work just fine if you're not using these things, but if you're curious and motivated and a great thing to teach yourself, to just better empower you, to get the most out of your hearing aids, absolutely, go ahead and explore. It's a really great thing to have.
So, I just wanted to show you guys again, just an example of what some of the hearing aid apps look like. So, again, with this particular app made by Phonak, we can see that we do have the option to customize some of the frequencies. There's a treble adjustment, and mid adjustment and bass adjustment, overall volume adjustment, overall noise adjustment. And then you can actually save that and create a special program. So, maybe you had adjusted it for going to a play, you could save that as your play program. There's also these little cheats for getting more comfort from your hearing aids, if you're somewhere quite noisy or more clarity, or just with somebody that you're having a harder time hearing, you need more distinction. So, again, each app is going to have a different look and a different interface, but generally speaking, a lot of the same features.
The benefits of hearing aid Apps
So, we've talked about a little bit of this already, the benefits of the apps. Adjusting the tone of the hearing aids, and this is something really important to note. If you're brand new to hearing aids, and this is your first pair of hearing aids, and you just got them and we've got the app installed, the best thing to do is just not do anything to them in the app. And the reason for that is that we want your brain to get used to the sound of the hearing aids. We want to retrain the brain to listen with what the hearing aid is giving it - it's important for our brain to relearn how to hear with hearing aids.
So, in the very, very beginning, if you're getting hearing aids for the first time or even getting a new pair of hearing aids, try to just give them a good week or two without making a ton of adjustments on your own. That way, when you come back to your Audiologist, whether it's me or somebody else, and you're telling them the things that are great about the hearing aids or things that are not working for you about the hearing aids, we're getting feedback about what we have ultimately programmed for you, not settings that you have adjusted that we're not able to control or necessarily see how they got utilized.
As a good rule of thumb, if you need more clarity, if you're in a situation where things are not as clear or maybe a little bit more muffled, try increasing the high frequencies. High frequencies is the spot where most people do have hearing loss. If they have age or noise-related hearing loss, that's typically where we're giving you a good amount of amplification already, but if things are just not quite where you want in terms of clarity, a little bit more high frequency help it's going to give you more crispness or more distinction, help you get those soft consonant sounds. If there's a lot of background noise, as a general rule of thumb, most background noise does tend to be low-pitched. So, in that instance, you might want to try decreasing the low frequencies that will often reduce, or at least suppress to some extent background noise that you may be hearing.
Tracking your phone/hearing aids
I mentioned earlier that some hearing aid apps will track the location of your hearing aids, kind of. So, the key thing to understand about the apps that do offer location services or a find my hearing aid feature is that your hearing aids do not have GPS built into them, but your phone does. So, what we're doing is telling your phone to remember the location of everywhere it goes, whether that's to church, whether you're driving in the car to school or to work, remember the location of everywhere your phone has gone, but also remember where the hearing aids actively connected by Bluetooth everywhere we've been. So, you really do have to be somebody who takes your phone everywhere you go for this to really be effective for finding lost hearing aids if you did happen to lose your hearing aids.
If you, for example, have your hearing aids connected to your tablet and you have that location allowed, but you don't bring your tablet everywhere you go, your tablet is always going to think your hearing aids are at home, because your tablet is not leaving the house when your hearing aids leave the house. Hopefully, that makes sense to people why it's just so important to... Not that it's important in life to carry your phone with you, but for hearing aid tracking, it is. Some apps do offer some pre-set programs as well. So, if you or I, or whoever your Audiologist is haven't set up any manual programs, some apps do have some pre-sets in there. You can always try out. Some will have like a restaurant program or maybe a live music program that you can try.
And some hearing aids like Signia in particular, I know their app has a mask mode. So, that's been really great during the pandemic and was developed because of the pandemic. We know that people wearing masks are going to sound more muffled, because the mask naturally is blocking more of the clarity of their speech and making them a little bit softer. So, by enabling mask mode in your hearing aids, all of a sudden, we're going to help give you an extra boost to overcome what that mask is doing to the person's speech. Widex in particular, I know their app has something cool called SoundSense Learn. So, basically, it's a feature again, you could use if you're in an environment like a pub where you're having a hard time hearing. It's going to ask you a couple of questions about where you are and what your goal is. So, maybe I'm saying, "I'm in a really noisy place and my goal is to hear my friend better." Then you can just go through these series of A/B comparisons.
So, it's going to say, "Hey, which sound quality is better, sound quality A or sound quality B?" And you listen and you pick A or B, A or B, and it's going to fine-tune the sound for you. So, that one is neat because it can guides you through that process. If you don't have that background knowledge about which sounds you want to adjust, you don't have to have that background knowledge, you just have to decide, "Hey, which was..." It's like being at the optometrist, "Which is better, one or two, one or two?" So, it's very much the same idea there. Just some quick examples of, again, different apps and what they look like. This is Oticon's app here showing us volume adjustments, a mute button, where we're going to adjust our programs that we have, a find my hearing aid function to bring up a map and see where left and right hearing aids are, just an example of an equalizer what it might look like. Some of them will even come with pre-sets you can choose.
Again, some apps do come with pre-set programs you can try out, like for a cafe or for outdoor sporting event or for watching television. This one here is Signia's app with that mask mode button that you can enable for use for anybody who's wearing a mask that you need to hear better. So, I think we're all getting kind of where I'm going with the benefit of the hearing aid apps is that there's a lot of customizability in here and that we can also, if we need to make remote adjustments in the hearing aids as well for you guys, if you're not able attend the clinic. So, the thing to know about the remote adjustments is you do have to have an internet connection for that to work.
So, earlier I had said how great it is that we have Bluetooth and you don't need the internet for Bluetooth and by and large, that is true, but if we are going to attempt to remotely connect to your hearing aids from my computer to you at home, you do have to be connected to the internet. In this instance, we do need an internet connection to either send you settings or live connect to you through a video call and adjust your hearing aids.
So, if we ever are going to do that, do just make sure you have a good internet connection. If you've got a good internet connection at home, great. Not super great to do this if you're just out and about without a strong internet connection, or you're just trying to use public Wi-Fi, sometimes that can be spotty. Otherwise, nice and easy to use. If you do have questions about that too, you can always again, reach out to myself or reach out to your audiologist or the clinic. If we do need it, we can give you a little more specific detail about how it's going to work with your specific hearing aids. Troubleshooting Bluetooth, this is something we spend a lot of our time doing these days. Bluetooth while convenient is not perfect, and it's not that it's not perfect just for hearing aids, Bluetooth is just not perfect for all Bluetooth devices.
So, ultimately Bluetooth is a wireless signal and its range is limited. So if, for example, you were streaming music from your cell phone into your hearing aids and you left your cell phone on the couch, and then you went upstairs, eventually you're going to be too far away for that Bluetooth signal to effectively communicate from your phone to your hearing aids and things might get crackly or spotty or cut in and out, or may just quit altogether. So, ultimately, being within direct line-of-sight is always going to be best, even though sometimes Bluetooth can get around walls. Like if you, again, left your phone in the living room, but you went to the kitchen to grab a snack, yeah, sometimes that will work, but sometimes not. So, just understand that if you're getting quite far away, it's not unreasonable for the Bluetooth connection to start to cut in and out or drop all together if we don't have that direct uninterrupted line-of-sight.
The environment that you're in may also help or hinder how that Bluetooth signal is getting from your phone or your tablet to your hearing aids. I'm just going to jump ahead a second, there's a nice visual here. So, when you're at home and you're in a room, there's lots of walls here for a signal to bounce off of. I know this is a little bit small, but what we're looking at is a person standing in the kitchen and their phone is on their kitchen counter. There's lots of walls and covered doors to help bounce that signal around and into her, I assume it's a woman, into her hearing aids. That's going to really optimize the chance of that signal of getting to the hearing aids and getting to the hearing aids strongly.
If we contrast her with our lovely man riding his bicycle with his phone in his back pocket, there's no walls outdoors. So, that signal, it has nothing to bounce off of. So, there's a much greater chance that that signal is not going to reach the hearing aids with the same effectiveness, even though the phone is fairly close by, there's a good chance that maybe spotty or get interrupted. So, in general, back pocket is not the best place for your phone or your tablet to be if you're wanting to actively stream. Definitely, try to keep it in a front pocket or in front of you or in a purse or something like that that's on the front. For whatever reason, if things are kept to the backside, we can get a little bit of body shielding where your body is physically blocking that signal. And then again, if you're outside, there's no other walls to bounce that signal back to the hearing aids.
Connecting to multiple devices:
Other things we can do to help troubleshoot Bluetooth, most of our hearing aids, you can connect them to multiple devices. So, lots of my patients will have maybe their phone and their tablet connected, because sometimes they make phone calls on their phone while they're out and about, but sometimes they're at home and they want to watch Netflix on their tablet, you can have both devices connected. The problem is Bluetooth is not super perfect. So, the Bluetooth and the hearing aids, it's just going to automatically connect to whichever one sometimes just has a stronger signal. It doesn't necessarily know that you're intending to use Netflix versus use your phone. So, if you do have multiple devices connected, a good rule of thumb is if you're intending to switch from one device to another, if you can just disconnect the hearing aids or toggle Bluetooth off temporarily, just to make sure that the hearing aids really only have one option for which device they are going to latch onto and which device they are going to root that sound to, if that makes sense.
We have seen some issues as well with Apple products, in particular, if you have multiple, multiple, multiple devices that are connected using the same Apple ID, there's something going on with the Apple ID sharing that will cause other devices to disrupt, even though you haven't paired to them. So, this, I see more if like a husband and wife are sharing an Apple ID between the two of them, so ultimately they might have like two cell phones and two tablets, maybe there's an Apple Watch involved. It's a lot of devices, so it's best not to share that Apple ID with other people and to minimize the devices that you are connected to.
If for some reason, things are slow to work on your phone or your tablet, just close any apps that are running in the background that aren't needed. On newer iPhones, you're going to swipe up from the bottom and that's going to then shrink the apps a little bit for you and you can swipe up to close them. On older iPhones with a button, you do a double click, a fast double click on that home button, and then same thing that apps will appear in a smaller form and you swipe up to close them. So, when we're talking about closing them, that's the equivalent of, if you're on a computer, hitting that X in the top right-hand corner to close things. Otherwise, if you haven't actually hit that X and closed things, then what's going on is things are just still running in the background, they're open, they're just minimized and that's taking up brain power from the phones or computer basically.
Every now & then, close open apps
So, just every now and then, periodically, go through and close things, that's a really great habit to get into. On Android, they should have a way. I can't remember if you pull down from the top and then it lets you close the apps individually as well. Again, different on every phone. If you're not sure, you can just Google, but definitely a good thing if things are acting up, close the apps and just reopen them if needed. Moving on, oh, so just some other troubleshooting tips in general. What if your hearing aids aren't streaming and you're thinking, "Christine, you told me that if I play the music, it's just going to go into my hearing aids and it's not." Go ahead into either that Bluetooth menu or that accessibility and hearing devices menu, and just make sure the hearing aids are connected.
Again, Bluetooth is great, but it's not perfect. So, every now and then, that connection may fail to reestablish when your hearing aids turn on in the morning. So, if the case, basic, basic troubleshooting works 90% of the time. And that basic troubleshooting, you just try turning your Bluetooth off and on, and turn your hearing aids off and on. Just reboot both devices that you're trying to utilize and that should, for the most part, resolve it. If that doesn't, try turning your phone all the way off and all the way on rather than just toggling Bluetooth off and on. The good old turn it off and turn it on tip really does work most of the time. What if your hearing aids are connected, but things are cutting in and out? Is it possible that this signal was interrupted at any point in time?
So, sometimes this will happen if, say for example, you're streaming music, but a text message sound came in and that was also utilizing a Bluetooth signal, that might just quickly and temporarily disrupt whatever you're listening to. So, that can be a good thing to be aware of, and you might need to go into your phone settings and see if there's any notifications that need to be turned off. The interesting thing with Bluetooth is, and I've noticed this and I don't think I would've realized this if I wasn't a hearing aid user myself is that for myself personally, when I have my hearing aids connected to my laptop, computer and Bluetooth is active, sometimes I'll go onto websites and I can hear my hearing aids toggle into Bluetooth streaming mode, even though there's not actually any audio sound being streamed, but I can hear that change in the sound quality.
So, every now and then, you get something funny like a webpage or a notification that's going to send a Bluetooth signal, but it's not actually sending a sound that you're hearing. So, every now and then, that does occur to people and they intuitively just think, "Oh, it keeps cutting in and out. It's cutting in and out." And I guess, the perception is it's cutting in and out, yes, but it's actually just being disrupted by something else. So, if we can try and figure out what that something else is, we can help to minimize that disruption.
Other basic things, just try and be close to your phone or your tablet or computer, whatever you're trying to stream to. If your hearing aids are connected to multiple devices, for example, myself personally, I have my hearing aids connected to my computer and my cell phone, if I'm streaming something on the computer and my cell phone starts ringing from like a spammer because they're the only people who call me, it is going to interrupt what I'm listening to on my computer. So, the phone is going to interrupt. So, in that instance, it would've been better if I had turned my Bluetooth off on my cell phone proactively just to prevent that disruption. If you don't, it's not the end of the world, but it's just something to learn what works for you personally and your usage and your habits as time goes on.
Shared Apple ID?
Again, I talked about, do you have a lot of devices that are using the same Apple ID? Are you sharing an Apple ID with your son and your daughter or your husband? If so, maybe time to get your own and just minimize how many devices are connected to that Apple ID period. If some of these basic things are really not working, absolutely feel free to call the office and schedule an appointment with your audiologist, and we may have some better tips and tricks or just make sure that the hearing aids themselves are not cutting in and out, even though maybe something is not actually Bluetooth-related. So, if you can't troubleshoot it yourself, we're always here to help you.
Hearing aids compatible with the app?
If your hearing aid app is not connected, again, just make sure the hearing aids are compatible with the app. You might want to check the manufacturer website. You do want to make sure that your phone or tablet has the minimum required software installed. So, I do see sometimes patients coming in with older iPhones or older Android phones that just aren't compatible with the app itself or the app has been updated, and now requires you to have newer operating system on your phone or tablet that you currently have. So, sometimes that can happen. If all those fails, just delete the hearing aid pairings and repair them to the app. If that doesn't work, then I would say, delete the app itself from the phone, uninstall it and reinstall. It's even better if you can uninstall the app, restart the phone and then reinstall the app. Every now and then, it's not that common, but every now and then, the app will install with just some sort of weird glitch that doesn't allow things to work perfectly. And just our only way to resolve that is to delete it and reinstall it.
If you're not familiar with how to delete an app from your phone and reinstall it, again, really great place to look would just be search on YouTube, search on Google for the phone that you have and just search how to delete an app. And if that doesn't work, you can call the office as well. That one in particular is harder for us to troubleshoot over the phone unless we personally are very familiar with the phone that you have. So, quick Google or YouTube search should easily find you something that can show you with pictures what to do. Other good tips, just keep your phone or tablet software up to date. Ensure the hearing aid app is up to date.
Keep the app up-to-date:
So, if you can, if you get asked to or prompted to when you install the app, allow for automatic updates just to keep it working as well as possible. They will roll out updates fairly frequently to catch any bugs that happen occurring and fix those. So, it's always great to keep those things up to date. If you're in a situation where you have two hearing aids and it's not a Phonak or Unitron hearing aid and only one is showing up, or you can only get one connected, but both are showing up, see your audiologist. Sometimes the hearing aids have just lost their wireless connection to each other, and we need to establish that wireless connection to each other before they can then connect to your cell phone or tablet together as a pair.
Still have questions?
Again, as I was saying earlier, if you're finding a lot of this stuff kind of over your head, or it feels like it's out of your league in terms of what your technology and experience is, there's classes you can take. I just did a quick Google search, I found when I was Googling, there's a company called victoriatechtutor.ca here in Victoria that offers technical support and technical classes and tutoring for seniors. Oak Bay, I searched for Oak Bay just because that's where I am working out of. Oak Bay Rec, they also offer some like tech classes and computer classes in general. So, a lot of the troubleshooting skills for if these things are failing, do require having a little bit of a working knowledge already of just general being tech savvy. So, if you're not sure, you always take a class too, that's always another great resource to have just in your back pocket. And that is it. If you do need a follow up appointment, you can always visit our website, give us a call either here at the Oak Bay office or the Broadmead office.
If you want to talk about hearing aid apps with an Audiologist, please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921
Submitted by Martine Schlagi... on Tue, 04/26/2022 - 00:00
How you can benefit from Tinnitus Activities Treatment
This year at the Healthy Hearing Expo Audiologist Martine Schlagintweit focused on Tinnitus Activities Treatment, which includes counselling of the whole person and considers individual differences and needs.
Today, I'll be talking about managing your tinnitus and to get started, I'd like to keep things general with an overview of what tinnitus is and the more general principles of management for this symptom. And then we'll dive into Tinnitus Activities Treatment, which is a behavioural treatment for tinnitus. And we'll talk about how we use this system at Oak Bay Hearing Clinic and Broadmead Hearing Clinic.
The photo you see here on the top right of the screen is a joke that was passed along to me by a client who successfully manages their tinnitus and who has seen us for tinnitus management. And I think this is a really, really important thing to touch on. And that is that tinnitus can be an unpleasant and chronic symptom for a lot of people, but it's okay to have a bit of fun with it and to integrate humor into healing. I think that's such an important step that we can take to kind of make the ride with tinnitus a bit more pleasant. By the end of today's presentation, I'd like everybody to have a comfortable knowledge of what tinnitus is and to have some familiarity with the types of tinnitus, because there are two different types of tinnitus. And it's also important to me that we all walk away from here today with an understanding of the goals of tinnitus treatment and management. And ideally, you'll also have some insight into Tinnitus Activities Treatment and how that's implemented here at our clinic.
3 tinnitus principles
So to really define tinnitus, we have to meet three pre-main principles.
Tinnitus has to be heard, you can't smell it, you can't see it, you can't taste it. This is a hearing phenomenon.
Tinnitus is involuntary. So tinnitus is not something that you can produce intentionally. It's sort of just something that happens in your body.
Tinnitus is in your head.
So it's not created by an external sound source. It is a sound that's perceived through the auditory system then the auditory neural tract...the nerves running between the ear and the brain and inside of the auditory cortex in the brain, are coding for sound when there's no sound present in the environment. And a lot of people will actually describe that as a phantom sound.
Who has tinnitus?
So let's start with a quick poll here. How many people in our audience have tinnitus? Can you see the poll there? I see a lot of people doing hand raising. That's great. I'm going to submit my response to the poll, which is yes. I'm seeing a 100% yes rate here and I'm seeing tons of hands up in the audience. So I can see that pretty much everybody watching this presentation is experiencing tinnitus and that might have been the motivation for why they're joining us today. So I see a 100% response rate. So tinnitus is actually incredibly common. About 50 million people in the United States and 10 to 20% of all North American individuals experience chronic tinnitus or report chronic tinnitus.
About 80% of people with hearing loss have tinnitus. And we actually call this the 80/80 rule because 80% of people that have hearing loss have tinnitus and 80% of tinnitus patients also have hearing loss. So that's what that vice versa situation and that's called the 80/80 rule. And part of why that might actually be the case is because both tinnitus and hearing loss may share a causative factor or might share a cause that causes both of these symptoms or gives rise to these symptoms. And does anybody know what that could be? I'm going to launch another poll here and you can respond in the poll and let's launch that. So let's see if anybody can guess what the most common cause of tinnitus and hearing loss is.
Let's see here, getting nine responses, it's creeping up. So hopefully you guys have allowed the app to kind of give you a pop-up so that you can participate in the poll, can see about 12 responses there. You can also feel free to pop it in the chat if you'd like to, if that's a little bit easier for you, we'll let that run for another moment here. Good. So we're capping out at about 16 responses there. So the correct answer here, which most of us came to is actually noise exposure, noise exposure is the most common cause of both tinnitus and hearing loss. Stress is certainly a factor when it comes to tinnitus, but generally, it is not a causative factor, it's what's called an exacerbating factor. So stress makes it a lot worse, but it doesn't typically cause the tinnitus.
Most tinnitus isn't bothersome
So the majority of people with tinnitus are actually not bothered by their tinnitus and they really only notice it in quiet spaces or when they take a pause in a really quiet area. Some examples of that might be when they're reading or upon waking up in the night. But these people say that they hear it, but it does not affect their quality of life. A very small subset of people that report chronic tinnitus are bothered by it. And that's about three to 5% of people with tinnitus. And that group will report a significant disturbance to their quality of life. And they're often quite distressed by the experience of tinnitus. It's annoying to them, it's aggravating. It prevents them from engaging and participating fully in their day-to-day life. Often it will have an effect on their relationships and kind of maintaining their mood throughout the day.
And touching on that, about half of the people with bothersome tinnitus experience kind of concurrent psychological or psychiatric conditions such as depression, anxiety, or they've recently experienced a really stressful experience or crisis. And a pretty typical story for me in the clinic is to have a new patient come in. They're there for a tinnitus evaluation and they might sit down and start off with a story like this.
So I know I have a bit of high frequency hearing loss, but that's been there for a long time and I haven't done anything about it. And the hearing loss really doesn't bother me at all. And my ears have always actually rang. They've been ringing for about 10 years now. And again, that never really bothered me at all. And my hearing didn't bother me at all. I wasn't really aware of my ears, but then I crashed my vehicle last year. I didn't get hurt in the accident, but the experience really, really shook me up and I lost sleep over it for weeks. And then my tinnitus got super loud about a week and a half after the accident and it's been loud and bothersome ever since. And I just can't seem to ignore it now. So that's a very, very, very typical example of what somebody might present to the clinic and say when they are seeking tinnitus treatment or tinnitus management.
There are 2 types of tinnitus
Now, before we get any deeper into this discussion, I think it's really, really important that we differentiate that there are actually two types of tinnitus. The first is the far more common and most likely to be chronic type of tinnitus and that's called subjective tinnitus. So that's 95 to 98% of tinnitus cases and subjective tinnitus can be defined as the experience of sound when there's no identifiable sound source present. And only the person with subjective tinnitus can hear the sound of their tinnitus. The second type is called objective tinnitus. And this is rare, super rare. Objective tinnitus is a sound that is generated within the body and does have an identifiable source.
What causes tinnitus
It often stems from some sort of anomaly or occurrence or physical anomaly, such as a foreign body moving around in the ear canal. Sometimes that's problems with the eustachian tube. That's the tube that runs from your middle ear into the back of your throat. And sometimes that can fall open and you'll hear your own body sounds like breathing or swallowing. And occasionally, there's a situation where there might be small cracks in the bones lining the inner ear, which leads to people reporting things like they can hear their eyes rolling around in their head or the muscles of their neck sliding against each other.
Objective tinnitus can occasionally be treated medically or surgically. So a differential diagnosis for your tinnitus is super important. So if you're experiencing tinnitus, you've never had it evaluated, at the very least go for an audiological assessment to figure out if you're experiencing that subjective tinnitus, which is far more common, or objective tinnitus. So that kind of leads me into what should you do if you have tinnitus and what does a typical tinnitus care path look like?
3 steps to successfully assessing and managing tinnitus
Step one: medical clearance. So that's where your health professionals are going to use all of the diagnostic tools in their respective toolkits to determine if there's an underlying pathology or problem that is causing the tinnitus. And a thorough hearing test, questionnaires, and possibly some medical imaging may be a part of that process. And this step often involves consulting with some other professionals. Your Audiologist, your psychologist, your physician, in some cases, and you may even be referred on to an otolaryngologist or ENT surgeon, pharmacist, what have you.
Step two: treatment. That may look like medical intervention for an objective tinnitus case. In most cases, it's far more common that that's going to be a behavioural tinnitus program offered through audiology. Some sound therapy also offered through audiology and may involve some psychological intervention if the distress level associated with that tinnitus is high or you're having some psychological or behavioural issues related to the tinnitus.
Step 3: healing. Now, step three, we don't talk about this step a lot, but I think it's a really, really important and possibly the most important step. And that's our healing phase. So once you've completed a behavioural intervention program or tinnitus intervention program, where you've learned all these strategies to manage the tinnitus and you've started using sound therapy, using those strategies consistently, whenever you're noticing your tinnitus, is very important and that's your healing phase. So you've figured out what works for you and you continue to use those strategies on an ongoing basis to continually manage that tinnitus symptom. And that's where we can really see some relief.
Beware of scams
Something that I think is really important to acknowledge is that people with tinnitus can be a bit vulnerable to falling victim of scams or investing in products that claim to cure tinnitus with a complete lack of evidence to support those claims. A lot of those products are actually registered with the FDA as food products, and that's why they can make those claims in their advertising without facing any sort of punitive action by the FDA. It's completely unregulated that component. And unfortunately, the number of poorly researched and ineffective tinnitus cures and supplements by far outnumber the effective and well-researched programs that we actually do see some success with. Presently, no evidence supports the use of supplements, dietary changes, and not even any medications presently that have been demonstrated to successfully decrease the awareness or perception of tinnitus. Now, that being said, I'm not saying that this is not a treatable or manageable symptom. There are plenty of programs that are well-researched and have an excellent success rate, which we're going to speak about in just a moment here.
So let's dive into some of those general principles of management. We're not talking about any specific behavioural program presently. We're just talking about those three steps to managing tinnitus successfully. So step one is going to be your audiological assessment for tinnitus. This allows us to identify the type of tinnitus, that's subjective or objective. We're going to detect possible issues requiring medical attention. And we're going to characterize the tinnitus and its impact on the person's quality of life, which helps us determine what the treatment plan will look like. Now, Audiologists, we start with the audiological assessment because Audiologists are perhaps the only health professional with the appropriate training and experience to evaluate tinnitus successfully. Tinnitus care doesn't actually fall into any other profession, scope of practice, other than maybe otolaryngologists. And that tends to be more for objective tinnitus. Now that being said, your audiologist is likely not going to be the only professional you consult with in regards to your tinnitus. You may see physician, psychiatrist, otolaryngologist, occupational therapists are often also involved as well.
Now this is an example of what you might kind of go through in a tinnitus evaluation. So your Audiologist is going to take a thorough history. They're going to examine your ear canal. That's what this lady's doing here. We're going to do some pure tone testing. So that's just testing your sensitivity to the sounds. And then also some pressure tests or temp anthropometry to see how well your eardrum and middle ear bones are working together. And each component here is kind of helping us with the standard battery to see if there are underlying medical issues.
But in addition to those measures, we'll also have the patient fill out tinnitus specific questionnaires. It'll take four tinnitus characterization measurements. And on this side, it's a little bit blurry here, I hope you can see clearly, we have kind of our standard components of the audiogram there. And then at the bottom, that's usually where we write the results of our tinnitus characterization measurements. And we use those to determine the subjective pitch and loudness of the tinnitus. And we also determine how much masking sound is needed for the individual to become less aware of their tinnitus. And that helps inform our treatment.
So at this point, you would've undergone your audiological assessment. The Audiologist is going to make some referrals as needed. So that might be to a physician, again, psychiatric or psychological intervention. They may recommend to your physician that you see otolaryngology or ENT surgeons. And then we would determine the most appropriate treatment plan in terms of audiological management of the tinnitus symptom. So for some people with subjective tinnitus, that step's likely come to involve some degree of sound therapy and often participation in a behavioural tinnitus management program. So the goals of tinnitus treatment are not actually to get rid of the tinnitus itself. And there's a researcher named Moller who did a lot of in investigation into this in the 1980s. And I think that he really said this best. So I'm just kind of quote from here. And what he said was that tinnitus is not just one thing, it's many things.
So when people say they want to cure tinnitus, it's very much like saying they want to cure cancer or cure pain. And the problem that we have with that is that the cancer pain and tinnitus are all not one single thing. They're multiple entity things and each has many, many forms, shapes, sizes, manifestations, and perceptions, of the way you hear it. And further, it's important to realize that the perception of the tinnitus itself varies greatly from between each person that experiences it. So researchers like Moller, reasons that curing cancer, tinnitus or pain with a single solution, it is a noble cause and an honourable goal, but it's very, very unlikely to happen just because of the nature of the condition that we are trying to manage.
The goal of tinnitus treatment
So bearing that in mind, the goals of successful tinnitus treatment are to reduce the impact on quality of life that the tinnitus has for the individual and to habituate to the perception of tinnitus. And that is a fancy way of saying that getting to the point of being accustomed to the tinnitus, that the brain actually starts to filter out the sound of the tinnitus, just like it would with traffic noise outside of a window, or a noisy fridge or planes or trains taking off near your home, if you live close to a station.
And the best way to do that is through behavioural tinnitus management programs. And the one question that I get pretty much every time I see a new tinnitus client is, "Do these programs actually work?" And the shorter answer here is absolutely. Almost every single behavioural tinnitus management program that's well-researched has a document SID success rate and the most successful programs are based in cognitive behavioural therapy and cognitive behavioural therapy, or CBT is a type of psychotherapy in which negative patterns of thought and maladaptive behaviours about a trigger, in which in this case is tinnitus, are challenged in order to alter our unwanted behaviour patterns or address the mood challenges related to that trigger. And CBT, in combination with sound therapy, has the highest success rate out there for successfully managing tinnitus. And we see rates of about 80 to 87%. So that's a really, really good outcome if you're engaging with a treatment.
The realities of tinnitus treatment
Now, it's really important to talk about the realities of any treatment program. We can talk about that 80 to 87% success rate, and that's the success rate of achieving our two treatment goals. Number one is reducing the impact of tinnitus on the quality of life. And two is habituating to the tinnitus, but the reality of behavioural tinnitus management programs is that you are going to be working with a multidisciplinary healthcare team. So behavioural therapies tend to require patients to see multiple health specialists, that could be doctors, audiologists, other professions, and this can sometimes increase the complexity of the treatment as well as the cost of the treatment, whether that's done through the public or private system and kind of the onerous nature of it, because you will be going to multiple appointments in multiple places in some cases. We also have to consider the time and effort that behavioural therapies take because they often require multiple clinical sessions over several months or even years for some patients.
So the results are cumulative and they actually do usually require that you fully complete the full course of clinical sessions. So it can be quite timely. And it does require a lot of effort to get there and to schedule those appointments and make sure that you're staying on task with them. And finally, we have our commitment, and this might actually be the most important factor. And that's just that all tinnitus management systems require the patient to embrace the treatment with an open mind, with positive expectations, and a willingness to participate fully in the activities and exercises to the best of their abilities. And simply put, that's you get out what you put in. So the more effort that somebody puts in towards it and is committed to the process and says, "You know what? This is going to work for me and I'm going to make it work for me." We really do see great success. But again, that does take that time and effort component. It takes a bit of diligence and discipline to actually go through with that.
Tinnitus management programs
Now there are many well-researched tinnitus behavioural management programs, every single one of them has been shown to be effective. We touched on that before, or at least the ones that are listed here, but at Broadmead Hearing Clinic and Oak Bay Hearing Clinics, we kind of reviewed all of the available programs and evaluated them for things like cost to the patient and the ability to customize the program to the patient's needs. And after doing that review, we selected Tinnitus Activities Treatment. So that's what we offer here at Broadmead and Oak Bay Hearing Clinics. Specifically, we chose Tinnitus Activities Treatment or TAT, as I refer to it, because it's one of the most well-researched programs. And it has these ongoing studies at the University of Iowa. So they're continually evolving this program and integrating new research to make it better so that you don't get this stagnated treatment that's really out-of-date.
It takes a highly patient-centred approach with a customizable format. So they do have a standard kind of flow of the treatment, but not everybody needs every single component and we can easily customize it to what the needs of the patient are. And it has really excellent activities that engage the patient and facilitate that commitment and compliance piece, which has been difficult for patients in the past. And not only that, but it's incredibly cost effective for our patients because the materials are provided free from the University of Iowa to the clinicians. And it's completely compatible with the requirements of third party insurers like Veterans Affairs Canada, and WorkSafeBC, which is important for a lot of our clients.
Tinnitus Activities Treatment
So some of the components here of Tinnitus Activities Treatment is that it is a behavioural tinnitus management approach. It's heavily based in CBT, or cognitive behavioural therapy. And it uses that CBT-based counselling in a picture format. So we use picture-based format to increase the kind of standardization across clinicians and make sure that the clinician doesn't skip over important concepts. And we kind of ensure that our sessions flow in an orderly way by engaging with that format. It does follow an incremental and learning-based approach, to explore the four key areas that tinnitus can have an impact on somebody's quality of life, those being thoughts and emotions, hearing and communication, sleep and concentration.
And with this program, we do use activities or homework, so to speak, and journaling, to engage with the patient, demonstrate their understanding of the key concepts that we cover with the program, and to track people's progress. It also is a really nice thing to look back on and completion of the course, if you do end up having a surge of your tinnitus, looking back at what were successful management strategies for you, you're not required to base this into your memory. You can actually look back over all the work that you did through the program and see what worked for you.
4 guiding principles
There's four key guiding principles to the TAT program. One is that we help the patients develop really realistic expectations for treatment. We provide informational counseling using pictures. So that's our picture-based counseling. We customize the program to meet the needs of each individual patient. So we take a very patient-centered approach because everybody's a little bit different in what bothers them about their tinnitus. And finally, we do advocate for the use of sound therapy through Tinnitus Activities Treatment. And we usually set this to the lowest level that provides relief for the patient.
Beyond that, TAT actually also fits very nicely into our three general guiding steps of tinnitus management. So our phase one is our assessment or medical clearance phase and with TAT, that means the standard audiogram that we discussed earlier with two questionnaires. So those are two tinnitus questionnaires. One is an open-ended questionnaire.
So you have the patient list the problems that tinnitus causes in their life. And this gives us insight as to why the patient's there, what bothers them about the tinnitus and often helps us identify some treatment goals. And then we also use standardized questionnaires. There's four available. My favourite, I think that the kind of easiest for the patient and the easiest to interpret is the tinnitus activities questionnaire. These are standardized scored questionnaires, and they really do help kind of identify which area is the most problematic for the patient.
So that's that thoughts and emotions, hearing, sleep, or concentration areas. And they also help clinicians and patients communicate to other professionals who may not be as familiar with tinnitus management, what kind of impact the tinnitus is really having. And that can be super important, especially in cases of tinnitus developing after a motor vehicle accident or tinnitus developing after a workplace accident, or even after somebody's service, where they were exposed to tons of noise through serving with the military or Navy, or what have you. It kind of helps us demonstrate, "Hey, there's a real issue here. It's quantifiable. And this is how we talk about it. And this is how we demonstrate progress in our management program."
So this is an example of the tinnitus activities questionnaire. It's actually a 20 item list and you rate the statements in terms of their truth from 0 to a 100. So that gives us some very precise data points. And it allows us to kind of focus on which areas are most problematic for you. So kind of wrapping up our phase one for our TAT is we provide the thorough audiological evaluation. We do our tinnitus characterization measurements, and we provide referrals to other professionals as needed.
And then we do a little bit of an intro. So we familiarize the patient with their hearing test result. We provide information to them about tinnitus and we score the questionnaire to build the treatment. And this here is a typical outline for what treatment might look like. So depending on the questionnaire scores that you may need, all of these sessions, or maybe just a subset, like the introduction, sound therapy... Rebecca, we're getting to that. Thoughts and emotions and hearing and communication. Some people will require the sleep module, others, just the concentration. Again, this can be very, very flexible, and we do that based off of the evidence that you provide us with. So it's an evidence-based approach.
So coming in here to phase two, which is treatment. Sound therapy. So coming back to our 80/80 rule, about 80% of people with hearing loss have tinnitus and 80% of people with tinnitus have hearing loss. So sound therapy is a tool that we can integrate to treat actually both of those symptoms. So what we're essentially doing there is using masking, so some low level sound, to kind of partially cover the tinnitus. And we also use amplification. So that's treating a hearing loss using amplification or hearing aids to reduce the contrast between the tinnitus and the acoustic environment. And that helps promote habituation of the tinnitus and deals with the awareness of the perception of our tinnitus.
Usually for our masking, we're going to be using soothing or relaxing sounds to reduce the stress or anxiety related to the tinnitus, which originates in our limbic system. And then we also can use things like interesting sounds that kind of distract the patient from the tinnitus. So that's not at a lower order. It's kind of more higher ordered cognitive processing there. And you can do that using podcasts or radio shows or meditations, kind of something that requires active listening and attention. Now let's talk a little bit more about sound therapy. So coming back to that 80/80 rule, we know that tinnitus and hearing loss go hand in hand, but only about 50% of people who have tinnitus and a documented hearing loss use hearing aids. So I'm just going to start a poll here.
And I just want to know from our audience, if you were to attend a tinnitus evaluation and your audiologist came out with the results that you have a high frequency hearing loss that is likely causing your tinnitus and they recommend hearing aids to manage your tinnitus and hearing loss, would you use the hearing aids? So I'm seeing a lot of hands up. I'm going to take a look at the chat, because sometimes I think that the results of the poll can kind of go flying through there. All right. I'm seeing lots and lots of people responding here, 20 responses, great, climbing up there.
So we're at about a 100%, everybody that is responded to the poll. And I see a lot of hands up are saying, "Yeah, for sure. I would use hearing aids if my audiologist recommended it to manage my hearing loss and tinnitus." And with our data that we have, we know about 50% of people who receive that news and receive that recommendation actually follow through on it. So I think about half of us are maybe a little bit too confident in our positive yes response, but I will say that it's great to have the intent there because hearing aids are one of the most effective management strategies for tinnitus and sound therapy delivered through hearing aids is actually far more effective for populations with hearing loss than using sound played through Bluetooth speakers or pillow speakers or any other sort of external sound source.
Tinnitus behavioural program
So the other component here, it being a behavioural program. So we have the sound therapy and again, that's going to be our relaxing sounds. Sometimes that's going to be our information-based masking or even just amplification. We also have the behavioural components. So we're going to be introducing strategies and information about managing tinnitus in those four key areas, which are those thoughts and emotions, hearing, sleep, and concentration. Now the pro purpose here is to facilitate patient engagement with the program and encourage the commitment. So we do a really, really structured program where we're providing information in a module-based format. So those picture-based modules, and at the end of each module, we provide activities that we require the patient to complete before engaging with the next module.
So an example of a TAT activity is journaling and TAT is rooted in cognitive behavioural therapy, which also integrates tons and tons of journaling. Generally, we use journaling to identify patterns in our thoughts and behaviours surrounding our tinnitus and through journaling, we become observers of ourselves, objective observers of ourselves, where we kind of can see where our problems are, where we might be telling ourselves stories about the tinnitus that may or may not be true. We do kind of listing successful management techniques within our journaling. So a typical journal might look like, "On this day I was reading in a dead quiet space and my tinnitus felt really loud and intrusive at that time.
So I implemented my sound therapy strategy. So that might be switching a mode on a hearing aid or using a Bluetooth speaker to play some low level sound while I was doing my reading. And my tinnitus was far less noticeable after that." So we would then know from the journal on that date that using low level sound or masking was effective for that person. We also provide concentration exercises because our concentration on sound is actually modulated consciously when we allow it to be. So we can do some exercises where we're focusing on specific sounds in our environment and then refocusing on our tinnitus and then focusing on the other sounds. And we can actually observe how our brain can shift its attention.
A few questions...
"How do you categorize pulsatile tinnitus?"
Now pulsatile tinnitus can be subjective or it can be objective. So that is actually a really great question, that kind of highlights why it is so important to have a tinnitus evaluation with somebody that is qualified to provide that service. In some cases, pulsatile tinnitus is objective. So we see that in cases where there is a blood vessel that is in close proximity or has kind of migrated to sit right next to the auditory nerve. So that's one condition that we see. We do also see glomus tumors sometimes, where there's a little kind of net of blood vessels that sit on the eardrum and they kind of pulse as the blood flushes through them. So that's pulsatile tinnitus. Usually, we would send somebody for medical imaging if they had pulsatile tinnitus. And if that came back clear, then we would classify it as a subjective form. So that's how that's diagnosed thermally.
"How long does the TAT program usually run?"
So that is a great question. We usually do about one session per month or each session is separated by two weeks to a month. So there's a total of six sessions that can take place. Most people get that completed within six months. Not everybody needs every session though. So we do see people going through that program a bit faster, Judith. Rebecca, great question. "How much do these programs cost?" So the cost of a Tinnitus Activities Treatment program at Broadmead Hearing Clinic... I'll just pop you back to the end here. For the initial evaluation is $150.
Each of the modules is an hour long and it costs $150, if ear level sound generators are prescribed. So that's for somebody that has normal hearing. If you have normal hearing and tinnitus, then ear level sound generators cost $1,800 for a pair. If you do have hearing loss, we would recommend using a hearing aid. So you would be looking at the cost of whatever hearing aid is recommended. We would not typically charge extra for the tinnitus modules at that point, because we could do that with our follow-ups for the hearing aid fitting.
"How long, from start to finish, does the TAT program take?"
And again, that can be completed within six months. Somebody asks, "Are tinnitus sounds both high frequencies and low ones?" And absolutely, tinnitus can sound like so many different things. I've heard people describe their tinnitus as the low rumble of a truck going by, and others will describe it as the high pitched whine of a mosquito flying by their ear.
"I've had tinnitus for four months and I know it comes and goes, but I haven't had a single event in over three weeks, is this normal?"
And in this case, the individual says that their tinnitus is tensor tympani and stapedius myoclonus. So that can be a form of objective tinnitus. That's actually a very interesting form of objective tinnitus. One that I could sometimes record with my equipment here. Usually, there's different triggers that can cause that just like any myoclonus or even an eye twitch can occur. So I would recommend checking in for an appointment on that one, but intermittent tensor tympani and stapedius myoclonus is actually quite typical. It doesn't usually stay for months and months. It doesn't tend to be chronic.
"Please discuss medications causing tinnitus."
Anne, I'm not going to go into a full discussion of medications causing tinnitus because I think that it's really, really important to integrate the best professionals to do that. And usually, I would like to invite a pharmacist for that. Medication can sometimes contribute to tinnitus. Usually it's a side effect. It's very typical in aminoglycoside antibiotics, cisplatin, which is a cancer treatment. We also have heart and blood pressure regulation medications often will cause a little bit of tinnitus as a side effect and the most common one, actually, that surprises a lot of people is aspirin will cause tinnitus as well. It also causes hearing loss while you're using it. So Anne, there you go.
"Why does the tinnitus level rise and fall at different times?"
And then the subsequent question was, "Can tinnitus get worse with sleep deprivation?" And the answer to both of those questions is kind of similar. Number one, yes. So tinnitus level will rise and fall. Often, this is actually not related to the level of neural activity in the auditory tract. It's the limbic system or the hippocampus in the limbic system, which is part of the brain, that filters or monitors our sensory information. So at any given moment, we have so much sensory information coming at us. We have sights, we have smells, we have sounds, we have sense of clothing on our bodies, our sense of touch. And some of that is monitored consciously. And some of that is monitored subconsciously. And our subconscious system is basically just taking in all this information and deciding what amount of that information needs to be made conscious or needs your attention.
And usually, the things that get our attention are perceived as things that might be a threat to our wellbeing, things that are unexpected, things that are scary or things that are new to us. Tinnitus can often fall into one of those characterized and be misidentified by the limbic system in our brain as something that's really important, just like a fire alarm or what have you would be. And that comes down to our habituation. So over time, we can actually learn different responses to the tinnitus. So we experience tinnitus and nothing bad happens or we experience tinnitus and we have a really bad day, and that kind of leads to different outcomes or different responses to the sound of the tinnitus. But generally, what's happening there when our tinnitus gets loud or becomes more noticeable is our limbic system stops filtering out that tinnitus.
And usually, we find that in quiet spaces where there's not a lot of other external auditory information coming at us, we become quite a bit more aware of the tinnitus. Another situation is if we've had a stressful day and then we finally sit down and try to relax. Our limbic system is a bit hyperactive in that case, we have quite a few more stressed hormones flowing through our body. And so our tinnitus is perceived as loud. Our limbic system doesn't filter it out. Similarly, a lack of sleep, sleep deprivation will also make our tinnitus louder or contribute to our sense of tinnitus being annoying because our limbic system is not as efficient at filtering out that tinnitus when we have a lack of sleep. Ron has asked, "Does tinnitus increase with age?" We actually have some evidence that yes, but not because tinnitus is part of our natural aging process.
Usually, it's that hearing loss is part of our aging process and about 80% of cases of hearing loss will present with some tinnitus. So that's why we see more tinnitus in a higher age group there, Ron. "Does high blood pressure affect tinnitus?" Sometimes. Yes, that is a great question there, Trisha. Sometimes it does. Sometimes we get something called venous hum. Venous hum is a condition in which the blood flowing through our veins actually makes noise. And that's a form of objective tinnitus. Sometimes our blood pressure will change and will actually kind of face a situation where our nerves are just being activated by the rushing of blood in that area. So we get a little bit more spontaneous activity in our auditory nerve fibres.
"Are extreme low frequency sounds a problem?"
So Lynn, I'm not going to answer that same question. What I'm going to say here is that loud sounds are a problem. Noise exposure can be a problem. So whether that loud sound is high pitch or whether it's low pitch, if we are exposed to really, really loud sounds, especially impulse noise, like a jackhammer or a kind of repeated... Some people are shooting guns recreationally, or what have you, loud sounds are problematic and they will often cause tinnitus. They will sometimes cause a temporary hearing loss, which recovers, but the tinnitus remains. And sometimes they'll even cause a permanent hearing loss at the same time. Low frequency sounds, we don't worry too much about the pitch component. Low frequency sounds can just be annoying because they can travel so far. They have a long wavelength and they can kind of pass through concrete and things like that.
"Does low blood pressure affect tinnitus?"
I would describe this as blood pressure affects tinnitus. If you have your what's called homeostasis or a healthy blood pressure that stays within a given range, if we fall outside of that range, if it goes high, we can expect some tinnitus. If we go low and we experience what's called presyncope or before we faint, right before we faint because our blood pressure has gone so low, we will often experience quite a bit of tinnitus in that situation. And that's just because your nerves are going, "What is going on here? There is such low blood pressure. I'm not getting the oxygen I need." And they start to spontaneously fire quite a bit. You'll also notice that the body starts to sweat. We feel really uncomfortable. Sometimes get a bit dizzy and have to sit down in that situation. So yes, blow blood pressure can contribute to a sense of tinnitus. Ear pain or pressure.
"How is tinnitus related to otosclerosis?"
Otosclerosis, absolutely. Tinnitus is actually one of the first symptoms of otosclerosis. Otosclerosis is a condition in which our auditory bones or our ossicles, which are in the middle ear, start to fix themselves in place. They become very stiff and they no longer transmit as much sound through to the cochlea, which is our sensory organ of hearing. In that situation, what we see happening is there's a cellular process where our bone actually starts to become spongy in the early stages. And that changes the way that sound is transmitted to the cochlea, that interferes with the transmission of sound from the outer hair celAnd the movement of our ossicles or ear bones moves the fluid in the cochlea and the cochlea is our inner ear. And inside of our cochlea, we have things called hair cells. And those are our sound receptors. And the disruption of the little projections that look like hairs is what tells the hair cell or the sound receptor to send a message to the nerve fibre that is connected to it that a sound has occurred and to create activity or nerve activity, which is then interpreted by the brain. But our hair cell communicates with that nerve fibre by releasing chemicals and the chemicals are absorbed by the nerve fibre. And that's what tells it to become activated.ls. I'll show you this here. So the way we hear is that we have a sound source of vibrating in the environment that creates sound waves, which enter our outer ear and are kind of amplified because our outer ear is a resonator. Those sounds vibrate our eardrum and the bones attached to the eardrum and our ear filled space.
When we develop otosclerosis or when we have strange ear pressure or we have fluid behind our eardrums, that whole system is thrown a little bit out of whack. It changes the way that ear bones move in the socket, in the inner ear or the joint. And that kind of disrupts the way the wave travels across our hair cell, the hair cell then releases chemicals in a kind of more abnormal way. That's called synaptopathy. And we end up with this kind of net increase in spontaneous neural activity. So we can look here. This is a good example of this.
What we see here is we have normal hearing. Our auditory nerve fibres are actually never dormant. We have spontaneous activity on the nerve, which we typically don't hear, but we can measure it using something called otoacoustic emissions. When we have hearing loss and no tinnitus, what we see is that we have less spontaneous activity because we've often lost some nerve fibres. So there's less fibres to carry that information. But we actually see a net reduction in the spontaneous activity if we have hearing loss with no tinnitus. But when we have hearing loss and tinnitus, we actually see an increase in the spontaneous activity of the nerve fibres So you would think that we'd see less because we're not getting as much activity from the sound receptors, but we actually see this net increase and that spontaneous activity on the nerve fibres, that increase is actually interpreted by the brain as sound. So that's what that tinnitus really is and what it's doing.
TAT picture modules
I do have some examples here that I just like to show you that these are examples of what the picture modules offered through Tinnitus Activities Therapy are, these are some pulled directly from some of the modules, which I've actually used to answer some of the questions so we can see that it is a helpful resource there. What we can see here is when we kind of talk about habituation and talk about different reactions to sound, is that our brain can learn a response to a sound. So in this case, we have a doorbell and a reaction can be neutral.
So if we have a sound like a doorbell and we don't have a great emotional reaction to it, then it's probably not going to bother us. We're going to just go investigate. If we have a sound and then a consequence that is adverse or scary or unexpected and unpleasant, then that doorbell is going to produce anxiety for us. And the next time we hear a doorbell, we might be a little bit wary of going and answering that door because we had a bad experience the previous time. We can actually learn a new response.
So if we have one of these neutral sounds like a doorbell, which in and of itself, that sound doesn't carry a whole lot of information. And then we have a consequence that is positive or pleasant and that we enjoy. Then we can change our experience of that sound. We can interpret things differently and we can say, "Okay, this sound was very negative for me in the past when I had that negative experience. Now I recognize that I've heard this sound and other consequences can arise from that sound. So I no longer have this adversarial reaction to it. I can neutralize that.
Keeping in mind here, that things that capture our conscious attention are things that are unusual, things that are important, so signals and alerts, or things that are scary or unexpected. And we tend to notice things that fall into those categories and we tend to ignore or filter out things that are not important, or don't fall into these four categories. So examples here could be a loud refrigerator. That's a sound that it's unimportant. It doesn't carry a whole lot of information for us, it's not scary, it's not unusual, what have you. And what we'll see there is that our brain will filter that out, our limbic system does that very effectively. Situations where we have something scary or unexpected, if we hear a lion roar or a dog bark very close to us that we weren't expecting, we generally cannot ignore it. It grabs our attention very quickly.
And there's also situations where we can hear sounds that we're exposed to, and we can monitor that information for something that might be important, but we don't have to attend to every single sound in the environment consciously. So that's an example of a crowd. So we also have our tinnitus and attention. So we have to consider our two types of attention here. We have subconscious and conscious attention. Our brain monitors background sounds all the time. This is normal. It's a subconscious process. We're usually not aware of that. We only really pay attention to the important, strange, fearful sounds. And those tend to be monitored more closely, or when those are in our environment, we tend to be a little bit more alert to the sounds or if we're expecting a certain sound, that doesn't happen at a predictable time.
If we can reinterpret the tinnitus as an unimportant sound, what we'll see is that we pay less attention to it. And over time, our brain recognizes that there is no unexpected or poor consequence that arises from the tinnitus. So we become less bothered by it. And our limbic system in our brain is less likely to closely monitor that sound. And then we eventually habituate to it and actually have to get to a point where we have to pause what we're doing, think about the tinnitus and listen for it to be able to hear that sound.
This is where I'm going to leave things for today. I think that it's important to always appreciate just how complex the process is for the way that our brain interprets sound. We kind of have all these different steps along the pathway, where we have the sound being coded into neural code by the cochlea, it then travels up our brain stem for subconscious monitoring. And that's our limbic system, which decides whether those sounds are going to be consciously perceived or heard and interpreted and get our attention. And then we have these adjacent processes. So we have emotional reactions to the sound, whether we want to or not. And we also have experience or memory with sounds that contribute to the way that we interpret given sounds.
We can consciously monitor and change the way that our brain interprets information. And that is a key component that we look to with Tinnitus Activities Therapy.
If you want to know more about Tinnitus Activities Treatment, schedule a Hearing Evaluation with an Audiologist. Please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921.
Submitted by Anonymous (not verified) on Tue, 04/26/2022 - 00:00
Improve your communication skills
Phonak Canada Audiologist Janet Clark shares resources that empower you to improve your communication skills for the most comprehensive hearing solution.
Auditory skills training is a technique used to enhance listening skills and improve speech understanding. After a diagnosis of hearing loss, it is important to train the brain to interpret and understand auditory information. This training is commonly referred to as "auditory rehabilitation" in adults.
Learn about the new HearingSuccess portal - a toolkit for auditory skills training
Get the maximum benefit from the technology you already have
Find out how auditory skills training (hearing re/habilitation) can benefit you!
The hearing loss journey
So firstly, in terms of your journey with your hearing, we do know that hearing loss challenges are not completely fitted or eliminated after fitting a hearing aid or a cochlear implant. And I'm sure you've either spoken to those or had personal experience where the hearing aid has certainly given you a lot more awareness of sound. But it can sometimes, especially in the early days of getting hearing technology be somewhat overwhelming. And what we know is that if we can offer some additional tools to help people maximize the benefit from the hearing aid technology, then there are actually spinoff effects in terms of how people manage with particularly challenging situations, like hearing and noise, which is often the main reason that people end up going to a hearing clinic in the first place because they're starting to have some trouble hearing in background noise.
Okay. So why is, especially if you've plucked up the courage, gone in to get an assessment, acknowledge that you could benefit from some amplification, you've got a hearing aid, why are we saying that it isn't always enough just to have done that? So I'm just seeing some people are saying they've got an echo problem. I wonder if my volume's too high, if I bring it down a bit, is that too quiet? Is that any better, we'll just see if that helps. But what we know from research is that the brain is plastic. And by that we mean that if you rehearse or practice or perform certain functions over and over again, the brain actually commits those neural pathways that get fired when you do that particular activity. It cements those.
Now, if for example, you've been able to hear high pitch sounds for a long time, and then you gradually lose some of your hearing in the high pitched sounds, what can happen is the brain takes the area that would have processed those high-pitched sounds and it uses it for something else. So, it might start using it for some of the mid-range sounds or sometimes even other things altogether, like feelings or perceptions. So what we need to do when the hearing aid is fitted, for example, a new hearing aid to someone that's never worn one before, is we need to give the brain lots and lots of practice of hearing these sounds again, which it hasn't heard for a long time. And by wearing the hearing aid more and practicing more with the amplified sound, the brain can actually reorganize itself to take advantage of that information. So, what we know from hearing aids in some folks is that when you fit the technology they're aware of sounds, but not necessarily aware of what those sounds mean or can make sense of them. They almost have to relearn to match some sounds to the source.
So we know that hearing aids help us pick up the sounds, but it doesn't address the understanding of sounds, or words, or picking speech out of background noise, because that's a function of the brain, not a function of the ear. So I think the one message I would take away from this is that this ability of the brain to learn and reorganize itself doesn't have an age limit on it. And I find that tremendously hopeful and a positive thing. So, it really doesn't matter how old you are, the brain is capable of this plasticity. You might just need to where the hearing aids a little bit longer to get more practice.
The benefits of stimulating your brain
Now, one other benefit of stimulating the brain is not only that it strengthens the pathways that are important for language and for listening and developing our thinking and our cognitive development, but it also refines our top down processing or understanding. And what I mean by that is top down, that means from the brain down. So as we get older and we've got a full rich life of full of experiences, we've got a well-developed language system at our fingertips, we can use that knowledge to fill in the gaps. So if we miss some information, we are using our experience of the world and our experience of language to fill in the gaps. A child that is learning language doesn't have that ability. So never let anyone say that aging is terrible. It actually has some benefits because you gather wisdom and knowledge, so that's all a good thing.
The other thing about stimulating the brain is it helps us improve the perception of speech and especially the perception of speech and noise, which can be very challenging. And also, anything that we use, to help us understand speech, any thinking processes like our focus or our attention or the speed at which we can process the information coming in, or our working memory. All these things with some practice or with some activities to strengthen them can actually help with this top down processing and help us develop the understanding side of speech and sound and music and language when we get our hearing loss addressed by a hearing aid, for example.
What is auditory skills training?
So, what is auditory skills training and why is it useful? I think we've already looked at some of the things, and what I would say is auditory skills training by itself isn't really as useful as if it supplements a well fitted hearing aid. So, it is supplemental to the hearing aid management. So what it can do is it can strengthen clinical outcomes, because if you are enhancing the skills from auditory skills training, it will improve the way that you make the best use out of your hearing aid devices. It also helps you adjust to the technology. And I would say in that instance what it would do is be able to give you some really targeted feedback to give to your audiologist so that they can fine tune that device for your very specific listening environments. And modern hearing aid technology has other things in it, in the devices that help clinicians with that as well.
And I put this last one, not likely. It can improve quality of life. It's a positive cycle. If you are experiencing success with your hearing aid, if you do some of this training, so you're taking ownership of managing your hearing loss and you come to a point where you can cope better in background noise, or you don't get as fatigued in background noise. That would mean that you'd want to wear your hearing aid more because it's a positive experience. And it may also prevent that slow withdrawal from social functions that sometimes happens to people with hearing loss. Because they find them so difficult to listen in that it's easier just to extract themselves from those social interactions. Now, I know that at present and over the last two and a half years social interactions maybe haven't been entirely face to face. But even if they're not, or even if you're still practicing physical distancing, masks can cause quite a lot of additional trouble in terms of using that top down processing. Because you're going to be missing some of the visual cues.
So, anything we can do to make your response and your use of the hearing aid technology stronger will stand you in good stead. So, let's have a look at the clinical outcomes. As I said, it can help improve your speech recognition and speech perception. So speech perception means that you perceive someone's talking and speech recognition means that you then understand what they're saying. And these sorts of auditory skills training exercises can help improve speech perception in quiet and in noise, and it can reduce your listening effort. And if it reduces listening effort, it means you're going to be overall less fatigued if you're in social environments, which might encourage you to participate more, which can lead to a fuller, richer social life. Okay, the other thing that we've noted in some studies is that auditory skills training can not only increase people being willing to adopt hearing aid technology, but it can absolutely improve satisfaction with hearing aid technology. And as I said, the more satisfied you are, the more you're likely to wear the devices in a range of situations, and the more you are able to live your life as fully richly as possible with regards to communication.
It can also give you more confidence. It does take a lot of personal confidence to acknowledge that one has a hearing loss and to seek help to do something about it. For some people, they still feel very much a stigma of wearing a hearing aid, although nowadays a lot of the devices are very discreet and very small. But it can improve that confidence that allows you then, as I said, to go out and to do things that you either you used to do and you stopped doing because it was too difficult to hear. Or things that you've always wanted to try. That if you're feeling more confident in your ability to hear and understand in a range of listening environments, you're more likely to take part, which is fantastic. And that could reduce some of those limitations you might have in day-to-day life. Also, the improved confidence people pick that up, right? So people would be aware of the fact that you are appearing confident and would be more likely to engage or communicate with you as well.
Free online hearing portal
Now, one of the things that when we talk about auditory skills training, I am talking about a particular set of exercises and tools that are available online for free at www.hearingsuccess.com. I do have to say that this is the work of Audiologists that work for two companies that is owned by Phonak's parent company. So Advanced Bionics, who produce cochlear implants, and Phonak with the hearing aids. But the actual exercises themselves are not linked to a specific model of device. So it really doesn't matter what type of hearing technology you use, there are tools on this website for free that you can have full access to. But just to reinforce that these were not designed the tools by marketing people or our engineers, these were designed by Audiologists and speech language pathologists.
So, there are two aspects to what you will find on this online portal. You will find something called WordSuccess, which helps you deal with phrases and words and practices them in increasing levels of difficulty. And you can pick that in terms of background noise levels, the types of noise levels you hear. And then SoundSuccess, which is really interesting, because it goes beyond speech and looks at things like, can you train your hearing using some music as tools? So for example, it gives you very easy examples of listening to different types of guitar music, classical guitar music. And then it will give you a piece where that is embedded. The guitar music is embedded in say a full orchestra setup, and they ask you to focus on the guitar. So it's training your brain, not only in things like music, but also in auditory attention and focus, which is equally important in terms of learning to understand all the additional auditory input you're going to get with your hearing aids.
And all you would do when you log into www.hearingsuccess.com is you have to register, there's no charge for that. And then you would in the right hand up a corner there's a little dropdown menu, and you would select that you're an adult with a hearing aid. So it would pull up the tools that are appropriate for people with hearing aids versus say, people with cochlear implants. The lovely thing about this being online is that you don't have to travel anywhere to get to it. It's not going to cost you anything. And because it's online, you can access it whenever you feel you have the time, so you're not set to a certain appointment time. So really if you are having relatively quiet day or afternoon at home, you could choose to do this.
The other thing is that, as I said, it doesn't just give you speech or picking out words or phrases in background noise, it also allows you to practice listening to someone and focusing in on someone without needing another communication partner to help you. So you can do this totally under your own steam, in your own time, in your own home, even in your PJs if you wanted to.
And I think you would get the satisfaction because it's graded in difficulty where you can go at your own pace. And you can go back if you're having particular difficulties with something. And you can do as much or as little as you want to. So it is customizable. The WordSuccess can actually also be an app. The SoundSuccess is usually something that you would use your tablet or your computer to access. But as I said, everything's first loaded on one page. You select the fact that you wear a hearing aid and you're an adult, because you will see some tools that are specifically for teens or specifically for young children. And then as I said, you can access that whenever or whatever attire you're wearing at the time, that's fine, because you don't have to physically go anywhere.
Share your results with your clinician:
The other thing too is you can share the results or you can discuss your results with your clinician if that's something that you would like to do. And it will hold your place as to where you got to, the level that you got to in a particular area or function. And then you can pick up where you left off when you come back into the portal. So really, as I said, very easy way to practice. And as I said, there's also some rehabilitation support. It can give you some speech, reading skills, some communication tips. And one of the other nice things about the webpage is it actually also has a sort of a blog, number one, that you can read input from people that wear hearing aids and some of their experiences, but it also gives you a place where you could chat with others that share the fact that they have hearing loss and have chosen to do something about it.
And often there's no one that's really going to understand you and some of the challenges that you might have faced as much as someone that's having some of the same difficulties, number one. And number two, it can be a way of kind of motivating or sort of encouraging you to do a bit more on this training site, if you've got a competitive spirit, for example.
Communication tips & strategies
Okay, so as I said, there's some tips and strategies for communicating that you can share with those whom you talk with regularly. There's some generic information on hearing technology. There are some exercises to practice listening skills. And one of the lovely ones that I liked was it's a song that plays, and it's got the lyrics in front of you, but it leaves some words out. And so, as you are listening, you're anticipating that line that's got a word missing and then waiting for it and listening for it and filling in those gaps. So, it's really trying to find lots of interesting ways to focus your attention and to pay attention to what's being said accurately. And then, as I said, also this online community of people that have the same challenges.
So let's take Noah here as an example. He says, "I need to follow conversations at my large family dinner table every night. I want to be able to carry on a conversation at a crowded local cafe with my buddies. And I want to be able to hear the speaker at my local community lecture each month." So what additional actions can you take to address his expectations and make them realistic expectations for hearing in those three communicative environments that he's identified?
So, certainly one of them is getting seen by an Audiologist, having hearing assessed and based on the hearing loss setting, appropriate technology and measuring that that's providing the right balance of sound for him. You can also remind him that the brain needs to practice to learn how to make sense of sounds that it hasn't heard for quite a while in the same balance. You can also remind Noah that, "Hey, if you do some structured, repetitive auditory skills training that is very carefully graded in levels of difficulty at your own pace at your own home." This could help you train so that in those environments he identified he won't be as fatigued, and he'll actually have more success.
You could also say that, "There's this wonderful website, hearingsuccess.com." And he can sign up there for free and get some of these skills trainings. Or you could tell him all of the above. And I think if you have been able to join us for this talk so far, you'll realize that the correct answer for that was all of the above. And that's how you could support Noah. So I would say, give hearing success a try. It's really, it's going to cost you nothing, only a little bit of time. And you might actually find it's a lot of fun. And before you know it, you're so busy focusing on your hearing and your understanding and listening that the focus on the actual physical device behind your ear or inside your ear is not as great as it was when you first got your hearing aids.
If you’re ready to improve your communication, schedule a Hearing Evaluation with an Audiologist, please call: Broadmead Hearing Clinic: 250-479-2969 or Oak Bay Hearing Clinic: 250-479-2921.