Healthy Hearing Expo Transcripts 2017

Healthy Hearing Expo 2017
April 12th, 2017

10:30am Presenter: Lia Best, "Current Research Regarding the Effects of Hearing Loss”

Dr. Wright: Hi everyone. Welcome to the 8th Annual Healthy Hearing Expo. I'm Erin Wright, one of 4 audiologists working with Broadmead and Oak Bay Hearing Clinic. We talk about hearing loss and products available from manufacturers.

We're happy you've come today to learn about hearing loss and hearing aids. First, we have Lia Best presenting – Dr. Lia Best – who just completed her doctorate. Way to go Lia! [Applause]

It took her years and hard work. She's talking about Hearing loss and the most current research. It affects cognition and so on. Welcome Lia!

[Applause]

Lia Best: Thank you! I want to be sure the microphone is working. Can you all hear me?

Woman: Be louder!

Lia: We have captioning. They will transcribe anything we say. The transcripts will be available in about a week. You can access it through the website. I'll talk about current research on the effects of Hearing loss. There's much research being done and how it affects the brain, and cognition. There's concern about dementia. I'll cover some of that, hopefully being clear.

Here's our talk outline. I'll go over how we hear, the brain, your peripheral auditory system, and the ear as we know it. The central auditory system is the part of the brain processing sound. We'll talk about cognition, hearing loss and balance. We'll talk about dementia also.

First, let's understand how the ear works. You may know this. I'll show a video. I'll describe what's happening as it plays.

Narrator: Ears pick up sound waves and change it so the brain can interpret it. Sound waves are vibrations, with slow vibrations being low sounds, and quick vibrations being high sounds. As the ear drum vibrates, it sets the ossicular chain in motion, with anvil, stirrup and so on. In the inner ear, the cochlea plays a role. The cochlea is a spiral-shaped tube filled with fluid and hair cells, which have varying degrees of sensitivities for different tones. The ear perceives the entire spectrum of sound. It's a complex process which involves the movement of the hair cells. Hair cells at the lower region of the cochlea are for high frequency.

Lia: I didn't want him to talk! I'll pause it here because this is important.

 

Tonotopic means specific parts of the cochlea are responsible for different frequencies. At the top, the hair cells get the brunt of the damage. Health issues attack the higher frequency hair cells more than the low ones. Age related Hearing loss often have poor high frequency hearing loss more than low tones.

To understand speech, we rely on high frequency hearing a lot. Low frequency hearing only gives us about 10% of the information, and high frequency gives 90%. It's a catch 22. Speaking English, you have a two-pronged problem.

I'll skip ahead.

Sorry! I'm a Mac user and struggle with PC. [Laughing]

It's important to think about how we hear with our brain. I showed you the ear. It's necessary for hearing. Most hearing loss we know is caused by a problem in the ear, the hair cells. But the brain processes sound. The ear sends the information up to the brain.

The auditory cortex, in our temporal lobe, is the primary part of the brain that understands sound, where we process speech and language. We appreciate music from this place and learn languages here.

Much research is related to sensorineural hearing loss. You may not have this type of hearing loss, instead having conductive hearing loss. Some of the research may not apply to you. Most people here probably have sensory hearing loss, which is age related hearing loss or noise induced hearing loss or different hearing disorders such as a disease.

With age related hearing loss, there's a loss of high frequency hair cells. On the left, are healthy hair cells. On the right, they are damaged. They aren't gone. They are just warped and bent and not functioning as they should.

These hair cells are critical for speech understanding. If they are missing with age related or noise induced hearing loss, you struggle with speech understanding.

With the auditory nerve, with age induced or noise induced hearing loss, you see a loss of connection between the auditory nerve fibre and the hair cells. On the right, you see there's many missing.

This is important research done by a team led by Kajawa [sp?] and Lieberman who did work on rodents. Here's a rat exposed to noise for 3 days. These nerve fibers are important for speech understanding in background noise.

With many nerve fibers, you get synchronized firing, so a faster processing. It's harder to process the sound in a challenging environment.

To the brain, where we process sound, there's recent research on age related hearing loss and changes in brain size. There's a correlation between the severity of hearing loss and the size of white brain matter. There's smaller brain volume in white matter with Hearing loss. In neuroscience, there's the use it or lose it principle. If certain things are used often, they are strengthened. They get neurons and nutrients which help growth. If not - if dormant - it may atrophy.

This is early research. More research needs to be done to figure it out.

Next, there's a difference between a correlation and a causation. Most of my research is correlational research, meaning, not that one thing caused another. For example, to measure ice cream sales in a town and speeding tickets, one didn't case another, it could have been because of sunny weather. If you read about a causal relationship, have a critical mind and understand it could be a correlation and not a causation.

Before talking about how the brain works, I'll talk about cognition. The definition of cognition is the mental action of acquiring knowledge and precision through thoughts, experiences and sense. It reasons, problem solves, focuses attention, understands and learning language and is part of our memory and working memory. There's something called cognitive load, where our brain can do many tasks at one time.

In school, when writing an exam, there's a strain on your cognitive load, using your working memory, your long-term memory, to remember what you studied. To have to attend to the test, tuning out background noise. That's strain on your cognitive load. After a big exam, often people feel tired though they didn't exercise a lot.

Research is now looking at how hearing loss may affect our cognitive load. Some research shows that adults with mild to moderate hearing loss have greater issues with cognitive functioning. They found that mild, untreated hearing loss was significantly increasing cognitive load. They measured this by looking at how long it took people to answer questions.

The neuroscientist responsible for this research said that you have to put so much effort into understanding what was said that you move resources away from processing it. We can't talk about cognitive load without talking about auditory processing. Auditory processing is what happens in the brain when we hear things.

If we go from the auditory nerve to the auditory cortex in the brain, we go from a few neurons to thousands. There's a lot of firing and activity going on. The central auditory nervous system includes the primary auditory cortex. It's responsible for understanding sound, language, learning music, hearing and background noise.

I won't talk too much about hearing and background noise because there's a different talk about that today. If there are some problems in the brain, we would expect problems with auditory processing. Certain degenerative disorders that involve demyelination, like multiple sclerosis, the speed of information transfer is reduced. Some individuals with multiple sclerosis will have difficulty with auditory processing, but it might not show up on a hearing test because it's not hearing so much as processing in challenging environments.

We also have found that tests will show auditory processing deficits despite a normal audiogram. I'll talk more about that. As audiologists, we can go further than the audiogram and measure your auditory processing. One of the ways we can do this is a speech and noise test. They do this with children because children can have an auditory processing deficit. We can test to assess different aspects of auditory processing.

There was a case study recently that looked at a specific part of the brain: the insula. The insula is located in the primary auditory cortex. Until recently, we didn't know what it did. We knew it was involved in hearing, but didn't know exactly what it was. It's hard to isolate small structures.

There was a case study with a gentleman who had a stroke. First, it affected the insula on one side, and then the next day, on the other. This was very rare so they tested him a bunch. They ran auditory tests and he was essentially deaf. He could not understand or process any sound, but his ear was fine. This showed us that the insula is a critical part of what we think we hear with. It's not necessarily coming from the ear.

Why is this important? It's going to affect our daily lives. We have to think about hearing loss as more than just the ear. There was research out of the John Hopkins School of Medicine. The researcher found an increased risk of falls in people who had hearing loss. Even with mild hearing loss, there was an increase in the reported number of falls.

People will come in and say their hearing loss isn't that bad and they can leave it. We're starting to wonder if mild hearing loss really is a mild problem. The research shows it can have significant impacts on quality of life. It's not just the level of hearing loss on a chart. How is it impacting you?

Why does the relationship exist? They thought maybe the hearing and balance organs are affected by age and noise. The second theory is that decreased hearing sensitivity makes it more difficult to navigate our environments. Usually, you can hear your footsteps and know what surface you're walking on. Our brain registers those things all the time. The brain is necessarily for navigating our environment.

The third issue is the reduced cognitive resources. If you work so hard at hearing, you might be less aware of a log on the ground or a rock sticking up. That might be where those falls occur.

When I first started working at Broadmead Hearing Clinic, I had a client come in. We always ask what the reason for the visit is, and she said, "I fell and I need hearing aids." I thought that was interesting. No one had said that before. She said, "I wouldn't have fallen if I could hear better." I wanted to delve into it.

 

She said she and her daughter were walking into Thrifty's. She was concentrating on what her daughter was saying and tripped on a potted flower that was in the way. It shouldn't have been there but she was concentrating on her daughter. It was interesting that she knew that was the reason right away.

People always wonder if something might not have happened if they had their hearing checked. A week ago, I had a client come in. She thought her hearing had changed. We thought, "Let's test your hearing and check the hearing aids." The hearing aids were working and the hearing test was good, but she had recently broken her ankle. She was walking with a cane and having a hard time walking down the hall.

She said it had changed her life because now she has to think about every step she takes. I think that was pulling on her cognitive load. In her mind, she felt like it took away from her hearing, but it wasn't that her hearing was worse. The extra effort in walking took some of those resources away.

This is an important topic right now. [On screen - dementia.] You might have seen information about hearing loss related to dementia. I want to talk about that research.

Dementia is having memory problems, language problems, and personality changes. There are over 100 different forms. The cause of dementia is damage to the brain due to disease, like Alzheimer's, or other issues. In developed countries like ours, the number of people with dementia will increase by 100%.

This is a big problem for our world and we need to try to understand it. We want to look at different treatments or management strategies that can delay the onset of dementia and improve the quality of life for people dealing with it.

In all of the research I have done to date, there's no substantial evidence that hearing loss will cause dementia. That's important. You'll see, "hearing loss linked to dementia" and our brains put it together. We worry and freak out, thinking it might be true. There's a very important researcher named Pierce Dawes. He has a PhD in experimental psychology. He's a big leader in the field of dementia.

Another famous audiologist named Gus Muller did an interview with him about this. We wanted to know if it was something we should worry about. He does interviews frequently based on questions the audiology community has. A lot of my material comes from that. You can access it online.

Hearing loss may contribute to dementia but there are three possibilities. As I mentioned, hearing loss pulls on our cognition. Cognitive decline might also impact hearing. If you have issues with cognitive function, it takes resources away from hearing. There also may be a shared factor that impacts both hearing and cognition.

Let's explore this more. We know having a hearing impairment impacts cognitive functioning. The association between hearing and cognition has been measured. It can be an indirect effect. Hearing loss may lead to social isolation, depression, and reduced self efficacy. Maybe there's an indirect relationship.

Both hearing loss and dementia are complex and multifactorial. They have similar underlying causes, such as age, inflammation, cardiovascular changes, etc. They share some environmental or lifestyle risk factors, like smoking or diet. Again, correlation doesn't mean causation, but it doesn't mean we should ignore it. There is going to be more research on this in the future.

It's important to touch on the social implications of hearing loss because of the link to dementia. There was a study done by the National Council of Aging. They found untreated hearing loss had emotional and social consequences. People with untreated hearing loss were less likely to participate in social activities compared to those with hearing aids.

You might think, "I don't want to go to this party" because you're not going to hear anything, or go out for dinner because it's not that enjoyable.
 

Hearing loss is associated with true physical changes in the ear, with damage to the cochlea, the auditory nerve and changes in the brain. These changes reduce the amount of information and speed at which auditory information is processed by the brain. We don't have to worry about that correlation because we know it happens.

Things are more complicated. We think these additional resources for hearing and processing, especially in background noise, add to our cognitive load, which leads to potentially increased risk of falls. It may lead to increased social isolation, which leads to lower quality of life.

What about hearing aids? Can we prevent this or slow it down? It's hard to answer with a properly controlled study. You can't take two groups of people with Hearing loss and only give one group treatment. They can't do the well-crafted research designs on it. It may take longer to see these effects than a 5-10 year study. We don't have enough information now to say something will prevent dementia or cognitive decline. However, intervening with amplification may help with social limitations with Hearing loss. I'm losing my voice, sorry.

If someone doesn't go to a social event due to hearing loss, or struggle so much with one on one conversations, it affects quality of life for them and their family. Hearing aids help with that. Improving the amount of information coming into the brain, lessens the cognitive load. It helps be being in social environments.

Thanks for listening!

[Applause]

We have time for questions.

Woman: You talked about hearing loss, the high end and low end. Does the same research apply to that lower end hearing loss?

Lia: The research mostly looks at the entire cochlea. For English speakers, if you have a high frequency hearing loss, it's more problematic. If you speak a primarily tonal language, you don't rely on high frequency as much. That's where it does matter. The research is sensory hearing loss in general.

Woman: You talked about damage to the temporal lobe affecting the cochlea -- there's a right and left temporal lobe. If you're hit on the right side, that affects hearing on your right side?

Lia: Yes, your hearing happens in your temporal lobe. If hit, it could affect your hearing. It doesn't affect your cochlea necessarily. If damage affects blood flow, there could be an auditory processing deficit.

Woman: Does the brain recover when you correct your hearing?

Lia: We don't have enough evidence to say whether one intervention will impact the changes that already occurred. We can assume it helps prevent it from declining. We don't know enough yet.

Man: Can we also have the slides on the website?

Lia: Good question. I'll post this on there. Yes. The question was, can we also have the slides on the website? I don't see why not! I don't know how to do it but someone does! [Laughing]

Man: Not having conclusive research on the impact on cognition, however, is there current research that's documenting impact on the auditory nerve itself?

Lia: Good question. Is there research showing hearing loss helping the auditory nerve? Right?

Hearing aids helping the auditory nerve, excuse me. I haven't seen that yet, but it's the next step I think. Research on noise induced hearing loss, that was a big uh oh. We didn't know that until recently. When exposed to noise, you can get temporary loss of hearing. Then it goes away. It looks normal. However, they showed it's not. There could be some permanent changes that happen. Neurons need nutrients to stay alive. If there's problems at the synapse level, it could atrophy.

I think if we keep the auditory pathways strong, the neurons stay strong. But they haven't done or published that research yet.

Woman: Noise, is that common noises like lawnmowers or leaf-blowers? Or loud noises?

Lia Best: It has to be hazardous, like loud sounds. Poor animals, they were exposed to series of different amounts to find that relationship and what happens.

Man: Is there research on car accidents and whip lash affecting hearing loss?

Lia Best: Probably. With swelling, with a concession, that could be induced by the whiplash itself. I think there's research. I didn't explore it much. We see with patient is with whiplash, they struggle with hearing sometimes.

Woman: For sudden sensory hearing loss, what part of the body does it affect?

Lia Best: Good question. For sudden sensory hearing loss, where in the body is that? 9/10 times it's the cochlea. Often, it's a virus that affects the ear out of nowhere. They called it idiopathic because they don't know why it happened, or what virus. It attacks the cochlea and damages the hair cells. It's a metabolic disaster and the hair cells don't recover.

In the back.

Man: Thanks for pointing out that correlation doesn't mean causation. You're a better scientist than many out there! [Laughing]

Lia: Thank you! [Laughing] in school, they tell us to be careful about that. It's easy to get caught up, "this is crazy" etc. It gets much buzz in the media, because they want to know about science. Yet we must be critical about it. Ask questions, and just because you found it on the internet doesn't mean it's true! [Laughing]

If you find something I didn't talk about, email our call us. We publish a blog with interesting information. It's on our website. We try to analyze if it's worth noting. We try to be informative.

I should pause. And give you all a break before the next presentation.

[Break]

 

11:30am Presenter: Alison Love, "Understanding and Managing Tinnitus.”

Alison: I'd like to do a quick sound check. People at the front, it's not booming at you? I'm going to get started in a couple of minutes.

Dr. Erin Wright: Thank you for coming to our 8th annual hearing expo. Our speaker is Alison Love. She is an audiologist at our Broadmead Clinic. She has a lot of information to share today about current research around tinnitus and management strategies. Welcome Alison. [Applause.]

Alison: Thank you for coming to the talk. This is a great turn out. Can you hear me at the back? My name is Alison Love and I am one of the four audiologists who works at the Broadmead and Oak Bay Hearing Clinics. Today I am going to be talking about tinnitus, specifically understanding and managing your tinnitus.

So just a bit of an introduction to who I am. I did my undergraduate degree in Linguistics at the University of Victoria, and my Masters of Science in Audiology at the University of British Columbia in Vancouver. I worked at Broadmead Hearing Clinic for a couple years shortly after I graduated, and then spent a few years living on the mainland before returning in January.

It's great to see a lot of familiar faces today. One thing I've noticed from working in hospitals, public health clinics and private clinics is that I've encountered a lot of people with tinnitus as a primary concern. I'm sure you have tinnitus or know someone who does.

As a side note, tinnitus – tin-nit-us or tin-eye-tus are both fine.

Today I'm going to talk about tinnitus and what causes it. Then I'll talk about tinnitus management.

Tinnitus is the perception of sound when there's no external noise present. Most of the time, people describe it as a ringing, humming, or buzzing. Some people say it sounds like music in their ears. It can be acute/temporary or chronic/ongoing. It can affect one ear, both ears, constant or come and go.

It can vary greatly in volume, pitch and quality. It's very subjective. It can vary a lot between people.

The American Tinnitus Association has compiled a playlist of the most common sounds of tinnitus. I'm going to play some for you. This is what someone with tinnitus might here.

The first is a 400-hertz tone. That's very high frequency. I have no idea how loud this will be so I apologize in advance.

Man: You might have to exit the presentation and click on the link.

Alison: I might have to come back to this. I'm sorry, I don't think this will play. I'll try again at the end. It's just a few examples of high frequency sounds. One is a tea kettle, one a buzzing noise, etc. I can pass the link out.

Tinnitus is not a disease. It's a symptom of an underlying health condition. Like pain, it is not a disease but a symptom of something else. 75-80% of people with hearing loss report having tinnitus. The most common causes are age-related and noise-induced hearing loss. It could be fluid behind the ear drum or the construction in the ear canal.

It could also be from something like whiplash or a neck injury. The TMJ is the join connecting the skull to the jaw bone. Issues with that joint can also cause tinnitus. Nasal congestion can be a trigger for tinnitus. Some medications can have tinnitus as a side affect, like high doses of aspirin, chemotherapy drugs, etc. 

 

 

Other medical conditions like blood pressure, allergies, etc. can also cause tinnitus.  There are many causes. The vast majority of tinnitus cases are due to hearing loss. I'll talk about the hearing system and how we hear.

I want to see if this is working.

Sound waves will travel through the ear canal and bounce against the ear drum. Then they reach the three tiny bones in the ear drum. They travel through the bones and the sound reaches the cochlea. In the cochlea, we have thousands of tiny hair cells. They take the mechanical signal, convert it to an electrical signal, and the signal is sent along the auditory nerve to the brain, where it is perceived as sound.

When the signal reaches the brain, we can draw on other parts of the brain to make sense of what we've heard.

When we have sensorineural hearing loss, we have damage to the cells in the cochlea. These rows are outer hair cells and inner cells. On the right, we see an ear with damage and hearing loss.

When there's hearing loss, the outer hair cells are damaged, but they continue to fire signals even when there isn't an external sound source present. This misfiring sends a signal to the hair cells and the auditory nerve. Then we perceive it as a sound, even when there is no sound externally.

Tinnitus has been compared to phantom limb syndrome. They call it phantom sound. When someone has phantom limb sensation, there's a peripheral structure missing, such as a hand. The hand is missing, but the nerves running up to the brain are still intact. If there's a sensation, like pain or just awareness, it feels like there's a hand there when there isn't.

With tinnitus, the structure damaged is the outer hair cells, but the nerves to the brain are still firing so the brain perceives a sound because it is being stimulated.

An important thing to note is that we don't just hear with our ears. We hear with our brain. If you visited a friend who lived near a train track, you might wake up when the train rolls through, but your friend would say they don't hear the train anymore. It's not that the friend doesn't hear the train, it's that he's habituated to the noise of the train.

The goal of a tinnitus management program is to get someone to the point where they're no longer listening to the tinnitus even if it is present.

I have a few statistics for you. 10-15% of the population is affected by tinnitus. Only about .5% of the population say that it affects their quality of life. Why is there a discrepancy here? This can be explained by the tinnitus cycle, on the slide here.

The first thing that happens is that you become aware of your tinnitus. Maybe you noticed it for the first time, or maybe it has been there for a while and something triggered it to make it noticeable. This can be distressing if you don't know anything about tinnitus.

The emotional reaction triggers your amygdala. If your amygdala is activated, it associates other things with the tinnitus, like worry and confusion. Your brain focusses on the tinnitus because it's labelled as a threat. It will especially attend to the tinnitus in a quiet environment because there isn't other sound to listen to.

Noticing your tinnitus can interfere with your ability to relax or to sleep. That causes more stress and anxiety. Then the autonomic nervous system kicks in. You might have heard of fight or flight. When the response is triggered, your heart rate increases, your breathing speeds up, your muscles tense. Your body gets ready to fight.

Your body sees tinnitus as a threat to the body so it gets worked up in this way. Noticing the changes can lead to more stress and anxiety. It might start to affect your relationships, your ability to work or your ability to concentrate. That leads to more negative feelings about your tinnitus. This is a negative cycle that continues to perpetuate. There's a circular relationship between tinnitus and things like anxiety/worry.

We need to do tinnitus management. That involves tools to address the awareness and burden of tinnitus. There's no cure for tinnitus. We're not talking about getting rid of it or fixing it. We're learning how to manage it and live with it.

Even people with severe cases of tinnitus can be helped with the right tools and strategies. The first step is to talk to a medical professional. A primary healthcare provider will know your history and can rule out things that might be related to tinnitus.

The next step is to find someone like an audiologist. An audiologist is trained in hearing disorders. We have a minimum of a master's in audiology and a lot of experience working with people with tinnitus. At an audiology appointment, we would do an assessment and see what kind of impact it's having on your life. We would do a diagnostic hearing evaluation, which is a full hearing assessment.
 

Are there other red flags, for example. Then we come up with a treatment plan, counseling for tinnitus and plan for on going follow up. No two tinnitus patients are the same, therefore not two treatment plans are the same.

Mostly, it's caused by sensorineural hearing loss. There's no cure for that. A treatment plan focuses on reducing the impact of it, how you attend and feel about it, and how you emotionally react to it.

What are the treatment plans? I'll talk about in depth for the different treatment options. I'll go through each.

General wellness means changes in lifestyle and wellness activities that affect the burden of tinnitus. There's no evidence that links specific foods or their elimination to tinnitus symptoms. Yet a healthy diet can have a good effect on the body, increasing energy levels, decrease tension etc. This positively affects tinnitus. There's not much evidence that links caffeine to tinnitus yet any patients with tinnitus notice more caffeine increases their awareness of tinnitus. It's an individual observation, not everyone would notice that connection. You could start with that.

Physical activity reduces stress, which can exacerbate tinnitus. Also, social involvement has a positive impact, because if it's severe tinnitus, they could withdraw from social activities. Avoiding that isolation, creating a social and support network for difficult times with tinnitus is helpful. Also, hobbies. We try to distract from tinnitus. For example, cycling, exposed to wind noise, that can help make tinnitus less noticeable.

Also, general stress reduction like yoga, meditation. Sound therapy is reducing external noise to alter someone perception of tinnitus. People ask, why put more noise into an already noisy ear?

First, when we choose the sound we listen to, we can find a positive reaction, not the negative reaction to tinnitus that we wouldn't pick. A sound masker can have a phase cancelling affect, canceling out the tinnitus affect. That's not found for everyone.

Also, sound therapy is about controlling what a person hears, and therefore they feel more control over their tinnitus. A sound masking device is kept on your tabletop or bedside. It usually has several pre-set noises, such as white noise, or ocean waves. There's other ways to create sound masking in the absence of one of these, such as opening a window, putting on a fan, putting on a radio to static noises.

We try to found a sound that creates a positive emotional response, distracting from the tinnitus sound. I talked about hearing aids because they amplify external noises, increasing auditory stimulation in the brain which helps with tinnitus. Combination devices have tinnitus masking built into them. It's an option for someone with hearing loss and tinnitus. It combines treatment for both.

Most folks have seen someone with hearing aids or have one themselves. I won't get into hearing aids. It's a small electronic device sitting in or behind the ear, with a small speaker in it. It can be effective for someone with tinnitus.

When we amplify environmental sound, to mask the tinnitus, or come close to it, it's harder to perceive tinnitus, so the brain focuses more on external noise. It allows the brain to get auditory stimulation, that would wouldn't get otherwise. It gives the auditory cortex more sound to focus on other than the tinnitus. Hearing aid can improve communication by amplifying the sound of voices, for example.

If you have hearing loss and tinnitus, Hearing aids are likely going to be the most effective form of treatment.

This is a visual analogy for tinnitus. The grasshopper is the tinnitus and the background is sound you focus on. Here, the background noise is muffled and the tinnitus is very clear and obvious to pick out. Picture B on the right side, has a hearing aid. The background is clear, sharp and distinct. The tinnitus is still there, the grasshopper, but it's less obvious. It doesn't stand out as much. The listener can focus less on the tinnitus and more on the environmental sounds.

Behavioral therapies focus on a person's emotional reaction to tinnitus. Is a mild, deeply distressing or not? Patients may say, “It's not a big deal.” This reduces the anxiety or distress people may feel around their tinnitus. It increases quality of life. It provides skills to reduce the amount of attention paid to tinnitus, and our coping ability, and creates alternative thinking.

I'll talk about the most common tinnitus treatment behavioral therapies. First, cognitive behavioral therapy, used for treating anxiety, depression, post traumatic stress disorder etc. This helps create coping strategies and skills, changing negative thoughts, behaviors and so on to focus on making a neutral response to tinnitus. You won't love it, but you won't think of it as a negative thing.

Mindfulness based stress reduction was made by Jon Kabat Zinn in the 1970s from working with Buddhist teachers and yoga. It was used to help people cope with stress, anxiety, pain and illness, and recently, for tinnitus treatment. Mindfulness is a non-judgmental awareness of your physical sensations, your emotional reactions, and cognitive processes. It's an awareness of your body and your thoughts. This stress reduction combines body awareness, deep breathing, relaxation and yoga. There's programs that adapt this program to tinnitus treatment. Usually it's a several weeks-long program you do online.

Tinnitus retraining therapy is a gold standard for years. It's the most common therapy you'd hear about combining cognitive behavioral therapy counseling with the use of sound maskers to help habituate you to your tinnitus. The counseling demystifies tinnitus and helps classify it as neutral as a signal. The sound masker puts a low level white noise in the ear, to help mask the tinnitus. This approach is based on retraining the subconscious part of the brain to ignore tinnitus.

There's no specific medications approved by the FDA for tinnitus. There's no medication to cure tinnitus yet there's medications that may provide relief. First, talk to your primary care provider, as not all drugs are right for everyone.

Antidepressants and antianxiety are the most often used. Think about the tinnitus cycle I talked about. These medications hopefully interrupt the negative circular relationship between tinnitus and depression, anxiety, worry etc. However, the medications don't impact tinnitus directly, therefore not effective for someone without depression or anxiety. So not for everyone.

There's research showing these medications may reduce neural plasticity, the ability to create new connections in the brain, making it harder for patients to habituate naturally to tinnitus. There's different natural substances that could be marketed as a tinnitus remedy, though there's no scientific evidence that they work. You could hear testimonies from those that say they tried these products and said they worked. It could be a short-term placebo effect, however.

Something to keep in mind is that these substances might not be regulated for safety by the FDA. There are some drug trials to treat tinnitus, but it's hard to know when these therapies will be on the market.

The vast majority of the time, tinnitus is caused by hearing loss but very rarely, tinnitus is caused by a physical dysfunction somewhere else in the body. TMJ can cause tinnitus. In this case, dental treatment such as bite realignment might help get rid of tinnitus. A dental health professional could investigate this. It could be wax or fluid behind the ear drum. An audiologist could identify this and refer to you.

Damage to the head or neck can involve blood flow issues, which can be treated using physiotherapy or other treatments. A doctor or primary healthcare provider could help plan the best treatment.

Some tinnitus is caused by medication that causes changes to the cochlea. Some medications are toxic, but most are just a temporary change. The effect is reversible. Most of the ototoxic drugs that cause this can be dealt with.

If there is concern that medication is the cause of tinnitus, it's important to talk to your doctor. Stopping the medication or changing the dose could have a negative effect and outweigh any potential benefit.

I want to leave some time for questions so I'm going to run through these experimental treatments quickly.  These are perspective treatments for tinnitus.  They're still in the trial phase. 

 

Repetitive Transcranial Magnetic Stimulation, Transcranial Direct Current Stimulation, and Deep Brain Stimulation all work to reduce neural activity. 

 

These treatments reduce neural activity.  Deep brain stimulation is used for Parkinson's, tremor and so on.  It's a more invasive treatment.  There's direct stimulation of the brain with an implant in the brain.  These are treatments validated for clinical use for tinnitus.  In the meantime, we look at different treatment options I already talked about. 

 

Here are some links for more information on tinnitus and tinnitus management.  I'll email these to anyone who wants them.  You don't have to scribble these down.  This concludes the presentation. 

 

We'll have time for questions.  You can ask me a question personally too, because we'll be outside for the next few hours.  Approach us with any questions. 

 

Man:  For lines of communication between an audiologist and a family doctor, does communication in fact occur? 

 

Speaker: Yes, is there direct communication between an audiologist and a family doctor? At our clinic, when you come in for a diagnostic hearing test, or a tinnitus test, we send a written report with a copy of the audiogram to a family doctor or specialist the patient is seeing. We're explicit in that the treatment and therapy we recommend and have communication with the physician if they have questions. Or if there's any medical reason that could cause the tinnitus, we refer that back to the doctor. We keep nothing secret. The best approaches are to have a multi-disciplinary team, working with the audiologist, the family doctor, the ear, nose and throat doctor all in the same loop. Great question.

Other questions?

Woman: Are your assessments covered by MSP or extended medical benefits?

Speaker: Great question. Are they covered by MSP or benefits? Some benefit plans, for the hearing assessment, there's a 45$ fee. It's part of the cost for doing the assessment. MSP doesn't cover that. There's not much coverage in BC for hearing aids or tinnitus therapies. If you have an extended health plan, that could kick in for some cost for hearing aids. Also, hearing tests could be used as a medical expense on income taxes. There's 3rd party funding, Veteran's Affairs, WorkSafe BC etc.

Woman: You said a hearing aid can help with tinnitus because it includes a masker in the hearing aid. What if you don't have any hearing in the ear with tinnitus?

Speaker: Great question. What if there's no hearing in the ear with tinnitus? If there's no hearing, we won't put an hearing aid in that ear to deliver sound to that ear. Again, the idea of having sound masking. It doesn't have to mask the tinnitus. Having sound present provides relief for most, but it doesn't have to be so loud it is louder than the tinnitus.

 

Instead, we give the brain something to hear other than tinnitus. Focusing on treatment for the ear with hearing, and looking at options in the environment for other sound sources. We can't fully mask tinnitus in an ear without hearing, but you don't need that to get some relief from tinnitus.

Anybody else?

Man: Perhaps off topic, but what about hyperacusis?

Speaker: That's extreme sensitivity to sound, and that goes hand in hand with tinnitus. Often, with hyperacusis, or extreme sound sensitivity, they also have tinnitus. The same therapies are used for both of these conditions. Being conscious of the level of sound, being uncomfortable loud. With hearing aids, with hyperacusis, they often have hearing loss. With hearing aids, we spend time setting them up so they are in a comfortable level, not causing discomfort or pain. Again, the same therapies for tinnitus can be used for someone with hyperacusis.

Woman: With background noise, if I had music playing, that could be a distraction for tinnitus. Yet I find it irritating, because I can't hear normal sounds. Can you speak to that?

Speaker: Yes, does music help with tinnitus? Often, hearing music, or. TV or radio playing, it's more distracting from what you want to hear. Often, with a tinnitus masker, or using sound masking, we try to pick a sound we're not consciously listening to, such as white noise, a steady static sound, or rain drops, or ocean waves, which are environmental sounds.

 

These are easier to put in the background, because they don't provide useful information. Music, or TV, or a conversation, that's distracting. The goal is a positive sound, but not one that's too meaningful. However, some find putting on the TV when going to sleep is helpful for not listening to tinnitus. There's no one treatment for everyone.

Man: This may sound counter intuitive but could hearing aids with the increased amplitude in your ear contribute to the experience of tinnitus?

Speaker: Can the hearing aids contribute or --

Man: Because of the increased volume in your ear ---

Speaker: No. I haven't seen a case where a hearing aid made the tinnitus worse long term. No. Again, tinnitus isn't caused directly by a sound in the ear, it's more the way our brain responds to tinnitus. It's our awareness and reaction to tinnitus. A noise in the ear, like a hearing aid or a sound in the room, won't cause tinnitus that wouldn't be there otherwise.

Man: But tinnitus can be a result of loud noises.

Speaker: Yes, but that's due to damage in the inner ear caused by loud noise exposure.

Man: Would you use a masking hearing aid if the hearing issue isn't at a hearing aid point?

Speaker: If no hearing loss, can you still use --

Man: If your hearing loss isn't where you'd try a hearing aid?

Speaker: Do you use a masking device, even without a severe hearing loss? Yes, there's some hearing aids used solely for tinnitus.

If there was tinnitus in a normal hearing ear, you could get a device called an "ear level" or an ear tinnitus masker. It's the same idea of putting low level constant noise in the ear. The noise could be controlled by the person. It could be set up to be manually controlled, when the tinnitus is bothersome.

Woman: Could you wear it to bed?

Alison: It's not generally recommended. People usually wear these during the day and then find something else for bed time, like a noise generator, rather than wearing it 24/7. That's hard on your brain and on the hearing aid. It's recommended that you take out the masker during the day and find another option for the night.

Woman: Is there any listing that talks about restaurants that are good for people with hearing loss?

Alison: No but I think that's a great thing for you to get on! There should be. There's a great variability in the acoustics of different rooms. This is the last. Some restaurants have really poor acoustics and can be challenging for people with hearing loss. Other restaurants are a lot easier. As far as I know, there's no list.

Thank you everyone.

[Applause.]

[Break.]

12:30 PM Presenter: Kate Yakimow, "Challenges Surrounding Hearing in Noisy Environments."

Kate: How's the sound? Can you hear me in the back? We'll let a few people trickle in.

Woman: I'm having trouble hearing.

Kate: Oh dear. I can try to speak up. Is that better? I was always the noisiest kid in class. It makes sense that I work for a hearing aid company! [Laughing.] I'm well suited to this.

Woman: Erin is doing a radio announcement.

Kate: Here she is. Can we turn the mic up a little?

Dr. Erin Wright: Hello everyone. Thank you for attending our 8th annual hearing expo. I work at the Broadmead and Oak Bay Hearing Clinics. This is Kate Yakimow with Oticon.

She's going to talk about noise. Noise is the most common complaint and difficulty we see. That's where the research dollars are being spent: how to help people hear better in noise. Welcome, Kate.

[Applause.]

Kate: That was my whole talk. [Audience laughing.] I have a few extra things to add. Thank you for having me. I work at Oticon Canada. I have had the fortune of travelling around the country working with all sorts of Hearing Clinics all over the nation. If you found yourself in the care of Erin or her team, you've found the best in the country. Kudos to you.

My job is to talk about why noisy environments or complex hearing environments are tough for people with hearing loss. We're going to talk about the type of listening environment I mean, or the ways someone you know has tried to overcompensate for a complex hearing environment.

On the manufacturing side, we have found different modalities to build into our hearing aids to make these environments better for you. I'll talk about how we know they work.  We want to make sure you're doing better. 

 

We want to send you into the world. When I say “complex listening environment,” this is what I mean. Dishes, cleaning.

Of course, you have speech coming from every direction, with every volume, pitch, voice type, etc. That's a complicated listening environment. We want to talk about why that's difficult to navigate. We also want to have a quick review of how hearing works in the first place.

This video is from the BBC. It follows a sound wave. The sound wave goes down your ear canal. It pulls the pressure in and out. The pushing and pulling is transmitted to a series of tiny bones. As sound pressure pushes on the ear canal, these bones vibrate against each other. That cascades across the chain of bones.

If there's a loud sound, we have a tiny muscle that pulls the bones out of alignment and give a safeguard to something very loud. Ultimately, the bones jiggle against a fluid-filled structure. The fluid moves back and forth like waves. On the inside of the fluid-filled structure, there are microscopic hair cells that move in the waving fluid and transmit sound information to your brain. That's a quick review of how this process should work.

Here's a picture of those hair cells in minute detail. In it's most simplistic form, you can think of each cell or hair as responsible for transmitting a different sound. Each piece of sound information is delivered to your brain to create a picture of the sound around you in a given situation.

This is a picture of healthy hair cells at the top and damaged hair cells at the bottom. You see the holes in the bottom picture. If each cell is responsible for one slice of the environment, now you're missing a few slices. Now you can no longer get the sounds they're responsible for. I think of it like losing resolution in our listening.

If the sound is loud enough, we could stimulate hair cells in the vicinity, but that gives a dull picture of the sound rather than a sharp picture. I think photography is a great analogy for what happens over time, whether due to sound exposure or wear and tear. We lose information, we've lost resolution of the sound picture around us.

To take it back to the complex listening environment versus a simple listening environment, I like to use an image. If you have a simple image, you don't need a high resolution of that image to still get the gist of what's there. If you've thought, "I don't have hearing loss because if I'm in a quiet environment, I hear fine. If I'm one on one with someone, I'm okay. It's the noisy environment that gives me trouble."

That's because in a simple listening environment, you don't need a complex picture of the soundscape around you. If you have a more complex photo, blow it up or amplify it, you don't get the same information. You've lost all integrity of the photo. If we don't get the sound we need in a high resolution way, we lose the integrity of the sound picture. Does that make sense?

There are lots of ways we manage through these listening environments. I had conversations already today about lip reading. It's a huge part of the equation. Folks with good hearing use lip reading to supplement voices as well. It's never more important than getting the full gist of a conversation. We know lip reading helps us out in these situations.

Another thing you can draw on is your memory. You can use cues from the environment to give you an idea of what's going on. We use context and memory to fill in the low resolution sound picture we're getting. You could also continue to ask people to repeat themselves, with the cool move: cupping the ear. [Audience laughing.]

There are lots of ways to self-manage but there are consequences to that. The biggest one is that you don't have an infinite amount of energy on a given day. If you are navigating through a difficult, complex listening environment and you're not getting all the sound information your brain is expecting, it starts to scramble trying to figure out what's going on.

Your brain knows what it wants from a soundscape environment, and if it doesn't get that, it freaks out. Layer on top of that the extra energy to focus, to lip read, to call on contextual memory, and it becomes an exhausting proposition. At the end of the day, you're tapped.

Ultimately, then, you might employ the worst possible scenario, which is complete avoidance of this type of complex listening environment. We can't have that. What can we do on the hearing aid side?

Erin mentioned that now that we've taken care of the basics of hearing aids, making them small, aesthetically pleasing, they don't whistle anymore, etc. Now we spend the vast majority of our time thinking about you in complex listening environments, worrying about you in complex listening environments, and the vast majority of our research dollars go to helping you figure out how to do better in these environments.

One of the focuses is making sound loud enough to come across. From there, it's important to decrease the sounds that are not likely to be of interest. The way we accomplish that is by building tiny computers -processors or chips - that can see sound signals differently.

Here are speech signals layered on top of these other one. Speech looks one way to a computer. The grey is different. To a computer, noise looks different. We can manage the two signals independently from one another. This is a simple environment. We create processors or computers over time that do better at distinguishing between different types of sound. For example, bird song, or music, which look digitally different. We manage them differently then.

A more new and important development is the idea of communication between two hearing aids. It's been around for a few years and is getting better. In a busy listening environment, to find sounds, your brain tells the difference between the voice being at your right or left ear by timing. It's slightly quicker on the side where the sound is coming from. When we've lost resolution of the soundscape, this is some information we're missing. But we can recreate or redeliver with communication between the two hearing aids on each side of the head. It helps localize sounds in a busy environment.

A big advance over the last decade is the idea of a directional microphone. You may have a hearing aid with a directional microphone. It helps create a narrow beam of amplification in front of you, helping with a one on one conversation. It's now automatic, when noise environment gets high, we click into that directional mode without a manual switch. This has served us well over the last several years. However, there's compromises.

For example, if someone's voice at the table is of interest to you, but are talking to multiple people at once. You have to face the person you want to hear. At Oticon, we've launched the next step for this listening environment. While the first did a good job, it didn't address the situation of a multi speaker environment you wanted to be a part of.

Also, it didn't address the fact that this [indicating] deprivation, closing off the environment from your brain, your brain knows something isn't right. It tries to gather listening information it's not getting. It doesn't alleviate the stress/pressure it puts on your system for hearing.

We made open sound navigator. It was launched last year, and helps with complex listening environment. We have a processor fast enough, as technology moves quickly, which can manage multiple different speech sources in the environment. They are weighted based on where they are with respect to the wearer and how far away they are. Voices closer to you have a higher priority than a far away voice. It's as your brain likes to do things.

Research in the field has shown that folks with hearing loss can attend to voices they want to hear if they can attend in the way the brain prefers. If you gather information in the environment, we do a great job at attenuating noise. You make sense of all the information, and attend to the information you want. It's fun to work with these recently, as patients feel the difference between the closed off difference between a directional microphone and an open navigator.

I'll finish up on this note. Are we on the right track with these? On the top left of this slide is a schematic for a hearing and noise test. We have a surround sound system, with a hearing aid with the feature off, asking them to say back sentences to us. Them we compare it to when the feature is on. If there's improvement, we know we've done a good job.

On the left side, on the bottom is a schematic for a signal to noise ratio. How much have we elevated the signal, the sound information we want to hear, above the sound information we don't want to hear? If we've improved it, we have a probe microphone in the ear, with microphone on, and if we've improved it, the new feature is working.

On the right, are newish measurements to ascertain if we reduced the cognitive effort you're outputting in a complex listening environment. On the bottom right, there's pupillometry, where you're an a complex listening environment and we measured how much their pupils deleted when working hard to hear the sentences. We used an old directional style microphone and the new OpenSound Navigator, and the latter did better in the complex listening environment for listening effort. There was reduced cognitive strain in that situation for that patient with the new device.

The top right is another hearing aid manufacturer. We're not the only ones thinking of hearing and cognition and how complex listening environment are taxing on the brain. On the top right, you've got feature off/on, and how stressed the brain was in each case. There was a reduction in the cognitive load with the new hearing aid feature. We really care that these work for you in a subjective way, your own personal cognitive load effort. We want the complex listening environments to be easier for you, because you'll enjoy your life more.

That's all I have for complex listening environments. I hope it was interesting for you. I'm happy to take questions now.

Woman: Last year we heard –

 

[Applause.]

We heard about hearing and music, and how certain hearing aids are better if you like music. Does this improve going to the opera so the singers aren't off-key?

Kate: Depends on the opera! [Joke/joking.] It's the ability of the computer to analyze the environment, the ability for that computer to tell the difference between different types of sound, discreetly. In the past, we handle music like noise, being able to distinguish speech and noise, but non-speech sounds were harder.

 

Now, we are better at understanding how music looks to a computer. We mange it differently than noise. We want to keep it natural, keeping the integrity of the sound as close to itself. When we add new technology to hearing aids, yes, we're doing better and better for music.

Man: Will the new technology in hearing aids, distinguishing sound from meaningful signal, be set up so the wearer of the hearing aid can define what is noise? For example, it's often in watching a movie, the speech is obscured by the background music, because directors think it adds to the mood!

 

I want to turn down the music, so I can hear what's being said. It's true in real life, with a band in back playing music. Do you see that hearing aids would be designed such that the user can perhaps, in a moment, turn down music, or turn down some other sound, which isn't pertinent to the situation at hand?

Kate: Right. Signal wise, telling different types of sound differently. I would like to be able to do that too! I don't have Hearing loss but I'd like that! We don't have magic, and I don't think that situation is specific to hearing loss. But with background noise, which is sometimes speech too! At a wedding, with tables all around you, and you're at one table. You can't manage every single voice in the room! As sounds get further away, the well defined signal, well it gets less well defined over time. The valleys of speech as the sound is further away, looks more like noise. An advanced hearing aid can prioritize the signal based on how well defined the signal is.

We can deliver and retain that difference in the way your auditory system does if you didn't have Hearing loss.

Dr. Erin Wright: I'm going to add to that. With the advent of connectivity of hearing aids to iPhones, there are apps now that have equalizer bands. You can adjust frequencies, play around and then save it as "my Starbucks setting." [Audience laughing.] The connectivity piece with the hearing aids has more flexibility for the user to fiddle around with.

Thank you for coming to this! Our next talk is at 1:30, in 25 minutes. Thank you, Kate, for coming here from Ontario. Thank you as well.

[Applause.]

[Break.]

Dr. Erin Wright: The next talk is about what's new in hearing aids in 2017, things just about to be released and that currently exist.

1:30 Presenter: Dr. Erin Wright, "What's New for Hearing Aid Technology in 2017."

Dr. Erin Wright: Thank you for coming to our 8th annual healthy hearing expo. We put this on with the goal of educating people in the community about hearing loss and how to manage it.

Audiology is the profession that is responsible for managing hearing loss. A lot of people wonder when to go to an ear doctor versus an audiologist. Audiology is for managing surgically untreatable hearing loss. This event is for everyone to take a look at the products to help people manage their hearing loss.

I own the Oak Bay and the Broadmead Hearing Clinics. I open the Oak Bay Clinic about 6 years ago. We have a team of 4 audiologists. I'm very proud of the people we have on staff. They're smart, kind, patient women. I'm happy to have them on board with me.

I wanted to start this talk by educating people about the hearing aid industry and how it works. Then we'll go into different features that might be available with different hearing aids that you may benefit from. Lastly, I'll talk about innovations we can see within the next year or two in the industry.

98% of the hearing aid marketplace is dominated by the "big 6" hearing aid manufacturers. Phonak and Oticon control about 24% of the market. Widex and ReSound control about 9%. Siemens controls 17% and Starkey 9%.

What has happened in the last 7-8 years, maybe 7-10 years, is that these hearing aid manufacturers have secured retail outlets to dispense their particular product. Prior to 10 years ago, towns like Victoria and everywhere else would have clinics that would choose the best products for each solution.

These companies put a lot of work into research and launch new products every 3 years. At the end of the 3 year cycle, when a hearing aid was about 2 years old, nobody was ordering those hearing aids because another manufacturer had launched a new one. They realized they needed to secure a channel for having their 3 year old hearing aids continue to go into the market.

They started purchasing independent hearing clinics so that now, most clinics are owned by hearing aid manufacturers. In Victoria, there are all of these choices. [On screen.] There are 23 hearing aid clinics in Victoria. Only 4 of them [bolded] are independently owned, separate from any hearing aid manufacturer, investment or anything like that.

Broadmead and Oak Bay are independently owned. That's why we can put the event on. There's a clinic in Saanich and Stacey Frank has a clinic in Oak Bay as well. All other clinics are owned by manufacturers.

In your best interest, as a consumer, you want to make sure the professional you're seeing is recommending the best product for what you need. Dexterity, cosmetics and connectivity all need to be considered.

As I said, there are different things we look at as audiologists when it comes to your hearing exam, case history, lifestyle, who you live with, what environments you're in, etc. We try to take those pieces of information and synchronize them to suit your lifestyle. As you see your audiologist and try to get your hearing loss managed, it's important to be upfront about what you're looking for.

If it's cosmetics, just say it! Say, "I don't want anyone to see these hearing aids. That's my #1 priority." Be honest with the audiologists so we can focus on what you're saying, really listen to what you need and find the right solution from one of the big six manufacturers.

They all do things a bit differently. Some manufacturers are great at making hearing loss for people with severe to profound hearing loss. Phonak makes an excellent product for people with severe hearing loss. Some manufacturers are wonderful at making them tiny and fit right into your ear canal. Some manufacturers do a great job for people suffering from tinnitus. Some products have sound therapy installed in them. If you have tinnitus, that's a feature we want to access.

Some have rechargeable batteries, some connect to a TV, etc. There are different things available. Part of our job is to fine-tune your needs. We pride ourselves on using these manufacturers and staying up to date with the technology. It's not easy! These companies release things all the time. We need things in our mind so that when someone comes in with a unique need, like something water proof that also connects to a TV, we have to find something that meets those needs.

I'm going to talk about the features that meet the needs we're focusing on in 2016. There's a big push around connectivity to iPods, iPads, etc. Apple is a company that has created a native app on their devices - it's on everybody's phone or tablet already, you don't have to download it.

ReSound is one of the manufacturers. They are a very innovative company. They were the first company to market when it connects to phones. ReSound did that in February 2014. Starkey launched a product after that. Oticon launched the Opn in June. Widex launched the Beyond after that.

Siemens sold their hearing aid division to Sivantos. They were allowed to use the Siemens name and are now leaving it behind. They're launching their iPhone connected hearing aid this summer. Word on the street is that Phonak is coming out with something in 2017. We're not sure about that but they're all moving in this direction.

What is the benefit? Why do I need this? Some people come in and say they don't want the bells and whistles. They just want a hearing aid.

The fact that a hearing aid can connect to a phone or iPad is not what makes it more expensive. They can connect at all different price points. It's not about most or least expensive. It's just a matter of whether you want this type of connectivity or not. It's things we can do to enhance your experience.

All audiologists know that hearing aids alone are not the answer to the problem. It's one piece of the puzzle.

For example, you could sit in the front row! You use different adaptive strategies, and technology is just one piece. It's not the whole solution. Connecting your hearing aids to other things can help, for example, listening to the TV when there's much background noise.

One benefit is that you can use different apps on the phone. Each hearing aid company made their own unique APP. Apple has one that lives in your phone. You can download the ones designed by the manufacturers which allow you to control more things. For example, Widex Beyond, has given people much control over how the Hearing aid sounds.

Someone asked, what can I do to be the one to make the adjustments? On the Widex app, they've given people an equalizer where people can control the bass and the treble. On the bottom, there's sound direction. You can manipulate your hearing aid microphones. For example, you're driving, and have kids in the backseat. You can flip it to be rear facing to pick up their voices.

You have more choices for how the hearing aids functions with something unique in your environment. You can do simple things like increase volume, or there's sound mixer. You change the amount of sound coming in from for example, a TV, as it relates to how much sound the Hearing aid picks up.

Say I'm driving, my husband would be earing a microphone, and the radio is on, and the windows are down, and it's harder for me to hear him. I use the sound mixer to bring up the sound of his voice, and lower what my hearing aids are picking up, so I don't hear the radio as much.

"Where's my hearing aid?"

[Audience laughing]

This is great, your app finds it through GPS, or if you lose it at home, you use the "warm/colder" to walk around the house to find out where it is! [Laughing]

Also, how well do they connect to TVs? In my experience, people with direct connected hearing aids, people like being able to hear the TV though the hearing aids themselves. I wish I videoed my parents when I connected them to the TV. They had hearing aids for a while. I connected them to the TV, and it was adorable! They looked at each other, watching curling. My dad left to slip the steak. He came back, and hadn't missed out on anything! He still heard what was going on in the TV. He was sooo happy! How cute!

 

I see people in the clinic, but not in people's home, doing things. It allows people to mute the TV volume, so your partner doesn't have to watch football for one. Or British TV shows like Downton Abbey, with their accounts. It's easy when you directly connect to the TV. We've had this ability using an intermediary device that people wear around their neck. Yet that has to be charged, and put on etc. Now, it's straight from the TV right into the hearing aids.

Also, they can connect to the internet. Here's a video. There's 3 scenes. One, the woman hears the door ring. Second, a child has a low battery, and third, a guy turns on his TV. This shows you how hearing aids can do more than they did in the past. They connect to other devices, also connected to the internet. For example, Oticon has the Opn the first and only internet connected hearing aid.

Here's my video.

[Light music in background]

[Computer beeps]

Man: TV on.

Computer: TV.

[End]

That video with the girl with the low battery tugs at my heart. I used to be an education audiologist and kids with dead batteries, sitting all day with a dead battery. How hard! The kids are little. They don't know what's going on. But this technology, the parent could know, get a text message that their kids battery was low. How amazing!

Next, things that are happening in the industry. For example, rechargeable batteries. Siemens has had a rechargeable battery in the past, but with limitations. I'll talk about different types of rechargeable batteries available for hearing aids in today's market.

Zinc-air is used by most people. It's a disposable battery that lasts a week. Then you get another one. Siemens first version of their battery was a Nickel Metal Hydride battery. Great but not a great battery life, lasting only 12 hours. You put it on the morning, and by 9pm, the battery was too low. The battery industry has a huge role in the development of this new technology. The technology is very advanced, and has much battery drain. How do they make the products efficient and connected without making a short-lasting battery?

Silver Zinc is another type of rechargeable battery that's new in the market. Unitron has launched a product called the Tempest using this type. Also, Starkey uses this. It's the best option in my opinion. First, great battery life for the day. You charge it, and it lasts something like 24 hours on one charge.

That single battery cell, which is in the hearing aid, is supposed to last a year, and then you replace it. It's replaceable. Each battery lasts about a year. If you leave, go camping, without a charger, you can replace it with a regular zinc-air battery. It's flexible because you can use zinc-air batteries when needed, but also recharge it.

Then Lithium-Ion batteries, new as of this year, with Phonak and Siemen's using this. The battery is integrated right into the hearing aid, and you have to send it back to get the battery changed. The manufacturers are saying these batteries will last 3 years, then you send it back to the manufacturers. It's so new, however, so we don't know if they really will last 3 years.

 

Usually, the more you charge them, the less time they hold the charge. Towards the end, you might recharge it but only get 6 hours of life. That doesn't work for those with hearing loss. Also, there's a safety concern, with pets eating a hearing aid. Not good with a lithium battery. They don't maintain battery life and maintain connectivity without using a middle man.

Phonak has an integrated lithium battery. They have the first power hearing aid using a rechargeable battery, for those with a severe or profound Hearing aid. They need a hearing aid with much power. So Phonak launched a power rechargeable product, which is great as an option.

The smallest rechargeable battery is made by Unitron, a sister company to Phonak. They use the silver oxide battery, the least expensive and with the smallest shell on it.

Also, we have had to decide which is more important, rechargeability or connectivity because we can't have both. Should the hearing aid be rechargeable or connected? But now --- drum roll please! [Joke/joking.]

There was a conference held recently and Oticon announced that they'll have a hearing aid that can be both rechargeable and connected.
 

This is going to happen with the Opn hearing aid. Kate talked about that hearing aid. It has been available since June. They are going to use the single cell silver oxide battery to be able to recharge that product. The good news about this is that anyone who has an Opn hearing aid, we're going to be able to retroactively re-fit it so you don't have to buy a new one. They're going to send us a kit to change the battery door, and a charger so the hearing aids can become rechargeable. That's coming out in June. We're not sure when we'll get them in Canada, but it's exciting to see both those features in one hearing aid.

I would also like to talk about how hearing aids are getting smaller. Phonak released a hearing aid with a titanium shell. You usually see the beige acrylic shell and they have to have a certain thickness so they don't crack. The thickness had to be a certain density to preserve the features inside.

Phonak released the medical grade titanium hearing aid that fits right into the ear canal. This is good for people who want a hearing aid to be really small. If your ear canal is small, there isn't room to fit all the components, so it has to stick out or use the behind the ear kind. Because this titanium shell is thinner, there's less space required for the shell and it can fit deeper in the ear.

It's great for hypoallergenic concerns. The material is strong and good for allergies.

The next part is things that are not yet in our market but set to be released in 6 months to a year. ReSound is a very innovative company. They've been first to market a lot of features. They connected first to the TV and had the wire in the ear. The new hearing aid is the Linx 3D. It should be able to connect to the Cloud.

Apparently ReSound has developed their own Cloud. What this means is that if you use this hearing aid, and you're in an environment and you're not hearing well, you can go into the app. The app will lead you through a series of questions. Then you can send your audiologist a message. "Erin, my hearing aids are sounding tinny. Is there anything you can do?"

I would create an adjustment and send it to your hearing aid through your iPhone. You don't even have to see me! This is the first attempt at this. This product will be launched May 2nd. I have a client who comes from Haida Gwaii every year so for people at a distance, this will be great, or even for people who have trouble getting into the clinic, or people who are just really busy.

There are lots of ways this technology might be beneficial. This is the first attempt so we'll see how successful it is. It's exciting to get something done right away, not have to wait for an appointment to get your problem solved a week later.

You can get these Cloud-based adjustments if you have Apple based phones.

The next is a concept being developed in Denmark. Oticon and Widex are based in Denmark. Widex is working on a fuel cell. This is interesting because this is going to be Widex's version of a rechargeable battery. They're not going to use the other batteries.

Widex is saying that within a year and a half, they're going to launch a hearing aid that doesn't use a battery at all. It will use a fuel cell. It won't use hydrogen but methanol. The benefit is that it takes 30 seconds to recharge the product. This is the mock up of what that product is going to look like.

That will be interesting. We won't even have to deal with batteries. Moving away from disposable batteries is better for the environment and less expensive in the long run. I'm confident that in the future, we won't use disposable batteries in hearing aids. We're all moving towards this technology.

I also wanted to touch on implantable hearing aids. Some people want to know if there are implantable hearing aids or surgery for hearing loss. One option here is the "ear lens." I have a video here.

Ear lens is currently not available in Canada but you can go to the States to get it. This is how it works.

[On screen - captioned video.]

That's a company in California developing that product. This is another one, the Esteem. The Esteem is a processor. You can see that at the top. It's implanted behind ... let me see if I have this video. The processor is implanted behind your ear in your mastoid bone. The surgeons put drivers between the middle ear bones to try to amplify the sound to go further into the cochlea. There's no external processor for that device. That closest place to get that device is in Portland.

Those kinds of things are eventually going to reach our neck of the woods as well. There are many different ways things are advancing on the medical side of technology as well.

That was my last slide! My computer won't move me to the next slide. [Laughing.] There.

[Audience laughing.]

Thank you all for coming and being advocates for your own hearing loss. It's about gathering information so you can be an informed consumer when you're in the process of getting hearing aids. Thank you for coming.

[Applause.]

Do you have a question?

Woman: For iPhone connectivity, would that include iPad?

Dr. Erin Wright: Yes, iPad, iPhone but not your computer.

Man: What about cochlear implants?

Dr. Erin Wright: Cochlear implants are for people who cannot be assisted by hearing aids. You go to Vancouver, to St. Paul's hospital, to get a cochlear implant.

[End.]