Understanding Auditory Processing Disorder

 By Frankie Huang

April 4 is Auditory Processing Disorder Awareness Day and the Hearing Health Foundation is highlighting the effects and challenges associated with living with APD.

Auditory processing disorder (APD), also known as central auditory processing disorder (CAPD), is an auditory deficit affecting how the central nervous system interprets verbal information. Those living with APD show impairments in sound localization, specifically their ability to isolate a sound source in social environments.

Approximately 5% of school-age children have APD. Children with APD often are uncertain about what they hear and have difficulty listening in loud background noises as well as understanding rapid speech. Often distracted, they can struggle to keep up with conversations which impedes their ability to read, spell, and follow oral directions.

Researchers found a correlation between working memory capacity, which is the ability to retain and manipulate information, and speech development. They found that working memory capacity was significantly lower in children with APD and may be the cause of their inability to separate and group incoming information and, in turn, lead to poor speech perception in noisy environments.

Other researchers found that peripheral hearing loss may affect performance in certain APD tests in older adults. Older adults with mild to moderate hearing loss did significantly poorer on tests that require recalling words, identifying high and low tone patterns, and repeating short sentences.

Although APD can be difficult to diagnose, there are telltale signs: poor auditory memory, difficulty identifying sounds, and a delayed response to verbal requests and instructions. APD is sometimes misdiagnosed as ADD/ADHD or dyslexia, so if you suspect you or a loved one may have APD, it is advised that they go through an individual comprehensive assessment with an audiologist for a more accurate diagnosis.

It is important to understand that research is still needed to understand auditory processing disorders, accurate methodologies for diagnosis, and the best interventions for each child or adult. Even though there are available strategies to treat children with APD, researchers are hard at work finding alternative treatments that will improve the lives of those suffering from APD.

Learn about Hearing Health Foundation’s 2016 Emerging Research Grants recipients who are conducting research to improve the lives of those affected by APD. These grantees are General Grand Chapter Royal Arch Masons International award recipients and we are grateful to the Masons for their ongoing support.

Urgent Call to Action: Proposed Cuts to Hearing Research

By Nadine Dehgan, Elizabeth Keithley, Ph.D., and Peter Barr-Gillespie, Ph.D.

Hearing Health Foundation (HHF) is deeply concerned to learn the Trump administration has proposed an 18% cut to the budget for the National Institutes of Health (NIH).

Such a cut would be devastating for all medical research - including hearing research. As an advocate for the millions of Americans who have hearing loss we are especially troubled.

A drastic decrease to the funding of hearing research would disrupt the efforts of the many hearing researchers who dedicate their lives to finding cures and treatments for hearing loss, tinnitus and balance disorders.

HHF and the NIH are partners in funding research. HHF’s two research programs—the Emerging Research Grants and the Hearing Restoration Project—both rely on NIH support. HHF's funding alone cannot support these labs.

Private funding of hearing research is dwarfed by NIH support, and these proposed cuts could harm the research program of each and every hearing research lab, including those supported by the HHF.

As people with hearing loss, parents of those with hearing loss, children of those with hearing loss and as the leadership of the Hearing Health Foundation we ask your support. Financial support is always needed and welcome - but in this case we are specifically asking for you to contact your representatives to let them know that you oppose cuts to the NIH (and in fact support increases to the NIH’s budget).

If you are passionate about funding the research that will lead to cures for hearing loss and balance disorders, now is the time to act.

Please join us in contacting your Senators and House Representative's offices today.

With our sincere thanks,
Nadine Dehgan | CEO of HHF
Elizabeth Keithley | Chair of the Board
Peter Barr-Gillespie | HRP Scientific Director

Low Income at Disproportionate Risk for Hearing Loss

By Morgan Leppla

Hearing loss affects people of every age, race, and socioeconomic level. However, there are circumstances that put different people in danger of acquiring it. While some causes of hearing loss are avoidable or controllable, others are are not easily escaped. Low income people are much more likely to suffer from hearing loss than those who earn higher salaries, witnessed in both children and adults.

There are a number of reasons for this disproportional risk. Access to regular and preventative health care can be scarce so the prevalence of health problems tends to be higher overall, including that of hearing loss. Middle ear infections are more common, as is lead poisoning and malnutrition. Such detriments affect physical as well as mental development in children, and impact socio-emotional and academic performance. This disparity is heightened within underfunded school systems where sufficient accommodations for all disabilities, including hearing loss, may not be available.  

Low income caretakers of children experience additional external burdens due to a host of factors, such as long work schedules, literacy level, and language proficiency. These factors also make it difficult for caretakers to advocate on behalf of their children, or possibly notice their children’s developmental delays as a result of potential hearing loss.

Low income individuals who have emigrated from developing nations are also more likely to have already experienced some degree of permanent hearing damage. They are also often ushered into low-paying jobs that can include occupational workplace hazards like dangerously loud noises or exposure to chemicals.

People of color have  a higher risk for acquiring hearing loss. While non-Hispanic Whites still constitute the largest single group of Americans living in poverty, ethnic minority groups are overrepresented (27.4 percent African-American; 28.4 percent American Indian and Alaskan Native; 26.6 percent Hispanic, and 12.1 percent Asian and Pacific Islander compared with 9.9 percent non-Hispanic White). 

Lastly, men of all races, in low income jobs that may include physical labor, are even more at risk than other men. (If you didn’t already know, men are more likely than women to have a hearing loss, regardless of income levels).

Preventing hearing loss requires effort communicating with groups that are more at risk. If we are to end hearing loss as an epidemic, it makes sense to promote and extend hearing health care to populations who could use it most.

Under Normal Circumstances

By Morgan Leppla

March is Disability Awareness Month. In honor of this important awareness month, Hearing Health Foundation is raising awareness and celebrating all of our different abilities and doing our part to reduce the stigma of living with hearing loss and its associated disorders.

Whether we like it or not, people compare themselves to others. Maybe contemporary culture brings it out in us, or perhaps that impulse is rooted in Darwinism ideology of survival of the fittest, reminding us of competitive advantages. Who is taller, more intelligent, faster?

Possibly, it also has to do with how we conceptualize normalcy. In the mid-1800s, Belgian statistician Adolphe Quetelet introduced the idea of “l’homme moyen” (average man) when he realized that human traits are distributed over a bell curve. So the average man would have the mean of all human traits in a single abstract person.

“Normal” entered English vocabulary in 1840 and has since been used to describe bodies and behavior. However, before society focused on the “the norm” it concerned itself with “the ideal.” Take the most coveted parts of bodies and traits that exist and combine them, and that would be the ideal person.

So why is this distinction meaningful? Because every living person is non-ideal, since by definition it cannot exist in one person, whereas people (bodies and traits) can be “normal.” On the contrary, normalcy is attainable on an individual level. And society’s reactive effect to the creation of normal humans was the production of their dichotomous counterparts: the extremes or deviants at the tail ends of the bell curve, the abnormal.

However, a collision of the normal and the ideal occurred when English statistician Francis Galton decided to rank human traits, created quartiles on an intelligence bell curve, and ordered them one to four. One was lowest intelligence and least desirable while four was highest intelligence and most desirable. He reoriented the human ideal using the norm. And now, I would say, it is “normal” to want to be the smartest, most athletic, most attractive, etc.?

The latter half of the 19th century employed pseudo-empirical justifications for describing how bodies should be in fairly clear terms. And to focus on distribution of differences warps the way society approaches normalcy as a concept. It allows us to draw lines where perhaps they ought not exist.

Thus we arrive at the construction of disability. Anyone who does not physically look like others or does not act like others is perceived as deviant or abnormal because they are at the wrong end of the bell curve. Beyond the initial construction of the human normal, barriers that are literal, educational, communicational, and attitudinal further maintain “disability” since nonexistent or poor accommodations along with stigma exacerbate “disabling” differences.

Hearing Health Foundation is encouraging everyone to think about how “norms” have molded our preferences and attitudes and whether that translates to treating people differently. Life may be more arbitrary than you think, and more can be going on than what meets the eye.

HHF is committed to spreading awareness of hearing loss and its associated disorders as well as reducing the stigma attached to them. If you’d like to share your story and experiences with our community, please email us at info@hhf.org.

A Healthy Heart Could Mean Better Hearing Health

By Frankie Huang

In honor of American Heart Month in February, Hearing Health Foundation wants to shine light on the link between heart disease and hearing loss. According to the Centers for Disease Control and Prevention, 610,000 Americans die from heart disease each year, making it the leading cause of death for men and women in the U.S.

Heart disease is linked to or causes numerous health issues, including hearing loss. One study suggests that low-frequency hearing loss may be able to predict cardiovascular health. Using an audiogram, researchers were able to determine the probability of cardiovascular disease in men and women. The study found that there was a correlation of heart attacks in men, and a correlation of claudication (pain caused by too little blood flow) in women.

High blood pressure can also be a contributing factor to developing hearing loss, since the inner ear is sensitive to blood flow. High blood pressure damages blood vessels and increases the risk of plaque buildup in the arteries, making it harder for blood to flow throughout the body. In other words, inadequate blood flow and nerve damage in the inner ear may lead to irreversible hearing loss.

A common cause of heart disease and hearing loss is smoking. Smoking increases blood pressure and plaque buildup, and causes hardening of the arteries, all of which decreases blood flow to the organs and other parts of the body. The effects of smoking damages the cardiovascular system, boosting the risk of hearing loss. Additionally, cigarettes contains nicotine, disrupting the neurotransmitters in the auditory nerve (which tell the brain which sound you are hearing) and preventing the brain to accurately interpret sound. Cigarette smoke contains many harmful chemicals that are believed to be ototoxic (toxic to the ear) that may damage hair cells.

There are a variety of ways to prevent heart disease and cut your risk for hearing loss. Eating healthy and incorporating moderate exercise into your daily life can drastically improve your health. Include more fish in your diet: Salmon, mackerel, and herring are high in the omega-3 fatty acids that help reduce high blood pressure and prevent plaque buildup, so you can decrease your overall risk of hearing loss.

Remember, a healthy heart leads to better hearing health.

When It's Not Just Hearing Loss

By Morgan Leppla & Laura Friedman

This year Autism Sunday, an international day to raise awareness of autism spectrum disorder (ASD), is on Feb. 12.

Did you know that one third or more of pediatric hearing loss cases overlap with another condition? This may sometimes be ASD, making treatment and management of co-occurring conditions a challenge.

In a 2007 report in the Journal of Deaf Studies and Deaf Education, British researcher Lindsay Edwards, Ph.D., cites an estimate that 30 to 40 percent of children with hearing loss have co-occurring conditions that could prohibit them from forming language, speech, and sociocognitive skills. But despite this large percentage, there is little research on hearing loss that occurs with other disorders. What research there is has shown the benefit of cochlear implantation for children with additional needs (such as physical or learning disabilities), and the difficulties of language acquisition and development for 3-year-olds with developmentally related conditions such as ASD, cerebral palsy, or Down syndrome.

One silver lining is that the fact that 30 to 40 percent of pediatric hearing loss may occur with other conditions may prove helpful in predicting future disorders. A July 2016 Autism Research paper suggests that a noninvasive measure of otoacoustic emissions in the inner ear—a common hearing test for infants, who are preverbal—may help identify the risk of ASD at an early age, accelerating treatment. Study author Anne Luebke, Ph.D., of University of Rochester Medical School, found that children with ASD often have trouble hearing a frequency range (1–2 kHz) that is important for understanding speech. The range includes sounds for the meaning-conveying consonants S-, H-, and F-.

Scientific conclusions can help shape future research, but cannot illustrate daily life for families with children with co-occurring conditions. Dual diagnoses make unlocking any child’s learning style challenging, but reviving research and upgrading professional training are essential tools in order to advocate for and successfully educate children with co-occurring conditions.

If you’re interested in funding research related to diagnosing and treating co-occuring disorders, such as hearing loss and autism, please consider donating today: hhf.org/donate or contact us at development@hhf.org.

This blog was adapted from an article original appearing in Hearing Health magazine’s Fall 2016 issue. For references in this story, see hhf.org/fall2016_references.

Noise-Induced Hearing Loss Affects More Than 50% Not in Noisy Jobs

By Yishane Lee

The Centers for Disease Control and Prevention (CDC) made an announcement Feb. 7 on the dangers of noise-induced hearing loss (NIHL). Among the many statistics cited, the CDC says:

• 40 million U.S. adults ages 20 to 79 have NIHL

• More than half (21 million) with hearing damage do not have noisy jobs

• One in four U.S. adults who say they have good or excellent hearing actually show hearing damage

• Hearing loss is the third most common chronic health condition in the U.S.

• People report hearing loss at a rate nearly double of those reporting diabetes or cancer

The CDC says its latest Vital Signs report, using data from more than 3,500 hearing tests in the 2012 National Health and Nutrition Examination Survey (NHANES), shows “much of this [hearing] damage is from loud sounds encountered during everyday activities at home and in the community,” such as using a leaf blower or going to a loud concert without hearing protection. Nearly three-quarters of those who are exposed to loud noises never or rarely use hearing protection, the report says.

According to the press release, CDC researchers “found that 20 percent of people who reported no job-related noise exposure had hearing damage in a pattern usually caused by noise. This damage—shown by a distinctive drop in the ability to hear high-pitched sounds—appeared as early as age 20.” But it added that while a few studies have linked noise exposure among young people to the use of portable devices and entertainment venues, more research is needed to determine the relationship between this type of early noise exposure and hearing loss in older age.

Untreated hearing loss is linked with anxiety, depression, loneliness, and stress, the CDC says. In addition to causing hearing loss, chronic noise exposure can worsen heart disease and increase blood pressure, among other adverse health effects.

But don’t forget, noise is the only fully preventable cause of hearing loss.

Please see HHF’s resources on NIHL here, as well as our Summer 2015 cover story about NIHL. Taking care of your hearing should always be part of your overall health. If you suspect a hearing loss, get your hearing checked, and if you do have a hearing loss, get it treated. Avoid noisy areas, and wear protective earplugs or stronger when you need them in noisy environments. Download the CDC’s fact sheet here.

Receive updates on life-changing hearing research and resources by subscribing to HHF's free quarterly magazine and e-newsletter.

Want to Be Happier in 2017? Try a Hearing Test.

By the Better Hearing Institute

When you’re making your list of New Year’s resolutions and to-dos for 2017, be sure to put this one near the top: a hearing test.

That’s right. Research shows that when people address hearing loss it improves their quality of life in many ways.

And it’s no wonder. Ignoring a hearing loss and leaving it unaddressed can be exhausting, lead to isolation, and has been tied to an assortment of health conditions, including depression, diminished cognitive function, and an increased risk of falling.

But when people get a hearing test and use professionally fitted and individually programmed hearing aids—when recommended by a hearing care professional—most say they’re happy with the improvements they see in multiple areas of their lives.

Here are just a few potential perks of treating hearing loss that may surprise you:

1. Your spirits may brighten. People with hearing loss who use hearing aids are less likely to feel down, depressed or hopeless, BHI research shows.
   

2. Your relationships may benefit. Most people with hearing loss who use hearing aids say it has a positive effect on their relationships, according to a BHI survey. Research also finds that they’re more likely to have a strong social network.
   

3. You may start to see life’s sunny side a little more. People with hearing loss who use hearing aids are more likely to be optimistic, feel engaged in life, and even get more pleasure in doing things, BHI research finds.
   

4. Taking the reins on life might become easier. BHI research shows that people with hearing loss who use hearing aids are more likely to tackle problems actively. Not a bad New Year’s resolution in and of itself.
   

5. It may lighten your cognitive load. Experts say that effortful listening due to unaddressed hearing loss is associated with increased stress and poorer performance on memory tests. If you don’t have to put so much effort into listening due to untreated hearing loss, more cognitive resources may be available for other things—like remembering what was said, or enjoying the conversation with friends.

So, go ahead. Make a hearing test one of the New Year’s resolutions you keep in 2017. 

So do it for your health. Do it for your happiness. Get a hearing test.

To take a free, quick, and confidential online hearing check to help determine if you need a comprehensive hearing test by a hearing health care professional, visit www.BetterHearing.org

The content for this blog post originated in a press release issued by The Better Hearing Institute.

Greatness Always Has a Price

By Morgan Leppla and Laura Friedman

Signed in 1990, the Americans with Disabilities Act (ADA) is the most contemporary federal legislation related to disabilities, outlining important workers’ rights and their employers’ obligations to provide reasonable accommodations. However, it does raise questions in regards to union contracts under the National Labor Relations Act (NLRA), which was passed in 1935 and protects workers’ rights to unionize, collectively bargain, and take action (e.g. strikes). Thus, portions of the NLRA and ADA conflict with each other, putting strain on union workers who need reasonable accommodations.

The ADA outlaws discrimination against qualified individuals with disabilities, stating that individuals must negotiate with employers for “reasonable accommodations.” On the other hand, the NLRA prohibits union members from negotiating individually. Once the ADA was passed in 1990, it outlawed any part of previously entered collective bargaining contracts that included discriminatory clauses. Additionally, an employer cannot use a collective bargaining agreement as a means to engage in discriminatory practices that are otherwise prohibited by the ADA.

The challenge for employers is balancing their dual obligations to comply with established collective bargaining arrangements while accommodating individual workplace needs.

Many union contacts contain seniority clauses, providing benefits based on how long union employees have been in their position. For example, an employee who is at a company for 10 years may choose their hours before the newest hire. However, if the newest hire has a disability, it may be necessary for them to pick their hours before the more senior worker as a reasonable accommodation. This violates the union contract and NLRA for two reasons: 1) it can be considered direct dealing with an employee, and 2) it overlooks the terms of the contract. Even so, this accommodation does not otherwise pose “undue hardship,” and therefore should be granted under the ADA.

NOT SO FAST: Firstly, the NLRA does not contain language that protects people with disabilities. Secondly, the ADA was meant to expand upon, not replace, the Rehabilitation Act of 1973, which prohibits discrimination against people with disabilities in federal hiring practices and requires affirmative action in hiring for federal agencies, programs that receive federal funding, federal contractors, and subcontractors. However, the ADA does not have an affirmative action requirement, so employers are no longer obligated to give applicants with disabilities preferential treatment throughout the recruitment or hiring process. Furthermore, ignoring the seniority clauses in collective bargaining agreements would be using affirmative action in the hiring of persons with disabilities, and therefore illegal, adding the web of confusion as to which legislation must employers comply with.

Other issues are related to privacy of medical records. In one instance, a union needed workers’ medical histories in order to meaningfully negotiate their contract, which is permitted by the NLRA but prohibited by the ADA. Due to lack of evidence, guidance, and clarity, the court had the parties settle. While in this particular instance the issue was put to bed, the inability to make a decision failed to set a precedent which could address future disputes.

This amounts to a murky legal landscape. While some of the language has been interpreted by courts, there is a lot employers and individuals need to navigate on their own. Such uncertainty and lack of clarity further hurts the disabled individual because they have to take extra strides to ensure that they receive reasonable accommodations and are not subjected to discrimination based on disability by either the terms of a collective bargaining agreement or the actual employer.

Have a personal experience with discrimination in the workplace or with negotiating reasonable accommodations with an employer? 

Please share it with HHF by emailing info@hhf.org today!

FOOTNOTES:

• http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1300&context=edicollect

• https://www.eeoc.gov/laws/regulations/backqround_and_summary.cfm

• http://www.americanbar.org/content/dam/aba/events/labor_law/basics_papers/nlra/collective_bargaining.authcheckdam.pdf

Labor Day: A Reflection of Disability in America's Workplace

By Morgan Leppla

Did you know that the first Labor Day in the U.S. was celebrated on September 5, 1892, to commemorate the achievements of the labor movement? More than a century later, we still celebrate our workforce for their contributions and successes. Mandatory safety regulations in the workplace, anti-discrimination policies, and establishing minimum wage are some of the noteworthy milestones accomplished.

Labor Day exudes an inclusive spirit. 

But what about individuals who have a disability?

The Americans with Disabilities Act of 1990 (ADA) mandates that employers must make reasonable accommodations for qualified candidates with disabilities in the workplace. However, many people do not speak up or are ashamed to disclose their disability and needs to their employer, including those with hearing loss.

The employment rate for people who are deaf or hard of hearing in the U.S. is 50 percent, compared with 70 percent among workers who do not have disabilities. There is also a stark disparity between annual income for those who have a substantial hearing loss or are deaf, compared with their typical hearing peers: $38,000 per year vs. $50,000 annually in 2011.

A hearing loss may affect one’s ability to remain communicative and productive in the workplace, as the majority of today’s jobs require some form of verbal correspondence. Whether that is listening to instructions on a construction site, providing medical expertise, or receiving feedback from a supervisor, the words people say tend to be important. Gaps in understanding lead to gaps in accuracy, productivity, and performance.

This is not just an individual worker’s problem either. When people stop working at optimal capacity, bottom lines shrink. And considering that 67 to 86 percent of the 48 million Americans who have hearing loss do not have hearing aids, more dollars than you’d expect could be lost.

Workers’ general wellness includes knowing about, managing, and treating hearing loss, as well as feeling comfortable asking for reasonable accommodations without fear of discrimination. Eradicating the stigma surrounding hearing loss is key to addressing it as an epidemic medically, economically, and socially—and we at HHF are working hard to eliminate that stigma through building education and awareness.

Labor Day is about honoring the workforce. Please join Hearing Health Foundation in celebrating the progress made for American workers, as well as acknowledging the obligation to improve the livelihood, both in and out of the workplace, of our fellow citizens.