Labor Day and Working with Hearing Loss

By Katelyn Serpe

Since 1894, when Labor Day was named a federal holiday, the United States has celebrated the labor movement and the many contributions that workers have made in improving the lives of Americans across the country. Establishing a minimum wage and child labor laws are just a few of the accomplishments that have been made since the start of the labor movement.

Among these accomplishments are various workplace safety regulations, including recommendations for occupational noise exposure. Yet despite these regulations, the National Institute for Occupational Safety and Health (NIOSH) estimates that 30 million U.S. workers are exposed to noise levels high enough to cause hearing loss. With approximately 150 million Americans in the workforce, nearly 1 in 5 U.S. workers are exposed to noise levels high enough to cause hearing loss.

According to the Centers for Disease Control and Prevention, an estimated 24% of hearing loss in the United States has been a result of workplace exposure, yet people with a hearing loss are often hesitant to disclose their hearing loss in the workplace due to the associated stigmas. Some people with a hearing loss may not seek treatment immediately if they view their hearing loss as an unimportant issue. Yet others may not even be aware they have a hearing loss due to the low number of people who regularly receive hearing screenings.

People with hearing loss are less likely to be in the labor force with nearly half (47%) of people with hearing loss not in the labor force compared with 23% of typical hearing individuals. And the unemployment rate for those with a hearing loss is nearly double that of the typical hearing population.

Having a hearing loss comes with its own challenges but an undisclosed hearing loss in the workplace can increase work-related stress and cause problems in the workplace. Most jobs require some form of verbal communication and an undisclosed hearing loss can decrease efficient verbal communication. This can result in incorrect work due to a lack of comprehension of verbal instructions or a general decrease in productivity. A person with undisclosed hearing loss may, therefore, lose out on promotions and possibly face a loss in annual wages. People with untreated hearing loss can lose as much as $30,000 in annual income and earn approximately 25% less than their typical-hearing peers.

Fortunately, the use of hearing aids has been shown to nearly eliminate the risk of income loss for those with milder hearing loss, and reduce the risk of income loss significantly for those with moderate to severe hearing loss. But while it may seem that the use of hearing aids is a solution for the risk of income loss for people with hearing loss, only 1 in 4 people who could benefit from hearing aids currently owns them.

Employers can help reduce the economic costs of hearing loss by creating environments where people with a hearing loss are unafraid to acknowledge their hearing loss. Making hearing tests part of a company wellness program, making sure hearing aids are covered by company insurance, and providing reasonable accommodations for those with hearing loss are some steps that employers can take to decrease the stigma of having a hearing loss in the workplace.

Through education and raising awareness about the prevalence of hearing loss among Americans, Hearing Health Foundation hopes to erase the stigmas surrounding hearing loss.

We hope you will join Hearing Health Foundation this Labor Day in celebrating the achievements made so far to improve the lives of working Americans while also encouraging further progress to improve American lives both in and out of the workplace.

The Path to Funding for Universal Newborn Hearing Screening

By Pranav Parikh

Due to the complexities of a multi-trillion-dollar federal budget, it can often be difficult to understand where all the money ends up. For recipients of Medicaid and their children, part of the government’s longstanding policy is to provide access to quality healthcare low-income communities could not otherwise afford. Medicaid recipients represent approximately 23 percent of the total U.S. population, with an enrollment of 74,550,529 individuals.

According to President Donald Trump’s Fiscal Year (FY) 2018 proposed budget, deemed the “America First” budget, and a nonpartisan CBO report, Medicaid will receive cuts totaling $610 billion USD over the next 10 years. In 2015, the U.S. Government spent $545.1 billion USD on Medicaid services. President Trump alludes to waste and redundancies as his justification of the proposed cuts.

One of the planned cuts will negatively impact newborn children and be detrimental to the well-being of infants across the country: Universal Newborn Hearing Screening. The terrifying impact is summarized below.
 

What exactly is being removed?
In his FY18 proposed budget, President Trump upheld his campaign promise by cutting what he deems “unnecessary and wasteful spending.” Unfortunately, one program that got the axe was the $18 million USD allocated towards newborn hearing screenings. This earmarked funding has doubled the percentage of newborns receiving hearing screenings before leaving the hospital from 46.5% to 97% just in the last decade. Without early detection, children will be at a distinct disadvantage in tackling hearing loss present at birth.

Why does this matter?
Every day, 33 children are born with some form of hearing loss, designating hearing loss as the most common congenital birth defect in the U.S. Reasons babies may have hearing loss present at birth include an inherited trait, ototoxic chemical, or a viral infection during a mother’s pregnancy. Challenges associated with having hearing loss can be overcome through early intervention, however it is imperative treatment and therapy are started as early as possible. As stated on the U.S. Government Department of Health and Human Services website, “If not identified early, [hearing loss] is likely to delay or impair a child’s development. Hearing problems are difficult to detect through observation alone, so almost all newborns have their hearing checked with special equipment.” 

What types of tests are done?
Aside from behavioral characteristics displayed by infants with hearing loss, there are two main tests conducted by physicians to determine any level of auditory impairment. The first of which is called Otoacoustic Emissions, a test designed to the test functionality of outer hair cells. A negative reading on this test is typically associated with cochlear dysfunction. The second test is called Auditory Brainstem Response (ABR) and determines activity of the auditory nerve through stimulation in the baby’s ear. A negative reading on this test indicates some issue with the vestibulocochlear nerve such as auditory neuropathy, but could also indicate problems with other parts of the ear. Both of these tests can be done while the baby is asleep and offer more concrete evidence to either rule out or diagnose infant hearing loss.

Have studies shown early intervention to be more effectual than later in childhood?
Yes, there are many studies that have shown that early intervention, especially for those receiving treatment within the first six months after birth, increases levels of cognitive function and advanced development. The control group of one study, led by Dr. Christine Yoshinaga-Itano at the University of Colorado-Boulder, showed that those who did not receive treatment or therapy within the first six months after birth had greater difficulty with oral communication and language comprehension.

What happens if children have undiagnosed hearing loss?
Hearing loss as a condition can present a number of symptoms associated with other disabilities, leading to improper diagnoses. For example, when children exhibit a lack of response to loud noise, or don't answer when spoken to, they sometimes are misdiagnosed by professionals as being autistic. If hearing loss is present and detected at birth, doctors will have access to necessary information earlier and children will be better off in the long run in developing their communication and learning abilities.

If funding for newborn hearing screening is decreased or removed entirely, what does that mean for those suffering from hearing loss?
At the moment, only 67.1% of those diagnosed with hearing loss receive early intervention before six months of age. With lower early detection and screening rates, this percentage will drop further. Without early intervention programs in place, children are at a noticeable disadvantage in developing hearing and speech functionality. After the age of three, it is considerably more difficult for children to develop the speaking and listening skills that are in line with their typical-hearing peers.

Would early intervention actually save money down the road in potential education costs?Some students with hearing loss utilize special education services, such as CART or note-taking, to ensure they don’t miss any of the materials and learnings while in the classroom. Access to the necessary technology and equipment, as well as highly trained teachers, is an expense incurred by school districts across the country.

A recent report released by the National Center for Hearing Assessment and Management states that treatment of hearing loss in children within the first three months of life can save up to $400,000 USD in eventual special educational costs by the time the hard of hearing student graduates high school. By bridging the gap early, and ensuring better interpersonal and cognitive skills in the first years of age, these children will require much less specialized instruction in future years. Essentially, early detection and intervention pays for itself.

Is there any legislation, not including the President’s proposed budget, that addresses this issue?
In March 2017, the Early Hearing Detection and Intervention (EDHI) Act was introduced on the House floor by Representatives Doris Matsui (D-CA-06) and Brett Guthrie (R-KY-02). A companion measure was also introduced in the Senate by Senators Rob Portman (R-OH) and Tim Kaine (D-VA). EHDI reauthorizes funding for Universal Newborn Hearing Screening for the next five (5) years, as well as establishes a database hub to collect information on the results of these tests. If the measure passes, parents will be assured of their child’s hearing health, and one of the nation’s largest public health concerns receives the necessary attention it deserves.

Undoubtedly, funding for newborn hearing screening is imperative. Hearing Health Foundation (HHF)'s Pranav Parikh spoke with Congresswoman Matsui’s staff on the reasons for proposing the legislation, and why she took the lead on tackling such an important issue. “So much of a child’s development happens in the first few years of their life, which is why early detection and intervention is so important,” said Matsui. “This bill will ensure that more infants have access to critical hearing screenings, so parents can be informed about the options for their children’s care.” It is comforting to know children suffering with hearing loss have an ally in our nation’s capital.

As Vickie Glenn, a Medicaid Coordinator for Tri-County Special Education recently stated in a New York Times article, “This isn’t Republicans or Democrats. It’s just kids.” Fortunately, President Trump’s proposed budget appears to be a “purely political document,” according to Peter Coy from Bloomberg BusinessWeek, possibly serving as a trial balloon and nothing more. Congress, even with a conservative majority consisting of many fiscal hawks, will likely reject many of the proposed cuts, as Texas Senator and chairman of the Freedom Caucus John Cornyn remarked, “we know the President’s budget isn’t going to be passed as is.” For now, at least, Universal Newborn Hearing Screening will receive its necessary and deserved funding.

And, finally, an urgent call to action from Nadine Deghan, CEO of HHF:
HHF has strongly supported Newborn Hearing Screening. In the 1990s, we championed legislation to encourage these simple but critical tests for our nation’s babies. For those who feel passionately about newborn screening funding, please contact your Congressional Representative and your Senator to let them know your views.

Getting Married? Turn It Down

By Emilio Cortez, Ed.D

Wedding day celebrations often include music, but when music is too loud, you and your guests may experience hearing loss as a result. The problem of loud music is rampant and has contributed to the growing number of 48 million Americans who suffer from hearing loss.

Many bands and disc jockeys play music at 100 decibels (dB). If you’re not wearing earplugs, 100 dB can cause hearing loss in just 14 minutes, according to the Centers for Disease Control and Prevention. A telltale sign that music is too loud is when you need to shout to the person next to you just to be heard. If the music at a wedding is played consistently at 90 dB of loudness, hearing loss can occur after two hours of exposure.

Since we are all the targets of dangerous decibels, we need to remember, “Be decibel-wise: under 85 keeps hearing alive.”

When interviewing bands or DJs for a wedding, insist that you want the music to be no louder than 80 dB—and then be prepared for bewildered faces. Since many musicians and DJs are accustomed to playing very loud music, some of them have already lost hearing, so 80 dB won’t seem loud enough; an alternative plan would be to make earplugs available to your guests (see below).

The louder music is played, and the more guests that attend a wedding, the louder guests must talk to converse which adds to the total loudness. You may want to appoint a wedding helper to monitor the music’s loudness and to remind musicians to turn down the volume as needed. Also, by having the music alternate between loud songs and softer music, you can give your guests and their ears a healthy rest from potentially dangerous decibels.

Many free decibel meter apps are available for both Apple and Android smartphones. You can check it for accuracy by talking into it in a normal speaking voice. You should be getting a reading somewhere between 60 and 70 dB, which is a normal reading for conversational speech. The National Institute for Occupational Safety and Health has blogged about the accuracy of decibel meter apps.

If you choose to use earplugs that conform to your ear canal size, refer to the YouTube video, “Fitting Foam Earplugs.” In essence you want to roll the earplug down to toothpick size and then insert it into your ear, allowing it to expand in order to provide the most effective hearing protection.

My daughter is getting married this August, and I had her share this information with the prospective DJ so he knows exactly what I will be expecting as the father of the bride! Noise is the most preventable cause of hearing loss. Don’t squander it on your wedding day.

Emilio Cortez, Ed.D., is a member of the Hearing Loss Association of America of Pennsylvania and a co-chair of its Turn Down the Volume Committee.

Paying Tribute on Armed Forces Day

By Siera Whitaker

May 20 is Armed Forces Day and Hearing Health Foundation is paying tribute to the men and women who serve in our armed forces.

The number one and two war wounds for active service members and veterans are hearing loss and tinnitus, directly impacting their ability to conduct missions and follow instructions. According to the U.S. Department of Veterans Affairs, by the end of 2014 over 933,000 veterans received disability compensation as a result of hearing loss, and about 1.3 million received compensation for tinnitus.

Extended, unprotected exposure to noise that reaches 85 decibels (the sound of a lawnmower) or higher can cause permanent inner ear damage. The Centers for Disease Control and Prevention (CDC) states difficulty with hearing is the third most commonly reported chronic health condition in the U.S.; approximately 40 million Americans ages 20 to 69 have hearing loss in one or both ears, and one main cause is excessive, loud noise.

When it comes to hearing loss and tinnitus, soldiers are at an increased risk. They are susceptible to noise-induced hearing loss (NIHL) because they are exposed to loud machinery and explosions on a constant basis. In combat, soldiers are often exposed to sudden noises, such as from an improvised explosive device (IED) or other similar weapon, which are difficult to predict and be protected against. These sudden noises can result in temporary hearing loss and put military personnel at risk. However, the word “temporary” should be approached with caution. Repeated short-term hearing loss can damage the sensitive hair cells in the inner ear, leading to hearing loss that becomes permanent.

Hearing loss as a result of noise is 100 percent preventable. Wearing hearing protection such as noise attenuating helmets, which use ear cups to protect against hazardous sound, or Tactical Communication and Protective Systems (TCAPS), can go a long way to reduce overall exposure.

Since these brave men and women are disproportionately impacted by hearing loss and tinnitus that likely affects many other aspects of their lives, Hearing Health Foundation is proud to pay tribute to them on Armed Forces Day. If you are a veteran, current service member, or have family or friends who have bravely served our country, please check out our veterans' resources and share your story about hearing loss or tinnitus with us.

The Importance of Early Intervention

By Frankie Huang

May is Better Hearing and Speech month and Hearing Health Foundation (HHF) would like to take this opportunity to raise awareness on the importance of early intervention for hearing loss in children, and the significant impact it can have on language development.

Hearing Health Foundation was instrumental in advocating for the Universal Newborn Hearing Screening legislation, as today 97% of babies are screened before they leave the hospital. In 1993, that number was 5%. Approximately 3 out of every 1,000 children in the United States are born deaf or hard of hearing. More than 90 percent are born to parents with typical hearing. Fortunately, early identification allows children with hearing loss to receive help they need during the first two years of life, a critical period for the development of speech and language skills. The earlier a child’s hearing loss is detected, the sooner the family can gather as much information as possible to make the best decision for their child’s language and communication approach.

With early intervention, children with hearing loss are able to develop language skills to help them communicate freely and actively learn. There are many services available to support children. For example, the Individuals with Disabilities Education Act (IDEA) ensures all children with disabilities have access to services they need for a good education. In addition, Head Start and Early Head Start are federally funded programs to help young children of low-income families become better equipped to succeed in school.

However, if the child’s hearing loss is left undetected or untreated, hearing loss can negatively impact a child’s language development. Delayed intervention can also adversely impact a child’s language development. One study had found that children who received earlier amplification or cochlear implantation had better language outcomes. Maternal education and communication modes used during early intervention can also improve language skills over time. A longitudinal study concluded that children with permanent hearing loss enrolled in an early intervention program before the 6 months of age developed on par with age-appropriate language skills than those who were enrolled after 6 months of age.

Similarly, another study had suggested that early enrollment in intervention programs were linked to higher language scores. It concluded that children enrolled before 11 months of age showed better vocabulary and verbal reasoning scores at 5 years of age compared with those enrolled later. Children that were enrolled later may experience delays that can interfere with academic development and comprehension in the classroom.

In the same study, the results suggest that family involvement was a contributing factor for the best outcomes of early intervention. Positive language outcomes were correlated with families that were highly motivated and active with their child’s intervention, while limited family support was associated with poor language outcomes. Also, families who were actively involved with early intervention were more likely to communicate better with their children, which contributes toward their overall growth. However, it is also important to consider the contrary; a lack of family involvement poses the largest challenge to early intervention. Specifically, a systematic review on the follow-up rate in newborn hearing screenings found that, on average, 20% of babies who failed the initial screening did not return for follow-up testing. The high loss to follow-up is believed to be attributed to a lack of adequate knowledge of the risks of hearing loss. This is the largest threat to the success of the newborn hearing screening program, as it becomes the family’s responsibility to follow-up on care beyond the initial hearing screening prior to discharge.

It is important to remember that hearing loss can occur at any time of life. Some forms of hearing loss do not appear until a child is a toddler or enters school, or even later. In addition, illness, ear infections, head injury, certain medications, and exposure to loud noise are all potential causes of hearing loss. In particular, recurring ear infections may negatively affect language development because of the resultant fluctuating hearing loss’ lack of steady auditory input necessary for speech and language development.

Even if your child or a child of a loved one does not have hearing loss today, Hearing Health Foundation strongly encourages regular checkups and annual hearing tests performed by audiologists, ENTs, pediatricians, or other health providers to monitor potential changes in hearing. These professionals are also excellent resources for intervention services to help overcome barriers to communication.

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

What's That Noise?

By Laura Friedman

In honor of World Tinnitus Day April 18, Hearing Health Foundation (HHF) wants to draw attention to the effects and challenges associated with tinnitus.

The U.S. Centers for Disease Control estimates some 15% of Americans—about 50 million people—have experienced tinnitus. Roughly 20 million people struggle with chronic tinnitus, while 2 million have extreme and debilitating cases. It is also a top war wound among active U.S. military personnel and veterans.

Tinnitus is defined as the perception of sound when there is no external, acoustic source. Individuals with tinnitus may describe the noise as buzzing, hissing, whistling, swooshing, or clicking. Roughly 90 percent of tinnitus cases occur with an underlying hearing loss.

Tinnitus can be either intermittent or chronic. People who experience intermittent tinnitus occasionally hear sounds in their ears that can last from minutes to hours after being exposed to excessively loud noises. An example would be someone sitting near the fence of a NASCAR race without wearing hearing protection. People with chronic tinnitus, on the other hand, often experience noise more frequently, which can last for more than three months.

The impact of tinnitus on everyday life differs from person to person. Researchers found that most people with chronic tinnitus are not too bothered by it. Many of these people prefer to only see a doctor for assurance that their tinnitus is not an indication of a serious disease or impending deafness. People who were bothered by their tinnitus reported that it was annoying, invasive, upsetting, and distracting in daily life. In a small tinnitus self-help group, some members frequently describe having problems sleeping, understanding speech, poor concentration, inability to relax, and depression.

People with age-related hearing loss, or presbycusis, may also experience a ringing, hissing, or roaring sound in the ears. Presbycusis progresses over time and is generally more severe in men than in women and the risk increases with age, as shown in epidemiological surveys.

Although there is no cure for tinnitus, there are available treatments that can minimize tinnitus symptoms. Tinnitus Activities Treatment (TAT), cognitive behavioral therapy (CBT), and Tinnitus Retraining Therapy (TRT) are sound therapies that can lessen the effects of tinnitus, often times very helpful in combination with counseling. Furthermore, by using hearing protection and noise reduction technologies, and by avoiding excessive noise, many people can prevent significant hearing problems.

Taking care of your hearing should always be part of keeping healthy overall. If you suspect a hearing loss or tinnitus, HHF recommends getting your hearing checked. If you do have a hearing loss or tinnitus, talk with your hearing healthcare professional about available treatments. For more information, visit hhf.org/tinnitus or email us at info@hhf.org.

Laura Friedman is the Communications and Programs Manager of Hearing Health Foundation.

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.