Resources

Your Concerns About Cochlear Implants, Answered

By René H. Gifford, Ph.D, CCC-A, and David S. Haynes, M.D., FACS

“If you qualify for a cochlear implant (CI) but do not have one, please indicate reasons you have not pursued.”

This question was one of three dozen on hearing conditions posed in Hearing Health Foundation’s 2017 Reader Survey, which was administered through the pages of this magazine, online, and also with Hearing Loss Association of America, through their magazine and online. More than 2,300 people responded to the survey. Those who responded to the CI question above gave the following answers, and they were able to check off as many as applied. In order of popularity, the responses were: 1) not convinced of improvement, 2) surgery complications, 3) waiting for biological cure, 4) concerns about sound quality, 5) cosmetic, and 6) fear of discomfort.

Although “other” with a fill-in option was offered, age did not appear to be a primary concern. In fact, many older adults with severe to profound hearing loss whose hearing aids are no longer are beneficial have found success with CIs, as demonstrated by Barbara Sinclair (page 20), who received an implant 17 years ago at age 72, and our cover story author Bruce Douglas (page 6), who had implantation surgery at age 91.

Part of the survey’s purpose is to better understand the needs of our community of readers and supporters, and so, as cochlear implant surgeons, we wanted to address these concerns.

Source: University of Illinois Hospital

Source: University of Illinois Hospital

Not convinced of improvement

All CI centers, including ours at Vanderbilt University Medical Center, perform extensive presurgical testing to determine if a CI is the right option for a patient, versus the continued use of hearing aids. The testing, based on data and experience, answers this question with an incredible degree of accuracy. Our goal is to reach a level of hearing that dramatically outperforms the best hearing aid outcomes for a given individual. Expectations are much higher than this, however, and it is extremely rare for a patient who is wearing their implant full-time not to experience much better preoperative hearing performance. The benefit has been so pronounced that Vanderbilt and other CI centers are working to expand implantation criteria so that this technology reaches people with milder forms of hearing loss.

Surgical complications

Cochlear implantation has one of the most favorable risk–benefit ratios of any surgical procedure in the U.S., offering significant communicative benefit while incurring little risk. Our center performs nearly 300 implants per year, and we monitor and track all procedures, outcomes, and complications. As with any operation your surgical team will provide a list of potential complications in order to be comprehensive, but the actual incidence of CI surgery complications ranges from under 1 percent to 3 percent. If any do occur, they are considered minor and temporary, such as postoperative taste disturbances and dizziness. At most CI centers, implantation is completed as an outpatient procedure and generally performed in 1 to 1.5 hours. We recently completed cochlear implantation on a 96-year-old patient who went home on the same day of surgery.

Waiting on a biological cure
The field of hearing restoration through hair cell regeneration—some of which is being conducted by HHF scientists, through the Hearing Restoration Project—is still in its earliest phases. While there have been exciting advances in gene therapy, current technology via cochlear implants can provide people with severe to profound hearing loss immediate access to sound, and all the benefits that this brings. In addition, improved success with CIs is linked to implantation that occurs closer to the onset of hearing loss, as auditory pathways in the brain need to be stimulated or they weaken. Otherwise the resulting permanent changes in the brain’s auditory centers may limit the ability of a patient to hear, even with a perfectly intact cochlea.

Concern about sound quality
Despite CIs being a mechanical device, the voice sound quality has the potential to be no less electronic sounding than that from a telephone, computer, or television. Often the abnormal sound is due to the stimulation of an ear that hasn't heard for many years (or an ear that has never heard). If this occurs, it typically dissipates with continued use of the CI and the stimulation of auditory pathways. Signal processing technology also continues to advance at a rapid rate, allowing for personalized programming for the best hearing outcomes, and—especially with any neural changes with age—programming is important to do at regular intervals.

Cosmetic
The thin internal portion of the CI is designed to sit flush with the skull and is not visible. The visible external components (the battery, sound processor, microphone, and transmitting coil) mostly fit behind the ear, not much larger than a standard behind-the-ear hearing aid. The latest sound processors are self-contained in a single unit about the size of a half dollar coin. These “off-the-ear” processors do not have an over-the-ear component, but rest directly over the magnet that is behind the ear and within the hairline. Eventually we expect that all implanted systems will be compatible with these smaller, off-the-ear processors, and nanotechnology and battery miniaturization will further reduce processor size. (And, the
boom in wearable consumer technology makes visible devices even more mainstream.)

Fear of discomfort
Implantation incisions behind the ear heal quickly, and the drilling of the bone required to place the
implant is a simple mastoidectomy. It is a component of most ear procedures and is not painful. Our center performs over 1,200 mastoidectomies per year across various different ear procedures. Postoperative discomfort is a rare complication and easily managed with over-the-counter medications such as acetaminophen (Tylenol).

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Do You Qualify?
If you have a hearing loss that prevents you from talking on the phone without visual cues (such as needing video calls or caption calling); are unable to understand television programs without closed captioning; and/or are actively avoiding large group gatherings for fear of conversational difficulty, talk to your hearing healthcare professional to see if you may be a CI candidate. CIs are the most successful sensory restoration prostheses to date and have been successfully placed in more than half a million individuals worldwide. The wonders of this technology vastly improve hearing, speech understanding, and overall quality of life.  

René H. Gifford, Ph.D, CCC-A, is a professor in the department of hearing and speech sciences with a joint appointment in the department of otolaryngology at Vanderbilt University, Tennessee. She and HHF medical director David S. Haynes, M.D., FACS, direct the Cochlear Implant Program at the Vanderbilt Bill Wilkerson Center.

This article also appeared in the Fall 2018 issue of Hearing Health. For references, see hhf.org/fall2018-references.

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How My Hearing Loss Makes Me Better at My Job

By Sarah Bricker

My hearing loss journey led me to a position as a communications specialist at Starkey Hearing Technologies, the Minnesota-based hearing aids manufacturer. Managing a hearing loss at work has meant that I sometimes have trouble hearing speech in noisy conference rooms, and that I may miss various sound cues during international phone calls. Yet as I navigate these challenges in the office, I can also see that having a hearing loss has actually helped me to become a better employee.

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I am comfortable asking for help. There’s a misconception that asking for help means you’re incapable of doing your job or it will make your boss or colleagues think less of you. But I see asking for assistance as showing an interest in learning and growth and a desire to recognize weaknesses and overcome them.

“Hard work” is my middle name. Having a disability often means I have to work a little harder than those with full abilities. I may have to try harder to hear in staff meetings, when talking to clients on the phone, or when attending a seminar in a large auditorium—but I also focus and do due diligence before and after meetings and calls to make sure I didn’t miss anything. Even with my hearing aids, it’s better to be safe than sorry.

I find creative solutions. Because my hearing loss can sometimes prevent me from doing something the usual way, I am always looking for an innovative approach. I believe this is a life skill that will enable me to take on challenging projects at the office and figure out solutions others may not have considered.

I am more accurate in my work.
I know I may miss parts of conversations and other sound signals, but being aware of this has set me up to be extremely detail-oriented otherwise. I am hyper-aware of all the minutiae and will carefully analyze each element of an assignment before I consider a project finished.

I work well alone and with a team! Having a hearing loss means I’ve learned the skills necessary to be self- sufficient and to succeed on my own. By the same token, my hearing loss has also given me an underlying “Go Team!” attitude from years of asking for help. I know I can rely on my team, whether it’s to fully follow a group discussion or to make sure I get all the notes I need in a conference hall.

I am patient. Hearing loss means I may have to listen to the same phrase three times before understanding it, but that’s okay. I’ve learned that getting it right is more important than getting it right now. That outlook is extremely beneficial when it comes to long-term projects and client relationships, not to mention everyday interactions with colleagues, friends, and family.

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Texas native Sarah Bricker holds a bachelor’s degree in journalism from the University of Missouri and is a communications specialist at Starkey Hearing Technologies in Minnesota. She has a profound progressive sensorineural hearing loss that was diagnosed at age 13. This article originally appeared in the Winter 2017 issue of Hearing Health magazine.

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Hyped Up Now, Hurting Later

By Yishane Lee and Lauren McGrath

In an interview, longtime healthcare professional Bob Kambic warns about the health risks of the over-amplification that is becoming increasingly common at recreational events.

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What got you interested in the topic of the dangers of loud entertainment?
I am 75 and a grandfather. Recently I was in Detroit for an event in which my grandchildren participated. The finale of the event was held in Ford Stadium, a football venue. The electronically amplified sound was deafening even wearing my noise-canceling headphones.

The 30,000 or so people in the stadium were subject to what in other places would be called torture. I wondered, is there a way to tell the organizers they are harming our young citizens, the future of our country?

As a retired healthcare professional, I have a half century of experience in the healthcare field and more than 50 publications in peer-reviewed journals. This got me thinking about noise levels in entertainment venues. Raising awareness of this public health problem needs to be done.

Why is the music so loud?
Consider a musician playing an electric guitar in front of a crowd. She will hear her music from an amplifier. But she then finds that she likes it loud and turns the small knob up. After weeks or months that level is not satisfactory and she makes another turn up.

Over time, as the louder sounds gradually diminish hearing, it becomes necessary to turn the knob up more and more. For music professionals, this is called increasing the gain, which is one way to increase the volume of sound from the speakers. The other way to increase volume is to turn up the signal coming out of the speakers themselves.

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When musicians play to big crowds they now have amplifiers and systems that produce thousands of watts of power and can project over 100 decibels (dB). This technology is also used for recorded music. It “entertains” but it also may harm the listeners’ ears. Musicians and their producers know that “loudness does not equal quality”—but that caution can get lost in the need to entertain.

By 2022, live music industry revenue is projected to be worth $31 billion worldwide, according to PricewaterhouseCoopers. Like other industries, the money is the driver. To me this means the live music industry will continue to use larger and louder electronic amplification.

The electronically amplified sound is now also ubiquitous at rallies and sporting events, both professional and collegiate—or even younger—to hype up the crowd.

What can we do to protect our hearing, and especially the hearing of children?
Earplugs. I was happy to see an article in a music industry publication saying that the purchase of custom musician’s earplugs is one of the best investments a music industry worker can make. They didn’t recommend earphones, mixers, digital equipment, or music instruments—just earplugs. Frequent concert-goers should also invest in custom musician’s earplugs.

For children, this is a tough question because kids don’t want to be told what to listen to and how loud the sound should be. But there are a variety of products for hearing protection. The first are simple foam earplugs, widely available at hardware stores, pharmacies, and online. The disadvantage is that they must be pushed into the ear canal and may not fit all size ears. (See “8 Pairs of Earplugs in 4 Noisy Settings,” next page.)

The next step up is over-the-ear earmuffs that cover the ear entirely. They are long-lasting and work well but they are also big and bulky.

Finally there are noise-canceling headphones made by audio or electronic equipment manufacturers. I use battery-powered noise-canceling headphones on airplanes and trains, and was wearing them at the event at the Ford Stadium. You may want to explore the varying prices and technology. Many can also play personal music through wireless and/or wired connections.

Besides using hearing protection, what else can you do?
Take action against unnecessary noise. Groups of parents can petition their schools and sports teams to reduce amplification at indoor and outdoor events. Decibel meters are inexpensive or free as smartphone apps and can be used to show managers and administrators the sound level at events, and when the volume reaches dangerous levels at over 85 dB.

The music and electronic sound industry is in control of this problem because of the amount of money in the industry, but also because well-known musicians such as Huey Lewis and Eric Clapton, who are open about their hearing loss, are helping to raise awareness. Media coverage and local action can bring attention to bear, and over time the industry may become aware of amplification as a health problem for everyone, including the audience, not just for those in the industry.

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Bob (Robert T.) Kambic, MSH, is a retired health professional who worked at the U.S. Department of Health and Human Services and the Johns Hopkins University (JHU) Bloomberg School of Public Health. He is a current visiting scientist with the JHU Medical School Division of Health Sciences Informatics and plays and sings American traditional music using acoustic instruments.

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Hearing Loss and Disability Benefits: Who Can Qualify

By Mary Dale Walters

Acoustic trauma is a common characteristic of military life. No matter which branch served and whether in peacetime or wartime, hearing loss and tinnitus are the top two health conditions for which veterans receive disability benefits from the U.S. Department of Veterans Affairs (VA). Hearing impairments also may be a factor in eligibility for Social Security Disability Insurance (SSDI) benefits. But just who can receive benefits for these conditions?

In order to qualify for both VA disability and SSDI benefits, hearing loss must be significant: Veterans must have experienced a profound loss of their auditory capacities or be fully deaf. That means individuals who fall into the “mild to moderate” range are likely not eligible for SSDI benefits, and these may include those who rely on hearing aids to improve their hearing.

If a veteran is one of the remaining 30 percent who has experienced severe hearing loss, he or she may be eligible for SSDI benefits, provided they meet the other qualifications laid out by the Social Security Administration. On the other hand, VA disability benefits allow for lesser impact and disability ratings as low as 10 percent for service-connected conditions. That’s why more veterans may qualify for VA disability income, rather than SSDI, with a hearing-related condition.

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Like all VA disability claims submitted by veterans, the better you can demonstrate that the hearing loss or acoustic trauma incurred during your military service caused or contributed to your current hearing loss today, the more likely your VA disability claim is to be awarded.

With SSDI benefits, there is one situation in which a veteran may be highly likely to receive approval: cochlear implants. Having a cochlear implant in one or both ears automatically grants an individual eligibility for SSDI benefits for a year after the procedure. Following that one-year period, recipients take a Hearing in Noise Test (HINT). Benefits are only extended if the test is failed.

If an individual does not have a cochlear implant, he or she must pass one of two tests: audiometry, which measures the “threshold sensitivity for air conduction” in both ears; or a word recognition test, where an individual must be unable to repeat more than 40 percent of the spoken words due to their impairment.

Sometimes, even if hearing loss is not profound, it can be the basis for a successful SSDI award if combined with other qualifying conditions. Hearing loss and tinnitus can cause or aggravate other medical issues such as insomnia, depression, anxiety, and headaches. Hearing loss can also be intertwined with other vestibular disorders such as vertigo, vestibular migraines, and Ménière’s disease. For this reason, hearing loss can limit functional capacity and allow you to qualify for VA or SSDI benefits. For SSDI specifically, you will need to demonstrate you are unable to gain employment due to your condition.

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If this seems a little confusing, it can be. The issue of hearing loss and dual eligibility point to the benefit of having expert help in the disability claims process. Assistance can be vital when filing a VA disability appeal. When applying for SSDI benefits due to hearing loss, tinnitus, or related conditions, it’s critical to apply immediately—and be prepared to wait. In the meantime, put together a budget and start spending smarter to protect your financial assets.

Mary Dale Walters is a senior vice president at Allsup and editor of the ebook, “Applying for Social Security Disability Insurance: Getting It Right the First Time."

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How to Create a Healthy Hearing Environment for Children

By Alyson McBryde

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“How many times do I have to repeat myself?” If you’re a parent or guardian, chances are you’ve said this to your child before. Indeed, a part of parenting is repeating yourself―but what if it becomes part of a bigger issue?

In 2015, the World Health Organization (WHO) estimated “1.1 billion teenagers and young adults are at risk of hearing loss due to the unsafe use of personal audio devices including smartphones, and exposure to damaging levels of sound in noisy entertainment venues such as nightclubs, bars, and sporting events.”

The WHO indicates “unsafe levels of sound can be, for example, exposure to in excess of 85 decibels (dB) for eight hours of 100 dB for 15 minutes.” Exposure to dangerously loud sounds could damage the sensitive structures of our inner ear and lead to permanent hearing loss. Here’s the thing about noise-induced hearing loss: it is 100% preventable.  

As a parent or guardian, you can implement fun and effective hearing loss prevention activities and strategies like these:

Lead a Learning Experience
Look for science videos and activities that demonstrate how sound, the ear, and hearing work. Great examples include Hearing Health Foundation (HHF)’s interactive, captioned video, Kids Health, and The Magic School Bus.

Watch Out for Noisy Toys
A study on sounds emitted by children’s toys found “the average sound levels of the various toys were 106.8 dB measured at a point nearest the sound source,” according to ASHA. Use a decibel-measuring app to check out your kids’ toys before they play.

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Limit Time with Electronics
NBC News reports: “Each new generation of teenagers has found a new technology to blast music – from the bulky headphones of the 1960s to the handheld Sony Walkmans of the 1980s. Today’s young people are listening longer, more than twice as long as previous generations.” Remember when our elders told us to “go outside and play”? Encourage your kids to do the same.

Turn Down the Volume
Enforce the 60-60 rule: Allow your child to listen at 60% volume for 60 minutes at a time. Look into apps that allow you to set parental controls on volume levels and encourage your kids to take a break from nonstop sound! 

Beware of Noise Levels at Live Events
Did you know a live ballgame can reach 120 decibels? Live sporting events can be extremely dangerous for little ears. The same goes for live music shows. Bring along a pair of foam or custom-made earplugs!

Keep Those Little Ears Warm
If you live in a place with cold winters, make sure you kids have earmuffs or hats that cover their ears. Cold air may affect hearing with exostosis, known as “surfer’s ear,” which happens when abnormal bone growths interfere with the auditory process.

Swim Safely
During the summer, while attending swim lessons, or on vacation, protect your kids’ ears with swim plugs. Swim plugs help to prevent swimmer’s ear, or otitis externa, caused by bacteria inside the ear canal, which can lead to trouble hearing.

Treat Ear Infections Immediately
Kids experience ear infections far more regularly than adults due to the size and positioning of their Eustachian tubes. Seeking immediate treatment from an ear-nose-throat (ENT) specialist for otitis media―ear infections―could help prevent hearing loss in kids.

Invest in Earplugs
Whether they are made of generic foam or are custom-molded to fit in their ears, earplugs are a great barrier between little ears and dangerous levels of sound. Carry a pair wherever you go―you never know when you may need them! 

Get Their Hearing Tested
Hearing health should be treated no differently than any other part of your kids’ overall health. In the same way your kids get a full physical and vision test annually, build a hearing test into the routine! Hearing tests keep track of your kids’ hearing abilities, and if anything changes, your hearing health professional can help find a solution.

Alyson McBryde leads the customer success team for HearStore.

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Communicate Effectively 
Over the Phone

By Dusty Ann Jessen, Au.D.

Even with email, texting, and video chatavailable, the humble telephone remains a primary means of communication in the workplace. Telephones, of course, render the communicators unable to see each other when talking, so they can’t take advantage of important visual cues, including knowing when it’s their turn to talk. This is especially disconcerting for those with hearing loss; however, communication breakdowns can happen over the phone even between people who don’t have difficulty hearing. Here are simple strategies to help.

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If you are the speaker, you are responsible for conveying a clear message that is received accurately. Focus on the call (don’t multitask!), and make sure the telephone receiver or headset microphone is near your mouth. Speak at a slightly slower pace and enunciate clearly. If your listener is struggling to understand, don’t just repeat what you said; rephrase it or provide additional clarification. This is especially important when conveying letters or numbers; say “C, as in Charlie.”

If you are the listener, place your full attention on the phone call. Turn up the volume to a comfortable level, and consider using the speakerphone so you can hear with both ears. If you miss a word or sentence, don’t just say “What?” Ask your speaker to rephrase the last sentence. You can also ask follow-up questions requiring a yes/no answer (easy words to understand over the telephone) and repeat back what you think you heard.

For optimal hearing—and whether your workplace environment is an office, classroom, or factory—do your best to eliminate background noise when on the phone. Turn off any distracting sounds in your environment, such as silencing a cell phone or muting your computer, or find a quieter place to conduct your phone call.

Landline phones are available with amplifiers and tone controls. Landline phones work well with the telecoil (t-coil) built into most hearing aids (ask your hearing health provider if you are unsure). The t-coil is a small copper coil that picks up the electromagnetic energy naturally emitting from landline phones for a clear signal, without needing a microphone.

If you are in the market for a new cell phone, be sure to choose one that is “hearing aid compatible,” with a microphone (M) and telecoil (T) rating of 3 or 4. Many advanced hearing aids can connect wirelessly to mobile phones, creating a convenient “hands-free” option with excellent sound quality.

These strategies can be applied to many other situations as well. Enunciating clearly on the phone will make you a better communicator all around. Getting out of the habit of asking only “What?” and replacing it with a polite, “Can you please rephrase that?” will help in any situation. Reducing background noise and taking advantage of technology can improve communication efforts for everyone.

Dusty Ann Jessen, Au.D., is based in Colorado. This article, which also appeared in the Winter 2017 issue of Hearing Health magazine, is adapted with permission from her book, “5 Keys to Communication Success.” For more, 
see 5keys.info.

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ReSound LiNX Quattro: More Access to Sound; Rechargeable Convenience

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By Dr. Laurel A. Christensen

In September, GN Hearing launched ReSound LiNX Quattro. Described as the world’s first “Premium Plus” hearing aid, ReSound LiNX Quattro has generated strong interest among the hearing loss community. As ReSound’s Chief Audiology Officer, I’ve answered many questions about this latest innovation in hearing to facilitate informed decision-making. Here are two of the most common questions I receive.

Can you share the latest features and improvements in ReSound LiNX Quattro? What makes it “Premium Plus”?

ReSound LiNX Quattro is the fourth generation of the LiNX hearing aid family. LiNX streamlined technology with Made for Apple hearing aids in 2014, and brought remote fine-tuning capabilities to audiology in 2017 with ReSound Assist, which allows for adjustment without an additional clinic visit. Both of these breakthrough features are included with ReSound LiNX Quattro, plus more.  

Built on a newly designed, powerful microchip platform, it brings users an unprecedented combination of benefits, while enabling hearing capabilities never before possible. Putting sound quality first, ReSound LiNX Quattro technology enables patients to hear more “Layers of Sound,” delivering an extended range of sounds never before heard clearly through hearing aids. The sound quality is natural; soft sounds are clear and loud sounds are rich, full, and distortion-free. Users enjoy an especially marked improvement when listening to music.

The powerful radio provides more reliable, faster streaming and connectivity to any wireless accessory or mobile device. Using the ReSound Smart 3D app, users can take advantage of on-the-go sound personalization such as changing hearing aid programs, adjusting volume, decreasing the level of background or wind noise in the environment, and adjusting streaming sounds from a mobile phone. Also included is a geo-tag function for frequently visited locations so users can return to their preferred location-specific settings as desired.

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Finally, ReSound LiNX Quattro is the world’s most advanced rechargeable solution. As many hearing aid users know, changing batteries weekly can be cumbersome, especially for those with impaired dexterity and eyesight. The built-in lithium-ion batteries eliminate the weekly need to change batteries with a rechargeable battery that lasts up to 30 hours. The recharging case holds 90 hours of portable power, greatly reducing the fear of depleted batteries.

How does ReSound LiNX Quattro actually extend the range of hearing? 

ReSound LiNX Quattro introduces four newly designed microchips that combine to deliver twice the memory, 100 percent more speed, and 30 percent more computing power—with 20 percent power consumption reduction.

The new chipset allows for an increase to 116 dB of input dynamic range so that sounds enter the hearing aid without distortion. In addition, the frequency bandwidth has been extended to 9.5 kHz both for the hearing aids and for sounds streamed to the devices.

In many other hearing aids, sounds outside these ranges are not heard or are heavily distorted. With ReSound LiNX Quattro, sounds typically missed such as birds singing, higher-pitched speech, or music are clearly discerned.

And by expanding access to sounds, especially higher frequency sounds, we observe improved spatial perception in users, with more cues for localization.

Learn more about ReSound LiNX Quattro.

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Laurel A. Christensen, Ph.D. is the Chief Audiology Officer of GN ReSound Group.  In this role, she leads Global Audiology & User Experience in Research and Development.  She holds adjunct faculty appointments at Northwestern and Rush Universities and is a former member of the Executive Board of the American Auditory Society and a member of the Advisory Board for the Au.D. Program at Rush University.  In 2015, she received the Distinguished Alumna Award from the Department of Speech and Hearing Sciences at Indiana University.

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How to Buy Hearing Aids

By Barbara Jenkins, Au.D., BCABA

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A friend’s mother needs hearing aids. She has a daughter in the hearing industry, she has insurance to cover hearing aids, she holds a Ph.D. in molecular biology, and she is still overwhelmed and confused by where to go, what the options are, and what is best for her.

Sound familiar? There is so much information—and disinformation—available about hearing aids that even some physicians are confused.

As with any big purchase, selecting a hearing aid can be difficult and confusing if you don’t have the right information or know the correct questions to ask. Bring a copy of this checklist with you on your next appointment, and feel confident in your decision to improve your life through better hearing.

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Hearing Healthcare Checklist

1. Where do I go for a hearing test?

Most hearing loss (up to 90 percent) is a result of non-medically treatable issues. But that means as many as one in 10 people will have a medical issue associated with their hearing loss. If this is your first hearing evaluation it would be prudent to see your primary care doctor first, then be referred to a specialist for a diagnostic audiogram (hearing evaluation).

Audiologists have a minimum of seven years of university training (master’s or doctorate level). Hearing instrument specialists can perform hearing tests but do not have the medical training to rule out medical issues—causes for hearing loss such as syndromes, Ménière’s disease, Usher Syndrome, sudden-onset, genetics, ototoxic drugs, etc.

If you know that there is no medically treatable issue associated with your hearing loss, either type of provider should be fine. If you’re in doubt, ask your physician which professional they recommend. They might refer you to an ENT (ear, nose, and throat specialist, or otolaryngologist).

2. Where do I buy my hearing aids?

Typically, once an audiologist or hearing instrument specialist has evaluated your hearing, you should be able to purchase your hearing aids from them. Requirements differ by state, but generally speaking the professional is trained in hearing aid selection, fitting, and care.

Make sure you are comfortable with the quality of care and the options offered by the provider. If only one brand of hearing aid is available, that’s a red flag. Be sure your provider offers a range of choices, in all styles and at all price points.

You can also opt to get a second opinion. This will give you additional provider choices, so you can go with the person with whom you feel most comfortable. After all, you will be starting a relationship that may last for years.

3. What style of hearing aid is best for me?

A hearing aid’s style (shape and configuration) is determined by the severity of hearing loss, manual dexterity and vision ability, comfort, and/or cosmetic appeal. Whether you get a larger, behind-the-ear hearing aid, or one that is nearly invisible in the ear canal, the cost is roughly the same. Discuss options with your provider and ask about the benefits and drawbacks to each type of device. Here is a brief overview of hearing aid styles, categorized from a larger size to smaller:

Behind-the-ear (BTE); receiver-in-canal (RIC) (also known as receiver-in-the-ear, RITE): These are currently the most popular due to durability, comfort, and cosmetic appeal. They may be a bit more difficult to put in the ears at first, but since less of the circuitry is inside the ear, they usually offer more natural sound. Also, RICs can be discreet, with only the speaker wire visible at the top of the outer ear.

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In-the-ear (ITE); in-the-canal (ITC): This category is among the best for ease of use. Just one piece goes into the ear, with a portion of the device visible outside the ear. Many people like ITEs because they are easy to insert into the ear, and the battery
life is better than that of their smaller, ITC cousins.

Completely-in-the-canal (CIC); invisible-in-the-canal (IIC): These typically fit deeper into the ear and are a very good choice for people who wear helmets or use stethoscopes. Since they are deep in the canal (making them less visible), the most common complaint is that they may not feel as comfortable as the BTE styles, and depending on usage you must change the batteries once or twice a week. (BTEs and RICs often use larger batteries for more power, and last longer.)

4. Which fidelity level is best for me?

Once you have chosen your preferred style of device, you must choose the fidelity (technology) level of the computer chip in the hearing aid. This is where the cost differences in hearing aids become apparent.

Most manufacturers have three levels of fidelity in their newest hearing aids as well as in their economy-priced models. The higher the level of technology, the better and faster the hearing aid can separate noise from speech. This means the speech and sound information passed to your brain is more accurate. Every level will help one-on-one conversations in quiet environments; the more advanced chips will boost clarity and noise reduction even more effectively. In most cases, get the best hearing aid you can afford, but don’t feel pressured into a decision. Take advantage of the 30- to 60-day trial period that is required in most states (in some cases paying a small fee to return the devices).

5. What other special functions do I need for better hearing?

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In the past few years, new features have emerged that have dramatically changed how we can interact with hearing aids.  

Rechargeable batteries: Rechargeable hearing aids are now available, requiring changing the battery only once every one to three years. These devices are recharged by placing the entire hearing aid unit on its charging dock. Not having to frequently manipulate the battery door is very helpful if you have vision or dexterity issues or if you tend to forget your batteries.

Almost waterproof hearing aids: There are now hearing aids that are so waterproof they actually dry themselves when they get wet. They are also dust- and shock-resistant. These are great for people who frequently spend time outdoors or who just perspire a lot. While it is not recommended swimming with them, these devices should survive taking a shower if you forget to take them out.

Bluetooth-enabled hearing aids: Many manufacturers now give you the ability to adjust your hearing aids with your smartphone, using Bluetooth wireless connectivity. You may even be able to stream sound directly to your hearing aids without the use of an additional device like a neck loop. If you’re tech-savvy, this may be for you.

Once you’ve gone through the items in this checklist, I hope you feel more confident about making decisions and improving your hearing.

Staff writer Barbara Jenkins, Au.D., BCABA, serves as Colorado’s professional state commissioner for people with hearing loss and was awarded the 2010 Leo Doerfler Award for Clinical Excellence by the Academy of Doctors of Audiology. Her office, Advanced Audiology, won the Most Humanitarian Hearing Care Office Award at the 2015 Signia Aspire Conference. For more, see advancedaudiology.com. This article also appeared in the Fall 2017 issue of Hearing Health.

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FCC Announces Intent to Automate Phone Captions

By Kathi Mestayer

The Federal Communications Commission (FCC) recently announced in the Federal Register that it intends to allow telephone captions (IPCTS) to be 100 percent provided by automated speech-recognition (ASR) software. I wrote about how it's done currently by a human/software "team."

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The change would save money by making the role of the human captioning assistants optional. But nobody knows what the effect would be on caption quality, as there are no current standards for accuracy or delay in telephone captioning provided under the Americans with Disabilities Act, and regulated by the FCC.

Underscoring that issue is the letter posted by a group of consumer groups, which states:

"The Commission is putting the cart before the horse by allowing ASR-based IP CTS services without developing standards and metrics for the provision of IP CTS to ensure that consumers receive robust service from all providers, regardless of the underlying technologies used to provide the service. Inaccurate and unreliable IP CTS service stand to substantially harm consumers who rely on them for communications with family, friends, employers, and commercial transactions and lack the means to qualitatively compare services in advance."

That document, available online, was filed by the Hearing Loss Association of America, Telecommunications for the Deaf and Hard of Hearing, Inc., National Association of the Deaf, and Gallaudet University’s Rehabilitation Engineering Research Center on Technology for the Deaf and Hard of Hearing.

The public comment period for this proposed change is open until Sept. 17, 2018. You can submit a formal comment at the top of the page in the Federal Register that announces the proposal.

Kathi Mestayer is a Hearing Health magazine staff writer.

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How Nutrition Affects Our Hearing

By Meagan Rowley

Nutrition is fundamental to health, but seldom does one learn about the relationship between diet and the auditory system. Nutrition and hearing ability are, in fact, connected.

There is no specific food that will definitely cause or prevent hearing loss. Likewise, lost hearing cannot be restored through a diet change. However, new research suggests that certain nutrition patterns may actually decrease—or increase—your risk of developing hearing loss.

A 22-Year Diet Study

A Brigham and Women’s Hospital study monitored the hearing health of more than 70,000 women on various diets for 22 years. These diets included the Alternate Mediterranean Diet (AMED), Dietary Approaches to Shop Hypertension (DASH), and Alternative Healthy Eating Index-2010 (AHEI-2010). These diets favor fruits, vegetables, seeds, nuts, legumes, whole grains, seafood, poultry, and low-fat dairy. All three also advise limiting foods that are high in sodium (salt) and LDL (low-density lipoprotein) cholesterol, discouraging consumption of refined and red meats, processed foods, and sugary drinks.

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Women following diets similar to the AHEI-2010, DASH, and AMED decreased their likelihoods of hearing loss by at least 30 percent, with DASH and AMED showing the greatest benefits. The researchers found that diets that prioritize fruits and vegetables with minerals like folic acid, potassium, and zinc decreased the risk of hearing loss.

Beneficial Nutrients

Other findings indicate that certain nutrients are associated with positive hearing health outcomes. Potassium—a mineral found in bananas, potatoes, and black beans—plays a large role in the way that the inner ear functions and converts sounds into signals for the brain to interpret. Regular intake can help you maintain your current level of hearing, says Sherif F. Tadros, M.D., of the International Center for Hearing and Speech Research in a Europe PubMed Central published study.

George E. Shambaugh, Jr., M.D., of the Shambaugh Hearing and Allergy Institute reports that the zinc in almonds, cashews, and dark chocolate can be an effective treatment for tinnitus, hearing ringing or buzzing without an external sound source. Magnesium is believed to combat free radicals emitted during loud noises and act as a barrier protecting inner ear hair cells.

Folic acid has also been shown to possibly slow the onset of hearing loss. Blood flow is restricted by homocysteine (an amino acid), so folic acid works to metabolize it to keep blow flow regulated. According to Jane Durga, Ph.D., of the Nestlé Research Center in Lausanne, Switzerland, because the inner ear relies on a regular flow of blood, folate is extremely important. Foods high in folic acid include spinach, broccoli, and asparagus.

Adverse Effects of Malnutrition

Conversely, malnutrition negatively affects the human body. In an examination of 2,193 participants ages 16 to 23, Susan D. Emmett, M.D., and colleagues found that malnutrition not only stunts anatomical development in children, but slows inner ear development. Malnourished children were observed as being twice as a likely to develop hearing loss as young adults compared to their well-nourished peers.

Further, the study acknowledges that that stunting often begins before birth. A malnourished woman who is pregnant or nursing is likely to pass on any deficiency she may have to her child. Hindered inner ear development in utero caused by malnutrition contributes to a higher risk of hearing loss than does malnutrition in vivo.

Diabetes Connection

Individuals with type II diabetes also are more likely to develop hearing loss than their nondiabetic counterparts, according to an National Institutes of Health-funded project by researcher Chika Horikawa, Ph.D., of Japan’s Niigata University. Subjects with prediabetes—those who have elevated blood sugar levels but not elevated enough for a diagnosis of diabetes—also have a 30 percent increased risk The study authors attribute the higher risk to damaged nerves and blood vessels of the inner ear, a consequence of having type II diabetes for an extended period of time.

Though rarely acknowledged, diet has a lot to do with the auditory system. Adding just a few foods to your daily diet and paying attention to the nutrients that your diet is missing may significantly impact hearing over the long term.

As an aspiring doctor currently studying nutrition during my undergraduate years, I understand how important it is to look at an individual's state of health from different angles and perspectives. Nutrition is vital to every aspect of health.

An HHF summer intern, Meagan Rowley is a senior on the pre-medicine track studying human nutrition at Case Western Reserve University in Cleveland.

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