A Tribute to Our Nation’s Veterans

By Laura Friedman

Each year on Veterans Day, November 11, we proudly honor the men and women who have bravely served our country and fought to protect our freedoms.

Veterans Day is important because it honors our soldiers and it is a time to raise awareness about their experiences on and off the battlefield. Noise-induced hearing loss (NIHL) and tinnitus (ringing in the ears) are the top two health conditions among military veterans, according to the U.S. Department of Veterans Affairs (VA). By the end of fiscal year 2016 over 1 million veterans received disability compensation as a result of hearing loss, and about 1.6 million received compensation for tinnitus.

In addition to being disproportionately affected by hearing loss and tinnitus, our soldiers and veterans are also more susceptible to developing central auditory processing disorders (CAPD). CAPD occurs when one can hear sounds but is unable to understand the words. It is sometimes caused by intense exposure to sudden and loud noises from improvised explosive devices (IEDs), ammunition and engine noise.

"Both post-blast trauma and CAPD are difficult, diffuse disorders where more work is needed, particularly on people working in extreme conditions, acoustic and otherwise, such as veterans." —Edward Bartlett, Ph.D., Associate Professor, Biological Sciences and Biomedical Engineering Purdue University

Blasts 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 permanent hearing loss.

Hearing loss and tinnitus as a result of noise is largely preventable. There’s a misconception that not using hearing protection would inhibit vital communication and mission readiness. With today’s increasingly sophisticated technology, soldiers no longer need to choose between protecting their ears or their lives. Wearing hearing protection such as noise-attenuating helmets, which use ear cups to protect against hazardous sound, or Tactical Communication and Protective Systems, which protect against loud noises while amplifying soft ones, can go a long way to reduce overall exposure, while ensuring vital communications.

Any form of hearing loss can be detrimental to soldiers on duty, as the ability to hear signs of danger and to communicate with fellow soldiers is crucial for mission success and survival. Off-duty, hearing loss and tinnitus can also impact one’s well-being.

Regardless of age, type of hearing loss, or cause, if left untreated or undetected hearing loss can lead to considerable, negative social, psychological, cognitive, and health effects. As a result, it can seriously impact professional and personal life, potentially leading to isolation and depression. Treating hearing loss can also decrease one’s risk of acquiring other serious medical conditions, such as cardiovascular disease, dementia, and diabetes.

Veterans who have acquired hearing loss and tinnitus, either as a result of war or through other causes, can seek treatment at their local Department of Veterans Affairs (VA) medical center. Through partnerships with local community providers, the VA offers comprehensive hearing health services including screening, evaluation, treatment, and/or management of hearing, tinnitus, and balance disorders.

While it may be daunting to take the initial step of having a hearing test, it is important to know there are many different treatment options available. Some forms of hearing loss, such as those that affect the middle ear, are treatable through surgery. Damage to the inner ear and auditory nerve can cause permanent hearing loss; however technologies such as hearing aids, assistive/alerting devices, TV and telephone amplifiers, and cochlear and other auditory implants can optimize residual hearing by amplifying sounds.

As for tinnitus treatments, many patients have seen improvements with counseling and sound therapy, cognitive behavioral therapy (CBT), and the use of white-noise machines. Be sure to discuss the cause of your hearing loss and tinnitus and various treatment options with your audiologist or ear, nose, and throat specialist (ENT).

“On this and every Veterans Day, HHF sincerely thanks our military and our veterans for their brave service and sacrifice. I would also encourage all members, past and present, to have their hearing tested and monitored by a hearing health professional on a regular basis.” —Nadine Dehgan, CEO, Hearing Health Foundation.

Please visit va.gov/directory/guide to find your local VA medical facility. Please also see our Fall 2017 issue of Hearing Health magazine, whose theme is Veterans & Seniors, available at hhf.org/magazine.

One Man's Military Perspective

By Colonel John T. Dillard, U.S. Army (Retired)

The top two disabilities for our returning veterans from Iraq and Afghanistan are hearing loss and tinnitus, or ringing of the ears (which is actually a sound inside the brain). Both conditions became a problem for me and for many of my friends in the service. A lifetime spent in the U.S. Army, starting in the 1970s, meant frequent exposure to gunfire and proximity to screaming jets and helicopter engines.

Even during a peacetime career in the military, our soldiers, sailors, airmen, and marines are subject to a barrage of auditory insults from the weapons and equipment they operate. It all stacks up to a gradual, although sometimes very abrupt, loss of hearing, usually starting at the higher frequencies. For those in the service, any age-related decline in hearing gets accelerated, to the extreme, by repeated exposure to noise at unsafe levels.

For me, tinnitus began faintly and increased with more hearing loss, reaching a crescendo with one big acoustic trauma—a gunshot right next to me in 2009. I immediately began searching for any kind of treatment that would alleviate the loud ringing in my head, which was actually measured in a laboratory at being around a constant 70 decibels. That is roughly equivalent to the noise inside a fairly strong shower, and I soon discovered that people would use long showers to find a bit of relief by masking their tinnitus. (However, I take short showers!)

Armed with a background in biology and technology, I began to review all the research I could find. As it turns out, the typical tinnitus condition consists of several brain components: auditory (hearing it); attentional (your awareness of it); memory (persistence); and emotional (how it affects your mood). After many hours on the web, I spent thousands of dollars on things that didn't work, undergoing treatments in all areas of pharmacology, sound therapy, acupuncture, hyperbaric oxygen, and even transcranial magnetic stimulation.

None of these had any effect for me whatsoever. And despite some incredible recent advances in neuroscience to better understand all of the brain’s complexities, there is still no proven cure or even a viable treatment for tinnitus or to reverse hearing loss.

I eventually realized I would have to tackle my tinnitus with the only things out there that to me were credible for managing tinnitus. I eventually found an audiologist who would fit me with hearing aids that provided a built-in tinnitus masking sound. Without a doubt, this became the best purchase decision of my life...

Continue here to read the full version of "One Man's Military Perspective" in the Fall 2017 issue of Hearing Health. Colonel John T. Dillard, U.S. Army (Retired), resides in Carmel, California, with his wife of 30 years. A senior lecturer at the Naval Postgraduate School in Monterey, Dillard spent his army career serving in mechanized and parachute infantry assignments and managing programs to bring new technological capabilities to warfighters. He serves on a consumer review panel of tinnitus treatments for the Department of Defense (DoD)’s Congressionally Directed Medical Research Programs and also conducts acquisition policy research for the DoD.

Universal Newborn Hearing Screening to Prevail Under EHDI Act of 2017

By Nadine Dehgan

Federal funding for universal newborn hearing screening will prevail until 2022 under the The Early Hearing Detection and Intervention (EHDI) Act of 2017, which officially became law last month. Hearing Health Foundation (HHF) is ecstatic that there was bipartisan support for critical early testing and intervention for children with hearing loss.

Introduced in March by Representatives Brett Guthrie (R-KY) and Doris Matsui (D-CA) as an amendment to the Public Health Service Act, the EHDI calls for early detection, diagnosis, and treatment of deaf and hard-of-hearing newborns, infants, and young children. Each day nationwide, 33 newborn babies—approximately three out of every 1,000 births—are diagnosed with hearing loss, making it the most common congenital birth defect. Left undetected, hearing loss can negatively impact a child’s speech and language acquisition, academic achievement, and social and emotional development.

HHF, a long-time supporter of universal hearing screening for newborns, applauds the enactment. HHF was instrumental in highlighting the need for similar legislation in the 1990s. In 1993, only 5% of newborns were tested at birth for hearing loss. By 1997, 94% were tested before leaving the hospital, and today 97% of babies are screened before they leave the hospital.

Earlier drafts of the federal budget put the coverage of these crucial procedures at risk, prompting legislators in both the Republican and Democratic Parties to take action quickly. In addition to the bill in the House, a companion measure was introduced in the Senate by Senators Rob Portman (R-OH) and Tim Kaine (D-VA). In early October, the House passed the Act following the Senate’s unanimous approval in September.

“This program exemplifies the importance of early detection and intervention,” said Congresswoman Matsui. “By ensuring that infants have access to hearing screenings at birth, parents can make informed choices about their care management early on. This is critically important, given that so much of a child’s development happens in the first few years of their life. I’m pleased that through the passage of this legislation, the newborn screening and intervention program can continue to improve health outcomes for kids.”

I Will Never Know What It’s Like to Not Feel Dizzy: My Ménière's Journey

By Lauren Edmiston

I can still remember the beginning—it’s my earliest childhood memory.

I was in the hallway of a house with my mom, my grandfather, and my brother when I started to feel weird, so I ducked into a walk-in closet to recover. Down on my hands and knees in the closet, the floor was caving in. I began falling in lightning speed, couldn't grab anything, and could only see bits and pieces of light. My surroundings were blurry.

I was a four-year-old girl simply exploring the hallway of a house. That first memory was, in fact, my first ever full-blown episode of vertigo.

I was taken to the hospital for my first of many tests and doctor's visits as a child. Vertigo was not on anyone’s radar, much less Ménière's disease for someone so young. I was misdiagnosed repeatedly, starting with potential brain tumors and neurological disorders.

The dizzy spells continued throughout my childhood and became normal to me. Waking up some mornings and not being able to get out of bed was normal. Not being able to function with tall ceilings was normal. Sitting at church knowing that if I stood up from the pew to take about five steps I’d have an episode was normal. That sensation that starts out much like an anxiety attack, a sensation that I’d feel through my entire body before suddenly spinning uncontrollably, was normal. But it wasn't normal. I advocate for that little girl today because now I know the truth. It was a hard journey learning that I was different.

I was homeschooled, so it wasn’t until around age eight when I realized that not all kids functioned like I did and that there was something "wrong" with me. I was determined to do things my friends did, like gymnastics and soccer. Yes, I did both. Yes, I fell on the balance beam. Yes, I fell on the field. But I kept going.

Adulthood is not easy with Ménière's disease. But childhood with Ménière's disease? It shouldn't happen. Ménière's disease was still not an option or even discussed because of my age. I was 10 when my mother's best friend was diagnosed with Ménière's and recommended a doctor at the ear clinic. My mother’s friend and I always had similar quirks, after all.

I went and, just like that, I was diagnosed—officially this time. Six years of being “just a little different" instantly explained. But also, just like that, there was the realization that not a whole lot could be done. It was not very common to be a child with Ménière's disease—in both ears.

I entered a remission phase at 19 and I'm now 26 with two kids. I still have Ménière's and I will never know what it's like to not be dizzy. I still experience the dreaded ringing and fullness. I'm still incredibly sound-sensitive and I still have days where I wonder how I'm going to get through it with my kids.

I tell my story for parents that might be going through Ménière's with their children. I tell it for people that read my words and can relate to every single one. You’re not alone. You’re not just sensitive to your surroundings. You’re not over exaggerating; you fight a silent illness, you navigate an alternate universe. Never stop fighting for a better quality of life.

But, also, remember to share your story with honor. If you can relate, you can help impact lives of people just like you and me.

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

FCC Improves Phone Accessibility for People with Hearing Loss

The Federal Communications Commission on Tuesday, October 24 approved updates to various Commission rules for hearing aid compatibility and volume control on wireline and wireless telephones.

Under the Hearing Aid Compatibility Act, the Commission is required to establish rules that ensure access by people with hearing loss to telephones manufactured or imported for use in the United States. With this action, the Commission continues its efforts to ensure that tens of millions of Americans with hearing loss have access to and can benefit from critical and modern communication technologies and services.

With the Order, the Commission adopted a revised volume control standard for wireline handsets to provide a more accurate measurement of voice amplification. The Order also implements a provision of the Twenty-First Century Communications and Video Accessibility Act to apply all the Commission’s hearing aid compatibility requirements to wireline telephones used with advanced communication services, including phones used with Voice-over-Internet-Protocol (VoIP) services. Compliance with these provisions must be achieved within two years.

Recognizing the increased reliance on wireless phones, the Order further requires that, within the next three years, all wireless handsets newly certified as hearing aid compatible must include volume control suitable for consumers with hearing loss. It also reminds manufacturers and service providers of existing outreach obligations to ensure that consumers are informed about the availability of hearing aid compatible phones, such as by posting information about wireless phones on their websites.

More information on existing FCC hearing aid compatibility rules is available online at https://www.fcc.gov/general/hearing-aid-compatibility-and-volume-control.

Action by the Commission October 24, 2017 by Report and Order and Order on Reconsideration (FCC 17-135). Chairman Pai, Commissioners Clyburn and Rosenworcel approving. Commissioners O’Rielly and Carr approve in part and dissent in part. Chairman Pai, Commissioners Clyburn, O’Rielly and Carr issuing separate statements.

CG Docket No. 13-46; WT Docket No. 07-250; WT Docket No. 10-254

This press release was republished with permission from the FCC. For additional information, contact Michael Snyder at (202) 418-0997 or michael.snyder@fcc.gov.

Gaining Better Clarity of Neural Networks

By Pranav Parikh

The ear, just like any other organ in the human body, uses nerves to function properly. One of the most vital nerves that the ear uses is the cochlear nerve, which connects the inner ear to the brain, or more specifically to the tonotopically-based regions of the cochlear nuclear complex located in the brainstem. This nerve shares the same shape and design of most nerves in the body, with dendrites absorbing information from various sources, sending the signal down the axon of the nerve through action potentials, and terminating the signal in a synapse so the message can be spread. In order to allow for this process to occur expediently, the nerve encounters a process known as myelination (providing a myelin sheath to propagate a signal faster). This is done through a glial cell known as an oligodendrocyte. Oligodendrocytes form a layer of lipid (fat) and protein around the axon to provide insulation, thereby allowing for signals to be sent to the brain more efficiently.

The immunoreactivity of Olig2 was detected during postnatal day (PND) 0 to 7, which became weaker after PND 10. Before PND 7, the majority of Olig2-expressing cells were found within the modiolus at the basal cochlear turn, while a few cells were located peripherally to the DIC-PCTZ and in close proximity to the spiral lamina at the basal cochlea turn. After PND 7, Olig2-expressing cells were fully overlapped with the DIC-PCTZ within modiolus at the spiral lamina in the basal cochlea.

A team of scientists led by Dr. Zhengqing Hu, funded by Hearing Health Foundation through its Emerging Research Grants program (2010 & 2011) was able to analyze oligodendrocyte protein expression in the cochlear nerve of postnatal mice. Through the use of Differential Interference Contrast (DIC) microscopy, they were able to investigate the cochlear nerve at staggered postnatal days, meaning the period following birth.

Their findings indicate oligodendrocytes are found to migrate along with the transition zone between the central and peripheral nervous systems. As the fetus develops after birth, and myelination occurs in the nerves connecting to the brain, the oligodendrocyte protein marker Oligo2 was observed. This could mean loss of hearing function could be connected to unmyelinated axons. There are many other neurodegenerative autoimmune diseases, such as multiple sclerosis, caused by demyelination, and hearing loss could potentially be added to that list. Dr. Hu’s work improves clarity of the neural network connecting the inner ear and the brain.

Zhengqing Hu, M.D., Ph.D. , is a 2010 and 2011 Emerging Research Grants recipient. Hu's research was published by Otolaryngology-Head and Neck Surgery on July 11, 2017.

We need your help supporting innovative hearing and balance science through our Emerging Research Grants program. Please make a contribution today.

Idaho Seniors Receive Hearing Health Resources

Idaho Senior News, the Gem State's oldest and largest publication for individuals 50+, printed hearing loss resources in its October 2017 edition. Authored by Hearing Health Foundation (HHF)'s Communications and Programs Manager Laura Friedman, the piece educates readers about hearing loss—the third most common health problem in the U.S.—noting that the condition is most common among older adults.

Left untreated in adults, hearing loss can "lead to considerable negative social, psychological, cognitive and health effects and can seriously impact professional and personal life, at times leading to isolation and depression," Laura writes. 

But there is good news. The most common form of hearing loss, noise-induced hearing loss, is preventable. "If you are in an environment where you have to shout to be heard, it is probably too loud."

Laura's full article, "Hear, Hear: All About Hearing Loss," is available in this PDF on the Idaho Senior News website on page 19. 

A Tool to Discover Quieter Restaurants and Voice Concern for Loud Noise

By Gregory Scott

Restaurants and bars are simply too loud. In New York City, restaurants, on average, have decibel levels (77 dBA) that make conversation very difficult.  And bars are even worse with sound levels (81 dBA) that put people in danger of noise-induced hearing loss.  

When you go out, do you strain to hear a friend, family member, date or business partner?  Do you wish venues were quieter to carry a conversation? Looking for a polite way to ask managers to reduce their noise levels? Do you seek a way to find out where the quieter spots are in your city?

These questions have been on my mind the past few years. As someone with hearing loss, I am sensitive to loud venues and have often struggled to hear companions in noisy bars and restaurants.

I recall many times sitting at a restaurant table feeling completely lost in the conversation while others conversed and connected with each other. I would often nod my head in unison with the conversation, pretending to hear my companions when I could not, and then idly pass the time by entertaining myself with whatever fiction entered my head. At home, I would google “quiet spots,” which was often a fruitless endeavor. A place listed as quiet would often be blasting with music when I arrived with my date. This type of setting was not a great environment to talk in and get to know someone.

To overcome these issues, a free iPhone decibel meter app called SoundPrint has been created primarily for the hearing-impaired community, but even those with typical hearing can benefit. SoundPrint is also helpful for the blind, those with autism, or those who simply prefer quiet environments.

SoundPrint allows you to discover the quieter venues in your city. Using the app’s internal decibel meter, you can measure the actual noise level of any venue, which is then submitted to a SoundPrint database that anyone can access to find out if a certain venue is quiet or loud. A database for your city is created and, with each submission, is enriched and becomes more valuable. In addition, submitting SoundPrint measurements is an effective way to tell venue managers that you and others care about noise levels and that they should mitigate the increasing din.

An initial trial in New York City has begun and to date, 3,000+ venues have been measured, many of which have been measured three times or more. This has resulted in an invaluable curated list of 30 local quiet spots where one can actually hear others! No longer am I just sitting at a restaurant table unable to participate; rather I am engaged in the conversation and able to connect with companions.

The goal is to generate a similar list for other cities and let venue managers know that we care about noise. Join the SoundPrint community by measuring a venue when you are out. By doing so, you are helping each other discover which venues are quiet and noisy.

Gregory Scott is the founder of the SoundPrint app and is involved in the New York City hearing-impaired community. For more information, and to join the newsletter, visit SoundPrint's website and download the app. SoundPrint is only available for the iPhone, but venues are searchable on the app’s website. Greg is looking for SoundPrint ambassadors for other cities outside of New York (greg@soundprint.co).

New Clues to Sound Localization Issues in Fragile X Syndrome

By Pranav Parikh, Kathleen Wallace, and Elizabeth McCullagh, Ph.D.

Fragile X syndrome (FXS), the most common genetic form of autism, is characterized by impaired cognition, hyperactivity, seizures, attention deficits, and hypersensitivity to sensory stimuli, specifically auditory stimuli.

Individuals with FXS also experience difficulty with determining the source of a sound, known as sound localization. Sound localization is essential for listening in the presence of background noise such as a noisy classroom. The ability to localize sound properly is due to precise excitatory and inhibitory inputs to areas of the brain. 2016 Emerging Research Grants recipient Elizabeth McCullagh, Ph.D., and colleagues hypothesize that the auditory symptoms seen in FXS, specifically issues with sound localization, are due to an overall imbalance of excitatory and inhibitory synaptic input in these brain areas.

Investigators compared number and size of synaptic structures in different areas of the brainstem responsible for sound localization for several inhibitory neurotransmitters (glycine and GABA) and the primary excitatory neurotransmitter (glutamate) in a mouse model of FXS with a control group. The areas of the brainstem responsible for sound localization are connected to one another in a frequency-specific manner, with low frequency sounds stimulating similar areas and the same for high frequency. It was found that most areas of the brainstem examined did not have changes in number or size of structures, but one area—the medial nucleus of the trapezoid body (MNTB)—had alterations to inhibitory inputs that were specific to the frequency encoded by that region. Glycinergic inhibition was decreased in the high frequency region of MNTB, while GABAergic inhibition was decreased in the low frequency region.

The study by McCullagh and team in The Journal of Comparative Neurology is the first to explore alterations in glycinergic inhibition in the auditory brainstem of FXS mice. Due to the well-characterized functional roles of excitatory and inhibitory neurotransmitters in the auditory brainstem, the sound localization pathway is an ideal circuit to measure the sensory alterations of FXS. Given the findings in this study, further knowledge of the alterations in the lower auditory areas, such as the tonotopic differences in inhibition to the MNTB, may be necessary to better understand the altered sound processing found in those with FXS.

Elizabeth McCullagh, Ph.D., was a 2016 Emerging Research Grants scientist and a General Grand Chapter Royal Arch Masons International award recipient. For more, see “Tonotopic alterations in inhibitory input to the medial nucleus of the trapezoid body in a mouse model of Fragile X syndrome” in The Journal of Comparative Neurology.

We need your help supporting innovative hearing and balance science through our Emerging Research Grants program. Please make a contribution today.

Protecting Your Hearing Means Protecting Your Mental Health

By Carol Stoll and Lauren McGrath

October is Protect Your Hearing Month—and, today, October 10, is World Mental Health Day, a time for mental health education, awareness, and advocacy. Hearing loss and tinnitus (ringing in the ears) can increase one’s risk of developing mental illnesses including depression, anxiety, schizophrenia, and dementia, and can trigger episodes of extreme anger and suicidal ideation. Protecting one’s hearing not only prevents or delays hearing loss, but also benefits mental wellness. Understanding the signs of mental illness and having access to mental health resources is critical—and can even be life-saving—to all individuals with hearing loss or tinnitus.

According to an April 2014 study published in JAMA Otolaryngology Head & Neck Surgery, 11.4% of adults with self-reported hearing impairment have moderate to severe depression, significantly higher than the 5.9% prevalence for those with typical hearing. Individuals with hearing loss have reported feeling socially inept in group settings, entering conversations at inappropriate times, talking off-topic, or dominating conversations and coming across as rude simply because talking is easier than listening. When a person cannot hear properly, engaging in conversations is a daily struggle, and can lead to social isolation and depression. Other factors that increase the risk of depression include being female, low-income, a current smoker, binge drinking, having fair or poor health status, trouble seeing, and sleep disorder. However, even controlling for these factors, those with hearing impairment still had significantly higher rates of depression than those without hearing impairment. In people 65 and older, hearing impairment is among the most common chronic conditions associated with depression.

In addition to depression, hearing loss has been linked to schizophrenia. Several studies support the social defeat hypothesis, which proposes that social exclusion and loneliness can predispose people to schizophrenia by increasing sensitization of the dopamine system. In a December 2014 study published in JAMA Psychology, participants with hearing loss reported significantly more feelings of social defeat than healthy controls. Though their psychotic symptoms were similar to the control group, exposing them to a stimulant drug showed that those with hearing loss had significantly higher than normal dopamine sensitivity. Further studies are needed to draw definite conclusions of the causation, but this research is a first step in understanding the relationship between hearing impairment, social defeat, and psychosis.

In older adults, hearing loss is associated with cognitive decline and dementia, according to a February 2013 study published in JAMA Internal Medicine and several other studies conducted at Johns Hopkins University. The scientists concluded that reduced social engagement and a cognitive load focused on coping with hearing loss rather than higher level thinking can lead to poorer cognitive functioning and faster mental decline. Hearing aids could possibly be a simple fix to increase healthy brain function in the older adult population and reduce the risk of dementia.

Exposure to noise often results in tinnitus instead of or in addition to hearing loss, which can also contribute to a range of psychological disorders. Tinnitus affects about 1 in 5 people in the U.S., and causes permanent ringing in the ears. Though research for therapies is ongoing, there is currently no cure. Without therapy, constant ringing in the ears can be debilitating; it can affect job performance, cause insomnia, and provoke fear, anxiety, and anger. This can lead to depression, anxiety, suicidal ideation, and can exasperate post-traumatic stress disorder (PTSD).

Compromised hearing is an invisible disability, often unnoticed or ignored even by those affected. However, hearing loss and tinnitus are widespread and can have serious psychological repercussions. Hearing loss caused by noise exposure is completely preventable by taking simple measures like turning down the volume on your earbuds and using hearing protective devices in loud situations. Regular hearing screenings can also help detect hearing issues early on. Talk to your audiologist about best ways to treat or manage your hearing impairment. Find help for mental illnesses here.

Per the National Institute of Mental Health: "If you are in crisis, and need immediate support or intervention, call, or go the website of the National Suicide Prevention Lifeline (Voice: 1-800-273-8255 or TTY: 1-800-799-4889). Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals. If the situation is potentially life-threatening, call 911 or go to a hospital emergency room.”

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