On Friday, September 5, 2014 we visited a rehearsal of the Fairport High School Day Jazz Band, directed by Bill Tiberio. We have “adopted” this award-winning ensemble as part of the Adopt-a-Band program initiated by Etymotic Research. Students had an opportunity to learn about hearing, acoustics, the dangers of loud sounds, temporary and permanent ear damage. Strategies to conserve hearing while enjoying playing and listening to music were also discussed. This was a fun, interactive session, with questions, demonstrations, sound level measurements. The band was able to play for us and have their sound level measured. At the end of the session we provided the young student musicians with instant fit high-fidelity hearing protection plugs. Custom fit hi-fi plugs will be available to them at reduced cost.
We feel the Adopt-a-Band program is a valuable asset connecting audiology, schools, the arts and the sciences. We were impressed at the maturity and interest demonstrated by the students, and our visit was very enjoyable! It is rewarding to bring diverse aspects of the community together in unexpected ways. We look forward to following the band through the school year and in the future. We know their endeavors will bring many rewards.
The vast majority of patients seen for hearing loss present with roughly the same hearing in each ear. Symmetric hearing is expected in typical cases related to aging, noise exposure, toxicity, heredity and many disease processes. Noise exposure may affect one ear to a greater extent if a constant source of occupational or recreational sounds is located closer to that ear, as in various machinery, firearms, musical instruments, etc. Significant asymmetry, however, is never taken lightly, and such patients are encouraged to be evaluated medically. This may be a “red flag” for diseases of the ear or “retrocochlear” conditions affecting the hearing nerve leading toward the brain. Many of these conditions can produce associated symptoms, such as dizziness/imbalance and/or tinnitus.
Occasionally we will see a patient with normal hearing in one ear and significant loss in the other. One ear needs no help to hear, while the other is in need of amplification or perhaps is a total loss. This condition is very often left untreated by the patient. Obviously, one ear is pulling in as much sound as possible, however, the other ear is depriving the listener of half the sound of the world. What are some consequences for non-treatment, and what are the options for these patients?
For more significant asymmetric losses, localization of sounds becomes very difficult. The brain is wired to receive input from both sides and to locate sounds based on the loudness difference between the ears, as well as the time difference. Sounds are assumed to be more intense or heard sooner in the ear closer to the source. The brain is also thought to be responsible for listening in the presence of background noise. This ability is thwarted by hearing asymmetry, as input from both ears is needed for this function. Additionally, the brain can squelch echoes in somewhat in reverberant rooms, but needs two good ears to do so. These consequences can be summarized by stating that single-sided hearing is effective only in quiet spaces with good acoustics and preferably when using eye contact.
Several options for treatment are available. If the poorer ear is near-normal, the patient may opt to wait until the hearing decreases to a more significant level. With greater losses, a hearing aid on the poor side is often extremely helpful for increasing hearing, improving communication and restoring sound localization. In the case of profound or even total loss of hearing, often known as “single sided deafness”, a traditional high-powered hearing aid may not suffice. One option is a CROS (contralateral routing of sound) instrument that places a microphone on the poor side and transmits the sound to the functional ear. Patients eventually learn to differentiate sounds from each side, even if they are being perceived in the same ear.
We should neither underestimate the importance of hearing from both ears, nor fail to recognize the importance of a correct diagnosis and follow-through. It begins with a single appointment for thorough diagnostic testing and continues as a collaboration between an educated patient and a professional. Let us put you on a clear path to good hearing and health.
By now you may have heard of new hearing technology that is able to link (“stream”) your iPhone or other smart phone to hearing aids. The idea that a hearing aid user may be able to listen to a mobile phone through hearing aids via a wireless connection is long in coming, but it has become a reality. We now have access to these systems here in our office.
The main purpose of any hearing instrument is amplification of live sound, particularly speech, in environments such as home, work, travel or social activities. This is done selectively, based on the kinds of sounds a patient hears well and the kinds he or she hears poorly. All digital hearing instruments must be programmed by a professional qualified to select appropriate gain, compression and other parameters for the patient’s specific loss and needs. This must be done in person for even a reasonably good outcome.
The idea of pairing phone to hearing aid wirelessly was predicted years ago, and the capabilities of modern microchips and streaming technology has finally enabled this. Adding a mobile phone, such as an iPhone, to the mix requires even more interaction between professional and patient. These are not plug-and-play devices. Instruments must be paired, and the user must be familiar with the controls and devices used for the pairing. This is accomplished during a consultation in our office.
The benefits include: customized settings for various environments (perhaps your living room or favorite restaurant) selected by the user, hands-free iPhone use, using your mobile device as a microphone to improve listening in noise, adjusting hearing aid settings using your phone, streaming music or videos wirelessly through your hearing aids, applications (apps) to help find missing hearing aids.
Current iPhones (5s, 5c, 5), iPad Air, iPad 4th generation, iPad mini, and iPod Touch 5th generation are compatible with these hearing aids. This is “MFi functionality” bringing you the ultimate marriage of hearing aid and phone technology. Call us to find out if you may benefit from this incredible advance. We want to keep you on a Clear Path to good hearing and ear health!
Recently a female patient in her early 60s came to our office and reported she felt she had lost virtually all her remaining hearing over the past month. She had a long history of hearing loss, middle-ear disease, Eustachian tube dysfunction and multiple ear surgeries. She is a hearing aid user, but was not hearing from her instruments. They were working properly and set to her most recent hearing test levels.
Knowing this woman’s medical history, we examined her ear canals with a high-resolution fiber-optic camera after asking her in-depth questions about her recent history. The ventilation tubes most recently inserted in her eardrums were not visible and appeared to be overgrown with skin tissue. Tympanogram results indicated no drum vibration, and the canal volume was normal, indicating the tubes were either absent or clogged.
When the patient was tested in our sound-shielded booth for hearing levels, we found a drastic decrease in hearing levels for both ears. She was not totally deaf, but had a “severe” level of loss, whereas she had formerly been mild to moderate. This person was anxious about her ears and fearful she would lose all remaining hearing. The change was clearly due to the condition of her middle ear and it was clear this woman needed medical or surgical intervention without delay. This early diagnosis was critical.
It may have been easier to simply turn up the gain on the woman’s hearing aids or fit her with new instruments and tell her to call if her hearing improved on its own. Sometimes, however, the easy way to approach a problem is not the best way. After obtaining all history and test data we called the otology practice that had operated on her ears. They accommodated her immediately. In this case the physicians and surgeons were in the best position to address the medical needs of her ears. The diagnostic information we supply will support their medical diagnosis and treatment. We will follow up with the patient as she improves.
Because we are not a retail-model “hearing aid boutique”, we were able to identify and diagnose a problem, integrate it with a patient’s medical history and guide her to the best available help. We take enormous pride in our work as a diagnostic center and satisfaction in partnering with other professionals to solve problems . This has been just one example of such an interaction. An early diagnosis and prompt action was crucial for this patient! As always, we hope to keep you on a CLEAR PATH to good hearing and health.
Much is known about the deterioration of hearing caused by noise exposure, toxicity and the aging process. Inner-ear or “sensory” hearing loss accounts for the majority of cases seen in hearing centers and reflects the risk factors of the population. Hearing, however, relies on more than the ear. There are brain and nerve relays and processing centers that work constantly to help us make sense of the sounds our ears take in. When faced with patients whose hearing abilities in quiet greatly outpaces their ability in noisy environments, one realizes there may be problems beyond the ears that affect the ability to listen effectively in poor acoustical surroundings. There are major connections between the elements of hearing and the brain.
Research has found that in patients with significant hearing loss, the aging of the brain may be accelerated by at least six years, and hearing loss is associated with reduction in brain volume exceeding that which would be expected for the patient’s age. Researchers estimate the brain’s aging process can be accelerated by more than six years in patients whose hearing loss affects listening to speech.
Central presbycusis is a term used to describe a limitation the brain has imposed on hearing beyond what one would expect from inner ear damage alone, based on standard audiometric testing.
Presbycusis (or “presbyacusis”) means “elder hearing” and describes hearing that has been affected by the aging process. The most typical consequences are poor high-frequency hearing for sounds such as alarms, phones and electronic beeps, difficulty hearing consonant sounds such as /s/, /f/ and /th/, and reduced clarity of speech and music. Most often this is due to gradual deterioration of the sensory cells in the inner ear.
“Central” refers to the central nervous system, the brain and nerve network involved in hearing. The nervous system/brain processing of sound allows us to take the signals our ears detect and “decode” nerve impulse patterns that tell us: what kind of sound we’re hearing, the identity of a speaker, what words mean, how loud or soft sounds are, whether music sounds “musical”, the direction(s) sounds originate from, and other aspects that give meaning to sound. Another function of the brain in listening is to “filter out” and ignore background noise, a typical property of younger ears. This brain function may fade over time irrespective of hearing levels. Overall, many brain regions operate in concert, providing us with all the information we extract from the sounds we hear.
There are tests beyond the traditional hearing diagnostic evaluation that can help assess the ability to hear in the presence of background noise, learn sequences of sounds or repeat complex patterns. Often we need to use additional assessment tools, in order to learn the nature of the problems a patient complains about. Not surprisingly, a five minute free screening at a retail hearing aid center yields very little useful information about the true state of a person’s hearing system. The options we select for rehabilitation and counseling depend on more than just numbers on one sheet of paper. Choose professionals wisely when you suspect a problem. When the time comes we will be there for you and will do our best to keep you on a Clear Path to good hearing!
Much has been written, here and elsewhere, about treatments for tinnitus, the often bothersome perception of phantom sounds. These sounds are reported as ringing, buzzing, hissing, humming or other essentially steady sounds in one or both ears. In our experience the problem is not the noise itself, it’s the patient’s reaction to the noise, or the degree to which he or she actively listens to the sounds. Tinnitus turns out to be a problem of “hypermonitoring”
Many patients report they rarely pay attention to their tinnitus. They typically hear it more during quiet times but may not regard the sounds as worthy of their attention. The brain can “let go of” or ignore stimulation it does not consider important enough to monitor. This is partly due to a safety mechanism whereby we monitor our environment for potential threats. Sounds that are well known to us as non-threatening are not given high priority. Think of the hum of a refrigerator vs the strident sound of a rattlesnake. Which sound deserves more attention? In fact, we are more likely to pay attention to an appliance when it is malfunctioning and producing an unusual noise. It is interesting that many patients liken their tinnitus to cricket chirping, yet they do not complain of real crickets during the summer. Also a lighted candle can be dominant in an otherwise dark room, but seems insignificant in a well-lit room. This demonstrates how our environment and expectations influence our perceptions.
At Clear Choice Hearing and Balance our tinnitus treatments safely promote the process of habituation. In this manner the tinnitus can eventually become no more threatening than a refrigerator. This process typically takes time when protocols are applied consistently, but studies have found that it is effective 70-90% of the time when compared to older methods such as “masking”. Other studies have examined the factors contributing to success of treatment, and the most important factor was patient follow-through, particularly concerning devices or products that have been recommended. For example, patients with significant hearing loss should wear hearing aids. Additionally, other devices, such as the Serenade® device by SoundCure™, have been used in treatment. High compliance correlated to good success. Poor compliance did not.
This process may take the form of a gradual lessening of awareness at all times, but often the result is shrinking “windows” of time when the tinnitus is bothersome. Either way thousands of patients across the world have learned from experience that a “cure” is not necessary if the sounds of tinnitus become just another benign part of your auditory world.
Contact us and let us explain further and help put you on a clear path to good hearing and ear health.
Lately it seems hard to escape the constant flow of pharmaceutical commercials and print ads for a seemingly endless list of maladies. In our own office we see many patients whose medication lists span more than a full page. All of the drugs listed may be necessary and effective, however, do ALL disorders require medications, and can drugs (or surgery) cure or improve all conditions?
In our work diagnosing balance/dizziness disorders, we often find problems caused by the “vestibular system”, or the inner ear balance center. The ear is a balance organ first, a hearing organ second. Our VNG (videonystagmography) test battery provides clues about the origin of the “lesion”. The eyes, it turns out, are not only the “windows to the soul”, they are the windows to the inner ear. When eye movements follow a particular pattern, we may discover one ear is weakened in its ability to send nerve impulses to the brain when the head changes position. This may be due to conditions such as labyrinthitis or vestibular neuronitis, and dizziness are the result of mismatched messages from the ears. Normally the ears work as equal partners, however, if one is damaged and sending weaker signals, the brain may not be sure which ear to “listen to”.
Research has shown that medications given to ease symptoms by suppressing the vestibular system cannot strengthen the weaker ear, but can actually delay improvement in symptoms. Vestibular rehabilitation therapy can promote a “recalibration” of the brain to mismatched signal strengths and improve patients’ symptoms without medications.
A very common vestibular problem is positional vertigo (BPPV), in which tiny bits of debris (“ear stones”) block one of the semicircular canals. Again, this disrupts the signals the brain has become accustomed to for information about the position of the head, resulting in intense, brief spinning dizziness. When this is discovered, treatment involves a specific series of movements designed to clear the debris from the canal. It is not reasonable to assume a drug can seek out calcium crystals and physically move them.
Finally, it has been mentioned here and elsewhere that tinnitus (phantom noises in the ears) should not be treated with medications. Drugs such as antidepressants should be taken only for their intended purpose. For some patients, an underlying psychological condition may exacerbate the reaction to tinnitus. This should be discussed with a psychologist or psychiatrist, however, tinnitus on its own does NOT require medications. Strategies such as Tinnitus Retraining Therapy and/or amplification can be very effective without changing your blood chemistry or causing side effects.
Modern-day medications can improve or alleviate many ailments, however, medications are not always the best option for all conditions. An otologist or audiologist can help you select the most effective treatments.
Seek local professionals who are truly local. Much has been made in the press lately about businesses and jobs leaving or staying in New York State. One can easily argue the pros and cons of remaining in NY, however, it is no secret we have a long-standing tradition of excellence in the Rochester area in terms of the medical, engineering, optical, arts and academic fields. Our region is even an important and vital place to the Deaf community. We are the original home of Kodak, Xerox, Wegman’s, Bausch and Lomb, Paychex, Genesee Brewing, Hickey Freeman and many other influential businesses. Local professors and researchers are consulted regularly by national news sources. Performers such as Garth Fagan, Chuck Mangione, Renee Fleming, Cab Callaway and Lou Gramm have called Rochester home. One could conceivably live an entire day using only products, services, information and entertainment originating right in our back yard.
There is a trend in the business world to grow outward and/or expand the scope of one’s reach. Major retailers are now adding grocery market sections, optical centers, automotive areas and even hearing centers. People are likely enticed by the convenience of “under one roof” shopping, perceived low prices and “discounts”. This retail model, as applied to the hearing center, carries with it several troubling implications. Hearing instruments are sold as appliances to “customers” instead of being dispensed as medical devices to patients. True diagnostic examinations may not be performed at all (see earlier blog entries on free screenings vs. diagnostic testing). The qualifications and experience of the employees may be limited. Finally, money paid for products and services will end up primarily at corporate headquarters instead of being reinvested in the local economy.
Similarly, there are stand-alone hearing centers whose headquarters exist out of state. Some of these are large, publicly traded corporations. Their professionals typically do not have the autonomy to select from an array of product brands or services to which a local business has access. Audiology and hearing aid dispensing are equal parts science and art. A hearing-impaired person in search of help should not have to be worried that his needs are secondary to the needs of stockholders and CFOs. If you call a center, even if the phone number appears local, ask the person who answers if the call is received locally AND if the business is wholly owned locally. Often calls are routed to phone banks at corporate headquarters far from New York State.
There are several excellent locally owned and operated hearing centers in this region. We hope you choose us, of course, but no matter who you see, be sure to keep it local. You only get one set of ears!
Screenings vs diagnostic evaluations
Hearing centers may occasionally produce marketing materials enticing potential patients or clients with “free hearing screenings”. While the idea of getting some service for free may be appealing, and while quick screenings can be useful at informal occasions such as health fairs, they are of extremely limited benefit to people who have genuine concerns for their hearing or ear health.
The purpose of a screening is to identify a potential problem with hearing or the health of the ears. The subject is asked to respond to tones presented to one or both ears until the lowest levels of sound detected by the subject are recorded. This may be performed in a room that is not isolated from outside noise. The only information generated in this scenario is difficulty with certain tones in the specific environment used for the screening. Precise hearing levels in quiet, word recognition, and “site of lesion” (outer ear, middle ear, inner ear, auditory nerve pathway, etc.) cannot be evaluated in this manner. A “failed” screening identifying a potential problem should necessitate a full diagnostic battery.
Diagnostic audiometric evaluations are always the standard in identifying and quantifying disorders of hearing and their likely origins. Appropriate treatment depends on accurate, reliable and valid examinations of the elements of hearing in a sound-shielded environment. In our office we “work our way inward”. We begin with a fiber-optic high-resolution magnified video image of the outer ear structures, from the pinna (visible area) through the canal to the eardrum. Is cerumen (ear wax) interfering with hearing? Then, since we cannot see past the drum, we use tympanometry to determine the health of the middle ear space. This includes the three tiny bones (ossicles) behind the drum and the Eustachian tube. This structure drains the middle ear to the throat and allows air to infiltrate the space. Acoustic reflexes rely on the auditory nerve and facial nerve while protecting us from loud sounds. Otoacoustic emissions use a variation of SONAR technology to gauge the integrity of cells in the inner ear hearing organs.
Along with these “objective tests”, the subject must enter a sound-treated booth and don special headphones or earphones and respond to tones. Ear-specific threshold levels are obtained for many frequencies, revealing the absolute limits of hearing. Threshold levels for words are also measured, after which word recognition percentage is determined for each ear using approved word lists at a “comfortably loud” level. Bone conduction tone thresholds should be measured, in order to determine if a “conductive loss” in the outer or middle ear is preventing sound from reaching the inner ear.
All the diagnostic information can be integrated by an audiologist to determine if atypical results require referrals to other professionals, such as otolaryngologists. These physicians may order imaging studies and/or diagnose diseases of the ear that may be treated medically or surgically. More typical results are evaluated for level of impairment, in order to inform the audiologist and patient and guide the best options. Caring for ears and hearing often takes a team effort. A five minute screening is not sufficient for effective management of most patients.
Many people use “dizziness” and “vertigo” interchangeably. While the group of conditions known as vertigo produce dizziness sensations, not all dizziness is vertigo. Let us examine the difference in these terms.
Dizziness essentially refers to a sense of physical disorientation in space or illusory movement. There may also be a sense of “light-headedness”, where the person may suffer momentary altered sensations, such as blurred vision and difficulty maintaining balance. One such condition is known as orthostatic (or positional) hypotension, which is temporary low blood pressure in the head. The brain and sense organs of the head are the biggest consumers of the oxygen carried in the bloodstream. When the head rises (as from a bed) too rapidly, the resulting lack of oxygen reaching the head can momentarily cause a dulling of the senses and “dizziness”. This typically lasts for seconds. Similar sensations of unsteadiness can also be psychologically influenced, including those caused by fear of heights, bridges or enclosed spaces.
Vertigo, on the other hand, typically refers to a spinning sensation and is most often related to the main balance organs of the body, the ears. Benign Paroxysmal Positional Vertigo (BPPV) is a common condition that causes many people to avoid provoking movements, such as bending downward, lying back or rolling in bed. It is caused by an accumulation of mineral debris which has migrated from one part of the inner ear (the saccule) into one of the semicircular canals. These calcium-based otoliths “ear stones” are used to sense linear acceleration, as motion causes them to move toward, and bend, specialized cilia on balance receptors known as “hair cells”. When the acceleration signals from both ears match each other and reinforce what the eyes see, we sense acceleration. If the debris happens to block one of the semicircular canals and stimulate the sense organs incorrectly, the brain will receive mismatched signals about the head’s position or movement. Dizziness is the mind’s way of expression confusion with conflicting information.
Positional vertigo typically is triggered by movement or position. Its most common presentation, posterior canal BPPV, canalithiasis variant, is characterized by spinning dizziness, nausea, a twisting movement of the eyes and brief duration (15-30 seconds). The symptoms typically fatigue upon repetition, and repeated movements tend to result in milder dizziness.
The quickest, least invasive, most cost-effective and best treatment for positional vertigo is called a canalith repositioning maneuver. With versions named after researchers named Epley, Semont, Gans and others, the clinician uses gravity and the density of the particles to unblock the canals and allow the debris to clear into an area where it can be easily absorbed. Obviously no medication can specifically target crystalline debris in the inner ear, pick up the stones and remove them.