A Brief History
The introduction of the jet engine aircraft in the late 1940s and early 1950s raised concerns about hazardous noise and was one of the most important occurrences to the subsequent development of hearing conservation programs (Nixon, 1998). No sound of the jet engine’s magnitude had ever been routinely experienced in the military or by civilians. In 1952, the Navy conducted a study to evaluate the effects of the jet engine noise on personnel aboard the aircraft carrier USS Coral Sea. The study verified the seriousness of the high-intensity noise problem. In response to the problem, the NAS-NRC Armed Services Committee on Hearing and Bioacoustics (CHABA) was established in 1952 (Nixon, 1998). It was their job to examine the areas of (a) effects and control of noise, (b) auditory discrimination, (c) speech communications, (d) fundamental mechanisms of hearing, and (e) auditory standards. CHABA members were at the forefront of hearing conservation program (HCP) development. They began sponsoring and publishing reports related to noise in the military. They went on to publish a Memorandum No. 2 on “Hearing Conservation Data and Procedures” in 1956. The Memorandum described components of a hearing conservation program and provided recommendations for their implementation.
In 1956, the Air Force was the first to establish a comprehensive hearing conservation program. The Regulation was revised in 1973. Both were model programs after which many organizations within and outside the government were created (Nixon, 1998). In 1978, the Department of Defense Instruction (DODI) 6055.3 was published and contained requirements that attempted to make all hearing conservation programs uniform across services. By 1980, the three branches (Air Force, Army, and Navy) had established hearing conservation programs in compliance with DODI (Nixon, 1998). In 1987, the DODI was revised. The most current DODI is 6055.12, and ensures that all services have a hearing conservation program implemented and these programs should include: a) sound measurements, b) engineering control measures, 3) noise labels in hazardous areas/on equipment, d) issuance of hearing protective devices, e) appropriate education to all personnel working around hazardous noises, f) routine audiometric testing which is to be stored in the Defense Occupational and Environmental Health Readiness System (DOEHRS), g) access to materials, h) record keeping through DOEHRS, and i) program performance evaluations (DOD, 2010).
NIHL in the Military
Northeast Florida is home to many military installations, including Naval Air Station Jacksonville, Naval Station Mayport, Kings Bay Naval Base, Camp Blanding Joint Training Center, Naval Aviation Depot Jacksonville, and Marine Corps Blount Island Command, which together provide employment to more than 50,000 active duty, reserve, and civilian men and women. As of 2011, there were 2,226,883 military members in the United States serving (including active duty, National Guard, Air National Guard, and reserves). Within the military population, an estimated 60% of veterans returning home from war have a hearing loss (CDC, 2013). Disabilities of the auditory system, including hearing loss and tinnitus, are the third most common injury experienced by veterans (Helfer, Canham-Chervak, Canada, & Mitchener, 2010). As far back as World War II, handguns, rifles, artillery rockets, ships, aircraft carriers, vehicles, communications devices, and many more, have been sources of potentially damaging noise levels (Humes et al., 2006, p. 201). Hearing is critical to the performance of military personnel, and noise-induced hearing loss (NIHL) is a severe impairment that can potentially reduce military effectiveness.
Several studies have been conducted to document reports of military hearing loss and tinnitus and effects due to noise. Results from a study conducted in 2010 using data between 2003-2005, found that a total number of 88,285 hearing impairment and noise-induced hearing related injuries (NIHI) were documented—unspecified hearing loss, tinnitus, perforations of tympanic membrane, acoustic trauma, impairment of auditory discrimination, etc. (Helfer et al., 2010). Overall, NIHI visits were reported for 9.6 per 1000 personnel.
How Does NIHL Occur? How Can It Be Prevented?
Loud noises destroy the ear’s special cells, called “hair cells.” They lie within the sensory organ of the ear, called “the cochlea”. The cochlea cannot regrow new hair cells. Once they have become permanently damaged, they are no longer a useful part of the cochlea. Hair cells are important because they help translate sound into a signal the brain interprets, or “hears.” The hair cells can be damaged significantly by a single impulse sound — gunfire, for example, or by prolonged noise exposure at levels that are harmful to healthy hair cells (greater than 85 dB).
Prevention is key in helping to reduce the number of military members and veterans with NIHL. Hearing conservation programs are a step in the right direction. Hearing protection devices, such as passive and active earplugs and earmuffs will also aid in prevention when used properly. Engineering controls to help reduce excessive noise levels should also be implemented. Most importantly, education about the dangers of hazardous noise levels is paramount to further reducing the incidence of NIHL in military members and veterans. Over the past several years, all branches of the military have been making strides towards better education about hearing loss and taking steps towards providing the best hearing protection for soldiers.
For the general population, three strategies you can use for prevention are: 1) walk away- at further distances, dangerous noise levels are not as harmful to your ears, 2) turn it down- if you have the ability, make sure you are listening to things at safe levels, reference the dB level above, and 3) protect your ears- always have a pair of earplugs or muffs on hand when you go to concerts, loud sporting events, hit the shooting range, etc. And just remember, currently, there is no cure for hearing loss, so try to protect the healthy hair cells you have!
DoD. 2010. Department of Defense Instruction 6055.12: DoD Hearing Conservation Program. Washington, DC: Department of Defense
Helfer, T. M., Canham-Chervak, M., Canada, S., & Mitchener, T. A. (2010). Epidemiology of hearing impairment and noise-induced hearing injury among U.S. military personnel, 2003-2005. American Journal of Preventative Medicines, 38(1S), S71-S77. doi: 10.1016/j.amepre.2009.10.025
Humes, L. E., Joellenbeck, L. M., & Durch, J. S. (2006) Noise and military service: Implications for hearing loss and tinnitus. Washington, DC: National Academies Press
Nixon, C.W. (1998). A glimpse of history: The origin of hearing conservation was in the military? Wright-Patterson Air Force Base, OH: U.S. Air Force Research Laboratory
Advancements in Cochlear Implant Technology
In recent years, technology has become available that has allowed hearing aid users to connect their hearing devices directly to their Apple IPhone. This technology has allowed users to stream phone calls, stream media, and use their phone as a remote control without the need for an extra piece of equipment (neck worn device, etc.). Unfortunately, this option has not been available for cochlear implant users. However, with the release of Cochlear Americas’ Nucleus 7 sound processor, this is now a great option for IPhone and Cochlear Americas implant users.
But what about users without iPhones?!
Not to worry, there are still those “in-between” devices that will allow users to connect to their cell phones with Bluetooth. These types of devices are available to users of all three of the cochlear implant companies with which we work (Advanced Bionics, Cochlear Americas, and MED-EL).
If you or a loved one are a cochlear implant user looking to upgrade technology or if you are someone suffering from hearing loss and believe the cochlear implant may be the best solution for your hearing needs, contact our clinic at 904-399-0350.
The Phonak Belong Platform: An Overview
Last week Phonak launched their ‘Made for All’ direct connect hearing aid, the Audeo B-Direct. Using a new proprietary 2.4 GHz radio chip these devices allow users to stream phone calls directly to any cell phone with Bluetooth without an intermediary device. Current technology from other hearing aid manufacturers allows only users of an Apple phone the ability to stream phone calls. The Made for All technology will allow Android, iOS or other Bluetooth cell phone users access to hands-free phone use. By utilizing built-in microphones as a voice pick-up feature, the Audeo B-Direct is able to function like a wireless Bluetooth headset. Once a phone call is received by the user, they are able to answer calls with a push of a button on the hearing aid. At this time, streaming of the phone call is only heard on the user’s preferred side, not to both devices. Patients will also have the ability to balance environment noise when background noise is present by either using the volume control on their phone or directly on their hearing aids. Using a streaming protocol called AirstreamTM Technology, the new TV Connecter from Phonak offers a “plug and play” solution that turns Audeo B-Direct hearing aids into wireless TV headphones. This device allows users to stream content from their TV without having to wear a body-worn streamer and is capable of streaming to multiple hearing aid wearers at the same time.
Virto B Biometric Calibration:
Another recent launch from Phonak is the use of Biometric Calibration in Virto B custom hearing aids. Using 3-D modeling software 1,600 biometric data points are identified from an earmold impression and are used to calculate calibration settings that are unique to each user. This technology allows individual ear anatomy and its effects on the acoustics of the incoming sound to be accounted for which provides a 2dB improvement in directionality. Another available option is the Virto B- Titanium invisible in the ear (IIC) option, which is made from medical grade titanium. Titanium is stronger and thinner than acrylic, allowing for significantly reduced device size.
Audeo B-R and Bolero-PR Rechargeable Options:
Phonak continues to offer a built-in rechargeable device option (Audeo B-R and Bolero B-PR). With a single charge, the device is powered for up to 24 hours. Smart charging options are also available, which allow on the go users to charge from anywhere, without having to worry about running out of power.
If you or someone you love is noticing hearing difficulties and would like to discuss hearing aid options, contact The Hearing Center at JHBI at (904) 399-0350 ext 246 to schedule an appointment to speak with an Audiologist about your options!
Hearing Loss and Communicating with Family
If you have hearing loss, you have probably noticed that your difficulty hearing is not just a problem for you, but for your whole family. When families have trouble communicating, they often report a decrease in perceived intimacy and an increase in conflict. This is because for most people, verbal communication is how we connect. When you cannot hear your friends and family, it becomes difficult to participate in a lot of things, from milestone events to nightly dinners. As the person with hearing loss, you are certain to feel this isolation and usually your family feels the disconnect as well. Even if you use hearing aids, there may still be some situations you cannot communicate well in depending on the severity of your hearing loss.
The first step to bridging the gap created by a hearing loss is simply to start the conversation on why you might not be participating the way you used to. Many times, people with hearing loss are assumed to be rude or dismissive because they are not responding in the expected way. Explain to your family that you are having trouble hearing them and go into detail about what situations make it worse. If you have extra difficulty understanding your spouse when he or she talks from another room, be very clear that this is not a situation you can succeed it. Explain to your children or grandchildren that they need to turn the television off when you are having a conversation so that you can hear them. Pinpoint situations that you really struggle in and work to tackle one at a time. Be patient with yourself and your family though – it may take a few reminders for them to break long standing habits.
Another good step is bringing your family or close friends to your audiologist appointments with you. Your hearing healthcare provider can explain your hearing loss and the limitations you might continue to have, even with hearing aids. Sometimes, it’s helpful for a third party to remind your family of the things they can do to help you succeed in hearing with as little frustration as possible. Your audiologist is there to help you as well as those closest to you in every aspect of your hearing loss journey so be sure to utilize them as a resource.
The Link Between Hearing Loss and Cognitive Decline
Recently, the Hearing Center at Jacksonville Hearing and Balance Institute partnered with Phonak (a major hearing aid company) to give a presentation to the community regarding the connection between hearing loss and cognitive decline in older adults. Unfortunately, it filled up too quickly for us to accommodate everyone who wanted to attend. Just in case you missed it, here are some of the highlights from the presentation:
The study in question was conducted by Frank Lin, Ph.D. and his colleagues at Johns Hopkins University using information gathered from older adults over a period of decades. The researchers found that those individuals with untreated hearing loss (whether it was mild, moderate, severe, or profound) were significantly more likely to experience cognitive impairments than their normal hearing peers.
But just how are hearing loss and cognitive impairment connected? As Dr. Lin reports, “Your inner ear has to take in a complex sound and convert it into a signal that goes into the brain. When we say that people have hearing loss, it means the inner ear is no longer as good at encoding those signals with accuracy and fidelity. So the brain gets a very garbled message — you can hear what’s being said but you can’t quite make it out. It takes a little more effort to hear what that person said. As a result, the brain has to re-dedicate sources to help with hearing and sound processing. That comes at the loss of something else.” Dr. Lin also notes that, “As we develop hearing loss, we withdraw socially. You’re less likely to go out and you may be less likely to be engaged in conversation.”
While more research needs to be completed regarding the link between hearing loss, social isolation, and cognitive decline, these early results certainly emphasize the importance of hearing heath on one’s overall health. Unfortunately, up to two-thirds of adults with hearing loss remain untreated. Here at JHBI, we hope that by increasing awareness about this topic, we can identify hearing impairments and possible intervention strategies earlier rather than later.
Lin, F. R., et al. (2013). Hearing loss and cognitive decline in older adults. JAMA Internal Medicine(4), 173, 293-293. doi:10.1001/jamainternmed.2013.1868
Boosting Your Hearing Aid Performance with Wireless Technology
Even with the best hearing aids, it can still be difficult to enjoy your favorite song or your favorite TV show, or hear a speaker clearly in a business meeting or at a restaurant. It may even still be difficult to hear someone talking to you on the phone. Over the past 10+ years, hearing aid manufacturers have developed wireless accessories to accompany hearing aids. These devices can be used in even the most complex listening environments. Today, some hearing aids will even connect directly to iPhones. Below is a list of outlined accessories and their uses as well as more information regarding direct connectivity options.
Several hearing aid manufacturers now offer direct-to-iPhone hearing aid options. Starkey, Oticon, Resound, and Widex hearing aids can be connected via bluetooth straight to your cell phone and most apple devices! Each manufacturer has their own free, downloadable, and user-friendly app which can control your hearing aids, including volume control, program changes, and some even allow you to control the directionality of your microphones in different listening situations. Phone calls are streamed directly to your hearing aids; your music, a video, a movie, anything streaming on your phone…that’s right! It goes straight to your hearing aids! They have now become wireless headphones!
Cell Phone Accessories:
With the technology of bluetooth, connecting your world to your hearing aids has become easier than ever. Several manufacturers offer wireless accessories that either clip to your lapel or hang around your neck. These intermediary devices allow your cell phone to talk directly to your hearing aids. As long as you are wearing your clip-on or your neck loop, your phone calls can stream directly to your hearing aids, as well as any other audio streaming from your cell phone. All it takes is a simple pairing procedure which your audiologist can help with!
With a TV Link, you will have the audio from the TV streaming directly into your hearing aids. All you have to do is hook up the accessory to your TV. Enjoy the comfort of listening to your favorite show at the volume you prefer while your loved ones can still enjoy the show at their preferred volume. Most TV Links require an intermediary device, however, which connects to the hearing aids and the TV Link then connects to the intermediary device.
Many manufacturers make accessory options in the form of a remote microphone. Remote microphones significantly improve the signal-to-noise ratio in noisy environments. Although most hearing aids at all technology levels reduce background noise levels in noisy environments to some degree, a remote microphone brings the speaker’s voice directly to the hearing aid users’ ears. The speaker wears the remote microphone and the listener wears an intermediary device which streams the signal to the listener’s hearing aids. This makes for exceptional speech understanding in noise and better understanding over longer distances. Some remote microphones can transmit to the users’ hearing aids from up to 80 feet away!
If you would like to learn more about these devices for your hearing aids and learn what your options are, schedule a hearing aid consult with an audiologist today! They should be able to answer any questions you might have! Just call: 904-399-0350
Please Join Us!
Where: Maggiano’s Little Italy in St. Johns Town Center
When: Wednesday, July 12
Time: 6:00 pm-7:00 pm
Jacksonville Hearing and Balance Institute invites you to an important hearing educational seminar followed by hors d’oeuvres and drinks. We will discuss the causes and consequences of hearing loss, the relationship between hearing loss and cognitive decline, brain cognition health tips, and how to arrive at a hearing health care solution. The providers at Jacksonville Hearing and Balance Institute will offer advice and practical tools for individuals and families impacted by hearing loss.
Join us for:
- More information about the relationship between hearing, cognition and your overall health and well being.
- The latest information on hearing loss treatment to clear up any confusion about hearing aids. If you or a loved one are experiencing symptoms of hearing loss, then don’t miss this special opportunity!
RSVP required by Friday, July 7th ~ Limited Seating
Becoming More Successful With Your CI
One of the most important steps in the cochlear implant process is rehabilitation. Research studies demonstrate that patients adjust more quickly and achieve greater overall success when they actively participate in a rehabilitation program. Rehabilitation with a cochlear implant can be done at home with computer based programs and listening exercises with family members or in a more formal setting with an auditory verbal therapist.
After a cochlear implant is activated it is important to complete listening exercises to help teach the brain how to listen with a cochlear implant. Immediately following activation, speech often sounds strange and unclear; this is because sound is being delivered to the brain through electrical stimulation (versus acoustic stimulation). The brain must adjust to this new way of receiving sound input. This process of “brain acclimatization” can be greatly impacted by the amount of effort put into the rehabilitation stage. Imagine never completing physical therapy after a knee or hip replacement; it would be very difficulty to walk effectively and progress may be much slower. Fortunately there are many resources available for patients to help them with their “listening therapy’. Each cochlear implant company offers an abundance of support and activities intended to help the brain acclimate to listening with a cochlear implant.
Cochlear’s Communication Corner offers specially designed activities for every age group from young children to older adults. Each group offers activities that range in difficulty to allow you to tailor you rehabilitation process to your specific needs. They also offer a Music program to help you enjoy the sounds of music again. In addition Cochlear has a telephone program called “Telephone with Confidence”. This program allows you to practice listening on the telephone through guided activities.
Follow this link: http://www.cochlear.com/wps/wcm/connect/us/communication-corner
The Listening Room:
Advanced Bionics’ The Listening Room provides numerous listening activities for people of all ages. Activates vary in difficulty and are labeled as beginner, intermediate or advanced to allow you to work through hearing skills at your own pace. The activities can be completed with a listening partner or done independently. Lessons are designed to improve speech understanding as well as increase music appreciation.
Follow this link: https://thelisteningroom.com/
BRIDGE to Better Communication:
MED EL’s BRIDGE program contains listening exercises for various age groups. The activities for adults focus on sentence recognition. The recorded activities can be done independently and allow the listener to vary how the sentences are presented to mimic more ‘real world’ scenarios. There are also activities that can be completed with a partner. Suggestions are given on how to increase the difficulty of the task to ensure the listener continues to make progress once a particular skill is mastered.
Follow this link: http://www.medel.com/us/soundscape/#prettyPhoto
Congratulations! You should consider your decision to purchase hearing aids to be a smart investment of both your time and money. As you continue to get used to your new devices, you will likely develop a strong bond with your hearing aids, and will want to be without them as infrequently as possible. It is important that you develop a basic hearing aid maintenance plan that you routinely follow to ensure peak performance of your devices. You should also be familiar with common causes of hearing aid damage so that you can avoid exposing your hearing aids to hazardous conditions (although even the most meticulous hearing aid wearer will need a repair at some point in time!)
Damage to Hearing Aids: What to Expect
Moisture and earwax are two of the most common causes of hearing aid damage. It is estimated that as many as 75% of the hearing aid repairs seen in our office are related to these two items.
- Earwax: Although the degree to which a hearing aid is exposed to earwax is determined more by body chemistry than good cleaning practices, cleaning your hearing aid regularly with a lint free cloth or hearing aid cleaning wipe will limit the problems resulting from earwax. Cleaning your hearing aid with a solvent or household cleaner is not recommended and can result in damage to the hearing aid casing or components.
- Moisture: Moisture problems related to the environment are difficult to avoid, and the use of a hearing aid drying system (discussed below) is the best solution for this. To avoid accidental moisture damage, avoid storing your hearing aids in your bathroom or kitchen where moisture levels are high. We recommend storing in the original case on your dresser or nightstand. In addition, posting a note on your shower door can help prevent accidentally wearing your hearing aid into the shower.
- Other: Other common reasons hearing aids become damaged include:
- Pets (many pets love to chew hearing aids)
- Hairspray or other hair products
- Dropping the hearing aid
- Incorrect battery insertion
- Exposure to excessive heat (being left inside a car, etc)
Hearing Aid Care Products
Routine Care = Longer Hearing Aid Life and Better Hearing Aid Performance
There are many products designed to help you care for your hearing aids. Listed below are some of our most commonly recommended products:
- Hearing Aid Dryers (Desiccant jars): Basic dry jars cost as little as $10.00. More sophisticated electric dryers are also available for purchase and contain UV lamps which have antimicrobial benefits.
- Cleaning Wipes: Wipes designed specifically for use with hearing aids help control wax build-up.
- Tubing Blowers: Tubing blowers are used to clean the tubing of behind-the-ear hearing aids. This also helps with moisture build-up which often occurs in hearing aid tubing, which may help reduce how often tubing needs to be changed.
Establishing a good maintenance plan is an essential part of your hearing aid journey and will help ensure that your hearing aid functions at peak performance for many years to come. If you are unsure of cleaning procedures for your hearing aid or are in need of a hearing aid repair, make an appointment with your audiologist to discuss the proper plan for you and your hearing aids!
Do I need a hearing aid?
This is a question that the audiologists and physicians hear every day at The Hearing Center and JHBI. Let’s take a look at what matters (and what doesn’t!) when it comes to making that decision.
The first step to deciding whether or not it’s time to try hearing aids will depend on your hearing loss. Hearing aids can be programmed to fit all different degrees and configurations of hearing loss, from mild to profound. However, you have to keep in mind that what your hearing loss looks like will greatly affect your outcome with amplification. For example, patients that have very little usable hearing left may be better suited to a cochlear implant. Patients with middle ear problems may want to try a bone-anchored hearing device. So how do you know what’s right for you? That’s an easy one to answer- you just have to ask an audiologist. Come in for a hearing aid consult. If hearing aids aren’t the correct choice for you, we promise to guide you to whatever is.
Most people with hearing loss know that they have trouble hearing. In fact, that is usually what drove them to get a hearing test in the first place. However, even with severe hearing loss, some people will deny any hearing difficulties. Hearing aids are a process that involve both commitment and work on the part of the new user, so that person has to be invested in a positive outcome. In other words, it is important that you feel like you have something to gain from wearing a hearing aid. If you are convinced that you are not having any difficulty hearing, it will be hard to justify using hearing aids. Keep in mind, though, that sometimes it is actually the people you are talking to that take the brunt of a hearing loss. Are they frequently repeating or speaking up so that you can be apart of the conversation? Look to those closest to you for honest opinions about how they are affected by your hearing difficulties. If they are expressing frustration, that might be a reason to consider trying hearing aids.
Hearing aids are for people with hearing loss, no matter their age. It does not matter at all how old you are- If you have a hearing problem, it is time to consider a hearing aid. Please do not wait until you reach a certain age to start considering a hearing aid.
It’s okay to be worried about what a hearing aid will look like. We are all human, and we want to present our most confident self to the world. For some people, it’s scary to think about what a hearing aid will look like. The good news is that we have come a long way from the large devices that used to be the industry standard. Most styles are nearly invisible these days. Depending on your ear canal size and hearing loss, your audiologist can guide you into the most discrete style possible.
For many people, the price of hearing aids can be very intimidating. At JHBI, we offer different levels of hearing aids at varying prices to meet the needs of everyone that comes through our door. We also have some financing options that may help. We encourage you to come in and see what we have to offer and talk about what your budget allows. Even if a hearing aid isn’t an option for you currently, we may be able to find some ways to help you hear better that are within reach.
For more information on hearing aids, click on the following link: https://www.betterhearingjax.com/hearing-technology/our-hearing-aids/