Hearing loss can be a problem for the whole family, not just the individual. Below are a few strategies that can help with effective communication at home:
- Maintain eye contact : Face the speaker and maintain eye contact. Facial expressions and body language add vital information to communication
- Gain attention: Gain the listener’s attention before you begin talking. If the person with hearing loss hears better from one ear, move to that side of the person.
- Keep hands away from face: When talking, try to keep your hands a way from your face. You will produce clearer speech and allow the listener to make use of those visual cues.
- Speak naturally: Speak distinctly, but without exaggeration. You do not need to shout. Shouting may actually distort the words. Try not to mumble. Speak at a normal rate, not too fast or too slow. Use pauses rather than slow speech to give the person time to process what you are saying.
- Rephrase rather than repeat: If the listener has difficulty understanding something you said, find a different way of saying it. If he or she did not understand the words the first time, it’s likely he or she will not understand the words the second time.
- Converse away from background noise: Try to reduce background noise if possible. Turn off radio or television. Move to a quiet space away from the noise source. When going to a restaurant, ask for a table away from the kitchen, server stations, or large parties.
- Move to an area with good lighting: Sit where there is good lighting so that your face can be more easily seen. Avoid strong lighting coming from behind you, such as through a window.
A cochlear implant can be a life changing treatment for people with severe hearing loss who receive little benefit from hearing aids. An important component of the cochlear implant process is to approach the first several weeks after activation with realistic expectations, commitment and patience. A cochlear implant is designed to bypass the damaged hair cells of the hearing organ, the cochlea, and deliver sounds to the brain by directly stimulating the auditory nerve. The brain then interprets the sound as a meaningful message. This mechanism is very different than the way our natural hearing system is designed so right away the brain is unable to recognize the sounds delivered by the cochlear implant. The good news is that the brain is an amazing organ and capable of learning new things all the time. The brain will learn to recognize speech and environmental sounds with exposure, experience and practice.
Exposure: Once the cochlear implant is activated the brain needs to hear sound in order to begin to learn to adapt. Although conversation will likely sound strange and unclear at first the only way to make progress is to expose yourself to all kinds of sound; conversation, music, environmental sounds…anything!
Experience: A key part of cochlear implant process is experience; wearing the cochlear implant all day every day, allows speech and other sounds to become more pleasant and clear. Think of the adjustment to a cochlear implant as being a marathon rather than a sprint.
Practice: Finally practice, practice, practice! Similar to completing physical therapy exercises at home following a hip replacement surgery, listening therapy must be completed to teach the brain to listen with a cochlear implant. There are many types of listening exercises that can make practice enjoyable. These can be done on your own or with a partner.
Keep in mind everyone progresses at their own pace, have patience with the process and know that the benefits will be worth the journey.
Sound and Taste: Where Is the Connection?
Synesthesia is a neurological phenomenon in which two or more senses interact; stimulation of one sensory or cognitive pathway leads to automatic, involuntary experiences in a second sensory or cognitive pathway. One of the most common forms of synesthesia is grapheme-color synesthesia, in which people perceive individual letters of the alphabet and numbers to be “shaded” with a color. Other forms of synesthesia include correlating sounds with scents, sounds with shapes, or sounds with taste. This brings us back to: sound and taste, where is the connection?
Sound and Taste
Although not directly described as synesthesia, Charles Spence, an experimental psychologist at the University of Oxford has devoted much of his career specializing in research about the integration of information across the different senses. His work helps to explain why food can be more or less enjoyable depending on environmental features/atmosphere, colors, or in this case, sounds. Some of his most noteworthy work relates to how our perception of taste is effected by other sensory modalities, say sound, for example. As Spence writes, “Many of the food properties that we all find highly desirable – think crispy, crackly, crunchy, carbonated, creamy, and of course, squeaky (like halloumi cheese) – depend, at least in part, on what we hear”. Perhaps his most notable experiment in the field of cross-modal research was “The Role of Auditory Cues in Modulating the Perceived Crispness and Staleness of Potato Chips,” published in the Journal of Sensory Studies in 2004. From this research, Spence concluded that food can taste different depending on changes in sound. In general, higher pitched crisps with more crunch were reported to be more fresh and more desirable in taste. More recently, he found that higher-pitched music enhances sweetness. The evidence shows that when people are asked to match tastes with a specific pitch or musical instrument, the majority of people will match sweet-tasting foods with sounds having a higher pitch and the sound of the piano while matching bitter-tasting foods with lower pitched sounds and the sound of a brass instrument. Another thought: Ever think about why tomato juice or a Bloody Mary is more appealing on an airplane? Spence explains that the 5th flavor of taste, umami—a meaty, protein-like flavor described by the Japanese is actually enhanced in flight. According to research done by Spence, the loud engine noise of the plane at upwards of 85 decibels can influence how you taste food and beverage. It tends to suppress sweet and salty whilst enhancing umami, thus, you choose to drink tomato juice. Many drink options on planes tend to be sweet, hence juice and soda. Tomato juice is one of the only savory options. In fact, the German airline Lufthansa estimates people consume about as much tomato juice as beer aboard its flights! Spence’s suggestion to make more things taste appealing in air is to simply use noise-cancelling headphones. There is also work being done looking at different music people listen to on flights and how that can possibly contribute to how things taste. More work is being done in this area related to how restaurants can use sound to enhance the dining experience and food and beverage companies can utilize sound to better market their products.
Charles Spence recently published a book called Gastrophysics: The New Science of Eating. It is about the quirks of human perception and how they play out at mealtimes. https://www.amazon.com/Gastrophysics-Science-Eating-Charles-Spence/dp/0735223467
Also, click these links to view some interesting videos about the topics discussed above:
What Kind of Hearing Loss Do You Have?
As described in our last blog post, the human ear can be divided into three general parts: the outer ear, the middle ear, and the inner ear. Hearing loss can occur in any, or multiple, parts of the pathway from the ear to the brain. Depending on where the hearing loss is occurring, hearing loss can be classified into three different types: conductive hearing loss, sensorineural hearing loss, and mixed hearing loss.
Note that in order to determine the type and degree of hearing loss, an audiologist would perform a hearing test and graph the results on an audiogram. In addition, different types of hearing loss require different types of intervention. Make sure to discuss all of your options with a medical provider.
- Conductive hearing loss occurs when sound cannot be transmitted from the outer ear, to the ear drum, and into the middle ear space (where the smallest bones in the human body, the ossicles, are located). This type of hearing loss can often be corrected medically or surgically. Common causes of a conductive hearing loss may include:
- Middle ear infection (otitis media)
- Earwax (cerumen) impaction
- Fluid or pressure in the middle ear from colds or allergies
- Poor Eustachian tube function
- Perforation in the eardrum
- Head trauma
- Swimmer’s ear (otitis externa)
- Sensorineural hearing loss happens when there is damage to the inner ear (the cochlea) or to the nerve pathways from the inner ear to the brain. This is the most common type of permanent hearing loss. And even when speech is loud enough to hear, it may still be unclear or sound muffled. Common causes of a sensorineural hearing loss can include:
- Exposure to loud noise
- Genetics (hearing loss that runs in the family)
- Drugs that are toxic to hearing
- Mixed hearing loss occurs when a conductive hearing loss happens in combination with a sensorineural hearing loss. In other words, there may be damage in the outer or middle ear as well as damage in the inner ear or auditory nerve. Common causes of a mixed hearing loss can include any combination of the other issues listed above.
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
The Benefits of Binaural Listening
The question regarding whether to purchase one or two hearing aids is an important topic to address with your audiologist during a hearing aid consultation. Hearing aids are an investment in your hearing health that can contribute to improved communication with family and friends and lead to better quality of life. Hearing aids are also a financial investment and it makes sense that many people want to weigh the benefits versus the cost.
In some cases one hearing aid truly is the best option. For example, a person may have a hearing loss in only one ear and normal hearing in the other ear. Another example is a person who has very little useful hearing in one ear; in this case a hearing aid may not provide any benefit at all and a cochlear implant may be the better option. In most other cases if both ears have a hearing loss then two hearing aids are better than one.
Binaural hearing is the term used to refer to hearing with two ears (whether with two normal hearing ears or with two hearing aids). Bimodal hearing applies to people who wear a hearing aid on one side and a cochlear implant on the other ear. Studies have shown that binaural/ bimodal hearing have many benefits and leads to improved communication ability.
Detecting Location of Sound
The ability to detect where sounds are coming from is called “localization” and is a function of the brain that is dependent upon sound being heard well by both ears. The brain uses timing and loudness cues to determine which ear received the sound first and at which ear the sound was louder in order to determine where the sound is located. The brain is unable to detect the location of sound accurately with only one (amplified) ear.
Understanding in Noise
When sound reaches the ears, the signal travels to the inner ear and is then transferred to the hearing never. It then travels up the brainstem to the hearing centers of the brain. The brain analyzes and combines the sound heard from both ears to help “tease out” the speech signal from the unwanted background noise. If the brain only receives sound from one amplified ear it has much more difficulty separating speech from noise.
When sounds are received by both ears the signal travels through multiple pathways in the brainstem. This double input of information to the brain creates a boost in the volume of the speech signal making it easier to hear. This boost or summation of volume does not occur with one ear.
Studies have shown that when the brain listens with two ears, less effort is needed to hear and understand speech which helps to reduce fatigue.
For more information about the benefits of listening with two ears or about bimodal benefit for cochlear implant users call Jacksonville Hearing and Balance Institute at 904-399-0350 to set up a hearing aid consultation.
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.
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
Sudden Sensorineural Hearing Loss (SSNHL)
A rapid decline in hearing that occurs all at once or over the course of several hours and should be treated as a medical emergency.
SSNHL most often occurs in one ear and may be accompanied by a feeling of fullness and ringing (tinnitus) in the affected ear as well as a room-spinning sensation (vertigo). Some individuals report hearing a loud “pop”. The hearing loss may be noticed first thing in the morning upon waking or when holding a telephone up to the affected ear. Other indications of a SSNHL include difficulty with understanding conversation in noisy environments and/or difficulty hearing sounds directed at the affected ear. In some cases voices may sound “fuzzy” or distorted.
It is estimated that the incidence of SSNHL is 20 cases per 100,000 persons a year. Both men and women are affected equally. SSNHL can occur across the lifespan however, there is a higher incidence for individuals in their 40s and 50s.
There are many possible causes of SSNHL however, cause is only identified in about 15 % of cases. Many times the reason remains unknown. Some causes of SSNHL include, viral infections, autoimmune disease, ototoxic (toxic to the inner ear) medications, trauma and compromise of blood circulation to the inner ear.
Treatment for SSNHL should be sought immediately. There is a high chance of recovery of hearing with prompt treatment. Unfortunately, many things can delay a person from seeking treatment. Symptoms of SSNHL are often thought to be related to allergies, a sinus infection or wax build up which can also result in a feeling of fullness in the ear and muffled hearing. In most cases the aforementioned will not be accompanied by tinnitus or vertigo and will likely affect both ears (unlike the typical presentation of SSNHL).
If a SSNHL is suspected it is very important to have an evaluation performed as soon as possible by a medical professional who specializes in disorders of the ear such as an otologist or otolaryngologist. Case history information, physical examination and results from a hearing evaluation completed by an audiologist will help confirm a SSNHL. Often times an MRI and blood work will be ordered to help determine the cause of the SSNHL. Treatment most commonly includes a course of corticosteroids given either in pill form and/or as an injection into the middle ear space.
In 30 to 60% of SSNHL cases spontaneous recovery of some or all of the hearing may occur within fourteen days of onset. In many cases however, the hearing does not recover on its own. The chance of partial to total recovery of hearing is high if treatment is received within ten days after onset, with the highest chance of recovery being when treatment is received within 72 hours of onset. In cases where treatment is delayed more than two to four weeks after onset, the chance of recovery is low and often times the hearing loss is irreversible.
If you experience a sudden change in hearing in one ear, which may or may not be accompanied by fullness, tinnitus and vertigo, please seek medical care immediately.
Noise Induced Hearing Loss
Exposure to loud noises is a common cause of hearing loss among the population. Noise induced hearing loss (NIHL) is characterized by a “gradual, progressive loss of high frequency hearing sensitivity that usually presents as a “notch” that occurs at or around 4000 Hz.” For more information on noise induced hearing loss, visit http://american-hearing.org/disorders/noise-induced-hearing-loss/ .
How can you protect your hearing?
There are many ways to prevent NIHL, such as:
- Avoid or limit exposure to dangerously loud sounds
- Decrease the volume of music systems
- Move away from loud sound sources when possible
- If you must be around loud sounds, use appropriate hearing protection
What kind of hearing protection devices are available?
At The Hearing Center, we offer a variety of hearing protection devices. Common devices include:
- Swim plugs are designed to prevent moisture from entering the ear canal during swimming, showering and water sports
- Shooter’s protection is designed to protect hunters/shooters from impulse noises up to 160 dB peak SPL. These devices can be made with special acoustic filters that allow for awareness of conversation and the ability to track animals.
- Industrial noise protection- Some work places require workers to wear custom hearing protection due to exposure to dangerous sound levels. Employees who work in industrial factories, construction sites and around aircraft equipment are likely to be required to wear hearing protection. Specialized devices can be made that can connect to radios for those who work in jobs that require radio use.
- Musician earpieces provide hearing protection for musicians who practice and perform in a variety of settings. Depending on the source and location of the sound, different levels of attenuators can be used in the earpieces to allow for optimal hearing protection.
- Motorcyclist’s protection is designed to help eliminate wind noise under a helmet.
- Custom sleep plugs can be used to promote interrupted sleep.
- Custom fit ear tips for mp3 players or other headphones are designed to have standard earphones fit into a custom fit ear tip. These earplugs help block excessive environmental noise and allow the listener to turn down the music volume.
If you believe you have a noise induced hearing loss, or at risk of one, make an appointment with your JHBI audiologist to discuss a custom hearing protection option that is suitable for your needs!