Hearing Health Spring 2023

Hearing Health

The Veterans & Hearing

Hearing loss from loud sounds is permanent but preventable

The mission of Hearing Health Foundation (HHF) is to prevent, research, and cure hearing loss and tinnitus through groundbreaking research and to promote hearing health. As the largest nonprofit funder of hearing and balance research in the U.S., we are a leader in driving scientific innovation and finding better treatments.

This issue’s theme is Veterans & Hearing Preservation, underscoring how hearing loss and tinnitus are consistently the top two health concerns among service members and veterans. With Memorial Day around the corner and the Fourth of July this summer, we are all reminded of the sacrifices our service members make every day for our country. Hearing damage from loud sounds is permanent, but preventable, and through our Keep Listening prevention campaign, we are continuing to sound the alarm about the risk to hearing from excess noise and how simple lifestyle changes can protect your hearing and overall health, including brain health.

HHF remains committed to creating a culture shift around healthy hearing, so that getting regular hearing tests, being aware of sound exposure, resting our ears, and wearing earplugs when needed are as reflexive as buckling seatbelts or applying sunscreen. Turning it down even just a little can help save hearing. Let’s love our ears.

Please enjoy this issue and share it with family and friends. Thank you for your support and for being a part of our community.

Timothy Higdon President & CEO Hearing Health Foundation

Hearing Health

The Veterans & Hearing Preservation Issue Spring 2023, Volume 39, Number 2

Features

08 Veterans A Veteran of Afghanistan and Iraq Urges Better Hearing Protection for Soldiers. Jon Barton

11 Veterans Let’s Take Care of Hearing Now. Derek Coy

14 Hearing Health Balance Problems? Noise May Be the Culprit. Rohima Badri, Ph.D.

16 Managing Hearing Loss The Ups and Downs of Being Hard of Hearing (and What to Do in Response). Bruce L. Douglas, DDS, MPH

19 Research A Scientist Steps Up to Serve.

20 Hearing Health Watching “Star Wars” With Common Sense.

Yishane Lee

23 Advocacy A Retired High School Teacher Continues to Educate. Susan Monroe

24 Education Top 3 Questions People Have About Their Ears. Kathleen Wallace, Au.D

28 Veterans A Pioneer in Hearing Conservation. Pat Dobbs

30 Meet the Donor My Hope Is to Turn Pain Into Progress. David Treworgy

34 Progress Report Highlights From the Hearing Restoration Project. Lisa Goodrich, Ph.D.

36 Progress Report Recent Research by Hearing Health Foundation Scientists, Explained.

Publisher Timothy Higdon, President & CEO, HHF

Editor Yishane Lee

Art Director Robin Kidder

Senior Editor Amy Gross

Staff Writers Pat Dobbs, Shari Eberts, Stephen O. Frazier, Kathi Mestayer

Advertising GLM: 212.929.1300

hello@glmcommunications.com

Editorial Committee

Judy R. Dubno, Ph.D.

Christopher Geissler, Ph.D.

Lisa Goodrich, Ph.D.

Anil K. Lalwani, M.D.

Rebecca M. Lewis, Au.D., Ph.D., CCC-A

Joscelyn R.K. Martin, Au.D.

Kathleen Wallace, Au.D.

Board of Directors

Chair: Elizabeth Keithley, Ph.D.

Sophia Boccard

Robert Boucai

Judy R. Dubno, Ph.D.

Jason Frank, J.D.

Jay Grushkin, J.D.

Roger M. Harris

Cary Kopczynski

Sharon Kujawa, Ph.D.

Anil K. Lalwani, M.D.

Paul E. Orlin

Robert V. Shannon, Ph.D.

Nancy Young, M.D.

Hearing Health Foundation

PO Box 1397, New York, NY 10018

Phone: 212 257.6140 TTY: 888.435.6104

Email: info@hhf.org Web: hhf.org

Hearing Health Foundation is a tax-exempt, charitable organization and is eligible to receive tax-deductible contributions under the IRS Code 501(c)(3). Federal Tax ID: 13-1882107

Hearing Health Foundation (HHF) and Hearing Health magazine do not endorse any product or service shown as paid advertisements. While HHF makes every effort to publish accurate information, it is not responsible for the accuracy of information therein. See hhf.org/ad-policy.

Cover Retired U.S. Marine Sgt. Jon Barton served in Afghanistan and Iraq. Credit: Bella Saville Photography.

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Hearing Health magazine (ISSN 2691-9044, print; ISSN 2691-9052, online) is published four times annually by Hearing Health Foundation. Copyright 2023, Hearing Health Foundation. All rights reserved. Articles may not be reproduced without written permission from Hearing Health Foundation. USPS/Automatable Poly

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MAKE CALLS WITH CONFIDENCE.

A B O U T U S

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dear editor: What a terrific magazine! I’m delighted to get the newest Winter 2023 edition of Hearing Health. I’ve been wearing hearing aids since 2001 and have upgraded them as my hearing declines.

Recently I have been appointed to my church’s Worship Team, focusing on hearing issues, and two particular articles really relate to my situation.

The article “Not Everyone Qualifies for OTC Hearing Aids” is wonderful as well as exactly what people who are just starting their hearing journey need to read. I would like to buy some reprints of the article to hand out to the people who ask me about OTC aids. Is this possible?

And the article titled “Educate, Educate, and Advocate, Advocate” contains very important information for the people with whom I work. Could I buy some reprints of this, too?

I’m delighted to have found your publication! Thanks for all the pertinent information. (I never even heard the word “misophonia” before, let alone know how to treat it.)

Thanks for any help you can give me.

Susan Monroe North Carolina

from the editor: We fully appreciate this wonderful letter! We encourage our readers to freely make copies of the articles they want to share with their community, citing Hearing Health Foundation as the source (and our website hhf.org). If you email editor@hhf.org we can send PDFs that may be easier to copy.

To read the Winter 2023 issue and all our past issues, please see hhf.org/magazine.

We are thrilled that after following up with Susan by email, she shared her own story—with lots of humor and candor—on page 23.

on the industry. The jury is still out on that.

Along with valuable information is always the realization that even with my corrected moderate hearing loss that occasionally causes me minor frustrations, I have absolutely no tinnitus and none of the other severe hearing problems mentioned in every issue that can and do seriously impact the quality of life.

It reminds me what I already know—that I have a blessed life at age 79-plus. It also jogs my memory to remind me that that a rock and roll palace (a former roller skating rink) with large loudspeakers every few feet was partially responsible for my hearing loss… learned too little too late.

Thanks again for your excellent magazine.

John Morrison

Michigan

dear editor: I read Pat Dobbs’ story “Let’s Remember No One Hears Perfectly” in the Spring 2022 issue and have to admit, I’ve tried many of her techniques. I plan to start looking for quiet spots in the future as well.

Typically, when I encounter a new person, I debate whether I’ll let them know that I’m wearing hearing aids and hear poorly. If I decide to keep it a “secret” sometimes I regret my decision as the conversation progresses. At that point I say, “I wear hearing aids and hear poorly, you’re probably picking up on that.” It’s a fun way to put out the information.

Thomas Silveria

Rhode

Island

dear editor: I have been receiving your magazine for about five years and never an issue goes by without several very helpful articles. Good one this Winter 2023 issue on OTC hearing aids. Been wondering about their impact

We always appreciate hearing from our community with any and all types of feedback. Letters may be edited for length and clarity. Please email us at editor@hhf.org.

Healthy Hearing Habits for Life

For World Hearing Day March 3, HHF launched a new 60-second video to help create a culture shift about how we think about our hearing. In “Love Your Ears,” we describe how half of young people (ages 12 to 34) are at risk of hearing loss from loud sounds, and ask: Why are we so reckless with our hearing? In a nutshell, it’s because we take hearing for granted. We protect our health every day—by wearing sunscreen, buckling up, and making smart diet and life choices—let’s make hearing part of it. Watch the video (stills shown above) at youtube.com/hearinghealthfoundation.

Research Webinar Updates

Launched in October 2020 and presented quarterly, HHF’s research webinar series features notable Emerging Research Grants (ERG) alumni who share their scientific findings on topics including tinnitus, hyperacusis, “hidden” hearing loss, Ménière’s disease, and auditory processing disorders. Moderated by Anil K. Lalwani, M.D., the head of HHF’s Council of Scientific Trustees and a member of HHF’s Board of Directors, the webinars include an open Q&A period. All are available as captioned recordings at hhf.org/webinar, where you can also sign up to get alerts about future webinars.

ARO MidWinter Meeting

The annual Association for Research in Otolaryngology (ARO) MidWinter Meeting is the preeminent conference for scientists and clinicians conducting research in the hearing and balance fields. HHF was pleased to attend the 46th meeting in February 2023—the first in-person meeting since January 2020—and see so many of our funded researchers, past and present.

HHF President and CEO Timothy Higdon (far left) met with Stefan Heller, Ph.D. (near left), of Stanford University, a member of HHF’s Hearing Restoration Project, and a 2001–2002 ERG scientist. For more, see hhf.org/blogs/aro-midwinter-meeting-in-person-again.

A Veteran of Afghanistan and Iraq Urges Better Hearing Protection for Soldiers

By Jon Barton

Last year, in 2022, I donated about $1.2 million in military and tactical equipment to Ukraine. I wasn’t trying to do anything political. I was just trying to help humans.

All told I sent over 80 percent of my inventory— hundreds of uniforms, boots, and gloves in various camouflage colors and conditions. I had all this inventory because I own a military consulting and rental company that advises film and TV productions.

But what I could not provide is enough protection from loud sounds. Explosions, artillery fire, gunshots, aircraft, tanks, armored vehicles—war is noisy. And I know that noise exposure, whether it’s a sudden burst or a constant drone, will affect civilians and soldiers alike for decades to come. Already there is a report in The Hearing Journal regarding Ukrainian refugees who are arriving in Poland. They are showing significant hearing loss, with perforated eardrums from bomb shockwaves.

I know. My hearing was damaged during two combat tours as a Marine infantryman, and later as a Light Armored Reconnaissance (LAR) vehicle commander, from 2001 to 2011.

The most common disabilities experienced by veterans are hearing loss and tinnitus. These are less visible but insidious conditions that can seriously upend every aspect of our lives, from our overall physical and psychological wellness to social interactions, and including work performance.

Hearing damage—hearing loss and tinnitus (ringing

in the ears)—can result from exposure to loud sounds. In recent conflicts, service members are particularly affected by roadside bombs and other improvised explosive devices (IEDs). But even soldiers in training can have their hearing impacted if proper precautions aren’t taken.

Of course, I am proud to have served my country and recognize that the hearing loss and tinnitus I experience now does not approach other severe wounds of combat. My hearing was damaged when the pressure from a rocketpropelled grenade pierced my eardrum. It was aimed at a building where we were bivouacked.

When I entered basic training in 2001 I was issued earplugs, but they were faulty. Shortly before my first deployment to Iraq in 2003 I received 3M earplugs that kept falling out, and that later became the focus of a class action lawsuit. (I was a plaintiff in a separate lawsuit, though I was not deposed.)

Advocating for better hearing protection has become a personal cause. In addition to that caused by the rocketpropelled grenade, my hearing damage was compounded by countless firefights and riding in noisy armored vehicles as a platoon commander.

But I did not realize that playing video games, which I do with the volume cranked up so I can hear, was also harming my hearing. Until I started working with Hearing Health Foundation on their Keep Listening campaign, I didn’t fully grasp that this activity my buddies and I do to relax, could be making our hearing worse.

It

Getting the Best Protection

rocket-propelled

Hearing loss is a constant struggle for me, both physically draining and psychologically frustrating. People have to yell to get my attention even if I’m in the next room. I hear ringing in my ears that causes dizziness and headaches. I can’t hear certain frequencies, which makes listening to music difficult. I don’t talk on the phone unless I use earbuds, otherwise I can’t hear what the other person is saying. I find myself talking much louder than I should or need to in social settings. I can’t hear the TV unless I blast the volume so loud others can’t tolerate it.

Today for my work, I use expensive, custom-fit, electronic in-ear voice-activated earplugs, and clip-on ear, and/or advanced frequency-activated, helmet-integrated over-ear headsets. I train actors in using this cutting-edge ear protection equipment on set because I feel life can imitate art, and if military leaders see these used in action movies, then perhaps they’ll push to get them in their military units. It has always upset me that I never had these devices on the battlefield, so in the wars I create, I want to make sure everyone has the best protection.

I’m aware that hearing damage has broader health ramifications. Most concerning to me is the link between untreated hearing damage and cognitive decline. Difficulty hearing also puts stress on the heart by releasing fight or flight hormones. While I have not had these problems, I’d be a fool if I didn’t worry about the future.

I know I’m not alone. Every veteran out of many dozens

I know has some degree of hearing loss. Many of my older vet friends wear hearing aids because their hearing has become worse over the years. Because of this, I am always telling fellow vets and everyone else to protect their hearing from loud sounds and to get their ears checked twice a year.

In training we were taught to use hearing protection, or “ear-pro” in military terms. We used protection religiously in training, and earplugs were mandatory on almost all live-fire training ranges.

But the military’s operational practices during combat are far less restrictive than in training. Basically, ear-pro is optional in war.

The bigger issue was not having access to more advanced ear-pro technology that pilots, tank drivers, flight line crew, mechanics, and others did have. Some of that technology is making its way into the infantry and other fighting units. However, it took until 2021 for combat ground units to finally get full over-the ear-combination communication and ear-pro equipment.

In my time in the Corps I only ever witnessed stepchange technology in ear-pro twice. The first time was right before combat deployments in 2003, where we switched out our little green flimsy stick plugs to new “cutting edge” long and short, double sided combat plugs. They turned out to be just as flimsy, and just as impossible to fight in. Five years later when I left the infantry and became a vehicle commander I was issued my first combat

Of course, I am proud to have served my country and recognize that the hearing loss and tinnitus I experience now does not approach other severe wounds of combat. My hearing was damaged when the pressure from a

grenade pierced my eardrum.

was aimed at a building where we were bivouacked.

Advocating for better hearing protection has become a personal cause. In addition to that caused by the rocket-propelled grenade, my hearing damage was compounded by countless firefights and riding in noisy armored vehicles as a platoon commander. But I did not realize that playing video games, which I do with the volume cranked up so I can hear, was also harming my hearing. I didn’t fully grasp that this activity my buddies and I do to relax, could be making our hearing worse.

vehicle crewman (CVC) helmet. This amazing piece of kit had high-speed noise-canceling headphones built right in, and it was a game changer.

Unfortunately, going from grunts to the “iron horse” made me aware of how bad we had it on the ground side regarding ear-pro. On my first training op at Camp Pendleton as a vehicle commander, I took my CVC off and immediately became aware of the noise damage your unprotected ears could suffer just from riding inside an armored vehicle.

During this training op, with my helmet on I was able to communicate safely and effectively with my crewmen while all around us roared a vicious, unrelenting, and unbearable cacophony. But seated right behind me on the troop benches were my infantry brothers, who could only communicate with hand signals and were driven nearly mad by the noise onslaught to their ears for hours.

As a Sergeant and a Marine, I fully understand that noise in the battlespace is just another part of the “fog of war,” but that was the first time I began to wonder why had we spent so many years with little sticks in our ears during combat when technology existed that could have helped us be more effective warfighters.

Since I first aired these concerns in Stars & Stripes in the fall of 2021, I see that the military now makes annual hearing tests mandatory (instead of every six years). I’d also like to see soldiers taught how to evaluate their own hearing, such as with an online hearing test, with an open path to bringing it up the chain of command. I also

encourage the military to standardize the best hearing and communications equipment, create a more rigid policy for its use, and improve education about the importance of hearing protection.

There is always room for every branch of the military to do better in protecting the well-being and health of its soldiers. I hope my experience and that of others will help bring about new policies and practices to do that.

Jon Barton is a military technical consultant to Hollywood productions on war and combat. He served with the U.S. Marines from 2001–2011 as an 0351 infantry assaultman, LAR antitank vehicle commander, and battalion-level asymmetric warfare/counter IED instructor. He is the author of more than a dozen screenplays and military science fiction books. For more, see night-fire.com. Special thanks to Suzanne Trimel for help with this story.

Let’s Take Care of Hearing Now

Teaching by example, a former Marine who served in Iraq helps his fellow veterans take of their health to avoid regrets later. By Derek Coy

My music taste is very eclectic, thanks to my formative years. One of my favorite things to do as a kid was dig through my mom’s old albums, choose a few, put some headphones on, and be entertained for hours. The playlist included anything from Lionel Richie to the Doobie Brothers. Quinceañeras and weddings were cultural staples for me growing up as well, so listening to Tejano music blaring all night was not uncommon.

Mix that with growing up during the golden age of hip-hop and listening to music in cars with laughably loud sound systems, and I can say I was definitely exposed to quite a bit of loud music during my early years.

Still, this doesn’t quite compare to the noise I experienced during my time in the military, including a year deployed to Iraq where I worked in close proximity to aircraft, constant exposure to firearms and explosions, traveling aboard the aircraft carrier USS Essex for a year (an incredibly loud environment), and living on an airbase when I wasn’t deployed.

All of this has added up to my having chronic tinnitus and a hearing loss. And it’s why I now am working to sound the alarm about the importance of taking care of hearing from a young age, especially among young service members and veterans.

Four Years of Service

I followed in my father’s footsteps and became a Sergeant in the U.S. Marine Corps. I served from 2004 to 2008, including a deployment to Iraq from 2005 to 2006, and another aboard the USS Essex for all of 2007.

I had a very atypical time in the military, and served with several different units doing anything from security and operating heavy equipment to driving Humvees.

I do assume some responsibility when it comes to my hearing from listening to music, loudly, when I was younger, but I was somehow able to join the service with most of my hearing intact.

Then, as my service continued, I noticed it worsening. It

I noticed the tinnitus after my first deployment to Iraq. There were so many changes and adjustments throughout that year that I just learned to deal with things and move on, so it wasn’t until I was home for a few months that it dawned on me that the ringing in my ear was happening a bit frequently. Unfortunately, like most people in the military, I just tried not to think about it and didn’t pay it much attention.

wasn’t until my final health screening before leaving the service that I realized my hearing had diminished measurably during my time in the Marines.

In particular I noticed the tinnitus after my first deployment to Iraq. There were so many changes and adjustments throughout that year that I just learned to deal with things and move on, so it wasn’t until I was home for a few months that it dawned on me that the ringing in my ear was happening a bit frequently. Unfortunately, like most people in the military, I just tried not to think about it and didn’t pay it much attention.

Now I have periodic and sustained ringing in my ears and difficulty hearing in both ears, one more so than the other. I am service-connected for hearing loss and tinnitus from the Department of Veterans Affairs, and while I was not indicated for hearing aids, I now carry earplugs and use them the most when I take the subway, which is nearly every day. I had been using the typical disposable foam earplugs, but the waste bothered me. Recently I started using high fidelity concert earplugs that are reusable and work well.

City Living

I love living in New York City. It’s my favorite place in the world, but doing so with a hearing loss has been a challenge. You can get pretty much whatever you need in NYC— except for silence. It is great to meet with friends over drinks and dinner, but since space is limited in the city, you are often in pretty close proximity with a lot of other people. Every person at every table or at the bar is conversing, and it can be difficult to focus on listening to someone when there is a ton of competing ambient noise.

Even if the location is relatively quiet, there is always noise coming from the street or competing background music. One on one I tend to do all right, but if I’m with a group of people, I often miss out on parts of the conversation and hate asking for folks to repeat themselves all the time. I very frequently try to gauge body language to pick up on the missed words.

Living in a noisy city can be a bit anxiety-inducing, too, since I can’t rely on my hearing as much as I’d like. I find myself more hypervigilant than usual to make sure I don’t find myself in a precarious position. There are always crowds of people walking around, and I try to be aware of my surroundings. But every now and then someone will walk past me from behind, and that can be jarring if I thought I was alone because I couldn’t hear them.

It’s also hard to differentiate general crowd noises from what could be an emergency—

These photos were taken during Coy’s promotion to Sergeant. “I was fortunate to have my father award that to me during the ceremony—which was one of the great days of my life,” he says.

both of which are frequent in the city. Sometimes I can’t tell if people are screaming from something bad, or cheering for a street performer!

Until the start of the pandemic I, like many others, didn’t realize how much I rely on reading lips to supplement my poor hearing. Once we all started wearing masks, it became increasingly difficult for me to understand what people were saying. Like many other things these past few years, that took some adjustment.

Long-Term Effects

There’s a certain amount of pride often seen in the military where enduring pain and sacrificing your well-being for a larger purpose is revered and often rewarded. Of course, there is a need for that at times in the military and it’s something that is reinforced in training, but no one tells you it isn’t helpful once you transition back to civilian life, and that in fact it’s often detrimental. It’s great that we can get away with a lot when we are younger—no sleep, poor diets, and self-medication—but Father Time is undefeatable, and that amount of resilience has an end date much sooner than we think when we are young.

I recently gave a presentation on healthcare options to a group of student veterans and I touched on this idea. It was clear that many, like me, never really considered the long term effects of their time in service—and what’s more, now that their service was completed, that they need to be responsible for their health themselves.

This is because in the military, there is always someone to take care of whatever specific need you may have, but it’s the opposite once you get out. As civilians, former

soldiers must learn to be mindful about their own health needs, and they need to do this starting from a young age.

Preventative measures always pay dividends in the long run. It’s counter to what we believe when we are young, but we aren’t invincible. I never really planned or thought about longer term issues or the repercussions of my lifestyle, and I wish I had taken better care of myself, such as by carrying and wearing earplugs in noisy settings.

I advise the young service members and veterans I meet to start proactively protecting their health now and to not let any concerns, such as hearing damage, persist before addressing them. From the feedback I’ve received, this is a message that resonates. I can only hope that we all are able to adopt healthy habits for life, including for our hearing, so we’re able to live life to the fullest.

Derek Coy is the senior program officer for veterans’ health at New York Health Foundation in New York City.

I advise the young service members and veterans I meet to start proactively protecting their health now and to not let any concerns, such as hearing damage, persist before addressing them.

I share how I wish I’d taken better care of myself, such as by carrying and wearing earplugs in noisy settings.

BalanceProblems? Noise May Be the Culprit

By Rohima Badri, Ph.D.

Have you ever felt dizzy, nauseous, or unsteady on your feet after leaving a loud concert? That could be the balance organ inside your inner ear reacting to the loud sounds.

We now know that noise affects our hearing and increases our risk of hearing loss and tinnitus. However, the balance (vestibular) organs, which are also located in the inner ear, can also be affected by noise overstimulation and cause devastating effects—dizziness, vertigo, imbalance, and blurred vision, to name a few.

According to the National Institutes of Health, 90 million Americans experience dizziness at some point in their lives. Vestibular disorders are common health complaints among people over the age of 70, causing falls and loss of balance. Individuals with balance conditions are highly prone to anxiety, depression, and cognitive deficits.

The vestibular system in the inner ear consists of three semicircular canals filled with fluid that aid in detecting various head movements, such as tilting the head up or down, to the right or left, or in a sideways motion. The utricle and saccule, two nearby otolith organs, sense acceleration and respond to gravity. Collectively, the five organs receive sensory data from both ears, which is then processed in the brain and sent to the organs that help us balance and orient us to our surroundings.

Both human and animal studies show that prolonged or intense noise exposure can cause structural and functional damage to the vestibular organs and their pathways leading to the brain. Significantly, research indicates that the extent of noise damage to the vestibular system, like the auditory system, is determined by characteristics such as duration, frequency, level, and time course. For example, vestibular damage can be caused by both brief exposure to an intense sound like an explosion or by repeated/ continuous exposure to loud sounds over a period of time.

Hearing and balance are more connected than we

realize. Jennifer Stone, Ph.D., a member of Hearing Health Foundation’s Hearing Restoration Project, presented a webinar on the relationship between balance and hearing that emphasized the close relationship between the hearing and balance organs.

“People who have hearing loss are much more likely to have balance disorders than those who do not have hearing loss,” she explains in the webinar. “This is in large part because the primary organs for hearing and balance are both located in the inner ear in a common space, and they share similar biological and physiological features. So, importantly, the same things that cause hearing loss also induce vestibular deficits and vice versa.” She adds, “Our vestibular sense, like our hearing sense, is crucial for our well-being.”

Noise-induced vestibular damage, like noise-induced hearing loss, can be prevented. Protect both your hearing and your balance by following safe listening practices, keeping up with regular hearing checkups, and being on the lookout for any problems with balance.

Rohima Badri, Ph.D., lives in New Jersey. For healthy hearing tips, see HHF’s Keep Listening campaign at hhf.org/keeplistening. For references, see hhf.org/spring2023-references.

Invisible Hearing Aid Uses CIA Technology

So Powerful That It Can Pick Up a Whisper Across the Room

Here’s How You Can Get Them Today To Hear More Clearly And Stay Engaged in Conversations…

Most modern hearing aids have serious flaws:

• Everybody notices them – they’ll make you look 20 years older the instant you put them on

• They collect sounds from behind you – which makes hearing your friends in a restaurant or crowded room impossible

• They use 10-year-old technology that amplifies everything (sometimes too loud!)– which can cause even more hearing loss!

Fortunately, there is a better way. Soundwise uses CIA technology that was specifically designed to pick up whispers so hearing your loved ones or the television so much clearer is virtually guaranteed.

No more avoiding noisy restaurants, movie theaters, or crowded places. You can hear your friends AND enjoy life thanks to Soundwise.

Plus, hearing loss is a leading cause of dementia and deadly falls among seniors. Don’t become another victim!

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• CIA-developed digital audio enhancement

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• Backed by Board Certified Hearing Specialist Dr. Kenneth Nunnally

• Risk-Free Home Trial with ONE YEAR Guarantee –the only one of its kind in the industry!

• Free portable charging station so you’ll never have to worry about batteries – the charge lasts 2 full days!

Dr. Kenneth Nunnally

By Bruce L. Douglas, DDS, MPH

The Ups and Downs of Being Hard of Hearing (and What to Do in Response)

I am 98 years old this year and work at the University of Illinois School of Public Health, where I am a professor of health and aging. It is actually my sixth appointment at the university. I have been leading a research project on “the effect of senescence on the quality of life of older people,” with a high priority on communication ability, especially hearing loss.

This subject is near and dear to my heart. It’s of great concern to me that hearing problems do not receive their fair share of attention as research proceeds on issues of quality of life among the aging population.

In addition to working as an oral surgeon, dentist, state legislator, and activist, I am a U.S. Navy veteran, and it was during my service, while on active duty during the Korean War, that a one-time noise exposure from an M1 rifle during a training exercise (none of us used hearing protection) left me with permanent, chronic tinnitus. I had earlier been living with a hearing loss, something my father and grandfather also experienced, although I did not use hearing aids till well after my service. After wearing hearing aids for decades, I had cochlear implant surgery in my right ear at age 91.

Even with this remarkable technology that continues to improve, managing our expectations of how well these devices do or do not work affects our ability to communicate. Here I detail the ups and downs.

Ups

It’s no secret that there are lots of sounds that are better not heard, so on some occasions I actually turn off my hearing aids. I even do it at home when some voices are, in my opinion, better not heard by me! Of course, no one knows that I’ve escaped into the peaceful world of silence.

Since my hearing aid and cochlear implant are controllable on my cell phone, my wife, daughter, and grandson—all occupants of my home and with whom I eat dinner regularly—assume that I am being momentarily rude and answering a text message. Also, I can turn the sound down considerably if I wish, which is a unique characteristic of hearing assistive devices, as compared with human hearing capability.

Then, there’s the delightful experience of succumbing to deafness when I retire for the night, and my hearing devices are comfortably sitting in their dehydration machine. If you’re wondering how I handle emergencies, I have a device that flashes strobe signals if the burglar or fire alarm sounds off, and a vibrating pad under my pillow that I use to awaken in the morning. If my wife needs to communicate with me during the night, she has a button that turns on our bed lights and I have learned to read her lips if she wishes to tell me something important. My hearing aids are just an arm’s length away and available if necessary.

These ups are not gimmicks! My hearing devices are important parts of my life and my close relatives know and respect that fact.

Downs

Now to the “downs,” and there are many. Being hard of hearing, even with my advanced equipment at work in both ears, can be a drag! I have learned to live with most inconveniences that accompany near deafness, but doing so can, to put it mildly, be overwhelmingly tiring.

The tiredness that I feel at the end of a normal day at the university is unlike the tiredness one feels after working out or climbing flights of stairs. It is instead what

I call cognitive exhaustion. It’s a sensation that can only be modified with one glass, in my case, of red wine, and 15 minutes of watching the TV news before I’m ready to rejoin the human race and sit down at the dinner table.

The hardest part of being hard of hearing is that you are a victim of an invisible condition. Therefore, companions or even knowledgeable close relatives either don’t know, or forget, that you have difficulty hearing, unless the environment around you has been modified to accommodate your hearing loss.

That’s not difficult to do at home, but it’s near impossible to do in the outside world. Most of us think of that world as “hostile” and the people in it “insensitive,” but it’s something to which we must adjust, if we want to remain working in parts of it.

We don’t want sympathy. We want sensitivity to the fact

that we cannot communicate with someone effectively unless we can see that person’s mouth as they speak and the person with whom we are talking is “nearby”— meaning, in the same room.

Most of us hear the spoken word, but we have difficulty understanding it if it isn’t spoken clearly or spoken too rapidly. We invariably have difficulty with accents and high pitched sounds, which usually means women’s voices. Unfortunately most people with hearing loss are hesitant to spend a few moments explaining to their companion(s), at the beginning of a social interchange, that they are hard of hearing and that it would be very helpful if others would take that into account.

The Biggest Challenge

The sad reality is that such hesitancy often leads to the biggest problem in the arena of hearing loss, and that is people who are hard of hearing too frequently acting like they are hearing when the opposite is the case.

And they in effect deceive their companions into thinking that they are in on the conversation. In frustration, the person with a hearing loss uses facial expressions and head movements to lead their companion to assume that they are hearing and digesting everything that is being said. Depending on the nature of the relationship, the results of such deception on the part of the person with a severe hearing loss can cause social chaos and extreme embarrassment.

The personality of the person with a hearing loss relates intimately to how they act and react to adverse social situations. My advice is to follow the principles of prevention, which I break down into primary, secondary, tertiary, and auxiliary categories.

Primary prevention suggests that it may be wise to avoid these situations entirely. But if Covid has taught us anything it is that humans are social creatures, so completely avoiding social situations will not benefit our mental health.

Secondary prevention consists of prepping your audience beforehand about your problem. Request that when they are addressing you, they face you and try to speak slowly and clearly. At least you are informing people of your problem, and sparing yourself the social ostracization that sometimes accompanies such situations.

Auxiliary prevention consists of setting up the environment beforehand and taking into account the potential challenges. We can change the location of chairs, close curtains or drapes, turn off background music, and ask to chat in a location far from other competing conversations. We can delay communication until these parameters are met and/or we can talk face to face.

Now a professor of health and aging, Bruce Douglas is a U.S. Navy veteran who was on active duty during the Korean War.

Personality, Age, and Advice

The personality and, usually, age of the person with a hearing loss are inextricably related to how well they can handle the “downs” of hearing loss. Let’s face it, it’s a tough life for people with hearing loss. We have to adjust to an unintentionally adverse world in which very few people have the patience and sensitivity to accept our handicap with equanimity.

It is not uncommon for those with hearing loss to compensate for not being able to hear in social situations to become the dominant speaker. I gradually realized, supported by my wife’s observations, that my tendency to lead or even monopolize discussions was that as long as I was talking, I did not have to strain to understand what other people were saying.

It is wise for those among us who find that withdrawal from social challenges is their last resort, to seek help from a therapist, preferably one who also has a hearing loss and understands the challenges from personal experience. That recommendation applies to people of all ages. It just isn’t worth the pain that results from withdrawal and the loneliness that accompanies it.

I believe the main way in which to approach the downs of hearing loss is to look in the mirror and decide, along with your closest friends and relatives, what you want (and need) out of life. Hearing aids and cochlear implants have improved tremendously in recent years, but they are still only devices to help you to subsist, under the best of circumstances, within your own capabilities and circumstances, in environments of your own choosing. Groups, restaurants, large family gatherings, and any

places with loud background noise are not places of comfort for those who have hearing loss and who want to participate in the activities that take place in such settings. Auxiliary prevention answers the question of how to handle mildly adverse environments, but it requires a degree of aggressiveness that is not within the comfort range of many people with hearing loss.

Finally, if I may speak for all of us with a hearing condition, I ask our family, friends, and folks we interact with on an everyday basis to please be patient. We have an invisible condition, most often beyond our control, and it’s all we can do to try to hear and listen to you and respond to the best of our ability.

Bruce L. Douglas, DDS, MPH, is a professor of health and aging at the University of Illinois at Chicago School of Public Health. He shared his hearing loss journey in the Fall 2018 issue of Hearing Health, at hhf.org/magazine.

It’s no secret that there are lots of sounds that are better not heard, so on some occasions I actually turn off my hearing aids. I even do it at home when some human voices are, in my opinion, better not heard by me! Of course, no one knows that I’ve escaped into the peaceful world of silence.

Douglas was stationed in the Japanese port of Sasebo, where U.S. Marines took off for the Korean battleground.

A Scientist Steps Up to Serve

Vijaya Prakash Krishnan Muthaiah, PT, Ph.D., is an assistant professor in the department of rehabilitation sciences at the University at Buffalo (UB), the State University of New York. His 2019 Emerging Research Grant was generously funded by Royal Arch Research Assistance.

Currently at the UB Brain Plasticity and Neurorehabilitation Laboratory, Krishnan Muthaiah’s research investigates how neurotrauma and occupational hazards—especially noise exposure—affect the inner ear and respective higher centers of the brain. He has been focusing on auditory and vestibular neurodegeneration using both preclinical animal models and human subjects.

Here is the published research so far stemming from his 2019 grant:

» Evidence of Brain Tissue Damage From Blast Overpressure

» Mass Spectrometry Imaging Reveals Effect of Blasts on Neurotransmitter Levels in the Chinchilla Model

» Identification of a Potential Therapeutic Approach for Blast-Induced Hearing Loss and Tinnitus

Because Krishnan Muthaiah’s work led him to interact with and interview members of the military, he was inspired to serve himself. We cannot think of a more meaningful way to show dedication to the service our military provides.

“I bring veterans from VA Buffalo as our study participants,” Krishnan Muthaiah says. “In addition to blast TBI [traumatic brain injury] as my research focus, I also focus on environmental metal ototoxicity.

“During the course of my interaction with many veterans during the studies, I got inspired and inquired about the opportunities,” he continues. “I found that I am eligible to join the U.S. Coast Guard [USCG] even though I am 40 years old. Hence, I took the opportunity to join as a reservist and completed the Coast Guard boot camp training.”

Krishnan Muthaiah is a reservist at the Inspections Division, Sector Buffalo, USCG.

“I graduated from the 2022 DEPOT, which is Direct Entry Petty Officer Training Boot Camp, at the USCG Training Center in Cape May, New Jersey, with enlisted rank E3,” he says. Upon successful completion of additional training this summer, he will be rank E4. We thank Krishnan Muthaiah and all service members for their dedication. —

Yishane Lee

Vijaya Prakash Krishnan Muthaiah, PT, Ph.D., is a 2019 Emerging Research Grants scientist generously funded by Royal Arch Research Assistance. To read details about his research, see hhf.org/spring2023-references.

Watching ‘Star Wars’ With Common Sense

When my now-teenaged kids were little, the video media they consumed was of the “Thomas the Tank Engine” and “Peppa Pig” variety. I realize now I likely had both on repeat largely because the characters’ British accents gave a cultured sheen to what could, as a genre, feel like mind-numbing dross. The shows were reliably tame and even-keeled, with the most action-packed drama coming from, say, a train that’s lost its parking spot in the depot, or Peppa muddying her boots one too many times.

Gradually, as our kids got older and their attention spans and interests grew, and bedtimes grew later, we started watching movies together. This was a massive turning point in our social life: the advent of family movie night! There was one summer in particular, ahead of J.J. Abrams’ reboot of the “Star Wars” franchise, where we sat the kids down and, one by one, rewatched every single “Star Wars” movie in order, and interspersing the films with shorter episodes from the animated TV shows “The Clone Wars” and the genius “LEGO Star Wars.”

The hope was the kids would develop their own love for these rich galaxies of droids and planets and creatures and the ongoing fight between good and evil. My husband owns the (now non-canon) universe-expanding paperbacks, and I am old enough to remember going to the original “Star Wars” with my family (my dad fell asleep) and dressing up as Leia for Halloween.

After being able to immerse the kids at home with all the background movies and TV shows, we felt prepared for the new “A Force Awakens,” released in December 2015. Even at our small theater in the suburbs, the first “Star Wars” movie in 10 years warranted the hiring of local actors dressed up as the characters from the film. I mean, it was really an event on this Saturday morning—which

By Yishane Lee

was actually our second viewing, because my husband and I had gone to see it the night before, opening night, with other parent friends of a certain age.

But in contrast to watching the “Star Wars” oeuvre at home, in the theater we couldn’t control the volume. Our younger child, then age 6, was immediately deeply uncomfortable, squirming around with his fingers in his ears, and I hadn’t thought to bring earplugs. It really got me thinking about the volume level in movie theaters.

It Makes Sense

Most parents and caregivers are familiar with Common Sense Media, referring to this website on a regular basis to get a “is it safe for the kids or not?” read on whatever new movie, show, game, or other media has penetrated their consciousness so that they are begging their parents to watch or play it. If you do not have a child in your orbit it’s quite possible the name does not ring a bell at all, but for those of us having to manage the media deluge, it’s invaluable for its expert ratings on content, much more detailed and nuanced than the MPAA’s PG, PG-13, or R ratings.

Common Sense flags and rates the level of violence, sex, and language depicted, and suggests an age, like “10+”, for the movie to be appropriate. These ratings have expanded to details about drinking, drugs, and smoking; consumerism; and even whether there are positive messages or diverse role models—all represented by clever little icons: lips for sex, romance, and nudity; $ for products and purchases, #! for language.

As the sound level of movies continued to bother our son, and actually all of us especially during previews, I realized the one rating that is sorely missing is a volume

rating. This is a bit of a surprise, given that the World Health Organization estimates 1.1 billion young people are at risk of permanent hearing damage due to excess noise. A BMJ Global Health report estimates that half the population ages 12 to 34 is in danger of hearing loss from loud music specifically, from attending live concerts and the chronic use of headphones and earbuds.

I have been working at Hearing Health Foundation since my son was 11 months old, and have become well aware of the damage to hearing from loud sounds. I’ve learned that hearing loss is permanent.

I’ve learned that hearing damage includes experiencing muffled hearing or tinnitus (ringing in the ears), and that even just temporary ringing can indicate early damage to our ears. And now, increasingly over the years, there is a growing body of research showing that untreated (and for that matter, undiagnosed) hearing loss is linked to a host of other health issues, including brain health.

Just imagine what the constant noise exposure is doing to our brains and ears—from loud environments including bars and restaurants, movies, gaming, and constant earbud or headphone use. And then think about that effect on the youngest brains.

Monitoring sound levels when headphones or earbuds are used is near impossible for a parents. We can set up a max volume level in the settings, maybe, but it’s far different from when our own parents could instantly hear us blasting music from a stereo or radio.

As parents, we try to be vigilant about media being safe for consumption, that it is age appropriate. We worry too about the effect of a screen’s blue light on teenagers’ sleep, and on vision generally (a growing number of children are being diagnosed with myopia). We worry about screen

time and social media use and the effect on mental health. We should also be aware of safe sound levels. It’s not just the screen time, it’s also the ear time.

When we use earbuds or headphones all the time, this is sound that’s piped directly into our ears. Not for nothing was there a lawsuit filed when a sudden Amber Alert caused permanent hearing loss, tinnitus, and vertigo in a 12-year-old who was watching Netflix on his phone with headphones when the alert about a missing child was issued, without warning.

Noise Ratings, Please

Here’s my suggestion: To determine a noise rating, we could analyze the frequency of explosions and other loud sounds—say, how many blasts per minute, on average—and the overall sound level of a film. The ratings would be given in terms of one to five megaphones.

Yes, I understand that the volume that movies play at in the theater is often set by the theater itself, on an individual or a chain basis. This is usually the excuse I’m given for why it’s fruitless to try to get the movie industry to turn it down. There also seems to be no industry standard for movie sound levels. (TV commercial volume levels are set by the Federal Communications Commission. You can even file a complaint at fcc.gov.)

Yet parents and caregivers would be far better equipped for loud movies if there was an overall noise rating, along with all the other ratings that Common Sense provides, so we can bring earmuffs or earplugs, or seek out “sensory-friendly” showings that some theaters host.

There is a ton of chatter online about the art of sound mixing so that the audience is able to easily hear the dialogue during quiet scenes while also not having their

Evidence of our “Star Wars” fandoom (opposite page, from left): LEGO Darth Vader, R2-D2 with friends, at a morning screening of the franchise’s big screen reboot, my Leia hair then, and my daughter’s Rey hair now.

This suggested mockup (above) is modeled on existing Common Sense Media ratings (right), to inspire a future category.

ears blown out during louder scenes. In action movies, I understand that the suddenness of loud sounds is part of the point, but a noise rating from Common Sense could at least give some advance warning.

Keep Listening

Here at Hearing Health Foundation our Keep Listening prevention campaign is dedicated to creating a culture shift in how we think about our hearing, so that we can prevent hearing damage from loud sounds and continue to hear the things we love, for life.

Part of this campaign—in addition to teaching safe listening practices (carry and use earplugs when you need to, turn it down, and rest your ears after loud events)—is to convey the message that having fun doesn’t have to be ear-damagingly loud.

As the Centers for Disease Control and Prevention (CDC) points out, “Noise above 70 dB over a prolonged period of time may start to damage your hearing.” In other words, even a 3 dB increase in volume doubles the sound intensity. A 10 dB increase is 10 times the sound intensity. Our ears, though, perceive the 10 dB increase as “just” twice as loud: Ten violins sound twice as loud as one violin.

However, the problem is that hearing damage comes from the sound intensity, not the perceived loudness. The CDC points out, “The risk of damaging your hearing from noise increases with the sound intensity, not the loudness of the sound. If you need to raise your voice to be heard at an arm’s length, the noise level in the environment is likely above 85 dB in sound intensity and could damage your hearing over time.” When’s the last time you had to raise your voice to chat with a dining companion? That would be just one example! The good news? By the same token, lowering the volume by just 3 dB can cut the sound intensity in half, and help save your hearing. Sound doesn’t have to go to 11 to be fun. May the (volume at) four be with you!

Yishane Lee is the marketing and communications director at HHF, where we are working to create a major culture shift around how we think about hearing health and hearing protection. Learn more at our Keep Listening prevention campaign. Special thanks to Ian Turley for research assistance. For references, see hhf.org/spring2023-references.

Share your story: How are you monitoring sound levels? Tell us at editor@hhf.org.

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A Retired High School Teacher Continues to Educate

By Susan Monroe

I started my search for hearing aids around 2002, a couple decades ago. I had one aid after another that didn’t work with my hearing disorder, but when I saw something on the evening news about a new prototype, I contacted the inventor and volunteered to try it.

It was a huge black disk that sat on my chest with a neck loop, kind of like an enormous medallion. The control buttons were situated around the outside of the circle. I was teaching high school so of course I had to explain to each class what this weird monstrosity of a necklace was.

I explained each button—except the last one, which was on the top right side. The students, of course, had to ask. I’d offhandedly explain, “Welllll…this is just a very small taser.” They would all exclaim in disbelief, “NUHHHH UHHHH!”

Then at least one kid would quietly ask, “Really?”

Teachers need some way to keep kids in line!

But as my hearing deteriorated, it became harder and harder to understand what teenagers were saying because they mumbled, and at warp speed. I’d ask all the time for them to slow down, but they didn’t.

Now and again, I’d say, very quietly, “I have something really important to tell you.” They would lean forward, and I’d mimic them, speaking nonsense syllables very quietly and very quickly. They would say, “WHAATT??”

And I would yell, “Exactly! That’s my point: WHAT??”

Sometimes that worked for a while.

And sometimes I’d listen to someone almost whispering, and I would answer them with a very intent look on my face, and give them a pretty long explanation, but I wouldn’t actually use my voice. I’d just mime and move my mouth while my expression remained earnest.

It confused them. That was my point. It was exhausting to keep reminding them that they had to speak up for me to hear. Though, even teachers who did not have hearing loss also had trouble understanding teen speech!

We recently moved to the Raleigh, North Carolina, area to help care for two young grandkids. One problem of changing cities is finding new doctors and dentists. We’re pretty old, so there are a lot of doctors.

One of my pet peeves is that doctors (and their staff)

seem to rarely look me in the face when talking to me. I have solved this problem. On the top of any intake sheet, I write this:

“I am a retired high school teacher. I am also hearing impaired. If you do not look me directly in the face when you speak to me, I will give you detention.”

They laugh—and they tend to remember! I am a fierce advocate.

Susan Monroe lives in North Carolina. She was inspired to share her experiences after reading “Educate, Educate, and Advocate, Advocate” in the Spring 2023 issue of Hearing Health magazine, at hhf.org/magazine.

One of my pet peeves is that doctors (and their staff) seem to rarely look me in the face when talking to me. I have solved this problem. On the top of any intake sheet, I write this:

“I am a retired high school teacher. I am also hearing impaired. If you do not look me directly in the face when you speak to me, I will give you detention.”

Top 3 Questions People Have About Their Ears

By Kathleen Wallace, Au.D.

Through my social media presence, I offer direct access to an audiologist to get any and all of your ear questions answered in a straightforward, simple to understand manner. Here are the three most common questions I’ve received:

Q: Are cotton swabs really that bad for your ears?

A: Unfortunately, yes. I know people love them and it can feel so satisfying but the truth is that your ears are self-cleaning and using cotton swabs like Q-tips disrupts this process. Instead of your earwax migrating naturally out of your ear canal, the swabs tend to push the wax back in and often deeper than intended, which can result in reduced hearing sensitivity, ear pain, or injury. In addition, earwax is actually good for you and is not a sign of poor hygiene! It prevents ear infections by maintaining a specific pH level in the ear and also creates a physical barrier to protect against any bugs or foreign bodies from entering the ear canal.

Q: Why are hearing aids so expensive?

A: The cost stems from a lack of insurance coverage and audiologists not being able to bill for many hearing aid–related services. To overcome this, audiologists have traditionally used a “bundled” model that combines the cost of the hearing aids with the audiologist’s professional services. The patient therefore pays a large lump sum up front, but then is fully covered for all care for however many years are outlined in the purchase agreement. It should be noted, however, that hearing aids truly are expensive, even for audiologists! If you are looking for more wallet-friendly alternatives, talk to your audiologist about options like an unbundled model, alternative technology, and hearing aid funding programs. (As for over-the-counter hearing aids, which are for adults with mild to moderate hearing loss, that’s worth an entire future column—stay tuned!)

Q: What exactly is tinnitus?

A: Tinnitus is when you hear a sound that is not actually present in your external environment. It may sound like a ringing, buzzing, chirping, or whooshing sound, or it may sound like the ocean, crickets, or TV static. There are two instances, however, that are particularly concerning and should be checked out by a medical professional: If the tinnitus sounds like your heartbeat or is in only one ear. This might indicate asymmetrical hearing, which could then mean something rare like an acoustic neuroma (a benign tumor).

The leading tinnitus theory is that your brain is expecting to get a certain amount of stimulation from your ears and if it doesn’t, it creates a phantom sound, which you perceive as tinnitus, to keep itself busy. This is why tinnitus often occurs along with hearing loss or after significant noise exposure, such as a concert. While there is no cure for tinnitus, it can be managed. Be sure to talk to an audiologist to learn more, especially if you haven’t had your hearing tested recently.

Have your own ear questions? Find Hearing Health editorial committee member Kathleen Wallace, Au.D., at @EarDocOfTikTok or @DrKathleenWallace on Instagram. She is also at TunedCare, tunedcare. com, and practices in New York City, kathleenwallaceaud.com.

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Earwax is actually good for you and is not a sign of poor hygiene! It prevents ear infections by maintaining a specific pH level in the ear and also creates a physical barrier to protect against any bugs or foreign bodies from entering the ear canal.

Please Help Us With This Brief Survey

Hearing Health Foundation would like to hear your opinion to better serve your needs. Please fill out this survey and use the envelope provided to mail it back, or answer online by scanning the QR code at left or visiting hhf.org/2023-survey. Thank you.

How important to you is HHF’s mission to prevent and cure hearing loss and tinnitus through groundbreaking research and to promote hearing health?

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How important to you are the following HHF funding priorities?

Hearing Restoration Project: The HHF-funded international research consortium working to regenerate sensory cells in the ear (hair cells) as a cure for hearing loss and tinnitus.

Emerging Research Grants: HHF seed funding for researchers working across the entire spectrum of hearing research and balance research, including many underfunded areas of otology.

Keep Listening: HHF’s hearing loss prevention media campaign.

How important to you are the following Emerging Research Grants funding priorities?

Who in your life has experienced hearing loss, tinnitus, or another hearing or balance condition?

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intolerance or increased sensitivity to noise)

chronic inner ear disorder affecting balance and hearing)

bone growth inside the ear)

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Many people choose to make a “legacy” or “estate” gift to a charity in their will or by beneficiary designation of part of a life insurance policy or retirement fund. If you have not already made a legacy gift to HHF, would you considering doing so to help HHF’s mission to prevent, research, and cure hearing and balance conditions?

 I have already included a legacy gift to HHF in my will, trust, or by beneficiary designation

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 Please have a planned giving officer send me information on legacy giving. I have filled in my contact information to the right.

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A Pioneer in Hearing Conservation

As the first audiology officer in the U.S. Navy in 1979, Herman Kidder, Ph.D., helped establish the Navy’s Hearing Conservation Program. By

Pat Dobbs

His chief immediately told him to take them off. When Kidder asked him to please put that in writing, the chief’s response was to order him to clean the bilge. To Kidder, this illustrated how his boss had no understanding of the effects of loud noise on hearing.

But despite wearing earplugs, Kidder suffered a significant hearing loss within a couple of months and requested a different job. He landed a position as hospital corpsman in the audiology department of the Otolaryngology Clinic Naval Hospital, San Diego.

After completing his enlistment and leaving the Navy, he received a Ph.D. in audiology. From his Navy contacts in San Diego, Kidder learned about a new program for audiology officers specially created by the surgeon general of the Navy, which became the Navy’s inaugural Hearing Conservation Program. In 1979, Kidder was appointed as the very first uniformed (commissioned) audiology officer in the Navy. The appointment of nine more officers soon followed.

“Ever since the advent of gunpowder, war has been associated with hearing loss. The Navy is no exception. A Navy ship is a floating factory that is sporting guns and making noise whether it’s shooting or not. High levels of noise are also associated with Navy planes, either on the ground or in the air, and on submarines when not in silent mode.”

So says Herman Kidder, Ph.D., who joined the U.S. Navy in 1970 as a machinist mate and worked in a noisy engine room. When he asked for earplugs, his chief denied the request, saying that Kidder wouldn’t be able to hear the engines run smoothly.

But Kidder, who had a master’s degree in speech pathology, understood well the impact of loud noises on hearing—and so he bought earplugs for himself.

In that position, Kidder says, “I participated in the creation and maintenance of one of the largest hearing conservation programs in the world. I also conducted investigative testing for civilian workers who were claiming hearing loss as a result of working in the Navy ship facilities.”

As part of the Hearing Conservation Program, ear protection was introduced and orders to wear it were enforced. The Navy offered insertable earplugs as well as earmuffs for louder noise. Today the Navy also uses sound cancellation devices, not available then.

The Hearing Conservation Program encompasses much more than the use of ear protection, Kidder says. Regular hearing evaluations are also important. “The program consists of a baseline hearing test taken in boot camp,” he says. “Every year—or more often depending on the noise level of the jobs—an additional hearing test is taken, and the results are compared with the baseline. If there is no change, the person goes back to work and is scheduled for a retest at a standard interval.

Retired and now a blacksmith, Herman Kidder, Ph.D., was the first commissioned audiologist for the U.S. Navy in 1979.

“If the test indicates there is a shift for the worse, the person is given an appointment with an audiologist for testing and follow up. This test can result in many different scenarios. The loss may have been the result of a medical problem. Or they may have been less compliant with the requirement to wear hearing protection, and education may be in order. If they are shown to be particularly susceptible to noise-induced hearing loss, they can apply for a different job in a less noisy environment. This is just a sketch of the program and with regulations related to who, what, why, when, and where.”

He adds, “My primary professional concern was the auditory communication capacity of the troops, which is a little recognized but crucial aspect of combat readiness. Being unable to hear the enemy during a combat situation is seriously dangerous.”

Today, the military takes hearing loss seriously—a far cry from the view of Kidder’s original boss in 1970. “Now each branch of services has a Hearing Conservation Program that is rigorously enforced,” Kidder says. “The program has saved countless individuals and their families the headache of severe hearing loss due to noise exposure.” Today the program uses more sophisticated equipment but the baseline test is still in place.

“I am very proud to have had a part in creating the Navy’s Hearing Conservation Program,” Kidder says. “I believe that it has made the quality of life better for literally millions of service people and their families. That’s because preserving your hearing is lifesaving as well as life improving.”

Kidder later served as senior audiologist at the Naval Training Center in Orlando and for Fleet Hearing Conservation programs at U.S. bases in Yokosuka and Okinawa, Japan. He also taught and oversaw the Hearing Conservation Program in South Korea and Subic Bay in the Philippines.

Kidder adds, “Hearing loss is a family disorder—it affects the family as well as the person with hearing loss.” His lifelong passion has been to preserve the hearing of

those who serve in the armed forces, and help veterans maintain their hearing health upon return to civilian life. Today Kidder is retired and lives in Deer Isle, Maine, with his wife, Frederica. He is a blacksmith. He wears two hearing aids and hearing protection when it is needed, and is always doing what he can to improve the lives of others.

Pat Dobbs has an adult-onset hearing loss and wears bilateral cochlear implants. She founded the Hearing Loss Association of America, Morris County Chapter, New Jersey, in 2011, and today is president of the international online hearing loss support group, Say What Club, saywhatclub.org. Now a resident of Deer Isle, Maine, she is forming the Downeast Chapter of HLAA. To learn more, email pat@coachdobbs.com.

“Hearing loss is a family disorder—it affects the family as well as the person with hearing loss.”

My Hope Is to Turn Pain Into Progress

Because of his hyperacusis, David Treworgy has had to sharply curtail doing activities he used to enjoy, such as running road races.

Most of my life I had no ear problems. I never thought about the noise I was exposed to, certainly never in terms of the grave hazard and enormous threat that I now know it to be.

By David Treworgy

I grew up in rural Maine and engaged in activities that, along with some kind of underlying susceptibility, probably got me to where I am today. For example, every summer I mowed a lot of lawns—for my family, my grandmother, and my neighbors—using a loud power mower. I also have done a lot of carpentry work with power tools like drills, sanders, and circular saws.

After college, I moved to Washington, D.C., and worked for the federal government as a management consultant. My work was primarily office work, which is relatively quiet. But parts of my job involved a lot of noise. Every day for years I spent two hours on the subway, which routinely reaches injurious noise levels with squealing brakes and train horns. I often flew in loud prop planes to visit government agencies in distant locations, far from major airports.

When I look back, I wish I had worn ear protection. But at the time there was no public health awareness of the dangers of noise.

Odd Ear Symptoms

About 10 years ago, I noticed odd ear symptoms. Working in downtown D.C., where traffic is heavy, I thought the city had raised the volume on its sirens. Before, sirens had never registered with me, just a fixture of city life that I could tune out. But now they were loud enough to cause physical ear pain. It felt like someone stabbing my ear with a knife. I got some earplugs and popped them in whenever an ambulance or fire truck approached, and that managed the problem for several months.

But I soon realized the sirens hadn’t changed— something about my ears had changed. Walking down the sidewalk with a colleague, a shop owner slammed the security shutters to cover the door. The rumble felt like sandpaper rubbing my ears. My colleague didn’t even notice the sound.

Within a month, even more routine sounds began to hurt, especially sudden, high pitched sounds—someone’s cellphone ringing would cause a point of pain deep within the ear canal. One building where I attended meetings had old elevators with a bell that would ding loudly as it passed each floor. Every ding felt like another stab of a knife in my ears.

I discussed my ear problems with my primary care physician, who had no information and referred me to an ENT (ear, nose, and throat doctor, or otolaryngologist). The ENT ordered some standard audiology tests. They all came back normal. The ENT diagnosed me as suffering from severe hyperacusis, but said there was no specific treatment, and suggested I try some supplements, which I did, but they did not help.

I then turned to the internet to research more about hyperacusis, and learned of a treatment called TRT or Tinnitus Retraining Therapy, often touted as having a high success rate for tinnitus and an even higher success rate for hyperacusis. It seemed promising. This treatment involves very mild broadband noise played into the ears via sound generators, with the volume raised very slowly over months.

While some patients report improvement, in my case it turned out to be counterproductive and lowered my sound tolerance dramatically. I never recovered from that worsening. I did this treatment with Pawel Jastreboff, Ph.D., the inventor of TRT himself, who couldn’t explain my results.

In more recent years, the availability of patient support discussion forums has grown. Now, with reports from many more patients, the consensus seems to be that TRT should be considered cautiously, and probably avoided, for all but the mildest cases of hyperacusis. Even then, TRT doesn’t account for the real-world noise environment or the problem of unexpected noise that can make tinnitus and hyperacusis worse.

A year after discontinuing TRT, I underwent a surgical clinical trial for hyperacusis called round window reinforcement. This surgery functions in some ways as a permanent earplug, building up a layer of tissue to dampen incoming sound. Though some patients reported improvement, unfortunately I was not one of them.

What’s more, it was strenuous to take a trip out of state for this surgery and stay overnight for a week. When I was entering the hotel they were vacuuming the lobby, which caused ear pain as soon as I walked in. I pleaded with them to stop until after I checked in, which they kindly did. And after all that time, effort, and expense of the surgery, I detected no improvement.

With the failures of the TRT and surgery, there remained little else to try. A year after surgery, as a shot in the dark, I tried a stem cell transplant, which did not help either, but at least it did not make things worse.

A Severe Case

Patients have taken to using “noxacusis” to describe severe cases which involve pain, and to differentiate themselves from more garden-variety loudness hyperacusis. This term was coined by Paul Fuchs, Ph.D., of the Johns Hopkins University School of Medicine, who discovered nerve cells in the ear that previously were thought not to exist. Mild

The old way of thinking is that there is one kind of hyperacusis, where everything sounds louder. Fortunately, science has progressed, and it’s now known that there is a more severe form, pain hyperacusis, where loudness passes some threshold and turns into actual pain. And that pain lingers and worsens. It’s impossible to describe how much suffering this condition entails.

cases behave differently from severe cases, though they can turn into severe cases with more noise exposure.

The old way of thinking is that there is one kind of hyperacusis, where everything sounds louder. Fortunately, science has progressed, and it’s now known that there is a more severe form, pain hyperacusis, where loudness passes some threshold and turns into actual pain. And that pain lingers and worsens. It’s impossible to describe how much suffering this condition entails.

This wretched ear condition has affected every aspect of my life. It’s hard to imagine a worse disease. It’s invisible and untreatable, with no objective tests and lots of misinformation in the medical community. I was forced to stop working because the normal, everyday sounds of being in an office caused me ear pain. The simplest of things—a door slamming, a phone ringing, a shrill voice, even the crackle of paper when opening mail or turning a page—sends a stabbing pain through my ears.

I was forced to discontinue volunteer roles with my university alumni association and my homeowners association. I couldn’t participate in telephone conference calls or meetings, both of which involve endless ordinary sounds that are painful for me.

I can’t go to a restaurant—silverware clinking on dishes, music, even just the noise of people talking all cause pain. So I always eat at home, using plastic utensils and silicone dishes. I must leave for the day when construction in my apartment building is going on.

As my sound tolerance decreased, I was forced to stop everything that brought me joy. I used to be an avid tennis player and road runner, running 5ks, 10ks, and half marathons.

I live near Arlington National Cemetery, which has little vehicular traffic, so I can go on daily walks. These are almost safe. Still, I must be cautious because the bells of the clock tower gong every 15 minutes and the funerals of veterans meriting special honor involve gunfire.

Much of the advice available from clinicians and online about hyperacusis is that “everyday sounds cannot hurt you”; that you must “push your way through the pain” and “live your life.” I followed this terrible advice at first and unfortunately I found my ears got much worse. Almost any audible sound now causes pain—it feels like burning acid being poured into my ears, or a severe sunburn in my ear canals.

Sounds can also trigger lingering ear pain even in silence, which can last for days or weeks and is best described as a deep burning sensation. The chronic pain often comes with a delayed reaction, so I cannot always tell when a particularly painful sound will be injurious later.

As my hyperacusis worsened, tinnitus settled in. At first it was very mild and not bothersome. Then it would start to have short spikes where it would be loud and bothersome for an hour. As time went on, the spikes grew longer and the milder periods shorter, to the point where now it is severe almost all the time and intrusive.

The tinnitus has a number of sounds, most notably hissing and screeching. I can avoid ear pain from sound by being in quiet places, but there is no escape from the severe tinnitus.

So I am balancing both conditions. While earplugs and earmuffs temporarily make my tinnitus much more severe, they have also been a lifesaver to keep my hyperacusis from worsening. I have a pair of protective earmuffs in every room, plus in the car, so they are always at hand.

The Power of Science

Historically there has been much medical information that later was wholly discredited—for example the practice of bleeding. George Washington is perhaps the most famous patient—doctors removed 40 percent of his blood in an attempt to reduce fever and inflammation, and then he died. There were also lobotomies in the 1940s and 1950s—the inventor won a Nobel Prize—and the use of thalidomide in the late 1950s and early 1960s, which led to monstrous birth defects.

These examples seem outdated and unsophisticated now that we know better, but the principle holds. The audiogram may show what the ear can hear, but not whether language can be understood. We have learned that the synapses linking the ear and brain play a huge role in “hidden” hearing loss, which is responsible for difficulty understanding speech amid noise. A gene mutation for susceptibility to hyperacusis was identified in a research paper published earlier this year.

Research is essential. I learned about Hearing Health Foundation through Bryan Pollard, the late founder of Hyperacusis Research. In partnership with HHF, Hyperacusis Research raises money to fund biological research to find a cure, and HHF awards research grants through its competitive Emerging Research Grants program.

I helped Bryan in his work by raising money through Facebook fundraisers and publishing an annual newsletter for donors. In addition, I lead patient support groups, including global Facebook support groups with several thousand members, and a regional support group for tinnitus and hyperacusis sufferers.

Sadly, Bryan passed away after illness in 2022. Several patients and their relatives took over his work. I have

joined the board of directors for Hyperacusis Research and I do as much as I can to assist in roles that do not worsen me. For example, I can answer occasional email inquiries from patients, but unfortunately I am not well enough to attend research conferences.

I spend as much time and energy as I can to further research for a cure, and hope I will see some breakthroughs in my lifetime. However, I know that the auditory system is a particularly complex part of the human body. The cochlea is the size of a pea, encased in hard bone, so it is impossible at present to do extensive research on living subjects.

I personally have signed up for the National Temporal Bone, Hearing, and Balance Pathology Resource Registry, which looks to better understand hearing and balance problems by analyzing donated human auditory systems. It is similar to being an organ donor, except that the donation of temporal bone after death helps scientists research better treatments and cures. I want to help future generations of patients long after I am gone. I know that HHF’s founder was instrumental in bringing regional temporal bone registries to the national level. The National Institutes of Health and Mass Eye and Ear now oversee the registry.

For all these reasons, I am making a planned gift to the Hearing Health Foundation. Hundreds of millions of people are affected by ear problems—not my rare pain hyperacusis, but hearing loss, tinnitus, aural fullness, and related conditions. Yet hearing research receives only a fraction of the funding spent on other diseases that affect large percentages of the population. I want to help make a difference, and I hope others will follow my example.

A Virginia resident, David Treworgy is a member of the board of directors for Hyperacusis Research. HHF is grateful to Treworgy for his support and to Hyperacusis Research for its support of our Emerging Research Grants program.

Share your story: Do you experience hyperacusis? Tell us at editor@hhf.org.

Support

Research is essential. I learned about Hearing Health Foundation through Bryan Pollard, the late founder of Hyperacusis Research. In partnership with HHF, Hyperacusis Research raises money to fund biological research to find a cure, and HHF awards research grants through its competitive Emerging Research Grants program.

In this image from a paper coauthored by several HRP researchers published in eLife in November 2022, day 8 reprogrammed hair cells are inner hair cell-like, innervated, form ribbon synapses, possess stereociliary bundles, and show evidence of mechanotransduction activity. OHC: Outer hair cell region, IHC: Inner hair cell region, GER: greater epithelia ridge region. Arrows indicate individual reprogrammed hair cells in the GER.

By Lisa Goodrich, Ph.D.

Highlights From the Hearing Restoration Project

Hearing Health Foundation’s Hearing Restoration Project continues to make significant advances in scientific research toward understanding how some animals are able to restore their own damaged inner ear hair cells. Our aim is to uncover and apply this knowledge to humans, bringing us closer to a cure. The projects of the HRP’s three working groups continue to make progress, with data collection and analysis continuing in line with the aims and milestones in this year’s project timelines. Here are highlights of recent accomplishments, details of which are forthcoming in a number of publications, some currently under review and others in preparation.

Cross-Species Epigenetics Working Group

» Refined a sorting process to generate large pools of pure supporting cells and hair cells from the zebrafish, and began defining the molecular details of how zebrafish supporting cells produce new hair cells when there is damage

» Gained insights into the mechanisms that shut down hair cell gene expression in supporting cells in the developing mouse

» Developed a method for performing multi-omic analysis of adult mammalian supporting cells, our target cell population for hair cell regeneration

» Produced multi-omic datasets from the human utricle (a balance organ in the inner ear), an important step toward learning why regeneration fails in humans

» Added Litao Tao, Ph.D., of Creighton University to the group, enhancing our expertise in epigenetic mechanisms

Integrative Analysis Working Group

» Added a dedicated analyst to facilitate and encourage interactions within the consortium

» Completed a cross-species analysis of how roughly 28,000 different genes are expressed in 28 types of hair cells from four species

» Produced a user-friendly app that enables real-time comparison of gene expression among 28 hair cell types and linked it to the gEAR for easy access by anyone in the field

» First public presentation of our collaborative efforts at the most recent Association for Research in Otolaryngology MidWinter Meeting in February 2023

» Generated transcriptomic data for mouse cochlear organoids that will serve as an effective platform for identifying drug candidates in the future

» Improved the gEAR, which enables data analysis and visualization for the entire research community:

• Added 168 new datasets in 2022 and created a secure section for HRP members to share their data directly

• Created lists of marker genes for easier mining of single-cell RNA-sequencing datasets

• Created a machine-learning tool that applies patterns from one dataset to another, making it easier to move between cell types and species

Reprogramming and Gene Delivery Working Group

» Demonstrated that a cocktail of three factors can promote conversion of nonsensory cells into hair cells

» Discovered that reprogramming of supporting cells is much more efficient when hair cells are entirely destroyed, illuminating new understanding of the relationship between the two cell types

» Secured encouraging preliminary data on two methods of viral delivery of reprogramming factors to a severely damaged cochlear epithelium, moving us closer to a means of delivering future therapies to the inner ear

For more information about the HRP’s published studies, details about major funding that has resulted from HRP research, and our work supporting the next generation of hearing and balance scientists, please see hhf.org/hrp.

Among the HRP’s accomplishments so far is the discovery that the reprogramming of supporting cells is much more efficient when hair cells are entirely destroyed, illuminating new understanding of the relationship between the two cell types.

HRP scientific director Lisa Goodrich, Ph.D., is a professor of neurobiology at Harvard Medical School. For references, see hhf.org/spring2023-references.

Recent Research by Hearing Health Foundation Scientists, Explained

Inner Ear Cell Types Between Fish and Mammals Show Similarities

A major cause of human deafness and vestibular dysfunction is permanent loss of the mechanosensory hair cells of the inner ear. In non-mammalian vertebrates such as zebrafish, regeneration of missing hair cells can occur throughout life. While a comparative approach has the potential to reveal the basis of such differential regenerative ability, the degree to which the inner ears of fish and mammals share common hair cells and supporting cell types remains unresolved.

In our paper published in eLife in January 2023, we perform single-cell RNA sequencing of the zebrafish inner ear at embryonic through adult stages to catalog the diversity of hair cells and non-sensory supporting cells. We identify a putative progenitor population for hair cells and supporting cells, as well as distinct hair and supporting cell types in the maculae versus cristae, patches of inner ear sensory cells involved in vestibular function.

The hair cell and supporting cell types differ from those described for the lateral line system, a distributed mechanosensory organ in zebrafish in which most studies of hair cell regeneration have been conducted. In the

maculae, we identify two subtypes of hair cells that share gene expression with mammalian striolar or extrastriolar hair cells (that is, hair cells in the maculae that are either centrally located within the striola, a central zone that includes a line where hair cell polarity changes direction, or more peripheral hair cells located farther away from that central line). In situ hybridization reveals that these hair cell subtypes occupy distinct spatial domains within the three macular organs—the utricle, saccule, and lagena— consistent with the reported distinct electrophysiological properties of hair cells within these domains.

These findings suggest that primitive specialization of spatially distinct striolar and extrastriolar hair cells likely arose in the last common ancestor of fish and mammals. The similarities of inner ear cell type composition between fish and mammals validate the zebrafish as a relevant model for understanding inner ear-specific hair cell function and regeneration.

This is adapted from the abstract of the paper in eLife. Hearing Restoration Project member David Raible, Ph.D. (left), is a professor in the department of biological structure at the University of Washington. One of the study coauthors is the late Neil Segil, Ph.D., also in the Hearing Restoration Project, of the University of Southern California.

This illustration in eLife shows the anatomy of zebrafish and mouse inner ears.

An Explanation of Divergent Test Results in Ménière’s Disease

Ménière’s disease is a disorder that causes symptoms including dizziness, hearing loss, and ringing in the ears. The cause of this disease is not well understood. To learn more about Ménière’s disease, our team used tissue samples taken from the ears of people who had Ménière’s disease during their lifetime and compared them to samples from people who did not have the condition.

Many patients with Ménière’s disease have abnormal results in a test of the inner ear called the caloric test, but another test called video head impulse testing often shows typical results, despite both tests being done on the same part of the inner ear.

Our results, published in the Journal of the Association for Research in Otolaryngology (JARO) in December 2022, found that in the ears of people with Ménière’s disease, there was a specific problem in the horizontal semicircular canal which is a part of the inner ear that helps with balance. This problem, called otolith membrane herniation, was found in 69 percent of the Ménière’s disease ears studied and was linked to abnormal results in the caloric test.

We also found that there was no evidence of a condition called endolymphatic hydrops in the horizontal semicircular canal, which had been previously suggested as a potential cause of the dissociation between the two test results. Additionally, we found that the size of the semicircular canal in some Ménière’s disease ears was smaller than the control ears. This suggests that the relative size of the inner ear structures may play a role in the development of the condition.

Taken together, this study refines hypotheses on the vestibular test dissociation in Ménière’s disease, holding diagnostic implications and expanding our understanding of the mechanisms underlying this enigmatic disease.

—Bryan K. Ward, M.D.

A 2020 Emerging Research Grants (ERG) scientist, Bryan K. Ward, M.D., is an associate professor of otolaryngology–head and neck surgery at Johns Hopkins University School of Medicine.

Top: These images in the JARO study by coauthor John P. Carey, M.D., are based on a 3D model that was then manipulated to look like the histology.

Above: This image from Bryan K. Ward, Ph.D., illustrates the otolith membrane herniation that was found in 69 percent of the Ménière’s disease patients in the JARO study. The image, from a separate study, was adapted from histology specimens included in the study as part of the NIDCD National Temporal Bone, Hearing and Balance Pathology Resource Registry.

A Method to Measure Neuroplasticity Found to Be Unreliable

There is a great deal of interest in understanding how the brain can adapt to sensory loss. The structure and function of the brain is able to change to compensate for a loss in hearing or vision. Unfortunately, many of the techniques used to measure such neuroplasticity may be invasive and expensive. As such, less invasive and more economical techniques to measure and study neuroplasticity can gain a lot of attention.

One such technique to help measure neuroplasticity, known as tetanization, has been purported to induce neuroplastic changes in the brain by rapidly and repeatedly presenting an auditory or visual stimulus, the tetanus, for a short period of time. Changes in the brain’s response to the tetanus are typically reported as evidence of neuroplasticity.

We recently reviewed the studies employing tetanization to study neuroplasticity in the human brain and conducted a study of our own that tested age-related differences in brain activity following tetanization.

We completed a meta-analysis comparing results across studies, including our own, published in the European Journal of Neuroscience in October 2022. We found that tetanization does not produce reliable changes in brain activity. Some studies report increased brain activity, some report decreased brain activity, and still others report no changes in brain activity following tetanization. These results are important for developing reliable, noninvasive, and affordable techniques to study hearing loss, vision loss, and neuroplasticity. —James

Dias, Ph.D.,

and Carolyn McClaskey,

Ph.D.

James Dias, Ph.D., is an assistant professor in the department of otolaryngology-head and neck surgery at the Medical University of South Carolina. He is a 2022 ERG scientist generously funded by the Meringoff Family Foundation, and was renewed for a second year in 2023. Coauthor Carolyn McClaskey, Ph.D., is a research assistant professor in the same department, and a 2023 ERG scientist (see page 46).

One technique to help measure neuroplasticity, known as tetanization, has been purported to induce neuroplastic changes in the brain by rapidly and repeatedly presenting an auditory or visual stimulus, the tetanus, for a short period of time. Changes in the brain’s response to the tetanus are typically reported as evidence of neuroplasticity.

How Sensory Gating May Aid in Better Perception of Speech in Noise

Typically developing children with typical hearing have more difficulty understanding speech in background noise than typical-hearing adults. This difference may be due to development of the central auditory pathways, as peripheral audition, which is measured with usual hearing evaluations, does not differ between children and adults, and the timelines between central auditory development and speech perception-in-noise (SPiN) ability are similar. For instance, children around the ages of 10 to 12 years begin to have adult-like SPiN skills, an age at which central auditory systems also begin to become adult-like.

One central auditory function that is also developing during this period is sensory gating. Sensory gating acts as an automatic “filter” that may suppress noise before reaching levels of attention. Indeed, my team and I have previously found that typical-hearing adults who struggle in background noise also tend to have worse gating function. Therefore, the development of gating may contribute to maturational trends in SPiN.

With this in mind, we measured sensory gating function in adults ages 22 to 24 years and children ages 5 to 8 years using cortical auditory evoked potentials (CAEPs) recorded via high-density electroencephalography. From this data, we were able to model the cortical gating response in both the children and adults, showing distinct developmental central auditory networks. Our results appeared in the Journal of Speech, Language, and Hearing Research in January 2023.

We also measured SPiN ability using a clinical measure, the BKB-SiN, which provides the signal-to-noise ratio necessary to correctly perceive 50 percent of the words in given sentences. While both SPiN and gating function were significantly decreased in children, there was no significant relationship between gating function and SPiN in the children.

When these results are considered with our previous, similar study conducted in typical-hearing adults with SPiN ability ranging from typical to moderate deficits, it may be the case that sensory gating only underlies clinical SPiN deficits. For instance, the child group in our 2022 study, while having decreased SPiN ability, still performed within age-appropriate limits. Similarly, in the adult group in our 2020 study, there was no correlation between gating function and SPiN ability when performance was within typical limits.

In this image in the Journal of Speech, Language, and Hearing Research, a portion of the study’s cortical auditory evoked potential (CAEP) gating current density reconstructions are shown; yellow indicates the most likely area of activation.

In other words, worse gating appears to be a significant factor only when SPiN performance is outside of typical limits. In future studies, we aim to examine sensory gating function in typical-hearing children with clinically low SPiN outcomes. Taken together with our other research, these studies can help test the hypothesis that tinnitus perception may arise from faulty “gating mechanisms” in the brain. This study is important because faulty gating mechanisms, also observed in tinnitus and hearing loss, appear to play a role in auditory disorders.

—Julia Campbell, Ph.D., Au.D.

A 2016 ERG scientist generously funded by the Les Paul Foundation, Julia Campbell, Ph.D., Au.D., CCC-A, FAAA, is an assistant professor of communication sciences and disorders in the Central Sensory Processes Laboratory at the University of Texas at Austin.

Hearing Involves Highly Distorted Processing of Sound by Sensory Hair Cells

Audiophiles typically seek out sound systems that most accurately reproduce acoustic recordings and add minimal distortion. Interestingly, our sense of hearing does not work in quite such a transparent way. In fact, a considerable amount of distortion is introduced by the sensory hair cells within the inner ear.

These cells—the inner and outer hair cells (see figure opposite page)—are responsible for converting soundevoked vibrations of the surrounding structures into electrical signals that are transmitted to the brain. Distortion results from the fact that this conversion process is highly nonlinear (i.e., the relationship between vibration and the resulting electrical signal follows a sigmoidal curve and not a straight line).

Studying the distortions generated within the inner ear tells us how these signals may influence our perception of sound and also provides insight into the processes that are involved in basic sensory hair cell function. This function is very difficult to study in live ears, as the auditory sensory organ—the organ of Corti—is located deep within the temporal bone.

To better understand the distortion that sensory hair cells generate, I used an imaging technique called optical coherence tomography (OCT) to see into the mouse inner ear and measure vibrations of the hair cells in response to sound. While OCT is commonly used to examine the health of the human retina, it is also powerful enough to see through the bone encasing the inner ear in mice, allowing me to visualize how the hair cells vibrate. Since the outer hair cells, in particular, use their electrical signals to drive the generation of mechanical forces, any distortions in the electrical signals are converted into vibrations of the cells and surrounding structures, where they can be detected using OCT.

By presenting two tones to the mouse ear, one at a frequency f1 and the other at a frequency f2, I was

Studying the distortions generated within the inner ear tells us how these signals may influence our perception of sound and also provides insight into the processes that are involved in basic sensory hair cell function. This function is very difficult to study in live ears, as the auditory sensory organ—the organ of Corti—is located deep within the temporal bone.

able to study vibratory distortions at mathematically related frequencies like f2-f1 and 2f1-f2. These distortion frequencies are of interest as they theoretically depend on different properties of the underlying nonlinear function. While the 2f1-f2 distortion is often assumed to be largest and has been most widely studied, I actually found that f2-f1 was much larger for a wide variety of stimulus frequencies and amplitudes.

Remarkably, the distortions were sometimes as large as the responses at the frequencies of the stimulus tones themselves. The resolution and sensitivity of the OCTbased approach allowed me to characterize how the distortions were shaped as they were transmitted from the outer hair cells to the surrounding basilar and tectorial membranes, and how they traveled to different inner ear locations, just like the vibrations that were produced by sounds directly presented to the ear.

The findings, published in the Journal of the Acoustical Society of America (JASA) Express Letters in November 2022, clarify how distortions are produced by the outer hair cells and how these additional signals may influence peripheral sound encoding.

Analysis of the distortions also allowed estimation of the nonlinear function that determines how the cells respond to sound, which so far has primarily been studied in vitro. Since the forces generated by outer hair cells serve to amplify the stimulation of the inner hair cells, which are the main communicators of auditory information to the brain, the findings also reveal aspects of the physical processes that are required for sensitive hearing.

—James Dewey, Ph.D.

This schematic cross-section from JASA Express Letters shows the organ of Corti in the inner ear, which contains the sensory inner and outer hair cells. Vibrations of the hair-like structures at the tops of the cells are converted to distorted electrical signals. Outer hair cells generate force in response to this electrical signal, causing distorted vibrations of the surrounding structures.

Support our research: hhf.org/donate.

A 2020 and 2023 ERG scientist, James Dewey, Ph.D., is an assistant professor of otolaryngology-head and neck surgery at the Keck School of Medicine of the University of Southern California.

A Unique, Fast Inner Ear Synapse Keeps Us From Falling

In a discovery more than 15 years in the making, a small group of neuroscientists, physicists, and engineers from several institutions has unlocked the mechanism of the synapses, paving the way for research that could improve treatments for vertigo and balance disorders that affect as many as 1 in 3 Americans over age 40.

The study published in the Proceedings of the National Academy of Sciences in January 2023 describes the workings of “vestibular hair cell-calyx synapses,” which are found in organs of the innermost ear that sense head position and movements in different directions.

“Nobody fully understood how this synapse can be so fast, but we have shed light on the mystery,” says Robert Raphael, Ph.D., a Rice University bioengineer who coauthored the study with the University of Chicago’s Ruth Anne Eatock, Ph.D., the University of Illinois Chicago’s Anna Lysakowski, Ph.D., current Rice graduate student Aravind Chenrayan Govindaraju, and former Rice graduate student Imran Quraishi, M.D., Ph.D., now an assistant professor at Yale University.

Synapses are biological junctions where neurons can relay information to one another and other parts of the body. The human body contains hundreds of trillions of synapses, and almost all of them share information via quantal transmission, a form of chemical signaling via neurotransmitters that requires at least 0.5 milliseconds to send information across a synapse.

Prior experiments had shown a faster, “nonquantal” form of transmission occurs in vestibular hair cell-calyx synapses, the points where motion-sensing vestibular hair cells meet afferent neurons that connect directly to the brain. The new research explains how these synapses operate so quickly.

In each, a signal-receiving neuron surrounds the end of its partner hair cell with a large cuplike structure called a calyx. The calyx and hair cell remain separated by a tiny gap, or cleft, measuring just a few billionths of a meter.

“The vestibular calyx is a wonder of nature,” Lysakowski says. “Its large, cup-shaped structure is the only one of its kind in the entire nervous system. Structure and function are intimately related, and nature obviously devoted a great deal of energy to produce this structure. We’ve been trying to figure out its special purpose for a long time.”

From the ion channels expressed in hair cells and their associated calyces, the authors created the first computational model capable of quantitatively describing the nonquantal transmission of signals across this nanoscale gap. Simulating nonquantal transmission allowed the team to investigate what happens throughout the synaptic cleft, which is more extensive in vestibular synapses than other synapses.

“The mechanism turns out to be quite subtle, with dynamic interactions giving rise to fast and slow forms of nonquantal transmission,” Raphael says. “To understand all this, we made a biophysical model of the synapse based on its detailed anatomy and physiology.”

The model simulates the voltage response of the calyx to mechanical and electrical stimuli, tracking the flow of potassium ions through low-voltage-activated ion channels from presynaptic hair cells to the postsynaptic calyx.

Raphael says the model accurately predicted changes in potassium in the synaptic cleft, providing key new insights about changes in electrical potential that are responsible for the fast component of nonquantal transmission; explained how nonquantal transmission alone could trigger action potentials in the postsynaptic neuron; and showed how both fast and slow transmission depend on the close and extensive cup formed by the calyx on the hair cell.

“The key capability was the ability to predict the potassium level and electrical potential at every location within the cleft,” Eatock says. “This allowed the team to illustrate that the size and speed of nonquantal transmission depend on the novel structure of the calyx. The study demonstrates the power of engineering approaches to elucidate fundamental biological mechanisms, one of the important but sometimes overlooked goals of bioengineering research.”

Quraishi began constructing the model and collaborating with Eatock in the mid-2000s when he was a graduate student in Raphael’s research group and she was on the faculty of Baylor College of Medicine, just a few blocks from Rice in Houston’s Texas Medical Center.

Quraishi’s first version of the model captured important features of the synapse, but he says gaps in “our

This illustration and microscopic images from Rice University show the relationship between motion-sensing vestibular hair cells (blue) of the innermost ear and the cup-shaped “calyx” (green) structures of adjoining nerves that connect directly to the brain. The rapid flow of information through the synapses helps stabilize balance and vision in humans and many other animals.

knowledge of the specific potassium channels and other components that make up the model was too limited to claim it was entirely accurate.”

Since then, Eatock, Lysakowski, and others discovered ion channels in the calyx that transformed scientists’ understanding of how ionic currents flow across hair cell and calyx membranes.

“The unfinished work had weighed on me,” Quraishi says, and he was both relieved and excited when Govindaraju, a doctoral student in applied physics, joined Raphael’s lab and resumed work on the model in 2018.

“By the time I started on the project, more data supported nonquantal transmission,” Govindaraju says. “But the mechanism, especially that of fast transmission, was unclear. Building the model has given us a better understanding of the interplay and purpose of different ion channels, the calyx structure, and dynamic changes in potassium and electric potential in the synaptic cleft.”

“One of my very first grants was to develop a model of ion transport in the inner ear,” Raphael says. “It is always satisfying to achieve a unified mathematical model of a complex physiological process. For the past 30 years—since the original observation of nonquantal transmission—scientists have wondered, ‘Why is this synapse so fast?’ and, ‘Is the transmission speed related to the unique calyx structure?’ We have provided answers to both questions.”

Raphael says the link between the structure and function of the calyx “is an example of how evolution drives morphological specialization. A compelling argument can be made that once animals emerged from the sea and began to move on land, swing in trees, and fly,

there were increased demands on the vestibular system to rapidly inform the brain about the position of the head in space. And at this point the calyx appeared.”

Raphael says the model opens the door for a deeper exploration of information processing in vestibular synapses, including research into the unique interactions between quantal and nonquantal transmission.

He adds that the model could also be a powerful tool for researchers who study electrical transmission in other parts of the nervous system, and he hopes it will aid those who design vestibular implants, neuroprosthetic devices that can restore function to those who have lost their balance. —Jade Boyd

This originally appeared on the Rice University Office of Public Affairs website. A 2022 ERG scientist, Robert Raphael, Ph.D., is an associate professor of bioengineering in Rice’s George R. Brown School of Engineering. He is also a 2007 ERG scientist. A former member of HHF’s board of directors and a 1987–88 and 1994 ERG scientist, Ruth Anne Eatock, Ph.D., is a professor of neurobiology at the University of Chicago.

For references, see hhf.org/spring2023-references.

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Meet the Researcher

Carolyn McClaskey, Ph.D. Medical University of South Carolina

Emerging Research Grants (ERG)

As one of the only funding sources available in hearing and balance science, HHF’s ERG program is critical. Without our support, these scientists would not have the needed resources for innovative approaches toward preventing, researching, and finding better treatments for hearing and balance conditions.

McClaskey earned her doctorate in psychology and cognitive science at the University of California, Irvine and completed her postdoctoral studies in auditory neuroscience at the Medical University of South Carolina, where she is now a research assistant professor in the department of otolaryngology. McClaskey is a 2023 Emerging Research Grants recipient generously funded by Royal Arch Research Assistance.

i have immense respect for the complexities of the human brain and its capacity to adapt. My research focuses on how the brain adjusts to the changes that happen with age and hearing loss. An overadjustment to change could be just as detrimental as an underadjustment, especially in an incredibly complicated system. If we can better understand how our brain adapts to hearing loss, and what happens if and when those changes get out of control, then we can work toward better solutions for the speech communication and hearing issues we face with age.

i have friends and family who are affected by hearing loss of varying degrees, but it wasn’t until I got to graduate school that I realized how widespread hearing loss is and how much it can affect us. Working in this field has helped me appreciate how common hearing problems are—especially as we get older—and how we need more awareness of hearing health.

my interest in neuroscience began after I hit my head in college, where I was studying biochemistry and music, and struggled to play classical piano for a couple days. That led me to wonder about the connection between hearing, music, and the brain. I love working with data and using research to understand how the world works. But if I had to pick another career besides science, I think maybe interior design, or being a writer, or photographer...something creative! Luckily science can be very creative too, so I feel like I’ve found a good compromise.

i also love nature photography, especially bird and wildlife photography. It helps me get away from my desk and out into nature, where I can spend time in a completely different environment. Some of the best wildlife photography happens when you can make yourself invisible in the environment and just passively observe nature in action—and a lot of action happens when humans aren’t around! I think that has a lot of parallels with science. It helps me think more carefully about my research questions and what we don’t know about hearing health and aging.

sometimes my fellow researchers are surprised to learn that I love listening to loud music. It’s terrible for your ears, I know! I don’t use earbuds, and I always wear hearing protection. Sometimes the dynamic range of the genre of music I like—electronic—means it gets loud at times, and I love that.

Carolyn McClaskey, Ph.D., is generously funded by Royal Arch Research Assistance. We thank them for their support of studies that will increase our understanding of the mechanisms, causes, diagnosis, and treatments of central auditory processing disorders.

We need your help funding the exciting work of hearing and balance scientists. Please consider donating today to Hearing Health Foundation to support groundbreaking research. Visit hhf.org/how-to-help.

Why I Am Leaving a Legacy to HHF

“I grew up in Taiwan and moved to the U.S. for my doctorate, spending my career in the lab as a molecular biologist. Since retiring, it has been amazing to see the leaps and bounds made in genetics and biology, so I am glad to be able to make a difference for the next generation of researchers with a planned gift to Hearing Health Foundation.” —Sally Lee, Ph.D.

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