Summer 2017
The Ultimate Consumer Resource on Hearing
The Travel & Leisure Issue Make the most of your downtime, whether it’s at home or on the road
hhf.org
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HEARING HEALTH The Travel & Leisure Issue Summer 2017, Volume 33, Number 3
If you or a loved one has a hearing loss, embarking on a dream trip abroad or fully enjoying downtime at home can present certain challenges—but all are easily overcome with foresight and preparation to make sure your needs are met.
Features
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The Brueggemans, whose son Jace was born with a hearing loss, organize an annual 5K walk/run to raise funds for Hearing Health Foundation.
12 Living With Hearing Loss My Own Personal Amusement Park Ride. Teri L. Rocco 16 Managing Hearing Loss In Transit. Ruth D. Bernstein 18 Travel Roundup In the Air and On the Road. 19 Statistics Noisy Environments, By the Numbers. 20 Entertainment You Can Go to the Movies When You Have a Hearing Loss. Shari Eberts 22 Entertainment See You at the Show! Lisa Carling
cover photo courtesy teri l. rocco, taken in the adirondacks
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Richard A. Felix II, Ph.D., is researching the effects of brain signal disruptions on auditory processing.
Hearing Health magazine (ISSN: 0888-2517) is published four times annually by Hearing Health Foundation. Contact Hearing Health Foundation for subscription or advertising information at info@hhf.org or 212.257.6140. Copyright 2017, Hearing Health Foundation. All rights reserved. Articles may not be reproduced without written permission from Hearing Health Foundation. USPS/Automatable Poly
Hearing Health Foundation and Hearing Health magazine do not endorse any product or service shown as paid advertisements. While we make every effort to publish accurate information, we are not responsible for the correctness of information herein.
23 Home House Hunting Tips When You Have a Hearing Loss. Erin Vaughan
24 Managing Hearing Loss No Puedo Escuchar. 30 Research Hearing Restoration Project Plans Announced for 2017–2018. Peter G. BarrGillespie, Ph.D. 34 Research Recent Research by Hearing Health Foundation Scientists, Explained. 38 Research Why Does AgeRelated Hearing Loss Occur, and What Can Be Done About It? Robert D. Frisina, Ph.D., and D. Robert Frisina, Ph.D. 40 Hearing Health How Will the Field of Audiology Evolve? Kathleen Wallace
Departments 06 Letter From the CEO
46 Meet the Postdoc
08 Letters to the Editor
48 Marketplace
10 Meet the Fundraisers
50 Meet the Researcher
27 2017 Reader Survey 44 Clarke Corner
Sponsored
45 Hearing Aids 101
42 Advertorial Editor’s Choice: Showstoppers
Visit hhf.org/subscribe
to receive a free subscription to this quarterly magazine.
statistics
FACTS ABOUT HEARING LOSS & HEARING AIDS Hearing Loss
1 in 5 Americans ages 12 and over
3
has a hearing loss, while 1 in 8 has a hearing loss in both ears.
Hearing loss is the third most common chronic health condition in the U.S. Almost twice as many people report hearing loss as report diabetes or cancer.
rd
90
More than 90 percent of children who are born with hearing loss are born to typical-hearing parents.
percent
Hearing Aids » Hearing aids have been shown to provide a significant benefit to individuals with hearing loss. An estimated 12.5 percent of U.S. children ages 6 to 19 show evidence of noise-induced hearing loss.
1
#
» Most hearing losses can be treated with hearing aids, but only one in five individuals who could benefit from using hearing aids, including those with mild hearing loss, currently owns them. » The risk of dementia may be up to five times greater and the risk of falling three times greater among people with untreated hearing loss.
Hearing loss and tinnitus are consistently the top reported health conditions for military service members and veterans.
hearing health
The Travel & Leisure Issue Summer 2017 Volume 33, Number 3 Publisher Nadine Dehgan CEO, Hearing Health Foundation Editor Yishane
Lee
Art Director Robin Senior Editors
Kidder
Laura Friedman,
Amy Gross Medical Director David
S. Haynes, M.D.
Staff Writers Emily
L. Martinson, Au.D., Ph.D.; Barbara Jenkins, Au.D.; Kathi Mestayer; Kathleen Wallace
Advertising
Laura Friedman advertising@hhf.org 212.257.6143 Editorial Committee
Robert A. Dobie, M.D.; Judy R. Dubno, Ph.D.; Melissa E. Heche, Au.D.; Stefan Heller, M.D., Ph.D.; Anil K. Lalwani, M.D.; Joscelyn R.K. Martin, Au.D.; Cynthia Morton, Ph.D.; Allen Ryan, Ph.D.; Samuel H. Selesnick, M.D. Board of Directors
Elizabeth Keithley, Ph.D., Chair; Sophia Boccard; Robert Boucai; Noel L. Cohen, M.D.; Judy R. Dubno, Ph.D.; Ruth Anne Eatock, Ph.D.; Jason Frank; Roger M. Harris; David S. Haynes, M.D.; Anil K. Lalwani, M.D.; Michael C. Nolan; Paul E. Orlin; Robert V. Shannon, Ph.D.
» Hearing aids have been shown to reverse negative changes (psychological and emotional) and may offset cognitive decline from untreated hearing loss. » Older adults who use hearing aids show reduced depression symptoms and improved quality of life.
For references, see hhf.org/summer2017-references.
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HEARING HEALTH
a publication of hearing health foundation
363 Seventh Avenue, 10th Floor New York, NY 10001-3904 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
Visit hhf.org/subscribe to receive a FREE subscription. If you would like to unsubscribe, please call us at 212.257.6140 or email info@hhf.org.
HEARING HAS A HOME The Alpha 2 MPO ePlus™ hearing device can provide significant hearing and speech recognition improvement1 for people with mixed, conductive hearing loss or single-sided deafness (SSD). § Up to 3X louder in higher frequencies which may aid speech recognition2,3 § Lowest profile processor and implant § Rechargeable system provides up to 1-year battery life4
1. Based on Alpha 2 MPO device performance. Roden D; Gallant S; Friedmann D; Kohan D. Comparing Hearing Outcomes in Osseointegrated Implantable Auditory Devices. Poster presented at the Combined Otolayngology Spring Meetings, May 2016, Chicago, IL. 2. Amos NE, Humes LE. Contribution of high frequencies to speech recognition in quiet and noise in listeners with varying degrees of high frequency sensorineural hearing loss Journal of Speech, Language, and Hearing Research (2007) 50, 819-834. 3. Internal data on file. 4. ZPower technical data on file.
Rx only. Refer to product instruction manual/package insert for instructions, warnings, precautions and contraindications. For further information, please call Medtronic ENT at 800.874.5797 or consult Medtronic’s website at www.medtronic.com/ent. © 2017 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. UC201712726 EN 05.2017
letter from the ceo
DEAR READERS & SUPPORTERS, as you know, hearing health foundation (hhf) is committed to funding innovative hearing and balance research and bettering the lives of those with hearing loss through advocacy, education, and awareness. Thanks to your generosity and our efficient stewardship, I am proud to say that this year we are funding hearing and balance science at the highest level ever in our foundation’s nearly six-decade history. Our leadership has covered all administrative costs so that every single dollar donated goes directly to research and programs. Please read about the 2017 projects for the Hearing Restoration Project starting on page 30, and summaries of published papers by funded Emerging Research Grants scientists on page 34. But there is still much more work to do. The proposed federal budget released in late May 2017 cuts the entire $18 million allotted for Universal Newborn Hearing Screening. Newborn screening was legislation that HHF was instrumental in securing in the 1990s. Testing infants’ hearing in the hospital soon after birth helps ensure the earliest possible detection and treatment of hearing loss— critical for a child’s long-term development and success. Today, 97 percent of U.S.-born babies are tested at birth, compared with only 4 percent in 1994. Eighteen million dollars is pennies in a $4.1 trillion federal budget, but the proposal also slashes the National Institutes of Health budget by nearly $6 billion, or more than 18 percent, and the Centers for Disease Control and Prevention’s budget by 17 percent. Collectively, these cuts would devastate scientific research and threaten established health programs fighting deadly and expensive conditions. It’s unclear how this will affect the proposed Over-theCounter Hearing Aid Act of 2017. In early May, I attended a hearing on this proposed legislation in Washington, D.C. As a way to better serve the needs of those with hearing
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hearing health
a publication of hearing health foundation
loss while also ensuring user safety, this act has bipartisan support in both the House and the Senate. To help shape HHF’s future in this uncertain climate, HHF is thrilled to welcome Robert V. Shannon, Ph.D., and Ruth Anne Eatock, Ph.D., to our Board of Directors. Both highly respected researchers and professors, their commitment toward advancing research to better understand hearing loss and its associated disorders make them perfect additions to our leadership team. To learn more, see hhf.org/blog?blogid=292. Science is essential to the advancements and discoveries of new therapies, technologies, and cures. If you are able to support our research efforts we would be grateful. Your gift will make a difference. The pace to cures and treatments is set by the funding we receive. Please also enjoy this Summer issue about travel and leisure, both at home and abroad. In addition, we have teamed up with the Hearing Loss Association of America to better serve our constituents' needs and raise awareness of the effects of hearing loss. We would love to hear from you through our joint reader survey on page 27, which is also available online for you to fill out and send to family and friends at hhf.org/survey. As always, please feel free to email me with questions or concerns.
Nadine Dehgan CEO, Hearing Health Foundation ndehgan@hhf.org
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letters to editor
@editor
dear editor: I read with interest the article “Cheaper, Over-the-Counter Hearing Aids Could Be on the Way,” in your Spring 2017 issue. As a technician working on musical instrument amplification I need to be able to hear the equipment clearly. But so far, my $6,000 experiment to try to improve my hearing has been a bust. Listening to music sounds awful. When I play an acoustic guitar, the hearing aids can't deal with pure tones, and the internal processors are too busy trying to fix a nonexistent problem. As for my electric guitars, impossible is the kindest word I can think of. I really liked this article. It addresses my biggest frustration with hearing aids: my inability to adjust my hearing aids myself. I have a wonderful audiologist who works with me, but while they work perfectly in an exam room, once you get out into the real world, they don't work so well. I know that if I had even limited access to the adjustment software I could adjust my hearing aids to work better for me during specific situations when they fail. I hope to see more articles addressing the end users of hearing aids becoming able to optimize their own hearing. Andy Berger, via email from the editor: Thank you very much for your feedback. The process to adjust hearing aids to your individual hearing loss can be time-consuming and frustrating. We encourage you to continue to work with your audiologist to make your investment work (most providers offer a limited trial period, too). There are some hearing aids that have smartphone apps so you can adjust settings in real-time, giving you more control. This useful integration with smartphones looks likely to continue. We will also be keeping an eye on the recently introduced Over-the-Counter Hearing Aid Act of 2017, broadening treatment options for those with hearing loss. Stay tuned!
dear editor: I’m a WWII vet living in an old folks’ home and profoundly hearing impaired. (The Navy did not provide us with the simplest of earplugs—can you believe it?) I want to thank you for your wonderful magazine and hope you will keep it coming.
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hearing health
a publication of hearing health foundation
Do you know why people keep referring to us as “hard of hearing”? It implies that we are hard to handle, hard headed, hard nosed, etc. Is a mobility impaired person “hard to walk”? A blind man “hard to see”? Perhaps you can help change the “hard” semantics to something better. It seems overdue to me. Thanks again for your magazine. William K., Oregon from the editor: Thank you for your letter. We try to use “person-first language” that identifies a person first and then the disability or condition. So, it is a “person with a hearing loss” rather than “hearing-impaired person” or “hard-of-hearing person.” We are glad to see this language is becoming more widespread.
dear editor: I'm writing as a regular reader of Hearing Health magazine—since 1987! I was a staff writer under founding editor Paula Bonillas and contributed stories for 10 years. Your recent Spring 2017 issue had probably the best story about athletes with hearing loss that I've ever read. “Advantage, Hearing Loss” is a wonderful spread of personal quotes that clearly illustrates their perspectives. Surely readers enjoyed the unique experience expressed by current and former athletes that hearing people rarely experience. The last article I wrote for the magazine was in 1998. I investigated the killing of a teenager in Oregon to write “Murder in Cottage Grove,” and 17 years later I converted the story into a novella titled “Backspace.” I am happy to say it’s now in its third edition. It’s been a fun trip—and a preservation of my own perspective on hearing loss, just like those athletes’ viewpoints. Thanks for the magazine. Stephen C. Baldwin, Ph.D., via email from the editor: From a longtime reader of—as well as writer and editor for—the magazine, your feedback and support means a lot. Thank you!
Share your story: Send us your feedback and stories at editor@hearinghealthmag.com.
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† Compared to other premium hearing aids. † † Compared to other premium hearing aids with narrow beamforming.
Sources: *Groth (2016), **Jespersen et al. (2016)
meet the fundraisers
How to Host a Fundraiser Host a fundraiser to help HHF find better therapies for treating and preventing hearing loss and tinnitus! Set up your fundraiser in three easy steps:
Through an annual 5K walk/run, the Brueggemans have raised thousands of dollars for hearing research.
1) Register. 2) Create your Giving Page. 3) Share with family and friends and ask for their support.
RACING FOR HEARING HEALTH
Get started at hhf.org/how-tohelp, where you can also see examples of past events and get ideas for creating your own— such as golf outings, bake sales, birthdays, weddings, marathons, and triathlons. Let your talents and interests guide your ideas; no event is too large or small.
since 2014, leslie and eric brueggeman have organized an annual 5K walk/run each August to raise money for Hearing Health Foundation. Their son Jace was born in 2013 with bilateral hearing loss and wears hearing aids. The race has grown to nearly 200 participants, every year raising thousands. We thank the Brueggemans, their family, friends, and all the participants for their dedication to funding groundbreaking hearing and balance research.
Questions? We’re here to help! Email fundraise@hhf.org.
Share your story: Tell us why you support HHF at editor@hearinghealthmag.com.
Support our research: hhf.org/donate
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hearing health
I WANT YOU TO HEAR. Every day, I want you to hear the love in my voice. The music box singing to you. The lullabies as you fall asleep. I want you to hear your name called at graduation. The words “You’re hired.” The words “I do.” The first words from your own child. I want you to hear the world today, tomorrow, forever.
Call 1 866 922 9211, or visit www.IWantYoutoHear.com for more information.
©2016 Cochlear Limited. All rights reserved. Trademarks and registered trademarks are the property of Cochlear Limited. CAM-MK-PR-273 ISS1 MAR16
living with hearing loss
MY OWN PERSONAL AMUSEMENT PARK RIDE After dealing with Ménière’s disease—and “drop attacks”— for decades, relief comes in the form of surgery. By Teri L. Rocco
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hearing health
a publication of hearing health foundation
living with hearing loss
The author on a hiking trip in Calf Creek, Utah (far left), and in the Catskills.
i drove up to my house, opened the door, and fell to the ground. Mom ran out the door in a panic as I crawled to the house. She helped me inside as my head spun out of control. My temperature spiked, I vomited, and then my temperature dropped so low I couldn’t get warm even as Mom covered me in blankets. Soon I was completely exhausted and could only sleep. After a few hours I recovered and figured the attack happened because I hadn’t eaten yet that day. That was in 1983, when I was 20, and it’s been a crazy roller coaster ride ever since. I had similar episodes on and off for the next 12 years, and we attributed it to my diet, or maybe not enough sleep. Eventually when I developed severe tinnitus and hearing loss in one ear, I was introduced to Ménière’s disease. The doctor prescribed prednisone, which gave me a headache far worse than any migraine, so I immediately stopped using it, figuring my body was trying to tell me something. Over the years, my symptoms varied and could include a “full” feeling in my head that made it hard to think, vomiting, spinning, feeling off balance, body temperature changes, and the strong need for sleep when the symptoms subsided. The longer I could feel the symptoms coming on, the longer the attack would last. One possible cause of Ménière’s is fluid buildup in the ear, so to help prevent attacks, I removed salt from my diet, which can make you retain water. I also used a homeopathic medication that helped with the dizziness. But I still had episodes. The worst attack happened while managing a major trade show when I was 35—I remember the exact date: September 19, 1998. I had minor off-balance episodes the week before, then at the first event I felt strange, like an attack was coming on, but not really. I tried to keep myself composed, but 30 minutes later, I found it hard to move. I was having trouble seeing, couldn’t talk, and my arms were tingling and numb. It was a “not in my own body” feeling that I had never felt before. A friend saw me and began screaming for help. After being practically carried to the car, I lost my dinner in front of everyone. Following that episode, dizzy spells plagued me every day for about six months. There were problems with driving and functioning like a normal person, and I worried about losing my job. How many times can you get caught under your desk barfing in a can while on company time and expect them to keep paying you?
Dizzy spells had always given me warning, and if I was driving I could pull over when I felt one coming on. This new “drop attack” was very different; it felt like my feet were flipped quickly over my head. It knocked me to the ground.
hhf.com
summer 2017
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living with hearing loss
Some attacks were gone hours later, while others came in clusters for months at a time. Sometimes I wouldn’t have a dizzy episode for months. I never knew when one would hit again. No one ever believed I was sick. Except for the moment I was spinning and vomiting, I looked just fine. And that couldn’t be further from the truth! Then, in 2003, I experienced my first “drop attack.” Prior attacks always gave me warning, and if I was driving I could pull over when I felt one coming on. This one was very different; it felt like my feet were flipped quickly over my head. The attack knocked me to the ground without warning, creating an extremely dangerous situation. I was prescribed a diuretic to help reduce fluids in blood vessels. It worked, and I was able to live a normal life and ride my motorcycle without fear. About four years later, I started feeling symptoms again, walking into things and experiencing minor spins. Then one day I spun violently in multiple directions with no warning. There was no way to tell what was up or down. I bent my knees and dropped to the floor so I wouldn’t go down head first. After two months of intermittent imbalance, there was only one more drop attack for the next six months so I wasn’t so concerned. Then I began feeling minor symptoms, and in the spring of 2008 is when the real nightmare began. I was driving a car 60 miles per hour in heavy traffic, with a passenger. All of a sudden it felt like I was on the top of a cliff, with a magnet in my head pulling violently toward a piece of steel at the bottom. I tried the best I could to stay in my lane, but saw only what I felt— that everything was flying by me even though it really wasn’t. I couldn’t tell up from down, had no clue where the road was, and no idea if I was heading for the center median. Somehow, I managed not to crash. According to my passenger, all of this took place in three seconds, but it felt much longer. It could have been deadly for both of us. After 25 years of living with Ménière’s, I finally realized it was time to get serious help. Research lead me to Eric Smouha, M.D., at Mount Sinai in New York City. He said that out of all the people who have Ménière’s disease, only 2 percent ever experience drop attacks. Lucky me! My options? 1) Change medication; 2) Inject a “poison” into my ear to “kill” the balance nerve; 3) Destroy the inner ear completely; or 4) Undergo Vestibular Nerve Section (VNS), a form of brain surgery where they find the balance nerve in its nerve bundle, and sever it (yikes!). I hit the internet and spent countless hours trying to educate myself. Drop attacks are rare, and of the few people I found on the internet who had experienced them, not one gave positive feedback. One even told me, “Nothing stops drop attacks, nothing!” I tried changing medication. It didn’t work. I tried the 14
hearing health
a publication of hearing health foundation
injections. Seven months after the third injection I thought I was in the clear, but a drop happened again, forcing me to choose surgery. Although destruction of the inner ear is less dangerous, it would have destroyed what little hearing I had in that ear. Since I still had hope of riding my motorcycle again, and knew how important hearing is when riding, my doctor and I chose VNS surgery. I feared the surgery wouldn’t work—or worse—but it was the only chance I had of getting back the life I loved. And, relief: The surgery and recovery both went well. Full recovery probably took six months, but I never felt any dizziness or pain during that half year. The doctor told me that my activity level and interest in hiking helped my recovery. Honestly if I’d known the outcome—I’ve been attack-free since 2011—I’d have done the surgery earlier, instead of waiting 27 years! I spent a lot of years being afraid and confused. Scary as it is to agree to such a surgery, it gave me my life back. Still, I know there are no promises. Symptoms I still have are hearing loss in one ear (so I admit I rely on my good ear), severe tinnitus that I can manage to mostly ignore, and walking into things more than the average person. I feel off balance and uncomfortable at times, which makes me think it might get worse again, but compared with what was happening to me before, these are just little annoyances. Every moment I am able to stand upright is a blessing, and I am thankful for the extra time I have been given to live a normal life. I’ve even returned to motorcycle riding and bought myself a beautiful new Harley Davidson Switchback, which has a large windshield and lockable hard saddlebags that make it ideal for the long, multi-day motorcycle trips I like to take to places like Maine and the Adirondacks. My hope, of course, is that I have experienced the last of my vertigo and drop attacks, but I will never forget what it’s like to live life while riding on my own personal amusement park ride.
Teri L. Rocco lives in New Jersey.
Share your story: Do you have Ménière’s disease or another balance condition? How have you handled it? Tell us at editor@hearinghealthmag.com.
Support our research: hhf.org/donate
T
It’s an exciting time in the realm of hearing aids. Not only are electronic components getting smaller and hearing performance is increasing, but the use of new innovative materials are being utilized, introducing new possibilities. While traditional hearing aids are made of acrylic and other composites, advancements in technology have allowed for a new material to hit the market… enter titanium.
itanium is the new black Terrific Titanium
The Art of Discretion
Renowned for being extremely durable and light-weight, titanium is used for various premium products such as high performance vehicles, watches and aircrafts and even in the medical industry for surgical implants — so why not use this resourceful material to build a hearing aid?
Because most hearing aid wearers are concerned about their hearing aids being visible, in-the-ear hearing aids are created to remain out of sight. Swiss hearing aid manufacturer Phonak has a new addition to its extensive portfolio that offers a super discreet fit along with excellent hearing performance. Custom-made to perfectly fit individual ears and personal hearing needs, the new Phonak Virto™ B-Titanium hearing aid is created from medical grade titanium using a sophisticated 3D printing technology — making it the smallest hearing aid Phonak has ever produced!
Phonak Virto B-Titanium in-the-ear hearing aids
Well, thanks to its properties, titanium makes for an optimal material for in-the-ear hearing aids — which sit inside the ear canal. Why? Being 15x stronger than acrylic shells, titanium allows for a hearing aid shell to be built as thin as a piece of paper, reducing its size significantly.
So, if you’re looking for a hearing aid that is super discreet and built to withstand the hard knocks that life can bring, then a Phonak Virto B-Titanium certainly is the new black!
Ask your hearing care professional today about the super discreet Virto B-Titanium. Explore www.phonak-us.com/virtob-titanium or call 1-877-841-6510. MS049184 PR001
managing hearing loss
IN TRANS IT
Here’s how to help make sure traveling with a hearing loss (your own or that of a loved one) goes smoothly, no matter the mode of transportation. Bonus: Many of these travel tips are useful even if you don’t have a hearing loss. By Ruth D. Bernstein » Tell everyone involved in your trip you have a
»
»
»
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hearing loss. This includes professionals such as the travel agent, ticket clerk, airline, cruise ship operator, and group coordinator You may want to put this information on your ticket or registration form. State your needs in writing, and request written confirmation of all arrangements. Keep copies of the confirmations in your travel file and present them as needed. Along with your identification, bring a list of medical and emergency contacts. Your ID should have your name, address, phone number, and the fact that you have a hearing loss. In the event of an emergency, the names and contact information of your medical providers and any family members will be important to have. Take advantage of the Transportation Security Administration (TSA)’s newly improved TSA Disability Notification Card. It allows airline passengers to discreetly let TSA security officers know of a disability, medical condition, or device that may affect security screening. While it doesn’t exempt you from a screening, the walletsize card, which you can download and complete, also provides contact information for TSA Cares, a helpline for people with disabilities to use for additional assistance. The Federal Aviation Administration allows assistive listening devices in your carry-on luggage. Be prepared to explain what they are. Remove batteries from assistive devices you are not using and put them in your checked luggage. Consider taking an old, spare pair of hearing aids with you, but also lots of batteries and a small
hearing health
a publication of hearing health foundation
»
»
»
battery tester. I spent an entire day in Madrid looking for the right hearing aid batteries, which were very expensive. At the airport, tell the person at gate check you have a hearing loss and can’t understand public announcements. Ask for preboarding. Sit where you can be seen. If in doubt, go back and ask if there have been any changes, politely. When I was traveling to London on Virgin Atlantic, the chief flight attendant happened to be at the check-in desk and heard me say I had a hearing loss. He then took the time to periodically make sure I was okay during the flight. When you board a plane or ship, immediately tell staff you are unable to hear the public address system and will need explanations in an emergency. If you are traveling alone, ask your seatmate to help you. On the way home from Sydney, Australia, I told the flight attendant about my hearing loss when I boarded. After several hours of flying, there was an announcement I couldn’t understand. The flight attendant came and told me we were landing in Auckland, New Zealand, because one of the plane’s engines had stopped working. I was grateful for the explanation because when we landed there were rows of emergency vehicles at the airport—and without context this would have been very alarming! When you travel with a tour group, explain to everyone that you have a hearing loss. It helps to demonstrate the assistive devices you use and to review communication tips (get my attention before speaking, face me directly, rephrase instead of just repeating when needed, etc.).
managing hearing loss
» If you have communication problems during the
»
trip, speak to the person in charge and explain your needs calmly and clearly. Be flexible in finding a solution and try to stay calm. Getting angry and shouting does not help. Use pencil and paper—the low-tech, inexpensive communication device, if necessary. In foreign countries, you can also use your smartphone’s
»
microphone or dictation app or Google Translate when you need help being understood. And finally, don’t forget to say thank you and to send feedback after the trip. Remember you can enjoy traveling when you have a hearing loss by taking responsibility for yourself, revealing your hearing loss, asking for help, being flexible—and keeping your sense of humor!
Practical Travel Tips for Everyone, With or Without a Hearing Loss » Pack copies of important
»
documents, and store them separately from the actual documents. This means making and bringing copies of your identification, itinerary, tickets, passport, driver’s license, credit cards, and a list of the medications you take. Also leave copies with a responsible person at home. Before my daughter Debby and I went on a group trip to Greece, I told her to a make a copy of her passport. “Mo-om,” was the response I got, but she did it anyway. At the end of the Greek trip, the leader gave Debby the wrong passport but since we had a paper copy, the U.S. Embassy in Athens was able to issue a temporary passport. Put your personal affairs in order. I went on a three-week trip and came home to discover none of my bills had been paid. The post office “lost” several bags of mail. It took months to straighten out the mess. After that, I authorized automatic payment of my most important bills. Also remember to put your mail and newspaper delivery on vacation hiatus.
» Use your smartphone to make
»
»
flying easier. Sign up for flight status alerts via email or text from your airline. Send your boarding pass to your smartphone. I was initially nervous about using my phone for my boarding pass and printed a backup for several flights. Now I don’t bother! Check identification requirements and baggage restrictions. Get the information by calling or checking the website of the airline or cruise ship you’re using. This information can change, so recheck details within 24 hours of your trip. Sign up for air traveler prescreening programs. Millions are enrolled in several trusted traveler programs, such as the TSA’s PreCheck program and Global Entry, a program run by U.S. Customs and Border Protection. Once your application is approved, each is valid for five years. Both require fees, but they are bargains if you fly often as you can avoid long security lines.
» Show up early for any
transportation. Especially air travel. I nearly missed a flight to Fort Lauderdale even though I had TSA PreCheck because they were short on staff. A traveler next to me in line joked, “At the rate this line is moving, I’ll be able to celebrate my birthday with my fellow travelers next month.” —R.D.B.
Ruth D. Bernstein is a board member for the New York City Chapter of the Hearing Loss Association of America, from which this presentation has been adapted. For references, see hhf.org/ summer2017-references.
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travel roundup
Inside planes and cars (and out), industry and government entities alike are working to protect hearing and provide access.
IN THE AIR AND ON THE ROAD Inside the Plane
Inside the Car
What are the long-term effects of airplane cabin noise on flight staff? U.S. House Transportation Committee member Peter DeFazio of Oregon asked the Government Accountability Office last November to comprehensively study the intensity and exposure of internal airplane noise. DeFazio wants to be sure hearing protection is offered if noise exceeds 85 decibels (dB) for eight continuous hours, the federal workplace maximum. The government is also working to make sure full accessibility for people with hearing loss stretches to in-flight entertainment. This July the U.S. Department of Transportation (DOT) Advisory Committee on Accessible Air Transportation will issue proposed rules to provide captioning for shows and movies on airplanes.
A quiet car interior blocks engine, tire, road, and wind noise, and promises comfort and distraction-free driving. Buick’s QuietTuning system includes Bose active noise cancellation technology, which uses ceiling microphones to detect noise and the car’s sound system to emit masking sound frequencies. In the event an unavoidable collision is detected, Mercedes-Benz’s Pre-Safe Sound technology uses the ear’s stapedius reflex to protect hearing. In response to sounds at 100 dB or louder, the stapedius muscle contracts and prevents some sound pressure from reaching the inner ear. The carmaker’s engineers determined that the same effect could be triggered by using wide-spectrum pink noise at 80 dB.
Outside the Plane
The electric engines in hybrid cars are nearly silent compared with gas-powered motors, and this is a problem when it comes to the safety of pedestrians (not to mention those with hearing loss, plus cyclists, runners, and pets). The DOT’s National Highway Traffic Safety Administration (NHTSA) estimates that 2,400 pedestrian injuries occur each year from hybrids, and that these injuries are 37 percent more likely
When the Federal Aviation Administration altered LaGuardia Airport flight routes four years ago, constant noise in Queens, New York, where the airport is located, became so severe it caused houses to vibrate. In response to complaints, Delta Airlines in March announced it is replacing noisy airplane models in its fleet with quieter, more fuelefficient models. 18
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Outside the Car
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from electric vehicles compared with conventional cars. To help alleviate the problem, last fall the NHTSA mandated that by September 2019 all new electric and hybrid vehicles make an audible sound when traveling forward or in reverse up to 19 miles per hour; over that speed the wind and tire sounds are deemed sufficient to warn pedestrians. Meanwhile, luxury carmaker Porsche is considering using the sound of a conventional gas engine piped into the interior of its new Mission E electric sports sedan, due out in 2018. Porsche is responding to customer feedback that without the engine growl, the sports car doesn’t seem like a sports car.
For references, see hhf.org/ summer2017-references.
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statistics
Noisy Environments, BY THE NUMBERS
A recent survey of U.S. adults by the American Speech-Language-Hearing Association (ASHA) reveals that when it comes to leisure activities, louder doesn’t necessarily mean better.
Bars, clubs,
and concerts are ranked as the top noisiest places
90 percent
51
percent More than half are concerned that
future exposure
to loud leisure settings could be harmful
Worry that
past exposure to
66 percent feel society has become noisier or much noisier
27
percent Do not return to a venue because they found it noisy. The youngest age group polled (18 to 29 years old) reported the most dissatisfaction with noise in public places
loud leisure settings may have harmed their hearing
shhh
Nearly half (46 percent) prefer quiet or even very quiet out-of-home activities
Restaurants and movie theaters also ranked high as locations where noise is bothersome or prevented them from visiting
ASHA’s May 2017 “Noisy Environments Poll” is based on a survey of 1,007 U.S. adults representative of population demographics. For references, see hhf.org/summer2017-references.
more than
1/3
(36 percent) Say loud noise has reduced their enjoyment of out-of-home activities
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entertainment
YOU CAN GO TO THE MOVIES WHEN YOU HAVE HEARING LOSS By Shari Eberts going to the movies can be challenging for people with hearing loss. The soundtrack is often deafeningly loud but the dialogue is too soft, making it hard to follow the plot. You can’t really ask the actors to repeat themselves, and your companions get annoyed when you ask “What did he say?” a hundred times during the film. I have a hearing loss, and perhaps not surprisingly, my family rarely went to the movies, waiting for the new releases to become available for home use where we could watch them with captions. But recently my son has been asking to go to the movie theater. He is getting older and wants to enjoy his favorite action flicks, such as the latest “Star Wars” movie, on the big screen. Who can blame him? I didn’t want to miss out on the experience (and I do love a big-screen “Star Wars” movie myself), so I experimented and found a way to enjoy going to the movies again. It has become a regular Sunday afternoon activity for our family. There are two important elements: noise-canceling headphones to block out the overly loud soundtrack, and caption readers to enhance the dialogue.
Noise-Canceling Headphones
I love my noise-canceling headphones and use them often when I travel on airplanes, at concerts, and even at Disney World. They not only help protect my ears, but also help me cope with situations that I find disturbingly loud, even if the decibel level is within normal limits. At the movies they work great! They not only ratchet down the volume, but when I use the noise-canceling feature, the background noise recedes and the dialogue is much easier to understand. This works well at loud Broadway shows too, where the music can sometimes overpower the voices. In the case of the latest “Star Wars,” a small flick of the noise-canceling switch and I was able to hear the rebels’ calls for help over the diminished roar of the Empire’s fighter planes. Excellent.
Caption Readers
Many movie theaters already offer caption readers, ahead of new U.S. Department of Justice legislation to require them (see “New Captioning Rules for the Big Screen,” far right), and in my experience most of the time they work quite well. There are two basic types of caption readers that I have seen. The most common I’ve encountered is Dolby CaptiView, which according to its website “consists of a small OLED display on a bendable support arm that fits into a theater seat cup holder.” The screen is small, but the captions are clear and easy to read. Built-in privacy visors prevent the captions from bothering those seated around you. 20
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entertainment
Loops in New York City’s Public Spaces
Many movie theaters already offer caption readers, ahead of new U.S. Department of Justice legislation to require them, and in my experience most of the time they work quite well.
The adjustable arm lets you position the viewer anywhere you like. I try to center it at the bottom of the screen like my closed captions at home. The captions often work for the previews, but not for the ads. The second type is Sony Access glasses. I have only used these once, and the captions were blurry so I could not read them. I should have exchanged them for a different pair, but they felt so heavy on my face, I wasn’t sure I wanted to wear them anyway. Other people I know use them frequently with success, so I may need to give them another try. A website called captionfish.com easily finds theaters with captioning for you. Enter your location and you can then search by theater or movie times. Or simply ask your local theater— with perhaps a gentle reminder about the new compliance rules that should be in place by next year’s summer movie season.
The former chair of HHF’s board of directors, Shari Eberts is the founder of livingwithhearingloss. com, where this originally appeared, and sits on the board of the Hearing Loss Association of America.
New York City may be the first major city to pass legislation requiring hearing loop technology in public spaces. According to the bill, public assembly areas that are being constructed or renovated using city funds must install hearing loop technology. A hearing induction loop uses wires connected to a sound system and looped around (surrounding or crisscrossing) a room to transmit sound electromagnetically to telecoils in hearing aids and cochlear implants. This allows hearing device users to hear announcements and music directly and clearly, without interfering background noise, and already optimized to their hearing. “Hearing loop technology makes such a radical difference in the ability of so many to participate fully in public life, and I’m proud that as a city we have moved to making it not just a priority but a requirement in our public investments,” says the bill’s sponsor, New York City Council Member Helen Rosenthal of Manhattan. It is estimated it will affect nearly 300 projects in the city.
New Captioning Rules for the Big Screen The U.S. Department of Justice issued new rules, effective in January 2017, for movie theaters to comply with the Americans with Disabilities Act by providing closed captioning for movies. Movie theaters must provide captioning and alert the public that they have the equipment and staff to assist in using it. This only applies to theaters that show movies in a digital format, and these theaters have until June 2018 to come into compliance. In addition, the theaters must stock a minimum number of captioning devices based on how many screens they have, ranging from four devices for one screen to 12 devices for 16 or more screens.
For references, see hhf.org/ summer2017-references.
Share your story: Have you tried captioning technology during movies or hearing loops in entertainment venues? Tell us at editor@ hearinghealthmag.com.
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SEE YOU AT THE SHOW! Theater fans with hearing loss can fully enjoy live shows, from Broadway in New York City to regional options around the country. By Lisa Carling
"Jersey Boys" on Broadway is one of many open-captioned theater options in New York City.
Theatre Access NYC
If your summer travel brings you to New York City, why not consider taking in a Broadway show? Theatre Access NYC is a one-stop website that helps you find accessibility information on current Broadway productions. This information includes the availability of assistive listening devices, prerecorded captioning on handheld devices, induction loops, and periodically scheduled, live open-captioned performances sponsored by Theatre Development Fund (TDF) and The Broadway League. See theatreaccessnyc.org.
TDF Accessibility Programs
Part of TDF’s mission as a not-for-profit service organization is to increase access to live theater for all audiences. That’s why TDF Accessibility Programs (TAP) for theatergoers with disabilities is such an important part of our organization’s outreach. TAP provides a membership service for audience members who are deaf or hard of hearing, have low vision or are blind, cannot climb stairs or need aisle seating, or require wheelchair locations. There is no annual fee, but you must provide proof of eligibility. For people with hearing loss, to become a TAP member and receive notices of upcoming TDFsponsored, open-captioned Broadway and Off-Broadway performances, please sign up at tdf.org/tap, or email tap@ tdf.org to have an application mailed to you. All seating for open-captioned performances is in the orchestra with tickets at a discount.
National Open Captioning Initiative
TDF offers a limited number of two-year regional theater partnerships to sponsor open-captioned performances and increase attendance by people who are deaf or hard of hearing. If your local performing arts center does not provide captioning for audience members with hearing loss and needs guidance implementing this type of programming, please ask staff to email tap@tdf.org for more information on 2018 National Open Captioning Initiative (NOCI) applications. This year’s regional theater partnerships include:
» American Repertory Theater, » » » » » » » » »
Cambridge, Massachusetts Artists Repertory Theatre, Portland, Oregon AT&T Performing Arts Center, Dallas Dallas Theater Center, Dallas Hippodrome Foundation, Baltimore Imagination Stage, Bethesda, Maryland Marin Theatre Company, Mill Valley, California Signature Theatre, Arlington, Virginia Slow Burn Theatre Company, Fort Lauderdale, Florida TimeLine Theatre Company, Chicago
Some may still have TDF-sponsored open-captioned performances; contact the theater directly or check the NOCI page at tdf.org. See you at the show!
Lisa Carling, the director of Theatre Development Fund’s accessibility programs, has three decades of experience designing and implementing services that make theater performances more accessible to people with disabilities around the country. Open captioning for theater is one of the nationally recognized TDF programs she was instrumental in forming, leading her and her team to earn accessibility recognition, including New York City’s 2016 Title II ADA (Americans with Disabilities Act) Sapolin Public Service Award. For references, see hhf.org/ summer2017-references.
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home
HOUSE HUNTING TIPS WHEN YOU HAVE A HEARING LOSS By Erin Vaughan
with a bit of extra planning and research, you can make sure your health, safety, and the quality of your hearing aren’t compromised by a new abode. Here’s how to simplify the hunt—whether it’s for a new home, a vacation rental, or both!
Look for Doctors and Health Providers Ahead of Time Seek out health professionals and services in your area ahead of time. The American Academy of Audiologists has a provider locator tool to search for professionals by city and state, zip code, or even by country. You can also connect with your local chapter of the Hearing Loss Association of America for recommendations. Look for Acoustically Friendly Surroundings You may be able to find a space that can help your hearing. Look for homes with triple pane or laminated acoustic glass that will block exterior noise from a highway, train tracks, or even a school. Softer, noise-dampening surfaces are also a plus, such as carpeted or wood floors instead of tile. Open floorplans, while popular, may not be the best choice acoustically, although you may be able to use window drapes or area rugs to help absorb sound.
Check If Local Authorities Offer Free Accessible Safety Equipment If you have a registered disability, your local government, fire, or police department may offer accessible safety equipment for free or at a low cost, This includes flashing smoke alarms, home security systems, and doorbell systems—some towns may even install this for free. Additionally, amenities like these can indicate a safer, community-minded town. Make Sure Your Realtor Knows About Your Hearing Loss Your realtor works for you and should be able to accommodate special provisions you need. This includes making sure they show you options that meet your requests, eliminating homes in noisy neighborhoods, or just being careful to rephrase details spoken to you when needed.
Take Advantage of Online Listings Online listings have become very thorough, with long lists of home features and professionally taken photos. While nothing can replace seeing a potential home in person, online listings can help you efficiently eliminate places that won’t work, without a visit. Vacation listings are also comprehensive; while you likely can’t visit ahead of time, read through reviews and contact the homeowner with questions, such as if there’s nighttime noise. Get a Feel for Your Future Neighbors Walk around the neighborhood and be alert for signs of neglect such as unkempt yards and exteriors and vacant or foreclosed homes. When you do zero in on a property, introduce yourself to your neighbors and establish a good relationship, just in case outdoor noise becomes an issue.
Finding your dream home can be overwhelming, but the end result of taking your time and doing your due diligence is that it meets all your needs. Happy hunting!
This is repurposed with permission from the website Modernize, whose goal is to empower homeowners with the expert guidance and educational tools they need to take on big home projects with confidence. For more, see modernize.com. For references, see hhf.org/ summer2017-references.
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No Puedo Escuchar Learn to say “I can’t hear” in multiple languages, and other key travel advice.
“I’ve learned how to say ‘I don’t hear so well’ or ‘I can’t hear’ in several languages—Spanish, French, Italian, and German! It helps a lot. Or, you can just take out your behind-theear hearing aid and show folks—it speaks volumes. “I bring a desiccant jar for my hearing aids when on the road, to avoid having to deal with different outlets using the plug-in kind I have at home. I also bring a spare old hearing aid if at all possible. I’ve kept mine, and they come in handy quite often, like when backpacking in the jungle in Bolivia, when you get really, really sweaty.” —Kathi Mestayer, staff writer
“Before a recent safari in South Africa, I made sure my dream trip didn’t tilt into a nightmare by counting my hearing aid batteries carefully to make sure I had enough for each day of travel, plus spare batteries just in case. I also brought wax guards (filters) to help make sure my hearing aids stayed clean and protected.” —Tish Hamilton
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“I saved roughly $80—or 15 percent— on my Amtrak ticket for a recent trip by indicating I have a disability. I still can’t believe it! “On amtrak.com, once I input my trip information and travel date, there was a drop-down menu to indicate which type of ticket I wanted. I chose ‘Passenger With Disability’ and then was prompted to select the type of disability and whether I required accommodations. Be sure to bring documentation of your disability with you on travel day!” —Laura Friedman, HHF communications and programs manager
“My hearing aids fit deep inside my ear canal, so when I get on the plane I shut them off—not sleep mode, but totally off so they act as earplugs. Sometimes I have to turn the sound back on and off several times during the flight to talk to the flight attendant or a seatmate, but I try to keep it off for the entire flight, from prior to takeoff until we reach the gate. “I like to reserve a seat on the aisle as far away from the engines and any outside noise as possible. I also wear a hooded sweatshirt or jacket on the
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plane for an additional barrier to the noise. Yes, I kind of look like a dork, but since it helps prevent the tinnitus and reduced hearing I can get after taking a flight, it is worth it.” —Shari Eberts, former HHF board chair; see page 20 for more
“When booking a flight, call the airline and let them know you have a hearing loss and that due to the pressure on the plane, that you would like to sit toward the front of the plane. Ask that they waive any extra fee, because this should be considered a handicapped matter. “Avoid booking a seat in the exit row, as it is probably best to leave the handling of emergency situations to those who can fully hear.” “Ask to pre-board because it gives you time to let the flight attendants know that you have a hearing loss. This is so they can alert you in case something happens on the plane. “And drink a lot of water before, during, and after your flight, because the pressure can clog your ears and they may not pop for a while!” —Alexis Lynn, staff member at the Children’s Hearing Institute
managing hearing loss
Paradise can quickly devolve into panic when sound suddenly turns into silence, particularly in a foreign country with small children. How can I protect them without hearing? How will we converse?
How I Made Friends on Vacation I’m in paradise, bobbing blissfully in shallow turquoise water, my toddler son tightly tethered to my body, my daughter and husband floating nearby. A marriage of sea and sky engulfs my eyes with blue as I inhale that distinctive scent of sunscreen and seaweed that exemplifies that wondrous thing: vacation. And the sound of the waves! So serene, so calming, so quiet… very quiet. Until it hits me that it is actually too quiet. Oh no. “Honey?” I call out to my husband, “I can’t hear. The thing died.” When on the verge of panic I forget my nouns. But he understands: The “thing” is my waterproof cochlear implant processor, and it’s stopped working, leaving me totally deaf. “Did the battery die?” he asks. I can’t hear but I can lipread. “I put in a newly charged battery this morning,” I quiver. “Are there more in your bag?” he persists. Of course I have more in my bag. I always carry spare batteries when traveling. And extra cables, earpieces, and mics. That’s life as a bilateral cochlear implant user.
But the “thing”—the waterproof CI processor, the engine of the implant— has no spare. Paradise can quickly devolve into panic when sound suddenly turns into silence, particularly in a foreign country with small children who need your constant attention. How can I protect them without hearing? How will we converse? This vacation is completely ruined! My husband talks me off the cliff. “Call the manufacturer and ask them to overnight you another,” he says. “Till then, stay on land with your regular processors, or come back in the water and make friends with the silence. I’ll watch the kids, don’t worry.” Make friends. Perfect advice for a person with bilateral cochlear implants. So I calm down and decide to make friends with the sympathetic sales rep at Advanced Bionics, who sent me a new gadget: a waterproof box to wear around my arm for my regular processors. I make friends with the hotel concierge, who promises to alert me the second my package arrives. I make friends with the beach lifeguard, letting him know that I am deaf. And that day, I also make friends
with the silence, remaining mindful that my situation is temporary and that my husband (my friend!) can take over for me when necessary. Maybe it isn’t paradise anymore that day, but the panic is gone. “I’m not alone,” I tell myself. “People are helping me. It will be okay.” And it was. —Caroline Oberweger, HHF development consultant
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managing hearing loss
Sleep Better in White (or Pink)
ABLE to Travel While Saving for the Future
White noise is a noise containing many frequencies at equal intensity (volume). It’s used as a masking sound, like static from a TV, to help you sleep or concentrate. In pink noise, the higher frequencies are lower in intensity, which most people find less distracting and more natural, and therefore more conducive to sleep. Research has supported the use of pink noise as a sleep aid. The Journal of Theoretical Biology says “steady pink noise has significant effect on reducing brain wave complexity and inducing more stable sleep time to improve sleep quality of individuals.” A paper in Neuron came to a similar conclusion: Pink noise leads to deeper, more restful sleep—and (as every college student eventually learns) better sleep means better memory retention.
Launched last year, ABLE accounts are a new financial tool for people with disabilities to put aside funds in a tax-free account. The accounts, named after the Achieving a Better Life Experience Act of 2014, allow families to save for a family member’s short- or long-term disability needs. The accounts allow saving without impeding a family’s ability to qualify for government support such as through Medicaid or Supplemental Security Income. While a special needs trust (also called a supplemental needs trust) allows families to save for a disabled family member and still take advantage of government benefits, the trusts are expensive to set up and maintain. The new ABLE accounts are easier to use, modeled on state-based 529 college savings funds. (So, they are not like retirement funds tied to an employer; you open them on your own.) Here are some general differences between the two tools. A special needs trust, like other trusts, can be formed in the present but is not funded until the future when the parents pass away. An ABLE account, on the other hand, is created and funded in the present and is controlled by the owner, the person with the disability. In a trust the trustee has control, not the disabled beneficiary of the trust. And while similar to 529s, currently you can only open one ABLE account; there is also a limit to the amount you can save. Get more details from a financial adviser or at enablesavings.com and ablenrc.org. —Y.L.
Pink noise leads to deeper, more restful sleep—and better sleep means better memory retention. The memory-boosting effect from pink noise was recently confirmed in the journal Frontiers in Human Neuroscience: Older adults who slept to the sound of pink noise performed three times better on memory tests compared with sleeping without the pink noise. Check your smartphone’s app store for white and pink noise options. For example, the free White Noise app for Apple and Android includes dozens of sounds—not only white and pink but also brown (which lowers the higher frequencies even more than white noise) and blue (higher frequencies have higher intensities), plus masking noises ranging from various types of rainfall, mechanical sounds, and animal noises (a cat purring!). Chances are you’ll find something that works for better sleep—and maybe even help your memory, too. —Yishane Lee, editor
For references, see hhf.org/summer2017-references.
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HEARING HEALTH FOUNDATION AND THE HEARING LOSS ASSOCIATION OF AMERICA 2017 READER SURVEY
survey
Hearing Health Foundation and the Hearing Loss Association of America are working together to better serve our constituents’ needs and raise awareness of the effects of hearing loss. To get to know you better, we ask that you complete the survey below. Please cut on the dotted line and, using the enclosed envelope, mail your answers to Hearing Health Foundation, 363 Seventh Ave, 10th Floor, New York, NY 10001. To complete the survey online, please visit hhf.org/survey.
de mog raph i cs 1.
2.
3.
4.
complete the survey online at hhf.org/survey
5.
Please indicate your age: under 18 years old 18 to 34 35 to 54 55 to 74 75 or older Are you a veteran or active military service member? Yes No What is your highest level of education achieved? Some high school High school graduate Some college or trade school Associate or bachelor’s degree Master’s or other professional degree What is your pretax household income? Under $25,000 $25,000 to $49,999 $50,000 to $99,999 $100,000 to $149,999 $150,000 or more What is your employment status? Employed or homemaker Out of work or looking for work Student Unable to work Retired
your h ea r i ng 6.
What is your level of hearing loss? Mild Moderate Moderately severe (continues next column)
Severe Profound I don’t know I don’t have a hearing loss 7.
Do you have trouble hearing on the phone? Yes No
8.
Do you ask people to repeat? Yes No
9.
Do you think others mumble? Yes No
10. Do you have difficulty hearing at the movies? Yes No 11. Do you have to read lips in order to hear? Yes No 12. Do you fail to hear someone talking behind you? Yes No 13. Do others tell you that you turn up the volume on the TV too loudly? Yes No 14. Please indicate the cause of your hearing loss: (as many as apply) Age-related hearing loss Noise-induced hearing loss Genetic or hereditary factors (e.g., Connexin 26, Usher syndrome) Medication Otosclerosis Head trauma or tumor (e.g., acoustic neuroma) Viral or bacterial infections (e.g., ear infections) I don’t know I don’t have a hearing loss Other ___________________
15. If you have noise-induced hearing loss, is it due to: Recreational noise (e.g., concerts) Workplace noise (e.g., military, construction, etc.) 16. How long have you had your hearing loss? Less than 1 year 1 to 5 years 6 to 10 years More than 10 years Since childhood I don’t know I don’t have a hearing loss 17. Do you use over-the-counter hearing devices or personal sound amplification products? Yes No 18. Do you use hearing assistive technology (e.g., an FM system, hearing loop, PockeTalker, captioned telephone)? Yes No
h e a r i ng a i ds 19. Do you wear hearing aids? Yes No If you answered NO to hearing aids: 20. Have you been told you would benefit from wearing hearing aids? Yes No If you answered YES to hearing aids: 21. When did you last purchase hearing aids? Within the past year 2 to 5 years ago (continues next page) hhf.org
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survey
22. What is your level of satisfaction with your current hearing aids? (1 lowest, 5 highest) 1 2 3 4 5 23. Does your hearing aid have a telecoil? Yes No 24. Who has the biggest influence on whether you purchase hearing aids? Primary care physician ENT Audiologist Family member or friend Other __________________ I don’t have a hearing aid 25. When purchasing hearing aids, please rank the importance of EACH factor: (1 lowest, 5 highest) ____ Comfort and quality ____ Cost (e.g., price, covered by insurance, free trial period) ____ Settings (e.g., programmable for a range of environments such as with a phone or in a restaurant) ____ Accessories (e.g., wireless compatibility, has telecoil, able to use with apps, able to self-program) ____ Cosmetic (e.g., less visible) 26. When considering hearing aids, please rank the importance of EACH of these potential barriers: (1 lowest, 5 highest) ____ Cost ____ Not sure where to get my hearing evaluated ____ Stigma (e.g., afraid I will look old, not competent, “disabled”) ____ Overwhelming process and/or confusing choices ____ I don’t think I need them
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co c h le a r i m p l a n t s 27. If you wear a cochlear implant (CI), when did you receive it? Within the past year 1 to 5 years ago 6 to 10 years ago More than 10 years ago Since childhood I don’t have a CI 28. If you do not wear a CI, have you been told by a professional that you would benefit from a CI? Yes No 29. If you qualify for a CI but do not have one, please indicate reasons you have not pursued: (as many as apply) Concerns about surgery complications or with losing residual hearing Cosmetic reasons Fear of discomfort Concerns about sound quality Prefer to wait for a biological cure for hearing loss Not convinced of significant improvement over hearing aids Other ___________________ I don’t have a CI 30. If you qualify for a CI and your insurance would cover all the costs (surgery, devices, therapy), would you be more likely to get one? Yes No
advo cacy 31. Have you ever felt stigmatized or discriminated against because of your hearing loss? Always Often Sometimes Never I don’t have a hearing loss
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32. How important to you are EACH of the following issues? (1 lowest, 5 highest) ____ Government should mandate that health insurers cover the cst of hearing aids and annual screenings ____ Restaurants, bars, movie theaters, health clubs, etc. should make sure the sound level is safe ____ Headphones and earbuds should have a volume limit at a safe level of sound 33. Do you think the government should allow safe, regulated, over-the-counter hearing aids to be sold? Yes No 34. How much hearing aid and/or audiological coverage do you receive through health insurance, Medicare, or Medicaid? Nothing Some, less than 25 percent Some, 25 to 50 percent Full coverage I don’t know 35. If your hearing aids were partially or fully covered every three years, would you be more likely to replace them more often? Yes No 36. If hearing aids were more easily accessible do you think it would change the public perception of hearing loss (e.g., stigma, discrimination)? It would reduce stigma It would increase stigma Nothing would change I don’t know Thank you for taking the time to complete this survey. We also want to hear from your family and friends; please access the survey online at hhf.org/survey. If you have any questions, please contact us at 212.257.6140 or info@hhf.org.
complete the survey online at hhf.org/survey
5 to 8 years ago Over 8 years ago I don’t know
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Hearing Restoration Project Plans Announced for 2017–2018 By Peter G. Barr-Gillespie, Ph.D.
hearing health foundation (hhf) funds the hearing Restoration Project (HRP) with the goal to determine how to regenerate human inner ear sensory hair cells and to eventually restore hearing in the millions of people with hearing loss. The HRP consists of leading hearing researchers who have dedicated their careers to understanding hearing and hearing loss. Hearing works when sensory hair cells detect sound waves, then turn those waves into electrical impulses that are sent to the brain for decoding. In humans and mammals, once these sensitive hair cells are damaged or die, hearing is impaired. However, most species, including birds and fish, are able to spontaneously regrow hair cells and restore their hearing. HRP scientists are tasked with uncovering how to replicate this regeneration process in humans. We have recently changed how we develop and fund research projects. At the HRP’s annual meeting in Seattle in November 2016, the HRP consortium decided to focus on multi-year projects, which permits researchers to commit to funding people in their labs for two to three years. This approach allows for continuity of the research projects, essential for their success, and was endorsed by the HRP’s Scientific Advisory Board (SAB) and HHF’s Board of Directors. (See Winter 2017’s “The HRP Shifts Gears for Greater Impact,” at hearinghealthmag.com.) The outcome of the Seattle meeting was that the HRP researchers agreed upon four major multi-year projects (on the following pages, numbers 1 through 4), which focus on single-cell sequencing, epigenetic DNA modification, bioinformatics, and gene testing. We also approved five projects (numbers 5 through 9) that fit into the larger HRP strategic plan outside the four major investigations. We are confident in this strategy shift and look forward to giving updates as the science progresses.
HRP scientific director Peter G. Barr-Gillespie, Ph.D., is the associate vice president for basic research and a professor of otolaryngology at the Oregon Hearing Research Center, and a senior scientist at the Vollum Institute, all at Oregon Health & Science University. Learn more about the HRP at hhf.org/hearingrestoration-project.
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Hearing Health Foundation is grateful to Peter G. Barr-Gillespie, Ph.D., for his guidance and leadership of the HRP, to the HRP scientists featured on the following pages for their work and commitment to the HRP consortium, and to the many donors who give to support this lifechanging research.
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project 1
project 2
project 3
Transcriptomics-based analysis of hair cell regeneration in non-mammals
Epigenetics of mouse inner ear maturation and transdifferentiation
Mouse functional testing
photo credits: jane g photography
Stefan Heller, Ph.D., Stanford University; Tatjana Piotrowski, Ph.D., Stowers Institute for Medical Research; Jennifer Stone, Ph.D., University of Washington; Mark Warchol, Ph.D., Washington University in St. Louis; Michael Lovett, Ph.D., Imperial College London
In this third-year project, we will disrupt hair cells, then analyze how gene expression changes in single cells from species that show robust hair cell regeneration. Heller’s lab will examine the consequences of aminoglycoside damage at the single-cell level in the chick utricle, while the Piotrowski lab will examine fish lateral-line cells. In another component, the project will add two time points to the chick cochlea and utricle bulk RNA-seq datasets that were generated by Lovett and Warchol and which are extremely valuable datasets for the HRP consortium.
John Brigande, Ph.D., Oregon Health & Science University
Neil Segil, Ph.D., University of Southern California; Jennifer Stone, Ph.D., University of Washington; Michael Lovett, Ph.D., Imperial College London
Many genes are turned off by chemical modifications (epigenetic marks) that prevent activation of the gene. One hypothesis is that mammals cannot activate a hair cell regeneration program after the first few postnatal days because the responsible genes have been epigenetically silenced. This second-year project looks at these epigenetic marks in the ear for every gene, during both early and late development. The investigators will use this analysis to find candidate promoter regions, which control gene activity. Preliminary data support the idea that supporting cells turn off expression of key hair cell genes (e.g., Atoh1), and so a plausible approach to triggering regeneration in the mammalian ear is to reverse such changes.
This Phase II HRP project is entering into its third year. The research involves delivery of genes and reagents that could regulate hair cell regeneration into the embryonic inner ear of mice. Two approaches will be taken. In the first, transcription-factor genes that may activate regeneration pathways will be delivered, and we will then assess their ability to trigger hair cell regeneration after those cells are killed. In the second approach, CRISPR/Cas9 reagents will be used to turn off genes that may be preventing hair cell regeneration. Using experimental approaches, the project will allow us to determine whether any specific molecules are capable of triggering hair cell regeneration in the mouse that may lead to regeneration therapies.
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project 4
project 5
project 6
Implementing the gEAR for discretionary data sharing within the HRP
Identification of candidate regulators of hair cell regeneration in the chick cochlea and utricle
Fish epigenomics and enhancer screening
Ronna Hertzano, M.D., Ph.D., University of Maryland
Here the gEAR (gene expression for auditory research) portal will be further developed for a second year to perform key gene comparison tasks for the HRP. The gEAR allows for the graphic visualization of gene expression data in an intuitive way: Multiple datasets can be displayed on a single page, all represented by cartoons and dynamically colored based on levels of gene expression. Additional features will be added through dedicated developer time to specifically serve the needs of the consortium, including additional dataset-specific graphics, tools for cross-dataset and cross-species comparisons, and intuitive integration of DNA-structure and gene expression.
Tatjana Piotrowski, Ph.D., Stowers Institute for Medical Research
Jennifer Stone, Ph.D., University of Washington; Mark Warchol, Ph.D., Washington University in St. Louis
This project has two components. In the first, the investigators will focus on validation of miRNA-seq data recently acquired by the HRP consortium; these new experiments will determine whether the genomics experiments accurately reflected miRNA fluctuations in the tissue, and may suggest candidate miRNA modulators of hair cell regeneration. In the second component, this project will test which specific signaling pathways are important for the proliferation of supporting cells and the regeneration of hair cells using pharmacological approaches.
As explained in Project #2, many genes are turned off by chemical modifications (epigenetic marks) that silence genes and prevent their activation. This inactivation often occurs at enhancers, which are regions of DNA that control the activation of genes. In this project, Piotrowski will use the ATAC-seq and H3K27ac ChIP-seq methods, which were successful for the mouse inner ear, to find enhancers that are active during hair cell regeneration in the fish. Identification of regeneration enhancers will enable the HRP to examine epigenetic marks comparatively—to determine whether regenerating species, such as the zebrafish and chick, utilize different enhancers than non-regenerating species like the mouse, or whether these enhancers are inactive in mammals.
At the HRP’s annual meeting in Seattle in November 2016, the HRP consortium decided to focus on multiyear projects, which permits researchers to commit to funding people in their labs for two to three years. This approach allows for continuity of the research projects, essential for their success. 32
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project 7
project 8
project 9
Fish CRISPR/Cas9 screen, enhancer screen
Integrative systems biology of hearing restoration
David Raible, Ph.D., University of Washington
Ronna Hertzano, M.D., Ph.D., University of Maryland
Establishing the human utricle from surgical patients as a translational in vitro model for hair cell regeneration Alain Dabdoub, Ph.D., University of Toronto; Stefan Heller, Ph.D., Stanford University; Michael Lovett, Ph.D., Imperial College London
The functional testing of candidate genes is essential for us to be able to wade through the dozens or hundreds of candidates that have been put forward from the Lovett-Warchol RNA-seq experiments. Raible has successfully developed a zebrafish CRISPR screen approach that allows for the rapid testing of candidate genes for their role in hair cell development and regeneration. Raible will continue in his characterization of genes that affect hair cell regeneration. In addition, the project includes a second aim that proposes to test candidate enhancers in the zebrafish.
The HRP consortium aims to identify factors that can either block or promote regeneration and has generated multiple genomics datasets from inner ears of regenerating and non-regenerating model organisms. This proposal aims to predict these causal factors by a detailed analysis of those datasets. The project’s two investigators—Hertzano, who is well versed in inner ear development and genomics, and Seth Ament, Ph.D., an expert in systems biology and neurobiology—will develop a quantitative model for the gene regulatory networks in hair cells and hair cell precursors that will allow them to predict key genes (e.g., master regulator transcription factors) that are associated with the ability to regenerate hair cells. They will use cutting-edge network biology approaches that integrate information about the preservation and divergence of gene co-expression across species and conditions, with information about the targets of hundreds of transcription factors.
These investigators will work with human utricles harvested during surgery to examine whether the response of human inner ear tissue to damage is similar to that of our mammalian model, the mouse. They will culture human utricles for extended lengths of time following damage with aminoglycoside drugs and determine whether the utricles show any proliferation of their supporting cells (making new supporting cells) or regeneration of their hair cells (making new hair cells). Mouse utricles have a limited ability to show proliferation and regeneration, and it is important to determine whether they are a good model for humans. The investigators also intend to examine gene expression in these human utricles to determine the molecular similarity of the cells of interest to their human counterpart cells.
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Recent Research by Hearing Health Foundation Scientists, Explained EMERGING RESEARCH GRANTS Recent accomplishments by ERG recipients underscore the importance of supporting early-career scientists who bring fresh approaches to hearing and balance studies.
Unraveling How Usher Genes Work and Interact By Junhuang Zou, Ph.D.
while extremely rare, usher syndrome is the most common cause of inherited deafness and blindness. The three clinical types have symptoms that vary in terms of age of presentation, severity, progression, and whether balance is affected. So far, 11 related genes have been identified, underscoring the complexity of this inherited disorder. In the U.S., types 1 and 2 account for the majority of Usher syndrome cases. We had earlier discovered that proteins encoded by four type 2 genes work to form a protein “complex” in fibrous links that connect stereocilia bundles at their base. Defects cause bundle disorganization and hearing loss, as the bundles must be arranged in precise rows to capture mechanical stimuli and convert them into electronic signals. But we do not know whether the equivalent four type 1 proteins form a protein complex. We also knew that type 2 and type 1 proteins interact in the lab, but it had been unclear whether interactions between these four type 2 proteins and four type 1 proteins occur in the ear. In this study, we identified a novel interaction between the type 1 protein myosin VIIa and the type 2 protein PDZD7. Using a mouse model, we also investigated the role of the four type 1 proteins in type 2 complex assembly—and found that the only type 1 protein involved is myosin VIIa. This type 1 protein, then, may hold a potential transport and/or anchoring role for type 2 proteins in hair cells. Another finding was that the type 1 protein harmonin is not involved in type 1 complex assembly. But similar type 2 proteins (PDZD7 and whirlin) are involved in type 2 complex assembly. Published in the journal Human Molecular Genetics in December 2016, this research provides insights into the complex interactions among Usher proteins, as we work to uncover more about the genetic mechanisms underlying the syndrome.
So far, 11 genes related to Usher syndrome have been identified, underscoring the complexity of this inherited disorder.
Junhuang Zou, Ph.D., is a postdoctoral researcher at Moran Eye Center, University of Utah. A 2013 ERG scientist, Zou received the C.H.E.A.R. (Children Hearing Education and Research) endowment.
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2012 ERG scientist Bradley J. Walters, Ph.D., and study coauthor Jian Zuo, Ph.D., in the lab.
photo credit: peter barta/st. jude children’s research hospital (top)
Success of Sensory Cell Regeneration Raises Hope for Hearing Restoration in an apparent first, st. jude Children’s Research Hospital investigators have used genetic manipulation to regenerate auditory hair cells in adult mice. The research marks a possible advance in treatment of hearing loss in humans and appeared in the journal Cell Reports in April 2017. Loss of auditory hair cells due to prolonged exposure to loud noise, accidents, illness, aging, or medication is a leading cause of hearing loss and long-term disability in adults worldwide. Some childhood cancer survivors are also at risk because of hair cells damaged due to certain chemotherapy agents. Treatment has focused on electronic devices like hearing aids or cochlear implants because once lost, human auditory hair cells do not grow back. “In this study, we looked to Mother Nature for answers and we were rewarded,” says corresponding author Jian Zuo, Ph.D., a member of the St. Jude department of developmental neurobiology. “Unlike in humans, in fish and chickens auditory hair cells do regenerate. The process involves down-regulating expression of the protein p27 and up-regulating the expression of the protein Atoh1. So we tried the same approach in specially bred mice.” The study’s first author, Bradley J. Walters, Ph.D., was a 2012 Emerging Research Grants scientist.
By manipulating the same genes, Bradley, Zuo, and colleagues induced supporting cells located in the inner ear of adult mice to take on the appearance of immature hair cells and to begin producing some of the signature proteins of hair cells. The scientists also identified a genetic pathway for hair cell regeneration and detailed how proteins in that pathway cooperate to foster the process. The pathway includes the proteins GATA3 and POU4F3 along with p27 and ATOH1. In fact, investigators found that POU4F3 alone was sufficient to regenerate hair cells, but that more hair cells were regenerated when both ATOH1 and POU4F3 were involved. “Work in other organs has shown that reprogramming cells is rarely accomplished by manipulating a single factor,” Zuo says. “This study suggests that supporting cells in the cochlea are no exception and may benefit from therapies that target the proteins identified in this study.” The findings have implications for a phase 1 clinical trial now underway that uses gene therapy to restart expression of ATOH1 to regenerate hair cells for treatment of hearing loss. ATOH1 is a transcription factor necessary for hair cell development. In humans and other mammals, the gene is switched off when the process is complete. In humans, ATOH1 production ceases before birth. “This study suggests that targeting p27, GATA3, and POU4F3 may enhance the outcome of gene therapy
and other approaches that aim to restart ATOH1 expression,” Zuo says. The research also revealed a novel role for p27. The protein is best known as serving as a check on cell proliferation. However, in this study p27 suppressed GATA3 production. Since GATA3 and ATOH1 work together to increase expression of POU4F3, reducing GATA3 levels also reduced expression of POU4F3. When the p27 gene was deleted in mice, GATA3 levels increased along with expression of POU4F3. Hair cell regeneration increased as well. “Work continues to identify the other factors, including small molecules, necessary to not only promote the maturation and survival of the newly generated hair cells, but also increase their number,” Zuo says.
2012 ERG scientist Bradley J. Walters, Ph.D., is an assistant professor at the University of Mississippi Medical Center. This article was repurposed with permission from St. Jude Children’s Research Hospital, where Walters was conducting postdoctoral training. Read more about Walters in Meet the Researcher, including his work with Jian Zuo, Ph.D., at hhf.org/summer2013-meetthe-researcher.
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Cortical Alpha Oscillations Predict Speech Intelligibility By Andrew Dimitrijevic, Ph.D. brain activity that originates from the cortex is known as alpha rhythms. Previous research has linked these rhythms to sensory processes involving working memory and attention, two crucial tasks for listening to speech in noise. However, no previous research has studied alpha rhythms directly during a clinical speech-in-noise perception task. For this project, my colleagues and I wanted to measure alpha rhythms during attentive listening in a commonly used speech-in-noise task, known as digits-in-noise (DiN), to better understand the neural processes associated with hearing speech in noise. Fourteen typical-hearing young adults performed the DiN test while wearing electrode caps to measure alpha rhythms. All completed the task in active and passive listening conditions. The active condition mimicked attentive listening and asked the subject to repeat the digits heard in varying levels of background noise. In the passive condition, the subjects were instructed to ignore the digits and watch a movie of their choice, with captions and no audio. Two key findings emerged from this study in regards to the influence of attention, individual variability, and predictability of correct recall. First, we saw that the active condition produced alpha rhythms, while passive listening yielded no such activity. Selective auditory attention can therefore be indexed through this measurement. This result also illustrates that these alpha rhythms arise from neural processes associated with
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Understanding the neural activity related to speech-in-noise tasks will inform the assessment of clinical populations with speech-in-noise deficits, such as those with auditory neuropathy spectrum disorder or central auditory processing disorder. selective attention, rather than from the physical characteristics of sound. To our knowledge, these differences between passive and active conditions have not previously been reported. Secondly, all participants showed similar brain activation that predicted when one was going to make a mistake on the DiN task. Specifically, a greater magnitude in one particular aspect of alpha rhythms was found to correlate with comprehension; a larger magnitude on correct trials was observed relative to incorrect trials. This finding was consistent throughout the study and has great potential for clinical use. We hope these results, published in the journal Frontiers in Human Neuroscience in February 2017, will propel the field’s understanding of the neural activity related to speech-in-noise tasks. It informs the assessment of clinical populations with speech-in-noise deficits, such as those with auditory neuropathy spectrum disorder or central auditory processing disorder (CAPD). Future research will attempt to use this alpha rhythms paradigm in typically developing children and those with CAPD. Ultimately, we want to develop a clinical tool to better assess listening in a more real-world situation, such as in the presence of background noise, to augment traditional audiological testing.
a publication of hearing health foundation
2015 ERG scientist Andrew Dimitrijevic, Ph.D., was a General Grand Chapter Royal Arch Masons International award recipient. Hearing Health Foundation would like to thank the Royal Arch Masons for their generous contributions to ERG researchers working in the area of central auditory processing disorder (CAPD). We appreciate their ongoing commitment to funding CAPD research.
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The ability to hear relies on the proper connections between the sensory hair cells in the inner ear and the brain. Activity of the sensory hair cells (red) and these connections (green) before hearing begins is essential for the proper development of hearing. Sonja J. Pyott, Ph.D., and colleagues investigated the mechanisms that regulate this activity.
A Balancing Act Before the Onset of Hearing
photo credit: sonja j. pyott (top)
By Sonja J. Pyott, Ph.D. the development of the auditory system begins in the womb and culminates in a newborn’s ability to hear upon entering the world. While the age at which hearing begins varies across mammals, the sensory structures of the inner ears are active before the onset of hearing. This activity instructs the maturation of the neural connections between the inner ear and brain, an essential component of the proper development of hearing. However, we still know very little about the mechanisms regulating the activity of these sensory structures and their neural connections, specifically during the critical period just before the onset of hearing. In our April 2017 paper in The Journal of Physiology, we report on our investigation of the role of glutamate, a neurotransmitter, in regulating activity of the sensory structures and their connections in the inner ear before the start of hearing. Neurotransmitters assist in the communication between neurons and are typically classified as either excitatory or inhibitory based on their action. Excitatory action results
Insights into neurotransmitter mechanisms may identify new ways to modulate activity and prevent congenital or acquired hearing loss. in stimulation; inhibitory action assists in the calming of the brain. Our research found that although glutamate typically excites activity, it also elicits inhibitory activity. This dual role for glutamate occurs because it activates two distinct classes of glutamate receptors: ionotropic glutamate receptors (iGluRs) and metabotropic glutamate receptors (mGluRs). Importantly, this dual activation balances the excitatory and inhibitory activity of the sensory structures—a balance that is likely important in the final refinement of the neural connections between the inner ear and brain prior to the onset of hearing.
As part of future research, we will further investigate the role of mGluRs, one of the distinct classes of glutamate receptors, in the development of hearing. We will also investigate if mGluRs balance excitatory and inhibitory activity in the adult inner ear, similar to its role prior to the onset of hearing. Insights into these mechanisms may identify new ways to modulate activity and prevent congenital or acquired hearing loss.
2007 and 2008 ERG recipient Sonja J. Pyott, Ph.D., is an assistant professor and the Rosalind Franklin Fellow in the department of otorhinolaryngology at University Medical Center Groningen, the Netherlands. For links to all of the published research, see hhf.org/summer2017references.
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WHY DOES AGE-RELATED HEARING LOSS OCCUR, AND WHAT CAN BE DONE ABOUT IT? By Robert D. Frisina, Ph.D., and D. Robert Frisina, Ph.D.
research over the past several decades, studying both aging humans and animal models, has revealed much about the salient features and characteristics of age-related hearing loss (ARHL), also known as presbycusis. Studies show that temporal processing abilities start to decline as early as middle age, meaning that the brain’s ability to rapidly time-stamp sounds and identify sound source locations is compromised. This leads to speech processing deficits, such as difficulty hearing speech in noise. Similarly, higher-level auditory coding and cognitive processing problems also occur more frequently with age. In addition, there is a link between untreated hearing loss and an elevated risk of dementia. Other research illustrates that structural changes within the cochlea are a key cause of presbycusis. Clinical and animal studies reveal that the degeneration of the stria vascularis, a key tissue in the cochlea, disrupts the balance of ions within the cochlea, causing a decreased hearing sensitivity. Cochlear changes have also been shown to induce plasticity in the parts of the brain used for hearing, with detrimental effects including the rewiring of how sound is encoded and interpreted by the brain. While highly condensed, this overview is representative of what we know about ARHL, and provides the context for current and future treatment options.
Current Treatment Options
Currently, you cannot go to your pharmacy and buy a drug to make you hear better, or to prevent ARHL. In fact, surprisingly, there are no drugs approved by the Food and Drug Administration (FDA) to prevent or treat any types of permanent hearing loss. That said, noise exposure can contribute to the accelerated progression of ARHL, so wearing hearing protection and monitoring noise levels may delay some aspects of presbycusis. In addition, widely accepted methods of lessening the 38
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overall effects of aging—such as through antioxidant-rich diets, caloric restriction, and exercise—may also improve sensory function for older adults. However, once ARHL has progressed to a noticeable level, there are no available biomedical cures or interventions. Treatment for hearing loss consists of the use of hearing devices, such as digital hearing aids, which continue to become more sophisticated, and have been very helpful for improving speech perception and communication abilities in seniors. Still, only one in five people who could benefit from using hearing aids, including those with mild hearing loss, wears them on a regular basis. Some computerized auditory training programs promote temporary improvements in speech or auditory temporal processing in older adults. However, research has shown that these benefits are short-lived, with specific positive effects disappearing after the auditory training stops.
A Potential Biomedical Intervention
As the causes of ARHL become better understood on both the cellular and molecular levels, targets for drug interventions to prevent or treat it become feasible. For example, inspired by the pioneering work of Dennis Trune, Ph.D., and colleagues, our team has demonstrated that a hormonal intervention can slow down certain key aspects of ARHL in a mouse model. Our research specifically looked at aldosterone, the main hormone that controls sodium and potassium ion concentrations in the body, and whose level, like most hormones, declines with age. Since cochlear function critically depends on potassium and sodium concentrations, particularly in the strial tissue, we theorized that aldosterone supplementation in older subjects may prevent certain aspects of presbycusis. To test this hypothesis, we gave aging mice aldosterone
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As the causes of ARHL become better understood on both the cellular and molecular levels, targets for drug interventions to prevent or treat it become feasible.
supplementation with a dosage designed to bring the aldosterone blood serum levels to within the range of a young adult mouse. We used subcutaneous time-release pellets for a four-month time period. Our results revealed a number of promising findings. First, the mice treated with aldosterone displayed a preservation or improvement of hearing demonstrated by pure-tone and auditory brainstem response testing, compared with the control group. Second, the treated mice displayed preservation of spiral ganglion cell bodies, which are crucial nerve cells responsible for sending auditory signal to the brain. Third, the experimental group showed improved function, maintenance, and survival of nerve cells in the ear through the mechanisms of specific proteins and receptors. Lastly, and significantly, the regulating pathways in the ear were blocked by the aldosterone therapy in the ear, preventing cell death due to aging of cells in the cochlea critical for hearing.
Future Breakthroughs
Given the current progress on identifying physiological and molecular biomarkers of presbycusis in both the ear and brain, we are on the cusp of developing drug therapies
to prevent or reverse the progression of ARHL. Every biological treatment effort, not just by our team and other top research groups, will require specially trained interdisciplinary researchers and clinicians to accelerate progress from preclinical, animal model studies to FDA clinical trials, and ultimately to the bedside. In addition, moving potential drugs toward clinical use requires thinking about drug delivery methods. Ideally compounds would be administered systemically so that an overall positive effect on sensory processing and the health of the older adult is achieved. This may be done orally or via new “smart” patches that biomedical engineers have already developed to deliver insulin or blood thinning drugs. Local drug delivery may also be achieved by reaching the inner ear via micropumps, nanoparticles, or special hydrogels that allow for precise dosage control and location targeting to avoid unwanted systemic side effects. While research continues to be conducted to better understand the exact effects of aging on hearing— both for the inner ear and the parts of the brain used for hearing—very exciting biomedical engineering possibilities are on the horizon for innovative protection and the restoration of hearing in older adults.
Robert D. Frisina, Ph.D., is a professor and the director of biomedical engineering in the department of chemical and biomedical engineering, and the director of the Global Center for Hearing & Speech Research, both at the University of South Florida. His father, D. Robert Frisina, Ph.D., was instrumental in setting up the National Technical Institute of the Deaf, part of the Rochester Institute of Technology, New York, in the 1960s, becoming its first director. For references, see hhf.org/ summer2017-references.
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HOW WILL THE FIELD OF AUDIOLOGY EVOLVE? By Kathleen Wallace
the american academy of audiology’s (aaa) annual conference, AudiologyNow!, took place in the Indianapolis Convention Center in early April. Although four days of lectures addressed nearly every aspect of the audiological scope of practice, one overarching theme emerged this year: How will the field of audiology evolve from here? This past year has posed several possible disruptions to the field of audiology, such as how over-the-counter hearing aid legislation will change delivery of services; how the continued interest in personal sound amplification products (PSAPs, also called “hearables”) will guide consumer choice; and how to improve evaluations and interventions to best serve individuals with hearing loss. These questions, along with many others, fueled conversation among hearing healthcare professionals from around the country. AAA President Ian Windmill, Ph.D., urged members of the academy to embrace disruptions to the field, including recently introduced legislation for nonprescription hearing aids. Although these changes may appear as an encroachment on the audiological scope of practice, Windmill says they may actually be beneficial to the field. Hearing healthcare has never been more in the public eye or as highly discussed by health officials, politicians, and consumers than in recent months, Windmill says. This increased awareness may lead to the prioritization of hearing health, as consumers grow more cognizant of the repercussions of hearing loss. Furthermore, the introduction of hearing solutions at various price points and technology levels may improve accessibility. If audiologists embrace these alternatives to intervention, they will successfully evolve with the field while simultaneously demonstrating to consumers their dedication to patient-centered care. This sentiment was echoed throughout the conference. Additionally, lectures discussed how audiologists may be able to improve delivery of patient-centered care through boosting counseling skills, using self-assessments, and promoting consumer education to shift the locus of control
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from care provider to joint decision-making between the consumer and the hearing provider. Lastly, leading professionals in the field are encouraging a return to audiologists’ roots as rehabilitative professionals. In the years since the audiological scope of practice expanded to include the ability to dispense hearing aids, audiologists have slowly shifted their focus from providing rehabilitative services to a device-driven practice centered on hearing aids. However, the delivery of unprecedented auditory rehabilitation to foster successful communication strategies will enable the profession to succeed in the face of the many disruptions to hearing technology. AAA’s willingness to acknowledge the challenges facing hearing healthcare is very promising to its successful evolution as a field. Many hearing healthcare professionals are embracing this opportunity to rethink the delivery of care and to improve patient satisfaction by challenging the status quo.
Staff writer Kathleen Wallace is pursuing a doctor of audiology degree (Au.D.) at the City University of New York's Graduate Center. She will graduate in 2018 upon completion of her fourth-year clinical placement at Mount Sinai Hospital, New York City.
Share your story: Hearing professionals, tell us your opinion about rapid changes in your field at editor@hearinghealthmag.com.
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SELF-ADVOCACY PROMOTES LIFELONG ACCESS By Cynthia Forsythe
column series
Children & Hearing Loss This is the last of eight columns from Clarke about children with hearing loss, their families, and the professionals who serve them.
1. 2. 3. 4.
self-advocacy is essential to the success of both children and adults with hearing loss. It requires knowing yourself and identifying your strengths, skills, and needs. Students with hearing loss must understand their hearing loss and their hearing technology in order to be equipped to ask for access and support during any transition or new situation. For young children, parents play the role of advocate by making decisions regarding technology, early care, and school placement. As children reach school age, parents remain involved, but students gradually take on more responsibility, aided by their network of teachers, special educators, speech-language pathologists, audiologists, and other professionals, all of whom help provide access and support for the child. We often see a strong emphasis placed on technology when it comes to self-advocacy. While access to functioning equipment is critical, it is important not to lose sight of how students are feeling about themselves. A student’s ability to feel confident in who they are and express what they need is just as vital as having the right technology and support. Helping them understand not only their hearing loss and technology but also their learning style and what will assist them in maximizing their potential is essential. Students benefit from coaching and practicing selfadvocacy. I often interact with students in role playing,
helping them to think ahead about what they might say when they have an issue with equipment, or experience a social situation where they don’t have access to sound. By scripting possible strategies and working through the feelings that may arise when making a request, students prepare themselves to respond confidently in real-life situations, and this can make all the difference in ensuring that their access is uninterrupted. Sitting near the person speaking and away from noisy areas of the room, having a note taker, and utilizing captioned media are good examples of improving access to sound, but the first crucial step is being able to ask for these supports. That’s why self-advocacy plays a key part of the Individual Education Plan (IEP) process. With the IEP, families and schools work together to incorporate various supports, and older students join the conversation to become empowered as they mature. We must remember that by teaching self-advocacy, we are helping to ensure an individual’s legal right to access in all situations. Students with hearing loss will continue to use their self-advocacy skills long after they have left school, to navigate new situations in work and life. We want to equip students from the start to make well-informed decisions and to understand the effects of their actions on their own experience, and feel confident in doing so. They learn they can actively make choices that either help or hurt them, and that it is ultimately up to them to take responsibility for advocating for their needs.
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overview diagnosis a m p l i f i c at i o n e a r ly i n t e r v e n t i o n
5. 6. 7. 8.
preschool mainstream s o c i a l i z at i o n s e l f -a d v o c a c y
Hearing Health Foundation thanks Clarke Schools for their eight-column series, all at hearinghealthmag.com.
Cynthia Forsythe, CAGS, MED, is a teacher of the deaf and a school psychologist at Clarke Schools for Hearing and Speech in Northampton, Massachusetts. A member of Clarke’s Comprehensive Educational Evaluation team, she has worked with students with hearing loss for over 30 years.
hearing aids 101
Have a Worry-Free Vacation While many vacation considerations are similar for travelers with or without hearing aids, here are some special tips for taking care of your hearing devices while embarking on your next adventure. Beach Vacations By Emily L. Martinson, Au.D., Ph.D.
As most hearing aid users know, moisture can interfere with hearing aids. Saltwater is particularly damaging. Make sure to take out your hearing aids before swimming, snorkeling, or scuba diving. Sand can also get into your hearing aids, especially the microphones and battery compartments. Be sure to keep your devices safely covered and away from sand. Remove your hearing aids before applying sunscreen, as it can clog microphones as well.
Amusement Parks
illustration credit: istockphoto.com
Roller coasters and other thrilling rides can jostle your hearing aids right out of your ears. Needless to say, a 40-foot drop from the top of a roller coaster can severely damage your devices! It is best to keep them in a safe place such as a zippered pouch, or ask someone not going on the ride to hold onto them. On water slides, the combination of water and fast movement can mean losing your hearing aids in water. Make sure your devices are safely removed before going on the water slide. But before you remove your hearing aids, be sure to listen to and follow safety instructions.
Educational Tourism
On tours of historical or educational sites, position yourself close to the tour guide to have the best access to speech information. To hear even better, ask the tour guide to use a remote microphone or FM system paired with your hearing aids so their voice reaches your ears directly.
Camping and Outdoor Vacations
If you use rechargeable hearing aids, when camping bring extra disposable hearing aid batteries since you wonâ&#x20AC;&#x2122;t have access to electricity. A portable storage jar with a desiccant is useful for overnight storage (it also helps you keep track of your hearing aids in a dark tent). It is very important to wear your hearing aids while rock climbing or participating in any extreme sport, as you will need to be able to hear safety information, but make sure they are secured to your ears using hearing aid tape or a headband.
Winter and Ski Vacations
Looking ahead to winter, the biggest issue for winter sports enthusiasts with hearing aids is ensuring their devices do not get lost in the snow. Either cover your hearing aids with your hat or helmet, or use hearing aid tape to secure them to your ears. Wind noise can also be an issue for skiers, so ask your hearing care professional to turn on the wind reduction feature on your hearing aids. Bon voyage!
Emily L. Martinson, Au.D., Ph.D., is an audiologist at Live Better Hearing in Maryland and Virginia. For more, see livebetterhearing.com
Support our research: hhf.org/donate hhf.org
summer 2017
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meet the postdoc
Meet the Postdoc C. Elliott Strimbu, Ph.D.
Columbia University Medical Center
After receiving his doctorate in physics at UCLA and completing postdoctoral work in Sweden at the Karolinska Institutet and at Linköping University, Strimbu is now a postdoctoral researcher at Columbia University Medical Center in New York City.
Hearing Health Foundation is proud to sponsor the attendance of postdoctoral researcher C. Elliott Strimbu, Ph.D., at the June 2017 Mechanics of Hearing Workshop at Brock University in Ontario, Canada.
In His Words all of my research since graduate school has involved using novel imaging techniques to study the mechanics of the inner ear. In spite of all we know about hearing and the auditory system, there remain many mysteries, even on the fundamental level. As a physicist I am interested in the basic mechanics of how the inner ear really works. for my ph.d. project we used high-speed video microscopy to study the motion of inner ear sensory hair cells. It is the mechanical deflections of these hairlike stereocilia that are converted to electrical signals that are ultimately sent to the brain. Although many groups have studied the deflections of the hair bundles, the use of an ultra-high-speed camera enabled us to record many cells in parallel and to study the effects of having many cells coupled together with a membrane. We were thus able to study the cells in an environment much closer to their native state in the ear. in sweden, i worked in a group that specializes in cochlear mechanics, using fluorescent dyes to image the hair cells and track their motion in response to sound. My work now uses optical coherence tomography, a new technique that works somewhat like an ultrasound but uses light rather than sound waves to form an image. my interests switched from pure physics to auditory research when, during a graduate seminar, I learned about hair cells detecting “subnanometer displacements” (one nanometer is about 40 billionths of an inch) and operating at frequencies of 80 or so kilohertz in some species. That really blew me away—because a nanometer is about the distance you would get if you lined up 10 hydrogen atoms in a row.
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so, in response to a quiet sound, hair cells in the inner ear are essentially vibrating the distance covered by a few atoms, and doing this thousands of times each second—and then converting this to an electrical signal that our brains can process. I realized that physicists and neuroscientists studying hearing had discovered a really interesting field with a lot of open questions. there is probably some hereditary tinnitus in my family; one uncle with severe tinnitus describes it as the buzzing sound made by old fluorescent lights. I also experience tinnitus occasionally, a high-pitched ringing that goes away after about a minute. When this happens, I usually make a joke about a hair cell in my ear dying. My father almost certainly has noise-related hearing loss from his job as a mechanic in a steel plant, but his hearing aid has really made a difference for him and for those around him. a colleague and i used to joke about writing a “murder mystery romance novel” set in an auditory biophysics lab, incorporating our experiments and experiences in the lab. One day we looked online and were shocked to discover that there was already a genre of “nerd romance” novels! I still think there’s a market for one set in a lab.
We need your help in 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.
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EMERGING RESEARCH GRANTS Can a chicken cure hearing loss and tinnitus? The answer, incredibly, is YES! Learn more at Hearing Health Foundation’s website.
As one of the only funding sources available to early-stage researchers, Hearing Health Foundation’s ERG program is critical. Without our support, these scientists would not have the needed resources for researching hearing and balance disorders.
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meet the researcher
EMERGING RESEARCH GRANTS
Meet the Researcher
Emerging Research Grants (ERG) As one of the only funding sources available to early-stage researchers, HHF’s ERG program is critical. Without our support, these scientists would not have the needed resources for their innovative approaches toward understanding, preventing, and treating hearing and balance disorders.
Richard A. Felix II, Ph.D.
Washington State University Vancouver
Felix received his Ph.D. in neuroscience from West Virginia University and completed a postdoctoral fellowship at Karolinska Institutet in Stockholm. He is now a postdoctoral research associate at Washington State University Vancouver. Felix’s 2016 Emerging Research Grant is generously funded by the General Grand Chapter Royal Arch Masons International.
In His Words how do different areas of the brain work together to enable us to understand speech and other important sounds in our environment? This is the topic of my research. Specifically, I am interested in how timing properties of brain activity contribute to the accurate representation of communication sounds.
older family members and friends have shared their difficulties understanding speech despite adequate amplification of the sounds. This complaint is common among those with CAPD, so I hope that my research will positively impact my loved ones and others with hearing and processing disorders.
when the timing of brain activity does not develop normally or is disrupted, the consequences are far reaching, including listening problems that can lead to learning disabilities and ultimately a reduced quality of life. I had studied distinct features of abnormal brain signals in children with central auditory processing disorder (CAPD) and wondered whether the altered function of specific circuits of auditory neurons could account for these abnormalities.
i am from the pacific northwest, attended graduate school in West Virginia, completed a postdoctoral fellowship in Sweden, and have family throughout the U.S., so most of my free time is spent traveling and maintaining friendships across the globe. I like competing in team sports and pub quizzes, and I am a karaoke enthusiast. I usually try to perform new songs onstage, but I often cannot resist Celine Dion.
as an undergraduate my original interest was history, but after a couple years it shifted to biology, due in large part to an enthusiastic and dedicated group of instructors. During my last semester I attended a seminar talk of an incoming faculty member and was blown away by the research that was presented on the auditory system of the bat. during my graduate and postgraduate work, my colleagues and I investigated the function of neurons specialized for encoding sound rhythms, which are important features of speech signals and vocalizations. I consider this a highlight of my career so far because we filled an important gap in knowledge in our scientific field.
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Richard A. Felix II, Ph.D.’s grant is generously funded by the General Grand Chapter Royal Arch Masons International. We want to thank the Royal Arch Masons for their ongoing commitment to research in the area of central auditory processing disorders.
We need your help in 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.
For more Living Well with Hearing Loss recipes: Visit: HamiltonCapTel.com/LivingWell The Hamilton CapTel phone requires telephone service and high-speed Internet access. WiFi Capable. Internet Protocol Captioned Telephone Service (IP CTS) is regulated and funded by the Federal Communications Commission (FCC) and is designed exclusively for individuals with hearing loss. To learn more, visit www.fcc.gov.
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