Hearing Health Summer 2021 A Publication of Hearing Health Foundation hhf.org
The Entertainment Issue Breaking barriers, raising awareness, and aiming for equity
h e a ri n g h e alt h fo u n dation
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FEDERAL LAW PROHIBITS ANYONE BUT REGISTERED USERS WITH HEARING LOSS FROM USING INTERNET PROTOCOL (IP) CAPTIONED TELEPHONES WITH THE CAPTIONS TURNED ON. IP Captioned Telephone Service may use a live operator. The operator generates captions of what the other party to the call says. These captions are then sent to your phone. There is a cost for each minute of captions generated, paid from a federally administered fund. No cost is passed on to the CapTel user for using the service. CapTel captioning service is intended exclusively for individuals with hearing loss. CapTel® is a registered trademark of Ultratec, Inc. The Bluetooth® word mark and logos are registered trademarks owned by Bluetooth SIG, Inc. and any use of such marks by Ultratec, Inc. is under license. (v2.6 10-19)
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The mission of Hearing Health Foundation (HHF) is to prevent and cure hearing loss and tinnitus through groundbreaking research and to promote hearing health. HHF is the largest nonprofit funder of hearing and balance research in the U.S. and a leader in driving new innovations and treatments for people with hearing loss, tinnitus, and other hearing and balance conditions. As part of our outreach, we provide this quarterly magazine for free to our vibrant community of readers and supporters, as well as to the dedicated professionals who work with them. Please subscribe at hhf.org/subscribe and make a donation at hhf.org/donate.
Summer 2021: The Entertainment Issue Events like concerts, movies, and sports can be loud and put hearing at risk, especially over time. But we can protect our ears while keeping it fun.
Timothy Higdon President and CEO Hearing Health Foundation
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Hearing Health The Entertainment Issue
Publisher Timothy Higdon, President and CEO, HHF
Summer 2021, Volume 37, Number 3
Editor Yishane
Features
10 Living With Hearing Loss True Talent Comes in All Forms. Jan Marcos Andrade
28 Managing Hearing Loss The Power of the Written Word. Shari Eberts
12 Music Sound of Real. Richard Einhorn. My Circuitous Path to Audiology. Jonathan Mikhail, Au.D. From a $3.95 Guitar to the Solid Body Electric Guitar. Les Paul and Sue Baker
30 Planned Giving Three Life Lessons. Betsy Glick
18 Hearing Health We Want You to Keep Listening, Safely.
37 Research Recent Research by Hearing Health Foundation Scientists, Explained.
21 Hearing Health Helping Others Has Helped Me. Helen Garrett. The Danger in Headphones. Jan L. Mayes. Banding Together to Prevent Hearing Loss in Young People. Kelly Culhane. Loud Noise Can Cause Hearing Loss Quickly or Over Time. Centers for Disease Control and Prevention
48 Research Do Transparent Face Coverings Help With Communication? B. Renee McDowell et al.
Departments
Sponsored
06 Letters to the Editor 08 HHF News 27 HHF 2021 Reader Survey 34 #StartWithERG Gail Seigel, Ph.D. 50 Meet the Researcher Ross Williamson, Ph.D.
47 Advertisement Tech Solutions. 49 Marketplace Hearing Health Foundation (HHF) and Hearing Health magazine do not endorse any product or service shown as paid advertisements. While HHF makes every effort to publish accurate information, it is not responsible for the accuracy of information therein. See hhf.org/ad-policy.
Cover Jan Marcos Andrade wants to see greater diversity and representation among models and actors. Photo by Viviimage Photography.
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Art Director Robin Senior Editors
36 Research New Working Groups Reaffirm Team Science Approach. Lisa Goodrich, Ph.D.
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Lee Kidder
Amy Gross, Lauren McGrath
Medical Director David Staff Writers Shari
S. Haynes, M.D.
Eberts, Kathi Mestayer
Advertising hello@glmcommunications. com, 212.929.1300 Editorial Committee
Judy R. Dubno, Ph.D. Christopher Geissler, Ph.D. Lisa Goodrich, Ph.D. Anil K. Lalwani, M.D. Rebecca M. Lewis, Au.D., Ph.D., CCC-A Jay R. Lucker, Ed.D., CCC-A/SLP, FAAA Joscelyn R.K. Martin, Au.D. Board of Directors
Chair: Col. John T. Dillard (U.S. Army, Ret.) Sophia Boccard Robert Boucai Judy R. Dubno, Ph.D. Ruth Anne Eatock, Ph.D. Jason Frank, J.D. Jay Grushkin, J.D. Roger M. Harris David S. Haynes, M.D. Elizabeth Keithley, Ph.D. Cary Kopczynski Anil K. Lalwani, M.D. Michael C. Nolan Paul E. Orlin Robert V. Shannon, Ph.D. Hearing Health Foundation 575 Eighth Avenue #1201, New York, NY 10018 Phone: 212.257.6140 TTY: 888.435.6104 Email: info@hhf.org Web: hhf.org Hearing Health Foundation is a tax-exempt, charitable organization and is eligible to receive tax-deductible contributions under the IRS Code 501(c)(3). Federal Tax ID: 13-1882107 Hearing Health magazine (ISSN 2691-9044, print; ISSN 2691-9052, online) is published four times annually by Hearing Health Foundation. Copyright 2021, Hearing Health Foundation. All rights reserved. Articles may not be reproduced without written permission from Hearing Health Foundation. USPS/Automatable Poly To learn more or to subscribe or unsubscribe, call 212.257.6140 (TTY: 888.435.6104) or email info@hhf.org.
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Call Forwarding If you need all of your phone calls captioned, set up call forwarding with your wireless provider to have calls to your existing phone forwarded to your InnoCaption number.
No Cost to Users InnoCaption is able to provide this captioning service free-of-charge to people whose hearing loss makes it hard to understand phone calls because we are certified by the FCC and receive compensation from the TRS fund.
Download the Innocaption app today!
www.innocaption.com Disclaimer: InnoCaption is ONLY available in the United States. FEDERAL LAW PROHIBITS ANYONE BUT REGISTERED USERS WITH HEARING LOSS FROM USING INTERNET PROTOCOL (IP) CAPTIONED TELEPHONES WITH THE CAPTIONS TURNED ON. IP captioned telephone service may use a live operator. The operator generates captions of what the other party to the call says. These captions are then sent to your phone. There is a cost for each minute of captions generated, paid from a federally administered fund. No cost is passed along to the InnoCaption user for using the service.
911 Calling Advisory: Calling 911 from a landline remains the most reliable method of reaching emergency response personnel.
letters to the editor
hearing health foundation
@editor
dear editor: I really enjoyed your Spring 2021 issue on tinnitus and hyperacusis. I have both and it’s a very difficult combination. What bothers me most is that often I need to wear earplugs to muffle noises but then the tinnitus is much more pronounced. It’s also difficult for other people to understand that when they make loud noises like slamming cupboards or banging dishes it can actually be very painful. I appreciate the work you and the people who wrote articles are doing to educate society about these conditions. I will be investigating habituation. Thank you. Joe D. Faithfull California
dear editor: Thank you for all the informative articles. Mostly I love the knowledge gain and feeling united with others out there with whatever form of hearing struggle they face. The poem by Sylvia Byrne Pollack in the Spring 2021 issue touched my heart. Every time I read it I cry, because I understand her struggle through these beautiful words, because they are my struggle too. Angela Schutte New Zealand
dear editor: As a longtime reader and former feature writer for Hearing Health magazine, I have three reasons why I enjoy reading the Spring 2021 issue. The different articles about tinnitus by Steve DiCesare, John Dillard, Jemma-Tiffany Rosewater, and Hazel Goedhart, and also Ankitha Lavi’s ASL lessons provided a nice practical balance of their perspectives. Of course the illustrations by
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Ian Miller enhanced the view of DiCesare with humor, hope, and reality. As a postlingually deaf person who has lived with tinnitus since 1989, I’m glad that HHF accepted their stories at face value without challenging, correcting, or rejecting their subjective narratives. Thirty years ago, a tinnitus organization turned down my story that touched on the very same issues brought up by the five writers. My point? Never doubt the sincere subjectivity and suggestions of a genuine tinnitus-enduring person. Lastly, if I may suggest another angle, history is full of creative tinnitus people, such as van Gogh, Beethoven, and Edison, no different from the five writers who shared their empirical insights. Steve C. Baldwin, Ph.D. Austin, Texas
dear editor: I appreciate your articles about noisy healthcare settings (in the Fall 2020 and Fall 2019 magazines). The worst issue is the heart monitor beeps that go off next to the patient’s head. I asked several nurses and doctors as well as management why they couldn’t have the alarm go off at the nurses’ station instead of next to the patient—which doesn’t do so much good anyway because no one heard it except me in the room. Sometimes it would go off every few minutes for hours at a time, at all hours of the day and night, when oxygen levels got below a certain number, or when a tube got blocked. Usually nothing really serious, but it prevented any type of sleep or tranquility. The answer I got was that’s the way the machine is made. It is impossible to change it. There has got to be a better way. Debora Masterson Los Angeles
letters to the editor
dear editor: Over the years I have never read any article in this magazine about my problem, which seems to be the opposite of the magazine’s focus. My problem is I’m hearing too much. I live in a rural neighborhood which is also next to a major highway. The constant noise from the traffic, some with extremely loud exhaust pipes, motorcycles, emergency vehicle sirens, farm equipment, plus the constant noise of nearby neighbors mowing their yards every other day with lawn mowers, lawn tractors, leaf blowers, grass trimmers, etc. Earplugs are not a good solution in my situation. I can’t believe I’m the only one who has this problem. Anonymous Cleveland from the editor: The issue of noisy environments is definitely on our radar, so we’ve publicized the efforts of Quiet Communities Inc. to advocate and legislate for quieter spaces, including one’s neighborhood and hospital room. We also hope our new prevention campaign (see page 18) will bring more awareness and help quiet down our noisy world.
dear editor: Thank you for Hearing Health magazine; it is interesting and informative. I lost most of my hearing ability 10 years ago, prompting me to wear hearing aids. Medicare does not include hearing aids in its coverage. I’ve written to my Congressional representatives, contacted AARP, and researched various Medicare supplement and advantage plans, none of which are satisfactory or effective. The current administration has opened the spending floodgates to just about everything one can imagine. Can hearing aids be considered “infrastructure,” I wonder? Why are hearing aids not on anyone’s agenda, and what is HHF
doing to influence this administration to include Medicare coverage of hearing aids? Harvey Krauthamer South Carolina from the editor: The Medicare Hearing Aid Act was proposed in the last Congress but stalled in the Senate. It was reintroduced in February 2021. The federal guidelines that were to come from the 2018 Warren-Grassley Overthe-Counter Hearing Aids Act were delayed by COVID-19 but now look to be issued in 2022. They will help make sure that OTC hearing aids, also called personal sound amplification products or hearables, are regulated and improve overall access to hearing devices. HHF is a founding and active member of the Friends of the Congressional Hearing Health Caucus, a coalition of industry, nonprofit, and professional groups that support the bipartisan Congressional Hearing Health Caucus, which encourages expanding hearing healthcare coverage and other issues. Given that untreated hearing loss is linked to dementia, the lack of Medicare for hearing aids—when an expensive Alzheimer’s drug with unclear efficacy seems like it will be covered—is something that Hearing Health contributor Katherine Bouton examines on her blog, katherinebouton.com.
We always appreciate hearing from our community. Letters are edited for length and clarity. Please email us at editor@hhf.org
Support our research: hhf.org/donate.
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NEWS
HHF
National Institutes of Health Grant for the gEAR Platform
Created by the gEAR, this figure’s resemblance to North America has made it easier to explain a Hearing Restoration Project goal to get from “Florida” (4) to “Cuba” (2).
Ronna Hertzano, M.D., Ph.D., and team are happy to report that their gEAR (gene Expression Analysis Resource) platform has been awarded a major R01 grant from the National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health. The gEAR is the data sharing and data visualization tool the team developed, maintains, and continues to expand that has had, since it was created in 2016, majority funding from Hearing Health Foundation through the Hearing Restoration Project. The NIDCD grant recognizes the gEAR’s value to the entire hearing and balance research community and will allow Hertzano’s team to further expand the tool’s capabilities.
Joining Forces With the HLAA to Empower People With Hearing Loss Hearing Health Foundation is pleased to have partnered with the Hearing Loss Association of America on several initiatives this spring and summer. HLAA, whose mission is to open the world of communication through information, education, support, and advocacy to people with hearing loss, has been a longtime partner of HHF. In May 2021, HHF joined the Alexander Graham Bell Association for the Deaf and Hard of Hearing, the American Speech-LanguageHearing Association, and the Hearing Industries Association, among others, as partners for HLAA’s PatientFocused Drug Development Meeting (PFDD). The virtual meeting centered on individuals with hearing loss, their 8
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daily lives, and their experiences with technology. The Food and Drug Administration employs PFDD meetings to solicit information directly from patients, caregivers, and families to support drug development and the review of marketing applications for new drugs. Beginning in mid-June 2021, HLAA’s annual Walk4Hearing program kicked off virtually. The program joins together people across the country who understand what it’s like to live with hearing loss, and doing it online means it can be done from the comfort and safety of your home. Because HHF is a proud National Alliance Partner for Walk4Hearing, a portion of the funds raised by your team can be directed
to HHF. Simply select HHF as your Alliance when you register your team to send 40 percent of the dollars raised to support HHF’s hearing and balance research. HHF was also thrilled to attend the HLAA Virtual Convention 2021 in late June 2021. The three-day event included a research symposium and workshops on advances in hearing aids, accessibility through mobile devices, hearing access in the workplace, and more. HHF staff enjoyed engaging with visitors to our virtual booth to converse about our life-changing research and awareness programs.
Support our research: hhf.org/donate.
Spring 2019
A Publication of Hearing Health Foundation
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Fall 2019
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The Managing Hearing Loss Issue
Share Stories and Solutions
Facing daily challenges with grit, and grace
The Older Adults & Veterans Issue Coping with hearing conditions due to age or service
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Winter 2020
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The Workplace Issue Hearing and balance conditions provide inspiration and create awareness on the job
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Summer 2020
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Hearing Health Foundation’s Hearing Health magazine is the ultimate consumer resource on hearing loss, tinnitus, and other hearing and balance conditions. Our FREE, award-winning quarterly highlights inspiring first-person stories and real-world solutions based on the latest research and technology. Hearing Health magazine provides opportunities to meaningfully connect with others in the hearing loss community.
The Noise-Induced Hearing Loss Issue Scientists research hearing conditions caused by loud sounds
To subscribe for FREE, please visit hhf.org/subscribe.
living with hearing loss
hearing health foundati o n
True Talent Comes in All Forms
I was flipping through the pages of this magazine, one after another, and was surprised to see that many of the photos did not show people with visible hearing aids. It spurred me to reach out and share my story, because I feel that the acting and modeling industries lack the inclusion of people who really use hearing aids. By Jan Marcos Andrade
I was born in Florida, where I still live. Twenty-eight years ago newborn hearing screening wasn’t mandatory. My parents recall that they didn’t feel it necessary or that they were advised to do it. When I was a toddler, my parents noticed I did not respond to what they said, including my name. They brought me to the doctor, who put me through a series of tests and determined I was nearly deaf, with moderate to severe hearing loss in both ears. I was 2 ½ years old. My parents were devastated, not knowing how I would be able to grow up “normal.” Would I ever speak? Would I need to be homeschooled?
Would I be able to get a job later on? They were determined to get me the best help possible. I saw more doctors and had more tests, and then was given the precious gift of hearing aids.
Front and Center
In grade school I wore a big rectangular device strapped to my chest with wires attached to a hearing piece into my ears. It turned heads in the hallways and classroom, and many students asked what it was. However, in third grade there was one student who laughed and said I was weird because of the device I had to wear. I felt extremely hurt for months afterward. But it pushed me to prove to myself that I am just as capable as anyone else. I decided to join the after-school drama and chorus clubs. These two enrichment activities opened my eyes—I saw how I could hone my voice and acting skills despite learning how to speak at a later age than other students. In special education I had been practicing my speech for years, stuttering occasionally. By practicing acting and singing in these clubs, before I knew it I was placed front and center of the chorus and in plays, and at school spirit rallies and events. Even in prekindergarten, I became the announcer for our talent show. I saw what I could accomplish and how far I could go. Since then, I’ve remained interested in acting and using my Jan Marcos Andrade has been a voice, body language, and behavior perfomer since prekindergarten, when to portray a character. When I watch he used a body-worn hearing device. actors in films, I always consider how their emotions and actions are Left: Andrade with his family.
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living with hearing loss
Representation in the media sends a message that you are welcomed, seen, and educating the masses on what disability actually looks like. This is my way of advocating, just being me in my character to represent how I’ve lived my experience and mesh it with the role I’m playing. portrayed, and I feel empathy for the characters’ struggles. As a novice professional actor, I keep getting told that acting is very hard and only those who make it big in Hollywood can earn a real living, and that I should go for an easier career. Every time I hear this, it brings me back to my grade school bullying experience and I become even more determined.
Many Dimensions
For a long time I struggled to find my identity in the Deaf community. I didn’t learn American Sign Language (ASL) when I was little, and I’m told I don’t look or sound deaf because of how well I speak. But saying this actually further perpetuates the stereotype of people with hearing loss as one dimensional, and I believe our community is more than just a shared language. I share many experiences with Deaf people and know that we are a diverse, wide-ranging community. Others have called me hard of hearing because I use hearing aids. It still does not change the fact that I am Deaf. If my batteries die, my hearing doesn’t exist, and even with my aids, my hearing isn’t perfect. I have always wanted to participate in the annual Easterseals Disability Film Challenge. This year I got the opportunity to do so, thanks to another actor I knew through our local Deaf artists community. I reached out to her and we spoke on the phone about our experiences in the entertainment industry as actors with hearing loss. We had a good laugh when we discovered we’d gone through the same challenges. What really struck a chord with us is the fact that mainstream society stereotypes all people with hearing loss as people who only communicate via sign language and can’t speak verbally. We both struggled to get accepted by talent agents or cast by directors because they expected us to know sign language. (That said, I know ASL is pretty awesome to speak so I have been picking it up to further embrace my roots in the community.) This gave us the idea for our Easterseals film—a mini mockumentary about being deaf and why we don’t sign. We talked about a few common questions and comments
we always get, such as “you can’t be deaf since you speak so well” and “you don’t sign?”, and went from there. The cast as well as the crew ended up all being disabled, too, so it was a great experience to be able to understand where everyone is coming from. And honestly, so far my roles are not all deaf-related or disabled characters. I think that if you can do the job nothing else should matter. Abled actors often take disabled roles, so why not disabled actors playing abled characters? This helps society understand that we are just like everyone else. Representation in the media sends a message that you are welcomed, seen, and educating the masses on what disability actually looks like. This is my way of advocating, just being me in my character to represent how I’ve lived my experience and mesh it with the role I’m playing. True talent comes in all forms and includes those with disabilities. I consider my hearing loss a gift, not a flaw, and I wear it like armor. I believe I can be the voice for many others through my acting, providing inspiration and motivation and showing the world that nothing can stop people with disabilities.
Jan Marcos Andrade is listed as “Jan Marcos” on backstage.com. Find him on Instagram @janmarcosofficial. His mother Cynthia shared their family’s story in the Winter 2014 issue, at hhf.org/magazine.
Share your story: Tell us your hearing loss journey at editor@hhf.org.
Support our research: hhf.org/donate.
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Sound of REAL
music and
hearing
The film “Sound of Metal” rings true, but for reasons that have less to do with audiology. By Richard Einhorn One day, a musician’s worst nightmare comes true. Without any warning at all, he permanently loses his hearing, plunging headlong into deep, bottomless silence. This sounds like the “elevator pitch” for last year’s “Sound of Metal,” a terrific film in which music, hearing loss, and deafness serve as the backdrop for an exploration of loss and difficult life choices in the face of an unexpected personal tragedy. In fact, it’s a description of what actually happened to me 11 years ago. Like Ruben Stone in the movie, I—a composer and record producer—experienced sudden sensorineural hearing loss, and like Ruben, it upended nearly every aspect of my life. Yes, the audiology in the movie is not “true to life,” but as far as I was concerned, it didn’t matter. After all, it’s a movie, not a textbook, and I’ve never looked to Hollywood for accurate medical information. “Sound of Metal,” like all good narrative fiction, focuses on the emotional journeys of its characters. And for me, having actually gone through similar situations to those in “Sound of Metal,” the film rings very true. One day while setting up for a pre-concert event, Ruben, a heavy metal drummer (brilliantly portrayed by Riz Ahmed) hears some odd sounds in his head. Then much to his horror, his hearing completely flatlines. Like Ruben, my sudden hearing loss was equally dramatic. In June 2010, I decided to get away from 12
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everything to focus on my music. I was feeling a bit dizzy as I drove up to western Massachusetts but didn’t think it was anything but allergies. I was still dizzy when I got to the motel and went to sleep. I woke up at 5 a.m. and knew immediately something was terribly wrong. My ears were buzzing with tinnitus and odd ringing sounds, similar to but much louder than those Ruben experienced in the movie. Then I noticed I could no longer hear the very loud air conditioner in my room. I had gone deaf. Panicked, I jumped out of bed and immediately collapsed to the floor. I had severe vertigo and the room was spinning all around me. I knew I had to get to the emergency room. I crawled slowly to the desk to find a phone book. The words in the Yellow Pages swam in front of my eyes. It took over 30 minutes to locate a cab listing. Sudden hearing loss in both ears—what Ruben experiences in the film—is uncommon. More typical is what happened to me. Only one ear, my right, was damaged by whatever caused my sudden hearing loss. But unfortunately, I already had significant hearing loss in my left ear (moderate to severe, and due to otosclerosis, a bony overgrowth in the inner ear). And so, the result was exactly the same as it was for my fictional double: For all intents and purposes I simply couldn’t hear a thing. At first, just like in the film, the medical professionals had to write everything they said down on paper. But as I waited to get examined, I texted my wife back in New York City and she, a resourceful person, found a smartphone hearing app. I downloaded it. Wearing earphones, I was able to use my phone as a microphone and amplifier to
music
Sudden hearing loss upended nearly every aspect of Richard Einhorn’s life, as it did for Ruben (far left, played by Riz Ahmed), shown with Joe (Paul Raci), in the film “Sound of Metal.” Watching Ruben take his hearing test brought back Einhorn’s own painful memories.
hear what my doctors were saying. Watching Ruben take his hearing test brought back my own painful memories of that awful day. That sense of “this really can’t be happening…,” his nervous fidgeting and desperation, the struggle to understand, even partially, what was being said—yes, that’s exactly what it was like. While Ruben received no medication in the film, I was prescribed steroids in the hope they would mitigate permanent cochlear damage from my sudden hearing loss. It didn’t matter. In the end, my hearing was just as irretrievably ruined as his. But again, my experience was more complex. Around two weeks later, I started to hear something in my damaged right ear—but it wasn’t anything good. Speech sounded like a science-fiction robot screaming at the top of its (mechanical) lungs. The sound was far stranger than any of the hearing loss simulations heard in the movie and extremely disturbing. Even now, that crazed robotic distortion in my right ear is still there, a major interference with my ability to hear speech and enjoy music. In the movie, Ruben, a recovering addict, joins an idyllic communal house for Deaf recovering addicts and takes a class in ASL (American Sign Language), quickly becoming fluent. The house is run with tough love by a Deaf Vietnam vet named Joe (in a pitch-perfect portrayal by Paul Raci, the son of Deaf parents). Joe instructs Ruben—who can barely control his emotional turmoil—to get up every morning, go to an empty room, and just sit. If he can’t sit still, Ruben should take a pad and pen and write. Write anything.
I’m not a recovering addict and my attempts to learn ASL all failed, but once again, the film echoes my own experience. As with Ruben, I often became overwhelmed by the isolation hearing loss imposes and anxiety over the future. I didn’t have a guru like Joe to lean on but I picked up a self-help book for artists that described a simple routine called “morning pages.” Get up early, grab a pen and a pile of paper, and before doing anything else, write out three pages. Subject? Anything at all. I started writing the next day and have done so every morning since, by now scribbling out well over 11,000 pages. I have ranted, waxed philosophical, written out dreams, analyzed poetry and art, sketched short stories, and imagined alternative lives. After a few years of morning pages, I added meditation to my morning routine. For me, journaling and meditation are critical coping strategies for the stresses hearing loss generates. I found it quite moving to watch the fictional Ruben reenact nearly the same morning ritual that I have actually been performing for over a decade—and was quite amused to see that his handwriting is just as bad as mine! It is one more example of how emotionally resonant the film is to my lived experience of sudden hearing loss. Ruben opts for cochlear implants, hoping to restart his musical career. Joe, who is proudly Deaf and has no use for implants, immediately kicks him out of the house. Ruben then flies to France to rejoin his girlfriend Lou. He attends a party held by her father, a pop songwriter, and quickly learns that the implants are no panacea. He can’t distinguish individual voices over the party’s din. When Lou and her father perform a soft ballad together,
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music
h e ar i n g h e alth foundation
Yes, the audiology in the movie is not “true to life,” but as far as I was concerned, it didn’t matter. After all, it’s a movie, not a textbook, and I’ve never looked to Hollywood for accurate medical information. “Sound of Metal,” like all good narrative fiction, focuses on the emotional journeys of its characters. And for me, having actually gone through similar situations to those in “Sound of Metal,” the film rings very true.
Ruben tears up, not because the song is so sentimental but because he can’t follow the music; his implants mangle the melody and harmonies. I don’t have implants, but once again, I’ve been there. Since my sudden hearing loss, large parties are often excruciating experiences. Like Ruben, I retreat to a corner and simply watch, impatient to get somewhere quiet. As for music—well, I’ve trained myself not to think about it. While my remaining ear enables me to hear well enough to compose—I’m creating music as much as ever—my perception of music is diminished and far less visceral. We last see Ruben alone on a park bench. He takes off his speech processors and everything’s silent. Ruben straddles two worlds now, a hearing world where he no longer easily fits and an enticing Deaf world which, because of his implants, may also not fully accept him. In the hearing loss community, many people I know worry that “Sound of Metal” may discourage people with profound hearing loss from getting cochlear implants. I don’t know if that will happen but it certainly hasn’t changed my mind. While on paper I’m a candidate for a cochlear implant, hearing aids still help me cope reasonably well. If, as is likely, my hearing loss eventually progresses to the point where aids provide no more benefit to me, I wouldn’t hesitate for a moment to get cochlear implants. That said, I have some friends with profound hearing loss who would never consider them, a position I also support. This is a personal decision. “Sound of Metal” is a powerful film with well-drawn characters that are brought to life by a fantastic cast that includes numerous members of the Deaf community. The film also has a gorgeous, evocative 14
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soundtrack of unusual music, electronic sound effects, and hearing loss simulations. Regardless of the liberties it takes with actual hearing health practices, it feels all too real to someone who actually experienced sudden hearing loss. What Ruben goes through is what I and many others have as well. The emotional weight of hearing loss is often given short shrift. This film shows how serious and all encompassing hearing loss can be.
Richard Einhorn is a composer, record producer, and hearing loss consultant and advocate. His music has been performed by major orchestras around the world. The former chair of the board of the Hearing Loss Association of America, he regularly speaks and writes about hearing loss issues with a focus on improving hearing health technology. “Sound of Metal,” directed and co-written by Darius Marder, is available on Amazon Prime Video.
Share your story: Tell us your hearing loss journey at editor@hhf.org.
Support our research: hhf.org/donate.
music
music and
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Metal band performer Jonathan Mikhail (far and near left) credits his father (center), an ENT and audiologist, for inspiring his eventual career in audiology.
My Circuitous Path to Audiology By Jonathan Mikhail, Au.D. I have always loved music and have been a musician since age 3, when my parents enrolled me in piano lessons. I wanted to grow up to be a touring musician, and this dream was realized when, during my final semester of college and after completing my bachelor’s degree, I performed as a guitarist and vocalist in a metal band that toured regionally. Thanks to my father, an audiologist and ENT (ear, nose, and throat specialist), I was more than informed about noise-induced hearing loss and tinnitus and did everything I could to protect my ears. He refused to let me go on the road without earplugs and soon, my band was playing while using in-ear monitors—devices to help us hear ourselves and protect us from auditory fatigue. I didn’t realize it then, but these paths were leading me to a career in audiology. When I was a child, my dad would beg me to come to his office to see the work he did. Eventually, to make some extra money, I’d go in and help with administrative tasks. In my final semester of college, I caved to my dad’s requests and shadowed him one afternoon. I was astonished by what audiologists actually do over the course of a day. I once believed that audiology was nothing more than fitting hearing aids—and I had no interest in selling a product. What I saw was my dad’s love for his patients and for the field of audiology. After this epiphany, I had to do some catchup work to become an audiologist. I had no relevant undergraduate prerequisites for the field, so I took a detour to earn a master’s degree in technical and professional communication before finally earning my Au.D. at Wichita State University in Kansas. I’m grateful for the extra experience I earned doing research and academic writing. Now I am pursuing a doctorate of education in health professions, and I am
I’m passionate about educating people to help save their hearing. able to bring an audiologist’s perspective to my studies, hopefully enlightening the greater medical community about the profession. As an audiologist, I work with many demographic groups, helping patients with hearing loss by fitting them with hearing aids. But I’m just as passionate about educating people to help save their hearing. Our hearing ability is truly a marvel, and while modern hearing aids are spectacular, no hearing device can completely replace the human ear. My clinic works with many industrial worksites to help promote hearing conservation and hearing health awareness. Each year roughly 22 million U.S. workers are exposed to dangerously high levels of noise. I’ve traveled around the country, providing audiology education and in-ear monitor fittings at churches, for touring bands, and for other groups. Hearing conservation and protection starts with educating the public, and then intervening when necessary, such as with hearing aids. I know those in the music industry depend on being able to hear. I still go to shows and concerts, wearing hearing protection, but not as a guitar player. I attend shows as someone who understands music and the science related to hearing and how important it is to protect our ears.
Jonathan Mikhail, Au.D., is an audiologist in Missouri. For references, see hhf.org/summer2021-references. a publication of hearing health foundation
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From a $3.95 Guitar to the Solid Body Electric Guitar How Les Paul’s persistence changed the world of music. By Les Paul from his memoir, with input from Sue Baker
Music legend Les Paul is famous for inventing the solid body electric guitar and other innovations related to recording music. Less known is that he also had a hearing loss and wore hearing aids in both ears. A tinkerer his whole life, Les describes the creation of the guitar in his autobiography, “Les Paul in His Own Words.” “I got my first guitar in 1927 at the age of 11. It was a little Troubadour flat top from Sears and Roebuck, a cheap little bow-wow that cost less than five dollars. I was so proud of that little guitar and spent most of my spare time playing it... anywhere somebody would listen.” When he started performing as a young teen, Les was known as Red Hot Red because of the color of his hair. He played regularly at a drive-in barbecue stand and was convinced his tips would increase if the people in the back of the audience could hear him sing too. He figured out how to amplify his voice and harmonica by mounting the mouthpiece from his mother’s telephone onto a wooden broom handle and wiring it to her radio. But then he was handed this note: “Red, your voice and harmonica are fine, but your guitar’s not loud enough.” That sparked Les Paul’s search for how to amplify his guitar. “I took my dad’s radio-phono player and took the tone arm off the phonograph and just jammed the needle right down into the guitar’s bridge and taped it in place. Then I turned up the volume and played through the amplified speaker. With my homemade microphone, I ran my voice and harmonica through my mother’s radio, and the guitar through my dad’s phonograph.” Les had just created an electric guitar! It was around 1928. “I loved the way my guitar sounded coming out of the speaker, so I started trying different things to deaden the vibration and stop the feedback. I tried filling the guitar
up with tablecloths and shorts and socks to muffle the sound…. That was a step in the right direction, but not the solution. So then I poured it full of plaster of Paris.” That was the end of the troubadour. Looking to sustain a sound without feedback, Les experimented with a two-foot piece of discarded rail and two spikes he got from the railway across the street from his house. “I took a guitar string and fastened it at each end of the steel rail, using the spikes like a bridge and nut to raise the string so it could be plucked. Then I took a telephone microphone, wired it into Mom’s radio for amplification, and placed it on the rail under the string.… The tremendous solidity of the rail allowed the string’s vibration to sustain for a longer time, and there was no feedback.” Though usually very encouraging to Les, his mother pointed out the Rail was not a practical guitar. In 1931, he got a Dobro guitar that had a metal resonator. A few years later, he purchased a Gibson L5, dubbed the cheapie, which became his favorite guitar when performing around the country. While in Chicago he expanded on what he learned from his plaster of Paris experiment. He had a guitar built with a half-inch solid top to which he added his homemade pickup. When that proved too heavy, he had a thinner version made. Around 1935, Les customized a Bell & Howell speaker designed for 16 mm film to create his first guitar amplifier that wasn’t a converted radio. He was constantly experimenting with his guitars, searching for a better sound. “I kept tearing up guitars experimenting with my electric sound, but I always used my Gibson cheapie when I played electric with [Fred] Waring, and it drove
Looking to sustain a sound without feedback, Les Paul experimented with a two-foot piece of discarded rail and two spikes he got from the railway across the street from his house. 16
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Les Paul’s first guitar at age 11 was a Troubadour like this one in the Sears, Roebuck & Co. catalog.
While his Log instrument had the sound Les Paul wanted, it didn’t look like a traditional guitar and met with a lukewarm response until he added nonfunctioning guitar wings to the center base.
the Gibson guys nuts. They tried everything to get me to change, but my little guitar had the sound that became my identity on the radio, and I stayed with it until my family of klunkers [three Epiphone guitars] came along. “I was looking for volume, tone, and sustain that could be controlled, still chasing the idea that started with stretching a guitar string over a section of railroad rail. I took a length of 4x4 pine, put an Epiphone neck on it, wound a couple of homemade pickups, and mounted them on the wood. Then I added a bridge and a Vibrola tailpiece, strung it up, and I had the Log. It was crude, but when I plugged it into an amp, it worked.” (Pickups are magnets wrapped in wire that convert the vibrations of the guitar strings into electrical signals that can be amplified.) When Les played the Log at a club, the response was lukewarm. “I went back to the Epiphone factory, took the sound box of an old Epiphone archtop, and sawed it in half right down the middle. Then I braced up the halves so they could be attached to the sides.” When he played his Log with the wings, a shape that looked more like a guitar, he got an enthusiastic response. Les concluded, “People hear with their eyes.” In 1941, Les took the Log to Gibson and tried to convince them that solid body electric guitars were the future. The response was laughter. Typical for him, Les kept going back to Gibson. It took almost 10 years before Gibson would build Les Paul’s design for a solid body electric guitar and even then, they hesitated to put the company’s name on it.
One of Les Paul’s experiments to deaden his guitar’s vibration and stop feedback included pouring the hollow sound box full of plaster of Paris.
Les Paul also wound a guitar string onto a piece of steel rail and train spikes, adding a telephone microphone and a radio for amplification, to create a vibration that lasted a long time without feedback.
“Les was a great innovator and experimenter,” said Paul McCartney, shown in this photo from May 1988.
Les told them, “Put my name on it,” and that is how a boy who wanted his guitar to be heard created the solid body electric guitar of rock stars. He applied that same persistence as he searched to improve hearing aids. He moved past his initial devastation at losing his hearing and focused on how to improve hearing aids until the end of his life. Les Paul, whose birthday was June 9, 1915, passed away in 2009, three years after the publication of his autobiography. The Les Paul Foundation continues to support one of his primary goals of eradicating hearing loss, with a current focus on research toward a cure for tinnitus.
Sue Baker (shown with Les Paul above) is the program director for the Les Paul Foundation. Hearing Health Foundation is grateful for their support of tinnitus research through HHF’s Emerging Research Grants program. For more, see lespaulfoundation.org and hhf.org/erg.
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We Want You to Keep Listening, Safely
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Hearing Health Foundation’s new public health campaign is aimed at preventing hearing loss from noise among young people.
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Hearing Loss and Overall Health
Hearing loss affects the brain, heart, and mental health, leading to social isolation, depression, falls, and even dementia, as mild to moderate untreated hearing loss has been linked to cognitive decline. It also impacts school and job performance: Unaddressed hearing loss is associated with lower income potential and higher unemployment. “Noise-induced hearing loss is the biggest public health emergency that most people don’t know about, even though hearing loss is more common than diabetes or cancer,” says Timothy Higdon, HHF’s president and CEO. “Too few young people—and their parents—recognize that hearing loss can occur at any age due to noise exposure. Teenagers and people in their 20s and 30s wrongly believe hearing loss affects only parents and grandparents—not them. “And that means many are tuned out to the danger of loud volumes heard through headphones and earbuds, and the ear-crushing sound at the movies, concerts, subway stations, gyms, and even weddings. With our ‘Keep Listening’ campaign, we want to help spread the word about the risk from excess noise and encourage everyone to take basic steps to protect their hearing.” The World Health Organization says 1.1 billion young people—or nearly 50 percent of the world’s population ages 12 to 35—are at risk for hearing loss due to prolonged and excessive noise exposure. In the United States, nearly one in five teenagers ages 12 to 19 already shows signs of noise-induced hearing loss. The “Keep Listening” public health ads will run on digital displays in PATH
image credit: the escape pod
The World Health Organization says 1.1 billion young people—or 50 percent of the world’s population ages 12 to 35—are at risk for hearing loss due to prolonged and/or excessive noise exposure. In the United States, nearly one in five teenagers ages 12 to 19 already shows signs of noise-induced hearing loss.
Hearing Health Foundation (HHF), whose mission is to prevent, research, and cure hearing loss and related conditions, launched a powerful outdoor public health ad campaign in June 2021 to drive home the message—especially to young people—that playing music too loud for too long on personal listening devices can cause permanent hearing damage. The visually provocative HHF ads and accompanying digital “Keep Listening” campaign (hhf.org/keeplistening) promote healthy hearing habits for life. While attention-getting, the campaign sends a positive message overall: that young people have the power to prevent noise-induced hearing loss by making simple changes in their listening habits and taking daily precautions. “Keep Listening” shares how proactively turning down the volume on headphones and earbuds and wearing earplugs in loud places, such as sports stadiums and concerts, can help make sure that hearing lasts a lifetime. The campaign includes a 30-second video that subverts the idea of a shiny new tech product launch. Headphones that are revealed to actually be grenades hammer home the message that listening to music on headphones at their maximum volume can cause permanent hearing damage in only a matter of minutes. The video is accessible through various types of online and social media platforms, the better to reach a young target audience.
Source: CDC
Listening to headphones at maximum volume can cause permanent hearing loss in minutes. @hearinghealthfoundation | hhf.org/KeepListening a publication of hearing health foundation
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Chicago agency The Escape Pod oversaw the creation of a video that subverts the idea of a shiny new tech product launch with a warning about permanent hearing loss from listening too loud for too long.
train stations in New York City that connect to New Jersey, on buses in San Francisco, and in train stations and around neighborhoods in Chicago. Award-winning Chicago agency The Escape Pod oversaw the creation and production of the ads and video.
Creating a Culture Shift
Just as public behavior changed when the cancer risk from secondhand smoke and sun overexposure was better understood, HHF wants to mobilize a culture shift on hearing loss so that all ages recognize the risks of excess noise. “Our goal is to persuade every young person that their hearing is precious and is worth protecting and preserving,” says HHF board member Anil Lalwani, M.D., the chief of the division of otology, neurology, and skull base surgery at Columbia University in New York City. “And that we can all protect our hearing without giving up activities we love.” Lalwani adds, “We’re definitely not here to tell anyone that they have to give up concerts or using personal audio systems with headphones or earbuds. It’s just the opposite—we want everyone to keep listening safely and judiciously.”
Even a small reduction in decibels can offer significant protection. Because the decibel scale is logarithmic, going just a little up—or down—in volume makes a huge difference.
Take Simple Precautions
Even a small reduction in decibels can offer significant protection, according to the World Health Organization. Because the decibel scale is logarithmic, going just a little up—or down—in volume makes a huge difference. » Turn down the volume on headphones. Listen as low as is comfortable, ideally only up to 50 percent of the max. Since headphones can reach 100 decibels—or more—this can permanently harm hearing in minutes. » Take frequent listening breaks by removing headphones or earbuds or walking away from loud sounds. The longer you can rest your ears between listening sessions the better. » Carry inexpensive foam earplugs with you at all times and use them in loud places—such as gym classes, bars, dance parties—and around lawn equipment, construction sites, even your kitchen blender. With prevention part of our core mission, HHF is thrilled to draw attention to this critical public health issue that is especially important to highlight among the younger generation. We want you to keep listening, safely. 20
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For more and to view the video, see hhf.org/keeplistening. For references, see hhf.org/summer2021-references.
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Helen Garrett with her husband Steve.
Helping Others Has Helped Me By Helen Garrett
For several summers, my husband Steve and I attended Celebrate Brooklyn Concerts in Prospect Park with friends. We always sat in the front section. None of us wore hearing protection. During many of the concerts the bass was extremely loud, causing pain in my ears. I complained about it, and would stuff napkins in my ears to try to block the sound. It never occurred to us to wear earplugs, and my guess is that many people there weren’t wearing them either. Two summers ago we went to a David Crosby concert at Lincoln Center Out of Doors in Manhattan, and because people were blocking my view (and the concert was that good), I went close to the stage—and the speakers. The music didn’t seem loud, but two nights later I woke in the middle of the night with an alarming, high-pitched buzz in my right ear. I got out of bed and went looking for the origin of the sound—in the guest room, out the window— and woke my husband and asked him what it was. When I realized it was all in my head, I dropped to the floor in a complete panic, terrified it would never go away. The next day I saw an ENT (ear, nose, and throat specialist) and had a hearing test that revealed a mild to moderate hearing loss in my right ear. The doctor recommended steroid shots, which didn’t help, nor did a change in diet. For the first two to three months, I had occasional bouts of severe tinnitus, and a couple of times a mild vertigo, but both eventually went away. Nowadays the tinnitus is always there, but it is rarely as debilitating as it was those first couple of months. Despite all this, including owning earplugs, it didn’t occur to me until I worked on HHF’s “Keep Listening” campaign how damage to your hearing is cumulative, and that I’ve been doing additional damage to my hearing through some of my regular routines. My coffee grinder, used daily, is 90 decibels or more, as is our mini food processor. (I know this thanks to the decibel measuring apps I learned about from HHF.) I now use earplugs when I run noisy appliances. Since I developed tinnitus, restaurants are often not enjoyable because of ambient noise. At parties, it’s hard
for me to follow conversations when multiple people are talking, and I often ask to have music turned down. If Steve says something to me in bed and my good ear is on the pillow, I can’t hear what he is saying. It’s not just about losing your hearing. I’m now aware that my quality of life and overall health could be more adversely affected. The strong connection between hearing loss and dementia has also been a real eye opener. I’ve become a passionate evangelist about the importance of hearing protection and the urgent need to make everyone more aware of the dangers of noise-induced hearing loss. We need to make this issue as mainstream as wearing seatbelts or using sunscreen. This campaign has also underscored for me the need to make our very noisy world much quieter. There is so much unnecessary excess noise in the world, including the idea that “fun equals loud.” For our collective health, and the health of all the world’s creatures, we must turn down the volume. The chorus to one of my favorite Joni Mitchell songs applies to so many of us: “Don’t it always seem to go/That you don’t know what you’ve got/Till it’s gone.” There’s no question in my mind that if I had known what it would be like to have my hearing impaired, I would have taken many more precautions. I took my hearing for granted until I had a problem. I hope we can convince more people— especially people in their teens and 20s—to protect their ears, now, so they can keep listening.
Helen Garrett lives in New York and is a consultant to nonprofits on branding, marketing, and social impact campaigns. While on staff at Amnesty International USA she helped create two benefit albums, the first featuring the songs of John Lennon with artists like U2 and Green Day, and the second featuring the songs of Bob Dylan with Miley Cyrus, Adele, Sting, and others.
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The Danger in Headphones An audiologist parent teaches her children safe listening habits. By Jan L. Mayes The introduction of the Sony Walkman in the 1980s ushered in an era of personal audio systems, everyone walled off in their own soundscapes thanks to headphones and, now, earbuds. Yet these personal audio systems also introduced a new danger to hearing health. Played too loud for too long, personal audio systems can help lead to permanent hearing loss. Loud sounds damage the auditory nerves, synapses, and cochlear hair cells needed for accurate sound processing. Sound and music distortion and problems understanding speech can happen before changes in noise-induced hearing thresholds can be detected on a traditional hearing test. Loud sounds can also cause tinnitus and hyperacusis. Tinnitus is when one hears sounds, like static or whistling, in the absence of an external source. Hyperacusis, or decreased sound tolerance, feels like the volume of all sounds is stuck on loud, even for quiet sounds that don’t bother others. (I have both conditions, which often coexist.) Kids are more sensitive to auditory damage from loud sounds, because hearing systems develop into their teen years. Hearing damage also has greater lifelong consequences when it begins during early learning and education. Plus, their ears have to last a lifetime. There are no national sound limit requirements for personal audio system manufacturers. In 2008 and 2017, research showed personal listening above the 50 percent volume setting puts users at significant risk of noise-induced auditory damage. Difficulty understanding speech leads to social isolation and hurts the quality of life for children, teens, and adults. 22
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Parenting as an Audiologist
As an audiologist, I know firsthand the dangers of noise to hearing health, including among children. Ever since my own children were little I have emphasized safe listening skills. The risk may be even more acute with personal audio systems as you cannot easily recognize when kids are listening too loud. Speakers blasting from a bedroom are one thing, but headphones or earbuds that are even a little too loud can be harder to discern. Parents ideally should talk about safe versus harmful sound levels long before their kids’ personal listening habits start. From the time they were toddlers, my kids and I went on “soundwalks” and talked about sounds we hear in everyday life. Which sounds did they like? Which sounds were uncomfortable or too loud? To handle unwanted sounds, I taught them to use their “finger plugs.” Sticking your fingers in your ears works like earplugs (although you have to drop whatever you’re holding). I also taught them that cupping your hands over your ears hardly muffles the sound waves, so better to use your fingers. I created a family hearing protection toolkit, with different types of earplugs for different situations. There were earmuffs my kids could use if they were at a loud activity, such as a sporting event. They knew my spouse and I use high fidelity or musicians’ earplugs for concerts, movies, or other loud situations like large parties where we still want to be able to communicate. For noisy, everyday situations where communicating isn’t as critical, such as in the presence of loud appliances
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For noisy, everyday situations where communication isn’t so critical, inexpensive foam earplugs can protect your hearing.
or yard tools, my kids learned that foam earplugs could do the trick. They learned that hearing protection needs to seal like swim goggles to block out harmful sound waves.
illustration credit: timea dancs
50 Percent Max
I had my kids wait until they seemed old enough to be responsible for their hearing health before they were allowed to use personal audio systems—for them, this was about ages 10 to 12. I explained the risk from high volume listening. I told them about cases where patients cried in my office because they wished their tinnitus would go away or that they could hear better. They say to me, if only they had known loud sound was dangerous. My kids and I talked about how personal listening is an individual activity where users can change safety settings or turn volume up anytime or to whatever level they want. I emphasized how I hoped they would commit to listening safely to prevent lifelong noise-induced auditory problems. We sat together while they accessed their devices’ settings and turned down built-in volume limits. Volume limiting headphones for kids are available, but they often allow unsafe volumes—85 decibels—and so the safe listening these products advertise just isn’t accurate. Since earbuds aren’t recommended until age 13, my kids used headphones before they reached their teenage years. And because they saw us using them, my kids wanted their own specialized musicians’ earplugs right when they turned 13 years old. With their headphones or earbuds on, I asked my kids
to begin with the volume at zero and slowly turn it up to find their lowest comfortable volume. They both have typical hearing, so around 20 percent of the maximum volume setting sounded good to them. This became their usual listening level. They could turn the volume up if they wanted to listen louder for a favorite song or when singing, dancing along, or exercising. But I asked them to follow a 50 percent maximum rule. This gave them a safe, soft-to-louder dynamic volume range for personal listening while protecting their auditory health. My children are now young adults. Fortunately, they still use their personal audio systems at under 50 percent maximum volume.
Set Limits
The World Health Organization’s World Report on Hearing, released in March 2021, suggests that personal listening limits of up to 60 percent of the maximum volume—an 80 decibel (dB) average—is safe. But this recommendation allows higher limits than the more protective 70 dB average for sensitive groups at greater risk, like kids, and a 75 dB average for adult users. As I report in a January 2020 American Family Physician article, coauthored with fellow noise activist Daniel Fink, M.D., the maximum average daily safe listening limit to prevent hearing loss in healthy adults is 70 dBA. (A-weighted decibels, or dBA, are adjusted for human hearing.) Higher intensity exposures may not be safe for auditory health regardless of listening time. Even 70 dBA exposure a publication of hearing health foundation
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Use Your Fingers, and More Tips Headphone users should be old enough to accept responsibility for their hearing health. (My children were about 10 and 12.) Here is my additional advice: » Always listen at a low, comfortable volume.
» Avoid listening above » »
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50 percent volume whenever possible. Turn on or turn down built-in volume limiting settings or safe listening features. Use well-fitting headphones or, when age 13 or older, earbuds with noise canceling or noise isolating features. When in loud noise, use earplugs or earmuffs. Some can safely connect to personal audio systems. Finger plugs are always on hand (pun intended). Check hearing with the hearWHO app, available at who.int/health-topics/hearingloss/hearwho. Support protective national sound limit requirements for personal audio system manufacturers. —J.L.M.
may not be safe for certain exposed populations, such as children or people with preexisting hearing impairments. Since there are no universal manufacturing standards, the actual volume varies a lot between different audio devices, headphones, and earbuds. Noise canceling or noise isolating features help people listen more comfortably at lower volumes when there is ambient environmental noise. You don’t have to turn it up too loudly (and unsafely) to hear over outside sounds. Stock earbuds tend not to fit well, so people use a higher volume to drown out other sounds. Deeper in-ear or canal-fit earbuds are better for safer listening. I should emphasize that headphones or earbuds are not hearing protection. Never slip earbuds under the cup of an earmuff or use earbuds as earplugs. What if you have already been using personal audio systems at over 50 percent of the volume? It’s never too late to listen more safely and stop any auditory damage from getting worse. If concerned, people of any age can do a quick hearing screening using the hearWHO app (who.int/health-topics/hearing-loss/hearwho). If the results show a problem, follow up with a hearing healthcare professional. Science is clear on the danger of noise to hearing. It is long overdue for federal authorities to require mandatory sound level limits for personal audio systems. Options should be protective enough for children and other users to prevent noise-induced auditory damage. It’s also time for mandatory noise control on a global scale instead of relying on education plus motivation on the part of children and teens to listen safely. Let’s better protect the hearing health of current and future generations.
Jan L. Mayes is a science reporter for the Quiet Coalition, part of Quiet Communities Inc. in Boston. A resident of Vancouver, Canada, she is a retired audiologist and award-winning author with special interests in noise, tinnitus, and hyperacusis. A version of this originally appeared on her website janlmayes.com/news. For references, see hhf.org/summer2021-references.
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Kelly Culhane (far left) visited the Centers for Disease Control and Prevention in 2019 to present her prevention project to CDC principal deputy director Anne Schuchat, M.D.
Banding Together to Prevent Hearing Loss in Young People By Kelly Culhane
Six years ago, at the beginning of my freshman year of high school when I was 14, I was searching for a topic for my Girl Scout Gold Award project when I heard an interview on National Public Radio. The interview was with Adele Sandberg, the founder of Ear Peace Save Your Hearing Foundation, an educational nonprofit. Sandberg was talking about noise-induced hearing loss (NIHL) in children, saying she uses pipe cleaners to demonstrate to elementary school students the permanent damage done by loud sounds to the tiny sensory hair cells in our ears, how that affects our hearing, and how simple it is to protect our hearing. It was a fascinating interview. For the first time I really understood that young people could experience permanent hearing damage due to loud noise. I decided to make NIHL the focus of my Gold Award project and contacted Sherilyn M. Adler, Ph.D., the executive director of Ear Peace Foundation, who has mentored me ever since. I wanted to educate my peers and speak directly to them about the dangers of NIHL and the importance of protecting their hearing from a young age, so I focused on posters, videos, and social media to reach the younger age groups. “Band Together to Protect Your Hearing” was a 12-minute film about NIHL that I created—from storyboard to script writing to video editing—for Ear Peace Foundation. It’s used as part of their Protect-a-Band program to prevent hearing loss among young musicians. I also created a short public service announcement, “Anything Goes Pizza,” a comedic video that highlighted the issue of hearing damage due to noise (a young pizza guy, who likes to listen to loud music on his earbuds, drastically misinterprets a pizza order). I also did video interviews with audiologists and my jazz band director on integrating learning about NIHL into the curriculum. From the beginning, I knew it would be difficult to
convince teens that NIHL is a serious problem for them. Many teens find the idea of hearing loss at a young age hard to believe, most likely because they haven’t noticed a problem yet and think of it only as an old person’s issue. I also made sure to model hearing safety by using hearing protection myself on a daily basis—at jazz band rehearsal, pep rallies, concerts, and loud movie theaters. I keep earplugs in a holder on my keychain at all times. My whole family now carries earplugs. We also realized that my brother, who continues to play jazz in college, has tinnitus. It was gratifying that, after becoming aware of NIHL through my project, a friend in the marching band was motivated to have his hearing tested. It showed that he already had some permanent hearing damage in one of his ears due to excess sound levels. My friend changed his behavior and, from then on, took careful steps to protect his hearing by using earplugs during rehearsals and performances. It’s my goal to help more young people understand that they can continue to safely enjoy their passion for music.
Awarded a prestigious Girl Scout Gold Award in 2018, Kelly Culhane is starting her third year at the University of Florida on the premed track, majoring in psychology and specializing in behavioral and cognitive neuroscience. She and Sherilyn M. Adler, Ph.D., coauthored a paper on preventing NIHL in young people and presented a poster at the International Commission on Biological Effects of Noise conference in June 2021. See earpeacefoundation.org. HHF is proud to join with Culhane, Adler, and Ear Peace Save Your Hearing Foundation on prevention efforts. For references, see hhf.org/summer2021-references.
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Common Decibel Levels
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A whisper is about 30 decibels (dB), normal conversation is about 60 dB, and a motorcycle engine running is about 95 dB. Noise above 70 dB over a prolonged period of time may start to damage your hearing. Loud noise above 120 dB can cause immediate harm to your ears.
Loud Noise Can Cause Hearing Loss Quickly or Over Time The Centers for Disease Control and Prevention website provides detailed information on noise-induced hearing loss. Hearing loss can result from a single loud sound (like firecrackers) near your ear. Or, more often, hearing loss can result over time from damage caused by repeated exposures to loud sounds. The louder the sound, the shorter the amount of time it takes for hearing loss to occur. The longer the exposure, the greater the risk for hearing loss (especially when hearing protection is not used or there is not enough time for the ears to rest between exposures). How loud something sounds to you is not the same as the actual intensity of that sound. Sound intensity is the amount of sound energy in a confined space. It is measured in decibels (dB). The decibel scale is logarithmic, which means that loudness is not directly proportional to sound intensity. Instead, the intensity of a sound grows very fast. This means that a sound at 20 dB is 10 times more intense than a sound at 10 dB. Also, the intensity of a sound at 100 dB is one billion times more powerful compared to a sound at 10 dB. Two sounds that have equal intensity are not necessarily equally loud. Loudness refers to how you perceive audible sounds. A sound that seems loud in a quiet room might not be noticeable when you are on a street corner with heavy traffic, even though the sound intensity is the same. In general, to measure loudness, a sound must be increased by 10 dB to be perceived as twice as loud. For example, 10 violins would sound only twice as loud as one violin. The risk of damaging your hearing from noise increases 26
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with the sound intensity, not the loudness of the sound. If you need to raise your voice to be heard at an arm’s length, the noise level in the environment is likely above 85 dB in sound intensity and could damage your hearing over time. The effect of lower noise levels over long periods is the same as louder noise levels over a shorter period. You can use a sound level meter to measure noise around you. Free sound level meters developed as smartphone apps are available. Some of these apps can predict your maximum allowable daily noise dose, like the National Institute for Occupational Safety and Health Sound Level Meter app developed for Apple iOS devices to help promote better hearing health and prevention efforts. (See cdc.gov/niosh/topics/noise/app.html.) The U.S. Environmental Protection Agency and the World Health Organization recommend maintaining environmental noises below 70 dBA (A-weighted decibels) over 24 hours (75 dBA over 8 hours) to prevent noise-induced hearing loss. The EPA also specified limits for speech interference and annoyance at 55 dBA for outdoor activities and 45 dBA for indoor activities. Noise is a significant source of hearing loss, but you can protect your hearing.
This is used with permission from the Centers for Disease Control and Prevention website page “What Noises Cause Hearing Loss?” at cdc.gov. A-weighted decibels, or dBA, emphasize the frequencies heard in human speech. For references, see hhf.org/summer2021-references.
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Hearing Health Foundation 2021 Reader Survey Hearing Health Foundation would like to hear from our community to better serve your needs. Please fill out this survey (also accessible at hhf.org/survey) and mail it back using the envelope. Thank you for taking the time. 1. What is your level of hearing loss? Mild Moderate Moderately severe Severe Profound I don’t know I don’t have a hearing loss
complete the survey online at hhf.org/survey
2. If applicable and known, please indicate the cause of your hearing loss. Check all that 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 Other: _________________ 3. Do you use hearing assistive technology (e.g., an FM system, hearing loop, PockeTalker, captioned telephone)? Yes No 4. Do you wear hearing aids? Yes No
5. Do you plan to purchase new hearing aids? In the next 3 months In the next 6 months In the next year I don’t plan on purchasing new hearing aids 6. What is your primary source for information about hearing aids? Hearing healthcare professional Hearing Health magazine Online research Other: _________________ 7. Do you wear a cochlear or another type of ear implant? Yes No 8. Where do you read Hearing Health magazine? Print Online Both 9. How did you hear about the magazine? Check all that apply. I subscribe Doctor’s office Family member Friend Social media Other: _________________
10. Please indicate your age. Under 18 years old 18 to 34 35 to 54 55 to 74 75 or older 11. What is your employment status? Employed or homemaker Out of work or looking for work Student Unable to work Retired 12. 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 Prefer not to answer 13. Are you a veteran or active military service member? Yes No We’d also like to hear responses from your family and friends. The survey can be completed online at hhf.org/survey. If you have any questions, please contact us at 212.257.6140 or info@hhf.org.
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The Power of the Written Word Universal captioning, or subtitling, enhances screenviewing for everyone. By Shari Eberts
It’s well known that people with hearing loss love captions because they help combat hearing loss exhaustion by reducing listening effort, help us fill in words that we miss during a speech or when watching a movie, and give us confidence that we can participate more fully in a number of different listening situations. During the pandemic, we seem to be reaching a tipping point where the value of captions is becoming apparent to everyone. Research published by Verizon Media and Publicis Media showed that consumers are increasingly watching videos on the go and in shared spaces. Half of those surveyed said they like captions because they often watch videos with the sound off, and 80 percent of people who use captions do not have hearing loss. Since the research came out in 2019, before the pandemic, it’s a safe bet these numbers are even higher today.
Advances in Technology
Social media sites like TikTok are making their platforms more accessible with captioning. Zoom finally promised to expand its excellent auto-captions to all free accounts starting in the fall of 2021. I had started an online petition to ask for this and garnered 80,000 signatures, earning coverage from the Washington Post and NPR. (You can request early access now at blog.zoom.us/update-on-livetranscription-for-free-accounts.) Google launched Live Caption, a feature that provides autocaptions for all English-language media content viewed in their Google Chrome browser. It works across social and video sites, on podcasts and radio content, and even on personal videos, and it is compatible with all types of computers—including Apple—as well as on Android mobile devices. As with any auto-generated captions, there are errors, but accuracy and speed will only improve as the artificial intelligence (AI) algorithm is refined. Products developed for a mainstream audience are also finding an eager market in the hearing loss community. Tunity, a smartphone app that lets you listen to a current TV broadcast on your smartphone when the TV is muted, was designed for use by hearing people in loud bars, but it also works well for people with hearing loss. Another such product is Otter.ai, a speech-to-text app that was created for transcribing business meetings, but can be used by people with hearing loss for real-time captioning.
Benefits Validated
Hearing Health Foundation uses a CART captioner for live captioning during its webinars. AI (artificial intelligence) subtitles are also increasingly improving.
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In a 2018 TEDx talk, Svetlana Kouznetsova, an accessibility consultant, points out that captioning is part of good universal design. Not only does it make it easier to view videos in a variety of settings such as on mute, but it also makes it easier to understand complicated or confusing content. It improves intelligibility if the speaker has a strong accent, when learning a new language, or for someone with auditory processing differences. According to a 2015 paper in the journal Policy Insights From the Behavioral and Brain Sciences titled “Video Captions Benefit Everyone,” more than 100 empirical studies demonstrate that captioned content benefits the public at large. The research found that whether the viewer has a hearing loss or not, captions improve video
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The research found that whether the viewer has a hearing loss or not, captions improve video comprehension as measured by higher rates of recalling facts, drawing inferences, defining words, and summarizing main ideas. comprehension as measured by higher rates of recalling facts, drawing inferences, defining words, and summarizing main ideas.
Make It Mainstream
In another TED Talk from February 2020, “How Technology Has Changed What It’s Like to Be Deaf,” writer Rebecca Knill says she is on a mission to change how we think about disability so that the world is more inclusive. Knill, who uses cochlear implants, points out that Millennials shifted the mindset around phone calls and voicemail by making texting mainstream. “Smart designers include multiple ways to access technology, but segregating that access under ‘accessibility’—that’s just hiding it from mainstream users. In order to change how people think, we need to be more than accessible, we need to be connected,” she says, noting that the Apple iPhone iOS includes the automatic transcription of voicemail. “Netflix, Hulu, Amazon Prime no longer say ‘closedcaptioned for the hearing impaired.’ They say ‘subtitles,’ ‘on’ or ‘off,’ with a list of languages underneath, including English.” A few years ago I saw an exhibit at the Cooper-Hewitt Museum in New York City, on disability and design. The exhibit beautifully demonstrated how creativity and design can help everyone overcome everyday obstacles. I remember a quote on the exhibit wall that read: “Disability is a design opportunity.” I love the optimism of that quote—that design can help make things accessible for all. This has been demonstrated countless times through things like wheelchair ramps, which assist anyone or anything rolling on wheels (strollers, luggage), sound-absorbing materials that improve for everyone the acoustics of a restaurant or meeting space, and now AI-generated subtitles across screens and devices. When design is universal, we all benefit. Staff writer Shari Eberts serves on the Board of Trustees of the Hearing Loss Association of America and is a past chair of HHF’s Board of Directors. A version of this originally appeared on her blog, livingwithhearingloss. com. For references, see hhf.org/summer2021-references.
Report Captioning Issues So Fixes Can Be Made
Television subtitling problems are fairly common, especially during live programs like the news or sports. I do my best to report captioning issues so the broadcaster or distributor can make fixes for other viewers. Most can be reported to the Federal Communications Commission at consumercomplaints.fcc.gov. Or reach out to the provider of the content directly via their website.
A Shoutout to Loops for Entertainment
While not audio-to-text, hearing loop systems are invaluable for improving access in entertainment venues. Wires installed around the perimeter of a large room, such as theaters and performing arts centers, pick up the sound system and send it directly to a tiny copper telecoil (T-coil) receiver that can be built into most hearing aids and cochlear implants. Be sure to request this helpful feature. The excellent sound quality is because the T-coil receives the sound directly. You just need to enable the T-coil setting on your hearing device; nothing else is required. Note that due to their small size, the smallest hearing aids may not have space for a T-coil. If you don’t have a T-coil in your hearing device, you can try hearing loop receiver earphones (you may need to remove your hearing aids to use them) or a neck loop. —S.E.
Share your story: Do you have a favorite captioning app? Tell us at editor@hhf.org.
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Three Life Lessons I am pledging to give to Hearing Health Foundation because I hope discoveries funded by HHF can help us prevent or cure hearing loss caused by ototoxic drugs in neonatal intensive care units, which is how I developed my sensorineural hearing loss. I appreciate HHF’s commitment to being a good steward of the funds that enable groundbreaking research on hearing loss, prevention, and cures. Here is my story. By Betsy Glick
Among other interests, Betsy Glick continues her artwork today with her pet sketching business. Opposite page: Glick (on the right) with her twin sister Bari at age 3.
When I was in sixth grade, I was in the spelling bee. When I got to the edge of the stage to spell my first word, I found I couldn’t hear it. I thought maybe I heard the word fine, everything is fine, so I spelled “F-I-N-E, fine.” But it was the wrong word, and everything was not fine. I tried again, maybe it was fun? So I spelled “F-U-N,” but it was the wrong word again. Now with my anxiety rising I stared desperately into the dark theater looking for clues. Then my identical twin sister Bari came to rescue me. She walked across the 30
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stage and stopped right in front of me and said, “Betsy, the word is vine.” Through tears I got the word right and ended up getting through several rounds, finishing 11th out of 300 contestants. But by then, the word “vine” wasn’t a place where people picked grapes; it was how kids picked on me. When they passed me in the halls between classes, they’d pretend to rub away tears and blurt “vine” sarcastically between feigned sobbing. My twin sister and I were born prematurely. I came out second, feet first, which is to say upside down from the way you’re supposed to come out. I was not breathing, and the drugs they gave me in intensive care gave me permanent hearing damage. In one fell swoop, I lost my ability to understand consonants and hear words in most situations. As a youngster, I wore one hearing aid, because when at age 6 I was fitted for two, the experience was so overwhelming I threw one of them on the floor. Fast forward, and on that day at age 11 on the spelling bee stage, the damn hearing aid battery died—and right along with it, my self-esteem. There are moments in life that define us; some are positive, and some cut us deeply. I have learned, though, that we have a choice to rise or fall. We can accept our challenges or run from them. This is what I learned from my impairment. I overcame my challenges and developed the skills and confidence necessary to become a national spokesperson, surpassing the spelling bee stage. I chose to prevail instead of cower to the negative pressure. Now when I meet others who are struggling, with hearing or really any impairment that is holding them back, I like to share three lessons to help them move forward. The first lesson that I learned is: It’s okay to be different. If you march to the beat of your own drummer, you’ll eventually find an orchestra that needs you. When I got teased as a kid, I became determined to prove I was neither deaf nor dumb. I never got used to the cruelty, and it fed my anger—but it also fueled my effort to succeed even more. Since kids teased me about not being able to hear, mocking me for needing everything repeated, I learned to turn a deaf ear to the mockery. I chose to become helpful and kind to everyone because I knew what getting treated like crap felt like. I developed workarounds when I could. I mastered hobbies where hearing really didn’t matter all that much— soccer, softball, basketball, art, piano, flute. Playing sports, if you keep your eye on the ball and have studied the game, memorizing plays and strategies, you can get by pretty well if you keep aware about where other players are, where the runners are, and where the ball is. With music, I can hear most instruments without my hearing aids in, and I like how I can make and practice
My twin sister and I were born prematurely. I came out second, feet first, which is to say upside down from the way you’re supposed to come out. I was not breathing, and the drugs they gave me in intensive care gave me permanent hearing damage. In one fell swoop, I lost my ability to understand consonants and hear words in most situations.
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Growing up, Glick developed workarounds for her hearing loss, mastering hobbies where hearing wasn’t so important.
I didn’t realize it then but those tragedies were why I chose jobs where I could make a difference, where I can highlight the work of unsung heroes and perform my own kind of public service. music without having to interact with someone talking. I can tell how loud I am playing by how hard I am hitting the keys (piano) or how much air I am forcing out on the instrument (flute). Learning how to make time for sports, music, art, and some parttime jobs led me to graduate high school ranked in the top 10 percent academically and with several varsity letters in sports and band. Later I graduated cum laude from the University of Pennsylvania. I learned resilience, coping strategies, and good habits early on. Being the target of taunting taught me compassion. I learned to listen with my heart, push past failure, and ultimately triumph through sheer perseverance. My second lesson is to recognize the mentors and friends who are your “angels.” I could not have succeeded without mine and I’m grateful for their help. You know who yours are—either we find these angels or they find us, or 32
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maybe nobody comes to mind for you because you had to be your own angel. My angels include my mom, who stood up to the school principal and made sure I got accommodations so I could hear in class. My second grade teacher, Mrs. Mesnicoff, saw my potential and helped me to not only catch up with my classmates but also accelerate. My friend and Penn classmate Marty Gordon told me about an incredible NBC internship that really shaped my professional career. And my former boss David Woods did something different with me than other angels: He called me on my B.S. He kept telling me, “Stop doubting yourself; you’re better than you think you are.” Actually David and I taught each other something. He once wrote on my performance review the words “despite her hearing impairment,” following it with a glowing evaluation. When I saw that I challenged him to
take the caveat out because I didn’t want to be treated differently. I want to be judged the same as everybody else. He later thanked me for teaching him how to focus on people as they are, not what they’re not. My third lesson is to embrace your fears and challenges and make them work for you. As a child I escaped to my room, often writing and dreaming about the ideal world I wanted to live in, one that was kind and full of nice people, because in reality my world was neither ideal nor kind. In first grade I got bullied and even pushed off the school bus. I cracked my chin and still have a scar that I hide with makeup. When I was a teenager my young dad died unexpectedly. Then my mom was in a car accident caused by a distracted driver and ended up in the hospital with broken ribs. And I saw a dear family friend suffer from her family’s substance abuse. I didn’t realize it then but those
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I want to be judged the same as everybody else. I want to teach others to focus on people as they are, not what they’re not.
tragedies were why I chose jobs where I could make a difference, where I can highlight the work of unsung heroes and perform my own kind of public service. Ten years after my mom’s accident I became a spokesperson for the American Automobile Association, creating a Most Dangerous Accident Corridors report. After my dad’s death and the life insurance benefits ended up paying for my Penn tuition, I orchestrated a national educational campaign called “Life Insurance. It Isn’t for the People Who Die. It’s for the People Who Live.” I’m living proof. The campaign that uses real life stories to encourage people to create a financial safety net still continues today. After my friend’s home life was ruined by her relative’s addiction, I orchestrated national communications for 5,000 community antidrug groups. Later, in complete contrast to all the bullies and tormentors who pushed me around and treated me like I didn’t matter, I was the employee handpicked by my bosses at the American Battle Monuments Commission to give actor Tom Hanks, the memorial spokesman, the very first official tour of the National World War II Memorial in Washington, D.C., immediately after President George W. Bush dedicated it in 2004.
Afterward, I joined Mr. Hanks at the newly dedicated World War II Memorial, located on the National Mall, to say thank you to the visiting World War II Medal of Honor recipients who risked their lives to defeat Hitler’s bullying and oppression. In my work now I’m fortunate to help tell the stories of unsung heroes who safeguard our national security, developing informative workshops for the TV and movie industry as well as victim-focused television public service announcements. Most recently I helped bring a six-part true crime series to primetime on CBS, airing in the fall of 2020, that showcased a federal agency’s most complex and heroic crime-stopping efforts. People have told me that I’m so lucky to work on such high-profile projects, and yes it takes a little luck to be in the right place at the right time. It’s also my own determination shaped from my experiences, my angels, and my personal choices that enabled me to embrace those opportunities once I got there. For everyone reading this today, please keep your eyes and ears open— glasses and hearing aids or not—as well as your minds and hearts, and please remember my three lessons: One, it’s okay to be different; two, thank the angels in your life, or be one; and three, embrace your
challenges and make them work for you—lean into them and see them as opportunities. There’s the saying, “You can’t go back and change the beginning, but you can start where you are and change the ending.” What ending do you want? I hope my story inspires you. Please, don’t let your dreams and opportunities die on the proverbial V-I-N-E.
This is adapted from Betsy Glick’s acceptance speech for the 2020 Joseph Wharton Award, given by the Wharton Club of D.C. Hearing Health Foundation sincerely thanks Glick for her support. A Virginia resident, Glick was also the 2019 Top Women in Communications Honoree by PR Daily for her extensive work in media relations. See her artwork at pets-by-bets.com.
Share your story: Tell us your hearing loss journey at editor@hhf.org.
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Seed funding for projects across the entire spectrum of hearing and balance
Why I Appreciate My
#StartWithERG
By Gail M. Seigel, Ph.D.
I was immersed in science at a very early age. My parents are a retired pharmacist and a nurse so I grew up reading the Merck Index and MedicalSurgical Nursing books. When I was very young I wanted to be a veterinarian, but later realized I wanted to work with smaller creatures—cells. My doctorate is in microbiology/immunology, but when the time came for my postdoctoral fellowship, I found a very interesting lab studying retinal cell biology and pursued that. Once I arrived at the University at Buffalo, I encountered some wonderful scientists in the Center for Hearing and Deafness, led by Richard Salvi, Ph.D. We found many common points of interest that led to fruitful areas of research that continue to this day. My lab is known as the Ocular and Auditory Neuroscience Lab, as we combine the best of both worlds as part of the center. This Emerging Research Grant represents the first awarded to me for auditory neuroscience, planned in conjunction with colleagues at the center. As such it is a career milestone—important not only for our tinnitus project, but also because of the gravitas it provides my research program for future funding opportunities in the field of auditory neuroscience. In the short term, I hope that people living with hearing and balance conditions can find relief and comfort. In the long term, I hope that new treatments will emerge that will provide permanent solutions. Funding through the Emerging Research Grants program is an integral part of the pipeline from research idea to therapeutics.
Personal Connection It was about 10 years ago that I woke up one morning and noticed a sound that I hadn’t heard before. I was recovering from an upper respiratory infection, so I thought that maybe it was just congestion. But the sound persisted. It was especially troublesome in those quiet minutes (or hours) when I was trying to fall asleep at night. I made an appointment with an ENT (ear, nose, and throat specialist), but I couldn’t get in to see him for three months. As I waited I continued to be very disturbed by the sound. Fortunately an audiology graduate student at the center volunteered to do a hearing test. I was 34
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reassured that my hearing was actually typical for my age, which was about 50 at the time. I also figured out that I could use an app on my phone that would generate white noise. At bedtime I kept the app running next to my bed and it masked the unwanted sound and allowed me to sleep. I also often like to use the sleep timer on my TV at night and it provides relief. The ENT eventually confirmed what I already knew—I had tinnitus and that although it was an annoyance, it was not something life threatening. Even before the tinnitus, I have always been very careful with the sound level when I play music. During the pandemic, I’ve been playing in a virtual Quarantine Band, where the sound is at a manageable level since I play alone in a room. But normally, in loud band rehearsals, I have musicians’ earplugs and a decibel app on my phone to monitor the sound intensity around me. I also try not to sit directly in front of the trumpets! Now that we are vaccinated, I am looking forward to playing shoulder to shoulder with my musical friends again. I am also on the board of the Rochester NY March for Science, promoting scientific outreach, especially to underserved populations. While we haven’t reopened yet, I am looking forward to again hosting a monthly “Ask a Scientist” booth at our farmers market where we highlight local scientists and present kid-friendly science demonstrations. And as of late May 2021, my lab is at full capacity again. I finally saw my grad student in person for the first time in over a year. We even ran separate experiments in the lab at the same time! After she left, I was alone and took off my mask for a photo op to mark the occasion.
Gail M. Seigel, Ph.D., is a research associate professor in the Center for Hearing and Deafness at the University at Buffalo, the State University of New York, where she runs the Ocular and Auditory Neuroscience Lab. Her 2019 Emerging Research Grant was generously supported by donors to Hearing Health Foundation. Seigel published a memoir in 2015 during her time in Buffalo, “Academania: My Life in the Trenches of Biomedical Research.” For more, see hhf.org/erg and #StartWithERG on social media.
Above left: Gail Seigel, Ph.D., and her fellow musicians formed a Quarantine Band to keep practicing together. She is in the top row, third box from the left, and also in the second row from the bottom, with her clarinet and a large flag visible. Above right: Seigel’s music room at home doubled as her microscope room during the pandemic. Opposite page: With mask and other COVID-19 rules increasingly relaxed, Seigel has been back in her lab at the University at Buffalo.
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New Working Groups Reaffirm Team Science Approach
By Lisa Goodrich, Ph.D.
This year’s annual meeting of the Hearing Restoration Project (HRP) was held over two days in mid-March 2021 via Zoom, like most scientific (and other) events over the past year and a half, and was also the first annual meeting I oversaw as the HRP’s new scientific director. This presented an opportunity to assess and reimagine the group’s structures, processes, and ethos, even as the consortium’s end goal—to discover mechanisms to regenerate inner ear hair cells in humans to cure hearing loss and related disorders—remains the same. A few years ago, the consortium decided to shift from proposals with multiple principal investigators (PI) to single-PI projects. The logic was straightforward: The outcomes of a few focused projects would help the HRP to refine its targets, and there is always a finite pool of funding available in any given year. The consortium and the Scientific Advisory Board (on which I sat before becoming HRP scientific director) must make difficult decisions about which experiments and projects are most urgent and promising. At the same time, the HRP is founded on a firm belief in the advantages of team science and a conviction that collaboration and exchange produce the best results. In surveying the group’s recent accomplishments, we agreed that we needed a new approach to mine our rich datasets and begin to directly test ways to regenerate hair cells in vivo. We also reiterated our commitment to facilitate hair cell regeneration research more broadly by making the data available to anyone in the field, as enabled by the gEAR platform, whose creation the HRP funded.
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We decided to form three working groups that will each submit one joint proposal per grant cycle. These working groups span the breadth of the HRP’s work as guided by its strategic plan: » The Cross-Species Epigenetic Analysis working group is producing epigenetic data sets for supporting cells in order to pinpoint the differences between successful regeneration in fish and chicks, and failure to regenerate (so far) in mammals; » The Integrative Analysis working group promotes data sharing, conducts cross-species analysis of data, and aims to more efficiently prepare data for publication; » The Reprogramming and Gene Delivery working group will test transcription factors to regenerate hair cells and develop new tools and methods to deliver these transcription factors to the inner ear. Every HRP member has a role to play, and our new comfort with Zoom meetings will make it that much easier to bring HRP investigators and members of their labs together on a regular basis. This restructuring of the HRP’s team science approach will reinvigorate the collaborative spirit and propel our work forward in new, creative ways. This renewed impetus should result more concretely in accelerated publication plans and, over a slightly longer term, additional major funding awards to members’ labs from the National Institute on Deafness and Other Communication Disorders to continue initial HRP research. I look forward to sharing details on the working groups’ projects and results as we embark on this exciting next phase of the HRP.
HRP scientific director Lisa Goodrich, Ph.D., is a professor of neurobiology at Harvard Medical School. For more, see hhf.org/hrp.
research
Recent Research by Hearing Health Foundation Scientists, Explained Several Novel Findings Describing Cochlear Hair Cell Regeneration in Birds
Chickens are an important animal model for hearing restoration research because they are naturally capable of regenerating cochlear hair cells. This fact has been known for many years, but the mechanisms that initiate and control this regenerative ability are unknown. The funding provided by Hearing Health Foundation through the Hearing Restoration Project (HRP) has helped the development of a new research program in the Stanford University laboratory of Stefan Heller, Ph.D., focusing on chicken hair cell regeneration. Several years after its inception, this research is now bearing fruit. In two high-profile publications in the journal Cell Reports in March 2021, a research team led by postdoctoral fellows Amanda Janesick, Ph.D., and Nesrine Benkafadar, Ph.D., reported several novel findings that lay the foundation for in-depth characterization of the cellular signaling that triggers and controls cochlear hair cell regeneration in birds. The work uses a recently developed technology called single-cell RNA-sequencing. This technology provides insight into changes in the activity of all genes as cochlear cells respond to hair cell damage and death. To properly leverage single-cell RNA-sequencing technology, Janesick developed a new strategy to injure the chicken cochlea. The goal was to damage all hair cells “at once,” which is usually impossible with sound exposure or systemic injection of an ototoxic drug. However, using a surgical approach to the chicken cochlea, it is possible to inject a tiny amount of the drug sisomicin into the inner ear, causing all auditory hair cells to disappear within 24 hours. Benkafadar took a closer look at the hair cells using single-cell RNAsequencing. She found that cochlear hair cells, when damaged and stressed by exposure to sisomicin, activate a particular set of genes related to cellular
Five days after ototoxic damage, the chicken regenerates sensory hair cells and neurons (green). Dead hair cell “ghosts” (red) float above the regenerating cells. Nuclei are marked in blue.
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A new hair cell type was discovered in the chicken inner ear. This finding will spur research toward uncovering the physiological function of this novel hair cell type. The work identified two distinct groups of supporting cells, which are the stem cells that give rise to new hair cells after damage.
stress. Her data show that hair cells “fight” to stay alive by invoking cellular repair mechanisms. Benkafadar further discovered a mechanism that gets activated to cause hair cells to destroy their genetic material and subsequently disintegrate. This process, called programmed cell death, is well known and is generally a safety mechanism to prevent stressed cells from harming the body. She found that in the chicken cochlea, hair cells “hang in there” for at least 16 hours before they dissolve and fall apart. During these 16 hours, the cells communicate with the remaining cells in the cochlea, the supporting cells. The researchers hypothesize that such signals ultimately instruct the supporting cells to commence the hair cell regeneration process. Ongoing work focuses on identifying the signals. In total, this research created a comprehensive inventory of more than 15,000 individual activated and deactivated genes throughout the first 24 hours of hair cell demise. This rich source of important data is publicly available to the research community and will become the basis for future work that is now directly aimed at finding the relevant genes that initiate and control hair cell regeneration in birds. In parallel, the HRP consortium is already working on comparing the identified genes with their mammalian equivalents, which will accelerate the translation of the findings toward future treatments. A second aspect of the work that came from Janesick’s comprehensive inventory of the different cell groups of the chicken cochlea was the identification of many new marker genes for the different cochlear cell types. Two surprises resulted: 1) A new hair cell type was discovered in the chicken inner ear. This finding will spur research toward uncovering the physiological function of this novel hair cell type. 2) The work identified two distinct groups of supporting cells, which are the stem cells that give rise to new hair cells after damage. Interestingly, the two groups are spatially distinct, corresponding to two different places in the cochlea that utilize different mechanisms for hair cell regeneration. One mechanism is based on cell division, which is the desired strategy that the Heller lab focuses on for developing future therapeutics to regenerate hair cells in the mammalian cochlea. “The HRP provided the funding to get this study started in an environment where it was impossible to obtain support for this work from the National Institutes of Health,” Heller says. “I hope that our data and the published results from the HRP consortium work will convince the NIH to support the necessary follow-up studies that will hopefully lead to new treatments for patients.” —Amanda Janesick, Ph.D., and Nesrine Benkafadar, Ph.D.
Amanda Janesick, Ph.D. (far left), and Nesrine Benkafadar, Ph.D., are postdoctoral fellows in the laboratory of Stefan Heller, Ph.D., a member of HHF’s Hearing Restoration Project and a professor of otolaryngology–head & neck surgery at Stanford University in California.
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Elusive Cell Type in Fish Sensory Organs Discovered One of the evolutionary disadvantages for mammals, relative to other vertebrates like fish and chickens, is the inability to regenerate sensory hair cells. The inner hair cells in our ears are responsible for transforming sound vibrations and gravitational forces into electrical signals, which we need to detect sound and maintain balance and spatial orientation. Certain factors, such as exposure to noise or antibiotics, cause inner ear hair cells to die, which leads to hearing loss and vestibular defects, a condition reported by 15 percent of the U.S. adult population. In addition, the ion composition of the fluid surrounding the hair cells needs to be tightly controlled, otherwise hair cell function is compromised, as observed in Ménière’s disease. While prosthetics like cochlear implants can restore some level of hearing, it may be possible to develop medical therapies to restore hearing through the regeneration of hair cells. Investigator Tatjana Piotrowski, Ph.D., at the Stowers Institute for Medical Research in Missouri, is part of the Hearing Restoration Project of Hearing Health Foundation, a consortium of laboratories doing foundational and translational science using fish, chicken, mouse, and cell culture systems. “To gain a detailed understanding of the molecular mechanisms and genes that enable fish to regenerate hair cells, we need to understand which cells give rise to regenerating hair cells, and related to that question, how many cell types exist in the sensory organs,” Piotrowski says. The Piotrowski Lab studies the regeneration of sensory hair cells in the zebrafish lateral line. Located superficially on the fish’s skin, these cells are easy to visualize and to access for experimentation. The sensory organs of the lateral line, known as neuromasts, contain support cells which can readily differentiate into new hair cells. Using techniques to label cells of the same embryonic origin in a particular color, other research had shown that cells within the neuromasts derive from ectodermal thickenings called placodes. It turns out that while most cells of the zebrafish neuromast do originate from placodes, this isn’t true for all of them. In a paper published online in Developmental Cell in April 2021, Piotrowski and team describe their discovery of the occasional occurrence of a pair of cells within post-embryonic and adult neuromasts that are not labeled by lateral line markers. When using a technique called Zebrabow to track embryonic cells through development, these cells are labeled a different color than the rest of the neuromast. “I initially thought it was an artifact of the research method,” says Julia Peloggia, a predoctoral researcher at The Graduate School of the Stowers Institute for Medical Research, co-first author of this work along with another predoctoral researcher, Daniela Münch, who says it is common in transgenic animal lines that the labels don’t mark all of the cells, especially when looking just at the nuclei of cells. The pair agreed that it was difficult to discern a pattern at first. “Although these cells have a stereotypical location in the neuromast, they’re not always there. Some neuromasts have them, some don’t, and that threw us off,” Peloggia says.
A normal invasive (that is, non-metastatic) behavior of cells after embryonic development is not often observed. Future research by the team will focus on identifying triggers for such behavior and the function of these newly differentiated, migratory, and invasive ionocytes, including how this process may relate to hair cell regeneration.
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A newly discovered cell type in lateral line neuromasts, Nm ionocytes, invade mature sensory organs in a salinity- and pH-dependent manner, a process named adaptive cell invasion. This process allows for physiological adaptation of sensory organs to fluctuating environmental conditions.
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By applying an experimental method called single-cell RNA sequencing to cells isolated by fluorescence-activated cell sorting, the researchers identified these cells as ionocytes—a specialized type of cell that can regulate the ionic composition of nearby fluid. Using lineage tracing, they determined that the ionocytes derived from skin cells surrounding the neuromast. They named these cells neuromast-associated ionocytes. Next, they sought to capture the phenomenon using time-lapse and highresolution live imaging of young larvae. “In the beginning, we didn’t have a way to trigger invasion by these cells. We were imaging whenever the microscope was available, taking as many time-lapses as possible—over days or weekends— and hoping that we would see the cells invading the neuromasts just by chance,” Münch says. Ultimately, the researchers observed that the ionocyte progenitor cells migrated into neuromasts as pairs of cells, rearranging between other support cells and hair cells while remaining associated as a pair. They found that this phenomenon occurred all throughout early larval, later larval, and well into the adult stages in zebrafish. The frequency of neuromast-associated ionocytes correlated with developmental stages, including transfers when larvae were moved from ion-rich embryo medium to ion-poor water. From each pair, they determined that only one cell was labeled by a Notch pathway reporter tagged with fluorescent red or green protein. To visualize the morphology of both cells, they used special electron microscopy to generate high-resolution, three-dimensional images. They found that both cells had extensions reaching the apical or top surface of the neuromast, and both often contained thin projections. The Notchnegative cell displayed unique “toothbrush-like” microvilli projecting into the neuromast lumen or interior, reminiscent of that seen in gill and skin ionocytes. “Once we were able to see the morphology of these cells—how they were really protrusive and interacting with other cells—we realized they might have a complex function in the neuromast,” Münch says. Peloggia adds, “Our studies are the first to show that ionocytes invade sensory organs even in adult animals and that they only do so in response to changes in the environment that the animal lives in. These cells therefore likely play an important role allowing the animal to adapt to changing environmental conditions.” Ionocytes are known to exist in other organ systems. “The inner ear of mammals also contains cells that regulate the ion composition of the fluid that surrounds the hair cells, and dysregulation of this equilibrium leads to hearing and vestibular defects,” Piotrowski says. And while ionocyte-like cells exist in other systems, it’s not known whether they exhibit such adaptive and invasive behavior. “We don’t know if ear ionocytes share the same transcriptome, or collection of gene messages, but they have similar morphology to an extent and may possibly have a similar function, so we think they might be analogous cells,” Münch says. Peloggia adds that their discovery of neuromast ionocytes will let them test this hypothesis, as well as test how ionocytes modulate hair cell function at the molecular level.
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Next, the team will focus on two related questions—what causes these ionocytes to migrate and invade the neuromast, and what is their specific function? “Even though we made this astounding observation that ionocytes are highly motile, we still don’t know how the invasion is triggered,” Peloggia says. “Identifying the signals that attract ionocytes and allow them to squeeze into the sensory organs might also teach us how cancer cells invade organs during disease.” A normal invasive (that is, non-metastatic) behavior of cells after embryonic development is not often observed. Future research by the team will focus on identifying triggers for such behavior and the function of these newly differentiated, migratory, and invasive ionocytes, including how this process may relate to hair cell regeneration. Peloggia plans to investigate what triggers the cells to differentiate, migrate, and invade, and Münch will focus on characterizing their function. “The adaptive part is really interesting,” Münch says. “That there is a process involving ionocytes extending into adult stages that could modulate and change the function of an organ—that’s exciting.”
This is adapted from a press release from the Stowers Institute for Medical Research, at stowers.org/news. HRP member Tatjana Piotrowski, Ph.D., is an investigator at the Stowers Institute for Medical Research in Missouri, where study coauthors Julia Peloggia and Daniela Münch are predoctoral researchers in the graduate school.
Given their adaptive and invasive behavior, these cells likely play an important role allowing the animal to adapt to changing environmental conditions.
Research Calls Attention to Dangerous Noise Levels in Gyms Fitness center instructors often turn up music volumes significantly during classes—sometimes loud enough to cause hearing damage—based on an assumption that participants will work out more intensely when volumes are raised. A new University of Maryland School of Medicine (UMSOM) study, however, found that those who attend indoor cycling (spinning) classes do not lower the intensity of their workouts when the volume is reduced to a safer decibel level. The findings were published in the January–March 2021 issue of the journal Noise & Health. “Our findings make a strong case for reducing music volumes in fitness classes to protect against hearing loss without sacrificing the intensity of the workout,” says study corresponding author Ronna Hertzano, M.D., Ph.D., an associate professor of otorhinolaryngology–head & neck surgery at UMSOM. “In fact, our study participants reported that they preferred the reduced sound level during their workouts.” An avid gym-goer, Hertzano is a member of HHF’s Hearing Restoration Project.
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These findings make a strong case for reducing music volumes in fitness classes to protect against hearing loss without sacrificing the intensity of the workout.
Previous research suggests that the average sound levels in group fitness classes frequently exceed 90 decibels, as loud as an approaching subway train, and often exceed 100 dB, as loud as a power lawnmower. The National Institute of Occupational Safety and Health recommends that a noise exposure of one hour not exceed 94 dB, and exposures to levels of 100 dB should not exceed 15 minutes to protect against permanent hearing loss. For the new study, the researchers selected a gym in the local Baltimore area and conducted surveys on participants, age 31 on average, who signed up for one-hour spinning classes. Music volumes in the spinning classes during the study ranged from 93 to 101 dB. In the classes that were 2 to 3 dB lower than the loudest classes—which translates to about a 50 percent reduction in power and a 20 percent reduction in perceived loudness—participants reported no differences in their exercise intensity. Those in classes with the lowest volume experienced a slight reduction in exercise intensity, but only two of these participants reported below-average exercise intensity. Overall, more than one in four study participants reported experiencing auditory symptoms following their spinning class, including ringing in their ears or muffled hearing. For those in classes with the highest sound levels, nearly one-third of participants reported that the sound level was too high, and nearly one-third reported that they would prefer a decrease of the music level. Only three of the participants reported using hearing protection, such as earplugs, during the study. “We also found that participants were most likely to report that the music level was satisfactory in classes where sound levels were lowest,” Hertzano says. “Importantly, the gym elected to maintain the music at the softer level after we made them aware of our study results.” Lawrance Lee, a fourth-year medical student at UMSOM; Benjamin Shuster, a research fellow in the department of otorhinolaryngology–head & neck surgery at UMSOM; and Yang Song, Ph.D., a postdoctoral fellow in the Institute for Genome Sciences at UMSOM, all served as lead coauthors on the paper. Study researchers also included Sharon Kujawa, Ph.D., of Massachusetts Eye and Ear in Boston and a member of HHF’s Council of Scientific Trustees. —Deborah Kotz
This is adapted from a press release from the University of Maryland School of Medicine, at medschool.umaryland.edu/news. Hearing Restoration Project member and a 2009–10 Emerging Research Grants scientist Ronna Hertzano, M.D., Ph.D. (far left), is an associate professor of otorhinolaryngology–head and neck surgery at the University of Maryland School of Medicine. Council of Scientific Trustees member and 1999 ERG scientist Sharon Kujawa, Ph.D., is an associate professor of otolaryngology–head and neck surgery at Harvard Medical School and the director of audiology research at Mass Eye and Ear. For references, see hhf.org/summer2021-references.
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Measuring Children’s Ability to Hear Speech in Different Competing Backgrounds Young children spend much of their day listening in noise. However, it is clear that, compared with adults, infants and children are highly susceptible to interference from competing background sounds. The ability to listen in competing backgrounds develops slowly over childhood, but the course of development is dependent on the type of background. For example, the developmental trajectory is more pronounced and prolonged for listening for a speech target in a competing speech background than in a steadystate noise background.
This chart shows individual thresholds as a function of child age (in log10 scale). Thresholds in the speech-shaped noise (SSN) condition and the two-talker speech condition are shown in red triangles and blue squares, respectively. The solid line represents the linear function for the child data: red for the noise condition, and blue for the speech condition. For each condition, the dash line shows the 0.05 quantile cutoff based on adult thresholds.
Data from infants and school-aged children clearly shows there is substantial improvement in the ability to hear speech embedded in competing backgrounds between these two time points. However, little is known about how the course of development unfolds during the toddler and preschooler years. Building on our recent methodology improvements for testing young children, the goal of this study was to examine age-related changes for 2- to 15-year-old children in the ability to detect a word presented in one of two competing background sounds: speech (comprising two competing talkers) or a steady-state noise. Children were tested with an observer-based testing method in which the child is trained to perform a play-based response when the target is heard. Based on the child’s behavior,
an experimenter determines, of the two possible time intervals, which interval contained the signal. Consistent with previous studies, results from our research, published in Ear and Hearing in April 2021, indicate that children had poorer thresholds than adults. Moreover, the child–adult differences were substantially larger for the speech than the noise condition. Based on the 0.05 quantile cutoff from the adult data (the dashed horizontal lines in the figure), adultlike performance was achieved at 6 years of age for the noise condition and at 15 years for the speech condition. A unique contribution to the literature from our study was that we documented limited improvement in thresholds between 2.5 to 5 years. This finding suggests that the large improvement seen between infants and school-aged children must be the result of auditory development that happens prior to 2.5 years of age. Results from this work also confirm that our testing method can be used to reliably collect behavioral data from toddlers and preschoolers for complex listening tasks. Now that we have established normative data for this task, future work in our laboratory will measure thresholds for these stimuli with children with developmental disabilities. Albeit limited, previous studies suggest that children with developmental disabilities—specifically children with autism spectrum disorder or Down syndrome—have poorer performance for complex listening tasks than age-matched, neurotypical peers. Documenting performance across the two background types is expected to advance our theoretical understanding of auditory development as well as pave the way for the creation of new clinical tools for monitoring hearing abilities in children with developmental disabilities. —Angela Yarnell Bonino, Ph.D., CCC-A A 2017 Emerging Research Grants (ERG) scientist generously funded by the General Grand Chapter Royal Arch Masons International, Angela Yarnell Bonino, Ph.D., CCC-A, is an assistant professor in the department of speech, language, and hearing sciences at the University of Colorado Boulder.
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The Gene C1ql1 Is Expressed in Adult Outer Hair Cells of the Mouse Cochlea A novel strain of mice has been created such that a fluorescent protein called mVenus, which is similar to the jellyfish protein called green fluorescent protein, is made to be present inside any cell that expresses the gene C1ql1. In the mouse cochlea, this reveals that C1ql1 is expressed in the outer hair cells. A dye called DAPI stains each nucleus blue.
Hearing depends on the transduction of sounds into neural signals by the inner hair cells of the cochlea. The cochlea also has outer hair cells with unique electromotile properties that increase auditory sensitivity, but they are particularly susceptible to damage by intense noise exposure and ototoxic drugs. Although the outer hair cells have synapses that allow communication with neurons that project to the brain, the function of this neuronal circuit and what auditory information it is sending to the brain is unclear. A previously proposed possible function for this circuit is that it may have a function in the detection of auditory pain, which would help us better understand hyperacusis, a condition in which a person experiences pain at a much lower volume level than listeners with typical hearing. As a postdoc, I had shown that the gene C1q-like 3 (C1ql3) and the C1QL3 protein it creates are important in allowing neurons to communicate with one another in the brain. Other research found that another gene in the same family, C1q-like 1 gene (C1ql1), is expressed specifically in outer hair cells, and not inner hair cells. These findings prompted a new investigation into the possible functions of the C1QL1 protein in the auditory system and a possible role at the synapses that may be contributing to the perception of auditory pain. We set out to investigate the function of C1QL1 in the cochlea using a mouse model where the gene is knocked out and no C1QL1 can be made. We hoped to find that removing this gene would provide evidence that the outer hair cell circuit to the brain contributes to the perception of auditory pain. Surprisingly, we found C1QL1 expression in the cochlear tissue of adult mice, but not in neonatal or developing 44
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mice, indicating that the protein is not involved with the development of any aspect of the auditory system. This developmental regulation is surprising as both C1QL1 and the related C1QL3 have synaptogenic functions—the formation of synapses between neurons in the brain, especially during development—but C1QL1 expression is absent during the primary postnatal cochlear period of synaptogenesis. This suggests that the C1QL1 protein is not required for initial synaptogenesis in the cochlea. We also did not find that the absence of C1QL1 altered an animal’s apparent perception of auditory pain. A promising future direction is to conduct similar experiments in older animals, as we found clues that the C1QL1 protein contributes to the maintenance of the outer hair cell synapses. Our research also alerts the larger cochlea scientific community about the expression of the C1ql1 gene specifically in outer hair cells, which may be useful for future experiments designed to better understand the function of these mysterious cells critical for hearing. —David Martinelli, Ph.D.
A 2019 ERG scientist generously funded by Hyperacusis Research Ltd., David Martinelli, Ph.D., is an assistant professor of neuroscience at the University of Connecticut Health Center.
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Creating Complex Virtual Environments to Potentially Help Characterize Dizziness Symptoms Persistent postural-perceptual dizziness (PPPD) is typically defined as having symptoms of dizziness and imbalance for three months or longer when lab test results cannot pinpoint a cause. In collaboration with researchers at the University of Haifa in Israel, our lab investigated two different virtual reality paradigms in an attempt to shed light on the mechanisms underlying PPPD. In our first study published in the Journal of Vestibular Research in March 2021, we asked people with PPPD and healthy controls to stand in a heel-to-toes position, or one foot in front of the other in a line (“tandem”). Using a head-mounted display (HTC Vive), we showed white dots against a black background, like stars in a night sky, that were static or moving during 20-second trials. On half the trials, participants performed a standard mental task (subtracting by units of three). We compared the two groups in terms of changes in postural sway and head movement in response to these tasks. The results showed that people with PPPD moved their head and swayed more than the controls on easier tasks, but this difference decreased as the challenge increased. Healthy controls demonstrated increased movement as task difficulty increased, while people with PPPD did not. It may be that patients with PPPD minimize their head movement to facilitate better stability overall. Our second paper published in the Journal of NeuroEngineering and Rehabilitation also in March 2021, involved a translation of a well-known dynamic test of balance and fall risk prediction, the Four-Square Step Test, into a virtual environment. The traditional FSST is typically conducted in a well-lit room with no visual distractions, and it only measures duration (speed in seconds). We showed that the FSST-VR allows for modification of the visual environment and measures duration as well as identifying movement strategy and quantifying head movement. People with PPPD and healthy controls performed the FSST task inside a virtual subway scene with three levels of visual complexity. Performance duration of both real and virtual tests was similar between groups. We did see moderate associations between head kinematics and selfreported overall anxiety, balance confidence, and dynamic balance that differed between groups, specifically during high visual load environments.
Namely, in the PPPD group, increased anxiety, reduced balance confidence, and slower speed on the Timed Up & Go test (sitting in a chair, standing up, walking to a point 10 feet away, walking back, and sitting again) were associated with a smaller range of head motion. This suggests that people with PPPD who are more anxious and less confident limit their movement, adopting a “high risk” stiff-motion strategy. In contrast, controls who are more anxious and less confident were associated with the opposite tendency—an increased range of motion.
The portability and simplicity of the head-mounted display setup may allow for a simple clinical translation and potentially serve as a differential diagnosis for PPPD and other vestibular disorders. Findings from both studies need to be replicated in larger groups of patients. The portability and simplicity of the head-mounted display setup may allow for a simple clinical translation and potentially serve as a differential diagnosis for PPPD and other vestibular disorders. —Anat V. Lubetzky, Ph.D.
A 2019 ERG scientist, Anat V. Lubetzky, Ph.D., is an assistant professor in the physical therapy department at New York University. For references, see hhf.org/summer2021references.
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Study Explains “Cocktail Party Effect” In Hearing Impairment Plenty of people struggle to make sense of a multitude of converging voices in a crowded room. Commonly known as the “cocktail party effect,” people with hearing loss find it’s especially difficult to understand speech in a noisy environment. New research suggests that, for some listeners, this may have less to do with actually discerning sounds. Instead, it may be a processing problem in which two ears blend different sounds together—a condition known as binaural pitch fusion. The research, coauthored by scientists at Oregon Health & Science University (OHSU) and VA Portland Health Care System, was published in the Journal of the Association for Research in Otolaryngology in April 2021. Lina Reiss, Ph.D., the study’s lead author, attributes these difficulties to abnormally broad binaural pitch fusion in people with hearing impairment. The new study suggests that, for people with hearing impairment, fusing of different sounds from both ears leads to sound blending together in a way that is often unintelligible. Reiss, who has a hearing loss herself, previously coauthored research in 2017 that first demonstrated broad binaural pitch fusion in hearing impairment. Together with her other 2017 study showing blending of the fused pitches, Reiss’s investigations suggested the possibility that similar fusion and blending could occur with sounds in speech. To test this theory, the OHSU and VA team recruited 11 people with typical hearing and 10 with hearing loss. Participants were fitted with headphones in a doublewalled, sound-attenuated booth. Two vowel sounds were played simultaneously through the headphones, with a different vowel sound played to each ear, and with voice pitch varying between male and female voices. Participants were then asked to respond on a touchscreen to identify the specific vowel sounds. Using statistical analysis, the investigators definitively revealed that people with hearing loss experienced an abnormal fusion of speech across both ears, even for different voice pitches. When different vowel sounds were fused, participants heard an entirely new vowel sound. For example, the vowel “ah” (as in “hot”) spoken by a female talker would fuse with the vowel “ee” (as in “heed”) spoken by a male talker, and be heard as “eh” (as in “head”). 46
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When different vowel sounds were fused, participants heard an entirely new vowel sound. For example, the vowel “ah” (as in “hot”) spoken by a female talker would fuse with the vowel “ee” (as in “heed”) spoken by a male talker, and be heard as “eh” (as in “head”). “Abnormal binaural fusion may provide a new explanation for the difficulties that hearing-impaired listeners have with understanding speech in multitalker environments,” the authors conclude in the paper. Reiss calls it a breakthrough, suggesting the possibility of new therapies to improve the perception of speech among the millions of people worldwide with hearing impairment. “This suggests more targeted rehabilitation strategies to improve speech perception in noise,” she says. —Erik Robinson
This is adapted from an OHSU press release, at news.ohsu.edu. Lina A.J. Reiss, Ph.D., is an associate professor of otolaryngology–head and neck surgery, and of biomedical engineering, in the Oregon Hearing Research Center at the OHSU School of Medicine. A 2012–13 ERG scientist, Reiss wrote about her experience with hearing and balance issues in the Summer 2020 issue of Hearing Health magazine.
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Do Transparent Face Coverings Help With Communication? By B. Renee McDowell, Morgan Howard, Celeste Watson, M. Bryson Howard, Au.D., and Samuel R. Atcherson, Ph.D.
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These are spectrogram recordings of the sentence “Such windows may be seen in French cathedrals” spoken through a face mask using a speaker mounted in a mannequin head. The top is through a surgical mask, revealing a 3.5 decibel reduction in what is heard, and the bottom is through a cloth mask with a transparent window, with a 13.5 decibel reduction. There is noticeably more white space for the transparent mask. This indicates a greater filtering of the higher frequency parts of speech, which makes it more difficult to tell consonants apart.
and conduct surveys on face masks. Our lab plans to keep studying the effects of all types of face coverings on communication and how best to remedy any shortcomings.
B. Renee McDowell, Morgan Howard, and Celeste Watson are doctor of audiology students, and M. Bryson Howard, Au.D., and Samuel R. Atcherson, Ph.D. are faculty members, all at the department of audiology and speech pathology at the University of Arkansas for Medical Sciences in Little Rock. Atcherson wrote about transparent face masks in the Winter 2020 issue of Hearing Health magazine, at hhf.org/magazine. For references, see hhf.org/summer2021-references.
Support our research: hhf.org/donate.
image credit: university of arkansas for medical sciences
Since the advent of the COVID-19 pandemic, surgical masks and other face coverings are no longer confined to medical spaces, but have become a common part of the social landscape to slow the spread of viruses. Many people, with and without hearing loss, quickly noticed how difficult it can be to understand others wearing masks and how difficult it can be to speak while wearing them. Covering the mouth can muffle the sound quality, often making it less loud, and masks generally cover the mouth and block facial expressions. Masks with a clear (transparent) window made of plastic or vinyl emerged to address these problems by allowing visual access to the lips and mouth. We collected various types of face coverings to study sound quality through a mask. We used a broad noise presented through a styrofoam mannequin head wearing a mask and with a speaker mounted in its mouth. The face coverings compiled included commercial and handmade masks, some with clear windows, and a variety of partial or full shields. The results of our study, published in The Journal of the Acoustical Society of America in April 2021, found that nontransparent masks had poor sound transmission (filtering) in the higher frequencies (pitches)—but the transparent options were even poorer. A typical hearing test involves a small range of frequencies that encompasses most sounds of speech, ranging from 250 to 8,000 hertz. Our research showed that most face coverings have a noticeable effect above 1,000 Hz. As a result, the quality of speech is impacted, particularly for sounds such as “S,” “F,” and “T.” A spectrogram comparison of a surgical mask to a homemade cloth mask with a transparent mouth window showed a greater filtering of the higher frequency parts of speech for the transparent mask. (See image, above right.) As a result, our study shows the transparent mask makes it more difficult to distinctly hear and tell consonants apart. The sounds are likely being reflected backward from the solid mask window, whereas surgical and cloth masks allow a little more sound to go through. The scientific community continues to research
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meet the researcher
hearing health foundation
Meet the Researcher
Emerging Research Grants (ERG) As one of the leading funding sources available for innovative research, HHF’s ERG program is critical. Without our support, scientists would not have the needed resources for cutting-edge approaches toward understanding, preventing, and treating hearing and balance disorders.
Ross Williamson, Ph.D University of Pittsburgh
Williamson received his doctorate from the Gatsby Computational Neuroscience Unit, University College London, followed by postdoctoral training at Massachusetts Eye and Ear, Harvard Medical School. Currently an assistant professor in the departments of otolaryngology and neurobiology at the University of Pittsburgh, Williamson is a 2020 Emerging Research Grants recipient. as a postdoc, I used some viral strategies to identify the different brain areas that were targeted by a particular type of neuron. It turned out that these neurons connect with many areas simultaneously—including brain areas that regulate emotions, anxiety, and fear. Some subsequent work showed that these neurons also remained hyperactive after noise exposure, so looking at how this alters downstream connectivity seemed like an interesting next step. i’ve always been obsessed with music. I grew up listening to the likes of Led Zeppelin and Pink Floyd, which naturally progressed into learning to play electric guitar. Trying to understand how guitar effects pedals worked led to a love of the mathematics behind signal processing. i have tinnitus. The truth is it’s due to a misspent youth attending too many rock concerts. (I’m still obsessed with Phish and have seen them 50-plus times.) I’ve realized that tinnitus really affects everyone differently. I’m fortunate in that I can typically ignore my tinnitus, but many others do not have this luxury. I’m fascinated by the neural circuitry that underlies this kind of heterogeneity. my formal academic training was largely quantitative (computer science, then theoretical neuroscience and machine learning). Because of this, whenever I get to actually experience neural data, either through hearing an electrophysiological recording or
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watching a two-photon imaging session, I’m always struck with this childlike wonder. I just love playing sounds to the brain and hearing/seeing it talk back to me—it’s so cool! outside the lab my greatest passions are music, books, and bikes. I love the tactile sensation of reading a book or setting the needle down on a vinyl record. I think that most of my profound scientific thinking occurs with a soundtrack, or while seeking out hills on my road bike. ultimately, I want to do good science that can make a difference. I hope that over the next decade my lab will have been able to contribute fundamental insight as to how different neural circuits process sound and how to repair these neural circuits when they go wrong.
Ross Williamson, Ph.D., is funded by donors to Hearing Health Foundation who designated their gifts for the most promising research. HHF sincerely thanks our community for supporting these projects that address the full range of hearing and balance science.
We need your help funding the exciting work of hearing and balance scientists. Please consider donating today to Hearing Health Foundation to support groundbreaking research. Visit hhf.org/how-to-help.
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6 Ways to Make an Impact Today and Tomorrow You can make a meaningful difference in hearing loss research. Whichever method below you choose, every gift to Hearing Health Foundation (HHF) counts.
The De Francescos named HHF in their estate plans.
Check or credit card gifts online or by mail are easy and immediate. For more of an impact, schedule a monthly gift that helps sustain research without interruption.
If you are in possession of life insurance policies that you no longer need, you can designate HHF as the beneficiary.
Donating appreciated stock can reduce your tax bill. You receive a charitable tax deduction for the full value of the stock, and avoid paying taxes on the stock as it appreciates.
IRA distributions that begin when you turn 70 1/2 can be taxed as income, but if you choose to donate them to HHF, you avoid the penalty.
A charitable bequest in your will can be a more substantial gift if you are unable to donate today. If you do not have a will, create one for free at freewill.com/hhf.
Retirement plan benefits left to heirs are more highly taxed than other assets. Make a meaningful gift to HHF instead, leaving lower-taxed assets to loved ones.
This publication is distributed for free through the generous support of our community. To learn more, visit hhf.org/how-to-help, email development@hhf.org, or call 212.257.6140.
