Winter 2020
A Publication of Hearing Health Foundation
The Workplace Issue Hearing and balance conditions provide inspiration and create awareness on the job
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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 disorders.
Winter 2020: The Workplace Issue Having a hearing loss in the workplace can present special challenges—whether to reveal or conceal, and how to ask for accommodations—while also teaching resilience and creativity.
Timothy Higdon, HHF CEO
a publication of hearing health foundation
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HEARING HEALTH The Workplace Issue
Publisher Timothy
Winter 2020, Volume 36, Number 1
Editor Yishane
Lee
Art Director Robin Senior Editors
Higdon, CEO Kidder
Amy Gross, Lauren McGrath
Medical Director David
Features
S. Haynes, M.D.
Staff Writers
Barbara Jenkins, Au.D.; Emily L. Martinson, Au.D., Ph.D.; Kathi Mestayer
12 Living With Hearing Loss Processing Auditory Processing. Luca M. Damiani
30 Living With Hearing Loss Four-Legged Hearing. Barbara Chase
16 Family Voices Out of My Shell. Julie Olson
31 Arts Hear the Music.
hello@glmcommunications.com, 212.929.1300
32 Media Breaking Stereotypes. Alexander Chern, M.D.
Editorial Committee
19 Workplace Conceal or Reveal Your Hearing Loss at Work? Katherine Bouton Progress in the Produce Aisle. Andrew Flavahan 22 Workplace Are You Faking It? Laura Friedman 24 Research I Can Hear and See You When You Wear a Surgical Mask! Samuel R. Atcherson, Ph.D. 26 Research The Latest Research on Hair Cell Regeneration to Restore Hearing. Lauren McGrath
34 Workplace Always an Audiologist. Dawn Doig, Aud(C) 38 Tinnitus Working With Tinnitus. Hazel Goedhart and Markku Vesala 40 Research Recent Research by Hearing Health Foundation Scientists, Explained. 47 Research Investigating Molecular Tracks. Victor Wong, Ph.D.
28 Research A Vision for Hearing Research: Peter Steyger, Ph.D.
Departments
Sponsored
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48 Advertisement Tech Solutions.
10 HHF News
49 Marketplace
50 Meet the Researcher David Martinelli, Ph.D. Hyperacusis Research Ltd.
Cover Luca M. Damiani in his studio in the United Kingdom. View Damiani’s video-poems at hhf.org/luca-damiani.
Visit hhf.org/subscribe to receive a FREE subscription to this magazine.
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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 Roger M. Harris David S. Haynes, M.D. Elizabeth Keithley, Ph.D. Anil K. Lalwani, M.D. Michael C. Nolan Paul E. Orlin Robert V. Shannon, Ph.D. 363 Seventh Avenue, 10th Floor New York, NY 10001-3904 Phone: 212.257.6140 TTY: 888.435.6104 Email: info@hhf.org Web: hhf.org Hearing Health Foundation is a tax-exempt, charitable organization and is eligible to receive tax-deductible contributions under the IRS Code 501 (c)(3). Federal Tax ID: 13-1882107 Hearing Health magazine (ISSN: 0888-2517) is published four times annually by Hearing Health Foundation. Copyright 2020, 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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h e ar i n g h e alth foundation
correction to the fall 2019 article “Hearing Help for Veterans”: Service members do not need to prove their hearing condition is service-related, nor is there a cost for hearing aids received through the U.S. Department of Veterans Affairs (VA).
@editor
dear editor: Your article “Hearing Help for Veterans” in the Fall 2019 issue had a number of inaccuracies. First it said “hearing aids purchased through the VA average $400 each vs. $2,400 through private practice.” Veterans do not pay for hearing aids through the VA [the U.S. Department of Veterans Affairs]. They are provided at no cost. The $400 is a wholesale cost to the VA, not to the veteran. Next, you cite that the VA requires “proof that your hearing loss is service-related.” That is untrue. Most of our veterans who have hearing aids have hearing loss that is not serviceconnected, and the VA provided the hearing aids. At one time the hearing loss did have to be service-connected to receive hearing aids but it changed about 15 years ago. There are many people out there who don’t know this. You also state that “active service duty members, veterans, and military personnel are eligible to get hearing aids through the VA.” Only veterans get hearing aids through the VA. The U.S. Department of Defense has its own audiology providers and provides hearing aids to active service duty members and military personnel through their system. Janet P. Andrews, Au.D., CCC-A Audiology and Speech Pathology Supervisor Physical Medicine and Rehabilitation Service New Mexico VA Health Care System from the editor: We deeply regret the errors in this article and apologize for any confusion the incorrect information may have caused. Service members do not need to prove their hearing condition is service-related, nor is there a cost for hearing aids received through the VA. We have updated the online version of this article at hhf.org/magazine and we very much appreciate the time and effort that Dr. Andrews and others took to alert us of our inaccuracies.
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dear editor: I just read the article “Have a Hearing Loss in the Hospital?” in your Fall 2019 publication and wanted to respond. My 91-yearold mother has a severe hearing loss. It started in her early 60s and has gotten progressively worse through the years. She wears up-to-date hearing aids in both ears but they don’t help much anymore. She is good at lip-reading in the right conditions. Unfortunately she also has recently been diagnosed with Alzheimer’s. Her hearing loss greatly adds to the confusion caused by being in an unfamiliar hospital setting. Luckily we have discovered a couple of free smartphone apps that have been incredibly helpful for family, friends, aides, doctors, nurses, assisted living staff, etc. The iPhone app is called Hearing Helper. The user presses the microphone icon and speaks into the phone; the words spoken appear on the screen; and you show the screen to the person who is hard of hearing. The size of the print is adjustable. It is not perfect and mistakes are made, but you can manually make corrections if needed. It has been an invaluable tool. We show the app to everyone who comes in contact with my mom and they are all very grateful to know of its existence. (For Android, the app is called Talk to Deaf Grandma.) Many times hearing aids need to be removed for various medical tests. These apps are helpful in these situations as well. The last time my mom was in the hospital the staff put a note on the door that my mom was hard of hearing and I think this was helpful in letting the staff know what to expect when approaching her. While HHF works on its various research initiatives it might also be worthwhile to work concurrently on further developing and improving speech recognition apps like those I’ve mentioned that can help people today. It would also be helpful if you could publish a list of the various organizations that are
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working to improve communication for the hard of hearing in hospital and other locations (airports, train stations, theaters, etc.) so the community can check other resources for currently available means of assistance. Thank you for all the work you are doing! Lisa M. New York dear editor: I read the article about communication difficulties in healthcare settings. Do you realize that almost everyone who walks into the hospital carries a support system, their smartphone, where they can use a voice recognition app? The one that I use is Live Caption. I recently came down with the flu even though I had the shot and spent a week in the hospital. The app was invaluable. Even with the hospital personnel having to wear face masks, with the app I was able to read and understand everything. In fact some of the hospital staff wanted to get the app themselves for their phones. I use it everywhere—doctor’s office visits, one-on-one situations, and even conversations with my wife. Just today I used it to converse with the service tech in understanding what had to be done on my car. Merv Daniels Florida from the editor: Thank you to our readers who let us know about their favorite livecaptioning apps; InnoCaption and Otter.ai also earn praise. It is fortunate that tech giants like Google, Amazon, Apple, and Microsoft are all working to continually improve voice recognition in their products for the general public, as this also benefits captioning efforts for those with and without hearing loss. Hearing loops remain one of the best ways for those with telecoil-enabled hearing devices to receive sound directly into their ears. Check Loop Finder (loopfinder.com) for a list of looped public spaces. To learn about the promise of transparent face masks to help improve communication, see page 24.
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dear editor: I am an otolaryngologist at the Cleveland Clinic, and I receive your Hearing Health magazine. I employ many strategies to encourage those who need hearing aids but who are resistant to them to give them a try. In my experience mostly it is older people who are resistant. I once gave a talk to caretakers of women titled, “Why Your Mother Won’t Get Hearing Aids.” I found the article in the Summer 2019 issue, “My First 48 Hours With Hearing Aids” by Adam Felman [originally published on Medical News Today], powerful and compelling and will share it with my colleagues and patients. Tom I. Abelson, M.D. Medical Director Beachwood Family Health & Surgery Center Cleveland Clinic
dear editor: I would like to comment on the Summer 2019 “Meet the Researcher” column about Babak Vazifehkhahghaffari, Ph.D. [a 2018 Emerging Research Grants recipient funded by the Children’s Hearing Institute]. The very first paragraph of “In His Words” really struck me as I have a cochlear implant that goes back to 1988 with upgrades to the current N6 processor (unilateral… I am deaf in my other ear). He mentions that perceiving pitch and music and understanding speech in the presence of reverberation, multiple speakers, or background noise remains very limited for those using cochlear implants. Those three words—“remains very limited”—are very reassuring to me because after all these years I still have trouble hearing in many venues. Hopefully in time his research into a solution will produce a vast means of understanding speech for the millions of cochlear implant users. Sarah Hodge Colorado
We always appreciate feedback from our community of readers. Letters are edited for length and clarity. Please email comments to editor@hhf.org.
photo credit: amanda janesick, ph.d., in the lab of hrp member stefan heller, ph.d.
Hearing Health Foundation (HHF) improves the lives of people with hearing loss and related conditions by funding research, connecting researchers, publicizing new findings, raising awareness about hearing loss, and promoting hearing health. Complex and interconnected, hearing loss and its variants impact speech processing, brain function, cognition, interpersonal relationships, psychological well-being, and quality of life. HHF’s advances in one aspect or disease-specific area of hearing often benefit many others, creating pathways to better prevention methods, treatments, and cures. » Fundamental studies of inner ear hair cell function
may shed light on these mechanisms: how hearing loss occurs, how balance is disturbed, how tinnitus is generated, how the brain processes sound and speech, and how cognitive decline accelerates. As a consequence, advancing knowledge in one area of research benefits many related areas and promotes novel therapies.
» Breakthroughs in understanding sensorineural
hearing loss also enlighten studies on tinnitus, hyperacusis, and auditory processing disorders because the biological systems that are involved— the inner ear, the brainstem, and parts of the brain such as the auditory cortex—are shared.
» Developing new means to deliver therapeutic drugs
to the inner ear across the blood-labyrinth barrier may lead to discoveries about that barrier that help scientists prevent damage to hearing as a side effect of other drugs (ototoxicity) or of infection.
» Work on the role of neural circuits in the auditory
processing of speech may improve our understanding of hyperacusis, as these same neural circuits play a role in the brain’s sensitivity to sound.
» Discovering how to regenerate inner ear hair cells
to restore hearing may also help medical researchers and clinicians treat tinnitus, which is often caused by these hair cells “mis-signaling” the brain.
In Memoriam: Robert Dobie, M.D.
Hearing Health Foundation (HHF) is deeply saddened to report that Council of Scientific Trustees (CST) member and Senior Scientific Trustee Robert (Bob) Dobie, M.D., passed away on Sept. 4, 2019. Dobie spent his career committed to excellence and innovation in otolaryngology research and clinical practice. Dobie was a highly respected member of our CST, the body that governs the grantmaking process for the Emerging Research Grants
(ERG) program. His duty as a CST member was to ensure that only the most promising hearing and balance research was funded, and as senior scientific trustee, he facilitated correspondence with the press and others outside of HHF. Dobie was also an ERG alumnus who received awards in 1986, 1987, and 1988 for his research on tinnitus at University of California, Davis. Beyond his service to HHF, Dobie was a clinical professor and chairman in the department of otolaryngology– head and neck surgery at the University of Texas Health Science Center in San Antonio. He previously served as the Director of Extramural Research at the National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health, and was a founder and initial director of the Virginia Merrill Bloedel Hearing Research Center at the University of Washington.
Dobie authored more than 200 publications and performed particularly impactful research on the effects of noise exposure on age-related hearing loss that helped inform regulatory agencies like the National Institute of Occupational Safety and Health, the Occupational Safety and Health Administration, the International Standards Organization, and the World Health Organization. Dobie will be fondly remembered for his compassion and influence on the understanding of hearing loss and tinnitus. “Bob has a remarkable legacy with limitless impact on science and health. Many of us have learned from reading his books and journal articles and hearing his presentations,” board member Judy Dubno, Ph.D., says. “In all these ways and many more, Bob touched so many lives and made each one better for knowing him.”
HHF Again Earns Top Charity Ratings In November 2019 Charity Navigator gave HHF four stars—indicating HHF is accountable, transparent, and financially healthy—for the fourth year in a row. Consumer Reports also included HHF as one of its “best charities for your donations” in the “blind and hearing impaired” charity category, also for the fourth year running. These two top-tier designations follow an earlier A+ rating renewal from CharityWatch in September 2019.
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For a comprehensive list summarizing the reach of our donors’ support in 2019, please visit hhf.org/impact-2019. HHF’s generous supporters are a tremendous part of why it has again achieved these top charity ratings. We sincerely thank our community of donors and supporters for being part of our mission.
Support our research: hhf.org/donate
photo credit (top left): jeffrey gould, action media productions
NEWS
HHF
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HHF CEO Timothy Higdon (left) and John Dillard, HHF Board of Directors chair, honor Elizabeth Keithley, Ph.D., with the Collette Ramsey Baker Leadership Award.
Keithley Honored With HHF Award In October 2019 HHF awarded Elizabeth “Betsy” Keithley, Ph.D., its inaugural Collette Ramsey Baker Leadership Award. A longtime HHF Board of Directors member and chair emerita, Keithley was honored for her decades of dedication to HHF, starting with the review of Emerging Research Grants proposals in the 1990s. “We cannot thank Betsy enough for her many years of service toward Hearing Health Foundation’s mission of preventing, researching, and finding a cure for hearing loss and related conditions,” says HHF CEO Timothy Higdon. An accomplished researcher, Keithley has investigated
mechanisms of inflammation and aging on the inner ear. Her interest in the auditory system stemmed from growing up with a mother who had a hearing loss and seeing firsthand the impact that hearing loss can have on a person’s life. Keithley is a professor emerita in the department of surgery and otolaryngology at the University of California at San Diego. “Betsy has generously devoted her entire career to the study of hearing and its preservation and restoration,” says HHF board chair John Dillard. “For this and her dedication to HHF, we owe her an immeasurable debt of thanks.”
New Leaders at Major Research Organizations Are Connected With HHF At a recent Friends of the Congressional Hearing Health Caucus meeting (back row, left to right): Kate Carr of Hearing Industries Association, Joy Onozuka of the American Tinnitus Association, Jerry White of American Speech-LanguageHearing Association, Debara Tucci, M.D., of the NIDCD, Julia Bellinger of the International Hearing Society, Timothy Higdon of HHF, and James Denneny III, M.D., of the American Academy of Otolaryngology–Head and Neck Surgery; and (front row): Joni Alberg of AG Bell, Lise Hamlin of the Hearing Loss Association of America, Donna Sorkin of American Cochlear Implant Alliance, and Catherine Palmer, Ph.D., of the American Academy of Audiology.
Debara L. Tucci, M.D., became the director of the National Institute on Deafness and Other Communication Disorders (NIDCD) in September 2019. Tucci is a professor of surgery and director of the cochlear implant program in the Division of Head and Neck Surgery & Communication Sciences at Duke University in North Carolina. She is a past member of HHF’s Council of Scientific Trustees (CST), the governing body of the Emerging Research Grants program that reviews each application for scientific merit and program relevance.
In addition, Ruth Litovsky, Ph.D., a professor in the division of otolaryngology–head and neck surgery at the University of Wisconsin School of Medicine and Public Health, is the 2019–2020 president-elect of the Association for Research in Otolaryngology (ARO), the world’s largest organization of hearing and balance researchers. The ARO’s annual Midwinter Meeting is a conference that showcases the latest findings and provides an opportunity for scientists, engineers, physicians, postdoctoral fellows, and students to meet and exchange ideas. a publication of hearing health foundation
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processing auditory processing By Luca M. Damiani
I am a lecturer and media artist living with the auditory disorders hyperacusis, tinnitus, and persistent posturalperceptual dizziness, all the result of a workplace accident. Trained in computer science, coding, and technology, I am using my art to respond to, interpret, and find a measure of relief from these conditions.
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living with hearing loss Opposite page: In this collage echoing his work, Luca M. Damiani is shown in his studio with his art and inspirations.
In January 2018, working as a digital producer, I was running a test setup in the auditorium of a London art gallery. Due to faulty audio equipment, a large set of wall speakers blew right behind where I was standing, exposing me to an incredibly high-level sound blast. The blast was so powerful that it knocked me to my knees. I subsequently suffered vertigo and felt faint and dizzy. Over the following weeks this dizziness and fogginess continued daily, accompanied by a continuous, highpitched whistling in both ears that varied in intensity and pulsation. In an attempt to reach a diagnosis for my symptoms, I underwent many visits, tests, and referrals to various doctors, clinicians, and hospital departments in the United Kingdom. Everyday life became harder and harder—being anywhere outside of the quiet of my own home (where I could play calming background music) started to feel painful to my ears and brain. Days were stressful and full of either overwhelming sensations of cloudiness and discomfort, or intense anxiety. I was also very, very tired, but unable to sleep. Around five months after the accident, my hearing— which had suffered a significant loss from the blast— returned. I am told this is unusually long (months vs. days) for hearing to resume after a noise event. But my hearing came back with an increased sensitivity to sound, causing discomfort and making my brain feel muddled. I developed a low tolerance not only for high-pitched and high-volume noises, but also for places with multiple ambient sounds. This finally brought a diagnosis of tinnitus that is bilateral, in both ears, as well as bilateral hyperacusis, or an intolerance to typical ranges and volumes of sound. Ten months after the accident I also received another diagnosis: persistent postural-perceptual dizziness (PPPD), distinct from the hyperacusis-caused dizziness in that it is constant and subject to visual stimuli and body/head positioning.
Researching My Conditions
Tinnitus is a hearing disorder that consists of the perception of a constant or intermittent noise in one or both ears usually in the form of ringing, whistling, humming, or pulsing, with no external sound source. The sound can appear at varying levels of intensity, pitch, and duration. Compared with hyperacusis, it is a relatively common auditory disorder that affects millions of people at some point in their lives.
One theory about the cause of tinnitus is that it appears that the brain, in adjusting to missing frequencies, ends up creating an electrical signal to replace the missing auditory information, and this manifests as a phantom sound. While there are therapies, plus a variety of organized support networks to help those with tinnitus, there is no known cure for the condition, and it can last indefinitely. Hyperacusis is an auditory condition characterized by a high sensitivity or decreased tolerance to everyday sounds. It develops when the central auditory processing in the brain perceives noise in an amplified way. It can lead to pain and at times extreme discomfort, which in turn can cause heavy fatigue, depression, and/or anxiety. It is less common than tinnitus, but hyperacusis and tinnitus have been found to occasionally coexist. While research is ongoing, as with tinnitus a definitive cause of hyperacusis is not known, and it can also persist indefinitely. In investigating my conditions, I learned that the auditory system is tied to the vestibular system. Eventually my balance also became affected, which led to the PPPD diagnosis. PPPD is a chronic disorder that is affected by sensory perceptions from both hearing and vision, as well as the position of the head. In a nutshell, my hearing, balance, and vision—all sensory inputs—have become, as the result of a single event, much more sensitive. In addition, this array of conditions has affected my high-functioning Asperger’s. The reaction to enhanced sensory sensitivity has impacted my normal daily activities and my level of brain overload to external stimuli.
From a single event, my senses of hearing, balance, and vision have become much more sensitive, and this has also affected my high-functioning Asperger’s. View Damiani’s video-poems at hhf.org/luca-damiani.
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Following my diagnoses, I began, in earnest and as much as my newfound levels of fatigue would allow, to investigate other people’s experiences, support organizations, and networks, as well as the various treatments, technologies, and therapies available. These include hearing aids—whose masking effect is a lifesaver for my tinnitus—and various sound-filtering and noise-canceling headphones, sound therapies, mindfulness techniques, cognitive behavioral therapy, psychotherapy, vestibular rehabilitation, and so on.
Daily Life
Hyperacusis has impacted my quality of life in every way. It is very difficult to tolerate everyday sounds—those that seem completely normal and are often unnoticeable to others. My work, home, relationship, financial, and social lives have all been affected, especially because hyperacusis has made it very difficult to function in situations outside of my own home. Living in the urban environment of London became intolerable, so I moved to the countryside near the sea. My artistic practice (which included travel to workshops, events, festivals, and installations) and my university teaching job became very difficult to maintain. The PPPD means I am sensitive to visual movements (going up or down, in real life or on screen), 14
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lights, patterns, layers and/or depths of sight, turning my head, etc. As I worked to readjust and reframe my life, it felt appropriate and healthy—not to mention advantageous—to stay active in my profession as much as my health allows, to use my artistic practice to look at and process my new circumstances, critically reflecting on them and using them to prompt an artistic response. This process has helped me learn more about these conditions and their patterns, and then begin to learn how to cope with them better. Creativity leads to my calmness. Looking at my auditory and balance conditions through an art and design lens, I am able to express in a visual, visible way this new, invisible—but all-consuming—experience of being. After all, art has the power to show or reveal the unseen or mysterious—and to create something new that we can connect with and better understand.
Finding Patterns
Part of my therapy is to keep track of and make records of my condition every day. I have to recognize and record triggers and reactions. I use sketches and notes, and I noticed that this log of activities reveals recurring patterns. Through this daily log I began to form shapes out of the patterns to use in my art. I derive patterns by categorizing
Stills from Damiani’s video-poems, at hhf.org/luca-damiani.
the reflections and reactions to different stimuli using codes and symbols, which I then turn into geometrical forms. Revealing patterns of moments and time, these forms are visual interpretations of my responses and feelings of processing each sound, and show aspects of the physical and emotional reactions connected to them. Using the sketches and notes that capture what I hear and feel, I create poems to accompany the moving images. The art, technology, data, and emotions become interrelated, overlapping in ways that also reflect what living with these multiple disorders feels like. These works also show a sense of continuity that evokes the ongoing nature of these hearing and balance conditions. As living with these conditions evolves, so has my attitude toward them as well as my art. Starting from a point of suffering, I have been working toward a new way forward, while continuing to process my physical and emotional reactions toward these multilayered conditions that have changed my life so dramatically. There is hope. I am swimming every day, in a pool as well as in
As a meditative exercise, swimming relaxes my brain, and this helps massively with both my tinnitus and hyperacusis. The sound of the water covers the tinnitus completely, like the masking hearing aids I wear. I also do a type of underwater swimming called dynamic apnea that results in virtually no sounds whatsoever, making it very effective for managing my hyperacusis. Another bonus is that I don’t feel off-balance while floating. the ocean, and this helps me cope both physically and mentally. I used to swim competitively when I was younger, and have continued swimming all my life, so this is something that hasn’t changed. Nowadays I swim for at least an hour daily, with my long swims reaching about 4 kilometers (2.5 miles). As a meditative exercise, swimming relaxes my brain, and this helps massively with both my tinnitus and hyperacusis. The sound of the water covers the tinnitus completely, like the masking hearing aids I wear. I also do a type of underwater swimming called dynamic apnea that results in virtually no sounds whatsoever, making it very effective for managing my hyperacusis. Another bonus is that I don’t feel off-balance while floating. I sometimes record the water during my long swims in the sea and/or underwater training at the
pool to use in my art. Swimming has already made an impression in my art, such as in the video-poem “Reload.” Perhaps this artwork in some small way may be useful as a means by which audiologists, psychologists, artists, and other people who are experiencing the different stages and degrees of auditory conditions can better understand and express what is being felt. I hope that this artwork can contribute to this complex, oftenhidden, debilitating, painful, and yet scientifically fascinating area, and illustrate how conditions that can be incapacitating can simultaneously be lived with through an exploratory lens.
View Damiani’s video-poems at hhf.org/luca-damiani.
Luca M. Damiani is a media artist and a lecturer in graphic and media design at London College of Communication, part of University of the Arts London, in the U.K. He has collaborated with many institutions, including Amnesty International, the BBC, Disney, the Tate Gallery, and the Victoria & Albert Museum. For more, see lucadamiani-art.com. This is adapted from an article published in Art Journal Open, artjournal.collegeart.org. For references, see hhf.org/winter2020-references. Share your story: Has a hearing or balance condition shaped your career? Tell us at editor@hhf.org.
Support our research: hhf.org/donate
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Julie Olson with her granddaughters Colleen (far left) and Kelly.
Out of My Shell Initially given no options to treat her hearing loss, a teacher quits her job prematurely but eventually finds the support, and technology, to help her return to a rewarding career. By Julie Olson Hearing loss came into my life when I was a college junior. I rushed to classes to get a seat in the front row, and I noticed that when listening to records with my ukulele folk music group, I heard lyrics differently. I would not have recognized these issues had I not been taking a class in speech education that included a unit on communication disorders. After talking to my parents and seeking medical advice, I sought testing and learned I had a progressive bilateral sensorineural hearing loss. The physicians told me I had the ears of a 60-year-old and that I’d be deaf by age 40. At 20, that seemed light years away to me, so I wasn’t too concerned. The doctors—who were reputable, and based at a wellknown clinic in the Midwest—also said nothing could ever be done to help me. They discouraged hearing aids because they were just a waste of money, and told me emphatically I’d just have to learn to live with it. Problem was, nobody told me how. The doctors just reiterated that there would never be a cure or any kind of treatment that could ever help me. This was in the early 16
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1960s when perhaps not enough was understood about hearing loss and treating it to help me.
Misunderstandings at Work
My hearing loss had minimal impact on the early years of my teaching career in physical education. I was fortunate to be able to work in just about any school. Women in P.E. in the 1960s were scarce as those in my field were still fighting for the enactment of Title IX, which eliminated gender discrimination in the academic system in 1972. A few years later, my hearing difficulties became more apparent. Proud of my fair and inclusive P.E. teaching style, I was disheartened to learn there were gaps in communication due to my hearing loss. A student who’d been assigned to be my teacher’s assistant very politely told me I’d misunderstood some questions from the class. I told her about my hearing loss and realized I had a problem. I did not have hearing aids or any way to help my hearing. Recalling my doctors’ dire predictions, I decided it was time to retire. So I did. I was in my early 30s.
family voices
My hearing loss had minimal impact on the early years of my teaching career in physical education. I was fortunate to be able to work in just about any school. Women in P.E. in the 1960s were scarce as those in my field were still fighting for the enactment of Title IX, which eliminated gender discrimination in the academic system in 1972. A few years later, my hearing difficulties became more apparent. Proud of my fair and inclusive P.E. teaching style, I was disheartened to learn there were gaps in communication due to my hearing loss. A student who’d been assigned to be my teacher’s assistant very politely told me I’d misunderstood some questions from the class. Trying to Manage
When I abandoned the career I loved, I also slowly became a social recluse. I had no idea how to help myself, nor did I know how to explain myself to others. I felt very much alone. I smiled in social settings and tried to bluff my way through conversations, sometimes embarrassingly unsuccessfully. Once, while hosting a party with my husband, a guest arrived late, apologizing because he’d “been at a neighbor’s wake.” I heard “neighbor’s lake” and responded enthusiastically. “I bet you had fun on the water!” I exclaimed, prompting odd looks. I felt like a complete fool. My neighbor, who was a medical doctor, also caught my bluffing and, concerned, referred me to a local otolaryngologist for another hearing test, but I wasn’t ready to do more about my hearing. I did, however, enroll in a stress management course in a hospital during that bleak time after quitting my job. For treatment, I was directed to lie down and listen to relaxation cassette tapes—which I could not hear. Obviously, the medical staff had no idea how to help someone with hearing loss mitigate stress. After many years of frustration, I became determined to make my voice heard and asked a few hearing specialists for help creating a support group for people with hearing loss. Their response? “Don’t waste your time. No one would go. People with hearing loss won’t come out of their shells to admit they have a problem.”
Finding Support
I eventually found support in coming out of my shell in two ways. First, a friend suggested that I sit in on a class in a nearby university’s speech and hearing program. I was happy to hear a graduate student give a presentation about how hearing aids do help many people with hearing loss, and even happier when I was invited back to be the guest speaker. Speaking to the class of graduate students, I opened up and shared my frustrations. I explained how humiliating it was to respond out of context. For the first time when talking openly, I didn’t feel I was boring someone. The class made supportive, encouraging suggestions. As part of the exercise, the students tested me, and while the diagnosis was the same, the tests showed a slight improvement with amplification. They encouraged me to try hearing instruments. I hesitated, concerned about the stigma (that still exists today) about hearing aids, but eventually I was fitted. The hearing aids helped in many situations, but I still had trouble in noisy places where most social activities take place. Life was better, but remained a challenge. In 1983, I found another form of support when I discovered Self Help for Hard of Hearing People (SHHH), today known as the Hearing Loss Association of America (HLAA). I was encouraged not only to attend their first annual convention but to start my own chapter in Appleton, Wisconsin, where I lived. Starting that chapter meant having to go public with my a publication of hearing health foundation
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hearing loss. I found the courage to ask a local newspaper reporter to promote the meeting, and 53 people showed up at the library to hear what I had to say. The therapeutic value of meeting and talking to other people with hearing loss was magic for all of us. We were no longer alone. Through SHHH I also learned about hearing loss research and the development of better technology, like FM systems, infrared systems, hearing loops, and cochlear implants. Until the late 1980s there had been little support for research in the field of hearing loss. The term “cure” was rarely used until recently. How amazing it is to hear that word now!
After treating her hearing loss, Julie Olson earned a master’s degree and returned to work.
Back to Work
Because I enjoy educating others about hearing loss, I enrolled in a master’s program in community human services, and technology made my studies possible. I developed my own program and completed my master’s with concentrations in counseling, organizational development, and aural rehabilitation. I taught adult aural rehabilitation at the university speech and hearing clinic for a few years, followed by a short return to P.E. for elementary and middle school students. I ultimately worked, until my retirement at age 67 in 2009, as a case manager in a human service agency. My department worked with low-income workers who wanted to return to school to qualify for higher-income jobs. It was interesting to learn how many of my clients had communication disorders, including a few with undiagnosed hearing loss. My supervisor asked me to develop a special in-service training program for them. It was so rewarding to be able to help people who were motivated to succeed in life. And in 2005, while at the agency, I became a cochlear implant recipient. I’ve adapted to being bimodal, using both cochlear implant and hearing aid technologies to hear well. It just keeps getting better! I am encouraged by the research being done today. I truly believe a cure for many types of deafness will be found. Living well with hearing loss is difficult but possible, thanks to advancements in technology and attitude. I am extremely grateful to my family—my husband, daughter, granddaughters—and many friends for joining me on this long journey coming out of my shell.
Starting a local chapter of the hearing loss group meant having to go public with my hearing loss. The therapeutic value of meeting and talking to other people with hearing loss was magic for all of us. We were no longer alone.
Share your story: Tell us your hearing loss journey at editor@hhf.org.
Support our research: hhf.org/donate Julie M. Olson, M.S., is the newsletter editor for the HLAA–Fox Valley Chapter, Wisconsin, and HLAA–Wisconsin, and a past president of the SHHH (now HLAA) National Board of Trustees. 18
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Tips for Working with a
Hearing Loss
Conceal or Reveal Your Hearing Loss at Work? By Katherine Bouton
The workplace poses a variety of issues for people with hearing loss at different stages of their lives and according to the severity of the loss.
One of the biggest challenges is applying for a job. If you have a hearing aid and/or a cochlear implant—or, for that matter, if you have any kind of hidden disability—and if you need accommodations, at what point do you bring that subject up? Writing Your Résumé
Almost all experts recommend that you not disclose your hearing loss on a résumé, just as you would not include your birthdate, religion, or marital status. People have preconceptions and prejudices about hearing loss, as they do about most disabilities. There’s a good chance you wouldn’t get past the résumé stage. That’s the only hard and fast rule. If you have mild to moderate hearing loss, your hearing aids are probably virtually invisible. If your hearing is good with the devices, there is no reason whatsoever to disclose the hearing loss. Unless it affects job performance, it’s nobody’s business. If your hearing loss is more severe, you’re faced with the difficult decision about when to disclose, how much to say about it, and at what point to ask for accommodations. For an in-person job interview, you may find yourself seated near a door to a noisy hall or next to a noisy air conditioner. Ask to move your chair, referring to the noise, or if the interviewer is framed by bright light, say you’d like to move so it’s not in your eyes. What if you find yourself in an interview with one of those impossible to understand people (mustache, mumbles, thin lips)? While most experts advise not disclosing a hearing loss during the interview, my view is that at this point, it’s probably better to acknowledge a degree of hearing loss so you can pull out your assistive listening device, whether it’s an FM system, a remote mic, or a Phonak Roger transmitter. Simply put it on the desk and explain what it is—and continue the interview.
Telephone Tips
Almost all experts recommend that you not disclose your hearing loss on a résumé, just as you would not include your birthdate, religion, or marital status.
The telephone is often difficult for people with hearing loss. Does your hearing aid have a telecoil (T-coil)? Is your office telephone T-coil–compatible? It has to be, per the Americans with Disabilities Act (ADA). You may need to flip the switch on your hearing aid to the telecoil program, but some hearing aids switch automatically to telecoil mode when they are in proximity to the receiver. Several companies make good landline– based captioned phones, and with proof of hearing loss, the Federal Communications Commission provides for a captioned phone for free (see fcc.gov/accessibility). Phone headsets can also be T-coil–compatible. I found, as someone who had minimally disclosed her hearing loss, that the headset was much more effective than the handheld phone. It was also much easier on my neck—no cricks from balancing a phone receiver on my shoulder all day. Cell phones pose different issues. Pay attention when you buy a cell phone to be sure its Hearing Aid Compatible (HAC) rating is high. The smartphone may be one of the best things that’s ever happened for people with hearing loss. Reading texts and email is easier than navigating voice calls. a publication of hearing health foundation
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Smartphones also allow captioned calls, in addition to text. Stenographers provide the captions when you use InnoCaption, combined with its patented technology, and I’ve found it very accurate. You can also use a smartphone app to create live captions for in-person conversations. Examples are Otter.ai, an Apple iPhone app, and Google Live Transcribe, for Android phones.
How to Manage Meetings
Most people with hearing loss have learned by experience how to handle meetings, but it can still be tricky. Arrive early to get a seat where you can see those speaking. Ask for an agenda before the meeting, and if someone is taking notes, ask to see the notes afterward. If you have disclosed your hearing loss and have an FM system, a remote mic, or a Roger assistive listening device, put the transmitter on the table and set it to pick up sound from every direction. If the room is small enough and the acoustics are good, and if people speak clearly enough and one at a time, this should work. Some people use two or more transmitters for meetings, one at each end of a conference table. Large meetings can be a challenge. If your presence is essential, ask for CART (Communication Access Realtime Translation), which benefits others as well, including those for whom English is a second language. A CART transcript is saved on the operator’s computer and can be used later
Phone headsets can also be T-coil-compatible. I found, as someone who had minimally disclosed her hearing loss, that the headset was much more effective than the handheld phone. It was also much easier on my neck—no cricks from balancing a phone receiver on my shoulder all day. as the basis for meeting minutes; it is also confidential. The cost of CART services varies, but in most areas it is under $200 an hour. That may seem like a lot in a small company, but unless the company can come up with another solution or show that the cost is prohibitive, it’s a violation of the ADA to require an employee to attend a meeting without CART support. How about teleconferencing? If the speakers are
Progress in the Produce Aisle
By Andrew Flavahan
Our new employee, Bill, was arranging a display of russet potatoes when a customer the entire produce department was weary of began to approach him. My heart sank, as I knew Bill is deaf and unable to read lips, and that this customer had in the past brought many of my coworkers to tears over a variety of issues. In our section we all keep an eye on one another and help when needed, especially when Bill started. This customer had earned quite a reputation over the years I’d worked in the supermarket. Although it was a busy Sunday afternoon, I tuned out the cacophony around me—dozens of conversations, the squeaky wheels of poorly maintained shopping carts, and the corporate-approved, uplifting music blasting over the intercom—to watch what would happen. 20
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“Excuse me?” she said, bending toward Bill and trying to get his attention. “Excuse me?!” she repeated. Getting no response, she widened her eyes and focused her gaze, and several other customers turned around to see what was going on. “Oh boy,” I thought to myself, as I began to walk over to help resolve the situation.
photo credit: istockphoto.com/enis aksoy (below left); joyce ravid (right)
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using Skype, Zoom, GoToMeeting, or a similar program, you have the advantage of being able to be able to see multiple speakers and to watch their lips. These programs generally have good audio systems. If it’s purely an audio conference, try to call in from a captioned phone or ask for CART. Video conferencing also allows those who communicate in ASL to sign. Ted Hart is the Microsoft researcher who helped adapt Skype Translator for use by people who are deaf and hard of hearing. He is deaf himself. At home he uses sign with his hearing wife, but to speak to her by phone involved multiple steps and a third party. So he developed Skype Translator, which allows you to read someone’s words as text. Technology such as video conferencing and voice-totext were not developed as tools for the deaf and hard of hearing, but they have proved to be invaluable. And because they are not solely aimed at those with hearing loss and benefit the wider community, they are bound to continue improving to help us all communicate better.
This is adapted from Katherine Bouton’s book, “Smart Hearing.” Katherine Bouton is the president of the New York City Chapter of the Hearing Loss Association of America (HLAA) and a member of the national Board of Trustees of HLAA. For more, see katherinebouton.com.
But then Bill turned, beaming with a smile from ear to ear, and he handed her his notepad. “What? What is this for? Hello? I need some help with the bananas!” She did not understand. Bill continued to smile, pointing to his ears and then to the sign-language insignia he wore on his shirt, without saying a word. Her mouth dropped, her eyes grew even wider, and her face turned as red as the beefsteak tomatoes I was standing next to. She threw her handbag onto the table Bill was working on, pulled out a pen, and quickly scribbled something down before handing it to Bill. He nodded his head in an understanding way as he read his notepad, then turned to her and gave her a reassuring smile before taking his own pen and writing down a reply. She eagerly took it when he handed it to her, and seemed to let out a long sigh as if she had just been relieved of a great burden. I was amazed. As Bill and the customer continued to pass the notepad back and forth, laughing and joking with each other, I turned to one of my coworkers who was also watching all of this happen with a relieved smile on her
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Shorthand Advice
» When needed, inform supervisors and colleagues of » » » » »
your hearing loss and remind them if they seem to forget. The solution may be full disclosure. Use a captioned telephone if your hearing loss is severe. While smartphone technology is constantly improving, a telecoil in your hearing aid can be essential for using the phone and other assistive devices effectively. If you regularly encounter customers or other people on the job, install a portable hearing loop. Ask a single speaker you need to hear to wear the transmitter from your assistive listening device system. Do everything you can to keep your job. Ask for the accommodations you are entitled to under the ADA. Keep a record of requests that are denied or ignored. Speak up about incidents of unintentional discrimination. If you belong to a union, keep the union rep informed.
Share your story: How have you handled a hearing loss in the workplace? Tell us at editor@hhf.org.
Support our research: hhf.org/donate
face. This was not what we had expected. This same customer had once yelled profusely because we were out of stock of a certain brand of apple, and had also once casually implied that one of my coworkers was “a bit dull.” But here she was, having a pleasant notepad conversation in the middle of our department as if she were catching up with a friend. Ever since then, she has been kind, patient, and far more understanding every time she has come into the produce section. We were all worried that Bill would be mistreated, but he ended up showing us, as well as the customer, that it is wrong to jump to conclusions about another person. We are all on this planet together, and it falls on each of us to have compassion for one another.
Andrew Flavahan lives in Pennsylvania and works in the produce department of a grocery chain.
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Are You Faking It?
Tips for Working
By Laura Friedman
with a
Hearing Loss
“Fake it until you make it” is a common phrase most of us have heard at some point in our lives. While I don’t remember when I first heard these words, I do recall receiving this advice multiple times early in my career from colleagues and mentors of all ages. Now in my early 30s, I’ve come to realize this phrase highlights how adults may not know what they are doing or where they are going in their personal or professional lives. But part of “adulting” means not letting our cluelessness show and appearing we’ve got it together. Personally, I find this advice to be misguided: For three decades I’ve been faking that I hear everything, with varying degrees of success. My ears have failed me many times, leading to completing a project wrong or missing a deadline, and sometimes even an angry or frustrated boss. Like many with or without hearing loss, I don’t always know when I mishear, but wonder when I am struggling to hear, would these unfortunate incidents have been avoided had I spoken up? Living with hearing loss is no small feat. In an ideal, perfect world, people’s differences would have no bearing on how others perceive them and the opportunities they are afforded. The reality is that not everyone has gotten the memo that we should treat others, regardless of our differences, with the same level of respect as we expect for ourselves. With that said, here are my tips for navigating hearing loss in the workplace.
To disclose or not to disclose, and when? Unfortunately, there is no one right answer for everyone. (See the previous story, “Conceal or Reveal Your Hearing Loss at Work?”) For me, I typically disclose sometime during the interview process, to either to ask for an accommodation, such as video calls, or in response to a question about my interests (I volunteer a lot in the hearing loss community). This often provides an easy transition into discussing how my hearing loss has shaped me into the person I am today. When speaking about my hearing loss I highlight the strengths and capabilities my hearing loss has given me, rather than leading with deficits and weaknesses. “It’s not what you say, it’s what people hear,” as communications expert Frank Luntz succinctly puts it. It’s all about how you frame your hearing loss. People respond to and feed off of positive energy, so if you focus on discussing your assets with a nonchalant attitude, it’ll put the person receiving the information at ease. This approach is not meant to take the seriousness out of the conversation but simply take into account how messages are framed and received. Transparency is a two-way street. By the time an offer is in hand, your manager and the HR department should already know about your hearing loss and should be discussing workplace accommodations. While it’s understandable that disclosing is uncomfortable and there is always a lingering fear of discrimination, withholding it can also set a bad first impression regarding trustworthiness. It can raise questions about what else you may be hiding out of fear of repercussions. The bottom line: The bigger deal you make of your hearing loss, the bigger the concern for the potential employer. Keep it simple and upbeat and focus on the positives. Confidence is contagious, so if you’re confident, they will be too. 22
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photo credit: liza chrust photography, lizachrust.wordpress.com
Confidence is contagious.
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When speaking about my hearing loss I highlight the strengths and capabilities my hearing loss has given me, rather than leading with deficits and weaknesses. Don’t be afraid to speak up. In a perfect world, people, once told what they need to do, wouldn’t forget or mess up. But the reality is we often need to repeat and reiterate the same messages and instructions multiple times before someone gets the hint. This applies to people (friends, colleagues, family) accommodating your hearing loss. For me, my biggest compliment and frustration is the same: People forget I have hearing loss. Apparently, I fake hearing so well they forget, so kudos to me for a job well done. On the flip side, when they fall back on non-hearing-friendly habits like mumbling, covering their mouth when talking, or using soft speech on a conference call, the loser is me unless I say something. If it’s an important call or a meeting that can’t wait, speak up, as you’re likely not the only person in the room struggling. Sometimes in client meetings I’ll pass a note to a trusted colleague or manager and ask if they too are having difficulty, and that usually leads to a quick resolution.
Shake it off. If the same colleague is consistently the perpetrator of hearing-unfriendly behavior, approach them in a nonconfrontational way. No matter how nicely you discuss how they are speaking, the receiving party will undoubtedly feel bad and possibly even attacked. While it’s annoying to constantly have to point out when you’re having trouble hearing, relationships matter, so approaching the topic delicately is always advised. The best advice I have is to try to have a sense of humor about it. Keep it light and upbeat and move on quickly. The less of a big deal you make it, the less of the elephant in the room your hearing loss will be, and the more willing colleagues will be to accommodate you.
Former Hearing Health Foundation staff member Laura Friedman is a vice president at Citigroup. This article originally appeared on the website for the Ida Institute, a Denmark-based nonprofit working to integrate personcentered hearing care, on its Managing Hearing Loss at Work resource page. For more, see idainstitute.com/tools/managing_hearing_loss_at_ work. For references, see hhf.org/winter2020-references.
Share your story: How have you handled a hearing loss in the workplace? Tell us at editor@hhf.org.
Support our research: hhf.org/donate
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I Can Hear and See You When You Wear a Surgical Mask! The surgical face mask is commonly worn in hospitals and other healthcare settings. Its purpose is to provide a protective barrier between the healthcare worker and the patient against airborne liquid droplets during talking, coughing, or sneezing, as well as offering some protection against bodily fluid splashes. While these surgical masks appear to be just paper, they are made with fabric that is breathable and blocks small particles often invisible to the naked eye. But what happens when the patient has a hearing loss in the healthcare setting? Or, what if it’s the other way around and the patient has to wear a mask, while the healthcare worker has a hearing loss? In these situations, the surgical mask now imposes a visual barrier to speechreading (lipreading). It blocks access to the lips, mouth, and teeth. It is this communication issue that has motivated the Association of Medical Professionals With Hearing Losses (AMPHL) to solicit solutions. My involvement in this issue began when I first joined the AMPHL oard of in 2001 and I learned a great deal from the early groundwork of Stacy Cordwell Carroll, RN, Ph.D., a nurse practitioner with a hearing loss. She had written about being able to speechread the words of a patient who could not use her voice to . Around this time, I came across an old clipping from a June 1938 Modern Mechanix magazine featuring a nurse wearing a clear mask alongside the headline, “Surgical Mask Made From Transparent Material.” You might think that after all this time, a transparent mask would be commonplace, but that’s not the case. I began my first research study in the mid-2000s with my colleagues Lisa Lucks Mendel, Ph.D., and Julia Gardino, Au.D. In that study, we explored whether the conventional paper mask distorted the sounds of speech and how well listeners with and without typical hearing could understand recorded sentences against a background of recorded dental office noise. This paper was published in 2008 in the Journal of the American Academy of Audiology.
Visual Cues The 2011 AMPHL conference in Portland, Oregon, was when I first met Jeanne Hahne, RN, MSN, who presented 24
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on her vision and invention of a transparent mask. Jeanne wanted to make the healthcare environment friendlier for children who would be able to see the smiles of those wearing the mask. She also realized that such a mask would remove communication barriers for individuals with hearing loss and for individuals who work in noisy settings. Years later, I asked Jeanne if I could study the acoustics and speech understanding of her invention, and that resulted in another publication with Lucks Mende and some audiology students and research associates. In that study, we added a third group of listeners who had severe-to-profound hearing loss, and because of the transparent mask, we were able to compare the groups with no mask, with a conventional mask, and with a transparent mask in both audio-only and audio-visual conditions. This paper was published in 2017, also in the Journal of the American Academy of Audiology. In 2017, Jeanne and I received a technology grant from the National Institutes of Health. We proposed that there was a need to improve communication, minimize communication-related medical errors, and increase patient satisfaction, and that this could be done through the use of a transparent surgical mask. Jeanne worked with a manufacturer to further refine the invention, now called FaceView Mask. I have since completed two additional research studies. The first study was to repeat the 2017 study, but with the FaceView Mask specifically, and the second study was to give some health professionals and student trainees the opportunity to provide their feedback while using the FaceView Mask in real world or simulated clinical settings. Results are underway and will hopefully be published in the near future. (FaceView is the mask that we used in our research, but it is not the only transparent mask available.)
Studying the Effects Combined, our studies have revealed a number of interesting findings. First, the conventional paper and transparent masks do affect the sound quality slightly, but not enough to affect speech understanding. Typical hearing listeners generally performed quite well whether there was no mask, the conventional mask, or the transparent mask even when noise was also present.
photo credit: ben krain, university of arkansas little rock communications
By Samuel R. Atcherson, Ph.D.
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For listeners with moderate and severe-to-profound hearing loss, access to the lips, mouth, and face with the transparent mask improved speech understanding compared with the conventional mask. The greatest improvement, on average, was seen among patients who have severe-to-profound hearing loss, as the clarity of sounds typically diminishes with the severity of hearing loss. Also, I was reminded during these studies that not all individuals (with or without hearing loss) can speechread at the same level! Granted, the individuals participating in my study had to repeat standardized sentences with noise presented in the background, as well as in a sound booth. However, in healthcare settings where communication is crucial, I believe that the transparent mask removes a critically important communication barrier. While it seems obvious that a transparent mask can help some individuals with hearing loss through speechreading, there are benefits for other communities. I know that some Deaf individuals who communicate primarily through sign language may use speechreading cues as a supplement to spoken language. Interpreters for individuals with hearing loss see value in the transparent mask whether or not they use sign language, or when their clients have different proficiencies in sign language. And in noisy environments, listeners with typical hearing rely on facial cues and speechreading to supplement what they hear, even if they aren’t aware they are doing it. What about people who come from different parts of the country or the world and speak differently? What about trying to understand someone who speaks softly, or at a pitch that is hard to understand? Or individuals with speech impairments? A transparent mask can supplement communication here as well. Hearing loss or not, visual access to all parts of the face is also likely to help improve recognition of how the person wearing the mask is feeling. For all patients, regardless of age, seeing anyone with a smile can put them more at ease in an already scary and stressful environment.
Samuel Atcherson, Ph.D., s a transparent mask.
I have struggled to understand them, especially when there is noise in the background. I know I have trouble with the way some people speak because of their accents. I can also imagine how frightening conventional masks can be for children and individuals with cognitive impairments in healthcare settings. As , I am also looking at amplified stethoscopes and how well they do or do not pick up sounds from the heart or lungs, and how amplified stethoscopes can be successfully used with hearing aids or cochlear implants worn by healthcare professionals or medical students. The goal is to provide strategies for using these various tools effectively. I believe in a future world where we can eliminate as many communication barriers as best we can. Samuel R. Atcherson, Ph.D., is a professor in the department of audiology and speech pathology and the department of otolaryngology–head & neck surgery at the University of Arkansas for Medical Sciences. A past contributor to Hearing Health magazine, he is an audiologist and researcher with a lifelong hearing loss. For references, see hhf.org/winter2020-references.
Better Communication
As I reflect on the work my colleagues and I have been doing over the past decade, I am excited about the transparent mask. I am also excited because I myself have a hearing loss, and I worry about being put in a compromising position where I might not be able to speechread. I have already experienced dental hygienists, dentists, nurses, and surgeons wearing conventional masks and
Share your story: How do you handle communication challenges in healthcare settings? Tell us at editor@hhf.org.
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The Latest Research on Hair Cell Regeneration to Restore Hearing Hearing Health Foundation’s collaborative Hearing Restoration Project consortium headlined a scientific conference in New York City to advance cures for hearing loss. By Lauren McGrath
The New York Academy of Sciences (NYAS) hosted “Hearing Restoration and Hair Cell Regeneration,” a symposium in early October 2019 to connect internationally recognized hearing loss experts from academia, industry, government, and nonprofit organizations. Hearing Health Foundation (HHF) scientists spoke and presented, and HHF also served as a promotional partner for the conference. Armed with the knowledge that non-mammalian species have the ability to regenerate their inner ear sensory hair cells and restore their hearing, 11 speakers delved into the science during the full-day symposium in New York City. This included two researchers who are funded by HHF through the Hearing Restoration Project (HRP): HRP scientific director Peter Barr-Gillespie, Ph.D., of Oregon Health & Science University, and HRP consortium member Tatjana Piotrowski, Ph.D., of the Stowers Institute for Medical Research in Missouri. NYAS program manager Kari Fischer, Ph.D., and NYAS Scientific Organizing Committee member Michael Franti, Ph.D., introduced the conference, which began with keynote speaker Barr-Gillespie and his presentation, “A Cross-Species Approach to Hair Cell Regeneration.” This presentation was an overview of the HRP’s work investigating the restoration of hearing in humans by converting remaining cells in the inner ear into functional hair cells. Barr-Gillespie noted that two pivotal papers from the late 1980s, “Regeneration of Sensory Cells After Acoustic Trauma” and “Hair Cell Regeneration After Acoustic Trauma in Coturnix Quail,” which were coauthored by HHF Emerging Research Grants (ERG) scientists Douglas Cotanche, Ph.D., and Edwin Rubel, Ph.D., respectively, added greatly to the knowledge of how hearing works. These HHF-funded discoveries that birds can spontaneously regenerate their hearing once it has been 26
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lost formed the basis of the HRP, established in 2011. The overarching principle of the HRP, Barr-Gillespie explained, is collaboration through the open sharing of data and ideas. Consortium members use a comparative approach, examining the hearing mechanisms of chickens and zebrafish, which both show robust hair cell regeneration, as well as mice, which do not show hair cell regeneration in the cochlea. Barr-Gillespie provided greater context on several active, species-specific projects led by consortium members. He noted that HRP members share their data through a portal, the gEAR (gene Expression Analysis Resource), developed by consortium member Ronna Hertzano, M.D., Ph.D., of the University of Maryland Medical Center, which enables analysis and visualization of complex data and resource-sharing among the greater scientific community. Barr-Gillespie posits that furthering our understanding of gene-regulatory networks used to build hair cells and maintain supporting cells will ultimately enable regeneration strategies. Piotrowski’s presentation, “Hair Cell Regeneration in the Zebrafish Lateral Line,” provided specifics that followed up on Barr-Gillespie’s overall summary of the consortium’s cross-species approach. Zebrafish lateral line cells are homologous to mammalian inner ear hair cells, but they detect water movement instead of sound in order to preserve their ability to orient themselves. Piotrowski’s lab investigates which genes, including transcription factors, guide the regeneration of hair cells and how these genes are regulated by enhancers. Enhancers are DNA sequences in the genome that increase the expression of nearby genes. Identifying the specific enhancers, for example, that are active in zebrafish regeneration provides a better set of candidate targets that could be useful in triggering regeneration in mice. The NYAS symposium also featured a poster session
HRP scientific director Peter Barr-Gillespie, Ph.D., was the keynote speaker at an October 2019 New York Academy of Sciences conference.
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by early career investigators including 2019 ERG scientists Anat Lubetzky, Ph.D., of New York University, presenting her research on balance, and Vijaya Prakash Krishnan Muthaiah, Ph.D., of the University at Buffalo, with his research on blast-induced traumatic brain injury. The inclusion of the poster session served as a welcome reminder that scientific research involves not only formalized collaboration, but also an appreciation that complex biological systems like hearing and balance depends on sharing information more broadly, and that better understanding of the basic science will inform future treatments and cures. The event provided a fantastic opportunity for senior experts in the field of hearing restoration to survey advances in the field in recent years and to confer— formally in the question-and-answer segments of the program and informally during breaks—on next steps and directions for future research. HHF is particularly proud of the prominence of both the HRP consortium and ERG program at the event. Our donors continue to fund groundbreaking scientific research and support scientists who are leading the way in achieving a core aspect of HHF’s mission: curing hearing loss.
Lauren McGrath is HHF’s director of marketing and communications. For more about the HRP including Barr-Gillespie’s full presentation, “A Cross-Species Approach to Hair Cell Regeneration,” see hhf.org/hrp.
research
Principles of the HRP
International composition (the U.S., Canada, and the U.K.) of 10 to 14 investigators, plus the scientific director Overarching principle is collaboration: the open sharing of ideas and data Funds projects not traditionally funded by the National Institutes of Health (such as genome-wide inquiries) HHF’s Scientific Advisory Board provides oversight and guidance to the HRP consortium
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Our Reach
The work of these HHF-funded researchers was cited by NYAS presenters: Kumar Alagramam, Ph.D.; 2002 ERG recipient Ruth Anne Eatock, Ph.D.; 1987–88 and 1994 ERG; member of the HHF Board of Directors John Brigande, Ph.D.; HRP consortium member Albert Edge, Ph.D.; HRP consortium member Andy Groves, Ph.D.; HRP and 1996–97 and 2012 ERG Michelle Hastings, Ph.D.; 2009 and 2011 ERG James Hudspeth, M.D., Ph.D.; 1979–80 ERG Lawrence Lustig, Ph.D.; 2002 ERG (and a presenter at the NYAS conference) For more, see hhf.org/erg and hhf.org/hrp.
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research
A Vision for Hearing Research A childhood hearing loss has driven a lifelong interest in hearing research for Peter Steyger, Ph.D., a member of Hearing Health Foundation’s Council of Scientific Trustees, and the director of Creighton University School of Medicine’s Translational Hearing Center.
people
In the U.S. are treated annually with
aminoglycoside antibiotics, whose
common side effect is hearing loss.
500,000 people
In the U.S. are treated annually with
chemotherapy drugs, which can cause hearing loss.
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“Hearing is vital to communication,” Steyger says. “Perceiving sound is integral to music, listening to stories, theater. That all contributes to the richness of human experience.” Jian Zuo, Ph.D., chair of the department of biomedical sciences, will head up drug design for the center. “There is a lot of synergy on this, a lot of interprofessional collaboration that is making this possible,” says Zuo, who is working on a project to target at what point and in what populations antibiotics or chemotherapy drugs for cancer affect hearing. “There are some very promising pathways that Dr. Steyger has identified, and some compounds that we’ve identified,” Zuo adds. “The great thing is that our vision, our goals, are identical in this: to develop the first drug that could prevent this kind of hearing loss in children.” Steyger notes the incidence of hearing loss for children in the U.S. under the age of 2 is about 1 in 200, typically caused by trauma, infection, or antibiotic drugs. By age 18, about 1 in 20 experiences hearing loss. From there, the frequency increases with age-related hearing loss added into the mix.
photo credit (top right): oregon health & science university
100,000
When he was 14 months old, Peter Steyger, Ph.D., contracted bacterial meningitis. Physicians in his native Manchester, England, managed to save his life through a course of aminoglycoside antibiotics, but a side effect of those drugs robbed him of his hearing. Some 50 years later, Steyger, with a doctorate in neuroscience and hundreds of publications on ototoxicity and cochlear anatomy, has dedicated his life and career to preventing a similar fate for other children. In May 2019, Steyger joined Creighton University in Omaha, Nebraska, as the director of the School of Medicine’s Translational Hearing Center in a move that he says is “a dream scenario that will help me fulfill my life’s goals.” Steyger spent more than two decades at the Oregon Health & Science University and the Oregon Hearing Research Center. The center will collaborate with Boys Town National Research Hospital and the University of Nebraska Medical Center. The expansive effort, Steyger says, makes it all the more likely that researchers will make significant breakthroughs. “We can move with more velocity,” he says. Steyger holds a major National Institutes of Health (NIH) grant and has another, a $3.5 million grant from the NIH’s National Institute on Deafness and Other Communication Disorders, on the way. The grants are dedicated to preventing, through clinical or pharmaceutical interventions, the kind of hearing loss Steyger experienced.
research
Left: As a child in the late 1960s, Peter Steyger practices enunciation during intensive daily speech therapy. Above: Steyger today.
Since he was 2, Steyger has been outfitted with the latest in technological advances in hearing aids and cochlear implants that, ironically, give him an advantage as he gets older and hears better. “Many in my age bracket are now experiencing age-related hearing loss,” he says. “I’m going the other way. The technology is really amazing in rehabilitating hearing loss. But what would be even better is if we could prevent hearing loss in the first place and give everyone that natural ability to hear.” In any given year, some 100,000 people in the U.S. are treated with aminoglycosides, the antibiotics that caused Steyger’s hearing loss, and up to another 500,000 are treated with chemotherapy drugs that cause hearing loss. Developing an effective compound to forestall that side effect is the center’s primary aim. The center will also examine the potential to restore hearing via repairing or replacing damaged cochlear hair cells. The department of biomedical sciences also has launched a new Bellucci Symposium on Hearing Research, sponsored by the Bellucci DePaoli Family Foundation and named for School of Medicine alumnus Richard J. Bellucci, M.D., an innovator in ear surgery techniques to treat conductive hearing loss. Steyger is eager to continue the research that was, for him, set into motion when he was a youngster. “It gets me up out of bed in the morning,” he says. “I’m very passionate about this, and it keeps me motivated when setbacks occur. It’s a way to pay forward the support I have received in the past. Hearing is vital to communication. Perceiving sound is integral to music, listening to stories, theater. That all contributes to the richness of human experience.”
This is adapted from the Summer 2019 issue of Creighton Magazine, at creighton.edu/creightonmagazine.
Share your story: How has a hearing or balance condition affected your career? Tell us at editor@hhf.org.
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living with hearing loss
hearing health foundati o n
Four-Legged Hearing A vocational nurse for over two decades credits the help she got at home from her hearing dogs. By Barbara Chase My sensorineural hearing loss was diagnosed when I was about 4, in 1954, well before newborn hearing screenings were commonplace. “Barbie needs to see your face when you talk, Mommy,” my sister announced one day, cluing my parents into a possible hearing problem. I wore behind-the-ear hearing aids and relied on speech-reading, but academics were a constant challenge. Math was the most difficult because teachers often faced the chalkboard while writing and explaining equations. My family spent many hours tutoring math to me to ensure I passed. After high school, I was employed as a nurse’s aide in a long-term care facility. Because I enjoyed working with and helping the elderly patients, I applied to vocational nursing school. I entered with strong professional references and the two instructors were aware of my hearing loss, so I felt secure. During the last week of the six-week academic training, one instructor requested a private meeting. She had concerns about my hearing loss. “What if you’re in a situation where you could not hear a patient calling or crying out?” Devastated, I reasoned with her, hoping she would allow me to begin clinical duty on a trial basis to prove my ability to meet their expectations. She pushed back, explaining I could be jeopardizing a patient’s life; she could lose her job. I was crushed. I ultimately chose to withdraw from this nursing school, knowing I’d be accepted to another one. I was—and graduated and passed the California State Board for licensure. Some time later, I visited the first nursing school. The instructor remembered me and congratulated me on my achievement. We chatted amicably before she revealed that the other instructor, the one who had questioned my ability, had since resigned—due to a hearing loss she herself experienced after I withdrew. I was in disbelief! With empathy I hoped she, too, had not faced discrimination. About halfway into my nursing career, in the 1980s, I found myself needing to rely more on speech-reading. I often felt tired and mentally overloaded in noisy environments. One of my biggest challenges was caring for my son, born in 1987. My husband, a firefighter who often worked 48- to 72-hour shifts away from home, cleverly devised a sound-activated light system to alert me when our son made noise or cried in his crib. This 30
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Barbara Chase with her hearing dog Fallon II.
was perfect—except during power outages. Then I saw an ad for Canine Companions for Independence (CCI), a nonprofit organization that provides service dogs for people with disabilities. I applied and was matched up with Ronnie, my first CCI hearing dog, who was followed by Fallon II a few years later. Highly trained, my canine-ear partners helped immensely at home, alerting me to many important sounds such as someone knocking on my door, the tea kettle whistling, or my phone ringing. Gradually and for unknown reasons, my hearing loss continued to decline and I found myself avoiding noisy places. I was also no longer able to auscultate (hear) important lung sounds using a stethoscope. In 1999 I made the decision to resign to ensure quality patient care. With my skills as a nurse, I transitioned to be the primary-care provider for my aging parents-in-law and, later, my mother. I am proud that I was able to remain productive and independent, largely because of the assistance of my hearing dogs.
Barbara Chase lives in Oregon with her husband Dan. For more about Canine Companions for Independence, see cci.org.
Share your story: Tell us your hearing loss journey at editor@hhf.org.
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arts
Hear the Music Through its Hearing Health Initiative, MusiCares® is highlighting how important it is for live-music professionals, and their fans, to protect their most valuable asset: their hearing. Artists and crew working on extended tours or at major music festivals are particularly at risk for hearing damage. Long hours, and repeated sonic punishment from months of working on stages with extremely powerful sound reinforcement, can take a terrible toll on hearing health—something many in the industry fail to realize. MusiCares, a charity that provides health, financial, and rehabilitation resources to music people in times of need, has been working to educate artists and crew about the real damage that sustained exposure to high decibel level sound can exact on hearing.
First and foremost, always wear hearing protection while attending loud concerts or events. And when possible, take breaks from noisy environments to prevent ear fatigue. “We know that 15 percent of all Americans between the ages of 20 and 69 suffer from hearing loss, and that figure doubles for the music community,” says Erica Krusen, the senior director of Health and Human Services for MusiCares. The typical concert averages 125 decibels (dB), according to the Occupational Safety and Health Administration (OSHA). For context, a whisper is around 10 dB while normal conversation is 60 dB. Add in that most concerts can run for hours—even longer with festivals—and the risk becomes even greater.
Share your story: Tell us your hearing loss journey at editor@hhf.org.
Here are three simple tips artists, industry workers, and fans should take to protect their hearing so they can keep the music playing for a long time.
1
Always Protect
First and foremost, always wear hearing protection while attending loud concerts or events. And when possible, take breaks from noisy environments to prevent ear fatigue. Rest your ears between shows and practices, because the longer your ears are exposed, the more damage is being done. Musicians should practice their music at a reasonable volume. And be aware of your surroundings, whether in the crowd, onstage, or backstage. Make sure you’re never too close to the sound reinforcement speakers.
2
Educate Yourself
Refer to the OSHA website at osha.gov to learn about the recommended maximum decibel exposure over time. Noise-induced hearing loss is damaging to delicate sensory hair cells inside the ear caused by a combination of volume and time. OSHA says 85 dB is a safe zone for eight hours, but as the amplitude increases, the exposure time decreases.
3
Get Regularly Tested
Get a hearing test at least once a year. If you attend a lot of shows you may not notice the decline in your hearing until it’s too late. Regular visits to the audiologist are essential for concertgoers and music industry professionals.
This article is based on material from The Recording Academy and MusiCares. For more, see grammy.com/musicares. For references, see hhf.org/ winter2020-references.
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media
h ear i n g h ealth foundation
Breaking Stereotypes An otolaryngologist in training with a hearing loss reviews recent (and more frequent) depictions of hearing loss in the media.
friend: This is my friend Ally. ally: Oh, my God! Hi. jackson: Hi. Hey. ally: I thought that might be you. jackson: What’d you say? ally: I thought that might be you. jackson: That’s me. ally: So why are you in here, hon? jackson: Sorry? ally: What brings you here? jackson: Oh, I was playing right around here tonight. I’m a musician. This exchange stood out to me while watching “A Star Is Born,” the blockbuster film from the summer of 2018 about a hard-drinking, seasoned rock star, Jackson (played by Bradley Cooper), who discovers and falls in love with a struggling artist, Ally (Lady Gaga). This scenario is familiar to most people (with or without hearing loss)—sometimes we miss a few words here and there when having a conversation in a noisy environment, such as a loud concert or a cocktail party. But something felt strange about this scene; this type of situation rarely happens in a movie, let alone twice in one scene, because movies are scripted. In most movies, any imperfections of daily life are often erased from dialogue so that everyone seems perfect—and this includes the ability to hear. As a resident physician in otolaryngology–head and neck surgery (also known as ear, nose, and throat surgery, or ENT) and as a person with a hearing loss, I suspected there was something more to this than meets the eye. Several scenes later, my hunch was proven correct when we learn that Jackson suffers from hearing loss and tinnitus. When Jackson visits a hearing specialist (a cameo by William Slattery III, M.D., an otolaryngologist from the House Ear Clinic in Los Angeles, and Cooper’s actual ear doctor), they discuss Jackson’s hearing loss and the importance of using in-ear monitors to protect his hearing while performing. In the next scene, Jackson adamantly 32
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refuses to use hearing protection when performing at loud rock concerts, and he later explains that his struggles with hearing and tinnitus began when he was younger. His hearing worsened throughout his career as a musician, suggesting he likely has noise-induced hearing loss from exposure to loud sounds, a common occupational hazard in the music industry. Hearing loss is both underrepresented and misrepresented in the media, which frustrates many of us who actually have hearing loss. When hearing loss is represented in the media, it is often in connection with aging—individuals who are hard of hearing have typically been depicted as elderly, isolated, and disabled individuals who are dependent on others. Other media representations of hearing loss focus on Deaf culture; television shows like “Switched at Birth” and “The Society” and movies like “A Quiet Place” and “Wonderstruck” represent individuals with deafness, but are not necessarily relatable for all individuals across a wide spectrum of hearing loss. In contrast, Cooper’s character in “A Star Is Born” is a famous, still-young music celebrity who does not meet the typical stereotype of someone with a hearing loss. As the movie progresses, we watch Jackson struggle with his hearing loss and its impact on his self-image as he continually refuses to have his hearing treated or protected while exposed to loud music onstage. Though Jackson’s struggles with his hearing are not the main focus of the movie, this subplot also reminds the public that this condition not only affects the elderly— young people can have hearing loss, too. One in five young adults ages 20 to 29 reportedly has trouble hearing. And fewer than 16 percent of individuals ages 20 to 69 who could benefit from wearing hearing aids have actually used them. I can relate to Jackson’s struggle to reconcile his image with his hearing loss. Even though I am currently an ENT (ear, nose, and throat doctor, or otolaryngologist) in training, pursuing a career that helps treat people with hearing loss, I spent almost 10 years of my life while in college and medical school refusing to wear my hearing aids when I certainly could have benefited from them. As a young person with a hearing loss, I made life harder for myself for no good reason other than what I felt was society’s perception of people with hearing loss.
photo credit (near right): disney studios
By Alexander Chern, M.D.
media
The media is the fastest and most cost-effective way to raise awareness and eliminate stereotypes, promote inclusion of individuals with hearing loss, and reduce the perceived stigma that is still ingrained in our society. Doing so will also help us fight the hidden epidemic of hearing loss, which is both highly prevalent and severely undertreated. The media is the fastest and most cost-effective way to raise awareness and eliminate stereotypes, promote inclusion of individuals with hearing loss, and reduce the perceived stigma that is still ingrained in our society. Doing so will also help us fight the hidden epidemic of hearing loss, which is both highly prevalent and severely undertreated. Not so long ago, people persisted in using terms such as “deaf and dumb,” “deaf-mute,” and “hearing impaired” to refer to these individuals. Such terms reflect the unconscious biases people have against such individuals who struggle with hearing, which, in part, prevents them from seeking treatment. I believe those who work in entertainment—writers, producers, and directors—should take the artistic responsibility to portray individuals with hearing loss in an accurate, authentic, and diverse way. In addition, the frequency of individuals with hearing loss portrayed in the mainstream media needs to more accurately reflect its real-life prevalence. According to the National Institute on Deafness and Other Communication Disorders, about 20 percent—48 million—
Kindergarten students in “Toy Story 4” reflect diversity.
Americans report some degree of hearing loss. Normalizing hearing loss and fighting stereotypes will also require the entertainment industry to show us more characters with hearing loss wearing modern, digital hearing technology. We also need more character development, storylines, and subplots about hearing loss, not to mention actors, directors, and writers affected by this condition who are best able to tell such stories. Diverse media representation will be crucial in raising awareness and educating the public about hearing loss. Released in 2019, the summer after “A Star Is Born,” the movie “Toy Story 4” is the latest installment of Pixar’s iconic “Toy Story” series that began 25 years earlier, in 1994. I was thrilled to see that the creators of the movie took a big step toward inclusivity when they featured a young boy wearing a cochlear implant with a bright green processor. It’s in an early scene when Bonnie goes to kindergarten for the first time and meets her classmates. I remember, as I am sure many of us do, what it felt like to be made fun of for wearing hearing aids as a child—it was embarrassing. For many, this perceived stigma is often a barrier to obtaining treatment for their hearing loss. Wearing hearing aids makes us feel different, and not in a positive way. Glasses, a medical device seen as part of everyday life for many people, used to be stereotyped as being worn by nerdy kids without any friends. However, glasses are now considered fashionable and stylish—many individuals wear glasses even if they do not have vision loss. There is no reason why having hearing loss treated with hearing aids or cochlear implants should be perceived any differently than having vision loss treated with glasses, especially nowadays when wearing name-brand headphones or earbuds or other accessories on the ear is commonplace. Though there is still a long way to go in raising awareness, breaking stereotypes, and making hearing loss hardly a big deal, that little boy in “Toy Story 4” rocking his bright green processor marks an important first step.
Alexander Chern, M.D., is a second-year ENT resident physician at NewYork Presbyterian Hospital, Columbia/ Cornell. For references, see hhf.org/ winter2020-references.
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Always an Audiologist A peripatetic audiologist travels to remote regions of the world, providing hearing tests and treatments to underserved populations— and penning a children’s book, too. By Dawn Doig, Aud(C)
Dawn Doig in the mid-2000s in Saudi Arabia, one of several countries she’s lived in and practiced audiology.
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hearing health
My father was born in Canada. An orphan, he spent time in a foster home as a child. When I was growing up, my family got to know his foster family very well, and even called his foster mother Grandma. In this family there were two grandchildren who were deaf, who married spouses who were also deaf, but they all had typical hearing children. I watched in fascination as the young hearing children who could barely speak signed with their parents. I had no idea what audiology was at the time, and little did I know that the seed had been planted for my future career. After earning a master’s in audiology (and my husband Bruce earned a dual degree in art history and education), we moved to Peace River, Alberta, with our 2-year-old daughter. For the next four years, I was the sole audiologist for 40,000 people. This was one of the greatest periods of growth for me as an audiologist, and I carried with me around the globe the invaluable experience I gained during this time. As a young clinician I needed to hone my audiology skills even though there was no one hhf.org
nearby to assist me. An introvert by nature, I had to become an advocate for my patients as well as the audiology program. One critical thing I learned was the importance of thoroughly understanding your testing equipment—how to troubleshoot and knowing when it may be malfunctioning. For instance, I noticed power surges to the clinic affected the equipment, and it was unnerving wondering if subsequent hearing tests might be inaccurate. Rural Canada was also the first place I realized that a population could be largely unaware of the issues surrounding hearing loss. Many of the patients I saw were older men who were lifelong farmers with noiseinduced hearing loss from farming practices and hunting. But a teenage boy I tested had the hearing loss of a much older patient and admitted he blasted his stereo in his car. When I pointed out the danger of losing his hearing permanently, he said he’d just get a louder boombox. At this time, the audiology field did not have the ability to test otoacoustic emissions or
workplace
Early in my career I realized that a population could be largely unaware of the issues surrounding hearing loss. Many of the patients I saw were older men who had noise-induced hearing loss from their work using noisy equipment and from recreational noise exposure. But a teenage boy I tested had the hearing loss of a much older patient and admitted he blasted his stereo in his car. When I pointed out the danger of losing his hearing permanently, he said he’d just get a louder boombox.
frequency-specific auditory brainstem responses. Our hearing aids were analog, and the average age of diagnosis was between 2 and 3 years of age, well past the critical period for speech and language development.
Heading Abroad
With cutbacks and a second child to raise, we headed to Abbotsford, British Columbia, near Vancouver, where I joined a private clinic. We bought a home and were beginning to put down roots, but in the summer of 1997 I went on a humanitarian trip to a school for the deaf in Lái Thiêu, Vietnam. This was my first time out of Canada, and it was unforgettable. At the school near Ho Chi Minh City we met three girls who sang to us in Vietnamese. They were deaf, but one of the sisters, who was trained to do speech-language therapy, had taught them to sing. A man who made earmolds so we could replace body-worn hearing aids with those at ear level was skilled beyond comprehension, especially given the limited resources available to him, and the patients’ needs. One father traveled 125 miles with his teenage
daughter, whose smile lit up the room after she was fitted with new ear-level aids. The career of Bob Carkner and his work bringing Canadian high school students to Guatemala and Vietnam was captured in a documentary, “A Man Named Bob.” When it aired on cable I made my TV debut. This life-transforming experience abroad inspired me to apply to be an audiologist in Kuwait as part of a collaboration between Dalhousie University in Canada and the Kuwait Ministry of Health. In January 1998, I boarded a plane with my two young children and headed to Kuwait. My husband, finishing up his teaching contract, followed six months later. Kuwait was still extremely segregated with respect to the sexes, and coping with roadblocks—both real (road accidents), and figurative (regulations)—was challenging. But we also discovered the foods shawarma and fatayar and the spice zaatar in Kuwait and love them all to this day. We learned the word yella (“hurry”) and still use it! It was in Kuwait that I wrote my children’s book “And So, Ahmed
Hears.” By this time, I’d had the pleasure of working with so many special children coping daily with hearing loss. The book was illustrated by my daughter, then 6, complete with a veiled mother. The character Ahmed is a conglomeration of children I’d met and worked with, and I wanted to help improve public awareness of pediatric hearing loss and the need for early diagnosis and intervention.
Remote Populations
When my family and I returned to Canada two years later, we settled in the far north where my experience working with non-English-speaking patients had prepared me for traveling with ENT doctors to remote Inuit villages above the treeline. I was the only audiologist for the vast area of the Northwest Territories, so I traveled frequently to small communities of 250 people or towns of a few thousand. Often it made more sense for us to fly and do clinic visits ranging from two to five 13hour days. Within the community, we traveled by van and quad (all-terrain vehicle). Anyone needing surgery in the remote villages had to be flown to
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h ear i n g health foundation
Yellowknife, the capital of the Northwest Territories. The winter lasted eight months a year with temperatures descending to minus 58 degrees F. I once slept in my clothes, parka, gloves, and boots, plus blankets, because the heat wasn’t working in the hotel. We visited an igloo once on Pelly Bay, in far eastern Canada, and found it incredibly warm inside. We just sat quietly and listened to the silence. Soon enough, I got itchy feet again. Bruce and I were each granted a leave of absence from our jobs, and in the summer of 2003, we packed up, sold our house, and flew to England. There I joined the Medway Maritime Hospital in Gillingham, Kent. The high incidence of middle ear pathology in the U.K. allowed me to learn all I could about bone-anchored hearing aids—knowledge that would prove useful later. That said, one year in England burned a hole in our wallets and we returned to Yellowknife.
Back to the Middle East
I received a call from Saudi Arabia a year later. A large rehabilitation hospital in Riyadh was looking for an experienced audiologist to help start an audiology unit. When I went home that night, Bruce and I discussed the possibility of Saudi Arabia with our children, then 11 and 14 years old, and in November 2005 I boarded another plane, eight months ahead of my family. The initial two-year contract in Riyadh turned into eight of the most rewarding years of my career. I wrote policies and procedures; started programs (NICU follow-ups, infant hearing screenings, oncology, cochlear implants, student internships); ordered equipment; and trained junior staff. I was finally able to catch up to my children’s Arabic ability (developed in Kuwait), learning to speak, read, and write Arabic. But sadly the leadership changed toward the end of my eighth year, undoing most of our work. I am hopeful the clinicians who left to complete clinical doctorates and 36
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who are gradually returning will be able to restore the clinic to its former status of delivering a high standard of audiology and speech-language pathology services. Over the years, I shared my book “And So, Ahmed Hears” with audiologist friends and asked if any of them knew of a company that might be interested in using it with their pediatric program. One happened to be working with Widex Canada, the hearing aid company, and she took the idea to the director. Widex published it as a humanitarian project (albeit with their own illustrations) to help increase public awareness about childhood hearing loss, and for several years it was available for free to families in Canada. In 2018 the book was republished by Pen It! Publications; it can be found on Amazon and through other online retailers.
Teaching, Plus Audiology
As our time in Saudi Arabia was coming to an end, I decided to go back to school to earn a master’s degree in teaching English as a second language. Bruce had followed me as a teacher for 23 years and now I would follow him. In 2013 I joined him in Ulaanbaatar, the capital of Mongolia, where I completed my practicum at the school where he was teaching. While in Mongolia, I was informed by many that I was the only certified audiologist in the country. I managed to visit several hearing clinics and was saddened by the condition of most. One ENT doctor I met had taught herself how to do hearing assessments from a textbook. With her heart in the right place, she was trying to do whatever she could to help the patients. At the children’s hospital, I saw that the assessments were conducted with the child in a small glass room with babies screaming in the soundbooth right next to it. Eventually in my third year in Mongolia I was able to start a hearing screening program at our school because there was some infrastructure in place that could help
workplace
The initial two-year contract in Riyadh turned into eight of the most rewarding years of my career. I wrote policies and procedures; started programs (NICU follow-ups, infant hearing screenings, oncology, cochlear implants, student internships); ordered equipment; and trained junior staff. I was finally able to catch up to my children’s Arabic ability (developed in Kuwait), learning to speak, read, and write Arabic.
sustain it. Our time in Mongolia is the reason why “And So, Ahmed Hears” was translated into Mongolian through the local Rotary Club. I am writing this from Cameroon, where I work in a pre-K to grade 12 school in the capital Yaoundé, teaching English as a second, third, or even fourth or fifth language. Although I am not currently practicing audiology, it will always be a part of who I am, and as in Mongolia I have been told that I am the only certified audiologist in the country. I visited a school for the deaf with our grade 3 classes and am trying to get help for the school to build a new facility. A friend in Canada donated a combined audiometer/tympanometer screener, but it has not been easy to implement the needed screenings and services. We just renewed for another two years in Cameroon so I will keep exploring options to help bring hearing tests and treatments to people throughout the country. After growing up in remote Canada and the Middle East, our now-adult children have more or less settled in Canada while my husband and I have continued our peripatetic lifestyle. I have been truly blessed with two extremely fulfilling careers in communication that have enabled me to work with people around the world.
Dawn Doig, M.Sc., M.Ed, Aud(C), is a certified Canadian audiologist who practiced for 23 years. She now works as an English as an additional language teacher in Cameroon. Including “And So, Ahmed Hears,” Doig has written more than 10 children’s books plus a cookbook. For more, see doigda.wixsite.com/mysite-1. She also wrote the poem “Hair Cell Eulogy,” at hhf.org/blog.
Opposite page (from far left): Dawn Doig and her husband Bruce in Mongolia; and Doig (fourth from right) with her staff in Saudi Arabia. This page (top): The cover of Doig’s children’s book, inspired by patients she has worked with; and Doig in Cameroon, where she now lives.
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tinnitus
h e ar i n g h ealth foundation
Working With Tinnitus By Hazel Goedhart and Markku Vesala
Work is an important part of one’s social environment and often provides a sense of achievement and self-worth. However, the data we’ve collected at Tinnitus Hub shows that more than a third—38 percent—of people who say they have tinnitus say that the condition has negatively affected their work prospects. This is not only life-changing for the person in question, but also means that tinnitus has a huge economic impact. As a volunteer-based, patient organization that runs Tinnitus Talk, a global online community for people with tinnitus, we would like to draw attention to this societal problem and push for tinnitus to be taken more seriously as a potential impediment to work.
Trouble Focusing
The biggest impact on work likely stems from difficulties with concentration, which many people with tinnitus report. Survey respondents indicate that tinnitus has affected their concentration mildly (41 percent), moderately (33 percent), or even severely (20 percent). Only a small minority report no concentration issues. This differs from the “concentration fatigue” that people with hearing loss can experience, when the brain has to put in extra effort to get the input it needs. Rather, it’s an effect of experiencing constant noise in one’s head and having to push that to the background in order to focus on other things. Of course, not everyone with tinnitus struggles, and many function in daily life without problems. The severity of tinnitus ranges across a spectrum, and often people who struggle at the onset of tinnitus later find good ways of coping. Nonetheless, severe tinnitus is frequently accompanied by anxiety and/or sleeplessness, which impacts the ability to focus at work. As one of our survey respondents puts it: “People don’t understand the everyday stress of always hearing a high-pitched sound.”
Has Tinnitus Affected Your Job or Work Prospects?
6.38%
Tinnitus has driven me to succeed more
I am struggling and thinking about giving up work due to tinnitus
55.30%
I have not felt a difference
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I struggled with work and gave it up
10.99%
Source: 2018 Tinnitus Hub survey with 1,800 respondents.
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9.60%
17.70%
I have not been able to pursue career progression due to tinnitus
tinnitus
The trouble focusing with tinnitus differs from the “concentration fatigue” that can come with hearing loss, when the brain has to put in extra effort to get the input it needs. Rather, it’s experiencing constant noise in one’s head and having to push that to the background in order to focus. Challenging Work Environments
Certain professions expose people to loud sounds that may cause hearing damage and/or tinnitus. These professions include military service, construction, manufacturing, and the music industry. A member of the Tinnitus Talk support forum posted about wanting to become a police officer. He stated that he is currently functioning very well with his tinnitus but was concerned about a potential setback due to the requirement to handle firearms. “In the police academy I would have shooting classes, and I am worried about it. This is the job I have always wanted.” Even exposure to lower-level sounds all day long, such as in a restaurant, call center, or primary school, can be harmful. People with tinnitus often suffer from increased sound sensitivity (hyperacusis), which means that an office work environment with typical levels of noise can end up causing ear pain or spikes in tinnitus. Patients may have to change jobs or give up their careers because of having tinnitus or hyperacusis. Simply getting to work can be a struggle for someone who is hypersensitive to sound: “It’s not easy sometimes. A city transit bus is a noisy environment and causes spikes that make me want to drive an ice pick into my ear, but I refuse to let this cripple me to the point where I can’t earn a living.”
Reactions From Employers and Coworkers
Many discussions on Tinnitus Talk highlight a lack of understanding from employers or colleagues and a lack of willingness to make adjustments to help the person with tinnitus. Some people hesitate to speak openly about their tinnitus. “I would like to be more open about my tinnitus, but I am afraid to as I will be discriminated against in my workplace. And now that I am looking for a job, I am even more fearful.” One can try to explain the tinnitus experience to colleagues, but a big issue is that tinnitus, like hearing loss, is a hidden condition and thus easily forgotten. Some people face disbelief or are even mocked by their coworkers for their tinnitus.
The Way Forward
So, what can be done? There are some relatively simple steps that employers and employees can take to help. Some people find it impossible to work due to tinnitus-induced anxiety and may need to take sick leave or a period of absence. When possible, this should be accommodated. For the vast majority, the anxiety passes, and after weeks or months or years, habituation sets in. Others may have to make permanent adjustments, like settling for a less demanding career. Be open to discussing the options available. Adjusting sound levels at the workplace is not always possible, but small changes can have major positive impacts, such as adjusting seating and allowing the use of headphones to provide white noise or minimize outside sound. Employers can also allow employees to work from home if possible. Each person’s needs are unique, and often merely trying to understand those needs and being accommodating can make all the difference to an employee with tinnitus. Educating employers and HR departments is essential to helping resolve career barriers faced by people with tinnitus. If you need advice as an employer/employee or want to share your story, please join us on the Tinnitus Talk support forum.
Hazel Goedhart is a director and the chief strategist for the U.K.-based organization Tinnitus Hub, founded by Markku Vesala. All referenced data comes from online surveys conducted by Tinnitus Hub. For more, see tinnitushub.com and tinnitustalk.com. Share your story: Tell us your hearing loss journey at editor@hhf.org.
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research
Recent Research by Hearing Health Foundation Scientists, Explained
Looking to Other Sensory Organs to Better Understand Hair Cell Regeneration Scientists have learned an incredible amount since the discovery three decades ago that some animal species are able to regenerate hair cells, but they are still only beginning to understand the genes and signaling involved in tissue regeneration. In a Sept. 25, 2019, article published in the Annual Review of Cell and Developmental Biology, Hearing Restoration Project (HRP) consortium member Tatjana Piotrowski, Ph.D., and colleagues at the Stowers Institute for Medical Research in Missouri summarize the existing literature on hair cell regeneration in the context of sensory cell regeneration more broadly. While there are many similarities in the development and regeneration of sensory cell types (those involved in vision, for example), recent research has highlighted significant differences. Cross-species comparisons are an important means of identifying these differences, which is why this approach is central to the HRP’s work. Studies suggest, for example, that the limited success that has been experienced in regenerating support cells in mammals may be because these cells are more differentiated in mammals than the analogous cells in zebrafish, a species that can regenerate. The researchers identify the key question researchers in the field need to answer to significantly advance their efforts: “Which signal or signals trigger hair cell regeneration?” There are numerous hypotheses about the mechanisms through which dying sensory cells signal the need for repair and regeneration, including molecular triggering of the immune system and inflammation. Work in the field thus far indicates that in spite of numerous differences, the molecular response that drives stem cell activation is fundamentally similar. Despite the fact that early efforts to regenerate mammalian hair cells have resulted in modest numbers of hair cells that fail to survive, there is sufficient promise that a better understanding of so-called downstream signaling 40
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pathways, which scientists hypothesize are typically epigenetically silenced in postnatal mammals, will prove key to moving beyond these preliminary results. In a separate study, Piotrowski and colleagues at Stowers and Cardiff University in the U.K. investigated the genes underlying two cell signaling pathways—PCP and Wnt—that are present in both humans and zebrafish and are known to affect the way in which sensory hair cells in the cochlea coordinate their orientations. Hair cells are “tuned” to respond to different sounds based on pitch or frequency. This is due to a collective property called planar polarization, or the orientation in which the hair cells are laid out. When sound enters the ear, the hair cells change the sound vibrations into an electrical signal that is sent to the brain, allowing us to recognize it. Genetic factors are thought to cause more than 50 percent of all incidents of congenital hearing loss, with many attributed to the misalignment of or damage to hair cells. Using zebrafish as a proxy, the team systematically switched off these genes in the zebrafish and were able to study the effects on hair cell direction. As published in Nature Communications on Sept. 6, 2019, the results showed that not only could the regularity of the hair cell pattern be destroyed, producing a random hair cell direction, but certain alterations to the genes could lead to the hair cells having circular or spiral patterns. —Christopher Geissler, Ph.D., and Cardiff University
A portion of this was adapted from a press release from Cardiff University on EurekAlert. HRP consortium member Tatjana Piotrowski, Ph.D., is an associate investigator at the Stowers Institute for Medical Research in Missouri.
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photo credit to gutter: photo credits: jane g photography; illustration: hearing research/elsevier
A Key Molecule Required for the Regeneration of Auditory Hair Cells in the Avian Inner Ear Hair cells in the cochlea are the only cells in our body specialized to encode the energy in sound waves. As a result, we lose our hearing when hair cells die, which occurs during aging and after exposure to excessive noise or ototoxic drugs. Research indicates that no adult mammals replace their auditory hair cells once they are lost. However, some mature non-mammals regenerate hair cells after damage. Of these animals, the bird’s auditory organ most closely resembles that of humans. Moreover, the regenerated hair cells in birds nearly restore hearing. Thus, birds are particularly important animal subjects for hair cell regeneration research. It has been known for years that supporting cells— also located in the hearing organ—are the source of the new hair cells in birds, but the molecules that enable supporting cells to regenerate hair cells are not understood. A January 2020 Hearing Research study by Liangcai Wan, M.D., and HRP consortium members Michael Lovett, Ph.D., Mark Warchol, Ph.D., and Jennifer Stone, Ph.D., explored the roles of a molecule called vascular endothelial growth factor (VEGF) in auditory hair cell regeneration in chickens. The team suspected that VEGF might be required for regeneration because the levels of molecules in the VEGF signaling pathway changed significantly after damage. When they silenced VEGF signaling, they found that hair cell regeneration ceased. Conversely, when they added excess VEGF, they found regeneration was enhanced. The investigators theorize that VEGF, which is abundant in typical hair cells, is released when hair cells die, promoting supporting cells to form new hair cells. This study reveals a novel mechanism controlling hair cell regeneration. Future studies should test if VEGF can enhance hair cell regeneration in adult mammals. —Jennifer Stone, Ph.D.
HRP consortium member Jennifer Stone, Ph.D., is the director of research in the department of otolaryngology–head and neck surgery at the Virginia Merrill Bloedel Hearing Research Center at the University of Washington. Learn more about the HRP at hhf.org/hrp and hhf.org/spotlight.
This figure shows a model for how vascular endothelial growth factor (VEGF) signaling may trigger hair cell regeneration in the auditory organ of birds. VEGFA (green), present in hair cells (A), may be secreted as hair cells die. VEGF may bind its receptors (B) on supporting cells (blue cells), which triggers them to divide (C) and form new hair cells and supporting cells. VEGF may also stimulate some supporting cells to directly convert into hair cells (not shown).
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EMERGING RESEARCH GRANTS
Size Control of the Inner Ear Through Fluid Pressure These are cross-sectional pictures from live 3D microscopic images of the developing zebrafish ear. The images are from time-points at 12, 16, 24, and 45 hours after egg fertilization, a span of time during which the ear rudiment grows more than four times in volume. The black coloring is a fluorescent protein targeted to the outer membrane of individual cells. The red is from a fluorescent protein targeted to the nucleus of individual cells where it binds to DNA. At 45 hours post-fertilization, the length of the embryonic ear’s long axis is approximately 1/10th the thickness of a penny.
The inner ear senses sound for hearing and body movement for balance. In the embryo, the rudimentary ear grows from a fluid-filled balloon that is enveloped in a tight layer of cells. In our paper published in the journal eLife on Oct. 1, 2019, we examined how this balloon grows into the more complex ear. Our work helped us formulate a new mathematical theory on how ear growth in animals is controlled. To do the research, we took advantage of the zebrafish embryo’s transparency by using a high-resolution microscope to take detailed 3D pictures of the inner ear as it grew during the first two days of fish development. We observed that the ear grows dramatically and increases its volume by four times over a period of 24 hours. Most of the increase in size originates from the accumulation of fluid and not because of cell division to increase the tissue mass. This was a very surprising finding since most tissues in development grow by increasing the number or size of cells. A second observation was that the ear pushed out the neighboring brain structures, and that the ear cells that envelop the balloon appear stretched. Both of these observations suggested to us that pressure within the developing ear was increasing. We wondered if cells control this pressure directly or if it is just a byproduct of the growth process. We decided to dive deeper. We designed and built a nanoscale pressure probe small enough to insert into the tiny ear of the fish embryo and sensitive enough to detect the first increase in fluid pressure. To examine if the pressure is monitored and controlled, we popped the ear with needles and observed that the ear would collapse, much like a balloon that has been popped. To our amazement, we watched the popped embryonic ear recover and rapidly catch up in size to the unpopped ear by briefly accelerating its inflation with fluid. Just as an engineer may design a thermostat to maintain the temperature of a room, we began to think 42
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that the developing ear has a way to tell itself when it has reached the correct size by monitoring the internal fluid pressure. We developed a mathematical model of this process. Next, we began to use this model to predict and test if the pressure also shapes the ear. The mechanical properties of the enveloping cells offer resistance to growth much like a belt worn around the waist. If the belt’s elasticity is locally changed, then growth rates can be controlled locally. This helps explain how the inner ear changes from a spherical shell to an elongated football-like shape. To summarize, our paper demonstrates how biology does not limit itself to gene regulation and protein activities. Mechanics matter. To function in a 3D world where there is inertia and resistance to growth, an embryo and its developing organs actually control physical forces and collect feedback on these forces to inform regulatory processes. This is yet another reason why animal development is so orchestrated, robust, and precise. Additionally, the crosstalk between mechanical forces and the behavior of cells in the ear is important to understand when investigating hearing and balance diseases where inner ear fluid pressure is out of control, such as Pendred syndrome and Ménière’s disease. —Kishore Mosaliganti, Ph.D., and Ian Swinburne, Ph.D.
Ian Swinburne, Ph.D., is a postdoctoral researcher in the department of systems biology at Harvard Medical School, Massachusetts, where his colleagues included Kishore Mosaliganti, Ph.D. Swinburne is a 2013, 2018, and 2019 Emerging Research Grants (ERG) recipient.
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Changes in the Tiny Vessels of the Inner Ear’s Balance Organ Reveal Links to Ménière’s Disease
(A) Uniformly thick vessels (red) in a vestibular schwannoma utricle with arrows pointing to a wrapping pericyte cell. (B) In a thick vessel from a Ménière’s patient, there is disorganization of the pericyte processes (white arrows) and evidence of degeneration of the vascular endothelial cells and thin areas of the vessel wall (green). (C) This zoomed-out image shows constriction in the blood vessels (left arrow).
The integrity and permeability of the blood labyrinthine barrier (BLB) in the inner ear is important to maintain an adequate blood supply and to control the passage of fluids, molecules, and ions. Identifying the cellular and structural components of the BLB is critical to understanding inner ear microvasculature (micro vessels) and designing the efficient delivery of therapeutics across the BLB, potentially to treat hearing and balance disorders such as Ménière’s disease. My team and I used fluorescence microscopy to study the microvasculature in the utricular macula, which detects the body’s linear movement, of patients who had undergone surgery for Ménière’s disease or vestibular schwannoma. As published in Frontiers in Cellular Neuroscience on Oct. 4, 2019, we found a significantly decreased number of junctions, total vessel length, and average vessel length in the microvasculature in Ménière’s disease specimens compared with vestibular schwannoma and control specimens. The vessels in Ménière’s specimens appeared disorganized with abnormal, uneven, or constricted shapes, atypical branching, and decreased coverage and thinning, leaving vascular endothelial cells (VECs) exposed and unprotected. Our prior research had shown that in Ménière’s disease, VECs are damaged and that they contain oxidative stress markers. Our new study underscores possible mechanisms behind BLB disruption in Ménière’s and the subsequent signs of edema (excess fluid), which disrupts the homeostasis of the hearing and balance structures.
The report indicates that interventions aimed at preventing damage to the microvasculature may help stop the progression of damage to the vestibular system, restoring balance and preventing vertigo spells. It could be that decreasing vessel constriction and BLB leakage will help prevent chronic damage to balance structures; this may help explain how steroids administered to Ménière’s patients provide temporary relief from dizziness symptoms. The paper also shows that human inner ear tissue can be used to compare and contrast findings in animal models to design better therapies for vestibular and auditory disorders. We hope that the deeper understanding of the anatomy of the BLB and its changes during disease will enable the development of noninvasive delivery strategies for treating hearing and balance disorders. —Gail Ishiyama, M.D.
Gail Ishiyama, M.D., a 2016 and 2018 ERG recipient, is a clinician-scientist who is a neurology associate professor at UCLA’s David Geffen School of Medicine.
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Children’s Working Memory and Phonological Awareness Benefit From Hearing Earlier EMERGING RESEARCH GRANTS
Literacy—the ability to read and write—is key for a child’s success in school. This ability requires phonological awareness, an understanding of a language’s sounds, and how to combine sounds into words. Children who are deaf or hard of hearing often experience difficulties with literacy given their limited access to sounds and the resulting poorer phonological awareness skills. In the September 2019 issue of Frontiers in Psychology, 2017 Emerging Research Grants scientist Christina Reuterskiöld, Ph.D., and team detail their study of the relationship among rhyme awareness (the first phonological skill children develop), vocabulary size, working memory, and linguistic characteristics of words in children with typical hearing and children with cochlear implants. Studies have shown that cochlear implants improve speech and language skills in children with hearing loss, but the researchers were more specifically interested in these children’s phonological awareness skills. They tested this by presenting the children with groups of words and asking them to identify the one that did not rhyme with the others. In contrast to previous studies on typically developing children, they found that in children with cochlear implants, it made little difference if a target word belonged to a group of many rhyming words or few rhyming words, or whether a child’s vocabulary was large or small.
This research suggests a potential association between hearing experience and working memory skills, further underscoring the importance of early treatment for hearing loss. Instead, it was working memory that proved most important. Working memory allows individuals to temporarily store or process information. The group found that there were no significant differences in working memory skills between children with typical hearing and children with cochlear implants with similar hearing experience. (These children had been implanted at an early age and were slightly older than the typical hearing children in the study.) The authors caution that their findings must be interpreted in light of the small number of children (six subjects) with cochlear implants who participated in the study. Nevertheless, this research suggests a potential association between hearing experience and working memory skills, further underscoring the importance of early treatment for hearing loss. —Christopher Geissler, Ph.D.
Christina Reuterskiöld, Ph.D., is an associate professor of communicative sciences and disorders at New York University’s Steinhardt School of Culture, Education, and Human Development. Her co-principal investigator was Katrien Vermeire, Ph.D., an assistant professor of communication sciences and disorders at Long Island University, New York. Reuterskiöld’s 2017 ERG grant was generously funded by the General Grand Chapter Royal Arch Masons International. 44
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Pinpointing How the Temporal Processing of Nerve Cell Signals Is Important in Hearing As many as 10 percent of preschool children exhibit some form of developmental speech processing disorder that cannot be attributed to known causes, such as hearing loss or neurological problems. Such listening disorders are accompanied by typical hearing, as determined by traditional hearing tests that assess inner ear function, indicating that these processing deficits are located within the brain. Studies of central auditory processing disorders (CAPD) have identified degraded timing of midbrain activity as a predictor of listening difficulties in adults and children, but the source of dysfunction is unresolved. Genetically engineered knockout mouse models in which a specific gene is knocked out, or removed, can be used to discover how the processing of timing information may be altered in the developing auditory system and, as a result, how problems with temporal processing impacts listening in humans. Our mouse model involves the disruption of cholinergic signaling. Nerve cells that are cholinergic use the neurotransmitter acetylcholine to send messages (in contrast to adrenergic nerve cells that use epinephrine or related substances to transmit signals). The CHRNA7 gene, which affects the function of acetylcholine, is considered to be a primary candidate gene causing a wide spectrum of neurodevelopmental disorders, including autism spectrum disorder. Genome-wide studies have found that CHRNA7 is one of a few genes associated with reading disability and specific language impairment, supporting the hypothesis that CHRNA7 is an important gene for the development of language. In our study published in the Journal of Neurophysiology in July 2019, we examined the temporal processing of knockout mice whose cholinergic signaling is disrupted compared with wild-type mouse controls. We found degraded, abnormal timing of neural activity in the knockout mice at the level of the auditory brainstem and midbrain. These findings underscore the importance of cholinergic signaling in types of neurodevelopmental and auditory processing disorders. Understanding the contribution of cholinergic signaling to auditory processing can help us increase the understanding of language impairment and assist in the development or refinement of noninvasive diagnostic tests, pharmacological treatments, and behavioral therapeutic strategies. —Richard A. Felix II, Ph.D.
Richard A. Felix II, Ph.D., is a postdoctoral researcher in the Hearing and Communications Lab at Washington State University Vancouver. His 2016 ERG grant was generously funded by the General Grand Chapter Royal Masons International.
Genetically modified “knockout� mice (red, right) show differences in the timing of auditory brainstem responses compared with wild-type (blue, left) mice.
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Unraveling Sound Frequency Organization in the Mouse Auditory Cortex Tonotopy refers to the spatial arrangement of where sound is perceived, transmitted, or received. “Tono” is from the Greek for frequency, and “topos,” place. There is tonotopy of the cochlea, in that higher frequencies stimulate neurons in the base of the cochlea, while lower frequencies stimulate neurons in the apex, or center. The orientation and placement of sensory hair cell bundles that react to sound waves and transmit that information to the brain are also examples of tonotopy. It is known that different regions of the brain respond to varying frequencies. But while the mouse is among the most popular model systems for studies of cortical sound processing and brain plasticity, fundamental aspects of core and higher order cortical field organization have been unclear. The bestfrequency organization (the frequency at which a neuron is most responsive) and naming scheme for additional higher order fields remain a matter of debate. In a study published in Cerebral Cortex on Oct. 30, 2019, a group of researchers, including 2017 ERG scientist Jennifer Resnik, Ph.D., and past ERG reviewer Daniel B. Polley, Ph.D., add to the knowledge of the tonotopy of the mouse auditory cortex.
EMERGING RESEARCH GRANTS
The imaging data suggests that in the mouse there is no ultrasonic field (which the researchers argue is a misnomer anyway in the mouse as it is an anthropomorphic term) or a secondary auditory cortex (as in other animals, including humans).
The five fields of the mouse auditory cortex: the primary auditory cortex (A1), anterior auditory field (AAF), suprarhinal auditory field (SRAF), ventral posterior auditory field (VPAF), and dorsal posterior (DP).
Using special imaging techniques on transgenic mice to gather cellular-level, high-resolution data for mapping and analysis, the team identified five fields. One is a previously unidentified area of the mouse auditory cortex at the ventral posterior extreme of the auditory cortex. The imaging data suggests that in the mouse there is no ultrasonic field (which the researchers argue is a misnomer anyway in the mouse as it is an anthropomorphic term) or a secondary auditory cortex (as in other animals, including humans). The team makes recommendations for tweaking the nomenclature of brain regions for better uniformity with other animal models and identifying brain areas for future investigation. —Yishane Lee
Jennifer Resnik, Ph.D., is a postdoctoral fellow in the Polley Lab, part of the Eaton Peabody Laboratories, Massachusetts Eye and Ear/Harvard Medical School. Her 2017 ERG grant was generously funded by Hyperacusis Research Ltd. Daniel B. Polley, Ph.D., has been a past reviewer of ERG grants. For references, see hhf.org/winter2020-references. 46
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2019 Emerging Research Grants recipient Victor Wong, Ph.D., cycles competitively.
Investigating Molecular Tracks By Victor Wong, Ph.D.
photo credit (top right): atkinns to
I was diagnosed with a profound bilateral sensorineural hearing loss at the age of 4, and since then I have worn hearing aids. My hearing has greatly affected my career decisions as I not only want to learn more about hearing loss but also am motivated to find solutions for it. I am a postdoctoral scientist working in the area of neuroscience, which provides me the opportunity to study the auditory system. My current work focuses on nerve cells (neurons). The success of cochlear implants as well as future therapeutic approaches to hearing loss depends on the integrity of spiral ganglion neurons—most notably the availability of functional neurites (axons) for direct electrical stimulation and the transmission of the sound signal. Not much is known about how these neurites grow and are regenerated. I originally specialized in diabetes and metabolism research during my graduate studies, and when I arrived at Burke Neurological Institute in New York, I started working with Brett Langley, Ph.D. He and I had a particular interest in post-translational modifications of microtubules in central nervous system neurons. Microtubules provide structural support and molecular “tracks” for transporting mitochondria and mRNA, which are important for neurite function and growth. “Post-translational modifications” refers to chemical modifications that regulate cellular activity, among other key roles. One of the modifications is the process of acetylation, which is a type of chemical reaction that can change protein function. A number of studies show that if you can increase this modification in microtubules, or in the mitochondrial transport protein called MIRO1, there are significant benefits such as neurite growth. Given my interest in hearing loss, I wondered whether this biological process also occurs in the specialized neurons in the auditory system. Thanks to the Emerging Research Grants (ERG) program, I am continuing the investigation into the role of molecular microtubules, establishing the importance of acetylation as a potential
therapeutic target to treat hearing loss. Eventually I hope my work will be an integral part of the push for therapeutic development for neurological disorders, including hearing loss. I am also motivated to use my work as a platform to educate and inspire the next generation of scientists, particularly encouraging people with various abilities to join STEM research (science, technology, engineering, and math). I have just begun working with Weill Cornell Medicine’s Diversity and Inclusion Office to make science and medical education and training accessible to all, and also to raise awareness of hearing health. We are planning to create an outreach program that allows students who are deaf and hard of hearing to gain an immersive experience in a laboratory. I am a staunch believer that passion and motivation are roots to success, and all of us, especially those with disabilities, have hidden potential and passion waiting to be unlocked.
Victor Wong, Ph.D., is a postdoctoral scientist at Burke Neurological Institute, Weill Cornell Medicine, in New York, and a 2019 ERG recipient. For more, see hhf.org/erg.
Share your story: How has a hearing or balance condition affected your career? Tell us at editor@hhf.org.
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meet the researcher
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EMERGING RESEARCH GRANTS
Emerging Research Grants (ERG) As one of the only 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.
Meet the Researcher David Martinelli, Ph.D.
University of Connecticut Health Center
Martinelli received his doctorate in developmental biology from Johns Hopkins University and the Carnegie Institution for Science. He completed postdoctoral training at Stanford University and is now an assistant professor of neuroscience at the University of Connecticut Health Center. His 2019 Emerging Research Grant was generously funded by Hyperacusis Research Ltd.
In His Words as a postdoc i studied a gene called C1q-like 3 in the brain. I showed it was important in allowing neurons to communicate with one another in the brain. In 2014, a paper suggested that the gene C1q-like 1, in the same family, was important in the cochlea’s sensory hair cells. At the time, I didn’t even know what hair cells were, so I sat on this publication for years. Then it was serendipitous that the neuroscience department where I am an assistant professor has long studied the auditory system. We could combine my expertise and tools to study C1q-like genes with experts on the auditory system.
in a high school genetics glass, I remember separating fruit flies whose genes made their eyes different colors. I loved it and majored in molecular genetics in college. In graduate school I joined the lab of Chen-Ming Fan, Ph.D. We studied a gene called sonic hedgehog (known as SHH, and not to be confused with Sonic the Hedgehog). Like a second father to me, Dr. Fan showed me how to mentor (we are still close), and I now consider teaching the students in my lab to be a sacred responsibility.
as we looked more closely at this gene, we realized that it may have a function in the detection of auditory pain. Hyperacusis is a condition in which a person experiences pain at a much lower volume level than listeners with typical hearing. Using a novel animal model in which this gene that is part of the pain circuit is missing, we hypothesize it will lessen the perception of auditory pain when high intensity sounds are presented.
David Martinelli, Ph.D., is funded by Hyperacusis Research Ltd. We thank Hyperacusis Research for its support of studies that will increase our understanding of the mechanisms, causes, diagnosis, and treatments of hyperacusis and severe forms of loudness intolerance.
for a science project when I was 14, I built a 6-foot-by-10-foot maze and ran my pet hamsters through to get a food reward at the end. The little critters did indeed improve their maze running time. My mother says after all these years that I am still playing with rodents, which is quite true.
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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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1 Dillon MT, et al. Effect of Cochlear Implantation on Quality of Life in Adults with Unilateral Hearing Loss. Audiol Neurotol 2017;22:259-71.
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