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HEARING HEALTH Volume 26 Number 3, Summer 2010 Publisher

Deafness Research Foundation Andrea Boidman, Chief Operating Officer Editor-in-Chief

Donna Lee Schillinger Art Director

Devorah Fox, Mike Byrnes and Associates Associate Editor

Jamie Morrison Medical Director

George A. Gates, M.D. Staff Writers

Samuel Atcherson, Ph.D.; Devorah Fox; Nannette Nicholson, Ph.D.; Jessica Woodard Advertising

866.454.3924, advertising@drf.org Contributors

Rod Anderson; Andrea Boidman; Joseph M. Furman, M.D., Ph.D.; Jochen Schacht, Ph.D.; Andra E.Talaska; Susan L. Whitney, P.T., Ph.D.; Alan Williamson Board of Directors

Clifford P. Tallman, Jr., Chairman; Robert Boucai; Judy R. Dubno, Ph.D.; George A. Gates, M.D.; Rebecca Ginzburg; Roger M. Harris; David S. Haynes, M.D.; Elizabeth Keithley, Ph.D.; Richard Miyamoto, M.D.; Michael C. Nolan; Paul E. Orlin; Peter Steyger, Ph.D.; Elizabeth Thorp; Richard A. Uzuanis; Ronald E. West A publication of

641 Lexington Ave., 15th Floor New York, NY 10022-4503 Phone: 866.454.3924 TTY: 888.435.6104 E-mail: info@drf.org Web: www.drf.org Deafness Research Foundation is a tax-exempt, charitable organization and is eligible to receive tax-deductible contributions under the IRS Code 501(c)(3). Federal ID # 13-1882107.

It has been the heartfelt aim of Deafness Research Foundation (DRF) to be a catalyst for advances in hearing research since its founding 52 years ago. While we mourn the loss of our founder, Mrs. Collette Ramsey Baker, who passed away on May 9 this year at the age of 91 (see p. 26), she would have been both proud and humbled to see – and hear – of the astonishing progress DRF has encouraged through its grants and leadership, much of which is featured in this issue of Hearing Health. In many ways, “New Treatments and Technologies for Better Hearing” (p. 30) is a progress report of research DRF has supported over the decades. The advances are amazing and techniques under development now are sure to revolutionize otolaryngology. Imagine being able to restore lost hearing, or to take a medication that would prevent hearing loss due to overexposure to loud noises! Even as we eagerly await such tantalizing promises, it’s encouraging to know of current solutions for those who face the agonizing ultimatum of losing their hearing or losing their life. Researchers at the Kresge Institute have found that several antioxidants, and possibly even aspirin, can prevent or reduce hearing loss for people who, in order to stay alive, need certain drugs that damage hearing. Find out more in “Ototoxic Drugs’ Dilemma: You Live, Hair Cells Die” (p. 39). The connection between the hearing and balance systems is often overlooked. Yet much of the research on the inner ear informs progress in treatments for both balance and hearing loss. Scientists at the University of Pittsburgh are formulating new diagnostic tests and treatments to help abate sensations of dizziness or lack of balance. “Advances in Vestibular and Balance Rehabilitation” (p. 8) describes these exciting solutions, some of which involve the use of computerized video games and virtual reality. And, as always, our diligent Trends reporters have gleaned from the best new products and technologies at the annual AudiologyNOW! conference, held this year in San Diego. Find out which new hearing aid, cochlear implant or other promising device could give you a new outlook on life this summer in “Showstoppers! On the Red Carpet in San Diego” (p. 12). No summer would be complete without some leisurely reading. So check out new hearing-related reads in “Beach Bag Essentials” (p. 36). Sun and fun to you this summer! Warm regards,

Cliff Tallman Cliff Tallman Deafness Research Foundation Chair, Board of Directors

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HEARING HEALTH Volume 26 Number 3

Summer 2010

Features

On the Cover New Choices for Better Hearing .........30 Showstoppers! from AAA .....................12 Protect Your Hearing with Antioxidants?...................... .............39 Good Beach Reads................................36

BALANCE ---------------------------------------------------------------------- 8

Advances in Vestibular and Balance Rehabilitation Susan L. Whitney, P.T., Ph.D., & Joseph M. Furman, M.D., Ph.D.

LIFE-CHANGING TECHNOLOGY -------------------------------------- 12

Showstoppers! On the Red Carpet in San Diego Nannette Nicholson, Ph.D., & Samuel R. Atcherson, Ph.D.

LIFE WITH HEARING LOSS --------------------------------------------- 24

Starving Artist No More Jessica Woodard HEARING HEALTH -------------------------------------------------------- 28

In Praise of Ear Plugs Alan Williamson MANAGING HEARING LOSS ------------------------------------------- 30

New Treatments and Technologies for Better Hearing Jamie Morrison VIEWPOINTS --------------------------------------------------------------- 36

Beach Bag Essentials: New Hearing-Related Reads for Summer “Cosmic Crystal Ball” by Joe Finkler

RESEARCH ----------------------------------------------------------------- 39

Ototoxic Drugs’ Dilemma: You Live, Hair Cells Die Andra E. Talaska & Jochen Schacht, Ph.D.

Next Issue Deafness Research Foundation 2010-2011 Grant Annoucements New and Improved Speech-to-Text Technologies The Gender Bias of Hearing Loss

Bernafon’s Spirit of America Collection of hearing instrument shells Photo courtesy of Bernafon”

Departments Hearing Health (ISSN: 0888-2517) is published four times annually by Deafness Research Foundation. Contact Hearing Health for subscription or advertising information at: info@drf. org or 866.454.6104. Copyright 2010, Hearing Health. All rights reserved. Articles may not be reproduced without written permission from Hearing Health. For permission to reprint an article in part or in whole, contact Andrea Boidman by email: info@drf.org. In no way does Deafness Research Foundation nor Hearing Health magazine endorse the products or services appearing in the paid advertisements in this magazine. Further, while we make every effort to publish accurate information, Deafness Research Foundation and Hearing Health are not responsible for the correctness of the articles and information herein. USPS/Automatable Poly

Opening Lines -------------------------------------------------------------------------3 Mailbag----------------------------------------------------------------------------------6 DRF Centerstage ------------------------------------------------------------------- 26 Have You Heard? ------------------------------------------------------------------- 44 Heard Around the World ---------------------------------------------------------- 45 Under the Scope -------------------------------------------------------------------- 46 Marketplace -------------------------------------------------------------------------- 48

Mailbag

Share the Road I read with interest the article "Life with Hearing Loss: Fast-Paced Canadian Race Car Driver Sets Sights on NASCAR" (Spring 2010). However, Kris Martin is not the first North American race car driver born profoundly deaf. My cousin, Greg Gunderson, has been racing since the late 1980s (I believe the first year was 1988). He is profoundly deaf and comes from a racing family. The 2010 season is Greg's 15th year of Sprint car racing. His Web site is www.gundersonracing.com. Marsha Gunderson via www.drf.org Editor’s Note: The above-mentioned article implied that Kris Martin hopes to be the first North American race car driver born profoundly deaf. In fact, he hopes to be the first born-deaf North American NASCAR driver. Our apologies to Greg Gunderson.

Racer Greg Gunderson with his wife Christa and their two daughters. Photo courtesy of www.gundersonracing.com

Good Vibrations The article “Cell Phones and Hearing Aids, More Compatible than Ever” (Winter 2010), did not say anything about the vibrate mode on cell phones. If you wear a hearing aid, as I do, it is hard to hear the ring tones, so I depend on the vibration to answer the phone. Most of the new phones have a very poor vibrate mode that cannot be felt. I just got a Droid phone – very nice and I can hear on it with a profound hearing loss, but cannot answer it because of the poor vibrate. So I will return it. Meanwhile, I’m still looking for one with a good vibrate mode. Jim Barnard Ventura, Calif. The Audiogram Explained, Again Some important information was omitted in final edits from my article “The Audiogram Explained, At Last” (Spring 2010). The following helps to more thoroughly explain the process of finetuning an audiogram for young children: When testing is new to a young child, it will likely be minimal response levels that are noted. As the child gains practice with the testing, thresholds will more likely be obtained. Often early testing of infants and young children will give only a general idea of hearing levels and type of hearing loss. It can take some time and a few test sessions to get a complete picture of a

young child’s hearing levels for all pitches. Treatment can begin based on the general idea of a young child’s hearing loss while still working to more accurately define the audiogram. Also, this statement: “If these bone conduction bracket symbols are above your Xs and Os on the graph, then hearing loss is all or partly conductive. This indicates that your inner ear is hearing well but something in the outer or middle ear is blocking hearing” should more accurately state that the inner ear is hearing better than the outer, middle and inner ear together. Melanie Sisson, Au.D., CCC-A Stonington, Conn. ■

Please send your letter to the editor to info@drf.org or Deafness Research Foundation, 641 Lexington Ave., 15th Floor, New York, NY 10022. Letters are printed on spaceavailable basis and edited for clarity.

Online Exclusives! “Listen to Your Buds” Kids’ Concert Series - A Photo Feature Going Bilateral: A Journey to Even Better Hearing Log on to www.hearinghealthmag.com

6 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

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BALANCE

Advances in Vestibular and Balance Rehabilitation BY SUSAN L. WHITNEY, P.T., PH.D., AND JOSEPH M. FURMAN, M.D., PH.D., UNIV. OF PITTSBURGH

bike ride sounds like fun – but your bike has been garaged for years. The last time you rode, you felt shaky. Now, you’re doing well to walk across the living room without losing your balance. Are you on an irreversible path toward needing a walker? Not necessarily. But the first step in the opposite direction is to see an ear, nose

8 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

and throat doctor. The inner ear is responsible for both hearing (cochlea) and balance (labyrinth). Some medical conditions affect both hearing and balance such as Ménière’s disease, labyrinthitis and inner ear concussions. Other times, balance problems occur independently of hearing loss. However, research on balance is benefiting both those with hearing loss and those without. Often a better understanding of balance can improve our understanding of hearing disorders as well. Balance disorders make people feel dizzy or unsteady. Some people with such disorders feel as if they are spinning, moving or floating, even while lying down or standing still. Difficulties with balance can arise from a variety of causes, including systemic diseases and specific disorders of the inner ear or brain. For example, there appears to be a relationship between difficulties with balance control and changes in the brain’s white matter, commonly seen in MRI scans of older adults. It is also fairly common for a person to experience dizziness in combination with migraine headaches.The first step in helping restore quality of life for people with dizziness and balance disorders is to find the correct diagnosis. A carefully designed questionnaire is one important diagnostic tool used to identify the source of a balance disorder. Joseph Furman, M.D., Ph.D., and Dawn Marcus, M.D., of the University of Pittsburgh, have developed a test that doctors and nurses can use to help them determine if a person’s dizziness might be the result of migraines. Normally migraines cause a severe headache but they can also result in dizziness. Oddly, it is even possible for people to experience the dizziness associated with a migraine without getting a headache. Another questionnaire, based on the International Classification of Function from the World Health Organization, is currently being designed to help clinicians follow improvement or degradation of a person’s ability to participate in regular daily activities within their home and community because of balance problems. Physicians, physical therapists and occupational therapists from the United States, Europe, Australia and South America helped select the

Figure 1. An older adult walking in a virtual reality grocery store. The person pushes the cart to move the treadmill at a speed that is comfortable to them as they shop in the “store.” An overhead harness prevents them from falling down. The physical therapist stands behind the person to protect them and to tell them what they should be looking for on the grocery shelf. The device is being used as physical therapy treatment for people with dizziness problems. Photos on p. 9-10 courtesy of Susan L. Whitney, P.T., Ph.D., and Joseph M. Furman, M.D., Ph.D.

most important factors the test should evaluate to determine if people with balance problems are becoming more or less able to participate in certain activities. The hope of this international group was that all healthcare professionals treating balance problems would start to look at similar indicators in order to determine if patients were improving or declining in their ability to deal with balance issues. In addition to these new diagnostic tools, many exciting advances have been achieved in the care and management of people living with balance and dizziness disorders. During the past several years, clinicians have worked with engineers on innovative methods of helping people regain control of their balance. Some of these ideas have come from scientists, while others have employed familiar products from the computer gaming industry. One such new technology is the Nintendo Wii™, a virtual-interactive computer game that requires some type of physical activity. The Tai Chi game provides feedback about shifting weight under your feet.The idea of using video games to help people is not new, but the new game systems are effective because the graphics are easy to see and the machines are simple to operate. No scientific studies have yet been completed to evaluate whether games like the Wii really do help people with balance and dizziness problems but ongoing research should soon provide answers as to whether this kind of technology is genuinely helpful. Previous studies done with people practicing activities while standing have improved their balance while standing still, but not while walking. Perhaps a Wii, or some similar new device, might be a fairly inexpensive way to improve walking balance in the future. These video games can make exercise fun and also provide feedback about how people are doing. For example, therapists could track how much practice their clients are putting in at home with these types of devices. At the University of Pittsburgh we have developed a virtual reality grocery store within the Medical Virtual Reality Center, which is designed to help people improve their balance during everyday activities (see Figure 1). By practicing walking in the virtual store on an instrumented treadmill, we hope to help people overcome balance and dizziness problems in ways that will transfer to real world walking. We are now completing an experiment to try to determine if walking in the virtual grocery store is an effective

type of therapy for people with balance and dizziness problems. People with balance and dizziness problems often complain that it is difficult to move their head without getting dizzy.Thus, investigators have been working on a new test protocol for determining if people can move their head faster, without dizziness, after they have completed a customized exercise program (see Figure 2).The team is also testing whether people with mild head injuries who

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Figure 2. The person is looking at the screen in front of him and is moving his head to the right, left, up or down depending on the test. Over several attempts, we determine how fast the person can move his head and still see the same size target on the screen. He is looking at an “E,” which is projected onto the screen for a short time as he moves his head. This test helps us to determine if a person is getting better after a dizziness problem.

are dizzy have trouble with moving their heads at normal speeds. Still other studies are evaluating a device designed to gather longitudinal data about how fast the person can move their head while simultaneously focusing on a target that is flashed quickly on a computer screen in front of them. Results thus far indicate that faster walking ability seems to be related to a person’s ability to move their head quickly while sitting down and performing this test. Preventing falls is a major focus of physical therapy for people with dizziness and balance disorders. Engineers around the world have been experimenting with devices that vibrate when the person begins to sway, tilt or topple, providing them with additional sensory feedback about their balance. Studies are trying to determine whether people with balance disorders can benefit from this type of technology. There is at least one study that suggests that vibration feedback under the foot can make a person steadier during walking. Others have shown that vibration feedback on a person’s torso can make them more stable when they walk. We know that people with vestibular (dizziness) disorders fall much more frequently than people who do not report dizziness, so any

additional sensory input that they can receive to help them with their balance may decrease the risk of falling down. A team of engineers, doctors and physical therapists from the University of Michigan and the University of Pittsburgh are working together to improve the design of vibratory feedback devices to prevent falls for people with balance disorders. Over the last two years, investigators have been trying to record balance through the use of an accelerometer, a small, inexpensive device that can provide information about how a person moves (see Figure 3), which is helpful in individual physical therapy as well as research. Employing Bluetooth technology, the device wirelessly records body movements. After collecting data on more than a hundred people, accelerometers may soon be used in clinical settings. The accelerometer provides similar information to recordings from expensive therapy devices, while offering much more convenience, mobility and cost savings. Small accelerometers are an exciting new addition to methods that record body movement in people with balance and vestibular disorders. At the University of Pittsburgh, we are working on moving new technology into the hands of front-line clinicians to help people with balance and dizziness problems. We hope that our research will improve quality of life of people who deal with balance problems and enable them to engage in all the activities that are important to them. ■

Figure 3. The accelerometer, placed around a person’s waist, records body movements. The readings are transmitted wirelessly via Bluetooth technology to a computer. The device appears to be accurate at recording body movement and is inexpensive compared to other machines that are currently in use. This was developed in collaboration with experts in bioengineering, physical therapy and otolaryngology.

Susan L. Whitney, P.T., Ph.D., is an associate professor in the Departments of Physical Therapy and Otolaryngology at the University of Pittsburgh and is the program director for the Centers for Rehab Services at the Eye and Ear Institute, University of Pittsburgh Medical Center. Joseph M. Furman, M.D., Ph.D., is a professor in the Departments of Otolaryngology, Neurology, and Physical Therapy at the University of Pittsburgh and is the director of the Division of Balance Disorders at the University of Pittsburgh Medical Center. The authors would like to thank Cary Balaban, Ph.D., for his assistance in coordinating this article.

10 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

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LIFE-CHANGING TECHNOLOGY

Showstoppers! On the Red Carpet in San Diego By NANNETTE NICHOLSON, PH.D., AND SAMUEL R. ATCHERSON, PH.D.

rends reporters set out like paparazzi to get a glimpse of this yearâ&#x20AC;&#x2122;s new premieres, stars and major players in the exhibit hall of AudiologyNOW!, the annual conference of the American Academy of Audiologists held in San Diego in May. Here are their finds.

12 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

Hearing Aid Premieres

Great strides continue to be made in application of digital signal processing strategies (DSP) for hearing aids. Each generation of technology benefits from the lessons of the past and progress seems to be exponential. And, there is a new buzzword: “insta-fit,” referring to open-fit, behind-the-ear (BTE) hearing aids that do not require an earmold impression or custom earmold. Some manufacturers have also introduced modular in-the-canal (ITC) models that do not require earmold impressions either. audifon USA featured elia, arriva and avero hearing aids, each presenting a DSP algorithm based on the company’s Storm platform. elia is available in receiver-in-the-ear (RITE), BTE, in-the-ear (ITE) and superpower custom devices with up to 70 decibels (dB) of amplification and super-fast DSP. arriva, available in BTE and ITE styles, features audifon’s AFC2 automatic feedback control algorithm, and a slower DSP algorithm to save 15 percent on battery consumption. Both devices are digitally programmed. In contrast, the avero achieves even longer battery life and can be adjusted outside of a hearing healthcare professional’s office via trimpots (trimming potentiometers), making it an ideal choice for individuals living in rural areas and receiving home medical services, or those living in nursing homes. More information can be found at www.audifon.com. Audina® Hearing Instruments debuted INTELLIO® and flx®. INTELLIO features advanced DSP algorithms including EnviroScan (high-precision listening in any environment), IntelliScan (automatic scanning of the environment to enhance listening experience and improve comfort), IntelliSense (adaptive directional microphone and digital volume control) and Softwave® (data logging and high fidelity audio processing). The flx, a BTE/ over-the-ear instrument, is now available with the Clarujust™ phoneme-based optimization fitting program. Developed with Audigence and the University of Florida, this fitting method uses speech sounds to program digital hearing instruments in conjunction with active patient participation.This Clarujust fitting program will be incorporated into Audina’s ezFIT programming software and will soon be released with other Audina instruments. For more information, visit www.audina.net. Bernafon’s Veras offers Bluetooth® capability and a versatile selection of fitting options, including Nano, Micro, Power BTE and custom choices. Music lovers, take note of Bernafon’s proprietary ChannelFree™ technology that treats incoming signals as a whole,

maintaining the original balance between low and high frequency harmonic energy. Learn more at www.channelfreehearing. bernafon-us.com. Clik® is a full-featured, open-fit, fully digital BTE hearing aid, developed by Ear Technology Corporation, that allows fitting without programming via a computer. Clik’s interactive design provides a host of programming options with the simple push of a button. See www.clik-hearing.com for more details. ExSilent, a Netherlands-based newcomer to hearing aid production, believes a hearing aid should not look like a hearing aid and is therefore dedicated to the development of next-generation technology and design. ExSilent presented two completely-inthe-canal (CIC) products: Q and Qleaf. The Q is invisible while wearing and ear impressions are not necessary due to its modular design and patented, flexible, hypo-allergenic soft tip available in a variety of sizes. The Q comes with four channels and six bands, which include adaptive noise reduction, adaptive feedback management and four programs for different sound environments. There is also the Q8, with eight channels and 12 bands. Smaller than the Q is the Qleaf, also a modular CIC, designed for people with smaller ear canals or curved ear canals. Qleaf has four channels, 12 bands, adaptive noise reduction and adaptive feedback manager, and Qleaf8 has eight channels, 12 bands, adaptive noise reduction, adaptive feedback manager and data logging. Visit www.exsilent.com for a preview of their innovative design. “Tailored to your needs” is ReSound’s new slogan and the company is introducing a new generation of hearing instruments featuring 2.4 gHz technology. The Alera™ delivers wireless technology that doesn’t require a body-worn streamer, has cable-free fitting and programming, and increased transmission capacity that provides patients with a greater range of TV streaming and remote-control operation. The instruments receive crystal-clear sound directly from TVs, computers and other audio sources up to about 20 feet away via Unite™, the transmitter that attaches to the audio source. More information can be found at www.gnresound. com. Hansaton USA, responding to the need to recharge, recycle and reuse, has introduced the AQ Custom Rechargeable Hearing System, with patented overnight rechargeable battery technology, eliminating the cost and hassle of changing small hearing aid batteries. Overcoming previous limitations, AQ instruments hold a charge for 20 to 30 hours of wear time and are backed up by a sixyear battery guarantee. AQ’s award-winning ITE design is suitable for a wide range of hearing losses. Check them out at www. hansaton-usa.com. Oticon has introduced Oticon’s Agil Pro the Agil Pro, a secondPhoto courtesy of Oticon generation wireless

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Kids on Safari – Oticon Safari, that is. Photo courtesy of Oticon Pediatrics

hearing instrument featuring Spatial Sound, which helps listeners organize sound and make sense of where it is coming from, intuitively and effortlessly.Agil Pro also offers Speech Guard, which preserves the natural characteristics of speech-like timing and loudness of sounds while enriching sound quality. Additionally, Connect (+) features Power Bass, which produces a rich lowfrequency sound experience and preserves fidelity in the low

frequencies where sound is reduced due to leakage from an open fitting. Music Widening is a feature designed to give the listener a comfortable and authentic perception of the naturalness, depth and spatial fidelity of music. The system provides excellent speech understanding in noise, significant reduction in cognitive efforts to understand speech, improved audio through wireless technology for open fitting and enhanced 3D listening. Oticon’s new Safari includes dedicated pediatric features, making it an attractive solution for children and teens, including extended bandwidth to allow audibility and access to all parts of speech, an LED status indicator to confirm if the child’s hearing aid is working properly, and Spatial Sound to help preserve naturally occurring loudness cues that are important for maintaining localization cues. In addition, the Streamer can be worn with Safari, serving as a remote control and allowing transmission of any audio signal directly to both hearing aids. More information can be found at www.oticonusa.com. “Life is on” with Phonak which features SoundRecover, a propriety non-linear frequency compression algorithm that gently compresses and shifts high frequencies, ensuring that the full range of sounds is audible, thereby enhancing natural sound quality. Versáta Art and Certéna Art complete the product family that Exélia Art began, extending SoundRecover benefits to all wearers regardless of hearing loss, lifestyle, personal preference, age or budget. Phonak introduced ZIP into the Audeo product line, a discreet, modular, instant-fit CIC hearing solution available in three faceplate colors (pink, cocoa and brown) and three performance levels (III, IV,V).The InstantFit CIC Audéo ZIP is a perfect solution for first-time users with mild to moderate hearing loss. The open TwinVent eliminates occlusion and the MultiFlex Canal guarantees a level of wearing comfort expected from a custom-fitted device. A size range of hypoallergenic silicone domes and/or SecureFit Tabs offer better retention than ever before. See www.phonak-us.com for more information. The new Cobalt+ and Gem+ are Rexton’s latest receiver-in-the-canal (RIC) instruments, packed with features Phonak’s Audéo Photo courtesy of www.phonak-us.com

14 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

Siemens’ Pure® Photo courtesy of Siemens Hearing Instruments

Open wide for better hearing with Sonitus Medical’s™ SoundBite™. Photo courtesy of SoundBite

including Feedback Preventer, Wireless Assistant, Focus 360, Sound Radiance and much more. These products are examples of Rexton’s ongoing commitment to make better hearing more accessible to all people with hearing loss. Visit www.rexton.com for more details. Siemens Hearing Instruments launched a new product line based on the company’s BestSound™ Technology platform, a sophisticated suite of device features which include SpeechFocus™, FeedbackStopper™ and SoundLearning® 2.0. SpeechFocus ensures that the optimal directional pattern for speech understanding is automatically engaged, even in the noisiest environments. FeedbackStopper employs Siemens’ Acoustic Fingerprint Technology to distinguish between feedback and external signals that mimic feedback. Siemens’ SoundLearning 2.0 learns the wearer’s listening preferences in specific situations and automatically adjusts itself when in similar sound environments. Tek®-compatible, discreet and comfortable, BestSound Technology is featured in Pure®, Life™ and Motion® hearing instruments which are designed for mild to severe hearing losses. For more information, visit www. siemens.com/hearing. Sonic Innovations’ Touch™, a micro RIC device from last year, was named Best of Innovations Honoree in the Health and Wellness category at the 2010 International Consumer Electronics Show. This year, Sonic unveiled Endura™, a slim, fullyfeatured superpower BTE with direct audio input (DAI) for iPod

and Bluetooth connectivity when paired with the company’s DAI cable accessory. It also has adaptive and automatic directionality, digital noise reduction, an automatic, hands-free program, four manual programs, 11 predefined listening environments, data logging and voice alerts. Endura provides enough power to assist those with even the most profound hearing loss. For more information visit http://us.sonici.com. Sonitus Medical™, founded in 2006, developed the SoundBite™ hearing system, the world’s first and only nonsurgical and removable hearing solution designed to transmit sound via the teeth and help people with single-sided deafness. Nearly invisible when worn, the SoundBite system consists of an in-the-mouth hearing device, custom made to fit around either the upper left or

WWW.DRF.ORG 866.454.3924 TTY 888.435.6104 SUMMER 2010 15

upper right back teeth, and a small BTE microphone. This system is currently available for investigational use only pending FDA 501(k) clearance to treat single-sided deafness. Future applications are intended for conductive and mixed hearing loss. Visit www. sonitusmedical.com for Kids pick their favorite more details. color with Starkey Pediatrics Starkey presented hearing aids. Photo courtesy of www.starkey.com OtoLens™, an invisible, ITC hearing aid with minimal occlusion. This custom-molded device is built using the Comfort Fit process and resides in the second bend of the ear canal – beginning where a traditional CIC would end.This device features the same technology and DSP as Starkey’s new Series iQ devices and provides a wide fitting range with 60 dB of effective gain. OtoLens takes advantage of Starkey’s T2 Remote technology that allows for adjustments of volume or memory using any touchtone phone. OtoLens uses a size 10 battery that can be changed by the user.

Starkey Pediatrics is a comprehensive program with an evidence-based approach to technology, service and the critical interaction between audiologists, patients and their families. Starkey is the only hearing aid manufacturer authorized to feature Nickelodeon™ characters from the network’s most popular TV shows, including SpongeBob SquarePants™, iCarly™, Go, Diego, Go!™ and Dora the Explorer™.Visit www.starkey.com. Unitron showcased SmartFocus™, propriety technology combining multiple adaptive features into one powerful algorithm featured across all of Unitron’s core product line, including premium-level Passport™ and advanced-level Latitude™. Also featured was Fuse™, an open, instant-fit, deep ITE with standard-sized

Starkey Pediatrics partners with Nickelodeon Photo courtesy of Starkey © 2010 Viacom International Inc. All Rights Reserved. Nickelodeon, SpongeBob SquarePants, Dora the Explorer, Go, Diego, Go!, iCarly and all related titles, logos and characters are trademarks of Viacom International, Inc. SpongeBob SquarePants created by Stephen Hillenburg.

domes. Features include SmartFocus technology, self-learning capabilities, automatic programs and the convenient Smart Control remote. Ziel™ is a BTE insta-fit counterpart to Fuse and is available in two models, the Zeil and Zeil+; three power levels, standard, power and high-power; and in two battery sizes, 13 for standard power and 675 for high-power. Learn more at www. unitron.com. Widex offered a sneak preview of their highly-anticipated Clear440. This innovative product will offer consumers wireless communication between the user’s two hearing aids, resulting in better performance in noise; a high-definition locator microphone; the Audibility Extender (frequency transposition) where high-pitch sounds that are currently out of a wearer’s range of hearing are brought into their range of hearing; and optional accessories to help users enjoy listening to music,TV and cell phone conversations. The Mind Series, including the Mind440, the most advanced hearing instrument in the series, drew interest not only for its ultimate sound quality and speech enhancement, but also for Zen, a music program that has shown promise as a sound therapy tool for tinnitus management. In addition, Mind220, a lower-cost version, offers outstanding features like the Audibility Extender, SmartSpeak (where the hearing aids actually talk to you to guide you through certain processes), a high-definition locator microphone, noise reduction, multidirectional active feedback cancellation and many more features. Learn more at www.widexusa.com.

Implant Technology Stars Advanced Bionics launched the first Web site supporting and connecting cochlear implant (CI) candidates and recipients. This online community, called Connect to Mentor (www.bionicear.com/ ctm), allows CI candidates to search for mentors who include

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Custom Covers by Skinit for Advanced Bionics Harmony® and Auria® sound processors Photo courtesy of Advanced Bionics

parents of implanted children, relatives of CI recipients and CI recipients themselves. Each volunteer mentor has a profile complete with a personal photo and facts such as favorite sound, personal interests, hometown, age they were implanted, severity of hearing loss and how they can help CI candidates. It is social networking for the purpose of supporting CI candidates. The Harmony Listening Check lets clinicians, educators and parents check a CI recipient’s microphones, FM systems or other connected audio input by listening to the output. Advanced Bionics also recently partnered with Skinit to offer custom-made covers for Harmony® and Auria® sound processors. With Skinit designs, recipients can customize their sound processors to match their mood or wardrobe or simply to make a fashion statement. Processors can be dressed with favorite colors, sports team logos, motifs or works of art.The Skinit Web site offers thousands of designs to choose from or the option to upload graphics for a one-of-a-kind look.The designs are a great addition to the 20 colorful caps and covers that are already available to people with an AB implant (www.advancedbionics.com/CMS/ Products/Skinits.aspx). Cochlear™Americas (www.cochlearamericas.com) announced that the FDA has approved the Nucleus® 5 System for adults and children with severe-to-profound hearing loss. The Nucleus 5 is water-resistant and has one of the smallest processors and thinnest titanium CI receivers. A wireless two-way remote assistant puts you in control of your (or your child’s) processor without having to touch your ear. The remote looks like a small MP3 player and features a full-color display and easy-to-use navigation menu. The Nucleus 5 also features AutoPhone™ for telephone detection through an automatic telecoil and Zoom™ dual-omni microphone technology to enhance listening in noisy environments. Finally, the Set It and Go™ SmartSound™ 2 program is designed to automatically adapt to changes in the listening environment. Last summer, Cochlear Cochlear™ America’s Americas released the Nucleus 5 System Cochlear™ Baha® BP100 Photo courtesy of Cochlear Americas sound processor, a bone

18 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

conduction implantable technology for conductive, mixed and single-sided sensorineural hearing loss. With advanced automatic digital signal processing, the BP100 was redesigned especially for children, sporting tamper-resistant battery doors, a key/lock function and titanium and plastic casing for maximum durability. MED-EL’s (www.medel.com/US) MAESTRO™ cochlear implant system includes two audio processors, different wearing options, two implant designs and a wide variety of electrode arrays. The PULSARci100 and SONATAti100 cochlear implant components offer the latest in technology. Audio processor options include the OPUS 1 and OPUS 2. The newest cochlear implant audio processor, MAESTRO MED-EL’s MAESTRO™ OPUS 2 OPUS 2, is ultra-thin Photo courtesy of MED-EL and light. One or two OPUS 2s can be singularly controlled remotely with a FineTuner Remote Control, which features large buttons and allows users to change settings on the fly without having to miss sounds because of having to remove the processor. Oticon ventured into a new area of care with the creation of a new division, Oticon Medical, and having received FDA clearance to market the innovative Ponto hearing system. Similar in application to Cochlear’s Baha system, Ponto and Ponto Pro are fully digital and programmable implant systems for people with bilateral conductive or mixed hearing loss and single-sided deafness. As with all implants, a surgical procedure is required. The external component clicks on or can be secured with an elastic band. Check it out at www.oticonmedical.com.

Special Guest Stars Tinnitus Relief/Management and Assistive Listening Technology Melmedtronics (www.tinnitustreatment.com) has a new FDAapproved hand-held device, The Inhibitor™, which offers temporary relief of tinnitus. It is placed directly on the bone behind

the ear and, when turned on, emits a 60-second ultrasonic signal. According to Melmedtronics, patients have reported total or partial relief of their tinnitus, ranging from minutes to hours to days, and in some cases, weeks. ReSound (www.resound.com) has a combination hearing aid and sound-generator device called the Live™ TS that is designed not only to amplify sounds for the person with hearing loss, but also to help relieve or reduce bothersome tinnitus.Typically, white noise (which has many frequencies) is used in tinnitus treatment devices, but LiveTS provides flexibility by allowing a low-frequency cut and/or high-frequency cut to maximize user comfort. Live TS can also be set to allow white noise to be modulated in amplitude over the course of two to eight seconds – another method of increasing patient comfort with white noise. Unique to Live TS is Environmental Steering™, an automatic volume control that adjusts the loudness of the white noise, as environment noise levels vary. Patients with tinnitus will often complain that their tinnitus is worse in quiet settings.Thus when the environment is quiet, the white noise increases, and vice versa. Artone Communication Solutions (www.artonecs.com), a relative newcomer to the hearing industry, develops, manufactures and exports a large variety of hearing assistance technology devices. They offer the Artone Bluetooth LoopSet, which turns a hearing aid into a wireless communicator. The TVB is a Bluetooth transmitter for television that sends a wireless signal

to the Artone Loopset. The latest development is the TVB+, a personal communicator with an integrated microphone, which also has an option to connect to any audio device to stream audio signal to hearing aids. audifon (www.audifon.com) offers the RadioLight DIR II, a wireless headset for use with TVs and radios, with a listening range of up to 100 meters. For hearing aid users who use mobile phones with Bluetooth technology, the looplink allows hands-free cell phone conversation. The newest product from Bellman & Symfon (www.bellman. com) is the Bellman Visit 433 Smoke Alarm transmitter which, when activated, sends a radio signal to one of several Bellman Visit Receivers, which vibrate or flash and can be placed in a hightraffic area or carried using the pager receiver.The receivers are also

Bellman & Symfon alerting devices Photos courtesy of Bellman & Symphon

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compatible with the Baby-Cry transmitter, Door transmitter and Telephone transmitter. Bellman & Symfon has collaborated with hearing instrument manufacturer Unitron on the Smart Alert™ Project. People wearing Unitron’s Passport, Latitude, or 360+™ product lines are able to receive audible alerting signals directly via their hearing aids, offering greater freedom of movement around the house or workplace. In the Bellman Audio line, the Domino Classic is a wireless FM microphone transmitter and receiver system for use with telecoil-equipped hearing aids or without any aids at all, up to a range of 75 feet. These products are available from authorized distributors like Harris Communications (www.harriscomm.com) and Sound Clarity (www.soundclarity.com). Bo Edin (www.edin.se) has developed the UniVox® DLS50, a compact loop amplifier with a dual-action automatic gain control for home use and wireless listening with telecoil-equipped hearing aids. It features a thumb-wheel volume control as well as bass and treble controls. The DLS-50 can be connected to a TV, stereo, MP3 player, microphone or any other sound source you want to hear clearly. A choice of loop pad, sofa loop or 100-foot room loop cable is offered. ExSilent (www.exsilent.com) introduced its wireless audio integration (WAI) system, a technology developed to provide one platform for the integration of wireless systems. The WAI works with radio waves, unlike other wireless hearing aids that work with induction. The “Y,” coming soon, is the ExSilent modular hearing system equipped with WAI technology. The Y headset consists of a pair of programmable BTE hearing modules with microphone and receivers in the canal, rechargeable batteries and a recharging cradle. Specific mobile Web applications for smartphones turn these devices into a remote control for the headset. Features which can be controlled through the Web app include changing programs and adjusting the volume. The newest product from Etymotic Research (www.etymotic. com) is etyBLU2, a Bluetooth noise-isolating, hands-free headset. Though not designed as an assistive listening device, the etyBLU2 may be an option for people with mild to moderate hearing loss who do not use hearing aids. It does two great things: the earpiece design isolates the user from extraneous noise and the noisecanceling directional microphone sits very close to a person’s mouth to block out background noise for the person at the other end of the Kidzsafe™ Earbuds Photo courtesy of www.oaktreeproducts.com call. The result is an

20 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

improved mobile phone listening experience at both ends of the conversation. Kidzsafe™ Earbuds, available from Oaktree Products (www. oaktreeproducts.com) and designed specifically for children, control the output level of audio devices no matter how high the volume is turned up. Even when the volume in the music goes up, the output is automatically adjusted to keep it below 85 dB for safe hearing. Complete with a storage pouch, the earbuds feature a rubberized earbud casing and premium gauge cord to prevent tangling and increase durability. They are compatible with any audio device. Phonak’s (www.phonak-us.com) connectivity interface is the iCom, enabling hearing instrument users to connect to a diverse range of communication systems like telephones, televisions, MP3 players, computers or other audio sources. TVLink is Phonak’s new wireless TV listening system with a Bluetooth transmission range of approximately 90 feet. TVLink’s base station doubles as a charging cradle for the iCom. Humantechnik (www.humantechnik.com) has three new alerting devices: The popular shake awake™ vibrating alarm clock for travel or home has been modernized and features a highcontrast color scheme for better visibility. The new travelTim vibrating alarm clock is compact and has a fresh, modern look. And visuTone is a flashing, acoustic alerting device to help with hearing the telephone or doorbell. The newest addition to the PhonicEar® family (www. phonicear.com) is the HearIt Mobile Bluetooth neck loop for mobile phones, offering wireless, hands-free communication between mobile phones and headphones or telecoil-equipped hearing aids. TV Ears® (www.tvears.com), well known for its wireless TV listening device system, now offers the TV Ears TV, a 32” HD, LCD “senior-friendly” TV equipped with an automatic selfpairing headset. Features include an automatic sleep timer that

The new TV Ears® senior-friendly HDTV Photo courtesy of www.tvears.com

Call for Nominations Student Category: Young people with hearing loss, ages 6 - 21 who are full-time students. The first place winner receives a $1,000 prize, $1,000 gift to winnerâ&#x20AC;&#x2122;s school and a set of Oticon advanced technology hearing instruments.

Adult and Advocacy Category: The 13th Annual Oticon Focus on People Awards wants to honor outstanding people with hearing loss who are helping to show that hearing loss does not limit a personâ&#x20AC;&#x2122;s ability to make a positive difference in their families, schools, communities or the world. Please take a few minutes to tell us about an inspirational person with hearing loss that you know whose achievements and contributions make them a role model for all.

Adult: People with hearing loss, ages 21 and above. Advocacy: Adults with hearing loss who are actively involved in programs to benefit the hard-of-hearing and deaf community. Top winners in each category receive a $1,000 prize, a $1,000 gift to charity of choice and a set of Oticon advanced technology hearing instruments.

Hearing Care Practitioner Category* All nominations must be postmarked by Sept. 20, 2010. We encourage you to nominate all of the outstanding hard of hearing people you know. Please visit www.oticonusa.com, under the Professional or Consumer section to fill out our Focus on People online form.

Hearing care professionals in general practice and Pediatric practitioners in school or clinical settings. The first place winner receives a $1,000 prize and a $1,000 gift to charity of choice. *nominees in this category are not required to have a hearing loss to qualify.

In all categories, second place winners receive $500 and third place winners receive $250. All nominees receive Certificates of Recognition from Oticon.

Oticon Focus on People Award Winners

29 Schoolhouse Road, Somerset, NJ 08873

1-800-526-3921

www.oticonusa.com

Award-winning headphones

Williams Sound® Digi-Wave™ wireless listening system Photo courtesy of www.williamssound.com

shuts the TV off after four hours of no volume or channel activity, and voice clarifying circuitry that increases the loudness of speech while decreasing background noise, particularly useful when watching action films. Oticon Pediatrics (www.oticonpediatrics.com) offers the Amigo Arc, an attractive neck loop that delivers an FM signal to telecoil-equipped hearing aids, CIs and osseo-integrated devices such as the Oticon Ponto or Cochlear Baha. In addition, earphones or DAI cords can be plugged into the receiver. Williams Sound® (www.williamssound.com) introduced the Digi-Wave™, a two-way, digital, spread-spectrum, wireless listening system, featuring portable transceivers for one- or two-way

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use, Maxi is your ﬁrst choice. With no complicated menus to get lost in and truly ergonomic design, Maxi is practically intuitive to use. Maxi delivers the outstanding ergonomics and all digital sound you deserve to enjoy everyday life, whether you are at home, at work or on the road. Contact us or visit our website. www.bellman.se/maxi

Contact our authorized partners for more information. Valid only in July and August Harris Communications 1-800-825-6758 Voice/TTY | www.harriscomm.com Sound Clarity 1-888 477-2995 Voice/TTY | www.soundclarity.com

operation and receivers for by Able Planet digital, one-way listening ap- Photo courtesy of www.ableplanet.com plications.With patented frequency-hopping technology, Digi-Wave minimizes interference from other devices. Digi-Wave is ideal for such applications as portable language interpretation, guided tours, conferences (two-way communication) and wireless intercom, as well as personal FM. Best Supporting Actors Able Planet, winner of 25 international consumer electronics show awards for innovation, design and engineering, is on top of their game! Able Planet embeds their patent-pending LINX AUDIO™ technology into an extensive line of headphones and audio and communications products that enhance sound quality and speech clarity and are usable by people with all levels of hearing. LINX AUDIO creates high-frequency harmonics that enhance sound quality and speech clarity of difficult-to-hear words or notes, which increases the perception of loudness without increasing volume.Visit www.ableplanet.com. The newest additions to the Ear Gear (www.gearforears.com) family is the Ear Gear BAHA model and Ear Gear Eyeglasses, for hearing instruments and glasses across all models. Hearing device users go crazy for Ear Gear – join them on the user-created Facebook page: search “I❤My Ear Gear!!!” Oticon Pediatrics has recognized the value of Ear Gear and includes these protective products in every Oticon Pediatric Care Kit. E.A.R. Inc. (www.earinc.com) is new to the scene with HearPlugz-DF™, a multifunctional, dual-filter, hearing protector: (www. hearplugz.com). This earplug is designed to improve speech understanding in noisy situations and to hook up to a two-way radio communication device. The Dry & Store® Global II conditioning system for all types of hearing instruments – traditional hearing aids, cochlear implant equipment, noise maskers and ear monitors – is new and improved with a redesign from Ear Technology Corporation (www.ear tech.com) Dry & Store® Global lI Photo courtesy of www.eartech.com

22 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

that includes the addition of a UV lamp to sanitize hearing instruments. Ever-Dry™ (www.ever-dry.com) is an innovative new hearing aid dryer that combines silica gel (a desiccant) with a gentle heater to automatically reactivate the desiccant while the hearing aids are not inside the drying box. Maintenance-free convenience eliminates the need to bake, microwave or replace the desiccant. “Loopum™ or Loseum,” (www.loopum.com) is the motto! Loopums are small loops that join the hollow tube of BTE hearing aids and the stem of eyeglass frames to prevent loss of hearing aids. A set of six Loopum connectors (three sizes) costs $5.95 plus shipping – the cheapest insurance against loss of hearing aids you can buy. Introducing Micro-Cera and Micro-Glaze, Microsonic (www.microsonic-inc.com) has targeted designs for individuals with severe allergic reactions to conventional acrylic earmold materials. Micro-Cera is a new earmold material and Micro-Glaze is a new process used to coat the entire earmold with an antibacterial material, thereby reducing skin irritation. uHear™ is Unitron’s (www.unitron.com) self-administered hearing screening test for the iPhone™ and iPad™, and has continuously maintained its position as one of iTunes’ top 10 medical downloads (of 140,000 applications) since its release. Search “uHear” from within the iTunes program on your computer, or download iTunes software for free at http://itunes.com. Varta (www.varta-microbattery.com) features innovative chargers and power one ACCU plus rechargeable cell-type batteries in p 13 accu, p 312 accu, p 10 accu and p 675 models. High-performance rechargeable batteries utilizing Ni-MH technology are fast charging. The power one Card Charger (www.poweronebatteries.com) is a convenient and portable quick-charging system shaped like a credit card, so you won’t leave home without it. It charges up to two rechargeable hearing aid batteries, depending upon which battery insert adapter is used. The 675 Charger will be introduced in the fall, charging one or two cells in about five hours. ■

Hearing aid popped out unawares? Loopum or Loseum! Photo courtesy of Loopum, LLC

Nannette Nicholson, Ph.D., is an associate professor and director of audiology with a joint faculty appointment in the Department of Audiology and Speech Pathology at the University of Arkansas for Medical Sciences (UAMS) and University of Arkansas at Little Rock (UALR), and a clinical staff appointment at Arkansas Children’s Hospital (ACH). Samuel R. Atcherson, Ph.D., is an assistant professor with a joint faculty appointment at UAMS and UALR and is director of the Auditory Electrophysiology and (Re)habilitation Research Laboratory located in the Department of Audiology and Speech Pathology. The authors would like to thank Andrea Boidman for her assistance with this article. Please contact Nannette Nicholson at NN@uams.edu with any questions or comments.

Varta power one rechargeable hearing aid batteries Photo courtesy of Varta

WWW.DRF.ORG 866.454.3924 TTY 888.435.6104 SUMMER 2010 23

LIFE WITH HEARING LOSS

Starving Artist No More BY JESSICA WOODARD, STAFF WRITER

oe Finkler, 71, is a prolific artist. But he hasn’t always been able to create to his heart’s content and pay the bills too. Overcoming an inaccurate diagnosis when he was a kid and then the challenges of establishing himself as an artist with hearing loss, Finkler has only enjoyed the liberty to work full-time at his passion for the last

13 years. Things were tough when he was a kid growing up in New York City. At a very early age, his mother noticed that he wasn’t learning to speak. Finkler doesn’t think he was born deaf: “I believe something happened between the ages of two and three,” he says. “I remember hearing music.” Doctors were stumped. His mother even got him an appointment with famed pediatrician Benjamin Spock, M.D., author of numerous books on childrearing. Unfortunately, most of the doctors, including Spock, thought Finkler was developmentally disabled. Consequently, at age six, Finkler was sent to a school for children with disabilities. Since he couldn’t speak, he used art to communicate. “I wanted to prove I wasn’t an idiot,” he recalls. One insightful teacher, who began to suspect the real reason why Finkler wouldn’t answer when called upon in class, took him to the principal’s office and suggested that he was deaf. The school arranged for an IQ test, which revealed Finkler’s well-aboveaverage intelligence. These results led to a hearing test, which finally diagnosed his hearing loss. Hair Dos and Don’ts is a collection of whimsical Joe Finkler cartoons, available for purchase at www.JoeFinkler.com and Amazon.com. Right: “Do I Need a Perm?” Above: “A Bot’s View of Eternity” in pen and ink . All photos courtesy of Joe Finkler

24 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

A teacher at a school for the deaf, where he subsequently enrolled, “saved my life,” he says. She taught him to pronounce every letter of the alphabet. However, as Finkler explains, “I was not given the opportunity to learn sign language, so I became a master in lip reading.” And with years of speech therapy, Finkler’s speech became clear. After completing his studies at the school for the deaf, Finkler started going to a regular high school.“I was out to prove to everyone that I was the same as them,” he recalls. Finkler became a star athlete, an honor student and the artist for the local newspaper and school yearbook. At 16, he knew he wanted to go to art school. This aim was complicated, though, by his increasing fascination with science. Earlham College, in Richmond, Ind., a Quaker school renowned for its strength in the sciences, admitted Finkler as a prospective scientist. Little did they know what would happen when he discovered the art of Paul Cézanne. “I started off as a biochemistry major,” he says. “By the third year, the formulas on the blackboard became paintings. I lost focus unless I transformed the laboratory to a studio where I began a journey to another kind of exploring.” In addition to Cézanne, Finkler found new inspiration in the works of Picasso, Van Gogh, Matisse and Rembrandt. “To succeed, I needed to study all the masters of the Renaissance period through the Impressionists and beyond,” Finkler recalls. So he switched his focus from biochemistry to art and English. During the summer, he attended art school in Woodstock, N.Y., while also working his way through

college. After graduating, Finkler unveiled his artistry at his first show in Taos, N.M., at the age of 22. The late 1960s found Finkler immersed in the hippie culture of Haight-Ashbury in San Francisco, and on a two-year road trip between New York and Florida. “I covered almost every state,” Finkler said. Making a living as an artist did not come easily, though, especially considering his hearing loss. To supplement his income, Finkler worked for a time as a painter of another kind - a house painter. And at his lowest point, he became homeless and without a place to create or store art. Thankfully, though, after an article was published about him 13 years ago in a local Woodstock newspaper, fortune smiled and he was able to purchase a home. “I’ve painted every day since then,” Finkler smiles. Finkler’s style is eclectic, with works featuring everything from rocks to robots, and his sense of humor is apparent in his cartoon drawings. “I use art, also, to express humor resulting in over 4,000 human drawings and cartoons,” he wrote in his autobiography. Finkler has organized his cartoons into books. One published work, Hair Dos and Don’ts, is a comic indictment of women’s hairstyles. “When I was living in Florida,” he says, “I couldn’t believe how much money was spent in hair salons. I find it very interesting.” Finkler has as many as 12 more illustration books he would like to have published, along with an autobiography. As Finkler continues to paint and draw, every corner of his house has filled up with illustrations. His art has been inspired, in part, by his hearing loss. Finkler says he’s “more sensitized to the actuality of what is going on around” him, which enables his creativity to come through even more powerfully via the paintbrush. He shares with the world his unique perspective on life through art shows in New York City. And though it’s been many decades since he fondly remembers hearing music as a child, Finkler has found genuine joy and success in channeling the creativity within him onto the canvas and the posterboard, where the supposed limitations of his hearing cannot reach. In fact, they serve, in some way, as a catalyst to his artistic expression. ■

Joe Finkler kicks back and enjoys a little hard-won artistic success.

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DRF Centerstage

COLLETTE RAMSEY BAKER FOUNDER, DEAFNESS RESEARCH FOUNDATION

n May 9, 2010, Collette Ramsey Baker passed away at age 91, with her adoring husband and devoted companion of 22 years, Maurice Baker, constantly at her side. She was born in 1918 in Waverly, Tenn. In her young adulthood, she became a favorite model of the renowned painter, Howard Chandler Christy. She was also a successful amateur golfer, setting the women’s record at her home club, Baltusrol, in New Jersey, winning its club championship for four consecutive years. After living with a substantial hearing loss for many years, at age 35, Ramsey Baker’s hearing was completely restored with an early fenestration operation. In gratitude, she founded the Deafness Research Foundation (DRF) 52 years ago, for which she became widely known and respected, and was listed in Who’s Who for Women. Under her leadership, DRF bestowed grants upon colleges and other research institutions for research and improvement of hearing. Since 1958, DRF has given over $25.5 million and over 2,000 grants

to hearing and balance research. Ramsey Baker received letters of commendation from many leaders and well-known people including Presidents Herbert Hoover and Dwight D. Eisenhower, as well as Helen Keller and Cardinal Francis Spellman. In 1960, Ramsey Baker and the American Academy of Otolaryngology-Head and Neck Surgery established the National Temporal Bone Banks Program to encourage individuals with ear disorders to pledge their temporal bones at death for scientific research. The program has grown into the National Temporal Bone Hearing and Balance Pathology Resource Registry, sponsored by the National Institutes of Health’s National Institute on Deafness and Other Communication Disorders. Ramsey Baker is survived by her husband, Maurice Baker, of Vero Beach, Fla., her brother, Charles Nicks, of Hayesville, N.C., her daughters, Collette Wynn of Washington Depot, Conn., and Janet Conrad, of West Chester, Pa., along with eight grandchildren and two greatgrandchildren. She was previously married

Collette Ramsey Baker Photo courtesy of DRF archives

to Hobart Cole Ramsey, and was blessed to have two such loving husbands in her life. In lieu of flowers, please send contributions in her name to Deafness Research Foundation, 641 Lexington Avenue, 15th Floor, New York, NY 10022-4503, www. drf.org.■

High School Senior Deserves a Standing Ovation BY DEVORAH FOX

As graduation day neared, Farida Esaa faced hours of violin practice to prepare for her

Violinist Farida Esaa performs at her Williamsport Area High School senior recital. Photo courtesy of Farida Esaa

senior recital in April. Plus she needed to complete a community service project in order to graduate. So she resourcefully decided to combine the two challenges by seeking out sponsors for each hour she practiced violin between January and March and donating the proceeds to the Deafness Research Foundation (DRF). Why DRF? “My ear, my sense of hearing, is very important to my being a musician,” Esaa says. This is especially true since she has learned to play violin using the Suzuki Method, which is hearing-based.* As a result, she was able to play at age five, but didn't learn to read music until she was eight.

26 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

As a student at Williamsport Area High School, in Williamsport, Pa., Esaa embarked on her community service project by e-mailing sponsorship invitations to friends, teachers and doctors at the local hospital. The response was more enthusiastic than she had expected. About 35 people agreed to sponsor her practice, and she found that they were far more generous than she had anticipated – with donations amounting to almost $1,500. DRF was not the only beneficiary. Knowing that her practice was going to raise money for a good cause gave Esaa added incentive and made her recital that

Congratulations to Bryanna Smith and Lucy Hewitt for their winning entries in Deafness Research Foundation’s drawing contest during Better Hearing and Speech Month in May. The contest theme was “It’s a Noisy Planet: What are You Doing to Protect Your Hearing?” ■

Winning Artwork by (l.) Lucy Hewitt and (above) Bryanna Smith Photos courtesy of Deafness Research Foundation

much more meaningful. “It was more than just the culmination of my years of practice,” she said. This fall Esaa is headed to Haverford College, near Philadelphia. She plans to “maybe become a doctor”…and definitely to keep playing violin. ■ *The Suzuki Method was conceived in the mid-20th century by Shin'ichi Suzuki, a skilled violinist but a beginner at the German language, which he struggled to learn. He noticed that all children pick up their native language quickly and thought that they could learn to play an instrument with the same ease with which they learn language. In the Suzuki Method, learning music by ear is emphasized inititally over reading musical notation, in line with obvious observations about language acquisition – children learn to speak before learning to read. Students are expected to memorize their complete solo repertoire, even after they learn to read sheet music. Though originally used for the study of violin, it has been adapted for other instruments and even non-musical subjects in early childhood education.

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HEARING HEALTH

In Praise of Ear Plugs BY ALAN WILLIAMSON

was standing at the kitchen sink cleaning my ear plugs in warm soapy water and suddenly wondered: How did I get to this level of personal strangeness? Or more specifically: How did I become a man who regularly buys, uses and cares for small pieces of molded rubber designed to plug up his ear canal and squelch all sound within a 30-yard radius? Having just used the phrase “squelch all sound” in the previous sentence, two things occur to me: 1) It’s a rare treat to be able to legitimately use the word “squelch,” and 2) the addictive power that “squelch all sound” implies provides the key to putting my curious ritual in perspective. Years ago, after my wife and I moved into our current home, I found myself repeatedly awakened at night by noise from our neighbor’s patio. The fact that the patio was only four feet from our bedroom window and contained a hot tub meant that gurgling water and babbling bathers were a recurring plot line in the live “Late Show” next door. After mulling over my options for a couple of weeks, I zeroed in on two potential courses of action. I could spend months carefully cultivating a relationship with my neighbor that would transition gradually and imperceptibly from cordial waves hello and goodbye, to casual conversations out in the yard about lawn fertilizer and the mating habits of Somali tree frogs, to becoming a trusted friend who makes a convincing case for getting rid of the hot tub on the grounds that it causes premature wrinkling and secondhand insomnia. Or I could just buy some ear plugs. I decided that buying ear plugs was the practical solution. But I had a lot to learn. Ear plugs, like so many seemingly simple items, offer a surprising variety of design features that can have a profound effect on the quality of desired deafness. I found that certain variables need to be taken into account on your way to successfully soundproofing your head.

Pick Your Plugs with Care The EPA (which turns out to be the Environmental Protection Agency, not the Ear Police Academy, as I had guessed) has established a range of noise reduction for hearing protectors. Ratings run from zero to 30 decibels (dB), with the high end

28 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

denoting better noise reduction and the low end denoting a complete waste of time and money. By way of comparison, let’s take a look at different decibel ranges and everyday activities where appropriately-rated ear plugs may be of benefit. • Over 25 dB rating: Effective for rock concerts, power tools, lawn mowing, car racing and opinionated gas bags. • 20-25 dB rating: Light vacuuming, moderately loud chewing, humming a Michael Bublé ballad. • Under 20 dB rating: Paint drying. The highest rating currently available in ear plugs is 33 dB. With this in your ear, a 75 dB noise such as a vacuum cleaner is about as menacing to the delicate hair cells in the inner ear as elevator music. Ear plug performance can depend on the materials they are made of as well. Today’s over-the-counter ear plugs come in soft foam, silicone and rubber. There are pros and cons to each. Foam offers the most hands-on control, allowing you to mold it into the perfect cylinder to fit your ear canal. The downside: When the compressed foam mixes with your ear wax it can gradually become slick and pop free. The next sound you may hear is an innocent bystander yelling something along the lines of, “Yuck, get it off me!” Silicone plugs are washable and last a lot longer.The downside:They come in premolded sizes, which may or may not fit well in the nooks and crannies of your ears. Rubber with flanges, my personal favorite, provides multiple rubber rims that you can twist and turn until they snugly adhere to the contours of your ear canal. Once secured, everything short of a nearby symphony orchestra escapes your awareness. While I’m delighted to credit rubber ear plugs with flanges for my ability to sleep well at home or away, I have to admit that their addictive power has led me to use them more and more during daylight hours. So complete is their sound insulation, that I’ve remained oblivious to the following disturbances: • The 2008 presidential race • 947 telemarketing calls, and counting • 391 debates about good carbs, bad carbs and low carbs

• •

The 2008 and 2009 hurricane and tropical storm seasons Coverage of the Bernie Madoff, Phil Spector, Michael Vick and Roman Polanski cases. My dependency on ear plugs has gotten so severe, my wife is taking a course in sign language to communicate with me. Hey, I wonder what it means when someone moves their hand back and forth several times like a windshield wiper and then carries luggage out to the car? I’ll have to ask her when she gets back. ■

Alan Williamson is a nationally published humor writer whose work explores the human dilemmas of everyday life. Shunning the complex issues and thorny global conundrums of the day, he chronicles the personal quirks, snags and convoluted capers that are grounded in real-life experience. Based in Fort Lauderdale, Fla., Alan can be reached at alwilly@ bellsouth.net or http://unauthorizedinsights.blogspot.com. When he’s not wearing ear plugs, he has excellent hearing.

Listen to Your Buds

Because misuse of personal audio technology can lead to noise-induced hearing loss, the American SpeechLanguage-Hearing Association (ASHA) launched a multifaceted campaign, “Listen To Your Buds” (LTYB), that teaches children to use the technology safely. From May 23-29, a new initiative of the campaign, “Buds in the Schools Week,” occurred in the Washington, D.C., metropolitan area school systems of Montgomery County, Prince George’s County, Washington, D.C., Arlington County and Alexandria City. Six concerts by leading children’s music artists wove in ASHA’s safe-listening message. Additionally, ASHA recently re-launched the LTYB campaign Web site (www. listentoyourbuds.org) which is aimed at empowering parents and protecting children from noise-induced hearing loss and other communication difficulties. A unique feature of the site allows users to take a personal pledge to protect their hearing. The site also features a calendar of events, designated sections for parents and educators, and access to other national organizations that help get the “Buds” safe listening message to parents, educators and children. In the coming months, ASHA will be introducing new site features including downloadable educational resources for families and additional multimedia. The campaign has been honored for three straight years by the American Society of Association Executives, and has been joined by the Consumer Electronics Association, The Parents’ Choice Foundation and other organizations. ASHA and the LTYB campaign was also the first to partner with the National Institute on Deafness and Other Communication Disorders on the “It’s a Noisy Planet. Protect Their Hearing” campaign, of which Deafness Research Foundation is also a partner. ■

MANAGING HEARING LOSS

New Treatments and Technologies for Better Hearing BY JAMIE MORRISON, ASSOC. EDITOR

30 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

ullets whizz overhead. A bomb just exploded 100 yards away. At this moment, his only thought is of survival. But his ears are taking a severe pounding. He’s wearing ear plugs but the sound is still deafening. Will his ears ever recover? For the soldier of the future, the answer will be, “Yes!” Before going into the extreme cacophony of battle, everyone in his platoon will have been given special drugs to protect their delicate inner-ear hair cells. And, even if his ears are damaged, doctors will be able to restore his lost hearing. Recent advances in hearing research are changing this presently fictional scenario into reality sooner than we thought possible. And you won’t have to be in the military to benefit from these futuristic technologies. Millions of Americans work daily in dangerously noisy environments that take a toll on their hearing. Others have experienced hearing loss due to disease or ototoxic drugs (see “Ototoxic Drugs’ Dilemma:You Live, Hair Cells Die,” p. 39). But for many, the causes of hearing difficulties are not so easy to pinpoint. About a third of Americans between ages 65 and 75 experience presbycusis – agerelated hearing loss – with the proportion rising to nearly half of those older than 75.Two to three of every 1,000 babies in the U.S. are born with varying degrees of deafness, due to a number of genetic or pathological factors. And about 4,000 Americans each year have their worlds turned upside down by sudden sensorineural hearing loss – partial or total deafness in one or both ears that occurs with no warning and often no discernible cause. With some 36 million Americans living with hearing loss – “the most common sensory defect in developed countries,” according to Michael Hildebrand, Ph.D., of the University of Iowa – advances in hearing research and technological developments in assistive devices have the potential to make an enormous positive impact on the overall health and quality of life of nearly 10 percent of our nation’s population, and hundreds of millions more worldwide.

Restorative and Preventative Therapy The holy grail of hearing research is restoring hearing loss due to damaged inner ear hair cells. Since more than 80 percent of hearing impairment is caused by the degeneration or loss of hair cells – due to loud sound, exposure to ototoxic (ear-damaging) drugs, aging or hereditary genetic defects – a breakthrough therapy in hair cell regeneration would have vast public health implications. While damaged human hair cells do not regenerate on their own, many researchers believe that regeneration can be achieved – because certain animals possess this ability. Douglas Cotanche, Ph.D., at Boston University, who received several grants from the Deafness Research Foundation (DRF) in the 1980s, says, “Birds are the only other vertebrates besides mammals with a cochlea. But we discovered that when bird hair cells are damaged, they are Opposite page: Anil K. Lalwani, M.D., professor, Departments of Otolaryngology and Physiology and Neuroscience and Pediatrics, member of New York University Otolaryngology Associates, works with a patient. Photo by Debra L. Rothenberg

replaced spontaneously.” Fish and reptiles have also demonstrated this facility. “In contrast, in mammals hair cells are only formed during a brief period in prenatal development,” says Matthew W. Kelley, Ph.D., of the National Institute on Deafness and Other Communication Disorders (NIDCD). “Because of this observation, several researchers have examined mammalian embryos to try to find the genes that are ‘turned on’ in cells as they are forming into hair cells.” Researchers uncovered one gene, called “Atoh1,” which, when removed from a developing mouse, resulted in no hair cells being developed. Conversely, when Atoh1 was introduced into embryonic mouse cochleae, it caused hair cells to grow. Another approach to regenerating hair cells employs stem cells. According to Kelley, “one option might be to introduce entirely new cells that behave like young cells that still have the ability to develop into different types of cells.” This would involve surgically placing “stem cells within the cochlea in such a way that they would fuse with the remaining cochlear structures and develop and function as hair cells.”While embryonic stem cells are perhaps the most widely known stem cells and have involved ethical concerns, many other sources of stem cells show promise, including those from bone marrow, the nervous system, abdominal fat and even skin. No hair cell regeneration research has yet been conducted on humans, but Kelley says the progress being made in animal models illustrates “how biomedical researchers are rapidly developing a much more complete understanding of the genetic and cellular processes that will need to be manipulated to initiate a biologicallybased treatment for restoring lost hearing. While we are still several years from a biologically-based treatment for hearing loss, this is an exciting time for hearing research and the potential for major breakthroughs has never been greater.” Indeed, one recent significant stride has come through the research of former DRF grantee Stefan Heller, Ph.D., of Stanford University, who, along with his colleagues, has created the first functional hair cells using mouse stem cells. “Fascinatingly, the cells were working,” said Heller, “which is a major step forward.” Such breakthroughs only come when researchers have the funding they need to carry out their research. This is why DRF is committed to raising and allocating the financial resources necessary to enable cutting-edge research to accelerate this effort. Aside from its ongoing efforts in this direction, DRF has spearheaded the ambitious Hearing Restoration Project, an endeavor which aims to raise $50 million over the coming decade to fund the ground-breaking work of the DRF-initiated Hearing Research Consortium. This team of internationally-recognized senior scientists would sychronize private, public and university research in a coordinated, integrated approach to solving the puzzle of regenerating human hair cells. Just as important as restoring lost hearing is the ability to prevent hearing loss in the first place. When it comes to noise-induced hearing loss, there’s good reason for hope. Richard D. Kopke, M.D., of the Hough Ear Institute in Oklahoma City, has studied the protective effects of N-acetylcystine, or NAC, an antioxidant compound approved by the Food and Drug Administration (FDA)

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Technology Answers Digital hearing aids, which have been on the market for 23 years, continue to innovate and improve. State-of-the-art hearing aids use technology to abate the tinny or hollow sound of hearing one’s own voice amplified (known as occlusion), as well as the annoying squeal of feedback, background noise and other formerly problematic byproducts of amplification. Receiver-in-the-ear hearing aids put the receiver, or speaker, inside the ear canal, which reduces both feedback and occlusion. The microphone, amplifier and battery remain behind the ear, connected via a nearly invisible wire. Major manufacturers have developed a number of ways to eliminate feedback. Siemens Hearing Instruments, for example, employs FeedbackStopper™ which “marks” the The totally surgically implanted Esteem® Prosthetic Hearing amplified sound transmitted into the ear so that, if it reRestoration Device uses a person’s natural eardrum to pick up turns to the microphone to be re-transmitted as feedback, sound. the instrument immediately recognizes the marked sound Image courtesy of Envoy Medical and stops it. Hearing aid users have named directional microphones some 25 years ago for treating liver damage caused by overuse as the innovation that has made the greatest impact on their satisof acetaminophen (e.g., Tylenol). A preliminary study of 650 faction with amplification. Additional microphones in the hearing military personnel in 2004 found that NAC seemed to reduce aid receiver can be manually or automatically engaged to pick up the incidence of hearing loss by 25 percent. Kopke says that NAC sound from the side or back, while simultaneously reducing sound “neutralizes the toxins, it helps the injured tissue to repair itself coming in from other directions. Now standard in many digital and it prevents some of the injured cells from dying. The result is hearing instruments, manufacturers are advancing this concept in a substantial lessening of permanent deafness than the noise would new proprietary technologies. Oticon’s Spatial Sound technology have normally caused.” enables a pair of their Epoq hearing instruments to communicate A more comprehensive evaluation of the sorts of treatments with each other wirelessly to preserve the location and direction Kopke has initiated has been launched, but the results are yet to of sounds, so the wearer can discriminate left from right, and up be released. And, while some experts question the effectiveness from down – and always know where to look. of compounds such as NAC in regard to protecting hearing, Smart hearing instruments have taken the guesswork out of adthe overall thrust of Kopke’s research seems to be bolstered by justing aids, too. In the past, hearing healthcare professionals made the work of other scientists, such as Jochen Schacht, Ph.D., and adjustments on the basis of patients’ self-reports, but new dataloghis colleagues at the Kresge Hearing Research Institute at the ging allows the hearing aid to record or log information about University of Michigan. Schacht has found promising results both what sorts of sounds the user is encountering day in and day out. from animal experiments and human clinical trials and his research With this information about specific listening requirements, hearsuggests that antioxidants, and even aspirin, can reverse hearing ing healthcare professionals are better equipped to accurately prodamage caused by ototoxic drugs. Agents such as resveratrol, found gram the hearing aid. Similar to datalogging, data learning enables in red wine, along with vitamin E and d-methionine, have been the hearing aid itself to analyze sound information by searching found to limit hearing loss in those taking drugs that are known to for patterns. The device then “learns” how its user responds to damage hearing. Furthermore, Jianxin Bao, Ph.D., of Washington various listening environments and adjusts itself to provide the University in St. Louis, has found that two FDA-approved optimum settings in different contexts. Furthermore, wireless connectivity is turning hearing aids into anticonvulsant medications used to treat epilepsy prevented noisecomplete listening systems. Some instruments access remote FM induced hearing loss in mice when administered either just before input, some automatically switch on when the user enters an inor just after exposure to loud sounds. duction loop field, and some connect via Bluetooth to neck-worn While Kopke, Schacht and Bao employ substances already apor handheld devices that input and synchronize sound signals from proved by the FDA, scientists developing new drugs got a boost devices such as cell phones, computers and MP3 players. with the February 2010 announcement by the Department of Health and Human Services that the National Institutes of Health and FDA are developing new collaborative efforts and policies Implants: High-Tech Meets Medicine aimed at speeding the delivery of safe and effective products and In the works since the late 1800s, research on using electrical stimtreatments to market. While we anticipate biological and pharmaulation inside the ear to restore and improve hearing took a giant ceutical-based solutions to hearing loss, we are not left without leap forward in the 1970s with the work of William House, M.D., present remedy in the form of effective medicine and technology. which was funded in part by DRF. Together with the engineering genius of Jack Urban, the first cochlear implant (CI) was success-

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fully developed. Since then, thousands of people have received CIs and the technology continues to improve and diversify, resulting in implant technology for use even in the middle ear. Envoy Esteem (www.envoymedical.com) is an example of a device that can be surgically implanted behind the ear and connected to the middle ear in adults with stable, bilateral sensorineural moderate to severe hearing loss. It is invisible from the outside and the only maintenance required is outpatient surgery every five to nine years to replace the battery. Esteem uses a person’s own eardrum as its microphone, picking up the vibrations received by the eardrum and converting them into electrical impulses. It then processes the sound to optimize it for the person’s particular needs and mechanically stimulates the stapes, or “stirrup,” in the middle ear, which then transmits the improved sound into the cochlea. MED-EL manufactures the VIBRANT SOUNDBRIDGE® – an implantable middle ear prosthetic intended to treat moderate sensorineural hearing loss. The company is currently researching the potential of this device to treat conductive and mixed hearing loss. The advantage of middle-ear implants is amplified hearing free of the care of hearing aids, occlusion or outer ear irritation. For people who are severely to profoundly deaf, the CI has truly lived up to its nickname – the bionic ear. By implanting an electrode array in the inner ear (cochlea) and connecting it to an external audio processor, the deaf can hear. This can be a tremendous help to children who would otherwise battle to learn. A recent study led by John K. Niparko, M.D., of Johns Hopkins University in Baltimore, noted an increased abil-

ity to acquire spoken language in children who received CIs before they were five years old. The results, published in the Journal of the American Medical Association, found that “the use of cochlear implants in young children was associated with better spoken language learning than would be predicted from their preimplantation scores.” And if bionic hearing in one ear makes such an impact, imagine what it can do in both ears. Prelimenary research indicates that the investment of cost and effort to receive two (bilateral) implants may pay dividends in signficantly better hearing. And yet there remain unsolved mysteries in converting sound to electrical impulse. Cochlear implants supply limited information on pitch, which creates certain challenges when it comes to enjoying music. Implant manufacturers have given great attention to the matter and according to Ward R. Drennan, Ph.D., of the University of Washington, are making progress. “An Advanced Bionics device…uses current-steering, a process by which the electrical current is balanced between electrodes, creating ‘virtual channels.’ It has been well documented that current-steering can create an increased number of pitch perceptions with a single pair of electrodes.” People with MED-EL implants, which include their Fine Structure Processing, have reported more enjoyment of music. And Cochlear is also developing technological and training approaches to increase music enjoyment. Another promising avenue for enhancing the CI’s ability to supply sound discrimination and musical enjoyment is being explored by Bruce J. Gantz, M.D., and Christopher W. Turner, Ph.D., of the

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For more information on SIPRelay visit www.siprelay.com © 2009 Sorenson Communications, Inc. All rights reserved. For more information about local 10-digit numbers and the limitations and risks associated with using Sorenson’s VRS or IP Relay services to place a 911 call, please visit Sorenson’s website at: www.sorenson.com/disclaimer.

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University of Iowa. For those who have residual hearing prior to implantation of the cochlear device, smaller electrodes can successfully be used in order to preserve a person’s existing hearing. This “hybrid” approach allows a person to hear certain frequencies of sound via their own ears, while hearing other frequencies, to which they had become deaf, via the CI. Hybrid hearing is thus far proving to allow for better sound discrimination in noisy contexts, as well as improved music enjoyment when compared to hearing via the CI alone. (See “Preserving Residual Acoustic Hearing with Combined Acoustic and Electric Hearing” in the Spring 2010 archives at www.hearinghealthmag.com.) Tinnitus With hearing loss often comes another malady – phantom noise. Roughly 25 million Americans have experienced tinnitus in which they hear ringing, roaring, hissing or clicking sounds, even though no such sounds exist externally. “Some cases are so severe that it interferes with a person’s daily activities,” says the NIDCD. “People with severe cases of tinnitus may find it difficult to hear, work or even sleep.” Former DRF grantee Michael Burger, Ph.D., of Lehigh University in Pennsylvania, is one researcher whose work could lead to treatments that alleviate tinnitus. His focus is the cochlear nucleus, the first central synapse in the brain, in which an excess of excitation combined with a lack of inhibition of neural activity is believed by many researchers to be a cause of the phantom noise.

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While Burger and others, such as DRF grantee Adrián Rodríguez-Contreras, Ph.D., of the City University of New York (see “In the Absence of Sound,” p. 46), explore potential tinnitus solutions, a currently available treatment is already solving problems for some who struggle with the ailment. “Neuromonics Tinnitus Treatment includes relaxation music as part of the treatment sound – which is more pleasant to listen to than the noise provided by maskers or amplified everyday sounds when using hearing aids,” according to the dcvice’s developer, Paul B. Davis, Ph.D., a hearing and speech therapist in Davie, Fla. Neuromonics modifies the acoustic properties of oridnary music for each person’s particular hearing loss profile. With time, users report being less aware of their tinnitus and less disturbed by it. Davis claims that “95 percent of patients reported improvement in tinnitus disturbance of at least 40 percent after six months” while researchers at the House Ear Institute in Los Angeles concluded that “the Neuromonics device appears to be useful as a means of significantly reducing the effects of tinnitus on an individual’s daily life.” Additional tinnitus treatments also show promise for helping ameliorate phantom noise. (See “Showstoppers! On the Red Carpet in San Diego” on p. 12.) With the advances taking place in hearing research and technological development, the future looks bright for those facing hearing challenges. And it will no doubt sound even better than it looks. ■

The Doctor Is In

DRF Centurions â&#x20AC;&#x201D; At the Forefront of Our Cause In 1963, the nationâ&#x20AC;&#x2122;s leading ear, nose and throat specialists came together with a simple but important goal: to advance the research crucial to their fields, knowing that their practices and patients would directly benefit from this work. This innovative group became The Centurions â&#x20AC;&#x201C; champions and supporters of Deafness Research Foundation (DRF). The Centurions now enjoy the support of more than 1,800 physicians, researchers and other professionals in fields related to hearing and balance sciences. Under the leadership of President David S. Haynes, M.D., and Secretary/Treasurer John L. Dornhoffer, M.D., The Centurions play an essential role in promoting DRF. To learn more about The Centurions, how to become a member or identify Centurions members in your area, please contact DRF at 866.454.3924, 888.435.6104 (TTY), visit our Web site at www. drf.org or e-mail centurions@drf.org. In each issue, a member of The Centurions fields questions about hearing health and related issues. In this issue, questions were addressed by Centurion George A. Gates, M.D., DRF Medical Director.

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I saw a TV ad the other day for an over-the-counter supplement-type product that claims to relieve tinnitus by improving the circulation in the ear. Is this worth trying? Mason Habersham Piscataway, N.J. Many treatments for tinnitus have been proposed but none has been found to be curative. Tinnitus is phantom auditory â&#x20AC;&#x153;painâ&#x20AC;? in the hearing nerve following loss of sensory cell input. It manifests itself in a sensation of hearing ringing, buzzing, hissing and even music. Fortunately, most peopleâ&#x20AC;&#x2122;s tinnitus is intermittent, louder when the room is quiet and the person is rested. Tinnitus masking appears to offer temporary suppression of the unwanted sound. If the sound becomes intolerable, a consultation with a clinic specializing in tinnitus retraining is often recommended. As always, consult with your doctor before trying new treatments.

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MANAGING VIEWPOINTS HEARING LOSS

Beach Bag Essentials New Hearing-Related Reads for Summer

hether you’re lying out on the beach or suspended in a hammock under your favorite shade tree, lazy summer days just beg for a good book. In between the romance novels, how about a good read that will better inform you on life with hearing loss? This selection of recently released titles offers something for readers of any age. Plugged In, The Everyday Adventures of Thomas and his BFF Vinton from Oticon Pediatrics, illustrated by Pete McEachen, 61 pp., $5.99 paperback, or complimentary with an Oticon Pediatrics hearing instrument ©2010 Oticon Pediatrics (www.oticonusa. com/children, pediatrics@oticonusa.com) Thomas, the hero of the new Plugged In comic strip, is a typical fun-loving boy who navigates the ups and downs of middle school with a sense of adventure – and a hearing loss. Oticon Pediatrics is bringing Thomas and his humorous antics to children with hearing loss through an exclusive arrangement with Plugged In’s creator, cartoonist and toy designer, Pete McEachen. Diagnosed with a bilateral, moderate-to-severe sensorineural hearing loss at age four, McEachen underwent intensive aural rehabilitation and speech-language therapy and was able to mainstream into the public school system. “Like Thomas, I sometimes mis-heard things with very humorous or embarrassing results,” explains McEachen. “And other times, just like Thomas, I turned off my hearing aids for a little ‘quietness’ in a busy day – an advantage that my normal hearing friends could only dream about.” As the parent of a child with hearing loss, McEachen also hopes that his comic strips will inspire kids with hearing loss to “be fun, be bold, and be themselves!” McEachen and his wife, Kimberly, are parents to four-year-old Connor and eight-year-old McKenna, who was born with a bilateral, mild-to-moderate sensorineural

36 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

hearing loss.“I think it is really important that kids understand that wearing hearing aids does not make them any less of a person,” he notes. “I want kids that have hearing loss or health and physical challenges to know that they can still be part of the crazy, exciting time of childhood – just like Thomas.” Thomas, his BFF (best friend forever) Vinton, and their spunky, upbeat friend Juliette are named after prominent historical figures with hearing loss or deafness: Thomas Edison, Vinton Cerf and Juliette Gordon Low. Kicking Up Dirt: A True Story of Determination, Deafness and Daring by Ashley Fiolek with Caroline Ryder, ISBN 9780061946479, 208pp., $21.99 hardback, ©2010 HarperCollins With her contagious grin and indomitable spirit, 19-year-old Ashley Fiolek is already the top female competitor in a macho man’s sport: motocross, a form of off-road motorcycle racing that is one of the most competitive and dangerous extreme sports in America. In the two years since she went pro, Fiolek has taken gold at the X-Games and won the American Woman’s Motocross Championship twice. In the thrilling 2009 finale, Fiolek crashed and snapped her collarbone, but got back on her bike and crossed the finish line to take home the championship trophy. Quitting has never been part of Fiolek’s vocabulary. But Fiolek’s rise has not come without obstacles. She was born profoundly deaf, which makes competition on the track downright dangerous. Misdiagnosed as mildly retarded by doctors, Fiolek was shy and introverted as a young child, until her grandfather – “Grandpa Motorcycle” – encouraged her to join the amateur motocross circuit. She began racing at age seven and as her successes grew through hard work and no small number of broken bones, so too did her confidence. Fiolek and her family never believed her disability should stand in the way of her dreams. Kicking Up Dirt is

a remarkable tale of a young woman’s courage and determination to rule the road. Deafness and Hearing Loss - The Essential Guide by Juliet England, ISBN 9781861440785, 128 pp., $15.08 (on Amazon.com), ©2010 Need2Know Books Losing the ability to hear properly can be a frightening prospect. How will it affect relationships, work or education? What if you are a teenager with hearing problems? This book helps people of all ages to come to terms with their hearing loss or deafness and to overcome new daily life challenges. The different kinds of hearing loss are explained, along with tips for coping. Young people, parents, teachers and professionals can learn what deafness is, why it occurs and what changes can be made to support those who have lost their hearing. If your child or partner is deaf or hard of hearing, you will find all the information you need in this handy guide, as well as advice if you are the one looking for some help and support.

The Consumer Handbook on Hearing Loss and Noise, Edited by Marshall Chasin, Au.D., ISBN 9780982578506, 224pp., $27.95, ©2010 Auricle Ink Publishers The two most common causes of hearing loss are noise exposure and presbycusis (hearing loss associated with aging). While being over the age of 75 is not preventable, hearing loss from noise is. In his introduction, Chasin poses the question: “What can be done today to prevent hearing loss tomorrow?” Written for the consumer who has suffered hearing loss caused by noise, many of the chapters have clear strategies that can be implemented to reduce further negative effects when noise cannot be avoided completely. The handbook also covers information useful to noisy industries, and would be a beneficial educational tool for university courses. Chapter topics include: the basics of hearing loss, noise and measurement; anatomy/physiology; harmful physical/mental effects; recreational noise; hearing in noise; combination of noise with chemicals in the workplace; tinnitus/hyperacusis; medical consequences; hearing

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healthcare and the law; standards and protection; and architectural strategies. Excerpts can be viewed at www.hearingproblems.com. Rhyming Signing:Proper Handshapes with Precise Movements for American Sign Language by Brad Wyant, ISBN 9780981721002, 227pp., $49.95 paperback (8.5 x 11), ©2010 Brad Wyant Students of American Sign Language (ASL) have a new resource to learn more vocabulary, which may make more sense than any approach they’ve tried before. This volume, which would make a good supplement to a course on ASL, is organized around handshapes. In the first pages, the reader realizes that, just by knowing how to sign the alphabet and numbers to 25, she also knows how to sign some 200 words that are expressed using these same handshapes. Wyant builds vocabulary by starting with a handshape and then teaching other words that use the same shape with a slight variation or a particular movement. For instance, the letter “b” is made with a flat, open hand, thumb tucked in the palm. Make that shape with both hands, place the hands on the side of the eyes, palms facing, move hands out and back a few times and you’ve signed the word “attention.” Untuck the thumbs, place

palms one on top of the other, raise the top hand and make a semicircular motion above the second hand and you’ve signed “college.” The “rhyme”is made by the similarity in the signs’ forms, not by the words in English. A logical way to learn, Rhyming Signing can give your ASL vocabulary a boost in short order. However, as the book does not address the complexities of ASL grammar, used alone it would be about as useful as introductory Spanish when carrying on a conversation with a native of the language. Teach Me to Love Myself: Memoir of a Pioneering Deaf Therapist by Holly Elliot, ISBN 9781935052081, 128 pp., $12.00 paperback, ©2008 White River Press This narrative, found after the death of its author, Holly Elliot, perhaps the nation’s first professionally trained deaf counselor-therapist, recounts a courageous mid-life career shift as a result of late onset deafness. In her work at the University of California Center on Deafness, Elliot became an advocate of total communication – a new concept at the time for rehabilitation therapy for people with hearing loss. The plainspoken account of one woman’s journey makes Elliott an unusual role model for women of her time. ■

Dedicated to Healthy Hearing

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38 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

RESEARCH

The Ototoxic Drug Dilemma: You Live, Hair Cells Die BY ANDRA E. TALASKA AND JOCHEN SCHACHT, PH.D.

earching the World Wide Web for “drug-induced hearing loss” or “ototoxicity” will yield several hundred thousand hits, providing a mix of useful and confusing facts. Anywhere between 100 and 1,000 medical drugs or chemical compounds are claimed to be ototoxic, that is, having the potential to damage hearing. Medications usually come with unwanted side effects; fortunately, most of these side effects rarely manifest themselves. Side effects are not a necessary evil of modern pharmaceutics; they date back to the beginnings of medicine. Our earliest ancestors were surely aware of the ability of some herbal and mineral remedies to cure or kill. In the case of ototoxicity, the first recorded incidence can perhaps be ascribed to use of mercury vapors to exterminate head lice, as documented by Persian physician Avicenna (985-1037). The modern recognition of ototoxicity as a potential problem was primarily associated with two medications: salicylate and the aminoglycoside antibiotics. Salicylate, in the form of willow bark, had a millennia-long history as a fever suppressant. After aspirin (acetyl salicylate) began to be widely used in the mid-1800s, it became apparent that tinnitus (ringing in the ears) and hearing loss were possible side effects of its use. Almost a century later, the aminoglycoside antibiotics were heralded as the long-sought cure for tuberculosis, only to find they caused permanent loss of hearing or balance in the first patients. Aside from these, there are a thousand other ototoxic medications? It’s not all that bad. Many such medications are of only historical interest, some are just anecdotally linked to ear damage, and others have exerted their toxicity through freak accidents such as the inadvertent ingestion of potassium bromate, an ingredient used

in home hair permanents (see Table 1, p. 40). The compounds that do warrant our attention because of continued use and potentially permanent damage include some industrial solvents, which are of concern to specific working populations; chelating agents used in treatment of the blood disorder beta thalassemia; and anticancer drugs of the cisplatin type and the aminoglycoside antibiotics – both important for a general patient population. Let us, however, start with aspirin, arguably the world’s most widely used medication. Most consumers will not even be aware of its possible actions on the cochlea, our auditory organ, as it generally requires rather high doses (around four grams per day, as taken against rheumatoid arthritis) to cause such problems. For unknown reasons, aspirin causes auditory sensations of tinnitus and elevated hearing threshold. Fortunately these are temporary symptoms and they subside when use of the drug is halted. No permanent auditory damage has ever been confirmed from aspirin intake, not even in people who attempted suicide by overdosing. The Lesser of Two Evils One might assume that, in the realm of modern medicine, we would discard an ototoxic drug in favor of a more perfect solution. In reality, there are many reasons that such drugs cannot be replaced. In most cases, the explanation is simply that there is no known “perfect solution” and the side effects must be accepted for the sake of resolving a more serious condition. That is the case for cisplatin and the related drug carboplatin: There are no other chemotherapy agents as effective against certain neoplasms in particular testicular and ovarian tumors, as well as many sarcomas and carcinomas. Cancer chemotherapy is notoriously riddled with serious side effects. Cancerous tissue has little that distinguishes it

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from normal human tissue and, hence, substances toxic to tumors also tend to be toxic to surrounding and systemic tissues. The ototoxicity of cisplatin has long been recognized and has been replicated in tests performed on research animals. In addition to injuring the auditory system, cisplatin may cause kidney and nerve damage. Established clinical regimens and combination therapy with other agents can minimize kidney and nerve damage, particularly since the kidney can repair minor injuries to its cells. In contrast, the incidence of hearing loss remains very high although few will lose their hearing completely. The typical progression is an initial loss of high-frequency hearing in both ears, advancing to the lower range of speech frequencies with continued treatment. A high-frequency hearing loss might go unnoticed by the patient; therefore, itâ&#x20AC;&#x2122;s important to monitor hearing during use of cisplatin. Interestingly, the hearing loss may occur gradually in some patients, or suddenly after a single dosing. Cisplatin ototoxicity almost exclusively affects the cochlea, while aminoglycosides can target both the cochlea and the vestibular (balance) system. Drugs of Many Uses: Aminoglycoside Antibiotics Aminoglycoside antibiotics (streptomycin, neomycin, gentamicin and others) were once widely used in the U.S. and elsewhere but are now only cautiously prescribed in industrialized nations.While economically advanced societies can afford alternative antibiotics against gram-negative bacteria, aminoglycosides are frequently the only accessible and affordable antibiotics in developing countries, and often procurable over the counter.

Just like cisplatin, aminoglycosides can be toxic to both the kidneys and ears, with the drugsâ&#x20AC;&#x2122; ototoxicity being of major concern because of the irreversibility of the ear damage. Ototoxicity will develop very slowly after days or weeks of treatment and may even progress after the end of drug administration. (A small number of individuals carrying a specific, maternally-inherited genetic mutation, however, can experience severe hearing loss after receiving only a single dose of an aminoglycoside.) Both ears are typically affected and the high auditory frequencies are lost first, again requiring audiological monitoring for early detection. Since aminoglycosides also have potential to damage the vestibular system, balance may be disturbed, creating a nauseous feeling or unsteady gait. Why some aminoglycosides specifically damage the cochlea, some the vestibular system, and some both, remains an enigma. Given an incidence of noticeable auditory or vestibular damage of 10 to 20 percent, therapy with these drugs is saddled with a major problem. Despite these limitations of use, even advanced healthcare has need of aminoglycosides to fight certain life-threatening infections.The World Health Organization also recommends the aminoglycoside streptomycin as part of the five-drug regimen against multidrug-resistant tuberculosis, and aminoglycosides remain in use against other multidrug-resistant bacterial infections. Furthermore, tobramycin is the accepted therapy in cystic fibrosis patients to prevent the build-up of pseudomonas bacteria in their lungs. Remarkably, these old drugs also perform new tricks. Recently it was discovered that aminoglycosides have the potential to abate certain genetic disorders. Diseases such as cystic fibrosis, Duch-

Table 1. Examples of Ototoxic Agents

Pharmacological Category

Ototoxicity First Documented Examples

Primary Effects on the Inner Ear

Heavy Metals

1000s

Mercurials, arsenicals

Hair cell death and permanent threshold shifts

Antimalarial Drugs

1800s

Quinine, chloroquine

Hearing loss of probably vascular origin

Anti-Inflammatory Drugs

1800s

Aspirin, naproxen

Tinnitus, temporary hearing loss

Aminoglycoside Antibiotics

1940s

Streptomycin, gentamicin, amikacin, kanamycin, tobramycin

Hair cell death and loss of balance or hearing

Other Antimicrobial Agents

1960s

Erythromycin, minocycline, vancomycin, chloramphenicol

Reversible hearing loss and anecdotal reports of permanent damage

Industrial Solvents

1960s-70s

Toluene, carbon monoxide, styrene

Threshold shifts and potentiation of other ototoxic drugs and noise

Anticancer Drugs

1970s

Cisplatin, carboplatin

Auditory hair cell death and permanent hearing loss

Loop Diuretics

1970s

Furosemide, ethacrynic acid, bumetanide

Potentiation of aminoglycosideinduced hearing loss

Chelating Agents

1980s

Deferoxamine

Hair cell death and permanent hearing loss

40 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

enne muscular dystrophy, Usher syndrome and Hurler syndrome are caused by genes with a mutation that generates premature stop signals. The result is truncated and non-functional cell proteins. Experiments in animals and preliminary trials in patients have shown that aminoglycoside therapy can override these stop signals, allowing for a small percentage of normal protein production, thereby alleviating the damage caused by these genetic diseases. If less ototoxic aminoglycosides were available, these drugs could hold promise for millions. As such, the quest for such “designer aminoglycosides” is well underway. Death of a Hair Cell The inner ear is a complex organ of sensory cells and supporting structures that work in concert to enable us to process auditory information. Ototoxins may affect any of the tissues but permanent damage is mostly caused by destruction of the “hair cells” (see Figure 1, p. 42). These sensory cells in the cochlea and vestibular organ are directly responsible for the conversion of mechanical energy from sound or movement into nerve impulses to the brain, giving us the sensations of hearing and balance. The catch is that our body is unable to regenerate auditory hair cells, thus leaving us with a permanent hearing loss when they are damaged.Vestibular hair cells have some ability to regenerate, though the repair may be slow and partial. Enabling efficient regeneration of our sensory cells should resolve the problem of ototoxicity but, while research into regeneration has provided some tantalizing results, clinical ap-

plication is likely decades away. The current approach to combating ototoxicity therefore must be prevention. Fortunately, research has made considerable headway into an understanding of hair cell death and survival, culminating in recent clinical trials. Auditory and vestibular damage by aminoglycosides and cisplatin is marked by an accumulation of free radical compounds, or ROS (reactive oxygen species). ROS are the Jekyll and Hyde of cellular physiology. On the one hand, they are normal metabolic products needed in the function of the cell; on the other hand, they are chemically highly aggressive oxidants which have the potential to wreak havoc by modifying or destroying DNA, membranes or proteins. A healthy cell will maintain a balance, utilizing its own antioxidants in order to allow ROS to function without doing damage. Ototoxins shift this precarious balance and, following increases in the number of ROS, cells begin to die. Understanding this common scenario of “oxidative damage” has been highly helpful in designing protective strategies. Fighting Ototoxicity with Caution and... More Drugs Our first line of defense against ototoxicity is cautious monitoring of drug dosing, serum levels and early signs of hearing loss. But even the most judicious use of cisplatin and aminoglycosides carries a potential risk. Here is where an understanding of the process of cell damage can guide the design of a pharmacological intervention. Since ROS accumulation is a pivotal step leading

Figure 1. Ototoxic drugs can induce death of hair cells, which are replaced by non-sensory cells or “scars,” thus resulting in loss of hearing. The left panel shows the three rows of outer hair cells (top) and the single row of inner hair cells (along the bottom) in the cochlea with their stereocilia (“hairs”) projecting from the tops of the cells. Fluid motion in the cochlea, triggered by sound waves to the ear, vibrates the stereocilia and initiates the transduction cascade of sound to nerve impulses. The right panel shows the cochlear hair cells of an ear affected by an aminoglycoside. Some hair cells have died and been replaced by scars, while the stereocilia of the remaining cells illustrate their stress with visible derangement. Photo courtesy of Dr. J.E. Hawkins, Jr.

to cochlear and vestibular damage, an obvious approach would be to help the cell to regain or maintain its oxidant/antioxidant balance. Counteracting ototoxic drug treatment with antioxidant supplements has successfully limited loss of hearing and balance in animal trials and is clinically proven and effective in limiting other cases of ROS damage. While not all antioxidants will be useful against hearing loss, several compounds have emerged as promising therapeutics since they are either already approved drugs or are available as food supplements. These agents include resveratrol (of red wine fame), vitamin E (alpha-tocopherol) and d-methionine. Animal experimentation with these compounds has indeed been so successful that several clinical trials have expounded on them and shown intriguing results for both cisplatin and aminoglycosides. Recent preliminary data from a clinical study suggests that cisplatin ototoxicity can be abated by d-methionine in humans. Although the observed protection was small, it pointed in the right direction and has encouraged further exploration. Even more astounding was the result of a clinical trial in which aspirin was used to alleviate the side effects of aminoglycosides. The study, published in the New England Journal of Medicine in 2006, showed a protective effect of salicylate against gentamicin-induced hearing loss. The incidence of hearing loss was reduced by an impressive 75 percent (13 percent of those receiving a placebo were affected, whereas only three percent of those concurrently taking aspirin were affected). Help, it seems, is on the way. What’s Next? We may assume that pharmacological intervention to abate ototoxicity will become a clinical reality, but there will be other approaches to the problem as well. Basic research is working on sev-

42 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

eral fronts. Gene therapy, whereby specific genes are introduced into the inner ear in order to augment cellular antioxidant proteins, has been carried out in animals. Regeneration of hair cells or generation of new hair cells from stem cells is in its infancy, but not without encouraging early results. Finally, novel antibiotics are on the horizon with similar antibacterial properties as aminoglycosides, but devoid of their problematic side effects. Some patients today must sadly choose to sacrifice inner ear hair cells for their greater good but research holds promise that tomorrow’s patients can save their lives and keep their hearing too. ■ Learn more about ototoxins by logging on to www.hearinghealthmag. com to read “Hearing Preservation on the Horizon” in the Winter 2009 archives. Andra E. Talaska received her B.S. in biological chemistry from the University of Michigan, writing her thesis on the protective action of herbal medications on drug-induced hearing loss. She joined the Biochemistry and Molecular Biology Laboratory at the Kresge Hearing Research Institute in 2003. Her collaborations with Jochen Schacht, Ph.D., have focused on the molecular mechanisms of drug-induced, noise-induced and age-related hearing loss. Jochen Schacht, Ph.D., has been researching the intricacies of the inner ear since 1972 and is a leading expert in research on acquired hearing loss. He obtained his Ph.D. in biochemistry from the University of Heidelberg, Germany, and now is professor of Biological Chemistry in Otolaryngology and director of the Kresge Hearing Research Institute at the University of Michigan. His laboratory investigates mechanisms of hearing loss induced by noise, drugs and age and has recently completed a successful clinical trial to alleviate ototoxicity. Schacht’s research on aminoglycoside-induced hearing loss is supported by a grant from the National Institute for Deafness and Other Communication Disorders, National Institutes of Health. Visit his lab online at www.khri.med.umich.edu/research/ schacht_lab or e-mail: schacht@umich.edu.

Detecting hearing loss early gives baby the best chance to learn spoken language Photo coutresy of David Kemp

Baby Ears Need Extra TLC

Jessica Gately’s pregnancy was normal, but the delivery was complicated, resulting in an emergency caesarean section. During 16 hours of labor, Jessica developed a fever of 101˚F. The doctors worried that it was a sign of infection, and informed Jessica that her baby, once born, would be whisked to the neonatal intensive care unit for immediate intravenous antibiotics in case the baby had developed an infection. Jessica would also need antibiotics. A neonatologist told Jessica that when newborns are at risk for an infection, possibly meningitis, the treatment is an antibiotic they can be confident will work fast and well – gentamicin, a known ototoxin. Baby Max showed no indication of any problems upon arrival – and after 24 hours, all tests confirmed that there was no infection. Max was discharged to the well-baby nursery when he was two days old. During Max’s newborn hearing screening, the technician explained to Jessica that since Max had been given the genatmicin, he would need a follow-up screening at three months. And, while the risk of hearing loss is rare for a newborn like Max, who was only on gentamicin for a couple of days, babies who are on gentamicin for a few weeks or months – especially those who receive increasingly larger doses – are at higher risk of developing a hearing loss from the medication. They should be sure to go for follow-up hearing screenings at three-month intervals through their first year of life, then annually until they reach school age and have access to school hearing screenings. Early detection makes a world of difference in language acquisition and overall learning. While Jessica knew that the risk for Max was slim, she made sure that he had his hearing tested at the recommended interval. It was normal – a happy beginning for Max and family.■

Have You Heard? Another AARP Benefit Even though 95 percent of Americans with hearing loss could hear better with hearing aids, only 20 percent currently use them, according to the National Institute on Deafness and Other Communication Disorders. To help close this gap, HearUSA, a leading hearing care provider, has initiated AARP Hearing Care. The program provides AARP members with access to a nationwide network of credentialed healthcare providers who can help them manage hearing loss through rehabilitation and consultation. Members are also entitled to discounts on hearing aid technology, extended warranties and battery supplies. Excellence in Workplace Hearing Loss Prevention In partnership with the National Hearing Conservation Association, the National Institute for Occupational Safety and Health recently presented the 2010 Safe-in-Sound Excellence in Hearing Loss Prevention Awards™, recognizing those who have excelled in preventing noise-induced hearing loss in the work environment. The recipients were: Etymotic Research, Inc.; the New York City Department of Environmental Protection and Parsons Brinckerhoff, Inc.; and Kris Chesky, Ph.D., and the College of Music at the University of North Texas. It’s an Award-Winning Noisy Planet The “It’s a Noisy Planet, Protect Their Hearing” campaign and Web site earned a Media Award for the National Institute on Deafness and Other Communication

Disorders. Recognized for its contribution toward raising public awareness of the hazards of noise by the National Hearing Conservation Association, the Noisy Planet Web site received 750,000 page views and 560 subscriptions to its e-bulletin. Its aim continues to be the education of parents of “tweens” (eightto 12-year-olds) about healthy habits that can protect their kids’ hearing for life. Deafness Research Foundation is proud to be an official partner of the “It’s a Noisy Planet, Protect Their Hearing” program. Visit the Noisy Planet Web site at www. noisyplanet.nidcd.nih.gov. Help for D/HH Victims of Domestic Violence Deaf and hard of hearing (D/HH) victims of domestic violence can get help specifically for their situation via a national hotline provided by the National Domestic Violence Hotline and Abused Deaf Women’s Advocacy Services. Trained and experienced deaf advocates who understand the unique ways in which deaf victims experience abuse, and who can communicate effectively with D/HH victims, are on duty weekdays, from 9:00 a.m. to 5:00 p.m. PST. The hotline can be reached via videophone at 69.17.111.201, instant messenger at ADWASHotline, or e-mail at ADWAS@ndvh.org. Free Hearing Protection AuDNet, Inc.’s NowiHear.com, a leading audiology care consumer education Web site, has joined forces with Oaktree Products to raise awareness about hearing loss prevention by distributing 1,000 free hearing protection devices to

U.S. consumers. Dispensed by AuDNet Preferred Provider Community members, the devices will be available to consumers until July 31, 2010, and provide hearing protection during everyday noisy activities such as mowing the lawn, using loud tools and attending noisy events or concerts. U.S. audiologists can get involved with AuDNet and Oaktree Products’ effort by becoming part of the AuDNet Preferred Provider Community. www.NowiHear. com also provides background and contact information on local audiologists around the country. Bueno! Phone CaptionSM (www.phonecap tion.com), a service that assists people with hearing loss in making regular telephone calls, announced service is now available in Spanish for people within the U.S. The service transcribes voice dialogue into text, allowing users to read captions of what the other party is saying. PhoneCaption.com’s service comes with a personal 800 number and caller ID. It is free and compatible with a multitude of media devices. ■

Hot Tips & News Clips Rayovac has launched the Hearing Professional of the Year Award. Submit your inspiring stories of helpful hearing professionals, along with nominations, at www.hearingprofessionaloftheyear.com by September 30, 2010. The National Hearing Conservation Association announces its 36th annual conference: Innovation & Technology, February 24-26, 2011 in Mesa, Ariz. Register at www.hearingconservation.org and visit www.drf.org/local+events to learn about upcoming events related to hearing health in your area and around the country. Find out about the latest fashions and watch celebrity interviews in American Sign Language online at Fashion News Live: www.fashionnewslive.com. ■

44 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

Heard Around the World Steady as She Goes Zentrip is a new, fast-acting motion sickness remedy in the form of a citrusflavored medicated strip placed on the tongue about an hour before activity. Zentrip contains meclizine hydrochloride, an antiemetic which blocks a chemical messenger in the brain, helping to reduce or prevent vomiting, dizziness and other sensations associated with motion sickness. But what if that feeling of being motion sick persists once you’re back on stable ground? Visit Deafness Research Foundation’s Facebook page to view a new video and learn about Mal de Debarquement syndrome, a condition of feeling seasick on dry land. National Parks Now More Accessible People with hearing loss will find new resources to access multimedia interpretation at national parks this summer. The National Park Service (NPS) now offers on-screen, open captions, subtitles or assistive listening systems. Its aim is “to enable viewers with hearing loss to participate fully when viewing video or multimedia productions without self-identifying.” Furthermore, NPS guidelines emphasize that park exhibits shall offer handsets, such as audio sticks, sound sticks and telephone receivers, which must have volume control and be telecoil compatible. And information desks shall allow for text telephone

Organ Pipe National Park now offers accessible exhibits. Photo by Andy Fisher courtesy of www.nps.gov

service (TTY) equipment. So, load up the RV and head out to experience a new depth of appreciation for the history and background of our most notable national landmarks. Mainstreaming D/HH Students in Vietnam The Oticon Foundation announced in May a $50,000 grant to the Global Foundation for Children with Hearing Loss to establish a teacher training program for teachers of deaf and hard of hearing infants and children in Vietnam. The grant enabled the Global Foundation to bring to Vietnam in June a total of 12 experts in audiology, speech therapy, early intervention and auditory-verbal education. The experts mentored 88 Vietnamese teachers and 25 families of children with hearing loss on helping children improve their spoken language skills and integrate more successfully into hearing society. Since each teacher works with approximately 10 children, the program will positively impact the education of more than 850 children. New Leadership at IHS The International Hearing Society (IHS), which represents hearing healthcare providers worldwide, has appointed Kathleen Mennillo as executive director, effective May 1. Mennillo, who takes over from outgoing director Cindy Helms, has served as education manager for IHS, which is based in Livonia, Mich. Mennillo earned a BA at the University of Michigan – Dearborn and an Kathleen Mennillo MBA from Davenport Photo courtesy of IHS University. Oticon Focus on People Nominations are now open for the 13th Annual Oticon Focus on People Awards to honor outstanding people with hearing loss who are helping to show that hearing loss does not limit a person’s ability to make a positive difference in their families, schools, communities or the world.

Since 1996, this national awards program has recognized and rewarded people with hearing loss who defy negative stereotypes of what it means to have a hearing loss. There are four categories: student, adult, advocacy and hearing care professional. Each first-place winner receives $1,000, plus $1,000 for their school or favorite charity. Winners in the youth, adult and advocacy categories also receive a set of Oticon hearing instruments. Visit www.oticonusa.com under the Professional or Consumer section to complete the online form by September 20, 2010. Chinese Use Noise in Law Enforcement Long Range Acoustic Device™ (LRAD®) products have been sold to Chinese national law enforcement agencies. The company states that LRAD-directed sound products and systems enable law enforcement to communicate clearly at safe distances, broadcasting critical information, instructions and warnings. Law enforcement personnel are trained on the proper use of LRAD and have full control of the audio output through a prominently positioned volume control knob. LRAD creates increased standoff and safety zones; supports resolution of uncertain situations; and potentially prevents the use of deadly force, with the use of targeted sound. Visit www.lradx.com for more on LRAD Corporation. London’s Deaf Rave Scene Babelgum’s Vice Versus (www.babelgum. com/viceversus), a weekly Internet show, takes viewers around the world to unearth the strangest, weirdest and most exciting underground scenes and cultures, and guess what they found in London? Known as Deaf Raves, these hard of hearing parties are organized by deaf people for deaf people and include a wide range of music styles such as reggae, R&B and house drum and bass. The music is turned up loudly so party-goers feel the strong vibrations through their bodies from the bass. Hearing companions are cautioned to wear ear protection. ■

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Under the Scope Adrián RodríguezContreras, Ph.D., studies electrical activity associated with hearing. Photo courtesy of Adrián RodríguezContreras, Ph.D.

In the Absence of Sound BY JAMIE MORRISON, ASSOC. EDITOR

eep thinkers continue to ponder the philosophical conundrum: “If a tree falls in the forest and no one is there to hear it, does it make a sound?” Adrián Rodríguez-Contreras, Ph.D., ponders just the opposite. He wants to know why we can hear a tree fall even if one isn’t falling. Or more accurately: How is it that the auditory portions of the brain can be active even in the absence of sound? An assistant professor at the City College of New York, Rodríguez-Contreras studies newborn rodents, which naturally are deaf the first 10 days after birth, to seek a greater understanding of how hearing develops in humans in utero. “We know that all auditory connections are already there before animals can hear,” says Rodríguez-Contreras. “You would think the brain must be silent during this period:The animal is deaf. But if you measure the electrical activity in the brain regions involved in auditory function during this pre-hearing stage, you find that

46 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

the auditory neurons exhibit activity. It turns out that the nervous system has intrinsic ways of generating electrical activity in the absence of any sensory stimulation.” Rodríguez-Contreras’ particular interest is in the olivo-cochlear cells in the brainstem. After sound proceeds through the mechanisms of the middle ear, it excites the hair cells of the inner ear, creating electrical impulses that get transmitted through the auditory nerve into the brainstem. The olivo-cochlear cells are just one of many groups of brainstem cells that are recipients of the electrical impulses originating in the inner ear. The cochlea, located in the inner ear, contains both inner and outer hair cells. While the process is not yet fully understood, Rodriguez-Contreras and other researchers do know that the inner hair cells in the cochlea initiate electrical activity towards the brain, while the outer cochlear hair cells receive electrical activity from the brain, enabling two-way communication between the ear and the brain. One type of message the olivo-cochlear cells

can convey from the brain to the hair cells is an instruction to focus on a particular sound.This is vital to our ability to attend to a particular voice in a roomful of talking people. An increase over the last decade in the incidence of neurological diseases in humans is at the center of RodríguezContreras’ interest in the developmental aspects of the olivocochlear. Many researchers believe that these diseases originate in problems that occur in the late stages of prenatal development, when the fetus is about six months along. But the onset of the disorder may not be evident until several years after the child is born. While not directly related to hearing loss, autism is one of these. Another is auditory processing disorder, where a person has perfect hearing as far as hearing tests can determine, yet they still struggle to understand what is being said. The mechanisms of the ear work well but the problem lies somewhere in the brain where sound is processed. (Read “Auditory Processing Disorders in Children” from the spring 2010 archives at www.hearinghealthmag.com.) “As we study the normal development of hearing,” says Rodríguez-Contreras, “we can begin to identify developmental variables that can be monitored in individuals that could help us predict who is going to have a neurological deficit in several years. Newborns are currently screened for hearing, but we could extend a battery of testing to find if there is an electrical signature in the brain of a child that would suggest that we should keep a watchful eye on them. The more we understand how hearing develops, the better we will be able to know ahead of time what is coming.” Rodríguez-Contreras also sees potential future benefits from his research for people with tinnitus. “If you understand how the auditory system is activated in the absence of sound,” he says, “you can begin to understand what happens in conditions like tinnitus, when people perceive a sound when there is no sound – the ringing in the ears, or ‘phantom noise’ experienced by those with tinnitus.” Rodríguez-Contreras’ research has been significantly enabled by the Deafness Research Foundation (DRF).“My laboratory started in 2008,” he says, “so we are a very junior group. It is difficult for junior groups to obtain funding. So having entities such as DRF is of tremendous help for groups like us who are in need of funding to get things started.” Born and raised in Mexico City, Rodríguez-Contreras studied biology at the National University of Mexico, where he met his wife, Jennifer, a Californian studying neuroscience. He completed his Ph.D. in biophysics at the University of Cincinnati and then conducted post-doctoral research at the University of California, Davis, and at the Erasmus University in the Netherlands. With two boys, ages nine and four, Rodríguez-Contreras and his wife keep plenty busy, but he likes to swim whenever he gets a chance and also loves living in New York, where he can hear some of his favorite music, like jazz and alternative. He even plays a bit of guitar himself. And as he plays, if you ask him about the sound made by that tree falling – or not falling – in the forest, he'll be able to give you an astonishing answer.■

WWW.DRF.ORG 866.454.3924 TTY 888.435.6104 SUMMER 2010 47

Marketplace

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Knowledgeable, caring staff committed to helping you find the right products and services to communicate freely and effectively without barriers. Assisted listening devices, hearing aid supplies, books, DVDs and gifts available online or by phone.

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PhoneCaption.com is designed to provide captioned telephone calls for the hard of hearing. We are the most innovative, technologically enhanced service available and are dedicated to improving the quality of life for the hearing loss community. Capture the conversation in text today!

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Harris Communications is the one-stop shop for deaf and hard of hearing people and carries a full line of assistive devices. Free catalog available.

Health Enterprises, Inc. is a worldwide leader in niche healthcare products. We manufacture a broad range of innovative, consumer-preferred products. Our goal is continued strong growth while providing quality, unmatched value and excellent customer service.

HearingBug offers an online catalog of assistive products for the deaf and hard of hearing. Our objective is to provide quality assistive listening devices quickly and inexpensively from the comfort of your home.

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PICTURE YOUR LOGO HERE Meet HearUSA Hearing Care Network – an experienced team of hearing care professionals. Learn how you can live happier, healthier and more securely. With better hearing, rediscover your family, your friends and your independence. Call today.

Your logo and information about your company or organization, your products or services, could be here. Hearing Health advertisers are featured in our Marketplace at no additional charge. For more information, e-mail advertising@drf.org or call 866.454.3924.

“Jodi-Vac has been producing hearing aid vacuum cleaners since 1999. As the owner of Jodi-Vac and a hearing aid repair technician for 15 years, I firmly believe that daily hearing aid vacuuming will keep your hearing aids free of wax.” – John Maidhof, owner, Jodi-Vac

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By advancing the field of hearing implant technology, MED-EL’s people and products connect individuals around the globe to the rich world of sound.

Too much noise can harm a child’s hearing. The Deafness Research Foundation and the National Institute on Deafness and Other Communication Disorders urge you to learn about noise-induced hearing loss and how to prevent it.

Oticon Pediatrics is dedicated to helping children with hearing problems achieve their full potential by delivering child-friendly solutions and services to children, families and professionals.

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RadioShack offers a broad selection of relevant technology products that includes leading national brands as well as exclusive private brands. Our trained sales experts offer friendly and personal service at more than 6,500 convenient locations nationwide.

SIPRelay is a free service provided by Sorenson Communications, which enables deaf and hardof-hearing individuals to place text-based relay calls from a PC or mobile device to any hearing individual in the U.S. who uses a standard telephone.

SoundAid Hearing Aid Warranties is a directto-consumer hearing aid warranty company offering loss, damage and/or component failure coverage on all makes and models of hearing aids and tinnitus devices.

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Sound Clarity, Inc. offers a complete line of assistive devices for people with hearing loss, including amplified telephones, personal amplifiers, hearing aid batteries and supplies and much more.

Do you shy away from the phone because you can’t understand people? With Sprint CapTel you can read captions of your calls while you speak and listen to your caller! Visit our Web site to learn more!

Ear Technology Corporation’s hallmark is innovation with a purpose, and with uncompromising quality. Our history is made up of practical, real-world solutions to unmet needs in the hearing healthcare industry. Our future is bright: Helping people hear better every day.

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Doctor-recommended TV Ears has helped over a million people with hearing loss hear the television clearly without turning up the volume! Thousands of our customers have said, “TV Ears has changed our lives!”

WCI is the nation’s largest distributor of assistive listening devices for people with hearing loss, including the CapTel® captioned telephone. The company specializes in helping hearing professionals provide total overall solutions for their patients.

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50 HEARING HEALTH A PUBLICATION OF THE DEAFNESS RESEARCH FOUNDATION

I AM A WIFE, MOTHER, AND GRANDMOTHER and I Chose AB

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She hears her favorite author narrate his latest audio book. She even hears her granddaughter sing “happy birthday” on the phone. Evelyn hears her best with AB. If you’re struggling to hear with hearing aids, then it’s time to consider a cochlear implant from Advanced Bionics. At home and on the town, many recipients hear their best with AB’s Harmony™ HiResolution™ Bionic Ear System, the world’s most advanced cochlear implant system. Only AB combines the highest-resolution sound with convenient wearing options that are easy to use each and every day.

Hear Your Best with Harmony Contact the Bionic Ear Association to get your FREE Bionic Ear kit. 866.844.HEAR (4327) hear@AdvancedBionics.com AdvancedBionics.com/HearingHealth 3-01392-B-Rev1

happiest How will you describe your new cochlear implant? You deserve the best in today’s hearing technology. Studies1 show that for cochlear implant users everywhere, the best means MAESTRO.™ It features the world’s thinnest and lightest audio processor – packed with real-world features and technology to optimize your hearing in all kinds of environments. Not surprisingly, the MAESTRO cochlear implant system is from MED-EL – the industry innovator for decades. If you suffer from severe to profound hearing loss, or your hearing aid isn’t making a significant difference, we’d love to hear from you. Contact us at 888-633-3524 for more information or visit medel.com.

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1 Haumann et al., 8th International Conference of the European Society of Paediatric Otorhinolaryngology, Budapest, 8–11 June 2008 and Brough et al., British Cochlear Implant Group Annual Conference, Cambridge, 22–23 June 2009