Health & Hearing
Hearing Health Do you have hearing loss? 1-minute self assessment test
Hearing Technology “Nothing like the old days!� Virtually invisible and Bluetooth enabled
Hearing Science Importance of early intervention in the treatment of hearing loss
How much do hearing aids cost? A guide to the range of financial assistance that is available
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Contents
> Forward
How the ear works.............................................................. 4 Understand how the ear works and processes sound
Hearing Loss...........................................................................5
Dear Reader, Thank you for taking the time to request and read through our magazine, Health & Hearing. For many of you, this may be a your first step towards addressing hearing loss or that of a loved one. In this magazine, we hope to enlighten you about hearing, hearing conditions and modern solutions. Although there are many causes for hearing loss, the incidence of the condition grows steadily as people age. While 30% of adults will be showing signs of the condition by the age of 50-years, this will rise to 70% of the population by 70-years of age. Hearing loss affects lives, lifestyles, relationships, and often leads to feelings of isolation. Studies have shown that when not managed, the condition reduces the effectiveness of people in the workplace and led to decreased household income. Even more importantly, people who address their hearing loss earlier reported feeling younger, more confident, and eager to once again enjoy the social situations that had become tedious. These findings are consistent with the experiences of the hundreds of clients who I have helped over the years to achieve better hearing and a better quality of life. But as you will read in Health & Hearing, there is some great news for Australians too. Our government recognises the impact that hearing loss has on both its citizens’ lives and the national economy. Subsequently, they provide pensioners and veterans with access to free digital hearing aids. Assistance is available to all people with hearing loss through tax rebates, health insurance, and compensation for hearing loss that has developed as a result of exposure to noise in the workplace.
Tinnitus..................................................................................... 8 This buzzing in my ears is driving me mad!
“I’m too young for hearing aids”.............................. 10 The importance of addressing hearing loss early – a scientific perspective
Hearing Loss & Dementia.............................................. 11 New study find links between untreated hearing loss and dementia
Hearing tests....................................................................... 12 This story explains common types of hearing tests and how to interpret the results
Reading your Audiogram.............................................. 14 Results of the air conduction and bone conduction hearing tests
Hearing Aids.........................................................................17 “Nothing like the old days”
Cochlear Implants............................................................ 21 How they can help
How much do hearing aids cost?.............................22
Who are The Art of Hearing? Australians are often shocked to learn that most hearing clinics are actually owned by hearing aid manufacturers or global retail chains – and thus are really just well disguised vehicles for pushing their own range of hearing aids. In contrast, The Art of Hearing is proudly independent. My staff and I will find you the best treatments from the full range of available solutions, including tinnitus management, rehabilitation, counseling, and hearing aids from all leading manufacturers. We are accredited to provide free hearing aids to pensioners and veterans under the Australian Government Hearing Services Program*. We are here to help you at every step of the way and find a solution that works for you. If you have any questions, or would like to arrange a hearing test or trial of the latest digital hearing aids, please don’t hesitate to call. Best regards,
Ravi Gupta Owner and Audiologist The Art of Hearing
We all know somebody affected by hearing loss
Ravi
Owner and Audiologist
A common question
would like to acknowledge the following sources in the development of this magazine:
References Listen Hear! – The economic impact and cost of hearing loss in Australia, Access Economics 2006 Cochlear Ltd – www.cochlear.com Office of Hearing Services – http://www.health.gov.au/hear Spinach Effect – www.spinacheffect.com.au The Impact of Untreated Hearing Loss on Household Income – Sergei Kochkin, Ph.D. August 2005 Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman A, Ferrucci L. Hearing loss and incident dementia. Arch. Neurol. 2011; In press. Hearing in South Australia: Disability, Impairment and Quality-of-life, Wilson DH (1997) Late-onset auditory deprivation: Effects of monaural vs binaural hearing aids. Silman, Gelfand, Silverman. (1984) Leading manufacturers GN Resound – www.gnresound.com.au Unitron – www.unitron.com.au Other suppliers Oticon – www.oticon.com.au Bernafon – www.bernafon.com.au Phonak – www.phonak.com.au Siemens - hearing.siemens.com/au/ Other links Australian Tinnitus Association - http://www.tinnitus.asn.au/tinnitus.htm
* Condtions apply under the OHS Voucher Scheme
Health & Hearing © - Spinach Effect Pty Ltd PO Box 2019, Glenelg SA 5045, Australia Ph: (08) 8294 7928 www.spinacheffect.com.au
Health & Hearing
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> The Ear
How the ear works In order to better understand hearing loss and what can be done, it is first important to understand how the ear works and processes sound.
Outer Ear
Sound first enters our ear at the Pinna, which is the visible part of the ear on the outside of our head. The Pinna is designed to collect sound waves and funnel them down the Ear canal towards the Tympanic membrane (eardrum). Together the Pinna and Ear canal are referred to as the outer ear.
Outer Ear
Thousands of tiny sensory hair cells within the Cochlea convert the vibrations into an electro-chemical signal that’s carried by the auditory nerve to the brain, where sound is processed and interpreted.
Middle Ear
The middle ear starts with the Tympanic membrane. As sound waves travelling down the Ear canal reach the Tympanic membrane, it vibrates like a drum. Behind the eardrum is an air-filled space containing three tiny bones, the smallest bones found anywhere in the human body. The vibrations in turn cause these bones to vibrate. The Middle Ear consists of the eardrum these tiny bones (Malleus, Incus and Stap-es) and the air pocket in which they reside.
Inner Ear
The cochlea and the semi-circular canals are our organ of both hearing and our sense of balance. The cochlea, semi-circular canals and the cochlear nerve (auditory nerve) comprise the parts of the Inner Ear. Sound passes to the Inner Ear via the vibrations of the Middle Ear bones, which are connected to the Cochlea at one end.
Electron Microscope image of healthy hair receptors
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Health & Hearing
Hearing
Loss We all know somebody affected by hearing loss, as nearly 1 in 5 Australians live with the condition. Hearing loss progresses over time and it is best to recognise the signs early.
Q
uality of life can be significantly compromised for people with hearing loss and their families. The extent of the hearing loss varies too, from a mild to a severe hearing loss where loud safety signals may not be heard. More commonly it is manifested as a difficulty with word understanding, particularly in the presence of background noise.
Health & Hearing
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Your Hearing Self Assessment Hearing Test
1. I feel discomfort or embarrassment when meeting new people because of my hearing o Never
o Sometimes
o Often
2. I find that following conversations in a noisy environment, such as a busy restaurant, can be very difficult o Never
o Sometimes
o Often
3. People seem to mumble more these days when they talk, and find myself asking them to repeat themselves more often than I used to o Never
o Sometimes
o Often
4. Others comment that I have the radio or television turned up too loud for their liking o Never
o Sometimes
o Sometimes
o Often
6. Family members have commented that they think that I may have a hearing problem – and they become frustrated when I’ve not fully heard what they have said o Never
o Sometimes
o Often
7. Following conversations on the telephone is particularly difficult, particularly with children o Never
o Sometimes
o Often
8. I used to be more active in group conversations. (E.g. dinner table) o Never
o Sometimes
o Often
9. I mishear what people have said and respond inappropriately o Never
o Sometimes
o Often
10. Sometimes I experience a persistent or prolonged ‘ringing in my ears’ (known as tinnitus) o Never
o Sometimes
In contradiction to many people’s understanding, hearing loss is rarely similar to the effect of turning down the volume on a stereo. It usually affects different frequencies of sound by varying amounts. This can lead to conversations being difficult to follow – particularly in noisy environments where competing background noise “scrambles” speech and conversations. Not surprisingly, being able to follow conversations is the single biggest reason that people seek our help. If you feel that your hearing is not what it used to be, or are concerned that a loved one may be experiencing hearing loss – take a couple of minutes to do the short self-assessment test provided here.
o Often
5. If I did not see the source of a sound, I find it hard to know what direction it came from o Never
Signs of hearing loss
o Often
Adding up your score Never =0 Sometimes = 1 Often =2
If your total score is more than 5, then your life is very likely to be affected by hearing loss and we would recommend a hearing assessment. If your score is more than 10, then there is little doubt that your life would be significantly improved by addressing your hearing loss and adopting a hearing solution.
Types of hearing loss There are three forms of hearing loss, Conductive, Sensorineural and Mixed hearing Loss.
Conductive Hearing Loss Conductive hearing loss results from a problem with the passage of sound through the outer ear and/or middle ear. Some common examples include:• Excessive cerumen (earwax) in the ear canal • Perforation of the eardrum • Middle ear infection with fluid build-up However, conductive loss accounts for only 10% of all hearing losses, and they range from mild to moderate in severity. The good news is that conductive hearing loss can often be medically treated. In many cases hearing can be completely restored.
Symptoms of Conductive Hearing Loss With conductive hearing loss, the overall volume of sound is reduced. Signs of conductive hearing loss may include:-
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Health & Hearing
• Turning up the volume on the TV or radio • Asking people to repeat what they’ve said • Hearing in one ear better than the other When volume is sufficiently increased, clarity and understanding are usually intact for someone with a conductive hearing loss. Other symptoms may also be present, such as ear pain, drainage from the ears, or a feeling of pressure or a blockage.
Sensorineural Hearing Loss Hearing loss that originates in the inner ear is referred to as sensorineural hearing loss or, in laymens’ terms, “nerve deafness”. The vast majority of hearing losses are sensioneural losses, and common causes include: • Genetic factors (i.e. hearing loss can run in families) • Excessive noise exposure either sudden or prolonged • Changes in the inner ear due to ageing Less common causes include: • Reactions to ear-toxic medications • Auditory nerve tumours • Conditions acquired prior to birth (congenital) • Infections such as meningitis and mumps • Kidney disease • Vascular disease Each cause can lead to damage to the sensory hair cells or nerves. Once damaged, the hair cells can’t repair themselves nor be medically treated. Therefore, 90% of hearing losses cannot be cured. A sensorineural hearing loss can be of any degree – mild, moderate, severe or profound. In more than 95% of cases involving sensorineural hearing loss, hearing aids or cochlear implants are the recommended course of treatment.
Why can I hear low pitched sounds better than high frequency sounds?
Symptoms of Sensorineural Hearing Loss While the overall volume of sound may be reduced, the clarity of sounds or voices is also affected. People with sensorineural hearing loss will often hear people speaking, but can’t always understand all the words, even when the volume is adequate. Music may also sound distorted, leading to decreased enjoyment. The symptoms of sensorineural hearing loss may include: • Turning up the volume on the TV or radio • Asking people to repeat what they have said • Perception of people mumbling or not speaking clearly • Lack of clarity when listening to speech • Difficulty hearing in noise.
Mixed Hearing Loss The transmission of sound can be blocked in multiple places along the auditory path. When a hearing loss occurs from conditions in the inner ear as well as the outer and/or middle ear, this is known as mixed hearing loss. An example of a mixed hearing loss may be someone with inner ear damage due to exposure to noise in their workplace over many years, who also currently has an infection that has led to a fluid build up in the middle ear.
Noise induced hearing loss Given the impact of noise, it is not surprising that males are considerably more likely to have hearing loss than women – including being twice as likely to have a moderate to severe hearing loss. These days, people are more aware of the damage that noise can do to their hearing. This is illustrated through mandatory provision of ear protection on work sites and within factories. Nevertheless, every day millions of Australians are exposing themselves to noise levels that will surely lead to long-term damage to their hearing, including the use of personal stereo systems. The chart below illustrates the time it takes to cause permanent damage to your hearing when you’re exposed to different levels and sources of sound.
Nerves have different sensitivities to deformation of the sensory hair cells within the cochlea. A sound that has high frequencies of vibration will excite receptor cells near the opening of the cochlea, while a sound mostly containing low frequencies will stimulate cells at the end of the cochlea. Over time the high frequency hair cell receptors receive more movement by the incoming pressure waves of the fluid inside the cochlea. For this reason, high frequency receptors are more prone to long term damage than the low frequency hair cell receptors, which are more protected further up the cochlea.
“What is the best protection against noise damage?”
Causes of hearing loss
Noise attenuating ear plugs
While the ageing process is a major contributor to hearing loss, it is certainly not a condition reserved for the later stages of life. Studies have shown that exposure to noise is thought to be a contributing factor in around 37% of cases of the condition. Interestingly, around 50% of Australians with hearing loss are still of traditional working age (i.e. under 65 years).
Ear protection is extremely important for people who are exposed regularly to noise. The best form of protection are custom fitted, noise attenuating ear plugs. These can purchased and fitted at a The Art of Hearing clinic
Other contributing factors of hearing loss include:• Infection or injury (17.1% of cases) • Born with hearing loss (4.4% of cases) • Other causes (16.8% of cases)
Health & Hearing
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> Tinnitus
This buzzing in my ears is driving me mad!
At some stage our lives, all of us are likely to experience ringing in our ears when there is no apparent source of a sound. It may be evident coming home from a rock concert, or for a short period as a result of a sudden extreme noise, such as a gun discharging nearby. Unfortunately for many people, this buzzing or ringing sound can be persistent, intermittent, and prolonged – and this is a condition known as tinnitus. It can cause frustration and great distress. While it does occur in every stage of life and affects both men and women, the condition is most common amongst men. According to an American study, almost 12 percent of men who are 65 to 74 years of age are affected by tinnitus. Tinnitus is not a disease in itself but rather a reflection of something else that is going on in the hearing system or brain.
Causes of Tinnitus Most commonly, tinnitus is related to hearing loss. Current theories suggest that because the cochlea is no longer sending the normal signals to the brain, the brain becomes confused and essentially develops its own noise to make up for the lack of normal sound signals. This then is interpreted as a sound, tinnitus. This tinnitus can be made worse by anything that makes our hearing worse, such as ear infection or excess wax in the ear.
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Other causes of Tinnitus include trauma to the ear resulting from: • Loud noise exposure • Adverse reaction to medications drugs such as aspirin, antibiotics and quinine • A symptom of Meniere’s disease, which can also cause dizziness, nausea, and fluctuating hearing loss • A rare cause is a certain type of brain tumor known as an acoustic neuroma. The tumors grow on the nerve that supplies hearing and can cause tinnitus. This type of tinnitus is usually only noticed in one ear
Health & Hearing
• Pregnancy, anaemia and an overactive thyroid can cause certain types of tinnitus • Benign intracranial hypertension an increase in the pressure of the fluid surrounding the brain • Jaw joint misalignment or muscles of the ear or throat ‘twitching’ can cause a ‘clicking’ type of tinnitus • Stress and fatigue can sometimes worsen the symptoms of tinnitus, as can caffeine, smoking and alcohol
Treatments for Tinnitus Most cases of tinnitus should be evaluated by an Ear, Nose, and Throat physician to be sure that the tinnitus is not caused by another treatable problem. While research has yet to discover a cure, there are a number of treatments to help sufferers manage the condition. Generally the process begins with trying to identify the cause. If hearing loss is present, a hearing aid is likely to reduce the problem. Some wearers report that hearing aids have completely alleviated their condition. Another option to help people manage is the use of a Therapeutic Noise Generator, a device which looks like a hearing aid and is recommended for people with no hearing loss. It produces a blend of external sounds which stimulate fibres of the hearing nerve, helping deviate attention away from the tinnitus.
Cognitive Behaviour Therapy (CBT), offered by clinical psychologists, can also be effective in alleviating distress and adapting to tinnitus. CBT is threefold: changing the way a person perceives tinnitus; teaching ways to focus attention away from tinnitus; and achieving control over stress. For the vast majority of people there is no specific surgical procedure that provides a treatment for tinnitus. However, following successful surgical treatment for some ear problems, tinnitus may sometimes disappear (e.g. otosclerosis, middle ear effusion). Accurate diagnosis and treatment of Meniere’s disease may also result significantly reduced tinnitus. There is some school of thought that herbal remedies and Vitamin B12, taken under medical supervision, may be helpful for some people. It really depends on the cause of the tinnitus and we recommend that you consult a specialist to discuss these options. Where tinnitus is related to a jaw alignment problem, it is treatable. If you suspect this is a possible cause, it is worthwhile consulting your dentist.
Unfortunately, tinnitus is not a simple problem with a simple solution.
Everybody’s tinnitus noise is specific to them, and as a result treatments need to be tailored to the individual. If you would like to discuss your problem or arrange an assessment, we recommend that you call us to arrange an appointment with one of our experts.
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Health & Hearing
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> The science
“I’m too young for hearing aids” The importance of addressing hearing loss early – a scientific perspective People often wait many years from the time that they first notice that their hearing is not what it used to be before they take the step to address their hearing loss. For most people, hearing loss occurs gradually and they often are not fully aware how much their hearing has changed.
Sensory Deprivation
The thought of wearing a hearing aid can cause many people to feel a little anxious – they worry (largely unnecessarily) about not wanting to be perceived as old or a possible stigma that may be associated with having a ‘disability’. Self image and pride are great inhibitors to people addressing hearing loss – more so than the perceptions others truly have about us.
The research revealed conclusively that a person’s ability to understand speech in an unaided ear deteriorated over time faster than their ability to understand speech in their aided ear. For most people, this deterioration in the unaided ear was reversible if a hearing aid is later fitted to this ear.
All around the country there are Aussie blokes sucking in their tummies, poking out their chests and thinking to themselves - “I’m doing alright for my age” and “you’re a handsome devil”. Unfortunately, hearing loss does not discriminate based on how young and sexy someone appears to themselves! Time and time again our clients tell stories about how they wish they had done something sooner. They feel younger and more confident as a result of wearing hearing aids. Now, research has revealed two scientific reasons to consider wearing hearing aids earlier – and these have arisen from studies on the topics of Sensory Deprivation and Neural Plasticity.
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– “Use it or lose it”
Studies looked specifically at people with hearing loss in both ears (binaural loss), comparing people who were fitted with hearing aids for both ears against people fitted with a single hearing aid.
However, if the period without a hearing aid is long enough, then not only is recovery unlikely but other full advantages of hearing with both ears may never be attainable. That is, if we don’t use it, we may lose it. This provides the rationale for addressing hearing loss sooner and fitting hearing aids to both ears, if both are affected by hearing loss.
Neural Plasticity
– “Use it or it will start doing something else” In basic terms, the role of a hearing aid is to amplify sounds to the amount required to restore normal hearing levels. Often newly fitted clients would say:- “It sounds horribly tinny”. The audiologist would then adjust the
Health & Hearing
hearing aids to suit the preferences of the wearer – however we now know that this may not have been the best approach. Sounds are processed in the brain by neurons that are ‘wired’ to process sound at specific frequencies. Research has now shown that when those neurons are denied those frequencies due to hearing loss, the brain will reprogram those neurons to do something else. In simple terms, this could be described as “use it, or it will start doing something else”. This process can be reversed over time, at least to some degree, in most people. This has led to three key improvements in the field of hearing care: 1. Someone’s ability to process the full range of sounds that make up speech is lessened over time by hearing loss, so earlier fitting of hearing aids is beneficial to the wearer 2. When introducing a hearing aid to someone who has lived with hearing loss for a long time, we need for them to hear those ‘tinny’ sounds as this helps retrain their brain, until the sounds no longer seem tinny at all. This is known as Aural Rehabilitation. 3. A client’s expectations need to be managed when being fitted with a hearing aid. As great as modern technology is, hearing aids cannot replicate normal hearing.
> Dementia
Hearing Loss and
Dementia Linked in study
A research team commissioned by the renowned John Hopkins School of Medicine in the United States has found a strong link between dementia and hearing loss. The research concluded that Seniors with hearing loss are significantly more likely to develop dementia over time than those who retain their hearing. The findings, the researchers say, could lead to new ways to combat dementia, a condition that affects millions of people worldwide and carries heavy societal burdens. The scientists report that their finding may offer a new starting point for interventions — even as simple as hearing aids — that could delay or prevent dementia by improving patients’ hearing. Although the study did not investigate the cause of the link between the two conditions, the researchers propose that the strain of decoding sounds over the years may overwhelm the brains of people with hearing loss, leaving them more vulnerable to dementia. They also speculate that hearing loss could lead to dementia by making individuals more socially isolated, a known risk factor for dementia and other cognitive disorders.
“...hearing aids... could delay or prevent dementia by improving patients’ hearing.”
“Researchers have looked at what affects hearing loss, but few have looked at how hearing loss affects cognitive brain function,” says study leader Frank Lin (M.D, Phd). “There hasn’t been much crosstalk between otologists and geriatricians, so it’s been unclear whether hearing loss and dementia are related.” To make the connection, Lin and his colleagues used data from the Baltimore Longitudinal Study on Aging (BLSA), which has tracked various health factors in thousands of men and women since 1958. First published in the February Archives of Neurology, the research focused on 639 people whose hearing and cognitive abilities were tested as part of the BLSA between 1990 and 1994. While about a quarter of the volunteers had some hearing loss at the start of the study, none had dementia. These volunteers were then closely followed with repeat examinations every one to two years, and by 2008, 58 of them had developed dementia. The
researchers found that study participants with hearing loss at the beginning of the study were significantly more likely to develop dementia by the end. Compared with volunteers with normal hearing, those with mild, moderate, and severe hearing loss had twofold, threefold, and fivefold, respectively, the risk of developing dementia over time. The more hearing loss they had, the higher their likelihood of developing the memory-robbing disease. Even after the researchers took into account other factors that are associated with risk of dementia, including diabetes, high blood pressure, age, sex and race, Lin explains, hearing loss and dementia were still strongly connected.
“A lot of people ignore hearing loss because it’s such a slow and insidious process as we age,” Lin says. “Even if people feel as if they are not affected, we’re showing that it may well be a more serious problem .”
Footnote: The research was supported by the intramural research program of the National Institute on Aging and results were first published on February 2011
So maybe you are too young not to wear hearing aids! There are many reasons to address hearing loss early - even if you feel that you can “manage a little longer without hearing aids”. As well as feeling the benefits to your life and lifestyle sooner, you will also stop any permanent loss of
future benefits and positive experience that you will enjoy when you get around to experiencing hearing aids for the first time. You could reduce risks of a range of physiological conditions that have been strongly linked to ‘unaided’ hearing loss.
Health & Hearing
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> Tests
Hearing
Tests
What will happen when I see an audiologist? Bone conduction tests The sensitivity of the cochlea can also be tested by placing a small vibrator on the mastoid bone behind the ear and again measuring the softest sounds that can be heard. Sounds presented this way travel through the bones of the skull to the cochlea and hearing nerves, bypassing the middle ear. This type of testing is called bone conduction. The air conduction and bone conduction hearing levels on the audiogram can tell us a lot about where a hearing problem is originating. For example, if bone conduction tests indicate less hearing loss than a test through headphones, results would indicate that at least part of the hearing loss can be attributed to conductive hearing loss. Reasons could include fluid in the middle ear, excessive wax, a perforated tympanic membrane, or that the bones of the middle ear are not functioning normally.
Otoscopic inspection Before performing a hearing test, an Audiologist will first examine the health of the Ear canal and the Tympanic membrane with an instrument called an otoscope. This inspection can provide a lot of information about what’s happening within the middle ear. It also identifies if there are any visible problems that may influence the results of hearing tests, such as a perforation in the tympanic membrane or compacted build up of cerumen (ear wax).
Audiogram and pure tone tests
Air conduction tests The most simple and common test of hearing ability is called ‘pure tone audiometry’ where you listen to a range of different pitched beeps (called pure tones) and indicate when you can hear them, generally by pressing a button.
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Speech Tests The ability to interpret speech is a function of the ability to detect and understand the sounds of speech. The range of audible sounds, not just the degree of hearing loss, varies considerably from person to person. The loudness of each tone is reduced until you can just hear the tone. The softest sounds you can hear are known as your hearing thresholds, and these are marked on a graph called an audiogram. When hearing is measured with pure tones presented through headphones, this measurement is called air conduction. The sounds go via the air, down the ear canal, through the middle ear, and to the very delicate organ of hearing in the inner ear—the cochlea.
Health & Hearing
Unfortunately, when hearing is damaged it is usually not just the volume of sound heard that is lost, often the quality of the sound is also distorted. Speech tests are used to determine how clearly someone can understand speech, when visible cues such as lip-reading are removed. They usually involve using common lists of words played (or spoken) at a constant volume that is appropriate to the client’s hearing loss.
Hearing tests are designed to find out what you can and can’t hear. Audiologists are skilled at using a range of techniques and equipment to assess your hearing health.
The client responds by guessing the word that was spoken and correct and incorrect answers are tallied.
Speech-in-Noise tests Given that people with hearing loss commonly have the greatest difficulty understanding speech in the presence of background noise, it makes sense that speech discrimination tests are also performed with the addition of a “noise” stimulus. This is often a ‘speech babble’ played at different volumes relative the loudness of the speech (words or phrases). The client responds by guessing the word or phrase that was spoken in the presence of background noise. Again, the results are tallied.
Aided vs Unaided Tests Following the fitting of a hearing device, a hearing care professional will run the tests again to compare how their client is able to perform in the speech discrimination tests with the benefit of a hearing aid compared to when they are not wearing a hearing aid.
Tympanograms and Reflex Tests Tympanograms measure the movement and flexibility of the tympanic membrane to identify whether it is moving normally. Results may indicate a problem in the middle ear that can cause a conductive hearing loss. When a child has a normal tympanogram, it may also be possible to test for the presence of a muscle reflex (acoustic reflex) in the middle ear. The absence of this reflex to different sounds gives information about the functioning of the auditory system.
Testing children and babies The ability to test babies and young children has a unique set of problems, related to the child’s age and ability to understand instructions on how to respond. Most children will be assessed using a combination of behavioral and physiological tests. Behavioural tests (Less than 7-months of age) Behavioural tests are based on observing a change in an infant’s behaviour in response to sound – such as startling to loud noises and stirring from sleep in response. Visual reinforcement orientation audiometry (7-months to 3-years of age) These are used to test the hearing of children between seven months and three years of age. VROA involves the child turning towards the loudspeaker when a sound is presented. By altering the frequency and intensity of the sounds, it is possible to find out about the child’s ability to hear sounds across a range of frequencies. Play audiometry (Over 3-years of age) This involves testing the child’s hearing when headphones are worn. Play audiometry works the same way as pure tone audiometry (person indicates when they can hear a tone), except when the child hears a tone, they put a marble in a marble race, press a computer key or put a piece in a puzzle.
Health & Hearing
Electro-physiological tests Physiological tests help determine which part of the auditory system is involved in the child’s hearing loss. Physiological tests measure a physical response of a specific part of the auditory system and require little or no co-operation from the child. Oto-acoustic emission testing (OAE) Provides an idea about how hair cells in the cochlea are working. They respond to sound by producing a very soft sound of their own called an otoacoustic emission. Brainstem evoked response audiometry (BERA) These look at the electrical activity generated in response to sound along the Cochlea nerve to the brain. It may be carried out while a baby is in natural sleep. Electro-cochleography (ECochG or EcoG) This is a medical test performed in hospital, under anesthetic. It picks up the tiny electrical signals generated in the cochlea in response to sound and provides information about the functioning of the cochlea and cochlea (hearing) nerve.
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> Your results
Reading your
Audiogram
The Audiogram is the graphical representation of the results of the air conduction and bone conduction hearing tests. The vertical lines represent the test frequencies, arranged from low pitched on the left to high pitched on the right. The horizontal lines represent loudness, from very soft at the top to very loud at the bottom.
Sometimes the audiogram will also show bracket symbols “[“ and “]”. These represent scores based on bone conduction tests, which as discussed earlier, bypass the outer ear and middle ear.
Type of hearing loss:
The Audiogram shows the minimum volume at which a person can detect a tone played at a particular frequency. “X” is used for the left ear and “O” represents scores for the right ear. The scores are compared to results obtained from persons with normal hearing – the line at 0dB.
Interpreting the Audiogram
• Sensioneural – Hearing loss (equally) for both air and bone conduction
The Audiologist will use the following characteristics of the audiogram to explaining the results of the audiogram: -
• Conductive – Normal hearing for bone conduction scores ([ & ]), and showing a hearing loss for Air Conduction scores (X & O)
• Mixed - Hearing loss for bone conduction score, and an even greater hearing loss for air conduction scores
Severity of loss: • The lower the scores fall on the Audiogram, the more severe the hearing loss.
This diagram shows the approximate sound levels of some common sounds. Speech and conversation usually falls into the yellow shaded area and, not surprisingly, this is commonly called the speech banana. We have placed some vowels and consonants within this area to show where those speech sounds fall in conversation at normal levels.
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Health & Hearing
Slope of loss: • Flat loss – A hearing loss where hearing is relatively even across all frequencies, which is more common for conductive hearing losses. • Sloping loss – Increasing degree of hearing loss the higher the frequency. This is the most common hearing loss that will be shown due to the ageing process and noise damage. • Other: Less common shapes include reverse slopes, cookie bites, corner audiogram
How the ears compare: • Monaural loss: Loss is only in one ear • Binaural loss: Loss is in both ears • Symmetrical: Hearing is relatively even in both ears • Assymetrical: Hearing loss in one ear is significantly worse than the other ear.
“My hearing is pretty good other than FOR those high frequencies” In interpreting an audiogram, it is a common for clients to misinterpret the results ~ looking at the good news rather than taking in the whole story. Low frequencies of sounds found in speech (125dB – 1000 dB) are largely responsible for a person’s interpretation of the volume of speech. High frequencies are responsible for the clarity that someone interprets speech. Some of the high frequency elements of speech include those made by words containing letters such as “f ”, “ph”, “th”, “s” and “t”. Because these sounds are difficult for someone with high frequency loss to hear, they may often mistake what has been said. For this reason, many people with greater losses in the higher frequencies commonly feel that: “I can hear ok, it is just that people sound like they’re mumbling”.
Here we can see the Audiograms of three people: -
1. Annie (75 years) – Housewife and grandmother of 12 wonderful grandchildren 2. Bill (55-years) ~ Carpenter 3. David (12-years) ~ Great cricketer
Annie has a moderate hearing
loss that is known as Presbycusis. This results from degeneration of the hair receptors within the cochlear due to the ageing process. Before she was fitted with hearing aids, Annie always found conversations with her younger grandchildren particularly difficult - especially when in a noisy situation. She also found telephone conversations difficult and noisy restaurants were the “bane of her existence”:
Bill has been on the tools
for 40-years as a carpenter and admits to rarely using ear protection for most of that time. His sharply sloping loss in the higher frequencies can largely be put down to the damage produced by electrical saws and other equipment that he has used in his job.
David is currently suffering from a nasty illness that has led to fluid gathering in his middle ear. He is not hearing very well at the moment and his ears are hurting and “feel tight on the inside”. This infection is causing a problem with the passing of sound through his middle ear, as can be seen by the Normal hearing scores he has from his Bone conduction tests, represented by the “[“ and “]”, but impaired Air Conduction results.
Common Audiograms
Health & Hearing
page 15
Rediscovering a full world of sound Although describing his life as fairly relaxed, Moshe Bernstein (59) was increasingly frustrated by difficulties he was finding in following conversations in noisy environments and clearly following the dialogue within a good movie. Six months on from being fitted with the practically invisible Oticon Intiga hearing aids, Moshe is again greatly enjoying the ease with which he can head out into the world. Fluent in Chinese (Mandarin) and currently working on his Ph.D. in Asian studies at the University of Western Australia, Moshe noticed that he was finding it increasingly difficult to remain actively involved in conversations – particularly in noisy settings. Moshe remembers: -
“It could be extremely frustrating sitting around a table participating in seminars... when the fan was whirring and the speaker was across from me I often could not understand a word. The hearing aids have changed that... sounds are now discernible.” These problems extended to great difficulty in social situations and parties, during which Moshe would feel “on the outside of conversations.” But like many in his situation, it took some time before he took the steps to do something about it. He responded to an invitation from The Art of Hearing earlier this year to undertake a free trial the latest in discreet hearing solutions. In addition to tackling the effects of hearing loss, the Oticon Intiga also promised to be ‘practically invisible’ to others.
“There is no doubt that wearing hearing aids greatly enhanced my ability to communicate when in China. I am very much looking forward to returning to continue my research next year.” Moshe said. Being able to give the hearing aids a thorough test and assess the difference that they could make to his life, before purchase, was also greatly appreciated. While reporting that it took a little bit of time to adapt to wearing the hearing aids. Moshe concludes: -
“My wife has also noticed a change in my ability to hear and converse more freely with others. I am extremely grateful to the team at The Art of Hearing for the opportunity to trial the hearing aids and would encourage others to do the same.”
Moshe recalls: - “I definitely had a vanity issue and preferred that other people did not notice that I was wearing hearing aids… even my son did not notice that I was wearing the hearing aids for a couple of months before I told him!” Now life is much easier with the use of his hearing aids. In an ultimate test of hearing in noisy environments, Moshe and his wife were in China earlier in the year. It was part of his research into a 1,000 year old Jewish community living within central China in a town named Kaifeng.
The Oticon Intiga is amongst a range of discreet hearing solutions available at The Art of Hearing
The Art of Hearing is offering free trials of the latest hearing aids from all leading manufacturers. To arrange your own free home trial, call The Art of Hearing on (08) 9390-8811. page 16
Health & Hearing
> Solutions
Hearing
Aids – “nothing like the old days”
This time last century, the only assistance that someone with hearing loss could use was an ear trumpet. While ear trumpets increased volume of sound, most people would still have major issues of clarity. Now 100 years on, there have been many advances in both medical solutions and hearing aid devices. Hearing loss can now be managed to ensure that it need not greatly affect the lives of most people with the condition.
In this section we will look at modern day hearing aids and medical solutions such as the Cochear Implant.
Health & Hearing
page 17
Features of modern hearing aids
With digital technology, devices can now break sound into as many as 24 different bands. Given that every person has a unique pattern of hearing loss, the sound quality provided by a modern hearing aid is far better the previous analogue technologies that were restricted to two bands – base (low frequencies) and treble (high frequencies).
If hearing tests demonstrate that you have a sensorineural hearing loss, we have some great news – modern hearing solutions are nothing like the large, noisy, clunky and whistling hearing aids of days gone by! Hearing aids are equipped with many incredible features that make even the most difficult situations manageable and they come in devices so small, that no one would ever notice that you’re wearing a hearing aid.
Feedback Cancellation Historically, one of the greatest complaints and a source of embarrassment for hearing aid wearers is related to feedback – the whistling sound created when amplified sound is picked up by the hearing aids microphone, causing squealing or whistling.
How do digital hearing aids work?
As you would know, sound travels in waves. The digital hearing aid can now detect the frequency of and the wave shape that is causing the feedback and counteract it within fractions of a second. So, there will be no annoying and embarrassing whistling from your hearing aid.
The most basic function of a hearing aid is to amplify sound. Digital hearing aids, which have only been around since late 1990’s, do this in a rather sophisticated way. As sound enters the device, it is broken into multiple frequency bands. Each band is then amplified by the amount necessary to return the wearer’s hearing to normal levels at that band.
Hearing aid models
DC
(deep-canal)
CIC
(completely-in-canal)
ITC
(in-the-canal)
Hearing aids are also available in an extensive range of colours and sizes. This chart shows some of the more common hearing aid models available. Mild to moderate hearing losses
Mild to moderate hearing losses
Mild to moderately- severe hearing losses
Fits deep inside the ear canal, making it invisible
Very small case
Small, one piece case
Fits inside the ear canal, making it practically invisible
Fits inside the ear canal
Less occlusion Not suitable for people with narrow ear canals
Size prevents the use of directional microphones
Size prevents the use of directional microphones
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Health & Hearing
Directional microphones are possible with this model
Open fit acoustics Improvements in feedback management have allowed hearing aid manufacturers to develop devices that do not obstruct the natural passage of sound through the ear canal. Previously, wearers of hearing aids would complain of a “talking in a barrel” sensation, like you can experience when using your fingers to block your ears and listening to the sound of your own voice. Open fit hearing aids have very thin tubes that enter the ear canal and smaller cases that rest behind the ear, making them barely visible. Additionally, hearing aids that sit within the ear canal can now have
greater ventilation. The end result is far more comfort and clarity for the hearing aid wearer of today.
Noise management One of the problems with older hearing aids was that they amplified all sounds equally – whether the source of the sound is the person who the wearer is listening to, or background noises, such as traffic, air conditioners, or ambient noise from a crowded room. This led to discomfort and did not help the user to follow conversations in difficult environments. Now digital hearing aids can actually tell the difference between speech and background noise and do this individually for every frequency band. The hearing aid then amplifies the speech sounds and reduces the amplification of background noise. Now consider the size of a hearing aid and the number of computations that it must perform every few milliseconds across
RIE
(receiver in the ear)
Mild to moderately-severe hearing losses Ear canal open for a natural sound quality Smallest external hearing aid, as the receiver is located in the end of the tube inside the ear Very small case that sits behind the ear, making it practically invisible
Open (open ear)
Mild to moderately-severe hearing losses Ear canal is open for a natural sound quality Very small case that sits behind the ear, making it practically invisible
BTE
(behind-the-ear)
up to 24 frequency bands and then deliver the enhanced sound into the ear canal. The mind begins to boggle! It may be easier to simply enjoy the results of noise management – greater listening comfort and clarity.
Power (high powered)
Mild to severe losses
Profound hearing losses
Fully featured hearing aids
More powerful
Larger case can be easier for wearers with dexterity considerations
solutions that provide the greatest levels of amplification
Case contains all features and sits behind the ear
Larger case worn behind the ear
Many colour options Many colour options
Many colour options
Health & Hearing
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as signals from the external devices are streamed directly into the hearing aid, without background noise and the need for the hearing aid to first process a sound signal.
Multiple and automatic programming Different listening environments often call for different settings within hearing aids in order to maximise their effectiveness. For example, when listening to music, the user would prefer to turn off features that may misinterpret elements of the music as noise. When in a quiet room, a wearer will not need the benefit directional microphones and noise reduction to the same extent they would in a crowd at the football.
Directional Microphones Most people with hearing loss find that trying to follow a conversation in a noisy place can be a tremendous struggle.
such as restaurants. This feature provides the greatest benefit in regards to improving a hearing aid wearer’s ability to follow conversations in noisy environments.
Logically, most conversations are with people who we are facing, while distracting background noise will come from the sides and behind us.
Connectivity to mobile devices and entertainment
A modern digital hearing aid can actually pinpoint the location of sounds. It does this by using more than one microphone and gauging the difference in time that it takes sounds to reach each microphone – even though the microphones are only a few millimetres apart!
Wearers are increasingly looking for solutions to improve the effectiveness of hearing aids in partnership with their mobile phones, digital radio, plasma televisions, and personal stereos (i.e. iPods and MP3 players).
It will then provide the greatest amplification to sounds coming from in front of the wearer and less amplification to sound coming from the sides and behind. Directional microphones can be extremely beneficial in difficult situations,
Advanced hearing aids allow the user to change the settings by pressing a small button on the device. The most advanced hearing aids will even listen to the environment and change the hearing aids settings automatically, without the wearer needing to touch or think about their hearing aids.
In response, manufacturers have developed streamers that connect wireless devices to the user’s hearing aid. The benefit is that this delivers improved performance in terms of speech intelligibility and sound quality
Two ears are better than one We were born with two ears for a reason: it helps with sound location and provides much clearer ‘stereo quality’. Advanced features such as directional microphones are far more effective when applied with two hearing aids. For these reasons, The Art of Hearing strongly recommend that our clients are fitted with hearing aids in each ear affected by hearing loss, as this will lead to a vastly improved benefits and client satisfaction.
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Health & Hearing
> Medical
Cochlear
Implants
A Cochlear Implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, Cochlear Implants do the work of damaged parts of the inner ear (cochlea) to send sound signals to the brain.
Cochlear Implants can help people who: • Have severe to profound sensorineural (inner ear) hearing loss in both ears • Receive no real hearing benefit from hearing aids • Have poor speech recognition Children in particular stand to gain significant benefit in hearing performance as a result of the increased sound stimulation during the developmental “window” that occurs during early childhood.
How do they work? Many people suffer hearing loss because they have damage to hair receptor cells in the inner ear (or cochlea). If some hearing nerves still work, a Cochlear Implant can allow you to hear. Here’s how: 1. An external sound processor captures sound and converts it into digital code
3. The implant converts the digitallycoded sound into electrical impulses and sends them along the electrode array, which is positioned in the cochlea (inner ear) 4. The implant’s electrodes stimulate the cochlea’s hearing nerve, which then sends the impulses to the brain where they are interpreted as sound.
What factors can affect these benefits? • How long has the patient lived with hearing loss • How severe their hearing loss is • The condition of the cochlea (inner ear) • Other medical conditions • Practice using their cochlear implant system
Call The Art of Hearing to arrange a consultation and assessment If you would like to know if you would benefit from a Cochlear Implant, call The Art of Hearing to arrange an appointment and a comprehensive assessment.
2. The sound processor transmits the digitally-coded sound through the coil to the implant
Grace Tern
Listening to 11 year old Grace’s piano performances and energetic conversations, it’s hard to believe that she is profoundly hearing impaired.
Reproduced courtesy of Cochlear Ltd
Grace’s mother shares her inspirational story: “When we first discovered Grace was profoundly hearing impaired we despaired about her future. We thought she would be confined to just signing as a means of communication. Then a friend told us about cochlear implants. We went ahead with the operation when Grace was 1 year old. In the days after switch on, I knew she understood me because she would give actions to familiar nursery rhymes. Speech followed and, within a year, she was tracking like a normal child.
Health & Hearing
Now, at 10 years, she’s as normal as a normal child can be. “My life would be very different without cochlear implants because without them I can only hear very loud sounds like thunder. Without my implants, I can’t hear voices and that makes it very hard to communicate!” - Grace
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> Costs
How
much? A common question from people who call The Art of Hearing is:
“How much do hearing aids cost?” While entry level hearing aids are free to pensioners, a ‘privately funded’ client can spend up to $12,000 on a pair of premium hearing aids with all the latest advanced features. But what will be the true ‘out of pocket’ investment for a client will come down to a number of factors, such as: -
Assistance with the cost of hearing aids • Is the client a pensioner or an active or retired member of the armed services (i.e. Army, Navy or Air Force)? • Does the client have private health insurance? • Does the client have a taxable income and lodge a tax return? • Has the client’s hearing loss occurred as a result of occupational exposure to noise?
Personal factors • Does the client have a binaural loss (two ears) or monaural hearing loss (one ear) • The severity and pattern of the hearing loss will influence the hearing care professional’s recommendation • The client’s budget
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FREE hearing aids for pensioners and veterans Ensuring that every Australian has access to better hearing is one of the federal government’s key health priorities. The Office of Hearing Services Voucher Scheme provides free hearing tests and hearing aids to pensioners and veterans, which are available through accredited providers, such as The Art of Hearing.
Who is eligible? You are eligible if you are an Australian citizen or permanent resident, 21 years of age and over, meeting one of the following criteria: • Centrelink Pensioner Concession Card • Gold Health Repatriation Card • White Health Repatriation Card (specifying hearing loss) • Centrelink Sickness Allowance You may also be eligible if you are: • Dependant of a person in one of the above categories • Active member of the Defence Force • Client of CRS Australia
Health & Hearing
How do you apply? If you believe that you may be eligible, call The Art of Hearing and we will provide you with, and assist you to complete, an application form for the Office of Hearing Services.
Insurer
Rebate
Phone
Website
MBF
$1000 per aid every 3 years
131 137
www.mbf.com.au
Medibank Private
$800 per aid every 5 years
132 331
www.medibank.com.au
HBF
$650 for first aid and $325 for second aid every 4 years
133 234
www.hbf.com.au
NIB
$800 per aid every 3 years
13 14 63
www.nib.com.au
HCF
$800 per aid every 5 years
13 14 39
www.hcf.com.au
The Art of Hearing recommend that you check with own health insurer to learn what benefits are available.
Private health funds Many private health funds offer rebates on the cost of hearing aids for their extras and premium plans. At the time of printing, the rebates above applied to five of Australia’s largest health insurers on their premium plans.
Tax rebates on hearing aids The government has exempted hearing aids from GST and provide a tax rebate of 20% on annual medical expenses in excess of $1500.
This could lead to a rebate of over $1,500 for advanced hearing solutions for clients who lodge a tax return.
Compensation for occupational hearing loss Until recent times, the damage caused by working in noisy environments was not fully appreciated by many companies. As a result, Australians working in factories, the building industry, mining industry, and other noisy workplaces were rarely provided with ear protection and hundreds of thousands of people have subsequently incurred occupational hearing loss. The state government provides a scheme for employees who have incurred occupational hearing loss with access to compensation.
Health & Hearing
This scheme is administered by WorkCover WA. If you would like advice regarding a claim for occupational hearing loss,
call The Art of Hearing and we will be happy to assist.
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Call now or drop in for more information and to book a consultation with the audiologist at the top hearing healthcare centre in Perth.
Head Office & Permanent Clinic
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9390-8811
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Suite 6, Kardinya Commercial Centre (Next to IGA), Kardinya 6163
2/73, Gibson Avenue (Next to Padbury Family Practice), Padbury 6025
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Ecko Rd
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f: (08) 9390-4592 e: info@artofhearing.com.au w: www.artofhearing.com.au
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2/2 Ecko Rd, Mount Nasura WA 6112
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Chisham Avenue Medical Centre, 1 Chisham Avenue, Kwinana 6167