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For all your hearing options
VERTIGO You may not have to live with it!
ASSISTIVE LISTENING DEVICES
for when hearing aids aren't enough
ED!
MYTHS BUST
COCHLEAR IMPLANTS FOR ADULTS ASK THE EXPERTS • Can hearing aids help tinnitus? • Dietary supplements for hearing loss
DID YOU KNOW
KEIRA
KNIGHTLEY CAN'T HEAR MUSIC?
Aug - Nov 2014
A “normal” phone A “normal” phone with over 40% with 40% betterover speech better speech understanding. understanding. The Phonak DECT is a normal cordless phone the whole family can use - but with one important difference: connects automatically wirelessly The PhonakItDECT is a normal cordless and phone the with Phonak can thereby improve whole family hearing can use aids - butand with one important speech understanding over 40%*. Phonak DECT difference: It connects by automatically and wirelessly is justPhonak one of hearing many ingenious from Phonak. with aids and solutions can thereby improve speech understanding by over 40%*. Phonak DECT is just one of many ingenious solutions from Phonak.
Simply ingenious Simply ingenious
www.phonakpro.com.au/dectphone * www.phonakpro.com.au/evidence www.phonakpro.com.au/dectphone
Editor in Chief Lucinda Mitchell editor@hearingHQ.com.au Sub Editor Judy Lockhart Contributors Karen Pedley, David Becconsall Experts Ass. Prof. Melville da Cruz, Dani Tomlin, Emma Scanlan, Roberta Marino Advertising Sales Executive Julia Turner jturner@hearingHQ.com.au 0414 525 516 Magazine Distribution distribution@hearingHQ.com.au
HQ FEATURES
8
BEAT DEAFNESS
12
COCHLEAR IMPLANTS FOR ADULTS
18
ASSISTIVE LISTENING DEVICES (ALDs)
Printed by Offset Alpine Published by The Tangello Group Pty Ltd EDITORIAL ADVISORY BOARD Prof William Gibson AM Head of ENT Unit, University of Sydney Prof Gibson holds the Chair of Otolaryngology at The University of Sydney. He is Director of Sydney Cochlear Implant Centre and the author of 185 texts and scientific articles. His AM was received in recognition of his services to medicine.
Assoc Prof Robert Cowan, CEO HEARing Cooperative Research Centre Principal Research Fellow of Melbourne University, A/Prof Cowan has researched and published extensively in the fields of audiology, cochlear implants, sensory devices and biomedical management. He holds the '06 Denis Byrne Memorial Orator Award.
Adjunct Prof Harvey Dillon Director of Research, NAL
Dr Dillon has researched many aspects of hearing aids, effectiveness of rehabilitation, auditory processing disorders and methods for preventing hearing loss. He has designed hearing aids, authored over 160 articles and his text on hearing aids is used worldwide.
Alex Varley, Chief Executive Media Access Australia
MAA focuses on identifying practical, realworld solutions for people with disabilities to access audiovisual content to empower people to be independent. They provide advice to government, industry, educators and individuals.
Dr Neville Lockhart
After 45 years of profound deafness Dr Lockhart received a cochlear implant in 2005. His involvement in the cochlear implant support group CICADA and his technology background (retired senior CSIRO scientist) led him to become editor of CICADA Magazine (now Hearing HQ).
Olivia Andersen, Founder/Director Hear for You
Profoundly deaf from birth, Olivia Andersen started Hear For You, a not-for-profit organisation to help young deaf people achieve their life dreams. The birth of her first child prompted her decision to have a cochlear implant.
Like Keira Knightley, some people can't hear music or keep to a beat despite having 'normal hearing'. We investigate why.
There are still many misconceptions about cochlear implants. The most surprising is that they are only for children. We bust 10 myths about cochlear implants for adults. Relying on hearing aids may not be your best (or only) option in every situation. We investigate the ALD options available and how they can benefit you. Cover image: Demotix
REGULARS
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EDITOR'S LETTER
30
NEWSBITES
25 28
ALL ABOUT‌ Benign Paroxysmal Positioning Vertigo (BPPV)
ASK THE EXPERTS Professional advice on reader questions and concerns.
REAL PEOPLE REAL STORIES Audiologist, mentor and passionate advocate, Zoe Williams hasn't let hearing loss limit her opportunities.
Research, innovations and things you need to know.
Sharan Westcott Clinical Manager, SCIC
Former principal audiologist for Australian Hearing, Sharan Westcott has provided audiology services to children and adults for more than 40 years and now coordinates a team of surgeons, audiologists, speech pathologists and social workers at SCIC.
contents
hearing
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HERE TO HELP
33
PRODUCTS & SERVICES
34
BOOKS ETC...
Organisations providing advice and support. Information at your fingertips. Book reviews.
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The Editorial Advisory Board provides guidance and expertise on a voluntary basis. They may not review every article and make no warranty as to the scientific accuracy of the magazine. They are not responsible for any errors published and do not endorse advertised products. If you have any questions about editorial content, please direct them to editor@hearingHQ.com.au. If you have questions about product suitability for your specific needs, we recommend you consult an audiologist or doctor. Any person with health issues or medical concerns should first take advice from a health professional.
Hearing HQ Aug - Nov 2014 3
ed's letter I find the human brain fascinating! Have you ever experienced buying a new car and having finally narrowed your choice down to one brand find you 'see' your favourite car everywhere you go? Or you've just become pregnant and notice there are babies at every turn? This happened to me in the most unexpected way recently. I was reading an interview with Keira Knightley who was being interviewed for her new movie in which she is a song writer cajoled into singing. If I had read this prior to being involved with the hearing industry I would have read her quotes (page 9) and just moved on. But my brain 'saw' an intriguing hearing issue which was completely overlooked by the journalist, and every other journalist who reproduced the quote afterwards. It got me thinking, then researching and our cover story on page 8 is the result. I hope you enjoy this story as much as I did researching it!
NEW INEXPENSIVE SOLUTION FOR HEARING SCREENING 'HearScreen', a new smartphone app, is set to offer an easy, inexpensive hearing screening option. The automated app has been developed by Prof De Wet Swanepoel (right) from the University of Pretoria, Sout Africa, who holds an adjunct position at the University of Western Australia, in collaboration with Prof Robert Eikelboom from the University of Western Australia. It can be loaded onto a smartphone, adheres to international calibration standards and has valid real-time noise monitoring to ensure reliable testing. A screening takes just one minute, the data is uploaded to a centralised site for evaluation and recommendations via the mobile phone network. “Anyone who knows how to operate a mobile phone can set up ‘HearScreen’. It significantly improves and alters current models of school and community-based identification of hearing loss,” says Prof Swanepoel. Field trial findings demonstrate screening outcomes equivalent to the present gold standard. Expected to be available towards the end of the year, this userfriendly interface and affordability will open up new models for early access to hearing loss detection within under-served communities. HearScreen is the winner of the prestigious 2014 NSTF-BHP Billiton award.
More information at www.hearscreen.co.za
Lucinda Mitchell Publisher & Editor in Chief To have your say contact: editor@HearingHQ.com.au
Hearing HQ Magazine is published by The Tangello Group Pty Limited 'The Tangello Group' (ABN 38 155 438 574) PO Box 1054, Lane Cove NSW 1595 and is subject to copyright in its entirety. The contents may not be reproduced in any form, either in whole or part, without written permission from the publisher. All rights reserved in material accepted for publication unless specified otherwise. All letters and other material forwarded to the magazine will be assumed intended for publication unless clearly labelled “not for publication”. Text, photographs and illustrations received in hard copy must be accompanied by a self-addressed envelope stamped to the appropriate value (including registered or certified mail if required) if return required. The Tangello Group does not accept responsibility for damage to, or loss of, submitted material. Opinions expressed in Hearing HQ Magazine are those of the contributors and not necessarily those of The Tangello Group. No responsibility is accepted for unsolicited material. No liability is accepted by the publisher, the authors or members of the editorial advisory board for any information contained herein. All endeavours are made to ensure accuracy and veracity of all content and advice herein but neither Hearing HQ Magazine, its publisher, contributors or editorial advisory board members is responsible for damage or harm, of whatever description, resulting from persons undertaking any advice or purchasing any products mentioned or advertised in Hearing HQ Magazine or its website. 4 Hearing HQ Aug - Nov 2014
Phonak & Advanced Bionics Team Up For Improved Hearing for Cochlear Implant Recipients Phonak and Advanced Bionics (AB) have announced their Naída CI Q70 behind-the-ear cochlear sound processor is now commercially available in the Australia. Along with 100% wireless connectivity to consumer electronics, including iPhones and well known brand android phones, there is an additional benefit of bimodal media streaming when you have a Phonak hearing aid and AB's Naida Cochlear Implant sound processor. And with nine colours to choose from you should be able to match to your hair colour, your glasses frames or your favourite outfit!
Ormia ochracea fly by Jpaur via Wikimedia Commons
newsbites
Fly’s Super-Hearing Power
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the key to reduced hearing aid energy consumption? A tiny, low-power device that mimics a fly’s hearing mechanism could prove a game changer for hearing aids of the future with hypersensitive hearing aids featuring intelligent microphones able to focus only on conversations or sounds of interest to the wearer. Ronald Miles at Binghamton University and Ronald Hoy at Cornell University discovered the Ormia ochracea fly's sophisticated sound-processing mechanism which resembles a see-saw and can determine the direction of sound to within two degrees. It was this discovery that inspired Neal Hall, assistant professor at Texas University's Department of Electrical and Computer Engineering, to lead a team to build a fly-sized, 2 millimetre wide, silicon pressure-sensitive device that replicates the fly’s super-evolved hearing structure. Fly-inspired hearing devices have been developed in the past. However it is the use of piezoelectric materials (which turn mechanical pressure into electric signals) that sets this device apart, requiring very little power for the device to operate. “Because hearing aids rely on batteries, minimising power consumption is a critical consideration in moving hearing-aid device technology forward,” Hall said. Source: http://bionews-tx.com. Article detailing both the device and the research can be found at http://scitation.aip.org/content/aip/journal/apl/105/3/10.1063/1.4887370
TROY CASSAR-DALEY
NAMED NEW AMBASSADOR FOR AUSTRALIAN HEARING
Australian Hearing has announced the appointment of Australia’s acclaimed country music singer, Troy Cassar-Daley, as its official Ambassador. The announcement coincides with Hearing Awareness Week (24-30 August), a campaign that promotes the importance of taking care of the nation's hearing. The accomplished singer and songwriter will perform his hits and make appearances at selected Australian Hearing centres, around the country, over the next two years. He will support Australian Hearing's ongoing efforts to help people overcome their hearing loss. Cassar-Daley will also be involved in raising awareness of hearing health amongst Aboriginal and Torres Strait Islander regions, where Australian Hearing is currently supporting over 220 communities.
NEW WEBSITE TO HELP AUSTRALIANS WITH HEARING LOSS The Australian Government Hearing Services Program assists over 600,000 people each year to access hearing services. www.hearingservices.gov.au has been launched to help Australians access services faster by allowing people to apply online. The website also contains a wealth of information about hearing and hearing loss.
CONGRATULATIONS to the Queen's Birthday 2014 Honours Recipients
Conjoint Prof. Gregory Ross LEIGH, AO For distinguished service to the deaf and hard of hearing community, particularly children, through education, research, public policy development, and specialist services. Kathleen Marie CHALLINOR, OAM For service to nursing in the field of audiometry. Bruce Railton MULLER, OAM For service to deaf and hard of hearing people.
Hearing HQ Aug - Nov 2014 5
{
newsbites Want to save a child in your life from life-long hearing damage?
The number of young people 10 to 19 years of age with noise induced hearing impairment has jumped nearly 30 percent in just five years according to Korea's National Health Insurance Service. We've found a really easy, step-bystep video to restrict the volume on iPhones, iPads and iPods (with password protection) http://www.cnet.com/au/how-to/restrictvolume-on-iphone-ipod-and-ipad/
HEARING HAIR CELLS new understanding of how they grow
According to a study published in the journal Proceedings of the National Academy of Sciences, researchers from Penn State University and the University of California have discovered an important new piece to the hearing hair cell growth puzzle. In previous research Aimin Liu, associate professor of biology at Penn State University and his colleagues discovered that a protein called C2cd3 was needed for cilia to grow on the surfaces of cells. The investigators knew cilia grow from a centriole - a structure that attaches itself to the inner surface of the cell and acts as an anchor for the cilia. A cell needs to amass a set of appendages at one end of the centriole prior to growing the cilia.
"You could think of cilia as the cells' antennae. Without cilia, the cells can't sense what's going on around them, and they can't communicate," says Liu. Liu's new research has now revealed that when there is no C2cd3 protein present, the appendages are not assembled at the end of the centriole. This means the centriole is not linked to the cell membrane and is unable to take on other proteins that allow the cilia to grow. "If we want to better understand and treat diseases related to cilium development, we need to identify important regulators of cilium growth and learn how those regulators function. This work gives us significant insight into one of the earliest steps in cilium formation." says Liu Source: www.medicalnewstoday.com/articles/271807.php
6 Hearing HQ Aug - Nov 2014
MED-EL have introduced a new optional accessory for their single-unit cochlear processor. The new WaterWear for RONDO速 is easily wrapped around the processor for complete protection from water and dust and is almost invisible. It consists of a tight transparent cover which slips over the processor and is closed with an adhesive strip. The strip provides a tight seal and prevents dust or water from getting into the audio processor achieving an ingress protection rating of IP68. They come in packs of three WaterWear covers and nine adhesive strips. Each WaterWear cover can be used up to three times while the adhesive strips are designed for single-use.
SUBSTANCE TO TREAT NOISEINDUCED HEARING LOSS Noise-induced hearing loss is one of the most common types of sensorineural hearing loss. In a study published in the US journal Proceedings of the National Academy of Sciences, Korean researchers at Ajou University have found that a substance used in asthma medication may help. Professor Park Sang-myun from the department of Pharmacology at Ajou University explained "when exposed to noise, an enzyme known as MMP3 is released and this can lead to hearing loss. The asthma treatment showed a protective response". In their experiment a mouse was exposed to 112 decibels of noise for three hours and changes in the cochlea observed. They found a Leukotriene receptor (CysLTR1), recognised for its role in asthma attacks, increased until three days after noise exposure. Treatment for four consecutive days after noise exposure with Montelukast, used in asthma medication, significantly decreased the permanent threshold shift and also reduced the hair cell death in the cochlea. The research team have suggested Montelukast could be used to make a new medication to prevent noise-induced hearing loss from worsening. Source: www.pnas.org/content/early/2014/06/19/1402261111.abstract
PARTICIPATION IN THE ADMINISTRATION OF JUSTICE
CAN YOU HELP WITH TINNITUS RESEARCH?
A novel treatment that may provide a cure for chronic tinnitus is seeking financial support for development costs through a crowdfunding campaign (crowdfunding is the practice of raising funds from two or more people over the internet towards a common Service, Project, Product or Cause). Based on ten years of neuroscience research, tinAway is the brainchild of Dr. Ian Dixon (who completed a PhD on chronic tinnitus at Monash University) and engineer Tony Burgess. The tinAway app blends neuroscience and innovative software development to run on a standard iPad. It is designed to deliver userspecific pulses of complex sounds in a brain training program, with the goal of stopping the brain’s misperception of irrelevant neuronal firing as sound.
In May this year a deaf woman was barred from serving on a Queensland jury on the basis it would introduce an Auslan interpreter as a ‘‘13th juror’’ into deliberations. It caused quite a media uproar. It was therefore satisfying to see that on 23 July in Sydney two jurors took an oath in sign language as part of a groundbreaking study examining the impact of having an interpreter in the jury room, and whether it affects the dynamics and communication between jurors. The mock trial, based on a real criminal case, involved two Auslan interpreters translating courtroom proceedings for the two deaf jurors before entering the jury room, where interactions were filmed and analysed. The study, funded by an Australian Research Council Linkage The grant, also involved 13 hearing jurors, a inventors retired judge, two police officers and two plan to witnesses played by actors. make tinAway The study is lead available through by Sandra Hale, iTunes should funding be Professor of successful. Once available, Interpreting and users would download tinAway is an independent, clinic Translation at audiological and then visit an audiologist who offering integrity and excellence the University would then teach them how to work with of NSW along with tinAway. Following this, tinAway would be used at in service for all our clients. professors David Spencer home or in the office. from the Australian Catholic In each session, the user would tune tinAway’s We provide;and Jemina University sounds to suppress their tinnitus noise temporarily. It is ■ Hearingfrom assessments for Napier, Heriot-Watt expected, by using tinAway daily, the key part of the brain private clients, pensioners University in the UK. The will be gradually re-trained until the suppression becomes and DVA clients pioneering international permanent and the tinnitus is gone. ■ Hearing Aids – all styles and research is aimed The goal of tinAway therapy is not masking or temporary best brands at initiating law suppression or some symptomatic relief, but to free people ■ Communication solutions reform on legal from tinnitus for good. The crowdfunding campaign launches ■ Implantable hearing solutions sign language on Indiegogo on 1 September at http://igg.me/at/tinaway ■ Tinnitus assessment and interpreting and treatment jury service. ■ Musician, swimmers’ & noise
Specialist Hearing Services
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BEAT DEAFNESS
Begin Again, released in Australia on 7 August this year, is a soul-stirring comedy featuring Keira Knightley as a lonely English songwriter in New York jilted by her rising rock-star boyfriend. Knightley's character, discovered by a has-been record-label owner, is cajoled into making an album and singing her own songs. 8 Hearing HQ Aug - Nov 2014
Film still: The Weinstein Company
With all good Hollywood movies, prior to launch, the stars are sent out on a gruelling publicity trail to drum up promotion through interviews. TV and radio stations, magazines and newspapers clamber for access to these personalities in the hope of uncovering a never-before-revealed fact about the high profile celebrities. As Lucinda Mitchell discovered, so it was with Keira Knightley's latest movie Begin Again, although there may be more to the story.....
It was British Hello! magazine that discovered that Keira Knightley doesn't 'hear' music when it's played because her brain doesn't 'tune in' to it. "I don't know anything about music at all. I never really listen to it. If it's on in a room, I can't really hear it. I don't have that sort of brain," she told Hello! "And that's another reason I was so interested in doing this film. I'm married to a musician, my best friends are completely obsessed with music, my brother was in bands - it completely surrounds me, but I really have to concentrate to pick it up." This insight piqued my curiosity! With a little more research I also discovered during one interview about her role in the 2012 film Anna Karenina, Knightley had joked "I found out I'm not a very good dancer. We spent about a month trying to work on it." In another she said " The dance sequences were really, really hard, and I'm not a natural dancer." She has describes her dancing as more like jumping up and down. If Knightley can easily hear voices, environmental sounds and even sing (admittedly described as meek and just barely floating on key) why can't she 'hear' music and why does she find dancing so difficult? While it would be impossible to 'diagnose' Knightley based on information from a few media interviews it did launch me on a fascinating journey of learning about the complex relationship between the physical apparatus we have that receives sounds (outer, middle and inner ear) and the process our brain goes through to interpret those sounds. First stop on this journey was tonedeafness or congenital amusia. "A person suffering from amusia can obtain no pleasure from listening to a melody," according to neuropsychologist Isabelle Peretz co-director of the International Laboratory for Brain, Music and Sound Research (BRAMS) a unit of UniversitĂŠ de MontrĂŠal and McGill University. In a paper published in the journal Current Directions In Psychological Science1 Peretz explains: "What distinguishes amusic individuals from ordinary people is their inability to recognize a familiar tune without the aid of the lyrics, their inability to detect when they sing out of tune, and their difficulty judging whether
two melodies are the same or different, especially on the pitch dimension." Then I discovered what is believed to be the first documented case of beat-deafness published in the journal Neuropsychologia2 by Jessica PhillipsSilver, a BRAMS postdoctoral researcher. This newly-discovered form of congenital amusia is a condition resulting in difficulty recognising the strong beat in music. With beat-deafness you can't move your arms, legs or body in sync to music. Nor can you tell if another dancer is moving in time to music. To put this in context it is useful to first understand Phillips-Silver's explanation "in music most people 'hear' melody but 'feel' the beat." In an online3 video she points out that as early as Aristotle's time people have understood there is a strong connection between sound and motion. Scientists like Phillips-Silver believe it is a two way street, "hearing sounds can make us move, but also the motion of our body can shape what we hear." The way you see the image (left) is an example of how our perception of the world is subjective. When you look at the image you either see a single white vase in the centre or you can see two black faces looking in. The image is ambiguous. It is the brain's job to interpret the visual information to make sense of the image. Sound too can be ambiguous and subject to perception demonstrated in this study documented online. PhillipsSilver gives the example of a bar of six beats (visually represented below). 1
2
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This is ambiguous because it can be broken down in a number of ways: Into two groups of three beats (like a waltz with an accent on 1 and 4) 1
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Or into three groups of two (like a march with an accent on 1, 3 and 5) 1
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Most often music we listen to gives us the accents. But, the researchers wondered, what would happen when the Hearing HQ Aug - Nov 2014 9
Do people cringe when you
sing?
If you answered yes then you're in good company. But researchers have found only 1 in 20 people truly has amusia. Tests have shown that some people with bad singing voices hear music just fine. People who are tone-deaf are a smaller group with a perceptual problem: they can’t pick out differences in pitch or follow the simplest tunes. Brain scans haven’t revealed major anatomical differences in people who are tone deaf, but more sophisticated tests have uncovered subtle variations. In a study comparing those who are tone deaf to people with normal musical ability, researchers used a brain imaging and statistical technique to measure the density of the white matter (which consists of connecting nerve fibres) between the right frontal lobe, where higher thinking occurs, and the right temporal lobes, where basic processing of sound occurs. The white matter of those who were tone-deaf was thinner suggesting a weaker connection. The worse the tone deafness, the thinner the white matter. Some experts believe there’s a great deal of overlap between how the brain handles music and how it handles speech, which also has elements of pitch and rhythm. Others, though, believe that musical perception and thinking occur separately from other functions, and that our brains are predisposed toward developing centres and networks dedicated exclusively to music. Source: Harvard Health Letter from materials by Harvard Medical School. "Tone Deafness Explained." www.sciencedaily.com/ releases/2007/08/070823214755.htm 10 Hearing HQ Aug - Nov 2014
six beats were presented without accents? Could movement of the body determine whether the brain interpreted the pattern like a march or like a waltz? Phillips-Silver hypothesised that when an infant listens to an ambiguous rhythm pattern but gets bounced on a particular beat of the pattern the baby will learn to feel the rhythm and therefore to hear the rhythm according to that beat. The study involved a baby, held by her mother, being bounced to a march beat for a training period of two minutes while listening to a music rhythm played on a drum (with no particular accent). The infant then listened to two versions of the rhythm pattern, one with the march beat accented and one with the waltz beat accented. Within minutes of listening to the rhythm pattern and feeling the bouncing of their body the babies formed a sensory representation of the rhythm pattern which has strong beats. The study showed the march group infants preferred to listen to the march pattern. Infants in the waltz group preferred to listen to the waltz pattern. They preferred the sound pattern that matched their training bounce pattern, recognising in the sound what they felt in their bodies. Phillips-Silver explains this demonstrates "a two-way-street between what we hear and what we feel in music." Now, back to the beat-deafness study published in the journal of Neuropsychologia: Through a recruitment process 23-year-old Mathieu was identified as not able to keep the beat in music. Participation in music and dance had always been difficult for him. The researchers carried out a number of tests with Mathieu along with 33 normal adults for control. In the synchronisation test the subjects were asked to bounce spontaneously to the regular, strong beat of a Merengue song (music originating in the Dominican Republic which became popular throughout Latin America and the US). For control conditions the subjects were asked to bounce to the auditory stimulus of a metronome and then wore noise cancellation headphones and had to mimic the bouncing of the experimenter (visual stimulus) who was listening to the metronome over headphones. Despite intact motor and auditory
systems, Mathieu was the only subject not able to bounce to the beat of the Merengue music. He was, however, able to bounce to the beat of the metronome without any visual stimulus and to mimic the experimenter's bouncing without any auditory input. Mathieu and 10 others then danced to eight different kinds of music including rock, swing, techno and even Egyptian percussion. Mathieu was out of time with five of eight musical genres. What's more he couldn't identify whether someone else was moving in time with music. "Mathieu doesn't completely lack musical talent. He can sing in tune and has a lovely voice." "Being on the beat requires the kind of anticipation that comes from perceiving it in the music and knowing when to expect the next one. So he never was able to keep up." said Phillips-Silver. "An amusic person may avoid challenging musical situations and, consequently, live in a musically impoverished environment," says Peretz. There does appear to be some good news though. Just like the two-way-street with the rhythm study, Peretz claims it is also possible that amusic children who seek music training to compensate for their difficulties may find by adulthood they no longer appear to have a severe problem. "Either way there would be deep influences on the brain and cognition," she says. Ok. So it may be interesting but what does it have to do with someone with hearing loss, I hear you ask? Whether you have mild hearing loss and a hearing aid or a hearing implant for severe hearing loss, the sounds you are receiving are not exactly the same as 'normal' hearing. This means your brain has to learn to interpret the new sounds as the speech (or music) you used to hear. If you leave your hearing loss unaided for too long, or avoid the listening situations you feel most uncomfortable with such as the phone, you make it harder for your brain to learn to interpret the sounds correctly. This of course means it will take much longer. Use that two-way-street. Get that hearing test, that hearing aid or implant and practicing listening! It may just have a deep, positive influence on your brain which helps you achieve success.
HQ
References: 1. Musical Disorders: From Behaviour to Genes, Current Directions In Psychological Science 2008 vol.17 no.5 2. Born to dance but beat deaf: new form of congenital amusia, Neuropsychologia, 49 (5), 961-969 3. www.jessicaphillips-silver.com/wp-content/uploads/2013/07/JPS_Feeling_the_beat.mp4
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S T N A L P M I R A E L OCH
C
Despite increased media coverage and more implant users in Australia every year, there are still many misconceptions about cochlear implants. One of the most surprising incorrect assumptions is that cochlear implants are only for children. Brisbane Audiologist Karen Pedley busts the myths about cochlear implants for adults. 12 Hearing HQ Aug - Nov 2014
Over half of all cochlear implants (CI) supplied around the world are fitted to adults. And while countries with good funding are experiencing the biggest growth in people over 70 years of age, the sad fact is less than 5% of eligible adults have a CI. Many Australian recipients are working adults who were struggling to do their jobs as their hearing deteriorated. In most cases they successfully return to the work force after their CI and by their first assessment they report increased confidence in social situations, less repetition at home and hearing more speech on TV than with hearing aids.
They also find they hear 'new' alerting sounds such as the phone, car indicators, or the beep of a microwave oven and they really enjoy the soft sounds such as birds that they had previously missed. Why is it then, with so many benefits to a CI, we aren't seeing more Australian adults taking advantage of this life changing technology? Here are 10 myths based around lack of information, out of date information or just misunderstanding - BUSTED!
1
YEARS AGO I WAS TOLD MY HEARING WASN’T BAD ENOUGH
Twenty years ago, eligible candidates for a CI had to have profound hearing
“
One of the most frequent comments I hear from new adult CI recipients at their first progress assessment after implant is "I wish I had done this years ago. I can’t believe I struggled on for so long."
Picture courtesy
S T L U D A FOR loss (worse than 90dBHL) at all major speech frequencies, in both ears. This, of course, reflected the CI technology of the day. With constant advancements in technology enabling improved sound quality and speech understanding, people with greater levels of remaining hearing can now benefit from a CI and can expect improvement over performance with traditional amplification. These days a typical CI candidate has moderate or poorer hearing loss in the lower pitches sloping to severe-profound in the higher tones. Some hearing aid users find amplification ineffective because their high tone hearing is almost 'off the scale' and can’t be reached by even powerful amplification (sometimes called a “ski slope” hearing loss). Even in the recent
past they may have been told they have too much hearing in the lower tones to qualify for a CI. But hope comes in the form of the recently developed modified ‘hybrid’ CI systems that combine the sounds from a hearing aid and a cochlear implant in the same ear. These hybrid implants increase the chance that hearing will be preserved. If you have a mildmoderate hearing loss in the lower tones, but profound hearing loss for the mid to high tones, a hybrid cochlear implant enables the audiologist to amplify lower tones with the hearing aid, and use the CI component to enable the high frequencies to be heard again. In short, the CI eligibility criteria are regularly updated reflecting constantly improving technology and outcomes. What was true yesterday may no longer be relevant next year - keep asking.
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nics
of Advanced Bio
IT LOOKS TOO COMPLICATED TO MANAGE
Most hearing aid users are familiar with placing a device over their ear. To learn the extra step of sliding a transmitting coil over the magnet at the implant site is not difficult and most people are comfortable with the process within a week. In addition, manufacturers have recently moved to an 'auto–on' system where the device switches itself on as soon as a functional battery is attached. Sound management has also become more automated making it even easier. Still not sure? Ask your Audiologist if you can try the switches and battery changes of the different implant systems to help you choose a device you can manage, especially if you have arthritis or loss of sensation in your finger tips. Hearing HQ Aug - Nov 2014 13
a CI bypasses the cochlea and sends the signal straight to the hearing nerve, the CI may in fact be more comfortable for loud sounds than a hearing aid. Many recipients report previously unbearable sounds, such as a child’s scream, more acceptable with their CI than previously with their hearing aid. In 2010, at ninety-nine years young, US citizen Hedwig Christoph was the oldest recorded recipient of a CI. (pictured with Otologist Jed A. Kwartler, MD)
3
I’M TOO OLD
Over the last 10 years an increasing number of recipients have received their first CI in their 70's, 80's and even into their 90's. The growing numbers of elderly recipients have enabled robust statistical analysis revealing that elderly recipients are at no greater risk of medical problems during the surgery, are able to manage the device, report significant improvement in quality of life and have outcomes equal to younger recipients for hearing in quiet situations. There is still some debate about whether older recipients have more difficulty hearing in noise with a CI than younger users, with some researchers reporting no difference and some suggesting older recipients should be counselled to expect only moderate improvement for hearing in noisy conditions. Increasingly CI clinics are working with psychologists to assess cognitive function such as memory, new learning ability and problem solving as part of the preparation for implantation. The results help the implant team create an appropriate support program and to adjust the management and training of new recipients so that progress is not compromised by any cognitive impairment.
4
LOUD NOISE IS UNBEARABLE WITH MY HEARING AID - I CAN'T COPE WITH MORE SOUND!
In many cases, the uncomfortable loudness experienced with hearing aids is the result of cochlear damage. Because 14 Hearing HQ Aug - Nov 2014
5
HEARING AID PROGRAMS ARE COMPLICATED I’M NOT SURE I'LL COPE WITH A CI AND REMOTE
CI processors have a variety of in-built technology to keep the level of sound comfortable and to automatically reduce noise. Like some hearing aids, new CI processors are now equipped with ‘scene classifiers’ which monitor your listening environment and automatically select the best microphone directional pattern (focused or hearing all around), and noise reduction technology, to suit the situation. This is all achieved on the one program. While the remote control is handy for troubleshooting it is not essential for everyday use.
6
I’VE READ COCHLEAR IMPLANTS COST $30,000
Most Australian states have both public and private cochlear implant centres (you'll find a list on www.hearingHQ. com.au). As there may be a wait to access a CI free of charge in the public system, it’s a good idea to ask your GP for a referral as soon as you think your communication needs are not being met by your well fitted and recently reviewed hearing aids. If you have private health cover, and have been in top hospital cover for at least a year, your fund is likely to cover the cost of the implant system itself and contribute to hospital, surgeon and anaesthetist costs. While there may be out of pocket expenses in a private clinic, the cost is generally less than a pair of premium digital hearing aids.
7
A CI WOULD BE MORE EXPENSIVE TO RUN AND MAINTAIN THAN MY HEARING AID Current CI systems come with a battery charger and 3 rechargeable batteries as well as a disposable battery holder for when mains power is not available. Each rechargeable cell will last about a year before it needs to be replaced. Kits also come with some spare parts, so most recipients don't need to start purchasing replacement components until the third or fourth year post implant. Manufacturers supply an electronic drying box with the implant kit to reduce corrosion from moisture and hence repair costs. Like any device worn on the head, most cochlear processors would need a service during the warranty period. This is free of charge if the device is under warranty. While your speech processor is being serviced, you are usually supplied with a ‘loaner’ speech processor to use in the meantime. Your implant team will teach you how to maintain your device, make suggestions to reduce kinking in your coil cable, optimise battery life and protect the processor from harmful chemicals to reduce wear and tear. Adults who have, or are eligible for, a government OHS (Office of Hearing Services) voucher can get essential replacement parts supplied for their CI, as well as repairs, at no cost.
For more on 'The Real Cost of Hearing Implants' go to www.hearingHQ.com.au.
AUSTRALIAN OWNED
8
I'M WORRIED I'LL HAVE TO KEEP HAVING SURGERY TO UPDATE THE CI
A cochlear implant is made up of two components – the internal (implanted) part and an external speech processor. The implanted part is designed to last a lifetime and is unlikely to ever need replacing. This doesn't mean you miss out on technology advancements for improved hearing however, as the manufacturers have developed these internal parts to be compatible with advancing external speech processor technology. External speech processors are generally designed to last between five to ten years and replacement of these involves only fitting and programming appointments with your audiologist. You would need to check with your health insurance company about whether they will cover the cost of the upgrade.
9
I CAN STILL HEAR WHEN I REALLY CONCENTRATE, DO I NEED A CI?
As hearing deteriorates, hearing aid users tend to employ a variety of tactics to compensate for the loss of information through hearing such as watching faces more, trying to anticipate what will be said, talking all the time to avoid having to listen, going off to do the washing up or other activity to avoid struggling to follow visitors’ conversation, making excuses not to go out, nodding and saying “yes”, even when they haven’t understood, to avoid asking for yet another repeat. This can become a way of life and many recipients say that they didn’t realise how much effort they were putting into everyday listening until they had a CI - the effort had become habitual. If, when using hearing aids, you answer yes to 3 or more of the statements below it may be time to talk to your hearing professional about a CI assessment: family have to repeat the sentence when talking to ■ My me more than half of the time.
YES
NO
tend to avoid answering the phone, it’s become too ■ Ihard to work out who the caller is.
YES
NO
can’t follow group conversation anymore. I just ■ Isitreally there and let the others talk.
YES
NO
family are always telling me I talk too loudly, ■ My especially when we are out.
YES
NO
When watching TV, I miss a lot of the plot. I have to ask family members what’s happening.
YES
NO
I rarely hear my phone ring, and I can’t hear the microwave beep or car indicators with hearing aids on
YES
NO
■ ■
hear together with Australia’s most experienced cochlear implant program
10
IT LOOKS LIKE A LOT OF EFFORT, ESPECIALLY AFTER IMPLANT, I DON’T KNOW THAT I'D HAVE THE TIME It is between two and four weeks after surgery that the speech processor is turned on. This is when your brain takes over, learning to match up the new sounds with its stored memories of how sounds used to be. In cases where the hearing has been lost since childhood, the brain may need to make new pathways. If you're receiving a CI after a recent hearing loss, this process can occur very quickly and you could be talking with greater ease with the family within the first week or two. The more speech you hear, the quicker your brain learns and the less artificial (robotic or high pitched) and more natural the sound becomes. This process can be helped along by making lots of opportunities for conversation, trying to listen without looking for some of the time, and with listening practice at home. This practice also helps the family to learn the best way to communicate with you. Even 30 minutes a day, 5 days a week in the first month can increase confidence with the device and improve speech understanding. If you don't have a listening practice partner at home your implant audiologist can explain ways to make listening opportunities in your everyday life to enhance your progress. Cochlear implants have changed the quality of life of many hearing impaired adults and their families for the better. They are effective, accessible and increasingly easy to use. If your hearing aids no longer provide functional daily communication, talk with your family doctor about a referral to your local cochlear implant centre.
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LISTENING DEVICES
ASSISTIVE
Hearing aid technology is developing at a cracking pace. Relying on hearing aids, though, may not be your best (or only) option in every situation. Lucinda Mitchell investigates the assistive listening devices available and how you can benefit.
Digital technology has made it possible to house many complicated features and powerful microphones in very small hearing aids these days. The latest devices automatically try to reduce background noise and usually have a few different program settings for use in different listening situations. Chances are, however, that hearing aids have not completely eliminated all your hearing-related problems. Or, you may have only one listening situation you struggle with, such as hearing the telephone, and don't need hearing aids. This is where Assistive Listening Devices (ALDs) can really help. ALDs describe a wide range of technologies that help amplify the sounds you want to hear in various listening situations. Recently there was even a report of devices being developed for people with 'normal' hearing to help in difficult hearing environments. Noisy restaurants, rooms with reverberation or distance from the speaker can be difficult for anyone, but particularly difficult for someone with a hearing loss. Any one of these conditions (distance, noise, or reverberation) creates listening problems. Often they occur together making it much more difficult. Depending on the ALD technology you choose, you may be able to use it on its own or in combination with your hearing aid. Many hearing aid and implant manufacturers are now also producing their own ALDs which 'talk' exclusively to their devices. There are many auditory and nonauditory devices that can be classified according to the need they address.
ALDs 18 Hearing HQ Aug - Nov 2014
Devices to facilitate: Face-to-face communication and access to electronic media Use of the telephone Response to important warning sounds and situations
FACE TO FACE/ELECTRONIC MEDIA
ALDs to improve speech intelligibility have been described as 'binoculars for the ears'. A remote microphone next to the speaker (or loudspeaker) or connected directly into the sound source (TV, MP3 player, etc.), brings the target sound closer to your ears before it has a chance to get mixed with background noise or room reverberation. This can be hardwired (direct audio input) or wireless.
Direct Audio Input
Direct audio input ALDs are designed to connect via a thin insulated wire from your hearing aid or cochlear implant (CI) speech processor to the sound source (TV, radio, MP3 player etc). The wires are usually quite short, stretching at most from the TV to the sofa. You won't need a telecoil (also known as a t-switch or t-coil) in your hearing aid when using these ALDs although you will need to check whether your hearing device has a direct audio input option. In some instances you can use regular consumer devices instead of hearing aids, such as headphones with a built-in amplifier connected to your MP3 player or computer.
Wireless Audio Input
There are five main types of wireless audio ALDs currently in use: Audio Frequency Induction Loops Audio induction loops, or hearing loops, have a microphone you position near the sound to be transmitted, an amplifier and a wire loop around a room or building. Sound waves picked up by the microphone are converted into an electric current which is amplified, sent to the loop which generates a magnetic field, then delivered to the hearing aid telecoil. The hearing aid then converts the magnetic field back into sound. The benefit is the sound source (a musical performance or voice) is transmitted to the hearing-impaired listener clearly without other distracting environmental noise.
Large Area loops are typically found in concert halls, train ticket booths and high-traffic public buildings but can also be installed at home. If you're having difficulty hearing in a public environment despite a 'loop available' sign, first check your telecoil is on. If it is on and hearing is still a problem, ask if the audio loop is switched on. It may be surprising, but some facilities have the technology yet don't have it turned on! Telecoils are available in most behindthe-ear (BTE) hearing aids and in some in-the-ear (ITE) hearing aids. A few inthe-canal (ITC) aids may have telecoils, however normally completely-in-canal (CIC) hearing aids don't. Personal induction loops are ideal for confined spaces such as the car. They enable you to carry on an adult conversation in the front while the kids are being noisy in the back. Soundfield Systems In any education environment, whether a classroom, laboratory, library or lecture theatre, students must be able to hear the educator’s voice clearly. The size or the dimensions of the room, the class working noise, external noise, distance between the teacher and students and poorly designed classroom acoustics can make understanding difficult, even for kids with normal hearing. Soundfield technology was created to alleviate these issues and improve sound quality with clarity, not just amplification. Four closely spaced unidirectional microphone capsules capture the teacher's speech and distribute it with low-level amplification through loudspeakers around the room.
Soundfield enables students using a personal FM system to hear several sound sources without having to juggle between devices. The teacher’s speech and an interactive whiteboard would be automatically coordinated. The benefits are threefold: the teacher doesn't need to shout to be heard ‒ reducing the overall noise of the environment and preventing hoarseness. Students with normal hearing are less likely to require repetition and are easier to manage, while hearing impaired students can follow everything going on in the classroom environment. FM systems Frequency modulated (FM) systems are effectively miniature radio stations operating on special frequencies. A transmitter microphone used by the speaker, such as the teacher in the classroom or the speaker at a lecture, transmits the sound directly to the receiver in your FM enabled hearing aid. FM systems are used in theaters, places of worship, museums and public meeting places. In these situations, the microphone/transmitter is built into the overall sound system. You are provided with an FM receiver that can connect to your hearing aid or CI. The receiver can also connect to a headset if you don’t wear a hearing aid. Personal FM systems are useful in a variety of situations, including noisy restaurants and meetings. They are also ideal for watching TV, allowing you to adjust the volume for your specific hearing comfort without affecting others. Several companies are now including
directional characteristics into their FM microphones for improved signal detection capabilities in noisy situations. The FM microphone/transmitter picks up sound more efficiently at the point of focus while de-emphasising sounds from other directions. The benefit of personal FM systems is the effective way they directly increase the level of the speech signal relative to the noise, (the speech to noise ratio). This system could be useful in a car to eliminate engine, road and traffic noise when conversing with a passenger. In fact this type of ALD may be all you need in unique listening situations if you have no other hearing problems. Want to hear your partner at dinner in a noisy restaurant? They can clip the microphone/transmitter to their top or wear it around the neck. Personal FM systems are also ideal for travel. When walking in the streets of a noisy city your partner wearing the FM microphone/ transmitter will ensure you don't miss important details or arrangements. Infrared Transmission Systems Infrared (IR) hearing systems are a
popular alternative to personal induction loop systems. A typical IR system consists of an audio source, infrared radiator (transmitter) and infrared listening receivers. IR light, the same type of electromagnetic energy as radio waves but much higher frequency, is transmitted to receivers worn by the listener within unobstructed line of sight of the transmitter. The benefit of these systems is signals don't 'leak' outside a room and therefore are a more secure communication system than FM or induction loop systems. As with FM systems you can use IR systems for watching TV, listening to the radio or to stereo without interruption from surrounding noise or need to turn the source machine up to high volume. It is good to remember ,when you get tired from concentrating while using your ALD for watching TV, you can always turn on captions, sit back and relax," points out Alex Varley, CEO of Media Access Australia. Bluetooth Bluetooth technology exchanges data (including sound and images) between electronic devices using short wavelength radio signals. As long as devices are within range they automatically find and communicate with each other. First used for computers to connect wirelessly to keyboards and printers, in the past few years we've seen a flurry of wearable devices including health, fitness and consumer electronics. Over two
billion devices are shipped annually. Bluetooth uses a technique known as frequency hopping which helps avoid interference. The disadvantage of this technology is it's short range (10 to 20 metres with hearing aids) and until recently it's need for high levels of power. To date it hasn't been incorporated into hearing aids. However in 2010 Bluetooth Smart was launched using a low energy feature of the latest Bluetooth specification, paving the way for hearing aids featuring Bluetooth. On 12 March this year the Bluetooth SIG and the European Hearing Instrument Manufacturers Association agreed to work together to establish a standard for new hearing aids with Bluetooth wireless technology. Apple has developed a new proprietary Bluetooth connectivity technology which enables hearing aids to communicate directly with its iOS platform on iPhones, iPads etc. The technology allows the devices to directly connect to hearing aids without draining the battery power. Several hearing aid manufacturers have released hearing aids this year utilising this new technology marketed as 'Made for iPhone™'. If you're not prepared to limit yourself to Apple products you can purchase a Bluetooth enabling device which receives the Bluetooth signal and converts it into an alternate sound signal compatible with hearing aids and CIs. The benefits of bluetooth connectivity include the choice to stream sound to both hearing devices or just one (when you're on the phone and want to know what's going on around you). You also don't need to worry about trying to position the mobile phone receiver close to the hearing device microphone! Because multiple devices can be paired to one enabling device it can interrupt the audio from your tablet to allow you to hear an incoming phone call.
ALDs 20 Hearing HQ Aug - Nov 2014
Smart phone Apps New smart phone applications (apps) that link smart phones to hearing aids enable you to pump up the volume on your hearing aids or use them as headphones to stream phone calls, videos and music. So far these apps are manufacturer specific however. There are a number of apps which give your smart phone the capacity to perform like a rudimentary hearing aid. You can also test your hearing, measure sound levels in the environment, get help with tinnitus and even use a hearing loss simulator to help your friends or coworkers better understand your hearing loss. For a list of apps go to www.hearingHQ.com.au.
TELEPHONE ALDs Telephone Amplifiers
There are three types of amplifiers for land line telephones. In-line amplifiers and volume controlled phones increase the level of sound from the receiver. Telephone ringers simply increase the volume of the ring. In-line amplifiers These are small devices which connect between the base of the telephone and the handset cord. They have adjustable volume controls and may also offer tone control to enhance the bass and treble pitch for improved clarity. In-line amplifiers are compatible with all analog and most digital phones, making them a great option for amplifying your telephone at work. By plugging in a neck loop, a severely hearing-impaired user can use the telecoil in the hearing aids to listen with both ears. These ALDs have the added benefit of being easily slipped into a bag to ensure you can use a phone anywhere. Volume Control Phones You can choose between corded or cordless volume control phones. These have in-built amplification systems allowing you to adjust the listening volume. Some brands offer a tone control for bass and treble pitch to assist clarity. These phone amplifiers are beneficial whether you have a hearing aid, CI or no device at all. Most have a telecoil which when used with a telecoil enabled hearing device will cut out background noise. Do check before you purchase. Other features to consider: is there is an
Free hearing aid trial. Call 1300 787 797 now for a referral to your local hearing clinic. The German engineered Siemens Pure is virtually invisible, tiny in size and provides industry leading sound quality, even in noisy situations.
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adjustable ring volume, and does it have a speaker phone function. If your residual hearing is insufficient you can still communicate 'by phone' using text or internet calls. Telephone ringer amplifiers Also called telephone ring signalers these devices are designed to increase the ringer volume of your current phone. Some models also offer a visual alert such as a flashing light. These are useful for noisy commercial areas which can mask the ring of an incoming call as well as for people with hearing loss.
Text Based Phone Solutions
Telephone Typewriters (TTY) TTY is a phone with an in-built keyboard. A small screen displays what the other person says and you can type your side of the conversation. There are two main models of TTYs: Superprint which provides a printout of the conversation, the preferred option for 'Type and Read' users, or Uniphone which combines TTY and a phone which is better for 'Type and Listen' or 'Speak and Read' users. You can obtain a TTY through Disability Equipment Programs offered by the major carriers. TTY handsets can be rented like standard phone handsets. With a TTY you can call someone with a normal phone (and vice versa) by using the National Relay Service (NRS). The NRS relays messages verbally to a hearing person from the TTY and then relays responses back to the deaf individual as text via their TTY. Hearing impaired people who speak can use a TTY to make 'Speak and Read' calls through the NRS, speaking directly to the other person and then reading the response on their TTY. SMS relay All you need for this is a mobile phone and an active account. You don’t need internet access or a data plan. You type your side of the conversation on your phone. The relay officer receives this as a series of SMS text messages and relays it verbally. The spoken response from the 22 Hearing HQ Aug - Nov 2014
other person is then converted and sent to you as SMS messages.
Internet Calling Solutions
Internet relay These calls are an alternative to TTY relay calls. All you need is a computer with an internet connection. You can even use some mobile phones. With internet relay you can call someone who uses a normal phone or a TTY. It is a Type and Read call where you use text to communicate, via a relay officer. You have complete mobility and are only restricted by your access to a computer and the internet. Video relay Video relay allows you to call a hearing person and communicate using Auslan (Australian Sign Language). This type of call requires a computer, tablet or smart phone, an HD webcam, Skype account and high speed broadband. Captioned relay This type of relay call is perfect if you prefer to use your own voice. You speak directly to the other person ‒ no typing. Their responses will be relayed to you in text so you will need to have access to a computer if using a land line or you can use an internet-connected mobile phone. You will find detailed explanations of how these work on the NRS website.
WARNING/ALERT ALDs
Alerting devices ensure you are aware of environmental sounds and situations at home, school, workplace, when travelling or during recreation.
ALDs
These systems use microphones or electrical connections to pick up signals and send them to you either via hard wired or wireless transmission. Examples include a doorbell, phone or fire alarm that trigger a flashing incandescent or fluorescent light, a loud horn, a vibrating device (pager, bed shaker) or a fan. Some systems use a combination of signals such as alarm clocks that beep, flash a lamp and shake the bed simultaneously . Some use coded flashing lights (five flashes for the doorbell vs. one flash each time the phone rings). Others employ a body-worn pager that vibrates and displays a number corresponding to the event (1 for fire; 2 for doorbell, etc). As technology changes rapidly so do ALDs Ð such as the mCareWatch, an Australian invention that is a mobile phone, GPS locator, activity monitor and SOS button all wrapped up in a watch. Most hearing professionals will be able to advise you of devices available in your area and ideally, be able to demonstrate the device to ensure it meets your needs.
HQ References Hearing Aids, 2nd edition; Harvey Dillon, 2012 www.bluetooth.org/en-us www.relayservice.gov.au
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all about...
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L A M S Y X O R A P N G I N O BE G I T R E V G N I N O I T I S O P
David Becconsall, B. App. Sc. Physiotherapy, BPPV specialist physiotherapist explains. Vertigo itself is usually not a serious condition and can often get better with time, however if you have ever experienced vertigo you'll understand how frustrating and debilitating it can be. Described as a ‘spinning’ sensation in the head, usually brought on by sudden changes in position, some people say it feels like standing still in a spinning room and can make you feel as though you are going to fall. Simple activities such as washing your hair in the shower, bending over while gardening or simply getting up out of a chair can provoke dizziness and a feeling of imbalance. The most common cause of vertigo is a condition called Benign Paroxysmal Positioning Vertigo (BPPV). Benign: not dangerous or fatal. Paroxysmal: rapid onset, typified by peaks and fading away. Positioning: triggered by changes in the position or movement of the head. Vertigo: unusual sensation of movement, usually spinning of yourself or the world around you.
Characteristics of BPPV
When it comes to diagnosis the two most important features of vertigo are its duration and whether it is caused by a change in body position. Typically BPPV vertigo is brief lasting no more than ten to fifteen seconds. Longer durations are rare. The attacks generally occur in bouts which may last for two to three days, persist for weeks or can even last for several months at a time. Symptoms are often worse in the mornings. The severity of attacks vary and may also be accompanied by imbalance, vomiting, light-headedness or neck pain. During acute episodes you may experience vertigo when turning your head to either side in bed, however the symptoms usually are the result of only one ear being affected. Dizziness will be worse lying on the affected side. BPPV can affect both ears at the same time (bilateral BPPV) but this is relatively rare and is usually seen after some type of head injury or fall.
Understanding the inner ear
The inner ear system, cochlear (hearing) and vestibular (balance) apparatus is encased in bone inside the skull and consists of delicate fluid filled membranes. Sensory information about motion, equilibrium, and spatial orientation is provided by the vestibular apparatus which, in each ear, includes the utricle, saccule, and three semicircular canals (horizontal, posterior and anterior). The utricle and saccule detect gravity (vertical orientation) and linear movement. The semicircular canals, which detect rotational movement, are located at right angles to each other and are filled with a fluid called endolymph. When the head rotates in the direction sensed by a particular canal, the endolymphatic fluid within it lags behind due to inertia and exerts pressure against the canal’s sensory receptor. The receptor then sends impulses to the brain about movement.
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all about... BENIGN PAROXYSMAL POSITIONING VERTIGO
When the vestibular organs on both sides of the head are functioning properly, they send symmetrical impulses to the brain. This system helps control the eyes during head movement. When there is inner ear dysfunction it causes a reflex eye movement called nystagmus. The brain perceives this eye movement as a sense of motion causing the vertigo.
electronystagmography (ENG), head CT, head MRI, hearing test, magnetic resonance angiography of the head and caloric stimulation (warming and cooling the inner ear with water or air to test eye movements). Positional vertigo can be caused by brain abnormalities or tumors, particularly if the vertigo lasts a long time after the motion which started it.
Diagnosis of BPPV
What causes BPPV vertigo?
It is important to document your vertigo attacks as best you can to assist in your diagnosis. Unfortunately, many have a difficult time describing their dizziness with many exhibiting nystagmus using the terms "swimmy head" and "lightheadedness" to describe vertigo or a spinning sensation. Your GP or specialist may perform a test called the Dix-Hallpike manoeuvre. They will hold your head in a certain position, then you are asked to lie quickly backward over a table. As you do this they will look for abnormal eye movements and ask if you feel as though you are spinning. It is the direction of the nystagmus eye movements which reveal which ear is affected and in which semi-circular canal or canals the problem is located in the case of BPPV. If the Dix-Hallpike test doesn't show a clear result, you may be asked to do other neurological tests to rule out other causes which may include an EEG,
Small crystals of calcium carbonate, called Otoconia, are thought to break away from the inside lining of the utricle. These cause no problems if the fragment remains in the vestibule. However, problems occur if a fragment drifts into one of the semicircular canals. While it is unclear why these crystals form it is their presence brushing along the delicate hairs lining the semicircular canal that bombard messages down the vestibular nerve. The extra nerve messages sent from the affected ear conflict with the normal messages sent from the other unaffected ear. The brain becomes confused and reacts to cause intense dizziness (vertigo). The most common area these crystals drift into is the posterior canal which helps sense vertical movement. Any vertical head movement can trigger vertigo. Horizontal canal BPPV is relatively uncommon, often following trauma. Vertigo is triggered by rolling to the affected side while lying down and tends
to last much longer than posterior BPPV. Anterior canal BPPV is extremely rare with a similar pattern to posterior BPPV.
Why do crystals shed?
The crystals can be displaced from the utricle and drift into the endolymph following a head trauma, viral infection or simply as part of the ageing process. It is also likely that inflammatory processes and disease activity can cause tissue 'debris' to collect within the canals. In most cases the cause of the crystal shedding is completely unknown.
Treatment of BPPV
The treatment of BPPV has changed radically over the last few years as more is learned about the condition. Particle repositioning manoeuvres are often the only treatment required to stop the attacks (considered to be remission). These involve turning the head in different directions to draw the crystals out of the canal to be reabsorbed over time. If there are crystals in more than one canal a combination of physical manoeuvres is performed. In some persistent cases such as particles 'stuck' on the membrane, it can take two or more repositioning manoeuvres to stop the bout of vertigo. Use of vibration of the mastoid bone can also help to loosen the debris. There are a number of repositioning manoeuvres in use - the most commonly
anterior canal
posterior canal
horizontal canal
utricle cupula of the posterior canal
cochlea
otoconia
26 Hearing HQ Aug - Nov 2014
saccule
talked about are the Brandt & Daroff, the Semont, and the Epley manoeuvres. A study published in the Revue de Laryngologie Otologie Rhinologie in 2001* evaluated the efficacy of these three physical treatments for BPPV. A total of 106 BPPV patients were randomly assigned to one of the three treatment groups, and responses were evaluated one week, one month and three months after the initial treatment. At the one-week follow-up the Semont and Epley manoeuvres produced similar cure results (74% and 71% respectively), both significantly higher than the cure rate obtained with Brandt & Daroff exercises (24%). By the three-month follow-up, the cure rate obtained with the Epley manoeuvre was higher (93%) than with the Semont manoeuvre (77%) although both remained higher than with the Brandt & Daroff manoeuvre (62%). However, the proportion of initially responding patients showing subsequent relapse was lower among patients treated by the Semont manoeuvre than among patients treated by the Epley manoeuvre. Brandt Daroff exercises these days are not given by specialists in this field. The Epley Manoeuvre is still done, however the Canalith Repositioning Manoeuvre (a modification of the Epley Manoeuvre) has an improved success rate as it is more specific to the Posterior Canal of the affected side.
Seeking treatment
When seeking treatment for vertigo, and in particular BPPV, always look for appropriately qualified professionals. The area of vertigo crosses over between different medical fields of neurology and ear, nose and throat so neurologists and ENT specialists are suitably qualified to diagnose and provide appropriate treatment of BPPV. There are also a small number of highly qualified physiotherapists specialising in this field having gained suitable additional training and professional experience. With six different canals and two common different presentations of BPPV, there is a multitude of manoeuvres that are specific to the canal and type
BPPV and Meniere's Disease
It is possible for someone with Meniere's Disease to also have BPPV and therefore diagnosis can sometimes be complicated. Meniere's Disease is characterised by vertigo, deafness, aural pressure, tinnitus and loudness intolerance emanating from the cochlea and a variety of vestibular symptoms including disequilibrium and "drop attacks". The key difference is someone suffering solely from BPPV will not have aural pressure, tinnitus or any hearing loss. Those with both BPPV and Meniere's may receive particle repositioning treatment in addition to other treatments for Meniere's. of vertigo. Successful treatment is dependent upon accurate diagnosis via interpretation of presenting nystagmus in different dependent positions. Correct diagnosis will ensure the correct manoeuvre is performed to provide the most successful management technique. Unfortunately the unknown aspects of canal size and canal orientation can affect the success of manoeuvres. It is the skilled professionals who are able to modify their techniques to accommodate most circumstances. In this internet age a huge resource of unregulated 'educational' material is available and while useful from an educational perspective it is very unwise to self-diagnose or perform any management techniques on the basis of the internet or youtube alone. So as with all medical conditions, seek advice from
appropriately qualified professionals. One significant advantage of specialist physiotherapists over ENT specialists or neurologists is of easier access: treatment areas are usually specifically designed for the manoeuvres and physiotherapists are able to allocate more time to assist in the management measures required during a treatment session. Vestibular physiotherapists are usually available in major city centres, at some public hospitals and at specific hearing and balance private centres. A resource of suitably qualified physiotherapists in your area may be obtained from the Australian Physiotherapy Association and more directly from the special interest group in neurology which may be contacted through the state branches of the APA. * www.ncbi.nlm.nih.gov/pubmed/11799859
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ask the experts Q
I was diagnosed with auditory processing difficulties as a child and have had multiple assessments throughout my childhood and early to mid-teens. I am now 23 and about to begin postgraduate study. My last assessment was conducted in 2005 but to have my auditory processing difficulties taken into consideration by the university Disability Liaison Unit I require an upto-date assessment. Can you recommend someone who does adult auditory processing difficulties assessments? Dani Tomlin: I think it is a good idea to have an up-to-date record of any auditory processing deficits you may have. Being the link between the sounds we hear, and our understanding of the meaning of the sound, auditory processing skills are an important aspect of a student’s learning experience. The good news is that most universities now offer many resources that will assist students with hearing or listening difficulties. Recorded lectures, for example, are now widely employed across faculties and allow the student to listen to lecture content in quiet and at their own pace. There is also a greater move towards interactive online course content that you may find beneficial. Adult auditory processing assessments are not offered as commonly as those for children but are available. I recommend you contact your local audiologist (you can find a someone near you by visiting www.hearinghq.com.au/services-inyour-area/audiology-services). As it is a specialised service you may need to make a few enquiries before you find a practice able to help. Your audiologist may also be able to recommend assistive strategies or a rehabilitation program to strengthen your auditory processing skills. Adult auditory processing assessments are offered at the University of Melbourne Audiology clinic (www.umac. org.au). This includes a comprehensive assessment of the skills required for effective listening to speech, particularly in noisy environments. Your Disability Liaison Unit will require a full report, so make sure that is included in the assessment when you are making your enquiries.
A
Q
I'd like to know what the Australian Government Services Program voucher is worth. Two different audiologists offering the same brand with different prices claim the voucher will cover it. When you ask what the value of the voucher is all they say is it varies. Can you please tell me what the voucher is worth. Emma Scanlan: There is no actual dollar amount that the voucher covers because there are a range of services and devices that are covered under the Commonwealth Government Hearing Services program. There is a very wide range of ‘free-to-client devices’ that can be fitted to a client that range from small in the ear devices to bone conduction aids and body aids, all of which have different costs but all of which are covered by the voucher. Some clients will need 2 hearing devices and others will need 1 and this will also impact on the cost. Different hearing service providers will be able to purchase devices from the manufacturer at different prices depending on their contracts, volume fitted and other factors. Some clients will need many appointments to be a successful device user, others will manage their device independently very quickly. The important thing is to find a qualified and experienced clinician who you trust to provide you with the best advice.
A
Q
There seems to be a lot of dietary supplements such as omega-3 fatty acids in fish oil being promoted to improve and maintain good eyesight. Are there any that are effective for good hearing health or to prevent or delay the development of age-related hearing loss, or is decline simply inevitable? Melville da Cruz: The idea that dietary supplements can maintain ear health and prevent hearing loss seems attractive, given that the use of various dietary supplements to maintain good general health and eyesight is being recommended. However to date there is little evidence to extend the recommendation to the use of supplements to prevent hearing loss.
A
Associate Professor Melville da Cruz Ear, Nose & Throat Surgeon
Dani Tomlin Audiology Lecturer & Clinician University of Melbourne
In animal experiments there is some evidence that the effect of temporary noise-induced hearing loss (the hearing loss you might feel immediately after attending a loud concert but that goes away in a day or two) can be prevented by a combination of antioxidants like beta-carotene, vitamin C, vitamin E and the mineral magnesium when administered before exposure to loud sound. Researchers now know noise-induced hearing loss is largely caused by the production of free radicals, which destroy healthy hair cells within the cochlea. The free radicals literally punch holes in the membrane of the hair cells, causing them to malfunction and eventually die, leading to a permanent hearing loss. The antioxidant vitamins may prevent hearing damage by mopping up the damaging free radicals. Magnesium, which is not an antioxidant, may help by improving blood flow to the inner ear. Further investigation with a whole range of antioxidant agents has been undertaken in animals including green tea, aspirin, and N acetyl cysteine, with the aim of identifying otoprotective agents. Further investigation in this field is required. To date there are no formal human trials that have documented a convincing hearing preservation effect with dietary supplements of any kind.
Q
Emma Scanlan Principal Audiologist Australian Hearing
I have tinnitus as well as hearing loss. Can hearing aids help me hear better and also help with getting rid of the tinnitus? Roberta Marino: Tinnitus or noise felt to come from the ears or head can be a debilitating condition affecting those without hearing loss but is more likely to occur in those with some form of hearing loss. It’s estimated that 7085% of the hearing impaired population experience some variety of tinnitus1. The prevalence rates are higher with increased hearing loss because it is a deficit in properly functioning nerve fibres that enables other nearby nerve fibres to stimulate the brain even without a sound being present1. It is normal for all of us to experience episodes of tinnitus and it’s often more pronounced after listening to loud noises / loud music. However, when the tinnitus is present constantly or affects sleep or an individual’s enjoyment of life, it is not considered normal. Often when people are stressed or tired, tinnitus perception can be heightened and can be more noticeable during quiet times or at night. Current research indicates that the use of amplification devices such as hearing aids can help diminish tinnitus disturbance in people with hearing loss. This is because hearing aids amplify external noise which can help “mask” the tinnitus. Hearing loss may change brain patterns which could be causing the tinnitus. Auditory stimulation through hearing aids could help re-establish proper functioning of the hearing nerve, pathways and brain. Also, because hearing aids help improve understanding of speech they decrease the “strain to hear” phenomenon and decrease the attention given to the hearing problems and tinnitus2. Some studies report that in approximately 50% of new hearing aid users, tinnitus is reduced with hearing aid use3.
A
Roberta Marino Senior Audiologist Specialist Hearing Services
Many hearing aids now also have an in-built “tinnitus masking” feature that generates an external sound through the hearing aid which can be helpful. The best people to talk to in regards to tinnitus and reducing it are Audiologists with a special interest / training in the area. Unfortunately, GPs are often not aware of treatment options or the cause of the tinnitus. Often people are told that “nothing can be done” to alleviate tinnitus but this is no longer the case. Tinnitus counselling, use of in-built tinnitus masking programs in hearing aids, medical treatments like the Neuromonics Tinnitus program4 (invented here in Australia) and Tinnitus Retraining therapy are all options in addition to hearing aids and some options are better than others depending on the nature of your tinnitus and your hearing levels. If your tinnitus is persistent and only in one ear, or is accompanied by dizziness and/or balance problems, consult your GP or audiologist to ensure there is no underlying medical condition causing the symptoms. 1 Martines et al., Investigation of tinnitus patients in Italy: clinical and audiological characteristics. Int J Otolaryngol. 2010. 2. Jastreboff PJ, Jastreboff MM. Tinnitus retraining therapy for patients with tinnitus and decreased sound tolerance. Otolaryngol Clin North Am. 2003; 36(2): 321-36. 3. Surr RK,Montgomery AA, Mueller HG. Effects of amplification on tinnitus among hearing aid users. Ear and Hearing. 1985;6(2):71-5. 4. Davis PB, Paki B, Hanley PJ. Neuromonics Tinnitus Treatment: third clinical trial. Ear and Hearing. 2007; 28(2):242-59.
Send your questions to: Hearing HQ Experts PO Box 1054 Lane Cove NSW 1595 or experts@hearingHQ.com.au
Hearing HQ Aug - Nov 2014 29
REAL PEOPLE Zoe Williams hasn't let hearing loss limit her or her opportunities. She finds inspiration from powerful insights from others - some of which she has shared with us. According to a fellow Hear For You volunteer "Zoe is nothing but inspiration. She is an audiologist, a mentor and a passionate advocate. Being able to sign, speak, wear both a hearing aid and a cochlear implant, Zoe is one of the very few people who has almost every access to both the deaf and hearing worlds.�
'' The only person you are destined to become is the person you decide to be. - Ralph Waldo Emerson
30 Hearing HQ Aug - Nov 2014
I was first diagnosed at two and half years old with a congenital mild to profound sensorineural hearing loss in my left ear and severe to profound hearing loss in my right ear. I grew up in Cairns, far North Queensland where I went to State school with a deaf facility for the first 3 years of primary school. I then changed to a Catholic primary school and for high school I attended a Catholic girls boarding school in Brisbane. I competed in school swimming, hockey, basketball, rowing, and touch rugby. I captained both hockey and touch rugby and had various other leadership roles. I went on to James Cook University and completed a Bachelor of Nursing Science degree and worked as a Registered Nurse Div 1. However, my real passion was to become an Audiologist, so I completed a Masters of Audiology at the University of Queensland. I now work as a Specialist Audiologist at Australian Hearing covering Paediatrics, Complex Adults and Aboriginals and Torres Strait Islanders, working in regional and remote communities. I have lived and worked in various States in this wonderful country. I have been honoured to be invited on the panel for Aurora and Deaf Children Australia deaf camps, answering questions regarding my experiences growing up with a hearing impairment. I am also a mentor for Hear For You. In the first few years of primary school I had excellent support. I had individual sessions of 30-45 minutes a day with a speech and language therapist and had speech therapy for 8 years almost on a weekly basis. In high school, I had a teacher for the hearing impaired visit weekly and I received the highest level of funding available towards tutoring in English and Maths to ensure I did not
fall behind. I also did private Speech and Drama classes and performed in Eisteddfods and Speech in Action exams. This was to help with my voice tone and confidence with speaking and giving presentations. I learnt Signed English when I was at the deaf facility but my main focus was on becoming an oral communicator. A few years ago I was reintroduced to the deaf community and this time I picked up Auslan. I now have access to both languages. I so desperately wanted to WALK hearing, TALK hearing and ACT hearing. I had this competitive spirit that wanted to be just like hearing people or even better. To achieve this I have always needed to wear my hearing devices. I wear a hearing aid on my left and cochlear implant on my right, which I got 18 months ago. I use my FM system and live captioning for training and I use bluetooth streaming for the phone and television. In any endeavour, once you start justifying performance with excuses you will never reach the standards required to be the best, and ultimately be successful. - Rod McQueen Fear of success and the fear of failure constantly plagued me throughout my life. There were times when I had the fear of not being understood or of being misinterpreted. So why attempt something when I had a fear of rejection by the hearing world? I would think out the scenario in my head how it would play out and how I would respond, like a visual rehearsal. I don’t recall ever not doing something because I am deaf. When I first arrived at my Brisbane all-girls boarding school in grade eight,
'' If you can’t change facts, try bending your attitudes.
real stories... I knew this was a place I needed to be in order to find and define myself. I was overwhelmed and very uncertain as I had a disadvantage that others were not aware of – my hearing loss. But I owned up. I am glad I did. Being hearing impaired wasn’t easy and it was easy to 'give up'. I suffered much criticism at first but later it all paid off. I could understand them and eventually they could understand me. I learned to know myself through my interaction with my fellow students and staff members. I made plenty of mistakes along the way, sometimes unknowingly saying something that was quite offensive. ( If someone had said it to me I wouldn’t have known if it were offensive or not). Hearing loss was a limitation as there were heavy demands on my communication with others and I had to endure long days with high concentration levels. I have now accepted my hearing loss so I have accepted myself and therefore I am tolerant of others. Indeed, my hearing loss has now become my gift as I pulled through my limitations with positivity and determination. Swimming meant a lot to me in my high school years as I didn’t have to listen much while I was swimming laps and it was a great place to channel all my anger and frustration with my hearing loss. I could scream loudly under water, blowing bubbles without saying anything I would regret. With every freestyle stroke I took I sliced the water surface like a punching bag. That’s probably why I made it into the school team. I have an amazing group of friends who match my checklist for good communication skills and who often help by letting people know how best to communicate with me. Once I had to sit in the back seat of the car and I could not follow the conversation at the front so I
stared out the window. My friend noticed and adjusted her rearview mirror for me to read her lips! It is not worth trying to be friends with people who make you feel small and do not remember to walk on the side of your better ear. People come into your life for a season, a reason or a lifetime
- Unknown
My family treated me no differently from my siblings. I am sure they knew I would get a few hard knocks however they looked on that as an opportunity to build resilience. The budding resilience they nurtured and facilitated is primarily what helped me to respond to awkward, confusing situations from small to large scale - from being teased about why my speech is a bit funny to discrimination and humiliation in the workforce. They always corrected me when I didn’t pronounce words properly and they still do to this day! It’s not that they are picking on me, but it is to save me embarrassment in the hearing world. Before the time of the internet I demanded my brother write out the lyrics of songs so I could follow what they were singing. Being assertive and wanting to be included brought out the ‘bossy boots’ in me. Humour plays a big part of life as my family taught me not to take myself too seriously and learn to laugh at myself. I value the honesty of my family in telling each other the truth about ourselves – not just saying what we want to hear. Listening fatigue comes with the territory of having a hearing loss. I would hit a brick wall every day at 3pm or some days earlier. I had to modify my diet and sleep patterns, cutting back on commitments but surprisingly it was the cochlear implant that improved my listening-fatigue significantly. I was
- Unknown
super anxious leading up to the operation but I had nothing to lose and everything to gain. I kept my expectations low. If I could ease my listening difficulties and be able to localise loud environmental sounds better and to have access to high frequencies sounds it would take the pressure off – (please note I did not say I wanted to hear everything). I have had some amazing highs in my life. I’ve also had major lows and I cherish my family and my friends – they have always provided me with learning experiences and assisted me in my progression through life. They share in triumphs and sympathise and encourage me when things don’t work out the way I dreamed. My family encourages me in different pursuits and appreciates all of my capabilities to achieve at whatever level I want to achieve. Family support is crucial in coping with life and bouncing back after setbacks with renewed confidence, hope and laughter.
''
Where there's a will there's a way.
here to help Many not-for-profit organisations around Australia and government agencies provide valuable support, advice and information on hearing issues. Please visit www.hearingHQ.com.au to find out more about any of these organisations and to link directly to their websites. For an organisation to be considered for listing they must be a not-for-profit, charity or completely free service. INFORMATION & SERVICES ACT Deafness Resource Centre - Canberra Information, referral and advocacy services T 02 6287 4393 TTY 02 6287 4394 F 02 6287 4395 Audiological Society of Australia Inc Information on national audiological services T 03 9416 4606 F 03 9416 4607 Australian Government Hearing Services Program Government assistance eligibility information T 1800 500 726 TTY 1800 500 496 Australian Hearing Australian Government audiology clinics T 131 797 TTY 02 9412 6802 F 02 9413 3362 Better Health Channel VIC Govt funded health & medical information www.betterhealth.vic.gov.au Deaf Can:Do (formerly Royal SA Deaf Society) Services to SA deaf and hearing impaired T 08 8223 3335 TTY 08 8223 6530 F 08 8232 2217 Deafness Foundation Research, education & technology support T & TTY 03 9738 2909 F 03 9729 6583 Ear Science Institute Australia Implant Centre Help with ear, balance & associated disorders T 08 6380 4944 F 08 6380 4950 Guide Dogs SA.NT Adelaide based aural rehabilitation service T 1800 484 333 TTY 08 8203 8391 F 08 8203 8332
Tinnitus SA Impartial tinnitus information and options T 1300 789 988
Cora Barclay Centre - Adelaide Auditory-Verbal Therapy for 0-19 year olds T 08 8267 9200 F 08 8267 9222
Vicdeaf Advice and support for hard of hearing T 03 9473 1111 TTY 03 9473 1199 F 03 9473 1122
Hear and Say Centres - QLD Early intervention and cochlear implants T 07 3870 2221 F 07 3870 3998
ADVICE & SUPPORT Acoustic Neuroma Association of Australia Support and information on treatment E info@anaa.org.au T 03 9718 1131/02 4421 6963 Aussie Deaf Kids Online parent support and forum www.aussiedeafkids.org.au Australian Tinnitus Association (NSW) - Sydney Support, information & counselling services T 02 8382 3331 F 02 8382 3333 Better Hearing Australia (BHA) Hearing advice by letter, email or in person T 1300 242 842 TTY 03 9510 3499 F 03 9510 6076 Better Hearing Australia Canberra Hearing Loss Management & Hospital Kit T 02 6251 4713 BHA Tinnitus Self Help/Support Group - TAS Support group for those with tinnitus T 03 6244 5570
RIDBC (Royal Institute for Deaf and Blind Children) Hearing and vision impaired education & services T & TTY 1300 581 391 F 02 9871 2196 RIDBC Hear The Children Centre - Sydney Early childhood intervention for hearing impaired T 1300 581 391 F 02 9871 2196 RIDBC Matilda Rose Centre - Sydney Early childhood intervention for hearing impaired T 02 9369 1423 F 02 9386 5935 Taralye Oral Language Centre - Melbourne Early childhood intervention & advocacy T 03 9877 1300 F 03 9877 1922 Telethon Speech & Hearing - Perth Early intervention program and specialist paediatric audiology services T 08 9387 9888 F 08 9387 9889 The Shepherd Centre - NSW & ACT Early intervention and cochlear implants T 1800 020 030 F 02 9351 7880
ADVOCACY & ACCESS SERVICES
BHA Tinnitus Management Services T 1300 242 842
ACT Deafness Resource Centre T 02 6287 4393 TTY 02 6287 4394 F 02 6287 4395
HEARnet - a better understanding of hearing loss & interactive ear diagram. www.hearnet.org.au T 03 9035 5347
Broken Hill & District Hearing Resource Centre Inc T 08 8088 2228 F 08 8087 9388 www. bhhearingresourcecentre.com.au
Arts Access Victoria/Deaf Arts Network T 03 9699 8299 TTY 03 9699 7636 F 03 9699 8868
Lions Hearing Clinic Free or low cost services in Perth T 08 6380 4900 F 08 6380 4901
CICADA Australia Inc For people with or considering cochlear implants www.cicada.org.au
Lions Hearing Dogs Australia Provide hearing dogs and training to recipients T 08 8388 7836 TTY 08 8388 1297
CICADA Queensland For people with or considering cochlear implants E cicadaqld@tpg.com.au
National Relay Service Helpdesk Telephone access service for hearing impaired M-F 9am-5pm, Sydney time SMS 0416 001 350 T 1800 555 660 TTY 1800 555 630 F 1800 555 690
CICADA WA For people with or considering cochlear implants Coordinator: Lynette 08 9349 7712
Parents of Deaf Children - NSW Unbiased information, support and advocacy T 02 9871 3049 TTY 02 9871 3193 F 02 9871 3193 SCIC - Sydney Cochlear Implant Centre Gladesville, Newcastle, Canberra, Gosford, Port Macquarie, Lismore, Penrith T 1300 658 981 Telecommunications Disability Equipment Contact information for special phones: Telstra 1800 068 424 TTY 1800 808 981 F 1800 814 777 Optus 133 301 937 TTY 1800 500 002 The Deaf Society of NSW Information & services to NSW Deaf people T 1800 893 855 TTY 1800 893 885 F 1800 898 333 SMS 0427 741 420 The Royal Victorian Eye & Ear Hospital Cochlear Implant Clinic T 03 9929 8624 F 03 9929 8625 E cic@eyeandear.org.au
32 Hearing HQ Aug - Nov 2014
Deaf Children Australia Services for hearing impaired children T 1800 645 916 TTY 03 9510 7143 F 03 9525 2595 Hear For You Mentoring hearing impaired teens E info@hearforyou.com.au Meniere’s Australia Dizziness & balance disorders support T 1300 368 818 F 03 9783 9208 Self Help for Hard of Hearing People (Aus) Inc Educational association T 02 9144 7586 F 02 9144 3936
EDUCATION Can:Do 4Kids - Adelaide Programs for deaf, blind & sensory impaired kids T 08 8298 0900 TTY 08 8298 0960 F 08 8377 1933 Catherine Sullivan Centre - Sydney Early intervention for hearing impaired children T 02 9746 6942 F 02 9764 4170
Australian Communication Exchange (ACE) T 07 3815 7600 TTY 07 3815 7602 F 07 3815 7601 Cap that! Captioned for Learning www.capthat.com.au Deafness Council Western Australia Inc T & SMS 0488 588 863 Deafness Forum of Australia T 02 6262 7808 TTY 02 6262 7809 Deaf Sports Australia T 03 9473 1191 TTY 03 9473 1154 F 03 9473 1122 Media Access Australia T 02 9212 6242 F 02 9212 6289 NMIT Centre of Excellence Vocational Education T 03 9269 1200 F 03 9269 1484
OTHER BHA Hearing Aid Bank - donate old hearing aids T 1300 242 842 T 03 9510 1577 Planet Ark - Find a battery recycler near you www.recyclingnearyou.com.au/batteries JobAccess Disabilities workplace solutions T 1800 464 800 TTY 1800 464 800 F 08 9388 7799
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books etc... For more book reviews go to www.HearingHQ.com.au
Deaf Sentence by David Lodge Funny and moving by turns, Deaf Sentence is a witty, original and absorbing account of one man’s effort to come to terms with deafness, ageing and mortality, and the comedy and tragedy of human lives. Deaf Sentence is a work of fiction, but Lodge admits in a postscript that he drew on his own experience with hearing loss, as well as that of his father's, to tell the tale of Desmond Bates, a retired professor of linguistics attempting to navigate the world minus one reliable sense. The subject suits Lodge because "deafness is comic, as blindness is tragic," in the words of Bates. Lodge specialises in that particularly British brand of wry, dry humor, that is more appropriate to the mishaps of deaf-induced misunderstandings than the arguably bleaker fate of all-encompassing darkness. Originally published in paperback the book is now available in a Kindle edition online at www.amazon.com.au
Grand Piano Passion Founding Editor - Nancy M. Williams This online magazine is an oasis of articles, essays, and original videos for studying the piano as an adult, making music despite hearing loss, and claiming your passion, whatever it may be. For Nancy reclaiming her passion for the piano despite hearing loss radiated out to different parts of her life. She is now a motivational writer and speaker, an award-winning creative nonfiction writer winning the 2009 Lamar York Nonfiction Prize and an ardent amateur pianist debuting in recital at Carnegie Hall in 2012. For your fill of inspirational and insightful articles, stories from musicians with hearing loss, a plethora of piano technique and theory articles as well as Nancy's award Grand Piano Passion™ | http://www.grandpianopassion.com/ winning essay Deserting the Piano visit www.grandpianopassion.com HOME
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Hearing Health Affirmations An online oasis of articles, essays, and original videos for studying the piano as an adult, making music despite hearing loss, and claiming your passion, whatever it may be.
Claiming Your Passion with a Slow Embrace
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After her workshop, Claiming Your Passion . . . Despite a Hearing Loss, Nancy M. Williams reflects on reasons to jump into your passion or ease in slowly.
Hearing health for the hard of hearing can be strengthened by affirmations. A mezzo-soprano singer with conductive hearing loss makes positive statements.
Cookie Monster and My Hearing Loss, in My CHHA Talk
Hearing Health Affirmations from a Violist
In her talk at the CHHA National Conference, Nancy M. Williams will reveal how Cookie Monster and her hearing loss helped her reclaim her passion for music.
Wendy Cheng, a violist with cochlear implants in both ears, states her affirmations, positive statements to enhance hearing health.
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Most Read Classical Piano Music Amplified™ Women Composers Celebrated in Classical Piano Recital The Chopin Prelude in E Minor Amplified Claiming Your Passion with a Slow Embrace
The Chopin Prelude in E Minor Amplified
The Debussy Rêverie Amplified
Satie’s Gymnopédie No. 3 Amplified
The Debussy Rêverie Amplified
Gain insight into how to play and interpret the Chopin Prelude in E Minor, from using tempo rubato to convey emotion to balancing the right and left hands.
Multiple perspectives for playing and interpreting the Debussy Rêverie, including communicating the music’s rises and falls through your own breath control.
Learn more about how to play and interpret Erik Satie’s Gymnopédie No. 3, which involves a wide spectrum of dynamic contrasts and leaps with the left hand.
How to Find a Good Piano Teacher: Getting Started
Piano Technique
On Bach and His Works
My Left Hand
How I Learned to Count at 49
Bass clef and left hand notes don't come easily, but this amateur pianist finds that understanding chord progressions is the first step toward improvement. »
An adult flutist has a secret: she never knew how to count music. After skating by in middle school band, she now adds logic and technique to her playing. »
A Frog Hop to the Bach Fugue in C Stephen Malinowski has created an entirely fresh approach for making Bach's music visual. His videos break down contrapuntal voices into a digestible form. »
Bach Inventions and Sinfonias from Simone Dinnerstein Simone Dinnerstein for Piano Students of All Ages
Musicians with Hearing Loss Simone Dinnerstein Plays the Bach Prelude in B Minor
On Chopin and His Works Relearning to Hear Melodies
Hear This! An Anthology
My Key to Music
Pat Dobbs, a pianist who is now relearning to enjoy music with a cochlear implant, has written an empowering set of principles for people with hearing loss.
Performed by musicians with hearing loss, Hear This! is a new CD anthology featuring tracks from pianists, guitarists, a cellist and others from the AAMHL.
To cope with a hearing loss, this singer and amateur pianist recalibrated her voice techniques and started using companion mics to access music once again.
El Deafo by Cece Bell with illustrations by David Lasky Going to school and making new friends can be tough. But going to school and making new friends while wearing a bulky hearing aid strapped to your chest? That requires superpowers! In this funny, poignant graphic novel memoir, author/illustrator Cece Bell chronicles her hearing loss at a young age and her subsequent experiences with the Phonic Ear, a very powerful—and very awkward—hearing aid. The Phonic Ear gives Cece the ability to hear—sometimes things she shouldn’t—but also isolates her from her classmates. She really just wants to fit in and find a true friend, someone who appreciates her as she is. After some trouble, she is finally able to harness the power of the Phonic Ear and become “El Deafo, Listener for All.” And more importantly, declare a place for herself in the world and find the friend she’s longed for. Publication: 2 September 2014 by Amulet Books, Kindle edition also available online at www.amazon.com.au Kimberly Brown: 15 tips for teachers who are working with deaf stude... http://limpingchicken.com/2014/0
The Chopin Prelude in E Minor Amplified Nancy M. Williams Plays the Chopin Raindrop Prelude Chopin’s Raindrop Prelude Amplified
Other Good Websites for Piano Students
15 Tips for Teachers Working with Deaf or HOH Students a blog by Kimberly Brown A college professor friend of Kimberly's asked her for advice on how to support a hearing impaired student. Kimberly has created a valuable list of ways teachers can help their hearing impaired students based on her own experience throughout high school and university: http://limpingchicken.com/2014/08/05/tips-for-teachers-deaf-awareness/
AmateurPianists AmateurPianists gives performance opportunities for outstanding amateur pianists.
Articles by Composer Bach Beethoven Chopin
Sing For Hope Sing for Hope’s mission is to make the arts accessible to all and is informed by our belief that the arts have unique power to uplift, unite, and transform individuals and communities.
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