Hearing HQ Dec14

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Dec 14 - Mar 15

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For all your hearing options

Troy Cassar-Daley

Raising awareness for healthy hearing

SPECIAL REPORT & hearing loss

SOUND

Switch on your best ever

SUMMER HEARING DIABETES:

The hearing loss link

WIN one of 6 Sennheiser RS180

digital wireless high-fidelity headphone systems valued at

$550 each

KELLY SLATER This world champion surfer knows the value of the right device to protect his hearing from water woes

Unitron design evolution leads to world recognition MoxiTM Kiss earns international acclaim with Red Dot and iF product design awards designed, including precision of the tooling to the micron level to get the smallest form possible, and a G2 curvature to ensure a luxurious finish.

Moxi Kiss by hearing aid manufacturer Unitron, has received rave reviews from the hearing healthcare community, and most recently, international acclaim, winning iF and Red Dot awards for product design excellence.

Advances in mechanical and electroacoustical design also ensure Moxi Kiss’ internal functionality upholds Unitron’s commitment to high-fidelity natural sound, providing wearers a high degree of listening comfort even in the most difficult noise environments.

The iF and Red Dot awards are internationally recognized labels for outstanding achievements in product design. For each individual award, Moxi Kiss was selected from a field consisting of thousands of entries and evaluated against such criteria as quality, innovation, functionality, and emotional content by a jury of experts and renowned designers from all over the world.

“The industrial design process that led to the creation of Moxi Kiss required an unprecedented level of teamwork and innovation from many parts of the Unitron organization. Project management, marketing , electroacoustic, mechanical engineering, and the company’s industrial design partner AWOL collaborated to deliver truly groundbreaking work,” says Edison Lee.

Moxi Kiss’ journey to the awards podium began nearly three years ago when Unitron embarked on a design evolution for its hearing instruments.

“We are honoured to have Moxi Kiss recognized by the world’s leaders in product design. Moxi Kiss represents the first step in a new design evolution for Unitron’s hearing instruments that will continue for years to come,” says Jan Metzdorff, President, Unitron. “In creating Moxi Kiss, our team studied the best in the world, pushed through design barriers and ultimately created an outstanding product design that is intelligent, beautiful, and truly worthy of international recognition.”

The intelligent design and luxurious finish of Moxi Kiss realizes Unitron’s design goal to create a product that wearers would rate as stylish, discreet and comfortable, and hearing healthcare providers would be proud to represent. The hearing instrument’s outer shell was meticulously

Speak to your Hearing Healthcare Specialist to trial Moxi Kiss

unitron.com/au

Publisher & Editor in Chief Lucinda Mitchell editor@hearingHQ.com.au Sub Editor Judy Lockhart Contributors Rebecca Barker, David Ryugo, Amy Molloy Experts Ass. Prof. Melville da Cruz, Emma Scanlan, Roberta Marino Advertising Sales Executive Julia Turner jturner@hearingHQ.com.au 0414 525 516 Magazine Distribution distribution@hearingHQ.com.au

content contents FEATURES

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SWITCH ON YOUR BEST EVER SUMMER HEARING

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SOUND AND HEARING LOSS

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RAISING AWARENESS, NOT HELL

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.

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.

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.

The devices and accessories that offer you the most active and social summer months imaginable.

Professor David Ryugo explains sound, how we hear, causes of hearing loss and hearing testing.

Award-winning musician Troy Cassar-Daley knows his hearing is his prized asset and he is taking precautions.

Cover image: Helga Esteb / Shutterstock.com

REGULARS

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NEWSBITES

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ALL ABOUT‌

ASK THE EXPERTS

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PRODUCTS & SERVICES

Professional advice on reader questions and concerns.

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HERE TO HELP

Research, innovations and things you need to know.

Diabetes and hearing loss

Information at your fingertips.

Organisations providing advice and support.

REAL PEOPLE REAL STORIES Music teacher, Dr Lindy Crocker, shares her hearing loss journey.

SUBSCRIBE Personal orders: for just $22 each year, receive 3 issues Multiple copies - Small: $30/year for 3 issues (5 copies of each issue) Multiple copies - Large: $50/year for 3 issues (45 copies of each issue) For all orders you can subscribe - online at www.hearingHQ.com.au

- post the form on page 26 to the address below - email subscriptions@hearingHQ.com.au Hearing HQ, PO Box 1054, Lane Cove NSW 1595

HQ

hearing

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 Dec 2014 - Mar 2015

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letter

from the publisher Sound can elicit the most extraordinary and unexpected emotional responses. Like Pavlov's dog, our brains link sounds to meanings without us even realising.

At the beginning of this summer, when I heard the first chorus of cicadas, my mood lifted and I found myself smiling. I had been transported back to my childhood home and the feeling of asphalt under foot as I ran barefoot and carefree around my neighbourhood.

Whether it is the sound of cicadas, kids squealing with delight as they play under the garden hose or the gentle lap of the ocean, the sounds of summer hold powerfully positive and very personal emotional meanings for most of us.

With the ever improving technology available, you don't need to miss out on those sounds that mean something to you if you have a hearing loss. To make it easy for you to achieve your best summer hearing we investigated the devices that will help make summer special. You'll find everything you need to know on page 8.

Lucinda Mitchell Publisher 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.

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Hearing HQ Dec 2014 - Mar 2015

newsbi newsbite ONLINE HEARING TESTS YOU CAN TRUST

For some time the internet has provided us with various online hearing test options. However it has been difficult to know whether they could be trusted to provide accurate and personally relevant measures.

In November that changed with the launch of the new Know Your Noise website that enables you to get personalised information directly relevant to your own situation. The website has been created by the National Acoustic Laboratories (NAL), is funded by the Australian Government Department of Health and sponsored by the HEARing CRC’s HEARsmart program.

NAL, the research division of Australian Hearing, is an internationally recognised leader in hearing research with expertise in many areas of hearing health, including noise measurement and hearing loss prevention. They have conducted several large-scale investigations of hearing health in Australia and the results form the basis of this new website.

Now you can find out whether your levels of noise exposure (at work and play) are putting you at risk of hearing damage, and you can take a hearing test to see how well you hear in a noisy background by visiting http://knowyournoise.nal.gov.au When you do, consider helping NAL build a more accurate picture of noise exposure in Australia by adding your results to their research study on noise exposure and bring us another step closer to a healthier hearing future for all Australians.

Government moves to water down captioning regulations Deafness advocates have condemned proposed changes to the regulations around closed captioning for television. A bill introduced into parliament in October includes several changes, with the most controversial being an end to the requirement that broadcasters report annually on their compliance with captioning rules. “This is a backward step that will reduce consumer protection and undervalues the importance of captioning,” said Alex Varley, CEO of Media Access Australia, which has lobbied hard against the changes.

CLOSING CAPTIONING? The bill has now been passed to a Senate committee for review, and a report is due in February 2015.

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NEW SURGICAL TRAINING INSTITUTE Cochlear Ltd. officially launched their new Cochlear Clinical Skills Institute in November 2014. The world-class medical facility includes an audiology education centre, lecture rooms and a $2 million surgical laboratory named the Gibson Room in honour of Professor Bill Gibson.

The Institute is based in the Australian Hearing Hub at Macquarie University, Sydney and allows visiting surgeons to practice their technique in Sydney while their colleagues at hospitals around the world watch live.

Advanced Bionics host their training facility in Valencia, California USA while earlier this year MED-EL opened the doors of their state-ofthe-art Temporal Bone Laboratory for surgical training in Innsbruck, Austria.

$150K FOR NATURAL DISASTER RESILIENCE FOR THE DEAF An investment of $151,678 under the Natural Disaster Resilience Program has been committed to help the Deaf Society of NSW better prepare the community for natural disasters.

The joint initiative between the Deaf Society, the State Emergency Service, Rural Fire Service and Fire and Rescue NSW is being funded by the Australian and NSW governments. It will involve identifying and training Deaf Liaison Officers, creating Auslan videos and pictorial guides, holding disaster preparedness workshops with the deaf community and conducting deaf awareness training for emergency service personnel and volunteers.

DO YOU STRUGGLE TO START THE DAY WITHOUT A COFFEE?

fear of tinnitus may no longer be a threat to your habit...

Until now caffeine has been thought to play a role in the development of tinnitus. However new insights from a US longitudinal study published this year suggest women who drink a lot of coffee may unknowingly be avoiding the development of tinnitus.

Researchers at Brigham and Women's Hospital (BWH) in Boston found that tinnitus is less likely to occur in women who consume the most caffeine. Their study followed more than 65,085 women aged 30 to 44, who in 1991 did not experience tinnitus. After 18 years of self-reported questionnaire follow-ups the researchers found that 5,289 women had tinnitus symptoms a few days a week or every day.

The authors of the paper A prospective study of caffeine intake and risk of incident tinnitus reported finding an inverse association between caffeine intake and tinnitus with the incidence of reported tinnitus 15 percent lower among the women who consumed 450 to 599 milligrams of caffeine per day compared with women consuming less than 150 milligrams per day (approximately one cup of coffee). The majority of caffeine consumed among the women was from coffee and the results did not vary with age.

In comparing their results with other studies the researchers note, "A recent randomized controlled crossover trial failed to demonstrate an improvement in tinnitus symptoms with cessation of caffeine intake while demonstrating harm in the way of withdrawal symptoms among participants." They further observed, "On the basis of the results of these studies, there is not persuasive evidence that reducing caffeine intake would be beneficial with respect to tinnitus." Their published paper does however warn, Our investigation evaluated the incidence of tinnitus and not the effect of caffeine among participants with existing tinnitus, we are unable to make a recommendation as to whether the addition of caffeine would improve symptoms."

Source: The American Journal of Medicine Volume 127, Issue 8, Pages 739–743 Hearing HQ Dec 2014 - Mar 2015

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newsbites newsbites David Brady, chair of Deafness Forum of Australia has delivered a video message we feel is important and touches everyone. It is published here for those of you who don't have access to watch his message online:

"Deafness in its varying degrees is one of the most misunderstood disabilities and because it is invisible it is frequently overlooked, neglected and forgotten.

One in every six Australians has some amount of hearing loss. It can be caused by hereditary conditions, infections, or disease. Others will damage their hearing from exposure to loud noise over time – long or short. Almost all Australians will lose the best of their hearing as they age.

Many assume it doesn’t require any special attention or services, even though it interferes with virtually every aspect of a person’s life. Hearing loss isn't just about “not hearing”. It goes beyond the ears. It affects education, work, personal relationships, health and well-being. It affects the individual and the people around them. Think about this. The total cost of hearing loss each year is equal to the cost of building a second Sydney international airport every 18 months. It’s a hidden debt Australia can no longer afford to ignore.

Hearing must become a mainstream health issue. What is it that we can all gain from hearing becoming the next National Health Priority? The answer is public awareness and that flows through to greater awareness amoung our political leaders, law-makers and policy developers. If we get their attention, there is the opportunity for conversations on a broader range of issues that are important to all our constituents in the deafness sector.

We need a national flagship campaign that draws together all the issues that relate to deafness and hearing loss. A campaign that will attract media and public interest. A campaign in which we all have a role to play.

We need a national public campaign that reaches out to millions of Australians – to make all of them pause for a moment and ask themselves the question, “Why isn’t hearing a National Health Priority?”

Some practical examples of themes that can be a part of our campaign are: • There is widespread under-managed hearing care in the community.

Many people who would benefit from hearing aids or even speech processors actually wait 6 to 10 years before seeking them.

• Auslan interpreter services, live captions and hearing augmentation systems should be and must be a common feature in the social, education, health, government service shopfronts and workplace settings so that quality communication access is available to everyone.

• Indigenous hearing health remains a massive public health problem.

• Hearing loss from loud noise is preventable but the Australian people are largely unaware of the significance of the problem and the simple steps they can take to address it.

I don’t underestimate the difficulty of achieving our objective, but I do believe that with a concerted and collaborative effort we can make it happen.

For a relatively small investment, today’s decision-makers can create a legacy that will bring millions of Australians into the light. This will be good for them, their children, and their children's children. It will be good for Australia.

Please contact Deafness Forum of Australia if you would like to help make Hearing Australia’s 10th National Health Priority: Mail: Open Systems House, 218 Northbourne Avenue Braddon ACT 2612 Email: info@deafnessforum.org.au Phone: (02) 6262 7808 (via the National Relay Service) To watch and share this and upcoming video messages visit http://vimeo.com/user20340525 6

Hearing HQ Dec 2014 - Mar 2015

1ST ON BIRTH CERTIFICATE

BRITISH SIGN LANGUAGE NAME

Hazel's British Sign Language name is not the letters H-A-Z-E-L, rather it is a combination of hand symbols which, when taken in context, describes her personality. Hazel's sign name is written as UbOtDDstarL representing a combination of hand movements that means smiley face.

While BSL was recognised as a language in its own right by the UK government in 2003 it took many months battling the UK registry office for UbOtDDstarL to finally take pride of place on her birth certificate.

Source: http://www.bslzone.co.uk/watch/deaf-world-britains-first-babybe-registered-sign-name/

LAST CHANCE TO HEAR

Cochlear implants only briefly gave Colin Anderson access to sound after he completely lost his hearing due to complications following a routine arthroscopy eight years ago. However, in March this year Colin became the first person in New Zealand to undergo an Auditory Brainstem Implant (ABI).

The local team of medical specialists were joined from Germany by Prof Behr for the five hour surgery to implant the MED-EL Auditory Brainstem Implant.

Bypassing both the inner ear and the auditory nerve, the ABI stimulates the cochlear nucleus of the brainstem providing users with a variety of hearing sensations to assist with sound awareness and communications. These devices offer hope to those who will not benefit from cochlear implants or hearing aids.

i TINNITUS RELIEF?

HOW DO YOU RATE FOR FIRE SAFETY? According to a recent study by Smoke Alarms Australia, we are becoming increasingly complacent1 when it comes to fire safety. When you are sleeping you don’t always register the smell of smoke, so without an adequate early-warning system you are twice as likely to die in a house fire. If you are deaf or hard of hearing and take off a hearing aid or hearing implant processor to sleep you can't rely on a standard audible smoke alarm. A number of States subsidise specialist alarms that include a strobe light and pillow shaker reducing the cost from $500 to as low as $20.

• NSW residents with severe to profound hearing loss can apply for a subsidised alarm for $20 through the Deaf Society of NSW at www.deafsocietynsw.org.au • A similar scheme supported by the Victorian State Government reduces the cost to $50. For more information visit www.vicdeaf.com.au • The Tasdeaf / Tasmanian Fire Service program reduces the cost to $50. Download the application form here http://tasdeaf.org.au/wp-content/uploads/2014/05/2014_ Visual-Smoke-Alarm-Subsidy-Application-Form.pdf • Deaf Services Queensland provide subsidised alarms for $50 or $20 for concession card holders. More information can be found at www.deafservicesqld.org.au/sass • In South Australia, if you are deaf or have profound hearing loss you can access the scheme at no cost: www.guidedogs.org.au/smoke-alarm-scheme • Unfortunately currently Western Australia and the Northern Territory do not have smoke alarm schemes for deaf people.

Source: Deaf Society of NSW 1. Australian homes with at least one non-working smoke alarm due to damage, fault or expiry, or where an alarm is absent, has increased year on year – from 39 per cent of inspected properties in 2010, up to 59.9 per cent in 2014.

hear together with Australia’s most experienced cochlear implant program

Irish medical devices company Neuromod Devices has secured regulatory approval in the UK and Europe for the sale of Mutebutton, a new self-administered, noninvasive, multi-sensory tinnitus treatment.

Expected to be made publicly available in early 2015 it “is the culmination of 10 years of scientific and clinical research," said Dr Ross O’Neill, CEO, Neuromod Devices.

The Mutebutton system combines synchronous audio and lingual (tongue) stimulation to promote neuroplasticity.

Used for a minimum of 30 minutes a day over a ten week period, the company reports treatment has been shown to gradually reduce the sounds of tinnitus in clinical studies conducted by NUI Maynooth and the Hermitage Medical Centre Dublin.

Neuromod Devices has not indicated when or if the device will be available for Australians.

Source: http://www. neuromoddevices. com/news/cemark

Advanced Bionics have launched the HiRes90K Advantage cochlear implant in Australia. According to the manufacturer it features the industry's thinnest pre-curved array called the Mid-Scala electrode and is designed to protect the delicate structures of the cochlea during surgery in an effort to retain existing hearing. Post market studies are ongoing to verify hearing preservation effectiveness.

‘NO GAP’ services*

✓ implant assessment ✓ medical care ✓ rehabilitation ✓ lifelong care ✓ public & private clients

from 4 months to 95 years *subject to your Health Fund rules

1300 658 981 scicadmin@scic.org.au

SYDNEY | NEWCASTLE | CANBERRA | GOSFORD | LISMORE | PENRITH | PORT MACQUARIE | DARWIN

Switch on your best ever SUMMER HEARING Hearing technology has come on in leaps and bounds. Rebecca Barker investigates which devices and accessories offer you the most active and social summer months imaginable.

Keep up-to-date with technology There are at least three factors to 8

Hearing HQ Dec 2014 - Mar 2015

nano-coated devices survived unscathed while 60 per cent of those without it stopped working and 100 per cent were visibly affected. Above all, the special covering extends both lifetime and reliability of your hearing equipment giving you better peace of mind. Finally, consider the wide range of products and accessories designed to enhance, waterproof or dry your hearing device.

This ensures that anyone, with any level of deafness, can enjoy the full spectrum of summer activities.

In your element Being in or around water is one of the best ways to make new friends, exercise, keep fit and cool down during warmer months. But it can be a tricky time for those with hearing issues or a tendency to suffer from ‘swimmer’s ear’. Also known as otitis externa, this is a painful condition caused by infections which can narrow the ear canal and damage ear function. Anyone who enjoys the water, whether starting out in swim school or conquering the waves like champion surfer Kelly Slater, is susceptible to this common affliction. As well as using custom earplugs, obtained from a qualified audiologist, swimmers can use

Main image: Peapop / Shutterstock.com

As the days grow warmer and the evenings lighter, the sounds of summer start to fill our lives. Whether it is the crash of surf, the chorus of cicadas, the splashing of children swimming in the pool or the chatter of al fresco diners enjoying a backyard barbecue, experiencing all the Australian summer has to offer is hard to beat. But if you are one of the country’s 4.5 million deaf or hearing impaired people, then this season’s melodies can sound muffled, irritating or merely pass by unnoticed.

Add to this, the damaging factors of warmer days on hearing equipment, such as increased dust, grime and moisture, from sweating, humidity, frequent showers and watersports and summer’s delights can seem daunting at times. So what can be done to enhance the hearing experience for adults and children as the temperature takes a hike?

consider when choosing the most suitable hearing device to manage environmental conditions as the mercury rises. The first is a standard two-digit rating (or IP – Ingress Protection) which scores electronic equipment’s ability to withstand damaging elements such as dust, dirt and water. For example, a hearing aid rated IP67 would perform well in a dusty environment, giving it a ‘6’ rating, and would function after being dropped into water of up to one metre deep, making it ‘7’ for liquid immersion. IP68 is currently the highest rating achieved in the range of hearing technology and offers protection against solid particles and long term use under water. This compares favourably for example with the IP54 rating of a typical mobile phone. Secondly, consider whether your hearing device has been protected with a special nano-coating.

This is a polymer layer, one thousand times thinner than a human hair, which protects a hearing product and its workings by repelling humidity and sweat. These instantly form beads of moisture and roll off. Tests by German hearing aid company Interton showed that over 5 weeks of exposure to unnatural levels of water and dust,

The world's most successful surfing champion, Kelly Slater

Swedish-designed earplugs called SurfEars that maximise sound and balance by letting sound in but keeping water out.

There is even an earplug suitable for extreme watersports like diving, called the Proplug, which works by barring water but enabling the user to equalise through in-built vents. In fact, science and research have moved so fast in recent years that many hearing aid manufacturers – and parents of hearing impaired children - have pioneered new products that can transform lives,

helping you and your family spend more time in the water and outdoors.

Whether you like going to the pool or beach, gardening or giving your all to your chosen sport, a whole raft of hi-tech protective and hearing designs will help you savour summer’s best. For example, inspired dad Eric Sherman was so frustrated watching his son grapple with wires and hearing equipment in the pool that he designed a tight-fitting, UV-protecting ‘rashie’, in a Ci Wear range, with pockets on the sleeves. It protects hearing technology and ensures tangle-free movement and comfort. “The idea came from watching our son swim

with his waterproof cochlear implant processors. We noticed he spent a lot of time attending to his processors and headpieces, instead of playing. We wanted to find something that he could wear that improved his experience in the water and not be a hindrance,” says Sherman.

Cochlear Implant Options Hi-tech waterproof options for cochlear implant users are certainly making big waves and users agree hearing in the water makes swimming so much more fun. One cutting edge arrival is Advanced Bionics’ Neptune (IP68), which is the

Ci Wear's UV-protecting ‘rashie’, with pockets on the sleeves.

Advanced Bionic's Neptune

world’s first and only swimmable sound processor for cochlear implant users.

The compact, lightweight and discreet device, which works well for people of all ages and lifestyles, comes in a range of trendy colours and has the flexibility of being worn in the hair, on the arm, under a collar or in a pocket. It suits a wide range of water-based activities including showering, bathing and swimming plus high energy pastimes such as waterskiing, rafting, windsurfing and snorkelling. Kristi Fulford, mother of Kaelen, 13, says the Neptune has transformed her daughter’s life and made swimming safer and less stressful. “In the past 10 years we have not had the opportunity to communicate to Kaelen in the water. The lifeguards at our local pool are all so amazed at the technology and that she can hear in the pool. She can now hear their 3 whistles when they tell everyone to get out,” says Fulford.

Meanwhile, Advanced Bionics’ AquaCase (IP68), a water-tight case, compatible with Naida cochlear implants, has already proved popular as a worryfree way of participating in a range of 10

Hearing HQ Dec 2014 - Mar 2015

adventurous hobbies and is ideal for boisterous kids. “The AquaCase works with a waterproof microphone, the AquaMic, and is a hard case that shields the processor, particularly when it might get knocked in sport. It has a clip to make it secure and is designed to float if it is dropped in water,” explains Sarah McCullough, a clinical and technical specialist with Advanced Bionics Australia.

Med-El's single-unit cochlear implant processor, the Rondo, is the only cochlear implant processor with no ear hook so it can be hidden easily under longer hair making it almost invisible. While not waterproof itself, the Rondo has its own completely waterproof cover called WaterWear (IP68). The sleek, skin-tight Med-El's Rondo with WaterWear

cover has been designed for optimal microphone performance and can be used three times and up to ten hours each time. Tested to a water depth of four metres, the covers will protect the Rondo in chlorinated, fresh and salt water.

With nothing behind-the-ear and no cables to worry about, Med-El's Rondo processor offers a real freedom for sports enthusiasts and leaves plenty of room behind the ears for sunglasses too. If your preference is for particularly vigorous exercise the processor can also be secured into a specialised headband.

Hearing impairment has not stopped Faye Yarroll from filling her summer’s with fun and activity. A bilateral cochlear implant recipient and an inspiring volunteer for the Cochlear Awareness Network, Yarroll is a keen swimmer. “Summer is a great time to play sports, catch up with friends or have a latte at your local café. But whatever it is that you are doing you need to think about how you look after your hearing equipment,” says Yarroll, who uses Cochlear’s Nucleus 6 speech processors, which are nano-coated for water resistance. Everyday occurrences like showering, sweating and being caught in the rain are not a problem with a few simple precautions, she says.

“As people are possibly feeling the heat more, or sweating more during outdoor activities, it is really important to use a ‘dry and store’ box every night to remove moisture from your processors,” says Yarroll. She also recommends changing microphone covers every two months to prevent dirt build-up and using a cover for added protection if the processor falls off during rigorous activity. Despite years of not entering the water because she did not want to swim totally deaf, Yarroll says a few accessories have now made the sport a favourite pastime.

She uses Cochlear’s Nucleus Aqua + (IP68), a reusable, flexible silicone sleeve which seals in a processor and must be used with the Aqua + coil, which is specifically designed for underwater swimming.

Capable of being submerged to a depth of three metres for two hours, it works for snorkelling but not diving and can be used in all kinds of situations including soapy baths, pressurised showers, chlorinated and saltwater pools and fresh

Make Waves

24697 r1.0

Now available in Australia, the fully waterproof WaterWear cover for RONDO gives you the freedom to enjoy all the summer activities you love.

Want WaterWear?

Go to medel.com/au/waterwear

medel.com

Hearing HQ Dec 2014 - Mar 2015

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Nucleus Aqua accessory

water. Cochlear also offers the Nucleus Aqua accessory (IP68), a single-use plastic enclosure with a zip-lock seal for the CP800 Series BTE sound processor, cable and coil. It is designed for use with rechargeable batteries only.

“It’s now a pleasure to go swimming once more and be able to hear, you just have to remember to use rechargeable batteries when using the Aqua accessories,” explains Yarroll.

As swimming is such an important skill in a country where the climate encourages cooling off in the water, thousands of children are now making the most of their watertight hearing devices and accessories. Around 10,000 people have been fitted with a cochlear implant in Australia this year, so the

Ben Robertson swimming with sound 12

Hearing HQ Dec 2014 - Mar 2015

new water-wise products are a blessing for many who don’t want to miss out.

In fact, they have changed 10-year-old Ben Robertson’s world, says his mum Karen. “Ben is a fish, he loves water. He would take off his sound processors and hop into the water. It just concerned me that he couldn’t hear me when he was swimming,” says Karen, who is pleased her son now has a safer environment.

“It’s so much easier now. I can walk to the back deck and call out to him while he is swimming,” says Karen, who recommends using a swimming cap or safety line to secure wires and equipment for vigorous jumping and diving.

Swimming in the pool, sea, water parks, rivers and lakes is now a hasslefree reality for people needing bone conduction hearing systems too. Until fairly recently all bone anchored hearing systems, for conductive or mixed hearing loss, featured an abutment (a small titanium connector which juts through the skin) just behind the ear to allow the external sound processor to transmit vibrations to the implant. The challenge

with these abutment devices is the need to keep the abutment site clean and dry as much as possible to avoid infections.

German Inventor Prof. Dr. Ralf Siegert developed the first abutment-free bone conduction hearing system called the Alpha 1 in 2006 in answer to user concerns. Purchased by US company Sophono in 2008, the device was commercialised and began selling in 2010 featuring a processor held to the head by a magnet. The improved Sophono Alpha 2 was launched in 2011.

Med-El's Bonebridge, abutment-free, bone conduction system, with Amadé BB audio processor is also held to the head over the implant by a magnet. And like their cochlear implant and Soundbridge middle ear implant, the Bonebridge allows the external audio processor to be upgraded to a newer generation of device, even years after the original implantation.

Cochlear also offers an abutment-free option with the Baha® 4 Attract System.

Amazing aids When it comes to hearing aids for our summer culture, Siemens Aquaris is the only hearing aid to receive an IP68 rating for continuous submersion under water. It's also dustproof and shockresistant. The waterproof, behind-theear aid with built-in tinnitusreducing technology includes a cover clip that minimises wind disturbance.

Accessories include a sports clip and Aquapac, which keeps remotes, mobile phones or MP3 players dry when you are poolside or in the yard.

“The Aquaris housing is one solid piece with no seams, screws or pins. From a design standpoint, we incorporated a silicone seal that prevents any water from getting inside the battery compartment, microphones and the receiver area,” says Eric Branda, Siemens senior manager of product management. “Any custom earmould can be used for daily use but we recommend a non-vented, fullyoccluding earmould for swimming,” explains Branda.

Phonak's Lyric is the only hearing aid currently available that will allow you

Hearing better than people with no hearing loss.

Research by Thibodeau (2013, 2014) shows that over distance in 75dB(A) noise, hearing aid users with a Roger system understand speech better than people without hearing loss by 62 percentage points.

The Roger Pen is just one of many ingenious solutions from Phonak. *

Simply ingenious

www.phonakpro.ca/roger-pen * www.phonakpro.ca/evidence

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Hearing HQ Dec 2014 - Mar 2015

Cafe culture While watersports and swimming are popular summer pastimes, many people simply enjoy more relaxing ventures such as visiting their local café or restaurant, going to the theatre or movies or hanging out with friends at a bar or music event.

However, these social gatherings can be tiring and tedious with the constant distraction of background noise.

Thankfully, many hearing instruments now include an array of features to tackle problems when you lose the ability to separate sounds from different directions, when sounds seem too loud, you have problems following conversations in a crowded or noisy area or you struggle to hear sounds like ‘f’, ‘s’ or ‘th’.

Restaurants, entertainment venues and outdoor eateries can become some of the hardest places to hear your friends and relatives during the summer exodus. If you suffer in this way, you are not alone.

In fact, Siemens reports that failure to understand speech in background noise is the most common complaint from new hearing aid wearers and poor performance in loud places is the most frequent reason for hearing instrument rejection. A wide range of aids have recently acquired or updated built-in technology to reduce hearing hurdles in these situations. For example, Siemens Binax system, which operates in its Pure, Carat and Ace styles, has been clinically proven to outperform normal hearing in difficult environments. The Binax platform builds on Seimens’ e2e wireless technology that improves binaural listening, synchronizing volume,

sound, program settings, directional microphones and exchanging audio signals between two personal aids. You also have the ability to discreetly change hearing programs, volume, base and treble using the free touchControl app for iOS and Android smartphones.

Siemen's Ace hearing aid featuring the Binax system and controlled by the touchControl App

Hugo Lacayo, an IT specialist who works with hearing impaired people has been thrilled with Binax and its wireless accompaniment easyTek, which directly connects to any Bluetooth product, streaming sound from televisions, MP3s, phones and the like. “These hearing aids are the best that I have tried. The clarity and how natural they sound is very impressive. Usually I love to tweak the hearing aids’ tuning, but with these hearing aids I have not had the need to tweak them at all,” says Lacayo.

Wind worries Binax-fitted equipment also reduces wind

Cafe image: ChameleonsEye / Shutterstock.com

to forget you're wearing an aid, with no daily insertion or removal, no batteries to change and no maintenance. Because it is placed close to the eardrum it is 100% invisible and according to Phonak it takes advantage of the ear’s natural anatomy to minimize background noise and deliver natural sound quality. Lyric devices are provided on an annual subscription and inserted by a hearing professional.

They can be worn up to four months before needing to be replaced at which time you simply return to your hearing professional's office for 10-minute replacement visit.

The Lyric can be used during most of your daily activities without any further thought: exercising, showering, sleeping and talking on the phone. Lyric is water resistant, not waterproof, and should not be completely submerged underwater so if you want to swim you'll need to use a custom made earplug to protect the aid from the water.

Like Unitron's range of hearing aids many other hearing aids these days achieve an IP57 rating indicating that after being submerged in one metre of water for 30 minutes the instrument returned to normal working condition once excess water had been wiped off and a new battery inserted.

Most manufacturers point out this rating does not mean their hearing aids are waterproof. Unitron advises that if you accidently jump in the shower with your aid on or drop it in the sink the device will still perform as expected once it is thoroughly dried out. You will need to completely dry out the hearing aids and earhook/external receiver if they become wet and thoroughly dry the battery compartment with a tissue before inserting a new battery.

It is important to remember however that the IP57 rating does not include salt water, chlorinated water, soap or other liquids with a chemical content.

At the very least, during the long summer months, always thoroughly dry your ears and use a drying box overnight to ensure your hearing equipment stays in top working order.

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noise and helps wearers focus on the direction of the most prominent speaking person in the vicinity, such as listening at a party or in a car. A spokesperson from Siemens explains the wind-reducing phenomenon. “It identifies the side on which the relevant signals are better and streams these to the side that is hit more strongly by the wind. In the rare cases in which the wind comes directly from the front, hitting both ears equally, there is no transfer of audio signals and the wind noises are weakened synchronously in both instruments,” he explains.

Other device options that help reduce the irritation of wind interruption include Widex’s Super range for people with severe to profound hearing loss.

These wireless, receiver-in-the-ear models reduce wind noise by 18dB, use batteries that last up to three weeks and incorporate an audibility extender that

aids speech understanding and makes background noise like birdsong crisper and less distracting.

Like many of today’s devices, Phonak’s aids incorporate features that enhance and clarify speech while you are in windy places, on the phone, in crowds and in the car. Its most basic models include the ability to reduce whistling sounds, background noise like engines and fans and an ‘ultrazoom’ option which homes in on the voices of people facing you rather than those to the side and back. Phonak’s top end models in the ‘Premium’ range include all these features plus an automatic zoom for voice enhancement, the means to allow both ears to hear on the phone and an ability to cushion loud, sudden noises. Studies show people experience a 70 per cent improvement in speech understanding in noise when Phonak’s Ultrazoom

Listen well with assistance While the next generation of hearing aids ensure you get the most out of your summer hearing experience, there is also a range of assistive listening devices (ALDs) that will ensure you don't miss out on the the summer season’s important moments.

The recent technological breakthrough that allows apps to be downloaded onto smartphones transforming them into inconspicuous hearing aid adjusters shows the exciting new levels the hearing industry has reached.

If you're not ready yet for a hearing aid but quiet sounds are an issue, Etymotic’s BEAN Quiet Sound Amplifier may help.

It requires no special fitting and operates through a discreet, earplug-style design that amplifies only soft sounds.

If you have hearing aids but are still challenged in summer situations such as at outdoor restaurants or on day trips you may find Bellman & Symfon’s wireless FM system, the Domino, helps to clarify speech and filters out disturbing background noise before it reaches your hearing aid or cochlear implant. Domino consists of a receiver, which detects voices close to you and a transmitter which picks up sounds further away. It

can be placed on a restaurant table or pointed at the person you wish to hear better and has rechargeable batteries that last all day.

Phonak has produced a cutting edge wireless microphone called the Roger Pen which will not draw attention to itself and can

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Hearing HQ Dec 2014 - Mar 2015

be placed on a table to help you hear and understand more speech in loud noise and over distance. It can be used as a standalone microphone or alongside the Roger Clip-On Mic and wirelessly communicates with a miniature Roger receiver that attaches directly to virtually any brand of hearing aid. There is a receiver for all cochlear implant brands too. Featuring Bluetooth technology it can be used to make mobile phone calls and to listen to TV and multimedia.

Kelly Jenkins, 34, a bone conduction implant recipient, knows only too well

Unitron's Moxi2 Pro

technology is used with Advanced Bionics’ ClearVoice system.

Meanwhile, Unitron’s Moxi2 Pro (behind-the-ear) and Quantum2 Pro (behind-the-ear and in-the-ear) designs use listening technology called SpeechZone 2 which can pinpoint speech within 360 degrees and respond intelligently for improved natural sound, less distractions and better understanding of voices in noise.

how ALDs can maximise your hearing, particularly when dining out in noisy rooms or courtyards. Using a portable, wireless mini microphone has resurrected her social life. “I had reluctantly let my friend choose a restaurant and knew there would be music playing, traffic going by and the chatter of other diners,” says Jenkins, who connected her new mini microphone to her Baha implant and placed it on the restaurant table. “I ended up having my first real restaurant conversation in over 10 years. It was a truly amazing experience,” she says.

And finally, what would an Australian summer be without the 'thwak' of a cricket ball hitting the bat? For many of us it means family gathered around the TV watching the boxing day match.

However, with Sennheiser’s RS180 wireless headphones set to your own sound satisfaction level you'll be able to hear the full commentary from the TV professionals rather than the family's boisterous observations which often drown out the most important stats.

Here's to happy summer sounds.

HQ

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A phone solution for people who are deaf or have a hearing or speech impairment

Sound & Hearing Loss Have you ever wondered about the sound of complete silence? It is not something we normally encounter. In fact, sound is always around us because it is created by vibrations in air or any elastic medium including water. There is the sound of traffic, of rustling leaves, of wind, car alarms, and ringing phones; there is conversation, dogs barking, and music. From an evolutionary perspective, sound provided information about the environment from a safe distance when the foliage was too dense or light too dim to see. Smell is too diffuse and is only effective when one is downwind of the odour. Touch is too late to alert us about a sabre-toothed tiger. Animals, including early humans, needed to know if a sound indicated a predator, the next meal, a competitor, or a potential mate. In the modern world, sound provides warnings of danger, alerts us to visitors, soothes us with music, and facilitates our humanity through spoken communication.

electronic devices emit a high frequency hum when turned on but we don’t hear it because it is beyond the range of normal human hearing. Vowel sounds are composed of low frequencies, whereas consonants are composed primarily of high frequencies.

Loudness is related to the pressure of the air waves conveying the sound. This pressure is measured in decibels and we are sensitive to sounds that can vary over 7 orders of magnitude, from a near silent whisper to the roar (and pain) of a jet engine. Loud noise is damaging to the ears in the same way that ultraviolet light

Understanding how we experience sound and what that means for hearing loss and hearing restoration is Professor David Ryugo's speciality. Having earned a bachelor degree in psychology from Yale University and a PhD in biological sciences from the University of California, he spent 9 years on the faculty at Harvard Medical School and 23 years at Johns Hopkins University School of Medicine before retiring as Professor Emeritus and joining Australia's Garvan Institute as Head of Hearing Research. David's research focuses on understanding brain mechanisms of hearing and studying the structure-function relationships in neuronal circuits of the auditory system.

exposure is damaging to the skin and radiation is damaging to genes; a little won’t hurt, but over time it all adds up.

Prolonged exposure to noise will result in hearing loss; sports fans who attend events attempting to break the Guiness World Record for Loudest Crowd Roar, are giving themselves noise trauma that will damage hearing.

Time is the third component to sound: there is onset, offset, and duration. It is used to define a melody, to represent letters in the international Morse Code, and forms the cadence or prosody for speech. Neural activity and features

Understanding How We Hear

There are three physical parameters to sound: frequency, loudness, and time.

Frequency is the number of oscillations (vibrations or cycles) that a sound makes in a second, and humans hear a range from 20 cycles per second up to 20,000 cycles per second (also known as Hertz, Hz). The note middle C is 256 Hz; the highest note on a piano is 4186 Hz. Most Hearing HQ Dec 2014 - Mar 2015

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of sound are linked in time and that is how the brain learns to associate specific acoustic events to auditory experience.

This linkage is why it is annoying when conversations in a movie are not precisely synchronized to movements of the mouth and why speech with a “foreign” accent is difficult to follow.

Our auditory system is a most remarkable biological entity that receives these vibrations in air by way of the ear and converts them to neural signals that are processed by the brain.

The processing occurs over neural circuits that analyze the components of frequency, loudness, and time to produce our precept of the sound—a conversation, a melody, or the ocean roar.

We don’t always appreciate our hearing until we lose it.

What Is In Store...

In Australia, the incidence of hearing loss increases with age. It is estimated that just over 20% of the population over 18 years of age suffers from hearing loss and that this number increases to 50% for those over 65 years. Three quarters of those over 70 years suffer from severe hearing loss according to the Listen Hear!

Access Economics Report 2006 1. As life expectancy rises, it means that a majority of us will spend the final decade of life with communication impairment.

The World Health Organisation reported in 2013 that approximately 360 million people worldwide are affected by disabling hearing loss and it emerges as one of the largest public health concerns for the future. It is not “life-threatening” but has an insidious adverse impact on our quality of life.

The Cost Of Hearing Loss

In children, hearing loss undermines

speech and language development, as well as socialization skills, which in turn can affect long-term academic achievement. Poor academic performance limits further educational opportunities such as university programs that will influence employment options.

Success in school influences one’s sense of self-worth, identity, and financial independence2. In adults, hearing loss has a negative impact on employment opportunities because sound is an important aspect of safety and communication in the work environment.

Hearing loss impairs your ability to communicate, enjoy radio or television, or be alert to important warning signals (e.g., smoke alarm, doorbell, and telephone rings). The difficulty in communicating when there is competing noise is a major complaint by those with hearing loss. It prevents the enjoyment of dining out in restaurants, attending parties, and even hosting family holiday dinners. Fundamentally, people are embarrassed to constantly say “what?” and still not understand after several repetitions. Withdrawal from these kinds of social events leads to social isolation, which can in turn bring on depression and early cognitive decline, especially in the elderly3.

The financial expense to society resulting from lost productivity and disability is estimated to be nearly $12 billion per year in Australia alone1. One cannot, however, put a price tag on the personal cost of lost quality of life.

So, What Allows Us To Hear

The external ear, where you park a pencil or hang jewelry, funnels sound into your ear canal. The sound vibrates the ear drum, and these vibrations are delivered to the coiled inner ear by 3

tiny bones. The vibrations in the inner ear stimulate the hearing receptor cells, which in turn cause neural signals to be sent to the brain for processing. The inner ear, smaller than the size of a pea, is responsible for our hearing.

The inner ear is an extremely delicate structure. Disease, head trauma, drugs, and loud noise can cause sensory receptor cells to die. When these cells die our hearing diminishes. Hearing loss reduces the resolution of our sound environment. When we are young, we have high-fidelity sound input to the brain. It is analogous to having high definition television for sight. Living in a noisy, industrialized society causes sensory receptor cells corresponding to high frequencies to die over time. We might notice this loss when consonant sounds of speech, such as ‘s’, ‘f’ and ‘th’, become difficult to distinguish.

As hearing loss increases, our sound environment “pixilates”. The sounds can be heard but the details are indistinct.

Softer sounds are not heard and sounds that are heard seem to run together.

Many people wrongly assume that hearing loss can be treated by simple amplification. In fact, hearing loss has many adverse symptoms: speech comprehension in a noisy background is impaired; tinnitus or ringing of the ears typically emerges; and sometimes there is severe loudness distortion. Hearing loss is not just about volume. Increasing the loudness often does not improve understanding; amplifying a fuzzy signal just gives you a loud fuzzy signal.

Hearing loss superficially resembles presbyopia—the need for reading glasses as one gets older. Presbyopia is a natural consequence of aging due to a stiffening of the lens that focuses the external world onto our retina. The retina

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is the sensory receptive part of the eye; visual problems caused by loss of lens flexibility, however, can be corrected by glasses that compensate for the lens.

There is no neural tissue involved in this condition. Hearing loss, in contrast, results from damage or loss of the actual hearing receptors. The receptors are small cells in the inner ear that convert mechanical vibrations of sound into neural activity in auditory nerve fibers.

When these cells are damaged or die, they are gone forever. Amplification by hearing aids cannot stimulate these damaged or missing cells and so part of the sound environment is lost. The added energy of amplification causes a spread of vibrations along the inner ear so that adjacent healthy receptors are stimulated, but these receptors represent a different frequency. It would be as if a pin prick on your skin felt like pressure from your index finger—the sensation of touch and its location would be experienced, but not with precise accuracy.

Sydney street image: Troy Wegman / Shutterstock.com

Keep The Noise Down

The most common cause of hearing loss is a result of exposure to loud sounds, particularly over an extended period of time. We live in a complex and noisy environment. Consider the volume of personal listening devices, environmental, industrial, and recreational noise such as sirens, trucks, stadium cheers, dance clubs, motorcycles, and even domestic devices such as vacuum cleaners, power tools, coffee grinders, and blenders. The effects of loud noise are cumulative. Small exposures are acceptable but over time, the summed amount of excess noise energy causes irreparable damage to the inner ear, where the sensory receptors are the most vulnerable. The insidious nature of noise damage means that it normally takes years for us to become aware of it.

A loud concert can produce temporary hearing loss and ringing in the ears but these symptoms tend to go away after a few days, and hearing seems normal again. It’s not. The problem is that the process of hearing loss has been initiated and we don’t even know it.

Recent studies have reported that noise exposure producing transient threshold elevation and no loss or damage to the receptor cells nevertheless causes the death of up to 50% of the sensory neurons that conduct information from

the sensory cells to the brain4. Death of these cochlear neurons is diffuse and slow, and continues for months and years after exposure. The damage has been done but is not detected by threshold sensitivity. Sound detection threshold is so basic and unchallenging that it is not a useful measure. It would be analogous to setting off a photographic flash bulb in front of the eye as a test of visual acuity.

The audiologic test needs to measure hearing ability and brain responses at different sound levels and under challenging conditions. It is common for an animal with hearing loss to exhibit normal thresholds but no growth in the response when presented with louder sounds. It is this “stunted” auditory response that is a problem because it demonstrates that the system has but one small response for all volumes.

The system has lost the ability to make loudness distinctions.

What is especially worrying is that it isn’t only loud sounds that cause cochlear neuron death. A new study examined the effect of moderate noise exposure: 84 dB for a week5. This level of noise exposure is within the American guidelines for 8 hr/day exposure for life (http://www.osha.gov) for which there was no measurable hearing loss. When the inner ears were examined using a microscope and special stains, it was found that up to 20% of the functional connections (synapses) between cochlear neurons and sensory receptors were lost.

National noise exposure standards were established with the assumption that there was full “recovery” of auditory thresholds following noise trauma. Now we can see that such standards are outof-date, generally incorrect, and therefore quite dangerous.

Because there is this relatively long delay between noise exposure and hearing loss, it is generally difficult to appreciate the consequences of noise damage. Our brains are remarkably accommodating and although the signals from the ear are diminished, the brain is good at making sense of what it receives or guessing at what it receives when it can’t really hear it. The brain uses “context” cues—the subject matter of any conversation limits the possible words that are used. A discussion of football will use substantially different words compared to a discussion of a dinner menu or a work topic. By narrowing the range of words and guessing verbs, nouns, and adjectives when necessary, communication can be achieved. Body language is also important, lip reading can come into play, and logic allows one to fill in the missing words.

The Importance of Testing

Hearing tests are not a routine part of a visit to your doctor. Moreover, it is estimated that an average of 10 years pass before someone actually gets their hearing tested after first noticing some hearing loss. At the audiologist’s office, your hearing sensitivity will be tested over a range of typically 100 to 6,000 cycles per second, or if you’re lucky, 100-8,000 cycles per second (CPS or Hz).

The problem is that our normal audible hearing range is from 20-20,000 Hz. In other words, we are not tested over our entire range of hearing nor over the high frequency range where hearing loss usually occurs. Ironically, this situation arises because the equipment to measure hearing is not designed to test higher frequencies. As a result, by the time the audiologist can detect a hearing loss, the individual has lost 60% of his or her hearing range.

The rationale for this incomplete test is that regulatory agencies have decided that human speech signals can be understood using frequencies below 4,000 Hz (http://www.safework.sa.gov. au). This standard seems based on the old black Bakelite telephones: the frequency Hearing HQ Dec 2014 - Mar 2015

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and comfort. And then you’ll need to learn how to use them effectively. Lastly, there will be situations with noise where hearing aids won’t be effective.

The Last Word

response for the original telephone ear piece was reportedly under 3,000 Hz. Speech understanding was reasonable so why would we need anything better?

The human voice, however, contains frequency components that exceed 30,000 Hz. Perhaps a range up to 4000-8000 Hz is adequate for basic communication without background noise but it represents an impoverished signal that is lacking many of the subtleties of the spoken word—richness of voice, emotional tone such as excitement or sadness, and localization cues. There is also an old maxim related to brain function: “use it or lose it.” It means that if we let brain circuits lie dormant, like a neglected piece of equipment, they will eventually disintegrate. In the brain, congenital deafness and hearing loss cause clear pathology in the structure and function of auditory circuits6.

If we start to lose high frequency hearing and do nothing about it, the 10 years of neglect will undoubtedly cause additional loss—what is already damaged gets worse and what is healthy might become damaged.

In this instance, hearing loss that accompanies aging could be a side effect of other dynamics in play. First, acoustic trauma experienced as a young person initiates processes of cell death that continue indefinitely. Add to this the continued effect of noise exposure.

Third, there are other variables that contribute to hearing loss—antibiotics and anticancer agents are known to cause hearing damage. Asprin is linked to the onset of tinnitus to hearing loss. As people age, the relative amount 22

Hearing HQ Dec 2014 - Mar 2015

of prescribed medication increases. And all the time, there is denial about hearing loss and perhaps inadequate treatment by hearing aids.

Managing Expectations

There is a frequent complaint that hearing aids are purchased but not used.

Why is this? Hearing aids are not cheap, so purchasing them and not using them is a problem. The common explanation is that hearing aids don’t do what the owner wants. Remember, the idea is that all conversations occur within a 20-4,000 Hz frequency range, although hearing aids can operate in a frequency range up to 10,000 Hz. But the highest frequencies tend not to be amplified because of a practical problem: When patients with hearing loss receive amplification of high frequency with their hearing aids, they tend to react negatively to the sound.

The high frequencies are distressing.

Herein lies a conundrum where the needed frequencies, when amplified, are annoying.

There is also a mismatch in expectation.

A primary reason for abandoning hearing aids is that the device isn’t nearly as good as Mother Nature’s original ear and the user has unrealistic expectations. The audiologists, perhaps, need to prepare the potential buyer for the realities of life with hearing loss: hearing aids work best in quiet and in one-on-one situations, and the most difficult situation is the most difficult to correct—understanding speech in the presence of other speech.

And to get the maximum effectiveness from a hearing aid, it might take from 6-8 visits for your audiologist to get the aid "fitted” properly. Hearing aids are not “plug and play.” They have to be adjusted exactly to your hearing needs

1. Protect your hearing from noise.

There are free apps for your smart phone that will measure ambient noise levels (RTA lite, which is basically a sound level meter; and Max dB Exposure Time, which sets time limits based on the measured ambient noise level). It is easier and more economical to protect your hearing rather than try to repair an injured system.

2. If you think you have hearing loss, go and get tested. If you’re not hearing, you’re not using that part of your brain; the consequence is that the neurons and circuits that aren’t being used will be lost, perhaps analogous to muscle atrophy from time in a plaster cast while a fractured bone heals. A hearing aid should boost the signals in that part of your impoverished auditory system and help preserve what is remaining.

3. If you purchase a hearing aid, have realistic expectations of what it can do.

4. Finally, it is promising that hearing aids are generally improving every year.

HQ

References: 1. Listen Hear! The economic impact and cost of hearing loss in Australia. 17-May-06. Report from Access Economics.

2. Gouskova, E. and E. Stafford (2005). Trends in household wealth dynamics, 2001–2003. Ann Arbor, MI: Institute for Social Research, University of Michigan.

3. Lin F.R., K. Yaffe, J Xia J, Q.L. Xue, T.B. Harris, E. Purchase-Helzner, S. Satterfield, H.N. Ayonayon, L. Ferrucci, and E.M. Simonsick (2013). Hearing Loss and Cognitive Decline in Older Adults. JAMA Intern Med. 173(4):293-299.

4. Kujawa, S.G. and M.C. Liberman (2009).

Adding insult to injury: Nerve degeneration after “temporary” noise-induced hearing loss. J. Neurosci.

29(45)14077-14085.

5. Maison, S.F., H. Usubuchi, and M.C. Liberman 2013 Efferent feedback minimizes cochlear neuropathy from moderate noise exposure. J. Neurosci. 33(13)5542-5552.

6. Ryugo, D.K., E.A. Krezmer, and J.K. Niparko (2005) Restoration of auditory nerve synapses by cochlear implants. Science 310:1490-1492.

6. Kral, A., J. Tilein, S. Heid, R. Hartmann, and R. Klinke (2004). Postnatal cortical development in congenital auditory deprivation. Cerebral Cortex 15(5):552-562.

6. Tirko, N.N., and D.K. Ryugo (2012) Synaptic plasticity in the medial superior olive of hearing, deaf, and cochlear-implanted cats. J. Comp. Neurol.

520:2202-2217.

6. Ryugo, D.K., B.T. Rosenbaum, P.J. Kim, J.K. Niparko, and A.A. Saada (1998) Single unit recordings in the auditory nerve of congenitally deaf white cats: Morphological correlates in the cochlea and cochlear nucleus. J. Comp. Neurol. 397:532-548.

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Life sounds brilliant.

Rais

sing Awareness, not Hell As an awardwinning musician Troy Cassar-Daley knows his hearing is his prized asset.

But a lifetime on stage next to loud speakers and screaming crowds can cause damage, which is why he’s taking precautions.

Amy Molloy meets the country singer campaigning for hearing health.

When award-winning country singer Troy Cassar-Daley is asked why hearing health is so priceless, he pinpoints one moment – and it’s no surprise it revolves around music. “I was sitting with my wife watching the Grand Final on television,” recalls Troy, “Over the cheer of the crowd I could hear music coming from downstairs. It was my two kids singing together, with one of my acoustic guitars, like a couple of angels. These are the same teenagers who’ve pulled each other’s hair and picked on each other over the years, but it showed a little bit of fragility in their robust lives. I remember thinking, 'Here’s a memory I can never replace.' ” With a career spanning more than twenty years, and a reputation as one of the nicest guys in country music, it’s no surprise that Troy is approached by many organisations seeking his patronage. But, above all others, the 45-year-old has chosen to support Australian Hearing, established by the Australian Government in 1947. The country’s largest hearing specialist, research organisation and largest provider of Government funded hearing services, Australian Hearing announced the musician as their ambassador to coincide with Hearing Awareness Week.

“The partnership came about organically,” says Troy, “One night my wife and I were watching a television show about cochlear implants. It was showing parents, who’d been profoundly deaf for most of their lives, hearing their children say they loved them for the first time. It was heartbreaking to think they’d never heard it before.”

He admits that, as a father, he was shocked by how deeply the documentary

affected him. Although, the singer has never personally experienced hearing difficulties, like many people Troy says he has felt disconnected and isolated at certain periods in his life, and so could relate on some level. “I believe that every person has a right to feel part of the world we live in rather than existing in the shadows,” he says, “I think there’s a lot we take for granted in life, but without hearing I wouldn’t have a career, without music I think I’d feel like a ghost.”

For Troy, connection and community are two important watchwords, which describe his values, his purpose and his driving factor. During his first official week as an ambassador for Australian Hearing, the singer travelled to the Dunghutti nation, to visit three locations where the organisation has centres and hubs, meeting over 500 people including elders and playing twelve songs (that’s half a concert).

“The highlight of my trip was going to a local nursing home in Kempsey,” recalls Troy, “After meeting the residents, as I made my way out, an elderly Aboriginal gentleman sitting in the corner started singing an old gospel song to bid me farewell as I walked away. It blew my mind, especially as I realised that if I wasn’t able to hear, I wouldn’t have been able to enjoy that man’s parting gift.”

Raised by a single mother in Grafton in New South Wales, Troy has admitted he didn’t have an easy childhood but says that, of all of his senses, hearing brought him the most comfort. “When I was young my mother played a lot of music on an old record player,” he recalls. “I didn’t have a brother and sister to fight Hearing HQ Dec 2014 - Mar 2015

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with so in the quiet times when mum was working and I was on the property by myself, music became an escape. When I was growing up, as an only child it was like my best friend.” At nine-years-old he came across a second-hand guitar and by twelve was busking on the streets of the country-music mecca, Tamworth.

Fast-forward two decades and, after winning the talent competition Search For A Star, Troy has gone on to sell in excess of half a million albums. In the house in Queensland, which he shares with his wife Laurel and two children, Clay and Jem, the walls are adorned with gold and platinum records. You might look at his life – a long-running career and a happy family unit – and think that he’s untouchable. But with two decades of performing comes health concerns. “I am all too aware that in my profession, you can lose [your hearing],” says Troy, “I’ve often played a very loud gig and gone to bed with a ringing in my ears, thinking, 'what am I doing to myself?' ’’ Many famous musicians have suffered hearing damage due to a lifetime spent next to blasting amplifiers. The lead guitarist of The Who, Pete Townsend, holds the Guinness World Record for the ‘loudest concert ever’. Now he wears a hearing aid.

Neil Young recorded his twentieth album Harvest Moon using an acoustic guitar because he was recovering from tinnitus and could no longer tolerate loud noises. Famous sufferers of the condition – which causes a persistent ringing sound in the ears - include Ozzy Osbourne, Chris Martin and Will.I.Am. Even Beethoven once complained ‘My ears whistle and buzz all day and night. I can say I’m leading a wretched life.’

This is why, ten years ago, Troy approached the audio equipment company Shure and asked them to make him in-ear monitors, which he now always wear when performing. “They look like big hearing aids but allow me to control how much volume goes into my ears,” says Troy, “I remember a young bloke coming up to me after a show in Victoria and asking if I had hearing difficulties like him. When I explained that the monitors were there to protect

my most precious assets he was thrilled that I was taking care of my hearing.”

In 2015 Troy will return to life on the road touring Australia with his band, but will make time to return home for an important appointment. “I’m going to have my hearing checked which I do once a year,” he explains, “I’m going to take photos of myself during the test with the headphones on and put the pictures on Twitter and Facebook. I’ll use it to encourage my social media followers to get their hearing checked too.”

The self-confessed optimist applies the same attitude to his partnership with Australian Hearing as he does to life – if there is a problem, then take productive action. “I can’t stand pessimistic people,” he says, “I find it’s a lot more harder and takes a lot more energy to be negative.

I’m not trying to be an evangelist, but in life it’s just so much easier to smile instead of frown.”

He was reminded of the resilience of the human spirit during a recent visit to Port Macquarie. As the ambassador he visited a school to surprise 12-yearold Watson Gebadi, a young client of Australian Hearing.

Watson (left) had raised $350 for Hearing Awareness Week by organising a raffle.

“This is a kid with hearing difficulties himself, but he was thinking about everyone else,” says Troy. “I think it’s especially important to raise awareness of hearing tests available to young children, from mainstream cities to remote Aboriginal communities. The biggest link in the chain between a student and a child is listening and hearing.”

As an ambassador, Troy plans to be hands on and spread the message that hearing loss can happen to anyone, but there’s also help out there for everyone.

“I think it’s my job to meet people and use my fan base and my music, to raise awareness of the services on offer,” he says. “Throughout my entire career my goal has been to improve the quality of people’s lives, and this partnership with Australian Hearing is another string to my bow. You don’t have to sit at a table feeling excluded from the conversation.

You don’t have to suffer in silence.”

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I have a grommet fitted in one ear because the Eustachian tube is not functioning. Is there treatment available to solve the problem because I want to have a Lyric hearing aid fitted? I have been told I can’t use the Lyric hearing aid with a grommet inserted because it could cause infection.

Melville d Cruz: The Eustachian tube is the structure which allows ventilation of the middle ear from the nasal airway. We are all aware of the function of the tube – it is the reason we can “pop our ears” when flying and also why our ears feel blocked when we have a cold or nasal allergy. In childhood the Eustachian tube is vulnerable to becoming blocked (or at least having reduced function). Sometimes this dysfunction persists into adulthood resulting in blocked ears and sometimes hearing loss. If there is an obvious underlying cause for the Eustachian tube dysfunction (eg nasal allergy or sinusitis) it can be improved by treating the underlying cause. Unfortunately most of the time no obvious cause can be found and the Eustachian tube dysfunction

A

persists for many years. A grommet is often used at this stage to relieve the “blocked feeling” and sometimes it improves the hearing loss too. Repeated grommet insertion or long stay grommets can be used to treat persistent Eustachian tube dysfunction.

The Lyric hearing aid is an in-thecanal long stay hearing aid which is placed deep in the ear canal very close to the drum. At times it may only be a few millimetres from the drum surface.

If there were a grommet in the drum it is likely that the deep placement of the hearing aid would interfere with the grommet and prevent it from functioning. The solution is to remove the grommet before reconsidering the Lyric hearing aid. Alternatively consider a different hearing aid which is also placed within the canal, is invisible from the outside and has a vent option. This would allow you to wear a hearing aid in conjunction with the grommet.

Q

Why are there different styles of hearing aids? I wanted one of the aids that fits right in the ear but my audiologist says I should have the one over the ear and I'm not sure why. Is there any difference apart from the way they look?

Emma Scanlan: Different styles of hearing aids suit different people.

The main reason why people choose the behind the ear style aid with an ear mould which sits in the ear is that they are much more powerful. With the in-the-ear style, even though they can now accommodate much greater losses than in the past, you are still limited by the physical size of the aid and the way it sits in the ear canal and concha.

Sometimes components such as a telecoil have to be left out of the in-the-ear aids to save space and this can reduce the functionality of the device for the user.

The other reason why a behind the ear aid could be preferable is because the ear

A

ts

mould can be made very open in what we call a skeleton style with a big air vent which lets lots of fresh air and natural sound into the ear. These are often better for people with tinnitus, good low pitch hearing or ear health issues. More recently we have seen very open fitted devices where there is no ear mould but simply a tube carrying sound from the aid to the ear and a dome to hold the tube in place. It is important to discuss all the aspects of your device decision with the Audiologist so you can make an informed decision for this important choice.

Q

Who do you recommend for insurance of the external cochlear processor? We have looked into insuring it through our home and contents insurance but wondered whether there were any other options?

Roberta Marino: It’s good that you are looking into insurance for your external speech processor. To replace an external cochlear implant processor would cost somewhere in the order of $9000 to $11,500. Not only would it be devastating to be without your hearing for a while (though I’m sure your implant clinic would be able to offer some short term assistance), it would also be very financially challenging for most people.

Firstly, check with your implant clinic on how much it would cost to replace your specific device as costs can vary between makes and models. I am aware of several insurance options: 1. Insure under your current home and contents insurance policy 2. Contact your private health insurance company to see if they are willing to insure your device (not all health insurance companies do this and you need to be an Australian resident) 3. MGA Insurance Brokers offer $10,000 Speech Processor Insurance with a $200 excess through CGU Insurance Limited.

This specialist MGA insurance for implantable devices covers the external speech processor and ancillaries for loss, accidental damage, fire or theft and includes 90 days overseas cover. The implanted portion of the device is not covered however. To find out whether your specific device processor is covered phone (03) 9845 6700, send an email to admin.knox@mga.com or visit the MGA website http://www.mga.com/specialistproducts/spi/

Q

I have total hearing loss in the left ear due to an immune response after I had a stapedectomy and have partial hearing loss (mixed, I think) in the right ear. Would I be eligible for a middle ear implant? I have an appointment at The Eye and Ear Hospital but would like an answer for this question before I get to Melbourne.

Melville d Cruz: Stapedectomy surgery for a conductive or mixed hearing loss due to otosclerosis usually has wonderful results. The hearing threshold is improved and the quality of sound is very natural. However it does carry risk of a dead ear, which occurs in 0.5-1.0% of surgeries despite the surgery being carried out competently.

In this situation it would leave only one hearing ear on the opposite side. In such a situation it would be strongly advisable not to undergo surgery on the opposite side because of the small risk of a second dead ear.

Fortunately there are several options for rehabilitating hearing in this situation with hearing aids of various kinds. A bone anchored hearing implant is one such device which can help. It is placed under the skin in the mastoid bone behind the ear and works by bypassing the middle ear and stimulating the cochlea directly through the bone of the skull. Bone anchored hearing implants have predictable hearing outcomes in conductive hearing losses. This hearing result can be experienced by a trial simulation of the bone anchored hearing implant before undergoing surgery to implant the device. The surgery to implant a bone anchored hearing implant is simple and carries no risk to the underlying hearing. An external speech processor held on by a magnet or small clip generates sound vibration to be transmitted to the implant under the skin.

There are several other kinds of middle ear devices which can also be used in this situation. A device which has recently become available in Australia is the Bonebridge. This is an active middle ear implant which has the source producing the sound vibrations implanted within the mastoid bone behind the ear, rather than externally in the speech processor as with the bone anchored hearing implants.

Many other implantable devices which can help are also being investigated.

Some are active devices that attach to

A

the middle ear bones such as the Vibrant Soundbridge. However these devices require more complex surgery than the Bonebridge or bone anchored hearing implant for placement. They also require manipulation of the middle ear bones, and hence carry a risk to the underlying hearing. These devices would not be suitable for surgery on the side of an only hearing ear.

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Hearing HQ Dec 2014 - Mar 2015

29

REAL PEOPLE real stories...

Teaching can be a rewarding and sometimes challenging career certainly not made any easier by rapid hearing loss. Term 3 this year marked Dr Lindy Crocker's last as a teacher. She retired from her role as Head of Performing Arts and Coordinator of Extra Subjects after almost 19 years as a teacher at Tara Anglican School for Girls in Sydney.

This is her story.

''

I don’t know if I had any hearing loss as a child. I remember in primary school being screened along with the other children and the school nurse held a pocket watch at a little distance and asked me to tell her when I could hear the ticking. She said ‘can you hear that?

Of course you can’.

Evidently I took too long to respond to the ticking. So actually, my hearing test was all over before I realised it began. I remember as a teenager being a part of gospel bands and every Friday and Saturday night we would be in the local School of Arts amidst massive reverberating sounds from the rock bands that played there and finally having our turn at performance with our much more agreeable sound level.

Whether that exposure to excessive sounds affected me – I cannot say.

Although I was successful at school I was never a good listener and would not be able to tell you much of what the teacher had to say. So when the learning was chalk and talk I felt disengaged but always excelled when the learning relied on a textbook. This may not have been a symptom of hearing loss but it is what I do recall when trying to search back to the origins of my hearing impairment.

However one day an episode in my music classroom, as class teacher, was a real confrontation about where my 30

Hearing HQ Dec 2014 - Mar 2015

'' hearing loss was at. Imagine this - music classroom, senior students looking on with eager expectation as we unpack and plug in a new synthesiser keyboard.

Trying out all the wonderful sounds that came with the touch of a button trumpet, harp, train whistle, shotgun, cicadas... Goodness I exclaimed! Some of the top notes aren't working to which my students laughed "you must be deaf Miss!" Actually it was not a laughing matter at all.

That was around 20 years ago when I suddenly found myself undeniably facing non reversible, degenerating and profound hearing loss. Like most people, I only associated hearing loss with old people or with disability. I had two young children, was building a career, was enjoying my music and was loving life – hearing loss wasn’t part of my plan! Hearing aids came next but my hearing loss escalated faster than the best hearing aids could address.

Years of trying to cope, hearing bits and pieces of conversations, misinterpreting dialogue more and more frequently, many instances of embarrassment and feeling foolish meant that I not only lost a lot of self-confidence, but became very concerned about my future as a musician, teacher, mother and wife.

When I was informed by my audiologist that I could be a candidate for a cochlear implant, the idea seemed ludicrous, out of reach and a last resort.

My hearing loss was not going to go away, but receiving a cochlear implant had so many uncertainties including the big one for me - my future as a musician and the person I truly am inside. Eventually the decision was made to proceed with surgery and I confess to many moments of tears in fear, heartache and foreboding about the potential outcome of a cochlear implant.

I had no doubt that speech wise, the implant would be a success for me but a future without my music involvements felt entirely foreign. Surgery was last December under Associate Professor Catherine Birman. Because my music was so important to me, the moment I arrived home after switch on, I was immediately drawn to playing the piano to hear what the effect would be.

Playing very familiar pieces was the way to go according to blogs I had read and although the sound through the cochlear processor resembled a child’s

toy piano and a thunk thunk thunk, it was within the spectrum of recognisable and I felt heartened about the potential improvement that was hopefully to come with time and persistence. Determined to explore my usual music ventures, it was three days after switch on that I was performing well rehearsed and entirely familiar music in a hand bells concert at a nursing home. A few weeks later I was successfully able to accompany our choir on the piano, engage in meetings at work and hold conversations in all kinds of listening situations. It was never a breeze, but the result of hard work, not giving up hope and having a belief that each day would mean hearing a little better, a little truer, a little clearer.

For my recovery and rehabilitation after switch on, I had taken six weeks leave from work with the intention of spending as many hours as I could in each and every day going through the exercises presented to me, engaging in simple conversations and playing my musical instruments. Until the second mapping, the sounds of any voice coming through the processor was a lot like Darth Vader from Star Wars. So I lived with Darth Vader in my head for a couple of weeks and heard his voice reading the children's audio books such as Alice in Wonderland and Anne of Green Gables. It was a little off putting but I was assured things would improve with further mapping – and they did. Darth is definitely gone. The staff at Sydney Cochlear Implant Centre at Gladesville have always given me hope, thoughtful understanding, support, endless encouragement and lots of homework!

Meeting with other cochlear implant recipients at different stages of their journeys has been an adventure in itself.

Today I barely think of myself as someone with hearing loss. The subtitles have gone from our home television screen and I can hear the radio conversations in the car as I drive along – all definitive signs of improvement. I feel vibrant, successful and happy. I am still progressing with my rehabilitation and very hopeful of ongoing clarity over time. One to one conversations and small group situations are not daunting for me anymore. I am improving in speech recognition in larger venues and restaurants where voices are not amplified and now don't have to rely on speech reading as I always needed to in

the past. There is still a way to go but it is hundreds of times better than relying on hearing aids alone.

There are many, many times in every single day when I smile inwardly to myself when I realise how far I have come as a cochlear implant recipient and the positive change this has made not only to my life, but for my family, colleagues, friends and acquaintances and newest grandson. I am ever grateful for this extraordinarily miraculous technology and to the fine dedicated people who work for us in this field. If I am asked whether I have any regrets about the cochlear implant surgery – my answer is none whatsoever.

I would sincerely encourage those considering a cochlear implant to investigate whether it’s the right way to go but know that it’s a chance to follow your dreams and hopes and to keep striving to achieve more in your life – a life changing gift to yourself.

'' HQ

Hearing HQ Dec 2014 - Mar 2015

31

all about. all about...

Diabetes & hearing loss

According to the World Health Organisation (WHO), 347 million people worldwide have diabetes and in 2012 diabetes was the direct cause of 1.5 million deaths1.

Diabetes mellitus, commonly referred to as diabetes, is a chronic metabolic disease characterised by high blood sugar levels (hyperglycaemia) over a prolonged period. It occurs as a result either of the pancreas not producing enough insulin, the hormone that regulates blood sugar, or when the cells of the body cannot use the insulin the body produces.

There are three main types of diabetes: Type 1 Diabetes results from the body's failure to produce enough insulin. The cause is unknown.

• Type 2 Diabetes begins with insulin resistance, where the cells fail to respond to insulin properly. As the disease progresses a lack of insulin may •

32

Hearing HQ Dec 2014 - Mar 2015

also develop. The primary cause is excessive body weight and not enough exercise1.

• Gestational diabetes is the third main form and occurs when pregnant women without a previous history of diabetes develop a high blood glucose level.

If left untreated, the WHO warns, diabetes can cause many complications and over time lead to serious damage to many of the body's systems including cardiovascular disease, stroke, kidney failure, foot ulcers and blindness.

While public awareness about diabetes has grown substantially over the past decade one aspect which has not been sufficiently written about is the link between diabetes and hearing loss.

There is a growing body of research on the complex relationship between diabetes and hearing loss. Most audiometric studies of hearing in patients with diabetes show a mild to moderate high-frequency sensorineural hearing loss (SNHL) as a result of damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain.

The first published link between diabetes and hearing loss was by Jordao2 in 1857. In 1975 Friedman et al3 reported a 55% incidence of hearing loss in diabetic patients, while other studies have reported incidence as high as 95%.

Because many of the studies had small sample sizes and some studies actually produced conflicting evidence, Venkata Kakarlapudi from the US University of Maryland School of Medicine felt there needed to be a large scale study to provide sufficient statistical power for accurate conclusions to be drawn.

His team conducted a

retrospective database review of more than 66,000 medical records from 1989 to 2002 aimed at identifying whether patients with diabetes have a higher incidence of sensorineural hearing loss than the general population.

In 2003 Kakarlapudi's team published a paper4 in Otology & Neurotology reporting the results. They found sensorineural hearing loss was nearly 30% more common in the diabetic patients than age matched non diabetic patients. They also found poor control of diabetes correlated with worsening hearing.

To further support our need to be vigilant about our health and avoidance of type 2 diabetes, in a 2013 paper5 in the American Journal of Medicine, Sharon G. Curhan from Brigham and Women's Hospital, Boston reported findings from analysis of data from the Nurses' Health Study II from 1989 to 2009. Higher BMI and larger waist circumference were associated with increased risk of hearing loss. Conversely higher physical activity was associated with reduced risk of hearing loss in women. These findings, it was suggested, provide evidence that maintaining healthy weight and staying physically active, potentially modifiable lifestyle factors, may help reduce the risk of hearing loss.

1. "Diabetes Fact sheet N°312". WHO. Updated November 2014.

2. Jordao AMD. Consideration sur un cas du diabete. Union Medicale du Paris 1857;11:446.

3. Friedman SA, Schulman RH, Weiss S. Hearing and diabetic neuropathy. Arch Intern Med. 1975 ;135(4):573-6.

4. Kakarlapudi V, Sawyer R, and Staecker H. The Effect of Diabetes on Sensorineural Hearing Loss. Otology & Neurotology 2003; 24:382-386 5. Curhan, Sharon G., et al. "Body mass index, waist circumference, physical activity, and risk of hearing loss in women." The American journal of medicine 126.12 (2013): 1142-e1.

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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

34

Hearing HQ Dec 2014 - Mar 2015

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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Call us today on 1800 826 500 to book your FREE hearing check.* * Visit our website www.hearing.com.au for more information and eligibility criteria.

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1800 826 500 www.hearing.com.au

AH0348 06112014

Hear the sounds you love this Summer