Hearing HQ Apr-Jul 13

HQ hearing

For all your hearing options

APR-JUL 2013

The

SPE C REP IAL ORT

REAL COSTof

HEARING AIDS

Hearing Tests

what to expect

Newsbites

Research, innovations and things you need to know

Analogue vs Digital The benefits explained

SWITCHED AT BIRTH Meet the cast of the runaway TV success changing the public face of hearing loss

Ask the Experts

Should I change to another audiologist?

Can painkillers affect my hearing?

Here to Help a comprehensive services & information directory

Learning to Listen

Hearing impairment is no barrier for this Aussie delivering exceptional customer service

trouble hearing? trouble speaking?

you can still…

stay in touch You can still make your own phone calls at no extra cost. The National Relay Service helps you:

Calls can be made to anyone, anytime from anywhere in Australia. Calls are confidential and training is FREE.

• have good phone conversations – with less misunderstanding and repetition

Find out more:

• keep in touch with family and friends.

www.relayservice.com.au

1800 555 660 helpdesk@relayservice.com.au

04/09

• make appointments and business calls

Editor Helen Lowy: editor@hearingHQ.com.au Sub Editor Simone Wheeler Contributors Daniela Andrews, Yvonne Keane, Roberta Marino, Donna Staunton, Monica Persson, Dr Louise Collingridge Experts Assoc Prof Melville da Cruz, Audiologists: Emma Scanlan and Roberta Marino Advertising Sales Executive Julia Turner: jturner@hearingHQ.com.au 0414 525 516 Publisher Lucinda Mitchell: lmitchell@tangello.com.au

HQ hearing

FEATURES

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SWITCHING VIEWS ON BEING DEAF This new TV show could just change the public face of hearing loss.

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THE REAL COST OF HEARING AIDS We investigate why hearing aids cost so much!

Printed by Offset Alpine 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.

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.

REVIEWS

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TECHNOLOGY Analogue vs Digital Hearing Aids - what you need to know.

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BOOKS ‘N BLOGS Great books for kids with and without hearing loss!

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REAL PEOPLE REAL STORIES Inspiring, life-changing stories.

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DEAFINING MOMENTS The funny side of living with hearing loss.

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PRODUCTS & SERVICES Information at your fingertips.

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HERE TO HELP Organisations providing hearing health advice and support.

REGULARS

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ED’S LETTER NEWSBITES Research, innovations and things you need to know.

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ALL ABOUT… ...hearing tests.

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ASK THE EXPERTS Professional advice on reader questions and concerns.

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.

contents

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LIFE IS GOOD A mum’s perspective on hearing loss.

DON’T MISS AN ISSUE! Subscribe for just $22 a year (for postage & handling) and have 3 issues of the magazine posted to your door. Mail the form on p18 or purchase online at www.HearingHQ.com.au.

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 Magazine is published by The Tangello Group Pty Limited (ABN 38 155 438 574) PO Box 649 Edgecliff NSW 2027 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 requested. The Tangello Group Pty Limited 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 Pty Limited. 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.

Hearing HQ Apr - Jul 2013

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ed's letter

To have your say contact me at: editor@HearingHQ.com.au or PO Box 649 Edgecliff NSW 2027 Please include your full name, suburb and state.

Letters may be edited for space.

Communication can take so many shapes and forms and the theme of “quality” communication seems to be a highlight of this issue. Communication isn’t only about hearing, listening and speaking, it is also the behaviours we employ when communicating, what is going on in our environment, and even how our thoughts, beliefs and sometimes even prejudices influence what we understand or comprehend. I’ve had personal experience of this over the past few months dealing with someone living interstate and how miscommunication can occur when you aren’t able to access all of those communication tools to help you interpret what is said and the frustration and upset this can bring. So as a hearing person I have even more respect for those who don't allow hearing loss to be a roadblock for day-to-day communication. And, I am inspired by the many people I meet through this role who have learned to compensate and adapt like Josh Cauchi in our Real People story (p22).

I’ve watched some previews of Switched at Birth, the new TV series in our cover story (p8), and am really hooked - as a communicator I love how the producers of this show have woven in all sorts of social issues that impact almost every sector of our modern society, not only the challenges of hearing loss. I can’t wait until it arrives in Australia soon. And, the piece I’m most proud of in this issue is our review of the hearing health industry in Australia as it relates to hearing aids – again this highlights how important understanding and communication truly is – and I hope it demystifies a very complex subject.

Next issue we look forward to bringing you Part 2 of this article on cochlear implants and other implantable devices.

Happy reading!

Helen Lowy Editor

newsbites Is STRESS affecting your hearing?

A recent study by Sweden’s Karolinska Institute and Stockholm University published in the BMC Public Health Journal has uncovered a clear association between stress, tinnitus and hearing loss.

Hearing loss is alarmingly on the rise in the industrialised world. Stress is also reported more often in developed countries, so scientists began looking to see if perhaps there was a link. 9,756 employed Swedes aged 16 to 64 took a 120-question survey about certain stressors about their psychosocial and physical work environment; lifestyle; physical and mental health; plus, questions on tinnitus (ringing in the ears), tinnitus severity and hearing complaints. The findings indicate that hearing problems are more common in the workplace than ten years ago, with similar results for men and women.

Hearing issues were more common in people exposed to various forms of stress like the threat of redundancy/bankruptcy, stress-related symptoms, poor sleep and ill health.

Images: Hair Cells - Wellcome Images; Runners - Omega

Source: http://www.biomedcentral.com/14712458/11/130/

Deaf Sports Australia sees the light To make mainstream sports events accessible to deaf and hard of hearing athletes and swimmers, Deaf Sports Australia (DSA) has been working with Omega SwissWatch to develop an electronic start gun system that simultaneously connects to a flash-start device. It was used at the 2012 National School Athletics championships and School Sports Australia has adopted the system for all its events. DSA is continuing to work with Omega to build a system with three lights for ready, set and go for deafonly events. DSA is also lobbying other sporting associations to ensure the system is available across Australia for any deaf and hard of hearing participants. For more information, email dsa@deafsports.org.au.

grow

Genetic patch helps ear hair cells to

Scientists at Chicago's Rosalind Franklin University have designed a tiny “genetic patch” that when injected into mice with Usher syndrome (a genetic condition that causes hearing, balance and sight problems) attaches to the mutation and keeps the body producing the protein called hormonin (required to build the tiny hairs in the ear that detect sound). There are many types of Usher syndrome tied to different errors in a patient’s DNA, but experts say this discovery is an “encouraging” start to understanding how to possibly rescue hearing in humans using an approach that targets a specific type of inherited deafness.

Following on...

...from our Newsbites last issue on drugs being developed to protect our hearing from loud noise, the University of Florida has started a Phase II human clinical trial to test if the oral drug SPI-1005 (containing ebselen) can prevent hearing loss caused by loud music. Volunteers will listen to preselected music delivered via iPod and earphones providing an exposure that results in small but reliable temporary auditory threshold shifts (TTS). Before and after exposure they will be given an oral capsule of the drug or a placebo, to assess the extent to which TTS is reduced and/or if the rate of recovery is accelerated. http://soundpharma.com/2012-12-05_ ClinicalTrialStart.pdf

Source: Nature Medicine (2013) doi:10.1038/nm.3106 Published online 04 February 2013

Hearing HQ Apr - Jul 2013

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newsbites

DIABETICS:

Screen for hearing loss early The link between hearing loss and diabetes (and that diabetics are 2.15 times more likely to develop hearing problems than non-diabetics) is already well-established. But, a new study by Niigata University in Japan published in November 2012 revealed the risk of hearing loss for diabetics may also be related to age. The study pulled data from 13 previous studies that included more than 20,000 participants. Results showed diabetics under 60 to be 2.61 times more susceptible to hearing loss than non-diabetics, compare to diabetics over 60 who are only 1.58 times more likely to be affected. While more research is needed to see if diabetes is a cause of hearing loss, the results propose that diabetics should be screened for hearing impairment from an earlier age than non-diabetics.

Source: www.dailyrx.com/diabetes-may-be-linked-hearing-impairment

Special Support App for sign language interpreters.

According to a study led by a researcher at John Hopkins University, hearing loss may be a risk factor for falls. Over 2,000 people aged 40 to 69 participated in a survey related to falls between 2001 to 2004. Each also had their hearing tested.

Results accounted for other factors linked with falling such as age and cardiovascular disease but found those with a 25-decibel hearing loss (classified as mild) were nearly 3 times more likely to have a history of falling. Every additional 10-decibels of hearing loss increased the chances of falling by 1.4 fold.

Google+ Hangouts, a group video chat App, allows an added interpreter to remain in the top right of the screen and automatically become the focus when he speaks to translate a deaf user's signs.

So not only will a deaf user be able to understand everything that's said in a Hangout, but they'll also be able to verbally speak to the other users with the interpreter acting as a proxy.

Source: http://www.hopkinsmedicine.org/news/media/releases/ hearing_loss_linked_to_three_fold_risk_of_falling

hear together

with Australia’s most experienced cochlear implant program

‘NO GAP’ services*

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

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Hearing HQ Apr - Jul 2013 SYDNEY | NEWCASTLE | CANBERRA | GOSFORD | LISMORE | PENRITH | PORT MACQUARIE

Bone conduction HEARING CAP!

Cynaps (derived from 'synapse') is the world's first Bluetooth enabled, bone conduction headset discreetly installed into a cap. You can listen to music or have a phone conversation while taking part in activities that require your ears, eyes and hands to be available - driving and biking are perfect examples. Unlike conventional headsets there is no pressure on your ears, so no painful adjusting for hearing aids. You can purchase Cynaps from maxvirtual.com. It comes as a standard cap, Nike Dri-Fit or if you want one for your hardhat or motorcycle helmet you can purchase a self-install module too!

Hearing-Friendly Phone

The new Uniden SSE series digital cordless phone released in late 2012 is specifically designed for easy use by seniors, the disabled and people with hearing or vision impairment. The hearing-impaired features include extra loud audio controls and hearing aid compatibility. The integrated digital answering machine has a slow playback function that slows down the voice when listening to messages. There are many additional features including extended digital coverage that eliminates reception drop-outs and provides greater call clarity and it is WiFi-friendly so will not interfere with other frequencies in the house. An optional personal alarm pendant linked to the fixed line phone system, that will dial up to five pre-programmed phone numbers, is available.

WORLD FIRST

COCHLEAR HAIR CELL DAMAGE BREAKTHROUGH Hearing loss due to auditory hair cell damage is normally irreversible because mammalian hair cells do not regenerate. Albert Edge, an otologist at Harvard University and the Massachusetts Eye and Ear Infirmary and his colleagues have previously shown that inhibiting Notch signaling was important for hair cells to form properly during foetal development.

Their follow-up study revealed that cochlear hair cell regeneration is in fact possible. The drug works by activating a transcription factor involved in hair cell development. "The improvement we saw is modest" said Edge. "So we're now looking at variations of the approach and whether we can use the same drug to treat other types of hearing loss."

Sources: http://www.biotechniques.com/news/ Notch Inhibition Induces Cochlear Hair Cell Regeneration and Recovery of Hearing after Acoustic Trauma. Neuron Vol 77, Issue 1, 9 January 2013

NOW IN AUSTRALIA

MED-EL’s Bonebridge is the world’s first under-the-skin bone conduction implant making it possible for people with conductive and mixed hearing losses or single-sided deafness to hear the full range of sound, without the complications usually associated with current bone-anchored devices, because the protective function of the skin is preserved. “This new transcutaneous [under the skin] bone conduction system means a huge improvement in [patient] quality of life.

Gone are the days of worrying about nasty skin infections and related device failures. It is a big leap in hearing implant technology,” said Professor Rajan, Professor of Otolaryngology, Head & Neck Surgery, University of Western Australia. The device consists of two components: an implant under the skin behind the ear and an audio processor to receive the sound waves. Sound signals pass through the skin and are actively conducted by the implant to the bone and inner ear.

For more information go to www.medel.com/int/bonebridge/

Hearing HQ Apr - Jul 2013

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maybe this show can...

Switcho Being

The Kennish family

* Daniela lost her hearing at 27 to an autoimmune condition. She now has two cochlear implants.

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Hearing HQ Apr - Jul 2013

What if you suddenly discovered your parents were not your biological parents?

That you were accidentally switched at birth by careless hospital staff? That you should have lived a whole other life somewhere completely different to the one you’ve had? These are the issues that are suddenly thrust upon the main characters of the socially groundbreaking (captioned) show Switched at Birth coming soon to FOX8.

The scene is set with the wealthy Kennish family make the shocking discovery that their daughter Bay is not in fact their biological daughter after questioning why Bay (played by Vanessa Marano) has a non-matching blood type to their own. When they track down the other affected family, they learn that their biological daughter Daphne (played by

Katie LeClerc) is living in a working-class neighbourhood with her single mother and Puerto Rican grandmother. Oh and she also happens to be deaf.

When the two families meet, the scene simply screams of awkwardness. The Kennish family are not sure how to communicate with Daphne who speaks with a deaf accent and communicates via a combination of ASL (American Sign Language) and lip-reading. ‘I can’t understand her,’ Bay murmurs rather rudely to her brother Toby (played

by Lucas Grabeel from High School Musical).

In fact, Katie LeClerc’s ‘deaf accent’ has been carefully practised. Unlike her character Daphne, who lost her hearing to meningitis at the age of three, Katie LeClerc suffers from a partial hearing

Images: © ABC Family

Daniela Andrews* doesn't often get excited about new television shows. (Please forgive her for not being interested in watching other people cook, or renovate, or try to find a wife, or try to find a wife while cooking and renovating.)

However, she has discovered that FOX8 is set to bring Australian viewers a family drama in 2013 that will strike a chord for anybody with a hearing loss. And it may just change perceptions about being deaf along the way!

Views n Deaf loss caused by Ménière’s disease, only diagnosed at the age of 20. Now 26-years-old, Katie talks about how she prepared for the role. “My hearing loss is not as progressed as Daphne’s is,” she explains. “I don’t speak in an accent like Daphne does.” When she got a call-back for the role, she was asked to have a go at doing a ‘deaf accent’. Wanting to make sure she caused no disrespect to the Deaf community, Katie spent hours researching and practising the accent.

Her dialect coach sat her down with an audiogram and helped her map out Daphne’s specific hearing loss and the sounds that she may or may not be able to say as a result. “I made my family crazy because I always spoke in the accent,” Katie laughs. “I had to get it perfect. I think it paid off.”

Daphne and mum Regina Vasquez

Communication issues are not the only ‘deaf’ issues tackled in the show with writers and producers unafraid to focus on the discrimination that occurs against deaf people from hearing people (and vice versa). Daphne, for example, sails through a job interview smoothly up until the point where her interviewer asks her what her accent is. (Russian?

Swedish?) Daphne explains that it’s a deaf accent. The interviewer awkwardly returns with the comment: ‘my dog is deaf!’ It’s a bittersweet scene that’s both hilarious and heartbreakingly familiar for those of us with a hearing loss.

On the flipside, when Bay falls for Daphne’s deaf friend Emmett Bledsoe (played by Sean Berdy) and begins to learn sign language to communicate with him, she’s met with a cold shoulder from

his deaf mother. Melody Bledsoe (played

by Marlee Matlin) doesn’t believe her son can have a future with a hearing person and is not interested in applauding Bay’s efforts to learn ASL. In fact, she publicly humiliates a nervous Bay for accidentally signing ‘you guys get circumcised a lot’, instead of ‘you guys hang out a lot’.

Cochlear implants and their associated controversy in Deaf culture are also covered in an early episode. Daphne’s biological father John Kennish (played by DW Moffett) offers to pay for an implant for Daphne under the assumption that her mother Regina (played by Constance Marie) could not have afforded to give her one. Regina naturally takes offence and has a rather heated conversation with Daphne’s real mother Kathryn Kennish (played by Lea Thompson)

Hearing HQ Apr - Jul 2013

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Toby Kennish played by Lucas Grabeel (l) Emmett Bledsoe played by Sean Berdy (r) Daphne Vasquez, played by Katie LeClerc (l) Bay Kennish, played by Vanessa Marano (r)

Melody Bledsoe, played by Marlee Matlin (right), is a deaf guidance counselor at Carlton School for the Deaf that her son Emmett and Daphne attend. Both Sean and Marlee are deaf.

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Hearing HQ Apr - Jul 2013

couldn’t afford to buy them. It wasn’t until years later that ABC Family, the US network that screens Switched at Birth, bought them for her after she was cast as Daphne. "I'm so, so thankful to have them, but sometimes they don't work.

Sometimes they don't really do a whole lot for me."

Though Katie has a partial hearing loss, both Marlee Matlin and Sean Berdy are deaf. The remaining ‘hearing’ cast of the show have had to learn ASL for their roles and to communicate effectively with their co-workers. As serendipity has it, Katie learned ASL before she even knew she had any hearing loss. “I started to take sign language in high school because I was very bad at Spanish,” she laughs.

“I fell in love with the language and the culture that surrounds it … I think things happen for a reason.”

The show has been quite successful in the US and producers have been praised for bridging the gap between the deaf and hearing worlds. In fact, they’ve been credited for making deafness “cool”.

There has been a significant increase in the number of fans who have been inspired to learn ASL as a result of the show. "It's shining a beautiful spotlight

on the deaf community,” says Constance Marie, going on to say that many teenage fans were petitioning their high schools to introduce ASL as a subject.

Katie LeClerc is equally thrilled with the success of the show and her contribution to casting light on living with a hearing loss. Though there aren’t currently any characters on the show who suffer from Ménière’s disease like herself, she is hoping to use her public profile to raise awareness about the condition. “Very few people really know about this disease,” she says. “Hopefully in the next few years they can make some medical advances and I’d like to believe that maybe I helped be a part of that in some small way.”

When asked how she copes with her condition on set, she admits it isn’t easy.

Though she follows a low-sodium diet and takes diuretics to control the fluid in her inner ear, she has no fail proof way of warding off a sudden attack. For Katie, these attacks consist of any combination (or all) of the following: severe vertigo, fluctuating hearing loss, pressure in the ears, tinnitus and headaches. (For more information on Ménière’s disease and tinnitus, visit hearingHQ.com.au.)

Images: Cast image - © ABC Family; Sean Berdy - Helga Esteb / Shutterstock.com

explaining her fears about the surgery.

‘What kind of mother doesn’t want her child to hear?’ Kathryn asks. Regina begs her to stop trying to change Daphne and to learn ASL instead. ‘Get to know the incredible person you gave birth to!’

Like her character Daphne, Katie LeClerc is a bit more open-minded about cochlear implants. Though she has been fluent in ASL since the age of 17, and has lots of friends in the Deaf community, she brushes off comments about the surgery being invasive. “I can understand that a portion of the Deaf community worries that maybe a way of life is going by the wayside because of the technology … but at the same time, I feel like it’s a very personal decision, whether to use that technology,” she says.

Katie’s fluctuating hearing loss means that hearing aids are not always helpful to her. Some days she can hear quite well but some days she hears nothing at all.

Her hearing loss was discovered, quite accidentally, when she was working on a documentary that required footage of somebody having their hearing tested.

She volunteered to take the test and was surprised to find that she was eligible for hearing aids. The only problem was she

Most of these symptoms affect her at night and she explains that the production team are aware of her condition and are very understanding of any on-set attacks. “One day on the set I did a stunt that involved my character dodging a car. Someone grabbed my shoulders and pulled me out of the way.

That day was especially rough on me, because there was so much jostling and movement.” She also spoke about the time she experienced a sudden vertigo attack during an interview on the red carpet. She persevered through the interview with her well-known bubbly smile, pretending she was fine yet all the while thinking “I’m sorry, I don’t know where your face is right now because I don’t know where I am right now.”

As Ménière’s disease tends to destroy a little more hearing with each attack, it is highly possible that LeClerc will become completely deaf someday. However, she’s not too concerned, claiming to be simply living by the moment and taking things one day at a time. “I have every intention in the world to continue with my career and keep up the good work,” she says. “It’s really hard for me to complain about Ménière’s disease because without it I wouldn’t have this job,” she says.

Katie cites her older sister, who also has Ménière’s, as her inspiration for

coping with the condition. Sixteen years older than Katie, her condition is far more progressed and her attacks can last around six days. “My longest Ménière’s attack has been three or four hours,” Katie says. She admires her sister’s ability to press on through the attacks as best as she can without letting her two children suffer. She claims her sister has taught her to “stay strong” and “keep a positive attitude” because “there’s really nothing you can do about it”. Instead she claims she is fortunate she knows how her own condition will progress and can prepare herself for it.

It seems the producers are on a winning path with the show. Yes, they have selected a wonderful, lovable cast with real-life experience of hearing loss to give credibility to their performances.

And yes, they’ve dared to venture into sensitive issues revolving around the deaf and hearing worlds. But in addition to that, they have also written dramatic storylines into their episodes to keep viewers watching. Trust me, the deaf issues are a mere side thread once you’re hooked on plotlines around broken hearts, long-lost fathers, hospital lawsuits, law-breaking teenagers and even deportation challenges. I, for one, will happily change the channel from yet another reality TV show to this one instead!

HQ

Image: Featureflash / Shutterstock.com

Producer continues her award winning risk-taking ways Lizzy Weiss, creator of Switched at Birth, won the 2012 Gracie Award for Outstanding Producer for her work on the show. In a recent interview she said "Our show is about a lot of things: nature vs nurture, mother/daughter politics, how issues of class and race affect parenting, etc. And while the insight into deaf culture is fascinating, I think ultimately, viewers stay for the storytelling. We pride ourselves on doing a show that's universal, emotional, and nuanced."

Weiss is continuing to push boundaries and take risks. In Season 2 the show takes the bold move of delivering an episode told entirely in sign language save for a few spoken words at the beginning and end. Subtitles keep the hearing viewer clued in, but when a deaf character is confused because they can’t hear something vital, the audience is, too. This makes for powerfully disconcerting television for hearing viewers. Something never seen before on mainstream TV, the cast see this silent episode as a grand experiment and are excited to see how viewers react. “This is an opportunity for the hearing person to watch at home and try to experience it [not hearing],” said Katie Leclerc. “It’s not exactly the same, but maybe you can try to imagine what your everyday life would be like.”

Katie LeClerc's openmindedness and respect for individuals, along with her strength to battle her Ménière’s may have something to do with her past. In junior high school, Katie was bullied quite badly by three girls.

They would poke her with sticks and spread vicious rumours. “One girl threatened my life,” she says. “I was terrified to go to school.” In the end, Katie's family moved from Colorado to California to help her make a fresh start.

Perhaps things worked out for the best as it was that move to California that kick-started her acting career.

It was her lead role in Annie in junior high that had her hooked on acting. Though based in San Diego, she begged her parents to take her to Los Angeles to give her a shot at an acting career.

Katie has since starred in small commercials, music videos and a couple of TV shows (including The Big Bang Theory and CSI). Starring in Switched at Birth, though, is definitely her biggest challenge yet.

Hearing HQ Apr - Jul 2013

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technology Digital vs Analogue Hearing Aids: It's Not Just About Old vs New Technology ANALOGUE HEARING AIDS Analogue hearing aids use transistors in a circuit to amplify and modify incoming sound.

Any change to the sound is made manually with the volume control, small trimmers to adjust the response or by sending the aid back to the manufacturer to have components changed. The single-use Lyric hearing aid, for example, is analogue.

Advantages: > Long-time hearing aid users may prefer analogue sound as it is what they are used to hearing. > Analogue generally costs less than digital. > Analogue is sometimes more powerful than digital.

PROGRAMMABLE HEARING AIDS The first use of digital technology in hearing aids was to use digital programming to make changes to the sound of an analogue hearing aid, so some digitally-programmable hearing aids may still be analogue. With programmable hearing aids your audiologist can modify the output sound and adjust the device if you need more power or a change in frequencies without sending it back to the manufacturer.

Advantages: > Sound and results can be changed by your audiologist. > Sound can easily be adjusted to better fit your preferences. > Analogue circuitry with some of the flexibility of digital aids.

excessive increases in bulk. Digital hearing aids provide more flexibility and can be used to process sound more selectively than an analogue device.

Advantages: > Certain "noise reduction algorithms" can be programmed into the circuit to help reduce background noise. > Digital feedback reduction can make more gain available without whistling occurring. > Some devices are able to have multiple memories for different listening situations. > Some devices select and follow the sound of voices with a self-focusing directional microphone. > The more sophisticated, the greater the degree of adjustability.

Things To Consider: > Digital does not always mean quality some low-priced digital hearing aids have reduced or eliminated most of the benefits above to cut the cost. > Sometimes you may experience better sound quality with an analogue aid than with a budget digital one. > A high-end, high-quality digital hearing aid can sound terrible if it is programmed incorrectly.

Digital devices are usually set up and adjusted by an audiologist using an appropriate computer interface. The complexity and flexibility can sometimes create a steep learning curve, so it pays to go to an experienced provider for fitting – and ask how long they have been fitting the recommended aid. > Expensive does not necessarily mean the hearing aid is a good one for you. Read about different brands, talk to other hearing aid users about their experiences and trial the device before you commit to purchase.

UNDERSTANDING ANALOGUE AND DIGITAL TECHNOLOGY

SOME USEFUL DIGITAL DEFINITIONS •

•

•

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BANDS are frequency ranges that can be adjusted individually, a bit like the graphic equalizer on your stereo system. When connected to the computer, the different frequency bands of gain can be adjusted up or down separately, much like sliding a sound control on a stereo. An entry-level digital hearing aid may only have one or two bands with up to 16 adjustable frequency bands for top-of-the-range digital hearing aids.

CHANNELS are similar to bands but are frequency ranges in which compression settings can be adjusted individually. If you are sensitive to loud high-pitched sounds your audiologist may choose to use more compression in the high-frequency channel to provide comfort in that frequency range without having to compress sounds in other ranges of speech. When noises like dishes clanging occur, the compression kicks in to reduce the amount of amplification in that channel.

INDIVIDUAL MEMORIES in a multi-memory hearing aid can be programmed independently to function for normal conversation or television in a quiet setting; for noise reduction; for telephone usage; and, music enjoyment. Typically multi-memory hearing aids have two, three or four memories and you change between memories by pressing a button on the device using a remote control or a magnetic wand.

Hearing HQ Apr - Jul 2013

Image: Titania1980 | Dreamstime Stock Photos & Stock Free Images

DIGITAL HEARING AIDS True digital hearing aids are technically referred to as DSP (digital signal processor) hearing aids. They convert the incoming signal from the microphone into a digital format, process it using digital technology and then convert it back into an analogue sound to be delivered to your ear. Digital technology converts the sound to numbers, permitting more specific and powerful manipulation without

THE

REAL

COST OF

HEARING AIDS

Image of woman: Siemens-Press Image

Helen Lowy deciphers the complexity of how Australia's hearing health industry works with the help of Donna Staunton (HCIA), Monica Persson (ASA), Dr Louise Collingridge (audiology consultant) and Hearing HQ's Editorial Advisory Board.

HEARING LOSS is a complex condition, yet most people assume that the simple purchase of a hearing aid will provide an instant fix, just like buying a pair of glasses across the counter. The reality is a hearing aid is just a small part of the necessary process and cost of achieving better hearing. Knowledge is power, so understanding what the process involves means you can be an informed consumer able to ask the right questions of the right people.

Public funding for hearing health Australia’s Commonwealth Hearing Services Program administered by the Office of Hearing Services (OHS) is the envy of many around the world.

It provides world-class subsidised audiology services to young people

under the age of 26 through Australian Hearing, its national chain of clinics, and to eligible patients (adults on an age, disability or veteran’s pension) through a voucher system with services provided

by Australian Hearing and approved private-provider audiology clinics.

According to the Hearing Care Industry Association, over 600,000 people access the OHS program in some form every year and in 2011/12 it provided over 300,000 of the approximately 400,000 hearing aids and devices sold in Australia.

While 1 in 6 Australians suffer from some degree of hearing loss, only 1 in 4 of us who could benefit from a hearing aid currently owns and uses one. On average it takes us 7 to 10 years before we actively seek help for a hearing problem.

Hearing aid ownership for adults with mild hearing loss is less than 20% and for moderate hearing loss less than 50%, indicating many wait until they qualify for the aged pension before addressing the problem.

Nearly half of the 3.55 million Australians who suffer from hearing loss are aged between 16 and 64 meaning a significant proportion fall outside of OHS eligibility criteria. This means more than 1.5 million Australians who are of prime working age and who suffer from hearing loss get little or no funding support or access to services and technologies that would enable them to communicate better at this critical stage of life, creating barriers to productivity, career establishment and advancement.

To understand the inequity of funding

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you need to understand: • that a hearing aid alone cannot fix your hearing problem • how hearing aids are treated by Medicare and the private health insurers • the importance of an audiologist and rehabilitative therapy • what the real cost of a hearing aid is By world standards hearing loss in Australia receives very good public funding. We have one of the highest penetration of hearing aid use in the world due in part to the priority government has given to this health issue. For those of us with hearing loss, 35% own a hearing device. While we joke many put their hearing aids in the drawer not their ears, the level of non-use by hearing aid owners is down from 25% to 13%, compared to the international average of 30%.

But there is always room for more funding and the Audiological Society of Australia, the Hearing Care Industry Association and others lobby for improved support for those who fall outside the OHS eligibility criteria.

Proposals include means testing to access the OHS voucher system for all Australians (in August 2010 the Federal Government agreed to this “in principle”); making hearing aids tax deductible; and providing low-cost reconditioned hearing aids.

A hearing aid alone cannot fix your hearing loss Professor Bob Cowan of the HEARing CRC explains: “Unlike most vision loss that can be corrected with a prescription for lenses, hearing loss is not only a peripheral access problem resulting from damage to the hearing organ. It is also an auditory processing problem in that the ability of the auditory pathway to transmit speech information to the brain can be adversely affected by the peripheral sense organ damage.”

Hearing, listening and comprehending are all reliant on brain function, so your hearing aid is only as good as the effort you (and your audiologist) invest in therapy to retrain your brain to make sense of the different information that reaches it. Unlike glasses, a hearing aid

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cannot recreate the hearing you once had, yet most people incorrectly expect instant positive outcomes once their hearing aid is fitted. The reality is it takes therapy and time for your brain to adjust.

Why Medicare doesn’t cover hearing aids

Generally, Medicare does not cover hearing aids, tests or audiology services as they are considered an out patient service (not a medical or surgical procedure). Some exceptions include limited funding for the Better Start Program for children, the Chronic Disease Management Scheme and the Aboriginal and Torres Strait Islander Program.

If your doctor suspects you have an ear disease or a condition that can be corrected by surgery and refers you to an ear, nose and throat (ENT) specialist, some of the diagnostic tests the ENT requests may be covered by Medicare.

Be aware that use of both Medicare and your private health fund to pay for these services is not permitted, but charges in excess of the Medicare benefit may count towards your Medicare Safety Net.

Can private health insurance help?

Because private health insurers are not legislated to cover out patient services they are not obligated to provide rebates for hearing aids. Some do cover the cost of hearing aids under their premium “extras” cover, but differ dramatically in what they pay out on hearing aids, how often you can claim and if you can claim on a second device if you need aids for both ears, so it pays to shop around.

Very few cover audiological diagnostics or rehabilitation services or hearing aid parts and even less cover batteries (which cost about $200 per year). Funds adjust their rebates every year so make sure you keep up-to-date with any policy changes and check on waiting periods and preexisting condition restrictions. (For a table of what the different insurers offer visit hearingHQ.com.au.)

Why audiologists “sell” hearing aids Australia’s hearing industry model is a complex one that combines the retail environment of “selling” hearing aids

within a professional “clinical” audiology practice.

This model, inherited from the US in the 1970s, is unique to audiology.

Although effective and appropriate in context of the complexity of most hearing issues, it can sometimes wrongly give the impression that the audiologists’ primary focus is to sell hearing aids.

Audiologists are highly-skilled allied health professionals who study hearing, communication and psychology.

They are university-qualified in the assessment and diagnosis of complex hearing disorders and the fitting and programming of hearing devices, but more importantly in the provision of rehabilitation to help you with your communication and cognitive abilities (how your brain processes auditory information). They also provide counselling and diagnose and treat balance disorders.

Only one part of their role is to advise you on what hearing aids are best for your specific hearing condition.

Hearing aids should not be viewed as an off-the-shelf product, because various steps are required to achieve better hearing. All involve an audiologist, who can greatly influence the quality of your hearing experience.

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Testing & Diagnosis: Before you purchase a hearing aid you need to determine if you actually need one. Just because people around you say you aren’t hearing well isn’t enough information to decide if you need a hearing aid. A comprehensive hearing assessment and professional analysis of the results is the only way to determine if you have the type of hearing difficulty that can be fixed medically, surgically, with a hearing aid, by changing the way you communicate or with a combination of these. A full hearing test takes about an hour and costs around $150. The “free” test some clinics use as a marketing tool to get you in the door is usually a basic screening test and may not be conducted by an audiologist or even an audiometrist (who has a TAFE qualification in conducting hearing tests and fitting hearing aids) but by someone without training in audiology.

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Prescription: Hearing tests look at not only the loudness of the sounds you can hear and the pitch, but also how you discriminate speech in different environments. Your test results enable an audiologist to determine if you require a hearing aid and what style and features would best suit your specific hearing levels, lifestyle, listening needs and budget.

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Programming & Fitting: Less than 5% of people can put on a hearing aid and walk away saying their hearing is much better now. For the majority, it is about choosing the right technology and changing their communication patterns. This is virtually impossible to do by yourself. A hearing aid needs to be custom-programmed to match your prescription and fitted to suit your ear shape so it is comfortable to wear. You will need instruction on how to use and maintain it, plus how to work the different functions and features so you get the best outcomes in a wide range of listening environments.

Image: Shutterstock / CandyBox Images

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Adjustments & Rehabilitation: Hearing aids do not fix hearing – sound still passes through your damaged ear. We live in a noisy world and your nervous system needs to adapt over time to amplified sound and background noise such as at a cafe.

This can sometimes be an uncomfortable process requiring several visits to your audiologist for adjustments and therapy. This is not dissimilar to having physiotherapy after an injury.

If you haven’t done anything about your hearing loss for a long time (on average we take 7 to 10 years to seek help with our hearing), your brain will have forgotten how to process auditory information and will need time to adjust and relearn – a good reason to act sooner rather than later. Just as vision prescriptions change over time, so too will a hearing script, so your device needs to be adjusted to match these changes over the years.

Hearing aids are one of the few health choices where you can try-before-youbuy and most clinics will provide a 30day trial period.

Why are hearing aids so expensive?

There is a widely held misconception that hearing aids are very expensive in Australia. The reality is the price you are quoted is “bundled” to include the device and a full suite of essential audiological services that you will require over the 3 to 5 year life of the product, plus maintenance, repairs and extended warranty.

On average the bundled package for a single hearing aid can range from $2,000 to $5,000. The price is based on the type of hearing aid (budget to premium model), the type of warranty and the types of audiological services and number of consultations.

Without testing, programming, fitting, rehabilitation and follow-up support, a hearing aid alone is less than optimal.

When you buy a hearing aid from an Australian hearing clinic you are also purchasing a relationship with a qualified professional who is dedicated to helping you improve your communication outcomes. Sadly this isn’t clearly communicated in the marketing we see and so the audiological services tend to be “invisible”, giving the impression the price you are paying is just for the hearing aid.

Bundling exists in the public system too. Patients can choose a service that is fully subsidised (not “free” but at no cost to them) or pay an additional amount (top-up) if they want a hearing aid with higher-level technology features. Public patients, for a small annual fee, can also receive subsidised batteries, maintenance and repairs.

Historically, because audiology is unlikely to maim or kill a patient, it is not required to be a registered profession in Australia. But it is a self-regulated industry with a highly-qualified workforce that operates under stringent care and service standards set by the OHS. And, because private clinics also see public patients through the OHS’s voucher program, their staff must meet OHS guidelines and be registered by an approved professional body like the Audiological Society of Australia (for a list of ASA registered clinics around Australia visit hearingHQ.com.au).

Unlike the medical profession, audiologists do not have a recommended hourly rate despite their university training. But as audiology practices are expensive to operate due to the specialised testing equipment required and the broad range of services offered,

most clinics cost their time at $200 to $300 per hour. By comparison, psychologists have very minimal overheads yet patients do not question their fee. So when you consider paying audiology services separately over a period of 3 to 5 years, bundled pricing is probably less expensive overall.

Different clinics do charge different prices. This is usually based on what services they specifically include and the number of hours estimated to deliver them. Most should be happy to explain the breakdown of their quote.

Be aware if you plan to shop around that clinics will not quote over the phone without seeing your audiogram. To get comparison quotes you need to make sure your hearing test is comprehensive and get a copy of the results (you will need to pay for this). Then ensure you are comparing the same make and model or at least similar features if the brand is different.

Having the manufacturers in “retail” not only increases competition - a good thing for pricing - but it also means they have firsthand access to consumer feedback and sentiment to help them develop products that meet the ongoing needs of everyday Australians.

Independent audiologists who usually operate their own clinics also offer a range of products and should be able to get in a particular brand for you.

They too may have an alliance with certain brands for which they get paid commission.

Ways you can manage or offset the cost of hearing aids

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Image of mousetrap: Flickr / SuperSchool

Communicate your budget: Your audiologist is not a mind reader.

Tell them upfront what you can afford and they will find a device that will do everything you need it do within that budget. Hearing aids are like cars - they come in budget, standard and premium models. You might dream Does it matter who owns the clinic? about a luxury car, but can only afford a The Australian hearing clinic market is small car or a budget secondhand model very competitive and open so we benefit - it still gets you from A to B! from a high standard of care and a wide Payment Plan: Find a clinic that choice of hearing aids (although with so offers a payment plan so you many brands and models available no can pay periodically rather than one clinic could stock them all). upfront in a lump sum.

Hearing Aid Audiology Chain Head Office Brand Alliance Banks: If you AudioClinic Denmark Oticon/Bernafon/Sonic can’t afford Bay Audio New Zealand new hearing aids Bloom Hearing Denmark Widex and don’t qualify Connect Hearing Germany Phonak/Unitron for government HearingLife Denmark Oticon/Bernafon/Sonic assistance, you may National Hearing Care Italy be able to get preThe large chains are mostly owned loved reconditioned ones from a hearing by international companies and some aid bank for a low administration fee. also manufacture hearing aids. While Programming and fitting may or may not manufacturer-owned clinics may appear be included. In some cases you may be to superficially be biased towards referred to a private audiologist to fit the promoting their own product range, they aid at a minimal cost. Run by volunteers, also offer other makes and models for these are located in most capital cities every type of condition. Even Australian (more details at hearingHQ.com.au).

Hearing aligns itself with certain brands Private Health Insurance: Review and currently has a partnership with your private health insurance cover Siemens, although they do offer other to ensure hearing aids are covered. brands. Ultimately, audiologists are If not consider changing funds, but speak bound by a code of ethics to make their to them about any waiting periods. clinical decisions about your needs, based Chronic Diseases Management on objective verification measures and Plan: This Medicare scheme your full clinical history, not a brand. provides a small rebate towards

allied health services used to manage a chronic condition (6 months or more).

If your hearing loss is related to this condition you may qualify. Ask your family doctor.

Net Medical Expenses Tax Offset: Hearing aids are considered an eligible medical expense by the Australian Tax Office (ATO) so keep your receipts and discuss your personal situation with your tax advisor or the ATO. Net medical expenses is the amount you have paid less any refunds you receive from Medicare or a private health insurer for eligible medical expenses over the tax year. Currently if you have over $2,120 in eligible out-of-pocket expenses, the ATO allows a 20% tax offset (that is, you get back 20 cents in the dollar) on anything over this threshold. There is no upper limit on the amount you can claim.

However, if legislation announced in the 2012/13 Budget in May 2012 goes through parliament before 30 June, this offset will become income-tested and if your adjusted taxable income is above $84,000 for singles and $168,000 for a couple or family, the tax offset reduces to 10% and the threshold increases to $5,000.

Insurance: Like other valuable items you own it is wise to check that your hearing aid is covered by your home contents and travel insurance for loss, theft and damage.

Avoid being tempted to buy online: Finding a cheaper hearing aid online may seem like a saving, but you could also be wasting money.

If you decide to go it alone keep in mind that if you are eligible you may not get any government support. Make sure you aren’t buying a discontinued product or the wrong one for your type of hearing loss. Check you are buying from someone qualified to advise you and understand you are unlikely to get any local product support or warranty if something goes wrong. More importantly you will have the added cost of a local audiologist to program, fit and provide follow-up care. So remember to add those costs in when you're doing your calculations.

Image of audiologist with patient: Siemens-Press Image

Important things to consider Visit your family doctor: GPs are not specialised in hearing so won’t have all the answers, but they can check your concerns are not related to a medical issue and if necessary, refer you to an ENT. Visit an audiologist: Your GP may recommend an audiologist but may not be aware of their billing structure, so make your own investigations – you don’t need a referral.

If you are eligible for public funding, your GP can assist you with applying for a voucher from OHS for a free hearing test. The OHS can then guide you to clinics you can access in your area.

Deciding on a clinic: Ask if you will receive a full hearing assessment or just a screening test and about the qualifications of the person you will be seeing. Also find out if you will see the same person every visit. Does the clinic offer a full range of brands and models? Are they aligned to a particular brand or receive commission? Do they offer a 30-day try-before-you-buy trial?

Take a friend or family member: Like any health issue that impacts your life, taking in a lot of new information can be overwhelming so it is good to take along an extra pair of ears to absorb the details and ask appropriate questions.

You can also forewarn your companion to interject and suggest a coffee to think about it if you feel you are being railroaded into a decision.

Care Plan and Quotation: Request an explanation of your audiogram. Ask if there are alternative treatments to a hearing aid and if not, what are the limitations not just the benefits of different hearing aids. Ask for a breakdown and explanation of their quote and the proposed care plan, as well as how much time is allocated to each consultation and how many times you can come back. They should be able to anticipate how long it will take you to adapt to using a hearing aid and what rehabilitation you require – this is often dictated by how long you've had your hearing problem without doing anything about it and how much of your brain’s auditory processing and your communication behaviour needs to be modified. Check the warranty provided and access to after-sales maintenance service like ear wax removal and repairs.

What a hearing aid can’t do for you: To avoid being disappointed in the technology, address how the features in your chosen device will and won’t enable you to hear better, especially in noisy situations where most people report difficulty. This will also prepare you for what communication skills you will need to learn during the therapy process.

The way forward

There are many schools of thought and debate from audiologists and consumers around whether hearing aids and audiology services should be charged

separately. While there are pros and cons, for the moment the majority tend to sway towards bundling as most cost-effective for patients and the most manageable for audiologists, given how legislation and our social services operate in Australia.

The typical method of purchase for most people overseas is for the product and service to be bundled as in Australia.

The reason hearing aids are sold direct to consumers (generally via the internet) in the US and some other countries is because they have different therapeutic goods licensing laws. In Australia we have very stringent regulations designed to protect consumers.

If hearing aids and audiology services were marketed separately, there is a risk of some people believing they are “saving” by forgoing essential clinical services, risking that their hearing aid will not deliver what it is designed to do and that their hearing will not be improved or possibly damaged further.

And finally it is important to understand that in this age of globalisation, while having access to more options through the internet is great, sometimes we can also make uninformed choices when we don’t have all the facts or appropriate professional help.

HQ

Next issue…

Look out for our report on funding support for cochlear implants and other implanted devices.

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HEARING TESTS

Image of hearing test © Alex_ostrometski | Dreamstime Stock Photos & Stock Free Images

Hearing tests are painless and easy. A regular hearing test can help identify hearing loss early and may help minimise further loss.

Hearing loss is classified according to several factors: > The degree or the amount/severity of hearing loss is ranked according to how you hear sound in your daily environment - mild (some difficulty), moderate (difficulty hearing most sounds), severe (extreme difficultly hearing all sounds) or profound (deaf). > Your ability to understand speech as opposed to hearing sound, usually measured by a percentage of your understanding of random words. > The location of the loss along different speech frequencies.

Some lose the ability to hear high-frequency sounds like birds or children’s voices, consonant sounds like “s” and “t” or can’t discriminate speech in noisy environments, often caused by exposure to loud noise or the ageing process. Others are unable to hear low-pitched sounds like male voices, vowel sounds or loudness, often from head trauma or ear infections.

Many believe hearing loss is about not hearing sound loudly enough, but it is more complex than simple amplification.

There are four main issues created by hearing loss that occur in different degrees for different people and different conditions: 1. Inability to hear the key parts of speech sounds 2. Difficulty hearing soft sounds 3. Problems separating sounds so voices become jumbled with background noise 4. Inability to tolerate loud sounds due to a reduced range of hearing

> Pure Tone Audiometry is a very simple test where you listen to a range of beeps (pure tones) and indicate when you can hear them. The loudness of each tone reducing until you can just hear the tone. The softest sound is your threshold. > Air Conduction testing measures your hearing with pure tones, but through headphones so the sounds go down the ear canal via the air through to the middle ear and the delicate inner ear (cochlea). > Bone Conduction testing checks the sensitivity of the cochlea by placing a small vibrator on the mastoid bone behind the ear. Sounds travel through the bones of the skull to the cochlea and hearing nerves, bypassing the ear canal and middle ear. > Speech discrimination testing checks for sound volume and quality loss. Hearing speech is a function of not only detecting sounds of speech but comprehending them. The range of audible sounds heard can vary from person to person and distorted sounds can be difficult to understand. > Tympanometry testing checks the function of your middle ear and the movement of the eardrum by pumping air into the outer ear canal to indicate the location of any blockage.

Air and bone conduction tests indicate the type of hearing loss you have and where the problem is: You have sensorineural hearing loss if the bone conduction hearing thresholds are the same as the air conduction thresholds, indicating there is no blockage of sound in the outer or middle ear. The hearing loss may be caused by a loss of sensitivity in the cochlea or hearing nerve.

You have conductive hearing loss if the bone conduction hearing thresholds are normal, but there is loss of hearing with air conduction, indicating the cochlea is normal and healthy, but there is some blockage to sound in the middle or outer ears.

Mixed hearing loss combining both sensorineural and conductive hearing loss is also possible.

A variety of tests are used to measure what sounds you can and can't hear and the functioning of your auditory system: Your test results are indicated on an audiogram, a graph that shows how loud sounds need to be before you can hear them and indicates the degree and type of hearing loss.

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I have recently started wearing a cochlear implant and my implant audiologist has told me I should transfer from my hearing aid clinic and become a client of Australian Hearing so I can get my implant batteries and processor parts covered. I don’t understand why I can’t remain with my current hearing aid clinic and receive cochlear implant parts from them?

Roberta Marino: While a standard hearing clinic receives funding from the government to supply you with hearing aid batteries and parts for hearing aids, they cannot access the additional funding that Australian Hearing receives for complex clients such as cochlear implant wearers. Therefore, it is highly unlikely that a standard hearing provider will be able to subsidise your cochlear implant parts and batteries.

You are under no obligation to transfer to Australian Hearing, but people who wear a cochlear implant and meet the following criteria are eligible to receive services from the Australian Hearing Cochlear Implant Support Program.

The criteria are: under 26 years of age and an Australian citizen or permanent resident, or an adult who meets the eligibility criteria for the Australian Government Hearing Services program and has a valid Hearing Services Card (the cost for this card is currently $40.53 per year or free for some eligible Department of Veterans Affairs card holders).

If you meet these criteria, Australian Hearing subsidises the cost of batteries required for your processor. This is useful as these higher voltage batteries are more expensive than your standard hearing aid batteries. They will also subsidise the cost of replacement parts - cables, coils, microphone cover replacements, battery units and dry briks for your drying unit.

If you qualify for a Hearing Services Card, the yearly fee is minimal if

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you consider that by using standard disposable batteries you will be paying $300 to $500 to power your processor.

In addition, if a cable or coil/cable combination breaks down you would be paying about $90 to $470 to have it replaced. If a battery unit broke down (such as a BTE controller) it could be an additional $500. All parts except for the processor normally only have a 12-month warranty.

The dry briks required for drying units (such as the Zephyr or Breeze devices) cost about $18 for a pack of 3 with each brik lasting around 2 months. (It is highly recommended that you place your processor in a drying unit to help prevent moisture damage).

If your processor is out of warranty (3-year warranty for Cochlear Ltd and Advanced Bionics processors and 5-year warranty for Med-El processors), it can cost somewhere between $300 to $400 to have it repaired. As a client of Australian Hearing these repair costs would be fully subsidised.

You can see how costs can easily accumulate especially once your parts and processor are out of warranty.

The Australian Hearing program is very generous and we are fortunate here in Australia that people who are on a pension or are under 26 years of age receive so much support. People wearing implants who are clients of Australian Hearing can now contact the Cochlear Implant Support Services toll free on 1800 131 339 or fax 02 9419 8397 or email cisupport@hearing.com.au for help with troubleshooting and for most replacement parts (they will post free of charge).

If you don't qualify for Australian Hearing's services, at least later processor models have the option of rechargeable battery units that can help diminish your power consumption costs.

Whether or not you are on a pension, if you lose your processor or it is

Emma Scanlan Principal Audiologist Australian Hearing

damaged beyond repair outside the warranty period, Australian Hearing will not replace the unit for you. So, it is strongly recommended that you insure your external speech processor at its replacement value.

Q

In the last issue you refer to a mobile phone with an inbuilt telecoil system. Can you please advise details of the phone and how my clients can purchase it?

Roberta Marino: The mobile phone with the inbuilt telecoil is the Oricom EZY100. It also has a +25dB volume boost.

I’ve had some implant patients who love the phone and others who haven’t had the best result, so it would be good if they could trial the system before purchasing or have assurance by Oricom that they can return it if not happy.

It can be purchased online at oricom.com.au or call 1300 889 785.

Alternatively, your clinic could become a distributor in which case it would be worth having a demonstration phone on hand that clients can trial before they purchase from you. I’ve found the whole range of Oricom phones very useful but on the odd occasion some people haven’t had much success with them and so the ability to return it or have a trial before purchase is really useful.

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Q

I am in my early 30s and have gradually started to lose hearing in one ear. My boss brought it to my attention as I don’t react when spoken to on that side. What should I do first – get my hearing tested or get my GP to refer me to an ear specialist?

Emma Scanlan: It is probably best to get a referral from your GP and see the ENT Specialist first as they will be able to schedule the appropriate audiological testing as well as undertake any other investigations that may be required. There may be some medical

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Associate Professor Melville da Cruz Cochlear Implant Surgeon

issue that can be resolved with medical intervention and longer term hearing management may not be required. If further hearing assistance is needed, you can see an audiologist and pursue this following the medical advice. There are a number of conditions that can cause a hearing loss in one ear to build up gradually including simple things such as ear wax and middle ear fluid - these can usually be medically-treated fairly quickly. In the case of wax build-up, as soon as it is removed the hearing usually returns to normal. Other conditions may take longer to treat or may not require medical intervention. The ENT Specialist will be best placed to advise you on your individual case.

Q

I’ve read regular use of over-thecounter painkillers like asprin, paracetamol and ibuprofen can result in hearing loss. I take these regularly for back pain. Should I be concerned?

Melville da Cruz: It is true that some commonly used over-thecounter pain relief medications are associated with sensorineural hearing loss or in medical terms ototoxicity (damage to the ear by a toxin). These medications have been associated with hearing loss, tinnitus and balance disturbances – symptoms all due to disturbance of inner ear function. This is particularly so for medications belonging to the aspirin group and closely related non-steroidal anti-inflammatory drugs (NSAIDs) – aspirin (eg Disprin, Aspro), ibuprofen (eg Advil, Nurofen) and naproxen (eg Naprogesic) are the most commonly used. Codeine is another common pain medication (and codeine/paracetamol combinations like Panadeine, Panadeine Extra and Forte)

A

Roberta Marino Senior Audiologist Specialist Hearing Services

associated with hearing loss.

However in clinical practice it is extremely uncommon to see a permanent or even measurable hearing loss related to the aspirin group as the hearing loss seems to be dose and duration related.

There have been reports of hearing loss in young adults who have taken one or more of the NSAIDs or aspirin-containing analgesics in high dosage continuously for years. At the recommended dosages for short durations (days to a few weeks) it is highly unlikely to cause hearing loss. If patients on regular dosages of aspirin or NSAIDs do have a hearing loss it is often due to another cause, most commonly ageing or a hereditary cause.

The hearing loss associated with codeine-containing painkillers has only just been described. It does seem to be associated with prolonged usage of moderate to high doses of codeine and can present as a sudden hearing decline in both ears.

Prolonged use of any medication for chronic pain may have serious consequences. Paracetamol containing medications may cause liver damage.

Aspirin and related medications may cause excessive fluid retention or precipitate an asthma attack. Fortunately from the hearing point of view, hearing loss is exceedingly uncommon, and when it occurs, it is often associated with a dramatic increase in tinnitus, so the ototoxic effect may be recognised early.

It may be reversible by reducing the dosage of the medication or ceasing it completely. If you do suspect that your pain relief medication is causing you harm, consult your doctor and discuss its continuing usage as a matter of urgency.

Send your questions to: Hearing HQ Magazine Experts PO Box 649 Edgecliff NSW 2027 or experts@hearingHQ.com.au

Hearing HQ Apr - Jul 2013

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REAL PEOPLE

REAL

Yvonne Keane, Australia's Pocket Rocket, is passionate about family, community, early intervention and making a difference.

Motherhood can be a high-wire balancing act at the best of times, jam packed with unforeseen challenges, occasional obstacles and unanticipated wobbles. Lately, for our family, one such unforeseen challenge has come sharply into focus - the issue of making sure each child receives equal attention and knows they are equally special.

A few years ago, a mother of twins mentioned to me that one of her greatest challenges was ensuring her hearing son felt as loved and important as his hearingimpaired brother. Initially this took me aback, but when you think about it, it is a very real struggle for most families who have a child with a disability or special needs and another that does not. Yet little is written or spoken of it. It makes sense that all of the therapies, appointments and attention one child receives could potentially leave their sibling feeling less significant.

I recently realised, with a great big dose of good old motherly guilt, that while I am completely focused on the language development of my 3-year-old son Asher, I have been comparatively relaxed with my one-year-old daughter Saskia. Woops!

I immediately corrected course, as all mothers do.

And then today I witnessed the most astonishing thing. Asher was sitting with his sister reading a book and gently coaxing words out of her. “Well, done Sas!” he encouraged. “You just said elephant!

Good girl.” Who would have thought?

My hearing-impaired child is teaching his hearing sister to speak!

Life is good indeed!

LEARNING TO LISTEN

''

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Hearing HQ Apr - Jul 2013

As a young ‘jock’ fresh out of high school, the first thing someone said to me about customer service was about listening.

They said “you can hear somebody say something or ask for something, but if you listen to what they’re really saying, or what they really want, you’ll make a great hotelier.”

Becoming a hotelier is in many ways linked to a very wise saying: “Hospitality is mostly about making a memorable, pleasant stay for customers. Whether that is a clean room, exceptional culinary experiences or luxury afforded no expense, hotels thrive on the ideas of listening to what the customers want. If hospitality was to suddenly develop deafness on a global scale, we’d lose our customers very quickly.”

I was born with a severe to profound hearing loss in both ears, which was not actually discovered until I was about two years old. As it is retold countless times, my parents took me to every specialist they could find to determine why I was not responding to them or my surroundings.

I was given many diagnoses, with each one not quite fitting the problem. Like all stories, this one had a bit of an anti-climax - at a regular GP check-up the local nurse discovered I wasn’t responding when she dangled her keys above my head and suggested I get my hearing checked.

I am forever thankful to that very smart nurse - it enabled my parents to follow-up

Josh Cauchi is a 29-year old with a passion for communication, even though he was born deaf. A seasoned hotelier, he deals with people from many different cultures, both customers and colleagues, in his role as the supervisor of Front Office training at the Sydney Marriot Hotel. He shares his inspiring story.

and enabled me access to hearing aids and the benefits they provide.

Because it was almost 2 ½ years from birth until I heard my first words from my parents, there was a lot of catching up to do. Our language and speech patterns are created in our minds the instant we are born. Hearing-impaired children often lack this learning curve and require intense efforts from all involved to understand sound, speech, inflections and tones. A child with a hearing impairment will spend most of their time listening as it’s difficult sometimes understanding what is being heard.

My mother was forever correcting my speech, sometimes to my embarrassment.

She would stop me from playing until I got a word right. As frustrating as it was at the time, in the long run those words ended up becoming part of my vocabulary and repeated use of them ensured others understood what I was saying.

My father has been a traveller his whole life. He is also an accomplished hotelier.

His job took him to the Asia Pacific region where I remember hearing for the first time local dialects of Singaporean, Chinese, Malaysian, Filipino and even a smattering of Indian. I would visit him and often be looked after by hotel staff.

Their accents were magical to me, but I could see how much effort they put into communicating with me in English. It wasn’t their first language, but even as a

STORIES...

youngster I understood how powerful and vital communication was.

My first job was working with the Sydney Media Village as part of the 2000 Sydney Olympic Games. I was a bellman and my job was to deliver bags to the different reporters, cameramen and tech crews. It was here that I learned the first part about listening: people communicate through their culture and being mindful of it helped smooth over confusion.

When I finished my schooling at 18, I decided that I wasn’t ready for university.

I had a passion to travel, but I also wanted to develop practical skills for the future.

My father was living in Hong Kong at the

time and offered me board while I worked in a hotel. Most of the staff where I worked spoke Cantonese, not English, so they had to teach me by communicating with mime and smiling faces. It required patience, but once this alternative method of 'listening' was established, it became easier.

After two years in Hong Kong, I travelled to Europe as a backpacker. Eventually, I found myself working for a deluxe fivestar hotel in London where I learned the other side of the hospitality coin: about the customers.

Listening to customers can be a complex process. Some customers are very straightforward telling you when they need some kind of service (housekeeping, room service, etc). Sometimes, however, it’s more about listening to the cues when a customer is anxious or upset and finding a way to resolve the problem. Often people will speak more with their bodies and faces than with their mouths and learning to listen to those cues is vital to customer service.

After two years in London I returned to Sydney where I have been working at the Sydney Harbour Marriott Hotel, Circular Quay. The ethos in the Marriott Company reflects very much in their customer service:

listening and empathising. My journey in listening has brought me into an industry where my skills can be uniquely harnessed.

My personal journey into discovering different methods of communication has enabled me to listen to people, even when I don’t understand their language.

For me, hearing and listening are two distinct skill sets that we learn over time. If it were a matter of simply hearing things, then it would be as if there was no sense to it all. It would be a directionless and empty experience. But listening requires a uniquely human skill, where we can interpret and reflect on what we are hearing.

My journey of hearing has been a journey of listening, of discovery and of learning the foundations of what makes for our language and culture. I’m privileged to have hearing aids that allow me to hear and I am grateful for the opportunities my parents gave me to discover a world where listening is a joy."

HQ

Ed: Josh has been accepted into the Sydney University Master’s Program to study secondary school teaching and is moving on to his next career.

Hearing HQ Apr - Jul 2013

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Deafining Moments Daniela Andrews, a Melbourne writer, lost her hearing to an autoimmune condition at 27. She now has two cochlear implants and two children.

I’m so glad I was lucky enough to get cochlear implants before I had children. And, I always knew that being able to hear was going to be handy when my toddler started talking. Handy? Let’s go with JawDroppingly Entertaining. Take the time when I was so impressed with his enunciation of ‘duck’ and ‘quack’ that I raced out to buy him a new bath squirter friend to go with the duck. Why, oh why, did I think that a crab would be a good idea? Next thing I knew, I had a toddler running around the house saying ‘crap … crap’. (Oh CRAP!) Sympathetic parents rallied around me in support.

I was told to steer clear of fire truck toys too. Oh and I should stop pointing out the clock. The other night, I showed him the Fat Controller in one of his Thomas books and my older sister, an experienced, wise mother-of-four shook her head at me with what I can only suspect was pity.

And it’s not just his pronunciation that provides the entertainment. At the moment, his favourite fruit is peach but he just can’t get the ‘ch’ sound out. Slightly unnerved with being asked for ‘pee’ straight after dinner, my husband and I decided it was time we fixed the problem. ‘Ch’, we said. ‘Ch.’ ‘Ch, ch, ch.’ ‘CH.’ We showed him how our mouths moved. We likened the sound to a ‘choo choo’ train. We could have rivalled Grandmaster Flash with our catchy ‘Ch-ch’ rap.

Our son stared at us in wonder, transfixed. His eyes lit up and we saw a hint of a smile cross his lips.

He sat up in his chair attentively and slowly opened his mouth… he was going to say it! He was going to say it! We hadn’t acted like fools for nothing!

And then we heard him… er… Let One Rip. It was our turn to stare at him wide-eyed as we processed what had just happened. He gave us a big cheeky grin and giggled. And though at first I tried to hide my laughter behind my serviette, I couldn’t contain myself any longer.

In that One Single Toddler Moment I had destroyed years of qualified arguments with my husband about women just not finding that sort of thing funny.

‘Damn,’ said our son from his highchair, echoing my thoughts exactly.

At least I know he was trying to say ‘down’, right?

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Hearing HQ Apr - Jul 2013

books 'n blogs Sophie’s Tales – online resources and books for children 4 to 7 How many dogs do you know who are also award-winning authors? Sophie the poodle is the alter-ego of Melanie Paticoff, who graduated with a bachelor degree in deaf education in 2011 and is now a graduate student in audiology and communication sciences. Inspired by her little cousin’s experience with hearing loss, Mel created the Sophie’s Tales website to provide a full complement of resources for children with hearing loss. Each product is designed to engage kids in learning language. Check out her YouTube video That’s Just The Way We Hear and her award-winning picture books for children with cochlear implants Sophie’s Tales: Learning to Listen and Sophie’s Tales: Overcoming Obstacles. The books can be purchased at sophiestales.com or the online versions on Apple iTunes. And, if you email mpaticoff@sophiestales.com you may even be able to have Sophie put paw to paper to include a special note to the child receiving the book.

A salty trilogy for young adult readers

Although the hero of The Salt-Stained Book is a 13-year old boy called Donny, this novel is also a good adult read because the grown-up characters are so interesting and beautifully crafted. Donny lives with his profoundly deaf mother, who has other problems now generally labelled ‘learning difficulties’, so is cared for by his grandmother. When granny dies suddenly, the whole landscape of his life changes and he ends up in foster care. Forced to build a new life, Donny finds an escape in a book about sailing and soon learns to sail, discovering that the sea is where he was always meant to be.

This is a story full of mystery and adventure that saves its most satisfying revelations for the end. Donny is nothing but resourceful and incredibly courageous. There is never a dull moment in his story. The Strong Winds Trilogy includes A Ravelled Flag and Ghosting Home by English author Julia Jones.

Wonderstruck will have readers over age 9

(as well as teens and adults) in awe. By awardwinning author and illustrator of children’s books, Brian Selznick, this book debuted at #1 on the New York Times bestseller list. It tells the story of two children whose lives, although set 50 years apart are interwoven and unfold in symmetry - Ben who runs away in the 1970s to New York to find his father and Rose, a deaf girl who in the 1920s runs away to New York in search of her idol, a silent movie star. Selznick’s key inspiration for the novel, that tells Ben’s story through prose and Rose’s story through stunning drawings, was his discovery that when movies incorporated sound, deaf people suddenly found themselves excluded from the cinema.

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here to help

There are many not-for-profit organisations around Australia and government agencies that provide valuable support, advice and information on hearing issues. Please visit hearingHQ.com.au to find out more about any of these organisations and to link directly to their websites.

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

The Royal Victorian Eye & Ear Hospital Melbourne cochlear implant centre T 03 9929 8666 TTY 03 9929 8052 F 03 9663 7203

Hear and Say Centres - QLD Early intervention and cochlear implants T 07 3870 2221 F 07 3870 3998

Tinnitus SA Impartial tinnitus information and options T 1300 789 988

RIDBC Hear The Children Centre - Sydney Early childhood intervention for hearing impaired T 1300 581 391 F 02 9871 2196

Vicdeaf Advice and support for hard of hearing T 03 9473 1111 TTY 03 9473 1199 F 03 9473 1122

RIDBC Matilda Rose Centre - Sydney Early childhood intervention for hearing impaired T 02 9369 1423 F 02 9386 5935

ADVICE & SUPPORT

Royal Institute for Deaf and Blind Children (RIDBC) Hearing and vision impaired education & services T & TTY 1300 581 391 F 02 9871 2196

Australian Hearing Australian Government audiology clinics T 131 797 TTY 02 9412 6802 F 02 9413 3362

Acoustic Neuroma Association of Australia Support and information on treatment T 03 9510 1577 TTY 03 9510 3499 F 03 9510 6076

Better Health Channel VIC Govt funded health & medical information www.betterhealth.vic.gov.au

Aussie Deaf Kids Online parent support and forum www.aussiedeafkids.org.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

Australian Tinnitus Association (NSW) - Sydney Support, information & counselling services T 02 8382 3331 F 02 8382 3333

Deafness Foundation Research, education & technology support T & TTY 03 9738 2909 F 03 9729 6583

Better Hearing Australia (BHA) Hearing advice by letter, email or in person T 1300 242 842 TTY 03 9510 3499 F 03 9510 6076

Ear Science Institute Australia Implant Centre Help with ear, balance & associated disorders T 08 6380 4944 F 08 6380 4950

BHA Tinnitus Self Help/Support Group -TAS Support group for those with tinnitus T 03 6244 5570

Guide Dogs SA.NT Adelaide based aural rehabilitation service T 1800 484 333 TTY 08 8203 8391 F 08 8203 8332

CICADA Australia Inc Support for people considering cochlear implants www.cicada.org.au

HEARnet - a better understanding of hearing loss & interactive ear diagram. www.hearnet.org.au T 03 9035 5347

CICADA Queensland Support for people considering cochlear implants cicadaqld@tpg.com.au

Lions Hearing Clinic Free or low cost services in Perth T 08 6380 4900 F 08 6380 4901

Deaf Children Australia Services for hearing impaired children T 1800 645 916 TTY 03 9510 7143 F 03 9525 2595

Lions Hearing Dogs Australia Provide hearing dogs and training to recipients T 08 8388 7836 TTY 08 8388 1297

Hear For You Mentoring hearing impaired teens info@hearforyou.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

Meniere’s Australia Dizziness & balance disorders support T 1300 368 818 F 03 9783 9208

Parents of Deaf Children - NSW Unbiased information, support and advocacy T 02 9871 3049 TTY 02 9871 3193 F 02 9871 3193 Sydney Cochlear Implant Centre T 02 9844 6800 F 02 9844 6811

Self Help for Hard of Hearing People (Aus) Inc Educational association T 02 9144 7586 F 02 9144 3936 Tinnitus Association of Victoria Support group for tinnitus sufferers T 03 9770 6075

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

EDUCATION

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

Catherine Sullivan Centre - Sydney Early intervention for hearing impaired children T 02 9746 6942 F 02 9764 4170

Can:Do 4Kids - Adelaide Programs for deaf, blind & sensory impaired kids T 08 8298 0900 TTY 08 8298 0960 F 08 8377 1933

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 ACT Deafness Resource Centre T 02 6287 4393 TTY 02 6287 4394 F 02 6287 4395 Arts Access Victoria/Deaf Arts Network T 03 9699 8299 TTY 03 9699 7636 F 03 9699 8868 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 EARtrak - Help improve hearing aid standards T 03 5174 0699 F 03 5174 8267 Hearing Aid Bank - donate old hearing aids T 1300 242 842 TTY 03 9510 3499 F 03 9510 6076 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

Cora Barclay Centre - Adelaide Auditory-Verbal Therapy for 0-19 year olds T 08 8267 9200 F 08 8267 9222

To have your organisation considered for listing please email editor@hearingHQ.com.au (you must be a not-for-profit, charity or completely free service)

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Hearing HQ Apr - Jul 2013

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