Hearing HQ Dec13-Mar14

HQ

Dec 2013 - Mar 2014

hearing

For all your hearing options

L SPECIA REPORT

AGE RELATED HEARING LOSS

the good, the bad & the sometimes downright hilarious

SUDDEN DEAFNESS EXPLAINED

SSD

BREAKTHROUGH

RED WINE

Can it protect your hearing?

SUPERHUMAN HEARING It may not be that far away!

JODIE FOSTER If she can wear hearing aids, you can too!

CAPTIONED RELAY call anyone, anywhere, anytime.

• captioned phone calls for people with hearing loss

find out more: www.relayservice.gov.au

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

11/13

• all you need is a phone and internet connection

Editor Helen Lowy editor@hearingHQ.com.au Sub Editor Simone Wheeler Contributors Daniela Andrews, Yvonne Keane, Bettina Turnbull Experts Assoc Prof Melville da Cruz Audiologists: Emma Scanlan, Roberta Marino Advertising Sales Executive Julia Turner jturner@hearingHQ.com.au 0414 525 516 Magazine Distribution distribution@hearingHQ.com.au 02 8095 9264 Publisher Lucinda Mitchell lmitchell@tangello.com.au

HQ hearing

FEATURES

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TALKING ABOUT HEARING LOSS

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TV CAPTIONING: THE GOOD, THE BAD & THE SOMETIMES DOWNRIGHT HILARIOUS

Printed by Offset Alpine EDITORIAL ADVISORY BOARD Prof William Gibson AM Head of ENT Unit, University of Sydney

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.

Cover image: Helga Esteb / Shutterstock.com

REGULARS

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Research, innovations and things you need to know.

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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.

DEAFINING MOMENTS

The funny side of living with hearing loss.

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.

ED’S LETTER

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NEWSBITES

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.

The complex psychosocial impacts of hearing loss and how to initiate a conversation with someone you care about on getting treatment.

Review of the recent major changes to Australia’s TV captioning regulations and what this means for the hearing-impaired.

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

contents

ALL ABOUT… Sudden unexpected hearing loss and what to do.

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ASK THE EXPERTS Professional advice on reader questions and concerns.

REAL PEOPLE REAL STORIES Australia's deaf sporting heroes.

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HERE TO HELP

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PRODUCTS & SERVICES

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LIFE IS GOOD

Organisations providing advice and support.

Information at your fingertips.

A mum’s perspective on hearing loss.

BOOKS ETC...

Extraordinary individuals unite on a journey, plus new short film.

SUBSCRIBE for just $22/year for 3 issues (postage & handling).

Mail the form on p24 or go to www.HearingHQ.com.au. For bulk orders subscribe online or email subscriptions@hearingHQ.com.au.

HearingHQ: PO Box 649, Edgecliff NSW 2027

|

(02) 8095 9264

The Editorial Advisory Board provides guidance and expertise on a voluntary basis. They may not review every article and make no warranty as to the scientific accuracy of the magazine. They are not responsible for any errors published and do not endorse advertised products. If you have any questions about editorial content, please direct them to editor@ hearingHQ.com.au. If you have questions about product suitability for your specific needs, we recommend you consult an audiologist or doctor. Any person with health issues or medical concerns should first take advice from a health professional.

Hearing HQ Dec 2013 - Mar 2014

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ed's letter During Hearing Awareness Week back in August I attended an event where former prime minister John Howard AC was a guest speaker. He mentioned the late Sir George Halliday, the ENT surgeon who operated on his otosclerosis, and that name rang a bell. I was about 6 and Sir George was about 72 and he put me in this scary chamber to test my hearing. My teacher thought I had a hearing problem and so as all good mothers do, mine made sure she took me to the best ENT in Sydney at the time. It turned out my hearing was fine but my tonsils and adenoids had to come out as bronchitis and ear infections were the cause of the hearing problem.

I never imagined in my 40s I’d ever become the armchair audiologist I have since being involved with Hearing HQ. I actually surprise myself at how passionate I am about being proactive about hearing loss now that I understand the impact it can have on our quality of life and overall health. So just like I got my eyes tested a few years ago because reading books and the computer screen was becoming a strain and the el cheapo magnifiers from the chemist weren’t doing the job any longer, I’ve got myself a referral from my GP to an audiologist and I’m going to have my hearing tested in early 2014. I’ve sensed for a long while that my hearing could be sharper and I find myself too often than I like asking people to repeat themselves or find conversations on the mobile phone testing at times.

As editor of Hearing HQ I feel it is my responsibility to practice what we report here, so look out for an update on my hearing in a future issue! And if I can do it, so can you or someone you care about who is reluctant to explore solutions for their hearing loss. I hope you find our feature story on talking about hearing loss, and more importantly doing something about it, helpful.

To have your say contact me at: editor@HearingHQ.com.au or PO Box 649, Edgecliff NSW 2027

Helen Lowy Editor

Hearing HQ Magazine is published by The Tangello Group Pty Limited 'The Tangello Group' (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 required. The Tangello Group does not accept responsibility for damage to, or loss of, submitted material. Opinions expressed in Hearing HQ Magazine are those of the contributors and not necessarily those of The Tangello Group. No responsibility is accepted for unsolicited material. No liability is accepted by the publisher, the authors or members of the editorial advisory board for any information contained herein. All endeavours are made to ensure accuracy and veracity of all content and advice herein but neither Hearing HQ Magazine, its publisher, contributors or editorial advisory board members is responsible for damage or harm, of whatever description, resulting from persons undertaking any advice or purchasing any products mentioned or advertised in Hearing HQ Magazine or its website.

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HQ Magazine Dec 2013 - Mar 2014

newsbites Competition increases in the CI market...

Integration in the hearing technology market continues with the acquisition of cochlear implant (CI) pioneer Neurelec SA in April 2013 by the William Demant Holding Group, a global supplier of hearing aids (Bernafon, Oticon, Sonic), diagnostic instruments (Oticon Medical) and personal communication devices (Phonic Ear, Sennheiser).

This follows the acquisition of Advanced Bionics in November 2009 by the Sonova Group (owner of hearing aid brands Phonak and Unitron and hearing care provider Connect Hearing) making it the first global hearing healthcare company to have a strong worldwide presence in hearing instruments and cochlear implant systems.

Oticon Medical is already established in the implant market with its Ponto system for conductive or mixed hearing loss and single-sided deafness enjoying nearly 25% of the world market in bone-anchored hearing solutions. Currently Neurelec is sold to hospitals in France and a few select markets, but with Oticon Medical's distribution power, investment capital and R&D capabilities the intention is to expand the brand internationally and make Neurelec a global CI player.

The philosophy behind integration is the potential to create highly innovative products that combine the best of both hearing aid technological advances and cochlear implant expertise.

Both Cochlear Limited, a publicly listed company and MED-EL, a privately-owned company manufacture only implantable hearing devices.

JOB CENTRE

FREE registration for job seekers.

FREE job posting for employers.

Help make www.HearingHQ.com.au the most comprehensive FREE service for anyone passionate about the hearing care industry.

2013 Lasker-DeBakey Clinical Medical Research Award

The Lasker Awards, popularly known as “America’s Nobels”, are among the most respected science prizes in the world.

The 2013 Lasker-DeBakey Clinical Medical Research Award honoured three scientists Ð Graeme M. Clark (Emeritus, University of Melbourne, Australia), Ingeborg Hochmair (MED-EL, Innsbruck, Vienna) and Blake S. Wilson (Duke University, North Carolina, USA) Ð for the development of the modern cochlear implant Ð a device that bestows hearing to individuals with profound deafness.

Clark and Hochmair independently developed multichannel cochlear implants that for the first time substantially restored a human sense with a medical intervention. Wilson's speech processing strategy revolutionised speech perception without contextual or visual cues.

As of 2010, approximately 219,000 people across the globe had received cochlear implants and more than 80% of the prostheses had been dispensed since 2000. The numbers are increasing rapidly; by the middle of 2013, more than 320,000 individuals were using cochlear implants and almost 40,000 had one in each ear. As the device's effectiveness has grown, so too has the number of potential candidates. Now, adults who have severe age-related hearing loss are taking advantage of the invention.

Graeme M. Clark University of Melbourne

Ingeborg Hochmair MED-EL

Blake S. Wilson Duke University

Can red wine protect your hearing?

Resveratrol, a natural phenol found in the skin of red grapes and noted for its antioxidant and anti-inflammatory properties, may have the potential to protect against hearing and cognitive decline, according to a study from Henry Ford Hospital in Detroit published in February 2013 in Otolaryngology – Head and Neck Surgery.

The study shows healthy rats are less likely to suffer the long-term effects of noise-induced hearing loss (NIHL) when given resveratrol before being exposed to loud noise for a long period of time.

Lead author Michael Seidman, director of the Division of Otologic/Neurotologic Surgery at Henry Ford Hospital said, “Resveratrol is a very powerful chemical that seems to protect against the body’s inflammatory process as it relates to aging, cognition and hearing loss.”

The study reveals that acoustic overstimulation causes a time-depended, up-regulation of COX-2 protein expression and that resveratrol significantly reduces reactive oxygen species formation, inhibits COX-2 expression and reduces NIHL following noise exposure in rats. This suggests that resveratrol may exert a protective effect, although other mechanisms may also be involved.

According to Wikipedia, red wine contains between 0.2 and 5.8 mg/l of resveratrol depending on the grape variety. Red wine is fermented with the skins, whereas white wine is not. The substance is also found in other foods like peanuts, cocoa powder, blueberries, mulberries and cranberries but in much lower concentrations by weight.

Implications of this study and how resveratrol in isolation might affect the human body are inconclusive. Excess consumption of alcohol can damage your hearing and general health. http://oto.sagepub.com/content/148/5/827

Hearing HQ Dec 2013 - Mar 2014

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newsbites ARE YOU READY FOR

super-human hearing?

A Commonwealth-funded research project could see Australian scientists delivering a technological solution to the number one problem for hearing aid and cochlear implant users – the ability to hear conversations in noisy situations.

Although in the early stages of development, the patented technology known as Super-directional Beamformer is currently being evaluated in hearing labs for a range of realistic acoustic settings and could be ready to be licensed for use in the next generation of hearing aids and cochlear implants.

Developed by HEARing CRC researchers at the University of Melbourne and the National Acoustic Laboratories, initial testing has shown the technology can improve speech understanding in noisy environments by up to 50% for hearing aid users. Trials have shown it can provide listeners with a 4-8 decibel advantage, more than double that of conventional microphones effectively giving people with mild hearing impairment “super hearing” that is superior to people with normal hearing.

HEARingCRC co-inventors Dr Jorge Mejia and Dr Richard Van Hoesel explain that unwanted sounds are reduced though combining the outputs of two microphones on each side of the head to create a super-directional output. “This creates an invisible beam that allows the wearer to tune into the person they are talking to while also reducing sounds coming from the side. Almost like a satellite dish where the radar swings around and picks up signals, when inside the hearing aid it will allow the wearer to steer the invisible beam to the left or right in the direction that the person is speaking.

It softens the sounds from all directions, allowing you to hear the sound in front of you,” added Dr Mejia.

Professor Harvey Dillon, director of the National Acoustic Laboratories said the technology is one of the most exciting innovations in the hearing devices industry. “I expect it will also help reduce the stigma of hearing devices turning something that indicates a disability into something that is supernormal.”

With evaluation to fine tune performance expected to be completed soon, the next steps will be exploring the commercialisation of the technology for inclusion into hearing aids and cochlear implant systems.3

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Hearing HQ Dec 2013 - Mar 2014

NOISE-INDUCED HEARING LOSS

Noise-induced hearing loss (NIHL) is a major health problem because opportunities for over-exposure abound and exposures that damage hearing are not necessarily painful or even annoying.

Visiting Harvard Medical School auditory neuroscientist Professor Charles Liberman is challenging the classic view of threshold sensitivity as the gold standard for quantifying noise damage in humans.

His research has shown that “normal” threshold sensitivity can mask ongoing and dramatic cochlear nerve degeneration in noise-exposed ears. This observation suggests that noise-induced damage to the ear has progressive consequences that are considerably more widespread than are revealed by conventional threshold testing, adding to the difficulty of hearing in noisy environments and could contribute to tinnitus (ringing in the ears), hyperacusis (over-sensitivity to certain sounds) and other perceptual anomalies commonly associated with inner ear damage. http://www.jneurosci.org/content/29/45/14077 http://jn.physiology.org/content/110/3/577.abstract

An expert on cochlear anatomy, physiology and NIHL, Professor Liberman will give an open lecture at the Australian Hearing Hub at Macquarie University in Sydney on 24 January at 1pm and will speak at the 2014 Australasian Auditory Neuroscience Workshop in Adelaide on 27 January.

Also speaking in Adelaide will be Dr Poppy Crum, an expert on psychoacoustics from Dolby Laboratories and a consulting professor at Stanford University, about cutting-edge technology in 3D sound and acoustics and where neuroscience crosses over to technology.

Sydney event information contact vivian.fabricatorian@nal.gov.au.

Adelaide event information visit www.aanw2014.com.

Meet the Thinnest & the Toughest

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Haumann et al. 2010.

It comes as no surprise that Apple is interested in the hearing aid category given it has lodged several patent applications over the last couple of years. One is for a hearing aid that would take the guesswork out of listening by smoothing out all the quirks.

The proposed idea would convert speech to text and back. The switch would remove any unusual pronunciation or too-quick talking before it reaches the listener's ear, promising real understanding not just a boost in volume.

Another pair of filings outlines a new social network specifically for hearing aids. Hearing aids worn by at least two users would work in tandem with a personal computing device to identify user identities, establish a communication link and then swap profiles -- not a list of likes and dislikes, but dynamic audio settings. It appears users could be able to update the sound processing on their respective devices to adjust for ambient noise and hone in on a specific source. If approved, it certainly lends a whole new meaning to "Can you hear me now?”

NEW FREE CAPTIONED RELAY SERVICE

A new free service has been added to the National Relay Service’s portfolio. Captioned relay calls mean the hearing impaired can now read the words being spoken by the person they are speaking to as text on their computer or smartphone screen. It is faster than a Speak and Read call on a TTY or text-based internet relay. Visit www.relayservice. gov.au for details.

SINGLE-SIDED DEAFNESS & TINNITUS BREAKTHROUGH

A six-year study by Australian researchers, published in The Laryngoscope, tracking the beneficial outcomes of cochlear implantation in treating single-sided deafness (SSD) has led to TGA approval of the world’s smallest cochlear implant, the MED-EL Concerto, as a valid treatment for SSD. Until now a cochlear implant was considered suitable only for those with profound hearing loss in both ears where a hearing aid provided no amplification benefit. However, thanks to the work of University of Western Australia professor of otolaryngology, head and neck surgery Gunesh Rajan and his team, including audiologists Dayse Tavora-Viera and Roberta Marino, the device will now help children and adults profoundly deaf in one ear to hear “in stereo”.

“People with single-sided deafness have big communication challenges, they cannot follow conversations in noisy environments or localise where sounds and voices come from,” explains Prof Rajan. “This condition is severely disabling especially when accompanied by tinnitus.” Most people in the study experienced significant relief from unbearable and unrelenting tinnitus.

“In children, single-sided deafness has a clear impact on their social, emotional and academic development. This is serious especially when considering around 3% of school children suffer from the condition,” added Prof Rajan. One-third of children with SSD repeat school or do less well than their potential due to the additional burden of background noise and the inability to localise sound sources. http://onlinelibrary.wiley.com/doi/10.1002/lary.23764/full

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Hearing HQ Dec 2013 - Mar 2014

newsbites HEARING LOSS ≠ HEARING AIDS If you had high cholesterol, before taking medication you’d start making some behavioural and lifestyle changes, so why should hearing loss be any different? According to Dr Anthony Hogan from the Australian National University School of Sociology, “Everyone thinks that hearing loss equals hearing aids, but it doesn’t [always] have to.”

He is the creator of Easier Listening, a new free interactive web-based program developed in association with hearservice, a division of the Victorian Deaf Society. Available at www.hearservice.com. au/easierlistening, it builds on 30 years of research and development in the field of hearing loss and is centred on the principles of the Montreal Model of Hearing Help.

The program uses real-life scenarios and straightforward listening tactics to help people manage some very common hearing and listening situations.

“We want to get people more aware of how hearing loss affects them day-to-day and then give them some really practical strategies on how they might manage those problems,” said Dr Hogan.

The program encourages users to think about the way they currently manage hearing and listening situations; to assess how they manage these situations and why problems sometimes arise; and learn new ways and skills for more effective ways to communicate.

It is recommend if you have a concern about your hearing to seek medical advice to determine if any underlying causes exist and to have your hearing tested to evaluate the severity of the loss.

If you do not have internet access a hard copy of the program is available for $10. For details email anthony.hogan@anu.edu.au

Research volunteers needed

Are you 18-85 years of age with normal hearing or a diagnosed hearing loss? Would you be willing to travel to Macquarie University in Ryde, Sydney?

If so, National Acoustic Laboratories, the research division of Australian Hearing, needs you.

To find out more phone Vivian on 02 9412 6800, email research@nal.gov.au or visit www.nal.gov.au/becoming-research-volunteer.

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Talking Most of us fear ageing, yet it is a fact of life, especially when it comes to our hearing. If Jodie Foster, at 51, can continue to work as one of the world’s highest-paid actresses in an industry defined by its dedication to youth and beauty, and wear hearing aids, then perhaps we should follow her lead!

Helen Lowy looks at why action on hearing health sooner rather than later is vital, the complex psychosocial impacts and how to initiate a conversation about hearing loss with someone you care about.

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Hearing HQ Dec 2013 - Mar 2014

Main picture: Helga Esteb / Shutterstock.com

Almost a must-have fashion item, today many people who don’t need them for seeing wear funky colourful frames. Yet, less than a generation ago glasses would have attracted ridicule.

Chances are you’d be called “four eyes” or a nerd. The phrase “guys don’t make passes at girls who wear glasses” didn’t seem too far from the truth. If you previously had 20/20 vision, reading glasses were viewed with fear and embarrassment – an outward sign of ageing.

Hearing health is every bit as important as vision health when it comes to maintaining a high quality of life into our later years. Despite the positive changes around visual impairment, there is still widespread reluctance to embrace treatment for hearing impairment because of the perceived social stigma about hearing aids. Yet if left untreated, hearing loss not only impacts relationships, it can pose a real safety risk and is associated with an increased risk for a variety of health conditions from heart disease to dementia.

Due to the fact we are living longer healthier lives, hearing loss is a condition that most of us will have to accept. Technically the hair cells in our ears, which do not regenerate, are designed to last about 70 years. The medical term for the gradual deterioration of hearing due to ‘wear and tear’ is presbycusis. A life of exposure to noise starts the deterioration of the hair cells many years before we realise we can’t hear as well as we used to.

One of the most prevalent yet unaddressed chronic health conditions in the developed world, hearing loss is a hidden disability. More than 20% of Australians over 15 and two in three people over 60 have a hearing loss. This figure will increase sharply as our population ages and we see just how much damage the iPod generation have done to their ears.

Australians on average take 7 to 10 years from recognising they have a hearing problem to doing something about it. Not a life-threatening condition, it does not receive the public education attention it rightly deserves, so people do not understand that damage to our auditory system is not just about dying hair cells and then getting acoustic information through a hearing aid or cochlear implant.

About AGE-RELATED HEARING LOSS The really important issue is taking early action because our hearing sense is cognitive not just peripheral like vision.

If you can’t hear, the brain’s auditory pathway is not stimulated and like a muscle that shrinks from lack of use, you begin to lose cognitive function (the ability for your brain to understand the sounds you hear). So 7 to 10 years of degraded hearing means by the time you decide to get a hearing aid your brain needs to relearn how to hear. Hearing is a case of “use it or lose it” and why there is so much exploration into the possible link between hearing loss and dementia.

Research indicates that hearing loss is anecdotally associated with a long list of issues: tension and stress, fatigue, irritability, embarrassment, anger, avoidance of and withdrawal from social activities, depression, negativism, rejection by others, reduced general health, loneliness, social isolation, less alertness to the environment, danger to personal safety, impaired memory, less adaptability to learning new tasks, paranoia, reduced coping skills and reduced overall psychological health.

Research also overwhelmingly shows hearing devices are linked with impressive improvements in the psychological and physical wellbeing of people with hearing loss in all categories from mild to severe.

QUALIT Y OF LIFE

In 2000, the world’s largest study on The Impact of Treated Hearing Loss on Quality of Life was released by the US National Council on Aging (NCA). Based on 300 ‘quality of life’ questions and a hearing assessment control tool, the study had a nationally representative sample of 2,069 hearing loss subjects aged 50 and over and for the first time involved their significant others (usually a spouse).

Consistent with other correlational and randomised studies, strong evidence was found that hearing aid usage is positively related to: • improved interpersonal relationships (especially for mild to moderate losses) including greater intimacy and lessening of negative dysfunctional communication • improved belief that the subject is in control of their lives • improved cognitive functioning • improved health status and less incidence of pain • enhanced emotional stability • enhanced group social activity • reduced discrimination toward the person with the hearing loss • reduced difficulty associated with communication • reduced hearing loss compensation behaviours • reduced anger and frustration • educed incidence of depression and depressive symptoms • reduced self-criticism • reduced anxiety symptoms • reduced paranoid feelings • reduced social phobias • greater earning power Respondents and their family members independently reported that hearing aid use significantly improved relationships at home and with family, feelings about self, life overall, mental health, social life, emotional health and physical health.

Based on these findings, few would disagree that uncorrected hearing loss is a serious issue.

Typical excuses used by those who delay action on their hearing loss are “my hearing isn’t bad enough yet” or “it’s so mild I can get by”. The tragedy is they aren’t aware just how far their quality of life has deteriorated, let alone the enormous stress and aggravation it is causing family, friends and even

associates. For those still working, their overall effectiveness, opportunity for promotion and earning power are all negatively impacted.

Key reasons that eventually motivate them to seek help are: 1. Their hearing problems become so unmanageable they can’t put it off any longer.

2. Family members, tired of communication difficulties, drive them to do something about it.

Hearing, listening, connecting

As the actual capacity to hear declines, so too does the closeness and intimacy that good communication brings. Continually repeating what is said breaks down spontaneity, so simple statements and questions start to replace longer, more interesting discussions.

In a 2010 online survey by a major UK hearing aid retailer more than 1,000 people over 40 with hearing loss revealed they often feel upset that their spouse is unable to empathise in terms of how the condition affects their daily life. A third said their inability to hear properly had caused major arguments with the family; 1 in 16 claimed their partner had threatened to leave or divorce them unless they sought help; 1 in 5 said they lied about their hearing loss to friends and family; two-thirds admitted to bluffing their way through conversations; and half said they had become depressed and isolated.

Therapists and marriage counsellors draw a distinction between hearing and listening, but for couples where one or both have a hearing loss this could be the root of many arguments. Feelings of frustration from being misunderstood during simple conversations can develop as the strain of repeating oneself reaches intolerable levels. The person with

Hearing HQ Dec 2013 - Mar 2014

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hearing loss can often miss the tone of voice in conversations leading to misunderstandings and feelings of hurt and resentment.

In 2009 Energizer’s US Specialty Batteries Division conducted an online survey to understand how a hearing impairment can affect relationships between parents and children. The survey polled two groups - baby boomers (born between 1946 and 1964) who suffer from hearing loss and adult children who have a boomer parent suffering from hearing loss - and found: • Hearing loss hinders relationships.

45% of children said a parent's hearing loss had an effect on the relationship they have with that parent. 36% said their parent misses important details about their lives; while 10% said they don't communicate or share information with their parent as much as they would like because hearing loss gets in the way.

• Putting appearance before family?

Although 72% of boomers said their hearing loss has affected the relationship they have with their children, only 11% choose to wear a hearing aid. Among the reasons for not wearing a hearing aid? 1 in 3 said they don't like the way hearing aids look or feel and they believe the device will make them look or feel older than they really are.

• Do as I say, not as I do. More than 80% of boomers said it was extremely or very important for their adult child to have their hearing checked; however less than half had their own hearing screened within the past 2 years!

• Dad, can you hear me now? 44% of children said their parent needs a hearing aid.

• You've got to see it to believe it. When it comes to having a visual impairment, 99% of the boomers polled said they wear glasses/contacts all the time or for specific tasks; only 11% wear a hearing aid.

What ’s stopping you?

In September 1983, 30 years ago, former US president Ronald Reagan, then 72, publicly got fitted with hearing aids causing the demand for hearing aids to double literally overnight. He let the public know that there was something out there that was very small and

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Hearing HQ Dec 2013 - Mar 2014

comfortable to wear. Today we have “smart” digital hearing aids and some are so small they fit into the ear canal and are entirely hidden from sight. Some models connect wirelessly to TVs and phones.

Technology is developing so rapidly that one day it is likely hearing aid users will do better in difficult listening situations than people with normal hearing.

“I was not aware of the seriousness of hearing loss and the potential for hearing aids to alleviate the problem. Every doctor in the world must be made aware of these findings!”

- a comment from a prominent US GP when presented the findings of the National Council on Aging’s study.

In one US study, close to 3,000 individuals with self-reported hearing loss were polled regarding their reluctance to try hearing aids. Their reasons were: 1. Stigma and cosmetics. Many people with impaired hearing lose selfconfidence and believe others will think they are less competent or attractive and so are embarrassed to wear hearing aids.

But, as they experience the improved quality of life provided by hearing devices, this concern usually passes.

2. Lack of awareness. Because people lose their hearing gradually they adapt to it without realising and so may not be aware they have significant hearing loss. It is often not until something embarrassing happens that they recognise their hearing has got worse.

3. Misdirected medical guidance.

A hearing test should be part of a regular medical check-up but is rarely recommended. In medical school GPs receive minimal training in this area, so don’t expect your family doctor to be knowledgeable about hearing loss,

brands of hearing aids and whether you need them or not. Many patients end up receiving misinformation from well-intending GPs, for instance, they may believe you are not a candidate for a hearing aid if you have a hearing loss in only one ear or if you can still conduct a conversation in quiet.

4. Not realising the importance of hearing. Of all our five senses hearing is perhaps the most important as it enables us to engage richly with people and the world around us. We forget how important this is for our quality of life as we live in such a visually-orientated society, so it is easy to take for granted.

Most psychosocial barriers are built up over years of compensating for and denying the existence of the impairment.

5. Misbelief that hearing aids don’t work. Too many people with hearing loss mistakenly believe that hearing aids are not effective. While they will never replace natural hearing, research shows that 76% of modern hearing aid users report satisfaction with their ability to improve their hearing and 66% report they have significantly improved their quality of life.

6. Failure to trust in a hearing aid provider. Training, education and experience has greatly increased over the years for both audiologists and audiometrists. Most provide a risk-free 30-day trial period.

7. Unrecognised value of hearing aids.

Many people who avoid amplification tend to believe that they won’t derive any benefit from hearing aids. The average person and most GPs have little knowledge of the long list of positive benefits of hearing aids.

8. Hearing aids are too expensive. They will probably be one of the smartest investments you will ever make if you follow the rehabilitation process and advice of your hearing health professional. While the upfront cost can be high (prices range from budget to premium), based on a three to five year life span, the cost per day is probably what you pay for a cup of coffee. If improved hearing keeps your brain working and helps you communicate effectively and maintain a good quality of life into your later years, surely that

is worth the investment. Just ask your family if the cost is worth it.

DENIAL AND RESISTANCE

More than two-thirds of people who refuse hearing aids do so because they think “my hearing isn’t bad enough” according to the NCA study. Because they fail to recognise the problem (denial), they do not take responsibility for it (resist treatment).

Because hearing loss occurs gradually and is characterised by difficulty only in certain situations (like in noisy environments, when someone speaks from another room or has their back turned), a person with mild hearing loss often mistakenly thinks their hearing is normal or perfectly fine for their age.

Family members, friends and co-workers are likely to spot the problem before the person does. Signs to look for include: • getting frustrated when talking to people (everyone mumbles) • straining to hear when someone talks • turning their head to the direction of

the sound • responding with a smile and nod but no further comment • listening to the TV or radio at a loud volume • unable to hear the phone or doorbell ringing • asking people to repeat themselves • answering questions incorrectly • avoiding conversations on the phone or in the car • avoiding noisy social events or activities • trouble hearing children and women • trouble distinguishing between words that sound alike • missing dialogue at the theatre or cinema

Easing the way

There are many ways to make communication better with someone who can’t hear well and who is in denial.

• Be patient. A person coming to terms with hearing loss is like a child learning to talk and listen. All the conditions of

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communication are changing.

• Accept reality. New elements are being introduced into your relationship but they are still the person you love; hearing loss doesn’t change who they are.

• Speak slowly. A person with hearing loss has to concentrate much harder to hear what is being said.

• Don’t shout. It doesn’t help and can give the impression you’re angry. Only talk louder if you have a naturally quiet voice. Speak distinctly and enunciate your words clearly.

• Don’t compete. For the best chance to be heard, understand difficult listening situations like when the TV, washing machine or dishwasher are on or if someone in the room is having an animated phone conversation. Even loud fans and whirring fish tanks can be distracting. People with hearing loss find it hard to block out sounds while they are straining to hear your words. Over the holidays consider using paper plates and plastic cutlery in place of silverware and china to cut down on noise.

Common myths that stop people doing something about their hearing loss:

1

A hearing test means hearing aids. Like a regular dental check or eye test, a hearing evaluation determines if you’re hearing as well as you could be. It’s an opportunity to discuss options to bridge any gaps in your hearing range. If the loss is mild, strategies for better communication might be a start or assistive listening devices may be suggested (electronic devices that help with specific situations like amplified headphones for the TV or a handheld personal amplifier for difficult listening environments).

2

Your hearing loss can’t be helped. It may have been true many years ago that age-related high-frequency hearing loss wasn’t treatable, but advances in technology mean nearly 95% of people with sensorineural hearing loss (damage to the inner ear that cannot be surgically or medically treated) can be helped with hearing devices.

3 4

My hearing loss is normal for my age. This is something well-meaning GPs often tell their patients. It is normal for overweight people to have high blood pressure, but does that mean they should not receive treatment?

Hearing aids will make me look older or handicapped.

The inability to hear is far more noticeable than a hearing aid and may well be interpreted as dementia or stroke.

Modern hearing devices are much smaller and far less intrusive than those used years ago. Plus, everyone wears something in their ears these days from music headphones to mobile phones.

• Don’t talk with your back to the person with hearing loss. Keep your hands away from your face. If they can see your face they can get a better sense of what you are saying and the sound quality is better.

• Don’t lean into an ear. If you do they can’t see your lips move. We all lip read unconsciously to some degree. It’s a skill many use without realising as their hearing starts to go.

• Make sure you have their full attention. Use their name to alert them you are speaking to them. A hearingimpaired person who is cooking dinner is not likely to pick up much kitchen chatter.

• Don’t walk away while you are still talking as your words will frustratingly get cut off. Don’t expect them to hear you from another room.

• In a small group, speak one at a time.

A hearing-impaired person will struggle to pick up anything from overlapping conversations. Dinner parties, meetings and book clubs can be difficult.

• Don’t give up. It’s frustrating to repeat something several times, but instead of shrugging it off as not important try rephrasing it in a way that may be more easily understood.

• Avoid patronising, particularly with seniors. While they may be hard of hearing it doesn’t mean they don’t understand. Speak in simple sentences with appropriate pauses and they should be able to hear what you are saying.

• Pay attention. Facial features often indicate what is going on in someone’s mind. A puzzled look probably means you are not communicating effectively so try rephrasing what you are saying.

• Avoid low lighting. Communication

is significantly better if the hearingimpaired person can see people’s faces clearly and pick up non-verbal communication hints.

• Agree on a signal to discreetly let your loved one know when they are speaking too loudly around company. People with hearing loss often cannot hear their own voice well enough to judge their volume.

• Don’t show annoyance. Though you may be frustrated, hearing loss is worse for the afflicted person. One day you may have to learn to live with your hearing loss (the price we pay for living beyond the biblical three score and ten years).

TOUGH LOVE

It can be frustrating to live with someone who has hearing loss, but the secret to avoiding resentment and anger is to help them achieve independent hearing.

In his book How Hearing Loss Impacts Relationships: Motivating your Loved One, US audiologist Dr Richard E Carmen has done a masterful job offering help to family members caught in the trap of compensating for a loved one.

He suggests it is counterproductive to repeat yourself, speak clearly or louder or interpret for a loved one because it assists in their failure to seek help. By relying on your good hearing, they never realise how much communication they actually fail to understand or miss completely because you have become their ears.

Once you stop compensating for them it takes only a short time before they realise without your help they are in trouble and this usually inspires positive action.

You need to create the need for your loved one to seek treatment. Your ultimate goal is to make them hear

independently of you.

Starting the conversation

• Discussing hearing loss can be a tough

topic to bring up with someone you care about, especially for the first time. It’s important to ease into the conversation gently. They may be aware they have a problem but are afraid to talk about it.

Or, because it has developed slowly over time and you’ve been compensating for them, they may be unaware of it.

• Set the stage for a successful talk.

Choose a quiet moment in a comfortable and familiar location and minimise background noises. Approach them with compassion and love and stay calm and objective. Respect that they may not be ready to accept their hearing loss – sometimes the conversation needs to take place in small steps over time.

• It might be helpful to document their hearing loss behaviours and yours as a helper to refer to during the discussion. Share the impact the hearing loss has on your relationship (rather than the frustration you feel) like the missed opportunities for conversation, connection and shared experiences.

• Using the phrase “I’ve noticed recently…” is a great conversation starter or “I’m concerned how often you ask people to repeat themselves”.

Give real examples that demonstrate the hearing problem. Maybe it is that the grandchildren won’t play games with them because they get frustrated with not being heard. Or perhaps you’ve noticed they don’t talk on the phone much anymore or that they are becoming withdrawn and avoid connecting with friends.

Hearing HQ Dec 2013 - Mar 2014

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The inability to hear is far more noticeable than a hearing aid and may well be interpreted as dementia or stroke .

Dealing with denial

• Tell them you’re going to begin to

practice “tough love” to help them hear independently and to make both your lives better. Explain it is not a step you are taking out of anger or vindictiveness but out of love and concern.

• If it feels too extreme to stop helping them when they don’t hear something, use the phrase “hearing help” as a preface each time you repeat something or convey what others are saying or interpret a phone call for them. This reminds them you are acting as their ears without cutting off communication completely.

• If you are really challenged by doing this, Dr Carmen suggests you may need to take an honest look at your own feelings about the situation. You may actually find some degree of satisfaction in being their link to the world and having them depend on you so much, locking you both into a pattern of codependency. If you suspect you’re caught in such a cycle, seeing a therapist for a session or two can help.

• If the “hearing help” suggestion isn’t working and they still won’t address their hearing loss, even stronger action may be necessary as long as their personality can deal with a more direct (but still loving) confrontation. You could try recording a video of them in a situation where they struggle to hear such as a family get-together, then sit down and view it with them privately to prevent embarrassment. If that doesn’t work, stage an intervention. Without giving them prior warning have family members meet with them for 10 to 15 minutes to talk about how the problem is affecting them. The overall message should be how much they care about them and miss quality communication and how they want a better quality of life for the person with the hearing loss.

Achieving success

Dr Carmen offers valuable steps to getting a loved one to take action.

• Recognise life patterns. We are all

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creatures of habit. The way someone manages their health is probably predictable. Are they proactive or ambivalent? Someone who talks about it but does nothing or won’t discuss it at all? Recognising a behaviour or attitude can help you approach the discussion about their hearing. Or, have you maybe been assisting them for so long that it’s now expected and has become part of their pattern? If so, now may be the time for you to change your pattern and in so doing, necessitate change in them by enlightening them to how much more difficult life is for you and others because of their lack of treatment.

• Identify challenges. If you see their patterns, you will likely also know the challenges you’ll face. If they are ambivalent about treatment, make your challenges clear to them. Gently share feedback from friends and family who are concerned about them. Explore some of the ideas suggested above to deal with denial.

• Commit to the changes. Don’t be afraid to be tough. Commit to no longer being an enabler by repeating or interpreting.

You cannot force someone to change, but you can provide gentle helpful guidance in the form of love and compassion.

Miracles can happen.

Breaking down resistance

When discussing hearing treatment, focus on the benefits. Be specific and provide real life examples like “you’ll be able to hear your grandson sing in church” or “when Bill tells a joke you’ll be able to hear every word”.

Ease into the idea of a hearing test. If they are still hesitant to visit a hearing health professional, an interim step could be to try Australian Hearing’s Telscreen online hearing test from the comfort of your home by phoning 1800 826 500 from anywhere in Australia at any time. It only takes a few minutes and provides an idea of what some parts of a professional hearing evaluation might be like to reduce any fear. The whole family could take one to show support.

While you're online explore the different types of hearing aid options together. Point out how sophisticated, cosmetically-appealing and unnoticeable

modern digital hearing aids are.

Hopefully by this stage they will be open to getting an expert diagnosis. Ask your GP for a referral to an audiologist so you can claim the evaluation on Medicare. Attend the appointment together so you too can understand the options available and ask questions.

TAKING RESPONSIBILIT Y

At the 2013 Better Hearing Australia conference in Sydney in October, Australia’s second longest serving prime minister (1996-2007), the Honourable John Howard AC who has been hearingimpaired since youth and has worn two hearing aids throughout his professional career said, “We are living healthier longer lives and there is absolutely no reason why we shouldn’t have the maximum available assistance and aids to allow us to enjoy those additional years to the full. Making sure that you can hear and that your sight is as good as it can be is all part of enjoyment of a longer life.”

Self-monitoring

The Better Hearing Institute suggests consciously self-monitoring situations in which you may be experiencing communication problems due to hearing loss to highlight the connection between these and your emotional response. For example, you may not realise that lately you feel tense in social situations, become tired more easily after a busy day at work or a social situation, that you bow out of previously enjoyed activities or are fighting more with your spouse over seemingly small things.

Try monitoring your hearing for a few weeks in situations with your family, friends and workplace. What everyday communication problems are you experiencing? Is it difficult to hear female voices, understand in background noise or participate in a conversation when multiple speakers are talking?

A simple awareness test you can do weekly is to ask yourself how often the following scenarios happen to you on a scale of 1 to 5 (where 1 is never and 5 is all the time). If you score 3 or higher you may have a hearing loss: • A friend or family member accused

you of not listening • You find yourself intently watching the speaker’s mouth • Family members complain you turn the TV or radio up too loud • You have difficulty hearing alarms and warning signals • You have difficulty hearing a voice from another room • You have difficulty hearing conversations in a moving car • You have difficulty hearing during family dinners or gatherings • You heard a person’s voice but it sounded like gibberish • You understand only part of what someone said • Someone was talking to you but you didn’t realise it

Nothing to lose , much to gain

Be proactive. Get tested. Find out exactly what your problem is. Do you have trouble hearing vowels or consonants?

High or low frequency? Get a copy of

your hearing evaluation and ask for it to be explained to you so you understand how to manage various listening environments better.

Other people may not be aware of your problem hearing unless told, so improve your odds of better communication and let them know. Stop pretending you can hear things that you miss and be frank about telling people how they can help you hear better. Ask them to get your attention before they start talking by tapping you on the arm or using your name. If you can’t understand someone because they are shouting (shouting distorts speech) calmly tell them that you would understand them better in a loud but normal voice.

Be practical. Carry a notepad and pen with you and ask people to write down names, addresses or financial amounts so you can be sure you have them correctly.

Explain this is why you want it written down. With instructions, repeat what you think you heard for clarification like

“So you want me to bring dessert on Saturday night?”

Learn coping strategies. In a noisy place the closer you get to the sound source the better you can hear. Sit in a booth rather than a table. If possible, sit with your back to a wall so there is no noise coming from behind you. Pick a place with good lighting so you can see faces and non-verbal information.

While people in the public eye may not make a big deal about wearing hearing aids for obvious reasons, it is reassuring to know that they are people just like us. They are not immune to hearing loss whether congenital like John Howard’s or acquired like Halle Berry’s (she was beaten by a boyfriend) or age-related as we suspect with the intensely-private Jodie Foster who was first photographed wearing a hearing aid in her left ear in Rome in 2007 at age 44.

What is important is that they are being proactive about their hearing loss and hearing quality of life.

HQ

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Picture: Alliance/Shutterstock.com 18

Hearing HQ HQ Aug Dec -2013 Mar 2014 Hearing Nov -2013

TV CAPTIONING: the good, the bad & the sometimes downright hilarious Following Daniela Andrew’s amusing but sad indictment on the quality of TV captioning last issue, we asked Media Access Australia CEO Alex Varley to explain the recent major changes to the way caption quality for TV viewers is being dealt with in Australia and what makes good quality.

“One day Australia will be a land of wall-to-wall captions” says Alex Varley “with Deaf and hearing-impaired viewers offered equal access to TV content no matter whether it’s broadcast, downloaded or streamed.” Until then, however, the situation is clearly very murky for the viewers and the networks.

Who regulates captioning?

Unfortunately, compared to countries such as the UK and USA, Australia has less regulation to protect the rights of TV viewers with hearing loss.

There are currently more than 40 commercial free-to-air broadcast television licensees (Nine Network, Seven Network, Network Ten, Southern Cross, Prime, WIN and NBN), plus

two national (ABC and SBS) and three paid subscription TV (Foxtel, Optus and Telstra) broadcast licenses.

“It is Australia’s Broadcasting Services Act (BSA) that sets out which channels have to caption which programs” explains Varley. “But, enforcing it and handling viewer complaints is up to the Australian Communications and Media Authority (ACMA).”

In June 2012, the BSA was amended to include mandatory caption quotas for paid subscription TV channels for the first time. It also stipulated an increase of caption quotas for the free-to-air primary channels between 6am and midnight to 95% by June 2014 and 100% by June 2015.

However, for subscription TV different quotas apply to each of the five categories of programming – movies, general entertainment, news, sport and music.

When are captions required?

The good news is the amount of captions required on TV in Australia is definitely on the rise.

On free-to-air channels all programs on ABC1, SBS1, Seven, Nine and Ten between 6am and midnight must have captions by 1 July 2014. But if you’re watching the digital channels or a catch-

up service online, whether or not your program of choice is captioned could be at the whim of the broadcaster.

Varley explains: “Special rules apply to the newer secondary digital multichannels such as Go, Eleven, 7TWO and ABC2. Even though these channels often play repeats of programs already shown with captions on ABC1, SBS1, Seven, Nine and Ten, not all of them are guaranteed to be captioned. This is due to a rule that states that only programs that were captioned on the parent channel must be captioned on the network’s multichannel. So, if Friends was broadcast on Nine with captions, the repeats on Gem must also be captioned.

But because the sci-fi series Torchwood was originally shown on Seven with captions, the repeat currently being broadcast on Eleven (part of Ten) isn’t required to be captioned.”

Most networks choose not to caption most new content on the digital multichannels with the exception of the ABC, which provides captioning levels approaching 100% on ABC2, ABC3 and ABC News 24. This rule is due for review by the Department of Communications.

“The first public consultation into digital multichannel captioning showed that some compulsory captioning levels were

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being contemplated,” Varley points out.

“But, the recent Federal election and the change of government have delayed that process. We are hopeful there will be some required increases in captioning levels on the multichannels from 2014.”

For paid subscription services such as Foxtel, the situation is more complex.

Captioning requirements for subscription TV became part of the broadcasting regulations only last year. Before then they were covered by agreements with the Australian Human Rights Commission (AHRC). The quotas vary greatly and range from 75% for some movie channels to 15% for some news channels.

“It’s encouraging to see some positive signs coming through with the implementation of the regulations like Foxtel starting to put captions on many of its on-demand new release movies, 90% of which are now released the same day as DVD.” The rule that repeated programs must be captioned also applies more generously to paid subscription TV where any channel showing a previously captioned program must show the repeat with captions.

But as Varley points out, “Unless all viewers have an encyclopaedic knowledge of what was broadcast where and all networks have clear records going back many years, then the policing of captioning could become an interesting issue and it is certainly unlikely every breach will be picked up.”

To complicate matters further, the announcement of which channels are captioning at what levels happens at the end of the financial year, not ahead of time. This is partly due to old AHRC agreements that had to be merged with current broadcasting regulations and a major review of these arrangements is due in 2015, so hopefully the system will be simplified.

Catch-up TV & video on demand When it comes to watching TV online, there is no regulation that guarantees access for hearing-impaired viewers.

ABC iView and SBS On Demand are

''

currently the only catch-up TV services that provide captions.

On iTunes, the most popular provider for Australians, only 26% of movies and 38% of TV episodes are captioned.

The excuses put forward by suppliers are usually a combination of financial and technical issues despite providers overseas managing to resolve these same issues. “I think that they are missing a massive opportunity to grow their markets” said Varley “not to mention satisfying the entertainment needs of hundreds of thousands of hearingimpaired Australians.”

In the UK, the main channels provide catch-up services with captions. In the USA, the 21st Century Communications and Video Accessibility Act of 2010 states that any program that was broadcast with captions must be captioned when it goes online. Karen Peltz Strauss of the US Federal Communications Commission told Varley that new technologies coming through to supplement traditional TV services were actually causing people to lose access to TV that they had in prior US laws. The US Act is a prime example of regulation keeping up with advancing technology with the legislation written so it will apply as much as possible to technologies and methods of delivery that are yet to be invented.

In 2011, the USA’s biggest video streaming service Netflix was sued by the National Association of the Deaf for failing to provide captions. After a successful court ruling, Netflix agreed to provide captions for 100% of its content.

This means that even movies and episodes that were never broadcast on TV will be captioned.

In Australia, Media Access Australia has released a report and call for action on this issue. There is a planned review of the whole area required by 2015 and Varley has recommended that the government departments responsible for this become proactive and look into how the British and Americans have made it work and replicate it here.

Good news for hearing-impaired Australians is that services such as Netflix are looking at Australia as a potential market and the bad news for

According to Chris Howe, Managing Director of Red Bee Media Australia, broadcasters globally are moving to more and more unscripted content, live crosses and discussions with experts as this delivers edgier content and the kind of up-to-theminute topical material audiences desire.

But for captioning, live content poses a real challenge in terms of delivering accuracy and a good customer experience. He explains, “Reading captioned content in a single stream textual format is a very different experience to hearing and understanding multi-streamed sounds and images simultaneously. And trying to effectively translate that sensory information and who is speaking, as well as correctly punctuating and spelling names of people and places is a complex job, particularly in a live scenario where there is no time to go back and make corrections.”

Captioning is still a human-driven service provided by highly-skilled people with many years training, using either stenographic or respeaking (speech recognition) techniques. Even though captioning relies on technology, human error still comes into play particularly in the high pressure scenario of delivering accuracy at speed.

Technology is not fail proof either.

Speech recognition software has made captioning easier in some respects with regards to managing the increased volume of captioning. And, with dedicated training, computer dictionaries become richer as more and more special nouns are added. But, the spelling of an unusual city or foreign tennis player’s name can often appear as nonsense on screen. As Howe says, “Teaching the speech recognition software all the place names and athlete names for the Olympics was an enormous task!”

Hearing HQ Dec 2013 - Mar 2014

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Image courtesy of Red Bee Media

Captioner at work

existing Australian providers is that they are clearly set up to deliver a service with captions giving them a big advantage.

“Often the threat of competition is a strong motivator for companies to sort out their customer service issues, so, the consumer should win either way,” Varley said.

“The more that happens in other countries to develop access makes me feel more hopeful that the range of captioned content available to Australians will increase too. Money speeds up action and I think the networks are starting to realise what a gold mine Deaf and hearing-impaired customers could be. In the meantime, it’s vital that viewers keep asserting their rights and tell them that they want to use their services, but only if there are captions.”

Quality of captions Up until recently, legislation only took into account whether a program was captioned or not. If the quality was really bad, the program would be deemed “not to have been captioned” and that was a breach of the regulations. The regulations now require good quality captions and give viewers the right to complain

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Hearing HQ Dec 2013 - Mar 2014

about poor synchronisation, spelling, punctuation, missing information and speakers not being identified.

While most captioning in Australia is of a very high quality, the main area of concern is programs that are scrolling captioned (live as the program goes to air and a few seconds behind the soundtrack) as these are generally less accurate than block captions (created ahead of time so they synchronise with the soundtrack).

“An alarming trend is the increase in programs with live scrolling captions due to a short turnaround time, when they may not really need to be,” Varley points out. “Most news bulletins now do this.

The Seven Network’s news bulletins set the bar high by providing block captions on all but live crosses. In its news bulletins you often see a mix of block and scrolling captions and you know that you are getting the best possible captions.

Others just live caption every part of the news.”

Reporting caption complaints “The complaint process is simple,” encourages Varley. The Australian Communications and Media Authority

(ACMA) relies on viewers monitoring captioning on TV and making complaints if captions are missing or of poor quality.

“If a complaint is upheld by ACMA it constitutes a breach of licence and can attract serious penalties, so avoiding them is a strong motivation for networks to maintain and improve the quality of their captions.”

ACMA deals with concerns related to commercial broadcasters while the public broadcasters deal with complaints directly. Varley recommends, “To assist with monitoring the progress of your complaint you should also send a copy to us at Media Access Australia. Ensure your complaint includes the name of the program, the time it aired, the channel, the geographic location where you viewed the program and details of the problem. And be aware it can take many months for a final decision on a complaint to be made.”

But encourages Varley, “Raising your concerns with the broadcasters and authorities is the most effective way of establishing where the problems are and improving outcomes. But to avoid embarrassment, first rule out any technical problems like poor reception!”

Media Access Australia Tel 02 9212 6242 info@mediaaccess.org.au www.mediaaccess.org.au/television/complaints ACMA Investigation Section PO Box Q500 Sydney NSW 2000 Fax 02 9334 7799 captioning@acma.gov.au For online complaint form: www.acma.gov.au/Citizen/Consumer-info/ Rights-and-safeguards/Captioning/complaintsabout-captioning-i-acma ABC Audience & Consumer Affairs GPO Box 9994 in your capital city Tel 139 994 (TTY 1800 627 854) For online complaint form: www.abc.net.au/contact/complain.htm SBS Ombudsman Locked Bag 028 Crows Nest NSW 1585 Fax 02 9430 3047 formalcomplaints@sbs.com.au For online complaint form: www.sbs.com.au/aboutus/contact/index/ id/142/h/Feedback-Complaints

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2013 Captioning Award Winners The winners of the 2013 Captioning Awards celebrating excellence and innovation and promoting better quality, frequency and wider use of captions on television, in cinemas, DVDs, theatre, live events and on public transport were announced at a function in Sydney hosted by Deafness Forum of Australia and Foxtel on 25 October.

The TV Captioning Award presented

by Free TV Australia went to the Seven Network’s multi-channels – 7TWO and 7mate for voluntary captioning beyond the legislated requirements.

Nominees were ABC News 24, Fox Sports’ coverage of the 2013 British & Irish Lions Tour, SBS’s coverage of the Tour de France, Showcase’s fast-tracked US programming, Network Ten/Red Bee Media for Neighbours on Eleven and tveeder.com.

The Entertainment, Cinema & The Arts Captioning Award presented

by Australian Communication Exchange went to Roadshow Entertainment for captioning all their DVD and Blu-ray titles, and now iTunes titles. Twilight Cinemas received an honourable mention for its open-captioned, family-friendly open-air cinema events.

The Online Captioning & Digital Innovation Award presented by Media Access Australia went jointly to Viostream, Viocorp’s online

video platform developed to enable organisations to publish accessible video content into their website, intranet, mobile app or social media network, and to the latest version of tveeder.com’s innovative tveeder website that enables the captions for all of the main free-to-air TV channels to be viewed (in real-time) over the internet. Nominees included ABC iView fast-tracked Doctor Who, Australian Human Rights Commission “20 Years, 20 Stories” online video, Cairns Regional Council’s website and SBS On Demand.

The Captions for Kids Award

presented by Captioning & Subtitling International went to ABC for Kids (ABC3) which although exempt from the captioning rules consistently captions close to 100% of content in contrast to the low levels of captioning of children’s programs on other channels. Nominees included ABC Splash archives, Ai-Media for AI Live, Community Connections: Social Work in Schools project, Forest Hill College, North Melbourne Public

School and Australian Communication Exchange’s OpenMi Excursions app.

The Award for Organisational Commitment to Captioning

presented by The Sub Station went to Forest Hill College for providing captioning of electronic resources as a College policy, ensuring that all students receive equal access to information and experiences. Nominees included the ABC, Australian Communications Consumer Action Network, Bradley Reporting Queensland, NSW National Parks and Wildlife Service and the Rural Health Education Fund.

The Roma Wood OAM Community Award presented by Printacall went to Anton Sammons of the Deaf Cinema Club, a non-profit organisation run by volunteers with the purpose of organising closed captioning as open captioned sessions at cinemas. Seven Network’s Presentation Media Services Manager Paul Richardson was also nominated.

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column Deafining Moments

Pictures: Baby on Zebra: Daniela Andrews; Worried woman: Karramba Production/Shutterstock

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

So many of us with cochlear implants can list a multitude of favourite sounds we love to hear.

A child giggling. A loved one’s whisper. Birds chirping. And on it goes. But … I’d like to dedicate this column to the sounds I’d rather not hear.

For example, the only time I want to hear music playing from our bouncing zebra toy is when my children are ON it. Or near it. Not at 2:45pm each day when I’m quietly sipping tea while my children are asleep, OK? It gives me the creeps. Whoever is bouncing on it while my children are asleep, (urgent whisper) go away. Before I call Ghostbusters. Or the people responsible for that sort of thing in any decade other than the 80s.

And while I’m on the subject of nap time, I don’t want to hear my next door neighbour start up the lawn mower about 30 seconds after I’ve just sat down with that tea. Cue child #1 screaming. Follow with child #2 screaming.

Complete with the sound of cold tea being poured down the sink 20 minutes later.

What’s worse than the sound of my neighbour’s lawn mower is the click-click-click sound of his cigarette being lit first. I’m sure he’s aiming for a Darwin Award, that is, trying to find the most gloriously embarrassing way of removing himself from the gene pool. I fear that I will one day hear the ensuing explosion that might result … oh well, at least I have noise filters, right?

Oh but if only those noise filters could filter out the sounds of birds in my roof. They were here last year too. We said we’d seal the hole in the roof after they migrated for the winter.

We forgot. Now they’re back. Their chirping is cute. Their feet? Not so much. Less like a cute pitter-patter and more like a vicious scampering from one side of the ceiling to the other. They can’t be sparrows. They’ve got to have talons. They sound like they have talons.

I wish I’d never seen Alfred Hitchcock’s The Birds.

But of course I’m still grateful for my cochlear implants. I’m grateful I can hear these sounds.

I’m grateful the birds will fly away once more. That we’ll be moving away from our neighbour next year. That there are plenty of tea bags in our pantry.

And most of all, that the damn bouncing zebra has an off switch.

all about...

SSNHL

Sudden Sensorineural Hearing Loss What is SSNHL? When the cochlea (sensory part of the ear) or the hearing nerve (neural part) is damaged or malfunctions we are said to have ‘sensorineural’ hearing loss. Sudden or rapidly progressive hearing losses are included under a single definition based on severity, time course, hearing test criteria and the frequency spectrum of the loss. Awakening with a hearing loss, losing hearing over a few days, selective low- or high-frequency loss and distortions in speech perception have all been classified as sudden hearing losses. SSNHL is determined by a loss of greater than 30 dB over three contiguous pure-tone frequencies occurring over a three-day period. It rarely occurs in both ears and is frequently accompanied by tinnitus (70%), vertigo (50%), aural fullness, headaches or vision changes.

What causes SSNHL? Sudden deafness has many possible causes, but for the majority of cases the specific cause cannot be identified (idiopathic). There are several theoretical possibilities as to what may be behind the development of SSNHL, but none individually can account for all episodes.

go unreported as recovery can often be spontaneous and without medical intervention (estimated at about 65%).

The condition is multifaceted and occurs across all age groups and doesn’t favour men or women. Fewer cases are reported in children and the elderly with young adults having similar incidence rates to middle-aged adults. The average age of those who seek medical attention is 40-54 years.

Is SSNHL temporary?

The hearing loss may be temporary or permanent. SSNHL is considered to be a medical emergency, so it is wise to seek medical attention as soon as possible as this ensures a better chance of recovering the hearing. The urgency depends upon the hearing loss being sensorineural or conductive (caused by a blockage or damage to the outer and/ or middle ear) – a GP can check this with a simple

The three most prevalent theories are: 1. a recent viral infection that may have damaged the cochlea; 2. a vascular compromise that may have altered the blood flow to the cochlea, which is very sensitive to changes in blood supply; 3. a rupture of the delicate membrane that separates the inner ear from the middle ear or the membrane in the cochlea that separates the fluid-filled perilymphatic and endolymphatic spaces may have caused an increase in pressure from within (cerebrospinal fluid) or without (middle ear pressure) from straining or changes in barometric pressure from flying or scuba diving.

Is SSNHL common?

The average incidence of SSNHL is about 5 to 20 per 100,000 people per year, but is probably much higher as so many cases

Hearing HQ Dec 2013 - Mar 2014

25

all about... tuning fork test. A sensorineural loss requires urgent referral to an ENT or better still a hospital emergency department.

How is treatment determined?

Every case is different and there is no clear cut diagnosis. The first step is a thorough search for potentially treatable causes. This is done by undertaking an exhaustive patient medical history to reveal any risk factors for hearing loss and a thorough physical examination.

This should include questions about recent events like air travel, strenuous exercise, weight-lifting, diving, falls, other head trauma, viral illnesses, respiratory infections, fevers, previous ear surgery, medications and exposure to pesticides.

On the basis of any findings, carefully selected laboratory and radiographic investigations are then made. Lab tests might look for infection, thyroid disease, diabetes, autoimmune diseases, syphilis or high cholesterol. An MRI with an injection of dye to better see small structures in the ear is the standard test for checking for skull base tumours like acoustic neuromas, especially as a 30-40% false-negative rates exists with auditory brainstem response testing (if hearing levels permit). About 1-2% of patients have an internal auditory canal tumour.

CT scans are generally not recommended in the initial evaluation unless the SSNHL may be trauma-induced.

Audiometry is mandatory including pure-tone and speech tests and immittance (tympanometry and acoustic reflex) tests. Auditory brainstem response testing and otoacoustic emissions tests may provide additional information regarding the functional integrity of the auditory system.

Vestibular (balance) tests may also be done. Even with all these tests, doctors may still not be able to ascertain the process within the body that resulted in the hearing loss.

What is the treatment for SSNHL? Attempts to treat SSNHL are difficult because the exact cause of the condition is often unknown. As a result, treatment regimes are varied and dictated by the factors revealed in the patient history, physical examination and test results.

Determining which treatment modalities are the most effective is also difficult due

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Hearing HQ Dec 2013 - Mar 2014

to the relatively high rate of spontaneous recovery.

Various classes of treatment are available but none have been conclusively proven to be effective.

The most popular treatment is antiinflammatory corticosteroids – firstly with oral prednisone followed by injecting dexamethasone into the middle ear cavity for patients with severe to profound SSNHL who do not improve on the oral steroids. Sometimes hyaluronic acid may also be injected into the cavity to increase the permeability of the membranes and the distribution of the steroid in the inner ear.

Other classes of treatment include vasodilators to improve blood supply to the cochlea and reduce vascular spasms; anticoagulants to improve blood flow; diuretics under the assumption that episodes of idiopathic SSNHL are secondary to endolymphatic hydrops (Ménière's disease) that refers to a condition of increased hydraulic pressure within the inner ear endolymphatic system; anti-viral agents; triiodobenzoic acid derivatives; and hyperbaric oxygen. Occasionally surgery may be recommended to repair an inner ear membrane tear.

Follow-up audiometry within six months of diagnosis should be obtained and patients who do not fully recover their hearing should consider aural rehabilitation and hearing aids or the use of an assistive listening device.

What outcome can be expected?

It is difficult to accurately predict the outcome of SSNHL given the low incidence of the condition and the unpredictability of its natural causes.

However, patients who seek medical treatment within 7-10 days after onset of the hearing loss do better than those who wait 30 days or more. The severity of the hearing loss is inversely proportional to the rate of recovery. Patients with a mid-frequency loss do better than those with high-frequency loss. Poorer recovery rates have been recorded for patients with vertigo. The intensity of the vertigo roughly correlates with the degree of hearing loss. Elevated ESR levels (a screening test that measures the sedimentation rate of red blood cells and can pick up inflammatory diseases) also signals a poorer prognosis. Patients with normal hearing in the other ear do better.

CASE STUDY

Bettina Turnbull, an audiologist, professional development manager for Connect Hearing and vice-president of the Australian College of Audiology shares her recent frightening experience of SSNHL. Recently, totally out of the blue I lost my hearing in one ear. Thankfully it has returned but it was frightening as there was a possibility that I could have ended up with permanent singlesided deafness.

As a hearing person who works with hearingimpaired patients it was a particularly eyeopening experience and I now have a much better understanding of how you actually “feel” when you have compromised hearing.

It happened at a training meeting. One of my ears blocked up and I started to hear an intermittent “chirp, chirp” sound like crickets at night. It was a very busy period and I thought a quite weekend and sleep would sort it out, but a few days later the same thing happened at another training meeting. Only this time is was much worse with nausea and light-headedness where I couldn’t focus my thoughts.

Surrounded by audiologists, I had my hearing tested to confirm I wasn’t imagining the hearing loss and promptly took myself off to Melbourne’s Eye and Ear Hospital emergency department. I was seen by an ENT who diagnosed idiopathic SSNHL (“not sure why” hearing loss) but she suspected the cause was a virus. I was prescribed a fortnight-long highdose course of the oral steroid prednisone and was advised not to fly for two weeks other than to get back home to Sydney (as flying stresses the ear and body).

I was told to rest and I now understand why.

Taking steroids at such a high dose was quite an experience – it's like having your blood rush around your head at 20 times the speed it should and the side effects include anxiety and insomnia.

I was totally surprised at how difficult it was to hear in a noisy place, even with one good ear. I felt disorientated, frustrated and my brain had to work ten times harder to concentrate on hearing what was being said. (For audiologists, this is an area we perhaps underestimate and should talk about with patients rather than just focusing on volume, clarity and functions.)

I was also terrified that my hearing may not return and anxious to investigate further what may have caused the hearing loss.

Once home I contacted my local ENT who organised an immediate MRI to check my inner ear structures were normal, which they were thankfully. He then injected another steroid - dexamethasone - into the middle ear space to be absorbed through the round and oval windows. This was done with a needle after anesthetising the tympanic membrane (eardrum). I was told to go home and lie on my good side for maximum absorption of the drug into the cochlea. Five days later I had another hearing test and things were very much improved. A week later my ENT repeated the injection treatment.

I am so relieved my hearing has returned. I still get ‘overload’ twang when sounds are quite loud but otherwise all sounds normal now.

Wherever she goes...

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27

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ask the experts Q

My child is due to have cochlear implant surgery soon. I’ve heard cochlear implant recipients have a higher risk of contracting meningitis. What precautions can we take?

Melville da Cruz: Meningitis is a serious infection of the fluids and linings surrounding the brain and spinal cord. It can be caused by a range of viruses or bacteria.

Although the incidence of meningitis following cochlear implantation has been very low, there was an increased concern of the risk of meningitis by implantees, their families and doctors following a report in the US1 (Sept 2003) of a cluster of bacterial meningitis cases in cochlear implant recipients.

The report investigated 118 cases of reported meningitis cases in implant recipients. Both adults and children recipients were affected with the age range of 13 months to 81 years.

The onset of the infection ranged from less than 24 hours following implant surgery to more than 6 years after. The most common infection was due to a particular organism called Streptococcus pneumonia. Although these cases suggested that meningitis was more prevalent in implantees these cases had occurred over a period of 20 years during which around 60,000 implant surgeries had been performed.

In the paediatric population the incidence of implant-associated meningitis was higher than non-implanted children indicating that cochlear implant surgery was an added risk factor for meningitis.

Subsequent investigations, both clinical and laboratory based, suggested that there were multiple factors involved in the meningitis cases leading to an ‘at risk’ profile of implant cases where particular actions are taken around the time of surgery to prevent meningitis. These risk factors included the presence of inner ear malformations, CSF leak2 during or after implantation, history of VP shunt2 (used for treating hydrocephalus) and recurrent otitis media (middle ear infection). There was also a particularly high incidence of post-implant meningitis with an electrode designed with a positioner (a small wedge designed to place the electrode closer to the auditory nerve endings), which has since been withdrawn from the market and subsequent electrode designs modified to minimise this risk.

Several strategies have been developed to minimise the risk of post-implantation meningitis. Not all strategies have been universally accepted, with the adoption of a range of strategies being left up to the protocols in various implant clinics, individual surgeons,

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implant recipients and their families.

Antibiotics are universally administered during implant surgery and continued for several days after. Similarly, measures to reduce the incidence of recurrent acute otitis media in infection-prone children by insertion of a grommet in both the implanted and nonimplanted ears, is also commonly practiced.

Emphasis has been placed on immunisation against a range of bacteria for implant recipients, particularly children, but also adults, those with inner ear malformations, CSF leak at the time of implantation or with VP shunts to optimise their immunisation status.

In Australia the national immunisation program ensures that children and adults have access to a range of bacterial vaccines to minimise the chances of infection, particularly Streptococcus pneumonia, Haemophilus influenzae type B (HIB) and menigococcus, from a young age. Immunisation against Streptococcus pneumonia, the most common bacterium involved in post-implant meningitis is strongly recommend for implantees of all ages by most surgeons. The immunisation schedule is widely practiced2, and changes made as new knowledge concerning the prevalence of infections in the community and more effective vaccines become available.

Hopefully these measures will see a further reduction in the already low incidence of bacterial meningitis in cochlear implant recipients over time.

Cochlear implants. Bethesda, Md.: National Institute on Deafness and Other Communication Disorders, 2003. (Accessed 1 July 1 2003, at www. nidcd.nih.gov/health/hearing/coch.asp.) 2. www. health.gov.au/internet /immunise/publishing.nsf.

1

A ventriculoperitoneal (VP) shunt is a device used to relieve pressure from the brain caused by fluid accumulation. VP shunting is a surgical procedure that is primarily used to treat a condition called hydrocephalus, which occurs when excess cerebrospinal fluid (CSF) collects in the brain’s ventricles. CSF cushions your brain and protects it from injury inside your skull. The fluid acts as a delivery system for nutrients that your brain needs, and also takes away waste products. Normally, CSF flows through these ventricles to the base of the brain. The fluid then bathes the brain and spinal cord before it is reabsorbed into the blood. When this normal flow is disrupted, the build-up of fluid can create harmful pressure on the brain’s tissues, which can damage the brain. VP shunts are surgically placed inside one of the brain’s ventricles to divert fluid away from the brain and restore normal flow and absorption of CSF. 2

Send your questions to: Hearing HQ Experts PO Box 649 Edgecliff NSW 2027 or experts@hearingHQ.com.au Emma Scanlan Principal Audiologist Australian Hearing

Q

I’ve just started wearing hearing aids in both ears and my own voice sounds terrible. My voice is echoey and it feels like I’m talking with a bucket over my head. I can hear everyone else much better than before but my own voice is so bad I don’t want to talk.

Roberta Marino: The unnaturalness of your own voice or the sound of chewing as well as the feeling of the ear being blocked or plugged up can be a real challenge for some people wearing hearing aids.

Called the occlusion effect, it is caused by the ear canal being either totally or partially blocked by either the hearing aid itself or an ear mould or plastic ear dome, depending on the hearing aid.

Normally when we speak, the bones in our skull vibrate and some of these vibrations escape through the ear canals. However, when the ear canal has something blocking it, the vibrations get trapped between the obstruction and the ear drum resulting in the amplification of a wearer’s own voice, especially in the lower frequency tones.

People with good low frequency hearing can be especially prone to the occlusion effect, particularly men with deeper, resonant voices.

As there are several solutions that could help your problem depending on your particular hearing condition, I strongly recommend you discuss your concerns with your audiologist. Typically there are three recommended solutions that could possibly reduce or eliminate the occlusion effect.

1. Venting: The creation or modification of an air vent in an in-the-ear hearing aid or the ear mould of a behind-the-ear hearing aid may help. An air vent running through the hearing aid or mould allows air trapped between the device and the ear drum to escape helping to reduce the amount of trapped vibration from the wearer’s voice and the consequent unnaturalness of the sound. Wider,

A

Associate Professor Melville da Cruz Ear, Nose & Throat Surgeon

shorter vents are typically more effective.

However, the use of an air vent and its width is highly dependent on the level of your hearing loss and which frequencies (pitches) of sound are affected. For good low frequency hearing and high frequency hearing in the moderate range, a wider, shorter vent may be a good option. But for a severe hearing loss across the whole pitch range there may not be much flexibility venting-wise because the wearer cannot afford to lose some of the amplified sound that will invariably also escape through the vent.

A wider vent could also lead to feedback, the whistling sound that is caused by amplified sound feeding into the hearing aid microphone and being re-amplified. This is more likely to occur when there is a wider vent and/or if high levels of amplification are required. Some feedback cancellation systems in hearing aids help to reduce the occurrence and severity of feedback, which allows more flexibility with larger vents.

The width of the vent also has to be limited in some cases because of the size of a person’s ear canal. For people with narrower ear canals there may not be much space to create a larger vent.

Open fit hearing aids can be a good solution for people with good low frequency hearing and a hearing loss predominantly in the higher frequencies.

These comprise of a behind-the-ear hearing aid with a thin tube receiver attached to an ear dome that sits within the ear canal. The dome (or tip) is made of a soft pliable material so it can accommodate larger vents. But this style of hearing aid does not suit all types of hearing losses due to the reduction of amplification in some frequencies that can occur and the reduced effectiveness of directional microphones and audibility in background noise.

Unfortunately with hearing aid fittings there can be a compromise between comfort and clarity. Research by Dillon, Hickson and Lloyd published in 2012¹

Roberta Marino Senior Audiologist Specialist Hearing Services

found that hearing aid non-usage rates have decreased from 23% in 2006 to 13% and attribute some of this success to the use of open-fit and thin-tube hearing aids. vent

Open Fit Hearing Aid (Unitron Moxi2 RIC)

vent In-Ear Hearing Aid (Siemens Insio ITE)

2. ITC models: Sometimes a deeper-fitting completely in-the-canal hearing aid can help with the occlusion effect by reducing the space between the hearing aid and the ear drum. However, these deeper fitting aids are not recommended for everyone and can only be fitted for certain hearing loss configurations. Also, some wearers can find the deeper sitting aids uncomfortable to wear.

vent In-Canal Hearing Aid (Unitron Quantum2 Micro CIC)

3. Setting adjustments: Sometimes changing the amplification in some frequencies can improve the quality of the wearer’s own voice so it is worth discussing this with your audiologist.

In some cases, unfortunately even with your audiologist’s best efforts, the occlusion effect can still be present.

Often the benefits of amplified hearing delivered by hearing aids eventually outweigh the negative by-product of having a blocked ear canal. ¹Dillon H, Hickson L and Lloyd T. Outcomes of the Australian Government Hearing Service Program.

Audiology Australia National Conference, Adelaide, 1-4 July 2012.

Hearing HQ Dec 2013 - Mar 2014

29

real

REAL PEOPLE

ADVANTAGE LUI!

Most Australians are passionate about their sport, both playing and watching, and those who are deaf or hard of hearing are no different.

Sydney-born 28-year-old John Lui is a deaf tennis player and coach who as a child dreamed of playing on the professional circuit. Today, as a singles player in deaf tennis he is ranked No. 8 in the world and No. 2 in Australia. He’s not far from reaching his goal to be in the world’s Top 5 and Australia’s No.1.

His father’s career took the family to Brunei, Holland, Hong Kong, Texas and Sydney, but as John recalls, “It was in Hong Kong that I really got hooked into tennis as an 11-year-old watching the legendary Pete Sampras on TV at his ferocious best on the hallowed lawns of Wimbledon.”

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Hearing HQ Dec 2013 - Mar 2014

top Deaf tennis players, but also the finest Deaf athletes from all over the world. I came away both proud and surprised that I’d been given an opportunity to represent Australia on the world stage.

And, I started to believe what many were saying, that I had a realistic chance of becoming one of the world’s top Deaf tennis player.”

During the opening ceremony dress rehearsal of the Taipei Deaflympics in 2009 where all athletes were invited to watch the ceremony from the stands, John was so inspired and moved that he shed a few tears. “This was the first time I felt that I truly belonged in an elite group of world-class athletes and decided to make this my life.” That same year he graduated from Macquarie University with a bachelor degree in Social Science/ Law and founded his own coaching business, Lui Tennis.

In 2012, John achieved his highest ranking of world No.7 in singles and looks to rise even higher.

It is through this world of deaf sports that John has made many lifelong friendships with his Australian Deaflympian teammates and international competitors. His respect and admiration continues to grow for these fellow athletes as they go on to win medals and set personal bests.

Regardless of the result or the sport, there is undeniably great honour and pride in this worldwide community of Deaf athletes to be representing their country with distinction on the world stage and John is proud to be one of them.

John is vice-president of Deaf Tennis Australia, a non-profit organisation that is responsible for all levels of deaf tennis from grassroots to national and international representative level. He is also the NSW Program Coordinator for Hear For You, a non-profit organisation that provides support and mentoring to hearing-impaired teens.

2013 Deaflympics pictures: Karen Clare

John Lui with team manager David Brady (left) at the 2013 Deaflympics in Sofia, Bulgaria

Born profoundly deaf, John wore hearing aids until he received his cochlear implant at the age of ten.

His identity as a tennis player was important through his teenage years as it gave him direction and optimism for the future. It also gave him common ground to share with people while living in other countries and it was a sanctuary where he could escape from everyday life. Plus it was something he was really good at.

While his talent was nurtured initially by his neighbourhood coach in Hong Kong who had the difficult task of teaching a stubborn but passionate kid the finer points of tennis and self-control, he learned a lot more during six months at the John Newcombe Tennis Academy in Texas in 2000. After Texas he returned to Sydney to complete his schooling at St Andrew's Cathedral School and further his technical and tactical training in tennis with John Eldridge.

The turning point in John’s tennis experience came in 2003 when he found out about Deaf Tennis Australia and was selected to compete for NSW in the Australian Deaf Games in Sydney. “I felt totally at ease with my teammates and the other competitors in the Games because everyone else was deaf. There were no misconceptions or prejudices over misunderstandings or any funny looks at my implant. I could just be myself,” says John. “I loved meeting people from all walks of the Deaf sporting community – those who were oral, signing or both! It was a whole new world I could be part of.”

Despite the excitement of the competition, John was plagued with doubt and disappointment that he would never be able to achieve his dream of playing professional tennis. But this started to change when he was selected for the Australian Team to compete in the 2005 Deaflympics in Melbourne. “During the Games, I was exposed to not just the

'

stories...

Watching the 2013 Deaflympics Tennis in Sofia, Bulgaria

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success in deaf sports GLEN FLINDELL (TENNIS): Once ranked as high as No.5 in the world for Deaf tennis, Glen suffered two bitterly disappointing first round losses in the 2005 and 2009 Deaflympics despite having high expectations. In Sofia in 2013, on his least preferred surface, he managed to not only win his first round match but made it through to the bronze medal playoff in both singles and doubles, twice coming within a set of taking a medal home but succumbed to the Austrians in both playoffs. He has been rewarded with a new ranking of World No.6 – not bad for a 33-year-old athlete!

AMY-LEA MILLS (ATHLETICS): With unshakeable faith in herself and trust in her grandfather/coach, Amy overcame her disappointing performance at the 2009 Taipei Deaflympics and the negative feedback to soar from 4th place to 1st on her last javelin throw at the 2013 Sofia Deaflympics. The teary emotion of the experience for both 26-year-old Amy and her stoic grandfather was enough to cause more than a few lumps in the throats of those from the Australian team who had come to watch and support her. This was definitely a much sweeter victory than her first gold medal in the 2005 Melbourne Deaflympics.

LAUREN HAY (CYCLING): A strong track athlete in the 2001 Rome and 2005 Melbourne Deaflympics, 32-year-old Lauren made the brave decision to switch to cycling after a knee injury in 2012. She placed a commendable 6th place in the 2013 Sofia Deaflympics.

MELINDA VERNON (ATHLETICS): A former City to Surf champion, Melinda dominated the 5,000m and 10,000m events at the 2009 Taipei Deaflympics by more than a lap over her nearest rival from Russia. In Sofia in 2013 she was suffering from the after-effects of

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with Australia’s most experienced cochlear implant program

an Achilles’ heel injury. Despite the blisteringly hot conditions she pushed through with a champion’s mettle. The 28-year-old claimed silver and bronze in the same events behind the same Russian who she beat for gold in Taipei and who had been able to train fulltime for two years prior to the Sofia Games.

2013 SPORT AWARDS Deaf Sports Australia

MALE ATHLETE OF THE YEAR Winner: Jack McLeod (golf) Nominees: Glen Flindell (tennis) Michael Anderson (swimming)

FEMALE ATHLETE OF THE YEAR Winner: Amy-Lea Mills (athletics) Nominees: Jamie-Lee Lewis (water polo) Melinda Vernon (athletics)

RISING YOUNG STAR AWARDS: Julia Algie (swimming) Monique Beckwith (swimming) Sekou Kanneh (athletics)

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here to help Many not-for-profit organisations around Australia and government agencies provide valuable support, advice and information on hearing issues. Please visit www.hearingHQ.com.au to find out more about any of these organisations and to link directly to their websites. For an organisation to be considered for listing they must be a not-for-profit, charity or completely free service.

INFORMATION & SERVICES ACT Deafness Resource Centre - Canberra Information, referral and advocacy services T 02 6287 4393 TTY 02 6287 4394 F 02 6287 4395

The Royal Victorian Eye & Ear Hospital Cochlear Implant Clinic T 03 9929 8624 F 03 9929 8625 E cic@eyeandear.org.au

Audiological Society of Australia Inc Information on national audiological services T 03 9416 4606 F 03 9416 4607

Tinnitus SA Impartial tinnitus information and options T 1300 789 988

Australian Government Hearing Services Program Government assistance eligibility information T 1800 500 726 TTY 1800 500 496

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

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

ADVICE & SUPPORT

Better Health Channel VIC Govt funded health & medical information www.betterhealth.vic.gov.au Deaf Can:Do (formerly Royal SA Deaf Society) Services to SA deaf and hearing impaired T 08 8223 3335 TTY 08 8223 6530 F 08 8232 2217 Deafness Foundation Research, education & technology support T & TTY 03 9738 2909 F 03 9729 6583 Ear Science Institute Australia Implant Centre Help with ear, balance & associated disorders T 08 6380 4944 F 08 6380 4950 Guide Dogs SA.NT Adelaide based aural rehabilitation service T 1800 484 333 TTY 08 8203 8391 F 08 8203 8332 HEARnet - a better understanding of hearing loss & interactive ear diagram. www.hearnet.org.au T 03 9035 5347 Lions Hearing Clinic Free or low cost services in Perth T 08 6380 4900 F 08 6380 4901 Lions Hearing Dogs Australia Provide hearing dogs and training to recipients T 08 8388 7836 TTY 08 8388 1297 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 Parents of Deaf Children - NSW Unbiased information, support and advocacy T 02 9871 3049 TTY 02 9871 3193 F 02 9871 3193 SCIC - Sydney Cochlear Implant Centre Gladesville, Newcastle, Canberra, Gosford, Port Macquarie, Lismore, Penrith T 1300 658 981 Telecommunications Disability Equipment Contact information for special phones: Telstra 1800 068 424 TTY 1800 808 981 F 1800 814 777 Optus 133 301 937 TTY 1800 500 002 The Deaf Society of NSW Information & services to NSW Deaf people T 1800 893 855 TTY 1800 893 885 F 1800 898 333 SMS 0427 741 420

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Hearing HQ Dec 2013 - Mar 2014

Acoustic Neuroma Association of Australia Support and information on treatment E info@anaa.org.au T 03 9718 1131/02 4421 6963 Aussie Deaf Kids Online parent support and forum www.aussiedeafkids.org.au

Cora Barclay Centre - Adelaide Auditory-Verbal Therapy for 0-19 year olds T 08 8267 9200 F 08 8267 9222 Hear and Say Centres - QLD Early intervention and cochlear implants T 07 3870 2221 F 07 3870 3998 RIDBC (Royal Institute for Deaf and Blind Children) Hearing and vision impaired education & services T & TTY 1300 581 391 F 02 9871 2196 RIDBC Hear The Children Centre - Sydney Early childhood intervention for hearing impaired T 1300 581 391 F 02 9871 2196 RIDBC Matilda Rose Centre - Sydney Early childhood intervention for hearing impaired T 02 9369 1423 F 02 9386 5935 Taralye Oral Language Centre - Melbourne Early childhood intervention & advocacy T 03 9877 1300 F 03 9877 1922

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

Telethon Speech & Hearing - Perth Early intervention program and specialist paediatric audiology services T 08 9387 9888 F 08 9387 9889

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

The Shepherd Centre - NSW & ACT Early intervention and cochlear implants T 1800 020 030 F 02 9351 7880

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

ADVOCACY & ACCESS SERVICES

CICADA Australia Inc For people with or considering cochlear implants www.cicada.org.au CICADA Queensland For people with or considering cochlear implants E cicadaqld@tpg.com.au CICADA WA For people with or considering cochlear implants Coordinator: Lynette 08 9349 7712 Deaf Children Australia Services for hearing impaired children T 1800 645 916 TTY 03 9510 7143 F 03 9525 2595 Hear For You Mentoring hearing impaired teens E info@hearforyou.com.au Meniere’s Australia Dizziness & balance disorders support T 1300 368 818 F 03 9783 9208 Self Help for Hard of Hearing People (Aus) Inc Educational association T 02 9144 7586 F 02 9144 3936

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

BHA Tinnitus Management Services T 1300 242 842

BHA Hearing Aid Bank - donate old hearing aids T 1300 242 842 T 03 9510 1577

EDUCATION

Planet Ark - Find a battery recycler near you www.recyclingnearyou.com.au/batteries

Can:Do 4Kids - Adelaide Programs for deaf, blind & sensory impaired kids T 08 8298 0900 TTY 08 8298 0960 F 08 8377 1933 Catherine Sullivan Centre - Sydney Early intervention for hearing impaired children T 02 9746 6942 F 02 9764 4170

JobAccess Disabilities workplace solutions T 1800 464 800 TTY 1800 464 800 F 08 9388 7799

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column books etc...

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

As my four-year-old son and I were leaving preschool recently I cautioned him, “Now, remember to hold my hand in the car park, Asher.” Just then another mother close by whipped around. “Oh! So you are Asher!” she said to him.

“My daughter talks about you all the time. It’s Asher this and Asher that…

She just loves you!” He smiled broadly.

And then with surprise she turned to me. “She never mentioned that he has hearing aids, though...” At that moment I was stunned and exhilarated that, to a child, Asher is simply recognised as a wonderful boy - fun and kind. To his little peers, he is defined foremost by his personality - rather than his impairment.

A rush of relief coursed through me and I was instantly taken back to the surreal moments immediately after he was diagnosed with his hearing impairment at just 6 weeks of age. I remember choking back sobs of fear in the hospital cafeteria as I processed the news. I worried at how my gorgeous boy might fair at the hands of children around him because of his difference.

And with this one small exchange four years later those fears that I had carried evaporated. To his peers, it seems, Asher is simply Asher – which is all I can ever hope for him. Life is good indeed!

NF2: Our Journeys To help and inspire others, 44 extraordinary individuals from around the world have united to create the first non-clinical book about Neurofibromatosis Type 2 (NF2).

NF2: Our Journeys contains a collection of inspirational life stories written by people with NF2 and is the first project by a new self-help, support and social advocacy group for people with NF2 called Can You Hear Us?, founded in January 2013

by Jessica Cook (who herself has the condition).

NF2 can cause hearing, sight, balance and mobility difficulties, and above all can be life-threatening. It occurs in 1 in 35,000 of the population and involves the growth of multiple benign tumours throughout the nervous system, most commonly in the brain and spine.

Can You Hear Us? are on a mission to prove it is possible to live a happy and fulfilled life while battling with a degenerative condition, that currently has no cure, through the uniting and presenting of people who refuse to be defined by the disease.

Funds raised through book sales will go towards supporting those with the condition and raising awareness. To order visit www.canyouhearus. co.uk (£8.99 including free international postage).

A new independent short film by Lisa Reznik based on a true story and exploring the emotional obstacles parents face when they get an unexpected diagnosis of hearing loss for their child is in the official selection for the 2013 Fort Lauderdale International Film Festival.

Filmed in New York, 95 Decibels is about a young family who suspect their first child isn't hearing. Having limited experience with deafness, the parents of Sophia must determine which medical options and communication strategies will best serve their toddler daughter. They seek the advice of medical professionals as well as parents of other hearing-impaired children in coming to terms with the decisions ... making these decisions becomes difficult and dramatic.

The story also explores the cochlear implant and the auditory-verbal therapy philosophy, a set of principles designed to achieve maximum use of hearing for learning. AVT promotes early diagnosis, one-on-one therapy, state-of-theart audiological management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching and demonstration, parents become the primary facilitators of their child's spoken language development.

Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social and occupational choices throughout life.

For those who were fans of the long-running hospital TV drama ER, the 28 minute 95 Decibels features hunky actor Goran Visnijic as ENT surgeon Dr Corry.

Visnijic played ER’s Dr Luka Kovac for nine years, joining the series in late 1999 to replace the departing George Clooney as the show’s male lead.

To view a trailer of the film or purchase a copy of the DVD online visit www.95decibels.com (US$35 including international shipping fee). Any questions?

Post on www.facebook.com/95Decibels.

For more book reviews go to www.HearingHQ.com.au 34

Hearing HQ Dec 2013 - Mar 2014

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