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Dec 15 - Mar 16
Avoiding summer hearing woes
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AUDITORY REHAB hearing aids only part of the answer
FIRE! FIRE! How to access smoke alarm subsidies
GEOFFREY RUSH
Cochlear Implant Diary - part 2
Why his senses are all mixed up
surgery & switch on
SPECIAL REPORT: You can boost hearing with your brain
REAL PEOPLE
Deaf lawyer Kathryn O'Brien tells her amazing story
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editorial advisory board Emeritus Prof William Gibson AM
Prof Gibson held the Chair of Otolaryngology at The University of Sydney until August 2013 and was head of ENT at The Royal Prince Alfred Hospital. He is the founder and director of the Sydney Cochlear Implant Centres, and still sees patients privately. He is also currently undertaking research into Meniere’s Disease.
Assoc Prof Robert Cowan, CEO HEARing Cooperative Research Centre
Principal Research Fellow of Melbourne University, A/Prof Cowan has researched and published extensively in the fields of audiology, cochlear implants, sensory devices and biomedical management. He holds the '06 Denis Byrne Memorial Orator Award.
Sharan Westcott Clinical Manager, SCIC
Former principal audiologist for Australian Hearing, Sharan Westcott has provided audiology services to children and adults for more than 40 years and now coordinates a team of surgeons, audiologists, speech pathologists and social workers at SCIC.
contents contents FEATURES
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SPECIAL REPORT: BRAIN POWER
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SENSORY RUSH
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COCHLEAR IMPLANT DIARY - Part 2
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AUDITORY REHABILITATION
Get to grips with your grey matter to maximise hearing with leading audiologist Catherine McMahon. Geoffrey Rush reveals secrets about his colourful life caused by a condition called synesthesia.
Liz Efinger has surgery and finally experiences 'switch on' day.
What is it and how can it help you?
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.
REGULARS
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NEWSBITES
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ALL ABOUT
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ASK THE EXPERTS
Alex Varley, Chief Executive Media Access Australia
MAA focuses on identifying practical, realworld solutions for people with disabilities to access audiovisual content to empower people to be independent. They provide advice to government, industry, educators and individuals.
Dr Neville Lockhart
After 45 years of profound deafness Dr Lockhart received a cochlear implant in 2005. His involvement in the cochlear implant support group CICADA and his technology background (retired senior CSIRO scientist) led him to become editor of CICADA Magazine (now Hearing HQ).
Olivia Andersen, Founder/Director Hear for You
Profoundly deaf from birth, Olivia Andersen started Hear For You, a not-for-profit organisation to help young deaf people achieve their life dreams. The birth of her first child prompted her decision to have a cochlear implant. The 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 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.
Published by The Tangello Group Pty Ltd EDITOR Rebecca Barker, editor@hearingHQ.com.au EXPERTS Assoc. Prof. Melville da Cruz, Emma Scanlan, Roberta Marino, Jawan Sayed CONTRIBUTORS Liz Efinger, Kathryn O'Brien, Assoc. Prof. Catherine McMahon, Prof. Louise Hickson, Emma Scanlan, Linda Collard ADVERTISING SALES MANAGER Sally Davis, sally@tangello.com.au 0438 177 036 PUBLISHER Lucinda Mitchell, lucinda@tangello.com.au Printed by Offset Alpine
FIRE! FIRE! plus research, innovations and things you need to know.
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REAL PEOPLE
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PRODUCTS & SERVICES
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HERE TO HELP
JobAccess.
Professional advice on readers' questions and concerns.
Inspiring solicitor Kathryn O'Brien was the first deaf lawyer to represent a client in a Queensland court.
Information at your fingertips. Organisations providing advice and support.
SUBSCRIBE Personal orders: $25/year for 3 issues posted to your home Multiple copies - Small Bulk: $35/year for 3 issues (5 copies of each issue) - Large Bulk: $55/year for 3 issues (45 copies of each issue) For all orders you can subscribe - online at www.hearingHQ.com.au - post the form on page 25 to Hearing HQ, PO Box 1054, Lane Cove NSW 1595
HQ hearing
Hearing HQ Magazine is published by The Tangello Group Pty Limited 'The Tangello Group' (ABN 38 155 438 574) PO Box 1054, Lane Cove NSW 1595 and 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”. 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 the accuracy and veracity of all content and advice herein but neither Hearing HQ Magazine, its publisher, contributors or editorial advisory board members is responsible for damage or harm, of whatever description, resulting from persons undertaking any advice or purchasing any products mentioned or advertised in Hearing HQ Magazine or its website.
Hearing HQ Dec 15 - Mar 16
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ed's letter
Research has shown that it can take 10 years or more for people with hearing loss to seek help. Living with hearing difficulties can be a lonely and emotional journey that deeply affects the individual and their loved ones. While today’s hearing technology can greatly improve common feelings of depression and social isolation, there are many ways to improve your quality of life and auditory ability other than using hearing aids and implants (see our practical features on auditory rehabilitation and JobAccess). With millions currently being spent on brain research, we welcome guest writer Associate Professor Catherine McMahon, head of audiology at Sydney’s Macquarie University, to show how this amazing organ complements our hearing and how we can maximise its potential over a lifetime. Plus don’t miss our celebrity special on actor Geoffrey Rush who reveals more cerebral secrets including an intriguing cross-sensory condition that colours his world. Enjoy the issue and feel free to get in touch! Rebecca Barker Editor
To have your say contact: editor@hearingHQ.com.au
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newsb newsbit LET THE GAMES BEGIN
The excitement of the Rugby World Cup is over but patriotism will be kept alive at the world’s first deaf rugby test in South Australia, which will be played between Australia and Samoa as a grand finale to the 17th Australian Deaf Games in Adelaide. Attracting more than 1,000 hearing impaired competitors from across Australia and the Pacific Islands and showcasing 15 sports including cricket, basketball, swimming and athletics, the fouryearly Games run from January 9 to 16. More than 100 volunteers will ensure the smooth running of the 7-day sporting extravaganza, for which Adelaide High School and surrounding world-class sporting facilities have thrown open doors to host events. Aussie basketball champ Sam Cartledge (far right), 21, who seized gold with the Australian men’s deaf basketball team at the Asia Pacific Deaf Championships in Taiwan earlier this year, is aiming to represent New South Wales in the game and also plans to compete in touch football and mixed netball. The multi-talented sportsman juggles three jobs with Australian Hearing, Deaf Sports Australia and Hear For You. “I am looking forward to having fun, winning and catching up with friends and athletes from all over Australia,” said Cartledge. Free transport will be laid on for competitors and their families. For more information and a sports schedule see www. austdeafgames.org.au.
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Sports Extra The amazing achievements of the country’s deaf and hard of hearing athletes are being celebrated at an exhibit at Melbourne Cricket Ground’s National Sports Museum. The Australia at the Deaflympics showcase gathers a collection of awards, uniforms and equipment used by deaf athletes who have battled adversity to reach the highest level of international competition. Visitors have the option to use a Conexu OpenAccess Tours app, which when downloaded onto a smartphone, offers tours in Auslan or captioned audio. The exhibition runs until October next year.
More than 100 deaf poker players descended on Melbourne’s Crown Casino in October to contest the Deaf Poker Australia (DPA) Championship. Players from all over Australia and New Zealand took part with Melbourne’s Khari ‘The Cobra’ Sou (below) becoming the third Melburnian in a row to win the coveted main event title.
L to R: Dean Barton-Smith AM, Former Deaflympian and Olympian; Helen Walpole, National Sports Museum Curator; Garry West-Bail, Deaf Sports Australia General Manager; Phil Harper, Deaf Sports Australia President; Megan Rowland, National Sports Museum Assistant Curator.
Birth Weight And Hearing Issues Linked He is also the first player in DPA history to win this crown and participate in the winning DPA State of Origin squad the same year. New South Wales’ Carlos Navarro and New Zealand’s Caleb Thorn clinched second and third places respectively. Deaf Poker Australia was established in 2008 as a nonprofit organisation to promote the card game throughout the country’s deaf communities. Both sign language and English are used at the tables and championship events are held at casinos in most states with the next championship taking place at Adelaide Casino in October 2016. For more information see www.deafpoker.com.au.
More needs to be done to improve the birth weight and growth of infants to improve their hearing outcomes, according to new research from the UK. Researchers at Manchester University discovered that very small and very large babies have the poorest hearing abilities compared to their peers. A study of up to 433,390 UK adults has linked being under and overweight at birth with poorer hearing, vision and cognition in middle age. Dr Piers Dawes, a lecturer in audiology at The University of Manchester's School of Psychological Sciences that led the study says: "These findings suggest that issues begin to develop right from early life. While interventions in adulthood may only have a small effect, concentrating on making small improvements to birth size and child development could have a much greater impact on numbers of people with hearing, vision and cognitive impairment,” says Dawes. The paper, ‘The Effect of Prenatal and Childhood Development on Hearing, Vision and Cognition in Adulthood’ was published in the journal PLOS One, and results strongly suggest that under-nutrition may impact on the development of the brain and sensory systems. Source: http://www.manchester.ac.uk/discover/ news/birth-weight-and-poorchildhood-growth-linked-to-hearingand-vision-problems-in-middle-age.
= child’s play... A child’s hearing is routinely tested at birth but not usually re-examined before school – meaning thousands of children start primary education with auditory issues that develop after infancy. A new mobile game called Sound Scouts is now available for iphones, ipads and tablets, to detect hearing problems in a child-friendly way. Launched by former television presenter Carolyn Mee, with support from the National Acoustic Laboratories, the game follows the adventures of Patch, a bionic-eared dog. Mee, who won funding for the project four years ago from NSW Digital Media initiative says a practical, fun game was needed to catch children who fall through the cracks of the current hearing test system. “Research has confirmed that more than double the number of children have a hearing loss detected between the ages of five and eight compared to the number detected at birth,” explains Mee. Sound Scouts is designed to determine between three types of auditory issues including conductive and sensorineural hearing loss and central processing disorders. Mee and her team hope many years of classroom anguish can be avoided using the game for early detection and possible treatment. “…No child has to go through years of school at a disadvantage to others because of unmanaged hearing loss,” says Professor Harvey Dillon, director of project collaborator National Acoustic Laboratories. See www.soundscouts.com.au. Hearing HQ Dec 15 - Mar 16
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newsbites newsbites FIRE! FIRE!
One in five people have a fire-related accident at home with 37 per cent of subsequent deaths happening due to a bedroom blaze at night. Unfortunately, the hard of hearing are at an increased risk of fatality. According to a recent survey by The Deaf Society, one in three people admitted they were not sure if they would hear their smoke alarm if asleep. To address this problem and the expense it can involve, organisations including The Deaf Society and Fire and Rescue NSW have launched schemes to lower the cost of smoke alarms from as much as $500 to $20. These subsidised specialist alarms, which include a strobe light and pillow shaker, can be obtained by filling out a form at www.deafsocietynsw.org. au/smokealarms. Most of the alarms can be linked to other same-branded devices around the house. Leonie Jackson, CEO of The Deaf Society stresses the importance of ensuring your home is fire-safe. “The lives of people with a hearing loss are at risk when in an emergency, particularly involving fire, because they are not given optimal, timely warning of a house fire threat. It’s important people with a hearing loss are able to have access to the specialty smoke alarms available,” says Jackson. For smoke alarm subsidies in other states see: www.vicdeaf.com. au, www.deafserviceqld.org. au/sass, www.guidedogs. org.au/smoke-alarm-scheme (SA), www.tasdeaf.org.au. Schemes are not available in Western Australia and Northern Territory but eligible candidates can apply for a grant in WA at www.ilc.com.au. 6
Hearing HQ Dec 15 - Mar 16
Can a computer predict cochlear success? Researchers at America’s Cincinnati Children’s Hospital are using a new computer program that analyses brain MRIs of hearing impaired youngsters to predict their language skill development after cochlear implant surgery. As noted in the journal Brain and Behavior, it is hoped the computer may be able to screen patients with sensorineural hearing loss before surgery to reduce the numbers of children undergoing expensive, invasive surgery that produces disappointing results. The computer is said to interpret data from functional MRIs that measure blood flow in infant brains during auditory tests. Medics are hopeful the computer will be a useful clinical tool. “We have developed one of the first successful methods for translating research data from functional MRIs of hearing-impaired children into something with potential for practical clinical use with individual patients,” said Dr Long (Jason) Lu, a researcher in the Division of Biomedical Informatics at the hospital. Lu’s study included 44 infants some of whom were hard of hearing and others with normal hearing. Twenty-three children had cochlear implant surgery and their language performance was measured two years later to be used as a benchmark for future computer analysis.
Holy Headphones Batman! Listening to music via headphones while exercising or cycling can be dangerous but a new bone conduction headband promises to deliver a safer experience. Following in the steps of similar devices, such as Aftershokz Bluez headphones, the Batband is a streamlined design that sits around the back of the head and transmits sound waves through three bony points in the skull, leaving the ears uncovered for hearing aids or simply listening out for conversation or hazards. Compatible with Bluetooth for wireless audio streaming, the headphones can be used for listening to music, gaming or making calls, by touching buttons on the band. Funded by the crowd-sourcing site Kickstarter through the European company Studio Banana Things, the headphones, starting from US$199, are batterypowered offering up to six hours of music or eight hours of talk time. Shipping is expected to be available to Australia from April 2016. For more information see www. batband.com.
Audiologists under microscope
After recent news exposes about audiologists upselling hearing aids to vulnerable clients, the Australian Competition & Consumer Commission – the country’s customer welfare watchdog – launched a survey urging people with concerns about audiologists’ conduct to contact them. Although the survey officially closed on November 6, the ACCC says it is happy to receive further submissions until the end of 2015. Around a third of Australian audiology clinics are owned by hearing aid companies and some audiologists gain commission by upselling their products. At present, there are no government regulations on who can sell and fit hearing aids. Audiology Australia has made calls to regulate the practice and recommends finding a reputable hearing clinic with university-trained audiologists. Its members are directed to follow a code of conduct that states they must declare any relations with hearing aid manufacturers or any conflicts of interest. Isabelle Arnaud, the ACCC’s national director of enforcement, said: “We are not investigating the industry as such, we are in the preliminary stages of gaging whether there is any questionable conduct in the industry,” she said. If you have a personal experience on this topic you would like to relate to the ACCC, phone 1300 302502 or visit www.accc.gov.au/contact-us.
A such as chronic pain, arthritis, depression
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TIC ATTRAC E TIO The beneficial effects GNof magnets to treat conditions
and even cancer, have been debated for years. But now recent studies show they may alleviate tinnitus symptoms. The irritating and often debilitating ringing, whooshing and whistling sounds that plague around 17 to 20 per cent of Australians are said to be caused by factors such as loud noise, medication or an underlying medical problem. These cause a fault in the hearing system and can lead to health issues like depression, stress and fatigue. There is no current cure for tinnitus but it can be eased by ear devices that mask the annoying noises and medications are being developed to treat it. In the meantime, researchers at Oregon Health and Science University in the US have developed a treatment regime that uses magnetic pulses to the brain which promise to ease symptoms for up to six months. In a clinical trial, documented in the medical journal JAMA, 70 patients underwent 2,000 magnetic pulses to the scalp over 10 days while others were placed in a placebo group. After 26 weeks, the treated patients noted up to a third reduction in tinnitus symptoms. Source: VA Portland Medical Center and Oregon Health & Science University; JAMA Otolaryngology – Head & Neck Surgery.
Enjoy more of the moments that matter most Roger is the new digital standard that bridges the understanding gap in noise and over distance, by wirelessly transmitting the speaker’s voice directly to the listener. Highly discreet and hassle-free, Roger devices provide a solution to individuals who struggle to hear and understand speech in difficult listening situations such as noisy classrooms, bars and restaurants, outdoors, in public spaces, and even in the car. Learn more at: www.phonakpro.com.au
Brain The brain plays a vital role in hearing but how can we unlock its mysteries and maximise its potential? Associate Professor Catherine McMahon (below), head of audiology at Sydney’s Macquarie University investigates.
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n power The world’s population is rapidly ageing due to longer life expectancies and declining fertility rates, particularly in the developed world. By 2050, for the first time in history, there will be more people aged 60 or over than those 15 and under. The United Nations World Population Ageing Report predicts the number of people 60-plus will double from 11.7 per cent in 2013 to 21.1 per cent by 2050 meaning there will be over two billion older adults. This provides a major challenge for developing financially sustainable policies and systems to maximise the health and social wellbeing of older people. There is increasingly good evidence that suggests as we age, sensory and cognitive abilities decline. This can lead to reduced independence, increased reliance on and use of health care and community services, and a higher risk of death. As recent studies show, the brain and ears are intertwined in this process. For example, researchers from America’s John Hopkins Medical Centre discovered that people with mild hearing loss have a two-fold increased risk of acquiring dementia compared to those with normal hearing. This statistic spirals to five times more likely for people with severe hearing loss. Furthermore, an Australian study in older adults showed that hearing loss is associated with an increased risk of mortality. This was supported by the findings of John Hopkins researchers, who discovered the greater a person’s hearing impairment the greater their risk of death (as
Peak Brain Matter
reported in the medical journal JAMA). Such declines are typically associated with reductions in brain volume and changes to brain and brainstem neural wiring patterns. For example, advanced cases of Alzheimer’s disease, the most commonly known type of dementia, show brain shrinkage and neural cell death while adult-onset hearing loss is associated with brain volume and white matter changes. But it is not all doom and gloom contrary to outdated ideas that the brain was fixed and unable to be rewired from a very young age - it is now known that it is an incredible, ever-changing organ that complements our hearing, among many other senses, throughout our lives. In addition, humans are resourceful and are able to find ways to adapt to reductions in sensory and cognitive information, despite significant brain changes. For example, the brain changes that occur in Alzheimer’s disease might occur approximately 20 years before symptoms of memory loss start to show. In the case of communication, while cognitive abilities decline from 20 years of age, knowledge of language and worldly experience increase with age, so older adults are able to use this knowledge and context to compensate for reduced cognitive and auditory function to make sense of what is being said. The ability of the human brain to adapt to change is known as neuroplasticity. Neuroplasticity can be beneficial, where brain function can be enhanced with
Peak Numeric Ability
Peak Inductive Reasoning
Insights Into The Aging Mind: A View From Cognitive Science. T Hedden & D Gabrielli Stanford University Peak Verbal Ability
increased use. However, sometimes it can also be detrimental. When there is a disconnect between the ear and brain, things can go wrong. Following are three auditory problems that highlight the interactions that occur between the ear and the brain: cross-modal plasticity; tinnitus; and auditory processing disorder. CROSS-MODAL PLASTICITY In people with severe-profound hearing loss, the auditory part of the brain can be partly taken over by the visual system through a process of competitive advantage known as ‘cross-modal plasticity’. Certainly, studies have identified that congenitally deaf adults show superior visual attention to hearing people. However, the question that researchers are seeking to address is whether cross-modal plasticity can limit the ability of individuals to perceive speech when audition is restored, such as through a cochlear implant. There is some research to suggest that this is the case. Researchers in Hanover, Germany, showed that visual patterns presented to post-lingually deafened cochlear implant users activate both visual and auditory centres in the brain. Importantly, they showed that people with a more active auditory cortex from visual stimuli had poorer speech perception abilities. TINNITUS Another adverse outcome of deafness is tinnitus - the ringing in the ear. Scientists now believe that tinnitus is caused by increased neural activity in the brain, often after the ear is damaged after exposure to loud noise. Tinnitus is likely to be a by-product of the brain’s effort to compensate for the reduced sound activity coming from the ear by turning up the volume as neural information is transmitted to the brain. Several animal and human studies of tinnitus have demonstrated that a reduction of neural input from the ear, can lead to enhanced Hearing HQ Dec 15 - Mar 16
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Understanding listening effort: Setting up for brain imaging and eye-tracking studies.
Simultaneous measurement of brain oscillations and pupil dilation in understanding how we use our brain to listen.
Brain imaging using the prototype cochlear implant magnetoencephalography (MEG) system in the KIT-Macquarie Brain Sciences Laboratory. Images:- courtesy of the HEARing Co-operative Research Centre.
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activity at higher auditory centres - in the brainstem or the brain. Around 25 per cent of people who have tinnitus are said to be bothered by it. These people are likely to also show greater than average activity in the emotional (limbic) and stress (autonomic) systems of the brain. AUDITORY PROCESSING DISORDER Auditory processing disorder was originally considered a disorder of people with normal hearing. It remains a broad umbrella term that is diagnosed by behavioural tests and the causes of this are highly debated, but it results in considerable difficulties understanding speech in noisy environments. It is likely due to multiple disruptions to the auditory pathway, such as poor integration of signals from each ear (which is important for sound localisation), or being unable to detect a difference in sounds that are played close in time or close in pitch. It is now becoming clear that auditory processing disorders can occur at the same time as hearing loss, making it more difficult to understand speech in noisy environments. THE IMPORTANCE OF RESEARCH The healthy adult brain has over 100 billion neurones and 100 trillion neural connections (synapses). Therefore it will take a concerted effort from scientists, funders, and patients to understand how it normally works, how disease or injury can affect this, and how therapies can restore function. America’s National Institute of Health (NIH) has committed billions of dollars to develop techniques and technologies to explore how the brain works. Known as the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative (see www. braininitiative.nih.gov), NIH has already allocated US$127 million since 2014 (around A$179m) to the project. High resolution imaging techniques, such as functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG), enable scientists to assess the brain’s structural and functional integrity. These technologies provide an insight for scientists to understand how rehabilitation techniques after damage or disease can restore the brain’s map. In our own research, conducted through the HEARing Co-operative
Research Centre program, we investigated how tinnitus affects the auditory brain of adults, and how treatment restores its function. In a 30week treatment program of 12 adults with significant tinnitus, everyone with the condition showed a positive improvement. We compared the brain’s response to a range of pure tones. At 500Hz (the sound level where all participants, including 10 control subjects, had normal hearing), we compared its location and amplitude. Our results showed two main points. Firstly, people with tinnitus had larger waveforms than non-tinnitus participants which did not change significantly throughout treatment. This suggests the brain’s auditory volume control in people with tinnitus is turned up higher than in people without it and that treatment was not effective in turning this down. Secondly, the tonotopic map was disrupted in people with tinnitus, where the cerebral response to the 500Hz tone was located at the front area of the brain. However, this did shift towards a more normal location throughout the program. Brain plasticity in adults during rehabilitation from injury has been observed in other areas of healthcare. For example, studies in stroke rehabilitation show associations between reorganisation of the motor and sensory cortices and functional recovery of limb and hand movements. Understanding brain plasticity might enable new tools for intervention to be designed or finetuned for people in need. The association between the sensory input received through the ear and the processing of this input by the brain has long been overlooked. For many years, the ability to perceive and understand speech has been considered to be a function of the ear and auditory pathways. However, recent research highlights the importance of the brain in this process, particularly in situations in which the auditory signal is degraded, either from background noise or from hearing loss. That is, when the signal is poor, the brain must work harder to understand what is said. This is now more commonly referred to as cognitive load, or listening effort. Anecdotal reports suggest that people with hearing loss are often fatigued by the end of the day, which probably results from
maintaining high levels of concentration or effort to participate in conversations. For some, this could lead to social isolation. It might also explain why two people can obtain the same speech scores on a clinical test but only one believes that it reflects how they hear in everyday life. Therefore understanding the brain’s capacity and how this interacts with incoming auditory information is critical for developing more targeted therapies and signal processing strategies for hearing devices. THE BRAIN AND HEARING AIDS For over 10 years, we have known that the brain’s capacity could be useful in programming a hearing device. In 72 people with similar levels of hearing fitted with hearing aids, a study from Denmark (published in the International Journal of Audiology) demonstrated that an individual’s cognitive ability or capacity (measured by the reading span test) provided a good predictor of speech perception performance. The research team later demonstrated that adults with higher cognitive capacity are able to understand speech in noise better using fast wide-dynamic range compression algorithms than those with lower cognitive capacity. Fast compression, also known as syllabic compression, was designed to provide the user with greater access to the speech signal within varying acoustic environments and is therefore typically used in programming
to recognise so seeing an audiologist early is wise.
hearing aids. Based on this research, scientists at Eriksholm Research Centre are now looking at how brain signals which measure aspects of cognition can be used to adaptively program a hearing aid. Importantly, there is now emerging evidence from large population-based studies in the UK, US and France which shows that simply wearing hearing aids might be able to reduce the accelerated mental decline that occurs in adults with hearing loss. In a study published by the American Geriatrics Association of 1,276 people with varying hearing difficulties and 2,394 with none, the ones with hearing loss, but not those wearing hearing aids, had greater cognitive decline over a 25-year period than control subjects. European studies have shown that people who need and wear auditory devices are also less depressed, less tired in the evening and find sleeping easier. Add to this the fact that many people take 10 years or more to decide whether to get hearing aids – hoping their condition will improve. But, in this time, the brain suffers by losing sounds it used
TRAIN YOUR BRAIN While it is important to understand how cognitive capacity affects speech perception and programming of devices, it is of considerable interest to know whether we can increase cognitive capacity or at least avoid the reductions that occur with age. Todd Sampson, who starred in the ABC science documentary series, Redesign My Brain, reports that there are multiple factors which can enhance the brain’s capacity. Certainly, there is now a substantial body of evidence to show that the most important factors include good nutrition, exercise and having sufficient sleep. However, there is considerable interest in the role of brain-training to enhance or maintain brain function and brain health. There are numerous online computerbased brain-training programs that are available. At this stage, most studies have demonstrated improvement on the tasks that were trained, but limited improvement on untrained tasks. Despite this, it remains a multi-million dollar industry. It is important to note that welldesigned, targeted training programs, used with the support of an audiologist, could show benefit for some people, such as those with hearing loss, on trained and untrained tasks. In any case, keeping the brain active in this way is great exercise for your grey matter.
HQ
How our brains help us hear Sound waves move through the ear and cause fluid in the inner ear, the cochlea, to move. This bends the hair bundles on the hair cells. As a result, small electrical signals are generated in the nerves which travel along the auditory pathway and are perceived by the brain. The cochlea and the auditory brain are tuned, like a piano, with low pitches located at one end and high pitches at the other. This is known as tonotopic tuning and is important for our perception of pitch.
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SENSORY
Rush
A fascinating cross-sensory brain condition gives actor Geoffrey Rush an extraordinary mind, writes Rebecca Barker.
Our brains and ears work together in quick-fire, complex ways to ensure we hear the broadest range of sounds in the most challenging situations. But sometimes our senses get mixed up, a condition called synesthesia, which could affect as many as one in 100 people. Australian acting icon Geoffrey Rush is one of them. Renowned for his performances in the movies Shine and The King’s Speech, Rush recently finished filming the fifth instalment of the Pirates of the Caribbean series in Queensland, in which he reprises the role of swashbuckling Captain Barbossa (due in cinemas in 2017). Though his vile character is cursed in the popular Pirates movies, he admits his real life sensory condition is a blessing – though it may make the sights and sounds of the upcoming Academy Awards in March a bit muddled. “I don’t think I knew about the phenomenon until I was in my 40s,” Rush explained to US magazine Psychology Today. He first started hearing sounds as colours when learning the alphabet in infant school in Queensland. “I’d hear the sound and I was aware that I was making that sound with my lips. And that it had colour…and I loved this. I have to admit there was a kind of pleasure principle involved,” said Rush. Days of the week also have colours for him with Monday being pale blue, Tuesday acid green, Wednesday,
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Hearing HQ Dec 15 - Mar 16
deep purple, Friday maroon, Saturday white and Sunday pale yellow. “My daughter will hear a truck going around the corner and she’ll say, ‘Dad, what colour was that?’ and I describe to her, it’s a shape, and it’s got purple in it and it’s got lots of colours because it’s an engine and it’s got layers,” explained Rush. Music also evokes sounds and colours for the actor. Researchers at the Australian National University have found that the areas of the brain that process language and colour are more strongly connected in synesthetes. These connections lead to a triggering effect, where a stimulus in one part of the brain causes activity in another, reports the US news website Science Daily. ANU Research School of Psychology’s lead researcher Dr Stephanie Goodhew explains there are many types of synesthesia. “Things like hearing shapes, so a triangle will trigger an experience of a sound or a colour, or they might have a specific taste sensation when they hear a particular sound,” says Goodhew. For actress Tilda Swinton, certain words relate to types of food – such as the word ‘table’ smells like cake and ‘tomato’ tastes like lemon. Though it may sound strange and confusing to people who do not experience it, synesthesia certainly seems to have enhanced the careers of creative types, such as musicians Stevie Wonder, artist Vincent Van Gogh and actress Marilyn Monroe to name a few.
ry a i D Cochlear Implant PART 2
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Having made the big decision to go ahead with cochlear implant surgery, as related in the last issue of Hearing HQ, I was anxious to proceed as quickly as possible. The next step was to visit my surgeon, Associate Professor Catherine Birman, of Sydney’s Macquarie University Hospital, who was going to perform the operation. I felt positive about this, as she had been highly recommended and was very experienced in this type of operation. The meeting went well and I was excited to finally have a date for the procedure. I could see no reason to wait any longer and as I had organised an overseas holiday, I was very anxious to pack in my initial appointments and the first few mappings before going away. Suddenly it all felt very exciting. The day of surgery arrived fairly quickly. In the end I was quite laid-back, just anxious to get over the hurdle of the operation well, so that I could start working on getting my hearing tuned into the implant. As the big day arrived, a friend kindly drove me to the hospital where the surgery was performed. I spent two nights there as I live by myself. After the procedure, the surgeon told me she was delighted with the results of the operation and informed me that all electrodes were working and now I just had to heal. The rest was up to me and the audiologists. The wound healed without any problems and I only needed a bit of pain relief in the first week. I must admit it was all rather tender and sore – especially where the processor was implanted. Recovery was routine but it took a lot out of me. I slept a lot, which was probably what I needed to do. It was a bigger procedure than I expected, and it really required the full two weeks postoperative recuperation. I was naturally filled with anticipation when that long-awaited 'switch on' day arrived. Finally I was at the threshold of ‘a new life’! A close friend, Julie, and also my old audiologist Roger Lovegrove came along with me for the momentous occasion. First, we went through the whole routine of setting up my new equipment 14
Hearing HQ Dec 15 - Mar 16
lear Cochplant im iary d
high as Liz Emotions run ar riences cochle Efinger expe gry and her lon implant surge on’ day. awaited ‘switch
which seemed to go without a hitch. I heard lots of strange sounds but nothing even slightly resembled anything like words and I was told to be patient and it would hopefully all happen. Admittedly, this was good advice as I tend to want things to happen yesterday! I was not disappointed that I couldn’t immediately understand anything through the new implant. I honestly didn’t expect to hear much and would have been absolutely amazed if it had been otherwise. Nevertheless, by the next day something seemed to be happening. I felt as if what I heard through my implanted ear was adding to the hearing through the hearing aid on my ‘good’ side. In other words, I seemed to be getting some sort of binaural hearing, even though, on its own, the left ear was hearing nothing but gobbledygook. I can only describe the sound on that side as a monotone, like underwater noises that did not seem to relate to speech but just seemed strange and annoying. On the upside, the binaural experience was different and exciting. I had not heard anything worthwhile through my left ear for about 15 years, and now one day after ‘switch-on’ I had this wonderful sensation of hearing on both sides, even if
Liz Efinger with Assoc. Prof. Catherine Birman at her six month checkup.
only slightly. In fact, when I disconnected myself from the processor, I didn’t like the sensation at all. The hearing level definitely dropped. My spirits lifted. Something was working! There was still a long road to travel but I felt I was on the way. I had a week to practice hearing and listening before my first mapping date. To summarise, I don’t think very much changed in this week. I started working on a few exercises which I got from an app I had downloaded. This was hard, and I didn’t do too well with it. In fact, one day I thought things had improved a bit, and then the next day I seemed to take a couple of steps backwards. The second mapping day arrived. I received a couple of pieces of extra equipment – one was to allow me to connect to Bluetooth, and listen to my mobile phone and iPad. In addition there was an extra external microphone to help me hear in noisy situations, which was not immediately connected at this stage. A very exciting thing happened on day eight after ‘switch-on’. When speaking on the phone with a friend, I asked her to talk with me while I had the phone up to the microphone on the cochlear implant – and – I recognised some words instead of the jumbled mess of sounds I had come to expect! I was over the moon that things were already happening. In truth, since then it has been a somewhat rocky road. After my second mapping I was a little shattered that what I was hearing seemed worse than ever. I had an afternoon when I felt like throwing the implant in the bin and was very upset as it was going to be another two weeks until the next appointment. However, with trepidation I did wear it the next day, and for a whole weekend of choir rehearsals. Somehow it wasn’t so bad after all. I realised I had to be patient and take it one day at a time. Progress in between mappings was slow. The ‘Donald Duck’ noises I initially heard continued to talk to me in the
Liz trying to interpret the 'gobbledygook' in her first mapping session.
background and adjusting settings to try to balance this was problematic. At week four after ‘switch-on’, I still struggled to understand the jumbled speech I was hearing. It was a case of persevering day by day, and hoping that suddenly the words would be there. People said to me, “So can you hear perfectly now?” which was annoying but they didn’t understand that it doesn’t work like that. It’s a long process of the brain learning how to decipher the sounds. On the third mapping day, I had a bad morning hearing many unpleasant sounds. However, the day before I had a very positive singing lesson. My teacher said she could definitely hear a difference and felt I was actually distinguishing between half notes. Her feedback
encouraged me enormously. The mapping went well, changes were made and I noticed a definite improvement. I felt I was really on the way even though things went up and down on a daily basis. I was told by my audiologist that my implanted ear would eventually become my dominant ear and the other one would act as a support. I had never dreamed of that happening. I persevered with the various suggested exercises, including reading aloud. I also used my excellent Sennheiser headphones on the cochlear ear, blocking out the other side as best I could and listening hard for comprehension. I was fortunate to have an extra mapping just before a choral event I was
due to take part in. My audiologists made some adjustments to my processor and I hoped it would make participation in the music events enjoyable. And so it was. The choral festival was pleasant and I felt I could participate to a point. However, after another mapping session and some more adjustments, I hit a low point. I felt despondent that progression had stopped. I am now five days since that last session, which I felt went well – a number of changes were made and I started to feel more upbeat about my imminent trip – a bridge holiday to Europe and a cruise across the Atlantic, via Iceland to New York. I know there will be difficulties as I am aware I still have a long way to go. There will be ups and downs and the hearing via the cochlear is still weird but on occasions when I might hear a person standing on my cochlear side actually speaking, or when I block my ‘good’ ear, 3 and listen hard to speech on PART final Tune into the the television or radio, and Liz’s of t en instalm ant I can almost understand the cochlear impl . ue iss xt ne speech - well - I call these diary my ‘WOW’ moments!
Diary
Do you struggle to hear even with hearing aids? A cochlear implant could help you restore your hearing. Unlike hearing aids, cochlear implants don’t just make sounds louder. They are a complex device that can replicate the hearing function of the inner ear. It is never too late to explore your options to improve the quality of your hearing – even if you are currently using hearing aids, you may experience a better result with a cochlear implant. Contact SCIC Cochlear Implant Program on 1300 658 981 to find out more today. Public and private clients Our cochlear implant ü ü services typically require Adults & children of all ages ü no out of pocket costs
1300 658 981 scicadmin@scic.org.au www.scic.org.au
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NEWCASTLE PENRITH
lear Coch ant impl y diar
auditory In an age of cost-cutting and Internet shopping, buying cheap hearing aids online is an appealing option. But putting on hearing aids is not the same as buying glasses to 'fix' a problem. To get the best results, you need auditory rehabilitation, say leading audiologists Louise Hickson and Emma Scanlan.
Professor Louise Hickson
What is auditory rehab? The aim of auditory rehabilitation is to make changes in communication skills and strategies to improve the ability to communicate for an individual, their family, friends and others in their lives. In this age of whiz-bang technology, hearing aids, implantable devices, streamers and other assistive devices, including live captioning – is auditory rehab still needed? There are a significant number of people who, even with well fitted devices, may only be able to understand less than 75 per cent of conversation even in quiet conditions. Many factors influence device outcomes, including degree of hearing loss, speech clarity, additional areas of difficulty such as visual or cognitive impairment, personality, expectations, motivation and available support. Many people will gain additional benefit from other types of training and rehabilitation which can build and maintain communication skills. One of the ways to provide auditory rehabilitation is to run a training communication education program. This 16
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can be as short as one session, or much longer, depending on someone’s needs and goals. Any successful approach should include determining needs, setting goals, implementing strategies and reviewing outcomes. These can be long or short-term goals and strategies. Reasons to do rehab Research shows that adults with hearing loss need more help than they receive from hearing devices alone (International Journal of Audiology, 2003), says Louise Hickson, Professor of Audiology at The University of Queensland and President of Audiology Australia. Auditory rehabilitation needs to be individualised and holistic. Education about how to listen and engage in conversation and how to apply communication tactics is very beneficial for both the person with hearing loss and his or her communication partners. People who receive this sort of assistance report improved communication and better quality of life overall, according to a 2007 trial evaluating the Active Communication Education program for Older People With Hearing Impairment. Communication is a two-way process and there is a great deal to gain by involving family in how to communicate effectively when someone has a hearing loss. It is very common for people who do not have any aural problems to be unsure how they can help those who do. But families often want to help. Professor Hickson says the most important things to do are to decrease the distance between the speaker and the person with hearing loss and turn down background noise. This simple advice should always be included in auditory rehabilitation. In her own collaborative research, Professor Hickson confirmed that many people with hearing loss do not choose to wear hearing aids, yet they still need help for their hearing difficulties. In these cases, education about communication is even more important. Audiologists can provide a wide range of assistance to people with hearing loss and their
families. “Despite popular belief, audiology is not all about fitting hearing aids,” says Hickson. Setting your goals Why is goal setting important? Goal setting in this context serves various functions. It helps everyone involved to know where to start – and when to stop. It is helpful in making sure that expectations are realistic, addressing individual priorities and providing a map to follow throughout the program. Once the goals have been established it is time to implement strategies. This will usually involve fitting some kind of hearing device using best practice and technology and instructions about management. It may also involve the use of additional devices to assist with particular situations such as streamers or remote wireless technology. For many people, to a greater or lesser degree, and depending on the approach of the clinicians that they see, they will then undertake communication testing and training, to address strategies and tactics. During the communication assessment, the audiologist will use the person’s test results on speech comprehension to pinpoint areas where improvement might be possible. These results are discussed in detail to make sure that any required training fits in with goals and is relevant. Communication training can be hard Emma Scanlan (left) conducting rehabilitation
rehabilitation work and there is no point putting effort into an area that is not important to you. The assessment and training conditions should match as closely as possible with the person’s goals. For example, if the goal is to be able to understand in a noisy situation, testing and training for improvement should also be done in noise. Sometimes the goal will be a listening (ears only) goal such as improving on the telephone, other goals will involve eyes and ears where lip-reading and body language cues are available and can be helpful, such as following conversation at a weekly sewing group. Practice makes perfect There will often be various elements of the training program depending on those factors listed earlier. The most common elements have some emphasis on listening skills and using listening to the best of one’s ability, listening with visual information available, communication strategies and conversational skills. Many training activities will be as close to real life as possible and have a major focus on using a range of skills in context. Communication tactics can be learnt and they are one of the most helpful ways to improve your ability in this area. Because the incorporation of tactics and strategies into daily life usually involves a change in behaviour (for people who don’t have well-developed skills in this area) it takes practice, like anything that is new. The important thing is that the tactic or strategy is explained to the person, then demonstrated and then the person is given the opportunity to practice in a safe environment until the skill is cemented. One of my favourite activities is a list of questions which the client can ask the audiologist and the client then repeats the answers. Once the communication tactics have been discussed and practiced this gives a ‘real-life’ situation in which to try them out. It also gives the audiologist the opportunity to make the answers as complex or simple as required and
also to make the communication style easier or more difficult to understand. By covering the mouth, speaking quickly or mumbling, the client can then be encouraged to use their tactics and strategies to get the clear message that was intended. Sometimes this involves simply asking the speaker for a repeat (“Could you please say that again?”) or a re-phrase (“Could you please say that again using different words?”). At other times it can be useful to repeat back that part of the message you did hear and just ask for clarification on the bit that was missed. For example, “I heard you say that someone was coming over on Tuesday but I wasn’t sure who you said, did you say Carol?”. This is helpful because it shows the other person you are listening, interested and trying and shares the responsibility of successful communication between the two parties. Conversational skills can include all forms of non-verbal communication in addition to voice monitoring, turn-taking and conversational cues. The reports of people that have undertaken auditory rehabilitation show they make better use of the information they receive, improve communication skills and are more likely to participate in favourite activities and be more social. One mum was struggling to hear while chatting with her son and home helper despite wearing well-fitted hearing aids. She worked with principal audiologist Emma Scanlan, of the Australian Hearing Hub at Sydney’s Macquarie University, to achieve three goals. These were to hear her alarm in the morning so her son did not have to wake her, to improve conversation with him as they read together at night and to converse with a home helper twice a week. The first goal was simply achieved by acquiring a vibrating alarm clock. The other two goals required specific skills and training. “We undertook a program that involved a range of activities to improve one-on-one conversation in a quiet place,” says Scanlan. The distance between the reading mum and her son
was reduced from around 4 metres to 1.5 metres and she worked on basic conversational tactics and the importance of lip-reading for consonants, as her assessment showed she found it hard to perceive high-pitched consonants. “We also spent some time discussing and practicing anticipation strategies and how to cope with changes in topic,” explains Scanlan. With regular practice and persistence, the mum rated herself as managing ‘much better’ on an improvement scale for both situations and could hear 75 per cent of the time (up from 25 per cent before the training).
MY REHAB JOURNEY
After being bullied as a child over her hearing loss, Elizabeth Ellis admits auditory rehabilitation helped turn her life around. “I can't for one minute imagine how difficult my life would have been had I chosen not to accept hearing rehabilitation and training,” says Ellis, who now wears a cochlear implant due to a severe hearing impairment. “There is no doubt that all the early years of training and practice have contributed to making the transition from hearing aids to cochlear implant much easier and more successful,” says Ellis, who lives in Wollongong, New South Wales. Rehab has enabled her to progress further than she had hoped with hearing and communication abilities. In fact, many people do not realise she has a hearing loss and even audiologists say they cannot detect an aural problem by listening to her voice and chatting with her. Family and friends are amazed at her capabilities since implant surgery. “The biggest thing they notice since having my cochlear implant is that I often understand the spoken word now without the aid of lip-reading,” says Ellis, who stresses how hours of practice and training helped her reach this point. “Why would one not choose hearing rehabilitation to sharpen their listening skills like sports people choose rehabilitation to strengthen muscles following an injury," says Ellis. Hearing HQ Dec 15 - Mar 16
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all about. all about... JobAccess:
Supporting deaf and hard-of-hearing people at work JobAccess exists to help people with disability, including deaf or hard of hearing people, stay in work or get work, writes Linda Collard, of WorkFocus Australia. JobAccess is a Government-funded service that removes barriers to work for people, in a fast, low-fuss way. It is also a service offering advice and support to anyone concerned about managing disability in the workplace. Nicola Tuckwell (below), manager of JobAccess service for the past nine years, says around one in five enquiries taken by her team are for support with hearing-related workplace issues. How can JobAccess help? JobAccess offers advice on anything to do with disability employment, as well as financial assistance to get work or stay in work through the Employment Assistance Fund (EAF) which is managed on behalf of the Australian Government. “One of the things our advisers most love about their jobs is working with people to find the best possible solution for their particular situation at their particular workplace. “It may be as simple as talking through your options, or an information request. Or it may be to fund some equipment that makes the workplace accessible for you,” says Tuckwell. People who are hard of hearing or deaf mostly use the Government’s Employment Assistance Fund (EAF) to access Auslan interpreting services, tablet devices to assist with Video Relay Service and real time captioning, as well 18
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as adaptive or assistive equipment in the workplace. “Technology boosts the available options all the time. The advent of Bluetooth and other technologies has opened up adaptive equipment suitable for medical practitioners, students, office workers and even musicians. And there’s always the next advance,” Tuckwell says. Finding the best workplace solution One recent client contacted JobAccess because her deteriorating hearing was causing her difficulty at work. A full time Registered Nurse at a district hospital, her genetic hearing condition meant she had worn hearing aids for more than 10 years. These had always ‘done the job’ for her, but now, despite a recent hearing aid update, she needed something more to allow her to perform all her work-related tasks to her full ability. It had become an issue for her to take blood pressure, a task she needed to perform many times a day, as well as use the phone at the ward desk. The team at JobAccess arranged for a worksite assessment. Both the nurse and her employer attended. As well as confirming the specific barriers she had called about, the worksite assessment identified that a constant need in the nurse’s role was communication by all channels, not just the phone communication that she had identified. As a result of the workplace assessment and conversations with the nurse about what she was finding difficult, the assessor identified a specially designed stethoscope (Cardionics E-Scope with headphones) to remove the barrier around taking blood pressure. In addition, an amplification system for landline phone and for face-to-face communication has been provided.
Funding for Auslan interpreters Through the EAF, JobAccess also provides up to $6,000 per deaf employee over 12 months for work-related Auslan interpreting. This may include onsite or remote interpreting and live captioning. This can be used for any work activity that an employer deems appropriate. Typically, this funding is used for important meetings or training. This type of EAF assistance is called Auslan – Level 1. Perhaps more importantly, it can really open up the workplace for people. For example, Caroline Browne, an Australia Post employee, is very much part of her community. Browne lost her hearing at the age of four as a result of meningitis, and is one of four deaf employees located at a delivery facility in Sydney. Browne has always had a positive attitude and is determined not to let deafness affect her employment opportunities. The idea of being a motorbike postie with Australia Post appealed to her. Browne grew up in the Cook Islands and loves the outdoors so she felt it would be a perfect fit – a job based outdoors allowing her to enjoy her passion for motorcycling. She applied for the job online through
While some of us prefer to play, there is no denying that work offers completeness
Image of Caroline Browne courtesy www.contently.tv
to many of our lives; a way of contributing to our community and families.
Australia Post’s website, declaring her disability in her application and was successful. That was eight years ago and Browne still has as much passion for the role today as when she started. “I ride a motorcycle to deliver the mail and I love the freedom of riding outdoors,” says Browne (above). She did encounter some initial frustration on starting the job. Because she relied on pen and paper for communication, at times she missed out on what was going on. To address this problem, Australia Post accessed support for her through JobAccess which provided an interpreter to help establish a meaningful communication process for both Browne and her co-workers. “My
frustration disappeared by having the interpreters in, and it's definitely made me happier,” says Browne. “Australia Post employs over 40 deaf employees across the country and JobAccess plays a big part in helping us support these employees and their managers,” explains Sharon Carroll, Diversity and Inclusion partner at Australia Post. “JobAccess consultants work closely with us to find solutions that benefit both parties, including practical services such as arranging Auslan interpreters to improve communication in the workplace. Working with JobAccess helps us meet our commitments to providing an inclusive work environment for our employees,” says Carroll. Tuckwell explains that JobAccess provides funding for interpreting for job interviews as well, known as Auslan Level 2 funding. “Sometimes, for a person who is deaf or hard of hearing, a job interview can be an enormous barrier to work. That’s why EAF assistance is available in this circumstance too. There is no limit to the number of job interviews for which it can be used, although it doesn’t cover travel assistance for the interpreters,” explains Tuckwell. Creating a better workplace “EAF assistance can also be used to help create a better workplace – with better communication. Should a co-worker or employer wish to better communicate with their deaf colleague who uses Auslan, the EAF will reimburse some of the costs of participation in a nationally recognised Certificate II in Auslan course,” says Tuckwell. This type of funding is known as Auslan – Level 3. This sense of understanding can also be fostered through deafness awareness training. “Whole teams can engage in training if they have a colleague who is deaf or hard of hearing, which can be fantastically positive for the person and the whole team. It can remove a sense of isolation and help the team function much better as a unit,” adds Tuckwell.
The EAF provides a maximum amount of $1500 (including GST) per eligible employee over 12 months for this type of training at work. This assists co-workers and employers to understand topics such as deaf culture, tips for communicating and to learn basic Auslan signs. “There are countless options to best meet the employment needs of deaf people, or people with hearing issues. If there is a barrier to working productively, or working at all, JobAccess will work with employers and employees or job seekers alike to get it removed,” Tuckwell says. “If you need advice or want to talk about your own workplace needs, we are here. We work with thousands of Australians every year - people in large Australian businesses, small business owners and employees and selfemployed people – getting them into
An Auslan interpreter at work
work or keeping them there,” she adds. All applications for Auslan assistance, deafness awareness training or disabilityspecific equipment or workplace modifications are subject to the individual meeting the EAF eligibility criteria. Auslan interpreters must be NAATI accredited. JobAccess is an Australian Government service delivered by WorkFocus Australia. For more information or to submit an application for Auslan interpreter funding, training or equipment, contact JobAccess or visit www.jobaccess.gov.au. Expert JobAccess advisers are available on 1800 464 800 (also TTY).
HQ
Hearing HQ Dec 15 - Mar 16
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Jawan Sayed Principal Audiologist Quality Hearing Care
Roberta Marino Senior Audiologist Fiona Stanley Hospital
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Q
I have had outer ear infections with blocked hearing after swimming. My doctor has told me they are due to swimmer’s ear and exostosis. Do I need surgery? Melville da Cruz: Swimmers ear and exostosis are common in people who swim a lot. The repeated exposure to cold water over many years produces a mild inflammation of the lining of the bony external ear canal on both sides, stimulating bone growth – a little like growth rings on a tree trunk. As the bone growth slowly progresses it produces three visible swellings in the ear canal (exostosis) which eventually constrict the canal leading to blockage. While the swellings are small, there may be minimal symptoms. With increased growth there may be water trapped after swimming with fluctuating hearing levels which improve spontaneously after a day or two. In time, trapped water, wax and debris lead to recurrent infections which are difficult to clear. Eventually with large exostosis there is near complete blockage of the ear canal and long periods of reduced hearing which can be disabling if they involve both sides. At this stage, using ear drops and clinical ear cleaning is not enough. Early on, small exostoses cause few symptoms and are often incidentally found during an ear examination for unrelated symptoms. As they enlarge, symptoms of blockage and hearing loss become more troublesome, especially for those who swim daily. Diligent water precautions, such as wearing earplugs and drying well after swimming are often helpful, but at this stage, the need for surgical treatment should be considered. Patients with larger occluding
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exostoses, who wish to continue swimming, will need to consider surgery as the painful infections are almost impossible to treat without a general anaesthetic for ear canal cleaning. Surgery involves “drilling out” the exostosis to widen the bony ear canal back to its usual dimensions. The operation is performed under a general anaesthetic, takes up to two hours depending on the size of the bony swellings and requires an overnight stay in hospital. It can take several weeks for the skin to grow over the widened canal. During this period strict water precautions and repeated dressings will be required. In time, the second side will require surgery. Once the exostoses have been surgically corrected and the area healed, they rarely need further treatment.
Q
I have a severe to profound hearing loss and need a cochlear implant. Will I be able to have MRI scans after I receive an implant? Roberta Marino: Your ability to undergo MRI (Magnetic Resonance Imaging), depends on the type of implant you receive and also the strength of the MRI machine. It is good to discuss your MRI options with your Ear, Nose and Throat surgeon so you can understand what scanning limitations may be present after cochlear implantation. MRI is an important medical test that most of us will need at some time in our life. It has become increasingly popular as it allows good visualisation of internal body structures with
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ts
Hearing HQ Experts Send your questions to: PO Box 1054, Lane Cove NSW 1595 or experts@hearingHQ.com.au
no adverse effects unlike other imaging procedures. If a cochlear implant is not MRI-compatible, or is only compatible at a certain strength of MRI, undergoing an MRI scan of any body part, not just the head, can lead to de-magnetisation of the internal implant magnet, displacement or turning of the magnet, heating and/ or vibration of the implant. In the case of middle ear or bone conduction implants, a loud noise can sometimes be heard during imaging. The strength of MRI is measured in Tesla (T). The higher the T-rating, the higher the image quality and the faster the scanning times. However, a higher rating results in a greater risk of interaction with a cochlear implant or other implantable hearing device including middle ear and bone conduction implants. Typically MRI scans are measured at 1.5T however there are MRI machines that can measure at higher strength of 3T and even 7T. Most implantable devices are now able to undergo MRI imaging of 1.5T without removal of the internal implant magnet. One of the newest implants from Med-El, the Synchrony, can now undergo MRI imaging of up to 3.0T because of its magnets’ unique self-aligning properties. Hearing implants can also create a blurring effect on the image making it difficult for doctors to pick up fine details particularly on the implanted side. If necessary, the magnet can be removed prior to surgery and replaced afterwards with minor surgery. Always advise your doctor and radiologist that you wear an implanted device. You can also carry your patient identification card which contains important contact information and details about the make and model of your implant so the manufacturer can be contacted if necessary. A Medic Alert necklace or bracelet telling people you wear an implant is also useful. People wearing bone conduction implants and middle ear implants also need to be aware about MRI compatibility before undergoing any scans. Some older middle ear implants such as the Vibrant
Soundbridge are not MRI-compatible. The newer model implants are safe to use in MRIs up to 1.5T.
Q
I am seeking a replacement for an aging Telecom amplified phone. I have a severe hearing loss and use two BTE aids, with T-switch. We are seeking a base station plus one additional handset. Preferably both handsets should respond to switching to T switch, and/or be amplified. Jawan Sayed: Hearing on the phone can be challenging in some circumstances for a person with normal hearing let alone someone with difficulties. Even when hearing aids are optimally fitted a person with a hearing impairment may continue to have hearing problems when on the phone. One of the main reasons hearing can become more difficult with phone use, is that you lose access to the visual cues that a normally present in face-to-face contact. In addition, the sound quality from a phone may be different from one model to another and using only one ear on the phone can make it harder to distinguish conversation. There are phones that have specific features which make them more effective and suitable for individuals with hearing impairment and hearing aid users. Features to look for when considering phone options are telecoil compatibility, handset volume control, speaker phone options and adjustable ring tone volume. Most current hearing aids have a telecoil feature designed for phone use. If a phone is telecoil-compatible it can be used by the hearing aid user to give them a better sound quality and can help to reduce background noise while listening to a phone conversation. Some phones will allow you to adjust the receiving volume by up to 20 decibels. Having access to the speaker phone function means you can listen to conversation with both ears. This can make it easier to hear especially if the phone also allows volume adjustment. This will allow you to hear the phone ring at different locations in the house. There are many phones available with the different feature options discussed above. Oricom offers corded, cordless, single and multiple handset options in
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their PRO range with the above features. Uniden also offers phones suitable for the hearing impaired in their SSE range. Finally, Telstra’s standard rental phone has inbuilt features to assist hearing impaired individuals.
Q
I love the summer months but often have trouble with my hearing aids cutting out when I wear them out cycling or doing heavy gardening. Is there anything to reduce dirt and sweat interfering with them? Emma Scanlan: Most of these issues are caused when perspiration or dirt enter the hearing aid microphone area or battery compartment and interfere with the hearing aid functioning. There are now a range of hearing aids that are either water and dust resistant depending on something called an IP rating. This rating designates how much water and dust the hearing aid can tolerate before it starts affecting the performance of the aid. The IP rating is a 2 digit number. The first digit represents protection against solid objects (like dust) and the second digit represents protection against the intake of liquids (like water or perspiration). The larger the value of the digit the greater the level of protection offered. For example, a hearing aid with a rating of IP22 would protect against solid objects over 12 millimetres and also vertically falling drops of water (like rain). However, a hearing aid with a rating of IP67 is totally protected against dust interference and protected in water immersion up to one metre depth. There is also a range of products to protect hearing aids or implantable devices. These range from plastic or spandex covers for the aids themselves to dehumidifying units that can be used overnight to remove excess moisture from the aids and battery compartment. Please ask your hearing professional about the options for your devices.
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Hearing HQ Dec 15 - Mar 16
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real pe ''
Inspirational solicitor Kathryn O'Brien was the first signing deaf lawyer in Queensland.
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Hearing HQ Dec 15 - Mar 16
I am a signing deaf lawyer. I cannot hear nor do I speak often. I was born profoundly deaf and diagnosed at an early age. With no immediate family history of deafness, I lived in a hearing world as a child with hearing siblings. My parents communicated to me solely in sign language using ‘Total Communication’ (TC). TC is sign language using lip patterns, fingerspelling, voice, written and visual aids. I attended various schools until high school in a special education unit where the teachers were trained in TC. When I started attending secondary education, I was placed in the mainstream classes where a teacher’s aide trained in TC would act as an interpreter for me. I loved learning different languages and took on the challenge of learning French. At university, I attained a Bachelor of Criminology and Criminal Justice, majoring in Applied Ethics and Criminology. My true passion was law since the age of eight so, I decided to study a Bachelor of Laws. I graduated with Honours in Law and undertook further study in which I attained a Graduate Diploma of Legal Studies, Practice and Ethics. This enabled me to practice law in Queensland after applying for a practicing certificate from the Queensland Law Society and being admitted to the High Court of Australia. Now I can now appear in any Federal Court. During my first couple of years doing law as a solicitor, I attained a Master of Laws. My next ambition is to get a Doctorate of Laws. I have a wonderful daughter who is hearing and she is 11 years old. I remember rocking her to sleep while typing up university assignments and she came to university classes. A criminal law lecturer once asked if she could carry my alert, (luckily quiet), daughter around during the lecture so, that I was able to focus on
the guest speaker. My daughter, like myself, is being brought up in a loving environment where learning is fostered, nurtured and encouraged. Like me, she has a love of languages and learning. She enjoys watching television and movies with me with closed captioning. Even when I am not around, she turns on the closed captioning to watch television. At university, I met my partner who is also a lawyer and has been with me for 12 years. Prior to entering the legal arena as a practicing lawyer, I applied to hundreds of legal jobs, even seeking work experience so that I could build up my resume. I have had numerous rejections but I knew that I could not give up since I had studied hard and for so long to attain my dream. At the time of my admission to the legal profession, the significance of my achievement was not lost on Queensland’s Chief Justice Paul de Jersey, of the Supreme Court of Queensland - the highest court in the state. He congratulated me before a packed Banco Court in Sydney, the Supreme Court in New South Wales, on my “very substantial achievement”. I still remember those words verbatim. My daughter was three at the time. My father was in attendance and he shed tears of pure joy seeing me achieve my dream. My mother was unable to attend due to work commitments but I received a moving text message from her. Part of the message from my biggest supporter, my mother read, “Crying myself to sleep every night for the first three years of your life just seems so far away now. I wish I’d known then what I know now.” My mother gave up her nursing career to attend to my needs as a deaf baby and toddler. She would attend sign language classes and return home to teach me how to sign and read. I was able to sign fluently by the time I was old enough to attend Year One at primary school being given the opportunity to attend
Images: Kathryn (top left) Lucid Photography and Latte magazine, Dan and Mischa by Bonnie Rose Photography
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preschools where there were other deaf children and teachers who could sign. I was lucky to have wonderful teachers, growing up, who encouraged my love for reading and learning. Lesley Bullen was one teacher who told my mother that TC/ Signed English would be ideal for communicating with me. I also had another teacher, Kate McKewen, who taught me the ABC and I realized the wonderful world of writing and reading. There have been numerous other teachers who I was lucky to bump into while I was growing up during my school years who passed on the torch in a relay of learning in different ways. I fell in love with the written word. Since then, I have mentored many other students, encouraging them with reading and writing. I have even encouraged students to start reading comics as I love words in any form. They have regularly thanked me for making learning fun and inspiring them to believe in themselves. I was lucky my employer, Brisbane’s Porta Lawyers, gave me a chance with some work experience. There were only a few technological modifications required around the workplace so that I could work effectively. I researched ways to get funding to enable these modifications and was able to apply to the Employee Assistance Funding scheme through JobAccess. As a result, we received sign language classes for the staff, flashing light smoke alarms for the office and a notebook with a web cam attached so that I could meet my clients online who communicate in sign language. This reduces the need to travel long distances to provide instructions. Now I cater to deaf clients around Queensland and interstate. The funding enabled my employer to be relieved of the financial responsibility of paying for sign language interpreters. I lobbied for extra funding as it is capped and learnt to book interpreters on a priority basis and to use alternative communication methods via webcam, faxes, and email while using the National Relay Service to talk to hearing people over the telephone. I clearly recall my first court experience as a profoundly deaf lawyer. My former supervisor accompanied me to court so that he could explain the significance of my appearance. He explained to the judge that he was hearing a deaf lawyer for the first time in Queensland which had never
been attempted before. The judge was impressed and congratulated me on my achievement. My journey has not been easy with many political challenges within the deaf community, growing up and being able to educate others about communicating with a deaf person. I had to challenge many misconceived perceptions of deaf people as a whole while functioning in mainstream society. I have come to learn a lot about myself, realising that a sense of humour is essential as is a loving family environment where communication is important and everyone is considered equals. Much to my surprise while growing up, I discovered older deaf people had misconceptions about themselves being unable to do things and there were many examples of this attitude being copied by the next generation. I decided to ignore these old fashioned notions and break through any barriers I faced. It was difficult in my first university year where interpreters used Auslan and not much TC, which I had relied upon at school. As a student, I had to lobby for interpreters who had an educational background and knew about TC to attend lectures with me so that I would not miss out on information and be able to participate with question and answer sessions. I also had notetakers who provided notes to me from lectures and tutorials so that I could see what I had missed while watching the interpreters. I learnt many strategies using “trial and error� tactics on how to maximise my studies. Being assertive and regularly seeing lecturers on my own to ask for clarifications, explanations, discussions and opinion on what I was learning was also important. I learnt to watch for students who took lectures seriously and were prepared to share information so I could approach them later and start discussions about issues. By befriending students and lecturers from various cultural backgrounds, I started to understand the world on a broader basis. Currently, I am practicing family law with overseas clients and interstate clients as well as doing commercial leasing and criminal law while assisting clients for wills and estate planning. I often organize workshops on a pro bono basis to travel around providing vital legal information to the deaf community.
The Australian Women's Weekly featured Kathryn in its `Women We Admire' feature (June 2012) for her success as the first deaf lawyer to work in a Queensland court.
Kathryn's husband Dan and daughter Mischa.
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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 Conexu Foundation Technology based communication access T 1300 077 321 SMS 0448 180 677 Deaf Can:Do (formerly Royal SA Deaf Society) Services to SA deaf and hearing impaired T 08 8100 8200 TTY 08 8340 1654 F 08 8346 9625 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
Acoustic Neuroma Association of Australia Support and information on treatment E info@anaa.org.au T 03 9718 1131/02 4421 6963 Aussie Deaf Kids Online parent support and forum www.aussiedeafkids.org.au Australian Tinnitus Association (NSW) - Sydney Support, information & counselling services T 02 8382 3331 F 02 8382 3333 Better Hearing Australia (BHA) Hearing advice by letter, email or in person T 1300 242 842 TTY 03 9510 3499 F 03 9510 6076 Better Hearing Australia Canberra Hearing Loss Management & Hospital Kit T 02 6251 4713 BHA Tinnitus Self Help/Support Group - TAS Support group for those with tinnitus T 03 6244 5570 BHA Tinnitus Management Services T 1300 242 842 Broken Hill & District Hearing Resource Centre Inc T 08 8088 2228 F 08 8087 9388 www.bhhearingresourcecentre.com.au 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
Parents of Deaf Children - NSW Unbiased information, support and advocacy T 02 9871 3049 TTY 02 9871 3193 F 02 9871 3193
Deaf Children Australia Services for hearing impaired children T 1800 645 916 TTY 03 9510 7143 F 03 9525 2595
SCIC - Sydney Cochlear Implant Centre Gladesville, Newcastle, Canberra, Gosford, Port Macquarie, Lismore, Penrith T 1300 658 981
Hear For You Mentoring hearing impaired teens T 02 8937 4150 E info@hearforyou.com.au
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 15 - Mar 16
Meniere’s Australia Dizziness & balance disorders support T 1300 368 818 F 03 9783 9208 Self Help for Hard of Hearing People (Aus) Inc Educational association T 02 9144 7586 F 02 9144 3936
EDUCATION Can:Do 4Kids - Adelaide Programs for deaf, blind & sensory impaired kids T 08 8298 0900 TTY 08 8298 0960 F 08 8377 1933
Catherine Sullivan Centre - Sydney Early intervention for hearing impaired children T 02 9746 6942 F 02 9764 4170 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 Telethon Speech & Hearing - Perth Early intervention program and specialist paediatric audiology services T 08 9387 9888 F 08 9387 9889 The Shepherd Centre - NSW & ACT Early intervention and cochlear implants T 1800 020 030 F 02 9351 7880
ADVOCACY & ACCESS SERVICES ACT Deafness Resource Centre T 02 6287 4393 TTY 02 6287 4394 F 02 6287 4395 Arts Access Victoria/Deaf Arts Network T 03 9699 8299 TTY 03 9699 7636 F 03 9699 8868 Cap that! Captioned for Learning www.capthat.com.au Deafness Council Western Australia Inc T & SMS 0488 588 863 Deafness Forum of Australia T 02 6262 7808 TTY 02 6262 7809 Deaf Sports Australia T 03 9473 1191 TTY 03 9473 1154 F 03 9473 1122 Media Access Australia T 02 9212 6242 F 02 9212 6289 NMIT Centre of Excellence Vocational Education T 03 9269 1200 F 03 9269 1484
OTHER BHA Hearing Aid Bank - donate old hearing aids T 1300 242 842 T 03 9510 1577 Planet Ark - Find a battery recycler near you www.recyclingnearyou.com.au/batteries JobAccess Disabilities workplace solutions T 1800 464 800 TTY 1800 464 800 F 08 9388 7799
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