A Change of Plans

Since 1927, May has been Better Hearing and Speech Month.

But there’s never been a year quite like this one.

Activities and programs meant to center, this year, on issues around “Communication at Work” have had to be shelved to deal with the elephant in the room that no one can ignore: COVID-19.

The organization that first established and still manages Better Hearing and Speech Month, the American Speech-Language-Hearing Association (ASHA), has had to switch gears.

Representing 211,000 members and affiliates — from audiologists to speech-language pathologists to support personnel — ASHA decided to turn its attention to the immediate matters at hand. The focus is now on providing resources for managing current circumstances — and helping shape the nation’s response to COVID.

This has included helping craft changes to federal telehealth payment regulations to allow for more “distance” consulting by audiologists, which was part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This month’s focus is also on helping hearing health professionals institute best practices in their facilities in order to restrict the spread of the virus.

In addition, ASHA has published a “COVID-19 and Hearing Loss in Adults: Strategies at Home” pamphlet to help individuals cope with issues during this time of restricted access to professional in-person support. Further guidelines will continue to be published throughout the month by ASHA.

Everyone in the hearing health profession is struggling to create new protocols on the fly. This includes students whose preparations for entering the field have been disrupted, researchers who have had to halt studies, and manufacturers whose product development work has been paused.

Eventually, in-person care will return. But rescheduling cancelled appointments and overdue hearing aid maintenance will have to wait for now.

Bluetooth-Enhanced Hearing Aids Are Becoming the Norm

Wireless has pretty much settled-in as a consumer buzzword. It basically means being able to connect computing devices without cluttering things up with a tangle of cords.

It is a capability that is increasingly being extended to hearing aids. Wireless capability is quickly becoming the norm.

And this is usually based on Bluetooth, the dominant wireless protocol.

What Bluetooth does is create a concentrated wireless network, one that doesn’t extend too far in any direction. That makes possible a wide range of inter-connectivity, from printers and laptops to smartphones and desktops.
And now hearing aids connecting with most of the above (though no one’s explored the possibility of a hearing aid talking to a printer).

What can also happen is, using an app, hearing aids can be fine-tuned and controlled without actually having to touch them. Given how small they are becoming, this brings an ease-of-use that wasn’t possible a couple of generations ago, when fumbling with dials and buttons was the norm. A wide range of adjustments can easily be made using a smartphone’s touchscreen.

A Bluetooth network can also mean you can stream audio from your smartphone or TV directly into your hearing aid. And by extension, Bluetooth allows hearing aids to become a part of the Internet of Things (IoT). This opens up a wide range of possibilities.

One of the most significant for hearing aid users is being able to upload data from a hearing aid to a hearing health professional, who can analyze it and make adjustments to your hearing aid that will increase its performance. Some models even allow this to happen in real-time.

Hearing aids aren’t what they were only 10 years ago.

For the Sake of the Ears, Remember That It’s Cold Outside

Now that we’re deep into winter, it’s time to remember to protect our ears from what the season can throw at us — the cold, the wet, the flu. And hearing aids need some special love too.
Since it’s the season to get sick, ear infections can be a regular aspect of winter. This will bring fluid buildup, which can actually cause temporary hearing loss. The best defense is to not get sick, so eat well, stay dry, push the vitamin C, and keep those ears dry—letting them get cold and wet in the weather will definitely make an ear infection more likely.

If you already use a hearing aid, then that bit about staying warm and dry will serve them well too. If you expect to spend time in the elements, then spandex hearing aid covers are available that will significantly cut down on their exposure to moisture.

But cold rain or swirling snow are not the only culprits. There is also the perspiration that will likely build up in your ear from being bundled up. Making sure your hearing aids get good and dry with regularity — consider an overnight dehumidifier — will protect your investment and ensure better operation.

And one way you might get sweaty is dealing with all that snow. If you have a snow blower, then remember that it can produce over 100 decibels when blasting away. Without hearing protection, that can damage your ears. So make sure you use some earplugs or noise-reducing headphones when running one.

There are any number of winter-related realities to prepare for. Protecting your ears and hearing aids is just one more.

How to Survive Black Friday With Hearing Loss

For some, Black Friday is a day of excitement. For others, it’s an enigmatic event to be avoided at all costs.

If you’re one of the former and have hearing issues — or maybe even if you don’t — there are some steps you want to take before venturing out into the stampede of Christmas shoppers. If carrying out your purchasing duties the day after Thanksgiving makes absolutely no sense — or instead you stay home and shop online — then you’ve got nothing to worry about.

Otherwise, it’s a jungle out there — and it’s best to be prepared.

Step one is planning ahead. Asking for information on the “day of” is not going to be easy — whether you have hearing issues or not. Store clerks will be at their wit’s end. It’ll be loud. If you have a game plan you can follow with a minimum of needing to talk to others, then all the better.

If you do need to talk to a store clerk, make sure you let them know you’re hearing impaired. This will hopefully alert them to the need to slow down and be as clear as possible.

Finding some partners to charge the ramparts with is also a good strategy, especially if noisy environments are a particular challenge. Likewise, remember that ears actually respond well to taking a break from loudness. Just going outside or sitting in the car periodically during the day will not only calm the nerves but also give the ear canal some rest.

Finally, neither ears nor hearing aids are big fans of the cold. So, it’s best to skip the “camping out for bargains” experience altogether. If Black Friday will involve extended time in the cold, then remember to keep your ears as warm as possible.

The Genetics of Auditory Disorders

Several factors can cause auditory disorders. The foundational trigger is genetics. Over 50 percent of newborns that present hearing issues have genetic issues that are the source of the problem. Hearing loss is an inheritance trait known as a genotype.

Genes are the instructions cells follow as they grow and develop. Mutations can develop in genes and passed on from generation to generation, which is known as a familial trait. Mutations can also develop anew. For example, exposure to radiation can cause them.

  • When both parents have a genetic predisposition for hearing loss it is passed onto a child and, if it manifests itself, is known as autosomal recessive hearing loss. This occurs even though both parents have normal hearing — the condition was just dormant in the parents.
  • With autosomal dominant hearing loss, a predisposition from one parent or a new mutation of a gene leads to hearing loss.
  • Males are far more common to be affected by X-linked hearing loss, in which a gene mutation in the X chromosome — of which males have one and females two — manifests itself.
  • Syndromes of the mitochondria, which are vital parts of cells that produce energy, can be passed on genetically and create issues in the functioning of the ear.

The fact is that the inner ear is a very complex example of evolved design. The cochlea, which converts sound waves into electrical signals and sends them through the nervous system to the brain, is a mechanism that requires a vast number of genetic instructions to develop properly.

Only a handful of genetic “wrong turns” can lead to hearing issues. That only about 1 percent of babies are born with genetic hearing loss is actually a profound testament to the majesty of biology.

The Link Between Diabetes and Your Hearing

The inner ear, where sound is converted to electricity (and sent to the brain via the auditory nerve network), is very dependent on healthy circulation. Though very small when compared to other vital organs, it is an energy-intensive part of the body and requires a constant inflow of nutrients.

This is why diabetes, unfortunately, is very much a risk factor for hearing loss. Current research posits that diabetics are two times more likely to have hearing issues than non-diabetics.

Since diabetes inhibits the bloodstream’s ability to transport glucose, a sugar vital to transferring energy to cells, it can prevent the ear from functioning normally. There is also evidence that the elevated levels of blood glucose — diabetes causes glucose to buildup in the blood rather than be transferred to cells throughout the body — damages the blood vessels that are vital to the inner ear.

One fundamental role these blood vessels play is in nourishing the stereocilia, the tiny hair cells that are a crucial part of the inner ear. These hairs cannot regrow or regenerate after being damaged. And a lack of healthy blood flow will damage them.

Diabetes, if untreated, can wreak havoc with much of the body’s functions. It can cause blindness, organ failure, and lead to amputation of extremities.

A 2012 study published in the Journal of Clinical Endocrinology and Metabolism concluded, after evaluating 13 other studies based on over 20,000 subjects, that the higher risk for hearing loss in diabetics was clear and cut across age and other risk factors.

The general advice to diabetics — exercise regularly and keep weight under control — will also lessen the chances of hearing loss. In addition, protecting ears from other risk factors, such as excessive noise, is even more important for a diabetic.

Is an Online Hearing Test Worth It?

Online hearing tests can be a helpful preliminary tool in learning more about any hearing loss you, or someone in your life, is experiencing. They aren’t a replacement for a medical examination by a hearing health professional — but they can be a way to confirm some preliminary concerns about hearing issues.

If there’s a suspicion that there’s a problem, using an online tool can confirm it — or maybe even help you realize that it was a false alarm, a momentary issue related to something like allergies or illness.

They can also be used at regular intervals to track your level of hearing. This long-term approach could help identify issues very early in the process (which is always the best time to seek out professional treatment).

In the case of short-term exposure to extreme sound — such as at a concert or in the workplace — testing online over the course of a few days might confirm that any hearing degradation was a temporary event. Or not.

One thing to keep in mind is the difference between calibrated and non-calibrated tests.

Calibrated tests are more precise — measuring from a baseline across frequencies, resulting in an audiogram — while non-calibrated tests depend on altering the volume level of the device you’re using, resulting in a less detailed result. Both are available online.

But even non-calibrated tests can accurately measure issues with hearing in noisy environments and speech recognition.

Most hearing aid manufacturers offer online hearing tests, including Oticon and Signia.

Six Obscure Hearing Disorders

There are a lot of ways to have hearing issues. Sure, you can stand in the front of the speakers at too many concerts or just be getting old, but there are some exotic conditions too. If you want to have some good party talking points, try one of these rare syndromes on for size.

  • Ménière’s disease
    A disorder of the inner ear that not only produces vertigo, but also incessant ringing, hearing loss, and pressure “pops” in the ear. The causes are murky, with some combination of fluid buildup, infection, autoimmune issues, head trauma, and genetics at work. Because of this, treatment is usually varied and complicated.
  • Benign Paroxysmal Positional Vertigo (BPPV)
    This condition stems from an accumulation of calcium carbonate crystals in the inner ear. And yes, they’re also known as ear rocks (though the technical term is otoconia). Sometimes the condition just goes away, but a range of drugs, surgery, and even head exercises meant to get the ear rocks to roll out of the inner ear are often prescribed.
  • Labyrinthitis
    As a result of infection affecting nerve transmitters and the inner ear, swelling disrupts communication to the brain (vision can also be interrupted). If treated quickly with antiviral or antibacterial drugs it’s treatable, but long-term damage can occur if it is not treated. Dizziness and nausea are also symptoms.
  • Acoustic neuroma
    A rare condition caused by the development of a benign tumor that interrupts hearing and balance information from being transmitted to the brain. Surgery is the common treatment to prevent further complications.
  • Autoimmune inner ear disease (AIED)
    Not well understood, AIED results in the immune system attacking the inner ear, leading to hearing loss, tinnitus, and balance issues. Steroids and blood filtration (plasmapheresis) are common treatments, along with hearing aids.
  • Otosclerosis
    This hardening of the inner ear’s bones is usually a hereditary condition. There are a variety of treatments to deal with what will inevitably lead to continual degradation of hearing.

Better Hearing & Speech Month: Four Families of Hearing Loss

Every May, the American Speech-Language-Hearing Association sponsors Better Hearing and Speech Month. This year’s focal point is “Communication Across the Lifespan.” So, a good time for a brief rundown of the four broad categories of hearing loss: auditory processing, conductive, sensorineural, and mixed. These are the foundation upon which a hearing health care professional will diagnose an individual’s symptoms.

When the issue is the brain’s ability to process the data being provided to it by the hearing apparatus — all the complicated things inside one’s ears — it is an auditory processing disorder. It isn’t a hearing loss problem, it’s a sound comprehension issue, one that is more common in children but will occasionally beset adults. Basically, people with auditory processing disorder just “hear” some sounds differently than the vast majority of people. It can often be mistaken for a learning disorder, so professional analysis is critical.

A more mundane problem is conductive hearing loss. This is a purely physical issue when something is interfering with the pathway between the outer, middle, and inner ear. That can be something as simple as earwax, an infection causing inflammation, or too much fluid in the ear—or something a little more extreme like a punctured eardrum or unusual bone growth.

Sensorineural hearing loss is unfortunately usually permanent. It is a situation where the information flow between the ear and the brain is irreparably compromised. This occurs when the Cochlea and/or auditory nerve are somehow damaged or genetically flawed. The vast majority of users of hearing aids suffer from sensorineural issues.

When more than one of the above is happening simultaneously — almost always conductive and sensorineural in tandem — it’s referred to as mixed hearing loss. Obviously, sorting out which issue is causing multiple symptoms can be a little more complicated.

Hear Better and Stay Out of the Hospital

Treating hearing loss will not only heighten your quality of life on a day-to-day basis. According to recent research, if you’re unfortunate enough to have a hospital stay, it will also make it less likely that you’ll make a return trip.

According to a Journal of the American Geriatrics Society article published in late 2018 entitled “Hospital Readmission Risk for Patients with Self‐Reported Hearing Loss and Communication Trouble,” people over the age of 65 with untreated hearing loss have a 32 percent higher rate of hospital readmission. This was the case regardless of why they were admitted in the first place.

The belief is that a degraded ability to communicate — and hospitals, especially emergency rooms, can be a noisy environment — leads to patients not hearing instructions about continued care or questions about how they’re currently feeling.

“Hospitals are noisy chaotic places, and people with hearing loss may have trouble understanding key information, such as what medicines they should take after discharge, or how they should watch for or manage exacerbation of their symptoms,” said Jan Blustein, one of the researchers at the Robert F. Wagner School of Public Service who worked on the study. “This puts them at risk for difficulties after they are discharged from hospital.”

This is not just a health issue either. Medicare regulations prohibit, in the case of some medical conditions, payment for readmission that occurs less than 30 days after discharge. This is obviously an issue for both the hospital and the patient.

What’s clear is that treating hearing loss is always in a person’s best interest. This study simply adds another reason why.