We usually post on serious issues, but once in awhile something tickles our funny bone and we just want to share.  That’s the case today with this video, which we hope you’ll find amusing when you click on the link:

Bet They Couldn’t Do This Without Their Hearing Aids

On a more serious note, this did get us thinking about fitting hearing aids to animals.  Holly spent several years adapting hearing aid receivers to custom molds for cats, as part of her doctoral research.  But the cats always shook their heads vigorously, sending the molds flying.  That was a long time ago and we wondered whether anyone else had had more success.  We found one link that may be useful to owners of animals with hearing loss.

Presented for your viewing enjoyment by

Your Tucson Audiologists,

Holly Hosford-Dunn PhD

and

Sharon K Hopkins MA

This is a quick post to alert you to a fascinating case study involving one-sided, mild hearing loss; one-sided, extreme tinnitus; and horrible migraine-type headaches.

The patient was an adult female.  As you’ll see from reading the article, her symptoms were suspected to be related to some sort of trauma — perhaps a chiropractic manipulation.  As far as we can tell, that suspicion remains only speculative.  She did have an audiology work-up but there is no report of whether her hearing symptoms were constant or if they fluctuated with her head pain.  There is also no mention of her word recognition performance and whether it fluctuated.

Suggested causes ranged from ear wax to brain tumors, none of which proved out.  In the end, the diagnosis turned out to be a old, almost-forgotten diagnosis called hemicrania continua–perhaps little used because it is based on symptoms and not on cause, which remains unknown.

From our reading, the symptoms that characterize hemicrania continua don’t include hearing problems and treatment is only intermittently effective.  According to the case history, this woman experienced complete recovery after receiving medication.  The diagnosing physician considered himself lucky to have stumbled on the case and “cure” and didn’t discuss the possibility that her condition may be recurring.

This is an interesting case history because it involves hearing complaints coupled with a clinical diagnosis for a condition that is not known to involve  hearing.  We’re not sure what to make of it, but want to archive it here on our blog in case we see anyone with a similar history and complaints.  We’re also interested in hearing from people who have experienced anything similar.

Along the way, we found a user-friendly slide show on tinnitus that patients may find helpful.  If you’re interested, just click on the link.

Submitted for your reading consideration by,

Your Tucson Audiologists,

Holly Hosford-Dunn PhD

and

Sharon K Hopkins MA

photo courtesy of migraine headache help

For several years, we’ve been reporting on correlations linking hearing loss and Alzheimers, depression, cognitive decline, social isolation, general health, and Quality of Life (QoL) measures.  Correlation does not imply causality, but the data keep coming, forging stronger links between healthy hearing and healthy living.  

Yesterday, Jane E. Brody published a thoughtful piece in the New York Times entitled Lifelines for Hearing Loss which draws many of those threads together.  It’s worth clicking on the link to read the full article, but we’ll give you first sentence to whet your interest:

Hearing loss, a disability currently untreated in about 85 percent of those affected, may be the nation’s most damaging and costly sensory handicap.

We hope you’ll read her excellent review, which is written for the general public.

Another report published in the September 6 issue of the Annals of Internal Medicine is written for an audience of scientists.  You may not want to slosh through it, so we’ll hit some highlights here and try to make it clear how the study was done.  You can also go to the “summary for patients” version prepared by the authors to get a more complete encapsulation.

The researchers collected reports of cognitive screening during routine medical exams performed from 1991 to 1993 on about 4000 older adults from diverse backgrounds. The study followed those 4000 for 13 years and found that:

 mild and moderate to severe cognitive impairment at baseline was associated with an increased risk for death over roughly the next decade after controlling for other mortality risk factors.

The study was compelling because it characterized the effects of even mild cognitive impairment on life expectancy as on the same order as diabetes and other chronic diseases.  If you’re wondering how commonly cognitive impairment showed up, it was present at baseline in about 20.2% of the adults, but that doesn’t tell us much because of the large range of subject’s ages:  60-102 years when they were first screened.

What does make the data interesting is the manner in which the researchers tracked those who were screened.  They looked only at the 60.3% who died in the 13 year period and measured the number of months each subject lived.  The median number of months for all of those subjects was 129 months (10.75 years).  Then, they measured the number of months subjects lived according to their cognitive status.  The results, shown in Table 1, make it clear that those with cognitive impairment had shorter life spans compared to those with normal cognitive function. The median length of life for subjects with moderate cognitive impairment was 6.25 year less than that of those with normal cognition.

The authors draw conclusions related to treatment options for older people, depending on their cognitive state.  For our purposes, we look at this study and consider the implications of Jane Brody’s article (above):

And now there is another major risk associated with hearing problems: dementia and Alzheimer’s disease. 

Correlation is not causality, but the links between hearing loss- dementia-Alzheimer’s disease, together with the links between cognitive impairment and longevity, make us want to hedge our bets and those of our patients by encouraging them to optimize their hearing abilities, in hopes of allaying cognitive problems, in hopes of prolonging meaningful life.  To the extent that these hopes are realized, the cost of hearing aids becomes small compared to the savings of good cognitive function and longer, fuller lives.

To our patients:  At TAI, we have two short screening tools for cognitive assessment if you are interested in filling them out:  the Short Portable Mental Status Questionnaire used in the study described above; also the Mini Mental State Exam (MMSE). [1]  . 

Presented for your reading consideration by

Your Tucson Audiologists,

Holly Hosford-Dunn PhD

and

Sharon K Hopkins MA

photo courtesy of Darroch Hearing

Do certain noises drive you crazy?  Have you ever noticed that some of the most irritating noises are not as loud as other, less irritating noises? Have you ever noticed that some of the sounds aren’t even what you’d call “noise”?  Do you ever wonder what your ears are up to?  So do psychoacousticians and cognitive psychologists.  Read on for some loose science with intriguing study results.

Here’s a list of the 10 top irritating sounds for people in Britain, based on a survey done by the Siemens Hearing Aid Instruments in 2006:

1. Children screaming
2. Nails on a chalkboard
3. Car alarm or house alarm
4. Dental drill
5. Dog yapping
6. Person talking with mouth full
7. Cell phone ringtones
8. Alarm clocks
9. Knife grinding on a plate
10. Person grinding teeth

Clearly, sound annoyance is not the same as sound loudness and not all noise is annoying.  When a sound is both loud and annoying, it really tops the list (e.g., baby screaming). But the sound of a person talking with a mouth full of food is highly annoying whether the person is speaking loudly or softly.  And, loudness aside, the annoying sound is speech, not “noise.”  Let’s conclude that some loud noises are especially annoying and some soft speech is especially annoying.

But what about sounds that we enjoy?   Here are some of the favorites from the same survey:

1. The glug of wine as it pours into a glass; 2) Rain falling, 3) Laughter

None of the top 3 is speech, so should we call them noise?  None are loud.  Let’s conclude that some soft noises are especially pleasing.

But consider favorites #11:  The acceleration of a powerful car and #15: Crowds chanting at a football match.

No doubt that those two favorites are noise… and loud noise at that.  Let’s conclude that some loud noises are especially pleasing.  As for speech, well it seems that NONE of the top 20 favorite sounds we like to hear are speech.

This post is in the “Psycho…” series and we think you can see why:  our brains+experiences+focus set our auditory preferences, so psychology trumps acoustics when it comes to perception and attention.  Of course, this poses huge problems for the engineering of hearing aids. When one reads that a hearing aid performs noise reduction, how do we know if that is good or bad?  If it is a favorite loud noise, do we want it reduced?  Or do we want it reduced sometimes but not at other times?  When we read that a hearing aid improves speech perception (or words to that effect), how do we know if that is good or bad?  The old joke about noise cancellation for a spouse’s speech is not entirely a joke, though that is a sometimes thing as well.

Readers:  pity the poor hearing aid designers, and take a few minutes to consider what you mean when you say you have “trouble hearing” or that you don’t like your hearing aids because they “make everything too loud.”  It will help if you break down both of those statements into exactly WHAT sounds are difficult to hear and exactly WHAT sounds are too loud.  Any help you provide is gratefully received by your audiologists and by the designers of your present and future hearing aids.

We’ll end this post by recommending you to a site called Noise Help where you can take a fast survey to rate how much different sounds annoy you.  We just took it and it was a lot of fun.  You could turn it into a party game for the holidays and help the cause at the same time!  We’ll also refer you to an attorney who hates noise in almost all forms and frequently blogs on the legality of different noises and possible remedies.  He may have some pointers for you!

Presented for your reading pleasure by your Tucson Audiologists,

Holly Hosford-Dunn PhD

And

Sharon K Hopkins MA

Sharon Hopkins is usually the Strong but Silent one in our office — programming hearing aids, performing hearing tests, working hard while Holly does the fun stuff like write posts.  But once in awhile, Sharon decides there is a topic about which she feels strongly.  When that happens, it’s worth listening to what she has to say because her vast experience down in the trenches gives her a keen perspective on the realities of hearing aid dispensing and audiology in general.  Here’s what she has to say on the topic of the new version of mail-order hearing aids…..  

Thinking about buying hearing aid(s) over-the-counter (OTC) or online, please consider this:

A lot of us research products over the internet, even purchase certain types of items online. Why? Availability, price, and easy access are probably the most common reasons to shop online. There is some good information out there. It is a good way to prepare the right questions to ask. Internet shopping is convenient, after all you can sit in your PJs at the computer 24/7 and get it delivered the next day to your door. Some products may not be available locally or the initial price may be less. I shop online too, but if I want to feel the quality, or need it to fit properly, or the product will require adjustment or service, I buy locally.

OTC or Internet hearing aid sales may seem attractive to those who don’t understand the process of diagnosing hearing loss or the fitting of hearing aids. Not everyone with a hearing loss should have hearing aids. Audiologists are trained to accurately measure the type and degree of hearing loss on calibrated equipment in a sound booth. We work with you and your physician to discover the origin of the hearing loss and whether it should be medically treated or if and when hearing aid(s) are appropriate. As Audiologists, we should:

• take the time to listen to your history, lifestyle, listening needs, and preferences for how you want to hear all the different environments that constitute your lifestyle;
• help you understand the acoustics of sound and the  physiology of hearing loss.  Hearing is personal and people have individual needs and preferences about how they hear. Your hearing and your preferences will change over time through a neural process called “acclimatization” as your ears and brain become used to hearing more and working together to optimize what you’re hearing;
• make adjustments to your hearing aid(s) as needed during the acclimatization process and maximize your benefits of amplification as your hearing needs change over time.

Some of our most technically savvy patients require the most time because they have researched online and more questions arise than were answered. We appreciate the effort and interest they take in their hearing. They begin to understand that even though hearing aids have become more automatic over the years they will only achieve optimal results with individualized fine tuning which is introduced on a time-line that is unique to each patient.

Thank-you for your consideration,

One of Your Tucson Audiologists,

Sharon Hopkins

Sharon K Hopkins MA, Dispensing Audiologist

Here’s an excerpt:

The concert hall at the Syndey Opera House holds 2,700 people. This blog was viewed about 11,000 times in 2011. If it were a concert at Sydney Opera House, it would take about 4 sold-out performances for that many people to see it.

Click here to see the complete report.

We’ve long known that there is some association between lead exposure and hearing loss in adults.  Now, a new study from Massachusetts Eye and Ear Infirmary indicates that “teens exposed to higher-than-normal levels of lead are more likely to have trouble hearing.”  The headline accompanying that quote is sure to alarm:  High Lead Exposure Linked to Hearing Loss in Youth.

But, don’t be alarmed.  Just register the already-known fact that you want to keep your kids (and yourself) clear of lead exposure.  Here’s a more sedate take on the study findings:

Good News

• only 1 in 20 adolescents had high lead concentrations (2 mcg/dL or higher) that might be linked to hearing loss.
• lead levels are lower overall than they were several decades ago.

• almost 1/3 of the adolescents with those high levels of lead had some degree of hearing loss (>15 dB threshold(s).
• the current US  standard for acceptable blood level in children is < 10 mcg/dL, which is 5 times higher than the “high” level defined in this study.

Holly Hosford-Dunn PhD

That’s the story most of the time.  But there is another group of patients who present in the audiologist’s practice with exactly the opposite set of complaints – they hear too much and the last thing they need or want is a hearing aid.  Who are these people, what is the problem, and why are they in a place associated with hearing aids in the first place?

We’ll answer those questions in reverse order.

• Q3:  Why are they in our offices?  They come in to see us because there is no other established option available.  The condition can be incapacitating for some.
• Q2 what is the problem?  The etiology of hyperacusis is unknown.   It could in the brain or in the ears, but people with hyperacusis notice life is better if they put plugs in their ears, so they suspect it is their ears.    The audiologist performs tests to test that theory, often confirming what the patients already know – that their hearing is not only “fine,” but possibly better than fine.  In fact, hyperacusis is  probably a complex “learned” interaction of the ears and brain in most cases and treatment (and treatment success) varies from individual to individual.
• Q1: Who are these people? They come in two types. People in the first group have hearing that is better than age-based norms. Those in the second group have normal hearing thresholds but cannot tolerate “normal” sounds (mid-level sounds  that are < 65 dB SPL). Both groups are rare, although we have not found incidence or prevalence data to tell us how rare either group is.  Anecdotally, we don’t see very many of them in the clinical setting, but we know them when we see them:“Whether hearing sensitivity is within normal levels or not, it is clear that audiologists will, on rare occasions, encounter patients who reported extreme hypersensitivity to everyday environmental sounds.” Shoup and Roeser (2007)[1] , p 332

In rare cases, extremely sensitive hearing may be a symptom of a medical condition (e.g., Addison’s disease) which can reverse with treatment.  Audiologists face a technical problem when testing people with better-than-normal hearing thresholds. It is very difficult, if not impossible, to ascertain how much better their hearing sensitivity is than normal, given the test booths and test equipment we have to offer.  That’s because people with extremely acute hearing in quiet do not hear quiet.  In what most of call “quiet,” this group hears molecules in the air space of the middle ear randomly bouncing into each other — a phenomenon known as “Brownian motion” that produces Brownian noise.   In a sound-treated booth under earphones, test sounds at levels below the level of Browning noise go undetected — not because the person’s hearing is not acute enough — but because those pesky molecules are “masking” the test sound.  End of test.  We’ll never know just how well those people hear!

What a racket! Click here to get an idea of what Brown Noise sounds like (it’s amplified so people with “normal” hearing can hear it)

Not surprisingly, there are websites dedicated to hyperacusis — for diagnosis, treatment, and support. Most of the websites are associated with tinnitus treatment as well, since it is another, much more common, ear/brain condition of unknown etiology with imperfect treatments that can be extremely debilitating and can occur in the presence of normal hearing sensitivity.

Also not surprisingly, opinions on treatment cut a wide swathe and will likely continue to do so until cause(s) of hyperacusis are definitively identified.  In the meantime, remember that these folks are out among us, trying to cope with a noisy world, and likely wearing ear protection to navigate.  We can do our part by having good communication manners and being aware of the impact our noisy selves have on others.

Presented for your reading pleasure by Your Tucson Audiologists,

Holly Hosford-Dunn PhD FAAA

and

Sharon K Hopkins MA FAAA

For those of our patients who insist on attending rock concerts, we thought you’d appreciate this information excerpted from a recent post by Dr. Marshall Chasin, world expert on all things musical as they affect hearing:

The human ear is much like any other body part- too much use and it may be damaged. The ear takes about 16 hours to “reset”. After attending a rock concert you may notice reduced hearing and/or tinnitus (ringing) in your ears. And if your hearing was assessed immediately after the concert, one would find a temporary hearing loss. After 16 hours however, your hearing should return to its “baseline” (hopefully normal) level. After a loud session or concert, don’t practice for 16-18 hours. Also, its a good excuse not to mow your lawn for a day or two!

If you want to read all of Dr Chasin’s tips for music lovers, check out his blog page.

Submitted for your reading pleasure by

Your Tucson Audiologists,

Holly Hosford-Dunn PhD

and

Sharon K Hopkins MA

photo courtesy of collider

Just a quick post to share an hilarious poem that we heard read by the poet, George Bilgere,  on Prairie Home Companion this beautiful Sunday morning. Click here to hear him read the poem (he’s a good reader) after he receives an entertaining introduction by Garrison Keillor.

Or, cut to the chase and read it below.   We’re sharing this one because it’s all about our favorite topics, in alphabetical order:  Attention, Audibility, Communication, Listening, Manners, Mental Health, Noise, Socializing, and Technology.

Bridal Shower

by George Bilgere