Memorial Day is coming up this month. I see many service men and women in my practice. I would like to thank them and their families for their service, dedication and sacrifice. Many of America’s heroes return from their deployment and/or service time with a hearing loss and PTSD (Post Traumatic Stress Symptoms Disorder). To understand PTSD, we need to define it. It is a traumatic event such as death, threatened death, serious injury or actual or threatened violence. There are simple PTSD and complex PTSD. Simple refers to a single discrete traumatic event which results in feelings of fear, terror or helplessness. Complex PTSD refers to those exposed to repeated trauma over time with some or all the symptoms of simple. The may also include but not be limited to excessive dependence, anxiety, self-hatred, distrust, shame, fatigue, sleep and eating disorders, depression, difficulty planning and difficulties with making decisions, sometimes to the point of paralysis or in need of a service animal.
To compound this disorder many are left with a hearing loss. Individuals with a hearing loss also experience isolation, depression, anxiety and many other communications impairing frustrating hurdles. Tinnitus (pronounced tin- eye-tus or tin-e-tus... either way it is annoying) is a humming, ringing, buzzing, swooshing or any other of a description of sounds in people’s head or ears not heard by others. This often accompanies both PTSD and hearing loss. Hearing loss and tinnitus have been known to be one of the most prevalent in service-connected disabilities. These two conditions together are often referred to as auditory dysfunction. One study noted more that 1.45 and 1 million Veterans receiving disability compensation for hearing loss and /or tinnitus. (Office of Public Heath, 2015 Veteran Benefits Administration 2016). In another study which looked at the prevalence of hearing loss and tinnitus cohort of Iraq and Afghanistan (IVA) with post deployment conditions including traumatic brain injury (TBI), PTSD, and other typical post concussive conditions such as headaches and vertigo/dizziness, the Veterans Administration (VA) data years 2001-2014, concluded that TBI, PTSD, and depression were significantly associated with increased hearing loss, tinnitus, or both.
That was just from the IVA deployment in those years. I want to say a big THANK YOU to all who have, are and will be serving in the military, firefighters, EMS, first responders, police, those who defend protect and serve this country and communities they live in as well as their families for the sacrifice they have endured not just in the battles but in the loss of their lives, hearing and overall communication abilities. They are our heroes in the real world. They are worth remembering, hearing and listening to.
Let's go to the movies and enjoy the sound! I recently sat down with Jeff Logan of Logan Luxury Theatres in Mitchell, Huron, and Dell Rapids to discuss individuals who would enjoy going to the movies but due to the acoustics, both for hearing and hearing impaired, don't benefit from this entertainment experience. Logan and I reviewed not only the assistance one may take advantage of at the movies but also church, restaurants and schools. We are fortunate in the cities of Mitchell, Huron, and Dell Rapids because Logan cares about his patrons having the best experience at the movies. He has purchased closed caption devices that set in the cup holders for individuals who prefer to read due to speech understanding or comprehension difficulties.
He also has new amplification headphones. The devices have a sound reduction effect, that limits the background noise thus amplifying speech. It also has a fabulous aspect for the visually impaired as it can be programmed to tell what is happening (i.e. Joan enter the room and looks at the letter.) The movies are just one area that assistive listening devices are and can be utilized. One of the areas whit the greatest difficulty hearing is while attending worship services. Many churches have installed amplification systems to assist hearing impaired parishioners in hearing the sermons, teachings, or homilies. And some restaurants have remodeled their space to improve acoustics and make a more enjoyable dining experience.
The hearing aid manufactures have also created new hearing aids that are connected to your phone. most are available for the iPhone or iPad, but few are streamable with Android. Manufacturers have also developed devices beyond the hearing aids to assist with various aspects of a better listening environments. The schools provide a FM system - or loop system - for students with hearing impairments. These work with the wearer's hearing aids or cochlear implant as the signal is transmitted directly from the educator to the hearing device. They may be a neck loop, body worn or at ear level.
The most important part is the student is receiving the best learning environment in spite of their hearing impairment. People with hearing loss struggle with understanding speech, even though the hearing aids are working overtime to pick up signals. Give your hearing aids a reprieve and reduce your listening fatigue by considering utilizing the facility's system, such as those used at Logan Luxury Theatres, churches, or schools. Don't be afraid to ask for assistance and let's enjoy going to the movies, places of worship, and school.
Don't dismiss the ringing in your ears. "The ringing in my ears is driving me crazy." "What is it and how do I get rid of it?" "I have heard many claims but I want the truth." These are the questions and phrases I hear often. The claims are real and it is called tinnitus. Tinnitus is, for most people, phantom perception or sound occurring in the brain's pathway due to a loud sound or background activity under stress related situations. The individual with the tinnitus is the only one who can hear it, which is called subjective tinnitus. On occasion, a rare condition occurs in which the tinnitus may be heard and measured by a train professional. Such tinnitus is related to blood flow or contractions of small muscles in the head and it may be caused by the inner hair cells being damaged. This is the objective of tinnitus.
In the general population, tinnitus may be caused from repeated exposure to loud sound, an episode of explosive sound, head or neck injury, stress, certain medications, ear disease, or dysfunction. The truth is millions of people suffer from tinnitus and there are many conflicting reports and causes as there are individuals. No two people listen the same way, share the same medical and environmental backgrounds, or go to the same places at the exact same time. No treatment - whether it is a medication or hearing aid - is going to be the right answer for everyone. If you are utilizing a hearing aid to mask out the ringing, one way or the other, you will need to have a good tinnitus matching procedure provided by a trained audiologist.
As an audiologist, I need to know the exact frequency and intensity as well as if it is maskable and by what type of noise, tone, or response pattern. I need to know if it is intermittent or continuous noise, if it is pulsed or sounds similar to a bee buzz, locust, ocean waves, hissing, highline wire hum, tea kettle whistle, or a telephone ring. There are a numerous amount of variables to just say it is related or probably related to a certain cause, and to treat everyone the same is not answering the questions or providing all the correct avenues of treatment.
So, for now, most will use the Band-Aid approach, but if you would like more information, call an audiologist
We as humans are so blessed to have bodies which perform so many functions without us having to think about them. An example would be breathing. Most of us don't have to tell our body inhale and exhale -it is an automatic function. Hearing and speaking are an important part of the whole-body health. This is a truth that has been proven by years of studies demonstrating the connections of the heart, mind and lifestyles.
Recent studies suggest mediation is not only good for your overall well-being, but it can improve your hearing abilities. It is true there are genetic and environmental factors (such as excessive loud noises) associated with the cause of hearing loss, however most of us have far more ability to prevent hearing loss, or improve it, than we realize. The use of hearing protection when exposed to loud sounds is the first thought. Turning down the volume is the second. Have you thought or inquired from you physician or pharmacist which medication maybe ototoxic and if it changes to those for others may be used? How about getting plenty of exercise?
Exercise improves blood flow. Research has shown at least two hours per week of waling decreased the risk of hearing loss. Exercise also helps the balance system and the cognitive functioning, such as memory, executive functioning skills and motor planning skills. Avoid smoking. Yes, you have heard this related to your lungs about a thousand times. But, your ears? Absolutely. It decreases oxygen to the blood thus increasing the likelihood of a hearing loss.
Meditation and positive thinking also are associated with better hearing. The 2016 Hearing Review found that, "those who meditated have an increased thickness of gray matter in the parts of the brain responsible for attention compared to those who do not meditate." The review suggests that by taking time to calm your mind and focus, your overall health, including your hearing skills, improves. That is pretty impressive. Mediation also improves the blood flow to the ears and increases the oxygen level in the body. The chattering voice that does not seem to quiet can be difficult to not focus on at first but with time, it fades into the background.
Thanks for paying attention. Happy health, hearing and mediating!
Then communicating with someone with a hearing loss, with or without hearing aids or cochlear implants, we need to be cognizant of both the listener and the speaker. The individual who has the untreated hearing loss will often be aware at some level that their hearing is not "what it used to be." They will tend to blame or question all around until they are ready to take ownership of their hearing loss. they will say others "mumble or don't speak clear" or "if they would only speak up and use clear English."
Although these things may be true, they are not true with all speakers. If you are the one hearing yourself say these things, it may be time to get your hearing checked. Checking will determine if it is your hearing, memory, auditory processing or if it is everybody else. When speaking with others who wear hearing aids or cochlear implants, remember as a speaker you have a duty to perform the following:
These are just a few suggestions to help reduce miscommunication. We all want to be heard and understood so remember your manners.
Statistics indicate by Jan 15th, 71 percent of the population have already broken their New Year’s Resolution. By Feb 1st, this stat jumps to 80 percent, and only 8 percent achieve the desired goal before the next year. Those statistics are startling.
So what did you decide to change this year? Anything? A lot of people indicate their resolutions are related to diet, exercise or both. Does what you eat matter to your hearing health? Yes it does. “You are what you eat” is the saying we have heard several times. But it is true. Exercise matters a great deal also, especially with regard to our cognitive abilities and, in turn, how the brain processes sound.
I am not going to tell you what to eat or how much exercise you need. Instead, I will divide food into two general categories. Those of “fast or restaurant food” and “store bought.” Category one contains the most processed foods, which are higher in fats, cholesterol, sugars and generally unhealthy foods. Category two includes healthy choices, such as fresh meats, vegetables, fruits, nuts and items containing a nutritional label.
Research has demonstrated the negative relationship between HEI (healthy eating index) and a high frequency hearing loss. The higher the HEI’s, the better the high frequency hearing. The people who consumed a healthy diet and better quality of foods did not have the associated hearing loss. This relates back to the oxygenated blood flow and amounts of fats, which are clogging up the arteries.
Exercise programs also increase the oxygenated blood flow to the inner ears. What about noise, hypertension and hearing loss? Yes, there is a correlation between these areas also. I would advise not putting your earplugs in and turning up the volume while working out. You are not helping your ears with this strategy. The longer the noise exposure, the more significant are the changes in both the auditory and cardiovascular systems.
To help you keep your hearing and your New Year’s resolution of diet and exercise programs, let me offer this piece of advice: Turn down the volume and increase your intake of vegetables, fruits and other healthy foods. Talk to a nutritionist, dietitian or health care professional whose profession it is to advise or guide you on nutrients. Stay away from items or labels of which you can’t program that works for you and your age level. Get a baseline hearing test by an Audiologist to determine where your hearing healthcare is at this time.
Hearing loss and sports presents a different kind of challenge.
However, many people have accomplished great things despite their hearing loss. The pain and frustration of being told you or your child have a hearing loss and the many ideas that go through one's mind can be overwhelming, so let me clear up a few myths.
No, a hearing loss does not prevent you from playing sports. It may be challenging wearing hearing aids or a cochlear implant but it's not impossible for those willing to overcome the barriers. Let's look at all that is need to play a sport. Do you have a coach, teammates, gear, sportsmanship qualities, confidence, self-esteem, patience and the ability to take direction and go for your dreams? Then play the sport.
There have been and are many professional athletes who have not let their hearing loss or deafness stop them from playing the sport they loved.
Heather Whitestone became the first deaf Miss America and her talent was dance, Chris Colwill is an international deaf diver and the Tamika Catchings is a WNBA player. In the NBA, there's Lance Allred while the MLB has Curtis Pride. The NHL has Jim Kyte and there's also Mat Gilbert, a rugby player. In swimming, there's Marsus Titus. And did I mention Alpine skiing gold medalist Edna Yakovishina?
These are just a few athletes who were either deaf or had a severe hearing loss. And they had help along the way. Before you jump into a sport, there are some things you should know.
Coaches need patients, to be vocal and not soft spoken. Give the students directions using gestures and confirm that the player understands. Don't talk with your back turned to the deaf player. Also make sure you are in good light but don't make the player look into the light because they need to read your speech cues.
Develop some strategies for getting the child's attention. And same as all sports, treat all the team members the same. Teammates need to be comfortable around a child with hearing aids or a cochlear implant. It is OK to ask questions about the implant or hearing aids. Know that you as a team need to work together to include all the teammates and their unique gifts.
As a player remember to turn your hat sideways during the rain to help protect your implant or wear sweatbands. Remember to keep a clean towel handy for you to dry your hair and head due to sweat or rain.
Develop strategies with coaches, teammates and the officials so communication is both at a developmental and competitive level. Remember safety. Try using mesh ear flaps to assist holding hearing devices in place and for added warmth. Discuss things with your audiologist. Audiologists are here to help you hear no matter what sport you choose to play.
Are there any links between hearing loss and osteoporosis?
The research does indicate there is a connection. Osteoporosis is the medical term given to a progressive metabolic disorder affecting both men and women. Women have higher incidence of this disorder. Although all nationalities or ethnic groups may be affected, it is most commonly found in Caucasians and women of Asian descent.
Osteoporosis is the degeneration of bone tissue that can cause loss of bone density which can increase the risk of bone fractures. Osteoporosis occurs when the bone is being broken down faster than the body can replace it. This process leads to bone weakness and thus increasing the likelihood of breakage.
Approximately 40 million Americans in 2015 either have osteoporosis or are at risk for developing the disease. Since this time it is estimated to have almost doubled.
And in 2006, researcher discovered a possible link between osteoporosis and otosclerosis. Otosclerosis is a bone condition which affects the bones of the middle ear. The bones of the middle ear, known as the ossicles, become fixed together into an immovable mass, thus not able to transmit the sound to the inner ear.
Only about 3 percent of the population has otosclerosis. This creates a conductive type of hearing loss. This type of hearing loss can be corrected by both hearing aids and surgical intervention. If the bony mass has affected the otic capsule of the inner ear then a sensorineural hearing loss. This type of loss is not surgically correctable.
Hearing aids are worth trying. If one has both conductive and sensorineural hearing loss this is known as mixed hearing loss. This type often finds patients as "advancing otosclerosis." Otosclerosis often occurs during pregnancy and may be genetic. It has a viral aspect to it as well. If the hearing loss is found not to be otosclerotic in nature, it does not mean that it is not related to osteoporosis. Sudden sensorineural hearing loss, appears to be greater in those an osteoporosis diagnosis.
In 2015, research suggested the increased of developing a sensorineural hearing loss was 1.76 times greater than that of a people with bone disease. In many previous reports, there appears to be a relationship, however casual in nature, risk which still remains between these two diseases.
Even when researchers have followed patients who were diagnosed with osteoporosis but not with hearing loss the rate of sudden deafness increased to 1.76 in the comparison groups. The true relationship between these two disorders remain, however, it is important that your audiologist or hearing healthcare provider understands the correlation and not ignore the possible increased risks.
Instead of discarding used hearing aids, donate them.
Recently a woman asked me what to do with a pair of hearing aids that were used by her deceased mother. I explained to the woman that she could bring them into Hearing Plus, LLC and we will donate them to the Hear Now Foundation in the woman's mother's memory.
It is a wonderful way to give the gift of hearing to the world. "'So the world may hear," as Bill Austin, founder of Starkey Laboratories, would say. Allow me to discuss this organization and why we team up with them and their cause.
According to Sarah Bricker of Starkey Hearing Technologies, the Hear Now Foundation is a nonprofit group which is both financially and application based with guidelines for assistance that need to be met and support documentation that is required before assistance is given. Setting forth guidelines necessitates a verification process to determine eligibility on a case-by-case basis.
Hear Now primarily serves an older population since there are usually services available for those under 18 or 21 years old. It is a national program serving those who are permanently in the United States.
In 2014, the program provided 9,671 hearing aids to 5,200 people in the U.S. The program is in great demand today because the population is aging rapidly. Hear Now is so important because hearing loss is such an isolating reality. If it is important to have people engage with each other, family, education, the workforce, society in general, it is necessary for people to be able to re-establish or maintain those connections.
The age group served through this Hear Now is also at or approaching an age when the savings they might have been able to put away for the future are now being used for medical bills and living expenses. In the light of those costs, purchasing hearing aids is the last item on the list.
Sister Joanita, the powerhouse behind the Hear Now program, first took her vows in 1966 and is still a Sister of St. Agnes to this day. As an Audiologist, I view Joanita as a modern-day Mother Theresa for the hearing impaired. She will send a letter to keep with your tax records if you plan to take a charitable deduction. You will then consult your tax advisor or accountant regarding any tax consequence of your contribution to Starkey Hearing Foundation, a 501 @ (3) non-profit organization. No goods or services are ever received in exchange for your donation.
We also take used or old hearing aids to enable others to hear the sounds of their loved one's voice, participate in conversation, pursue an education or seek gainful employment.
Rather than have your hearing aids in a drawer that doesn't hear, help someone else with the gift of hearing by donating them to the Starkey Hearing Foundation. It gives you a gift back knowing you are helping others communicate with the world.
Mr. Bill Austin's mantra, "Alone we can't do much, but together we can change the world." At Hearing Plus LLC, we hope and pray this becomes a raging fire of compassion and giving around the world. We thank you on behalf of those this gift is given to.
Why should I buy hearing aids from an audiologist and why do they cost so much?
That’s a great question and one that I will answer one at a time.
first, an audiologist is a highly trained and well educated professional. Entry level is a doctorate degree in hearing healthcare — meaning no less than eight years of college. They are health care professionals who evaluate or test, diagnose, treat and manage the hearing mechanism and hearing loss, tinnitus and balance disorders from newborns through geriatric populations. They make sure there is no medical reason for your hearing loss, tinnitus or balance disorders.
They can also bill their services to Medicare, Medicaid and insurance. This is why the testing is not free. Medicare requires a comprehensive testing to include certain aspects and therefore is not a screen nor a threshold test disguised as an evaluation. The hearing aids are prescribed by an audiologist.
Now, onto the cost portion of the question. Hearing aids today are instruments of precision with digital programming more advanced than that of the first space shuttle. The level of technology should be custom and prescribed for your specific hearing loss and needs as well as your lifestyle. It is similar to eyeglasses. You can get cheaters but they are not prescribed for you and may even cause you harm. The Better Hearing Institute, a nonprofit center for hearing advocacy, published a consumer warning against “do-it-yourself hearing care,” writing that “the process requires a complete in-person hearing assessment in a sound booth; the training and skills of a credentialed hearing healthcare professional in order to prescriptively fit the hearing aids using sophisticated computer programs; and appropriate in person follow-up and counseling. This is not possible when consumers purchase one-size-fits-all hearing aids over the Internet or elsewhere.”
So why the cost? In building a hearing aid the manufacturer requires space, assembly machinery and equipment to test hearing aids. Then they have technicians, scientists, administrative personnel, the equipment and employees to perform research, development, assemble, market and distribute the hearing aid information and hearing aids. Don’t forget to add in the cost for those employee’s life insurance and health insurance, vacation, sick leave, training, computers, supplies, a safe workplace, contribution to social security, pensions and taxes. Last but not least there is the number of federal and state laws governing workplace regulations and distribution of the medical devices. Oh, and be ready for the repair and replacement cost of your hearing device.
And I’m not done yet. The manufacturer is a business and in order to continue to operate they need a return on investment. They are continuously making improvements and developments on the technology. We want this process specified to each individual patient. Remember hearing aids are not electronic devices like iPad, iPod or televisions. Once you get to the hearing health care professional, the services are often “bundled.” This means the cost for the counseling on the care and recommendation of treatments, earmold impressions (if needed), probe microphone verification, re-evaluation with hearing aids in sound booth, orientation, instructions, routine follow-up visits for three years, unscheduled visits for adjustment over the coming years, minor repairs, loss and replacement of devices, rehabilitation services, audiologist’s time and business expenses.
Today’s hearing aids have more technology (up to four computers). This is to provide the assistance the wearer needs. There is financing available just like buying any other big item. If the provider is in network and willing to accept insurance, the insurance may pay a portion of the hearing aids.
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Patricia Larson Shields, AuD FAAA MA CCC-SP/L is a doctor of audiology with her degree from The School of Audiology of the Pennsylvania College of Optometry in February, 2003. She has been in business in Mitchell, SD since September, 1991.