Two is Better Than One

Most of us are born with two ears. We hear best when these two ears work together, how nature intended. Years of research supports the claim that people with hearing loss in both ears benefit more from wearing a hearing aid in each ear. This helps to give sound a more balanced, natural quality and, in complicated listening situations, hearing with two ears helps the brain to make better sense of your listening environment.

So what improvements can I expect with two hearing aids?

Improved Listening in Noise
Two hearing aids makes soft speech more accessible and in more noisy places, the speech is more easily separated from the background noise.

Improved Hearing Sensitivity
When wearing two hearing aids together, one gains a volume boost just by having the two ears working together. There is even a natural volume increase provided by the brain! People who only wear one hearing aid are likely to want to turn the hearing aid up quite a bit, leading to possible sound distortion and increased chance of feedback, or whistling. The sound quality is also improved when both ears are working together.

Improved Sound Localisation
It is the brain’s job to determine where a sound is coming from. This is possible because sounds may arrive at each ear at different times and intensities depending on which side/direction the sound came from. The brain is then able to analyse the timing (nanoseconds!) and volume differences to quite precisely locate the direction of the sound source, and thus, which way you need to look.

With one hearing aid, it will always feel as if sound is coming from your aided side, which may not always be correct.

Stimulation of the Pathway
A big benefit of wearing two hearing aids is that both auditory pathways get stimulated together. Nerve pathways that aren’t used can get rusty or unfit, so it is important to keep them active and firing! When there is a hearing loss present. This is done by wearing appropriate hearing aids.

Copyright: Francis Slabber & Associates 2017

Listening to Speech in Noise…

According to research, 16% of people with hearing aids never wear them. Of those individuals, 25% reported that it was either because the hearing aid provided no help in difficult listening environments, they amplified loud sounds too much or that listening in background noise was impossible.

In order to understand how hearing in speech in noise happens, we first have to understand how listening happens. In the inner ear there are 4 rows of hair cells: 3 rows of outer cells whose job it is to listen to soft sounds and detect speech in background noise, and 1 row of inner cells designed to manage loud sounds and stimulate the auditory nerve which sends the sound signal up to the brain. In most cases of hearing loss (particularly to do with aging), the outer hair cells are damaged first, hence most peoples’complaint of not hearing soft speech when there is noise in the environment. Should the hearing loss be more severe and the inner cells also be damaged, the signal would not be sent to the nerve. Should the nerve be damaged, the sound may not even reach the brain at all, or it will reach it in bits and pieces which sound like nonsense. After all of this travelling, the sound signal finally reaches the real ear – the brain. In combination, all of these structures are referred to as the Auditory System. We have found that in most cases people with limited damage to their auditory system do well with hearing aids, given that they received appropriate training and allowed adaptation to happen. After all, we can’t expect an external, electronic device to replace the real thing.

Just like we forget names, places or faces when we get older, the auditory system forgets and needs to be reminded and retrained. Complex sounds are more difficult to listen to, process and understand and hearing aids can only work with a loss of hearing, not a loss of understanding.Listening is not only a decision, it is a skill which has to be perfected and like all skills, it takes training and practice. If you have not heard properly in background noise for years and you expect to hear perfectly in noisy places with your new hearing aids, you would probably feel that the aids are making the noise louder than the speech. This is because the noise is easier to recognise and requires little to no understanding, than speech. The brain forgets how to process things it hasn’t experienced in a while and reverts back to the language it does know. Usually, this language is noise, especially when its amplified. The alternative is: don’t get old, never watch television and lock yourself in a quiet room where you only ever speak to one person at a time who has been trained to speak slowly and clearly!

Manufacturers tend to put a lot of emphasis on a hearing aid’s ability to reduce background noise and amplify speech, however, research is showing that the ear’s ability to do this is unique and is very difficult, if not impossible to recreate. To decipher speech properly, one needs fast cognitive abilities. I.e. One needs to be able to predict speech based on the context of the conversation and to be able to correct what you may have misheard, without requesting any more information. For this to happen smoothly, you need an active short term memory. Younger people are better at this because they are better able to listen, hear and think all at the same time! Older people need to devote cognitive effort to each of these processes in turn. Although some hearing aid technology can give you a fighting chance by controlling background noise, enhancing speech and automatically adjusting to the environment (some devices can do this at a speed of 100 times per second!), it can’t slow things down to a pace that each aging individual brain can cope with – yet!

The moral of the story is to visit a professional audiologist before too much damage sets in, get the best set of hearing aids that you can to make use of as much new technology as possible. Follow this up with good training with your audiologist and practise, practise, practise!

Copyright: Francis Slabber & Associates 2017

Living with Hearing Loss

Though endowed with a lively and passionate temperament and even fond of the distractions offered by society, I was soon obliged to seclude myself and live in solitude. Yet I could not bring myself to people: Speak up, shout, for I am deaf. So forgive me if you ever see me withdrawing from your company, which I used to enjoy. For there can be no relaxation in human society, no refined conversations, no mutual confidences. I must live quite alone and may creep in society only as often as sheer necessity demands.

In this touching excerpt from a letter written by Beethoven to his brothers Carl and Johan, we can hear the isolation, the sadness, the passivity, and the stigma that are hearing loss. Fortunately for most people with hearing impairment now, things are not quite so bad. Were Beethoven alive today, an array of devices would offer the hope of hearing and understanding. However, we need to consider hearing loss as more than just the loss of a sense of sound reception. We need to blend the use of sensory aid with the emotional, cognitive, social and often spiritual losses that hold those with hearing problems back from experiencing life.

It takes an average of 7 years for someone with a hearing loss to explore the help available. Over 16% of those that have hearing aids, do not wear them and an even smaller percentage use assistive devices. Another 16% of people who try hearing aids, reject them. Only 60% of those wearing hearing aids are satisfied with them. Surveys show that half of all hearing aid users would like more information about how to make the most of their hearing instruments.

Why is it that people with hearing loss take as many as 7 years to seek help? Stigma is still a valid answer. Hearing loss often associated with ageing in a youth oriented society, is seen as an embarrassment. In addition to stigma and possible denial, lack of information about hearing loss and how and where to seek help is certainly high on the list of why people don’t get help.

Hearing loss is one of the most prevalent chronic conditions affecting older adults. The exchange of information with others is an important aspect of everyday life. This can seriously impaired in individuals with hearing loss. These difficulties with communication may lead to a perceived reduction in quality of life. As life expectancy increases and older adults are living longer, an increasing number of individuals will be forced to endure hearing loss during their senior years. Understanding the impact that this has on quality of life is of great importance.

There may be a tendency to dismiss hearing loss as being either unimportant or an inevitable aspect of ageing. However, with services readily available that provide hearing aids, assistive listening devices, and aural rehabilitation, a person’s quality of life can be maintained and they can remain active and social.

Copyright: Francis Slabber & Associates 2017

Ear Hygiene

When it comes to ear hygiene, both the biggest hero and the biggest villain is ear wax. This sticky substance that healthy ears naturally produce is extremely helpful in trapping debris, repelling water, resisting infection and preventing insects and other undesirables from entering the ear canal. Ear wax is made up of oils and perspiration produced by glands in the ear canal, which become entwined with skin flakes and hair as it moves out of the ear canal. In a perfect world our ears are self-cleaning, and wax should slowly move towards the opening of the ear, where most of it either gets washed away or flakes off. However, sometimes this isnt the case, and where ear wax becomes impacted or blocks the ear canal it can cause infection and hearing loss.

Wax is likely to become impacted if it is pushed deeper into the ear canal by any foreign body. Unfortunately, usually the most common culprit for impacting wax are the implements used to try and remove wax from the ear- cotton buds. Although commonly referred to as ear buds, cotton buds only serve to push wax deeper into the ear, increased the chance of impaction. They also stimulate the walls of the ear canal to produce more wax than the ear would normally create. And, of course, there is always the chance that a surprise bump causes the ear bud to damage the ear drum or middle and inner ear structures. Also, dont be fooled by the promises of ear candles- in the long run the risk is too high to warrant the convenience of removing wax yourself. Wax should only be removed by a trained professional- it is not a DIY job.

There are certain strategies that can be used to try and reduce the build-up of wax in the ear and encourage the natural migration of wax out of the ear canal. Certain ear drops or oils can be used at night to soften wax, but these should only be used when advised by a doctor, especially if you have a history of ear infections. Its a good idea to wipe the outer part of the ear with a damp facecloth or towel to help the wax on its way out, but make sure not to go into the ear canal. Also make sure that anything that you are regularly inserting into your ear, be it a hearing aid or music earphones, are keep clean and regularly disinfected.

The other common complaint that we receive is that of itchy ears. There are so many reasons that our ears may become itchy, but it is vital that we dont try to scratch them inside, especially not with a paperclip, a hair pin, or any other creative ear-scratcher! The skin of the ear canal and eardrum is fragile and easily injured. Any prodding, poking or scratching may cause pain, bleeding or infection.

Itching in the ear can be caused by any foreign object in the ear, even a hair or dust. It can also be caused by the absence of ear wax, as the ear becomes dry. Often people used ear buds to address the itch, which only serves to further dry out the ear canal and cause more itchiness. Although dryness is a common cause of itchiness, the opposite also irritates the ear- having water trapped in the ear is a warm, dark, moist breeding ground for all kinds of bacteria. If you are battling with an itchy ear, it might be best to keep water out of the ear using an ear plug or avoiding swimming.

Of course, medical conditions like sinusitis, hay fever or allergies can also cause itchiness. This should be managed by your medical practitioner who may prescribe an eardrop, a sinus spray or antihistamines. You can also develop skin conditions like eczema, dermatitis, or psoriasis in the ear canal just as you would on other parts of your body. Again, these should be treated by a medical professional, ideally an Ear, Nose and Throat Specialist, who may prescribe some kind of cream or drops.

If you wear hearing aids and your ears feel itchy, it may be as a result of an ill-fitting aid or a sign that you require an alternative strategy to clean and maintain your hearing aids. This would be a good thing to visit your audiologist about. It is common to experience some itchiness as your ears adjust to having hearing aids in everyday, so always remember to wipe your hearing aids every day when you remove them and place the aids in a drying container. It may help to give the ears a days break to see if the itchiness gets better. If you are still battling there are certain creams that can help to relieve the itchiness- its best to ask your audiologist or ENT for advice on the best cream for you. Just always make sure not to get any cream onto the working parts of the hearing aids- its best to apply it at night once you have removed them.

Copyright: Francis Slabber & Associates 2017

Diabetes and Hearing Loss

In 2015 there were 2.28 million cases of diabetes in South Africa. Diabetes has been known to cause many side effects which can often be devastating and sometime even life threatening. One of the known complications is hearing loss, specifically high frequency sensorineural hearing loss.

How can a metabolic disease like diabetes affect the ears? Diabetes causes the body to create abnormal amounts of keratin, which upsets the pH balance and natural bacterial activity of the ear canal. This causes abnormal sensitivity to foreign materials, leading to increased irritation and infection. It can also cause recruitment, which is a distortion of loud sounds. Many diabetics have poor speech understanding, especially in noisy environments, and occasionally hearing loss can even be fluctuating. Diabetes can also cause tinnitus and balance problems.

So why is it important for an Audiologist to know if our patient is diabetic? When considering hearing aids for a patient there are many variables to determine, including the material used to build the hearing aid, and the size. Often an ENT consultation is required to assess the sensitivity of the ear canal, so that the right material and fit can be selected. The Audiologist would also need to consider fairly high end technology in the hearing aid, to be able to compress the loud sounds to prevent distortion in the ear. Where the hearing is fluctuating, the person may find a volume control or program button, or a remote control or Smartphone App helpful. The person may require more regular than normal adjustments of the hearing aid.

It is extremely important to be aware of one’s diabetes status, as well as to share this information with your audiologist. Knowing about the condition and it’s challenges will allow the audiologist to make an informed decision of a hearing aid that would meet the person’s needs, and to counsel the patient on realistic goals and expectations.

Copyright: Francis Slabber & Associates 2017

Making Conversations Easier

Today’s hearing aids may offer more flexibility and better sound than ever before but they still cannot repair a damaged hearing nerve or revive the ability to interpret what we hear. There are however techniques and strategies that can be applied to make conversation easier to follow.

Conversation is a 2-way street, there are certain things the speaker needs to do to ensure the message is received correctly and there are certain things the listener can do to ensure the message is heard and interpreted correctly.

The speaker should speak in a clear and concise manner, speech should become naturally slower and louder and stress or emphasis placed on certain syllables. Clear speech occurs when the speaker attempts to express every word and sentence in a precise, accurate and fully formed manner. It is not a substitute for other communication habits such as:
Maintain eye contact
Avoid speaking from a different room
Ensure your face is well lit
Avoid background noise
Do not over pronounce words or speak while chewing or smoking or while leaning on your hand.

Some of the things you can do:
Control the amount of background noise. Turn down the TV or radio
Face the person that you are talking to
Don’t talk from a different room or with your back turned. Even with normal hearing this can be trying and frustrating, and it is just not polite.
Speak at a natural pace
Do not shout or over-articulate. With some hearing losses, speech actually becomes less distinct with more volume and the hearing aids today aim to clarify speech and not amplify it.
If you are having trouble being understood, try rephrasing.
Use gestures, body language can make what you are trying to say much more visible and combined with good intonation patterns, it becomes less necessary to hear all that was said.
It is easier to follow a conversation if you know the context. All of us use predictive measures to understand fully what is said in conversation, but without a theme or topic it is difficult to guess what might be said next.
Do not interrupt each other while talking.

Copy Right: Francis Slabber & Associates 2017

Auditory Processing

Auditory Processing is the term used to describe where sound is organised and interpreted meaningfully in the brain. In other words, it is the efficiency and effectiveness with which the central auditory system (the hearing portion of the brain) does its job of interpreting sound into something meaningful. When the hearing system is compromised, the ability to listen effectively is negatively impacted. An Auditory Processing Disorder can exist with or without a hearing loss.

Common reported issues in adults with Auditory Processing Deficits include:
Lack of music appreciation
Difficulty following conversation on the telephone
Difficulty following directions or instructions
Difficulty following long conversations
Difficulty taking notes
Difficulty with remembering information that was heard rather than read
Difficulty learning a foreign language or understanding technical information where the language is novel or unfamiliar
Social issues – difficulty reading others pragmatic communication issues
Spelling, reading, writing issues
Organisational problems

The cause of an Auditory Processing Disorder could be:
Auditory Deprivation (untreated hearing loss)
Periods of anoxia (lack of Oxygen to the brain)
Congenital (born with)

Assessment involves a multiple step process conducted by an Audiologist.

Management is done through a 3 step approach:
1.Environmental Modifications – assess room acoustics and provide assistive options such as FM Systems.
2.Compensatory Strategies – these are strategies that can be employed in both a workplace and a social situation to ensure the best possible sound is received.
3.Treatment – the brain’s ability to learn new tasks and relearn forgotten tasks or skills is known as brain plasticity. These skills can be enhanced by using the following programs:
a.LACE – Listening and Communication enhancement
b.ARIA – Auditory Rehabilitation for Interaural Symmetry (Auditory Processing in Adults: Beyond the Audiogram., G.M. Whitelaw)

About Hearing Loss

Hearing loss is classified by its laterality (left, right, both sides), degree, severity and origin.

The origin of the hearing loss is important because it often helps us to decide upon a management plan. Hearing loss that comes from the outer/middle ear is classified as a conductive hearing loss. Logically, the problem here is with how the sound travels through these potions of the ear. Typical pathologies which can lead to a conductive hearing loss include:
– middle ear infections
– impacted wax in the ear canal
– conditions such as Otosclerosis or Cholesteatoma and many more.

Conductive hearing losses should always be investigated by an Ear, Nose and Throat specialist to first rule out any possible medical intervention.

Sometimes hearing loss happens because of damage to the inner ear (cochlea) or hearing nerve. This is called a sensorineural hearing loss (SNHL). This type of hearing loss is usually permanent and progressive in nature and cannot be treated medically or surgically. SNHL usually feels like a loss of speech clarity/understanding rather than a loss of volume. This type of hearing loss is most commonly seen in the elderly but can also be caused by:
– noise exposure
– certain medication
– trauma to the ear
– certain conditions such as Meniere’s Disease, Meningitis and many more.

A mixed hearing loss can happen when there is both a conductive and a sensorineural loss present. As before, due to the conductive component, an ENT consult is highly recommended prior to amplification to rule out any possible medical management.

Degree of hearing loss indicates the severity of the impairment, or how much hearing has been lost. We typically don’t work in percentages of loss any more but rather in degrees such as ‘mild’, ‘moderate’, ‘moderately-severe’, ‘severe’ and ‘profound’.

After the laterality, origin and degree have been established, management can be discussed for any hearing loss that may have been found during testing.

Copyright: Francis Slabber & Associates 2017