Taking The Edge Off this Noisy World

It really can be a noisy world. Most of us rarely give thought to just how noisy our world is. I can think of instances where this became apparent to me. A power outage is often a good time to gain perspective. When we lose power in the office and the lights, computers, photocopiers etc. go off, it always amazes me as to how quiet it is.  A good friend was just chatting with me remembering one of our great camping adventures in Algonquin Park. When I say adventure, that is precisely what I mean. We would typically canoe in deep into the park in order to get away from the casual campers and to find some peace and quiet. The down side of this meant long portage after long portage. Eventually, we would typically find great camp sites and have an exceptional time with friends. I recall one such trip where we were camping on a relatively small lake with virtually no one else at any of the other sites around the lake. That day I had been fortunate enough to catch a supper of speckled trout in a nearby stream and we feasted at supper time. After supper, my good friend Frank and I were at waters edge cleaning up some of our cookware so as not to attract the attention of the critters of Algonquin. We had paused momentarily to take in the tranquility and magnificence of the surroundings when we heard a rather unfamiliar and strange sound. At first neither one of us had any idea what this sound was but after a moment we both realized what it was that we had just heard. In the stillness of the evening what we had heard was the movement of air through the wings of a loon flying past us. How many times in my life had a bird flown past me with me never being cognisant of such a sound existing? Only due to the lack of other sound was I able to hear what was a virtual roar relative to the quiet that surrounded me.

Unless you happen to live in an area like Algonquin park, your world like mine is a noisy one. We are surrounded by all kinds of noise. For some, this noise can create all kinds of trouble. I have many patients with normal hearing that find the noise of this world excessive. Over the years, I have encountered many patients with head injury that have found the noise of traffic of the mall or the hockey arena etc. to be overstimulating. Many of these folks have had to avoid social settings of these other environments due to this great difficulty that they have.

In cases like this, I have found the prescription of a musician's ear plug to be a rather useful amplification of technology. The musician's ear plug is unlike other ear plugs in that they can reduce  sound without leaving you feeling plugged up. You lose very little sound quality but simply turn down the volume. To be able to do this for my head injured or easily overstimulated patient can mean the difference between completely avoiding a difficult situation and functioning in the real world. I will see some of my patients out and about wearing their musician's earplugs at the hockey arena or the mall etc. functioning without the added stresses that noise can cause.

What is interesting is that this was not necessarily the application for this technology that was envisioned and quite frankly not what I learned during any of my graduate or post graduate work but rather a common sense solution  that has worked wonders for my patients. I ran into a neuro-psychologist that sends me patients with these issues on a regular basis and she told me that neither was this an approach that she found along her educational pathway either but we both agreed that it has worked wonders for our patients. 

Things That Go Squeak

Quite some time ago, I had a patient I fit with hearing aids that had a high frequency hearing loss. This particular patient purchased an excellent pair of hearing aids that allowed him to hear rather well. As is my practice, I typically do a follow up two weeks after the fitting, to see how the patient is doing and in order to make the necessary adjustments that may be needed. When the patient came in for his follow up, he reported that the hearing aids cost him a lot of money. I started to explain the cost versus benefit to the patient but he stopped me, apparently I had misunderstood. You see, he was not complaining regarding the cost of the hearing aid, as a matter of fact, he was rather thrilled with his improved hearing. The cost that was he was referring to was related costs to purchasing the hearing aids. You see when he walked out to his car from his fitting appointment and turned it on, he became aware of a hole in his muffler that had to be replaced. At home, he had to fix creaking floors and squeaky doors, thus the commentary that his hearing aids cost him a lot of money.

I had another patient that came to the office with a funny story of improved hearing. The patient having just been fit was sitting in his kitchen enjoying a morning cup of coffee in peace and quiet, that is, until he detected a suspicious sound in his kitchen. This man’s quiet reflective time was interrupted by a persistent, rather loud ticking. As it dawned on him that this new sound in his kitchen was rather out of place, he became convinced that there was a ticking time bomb in his kitchen. Wasting no time he did the rational thing and ran as fast as he could out of his house. After viewing his house from across the road for a few minutes, it dawned on him that he did indeed have new hearing aids and that perhaps he was hearing something other than a ticking time bomb. As it turned out the wall clock that he previously believed was silent actually did indeed tick.

The examples I can give of the shock of improved hearing range from the flushing of a toilet sounding like Niagara falls to the clicking of one’s dentures being heard. Some of these sounds need to be dealt with by the audiologist, given that they go beyond what is necessary and normal but others really are long forgotten sounds. I have had patients tell me that they believed that new cars had soundless blinkers, that is, until they got their new hearing aids. There is such a thing as auditory deprivation, this is the effect on the brain relative to the long term absence of sound. Simply put, when one has not heard certain sounds for a long period of time, the brain forgets the sound exists. The longer the sound is missing the harder for the brain to reconnect to that sound rendering a useful component in the processing of information.  So while clicks and squeaks can represent long forgotten sounds more important is the high frequency speech signal that is integral to the discrimination of sound (understanding speech). The longer one has a hearing loss the harder it is for the brain to reacquaint itself with that formerly missing sound. So yes, things that go squeak are important in the context of conversation and understanding speech optimally.

Squirrels Can Cause Hearing Loss !!!

I love the great outdoors as much as anyone. As a matter of fact, I was once a wilderness life director at a summer camp, charged with capturing and taking care of many kinds of critters. What I did not realize was that my life as an audiologist would eventually intersect with that of my life as a wilderness life director. The problem is our furry friend the squirrel. Yes, the bushy gray or black or brown version. I had a patient who also loved the great outdoors and all of God's creatures. Together, with his wife, would spend time in their back yard, filling their bird feeders and then watching the  various birds come and eat. While this family lived in town, they were blessed to have other creatures also frequent their back yard and they felt compelled to make sure that they too were well fed. Amongst these creatures were the squirrels. This couple had the squirrels eating out of the palm of their hand and always kept a nice supply of unshelled peanuts around in order to provide for the squirrels. Sometimes, the squirrels would eat the peanuts right away and other times they would run off with their find to bury it to provide nutrition in the lean winter months (this is what squirrels do).

Given that this was one of my patients, it would be safe to surmise that he had a hearing loss and in this case also wore a hearing aid. One day this man decided that his grass was getting a bit long and required cutting. The man stood in his back yard with his lawn mower ready to go when he realized that he was still wearing his in the ear, custom fit, rather expensive hearing aid. Not wanting to waste a lot of time, he set his hearing aid on the picnic table and started to mow his lawn. In the blink of an eye, the well-trained peanut eating squirrel recognized on the picnic table what it believed to be the offering of a peanut and promptly scurried over and picked it up. Knowing winter was coming, he decided that he might consider burying this morsel of potential food. As the squirrel bounded off, he realized that the man mowing the lawn was also bounding in his direction waving and yelling. Having no intention of sharing his food, he scurried off to burry his food find.

It was a few days later that this man came to my office, embarrassed to tell me that he had lost his hearing aid in this manner and that for all his searching he could not find the hole in which his hearing aid was burried. Fortunately, the man had warranty left on his hearing aid and was able to have it replaced under that warranty. It turned out that it was the squirrel that had the big surprise one winters day when he was hungry and remembered that "peanut" that he had saved for just such an occasion.

Hearing is Hard Work

Just the other day, I had a patient ask me to write an article on what one might expect to go through with a hearing loss. This patient was actually asking about the psychological  and social effects rather than just the signs and symptoms of hearing loss. What is apparent to me is that hearing loss is not well understood by those that do not have it and often not even by those that do have it. This disability may not be visible but can still have a crippling effect on ones life.

As I talk to my patients, one of the first discussions I have with them relating to their hearing loss is that hearing can be tiring. Perhaps more succinctly listening can be tiring. When one has a hearing loss there are certain frequencies that are more difficult to hear and therefore one can be missing key information in speech. It might be understood that hearing  and listening with a hearing loss  forces one to constantly be filling in the blanks. The worse the hearing loss, the more blanks that need to be filled in. This might be a fun party game for a short time but in the context of engaging in conversation can be a lot of work. To constantly be filling in the blanks and often guessing in order to keep the conversation fluid can be difficult and yes tiring. When I tell my patients with hearing loss that I do understand that for them being in listening situations over prolonged periods of time can be very fatiguing, it is as if a burden has been lifted off of them. Sometimes, they realize why they are tired but other times they, themselves, have no clue that it is this high demand on them that is causing them to be stressed and fatigued.

So many of my patients are now much younger and involved in the workplace needing to stay on top of their game so to speak and the inefficiencies that a hearing loss creates for them are a significant aggravation to them. A hearing loss can effect ones confidence in the workplace especially when competing with or working with those that do not have to overcome this obstacle in relation to work. Some people understand what is happening to them while others start to question their own ability.

 It is interesting to note the strategies that may be employed when inefficiencies like a hearing loss present themselves. In some cases, the person with the hearing loss becomes dominant, taking over the conversation, directing the subject, and coming across as overconfident or overpowering. It is so much easier to be part of a conversation when you define the subject and lead it than to have to follow a conversation when someone else defines the subject and direction of the conversation. The other side of this coin is the individual who avoids conversation and comes across as lacking confidence given that they shy away from difficult listening situations. I have had many a capable patient consider leaving the work force due to the stresses of hearing loss and the inefficiencies and personal estimation of their diminishing abilities. Hearing loss can diminsh ones confidence.

The working world may not be the most demanding listening situation that one encounters. It is the social context that can be one of the most difficult areas for the hearing impaired. I often talk to my patient about work being a closed set environment, that is to say that in the context of ones working world we can often guess at the subject matter. If I work as an accountant, I can guess that my client will come to my office to talk about accounting related matters. Our ability to fill in the blanks in a closed set environment is so much greater than one without context. The social enviroment is complicated for this very reason. In a social setting the conversation can go in so many different dierctions making it very hard to guess at the content.

It is human nature to avoid situation and circumstance that we do not enjoy. When we find certain situations tiring or stressful  making us feel incapable, our natuaral reaction would be to avoid those situations. I have encountered many a patient that once were ultimately social individuals enjoying their human interactions that due to their hearing loss have withdrawn from doing the things they once enjoyed.

Because so little is understood by society regarding the effects of hearing loss, it is more than likely that the individual with that loss themselves do not have an understanding as to why they feel the way they feel. Why they are so tired at the end of their working day, why they do not feel like going to that party, why they do not really enjoy going to church the way they once did, and the list goes on and on. Here in my office, asI talk about the result of the hearing testing with my patients, it is very interesting  to see the initial reaction to a patient being told that they have a hearing loss and how negatively that initial revelation can be taken.  However as you start to explain to them how this hearing loss may have been impacting their life, it is amazing to note the change in the patient. It is as if a major weight or burden has been lifted off of them to know that what they have been feeling what they have been experiencing is just related to their hearing and can be overcome with the correct intervention. To be able to take ones life back is not an overstatment of how improved hearing can effect a life.

I have had so many experiences with my patients that have emotionally rocked me as they relate how improving their hear hearing has changed their life. In this day and age, we as audiologists have so much more knowledge to work with in our field. Technology has moved forward in leaps and bounds allowing us to do so much more for our patients. There are so many more positive outcomes for the treatment and remediation of hearing loss now that ever before. The profession of audiology has grown to require so much more education in order to meet our patients needs as best we can. My belief is that while all of these steps forward are immensely important, it is so much more important to really understand what a patient goes through relative to their loss and how it makes them feel as the loss impacts their life. One can not find and provide the best solution for their patient unless they have a solid understanding of that patient needs and struggles.

Sad and Happy

Have you ever been really sad but really happy at the same time? I encountered just such an emotional contradiction the other day in the context of my working life. Sometimes I look at my scheduler and know exactly who is coming into the office and other times I am surprised by the "unexpected" patient. On this particular day I was getting to the end of my day and had gone through a crazy day with so many walk ins as well as challenging patients. I had just finished with a patient and had wandered out of my office to pick up my next patient file when standing in front of me was a young woman that had a big smile on her face along side her mother. The young woman's comment upon seeing me was that I hadn't changed at all. As recognition registered in my head I was flooded with happiness to see before me a young woman that had come into my office 12 years earlier as a six year old that had just had severe Meningitis. At that time I had diagnosed a profound reduction in hearing and had recommended immediate cochlear implantation. I remember the emotional whirlwind that ensued as we tried to get everything in place for this child to be given the greatest chance. This child was just such a success story from the moment of her implantation but it was a child that I lost touch with as a result. I did hear a little bit here and there but she really did not need me any longer.

Here now in front of me was a beautiful young woman   that I couldn't help but seeing as a six year old. As I caught up with this young woman it was with great sadness that I heard her open up and reveal the immense challenges that she had faced in life. I heard a tale of self doubt of social isolation of an ensuing eating disorder and self destructive behaviour, a child that had volunteered herself to become a ward of the province at a young age. Now here stood before me a child that had come full circle reconnecting with her family trying desperately to get her life straight. While I am not naive enough to think that all of these struggles were purely due to her loss of hearing I do know with certainity that the loss of hearing did play a major role in many of these areas.

As I talked to this young woman about being caught between the world of the deaf and the world of the hearing  more than a few tears were shed by both of us. This brilliant beautiful young womans greatest ambition was actually rather simple, she wanted a life of certainity a life where she could have consistent expectations of her day to day existence. While I saw before me potential that had not been yet met her aspirations did not exceed the simple. The really copnfusing element for this girl was the fact that she had maintained perfect articulation and strong language skills which allowed her to come across as "normal" while internally she faced the stresses of functioning like a deaf person unable to "get " the inferred or concepts that are not concrete. This was a girl that was just so happy to have made a friend in the recent past with the realization that this was not a given in her life. The discussion we had surrounded her ability to connect better with the young since the young had no age appropiate expecation of her and allowed her to lead rather than follow. Leading has been so much easier for her given that this allows her to define the topics in conversation and create context.

Our conversation was a lenghthy one but allowed her to hear me tell her why she had felt the way she had for most of her life and to tell her that this was not out of the realm of the expected. It appeared as if a burden had been lifted the more we spoke.

I left my office so saddened to think of the struggles that this child had faced and wished that her life might have been different. I was however just so overjoyed to have reconnected with this young woman with the hope of staying in touch being able to help her atleast understand that what she is going through is understood by another.

Fail to Succeed

If I could give my children an opportunity in life that would allow them to succeed I might choose failure. If I were to endow my child with a characteristic that would allow them to success it might be confidence.While this juxtaposition appears to be contradictory there is validity to both statements. As I talk to parents of children that are struggling with school a common theme of concern is loss of confidence. When a child struggles with traditional learning  a disengagement occurs, but when a child looses confidence a wall goes up that is difficult to take down.

It is interesting that as I was writing this article my wife came to me and brought up the possibility that one of our boys was just a little overconfident about himself. I had to smile because she had no idea that I was writing this article on this subject. When a child struggles with school one of the at risk characteristics is confidence. The personality of the child has a lot to do with this sense for certain. We can have a child that struggles that is oblivious to their difficulty or you may have a very sensitive child that is self critical no matter what their level of traditional success.

I can say that on a personal level it has been my failures that have motivated me the most in life. It is the concept that to learn to ride a bike we may need to fall down a few times that holds true. The other part of that equation though is that one needs to be confident enough to get back on that bike and have the courage to fail in order to succeed.  As an aside I think that too many parents try very hard to create a clear path for their children clearing obstacles out of their way not allowing them to fail and pick themselves back up. In the workforce I hear many an employer speak to the fact that employees of the current generation that are facing adversity in the workforce tend to change jobs rather that stick it out and find ways to be successful.  While my failures in life can sometimes haunt me I can find no greater motivational factor. I know I am speaking from a personal point of view but I have observed a consistency amongst my "successful" patients.

Taking on the challenge of hearing aids relative to a hearing loss can be a difficult task at times but I have concluded that some patients are destined to do well while others are doomed from the start. The factors for success or failure often have nothing to do with the hearing loss. I suggest that you can find two individuals with identical hearing losses of equal age and ability and yet one might fail while the other succeeds at finding better hearing.

Motivation and self awareness plays a large role for sure. One needs to be aware of their difficulty and have a perception of need before they can take on the challenge of finding success through the use of hearing aids. when a decision is made to try hearing aids there are other factors that also come into play that affect the success or failure of this endeavour. Those that have the expectation of immediate success, may or may not be ultimately successful but those who are willing to face adversity and even failure without loosing hope and without giving up often find success. I often say that a patient that wants success will find it. The patients process is one that has to allow the Audiologist to hear their challenges (and there will be some) and find solutions to those challenges. With today's technology so much is within the control of the Audiologist. Digital processors require the expert use of knowledge in order to access  optimal performance for the patient. I find myself having patients walk in my door having been unsuccessful with their hearing aids purchased in other places but after a listening to the patient voice their concerns and targeting their need adjustments can be made to give the patient a much better hearing experience. Prescribing technologically advanced equipment without the expert knowledge that enables one to meet the patients needs is an inefficient use of technology and quite frankly a waste of money.

The truth is that patients can have varied and different experiences when it come to trying to improve their hearing. What may be true for one may not be true for another. It would be ill advised to base your potential experience on the experience of another. People have varied losses, some with greater challenge and others with less.  As stated earlier the motivation of each individual can vary as well as self awareness. What can be true and should be true is that while your experience with hearing aids can vary  the approach of the clinic is one that should be consistent. A clinic with a good reputation is one that creates a patient experience that is consistently positive.

"Doing good is good for buisness."

In January of this year I was fortunate enough to hear Richard Branson speak at a conference. Mr. Branson spoke with passion about his businesses but specifically about his belief that “doing good is good for business”. This statement is probably understood by most business owners but intent does not always translate into decision making that is consistent with this message. This statement that seems so simple gave me cause to pause and consider what I do in clinical practice that specifically meets this standard.

Certainly how we treat each other becomes a vehicle for doing good but more importantly why we treat each other the way we do becomes a core basis for doing good. Simply put, our motivations outweigh our apparent actions. One needs to really care about their patient in order to always make decisions and communicate direction that is in the patient’s best interest. In the clinical Audiology practice the Audiologist needs to be ethical in their approach putting the patient’s health and well being first but also advising the patient in a manner that is in their best interest. An example of this would be that when an Audiologist notes a possible noise induced hearing loss combined with a history of working in noise that the advice given would be that of Workplace Safety claim initiation as opposed to prescribing a hearing aid that incurs cost to the patient. The same would be true for Veterans with hearing loss being correctly directed. The Audiologist needs to pursue funding routes on the patient’s behalf whenever possible (and there really are several). My personal approach is that there should never be a patient that requires amplification that is turned away due to an apparent inability to afford better hearing.   Making decisions that are in the best interest of the patient even when it is inconvenient to the business is indeed good for business.

My clinic was established 19 years ago and we really were starting from scratch, trying to find a foothold in the community, trying to establish identity and thereby attracting patients.  I remember being acutely aware of every time the phone rang or a potential patient walked in the door. My mind was constantly calculating and recalculating the financial viability of each day and each week. At that time we were able to bill under OHIP (our version of socialized medicine) as well as other insurances but the real income for my company came from hearing aid sales. I can remember many a time when I would discuss a hearing loss with a patient that had come to me for hearing help fully expecting to purchase a hearing aid only to realize that they might actually qualify for complete funding under workplace safety or veterans affairs or a number of other programs. I can remember vividly the ethical debate that took place in my head knowing that we really needed the income now but that the right thing to do would be directing the patient to apply for funding that they themselves had no idea they were eligible for. I can liken this to that cartoon visual of a good angel on one shoulder with a harp and a bad angel on the other shoulder with a pitch fork trying to influence the head in the middle. I can say with certainty that each and every time it was the bad angel that was eradicated and poofed off while the good angel won out. Not easy decisions given the circumstances but these are the inconvenient decisions that allow one to build a positive business reputation with solidity. Looking out for a patient’s best interest should always come first. As an Audiologist, we are also often the first to see signs of retrocochlear pathology (fancy words for a possible acoustic neuroma or schwanoma, which in turn are fancy words for a form of benign tumor that affects the hearing). While red flags may pop up during testing in strong fashion at times often the red flags may be limited or minimal. Here is another example of keeping the patients health and well being a primary focus as opposed to choosing the route that makes the business money in the short run.

The approach of doing good while inconvenient tends to work itself out in the long run. Patients come back after being medically cleared with a renewed faith in the clinic knowing their best interest will be kept in mind, those that finally get their funding through Workplace Safety or D.V.A. or other agencies become patients for life, grateful for the efforts made on their behalf. These patients not only represent themselves but each individual represents hundreds of others, and sometimes more, and these patients become a great referral source through word of mouth.

In business we know that there is no referral source as effective as word of mouth. Word of mouth however is a two edged sword. If one has a bad experience word of mouth can have a negative connotation. My contention is that positive word of mouth brings patients to your door that have foundational confidence in the clinic prior to ever arriving. Confidence is a transferable commodity. When I hear a good friend speak in glowing terms of a business or individual, I find myself being implanted with the beginning of confidence in that business or individual. Whether that confidence grows or diminishes has a lot to do with what I might encounter on a personal level.

I recently had a discussion with my almost 16 year old son regarding good business practice. My son was selling one of his electric guitars to a friend at school in order to use his profits to help him go on a “Serve” trip (this is a youth mission trip). This guitar needed to be re-strung but my son felt like the cost of doing this would take away from his profit margin given that the buyer was more than happy to take this instrument the way it was. My intent was to try to get my child to understand that doing good is good for business. I am hopeful that my child will learn this lesson as he took this guitar to school today to show it to the buyer.

It takes a consistent approach of doing good that is culturally implanted in your clinic from the front office staff to the clinical staff that allows for optimal business growth from a strong foundation.

It is certainly empowering to hear The Richard Branson’s of the world with such tremendous resources both fiscal and human speak of the ability to facilitate change. I must say that while it is exciting to hear someone like this speak it can also make the rest of us feel, well, a little insignificant. I personally have had to come to understand that my “world” is the one I come in contact with and the one that I influence and while this may be a much smaller “world” it is one in which my actions can have a significant effect in and on. Richard Branson’s “world” by definition may be much larger but one he too has influence and an effect on.

In the field of better hearing our clinic supports the “Starkey Hearing Foundation” with a goal of providing amplification for children around the world. It really is an amazing organization. Bill Austin, the visionary founder of Starkey, has converted his life vision into his mission helping children around the world find better hearing, often for the first time. It is really exciting watching colleagues from around the country giving of their time and money working on these missions where in ten days to two weeks they can literally give thousands of children the gift of hearing. The stories are tremendous and moving and motivational. The web site for the Starkey Hearing Foundation has amazing video and pictures from these missions that all can find inspirational. At our Clinic we have a drop box much like the eyeglass program that we are familiar with for donated hearing aids to be used for the purpose of being refurbished or for parts that will be used for these children. As a company, we do what we can to help those that are unable to find the funds for amplification, we try to work with the service clubs in the area as well as agencies such as “The Canadian Hearing Society.”  We try to do what we can through the donation of time, service and in some cases technology in order to make better hearing accessible to all. “Doing good is good for business”!

Starkey Hearing Foundation

www.sotheworldmayhear.org/