Isolated and Alone

With the holiday season upon us, we  will inevitably find ourselves in challenging listening situations;  parties, dinners, church services, concerts etc….perhaps it is at times like these that we wonder why a loved one seems to avoid the very gatherings they previously enjoyed.

Are you perplexed by this unexplained change?  While there are many potential explanations for this change there is one that is readily understood and has the potential for a happy ending, so to speak.

Given that this article is dealing with hearing and issues related to hearing, I am obviously suggesting that hearing loss can lead to social withdrawal. I talk to people every day that have come to this understanding.  It stands to reason to say that we avoid situations that are difficult or challenging.  Why go to that party if the background noise is so loud that you can’t follow the conversations?  Why be in a listening situation that makes you feel like you are less than competent?  The resulting avoidance and ultimate withdrawal may not be sudden but perhaps a slow and insidious process which, nonetheless, will take root over time to such a degree that those around will start to take notice of this change in social interaction.

If one is inherently a social being and find themselves withdrawing from social settings the end result may be to miss those interactions to the point of depression.  I have heard patients rationalize this withdrawal suggesting that this is the way they prefer life. Typically, it is the family member that disagree in this regard.

It is one of the more amazing experiences to watch a patient re-engage with the world as their hearing is brought back through the use of prescribed amplification.  I have story after story related to me of the life altering changes that occur when one can communicate effectively.  To be able to connect with each other in social and other settings can be one of life’s great joys and when that is taken away, through the loss of hearing, the results can certainly be life altering, even devastating.

Perhaps it is time to find that happy ending.

Best Wishes for a Merry Christmas and a Happy New Year!!

To Clean or Not To Clean...

A common discussion point with my patients is the issue of ear wax and ear wax removal.  There seems to be a great deal of uncertainty as to what, if anything, needs to be done to keep ones ears clean.  

The use of a wax removal implement, such as a ‘Q-tip’, is one of the major points of discussion that comes up.  I can almost always tell when my patients’ have used ‘Q-Tips’ to clean their ears.  Typically, I see wax pushed down in the canal and impacted, often appearing hard and dry.  Ear wax, in dry form, is hard and can adhere to the canal wall.  Certainly one may find some wax on the end of the tip but the majority is pushed further down and or caked against the side of the ear canal.  I liken the use of a ‘Q-Tip’ to a rod used to load a musket; this doesn’t remove gunpowder but pushes it down and packs it into a solid wall barrier. Just like the musket rod the ‘Q-Tip’ pushes the ear wax down the canal and packs it into a solid barrier which can become an impediment to hearing - often causing discomfort as well as hearing loss.

The question that then arises is how do we keep our ears clean and prevent wax impaction?  The truth is – for the most part – ears are self cleaning.  A healthy ear canal is lined with tiny hair and hair cells that move debris out of the ear canal rather spontaneously.  The use of a wax removal implement such as a ‘Q-Tip’ actually compromises the ears ability to remove ear wax.

For those that have difficulty with wax buildup it can often be due to the ear canal being too dry. A drop or two of mineral oil, applied once a week before bed, can help keep the wax soften, allowing the ear to self clean.

So, when it comes to keeping your ears clean perhaps the less you do the better.

Life and Death Decisions

A long time ago I had to make a decision as to the profession that would occupy my future. Being an immigrant meant that my parents had a focus on improving our lives with the focal point being education. My parents themselves are well educated but they wanted more for my brother and I. The educational destiny chosen for me was that of a Medical Doctor. As the reality of this choice confronted me as a young undergrad I was faced with the reality that this professional choice would mean that the decisions I made could impact life and death. I could not bring myself at that time choose to pursue a profession that carried with it that kind of responsibility or burden. My heart didn't feel capable of dealing with patients where life and death was in the balance knowing my propensity for emotional attachment. In my naivety, I chose a profession that I thought was immune to such matters of the heart.

In the last couple of weeks, I have seen the passing of several patients who have also been my friends. Oscar was a man that bounded into my clinic about 6 years ago. Oscar was a man full of energy with a story to tell. Actually Oscar had many stories to tell. I can say with certainty that the vast majority of the time Oscar spent in my clinic was spent talking and sharing. Sometimes we talked about his families history of escaping slavery through the "underground railroad", sometimes we talked of his tough teenage years and dealing with the consequences, sometimes we talked about how a black man ended up in a town where he was the exception. Oscar shared real stories of real struggles but always with the theme being that of overcoming. When Oscar fell ill and had to have a lung removed, the story he told was one of overcoming. When Oscar found trouble in his relationships, the stories he told were of overcoming. The man chose happiness over despair. It was always with a smile on his face and a step always just a fraction away from dancing that Oscar chose to live his life. Two years ago Oscar was given the news that the Cancer was back, Oscar was ready to fight.  We have an amazing event that raises money for Cancer treatment in our community called the "Relay for Life". I was attending this event two years ago when I saw Oscar in marching with the cancer survivors in a ceremony of celebration and remembrance. When the group made their second round, I joined my friend Oscar and walked and talked. Just a few months ago we were attending the same event a year later and Oscar was there. As I joined Oscar in our walk of celebration and remembrance Oscar shared that he had actually temporarily checked himself out of the hospital where he had been for the week just to support this cause. Oscar had changed, his body had diminished but his spirit had grown. It was with deep sorrow that I walked with this man who showed nothing but joy. As I hugged him and sent him on his way  back to the hospital, sorrow was a feeling that I just couldn't shake.

Oscar passed away last week.

As an adult, I have come to realize that the profession that I have chosen is one in which I can not avoid the issues of life and death. I can not isolate myself from the kind of human contact that makes you feel deeply. Over the years, I have seen many a patient pass away, people that I have grown to know and love. While it is rare that the decisions I make on their behalf rarely have connotations of life and death, it is still undeniable that the impact that we have on each other through our time together has significant implications. I avoided a profession that involved emotional attatchment only to realize that it is sometimes the ability to feel for one another and be affected by one another that allows us to make professional decisions that are valued and appreciated. Getting to know my patient, understanding my patient, makes me a better Audiologist but more importantly, a better person, whose life is enriched by his patients.

TINNITUS

Do your ears ring, buzz, hum, roar, etc?  This manifestation is known as tinnitus.  Tinnitus can be a mild aggravation or, in some cases, debilitating.  Over the years I have encountered thousands of patients with tinnitus and quite a number of those have found it to be debilitating to varying degrees.  The vast majority of tinnitus sufferers however, find it to be an annoyance or inconvenience.

Tinnitus can be brought on by an increase in neural activity often specific to the auditory system.  Hearing deterioration, loss or damage can be a major contributor to tinnitus as can certain medications, musculoskeletal problems or even high levels of stress, as well as an array of other possibilities.  The vast majority of those that suffer from tinnitus are experiencing some degree of hearing loss.

While there may be a thousand potential reasons for tinnitus it is known that hearing loss is a major contributing factor causing this extra neural activity that presents as tinnitus.  The solution to tinnitus is dependent on the cause of it.  If tinnitus is linked to medication or other medical disorder then one needs to consult their physician.  If however, as in most cases, it is related to the hearing and the health of the auditory pathway then a hearing test is the place to start.  

A key point to keep in mind is that there is also a psychological component to tinnitus in that the more you think about it the worse it can seem.  One can find themselves crippled by tinnitus as a result of becoming focused on it.

There are a lot of assertions made regarding cures for tinnitus ranging from drugs, both natural and engineered, as well as devices marketed on mass.  As an audiologist I focus on evidence based findings born out through good research.  The current research based knowledge points to the use of sound generation to suppress neural activity coupled with appropriate counseling as the most effective approach to tinnitus management.  I have found that the use of amplification or sound generation, when correctly prescribed, can have a life changing effect on my patients.

As mentioned earlier, there can be a thousand causes for tinnitus so the solution can be different for each individual.  A hearing test with a qualified audiologist is a great place to start.

Using Your Brain To Hear

As I have grown a little older, I have often found myself stalling as I try to think of someone’s name, embarrassingly this might be someone familiar to me.  Sometimes it is a word that I try to remember that is illusive.  As my frustration rises at the inefficiency of my mind, I wonder what might be causing this seeming change.  Recently I was fortunate enough to hear a presentation on some research out of the University of Western Ontario that shed some light on this type of frustrating inefficiency.

MCI, minimal cognitive impairment, is a reality that many face as they grow older where our brains do not want to work as efficiently as we would like.  Yes, they do have a name for what we intuitively know happens over time.  The point of the study was that MCI, in combination with hearing impairment, adds another wrinkle to the ability to communicate effectively.  Functioning with a hearing impairment means that one is constantly putting 2 and 2 together, trying to fill in the blanks in attempt to make reasonable sense of what is being said.  Even minor changes in word recall that we encounter can create an increased difficulty in quickly and efficiently communicating.

So yes, when you didn’t quite catch what someone said it may indeed be your hearing, or the ability of the brain to process information effectively or maybe a bit of both.

Hearing Loss Unavoidable?

The Ear Company

“Everything related to hearing.”

It is absolutely unavoidable. No matter what we think, no matter how hard we try to prevent it from happening, it happens. Our hearing will change whether we like it or not. Certainly it is important to do all we can to protect our hearing but change is inevitable. Our hearing deteriorates for a variety or reasons, noise exposure plays an undeniable role but so does genetics and the process of deterioration that takes place over time.  

The complication with time-based deterioration is that this is typically a slow process that creeps up on us. Most often it is others that recognize the changes in our ability to hear before we do. I am of the opinion that we base normal upon ourselves and this is one of the reasons that we are not the best judge of our own hearing ability. 

Some of the signs of hearing loss are, difficulty hearing in a background of noise, loss of clarity more than volume, speech sounding more and more like a mumble, and television being turned louder but never getting clearer. These are just some of the signs of hearing loss. Rather than being the last to know that your hearing is changing it is wise to have that hearing test, be informed, know where you stand and have the ability to recognize change and deal with it sooner rather than later. The longer one waits to do something about poor hearing the poorer their outcomes are. 

Take it upon yourself to be the first to know and understand your hearing needs rather than waiting for others to point you in the right direction. Have your hearing tested, be educated, and make decisions for yourself based on an accurate understanding of what your needs are rather than misunderstanding, misinterpreting and feeling less than effective while engaged in the process of communication.

By Sanjeev Sukumaran Au.D.

May is Better Speech and Hearing Month

May is Better Speech and Hearing month, a time to consider the importance of the ability to communicate effectively.  Hearing is a key component of communication. Without being able to hear, we are just talking. When we are able to hear and respond appropriately, we are interacting and communicating.  The effects of hearing loss may not be as readily understood as some of the other disabilities.  Hearing loss may not be visibly identified and therefore is an invisible disability. 

What I know to be true with my patients is that reduced hearing has a significant adverse effect on understanding speech. When one struggles with understanding, they become self-conscious in environments where they have to communicate interactively. The bright and brilliant can loose self-confidence simply because they are not receiving a clear message. It is understood that for those with a hearing loss it can be fatiguing to simply follow a conversation over a period of time. This is true because these individuals are using a lot more of their intellectual resources to make sense of a conversation with missing pieces.  When you add a background of noise for these people a tough listening situation can get to be impossible. 

Those with hearing loss can compensate in many different ways, some might overcompensate by dominating a conversation not allowing others to define the direction of the communication. The majority of others, however tend to withdraw from social or difficult listening situations because they feel inadequate. The potential to feel a sense of loss and isolation is significant. It is difficult at best when a naturally social individual withdraws from taking part in one of life’s joys.

I have seen first hand the effects of better hearing allowing my patients to reconnect with family and friends. I have had patients and their families talk about how better hearing and improved communication can be life changing in a positive way. In the context of my elderly patients I often talk to them about the importance of conversation in their lives. We may have limitations to do physically what we once did but we can still have life changing and positive interactions with family and friends simply by having a conversation. May is better Speech and hearing month perhaps it is a good time to consider how well you really hear.