This Year Make Better Hearing A Priority

As the calendar year has turned over many people consider this a time of renewal a time of new beginnings, a time to reset life. This year our theme at “The Ear Company” is to put forth the idea that your quality of life, that your ability to live life to the fullest, is important. Being better and living better is a worthwhile endeavor. 

One of the disorders I often deal with is sudden onset hearing loss where the hearing changes rapidly and suddenly in one ear typically and seemingly without obvious cause. Going through something like this can be very traumatic and life changing as those that have experienced can attest to. For those that experience this sudden change the effects are perceived as life changing and horrible as communication barriers have been placed in their life where only a short time ago there was not an issue with hearing and communication. For those that go through this sudden change they see the effects of hearing loss clearly. The vast majority of those with hearing impairments do not have this experience, as typical hearing loss is insidious, changing a tiny bit at a time. Hearing loss for most creeps up in such a way that those that suffer from it are often the last to know. Both these types of loss may leave one with the same effects on communication but the sudden onset group has a better ability to recognize the life changing effects given their most recent point of comparison.

Making better hearing a priority this year is to say that effective communication should be a priority. To say that communication is a priority is to say that people are important to us and our relationships are important to us. To make better hearing a priority is to make our workplace interactions more efficient, the relationship with our significant others better, our social interactions easier and more rewarding. Better hearing and better communication ability allows us to live life more effectively and with greater joy.

This year “The Ear Company” is promoting better Living through better hearing making better hearing a priority.

The Top

In my professional life I have the privilege of going to conferences and workshops at which I get to hear amazing speakers. Over the years I have heard billionaires, presidents, CEO's, authors, thought leaders, elite athletes and then there is little old me. Being driven has always been a part of my makeup and while I may have lived a life of humble achievement I come away from these encounters feeling the need to be more, feeling like I have not done enough in life. This weekend as I was at the Academy of Doctors of Audiology Conference in Washington D.C., I was hit by a bit of an epiphany. As much as I feel the need to be like some of these high achievers perhaps offering my expert knowledge to the masses, the core of my being is moved by personal relationship. Being in my clinic allows me to get to know people, to get to know my patients. As I go through the journey of diagnostic assessment and then the process of intervention or remediation or sometimes simply visiting with or counseling the patient, there is a richness that forms in the relationships that occur. I don’t want to just help people I want to really know the person that I help. I don’t want to just share ideas I want to see change actually take place. It is on this grassroots level that I live and thrive. When we work with people in any capacity there is a great deal of pride that should be taken in what we do. The role of service to our fellow man is a worthy one and it is of primary importance that the world is filled with those that take this role on with enthusiasm. Those that care for the individual and work with people on a micro level rather than a macro level also need to know that what they do is important. To affect the life of one person at a time is still a worthy aspiration.

I Don't Have A Problem!

What do you do when you have a family member or friend that you know is having trouble hearing but either does not want to admit it or is completely unaware? First you have to understand that hearing loss more often than not is insidious creeping up on you just a little at a time . Those that suffer from hearing loss are often the last to know and recognize that loss.  It is not easy to admit that we are less than  perfect and that our body is failing us in some way .  I remember when I first recognized that I needed reading glasses, my arms just were not long enough to keep the book far enough away from me to read, eventually it dawned on me that maybe my eyes were not what they once were. As my eyes have changed for the worse over the years I find myself irritated by this inefficiency in my life, you can say the same about hearing loss but with the significantly added stigma of hearing loss being a sign of ageing. The reality is that our eyes changing and our hearing changing is a part of our natural deteriatory process. When patients ask me if their hearing will improve my answer is that when it comes to the ageing process very little if anything about our bodies improves (insert smile as I too am in that category).

It is amazing to me how many husbands and wives come in together for hearing tests. I often get a kick out of these appointments having to tell them that I am not a marriage counsellor and this is not a competition. Of course this is with a smile on my face. Often the couples come together because one of them recognizes that the other has a hearing problem but will not come in unless the other takes the initiative and comes with them making it less about their problem. The reality is that for many this routine assessment of one of their major senses is one that is approached with greater trepidation than a visit to the Dentists for tooth extraction without freezing.

Here is my advice when trying to get a family member to have their hearing checked. First approach with caution as this is a sensitive topic for many. It is important to point out that having a hearing test is much like having your eyes tested, it is just knowledge gained on the state of one of your major senses, what you do with the knowledge you have is another issue altogether. This is an important element to communicate as most people equate going to a hearing test with an admission of fragility and jump to the conclusion that the only reason to go for a hearing test is to get a hearing aid. Not everyone that comes in for a hearing test has a hearing loss of significance, many come in recognizing that their hearing is not what it used to be only to find that it is still normal but perhaps lower in the range of normal than it once was, others will present with some hearing loss but not enough to do anything about just yet, others still require further medical followup due to the parameters of their loss.

In recent years I will say that there has been a shift in who comes in my door with far more coming in between the ages of 40 to 60 than ever before. This age group seems to be far more self aware and would choose to know what is going on with their bodies and their functional ability especially in the context of the effects socially and in the workplace.

Changing the perceptions of what it means to have a hearing test is a long term societal and cultural issue but a good place to start is one person at a time.

Staying Connected

I was at a conference recently where we were discussing what our profession would look like in 2020. As a part of the discussion we were asked what we see as very different now than when we first started. As people began to talk I considered how my profession as well as my world has changed in the last many years. As much as I feel very current in my knowledge due to the education I have added in the recent past I still have a good recollection of what things were like in the early years of my profession. The cutting edge computer based technology that stood floor to ceiling has been replaced by hand held devices, the hearing aids that were adjusted with a screwdriver now have innumerable adjustments and functions that we could not have imagined in those early years. Technology certainly has come leaps and bounds. What did we ever do without the Internet or Google or texting or email.

How communication has changed. We live in a world where we are now able to contact one another and have conversations almost at will. We can Skype, email , text, even make a phone call from almost anywhere, we talk on Facebook, on imessage and other forms of social media. The reality is that we are far more connected now than ever before, perhaps sometimes to our own detriment.

In the world of the hearing impaired, staying connected has many meanings and implications. Certainly all of the technological implications apply but when the communication method is Auditory there can be some limitations and therefore lack of adoption or avoidance of use. Take the old school approach for example. The telephone can be a piece of technology that is avoided in a big way by those that are hearing impaired. I have many patients that simply will not answer the phone as it is just too difficult for them, instead they will allow other family members to take this task on for them. Some of my patients will use  a speaker phone to make it a little easier. The inability to see someones face in communication can certainly negate many of the nonverbal elements of communication that help the hearing impaired individual cope with their hearing loss.

Connected communication is for every age group. At one time texting and Facebook and Skpe etc. might have been considered to be used primarily by the young however in actuality every age group is now using this technology with those over 65 growing rapidly as a user group. Grandparents wish to stay connected with their grandchildren and their families and will use the technology that is used by that generation to keep in touch. To digress, it is a rare and wonderful occurrence to get an actual handwritten letter in the mail in today's society.

What I want to discuss her today is actually connectedness in communication on a one on one or group basis. In recent years my patient base has been getting younger and younger. I am seeing more people coming in to my clinic in the 40-60 age group than ever before. Given the change in our demographic  we are diagnosing mild hearing losses and moderate hearing losses that previously had gone undiagnosed till they were far more severe. Common to these losses are normal low frequency hearing and reduced high frequency hearing loss with the patient

not needing volume but needing clarity.  With clarity being the target we often do a trial fit with our patients fitting them with the appropriate device and allowing them time to be in their world assessing what differences and benefits they observe with the appropriate amplification. While the benefits can be many I want to focus on one in particular. One of the major benefits that can become apparent is connectedness. Those with mild and moderate hearing losses typically find themselves filling in the blanks during conversations, sometimes by context other times by the visual cues etc. . When the hearing is improved with appropriate amplification the patient will often report that they find themselves connecting to the conversation quicker and are able to stay connected to the flow of communication.

When one is fighting to stay connected with communication they are constantly recalculating what the possible pieces of missing information may be. For anyone observing they may notice that it takes these individuals a slightly and sometimes perceptibly longer time to catch on to the conversation. When one has to work this hard to stay connected they may find themselves fatigued when in prolonged listening situations. With the use of appropriate amplification one of the observable differences in communication ability is that the hearing impaired person tends to be able to follow the conversation with greater fluidity, in a more natural manner. Staying connected in conversation is not often discussed relative to hearing impairment but is definitely a significant goal with the use of amplification.

When one struggles with communication to a significant degree the tendency is then to disconnect from the difficult. To disconnect is to move towards isolation to pull away from those difficult situations. Finding ourselves connected to one another in conversation allows us to connect to one another on a deeper level as well. Communication connects us which is a good reason to communicate as well as we can. 

Hearing Loss and Depression

Robin Williams taking his life was a recent event that was surrounded by great sadness. This event highlighted an issue that plagues us with perhaps no soul left untouched by the disease that is mental illness and specifically depression. To some degree we each have our times of feeling down and sad wishing to withdraw from others on very healthy and normal terms and yet it feels lousy. Depression as an illness is obviously magnified to a far greater extent even to the point where one considers taking their life as a solution.

In my Audiology practice I have many patients that are open about their mental illness and depression. Over the years I have become acutely aware of the connection between depression and hearing loss. It only makes sense that when your hearing deteriorates without intervention one becomes less able to function in groups, having conversations in a background of noise and even on a one on one basis. When this degree of difficulty starts to effect the functionality of ones ability to communicate often that individual will start to avoid those situations that they find difficult moving in the direction of self isolation. For those whose life has been one where human interaction is common and important this self-inflicted isolation can lead to depression that spirals downward.

Recently I was running an earwax (cerumen) removal clinic and encountered a male in his thirties that had impacted wax. The patient reported that they had been plugged for a few months now and really wanted the wax removed. Typically when this is the case and I remove the wax occlusion my patients are amazed at the difference as being plugged and therefore hearing impaired had become a normal part of their life. That feeling of being able to hear again is like turning the light on for someone who was blind only moments ago and there is a degree of overwhelming hearing for a time. In this particular case when I removed the wax my patient had a far more honest insightful self-revelation as he told me that he instantly felt happier. What this patient told me in our conversation following the wax removal was that while he does not suffer from depression not being able to hear well was really bringing him down. Being plugged with wax had created inefficiency in a major sense that left him very tired at the end of the day from working so hard to simply hear. This man reported times where he did withdraw himself from social situations because as he put it “it was too hard”. Indeed to have one of your primary senses impaired makes one feel less like themselves.

There are now studies that verify and quantify this phenomenon that we as Audiologists have witnessed in our clinical practices for some time.

“In the new study, as hearing declined, the percentage of depressed adults increased -- from about 5 percent in those who had no hearing problems to more than 11 percent in those who did.

"We found a significant association between hearing impairment and moderate to severe depression," said study author Dr. Chuan-Ming Li, a researcher at the U.S. National Institute on Deafness and Other Communication Disorders. "The cause-and-effect relationship is unknown," Li said, citing a need for further studies.

The study was published online March 6 in JAMA Otolaryngology--Head & Neck Surgery.

The new findings make sense, according to two experts in the field who reviewed the study conclusions.

"It is not surprising to me that they would be more likely to be depressed," said James Firman, president and CEO of the National Council on Aging. "People with hearing loss, especially those who don't use hearing aids, find it more difficult to communicate with other people, whether in family situations, social gatherings or at work."

Experts who care for those with hearing loss have long noticed the link, said Robert Frisina, director of the Global Center for Hearing & Speech Research at the University of South Florida, in Tampa. "When they come in [to see about their hearing], they mention this," he said.”

“For the new study, the researchers looked at data from the U.S. National Health and Nutrition Examination Survey, including more than 18,000 adults aged 18 and older. The younger people self-reported on their hearing status, while hearing tests were given to those 70 and older. All participants filled out a questionnaire designed to reveal depression.

As hearing loss became worse, the depression did, too, except among those who were deaf. These adults, Frisina said, may be accustomed to coping with the loss.

Hearing loss was linked with an increased risk of depression in adults of all ages, but was most pronounced in the respondents aged 18 to 69, the investigators found. Women had higher rates of depression than men did.

Among those 70 and older, no link was found between self-reported hearing loss and depression. However, a link was found for women in this age group if the hearing test found a hearing loss.”

SOURCES: Chuan-Ming Li, M.D., Ph.D., researcher, U.S. National Institute on Deafness and Other Communication Disorders; Robert Frisina, Ph.D., director, Global Center for Hearing and Speech Research, and professor of chemical and biomedical engineering and communication sciences and disorders, University of South Florida, Tampa; James Firman, Ed.D., president and CEO, National Council on Aging; March 6, 2014, JAMA Otolaryngology--Head & Neck Surgery, online

http://consumer.healthday.com/senior-citizen-information-31/misc-aging-news-10/hearing-loss-linked-with-depression-study-685523.html

This kind of information is extremely important as it allows us to focus in on the preventable in health care. Seeing an Audiologist is typically seen to be just about hearing ability as opposed to being about healthy living. Depression is as real a health issue as is heart disease or cancer. We have become far more knowledgeable regarding our own health and well being than we have ever been before as a society yet here is an area that we perhaps do not give much thought to.

On the day after Robin Williams took his life I had a very painful conversation with a friend that was in a fight for his teenage sons life as his young son was enrolled in a program of intervention to help him cope with his own thoughts of ending his life. Mental illness is perhaps an even worse stigma than hearing loss and a struggle that is even harder to talk about than hearing loss. There is great societal reticence to accept treatment for depression as there is some resistance to accepting the reality of the diminishing of our sense of hearing and an even greater unwillingness to explore the solutions that may be readily available.

Eyes, Ears, Teeth

Those embarrassing purple teeth! Remember when the health nurse used to come to our school and give us those purple pills that when chewed would reveal the plaque in your teeth? It was back in those days that we went through dental screenings, vision screenings, and hearing screenings. There was a real effort made to educate the young as to healthy habits and the importance of good vision, dental health and hearing. I can still picture the oversized set of teeth and gums and the giant toothbrush that was used to teach us the right way to brush our teeth and the vision chart that we still use as well as what I now know as a screening Audiometer. I remember so well the room that our school provided for the screenings to be done and worrying about pass or failure.

Over the years it has become common practice for us to have our vision tested to see where we stand, we check our children’s vision and have ours checked periodically as adults. The dentist is now visited regularly to check dental work and to prevent decay through cleanings.

Hearing is a major and important sense that should be checked pre-emptively to be educated as to where we stand with this ability. We would not wait till we had lost significant vision before having vision testing or till several teeth had fallen out before we thought a dentist might be a good idea.

Each of us should have our hearing baseline tested in order to reference change in the future. Knowing that you have a mild hearing loss allows you to take action early and with great potential to optimize function.

Eyes ears teeth all need to be kept as healthy as possible with screenings and testing a necessary part of the process.

What is an Audiologist ?

     As I grew up my parents had an expectation that higher learning (graduate school and beyond) was simply a given. We were imigrants in 1970 comming to North America to achieve, audiology was a word I had probably never had a connection to. I doubt that audiology was a word that was part of my vocabulary until I was in University.
      In todays world there are many professions that did not exist 20 years ago, specializations in areas that seemed improbable in the past. In our education system students are supposed to know what they want to do for the rest of their lives as 18 year olds before they even have an inkling of all that is out there.
     As an Audiologist I posses a Bachelors degree in Communicative Disorders from Andrews University in Michigan, a Master of Science degree from The George Washington University and clinical Doctorate from Salus University in Pennsylvania.
     Audiologists through their years of education are trained in hearing and hearing disorders including vestibular and balance disorders as well as the remediation that might be appropriate. Remediation may be Hearing aids, Cochlear implants, Aural rehabilitation, Tinnitus management and vestibular rehabilitation to name a few areas of practice.
      A few years ago a young woman that I have watched grow up from the time she was a little girl asked to come to my office to find out what an Audiologist does. When a student comes to me to ask for advice or profesional direction this is what I have to offer, "you may not know exactly what you want to do professionally but you should have an idea of what kind of work you want". Do you want to work with people? Do you prefer working with equipment, computers, your hands? Do you want to work with others or by yourself?
     I just attended the 2014 Audiology Now conference which is a convention hosted by the Americam Academy of Audiology and was overjoyed to catch up with this same young woman, now a second year Doctoral student who had the honour of having a poster session at the conference. Lachelle has gone down this professional path and is enthusiastic about her future in her profession.
      Until you walk in our door at "The ear Company" you may not know what an Audiologist is and so I write this post for those of you that are in need of anything related to better hearing or balance. This is that little known profession that almost every one of us will one day need to utilize.

This link describes the profession od Audiology in a little more depth.
http://www.audiologist.org/ada-students/careers-in-audiology