There are some ear issues that may actually be from heart symptoms!  For example, some types of pulsing, whooshing tinnitus may be from uncontrolled hypertension.   A decrease in hearing as well as poor balance or dizziness may be from reduced blood flow from various heart related conditions including a occluded vessels, heart attack, a drop in blood pressure or even diabetes.   Of course, symptoms such as these may also arise from medication side effects which may first occur soon after starting the medication or several years after successfully taking it without difficulty.
     In a nutshell, if you have noticed a change in hearing, balance and/or tinnitus, please follow-up with your physician and get a thorough medical evaluation.  Many people think that hearing loss is normal with advancing age but don't realize that a change in hearing may be a "red flag" of conditions ranging from mild to very serious that may be correctable if caught early.  Your hearing is important!

Your Audiologist!

     I hope everyone made it through the Holidays with rest, happiness and some money!  Now for the annual life review and plan for improvement.  Some call it the New Years Resolution.  One of mine is to improve this website and blog more frequently about hearing related issues. 
     I would like to encourage you to search for hearing help in places that you may not have though of before--and please let me know what you find out.  I just found out that my place of employment pays up to 50% of some hearing aids, after the usual deductible for medical expenses!  The hearing aid usually falls under the category of durable medical equipment, so be sure to ask your benefits person at work about that!   In addition, some companies contract through another agency that may only cover certain hearing aids that are dispensed by participating providers so that it will be important to jump through all of the hoops if you want some coverage. 
   Limited now, because of the economy, Vocational Rehabilitation was able to provide some help to hearing impaired persons, including the purchase or partial purchase of hearing aids, depending on qualification. Vocational Rehabilitation has an office in most larger towns. You will need to ask for the person who works with the hearing impaired or deaf. 
    For military vets it may be worthwhile to check with the VA. Although not every VA Hospital has an audiologist, those that do frequently dispense hearing aids.  See if you quality.
    Finally,  for regular financially struggling folks,  there are still options.  There are payment plans through the hearing aid dispenser, audiologist or hearing aid manufacturer. Also, if you qualify the Lions Club recycles used hearing aids-call your local chapter for details and to find who dispenses for them.   SHHH (Self Help for the Hard of Hearing)  is also an excellent, helpful and knowledgeable organization that is available in many cities. 

Your Audiologist
   

     Auditory Neuropathy Spectrum Disorder or ANSD  is a relatively new and evolving diagnosis as more and more is found out about it.  It appears to be a specific type of hearing deficit that may involve the auditory nerve, the signal between the cochlear hair cells and/or the auditory nerve or a distortion of the connections within these areas.  Unfortunately, unless there is clearly an absent acoustic nerve evident by MRI or other diagnostic imaging test, the exact location of this disorder may not be identified. There is an excellent website with a link, at the bottom of the page,  to some ANSD simulations of what this disorder sounds like. 
     Now that infants have their hearing evaluated at birth, infants with ANSD are diagnosed early using Auditory Brainstem Evoked Response (ABR) screens.  This test generates a series of brainwaves that are compared and evaluated to determine whether there is the diagnostic reversal (or lack of) typical of this disorder.  However, please note that there are two approved infant hearing screen techniques: ABR or OAE.  ANSD will be missed if Distortion Product Otoacoustic Emissions (OAE's) are used as the infant hearing screen because this test looks at the outer hair cell function in the cochlea or inner ear and does not evaluate the same mechanism as the ABR even though OAE's are an excellent indication of inner ear function, the site of the more common sensorineural hearing losses.  For most, passed the OAE screen at birth indicates normal or near normal hearing. 
   New case studies indicate that ANSD may range from mild to severe and may apparently occur at any age, even in adults.  It is not always clear why this hearing disorder occurs.  In infants, high bilirubin levels are thought to be associated. In adults, there is even less information, but in some cases a viral infection is suspected as the precipitating factor.
    In an audiometric test booth, these kids may not respond to sounds in the usual way for a hearing or hearing-impaired person. They seemed to have poor auditory interest and difficulty localizing sound. Parents report that one of the most confounding parts of this disorder is that the hearing may seem to come and go or become better or worse.  In infants, left untreated, a speech/ language delay may develop. If ANSD is suspected, contact your local Ear, Nose and Throat physician or audiologist for further evaluation or a referral to a facility with expertise in this relatively rare disorder.

Sincerely,
                Your Audiologist

     I used to think that "perfect hearing" was only the ability to hear very soft sounds, ideally between 0-15 dBHL at the standard pitches that are tested during a hearing evaluation: 250Hz, 1000Hz, 2000Hz, 4000Hz and 8000Hz.  Then I found out that human hearing actually has an extended range and depending on your age, may be from 20Hz to 13,000 to 20,000Hz.   It is true that you need to have the ability, either naturally or assisted, to hear sounds at "normal levels" in order to function. But it isn't just about hearing sounds, it's about what the brain does with that information too. This is where is gets fuzzy.  Hearing aids, amplification, cochlear implants, etc. are better than they have ever been and for many the results are normal hearing.  But what about the people who expect even more? 
     Let me first say, that I do not sell hearing aids or hearing therapy.  I used to, but I don't like the money management part of it since most insurance companies and medicare don't pay for them currently.  I had difficulty looking at people and saying some of the prices, especially as the wholesale prices also increased, with the newest technology.  However,  before gagging at some of the prices realize that this is the price of technology and all of the amazing research behind it that is entirely funded by each amplification manufacturer (i.e. hearing aid, cochlear implant, hearing therapy).  In fact, if this private industry didn't do their own research, it wouldn't be done.       
      In search of "perfect hearing", sometimes even the most expensive hearing "aids" won't restore that. Why?
Using the comparison to eyeglasses- when a first time user puts them on, they immediately notice great vision through the center of the lenses but distorted and fuzzy vision toward the edges.  I remember feeling angry that I had to turn my head to see because of blurry peripheral vision.  I have normal vision as measured through the eye chart.  I accept that.  But is it really perfect?   The glasses definitely cause some strange images and shapes around lights... 
     The same is true with hearing.  Amplification can improve the hearing of soft sounds. But the fuzzy aspects of hearing such as hearing in background noise, telling where a sound is coming from and nuances of pitch, timing and loudness that are critical for "perfect" hearing may still be missing.  For those searching for hearing therapy to help these nuances there is research showing improved brain function for programs such as "FastForward".   However, at this point in time we do not have the technology to evaluate all aspects of hearing or expertise to create normal hearing for every person.   Even suspecting that completely normal  or "perfect" hearing may not be attainable, I would still say "go for it"!  Strive for the best hearing you can obtain.
     As I peer through my window testing people I have observed several people who appear to have "perfect hearing".  They pass all the complex listening tests with flying colors.  As I talk to them, I realize there is an element of stress missing that most of the other people I see have, including myself.  They have an assurance that what they hear is correct.  If they don't hear it, it's not there. WOW!   No random sounds or tinnitus!  No hearing one thing when really it was something else!  No searching the face for a meaning that couldn't be fully attained with the words alone!!  Wow!  I gush as I tell them about their amazing hearing and wonder why they came in the first place.  Surprisingly, most have them have felt that their hearing has become poorer. Imagine that!  People who have hearing that is even better than normal!
    As I look for the silver lining of hearing deficits, I know that each of us was uniquely created.  Auditory processing issues have caused me to have missed out on a great deal of gossip and other softly whispered things--- but who knomaybe that was good!

Your Audiologist

Eating, talking, watching TV, noise, talking and LISTENING!
For once, do not worry if you don't hear everything. 

Water running in the kitchen, rooms with poor reverberation mixed with people talking with their back toward you make for difficult auditory perception.  The meal itself with the clanking of utensils, plates being passed and a mouths full....all of this could lead to stress, if you let it.  But don't!  Do you realize that at least half of what people say is redundant and an answer of "Yes" or "No" is correct about 50% of the time.  It seems to me that most people only really want some eye contact and sign of approval.  However, even this becomes difficult once there is misunderstanding or not hearing stress.  So for a preemptive strike,  for your next gathering,  plan to relax  and  enjoy others, even if it's only by looking at them and smiling.  That's what I plan to do!

Happy Thanksgiving!
Your Audiologist

        When talking too loudly is a big problem for you or someone you know, professional help may be needed.  Generally for vocal issues a speech language pathologist would be the one to contact. As with most professions these days, the field of speech pathology is huge so interview before the first visit to save time.  Describe the problem and find out whether the professional has expertise in this area and if not, do they know of someone in the area who does. For speech language pathologists, the American Speech Language and Hearing Association (www.ASHA.org) provides voluntary listing of professionals with specialty areas.   Please remember that anyone worth their salt will recommend that hearing is evaluated first, since as mentioned in part 3, hearing loss and/or auditory processing deficit can result is talking too loudly with poor loudness modulation in various situations.
     As an aside, several years ago I a small device that was supposed to help teach people to not speak so loudly was tried with some autistic kids. The small square meter was attached on the collar or front of the shirt and it vibrated when loudness exceeded a preset level.  I don't know whether this is still being sold, I couldn't find it on the internet when I recently searched.  Something like this could be helpful for some people because it is basically a low-tech biofeedback device, theoretically alerting the wearer when he/she is speaking too loudly by vibrating. One big problem would be pairing the vibration with the correct speaker since it is just as likely that an increase in volume could come from another person speaking loudly in close proximity as it would be coming from the wearer's voice.  For a low-functioning person,  the correct paring of the stimulus and the response might be impossible without more sophisticated biofeedback, so that they may never realize why the device vibrated.  Therefore, it seems possible that an expert in biofeedback or behavior modification may  be helpful for some people.
    Finally,  because acceptable speaking volume is culturally and socially specific,  it will always be necessary for parents to teach young children where and when to use their "indoor voice" versus "outdoor voice".  For adults, this type of correction can be offensive or embarrassing and frustrating for everyone involved. However, if the loud talking is hearing loss related, then amplification will result in more normal loudness levels as the person is able to hear their own voice again.  

      Sincerely,    Your Audiologist

   

     A couple of years ago I started to notice people quickly turning to look at me when I was having a conversation. At first I thought it was coincidence but since it kept happening, I began to make mental notes.  It seemed to happen when I was talking in a quiet environment. I seemed to be  breathing deeply and projecting well-but wait! The rush of breath and the strain on my vocal chords was different than when speaking quietly.  Horrified that I had somehow lost the social skill of  vocal loudness control, I finally asked my family, who are always delighted to quickly tell me the truth- "Yes. You are WAY too loud!  Why do you talk so loud sometimes!"  UUUGH!   
   Vocal loudness modulation.  A sensitive, subjective topic with regional differences.  New Yorkers can be loud.  Rural people, generally soft-spoken.   A loud voice is expected at a game or on a noisy street, but not at a play or in an elevator.  Inappropriately loud people are perceived as rude and offensive, possibly "dumb".   I didn't want that, so why wasn't my loudness modulation working?
    When hearing is fully functional the comparison between the surrounding loudness and your vocal loudness is seamless and instantaneous.  However, even minimal deficiencies in hearing thresholds or auditory processing may affect loudness perception.  For example, it is normal for people to raise their voice  as the surrounding environment becomes louder in order to still be heard. This is referred to as the Lombard Effect and is a "red flag" for auditory difficulty (hearing loss and/or auditory processing deficit) if the background noise increases only slightly, but the person raises their voice significantly.  
     If  there is a recent change in loudness modulation, further evaluation by an audiologist and/or Ear Nose and Throat physician is needed to rule out a hearing loss or some other physical reason for this change. The most common cause of this phenomenon is sensorineural hearing loss or "nerve deafness".  People with this disorder  speak loudly at inappropriate times. When the hearing loss first starts, there may be memory about how loudly their voice should sound to themselves and may effectively modulate their volume accordingly. However, if hearing loss becomes worse, speaking increasingly loudly is common, because they can't hear themselves (or others) and their vocal volume may drift from a near shout to being almost inaudible. 
    Sometimes excessively loud talking is a symptoms of an auditory processing disorder. Although this is often first detected in school-age children, adults may develop this from illness, head injury or medication.    This symptom may indicate other auditory related symptoms such as difficulty hearing in background noise or even difficulties related to decoding or auditory memory.
    So- how do you know when you are  talking at the socially appropriate loudness?  Unfortunately you probably won't know.  For a quick answer ask your family or an honest friend.  If you want to be more stealth, look around and see if people are staring at you when carrying on a conversation in a "quiet" place such as a bank, library or office setting!
     

     It is critical that you CONTROL YOUR ENVIRONMENT, if you have hearing issues (hearing in background noise, central auditory processing or true hearing loss).   Believe it or not, this can USUALLY be done, even if you are taken by surprise!  Just a few strategies will markedly improve your communication ability and reduce, if not eliminate, your "being dumb factor".
     The first step is to realize what types of situations that have been difficult, annoying or impossible. Go ahead and jot a few down without evaluating for whether you thought that your hearing was involved or not.  There may be more than one annoyance factor but right now we are looking for common threads and things that can be controlled.  For example, most hearing challenged people will have difficulty in restaurants and social gatherings.   Since both of these situations involve people, the first conclusion might be to avoid people, label yourself antisocial or actively decide that you don't like those people.  However, what if the underlying issue is the "being dumb factor" of not knowing what is being talked about or even when the topic changes? Then the issue really changes from social to hearing challenging situations.
    There are several ways to take control of the situation.  It depends on whether you prefer the bold or stealth approaches .  Being somewhat shy myself, I'll start with the stealth strategies first.  You go into the hostile hearing territory and survey the situation.  Where are the lighting sources?  This is critical because lip reading and facial cues help you more than you know without your realizing it. Try to situate yourself so that the speaker has full light on the face. Avoid having the speaker silhouetted and back-lite.   Position yourself so that you can watch the speaker's face during the communication-which is probably the most difficult task in a social situation especially if the conservation quickly switches from one person to another.   However, once the frustration and anger start welling up, quickly change the strategy to further control the situation.  If you choose to stay in the group, try to identify the current topic and stay with it or try to direct the topic by asking a question or bringing up a topic with the primary speaker's (most talkative) in the group so that there are fewer people to watch.  If this is not working, try to break out of the larger group and locate a smaller group or one person to communicate with.  Of course, try to reestablish your optimal communication environment.
     For difficult speakers, fast-talkers, mumblers and those who look away from you frequently, sometime modeling what you need will subconsciously help them do the same.  For example,  having pleasant demeanor while talking slightly louder, slower and making excellent eye contact usually results in the other person doing the same without having to say a word.  However, if it doesn't and you still really want a successful communication, you will need to be bold and make some comment, "It is really hard to hear in here.", "I'm having trouble hearing you." or "I would really like to hear what your are saying, could we move over here.....(pointing to a more optimal listening area)".  This last comment can be perceived as a pick up line, so be careful about saying "let's move to somewhere quieter...." unless that is your intent. I have been embarrassed more than once my a misunderstanding while trying to improve my ability to hear.  Sometimes the one-on-one communication to optimize the facial cues and  quietly moving your conversation partner toward a quieter area to optimize auditory cues will give them the wrong idea! 
      It would seem that being bold and telling friend and others that you are having difficulty hearing would help, and it does for some, but it seems that most people have very short memories, are self-absorbed or don't know what to do with that type of information and quickly resume their natural communication style.  For better or worse, this is what I do.  If I have to communicate with them because of work or family issues I email or have short sentence conversations with limited topics while being very pleasant. However, if the person is not critical to my existence,  they fall to the bottom of my communication list.  They will become the ones I nod and smile at without really having any clue about most of what they are saying and so I avoid them.  
                               
Sincerely,
Your audiologist (with hearing issues)
    
    

     I used to think that only a few, insecure, people would quickly "feel dumb" whenever circumstances were a little challenging and didn't completely understand what was going on.  Now I realize that there are lots of people who feel this way for a variety of reasons, hearing loss and auditory processing issues included. 
    From an audiologists point of view, it makes perfect sense that hearing issues would lead to missing part or all of the message and make it difficult to follow instructions or lead to miscommunication.  On the surface of things, it would seem that asking a question or two would solve this problem.   However, please understand that for most people with significant hearing loss,  it would take more than just a few questions to clarify because in addition to missing part of the info,  in an attempt to comprehend, the listeners brain has been "filling in the blanks" and making a "best guess" from the message it thought it heard.  So after a very short while it's not a matter of clarifying a few words. It's a matter of rerouting entire sentences and topics. With this degree of miscommunication, both parties look at each other, with a new variety of emotions: anger, frustration, timidity, avoidance as well as "feeling dumb". 
    It would help to ensure complete understanding early on in a conversation with rechecks along the way, but how do you do this?  Most people will nod and smile even when not understanding hoping that with a little more information everything will make sense.  Even if they soon realize their error, it takes a huge amount of courage to stop the conversation and request clarification because this stops the flow of conversation and may create awkward moments.  Rather than feel awkward or "dumb", again other emotions may appear, such as anger.    Odd isn't it, that it would be easier to be angry at a friend or loved one than to simply say, "I'm sorry, I didn't hear that." or to restate the conversation in a different way. 
     Since this is such a daily problem and there are many simple steps that will make a huge difference to enhance the joy or communication for both parties, I think a multi-part blog would be best.  For now, just take a breath, and think about whether it is better to admit an event of miscommunication or to "being dumb".
    
     

     Auditory skills need a work out, just like the rest of our body, to maintain, improve and hone ability.  Kids may not have acquired the skills but adults may be loosing the skills.  Over the past couple of years several physicians, ministers and secretaries, expressed concern about not being able to hear, especially when background noise was present.  They had hearing that ranged from normal to some hearing loss. Each of them purchased Earobics from Amazon.com, ebay or other online sources and reported improved ability to hear in background noise. 
     Earobics by Cognitive Concepts, has been around for several years now. It is a collection of games targeting auditory processing skills such as correct identification of individual speech sounds and blending those sounds together to form words (Decoding) and memory.  At first this company had only Level 1 for 4-7 year old, which was the first one that I, as a almost 40 year old used with great benefit.  The graphics were geared toward kids with flat, cartoon like images. However, the content was and is excellent.  The skills required are basic at first, but with correct responses, become more difficult by increasing background noise and complexity.  Soon Level 2 for 7-11 year olds was released with colorful 3-D type characters for the games.  The context was the same as in Level 1, just presented differently.  Finally, Earobics for Adolescents and Adults was released with the same content, but with "more adult interest graphics", that, as I recall, are primarily brightly colored geometric shaped with the same excellent content.  To be truthful, I haven't examined the one for Adolescents and Adults that closely myself, but understand that it is also good.
     How you use this tool is of utmost importance. Those with poor auditory processing skills such as kids and English as a second language would be advised to use headphones with the computer for the best clarity.  Daily use is also recommended. I have heard recommendations ranging from 15-45 minutes daily.  The intensity and daily exposure seem to be key.  There are 300 + levels with automatic promotion to the next level with 80% mastery.   With daily commitment, completion of the entire program is possible within 2 months.
     Will Earobics fix every hearing problem?  No, but for $65-70 new and less than that used, it is a good place to start. Of course to know for sure, consider an audiological and central auditory processing evaluation from an audiologist.  For more suggestions will be coming soon about things you can do at home to help hearing.
     Your Audiologist