COCHLEAR IMPLANTS: WILL I HEAR BETTER THAN WITH MY HEARING AIDS?

 

Patients often ask me if they will ever end up in a cochlear implant.  Generally, most people with hearing loss do not reach that point.  Your hearing has to reach the bottom of the audiogram (hearing test graph) before a cochlear implant will help you hear better than with your hearing aids.  Sometimes a patient may qualify for an implant even though their "graph" portion of the audiogram is not in the profound range.  That may occur if your ability to "understand" speech becomes very poor, even when wearing your hearing aids.  The portion of the cochlear implant that is visible to others is the "speech processor", which looks like a large behind-the-ear hearing aid.  The speech processor has a wire coming out of the bottom of it which leads to a round disk which attaches magnetically to the patient's skin, above their ear.  The rest of the device is the "implanted" part and is not visible to others.  Speech processors have all decreased in size, and have greatly improved over the years.  A more in-depth discussion of cochlear implants follows:

 

What is a Cochlear Implant?

 

A cochlear implant (CI) is a surgically implanted electronic device that can help provide a sense of sound to a severely hard of hearing or deaf person.  Cochlear implants may help provide hearing in patients who are deaf due to damage to the sensory hair cells in the cochlea.  An implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of environmental sounds and assist them in understanding speech.  The surgery is performed by a Neurotologist (ear specialist), and the pre-operative testing, and post-operative programming of the device are performed by an audiologist.  There is typically a four to six week delay between surgery and device hook-up to allow the surgical incision to heal.

A cochlear implant consists of two main parts:

• An external portion that sits behind the patient's ear and consists of:
• A microphone which picks up sounds from the environment.
• A speech processor which selects, filters, and arranges sounds from the environment to be sent to electrodes in the cochlea.
• A transmitter which transmits power and the processed signal across the skin to the internal portion of the device.

• An internal portion that is surgically implanted under the skin and in the cochlea:
• A receiver/stimulator which receives the signal from the transmitter and converts it into electrical impulses.
• An electrode array which collects the electrical impulses and sends them to different regions of the auditory nerve. 

 

How does a Cochlear Implant work?

 

Cochlear implants are very different from hearing aids.  Hearing aids amplify sound and sends the signal from the outer ear through the middle ear into the cochlea.  The cochlea contains hair cells which have frequency (or "pitch") representation from high pitch to low pitch (think about a piano keyboard).  A cochlear implant bypasses the damaged hearing hair cells and directly simulates the auditory nerve in a frequency appropriate manner.  These electrical impulses on the auditory nerve are then sent directly to the brain for processing.  It takes time for patients to learn or re-learn how to process sound.  Some individuals may only learn to use the sounds for environmental awareness and safety, while others are able to use these sounds to have full conversations in person or on the phone.

What is the candidacy criteria for a Cochlear Implant?

The candidacy criteria for children and adults differ:  Current cochlear implant candidacy criteria for adults:  (Boys Town Research Hospital Website)

• Bilateral (both ears) moderate to profound sensorineural hearing loss (thresholds of 40 dB HL or greater)
• Limited benefit with appropriately fit hearing aids, defined as pre-operative test scores of:  ≤50% understanding of sentences in the ear that is to be implanted or ≤60% understanding of sentences when tested bilaterally (best aided condition)
• No physical contraindications for placement of the implant (i.e., CT scan results)
• Medically cleared to undergo surgery
• Realistic expectations
• Commitment to follow-up appointments

What are some Contraindications to receiving a Cochlear Implant?

• Deafness due to lesions of the acoustic nerve or central auditory pathway
• Active middle ear infection
• Absence of cochlear development
• Tympanic membrane (ear drum) perforations in the presence of active middle ear disease
• Medically unstable to undergo surgery
• Unrealistic expectations
• Not committed to follow-up appointments

Information from the NIH: National Institute of Deafness and Other Communication Disorders (NIDCD)

The Zombies May Be On To Something! Need Brains!

Healthy ones, that is.  Never before has there been more interest in "brain training".  My mother-in-law turned me on to "Lumosity" a year ago.  I have to admit, I was skeptical.  But I was also intrigued....could I preserve my brain function?  Could I stave off dementia?  We all know that we need to exercise our bodies for better health, but exercise our brain?

And what's the difference between Alzheimer's Disease and Dementia?  Both terms seem to be used interchangeably.  Dementia is defined by the Alzheimer's Organization as a term used to describe a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person's ability to perform everyday activities.  According to Alzheimer's Disease International, Alzheimer's disease is a FORM of dementia that destroys brain cells and nerves disrupting the transmitters, which carry messages in the brain.

Recent studies are suggesting a connection between hearing loss and dementia.  The relationship is being studied by Johns Hopkins University as well as other institutions.  Research which was published in the Archives of Neurology, found that seniors with hearing loss are significantly more likely to develop dementia over time than those who retain their hearing.  The study also found that the greater the hearing loss, the higher their likelihood of developing dementia.

At my national Audiology convention in April I attended multiple classes which presented research on the association of untreated hearing loss and dementia.  Although they are still studying the relationship, the underlying connection seems to be ISOLATION.  According to a Johns Hopkins study on hearing loss and cognitive function, isolation is a known risk factor for dementia.  When people have hearing loss, they become uncomfortable in social situations because they often can't hear and/or understand what people are saying.  Their hearing difficulties cause them to respond incorrectly or miss the punch-line of a joke.  Social situations often involve large groups of people and poor acoustics which makes hearing more difficult than usual.  Sadly their solution is to withdraw from situations where they have trouble hearing.  No more parties, dinner with friends, bridge club or church.

The same Johns Hopkins study, stated that the reason for the link between the two conditions is unknown, but investigators suggest that a common pathology may underlie both or that the strain of decoding sounds over the years may overwhelm the brains of people with hearing loss, leaving them more vulnerable to dementia.

In fact, the symptoms of untreated hearing loss and Alzheimer's Disease are extremely similar.  As we learn more about how the brain works, we may be able to prevent all forms of dementia, but for now we need to do whatever it takes to reduce the isolation which seems to be a factor.  So get your hearing tested!  Wear your hearing aids faithfully!  And stay with the group!  Preserve your brain and who knows, maybe a zombie may be interested in it.  You too could be zombie bait..... 

"WHY ISN'T MY BATTERY LASTING AS LONG AS IT USED TO?" OR "WHERE HAS ALL THE MERCURY GONE?"

 "WHY ISN'T MY BATTERY LASTING AS LONG AS IT USED TO?"

OR "WHERE HAS ALL THE MERCURY GONE?"

History of Mercury in Hearing Aid Batteries:

In the late 1970s, zinc air batteries were introduced and quickly replaced their predecessor, the mercuric oxide battery.  Zinc air batteries contained significantly less mercury, were superior in performance and were immediately more reliable.

Although, the development of zinc air batteries was an improvement they still contained added mercury.  In zinc air batteries, the mercury is fused with the zinc powder which prevents the battery cell from leakage or swelling, while activating the battery quickly.

Mercury is extremely harmful to the environment.  It can seep into the ground, via landfills, contaminating drinking water and food.  Exposure to mercury can result in contamination, deformities in offspring, permanent damage to the brain, and even death.  In 1996, legislation banned mercury from household alkaline batteries, but zinc air batteries were exempt until manufacturers could come up with an alternative.   

In June 2011, a number of states banned the selling or distribution of mercury containing batteries, including zinc air batteries.  Manufacturers have now removed mercury from hearing aid batteries to comply with the law.

Zinc Air Mercury-Free Batteries:

Without the added mercury, today's zinc air batteries need a longer time to fully activate, once the tab is removed.  They use oxygen as a source of power.  The battery ingredients begin to activate only when the tab is removed and air begins to enter the pinholes on the positive side of the battery.  As a result, it is recommended that you wait at least 2 minutes before using the battery, following the removal of the tab.  By waiting 2 minutes, the battery gets a big gulp of air which allows it to get a full charge, and can result in an extra day's worth of life.

Hearing aid batteries should be stored at room temperature, as heat can shorten their life.  There is no need to refrigerate them.  When carrying extra batteries be sure to place them in a "battery caddy" or case.  Batteries that are loose in a pocket or purse, near metal objects (such as coins) may short out when used.  

HEAT, HUMIDITY, AND HEARING AIDS

Protect your hearing aids from heat.  Never leave your hearing aids in a hot car or in direct sunlight.

Protect your hearing aids from moisture caused by high humidity.  Crackling or static sounds in your aid are symptoms of moisture.  This may be due to the aid getting wet, or even just from humidity in the air.  High humidity can cause moisture to collect in the hearing aid and/or ear mold tubing.  Even small amounts of moisture can have an effect on the sound quality of your hearing aid.  This moisture can cause corrosion to build up on the battery, the battery contacts, and  internal components.  To remove moisture from your aid, use dehumidifiers such as a Dri-Jar or a Dry and Store kit daily.  Both of these types of dehumidifiers are available at Hear Here.  Dri-Jars cost $12, and meet most moisture needs.  If your moisture problem is more severe, an electronic Dry and Store kit may be more appropriate.  Dry and Store kits cost $75, but can last a lifetime with proper care. 

Men Who Want to Stay Active, Feel Younger, and Remain Socially and Professionally Engaged Should Address Hearing Loss, BHI Advises

Better Hearing Institute Participates in National Men’s Health Week

Washington, DC, May 23, 2013—Hearing health affects a man’s lifestyle, and if he wants to stay active, feel younger, and remain socially and professionally engaged, he should address any hearing loss he may be experiencing. This is the overriding message that the Better Hearing Institute (BHI) is delivering to men around the country in support of National Men’s Health Week, which leads up to and includes Father’s Day. This year, National Men’s Health Week runs from June 10 through June 16.

Studies show that men who address their hearing loss—with the use of hearing aids or other appropriate treatment and accommodations—most often improve their quality of life because it helps them maintain a more engaged, active lifestyle at both work and home. Fortunately, the vast majority of people with hearing loss can benefit from hearing aids. In fact, eight out of ten hearing aid users say they’re satisfied with the changes that have occurred in their lives specifically due to their hearing aids.

For decades, research has shown an association between unaddressed hearing loss and a whole range of physical, mental, and emotional conditions—from depression, anxiety, and strained relationships to cognitive decline, difficulty learning new tasks, and even falling. A national BHI study, in fact, uncovered income loss as an under-recognized consequence of leaving hearing loss unaddressed. People with untreated hearing loss, the study found, lose as much as $30,000 in income annually, depending on their degree of hearing loss. But the use of hearing aids was found to reduce the risk of income loss dramatically—by 90 to 100 percent for those with milder hearing loss, and from 65 to 77 percent for those whose hearing loss was severe to moderate. The study also found that people with severe hearing loss who do use hearing aids are twice as likely to be employed as their peers who do not use them.

In recent years, considerable information has emerged on the link between hearing loss and several common chronic diseases that men suffer—including heart disease, diabetes, chronic kidney disease, Alzheimer’s disease, and depression. While research is still needed to fully understand the association between hearing loss and these illnesses, this relatively new information makes it all the more important that men include hearing health as part of their routine medical care.  Call or email Susan at Hear Here to schedule your free hearing test!

BHI reminds men that that there are simple things they can do to protect their hearing. Listening to smartphones and MP3 players only at a low volume, and wearing earplugs in noisy environments—like sporting events, clubs, concerts, or when using power tools and riding motorcycles—are examples.

A Technological Transformation
Many men enjoy and keep pace with the latest in consumer electronics. It’s surprising, then, to find that so many men are not fully aware of the technological revolution that has occurred in the hearing aid marketplace in the past few years. Unfortunately, the lack of awareness of recent advances holds many back from dealing with their hearing health.  To be informed healthcare consumers, men need to realize that today’s state-of-the-art hearing aids are highly effective, sleek, and sophisticated wearable electronics that can help them stay actively connected—not only to life, but also to their other prized electronics, from smartphones to home entertainment systems.

Here are five little-known facts about today’s modern hearing aids that active, youthful-minded men should know:

1.    They’re virtually invisible. Many of today’s hearing aids sit discreetly and comfortably inside your ear canal, providing both natural sound quality, and discreet and easy use.

2.    They automatically adjust to all kinds of soundscapes. Whether it’s the rustling of sheets and whispers on the pillow that you’re after, easy conversation in a crowded restaurant, or the chirp of crickets on a late summer’s evening, recent technological advances have made hearing aids far more versatile than ever before—and in a broad range of sound environments.

3.    You can do water sports and sweat while wearing them. Waterproof, digital hearing aids have arrived. This new feature is built into some newly designed hearing aids for those concerned about water, humidity, and dust. This feature suits the active lifestyles of swimmers, skiers, snowboarders, intensive sports enthusiasts, and anyone working in dusty, demanding environments.

4.    They love your smartphone, home entertainment system, and other prized electronics. Wireless, digital hearing aids are now the norm. That means seamless connectivity—directly into your hearing aid(s) at volumes that are just right for you—from your smartphone, iPod, television, and other beloved high-tech gadgets. What’s more, you own the volume. No one around you needs to be affected.

5.    They’re always at the ready. A new rechargeable feature on some newly designed hearing aids allows you to recharge your hearing aids every night, so they’re ready, ramped up, and waiting for you in the morning. There’s no more fumbling with small batteries. Just place the hearing aids into the charger at night, and they’re ready to go in the morning.

For a step-by-step breakdown of what to expect, ask, and look for when visiting a hearing healthcare professional and purchasing a hearing aid, download Your Guide to Buying Hearing Aids at www.BetterHearing.org, under publications.

School Band Performances Causing Hearing Loss

 Did you know that children and teens can incur noise induced hearing loss just from being in their school band or orchestra?  Loudness levels measured during practices and performances well exceed safe measures.  Concert band performances can average 93 dB and can cause hearing loss within 1 hour and 15 minutes of constant exposure.  Marching band performances register an average of 100 dB, and damage can be caused within 15 minutes!  Hearing loss is a function of exposure time, the average sound level, and the peak level of very loud sounds.  According to Etymotic Research Inc., exposure to a player's own instrument or nearby instruments can cause permanent hearing loss depending on the intensity and duration of the sound.  Some people are more susceptible than others to hearing loss from high-level sound.  The human ear overloads at high sound levels, making it difficult to impossible to distinguish the blend with other instruments.  Ringing in the ears and temporary hearing loss can occur from a single concert, sporting event or sudden loud noise like a firecracker.  Just as sunburn heals but leaves permanent skin damage, temporary hearing loss recovers but there can be irreversible inner ear damage that is not seen until later in life.  We need to protect our young musicians' hearing, so they may continue their passion for music without jeopardizing their futures.    Etymotic Research Inc. has developed a program called "Adopt-A-Band".  This program allows businesses and individuals to "adopt" a local school band by providing hearing protection to the band members.  This program educates our young musicians about the danger of excessive noise exposure.  For more information on adopting a band in your area, go to www.etymotic.com/adoptaband.  Let's give our students the opportunity to play loudly and proudly!

Two Ears Are Better Than One

According to Sergei Kochkin, Ph.D. of the Better Hearing Institute, there is an advantage to wearing two hearing aids. If you have hearing loss in both ears, then you are most likely a candidate for two hearing aids. While a hearing healthcare professional can best determine if you are a candidate for two hearing aids (a binaural fitting), the ultimate decision-maker concerning binaural instruments is the person who will wear them. It is important that the person with the hearing loss be given the chance to experience binaural amplification, before a decision on one or two hearing aids is made. Similar to the way refractory problems in both eyes are treated with a pair of glasses, it makes sense that bilateral hearing loss should be treated with binaural hearing aids. Let me share with you why two hearing aids are better than one.

Better understanding of speech. By wearing two hearing aids rather than one, selective listening is more easily achieved. This means your brain can focus on the conversation you want to hear. Research shows that people wearing two hearing aids routinely understand speech and conversation significantly better than people wearing one hearing aid.

Better understanding in groups and noisy situations. Speech understanding is improved in difficult listening situations when wearing two hearing aids.

Better ability to tell where sounds are coming from. This is called localization. In a social gathering, for example, localization allows you to hear from which direction someone is speaking to you. Also, localization helps you determine from which direction traffic is coming or where your children or grandchildren are playing. Simply put, with binaural hearing, you will better detect where sounds are coming from in every situation.

Better sound quality. When you listen to a stereo, you use both speakers to get the smoothest, sharpest, most natural sound quality. Plus, wearing two hearing aids generally requires less volume than one. The need for less volume results in less distortion and better reproduction of amplified sounds.

Keeps both ears active resulting in potentially less hearing loss deterioration. Research has shown that when only one hearing aid is worn, the unaided ear tends to lose its ability to hear and understand. This is clinically called the auditory deprivation effect. Wearing two hearing aids keeps both ears active.

Hearing is less tiring and listening more pleasant. More binaural hearing aid wearers report that listening and participating in conversation is more enjoyable with two instruments, instead of just one. This is because they do not have to strain to hear with the better ear. Thus, binaural hearing can help make life more relaxing.

Feeling of balanced hearing. Two-eared hearing results in a feeling of balanced reception of sound, also known as the stereo effect, whereas monaural hearing creates an unusual feeling on sound being heard in one ear.

Greater comfort when loud noises occur. A lower volume control setting is required with two hearing aids than is required with one hearing aid. The result is a better tolerance of loud sounds.

Reduced feedback and whistling. With a lower volume control setting, the chances of hearing aid feedback (whistling) is reduced.

Tinnitus masking. About 50% of people with ringing in their ears report improvement when wearing hearing aids. If a person with tinnitus wears a hearing aid in only one ear, there will still be ringing in the ear that does not have a hearing aid.

Consumer preference. An overwhelming majority of consumers who have hearing loss in both ears, choose two hearing aids over one, when given the choice to hear binaurally.

Customer satisfaction. Research with more than 5,000 consumers with hearing loss in both ears demonstrated that binaurally fit subjects are more satisfied than people fit with just one hearing aid.

Logically, just as you use both eyes to see clearly, you need two healthy ears to hear as clearly as possible. Before you decide on just one hearing aid, try two. Your hearing healthcare professional can demonstrate to you the binaural advantage during your trial period. Decide for yourself.

Thirty or Older? The Link Between Cardiovascular and Hearing Health Could Pertain to You, BHI Advises, Urging Hearing Checks

Thirty or Older? The Link Between Cardiovascular and Hearing Health Could Pertain to You, BHI Advises, Urging Hearing Checks

Washington, DC, January 21, 2013—In recognition of American Heart Month and National Wear Red Day®, the Better Hearing Institute (BHI) is alerting Gen Xers and baby boomers of the connection between cardiovascular and hearing health. A growing body of research indicates that a person’s hearing and cardiovascular health frequently correspond. In response, BHI is urging people with cardiovascular disease to get their hearing checked. Likewise, BHI is urging people with hearing loss to pay close attention to their cardiovascular health.

The Heart-Hearing Connection
The inner ear is extremely sensitive to blood flow. Studies have shown that a healthy cardiovascular system—a person’s heart, arteries, and veins—has a positive effect on hearing. Conversely, inadequate blood flow and trauma to the blood vessels of the inner ear can contribute to hearing loss.

The authors of a study published in the American Journal of Audiology concluded that the negative influence of impaired cardiovascular health on both the peripheral and central auditory system—and the potential positive influence of improved cardiovascular health on these same systems—have been found through a sizable body of research that has been conducted over more than six decades.

David R. Friedland, MD, PhD, Professor and Vice-Chair of Otolaryngology and Communication Sciences at the Medical College of Wisconsin in Milwaukee, has been studying the relationship between cardiovascular and hearing health for years. According to Friedland: “The inner ear is so sensitive to blood flow that it is possible that any abnormalities in the cardiovascular system could be noted here earlier than in other less sensitive parts of the body.”

In their study, published in The Laryngoscope, Dr. Friedland and fellow researchers found that audiogram pattern correlates strongly with cerebrovascular and peripheral arterial disease and may represent a screening test for those at risk. They even concluded that patients with low-frequency hearing loss should be regarded as at risk for cardiovascular events, and appropriate referrals should be considered.

According to the Centers for Disease Control and Prevention (CDC), cardiovascular disease is the leading cause of death in the United States. For more information about cardiovascular health and how people can reduce their risk of heart disease and stroke, visit www.heart.org.www.GoRedForWomen.org, and www.hearttruth.gov.

Hearing Loss Twice as Common in Diabetics

According to the National Institutes of Health (NIH), hearing loss is about twice as common in people with diabetes compared to those without the disease.  Yet unlike eye exams, hearing health examinations are often overlooked in the routine regimen of care for people with diabetes.  Unfortunately, the ramifications for leaving hearing loss unaddressed can be significant.  According to the Better Hearing Institute (BHI), numerous studies link unmanaged hearing loss to a wide range of physical and emotional conditions, including depression, impaired memory and ability to learn new tasks, increased risk to personal safety, reduced job performance and earning power, and diminished psychological and overall health.  Kathleen L. Yaremchuk, M.D., senior study author at Henry Ford Hospital in Detroit, stated, "A certain degree of hearing loss is common with aging, but it is often accelerated in patients with diabetes, especially if blood-glucose levels are not being controlled.  Our study really points to the importance of patients controlling their diabetes and paying attention to their hearing health.   According to BHI, the vast majority of people with hearing loss, including those with diabetes, can benefit from hearing aids.  In fact, studies show that when people with mild-to-profound hearing loss use hearing aids, they experience decreased depressive symptoms, anxiety and emotional instability; significant improvements in quality of life and functional health status; and have significantly higher self-concepts compared to individuals with hearing loss who do not wear hearing aids.